Triangular fibrocartilage complex tears (TFCC)

What is it?

The triangular fibrocartilage complex (TFCC) is a load-bearing structure located on the ulnar side of the wrist (the pinky side of the hand) between the ulna, triquetrum, and lunate bones. Its primary function is to stabilize and support the ulnar side of the wrist.

This complex consists of multiple ligamentous and fibrocartilaginous structures. The main components include the articular triangular fibrocartilage disc, radioulnar ligaments (dorsal and volar), ulnocarpal ligaments (ulnotriquetral, ulnolunate, and ulnocapitate), ulnar collateral ligaments, and the extensor carpi ulnaris tendon sheat. 1-5

How do you injure it?

TFCC tears can result from either acute traumatic injuries or degenerative changes due to overuse or repetitive microtraumas.

In traumatic TFCC tears, structures are often damaged by a loading or twisting force through the wrist. Common mechanisms of injury include:

• Falling onto an outstretched hand

• Forceful hyperextension or wrenching of the wrist

• Forceful traction of the wrist

• Forced ulnar deviation or high-load rotary movement (such as striking a ball with a bat or racquet)

Degenerative TFCC tears develop over time due to ongoing stress on the wrist. These injuries progressively worsen and are often caused by:

• Long-term participation in racquet or bat sports

• Repetitive pronation and gripping

• Repetitive hyperextension

• Repetitive traction of the wrist

Signs and Symptoms

• Ulnar-sided wrist pain

• Clicking, catching, or locking sensations

• Pain that worsens with activity

• Decreased grip strength

• Swelling and/or bruising (in traumatic injuries)

• Reduced range of motion or difficulty rotating the wrist and forearm

Risk Factors

Like most injuries, TFCC tears have both intrinsic and extrinsic risk factors. Extrinsic factors include the types of activities performed, environmental conditions, and sports equipment used.

For example, cricket batsmen are at higher risk for TFCC injuries during the downswing-to-impact phase of a hit. In this phase, the wrist is "unlocked" to control the direction of the hit using ulnar deviation and flexion. The sudden movement and impact leave the wrist vulnerable to ulnar-sided injuries, including TFCC tears (2-3).

Gymnasts are also at increased risk due to the significant tensile and compressive loads placed on the wrist during tumbling and hanging tasks. Repetitive weight-bearing can lead to inflammation of the tendons surrounding the TFCC (such as the extensor carpi ulnaris), which in turn can irritate and weaken the TFCC over time. 

Intrinsic factors are individual characteristics that predispose a person to injury. These include anatomical variations and underlying medical conditions. Individuals with a positive ulnar variance—where the distal articular surface of the ulna extends more than 2.5mm beyond the radius—are at increased risk due to greater compressive forces on the TFCC (3-6).

Other intrinsic factors include inflammatory conditions such as rheumatoid arthritis.

Rehabilitation

Rehabilitation of a TFCC injury depends on multiple factors, including the type of injury (acute or chronic), stability of the injury, and the functional goals of the individual (e.g., pain-free daily living vs. return to high-impact sports).

For acute TFCC injuries that do not require surgery, the wrist is typically braced to offload the cartilage complex and allow for healing. Rehabilitation focuses on providing support and stability by strengthening the wrist, hand, and fingers to reinforce the ulnar side of the wrist. The wrist is usually braced for 6–8 weeks, during which supination and pronation movements are initially restricted. As healing progresses, gradual weight-bearing and rotational forces are introduced to strengthen and support the TFCC and surrounding tissues. 4-5

In chronic TFCC injuries, splinting may or may not be required. Rehabilitation typically begins with strength and mobility exercises, emphasizing both supinating and pronating muscle groups. The primary focus is on regaining lost range of motion while avoiding excessive inflammation.

If surgical intervention is necessary, an arthroscopic procedure is performed to repair the damaged structures within the TFCC. Surgery is needed when conservative management fails, and/or the person continues to experience pain and instability through the wrist. Postoperatively, the wrist is braced for approximately 6 weeks, restricting supination and pronation movements.2,5 During this period, progressive range-of-motion exercises and tendon glides are introduced to prevent stiffness and facilitate mobility. Following the immobilization phase, rehabilitation follows the conservative procedure, emphasizing gradual strength gains, improved range of motion, and progressive loading of the ulnar side of the wrist through rotational and weight-bearing activities.

References 

1. TFCC Injury and Hand Therapy | Hand Therapy Academy [Internet]. 2020. Available from: https://www.handtherapyacademy.com/treatments/management-of-a-tfcc-injury-in-hand-therapy/

2. Dunn JC, Polmear MM, Nesti LJ. Surgical Repair of Acute TFCC Injury. HAND. 2019 Feb 14;15(5):674–8.

3. Casadei K, Kiel J. Triangular Fibrocartilage Complex (TFCC) Injuries [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537055/

4. Triangular fibrocartilage complex (TFCC) injury - Melbourne Hand Surgery [Internet]. Melbournehandsurgery.com. 2025 [cited 2025 Mar 3]. Available from: https://www.melbournehandsurgery.com/30-hands/injuries/246-triangular-fibrocartilage-complex-injury

5. Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? Journal of Clinical Orthopaedics and Trauma. 2020 Jul;11(4):570–9.