What is it?

The triangular fibrocartilage complex (TFCC) is a structure located on the ulnar side of the wrist. It is made up of cartilage which helps stabilize the bones of the hand and wrist. An injury to this area may cause pain, swelling or instability. If conservative treatments (NSAIDs, physical therapy, etc.) have failed, a sports medicine doctor may recommend an injection.

Typically, steroid (or cortisone), an anti-inflammatory substance, will be injected into the TFCC, but sometimes a physician may inject other substances. There is no evidence that the injection will heal the injury, but it may reduce pain and inflammation which allows for an earlier return to sports and physical activity.

Procedure and post-procedure guidance

An injection into the TFCC can be done with or without ultrasound guidance. The needle will be placed into the ulnar side of the wrist and directed into the appropriate location. The injection will include an analgesic medication, such as lidocaine, to minimize the discomfort during the injection. There may be some increased pain initially due to extra fluid in such a small area, but this will usually subside within 24-48 hours. Rare complications of steroid injections include infection or changes to the overlying skin causing an indentation under the skin (from fat atrophy) or causing it to appear lighter than normal (also known as hypopigmentation).

Injury prevention

Injuries to the TFCC are usually the result of a fall or forceful impact and are difficult to prevent. It is possible to cause a tear from overuse as well. Athletes who play full-contact sports, racquet sports or who put pressure on the wrists (such as gymnasts) are at greater risk of injury. Proper technique and appropriate training regimens are important.

Return to play

Return to sport after an injury to the TFCC will vary. Depending on the sport, some athletes may be able to compete while injured, but may require a splint or cast to immobilize the wrist joint for comfort and prevent further injury. Your doctor may recommend a period of rest or immobilization and may prescribe physical therapy during this time. In general, athletes who receive steroid injections should avoid sport for a minimum of 24-48 hours. If conservative treatments and injections have failed, you may be referred to an orthopedic surgeon to discuss surgical options.

AMSSM Member Authors
Justin McCoy, DO and Brian Larkin, DO

References
DeLee JC, Drez D, Miller MD, Thompson SR. DeLee and Drez’s Orthopaedic sports medicine: Expert consult – online and prine, 2-Volume set. 3rd ed. Philadelphia: Elsevier Health Sciences; September 2, 2009:875-883 chap 76.