The Triangular Fibrocartilage Complex (TFCC), found in the wrist, connects the lunate and triquetrum bones. This area can become injured through falling onto an outstretched hand or sports that involve heavy arm rotation such as swinging a racquet or bat. Degenerative tears of this complex may also develop over time.
Stretches
Stretching muscles and joints before and after physical activities or exercises is crucial in order to avoid injury, helping improve range of motion, reduce stiffness and prepare them for what lies ahead. Stretches may be performed using various techniques including dynamic and static stretches; dynamic ones involve active movements through full range of motion while static ones involve holding positions against resistance.
A therapist typically utilizes both types of stretching. Additionally, they will recommend specific wrist exercises aimed at strengthening tissues and muscles of both hands and wrists, and avoid exercises which place significant strain through these tissues, such as those which bend wrist towards or away from thumb (ulnar and radial deviation), which could aggravate an already healing injury.
Physical therapists use PNF as a technique for stretching TFCC. This involves isometric contraction followed by passive stretching for short periods to increase muscle length without pain or damage to ligaments or muscle fibers of the muscle. After each isometric contraction, they can gently stretch until they feel tightness in the tissue.
Physical therapists also may prescribe static stretches to increase flexibility of muscles around the wrist, including performing static stretches such as those listed here.
Remain on your back and bend one knee towards your chest while keeping one leg straight and engaging your core muscles. Hold this position for 30 seconds before switching legs.
An effective static stretch for the TFCC involves standing arm’s length from a wall or piece of sturdy exercise equipment and placing your right foot behind your left. Bend forward until you feel tension in the calf of your back leg; hold for 30 seconds before switching sides and repeat.
Taping
TFCCs are essential elements in the complex load transmission kinematics at the wrist, playing an intricate yet multifaceted role that leaves it vulnerable to injury and degeneration. Traumatic injuries (fall on outstretched hand or sudden twisting of wrist) or repetitive motions are usually the source of tears in this component; symptoms include pain on ulnar side of wrist and clicking, popping, or snapping sensations in wrist.
TFCC tears can typically be diagnosed by reviewing a patient’s history and conducting a comprehensive physical exam. A clinician will assess wrist range of movement and strength. He or she will palpate various structures within the wrist as well as conduct provocative tests like the “ulnar deviation test”, in which pressure is applied on one side while turning back towards neutral position to assess any pain that might exist.
Another test, known as the Piano Key Test, involves having patients lay their palms on a table and press down on the ulnar head of their radius while keeping their forearm supinated, looking for any signs of impingement which could indicate a tear of TFCC ligament. Finally, another method involves compressing wrist and rotating it painfully – this could also indicate a tear of this ligament.
On occasion, the TFCC may become damaged due to chronic inflammation from conditions like rheumatoid arthritis or other causes. This causes tendon and ligament fragility around the wrist area that increases their likelihood of tears; spontaneous tears may also occur as tissues break down over time due to repetitive stressors.
Most TFCC injuries will respond well to physiotherapy and rest, though for more severe or persistent pain conditions taping may help support and relieve pressure off of the TFCC. A brace, splint or cast may also be required in certain instances to stop wrist movement while it heals – this may prove especially helpful in cases involving more extensive or complete tears of the TFCC.
Bracing
TFCC refers to a complex of ligaments and the ulnar styloid bone in the wrist which help stabilize distal radio-ulnar joint (DRUJ). Sports activities or work which places excess load on wrist, such as lifting weights or pushing open doors with hand may lead to injuries which injure this structure, leading to pain and swelling that interfere with normal wrist function and require physiotherapy treatments in order to alleviate symptoms and restore normal wrist functionality.
Physical therapy offers another solution to wrist injuries – taping or bracing. This may be beneficial if your job or sport puts pressure on the wrist, such as opening doors, carrying heavy loads or doing push ups – your physical therapist can show you how and ensure a gradual start up process.
Injurys to the TFCC can cause discomfort in the wrist and hinder grip strength. Tears from such injuries can occur from falling onto an outstretched hand or from twisting it when gripping something (for instance when power drill binds up). More likely than other types of injuries to happen during repetitive wrist movements like golf, badminton tennis and gymnastics.
These injuries involve soft tissue avulsion of ligaments from the fovea and ulnar styloid base and can be hard to diagnose. They may not appear on standard X-rays and it may be difficult to differentiate them from bony fractures of the ulnar styloid base.
The TFCC is a fibrocartilage structure that contains tightly packed bundles of collagen fibers arranged in tightly spaced bundles. It is vascular in its periphery and essential to the stability of the DRUJ; two subsheath ligaments connect it to ulna and radius bones via its tight network of tissue connections – the Ulno-triquetral and ECU ligaments.
Fovea Sign (Ulnar Aspect of Wrist Pressing) can be performed to check for tears of the Trifid Fibular Complex of Carpal Tunnel Syndrome. Tenderness at this site could indicate that there has been damage to one or both styloid or fovea attachment sites could indicate a tear of this complex tissue; other tests include hypersupination and wrist loading. MRI can often be required as confirmation, though it can be painful; an alternative solution would be an arthrogram that would eliminate pain altogether.
Strengthening
TFCC ligaments provide stabilisation during supination (palm up) and pronation (palm down) movements of the wrist, protecting articular cartilage while transmitting loads safely through it. Their role can become compromised when there is too much compression or force applied through wrist joint, leading to pain and altered movement patterns. Most mild to moderate tears respond well to non-surgical treatment such as splinting or casting with guidance provided by physical therapists to ensure your wrist doesn’t become overloaded by therapy and that desired outcomes can be realized from therapy sessions.
TFCC tears typically result from falls onto outstretched hands, in which case the tendon sheath (TFCC) can become stretched or torn. Other mechanisms include excessive wrist movements from gymnasts landing on extended wrists or construction workers using tools like hammers and drills or athletes engaging in repetitive motion such as tennis, squash or weight bearing exercises – usually known as Type 1 injuries while degenerative or chronic types (Type 2) often manifest themselves through wrist arthritis (Morrison 2019).
Damage to the Trigger Finger Coordination Complex can result in symptoms including wrist pain on the ulnar side, clicking during movements involving that side and weakness in the wrist. Diagnosing such injuries typically requires client history review and physical exam to pinpoint, while in rare instances additional tests such as an X-ray CT or MRI might be required to confirm diagnosis.
Sports Rehabilitation Unlimited’s treatment process begins by reducing inflammation and pain around the TFCC area. Ice packs, manual therapy for wrist joints, electrical modalities and over the counter or prescription painkillers may all be effective methods.
Once swelling and inflammation have subsided, your Physical Therapist will initiate a program of re-education and neuromuscular rehabilitation to strengthen wrist and arm muscles to increase stability at the wrist and return normal wrist movement patterns. Regaining strength and proprioception after TFCC surgery usually happens quickly as your body adapts to healing wrist.
