Tears of the TFCC can follow an injury (called traumatic tears) or result from age-related wear and tear (called degenerative tears).

• Traumatic tears often follow a sudden impact or twisting injury. Sometimes TFCC tears accompany fractures (breaks) of the forearm bones (radius or ulna), but not always.

• Degenerative tears in older adults are the most common form of TFCC tear. As the TFCC thins with age it becomes more vulnerable to injury. Degenerative tears can also worsen or occur following an injury.

Some of the potential symptoms of a TFCC tear are listed below. Degenerative tears usually develop slowly and often exist without causing pain.

Sometimes present:

• Pain on the ulnar side of the wrist (little finger side).

• Pain worsened with side-to-side wrist movements (especially moving the wrist towards the little finger side, termed ulnar deviation) or when lifting or with rotation of the wrist or forearm.

• Weakness of grip or unreliable grip.

• Reduced ability to hold objects tightly.

Occasionally present:

• Prominence of the ulna at the wrist (when compared to the normal wrist).

• Clicking or clunking of the wrist (especially with wrist or forearm rotation).

It is important to correctly diagnose TFCC tears and exclude other causes of pain on the ulnar side of the wrist, such as ECU tendonitis or ulnocarpal abutment syndrome. The diagnosis is usually made on the history (your symptoms) and clinical examination. Plain radiographs (X-rays) are useful to assess wrist bone alignment and to exclude other possible causes of wrist pain such as arthritis. An MRI scan is commonly used to assess the TFCC.

The treatment for traumatic TFCC tears will depend on many factors, including your symptoms, whether the wrist is stable or unstable, the time since the original injury (chronicity) and the location and repairability of the tear. Some minor tears may heal with rest alone.

The treatment for non-traumatic (degenerative) TFCC tears is also detailed under ulnocarpal abutment syndrome.

• Non-surgical treatment for a traumatic TFCC tear depends on the time since injury and on the stability of the wrist. For stable traumatic injuries, wrist immobilisation (in a splint or cast) is prioritised, which is often combined with physiotherapy for strengthening exercises. For unstable traumatic injuries, physiotherapy can be trialled but surgery may be necessary. Painful degenerative tears may respond to painkillers, avoidance of painful activities, physiotherapy (mostly functional advice and splintage) and steroid injection (e.g. cortisone).

• Surgical treatment for a traumatic TFCC tear depends on your symptoms, the time since injury and on the stability of the wrist. Surgery can sometimes help to reduce pain and improve wrist stability but not all tears can be repaired. Some tears can be treated with keyhole (arthroscopic) surgical techniques whilst others may require open surgery or a combination (arthroscopic-assisted repair). TFCC repair is usually followed by several weeks of cast immobilisation followed by splintage and specialist physiotherapy. Stable and unstable TFCC tears may also be associated with painful wrist inflammation, which can be treated with keyhole (arthroscopic) surgery to debride (excise) the inflamed tissue for pain relief.

TFCC surgery is usually performed under general anaesthesia. Click here for an overview of the different types of anaesthesia and the general risks of hand surgery. The additional and specific risks associated with TFCC surgery will be discussed if surgery is an option. TFCC rehabilitation and repair can help to stabilise an unstable wrist but few will feel that their wrist is normal after this injury. TFCC repair can stiffen the wrist and limit wrist and forearm rotation.

Wrist arthroscopy is an established minimally-invasive or ‘keyhole’ surgical technique whereby a narrow camera (often 2.7mm in diameter) is inserted through small (keyhole) skin incisions on the back of the wrist. The inside of the wrist can be visualised (with the aid of a fibreoptic light source) whilst small surgical instruments are used to assess internal structures like cartilage, ligaments and the TFCC. Arthroscopy can permit removal of inflamed soft tissues (termed debridement) and can also assist with some treatments for ligament injury, TFCC tears, cartilage defects and arthritis. Matthew performs wrist arthroscopy and also trains other surgeons in wrist arthroscopy techniques.

Matthew provides all of the above treatments. He can refer you for wrist strengthening and rehabilitation with a physiotherapist when required.