TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (2023)

by Angela Prescott

The Triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage disc (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).

Anatomy of the Triangular Fibrocartilage Disc (TFC):

The TFC is a trianguar, biconcave (concave on both sides and thicker along its periphery) articular disc that sits at the distal ulna, between the ulna and the carpals. The central portion of the TFC is thin, and is made of fibrocartilage (the type of cartilage that is designed to withstand compressive loads; such as in the meniscus of the knee). Like in the knee, the inner portion of the TFC is poorly vascularized while the outer edge is well vascularized. For this reason, often internal tears never heal and the injury become chronic (or are a surgical and not a rehab concern).

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (1)

(Video) MRI Anatomy of TFCC

The TFC is attached to the wrist joint by the radioulnar and ulnocarpal ligaments (as well as smaller ligaments that attach it directly to the lunate and triquetrum bones). These ligaments are also stabilizers of the wrist. For this reason, any tear in the TFC or the TFCC (the disc plus the ligaments) often leads to instability in the wrist - a common problem with gymnasts that often requires bracing that compresses the radius and ulna and limits extension (tiger paws, pegasus wrist supports, etc).

The primary functions of the TFCC:

  • To support the ulnar portion of the wrist by increasing congruence between the ulna and the proximal row of carpals.
  • Load transmission across the ulnocarpal joint (partially load absorbing between the ulna and the carpals)
  • Allows forearm rotation by giving a strong but flexible connection between the distal radius and ulna.

How is the TFCC injured?

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (2)

As mentioned above, the TFCC complex stabilizes the wrist at the distal radioulnar joint. It also acts as a focal point for the force transmitted across the wrist along the ulnar side during weight bearing activities. Traumatic injury (such as a fall onto an outstretched hand) is the most common mechanism of injury. The hand is usually in a pronatedor palm down position. Tearing or rupture of the TFCC occurs when there is enough force through the ulnar side of the overextended wrist to overcome the tensile strength of this structure. (Sounds like most tumbling skills right?) The TFCC is also at risk with gripping or tensile loads (as seen when using a power drill that suddenly binds up or with gripping and pulling - such as many bar/ring skills) and can be torn this way as well.

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (3)

In gymnastics and acrobatics however, the TFCC can also be injured through overuse injury (both in support skills and hanging elements). As the wrist has evolved over time and is no longer designed for true weight bearing activities, the TFCC is smaller and thinner than analogous cartilage discs (such as the meniscus) in the lower extremities (legs). With repetitive weight bearing (both compressive and tensile), this area can become inflamed and tendonitis/tendonosis can develop in the anchoring wrist ligaments (often misdiagnosed as a wrist sprain). The subsequent inflammation can irritate the TFC, causing it to swell and/or weaken overtime. This causes subtle breakdown in the structure (as well as in the adjacent ligaments) that can lead to a traumatic tear with less force than required for a healthy TFCC.

Symptoms:(aka: why you're really here...)

The symptoms of an injury to the TFCC are relatively simple, though they are often misdiagnosed as a wrist "sprain." (Most non-orthopedics will use the term "sprain" as a catch-all for traumatic wrist pain that is not a fracture).

Primary symptoms:

(Video) TFCC Injuries

The main symptom is ulnar wrist pain (pain along the pinky side of the hand). In most cases it is right along the joint line, though some people will complain of "diffuse" wrist pain (a general pain that exists throughout the wrist joint). Often this pain is increased with weight bearing activities on the wrist (handstands or hanging) and rotation of the wrist (such as turning a doorknob or lifting a heavy pan with one hand). There is also often tenderness to the touch along the ulnar side of the joint.

Secondary symptoms:

Some other possible symptoms include: swelling in the area, clicking or popping in the joint (aka crepitus) and weakness (usually due to pain inhibition).

Differential diagnosis:(a.k.a. ruling out other more serious conditions)

The biggest concern for a gymnast/acrobat would be ruling out a fracture. A fracture at the end of the ulna would present with similar symptoms. The biggest difference is that with a fracture, supination and pronation (twisting) motions of the forearm would also be GREATLY limited, if not blocked due to an ulnar dislocation. If you (or anyone that you coach) is unable to twist the forearm without significant pain, my best recommendation is to send them for an x-ray to rule out the fracture.


While it's best to leave the diagnosing to the professionals, there are some quick tests that you can do on your own to differentiate a possible TFCC injury from general wrist pain.

TFCC provocation test: Hold the hand upright and neutral. Then perform ulnar deviation (tilt the hand toward the pinky) slowly. A positive test (meaning you may have a TFCC injury) is a specific pinch pain along the ulnar (pinky) side of the joint. A negative test (no injury) is reaching the end of the motion without pain or motion loss.

Fovea sign: Apply external pressure to the area of the wrist along the fovea of the ulna (see picture). This is the space along the end of the ulna along the lateral side of the joint. Compare this to the other side. If there is pain with pressure, the test is considered positive (This is a highly sensitive, newly approved test BUT does not rule out fracture so be warned).

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (6)


Treatment depends largely on the severity of the tear and how limiting it is to training and activities. Like any ligamentous injury, a TFCC tear can be separated into grades of levels. In the less severe cases, the ligaments will slowly heal (as they were not completely torn) and normal function can be regained. In the more severe cases, surgery is an option to re-stabilize the TFCC and the wrist joint. This is due to the fact the fully torn ligaments (and cartilage) do not actually regenerate to heal themselves. Rather they will "scar down" as the body lays down additional collagen (connective tissue) in an effort to "patch" the injury. Only a doctor (orthopedic) will be able to formally grade the injury (after using diagnostic imaging like an MRI or CT scan), so if there is a severe disruption in function (a.k.a. daily life is limited by pain), it is this author's recommendation that medical intervention be sought out.

(Video) Taping for TFCC Wrist Injuries | Tim Keeley | Physio REHAB

Stages of recovery (non-surgical)

Acute (early inflammatory phase):within 2-4 weeks after the initial injury

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (7)

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. The brace should be worn during daily activity to protect the wrist, and removed to allow for gentle movement and ice. The type of brace is non-specific, but during this acute phase, should support the wrist and the hand in a immobile position.

While the wrist is braced during activities of daily living, it is important periodically remove it and do gentle mobility exercises and hand motions to ensure that no motion is lost and to assist in the elimination of swelling. These exercises include: wrist circles, gentle wrist range of motion, towel squeezes (can also be putty squeezes), and opening and closing the hand into and out of a fist. (For specifics on these exercises or an email copy of them, email me at

During this time it is also important to ice the wrist periodically. This can be done with a gel pack, bag of frozen peas, or a Ziploc bag of ice cubes. Be sure to put a thin towel layer between the skin and ice, and only leave the ice on for 15 minutes at a time. This should be done 4-5 times a day, to deal with swelling and help to alleviate pain.

After the inflammatory phase:

While there is no way to know for certain (without the hands on assessment of a professional) whether or not the injury has progressed beyond the acute or inflammatory stage, a general guide that can be used is the return of near full, pain-free motion. At that time, it is prudent to progress to some light weight bearing and more resistance based exercises (again - email with specific questions). It is also important to consider functional bracing to protect the injury and to minimize pain until full strength is regained.

FunctionalBracing (a.k.a. bracing that can be worn during training):

Not every TFCC injury or wrist instability can be completely rehabilitated with exercise alone (especially during the first month or two). Often functional bracing (bracing during activity to support the instability) can allow an acrobat/gymnast/yogi to continue to train while still protecting the newly healed TFCC (which can remain fragile until about the 6 month mark).

There are many braces on the market. Here are some details about three that have been used in these acrobatic sports and weight training with success. (They are listed in random order - not a numerical rating system).

Tiger Paws (aka Golden Paws):These are a more rigid wrist support (though now they do offer different inserts to vary the stiffness) that cover the wrist part of the hand. Their purpose is to limit wrist extension/ulnar deviation in a support position (think handstand/bridge/down-dog). In the case of a TFCC injury, they are very effective at protecting it once healed as they restrict the position (extension) that places the most stress on it. The negative: they cover a portion of the hand so they are not as useful for work on apparatus (balance beam, trapeze, fabrics, etc) or with weight training.

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (8)

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (9)

(Video) Understanding TFCC (Triangular Fibrocartilage Complex Tear)

Pegasus wrist supports:This brace compresses the radius and the ulna (supports the distal radioulnar joint) while providing a small block against end range extension and ulnar deviation (the motions that irritate the TFCC). The big difference between this brace and golden paws is that the Pegasus wrist supports do not cross onto the hand. This allows them to be used on a wider variety of apparatus as the palm is left open and free. The negative: they do not support as completely as the Tiger Paws for TFCC because they do not block end-range extension fully and they are rather bulky at the wrist.

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (10)

Wrist Widget:This is a newer style of brace and is more minimal in its design. It was specifically designed for TFCC injuries and has been marketed for athletes, weekend warriors, and regular folks alike. Like the Pegasus wrist brace, it compresses the ulna and the radius for support. However, it begins to differ in that it does not restrict extension in any way. It minimally limits ulnar deviation and supports the distal radioulnar joint so that the connecting ligaments of the TFCC are not as "stressed." This brace is ideal for an older injury and for use on various apparatus (including things like partner balancing and acro yoga where wrist and hand holds are a requirement) and with weight training.

TFCC Injury: the "meniscus tear" of the wrist — ACRO Physical Therapy & Fitness (11)


  • The TFCC (Triangular Fibrocartilage Complex) is composed of a disc (similar to the meniscus in the knee) and several adjacent ligaments on the ulnar side of the wrist. It supports the ulna, connects to the radius and maintains joint space in the wrist during weight bearing (both hanging and support activities).
  • Injury can occur two ways: 1) trauma (usually into compression or strong traction with twisting)& 2) in some acrobats and gymnasts by simple overuse.
  • Treatment involves rest, ice, stretching/strengthening and functional bracing. It is key to allow the injury to rest during the inflammatory (acute) stage to minimize the risk of chronic pain and ensure the best chance at healing.
  • When in doubt - seek a medical consult to ensure that you are safe to return to sport.


Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.

Levangie, P.K. and Norkin, C.C. (2005). Joint structure and function: A comprehensive analysis (4th ed.). Philadelphia: The F.A. Davis Company.

Hagert E., Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist, Journal of Hand Therapy, 2010 Jan-Mar 23, 2-16.

Neumann DA. Kinesiology of the musculoskeletal system: Foundations for Physical Rehabilitation.2nd Ed. Elsevier Health Sciences; 2009.

Parmelee-Peters, K., Eathorne, S. (2005). The Wrist: Common Injuries and Management. Primary Care, Clinics in Office Practice, 35-70.

Rettig AC, Athletic Injuries of the wrist and hand, part 1: traumatic injuries of the wrist. Am J Sports Med 2003:31(6):1038-48.

Verheyden JR, Palmer AK. EMedicine. Triangular Fibrocartilage Complex. (accessed August 2, 2017)

Wadsworth, C., The wrist and hand examination and Interpretaion, J. Orthopedic and sports physical therapy, 1983, 108-20.


(Video) TFCC tear diagnosis


Can you workout 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.

What is the fastest way to heal a TFCC tear? ›

How is a TFCC tear treated?
  1. Medication: Anti-inflammatory medications (such as NSAIDs) can help reduce swelling and relieve pain.
  2. Bracing: Keeping your forearm and wrist stable with a brace or splint can allow your TFCC to heal.
  3. Injections: Cortisone shots help reduce the swelling of torn tissue.
26 Oct 2021

Does physical therapy help TFCC? ›

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.

What is a severe TFCC tears? ›

What is a TFCC tear? 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.

What is a severe TFCC tear symptoms? ›

Symptoms of a TFCC tear include pain on the outside of the wrist, reduced range of motion, swelling in the wrist, popping or clicking when moving the wrist, or limited ability to grasp objects. While anyone can develop TFCC, athletes, being over 50 and having chronic inflammation are risk factors for developing TFCC.

Does cortisone shot help TFCC tear? ›

Ultrasound-guided steroid injection

The use of ultrasound-guided steroid (also known as corticosteroid) injections for the treatment of TFCC tears is routinely suggested as a non-surgical option. Steroid injections help to settle the inflammation associated with TFCC tears (Robba et al (2019).

Does a brace help TFCC? ›

In most cases, TFCC tears are managed with anti-inflammatories and splinting for about four weeks followed by corticosteroid injections if necessary. After splinting the wrist for a period of time to reduce symptoms, range of motion exercises can be recommended to restore motion and strengthening.

How can I speed up the recovery of my wrist? ›

To speed the healing, you can:
  1. Rest your wrist for at least 48 hours.
  2. Ice your wrist to reduce pain and swelling. ...
  3. Compress the wrist with a bandage.
  4. Elevate your wrist above your heart, on a pillow or the back of a chair. ...
  5. Take anti-inflammatory painkillers. ...
  6. Use a cast or splint to keep your wrist immobile.
13 May 2021

Why is my TFCC not healing? ›

The cartilage and ligaments composing the TFCC are prone to degeneration and tearing. They do not have a good blood supply and therefore, injuries do not heal well.

Will an MRI show a TFCC tear? ›

Standard MRI can achieve high performance in detection of the TFCC tear. In a recent study, Zlatkin et al. found that the sensitivity, specificity and accuracy was 92%, 89% and 91% respectively (4).

Does it hurt to grip when you have a TFCC tear? ›

The most common symptom of a TFCC tear is pain and weakness at end range supination, with grip, and when bearing weight on the affected arm. There also can be numbness and tingling radiating toward the small finger.

What happens if a TFCC tear goes untreated? ›

The TFCC is what keeps the bones in the forearms, called the radius and ulna, from pulling apart. It works like a shock absorber for the joints on your hands, therefore, a tear, lesion or injury in the TFCC may cause acute wrist pain. If left untreated the pain may become chronic.

Can TFCC tear heal without 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 long does a TFCC repair last? ›

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.

Can you live with a TFCC tear? ›

While most people fully recover from a TFCC tear through either physical therapy or surgery, you may still feel mild pain or stiffness in your wrist for several years. Work with your doctor to manage any residual pain or stiffness.

What percentage of TFCC tears require surgery? ›

Among the patients with clinical diagnosis of triangular fibrocartilage complex injury, the rate of surgical intervention required after a minimum 4 weeks of immobilization was 43%.

Does TFCC tear show on xray? ›

X-ray arthrography presented with a pooled sensitivity of 76.2% and specificity of 92.5% for the detection of complete TFCC tear.

How do you know if you need surgery for TFCC tear? ›

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.

Does heat help TFCC tear? ›

The initial aim of treatment for a TFCC injury at Humpal Physical Therapy & Sports Medicine Centers 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.

Why is the TFCC critical to the wrist? ›

The triangular fibrocartilage complex (TFCC) is a load-bearing structure between the lunate, triquetrum, and ulnar head. The function of the TFCC is to act as a stabilizer for the ulnar aspect of the wrist. The TFCC is at risk for either acute or chronic degenerative injury.

What exercises can I do with injured wrist? ›

Resisted wrist extension
  • Sit leaning forward with your legs slightly spread. Then place your forearm on your thigh with your affected hand and wrist in front of your knee.
  • Grasp one end of an exercise band with your palm down. Step on the other end.
  • Slowly bend your wrist upward for a count of 2. ...
  • Repeat 8 to 12 times.

Should I workout with an injured wrist? ›

It is usually recommended that patients begin exercise and physical therapy only once they've gotten past the initial recovery stage and wrist pain has started to fade. Understanding how to start with exercise is very important.

Why does TFCC take so long to heal? ›

Mild injuries often do respond well to hand therapy. But more severe injuries or radial-sided TFCC tears have a more difficult time healing because of a natural (anatomic) lack of blood supply. In cases like yours where conservative (nonoperative) care does not yield the desired results, surgery may be necessary.

Can I still workout with an injured wrist? ›

Bodyweight exercises like planks and push-ups can be challenging, if not impossible when working with a wrist injury. One way to continue doing these exercises is to modify them with dumbbells or kettlebells.

Can I workout with an injured wrist? ›

It may sound obvious, but avoid anything that causes pain. Your doctor or physical therapist should be able to advise you further on warning signs to look out for when training, but avoiding pain is a good bet. Should your wrist hurt in any way, cease the exercise you're doing immediately and move on to something else.

Should I stop exercising if my wrist hurts? ›

How To Treat Wrist Pain. The first step (of course) is to stop doing any exercise that irritates the wrist. "You've got to cut off the inflammation and [keep] any further damage from occurring," says Mostoff.

How long should you rest a wrist injury? ›

Your Care Instructions. Your wrist hurts because you have stretched or torn ligaments, which connect the bones in your wrist. Wrist sprains usually take from 2 to 10 weeks to heal, but some take longer. Usually, the more pain you have, the more severe your wrist sprain is and the longer it will take to heal.

Should I stop working out if my wrist hurts? ›

Nagging injuries such as wrist pain from weight lifting are often gradual, so it may be tempting to act tough and work through the pain, but it the exact opposite of what you should do. You should never feel pain while exercising unless it is the “burning” sensation from the exercise itself.


1. TFCC Tear/Repair Stretches & Exercises Triangular Fibrocartilage Complex- Wrist Pain.
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2. TFCC Tear | Triangular Fibrocartilage Complex
3. TFC Surgery (Triangular Fibrocartilage Complex)
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4. Arthroscopic Foveal TFCC Repair
(David Tuckman, M.D.)
5. TFCC Tear / Repair Stretches & Exercises (Triangular Fibrocartilage Complex) - Ask Doctor Jo
6. How to Perform a TFCC Evaluation:Real patient, real injury!
(Ortho EVAL Pal With Paul Marquis PT)
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