INJECTION THERAPY FOR TRIANGULAR FIBROCARTILAGE COMPLEX (TFCC)

What is Triangular Fibrocartilage Complex (TFCC)?

The triangular fibrocartilage complex (TFCC) is a tiny cartilage between the forearm bone (ulnar) and the hand bone on the little finger side of the wrist (triquetrum). It causes pain on the little finger side of the wrist, which is increased by twisting the forearm and weight bearing through the wrist, such as doing a press up on all fours. Overuse of the wrist, falling on your hand, and lifting heavy weights in the gym can all cause a tear in the TFCC. They can sometimes happen for seemingly no reason at all.

Resting from the motions and activities that cause your pain, as well as physiotherapy and a wrist splint, can help you feel better. If your pain persists, you should see a doctor.

What are the symptoms of Triangular Fibrocartilage Complex?

The following are the signs and symptoms of a TFCC tear:

  • Swelling and pain on the wrist’s little finger side.
  • When the wrist is bent from side to side and when weight is carried through the wrist, such as during a press up or weight training, the pain worsens.
  • Wrist clicking is excruciating.

If this sounds like you, keep reading…

What are some additional conditions that are similar to Triangular Fibrocartilge Complex?

  1. Osteoarthritis of the wrist
  2. Carpal tunnel syndrome
  3. Osteoarthritis of the thumb
  4. Scapholunate ligament injury
  5. DeQuervain’s tenosynovitis

Triangular Fibrocartilage Complex (TFCC) vs Osteoarthritis (OA) of the wrist

A TFCC tear causes pain on the ulnar side of the wrist (little finger). During twisting and rotational movements, this is frequently linked with clicking. When you bear weight on your hands, both can be uncomfortable, but osteoarthritis wrist produces more widespread pain and stiffness. Wrist osteoarthritis is frequently associated with morning stiffness and pain.

 Anatomy:

 

How is the TFCC injured?

The TFCC gets injured in a variety of ways. Some of our customers record a specific injury, while others have a gradual beginning of discomfort and are unable to recollect a specific incidence.

Falling onto an outstretched hand is the most prevalent cause of injury. This can happen when you tumble on the street or when participating in sports, such as when you fall onto your wrist while playing football.

During a fall, your body’s primary defence technique is to soften the impact by extending out with your hands. This causes a high-velocity, direct impact on your wrist joint. Impact causes hyperextension of the wrist, which can lead to a wrist fracture or damage to the TFCC.

During a twisting action of the wrist, which creates higher pressure via these tiny structures, the TFCC is also at danger of damage. Wrist twisting motions are prominent in sports including boxing, tennis, and squash.

If no single incident has triggered the symptoms, pain usually begins as a ‘clicking’ feeling in the wrist that gets more prominent over time, eventually leading to agony.

Symptoms of TFCC injury:

The indications and symptoms vary, but pain, swelling, and soreness on the inside of the wrist are the most prevalent. Clicking and a feeling of weakness are also common complaints among consumers.

 

  1. Wrist pain on the inside (little finger side), which can sometimes extend into the hand and up into the arm.
  2. Wrist swells and becomes painful.
  3. Twisting and motions that compress the wrist joint, such as playing tennis or squash, or performing press-ups, bench presses, or Yoga positions, cause pain.
  4. Wrist slackening and clicking
  5. Grip strength deterioration
  6. Gentle movement helps to relieve pain.
  7. Pain worsens a few hours or days following a strenuous activity, such as a run.

How do you dianose a TFCC injury?

Clinically, diagnosing a TFCC damage is difficult. In order to build a hypothesis of TFCC injury, you’ll need a complete and detailed account of the events that led up to your wrist pain. Your physicians will evaluate your range of motion, wrist strength, and grip strength on a regular basis. Your clinician may also palpate (feel) various structures around your wrist and do compression tests, which are TFCC tests. Clinical tests will provoke discomfort and help your clinician construct a diagnosis if you have TFCC.

Diagnostic imaging:

An MRI scan is essential to completely analyse whether you have damaged your TFCC and to determine whether it is a partial or full thickness tear.The position of the TFCC is marked with an arrow in the MRI scan of the wrist shown below.

Treiser et al. (2017) reviewed the most specific and sensitive diagnostic imaging modalities for identifying TFCC injury in a meta-analysis. According to the findings of this study, MRI (magnetic resonance arthrography) and CT (computed tomographic arthrography) are both capable of identifying TFCC injury. All of our experts are properly qualified musculoskeletal sonographers and extended scope physiotherapists with a lot of TFCC injury experience.

We also do a diagnostic ultrasonography as part of your clinical evaluation (no extra charge). While the TFCC structures are not easily evident on ultrasound imaging, joint edoema (effusion) and inflammation are.

 How is a TFCC injury treated?

Injuries to the TFCC complex are often sluggish to heal, making for a painful trip for our clients. Because the cartilage in the complex has a weak blood supply, it takes 4-6 weeks for clients to notice a difference in their symptoms. Unfortunately, from what we’ve learned, it can take up to three months for symptoms to go away completely.

The TFCC is a complex structure that plays a critical role in wrist stability. It is critical to relax or alter your activity when you are wounded in order to allow your body to heal properly. Wearing a brace for up to 4-6 weeks following an injury is therefore advised. There are a variety of braces available, but the one shown below is a decent choice.

Following a full assessment and if the discomfort has subsided, you can begin a progressive stretching and strengthening home exercise programme under the guidance of a physiotherapist. A physiotherapist can examine your wrist and give you the right guidance and exercises. However, here are a few pointers that may be useful:

  • Avoid movements or activities that cause pain, such as racquet sports, weight lifting, or press-ups. Continued annoyance will delay your recuperation and may even worsen a rip.
  • Invest in a wrist brace. The use of a wrist brace will aid in the support of your wrist.
  • Wrap your wrist in a tea towel with a tiny bag of peas. This aids in the reduction of localised pain and inflammation caused by the injury.
  • Apply a non-steroidal anti-inflammatory lotion to the affected area. Before taking any drug, consult your pharmacist.
  • Limit the amount of ulnar deviation at your workplace by adjusting your workspace (side bending of the wrist). The TFCC will be less stressed if you maintain a neutral wrist position.
  • Gentle wrist stretches are a good idea. This will aid in the reduction of inflammation-related pain and stiffness.

What if it is not treating with physiotherapy?

Many TFCC injuries are not self-healing. If the discomfort persists three months after the injury and you’re still having problems regaining full function, an ultrasonography steroid injection may be a good next step.

Ultrasound-guided steroid injection

For the treatment of TFCC rips, ultrasound-guided steroid (also known as corticosteroid) injections are frequently recommended as a non-surgical alternative. Steroid injections can help reduce inflammation caused by TFCC tears (Robba et al). (2019).

An ultrasound-guided steroid injection is a very precise approach that uses real-time scanning to target inflammation. Steroid is a powerful anti-inflammatory drug that is deposited directly on the wounded tissue, reducing pain and inflammation. Steroid injections are used to relieve pain quickly and allow you to participate in rehabilitation exercises to strengthen the muscles in your wrist. This therapeutic combination, which includes steroid injections and exercise, has proven to be quite beneficial.

 Joint Injections provides an all-in-one facility for ultrasound-guided injections. On your first visit, we’ll confirm your diagnosis and, if necessary, administer an ultrasound-guided steroid injection. You are not need to be referred by your primary care physician.
 

We are frequently asked, “How many steroid injections may I have?”

 
This is dependent on a variety of things and can only be answered on an individual basis. However, you should not receive more than three steroid injections in the same location in a calendar year. Most of our clients only need one injection since it gives them a “window of opportunity” to start a rehabilitation programme. On rare occasions, a second injection will be required.

Surgical Option

Injection therapy and physiotherapy rehabilitation can treat the great majority of TFCC problems. If you are not improving and an injection has not offered significant pain relief, surgery may be recommended.
 
In most cases, partial tears do not necessitate surgical intervention. Arthroscopic repair is used to complete the surgery (keyhole surgery). Patients with TFCC rips have reported a 93 percent satisfaction rate after arthroscopic surgery (Doarn et al, 2016).
 
Other Wrist and Hand Issues:
  1. Osteoarthritis (OA) of wrist joint
  2. Carpal tunnel syndrome
  3. Osteoarthritis of the thumb
  4. Scapholunate ligament injury
  5. DeQuervain’s tenosynovitis
  6. Trigger finger/Thumb

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all hand and wrist disorders, including Triangular Fibrocartilage Complex. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.