Triangular Fibrocartilage Complex (TFCC) Injury

The triangular fibrocartilage complex (TFCC) is located on the ulna side (little finger side) of the wrist joint. The TFCC is formed from several components: Articular Disc, Meniscus Homologue, Ulnocarpal ligament, Dorsal & Volar Radioulnar ligament and Extensor Carpi Ulnaris sheath. Its function is to stabilise the wrist joint. 

TFCC injuries are split into 2 categories with various classifications within them:

• Class 1 occurs as a single traumatic event such as a fall on to the wrist in a rotated position (Ulnar deviation) which compresses the joint structures. This mechanism is common in sports (cricket, tennis, and goalkeeping injuries in football) and with slips/trips. (Classifications A, B, C & D) 

• Class 2 occurs due to more sustained/repeated mechanisms loading the area, causing degeneration.  (Classifications A, B, C, D & E) 

For further details on the classifications, please click here. 

Injury can also occur if there is a discrepancy between the lengths of the Ulna and Radius bones of the forearm, with a longer Ulna creating increased load on the TFCC. This can sometimes occur due to previous fracture or surgery.  

• Pain on the Ulnar (little finger) side of the wrist near the wrist crease.

• Grinding or clicking – with or without pain. 

• Weakness and reduced function – especially gripping.

• Swelling around the joint.

• Symptom exacerbation with activity.

Depending on the severity of the injury, Physiotherapy is likely to be beneficial in order to mitigate symptoms and restore function. Initial management advice will involve rest – potentially immobilising the wrist in a splint, activity modification and to reduce inflammation e.g. ice & NSAIDs. 

It is common for conservative (non-surgical) management – including good Physiotherapy, to be trialed for up to 6 months with favourable outcomes expected. This can consist of initial range of motion exercises before progressing to strength-based rehabilitation and a return to sport program if required. Alongside a personalised rehab programme, our Physiotherapists will give you self-management advice & education and may implement hands-on treatment techniques including manual therapy and soft tissue mobilisation. 

An MRI scan may be required to assess the extent of the damage, which could lead to surgical intervention if it highlights structural instability in the area and based on the patient’s goals.