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. 

• 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.

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.  

At Pure Physiotherapy, your clinician will take a thorough history of the injury and your symptoms to help understand your condition. They will then carry out a full physical assessment to provide you with a fast and accurate diagnosis. Receiving an immediate and precise diagnosis will allow the most appropriate management plan to be initiated straight away.

In severe cases, an MRI scan may be required to assess the extent of the damage. This could lead to an Orthopaedic or consultant review to establish if surgical intervention will be required for the best outcomes. This will be based on if structural instability in the area is present and on the patient’s goals.  

Your Physiotherapist will provide information on your injury so that you understand the which structures are involved and what you can do to support your recovery. For initial management, your clinician will recommend rest – potentially immobilising the wrist in a splint, activity modification strategies and ways in which you can reduce inflammation and control pain e.g. ice & NSAIDs. 

Depending on the severity of the injury, Physiotherapy is likely to be beneficial in order to mitigate symptoms and restore function. It is common for conservative (non-surgical) management – including good Physiotherapy, to be trailed for up to 6 months with favourable outcomes expected. Your Physiotherapist will design a bespoke exercise plan that will be modified as you make progress. The initial exercises will be aimed at range of motion before progressing to strength-based rehabilitation and a return to sport program if required. Alongside a personalised rehab programme, our Physiotherapists may implement hands-on treatment techniques including manual therapy and soft tissue mobilisation. With regular re-assessment, your Physio will make certain you are improving as anticipated and will make considered changes to your exercise plan to help achieve the best results.