What is TFCC?

If you are asking yourself this question, then this may be because:

Either your doctor told you that you have it (may God bless him, not many know about it)
Or you have just received your MRI report after having wrist pain for sometime

Either way: Your wrist pain that was superfically called wrist sprain has a name now: “TFCC”.

Note:

By the way: All the information I’m sharing here has been my own experience and/or well-researched by talking to 15 wrist surgeons from the US, Singapore, Italy, Spain and France. Each of them is considered an expert in their respective country and perform around 50 to 200 TFCC surgeries per year.

If you do not want to read articles and watch videos and want to save money and time, I am preparing a step-by-step guide. Email me at rt.azimi@gmail.com and I put you on the waiting list.

Introduction: What is a TFCC?

Let us make a long story short.

For those of you who are familiar with the meniscus of the knee, the TFCC is basically the same just in the wrist – but somehow for most doctors less known and less researched (don’t ask me why).

This is why 95% of doctors will probably lead you the wrong way.

The good news:

You have come to the right place.

The bad news:

This is a very notorious injury (more than a bone fracture) in terms of length – it may be couple of weeks, months or even years.

How long it really takes is a matter of:

finding the right information at the right time
taking the right decisions
finding the right experts

At what stage you are at, this blog is here to help you.

Everything on this website is for free and I am sharing all mistakes I did and all the research I have done and consultations in worth of (3k USD) with doctors from countries such as Spain, USA, Germany, Italy, France and Singapore.

Important note:

Please do not wait too long to take action.

A TFCC can become very serious – ignore those who say it is “nothing”.

In this article, I want to give you a lot of information on TFCC, so you can talk to doctors and very quickly find out whether you are talking to someone with experience.

Many things in this article is knowledge that 95% of doctors (GPs, general orthopedic surgeons and even hand surgeons don’t know).

Who is this article for:

For people who have been diagnosed with a TFCC tears and to know what is ahead of them and for those who have wrist pain and are unsure whether it is a TFCC tear.

What we discuss in this article:
We will cover the follwoing topic:

the location of the TFCC
the functionality and why it is important and how it triggers pain

What is a TFCC: The Location

Your TFCC is in your wrist.

It is between the ulnar bone and the radial bone.

It is at the base where your hand starts.

The TFCC spans between the ulnar bone and the radial bone like a triangle.

That is the reason why it is called the Triangular Fibor Cartilage Complex.

What is a TFCC: The functionality

So what does the TFCC actually do and why is it important?

I will first explain it with an analogy:

Imagine you have a trampolin.

A trampoline consts of:

trampoline legs
trampoline mat

The trampoline mat is your TFCC.

The trampoline legs are like the bones.

In the trampoline analogy, the legs are stabilized because they are stuck in the ground.

In our body, the bones are stabilized by the TFCC (so the mat).

This means once the TFCC has a tear, the legs become unstable and your wrist starts hurting.

This is just a very simple analogy for you to be able to imagine what is happening.

What is a TFCC: How can it be injured?

Let us go back to the trampoline example.

The more a person weighs the more the mat will go down.

That should be obvious.

Now imagine you put a rock on the trampoline or even worse it falls on the trampoline – what can happen then?

The mat tears.

Simple as that.

For our body, this sudden force of weight can be us falling on our hand.

The sudden force pushes a lot of weight on the TFCC that may tear it.

It doesn’t always need to be such a force. It can also be simpler like arm wrestling etc. that can cause smaller tears sometimes in combination that your TFCC is already not anymore of great quality.

Similar to a mat over time, our body degenerates (and also the TFCC) so we get more vulnerable to injuries.

What is a TFCC: How bad is the tear and can a TFCC heal it by itself?

This is the interesting part.

Just like with the mat, we could have several options:

no tear (because we were lucky)
a bit of mat thinning
a whole in the middle
a tear from on of the legs

We can have similar scenarios for a TFCC.

This is what makes it very difficult for doctors and you hear opinions from “it’s nothing, just wait” (reasonable if it’s small) to “we need to put a cast on” or “you need surgery”.

Actually, doctors who are not specialiized in TFCC (means they do not see at least 50 TFCC patients per year) often underestimate it.

Only experts know how fast a small TFCC tear that is sometimes painful can become very painful very soon if not taken care of and can lead to surgery.

Regardless of the level of pain and TFCC tear, experts usually will not risk it and have the mindset of “better safe than sorry”.

So they usually put a cast on, but not just any cast.

This is a special created cast to fit your wrist and arm and it spans until above your elbow.

Medical professionals call it the Muenster Cast.

This does not mean that your TFCC tear cannot heal with a different cast or without cast at all.

You can imagine it like crossing a street when it’s red.

Crossing a street when it’s red does not mean you will not be hit by a car – just the probability may be higher.

On the contrary, crossing a street when it’s green is also not a 100% guarantee that you will not be hit by a car – just the probability is lower.

Same with the muenster cast. The muenster cast is like using the green signal when crossing the street.

Any other cast, e.g

wrist splint
wrist brace
wrist widget

is like crossing a street with red light. It may just turn out well.

I think this the point that creates a lot of confusion for non-medicals people.

They hear very different opinions from doctors and it’s not that they are wrong.

It is a different mindset or let us say: It is a different risk appetite.

So at this point you should ask yourself:

What are you willing to risk?

Less aggressive treatment (smaller cast), then higher risk for surgery but you can work during this time.

More aggressive treatment (longer cast), then lower risk for surgery but you cannot work meanwhile (the cast will not let you).

What is a TFCC tear: The different types of TFCC tears

Dr.Palmer classified TFCCs into 2 big subclasses depending on the cause:

Class 1: Traumatic – this means a sudden force (accident or punch) made your TFCC tear.
Class 2: Degenerative – this means over time your TFCC gets thinner and it starts hurting more and more. This is usually caused by a positive ulnar impaction due to genetics, meaning the ulnar is longer than the radius. You can find out through an X-ray.

We mostly focus on class 1 in this article.

Class 1 has again subclasses defined by Palmer.

These are:

TFCC Palmer Class 1A: This is also called a central tear
TFCC Palmer Class 1B: This is can be a peripheral or foveal tear – or both.
TFCC Palmer Class 1C
TFCC Palmer Class 1D

Most people suffer from a TFCC Palmer 1A in combination with a TFCC Palmer Class 1B.

Unfortunately, many orthopedic surgeons only understand Class 1A (or mistakenly call a class 1A by Class 1B).

They often don’t understand how a TFCC Class 1B looks like and how to treat it.

And even goes further – Dr.Atzei from Italy has divided the TFCC Class 1B in more subclasses because even many doctors use a wrong technique there.
A classification as important as this happens only once in a century – for his findings, Dr.Atzei was rewarded with the Whipple Prize in 2007.

The Whipple prize is similiar to the noble price in the wrist community.

So in this table we want to briefly summarize what tear needs which techniques and how recovery post-op looks like – this is based on Dr.Atzei classification and paper.

Tear Type	Surgery technique	Rehab
TFCC Palmer 1A (central tear)	Debridement	2 weeks of short splint and then slowly starting physio
TFCC Palmer 1B Atzei Class 1 (peripheral tear)	Repair	6 weeks of muenster splint and then 6 weeks of physio – work after 3 months post-op
TFCC Palmer 1B Atzei Class 2 (periphal and foveal tear)	Repair + Refixation (bone anchor or bone tunnel technique)	6 weeks of muenster splint and then 6 weeks of physio – work after 3 months post-op
TFCC Palmer 1B Atzei Class 3 (foveal tear)	Refixation (bone anchor or bone tunnel technique)	6 weeks of muenster splint and then 6 weeks of physio – work after 3 months post-op
TFCC Palmer 1B Atzei Class 4 (chronic tear, means it cannot heal by itself anymore)	Reconstruction, e.g. Adam Berger technique	(I haven’t talked to doctors about this yet)

95% of doctors do not understand about these subclassification of a TFCC Palmer 1B which is extremly important.
I speak from experience because my surgeon from Germany has performed a repair although I had TFCC Palmer 1B Class 3.

You can watch this video by Dr.Atzei. He explains his classifciation in more detail.

It is quite technical. In my guide which I will publish I will explain this for non-medicals, so patient can understand this fast and qualify the right doctors.

Meanwhile:
Try to find out whether doctors know about the Palmer and Atzei Classification and whether they understand the different treatment between a peripheral and a foveal tear.

You will be surpised how many don’t know this – you have been warned.