Falling onto an outstretched hand is unfortunately an injury most riders know all too well. I can vividly recall such a fall I had myself that resulted in a trip to the emergency department and ended with me in a cast for 6 weeks for a fractured wrist. While fractures are a frequent injury resulting from a fall onto an outstretched hand, there is another common injury that not many people know about and can be easily missed.
Triangular Fibrocartilage Complex Tear
What is it?
The Triangular Fibrocartilage Complex (TFCC) is a structure comprised of ligaments and cartilage on the ulnar (pinky finger) side of the wrist. The TFCC helps to stabilise the joint between the two forearm bones (ulna and radius), and it acts as a cushion to share the load between the end of the ulna and the small carpal bones of the wrist.
There are two types of TFCC tears:
- Type 1 tears are called traumatic tears. Falling on an outstretched hand and excessive arm rotation are the most common causes. Unsurprisingly it is this type that is seen most in the equestrian population.
- Type 2 TFCC tears are degenerative or chronic. They can occur over time and with age. Some inflammatory disorders, such as rheumatoid arthritis or gout, may also contribute to Type 2 TFCC tears. Having a longer ulna bone can predispose you to the condition as it places more pressure on the TFCC.
What are the symptoms?
People with TFCC injuries typically report pain deep in the ulnar aspect of the wrist, particularly on any activities that involve twisting through the wrist or weight-bearing through the hand. Grip strength is often affected also. The pain typically gets better with rest or avoiding the aggravating activities. Occasionally you may notice swelling the wrist and a painful clicking on movement.
How do I know if I have a TFCC tear?
There are many possible causes of pain on the ulnar side of the wrist, and diagnosis can be difficult. Assessment by an experienced physio or sports physician is often sufficient, but sometimes further investigation is needed. A MRI provides us with the best diagnosis for a TFCC tear.
Most TFCC injuries respond well to conservative treatment including:
- Identifying and modifying/avoiding any aggravating activities
- Use of a wrist splint to immobilise the area
- Regular icing and anti-inflammatories
- If symptoms persist or if there is any associated instability in the wrist, referral for further investigation or for a surgical opinion is typically warranted.