What is a TFCC tear and does it need surgery? I am a physician who had a TFCC tear diagnosed on MRI. I never got surgery, why? How did I heal this problem? Let’s dig in.
What Is a TFCC Tear?
TFCC stands for Triangular Fibrocartilage Complex. It’s basically a triangular-shaped spacer with ligaments that lives on the pinky finger (ulnar) side of your wrist (1). This complex of ligaments stabilizes the bones on that side and adds cushioning. The TFCC can become torn with a fall on an outstretched hand, other trauma, or just wear and tear.
Instability is another feature of TFCC tears (2). The TFCC is part of an extensive group of ligaments that help stabilize both the small wrist bones and the ulna bone. If these become stretched and allow too much movement, this is called instability. These wrists are more likely to get beat up over time due to all of this extra motion.
Can a TFCC Tear Heal Without Surgery?
First, you must realize that the TFCC is a bit like a knee meniscus, with a zone that has better blood supply towards the outside of the wrist and a zone with poor blood supply towards the inside. Only tears toward the outside will likely heal on their own, as these have a good blood supply. About 30% of TFCC tears will heal on their own by about 6-months. (11)
Is a TFCC Tear Painful?
A traumatic tear (i.e. due a fall) can be very painful for weeks to months. The average wear and tear degenerative TFCC tear is usually associated with mild to moderate chronic pain on the ulnar side of the wrist. Usually activity with the hand such gripping things or manipulating objects that require force can be painful.
What Is a TFCC Repair?
There are two main surgical approaches, debridement and repair. Debridement means cutting out torn pieces of the torn TFCC (4). Repair means sewing a tear together that’s in the outside part of the TFCC that has a better blood supply. Both can be done with open surgery or arthroscopy (using a “scope” as in the picture above). There are three main surgical techniques: inside-out, outside-in, and all-inside.(3) In addition, some surgeons try to shorten the ulna bone, but the research shows that this is likely not needed (9).
Does surgery work? Debridement in one study didn’t produce better grip strength or pain relief (6). In another, only 40% of patients were satisfied (7). In yet another, tears that were due to wear and tear and those patients who had a long ulnar bone were associated with poor surgical results. (12) Having said that other studies have shown good results (8).
As far as repair versus debridement, one is unlikely to better than the other and neither have any high-level research to support that they work well versus a sham procedure (10). Meaning we have no gold standard research that shows us that either TFCC surgery is better than doing nothing. This is interesting as these are common surgeries,
What Is the Recovery Time for Wrist Surgery?
Recovery can take from 6 weeks to 4 months. You will be expected to begin using your fingers as soon as possible and while in a splint to keep them from getting stiff. Icing 3-5 times a day is used to reduce swelling for the first few weeks. As far as nighttime, your wrist will need to be kept elevated while you sleep.
Perc-TFCC Ligamentoplasty – Quicker Recovery for Some Patients
We have been using the Percutaneous TFCC Ligamentoplasty procedure for many years to help reduce recovery and eliminate the need for surgery in patients with TFCC tears with and without instability. This involves a precise ultrasound-guided injection of your own high dose platelet-rich plasma or stem cells into the TFCC and associated ligaments. The goal is to promote healing without the need for surgery.
I’m a big fan of this procedure after having it performed on my own right wrist. One day I was walking out of a convenience store and my shoe ties became accidentally locked and I went down hard on my right hand. After severe pain and barely being able to perform procedures for weeks, an MRI showed a TFCC tear. I also had wrist instability. Instead of surgery, I had the Perc-TFCC Ligamentoplasty procedure and never looked back. I now lift heavy weights without any issue and instead of being in a big cast or brace, I was able to return to work immediately and had an active recovery. Meaning, my recovery period, apart from a few days of wrist aching, was vastly quicker than if I had chosen surgery.
The upshot? TFCC tears can be painful and frustrating and many times surgery is recommended. However, you may be able to avoid invasive surgery with newer injection-based and image-guided procedures.
(1) Pang EQ, Yao J. Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU). Curr Rev Musculoskelet Med. 2017;10(1):53–61. doi: 10.1007/s12178-017-9384-9
(2) Atzei, A., Luchetti, R., & Garagnani, L. (2017). Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. Journal of Hand Surgery (European Volume), 42(4), 405–414. https://doi.org/10.1177/1753193416687479
(3) Trumble TE, Gilbert M, Vedder N. Arthroscopic repair of the triangular fibrocartilage complex. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1996;12:588–597. https://www.ncbi.nlm.nih.gov/pubmed/8902134
(4) Osterman AL. Arthroscopic debridement of triangular fibrocartilage complex tears. Arthroscopy. 1990;6:120–124. https://www.ncbi.nlm.nih.gov/pubmed/2363779
(5) Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. The Journal of Hand Surgery. 1994;19:143–154. https://www.ncbi.nlm.nih.gov/pubmed/8169359
(6) Nishizuka T, Tatebe M, Hirata H, Shinohara T, Yamamoto M, Iwatsuki K. Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain. Bone Joint J. 2013;95-B:1687–1696. https://www.ncbi.nlm.nih.gov/pubmed/24293601
(7) Minami A, Ishikawa J, Suenaga N, Kasashima T. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg. Am. 1996;21:406–411. https://www.ncbi.nlm.nih.gov/pubmed/19631508
(8) Saito T, Malay S, Chung KC. A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear. Plast Reconstr Surg. 2017;140(5):697e–708e. doi: 10.1097/PRS.0000000000003750
(9) Jung KJ, Nho JH2, Kim JH2, Kim BS3, Gong HS4. Triangular Fibrocartilage Complex Repair and Ulna Variance: A Systematic Review. J Hand Surg Asian Pac Vol. 2018 Sep;23(3):313-319. doi: 10.1142/S2424835518300025.
(10) Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop. 2018;5(1):6. Published 2018 Mar 13. doi: 10.1186/s40634-018-0120-1
(11) Lee JK, Hwang JY, Lee SY, Kwon BC. What is the Natural History of the Triangular Fibrocartilage Complex Tear Without Distal Radioulnar Joint Instability? Clin Orthop Relat Res. 2019 Feb;477(2):442-449. doi: 10.1097/CORR.0000000000000533.
(12) Roh YH, Hong SW, Gong HS, Baek GH. Prognostic Factors of Arthroscopic Debridement for Central Triangular Fibrocartilage Complex Tears in Adults Younger Than 45 Years: A Retrospective Case Series Analysis. Arthroscopy. 2018 Nov;34(11):2994-2998. doi: 10.1016/j.arthro.2018.05.044.
can tfcc tear heal without surgery