TFCC Tears Explained
By Mr Gavin Schaller FRCS(Tr&Orth) | Consultant Hand & Wrist Surgeon | Reviewed September 2026
In short: A TFCC tear is an injury to the triangular fibrocartilage complex, a small cushion and network of ligaments on the little finger side of the wrist that stabilises the joint and lets the forearm rotate. A TFCC tear causes pain on the outer edge of the wrist, often with clicking and a weak grip, and is common after a fall onto an outstretched hand or with repeated twisting loads. Many tears settle with rest, splinting and hand therapy. When symptoms persist, keyhole surgery through a wrist arthroscopy can repair or tidy the tear.
What is a TFCC tear?
A TFCC tear is a tear in the triangular fibrocartilage complex (TFCC), a structure on the little finger side of the wrist that cushions the joint and holds the forearm bones together. The TFCC sits between the end of the ulna — the forearm bone on the little finger side — and the small carpal bones of the wrist, and it is made up of a cartilage disc surrounded by ligaments.
The triangular fibrocartilage complex has two main jobs. The TFCC acts as a shock absorber, spreading load across the little finger side of the wrist, and it stabilises the joint between the two forearm bones so the forearm can rotate smoothly when turning the palm up and down. A tear in the TFCC therefore tends to cause both pain and a sense of instability or clicking on the outer edge of the wrist. Tears are described as traumatic, following an injury, or degenerative, where the cartilage thins and frays with age and load over time.
What causes a TFCC tear?
A TFCC tear is most often caused by a fall onto an outstretched hand or by repeated twisting and loading of the wrist, and it can also develop gradually as the cartilage wears with age. The triangular fibrocartilage complex is vulnerable whenever force passes through the little finger side of the wrist while the forearm is rotating.
Common causes and risk factors include:
A fall onto an outstretched hand, which can tear the TFCC and sometimes accompanies a distal radius fracture
Sports involving gripping, twisting or impact through the wrist, such as racquet sports, golf and gymnastics
Repetitive forceful rotation at work, for example using tools or turning heavy handles
A longer ulna relative to the radius, a variant called positive ulnar variance, which loads the TFCC more heavily
Age-related wear, which frays the cartilage and makes degenerative tears more likely from midlife onwards
Traumatic tears tend to occur in younger, active people after a specific injury, while degenerative tears are more common with age and often have no single triggering event.
What are the symptoms of a TFCC tear?
The main symptom of a TFCC tear is pain on the little finger side of the wrist, which is typically worse with gripping, twisting the forearm or pushing through the hand. The pain is felt on the outer edge of the wrist, in the soft area between the wristbone that sticks out on the little finger side and the base of the hand.
Common symptoms of a TFCC tear include:
Pain on the little finger side of the wrist, often described as deep or aching
A clicking, catching or clunking feeling when turning the forearm or moving the wrist
Pain when loading the wrist — pushing up from a chair, opening a door, using a tin opener
A weaker grip and reluctance to twist or bear weight through the wrist
A sense that the wrist is unstable or gives way with certain movements
Symptoms range from a mild ache with heavy use to persistent pain that interferes with everyday tasks. Ulnar sided wrist pain has several possible causes besides a TFCC tear, which is why a careful assessment matters before settling on a diagnosis.
How is a TFCC tear diagnosed?
A TFCC tear is diagnosed by clinical examination supported by imaging, usually starting with an X-ray and often followed by an MRI scan. The pattern of pain on the little finger side of the wrist, tenderness in the soft spot over the TFCC and pain reproduced by specific movement tests point strongly towards the diagnosis during examination.
An X-ray is taken first to check the alignment of the forearm bones and to rule out a fracture or other bony cause, and it can show a longer ulna that predisposes to TFCC problems. An MRI scan shows the soft tissue of the triangular fibrocartilage complex and can confirm a tear, sometimes with a contrast dye injected into the joint to improve accuracy. In some cases the most reliable way to assess and grade a TFCC tear is a wrist arthroscopy, a keyhole procedure in which a small camera is placed into the wrist joint, which allows the tear to be seen directly and treated at the same time. A careful assessment also considers other sources of ulnar sided wrist pain, from ligament problems to a lump on the wrist.
What are the treatment options for a TFCC tear?
Treatment for a TFCC tear begins with non-surgical measures — rest, splinting and hand therapy — and moves to surgery only when symptoms persist despite a fair trial of these. Many TFCC tears, particularly degenerative ones, settle well without an operation, so surgery is not the automatic first step.
Non-surgical treatment
Non-surgical treatment is the first-line approach for most TFCC tears and controls symptoms in a large number of cases. The wrist is rested from the aggravating activity and supported in a splint or cast, often for four to six weeks, to allow the irritated tissue to settle. A period of relative rest gives many tears the chance to calm down, especially where instability is not a feature.
A corticosteroid injection into the joint can help settle persistent inflammation and pain, and hand therapy plays an important part once the acute pain eases, restoring movement, grip and forearm rotation. Activity changes and a temporary support during heavy tasks help prevent symptoms returning. Non-surgical treatment is typically given a trial of around three months before surgery is considered.
Surgical treatment
Surgery is considered for a TFCC tear when pain and instability persist despite splinting, injection and hand therapy, or when the tear is clearly unstable from the outset. Most TFCC surgery is performed through a wrist arthroscopy, a keyhole operation using a small camera and fine instruments, as a day case under sedation & regional anaesthetic, or general anaesthetic.
The type of surgery depends on where and how the TFCC is torn. A tear at the outer, well-supplied edge of the cartilage can often be repaired with stitches, because this part of the TFCC has a blood supply and can heal. A tear in the central, poorly-supplied part cannot heal by repair and is instead trimmed and smoothed — a debridement — to remove the unstable flap causing the catching and pain.
What is recovery like after TFCC surgery?
Recovery after TFCC surgery depends on whether the tear was repaired or trimmed, and ranges from a few weeks to a few months before full function returns. A debridement, where the tear is tidied rather than stitched, recovers quicker than a repair, which needs time protected in a splint or cast for the stitched cartilage to heal.
After a debridement the wrist is rested briefly and hand therapy begins early, with most people returning to light activity within two to four weeks and heavier use over the following weeks. After a repair the wrist is usually supported in a splint or cast for around six weeks to protect the healing tissue, and forearm rotation is limited during that time, followed by a structured hand therapy programme to rebuild movement and strength. Return to manual work and sport after a repair commonly takes around three months. A hand therapist guides the pace throughout, and progress is checked against comfort and function rather than the calendar alone.
When should I see a hand surgeon about wrist pain?
You should see a hand surgeon about wrist pain when pain on the little finger side of the wrist persists beyond a few weeks, follows a significant fall, or comes with clicking, weakness or a sense of instability. Ulnar sided wrist pain has several possible causes, and a specialist assessment establishes whether a TFCC tear or another problem is responsible.
Prompt assessment is particularly worthwhile after a fall onto an outstretched hand, since the same injury can cause a fracture, a TFCC tear or a ligament problem, and these are treated differently. Pain that is not settling with rest, that disturbs sleep or that stops you gripping and twisting the wrist normally is also worth reviewing. An accurate diagnosis early on avoids prolonged discomfort and guides whether simple measures or surgery are likely to help.
My approach to TFCC tears
In my practice most TFCC tears are managed without surgery to begin with, and I reserve an operation for tears that stay symptomatic despite a proper trial of splinting, injection and hand therapy, or that are unstable from the start. A careful history and examination, backed by an X-ray and usually an MRI scan, establish the diagnosis and separate a TFCC tear from the other causes of ulnar sided wrist pain.
When surgery is needed I use a wrist arthroscopy to see the tear directly and treat it in the same procedure, repairing a peripheral tear that can heal or trimming a central tear that cannot. I set out honestly which tears are likely to do well with rest and which are better repaired, and I involve a hand therapist closely, since rehabilitation is central to the result. Related wrist injuries such as scaphoid fractures are assessed and treated in their own right when they occur alongside.
I consult at London Sports Orthopaedics, 31 Old Broad Street and operate at London Bridge Hospital, as well as Spire Bushey and Pinehill Hospital in Hertfordshire. If wrist pain on the little finger side is not settling, you are welcome to book a consultation.
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Frequently asked questions about TFCC tears
What is a TFCC tear in the wrist? A TFCC tear is an injury to the triangular fibrocartilage complex, a small cushion of cartilage and ligaments on the little finger side of the wrist. The TFCC absorbs load and holds the two forearm bones together so the forearm can rotate smoothly. A tear causes pain on the outer edge of the wrist, often with clicking and a weaker grip, and follows either an injury or gradual age-related wear.
Can a TFCC tear heal on its own? Some TFCC tears settle on their own with rest, splinting and hand therapy, particularly tears at the outer edge of the cartilage, which has a blood supply, and many degenerative tears where instability is not a problem. Tears in the central part of the TFCC cannot heal by themselves because that area has little blood supply, though they can still become comfortable with non-surgical treatment even when they do not knit together.
How long does a TFCC tear take to heal? A TFCC tear treated without surgery often settles over around six to twelve weeks of rest, splinting and hand therapy, though this varies with the tear and the demands placed on the wrist. After surgery, a trimming procedure recovers within a few weeks, while a repair needs about six weeks protected in a splint or cast followed by rehabilitation, with full function commonly taking around three months.
What does a TFCC tear feel like? A TFCC tear typically feels like a deep ache or sharp pain on the little finger side of the wrist, worse with gripping, twisting the forearm or pushing through the hand. Many people notice a click, catch or clunk when turning the forearm, along with a weaker grip and a sense that the wrist is unstable. Everyday tasks such as opening jars, turning keys and pushing up from a chair often aggravate the pain.
Do I need surgery for a TFCC tear? Most TFCC tears do not need surgery. Non-surgical treatment with rest, a splint, an injection and hand therapy controls symptoms in a large number of cases and is tried first, usually over about three months. Surgery is considered when pain and instability persist despite this, or when the tear is clearly unstable. When surgery is needed it is usually a keyhole wrist arthroscopy to repair or trim the tear.
How is a TFCC tear diagnosed? A TFCC tear is diagnosed by clinical examination together with imaging. The location of the pain, tenderness over the TFCC and specific movement tests point to the diagnosis, and an X-ray is taken to exclude a fracture and check the length of the ulna. An MRI scan shows the torn cartilage, sometimes with contrast dye, and in some cases a wrist arthroscopy gives the most reliable assessment and treats the tear at the same time.
Can a TFCC tear cause long-term problems if untreated? An untreated TFCC tear can cause ongoing pain, weakness and clicking, and where the tear leaves the wrist unstable it may, over time, contribute to further wear in the joint. Many tears settle with appropriate treatment, so persistent ulnar sided wrist pain is worth assessing rather than leaving. Early diagnosis allows the right treatment — non-surgical or surgical — to be chosen before symptoms become entrenched.
What is the difference between a TFCC tear and a wrist sprain? A wrist sprain is a stretch or minor tear of the wrist ligaments that usually settles within a few weeks, whereas a TFCC tear is a specific injury to the cartilage and ligament complex on the little finger side of the wrist that can persist and sometimes needs surgery. Ulnar sided pain, clicking and pain on twisting the forearm suggest a TFCC tear rather than a simple sprain, which is why lingering wrist pain is worth assessing.
Mr Gavin Schaller FRCS(Tr&Orth), Consultant Hand & Wrist Surgeon The Schaller Hand & Wrist Clinic About Mr Schaller
This article is for general information only and is not a substitute for a consultation with a qualified clinician. If you have concerns about your hand or wrist, please seek medical advice.
