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Triangular fibrocartilage complex tear is an injury to ligaments in the middle and outer side of the wrist. The TFCC ligaments keep the wrist joint stable. Sprained or torn TFCC ligaments can cause pain. This injury can happen from sudden trauma, such as falling on the wrist, or develop over time from repetitive trauma or natural aging. The most common types of tears, "traumatic" TFCC tears, often occur in athletes participating in racquet sports and gymnastics, and in manual laborers, such as those who use power drills. TFCC tears from aging, called "degenerative" tears, which can develop from wear and tear over time, most commonly are found in people over the age of 50. Physical therapists help people with TFCC tears reduce pain, swelling, stiffness, and any associated weakness in the wrist or upper extremity, and return to improved or normal use of the hand and wrist.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
On this page
- What Is a Triangular Fibrocartilage Complex Tear?
- How Does It Feel?
- How Is It Diagnosed?
- How Can a Physical Therapist Help?
- Can This Injury or Condition Be Prevented?
- What Kind of Physical Therapist Do I Need?
What Is a Triangular Fibrocartilage Complex Tear?
TFCC is a group (or "complex") of ligaments on the small-finger side of the wrist. These ligaments keep the wrist bones stable, and attach the 2 forearm bones (the radius and the ulna) together near the wrist. TFCC tears commonly happen on the dominant hand. There are 2 types of TFCC tears:
- Type I. The most common type of TFCC tear, from traumatic injury, usually occurs as the result of a fall onto the outstretched hand, or from a sudden pull ("traction") on the wrist.
- Type II. This type of tear results from a degenerative injury that develops over time, usually occurring with age. Although degenerative TFCC tears have been diagnosed in people as young as in their 30s, they are most common in those aged 50 years and older. There is an increased risk of degenerative TFCC tears if a person has had a previous wrist trauma, or if one of the forearm bones (the ulna) is longer than the other (radius) from birth.
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How Does It Feel?
With a TFCC tear, you may experience:
- Pain when leaning on the hand
- Swelling in the wrist
- Stiffness in the wrist
- Weak grip strength
- Clicking, catching, or creaking in the wrist
- Pain when turning a door handle or pushing up from sitting in a chair
- Pain when lifting heavy objects
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How Is It Diagnosed?
If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:
- How and when did you notice the pain and/or swelling?
- Have you been performing any repetitive activity?
- Did you fall on your hand?
Your physical therapist also will perform special tests to help determine the likelihood that you have a TFCC tear. Your physical therapist will gently press on parts of your wrist and arm to look for signs of tenderness or abnormal movement, observe how you can move your wrist and arm, and test your strength and flexibility.
To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an X-ray or MRI, to confirm the diagnosis and to rule out other damage to the wrist, like a fracture or infection.
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How Can a Physical Therapist Help?
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies from person to person, but successful results can be achieved more quickly when a physical therapist implements an individualized swelling-management, stretching, motion, and strengthening program.
During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:
- Apply light compression by wrapping the wrist a specific way, using a compressive wrap
- Rest the area by avoiding any activity that causes pain in the wrist
- Apply ice packs to the area for 15 to 20 minutes every 2 hours
- Begin using a splint or brace to protect the TFCC
- Consult with a physician for further services, such as medication or diagnostic tests
Your physical therapist will work with you to:
Reduce pain and swelling. If repetitive activities have caused the TFCC tear, your physical therapist will help you understand how to avoid or modify the activities, to allow healing to begin. The physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, compressive wraps, taping, bracing, splinting, exercises, and hands-on therapy, such as specialized massage.
Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the wrist, hand, and arm. These might begin with "passive" motions that the therapist performs for you to gently move your wrist, and progress to active exercises and stretches that you do yourself. If a splint or brace for your wrist is recommended, your physical therapist will teach you how and when to exercise the rest of your arm and hand, to prevent any problems from lack of use.
Improve flexibility. Your physical therapist will determine if any arm muscles are tight, start helping you to stretch them, and teach you how to stretch them.
Improve strength. If your physical therapist finds any weak or injured arm, hand, or wrist muscles, your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility. These may include using cuff weights, stretch bands, and weight-lifting equipment.
Improve endurance. Restoring your arm's muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things you like to do.
Learn a home program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs. If you do them as prescribed by your physical therapist, you can speed your recovery. If a brace or splint is recommended for you to use on your wrist, your physical therapist will explain how often you should remove it, and any exercises to do when it is removed.
Return to activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. If you are an athlete, your physical therapist may coordinate care with your coach and/or athletic trainer. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.
Speed recovery time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
If Surgery Is Necessary
Surgical repair of the TFCC could be recommended. After surgery, you will follow a recovery program over several weeks or months, guided by your surgeon and your physical therapist. Your physical therapist will help you minimize pain and swelling, regain motion and strength, and return to normal activities in the safest and speediest manner possible. Physical therapy may be able to help you avoid the need for opioid pain medication as well.
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Can This Injury or Condition Be Prevented?
To help prevent a TFCC tear, your physical therapist may advise you to:
- Avoid falling on your hand. If you have poor overall balance and are prone to falling, your physical therapist can help you strengthen your muscles, improve your balance, and lower your risk of falling.
- Avoid repetitive, high-impact activities using the hands. If your work requires such activity, your physical therapist can work with you to strengthen the muscles of your arms, wrists, and hands, and determine your best positioning to complete necessary tasks.
- Use a brace or taping. Athletes and manual laborers may benefit from specialized braces or taping. Your physical therapist can recommend what is best to treat your specific condition.
- Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.
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What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat TFCC tears. However, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist (certified hand specialist, or CHT) or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
- Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
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The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of TFCC tears. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Barlow SJ. A non-surgical intervention for triangular fibrocartilage complex tears. Physiother Res Int.2016;21(4):271–276. Article Summary in PubMed.
Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther. 2010;23(1):2–16. Article Summary in PubMed.
Rettig AC. Athletic injuries of the wrist and hand; part 1: traumatic injuries of the wrist. Am J Sports Med. 2003:31(6):1038–1048. Article Summary in PubMed.
Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist: anatomy and function. J Hand Surg Am. 1981;6(2):153–162. Article Summary in PubMed.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Expert Review:Feb 12, 2018
Revised:Feb 12, 2018
Content Type: Guide
Symptoms & Conditions
Triangular Fibrocartilage Complex Tear
The editorial board
- Medication: Anti-inflammatory medications (such as NSAIDs) can help reduce swelling and relieve pain.
- Bracing: Keeping your forearm and wrist stable with a brace or splint can allow your TFCC to heal.
- Injections: Cortisone shots help reduce the swelling of torn tissue.
Physical therapists help people with TFCC tears reduce pain, swelling, stiffness, and any associated weakness in the wrist or upper extremity, and return to improved or normal use of the hand and wrist.Which TFCC tears need surgery? ›
TFCC tears often get better without treatment, but a person will need to avoid using their wrist while the injury heals. For severe or persistent tears, a doctor may recommend surgery or physical therapy.How long does it take to heal from triangular fibrocartilage complex tear surgery? ›
Recovery time for TFCC tears that do not require surgery is generally four to six weeks. If surgery is required, it might take anywhere from six weeks to several months to restore full wrist function. Physical therapy and avoiding activities that put a pressure on your wrist might help you heal faster.What happens if a TFCC tear is left untreated? ›
What happens if nothing is done? If TFCC tear is left untreated, you may feel persistent pain, stiffness, clicking and most commonly weakness at the wrist joint. The joint may become unstable and could end up with arthritis of the joint.What aggravates TFCC? ›
Signs and Symptoms of a TFCC tear.
Pain is worsened with weight-bearing activities like pushups and by movements that involve twisting (technical term being pronation and supination) the wrist/forearm. Common aggravating activities include using a screwdriver, opening doorknobs, and turning a key in the lock.
If there is a tear of the TFCC with the instability of the distal radioulnar joint, this is potentially career-threatening. If there is a chronic tear, the athlete can receive counsel that the risk of further damage is minimal.Is heat or Ice better for TFCC tear? ›
The initial aim of treatment for a TFCC injury at Ogren Physical Therapy will be to decrease the inflammation and pain around the area. Simply icing your wrist assists with the inflammation and often relieves a great deal of the pain. In cases of more chronic pain, heat may be more useful.Should a TFCC tear be splinted or cast? ›
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.Is TFCC surgery worth it? ›
In conclusion, open surgery for TFCC repair results in significant early and late improvements in pain and function.
Acute peripheral TFCC tears which have been repaired within 3 months of injury give 60-90% good- excellent results, with 80-90% grip strength and range of motion compared to the contralateral side. Delayed repairs give less predictable results.What are the side effects of TFCC surgery? ›
The risks of surgery for TFCC tears include anaesthetic reactions, infection, poor scarring, ongoing pain, reduced grip strength, reduced range of wrist motion and complex regional pain syndrome.Do all TFCC tears require surgery? ›
The quick answer to this question is yes, a TFCC tear can heal without surgery. It's important to understand that the area toward the outside of the wrist will heal better without surgery, and it may take some time for your pain to improve.How do I know if I need TFCC surgery? ›
Your doctor will likely recommend about six weeks of physical therapy. This involves doing gentle exercises to help you rebuild strength in your TFCC. If resting your wrist and physical therapy don't provide any relief, you may need surgery to repair the tear.Can you lift weights with TFCC tear? ›
In all cases, during the initial inflammatory period rest (so no training, lifting or gymnastics), ice and immobilization are the recommended protocols. The best position for the injured wrist is in a neutral position (see left) and supported by a brace.Will a cortisone shot help a TFCC tear? ›
Steroid injection can be used as a nonoperative method in the treatment of TFCC injuries.Will a steroid injection help a TFCC tear? ›
Steroid is a strong anti-inflammatory medication and reduces the pain related to the TFCC tear. A steroid injection can significantly reduce your pain, allowing you to restore full range of movement and strength at the wrist and return to normal function.Can I drive with a TFCC injury? ›
Return to work, driving or sport? Return to sedentary or office based work at 2 weeks or when pain allows. Driving is safe after the splint has been removed. Manual work can be resumed at 6 weeks but can be longer if the work environment (such as repetitive hammering) particularly aggravates the TFCC.What does a TFCC tear feel like? ›
For some, a TFCC tear may not cause any pain or instability problems in a wrist. Often, MRI studies show tears in people with no pain or problems using the wrist. Others may experience some or all of the following symptoms: Clicking or popping while turning the forearm or moving the wrist from side to side.How long should you wear a brace for TFCC tear? ›
If you have surgery to repair the TFCC, your doctor will prescribe a brace to keep the wrist immobilized for up to six weeks after surgery. A TFCC tear can take as long as three months to heal after surgery.
A TFCC tear is an injury to the triangular fibrocartilage complex, soft tissues in the wrist that cushion and support the carpal bones and help stabilize the forearm. Injuries range from mild to severe, but all can disable the wrist.How long does a TFCC surgery take? ›
The time of surgery varied between 30 to 100 minutes, the shortest time was for the wrist arthroscopies and the longest for the combined open TFCC repair and tenolysis.Are you in a cast after TFCC surgery? ›
You will have your first post- operative appointment with our office approximately two weeks after your procedure with one of your surgeon's Physician Assistants. Your sutures and splint will be removed at this appointment, and you will be placed into a cast.How long do you wear a cast after TFCC surgery? ›
The cast will be removed six weeks after the operation. Cast removal is followed by physical therapy for six to eight weeks. Physical therapy may be needed to help you regain full joint motion, strength, and normal movement patterns. Some patients have difficulty regaining pinch and grip strength.Does cortisone shot help TFCC tear? ›
Cortisone injections can help with pain and inflammation from TFCC tears. Cortisone is a potent anti-inflammatory and should be directed to the exact site of the tear.What is arthroscopic repair of triangular fibrocartilage complex tears? ›
Arthroscopic TFCC repair: The arthroscopic technique is a less invasive procedure where 2 to 3 incisions of about 5 mm each are made in the wrist, through which a telescope (arthroscope) and other surgical instruments are passed. Repair is based on the damage caused to the ligament and cartilage.Should you ice or heat a TFCC tear? ›
Ice packs, or cold compresses should help alleviate the pain and inflammation on the wrist aside from taking pain relievers and anti-inflammatory medication. The doctor might likely advise the patient to lessen activities that may aggravate the condition.Does a brace help TFCC? ›
Wearing the Body Helix TFCC Wrist Brace stabilizes the tissues of the Triangular FibroCartilage Complex (TFCC), providing pain relief and supporting the structures of the TFCC while they heal.What are the complications of TFCC repair surgery? ›
The risks of surgery for TFCC tears include anaesthetic reactions, infection, poor scarring, ongoing pain, reduced grip strength, reduced range of wrist motion and complex regional pain syndrome.Does a partial TFCC tear require surgery? ›
The quick answer to this question is yes, a TFCC tear can heal without surgery. It's important to understand that the area toward the outside of the wrist will heal better without surgery, and it may take some time for your pain to improve.