Triangular Fibrocartilage Complex (TFCC) injury
Health in Sports Report - Issue 6
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What is TFCC?
Triangular Fibrocartilage Complex Injury (TFCC) is a small, cartilage-like structure in the wrist joint, often described as the meniscus of the wrist. The TFCC transmits force across the wrist from the hand to the forearm, carrying about 18 percent of the axial load from the wrist to the forearm. It provides a smooth surface for movements across the wrist.
Symptoms of TFCC injury
Symptoms include, but are not limited to, pain on the ulnar (bone of the forearm on the side opposite to the thumb) side of the wrist, a clicking sound or feeling of catching with wrist movement, and reduced grip strength.
Most injuries to the TFCC have a component of hyperextension of the wrist and rotational load. They may occur as a chronic injury from such activities as weight lifting or racquet sports, or as an acute traumatic injury that usually involves a single blow from a single application of force-such as a cross-body block in football.
Decreased strength, pain with range of motion (ROM) and pain with gripping are signs of TFCC injury. Among other tests during an exam, the physician may also note tenderness to touch of the ulnar side of the wrist.
The examiner places his/her thumb on the ulnar side of the wrist with the forearm in the neutral position to check for ulnar wrist pain and occasional clicking.
The athlete tries to lift out of a chair while bearing weight on the extended wrist.
Supination lift test
The athlete places his/her palms on the under-surface of a table and attempts to lift.
May reveal variable length of the ulna, a longer ulna is associated with an increased risk of injury.
Surgical procedure that allows the physician to view the inside of a joint through a thin instrument called an arthroscope. This can be both diagnostic and therapeutic.
There are many options for treating TFCC injuries. The most common methods include use of a splint or cast, rest, applying ice for 15 to 20 minutes several times a day, and wrist rehabilitation exercises. Medications may include an anti-inflammatory medication such as ibuprofen or a corticosteroid injection. In more severe cases, TFCC repair may include surgery for partial excision or ulnar shortening.
Return to sport
Although athletes recover at different rates, recovery is generally related to how long the symptoms were present before treatment started. The goal of rehabilitation is to return to activities as soon and safely as possible. It is safe to return to sport when the injured wrist has full range of motion without pain and the same strength as the uninjured side.
Acute traumatic injuries may not be easily avoided. Chronic injuries occur over time and may be avoided with several general measures, including proper conditioning to correct any strength deficits or muscle imbalances, good technique,avoiding rapid increases in training and avoiding early return after injury.