TFCC Injury (Triangular Fibrocartilage Complex)

• Ulnar-sided wrist pain: Aching or sharp pain on the little-finger side of the wrist
• Pain with forearm rotation (turning a doorknob, opening a jar, using a screwdriver)
• Pain at extremes of wrist ulnar deviation or axial loading
• A clicking, clunking, or snapping sensation with wrist rotation
• Wrist weakness or instability
• Swelling over the ulnar wrist
• A fall on an outstretched hand with the wrist in loaded, rotated position
• A forced twisting injury (e.g., catching a heavy object, sports-related load)
• Distal radius fractures (associated TFCC tear in up to 70% of distal radius fractures)

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

Physical Examination:

• DRUJ instability test: Ballottement of the ulnar head relative to the radius in neutral, pronation, and supination. Instability indicates radioulnar ligament disruption (Type 1B or 1D)
• Fovea sign: Deep tenderness with direct pressure in the "soft spot" between the ulnar styloid and FCU tendon, at the foveal insertion of the TFCC. This is highly sensitive and specific for peripheral TFCC tears and foveal disruption
• Ulnocarpal stress test (press test): Axial loading of the wrist in ulnar deviation with forearm rotation reproduces ulnar-sided pain
• Lunotriquetral ballottement (Reagan test): Shear force between the lunate and triquetrum to detect LT ligament involvement in degenerative TFCC disease

X-rays: Essential to measure ulnar variance (the height difference between the distal ulnar articular surface and the distal radius in neutral rotation), detect associated fractures, and identify early carpal arthritis.

MRI Arthrogram (MRI with intra-articular contrast): The imaging gold standard for TFCC evaluation. Direct MR arthrography (with radiocarpal joint injection of gadolinium) substantially improves sensitivity and specificity for detecting TFCC tears compared with conventional MRI alone. It differentiates central perforations from peripheral tears and demonstrates the foveal attachment.

Wrist Arthroscopy: The definitive diagnostic modality. Allows direct visualization of the TFCC disc, radioulnar ligaments, and ulnocarpal ligaments, assessment of cartilage, and, critically, simultaneous treatment. Many TFCC injuries are fully characterized and treated at the time of a single arthroscopic procedure.

• Non-operative: 6–8 weeks of immobilization; 2–4 months of therapy
• Arthroscopic debridement: Long arm splint 1–2 weeks; progressive motion; return to full activity at 6–8 weeks
• Arthroscopic repair: Long arm cast/Münster 6 weeks; progressive motion at 6–8 weeks; return to heavy labor and sport at 4–6 months
• Ulnar shortening osteotomy: Long arm cast 4–6 weeks until initial healing; forearm weight-bearing restricted 3–4 months until plate fixation secure; full recovery 4–6 months