Finger injuries / dislocations
Volar plate injuries
Recognising the Symptoms and Solutions
Ali Phillips | Hand & Wrist Specialist
Pain on the side of your wrist?
Hello, I'm Ali Phillips. If you're struggling with a persistent pain on the little finger side of your wrist, especially with clicking or a feeling of instability, you may have one of the common **TFCC injuries**. This complex wrist injury can be frustrating, but my goal is to provide clear, expert information to help you understand what's happening and the effective treatments available to get you back to the activities you love.
Book a ConsultationWhat are TFCC Injuries?
The Triangular Fibrocartilage Complex (TFCC) is a crucial load-bearing structure on the little finger (ulnar) side of your wrist. Think of it as the wrist's equivalent of the meniscus in the knee. It's a complex network of ligaments and cartilage that has two main jobs: firstly, it acts as a stabiliser for your wrist bones during gripping and rotation, and secondly, it serves as a shock-absorbing cushion.
When this structure is torn, leading to a TFCC injury, it can cause significant pain and a feeling that your wrist is weak or about to 'give way'. These tears can happen from a sudden injury or from gradual wear and tear.
Symptoms of a TFCC Tear
Ulnar-Sided Wrist Pain
A distinct pain on the little finger side of the wrist, which gets worse when you grip, twist your forearm, or put weight on your hand.
Clicking or Popping
A painful clicking, snapping, or catching sensation in the wrist, particularly when rotating your forearm (like turning a doorknob).
Weakness & Instability
A noticeable loss of grip strength and a feeling that your wrist is weak, unstable, or about to give way.
Diagnosing TFCC Injuries: Central vs. Peripheral Tears
Not all TFCC injuries are the same. Therefore, an accurate diagnosis, often confirmed with a high-quality MRI scan, is crucial because the location of the tear determines the treatment. A tear can be 'central' or 'peripheral'.
Central Tears (Wear and Tear)
These tears occur in the middle, cushion-like part of the TFCC, which has a poor blood supply. They are often degenerative, like getting grey hair, and are incredibly common on MRI scans, even in people with no pain. Consequently, a central TFCC tear is often an incidental finding and not the source of the problem.
Peripheral Tears (Traumatic Injury)
These are tears of the outer ligamentous part of the TFCC, which has a good blood supply. They are usually caused by an injury, like a fall or a sudden twist. These TFCC injuries are the ones that cause true instability and pain, and because they disrupt the wrist's mechanics, they rarely heal on their own and often require surgical repair.
Don't Ignore Wrist Pain from TFCC Injuries
Pain on the little finger side of the wrist should never be ignored. Getting an accurate diagnosis for your TFCC injury is the first step to understanding your wrist and finding the right path to recovery.
Get a Clear DiagnosisHow Can We Treat TFCC Injuries?
We will create a personalised treatment plan together, always starting with non-surgical options first for any symptomatic tear.
Conservative Care for TFCC Injuries
Activity Modification & Splinting The first step is always to avoid activities that cause pain. A supportive splint, like the WristWidget™, is excellent for stabilising the wrist bones and allowing the inflammation to settle.
Hand Therapy In addition, a specialist hand therapist will guide you through exercises to strengthen the supporting muscles and improve your wrist's mechanics, which is crucial for healing TFCC injuries.
Steroid Injections If pain and inflammation are severe, a targeted steroid injection can provide significant relief and help calm the symptoms down, allowing you to engage more effectively in therapy.
Understanding Surgical Repair for TFCC Injuries
Surgery is reserved for peripheral TFCC injuries that cause persistent pain and instability which have not responded to non-surgical treatment. The goal is to repair the torn ligament, restore stability, and allow you to return to your activities without pain.
The operation is typically performed as a day case, meaning you can go home the same day. We will discuss the best anaesthetic for you, which may be a regional block (where your whole arm is numbed) or a general anaesthetic (where you are asleep).
My Preferred Technique: Mini Open Repair. While keyhole surgery is an option, I have found that a mini-open repair provides a more reliable result. I make a small incision on the back of your wrist, which allows me to directly see the torn ligament. Using strong sutures and small bone anchors, often with the help of the Arthrex guidance system for precision, I securely reattach the TFCC to the bone. This provides excellent stability for TFCC injuries.
The decision to have surgery is always yours. You have the right to choose not to proceed at any time. The alternatives include continuing with non-surgical management (splinting, therapy, injections) or choosing no further treatment if your symptoms are manageable.
It is critical to understand that all surgery carries risks. While the vast majority of patients have an excellent outcome, it is my duty to ensure you are aware of potential complications, even if they are rare.
- Continued Pain or Instability: In a small number of cases (about 1 in 10 people), symptoms may persist after surgery. It is sometimes possible to perform a repeat (revision) reconstruction if required.
- Hardware Issues: This is a rare complication (happening in fewer than 2 in 100 cases) where the small anchors used for the repair could break or shift, which might require another operation.
- Infection: This is a very rare complication (happening in fewer than 1 in 100 cases). We take every precaution, but any surgery has a small risk of infection, which is usually treated with antibiotics.
- Nerve Injury: This is also a very rare complication (happening in fewer than 1 in 100 cases). There are small sensory nerves near the incision that can be bruised or damaged, potentially causing temporary or permanent numbness.
The decision to proceed with surgery is a fine balance between these risks and the potential benefits. Only you can make that final judgement, and I am here to answer any questions to help you do so.
Recovery is a significant commitment. You will wear a cast or splint for several weeks to protect the repair. After this, a dedicated course of hand therapy is essential to gradually and safely regain your wrist's strength and range of motion. While your wrist will feel stiff at first, most of my patients are back to almost all of their normal activities by five months after the operation.
Your Questions About TFCC Injuries Answered
Absolutely not. We treat patients, not scans. Central TFCC tears are extremely common findings in people with no symptoms at all. If your wrist feels stable and pain-free, an incidental central tear on an MRI requires no treatment.
They are most often caused by a traumatic injury. This commonly involves a fall onto an outstretched hand or a forceful twisting motion of the wrist, which is common in sports like tennis, golf, and gymnastics.
The peripheral, ligamentous part of the TFCC has a good blood supply, but the forces across the wrist are constantly pulling the torn edges apart. This prevents the ligament from healing in the correct position, which is why surgical repair is often needed to restore stability.
Diagnosis starts with a thorough clinical examination to test for pain and instability. This is followed by an X-ray to rule out fractures. To confirm the diagnosis and determine the exact type of tear, a high-quality 3T MRI scan, which we have available at the Healthshare Clinic in Winchester, is often required.
Recovery is a significant commitment. You will be in a cast or splint for several weeks after surgery. Following this, a dedicated course of hand therapy is essential to regain motion and strength. While your wrist will feel stiff at first, most of my patients are back to almost all of their normal activities by five months post-op.
Yes, absolutely. The entire goal of the surgery is to restore stability to your wrist so you can return to the sports and activities you love without pain or fear of your wrist giving way. The rehabilitation process will be tailored to help you regain sport-specific strength and movement.
The WristWidget™ is a specialised brace designed specifically for TFCC injuries. It works by gently squeezing the two forearm bones (the radius and ulna) together, which takes the pressure off the healing TFCC and provides excellent stability during recovery.
In my experience, the mini-open approach provides a better and more accurate view of the complex ligament structures. This allows for a very secure and anatomical repair, which I have found gives my patients the most reliable and stable long-term results.
An untreated peripheral tear can lead to chronic wrist instability. This ongoing abnormal movement can cause persistent pain, weakness, and eventually lead to wear and tear on the wrist joint, resulting in early-onset arthritis.
As a specialist hand and wrist surgeon based near Southampton, I have extensive experience in diagnosing and treating all types of TFCC injuries. I regularly treat sportsmen and women, particularly sailors, from across the Hampshire region.
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