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TFCC Injury

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TFCC injuries — pain on the ulnar side of the wrist, often with clicking, and treatment options.

Updated Aug 20264 citations
A hand-drawn illustration of a wrist loaded in a push-up with pain on the little-finger side.
The triangular fibrocartilage complex (TFCC), on the little-finger side of the wrist. Kieran Hirpara 4.0

What you're feeling

You are likely noticing pain on the outside of your wrist, near the little finger side. This area is where your triangular fibrocartilage complex sits. This structure acts like a cushion and stabiliser for your joint. When it is injured, that cushion wears thin or tears. You may feel a dull ache that turns sharp when you move your wrist in certain ways.

The pain often flares up when you put weight on your hand. Simple tasks like pushing open a heavy door, turning a stiff key, or lifting a kettle can trigger a sharp sting. You might also feel a clicking or catching sensation when you rotate your forearm, such as when turning a doorknob or using a screwdriver. This happens because the damaged tissue is getting pinched between the bones.

You may find that your wrist feels weak or unstable. Gripping objects firmly can become difficult and uncomfortable. You might notice swelling around the joint, especially after you have been active during the day. The pain can linger into the evening, making it hard to relax. Some people find that resting their hand on a pillow at night helps, but the ache can still disturb your sleep if you roll onto that side.

Morning stiffness is also common. You may feel tight and sore when you first wake up, which slowly loosens as you move around. However, this relief is often temporary. As the day goes on and you use your hand more, the discomfort returns. You might avoid using your affected hand for fear of causing more pain, which can make daily routines like washing your face or getting dressed feel more challenging.

What's actually happening

Your wrist contains a small, tough disc of cartilage called the triangular fibrocartilage complex. You can think of this structure as a shock absorber or a gasket. It sits on the outer side of your wrist, between your forearm bones and your hand bones. Its main job is to cushion the joint and keep everything stable when you move your wrist or grip things.

When you injure this area, that gasket can tear or wear down. This damage disrupts the smooth surface of the joint. Instead of gliding easily, the bones may rub against each other or press on sensitive tissues. This is what causes your pain and stiffness. The injury often happens after a fall or a sudden twist, but it can also develop slowly over time due to wear and tear.

Your surgeon uses a tiny camera to look inside the joint. This tool allows for an accurate assessment of the damage. It helps detect any other soft-tissue injuries that might be happening at the same time. By seeing exactly what is wrong, your surgeon can plan the right treatment to fix the tear and restore stability.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment, including history, examination, and imaging where needed, establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.

We begin with self-management and physiotherapy. You can adjust your activities to avoid movements that cause pain. Physiotherapy aims to restore strength and flexibility in your wrist and hand. We typically recommend giving this approach a fair amount of time to work before considering other steps.

If pain persists, we discuss medical management. This may include pain medication or anti-inflammatory drugs to help you manage discomfort. We may also offer injections, such as cortisone or hyaluronic acid, to reduce inflammation and provide relief. These treatments can help you stay active while your wrist heals.

Surgery is considered when conservative care has not provided enough improvement. Wrist arthroscopy allows us to look inside your joint directly. It helps us diagnose the issue accurately and treat it at the same time. Participants undergoing this procedure for persistent wrist pain improved on average by approximately 50% at one year. However, most patients continue to have some pain and disability after one year. We discuss these outcomes with you to help you make a shared decision about your care.

What to expect

You may notice some improvement in your wrist pain and function within the first year after treatment. On average, participants in studies improved by approximately 50% at one year. This means that while you will likely feel better, you should not expect a complete return to how your wrist felt before the injury.

Most patients with persistent wrist pain continue to experience some level of pain and disability after one year. You may find that moderate levels of discomfort remain even as your daily activities become easier. Recovery is a gradual process rather than a sudden fix.

Wrist arthroscopy is a safe procedure associated with minor and transient complications. However, the true incidence of these issues may be higher than previously reported. There may be more instances of trauma to the posterior interosseous nerve during routine wrist arthroscopy than have been previously reported. Detailed knowledge of anatomy is essential to minimize these risks.

If your condition is managed well with appropriate care, you can expect a steady, albeit partial, improvement in your wrist’s ability to move and bear weight. If left alone, persistent pain often continues without significant resolution. Recent technical developments allow for advanced treatments of difficult wrist disorders, which may help manage symptoms more effectively than previous methods.

You should approach your recovery with realistic expectations. While the procedure can significantly reduce pain and improve wrist flexion and extension, it does not guarantee a return to full, pain-free function for everyone. Your surgeon will guide you through this process, ensuring that the benefits of treatment are weighed against the potential for ongoing, albeit reduced, symptoms.

When to see someone

See your GP if you have ongoing wrist pain that does not improve with rest. Ask for a specialist review if you notice weakness, instability, or symptoms that interfere with sleep or work. These signs suggest a mechanical issue, such as a tear in the triangular fibrocartilage complex (TFCC), which is the cartilage cushion on the pinky side of your wrist. Wrist arthroscopy can help diagnose and treat this. Be aware that while many patients improve by about 50% within a year, some may still experience moderate pain or disability. Minor complications from surgery are usually temporary, but serious nerve injury is rare. Early assessment helps manage these risks and guide your recovery.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Triangular fibrocartilage complex injury is worth the extra reading because the technique debates that dominate discussion have not separated — while one detail of the post-operative regime, which attracts far less attention, appears to matter.

What the structure actually does

The TFCC is a disc of cartilage with a surrounding sling of ligaments, sitting between the end of the ulna and the carpal bones. It performs two jobs at once: it cushions load transmitted across the ulnar side of the wrist, and it stabilises the joint between the two forearm bones at the wrist — the distal radioulnar joint.

That dual role explains why injuries here present in two distinct ways. A tear affecting mainly the disc produces pain on load — pushing up from a chair, gripping and twisting. A tear detaching the deep fibres from their attachment on the ulna, the foveal insertion, produces instability, with the sense that the wrist gives way or clunks when the forearm rotates. The second matters more, because the ligamentous attachment is what holds the joint together.

MRI is accurate, with a qualification worth knowing

Diagnosis rests substantially on imaging. Across 1,298 patients, the overall accuracy of MRI was acceptable, and for peripheral tears the pooled accuracy was relatively high — with MRI using appropriate parameters described as an ideal method for diagnosing the different tear types [1].

The qualification is in the word "peripheral". MRI performs best at the outer, better-vascularised part of the complex, which is where repairable tears sit. Central and degenerate tears, and the precise state of the foveal attachment, are harder to characterise, which is why examination findings and sometimes arthroscopy carry weight alongside the scan.

The technique comparisons do not separate

Two operative debates recur, and neither has resolved.

For the common peripheral, ulnar-sided tear, a systematic review of 240 patients found a lack of high-quality evidence to draw firm conclusions on arthroscopic versus open repair, and no scientific evidence to suggest superiority of one technique over the other [2].

For foveal repair, comparing suture anchor with transosseous suture across 904 patients, both achieved improvement in functional outcomes, pain and grip strength with a low reoperation rate — though the range-of-motion comparison remained inconclusive [3].

The consistent message is that the repair needs to restore the attachment; the hardware used to achieve it has not been shown to change the result.

The post-operative detail that does appear to matter

Here the evidence is more discriminating, and it is practically useful. Comparing immobilisation regimes after foveal TFCC repair across 288 patients, post-operative immobilisation may benefit more from restricting forearm rotation than from restricting elbow motion, and the additional restriction of elbow flexion and extension has not shown a consistent advantage [4].

This follows directly from the anatomy. The repaired structure is loaded by rotation of the forearm, not by bending the elbow — so the splint needs to control the palm turning up and down. An above-elbow cast is often used to enforce that indirectly by preventing the elbow rotating, and this evidence suggests the elbow component is not the part doing the work. For a patient, six weeks in a brace that leaves the elbow free is a substantially different experience from six weeks in a cast above it.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading
  1. Wang ZX, Chen SL, Wang QQ, Liu B, Zhu J, Shen J. The performance of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury: a meta-analysis. J Hand Surg Eur Vol. 2015;40(5):477-84.
  2. Robba V, Fowler A, Karantana A, Grindlay D, Lindau T. Open versus arthroscopic repair of 1B ulnar-sided triangular fibrocartilage complex tears: a systematic review. Hand (N Y). 2019;15(4):456-64.
  3. Ma H, Wang J, Yang C. Effectiveness of suture anchor and transosseous suture technique in arthroscopic triangular fibrocartilage complex foveal repair: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1).
  4. Lee J, Lee T, Lee S, Lim H, Chang E, Park MO, et al. Postoperative immobilization after foveal triangular fibrocartilage complex repair: a systematic review and meta-analysis. J Hand Surg Am. 2026;51(5):512.e1-512.e11.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients [1].
  • Acute TFCC injuries require differentiation between those causing distal radioulnar joint (DRUJ) instability and those that do not [2].
  • Management of acute TFCC injuries ranges from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability [2].
  • About 40% of patients sustaining a TFCC tear without DRUJ instability still had pain and disability at 1 year [3].
  • Arthroscopic-assisted repair techniques provide detailed visualization and facilitate the repair of TFCC injuries and associated pathologies with minimally invasive techniques [5, 6].
  • Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes [7].
  • TFCC repair achieves good clinical outcomes with low complication rates [11].
  • There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair [12].
  • There is a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears [19].
  • In high-demand athletes, arthroscopic repair of TFCC tears is becoming the treatment of choice to obtain optimum physiologic strength, complete range of motion, stability, and the shortest possible postoperative period [25].
  • TFCC repair varies substantially from surgeon-to-surgeon, suggesting repairs are discretionary and preference sensitive [27].

Anatomy & Pathophysiology

  • The triangular fibrocartilage complex (TFCC) is a key anatomical structure involved in ulnar-sided wrist pain, alongside distal radioulnar joint (DRUJ) disorders and extensor carpi ulnaris (ECU) tendon disorders [16].
  • Ulnar-sided wrist pain often results from a combination of overuse and acute injury, requiring an understanding of sport-specific injuries and underlying biomechanics for effective diagnosis [32].
  • Determining the etiology of ulnar-sided wrist pain is challenging due to overlapping history and physical examination findings [38].
  • A systematic approach to evaluating patients with ulnar-sided wrist pain is imperative [42].
  • Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection [35].
  • Deep TFCC fiber tears may contribute to decreased wrist rotational positioning sense [30].
  • Deep TFCC fiber tears may have biomechanical importance in distal radioulnar joint stability [30].
  • The intensity of pain produced by stressing the wrist in different positions differs between traumatic tears and degenerative wear [41].
  • Distal radius fractures are common pediatric injuries with significant remodeling potential depending on age and deformity direction [36].
  • Associated ulnar styloid fractures and significant radial translation are predictors of distal radioulnar joint instability in the context of distal radius fractures [48].
  • Statistical analysis did not identify a correlation between any single radiographic parameter of distal radius fractures and associated triangular fibrocartilage complex injuries [45].
  • Load-bearing radioulnar measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury [18].
  • Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion [33].
  • When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of wrist pain [44].

Classification

  • TFCC injuries are differentiated based on whether they cause distal radioulnar joint (DRUJ) instability [2].
  • About 40% of patients with a TFCC tear without DRUJ instability still had pain and disability at 1 year [3].
  • Type 1B TFCC injury is the most common TFCC injury in patients with distal radius fractures (DRF) [8].
  • The presence of an ulnar styloid fracture associated with a distal radius fracture predicts the presence of traumatic TFCC injury, specifically TFCC type 1B injury [10].
  • Frykman Type VI and VIII distal radius fractures show a significantly higher incidence of TFCC tears [34].
  • The Melone classification system does not predict the presence of TFCC lesions after distal radius fractures [34].
  • Classification of central TFCC lesions as traumatic or degenerative depends on information provided upon viewing the lesion at arthroscopy [13].
  • Atzei's classification is used for the detailed classification of pc-TFCC tears [21].
  • The diagnostic accuracy of MRI for detailed TFCC classifications, such as Atzei's classification, is lower compared to wrist arthroscopy [21].
  • A treatment-oriented classification system categorizes five classes of TFCC peripheral tears based on clinical and arthroscopic criteria [28].
  • Coexisting type 2 TFCC tears significantly increase the risk of index surgery failure in patients undergoing arthroscopic repair of peripheral ulnar-side TFCC tears [14].

Clinical Presentation

  • Careful history and physical examination are required to determine whether a TFCC tear is symptomatic [9].
  • It is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary [9].
  • Disability outcomes were worse in patients with distal radial fractures where the TFCC was injured [20].
  • The 1B TFCC injury is the most common type in patients with distal radius fractures (DRF) and concomitant TFCC injury [8].
  • The presence of an ulnar styloid fracture associated with a distal radius fracture predicts the presence of traumatic TFCC injury, specifically TFCC 1B injury [10].
  • Classification of central triangular fibrocartilage complex lesions as traumatic or degenerative depends on the information provided upon viewing the lesion at arthroscopy [13].
  • Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tears [15].
  • MR arthrography is a more sensitive and specific method for the diagnosis of TFCC tears compared to conventional wrist MRI [22].
  • Load-bearing radioulnar (RaUl) measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury [18].
  • Ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, requiring distinction from atypical configuration of the prestyloid recess in CT arthrography [24].
  • There is a higher frequency of accompanying extensor carpi ulnaris (ECU) tendon and/or DRUJ disorders in patients with chronic TFCC tears compared to controls [23].
  • Damage to the TFCC itself may alter relationships of the DRUJ and the ECU subsheath, or various pathologies causing ulnar-sided wrist pain may drive patients toward surgery [17].

Investigations

  • Radiocarpal arthrograms were better at detecting TFCC tears than midcarpal arthrograms [47].
  • Midcarpal arthrograms were best for detecting lunotriquetral (LT) tears [47].
  • Arthroscopy remains the gold standard for diagnosis [47].
  • Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear [15].
  • CT arthrography and MR arthrography have statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries [53].
  • The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC are consistently higher compared with those of 1.5T wrist MRI [43].
  • In detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy [21].
  • Ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries on CT arthrography [24].
  • Distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist [24].
  • The presence of an ulnar styloid fracture associated with distal radius fracture predicts the presence of frequently occurring traumatic TFCC injury and TFCC 1B injury [10].
  • TFCC 1B injury is the most common type in patients with distal radius fractures (DRF) and concomitant TFCC injury [8].
  • There is a high incidence of TFCC abnormalities on MRI in asymptomatic subjects, particularly those over the age of 50 [51].
  • The presence of an abnormal TFCC on MRI may be of questionable clinical meaning due to the high incidence of abnormalities in asymptomatic subjects [51].

Treatment

Non-Operative Management

  • Nonsurgical treatment is moderately successful for treating patients with TFCC tears without distal radioulnar joint (DRUJ) instability [31].
  • Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation [46].

Operative Management: Indications and Selection

  • Acute TFCC injuries require differentiation between those causing DRUJ instability and those that do not, with management ranging from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability [2].
  • Careful history and physical examination are required to determine whether a TFCC tear is symptomatic, and it is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary [9].

Operative Management: Surgical Techniques and Approaches

  • Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques [5].
  • Open and arthroscopic techniques are available for TFCC injuries [4].

Operative Management: Outcomes by Technique

  • Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates [11].
  • A systematic review demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears [19].

Operative Management: Specific Populations and Pathologies

  • Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears [29].
  • Coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in patients with peripheral ulnar-side TFCC tears [14].
  • The combined extensor retinaculum capsulorrhaphy and suture repair effectively restores stability to both the DRUJ and ulnocarpal joint (UCJ) in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion [37].

Complications

  • Approximately 40% of patients sustaining a TFCC tear without distal radioulnar joint instability (DRUJ) instability still had pain and disability at 1 year [3].
  • Coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in patients undergoing arthroscopic repair of peripheral ulnar-sided TFCC tears [14].

Recovery

  • TFCC capsular reattachment performed with an arthroscopically assisted technique provides good long-term results [26].
  • Disability outcomes were worse in patients with distal radial fracture where TFCC was injured [20, 52].
  • In the first year after open TFCC reinsertion, 91% of patients returned to work, including 50% within 12 weeks [54].
  • About 40% of patients sustaining TFCC tear without distal radioulnar joint instability still had pain and disability at 1 year [3].

Key Evidence

  • [L4] Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients. [1] (10.1016/j.jhsa.2019.06.019)
  • [L5] Acute TFCC injuries require differentiation between those causing distal radioulnar joint instability and those that do not, with management ranging from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability. [2] (10.5435/00124635-200806000-00004)
  • [L4] About 40% of patients sustaining TFCC tear without DRUJ instability still had pain and disability at 1 year. [3] (10.1016/j.jhsa.2018.06.064)
  • [L5] The article reviews diagnosis, classification, and treatment options including open and arthroscopic techniques for TFCC injuries. [4] (10.1016/j.hcl.2010.07.003)
  • [L5] Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. [5] (10.1016/j.jhsg.2025.100857)
  • [L5] Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. [6] (10.1016/j.jhsg.2024.03.011)
  • [L4] Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes. [7] (10.1055/s-0039-3400454)
  • [L3] 1B TFCC injury is most common in patients with DRF and concomitant TFCC injury. [8] (10.1186/s13018-023-04438-5)
  • [L4] Careful history and physical examination are required to determine whether a TFCC tear is symptomatic, and it is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary. [9] (10.5435/jaaos-d-20-00998)
  • [L4] The presence of ulnar styloid fracture associated with distal radius fracture predicted the presence of frequently occurring traumatic triangular fibrocartilage complex injury and TFCC 1B injury. [10] (10.1016/j.arthro.2020.05.025)
  • [L4] Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. [11] (10.1055/s-0040-1718913)
  • [L3] There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair. [12] (10.1016/j.jhsa.2008.01.020)
  • [L2] Classification of central triangular fibrocartilage complex lesions as traumatic or degenerative depends on the information provided upon viewing the lesion at arthroscopy. [13] (10.1177/1753193416684658)
  • [L4] However, coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in these patients. [14] (10.1016/j.arthro.2020.05.012)
  • [L4] Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear. [15] (10.2174/1874325001711010525)
  • [L5] The article provides a concise approach to the diagnosis and imaging of ulnar-sided wrist pain, discussing anatomy, pathophysiology, and radiographic appearance of common entities including TFCC tears, DRUJ disorders, and ECU tendon disorders. [16] (10.1016/j.csm.2006.02.008)
  • [L3] This may be due to the damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery. [17] (10.1177/1558944720937369)
  • [L2] Load-bearing RaUl measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury. [18] (10.1016/j.jhsa.2022.01.008)
  • [L4] This SR demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears. [19] (10.1177/1558944718815244)
  • [L2] Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. [20] (10.1016/j.jht.2017.09.002)
  • [L4] In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. [21] (10.1186/s12891-023-07140-z)
  • [L3] MR arthrography is more sensitive and specific method in terms of the diagnosis of TFCC tears compared to conventional wrist MRI. [22] (10.1016/j.injury.2019.07.032)
  • [L3] We found a higher frequency of accompanying ECU tendon and/or DRUJ disorders in patients with chronic TFCC tears as compared to the control group. [23] (10.1016/j.jhsa.2016.07.040)
  • [L4] Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist. [24] (10.1186/s12891-022-05241-9)
  • [L4] In high-demand athletes, arthroscopic repair of TFCC tears is becoming the treatment of choice to obtain optimum physiologic strength, complete range of motion, stability, and the shortest possible postoperative period. [25] (10.1016/j.hcl.2009.05.011)
  • [L5] TFCC capsular reattachment could be performed with an arthroscopically assisted technique, providing good long-term results. [26] (10.1016/j.hcl.2017.06.005)
  • [L4] TFCC repair varies substantially from surgeon-to-surgeon, suggesting repairs are discretionary and preference sensitive. [27] (10.1055/s-0038-1625953)
  • [L2] The classification highlights clinical and arthroscopic criteria to categorize five classes of TFCC peripheral tears on a treatment-oriented system. [28] (10.1177/1753193416687479)
  • [L3] Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. [29] (10.1302/0301-620x.106b4.bjj-2023-0642.r3)
  • [L3] Deep TFCC fiber tear may contribute to decreased wrist rotational positioning sense and may have biomechanical importance in distal radioulnar joint stability. [30] (10.1016/j.jhsa.2018.01.022)
  • [L3] Nonsurgical treatment is moderately successful for treating patients with TFCC tears without DRUJ instability. [31] (10.1097/corr.0000000000000533)
  • [L5] Ulnar-sided wrist pain in athletes is a common problem often resulting from a combination of overuse and acute injury, requiring careful understanding of sport-specific injuries and underlying biomechanics for effective diagnosis and treatment. [32] (10.1016/j.csm.2019.12.008)
  • [L4] Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion. [33] (10.1177/17531934251397297)
  • [L3] The Melone classification system does not predict the presence of TFCC lesions, while Frykman Type VI and VIII fractures show a significantly higher incidence of TFCC tears. [34] (10.1177/1753193408090106)
  • [L5] Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection. [35] (10.1007/s00402-020-03371-0)
  • [L5] Distal radius fractures are common pediatric injuries with significant remodeling potential depending on age and deformity direction. [36] (10.1016/j.hcl.2005.09.002)
  • [L4] The combined HS and suture repair effectively restores stability to both the DRUJ and UCJ in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion. [37] (10.1016/j.jhsg.2025.100806)
  • [L5] Determining the etiology of ulnar-sided wrist pain is often challenging due to overlapping history and physical examination findings; a detailed history, systematic physical examination with provocative maneuvers, and appropriate diagnostic imaging are essential for diagnosis. [38] (10.5435/jaaos-d-16-00407)
  • [L3] The intensity of pain produced by stressing the wrist in different positions was different between a traumatic tear and degenerative wear. [41] (10.1177/1753193410377838)
  • [L4] A systematic approach to evaluating patients with ulnar-sided wrist pain is imperative. [42] (10.1016/j.jhsa.2014.07.004)
  • [L3] The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC is consistently higher compared with those of 1.5T wrist MRI, suggesting improved capability for detection of TFCC injuries. [43] (10.1016/j.jhsa.2008.02.028)
  • [L2] When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist. [44] (10.2106/00004623-199711000-00009)
  • [L3] Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. [45] (10.1177/1753193415624669)
  • [L3] Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. [46] (10.1302/0301-620x.103b8.bjj-2020-2310.r2)
  • [L4] Radiocarpal arthrograms were better at detecting TFCC tears and midcarpal arthrograms were best for detecting LT tears, with arthroscopy remaining the gold standard. [47] (10.1016/j.arthro.2020.12.108)
  • [L3] Associated ulnar styloid fractures and significant radial translation are predictors of DRUJ instability. [48] (10.1055/s-0034-1365825)
  • [L3] The presence of an abnormal TFCC on MRI may be of questionable clinical meaning, because there is a high incidence of TFCC abnormalities in asymptomatic subjects, particularly those over the age of 50. [51] (10.1016/j.jhsa.2011.10.006)
  • [L2] Disability outcomes were worse in patients with distal radius fracture where TFCC was injured. [52] (10.1016/j.jht.2017.09.012)
  • [L1] CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. [53] (10.1055/s-0038-1629911)
  • [L3] In the first year after open TFCC reinsertion, 91% of the patients returned to work, including 50% within 12 weeks. [54] (10.1016/j.hansur.2021.03.012)

References

[1] Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.06.019

[2] Management of Acute Triangular Fibrocartilage Complex Injury of the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200806000-00004

[3] The Natural Course of Triangular Fibrocartilage Complex Tear without Distal Radioulnar Joint Instability. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.064

[4] Arthroscopic and Open Repair of the TFCC. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.07.003

[5] WITHDRAWN: Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100857

[6] Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.011

[7] Patient-Reported Outcomes following Arthroscopic Triangular Fibrocartilage Complex Repair. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-3400454

[8] Association between imaging parameter changes and triangular fibrocartilage complex injury after distal radius fractures. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04438-5

[9] Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00998

[10] The Presence and the Location of an Ulnar Styloid Fracture Associated With Distal Radius Fracture Predict the Presence of Triangular Fibrocartilage Complex 1B Injury. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.05.025

[11] Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1718913

[12] Clinical Comparison of Arthroscopic Versus Open Repair of Triangular Fibrocartilage Complex Tears. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.020

[13] Diagnosing central lesions of the triangular fibrocartilage as traumatic or degenerative: a review of clinical accuracy. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416684658

[14] What Is the Effect of the Ulnar‐Plus Variance on the Outcomes of Arthroscopic Repair of the Peripheral Ulnar‐Side Triangular Fibrocartilage Complex Tear?. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.05.012

[15] Results of Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tear With Exploration of Dorsal Sensory Branch of Ulnar Nerve. The Open Orthopaedics Journal. 2017. DOI: 10.2174/1874325001711010525

[16] Imaging of Ulnar-Sided Wrist Pain. Clinics in Sports Medicine. 2006. DOI: 10.1016/j.csm.2006.02.008

[17] MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain. HAND. 2020. DOI: 10.1177/1558944720937369

[18] Load-Bearing Radioulnar Distances to Evaluate an Unstable Distal Radioulnar Joint in Patients With Triangular Fibrocartilage Complex Tears. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.01.008

[19] Open Versus Arthroscopic Repair of 1B Ulnar-Sided Triangular Fibrocartilage Complex Tears: A Systematic Review. HAND. 2019. DOI: 10.1177/1558944718815244

[20] Outcomes of surgically treated distal radial fractures with associated triangular fibrocartilage complex injury. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.09.002

[21] Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: a retrospective study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-023-07140-z

[22] Comparison between conventional MRI and MR arthrography in the diagnosis of triangular fibrocartilage tears and correlation with arthroscopic findings. Injury. 2019. DOI: 10.1016/j.injury.2019.07.032

[23] The Factors Correlated with the Extensor Carpi Ulnaris Tendon and Distal Radioulnar Joint Disorder in Patients with Chronic Triangular Fibrocartilage Tears. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.040

[24] Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05241-9

[25] Repair of Arthroscopic Triangular Fibrocartilage Complex Tears in Athletes. Hand Clinics. 2009. DOI: 10.1016/j.hcl.2009.05.011

[26] Arthroscopic Management of Triangular Fibrocartilage Complex Peripheral Injury. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2017.06.005

[27] Variation in Repair of the Triangular Fibrocartilage Complex. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1625953

[28] Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416687479

[29] Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b4.bjj-2023-0642.r3

[30] The Effect of Triangular Fibrocartilage Complex Tear on Wrist Proprioception. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.01.022

[31] What is the Natural History of the Triangular Fibrocartilage Complex Tear Without Distal Radioulnar Joint Instability?. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000533

[32] Ulnar-Sided Wrist Pain in the Athlete. Clinics in Sports Medicine. 2020. DOI: 10.1016/j.csm.2019.12.008

[33] Dynamic CT-based assessment of ulnar-sided wrist kinematics in healthy participants using automated 3-D analysis. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251397297

[34] The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408090106

[35] Distal radioulnar joint instability: current concepts of treatment. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03371-0

[36] Pediatric Distal Radius Fractures and Triangular Fibrocartilage Complex Injuries. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2005.09.002

[37] Extensor Retinaculum Capsulorrhaphy and Suture Repair for Ulnocarpal and Distal Radioulnar Joint Instability: One-Year Results. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100806

[38] Evaluation of Ulnar-sided Wrist Pain. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00407

[41] The Relationship Between Stress Positions and Pain Intensity in Triangular Fibrocartilage Lesions. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410377838

[42] Examination of the Wrist: Ulnar-Sided Wrist Pain Due to Ligamentous Injury. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.004

[43] Diagnostic Comparison of 1.5 Tesla and 3.0 Tesla Preoperative MRI of the Wrist in Patients With Ulnar-Sided Wrist Pain. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.028

[44] The Utility of High-Resolution Magnetic Resonance Imaging in the Evaluation of the Triangular Fibrocartilage Complex of the Wrist. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199711000-00009

[45] The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415624669

[46] Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b8.bjj-2020-2310.r2

[47] Evaluation of Diagnostic Procedures for Ulnar Sided Wrist Pain: 25 Years of Experience. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.108

[48] Radiographic Predictors of DRUJ Instability with Distal Radius Fractures. Journal of Wrist Surgery. 2014. DOI: 10.1055/s-0034-1365825

[51] Prevalence of Triangular Fibrocartilage Complex Abnormalities on MRI Scans of Asymptomatic Wrists. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.006

[52] Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2017.09.012

[53] TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1629911

[54] Factors associated with return to work after open reinsertion of the triangular fibrocartilage. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2021.03.012

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