Physical Therapist's Guide to
Triangular Fibrocartilage Complex Tear
Triangular fibrocartilage complex (TFCC) tear is an injury to ligaments in the middle and outer side of the wrist. The TFCC ligaments keep the wrist joint stable. Sprained or torn TFCC ligaments can cause pain. This injury can happen from sudden trauma, such as falling on the wrist, or develop over time from repetitive trauma or natural aging. The most common types of tears, “traumatic” TFCC tears, often occur in athletes participating in racquet sports and gymnastics, and in manual laborers, such as those who use power drills. TFCC tears from aging, called “degenerative” tears, which can develop from wear and tear over time, most commonly are found in people over the age of 50. Physical therapists help people with TFCC tears reduce pain, swelling, stiffness, and any associated weakness in the wrist or upper extremity, and return to improved or normal use of the hand and wrist.
What is a Triangular Fibrocartilage Complex Tear?
TFCC is a group (or “complex”) of ligaments on the small-finger side of the wrist. These ligaments keep the wrist bones stable, and attach the 2 forearm bones (the radius and the ulna) together near the wrist. TFCC tears commonly happen on the dominant hand. There are 2 types of TFCC tears:
- Type I: The most common type of TFCC tear, from traumatic injury, usually occurs as the result of a fall onto the outstretched hand, or from a sudden pull (“traction”) on the wrist.
- Type II: This type of tear results from a degenerative injury that develops over time, usually occurring with age. Although degenerative TFCC tears have been diagnosed in people as young as in their 30s, they are most common in those aged 50 years and older. There is an increased risk of degenerative TFCC tears if a person has had a previous wrist trauma, or if one of the forearm bones (the ulna) is longer than the other (radius) from birth.
How Does it Feel?
With a TFCC tear, you may experience:
- Pain when leaning on the hand
- Swelling in the wrist
- Stiffness in the wrist
- Weak grip strength
- Clicking, catching, or creaking in the wrist
- Pain when turning a door handle or pushing up from sitting in a chair
- Pain when lifting heavy objects
How Is It Diagnosed?
If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:
- How and when did you notice the pain and/or swelling?
- Have you been performing any repetitive activity?
- Did you fall on your hand?
Your physical therapist also will perform special tests to help determine the likelihood that you have a TFCC tear. Your physical therapist will gently press on parts of your wrist and arm to look for signs of tenderness or abnormal movement, observe how you can move your wrist and arm, and test your strength and flexibility.
To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an X-ray or MRI, to confirm the diagnosis and to rule out other damage to the wrist, like a fracture or infection.
How Can a Physical Therapist Help?
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies from person to person, but successful results can be achieved more quickly when a physical therapist implements an individualized swelling-management, stretching, motion, and strengthening program.
During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:
- Apply light compression by wrapping the wrist a specific way, using a compressive wrap
- Rest the area by avoiding any activity that causes pain in the wrist
- Apply ice packs to the area for 15 to 20 minutes every 2 hours
- Begin using a splint or brace to protect the TFCC
- Consult with a physician for further services, such as medication or diagnostic tests
Your physical therapist will work with you to:
Reduce pain and swelling. If repetitive activities have caused the TFCC tear, your physical therapist will help you understand how to avoid or modify the activities, to allow healing to begin. The physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, compressive wraps, taping, bracing, splinting, exercises, and hands-on therapy, such as specialized massage.
Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the wrist, hand, and arm. These might begin with "passive" motions that the therapist performs for you to gently move your wrist, and progress to active exercises and stretches that you do yourself. If a splint or brace for your wrist is recommended, your physical therapist will teach you how and when to exercise the rest of your arm and hand, to prevent any problems from lack of use.
Improve flexibility. Your physical therapist will determine if any arm muscles are tight, start helping you to stretch them, and teach you how to stretch them.
Improve strength. If your physical therapist finds any weak or injured arm, hand, or wrist muscles, your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility. These may include using cuff weights, stretch bands, and weight-lifting equipment.
Improve endurance. Restoring your arm’s muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things you like to do.
Learn a home program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery. If a brace or splint is recommended for you to use on your wrist, your physical therapist will explain how often you should remove it, and any exercises to do when it is removed.
Return to activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. If you are an athlete, your physical therapist may coordinate care with your coach and/or athletic trainer. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.
Speed recovery time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
If Surgery Is Necessary
Surgical repair of the TFCC could be recommended. After surgery, you will follow a recovery program over several weeks or months, guided by your surgeon and your physical therapist. Your physical therapist will help you minimize pain and swelling, regain motion and strength, and return to normal activities in the safest and speediest manner possible. Physical therapy may be able to help you avoid the need for opioid pain medication as well.
Can this Injury or Condition be Prevented?
To help prevent a TFCC tear, your physical therapist may advise you to:
- Avoid falling on your hand. If you have poor overall balance and are prone to falling, your physical therapist can help you strengthen your muscles, improve your balance, and lower your risk of falling.
- Avoid repetitive, high-impact activities using the hands. If your work requires such activity, your physical therapist can work with you to strengthen the muscles of your arms, wrists, and hands, and determine your best positioning to complete necessary tasks.
- Use a brace or taping. Athletes and manual laborers may benefit from specialized braces or taping. Your physical therapist can recommend what is best to treat your specific condition.
- Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.
Real Life Experiences
Annie is a 30-year-old health studies teacher. This past Saturday while playing tennis with her doubles partner, Annie reached too far to return a serve, lost her balance, and fell onto her outstretched right hand. She felt immediate pain in her right wrist. She had to stop playing, and returned home. The wrist didn’t swell very much or become black-and-blue, but throughout the day Annie felt a sharp pain in her wrist when she put any pressure on it, or performed normal activities like twisting a door knob.
At work on Monday, Annie realized that she couldn’t demonstrate CPR to her health studies class because of the pain she felt when leaning on her wrist and hand. During her lunch break, she made an appointment to see her physical therapist.
At her first session, Annie’s physical therapist asks her to describe her injury and her symptoms. Annie does so and also tells him that she is afraid to play tennis, and has chosen to not attend her yoga class, which she loves.
Annie’s physical therapist gently touches different parts of her wrist, hand, and arm. He moves her wrist in different directions, and pushes on several wrist bones. He determines that a consultation with Annie’s orthopedist is needed, and refers her to that office. The orthopedist orders an X-ray and MRI, and diagnoses Annie with a type I TFCC tear. Annie undergoes surgery to repair the torn TFCC.
After surgery, Annie returns to her physical therapist. He reexamines her wrist, hand, and arm for weakness or stiffness, and tests her ability to perform daily activities. He finds that she has overall weakness in her grip and her wrist and elbow muscles, and moderate stiffness in her wrist.
He asks Annie about her goals. She says she wants to return to playing tennis regularly, to return to her yoga classes, and to be able to demonstrate CPR and other procedures to her class without pain. She also wants to return to her normal daily activities at home.
In collaboration with the surgeon and the postsurgical protocol, Annie’s physical therapist develops a treatment plan that allows for the surgical repair to heal, while preventing any further loss of strength or motion in the arm or hand. He applies a splint, and teaches her how to put it on and take it off. He shows her special movements to do with her wrist when she removes the splint each day, and teaches her stretches and movements to perform at home for her hand, wrist, elbow, and shoulder. Annie is pleased to find that her home exercises reduce her pain enough that she doesn’t need strong pain medication or opioid medication.
Over the next few weeks, Annie’s physical therapist helps her restore the motion in her wrist, and the strength in her hand, wrist, and elbow. He designs and oversees her treatment program so that it causes her no pain. Two months after surgery, Annie is allowed to gradually lean on her hand. Her physical therapist has her begin to perform simple exercises holding her tennis racket. Gradually, he increases the tennis racket exercises to simulate slow motions of tennis strokes. As her strength and flexibility improve, he adds more sport-specific movements to her routine.
Three months after surgery, Annie is able to carefully return to the tennis court and her yoga class! She leads a CPR training session without any hesitation or pain.
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat TFCC tears. However, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist (certified hand specialist, or CHT) or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of TFCC tears. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Barlow SJ. A non-surgical intervention for triangular fibrocartilage complex tears. Physiother Res Int. 2016;21(4):271–276. Article Summary in PubMed.
Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther. 2010;23(1):2–16. Article Summary in PubMed.
Rettig AC. Athletic injuries of the wrist and hand; part 1: traumatic injuries of the wrist. Am J Sports Med. 2003:31(6):1038–1048. Article Summary in PubMed.
Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist: anatomy and function. J Hand Surg Am. 1981;6(2):153–162. Article Summary in PubMed.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the editorial board.