Commonly associated with sports that involve weight-bearing through the wrist (gymnastics) or involving repetitive radial and ulnar deviation of the wrist (javelin throwers, discus throwers).
Attritional tears or degenerative pathology involving the TFCC are common, with a reported incidence of tears being greater than 50% of those over the age of 60 years.
It is estimated that TFCC injury occurs in up to 80% of displaced distal radius fractures.


  1. Triangular fibrocartilage complex suspends distal radius and ulnar carpus from the distal ulna. It is the major ligamentous stabilizer of the distal radioulnar joint (DRUJ) and the ulnar carpus.
  2. Causative factors for TFCC injuries are Ulnar deviation with load compression on TFCC (fall on an outstretched hand)
  3. Forced ulnar deviation (swinging a racket or bat)
  4. Commonly associated with positive ulnar variance (this is when the joint surface of the ulna at the wrist joint is longer than the joint surface of radius) which occurs mostly post-surgery or post-fracture.
  5. Patients mostly present with:
  6. ulnar-side wrist pain
  7. frequently accompanied by clicking
  8. weakness in grip and instability
  9. X-rays may reveal any avulsion fractures associated with injury and MRI is highly recommended with high sensitivity and specificity for identification of tear.


  • Initial treatment consists of rest and icing.
  • Conservative treatment for 6 months is advisable if there is no instability.
  • Dry needling the TFCC helps to reduce pain.
  • Gradually proceeding to muscle activation and strengthening followed by stability and proprioceptive exercises in order to regain functional activities.
  • If the congenital ulnar variance is present, conservative management is started after 18years of age (i.e. post complete bone maturation) which includes
  • improving stability in the wrist joint.
  • Strengthening the shoulder girdle will help to offload the load on the wrist
  • If conservative management fails, surgery is considered.
  • Depending on the cause of injury the type of surgery will vary which includes arthroscopic repair, arthroscopic debridement, ulnar shortening, and the Wafer procedure.
  • Corticosteroid injections are also preferred in some cases.
  • Length of physiotherapy varies from 4 to 16 weeks depending on the surgeon’s preference.
  • Activity modifications are required on a long-term basis.

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