TFCC Injury (Ulnar-Sided Wrist Pain)

Overview

The triangular fibrocartilage complex (TFCC) is a small cushion of cartilage and ligaments on the little-finger side of the wrist, between the end of the forearm bone (the ulna) and the small wrist bones. It absorbs load when you lean on your hand and helps hold the two forearm bones steady as you turn your palm up and down. When it is injured or irritated, it causes ulnar-sided wrist pain — pain on the little-finger side — often with clicking and a weak grip.

TFCC problems can start suddenly, after a fall onto an outstretched hand or a forceful twist, or build up gradually from repeated rotation and weight-bearing: racket sports and golf, push-ups, planks and yoga in the gym, and long hours of mouse use or gaming with the wrist bent towards the little finger. From the forties onwards, the cartilage also naturally thins, and some people have a slightly longer ulna that increases the load on the TFCC. Our wrist sprain page covers acute sprains more generally; this page focuses on persistent pain on the little-finger side.

Many TFCC injuries settle with a period of load modification followed by a graded strengthening programme, although recovery can take weeks to months and outcomes vary. Persistent clicking, a feeling of instability, or pain that does not improve with good rehabilitation may need imaging and a specialist opinion.

Causes and risk factors

• A fall onto an outstretched hand
• A forceful twist of the forearm, such as a racket mishit or lifting with a twisted wrist
• Repeated forearm rotation in tennis, badminton, squash or golf
• Weight-bearing through the hand in push-ups, planks, yoga and gymnastics
• Long hours of mouse use or gaming with the wrist bent towards the little finger
• A slightly longer ulna (positive ulnar variance), which increases load on the TFCC
• Age-related thinning of the cartilage from the forties onwards

How we may be able to help

Our assessment uses specific tests that load the TFCC, checks the stability of the joint between the two forearm bones, and looks for other causes of little-finger-side pain such as a tendon problem, ulnar nerve irritation or a fracture. If a fracture is suspected after a fall, we direct you to urgent care first. We do not provide hand therapy or make splints; if a splint or brace is likely to help, a GP or specialist can advise on one. If there is persistent clicking, instability or no improvement, we can arrange an online private GP consultation for an X-ray, MRI or a hand specialist referral.

Physiotherapy follows a staged plan. Early on, we help you reduce the twisting and leaning movements that irritate the TFCC and may use gentle mobilisation of the wrist bones. We then progressively rebuild grip strength, control of forearm rotation and the muscles that stabilise the little-finger side of the wrist, before a graded return to weight-bearing, the gym and sport. We also look at your racket grip, technique and mouse set-up where relevant.

Kinesiology taping can give support and a feeling of stability during the early weeks and on return to sport. Interferential therapy or therapeutic ultrasound may be used as an adjunct for pain relief alongside the exercise programme.

What you can do at home

• Avoid painful twisting and leaning on the flat hand for now; do push-ups on fists or handles if they are comfortable
• Keep your wrist straight when using a mouse, bring the mouse close and consider a vertical mouse
• Use ice for 10 to 15 minutes after activities that flare the wrist
• Start the gentle grip and wrist exercises shown by your therapist, and build up gradually
• Return to racket sport and weight training step by step rather than all at once
• Lift with your palm facing up and both hands where possible, to reduce load on the little-finger side