You put a hand out to break a fall, or took an awkward swing at a padel ball, and the wrist felt wrong afterwards. Not the middle of it: the far side, under the little finger. Weeks later it still catches when you turn a doorknob or push up out of a chair, sometimes with a click as your forearm rotates. That pattern has a name: an injury to the triangular fibrocartilage complex, usually shortened to TFCC.
Hold your forearm out and rotate your palm up and down. The two forearm bones pivot against each other while your wrist stays connected to both. The TFCC is what makes that possible: a small complex of cartilage and ligaments slung between the end of the ulna (the bone on your little-finger side) and the wrist, acting as cushion and stabiliser 4. It carries roughly a fifth of what you push, pull or carry 4.
Injuries arrive two ways. Suddenly: "a fall with a significant twist applied to the wrist joint", or "forcibly twisting the wrist with a high torque, such as a power drill jamming or hitting a golf ball awkwardly" 4. Or gradually, from "repetitive movements of the wrist and mechanical stress in general of the distal radio-ulnar joint" 2, which is why it turns up in tennis, padel, golf, table tennis, baseball and javelin 2.
The symptoms follow from the anatomy: ulnar-sided pain, tender at the small hollow past the end of the ulna, minimal swelling, pain against resistance, reduced movement, the joint sagging under load, and a click on rotation 2; grip weakness is common too 1, and some tears leave the joint unstable 5. One caveat: TFCC lesions "can be asymptomatic or pauci-symptomatic" 2, so a scan finding doesn't automatically mean it's causing your pain.
These two get confused constantly.
| TFCC injury | Carpal tunnel syndrome | |
|---|---|---|
| Where you feel it | Little-finger (ulnar) side 2,4 | Palm, thumb, index and middle fingers 6 |
| What it feels like | Pain, clicking, catching, giving way 2,4 | Tingling, numbness, weakness gripping 6 |
| What sets it off | Twisting, gripping, weight through the wrist 2,5 | Often worse at night; pressure-related, not load-related 6 |
| What's wrong | Mechanical: ligament and cartilage under load 4 | A nerve problem: the median nerve compressed 6 |
If the main complaint is numbness and tingling on the thumb side, read carpal tunnel syndrome instead.
A TFCC injury is usually diagnosed provisionally from your story and a hands-on examination, and scans come second 4. The examination centres on two joints: the one between your two forearm bones, and the one between the ulna and the wrist bones. Do they hold their position when force is applied, or shift 4?
A plain X-ray shows any bony injury and helps establish whether those joints are stable 4. An MRI usually follows, and high-resolution MRI is reported to be up to 97% accurate 2. Wrist arthroscopy, where a small camera is passed into the joint, is considered the gold standard 2. It's only occasionally recommended 4.
A brace is a component, not the plan. In the study with the best conservative outcomes, a forearm orthosis held the wrist in slight extension for two weeks, then shifted to night-time and as-needed use 1. Good for settling symptoms early. It won't rebuild the strength or tolerance for twisting you need afterwards.
These appear in the literature: oral and topical anti-inflammatories, and steroid or hyaluronic acid injections 2; three of the sixteen conservatively treated patients in 1 also had a corticosteroid injection. Well Motion physiotherapists don't prescribe or administer any of these. That's a conversation for your GP or specialist.
If the DRUJ is unstable, surgical consultation is the right path rather than a longer conservative trial, and failure to improve conservatively is also a recognised indication 5. Surgery isn't a guaranteed fix, though: after debridement 92% of patients returned to work but "only 44% were free of pain", and after one common repair 68.3% returned to work with 41% reporting persistent pain 3. The rehabilitation afterwards is its own structured process: post-surgical rehabilitation.
Thin in both directions. One review concluded the literature "remains insufficient, making comparison between studies and techniques difficult" 3, and the study supporting conservative care most directly was retrospective, with its own authors calling for a randomised trial 1.
A TFCC injury with a stable joint is treated along The Well Motion Recovery Path™. The wrist earns each step by what it tolerates, not by a date.
How long it usually takes. Healing takes around three months, and normal function often takes 6 to 12 months 4. In one study of 20 racquet sport players, with no comparison group, the 17 who got back to their usual activity took 134 days on average 9. In a review of 10 studies of athletes who had surgery, non-surgical care was tried first for 6 weeks to 6 months 8. After surgery, your surgeon sets the timeline.
Prevention hasn't been tested for TFCC injuries, so these steps follow what's known about how they happen and heal:
Seek emergency care for severe wrist pain, significant trauma to the wrist, hearing "a snap, grinding or pop", a wrist that looks pale or abnormal, or a sudden loss of strength 6. Otherwise, see your doctor if wrist pain has come on suddenly or lasted a few months 6.
Book an assessment, rather than waiting it out, if:
None of that means something is badly wrong. It means the question that decides your plan (whether that joint is stable) isn't one you can answer from home.
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
A long time. Healing takes roughly three months, but "it is often 6 to 12 months before normal function is regained" 4. Splinting usually runs two to four weeks 1,2,5; the strength work runs on for months after. A stable injury is reasonably treated conservatively first 5.
You can't confirm it yourself, but the pattern is recognisable: ulnar-sided pain tender at the fovea, pain against resistance, reduced movement, the joint sagging under load, clicking on rotation 2. A physiotherapist adds specific tests 5, and confirmation usually comes from an X-ray plus MRI 4. The caveat: these lesions can be asymptomatic 2, so a scan alone doesn't prove it's your pain source.
Many stable tears settle well enough with structured non-surgical care, not quite the same as the cartilage knitting back together. With a stable DRUJ, conservative treatment produced satisfactory to excellent results at around two years, not statistically different from surgery 1. Against that, only two of 43 articles in one systematic review indicated conservative therapy may be adequate 3.
The recognised measures are relative rest, activity modification, anti-inflammatories and splint immobilisation 2,5, with the usual rest-ice-compression-elevation approach for wrist pain 6. Just as important is what you stop: limit pronation (turning your palm down), gripping and ulnar deviation (bending the wrist towards the little finger) 2,5, so no press-ups, pushing out of chairs, stiff jars, racquet strokes or torque through a tool. You can't assess your own DRUJ stability at home, and that decides everything 5.
There isn't one; there's a decision that depends on stability. Without DRUJ instability, conservative management is the first-line treatment; with it, the tear needs a surgical opinion 5. Where the DRUJ is stable, conservative care matched arthroscopic debridement on pain, movement, grip and function 1, and surgery has its own limits 3.
Numbness, tingling or pins and needles through your thumb, index and middle fingers, often worst overnight. It's a nerve compressed at the wrist, and there's usually plenty worth trying before surgery comes up.
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