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TFCC Injury

Definition

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

Causes and Risk Factors

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, that creates stress to TFCC, causing tear or even degenerative changes. In addition, inadequate warm-up and poor flexibility of wrist and forearm, is risk factor of TFCC injury too. Sportsmen involved in weight-lifting and racket sports may lead to chronic injury.

Risk Factors

  • 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

Common Symptoms

  • Pain and weakness on medial wrist joint
  • Rotational movement of forearm and wrist will aggravate the pain
  • Wrist swelling not prominent, but local tenderness in around medial wrist joint
  • When the wrist deviates to medial side, provotes more pain
  • Very few cases may lead to some wrist bone subluxation, causing prominent ulnar bone on dorsum, with reduced strength and range of movement

Management

If injury is not extensive with good joint stability, sports taping may be helpful to support the joint. Patient needs to apply ice therapy for 15-20 minutes for few times a day, and incorporates wrist strengthening in the later stage. NSAIDs or corticosteroid injection were shown efficient in controlling local inflammation, but not advise to do 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.

Preventive Measures

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

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