By Michelle Coil, MOT, OTR, CHT, PYT, CEAS
Founder of Virtual Hand Care
A TFCC tear (tear of the Triangular Fibrocartilage Complex) can cause chronic wrist pain, loss of strength, and decreased hand function if not properly diagnosed and treated. Due to its anatomical complexity, the TFCC is crucial for stability and mobility at the wrist.
The TFCC originates from the sigmoid notch of the radius and inserts into the ulnar fovea and the base of the ulnar styloid.
The TFCC is not one simple anatomical structure but numerous components. These include the dorsal and volar radioulnar ligaments, Extensor Carpi Ulnaris (ECU) tendon sheath, lunotriquetrial interosseus ligament, and the articular disc (also known as the TFC proper). Consequently, a TFCC tear can be complicated to diagnose.
TFCC Tear Causes
Trauma or degeneration are the likely causes of a TFCC tear. A type 1 TFCC tear is a traumatic injury usually involving a fall on the extended wrist or a traction type injury when the wrist is pulled or twisted. A type 2 TFCC tear is caused by a slow degeneration of the cartilage evolving overtime due to age or conditions such as rheumatoid arthritis, gout, or an ulnar length discrepancy (also known as a positive ulnar variance).
Additionally, how long it takes to recover from a TFCC injury varies depending on the type of tear, as stated above, and where the tear is located. Typically, a TFCC tear can occur along the peripheral or central portion of the fibrocartilage complex. A peripheral tear, occurs along the perimeter of the complex. This area is known to have good blood supply to allow healing. However, a central tear, located in the center of the fibrocartilage has a poor blood supply and is usually not repaired but debrided.
It important to note, the TFCC alone may not be injured and ulnar sided wrist pain can be commonly associated with additional wrist conditions such as ulnar carpal instability, distal radioulnar joint (DRUJ) involvement, or ulnar impaction. For that reason, it’s very important to get an accurate diagnosis from a Board Certified Orthopedic Surgeon who has completed a Hand fellowship.
TFCC Tear Recovery Process
Recovery from a TFCC tear can range from wearing a splint or cast for several weeks to having surgery. This particular post will address how long it takes to recover from a TFCC tear without surgery. (see our blog post on how long does it take to recover from wrist surgery? For more information on that topic).
Conservative treatment of a TFCC tear can take upwards of 12 weeks, although this protocol may vary amongst orthopedic specialists. If the wrist is stable then conservative, or non-operative treatment, may be effective. However, surgery may be indicated if the wrist is unstable and additional structures are injured.
Initially, if the wrist is found to be unstable and a conservative approach is attempted then a long arm or muenster orthosis limiting both forearm rotation and wrist motion may be indicated for 6 weeks. Followed by 2 additional weeks of immobilization to the wrist only.
If the wrist is stable, then immobilization of TFCC tear in a wrist cast or splint is recommended for 4-6 weeks. This will allow scar tissue to develop at the injury site. Occasionally, a steroid injection may be needed to calm swelling and decrease inflammation. Usually around 6-8 weeks, a slow progression of gentle range of motion, stability exercises, and protected daily use will begin. Continued protection of the wrist with taping, or the Bullseye TFCC Wrist Brace, should be continued after the initial 6 weeks.
Depending upon symptoms, light strengthening and stability exercises will begin around 6-8 weeks along with continued improvement of pain free range of motion to the wrist and forearm.
It is important to monitor symptoms and avoid weight bearing into the wrist for 10-12 weeks. Full recovery into higher level sports such as heavy weight lifting, gymnastic, or work tasks such as a heavy equipment operator could take longer.
Finally, it is important to be VERY patient when recovering from a TFCC tear. Avoiding stress to the wrist especially with twisting or weight during daily activities will require modifications. Ulnar-sided wrist pain can respond well with the right diagnosis and treatment plan. If all else fails surgery may be indicated.
Moreover, it is important to see a Certified Hand Therapist whom is expertly trained in your TFCC tear recovery.
Michelle Coil, Founder of Virtualhandcare.com has created an online virtual hand clinic dedicated to helping people with TFCC and other common wrist and hand injuries. Certified Hand Therapist can provide exercise programs, activity modifications, bracing, and education to empower you through your journey.