TFCC Tears: When the Pinky Side of Your Wrist Won't Settle Down | Form & Function MD
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TFCC Tears: When the Pinky Side of Your Wrist Won’t Settle Down

Form & Function MD · Dr. Ben, MD

Dr. Ben, MD · Orthopaedic Hand & Upper Extremity Surgeon

Pain on the small-finger side of the wrist is one of the more frustrating problems patients bring to me. It often comes with a vague story, a normal X-ray, and months of being told it's a sprain. One of the most common causes is an injury to the triangular fibrocartilage complex, or TFCC.

What the TFCC does

The TFCC is a group of cartilage and ligaments on the pinky side of the wrist, between the end of the ulna (the forearm bone on that side) and the small wrist bones. It acts as a cushion, absorbing load passed through that side of the wrist. It's also a key stabilizer of the joint between the two forearm bones, the distal radioulnar joint (DRUJ), which lets you rotate your forearm to turn your palm up and down.

Pinky-side wrist pain is real, common, and often under-diagnosed. A normal X-ray doesn't rule it out.

How it gets injured

TFCC tears fall into two broad groups. Traumatic tears follow a fall on an outstretched hand or a forceful twist, such as a drill that binds or a club that strikes the ground. Degenerative tears develop over time, particularly in people whose ulna is slightly long relative to the radius. That anatomy concentrates load on the pinky side of the wrist, a condition known as ulnar impaction.

Typical symptoms
  • Pain on the pinky side of the wrist, worse with twisting: turning a doorknob or key, pouring, wringing a towel
  • Pain pushing up from a chair or doing a push-up
  • Clicking or catching with forearm rotation
  • A sense of weakness or instability in the wrist
  • Pain with racquet and club sports

How it's diagnosed

The exam does a lot of the work. Tenderness in the soft spot just in front of the ulnar head, between the tendon there and the bony bump on the pinky side (sometimes called the fovea sign), is a classic finding. Specific maneuvers stress the TFCC and test the stability of the DRUJ.

X-rays don't show the cartilage but do show ulnar length and other causes of pain. MRI, sometimes with contrast injected into the joint, can show the tear. Wrist arthroscopy remains the most definitive way to see and grade it.

Treatment

Most TFCC injuries start with non-surgical care, and many improve with it.

The usual progression
  • Rest from the aggravating twist and a wrist splint or brace, often for several weeks
  • Hand therapy focused on wrist and forearm strength and stability
  • A steroid injection for persistent pain in selected cases
  • Arthroscopy when symptoms persist: central tears are usually trimmed (debrided) because that area has a poor blood supply; tears at the outer edge, which has better blood supply, can often be repaired
  • Ulnar shortening for degenerative tears driven by a long ulna, to unload the pinky side of the wrist

If the DRUJ is unstable, meaning the forearm bones shift abnormally relative to each other, the conversation changes. A tear that has detached the TFCC from its deep attachment on the ulna may need repair to restore stability.

The goal isn't just a quiet MRI. It's a wrist you can twist, push, and grip with confidence.
When to get it checked
Pinky-side wrist pain that persists beyond several weeks, clicking with rotation, a feeling that the wrist gives way, or pain after a fall that didn't show a fracture on X-ray are all reasons for a hand surgeon's exam.

This article is for education, not a diagnosis. If something here sounds like you, see a physician who can examine you.

  1. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14(4):594–606.
  2. Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 2008;33(9):1669–1679.