Wrist Cartilage Tear (TFCC)

TFCC is short for triangular fibrocartilage complex, a small cushion of cartilage and ligaments on the pinky side of your wrist. It does two jobs: it cushions the load that travels through the wrist when you press down through your hand, and it holds the two bones of your forearm together at the wrist.

TFCC tears come in two kinds. Traumatic tears come from a fall on an outstretched hand or twisting the wrist hard under load. Degenerative tears come from years of wear, especially in patients whose ulna bone sits a little longer than the radius (called positive ulnar variance) and grinds the cushion over time.

The classic symptoms are pain on the pinky side of your wrist, clicking when you twist your forearm (turning a doorknob, using a screwdriver), and sometimes a sense that the two forearm bones are shifting against each other when you load the wrist.

The most sensitive imaging is an MRI with contrast injected into the joint (MRI arthrography). The true gold standard is wrist arthroscopy, a small camera in the joint, which has the bonus of letting us treat the tear in the same operation.

For an acute tear, the wrist goes into a long-arm splint or cast with the forearm held palm-up. That position takes the load off the torn ligaments and lets the cushion settle. Motion is gradually added back in once the structures have stabilized.

Surgery is the answer for complete tears that have left the wrist unstable, for partial tears that haven't quieted with bracing and injection, and for any TFCC tear where the ulna bone sits too long and is grinding the cushion. In that case the ulna is shortened in the same operation.

The repair is done arthroscopically, small punctures with a camera, to either stitch the torn cushion back to the bone or trim a degenerative tear that can't be repaired.