There has been a surge in wrist injuries in the clinic, be it from golfing, DIY’ing, or sometimes just living. One of the more common causes of wrist pain is a Triangular Fibrocartilage complex (TFCC) lesion.
Wrist pain on the ulnar side from a sports injury is common and TFCC tear is one of the common causes of the symptoms. TFCC is a ligamentous and cartilaginous structures that is located between the distal ulna (forearm bone on the pinky side of the arm)and the carpals (hand bones). It comprises of multiple ligaments and an articular disc. It is the main stabiliser of the distal radial ulnar joint and the ulnar carpus.
The main functions of TFCC:
- It provides a gliding surface between the carpal bones and the forearm bones
- It gives support to forearm rotational movement and wrist flexion and extension movement
- It provides shock absorption to loading of the wrist
TFCC injury can present as diffuse or localized, with or without clicking noises emanating from the wrist. It is associated with intra and extra articular ulnar fractures but not to ulnar styloid fracture. TFCC injuries are commonly caused by a combination of excessive compressive force and ulnar deviation, or distraction force on the wrist. Common causes of TFCC injury included:
- Fall on extended hand
- Racquet sports such as tennis, squash, golf etc.
- Excessive ulnar deviation when using entertainment remote controller e.g. wii, PS4
- Excessive ulnar deviation when using power drill or screw driver
- Riding motor bike
- Heavy lifting using wrist only e.g. lifting heavy furniture, living room table etc.
- Distal radius fracture
- Positive ulnar variance (ulnar bone is longer than usual – risk factor)
The peripheral one third of the articular disc is vascularised whereas the central portion and the radial side are not. This means if the TFCC tear happened on the peripheral side of the disc it has a better healing ability and outcome.
Diagnosis is primarily based on patient history of the mechanism of injury and clinical tests. Magnetic resonance imaging is good at ruling in TFCC lesion but not as good at ruling out. Ultrasound may be used to assist in detecting the injured structure alongside with MRI.
Conservative management is the first treatment option when the distal radio ulnar joint is stable. Potential management strategies include:
- Anti-inflammatory medication
- Manual Therapy
Immobilisation allows time for the injured TFCC to heal. Strengthening exercises will be commenced if symptoms were cleared after immobilisation to restore normal wrist strength. If conservative management fails to reduce symptoms for an acute tear in three months, surgical management may be considered. Surgical techniques may involve debridement, pin fixation, ulnar osteotomy, ulnar bone resection or repair. Outcomes of surgery depend on the type of tear and surgical procedures. Majority of the time patients experienced good to excellent outcome.
Manual therapy, taping and exercise would be the main forms of treatment provided here at Thornleigh Performance Physiotherapy. We also supply splints, can cast, and advise regarding ongoing management.
If you have any questions regarding your wrist or hand pain, or were interested in seeing if we can help you, feel free to give us a call. Here at Thornleigh Performance Physiotherapy, the physios can give you an accurate diagnosis and cutting edge treatment, as well as advice on the best course of action for your condition to get you back on track sooner than you could’ve imagined. We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. Physiotherapists add life to years! So give us a call on (02) 8411 2050 to get started on a journey to a better you.