The triangular fibrocartilage complex (TFCC) is a small network of tissues that help articulate the motions of the wrist. Over time, small tears can develop in portions of this complex set of issues leading to several adverse effects.
To combat the progression of a TFCC injury, it is best to learn more about what a TFCC is, how a TFCC tear is diagnosed, and the treatment options available.
Anatomy of TFCC Tears
The TFCC is a set of connective tissues known as the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs) which attach bones at the edge of the forearm to those on the outside base of the palm.
In addition to the connective ligaments, the TFCC contains a band of rubber-like tissue known as the triangular fibrocartilage discus (TFC) which is nestled between these sets of bones and cushions their movements against one another.
Together, these tissues allow the hand to freely rotate at the edge of the forearm and provide protective padding to ensure both sets of bones do not rub against one another.
While all of the components work in unison to provide motion to the wrist, TFCC tears are specifically related to the fibrocartilaginous portion of the TFCC. Thus, a TFCC tear only occurs when the TFC becomes ripped or fractured.
Causes of TFCC Tears
Depending on the way the TFCC is injured, a TFCC tear will be categorized as either a Type 1 or Type 2.
Type 1 tears are referred to as traumatic tears. These types of tears occur due to an acute injury such as falling on an outstretched hand or excessive arm rotation.
Type 2 TFCC tears are those which are degenerative or chronic. These typically occur as a person ages and their cartilage is worn down. Other known causes are inflammatory disorders, such as rheumatoid arthritis or gout, which wear down the cartilage by applying undue pressure to the TFC.
Athletes, especially those whose sport of choice involves heavy or strenuous wrist motion – tennis, hockey, baseball – are most at risk of developing type 1 TFCC tears. As type 2 tears are degenerative, those over the age of 50 are especially susceptible to developing these types of TFCC tears.
No matter what type of TFCC tear an individual has, the problem will only worsen over time. Eventually, the microfractures and worn-down cartilage develop into full-on tears and lead to several unwanted side effects.
Symptoms and Signs of a TFCC Tear
TFCC tears are progressive injuries, so although a person may already have one, they may not experience the symptoms right away. As the tear gets deeper, the individual will start to experience pain around the outside of their wrist. This pain may be constant or may only appear after extended wrist use.
Other symptoms of a TFCC tear may include:
- Wrist weakness or a reduced ability to bear loads
- Clicking or popping sensations when moving the wrist
- Swelling around the wrist
- Wrist instability
- Numbness around the base of the palm
If these symptoms are a chronic problem, especially at a young age, it may be time to consult a doctor to properly diagnose the cause of the issue.
Diagnosing TFCC Tears
A typical consultation for an individual experiencing TFCC tear-like symptoms will begin with an exploration of the patient’s medical history and daily activity. If a tear is suspected, the doctor will begin a physical examination to examine the patient’s threshold of pain.
Physical examinations for TFCC tears involve:
- Palpation of the wrist: the doctor will apply small amounts of pressure to the outside of the wrist to centralize the area of pain.
- Wrist rotation: by extending the wrist to its outer limits of motion, the doctor will get an accurate idea of the tissues which may be affected by whatever is causing a patient’s pain.
If a tear is suspected, the doctor will propose one of several imaging tests. These include:
- X-rays: to rule out the possibility of a bone injury.
- MRI: to view the condition of the soft tissues within the wrist.
- CT scans: for a more developed view of the soft tissues as well as blood vessels within the wrist.
If these tests prove conclusive and the patient does indeed have a TFCC tear, the doctor will determine how progressed the injury is and develop a treatment regimen to meet the functional goals of the patient. This treatment plan typically begins with conventional medicines.
Conventional Treatments for TFCC Tears
Unlike some soft tissue injuries, TFCC tears can not heal on their own. Thus, conventional treatment options focus on maintaining the current state of the wrist, reducing pain, and restructuring the types of movements a patient is used to with their wrist.
Depending on the severity of the tear, a doctor will recommend one or a few of the following treatment methods:
Physical therapy is an umbrella term for any type of treatment via physical means. These types of treatments are typically the first line of defense against any soft tissue injury as they are simple, non-invasive, and show mostly positive results.
Massage, stretching, hot/cold therapy, guided exercise, and splinting are some of the most common physical therapies for soft tissue injuries.
By increasing blood flow in the affected area, massage can help reduce the risk of swelling. Stretches and guided exercise can increase blood flow and help a patient increase the range of motion of their debilitated wrist. Hot/cold therapy can help temper flare-ups of pain by numbing and relaxing the muscles and tendons within the wrist.
If over-the-counter medications such as naproxen, ibuprofen, or acetaminophen fail to reduce pain to an adequate level, doctors may prescribe stronger dosages of these medications or can move on to more powerful medications which inhibit the brain’s receptiveness to pain.
Medication may help in small dosages, but long-term exposure to medication risks liver damage, tissue degeneration, and a host of other unwanted side effects.
Steroidal injections have proven effective at combatting the swelling caused by several degenerative illnesses such as TFCC. In addition to calming down painful inflammation, the steroidal injection can also increase the range of motion and decrease the instability of the wrist.
In the same way, which medication can cause tissue degeneration over time, steroidal injections can do the same, but at a much quicker rate. Doctors will typically ask their patients to limit injections to once or twice per year to limit the degenerative effects of these types of injections.
Surgical intervention may be necessary in those cases which fail to respond to the above treatments. Some tears can be fixed with sutures where the TFC is “soldered” together. In other cases, the frayed edges of the tear will be debrided or removed completely.
If the medical imaging tests showed irregular bone structures within the wrist, these structures may be partially scraped to prevent them from causing further damage.
In any case, surgery will typically be the last line of defense against the effects of a TFCC tear or may be avoided altogether depending on the age of the patient. TFCC surgery will typically involve extended downtimes for the wrist and may impair an individual to continue their routine lifestyle.
Conventional treatments may be a good first step in treating the pain caused by a TFCC tear, but they are not aimed at restoring full function to the wrist, simply at reducing a patient’s pain. Moreover, these treatments do not combat the central cause of the pain – degenerated tissue.
For those seeking minimal downtimes and less invasive treatment options, there are alternative treatment options available. One such treatment, regenerative therapy, offers a solution to the underlying causes of TFCC tear-related pain.
Regenerative Therapy for TFCC Tears
Regenerative therapies are a treatment option that involves extracting tissues from a patient, processing them, and then reinjecting them back into the patient as close to the source of injury as possible.
At CELLAXYS, we offer two types of regenerative therapies – platelet-rich plasma (PRP) therapy and cell-based therapy.
PRP therapy uses the blood’s healing components, platelets, to restore damaged tissues and promote healing after an injury. Platelets serve as the first line of defense by releasing 10 Growth Factors to stimulate healthy tissues. They also send chemical signals to attract healing cells circulating in the blood.
The most important function of platelets is the production of fibrin, a sticky web that lays the groundwork for tissues to start building. PRP harvests healthy platelets from your blood and reinjects them into the injury site to promote healing.
PRP is the first “orthobiologic” procedure used in sports, orthopedic, and spine medicine for over 20 years. These procedures typically take about 45 minutes to finish.
Cell-based therapies focus on your own cells and tissues, known as “autologous” tissues. These procedures are also called “stem cell therapies.” Depending on your TFCC tear, your doctor will go for one of the two types of cell-based therapies:
- Minimally Manipulated Adipose Tissue transplant (MMAT). MMAT is highly-effective in replacing your damaged tissues with healthy adipose tissues. Your doctor can easily perform MMAT at multiple parts of your body within the same procedure. So you don’t have to visit the clinic again and again.
- Bone Marrow Concentrate (BMAC). This procedure focuses on the highly concentrated cells of your bone marrow and uses them to replace the damaged cells.
These procedures take around 1.5-2 hours to complete. Your doctors may ask you to go home after the procedure.
The benefit of these regenerative therapies over conventional treatments is that they treat the source of the issue, not just the effects of it. By repairing damaged tissue, a patient can regain lost range of motion and decrease overall pain. Additionally, these treatments have been known to continue working anywhere from 6 months to a year after a single injection.