Question 1

What is the TFCC, why is it important, and how is it different from wrist ligaments?

Accepted Answer

The TFCC (Triangular Fibrocartilage Complex) is a structure on the small-finger (ulnar) side of your wrist with TWO critical functions: (1) SHOCK ABSORBER: Acts like a cushion distributing load between forearm bones (radius and ulna) and wrist bones - TFCC absorbs 20% of load across wrist (increases to 40% with ulnar-positive variance where ulna longer than radius) | (2) STABILIZER: Holds distal radioulnar joint stable (joint where two forearm bones meet at wrist) during forearm rotation (turning palm up/down). ANATOMY: TFCC is complex of 5 structures - triangular fibrocartilage disc (cartilage cushion between ulna and wrist bones), radioulnar ligaments (stabilize forearm bones), meniscus homologue (small cartilage fold), extensor carpi ulnaris tendon sheath, ulnolunate/ulnotriquetral ligaments (connect ulna to wrist bones). PALMER CLASSIFICATION divides tears: Class 1 TRAUMATIC (1A central perforation, 1B ulnar avulsion, 1C distal avulsion, 1D radial avulsion) - acute injuries from fall/twist | Class 2 DEGENERATIVE (2A TFCC wear, 2B + lunate/ulnar chondromalacia, 2C TFCC perforation, 2D + lunotriquetral ligament tear, 2E + arthritis) - chronic age-related degeneration. DIFFERENCE FROM LIGAMENTS: Wrist ligaments (scapholunate, lunotriquetral) connect wrist bones to each other - TFCC connects forearm to wrist AND acts as load-bearing structure - TFCC injuries cause ulnar-sided pain (pinky side), ligament injuries cause radial/central wrist pain. BLOOD SUPPLY: Peripheral 15-20% of TFCC has blood supply (can heal with immobilization or repair) - central 80% avascular (no blood supply, won't heal, requires debridement if symptomatic).

Question 2

I have a TFCC tear on my MRI but my doctor says many people have tears without symptoms - should I have surgery or will it heal on its own?

Accepted Answer

CRITICAL POINT: TFCC tears are EXTREMELY common in people over 40 without wrist pain - studies show 40% of people aged 30-40 have TFCC tears on MRI, increasing to 50-70% over age 50, MOST asymptomatic. This is DEGENERATIVE wear-and-tear (like gray hair), not pathological. SURGERY IS NOT INDICATED for asymptomatic MRI findings. DECISION FRAMEWORK: (1) ACUTE TRAUMATIC TEAR (single injury event, young patient, previously asymptomatic wrist): Try immobilization 6 weeks first - peripheral tears (Type 1B-D with good blood supply) have 50-60% healing rate | If unstable (positive piano key test, DRUJ instability), consider early surgical repair to prevent chronic instability | Central tears (Type 1A) won't heal but may become asymptomatic with activity modification and strengthening | (2) CHRONIC DEGENERATIVE TEAR (age-related, gradual onset, patient over 40): Surgery should be LAST resort after 3-6 months failed conservative treatment (activity modification, anti-inflammatories, physiotherapy, possible steroid injection) - many respond to non-surgical treatment even with MRI-confirmed tear | Debridement may help if mechanical symptoms (catching, clicking) but won't eliminate all pain | (3) INCIDENTAL FINDING (MRI done for other reason, tear found incidentally, minimal symptoms): NO SURGERY - tear is red herring, address actual symptomatic issue. RED FLAGS requiring surgery consideration: Wrist instability (distal radioulnar joint), mechanical symptoms (locking, catching preventing function), failed 3-6 months appropriate conservative treatment, acute traumatic tear in young athlete. BOTTOM LINE: Most TFCC tears do NOT require surgery - MRI findings must correlate with clinical symptoms and examination findings - exhaust conservative options before considering surgery unless clear indication (instability, mechanical block).

Question 3

What's the difference between TFCC debridement and repair, and how does my surgeon decide which procedure I need?

Accepted Answer

TFCC DEBRIDEMENT vs REPAIR determined by tear location, pattern, and chronicity - uses Palmer classification. DEBRIDEMENT (trimming away torn tissue): For CENTRAL TFCC TEARS (Type 1A, 2C-E) in avascular zone (no blood supply - inner 80% of TFCC) - these tears CANNOT heal even with immobilization because no blood supply to deliver healing cells | Surgeon trims torn TFCC tissue back to stable rim using arthroscopic instruments - like trimming frayed edge | Creates smooth stable TFCC remnant that no longer catches/clicks but removes some shock-absorbing function | ADVANTAGES: Faster recovery (3-4 months), no immobilization requirements, can return to protected activity quickly | DISADVANTAGES: Doesn't restore anatomy, some permanent loss of load-bearing capacity (may cause progressive ulnar-sided arthritis long-term if significant tissue removed), 15-30% persistent symptoms | INDICATIONS: Degenerative tears, chronic central perforations, failed non-surgical treatment, older patients (over 50) with low demand. REPAIR (suturing tear back together): For PERIPHERAL TFCC TEARS (Type 1B-D) in vascular zone (outer 15-20% of TFCC with blood supply) - these tears CAN heal if repaired | Surgeon places sutures or bone anchors to reattach TFCC to ulnar styloid or fovea, restoring anatomy and stability | ADVANTAGES: Restores shock absorber function, better long-term outcomes, addresses associated wrist instability | DISADVANTAGES: Longer recovery (4-6 months), requires 6 weeks immobilization (no forearm rotation), 10-15% repair failure rate, more expensive | INDICATIONS: Acute traumatic tears, young active patients, tears with DRUJ instability, ulnar avulsion fractures. DECISION ALGORITHM: (1) Tear location (peripheral repair, central debride) | (2) Acuity (acute repair, chronic debride unless unstable) | (3) Age/demand (young active repair, older sedentary debride) | (4) Stability (unstable DRUJ requires repair) | (5) Ulnar variance (if ulnar-positive may need ulnar shortening instead/addition). Some patients need COMBINATION: Debride degenerative central tear + repair peripheral unstable component. Surgeon decides intraoperatively based on arthroscopic findings - may counsel you preoperatively about most likely scenario but final decision made during surgery when tear pattern fully visualized.

Medical Disclaimer

Wrist Cartilage Tears (TFCC Injuries)

📖What is Wrist Cartilage Tears (TFCC Injuries)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention