Triangular Fibrocartilage Tear

with Rehab

ExitCare ImageA triangular fibrocartilage tear is a tear in the triangular fibrocartilage complex (TFCC). The TFCC is a structure within the wrist. The TFCC along with the ulnocarpal ligament help stabilize the pinky side of the hand and forearm bones. A tear in the TFCC causes pain, instability, and/or a clicking sensation in the wrist.

SYMPTOMS

  • Pain, tenderness and/or inflammation around the pinky (ulnar) side of the wrist.

  • Pain that worsens with wrist movement, especially extension of the wrist, or gripping.

  • "Clicking" sensation with or without pain.

  • A crackling sound (crepitation) with motion of the wrist.

CAUSES

Triangular fibrocartilage tears occur when a force is placed on the TFCC that is greater than it can withstand. Common ways the injury occurs include:

  • Degeneration of the TFCC that occurs with age.

  • Falling on an outstretched hand.

  • One of the forearm bones (the ulna) is longer than the other (the radius). This pinches the TFCC.

RISK INCREASES WITH:

  • Activities that involve repetitive and/or strenuous wrist and hand motions (like racquet sports, golf, baseball, weightlifting or mountain biking).

  • Activities that have a risk of falling on an outstretched hand.

  • Poor strength and flexibility.

  • Poor technique.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique. When possible, have a coach correct improper technique.

PROGNOSIS

If treated properly, the symptoms of triangular fibrocartilage tears usually resolve with non-surgical treatment. Occasionally surgery is necessary to eliminate the symptoms.

RELATED COMPLICATIONS

  • Recurrent symptoms that result in a long term problem.

  • Prolonged healing time, if improperly treated or re-injured.

  • Arthritis of the wrist.

  • Inability to return to a high level of play.

  • Wrist stiffness or decreased wrist function.

  • Risks of surgery: infection, bleeding, nerve damage or damage to surrounding tissues.

TREATMENT

Treatment initially involves resting from any activities that aggravate the symptoms, and the use of ice and medications to help reduce pain and inflammation. It may be necessary to keep the wrist still (immobilized) for a period of time to allow for healing of the wrist. After immobilization it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist. If symptoms persist for greater than 6 months despite non-surgical treatment, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Triangular Fibrocartilage Tears

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow with your fingers pointing down.*

  • Gently pull the back of your hand towards you until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent rather than extended.

ExitCare Image RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm/fingertips back so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

ExitCare Image RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Wrist Flexion

  • Place the back of your right / left hand on a tabletop leaving your elbow slightly bent. Your fingers should point away from your body.

  • Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Wrist Extension

  • Place your right / left fingertips on a tabletop leaving your elbow slightly bent. Your fingers should point backwards.

  • Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Triangular Fibrocartilage Tears

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

ExitCare Image STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit holding on to the rubber exercise band/tubing with your opposite arm supported.

  • Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

ExitCare Image STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit holding on to the rubber exercise band/tubing with your arm supported.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge or a large, rolled sock in your hand.

  • Squeeze as hard as you can without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.