TFCC

TFCC stands for the triangular fibrocartilage complex, a structure on the ulnar side of the wrist that stabilizes the distal radioulnar joint and cushions the radiocarpal articulation. It consists of the triangular fibrocartilage disc, the radioulnar and ulnocarpal ligaments (including the anterior and posterior radioulnar ligaments), the ulnotriquetral and ulnohamate ligaments, the meniscal homologue, and the sheath of the extensor carpi ulnaris tendon. The disc fills the space between the ulna and the carpal bones, helping to distribute axial load and to guide forearm rotation.

During forearm rotation and wrist loading, the TFCC supports the joint surface and maintains distal ulnar alignment. It also transmits load from the carpus to the radius and ulna, particularly when the wrist is loaded in ulnar deviation.

Injuries most commonly result from a fall on an outstretched hand or from repetitive rotational forces; they may be traumatic or degenerative with aging. Symptoms include ulnar-sided wrist pain, clicking or instability, swelling, grip weakness, and reduced range of motion. Physical examination may reveal the fovea sign, piano-key sign, TFCC compression test, and tenderness at the ulnar aspect of the wrist.

Imaging starts with plain radiographs to exclude fractures; MRI is the standard noninvasive test for TFCC tears, with MR arthrography increasing sensitivity. Ultrasound can assist in experienced hands.

Treatment depends on tear type and chronicity. Nonoperative care includes immobilization, nonsteroidal anti-inflammatory drugs, and physical therapy; corticosteroid injections may be considered in selected cases. Surgical options include arthroscopic debridement for central tears and repair of peripheral tears, with reconstruction or stabilization procedures in selected chronic or irreparable cases. Outcomes vary with tear location and chronicity.