From the Guidelines
TFCC injuries should be diagnosed using MR arthrography, which has a higher sensitivity and specificity for detecting scapholunate ligament injury, lunotriquetral ligament injury, and TFC injury, as recommended by the American College of Radiology in 2024 1. When evaluating TFCC injuries, it is essential to consider the clinical presentation, which typically includes ulnar-sided wrist pain, clicking, and reduced grip strength.
- The diagnosis of TFCC injuries can be challenging, and imaging studies such as MR arthrography or CT arthrography are often necessary to confirm the diagnosis.
- MR arthrography has been shown to have a higher sensitivity and specificity for detecting TFCC tears, intrinsic ligament injury, and cartilage lesions of the radiocarpal joint, with sensitivity ranging from 63% to 100% and specificity ranging from 89% to 97% 1.
- CT arthrography is also a valuable diagnostic tool, with a sensitivity, specificity, and accuracy between 92% and 94% for triangular fibrocartilage (TFC) complex tears, between 80% and 100% for intrinsic ligament tears, and between 94% and 100% for articular cartilage abnormalities 1. The treatment of TFCC injuries should prioritize conservative measures, such as rest, ice, NSAIDs, and wrist immobilization, with surgical intervention considered for tears that do not respond to conservative treatment after 3-6 months or for complete tears in younger, active patients 1.
- Physical therapy focusing on wrist strengthening and range of motion exercises is often beneficial once acute pain subsides.
- Corticosteroid injections may provide temporary relief for persistent symptoms.
- Surgical intervention, either arthroscopic debridement or repair, should be considered for tears that do not respond to conservative treatment after 3-6 months or for complete tears in younger, active patients.
- Recovery from TFCC injuries can take several months, and proper rehabilitation is essential to restore wrist function and prevent recurrence.
From the Research
TFCC Injuries and Treatment
- The triangular fibrocartilage complex (TFCC) is a well-defined anatomical entity located on the ulnar aspect of the wrist joint, functioning primarily to stabilize the distal radio-ulnar joint (DRUJ) and act as a shock absorber across the ulno-carpal joint 2.
- TFCC injuries can result in persistent ulnar-sided wrist pain, and diagnosis and nonsurgical management of TFCC tears is well described, but there remains ongoing discussion about the optimal surgical technique, specifically open or arthroscopic 3.
- Arthroscopic repair with suture anchors and adjuvant platelet-rich plasma (PRP) injections has been shown to be a satisfactory method of repairing early foveal tears of the TFCC, enhancing wrist function by relieving pain and increasing tolerance for work or sports 4.
Treatment Options
- Initial management of TFCC injuries includes modification of daily activities, temporary splint or cast immobilization, non-steroidal anti-inflammatory medication, and corticosteroid injections, with surgical treatment advocated if conservative management fails to provide relief 2.
- Arthroscopic management can be instituted successfully in most cases, with the choice of operative treatment guided by the type and extent of injury, and may include debridement, repair, and ulnar unloading procedures like shortening or Wafer procedure 2.
- Platelet-rich plasma (PRP) injections have emerged as a potential adjunctive treatment for arthroscopic TFCC repair, but studies have shown mixed results, with some suggesting improved outcomes and others finding no significant difference in function or pain reduction 4, 5.
Injection Techniques
- TFCC injections can be applied using anatomical landmarks or under the guide of ultrasound (US), and a cadaveric study found that needle placement perpendicular to skin with 5 mm depth and just medial to ulnar styloid can be used as an accurate method of palpation-guided technique for TFCC injections 6.
- The study also found that injections with a 45-degree angulation to the skin surface, oriented from proximal to distal or distal to proximal, were less accurate, but no injury to neurovascular structures was seen in any of the injection groups 6.