Acute Injuries
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What is a TFCC tear?

The triangular fibrocartilaginous complex (TFCC) is an area of cartilage that covers the ulna on the small finger side of the wrist. It is composed of several components. The volar and dorsal radioulnar ligaments originate from the radius and converge to insert on the ulna at the fovea.  The articulate disc serves as the cushion over the head of the ulna. The volar lunotriquetral and lunotriquetral ligaments help stabilize the distal ulna. The ulnar collateral ligament, meniscus homologue and ECU tendon sheath complete the TFCC complex.

The purpose of the TFCC is to stabilize the distal radioulnar joint and protect the head of the ulna. Most power in the wrist originates from the ulnar aspect making the TFCC critical to activities. Injury to the TFCC can result in pain, instability, and weakness in the wrist.

How do TFCC injures occur?

TFCC injuries can be acute or chronic. Acute injuries occur from a fall on an outstretched hand, skiing, mountain biking or any other loading activity. Patients usually recall when the injury occurs and will experience swelling, pain and possibly clicking. Chronic TFCC injuries occurs from repetitive overuse activities such as typing, repetitive lifting or assembly line type work.

Diagnosing TFCC injures

The ulnar side of the wrist is sometimes referred to as the “Black Box” of the wrist because of the numerous structures that can be injured. Dr. Kavi Sachar has written a landmark article on this topic and it is referenced below. This article is used to teach residents and fellows about this complex topic.

A TFCC tear will present with pain at the base of the wrist on the small finger side. Patients will have swelling, difficulty with push up type maneuvers and with activities such as skiing, biking, and weightlifting.

The diagnosis is made through history, specific physical exam signs, X-ray, and MRI. MRI helps show how severe the tear is and if there are other injuries or arthritis in the wrist.

Nonsurgical treatment of TFCC injuries

Treatment varies depending on the MRI and exam findings. Initial treatment may consist of rest, anti inflammatories, splint immobilization, therapy, and cortisone injections. Depending on the severity of the injury, some TFCC injures can heal on their own. Dr. Kavi Sachar will evaluate you to determine which treatment is best for you.

Surgically treating TFCC injuries

In more severe cases and if conservative treatment fails, surgery may be indicated. Surgery involves either arthroscopic or open repair, debridement, or reconstruction.

Wrist arthroscopy is a commonly performed procedure to visualize and treat disorders inside the wrist. An extremely small 1.3mm camera and 2.0mm shaver are used to enter the joint. All debris is removed, and repairs are performed through pinhole size incisions. The incisions are small enough that sutures are not needed to close the wounds. Arthroscopic technology continues to improve, and more elaborate procedures can now be performed through this minimally invasive surgery. The TFCC can often be repaired arthroscopically. Depending on the type of tear patients sustain, internal sutures can be used to repair them.

Recovering from TFCC and wrist arthroscopy surgery

Rehabilitation after surgery depends on the extent of the tear and the type of surgery needed. Some injuries can begin therapy immediately and resume normal activities within a few weeks. More extensive injuries require immobilization and may take a few months to heal.

Schedule a consultation

Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on scaphoid fractures. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from scaphoid fractures, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.

At a Glance

Dr. Kavi Sachar

  • Specializing in Hand, Wrist, & Elbow Surgery
  • Board Certified Orthopedic & Hand Surgeon
  • Consultant to the US Ski & Snowboard Team & Colorado Avalanche
  • Learn more

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