TFCC INJURY

Triangular fibrocartilage complex (TFCC) is a complex structure, which is also described as wrist menisci. It is located on the ulnar side of the wrist and is composed of a group of ligaments and fibrocartilage. It has two main functions: firstly, to maintain wrist stability in rotational movement; secondly, to transmit and absorb the stress from the hand. Acute injury or chronic overuse will cause TFCC injury.

Quick and sudden wrist rotation when fall on outstretched arm is a common cause of acute injury, and may even leads to a wrist dislocation. Repetitive wrist and forearm rotation will cause chronic overuse, creating stress to TFCC, tear or even degenerative changes. In addition, inadequate warm-up and poor flexibility of wrist and forearm is a risk factor of TFCC injury too. Sportsmen involved in weight-lifting and racket sports may lead to chronic injury.

• Nonunion of wrist fracture
• Discrepancy between radius and ulna bone, too prominent of ulnar head
• Always operate modalities (e.g. electrical drill) or athletes participating in sports with repetitive wrist compression (eg: tennis, gymnastics) creating repetitive microtrauma to TFCC

• Pain and weakness on medial wrist joint
• Rotational movement of forearm and wrist will aggravate the pain
• Not prominent swelling, but local tenderness in around medial wrist joint
• Provoke more pain when wrist deviated to the medial side.
• In very few cases, this injury may lead to wrist bone subluxation, causing prominent ulnar bone on dorsum, with weakness and reduced range of movement.

If the injury is not extensive and the joint stability is still acceptable, sports taping may be helpful to support the joint. Patients need to apply ice therapy for 15-20 minutes for few times a day, and incorporate wrist strengthening in the later stage. NSAIDs or corticosteroid injection were shown efficient in controlling local inflammation, but not advisable to do so if symptoms are controllable. If the tear is severe, early arthroscopy of the wrist joint and immobilization provides promising results. If TFCC tear is not treated, in a long term wrist instability and loosen ligament may lead to overuse wrist arthritis, causing chronic pain and weakness.

• Learning proper sporting techniques of racket sports
• Sufficient warm-up of wrist and forearm
• Strengthening the muscles surrounding the wrist joint
• Avoid from high risk wrist movement (e.g. carry heavy object in awkward angle)

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