The TFCC or Triangular FibroCartilage Complex is a structure in the wrist, on the pinky or ulnar side, composed of ligaments and cartilage, and is an important stabilizer of the wrist during various motions. This structure also acts as a cushion between the ulna and the carpal bones in the wrist. The TFCC can be injured through trauma or degenerative changes over time.

• Trauma, including a direct fall on the hand, distal radius or ulna fracture, twisting injury, sports injuries like swinging a baseball bat or tennis racket
• Degenerative, including aging or as a result of positive ulnar variance (ulna is longer than the radius)

• Pain, especially in the ulnar (pinky) side of the wrist
• Clicking sensation during rotation or the forearm
• Weakness in wrist or grip strength
• Deficits to range of motion

• Avoid excessive ulnar deviation of wrist (moving wrist towards pinky) along with forceful forearm rotation
• Modify movements if pain is present in wrist
• Avoid repetitive forceful wrist movements

• X-rays are done to determine if there is positive or negative ulnar variance (is the ulna longer or shorter than the radius?)
• MRI, typically with contrast, is done to determine if there are any tears to the ligaments or the central cartilaginous portion of the TFCC
• Physical examination by physician or hand therapist to determine if joint instability is present

• Rest, Ice, Compression, Elevation
• Splinting to immobilize and prevent ulnar deviation motion of the wrist
• Anti-inflammatory medications
• Cortisone injections to decrease inflammation and pain
• Surgery including TFCC debridement of central tears or ligament repairs if peripheral tears and instability is present

• Custom splinting to immobilize and prevent ulnar deviation motion (ulnar gutter orthosis)  and occasionally forearm rotation (muenster orthosis)  motion, if necessary
• Modalities including moist heat, ice, ultrasound, infrared laser to reduce inflammation
• Education on activity modification to decrease inflammation
• Post operative range of motion, scar management, and strengthening
• Education on home exercise program