Triangular Fibrocartilage Tear

Hand
  • Carpal Tunnel Syndrome
  • Cubital Tunnel Syndrome
  • Trigger Finger/Trigger Thumb
  • Basilar Thumb Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
  • Dupytren’s Contracture
  • Tendon Lacerations
  • Tetraplegic Reconstruction

    Wrist
  • DeQuervain’s Tendinitis
  • Wrist Ganglion
  • Distal Radius Fractures
  • Scaphoid Fractures
  • Triangular Fibrocartilage Tear
  • Wrist Arthritis

    Elbow
  • Tennis Elbow
  • Distal Biceps Tendon Tear
  • Elbow Fractures
  • Elbow Ligament Injuries
  • Elbow Arthritis

    Shoulder
  • Rotator Cuff Tendinosis
  • Rotator Cuff Tear
  • Shoulder Instability/Dislocations
  • SLAP Lesions


    • The TFC is a constellation of many structures


    The triangular fibrocartilage complex (TFC) is a complex constellation of tissues on the ulnar (small finger) side of your wrist. The TFC may become injured by a trauma (fall, sports injury, etc) or over time if the ulna bone (the forearm bone on the small finger side) is longer than your radius (the forearm bone on the thumb side).

    TFC tears can lead to inflammation in your wrist, as well as arthritis and instability of the joint between the radius and ulna that allows your forearm to rotate (the distal radio-ulnar joint or DRUJ).

    MRIs are not very accurate in diagnosing TFC injuries, which can often be diagnosed based on a good history and physical examination. Nonoperative treatment starts with a splint, a steroid injection and avoiding forceful forearm rotation (like when using power tools) and avoiding loading the extended wrist (like when putting your body weight on your palm to get off the floor, out of a pool, pushing a heavy door open, etc). If you weight-lift, you want to use a splint while lifting to avoid loading the extended wrist.

    Arthroscopic view of normal TFC
    Arthroscopic view of normal TFC
    TFC central tear requiring debridement
    TFC central tear requiring debridement

    If nonoperative management fails, and the TFC tear is sufficiently painful, the next step is a diagnostic arthroscopy. If there’s just a flap of injured tissue causing the problems, but the DRUJ is stable, the flap can be removed arthroscopically. If the TFC is torn, but the DRUJ is stable, this tear can be repaired arthroscopically. If the TFC is torn and the DRUJ is unstable (loose), an open repair is probably the best way to go. All of these do well. If the TFC is torn, an above-elbow cast will be used for 2-4 weeks, and then therapy begun.

    Peripheral TFC tear requiring Repair
    Peripheral TFC tear requiring Repair
    TFC after Arthroscopic Repair
    TFC after Arthroscopic Repair

    If the ulna is too long it may have to be shortened, either at the time of initial surgery, or as a 2nd surgery if symptoms persist following treatment of the TFC tear. This is traditionally done through a long incision: 2-3 mm of bone is removed from the middle of the ulna and a plate is put on. A short-arm cast is worn for 6 weeks and heavy activities are avoided until the bone is healed. However, a newer technique of ulnar shortening can be performed through a smaller incision, with a quicker healing time. Immobilization is below the elbow, and for only 2 weeks. Most, but not all, patients may have this option available to them.