TFCC irritation
What is it?
Triangular Fibrocartilage Complex (TFCC) is a cartilage structure that lies between the ulna and
carpus. The function of the TFCC is to act as the main stabiliser of the distal radioulnar joint.
TFCC anatomy
Mechanism
Often injured in forced ulnar deviation or falling on an outstretched hand. Common in racquet or
stick sports and those that create repetitive ulnar and compressive loading including
gymnastics, weight lifting, boxing and surfing. TFCC injury should be investigated following a
distal radius fracture and wherever distal radioulnar joint (DRUJ) instability exists.
Clinical presentation
● Ulnar sided pain that worsens with grip, rotation and weight bearing
● Clicking sensation on wrist movement
● Point tenderness between the pisiform and the ulnar head
● Reduced grip strength
● Pain on resisted wrist extension and ulnar deviation
● Positive foveal sign = sharp pain with deep palpation
● Positive press test = reproduction of pain when lifting own weight up off a chair using the
affected wrist
● MRI imaging is useful for diagnosis of these injuries
Management
● Avoiding aggravating activities
● Avoiding repetitive wrist movements and trying to keep wrist in a neutral position where
possible
● Short period of splinting
● Tape to offload the TFCC
● Stabilisation exercises particularly involving ECU and pronator quadratus instability as a result of a complete ligamentous rupture often requires surgery as soon as possible.
