TFCC Tear

Overview

what it is and why it matters

Palmar dissection of the hand and wrist showing the eight carpal bones, flexor tendons, and median and ulnar nerves. — **Hand and wrist anatomy.** Eight small carpal bones form the wrist and connect the forearm to the five metacarpals of the palm. Finger tendons and the median and ulnar nerves pass through narrow tunnels in the wrist on their way into the hand.

The triangular fibrocartilage complex (TFCC) is a cartilage and ligament structure on the ulnar side of the wrist that stabilizes the distal radioulnar joint (DRUJ) and cushions load across the ulnar wrist. Tears are classified as traumatic (acute fall on outstretched hand, forearm rotation under load) or degenerative (age-related wear, especially with positive ulnar variance).

Symptoms are ulnar-sided wrist pain, clicking with forearm rotation, and DRUJ instability — a sense of the forearm bones shifting relative to each other.

Diagnosis

exam first, imaging second

The fovea sign (tenderness in the groove between the ulnar styloid and the FCU tendon) and the DRUJ shuck test (dorsal-palmar stress of the ulna on the radius) are key exam findings. MRI arthrography is the most sensitive imaging test. Wrist arthroscopy is the gold standard for both diagnosis and treatment.

Treatment Path

how care progresses at OSI

Long-arm splinting or casting

4–6 weeks of immobilization with the forearm in supination for acute tears.

Corticosteroid injection

Reduces synovitis and ulnar-sided pain in partial tears.

Physical therapy

DRUJ stabilization exercises after acute phase.

Surgical Options at OSI

if non-operative care isn't enough

Surgical management is indicated for complete tears with DRUJ instability, failed conservative treatment, or when the tear is associated with positive ulnar variance requiring correction.

Overview

Diagnosis

Treatment Path

Long-arm splinting or casting

Corticosteroid injection

Physical therapy

Surgical Options at OSI

Providers Who Treat Tfcc Tear

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Further Reading

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