Wrist
TFCC Tear (Triangular Fibrocartilage Complex)
삼각섬유연골 복합체 손상
TFCC injury causing ulnar wrist pain with distal radioulnar joint instability
- How common
- Uncommon
- Typical age
- Ages 20–50
What is it?
TFCC stabilizes the DRUJ and distributes load across wrist — damaged by trauma or positive ulnar variance
Commonly affected: TFCC (TFC disc, ulnar collateral ligament, ulnocarpal ligaments), distal radioulnar joint (DRUJ)
How it develops
- TFCC AnatomyTFC disc, ulnar collateral ligament, ulnocarpal ligament complex stabilize DRUJ and ulnar wrist
- Injury MechanismFall on outstretched hand in extension-supination axial load (Type 1A: traumatic), or chronic compression from positive ulnar variance (Type 2: degenerative)
- DRUJ InstabilityTFCC tear causes DRUJ instability → pain and clicking with forearm rotation
- Ulnar Wrist PainUlnar wrist pain over lunate and triquetrum, restricted rotation
Symptoms
- Ulnar Wrist PainDeep ulnar wrist pain (pinky side) — lunate-triquetrum-hamate region
- Pain with Forearm RotationForearm supination/pronation — worsens with screwdriver use, tennis serve, opening doors
- Clicking/PoppingClicking or popping within wrist with forearm rotation
- DRUJ InstabilityDistal ulna prominence (piano key sign) and DRUJ instability
How it is examined
- Fovea SignTenderness over ulnar fovea (between ulnar styloid and FCU tendon) → specific for central TFCC tear
- DRUJ Instability TestAnteroposterior stress to distal ulna → pain and instability → DRUJ injury
- Ulnar Wrist Stress TestUlnar wrist deviation + forearm supination maintained → ulnar pain → TFCC stress
- Piano Key SignDorsal distal ulna prominence → DRUJ instability. Depresses with pressure and springs back
Imaging
Measure ulnar variance and assess DRUJ subluxation
- Positive ulnar variance confirmation
- DRUJ subluxation (lateral view)
- Possible ulnar styloid fracture
Gold standard for TFCC injury — 3T MRI or MR arthrography
- T2 hyperintensity within TFC disc (tear)
- Central vs peripheral tear location
- DRUJ effusion and instability
Non-surgical care
- Wrist SplintingAcute phase neutral wrist immobilization for 4-6 weeks
- Physical TherapyWrist stabilization exercises, DRUJ stabilizer strengthening
- Steroid InjectionIntra-DRUJ steroid injection to reduce inflammation
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative treatment 3-6 months, DRUJ instability, need for sports return
Procedures that may be discussed
- Arthroscopic peripheral TFCC repair (type 1B) — most common
- Arthroscopic TFCC debridement (central tear)
- Ulnar shortening osteotomy (for positive ulnar variance)
Outlook
80-85% return to sport after peripheral repair. Central tear (avascular) doesn't heal well; debridement provides symptom relief