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# TFCC

The triangular fibrocartilage complex (TFCC) cushions the little-finger side of the wrist and holds the radius and ulna together as the forearm turns.

Official name: Triangular fibrocartilage complex

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## What it is

A cushion of cartilage and ligaments between the end of the ulna and the wrist, on the little-finger side.

## What it does

Cushions the ulnar side of the wrist and holds the radius and ulna together as the forearm turns.

## Key points

- Main stabiliser of the distal radioulnar joint (DRUJ): its dorsal and palmar radioulnar ligaments, anchored deep in the ulnar fovea, hold the radius to the ulna as the forearm turns
- Only the outer rim of the disc has a blood supply: peripheral tears can heal or be repaired, while central tears are usually debrided
- Palmer classification: class 1 traumatic (1A central, 1B ulnar, 1C distal at the ulnocarpal ligaments, 1D radial) and class 2 degenerative, linked to ulnar-positive variance

## Key facts

**Attaches**
Articular disc from the ulnar notch of the radius to the ulnar fovea and styloid, with dorsal and palmar radioulnar ligaments

**Function**
Stabilises the distal radioulnar joint; cushions the ulnar side of the wrist (loaded in ulnar deviation)

## Relations

**Above**
Head of the [ulna](https://durgical.com/en/anatomy/ulna/) and the DRUJ cavity, which the disc seals off from the radiocarpal joint

**Below**
[Lunate](https://durgical.com/en/anatomy/lunate/) and [triquetrum](https://durgical.com/en/anatomy/triquetrum/), which glide on its distal surface; the [ulnocarpal ligaments](https://durgical.com/en/anatomy/ulnocarpal-ligaments/) blend with its palmar edge

**Lateral**
Ulnar (sigmoid) notch of the [radius](https://durgical.com/en/anatomy/radius/), where the disc and both radioulnar ligaments arise

**Medial**
Ulnar styloid and fovea; the meniscus homologue and the ulnar collateral ligament on the far ulnar side

**Behind**
[Extensor carpi ulnaris](https://durgical.com/en/anatomy/extensor-carpi-ulnaris/) (ECU) tendon in its subsheath in the sixth dorsal compartment, which is counted as part of the complex

## How to find it

With the forearm in neutral rotation, the soft spot bounded by the ulnar styloid, the [flexor carpi ulnaris tendon](https://durgical.com/en/anatomy/flexor-carpi-ulnaris-tendon/), the [pisiform](https://durgical.com/en/anatomy/pisiform/) and the palmar ulnar head lies over the foveal attachment. The disc itself sits just distal to the ulnar head, on the little-finger side of the wrist.

## Examination

- Fovea sign: pressure in the soft spot between the ulnar styloid and [flexor carpi ulnaris](https://durgical.com/en/anatomy/flexor-carpi-ulnaris/) reproduces the pain; points to a foveal TFCC detachment or an ulnotriquetral ligament tear
- TFCC load (ulnocarpal stress) test: axial load with the wrist in ulnar deviation while the forearm is rotated; pain, clicking or crepitus suggests a TFCC tear or ulnar impaction
- DRUJ ballottement (piano-key test): the radius is held and the ulnar head pushed dorsally and palmarly, compared with the other side; extra glide means DRUJ instability, usually from a foveal tear

## On imaging

A PA view in neutral rotation (shoulder abducted, elbow at 90°) measures ulnar variance. MRI, or better MR arthrography, shows a tear and whether it is central or peripheral; contrast passing from the radiocarpal joint into the DRUJ marks a perforation. Arthroscopy remains the reference standard: a torn disc loses its normal springy tension when probed.

## Common problems

- Tear from a fall on an outstretched hand or from twisting; pain on the little-finger side of the wrist.
- Wear with age, especially when the ulna is a little longer than the radius (ulnar impaction).
- Clicking and weakness when turning a doorknob or lifting a pan.

## How it is diagnosed

Tenderness in the soft spot next to the ulnar head and pain with twisting tests. X-rays check ulnar length; MRI or arthroscopy shows the tear.

## Treatment

- Splint, activity changes and sometimes an injection.
- Arthroscopic trimming or repair of the tear.
- Ulnar shortening surgery when the ulna is too long.

## Clinical notes

- Distal radius fractures with a fracture at the base of the ulnar styloid can take the foveal attachment with them and leave the DRUJ unstable
- Galeazzi fracture-dislocation: a radial shaft fracture with disruption of the DRUJ, in which the TFCC is torn
- Ulnar-sided wrist pain has a crowded differential around it: ECU tendinitis or subluxation, [lunotriquetral ligament](https://durgical.com/en/anatomy/lunotriquetral-ligament/) tear, pisotriquetral arthritis, hook of [hamate](https://durgical.com/en/anatomy/hamate/) fracture
- Ulnar shortening osteotomy unloads the TFCC when ulnar impaction comes with positive variance

## Anatomical variants

- Central perforations of the disc become common with age and are often degenerative and painless, so an MRI finding needs clinical correlation
- Ulnar variance (length of the ulnar head relative to the radius) differs between people; the disc tends to be thicker with negative variance and thinner with positive variance

## Related conditions

- [Distal radius fracture (Colles)](https://durgical.com/en/conditions/distal-radius-fracture/)
- [Rheumatoid arthritis of the hand and wrist](https://durgical.com/en/conditions/rheumatoid-arthritis-of-the-hand-and-wrist/)

## Test yourself

Think of the answer, then tap the question to see it.

## What is the main stabiliser of the distal radioulnar joint?

The TFCC, through its dorsal and palmar radioulnar ligaments anchored deep in the ulnar fovea.

## Why can peripheral TFCC tears heal while central tears usually cannot?

Only the outer rim of the disc has a blood supply; central tears are usually debrided.

## How does the Palmer classification divide TFCC tears?

Class 1 traumatic (1A central, 1B ulnar, 1C distal, 1D radial) and class 2 degenerative, linked to ulnar-positive variance.

## What does the fovea sign point to?

A foveal TFCC detachment or an ulnotriquetral ligament tear: pressure between the ulnar styloid and flexor carpi ulnaris reproduces the pain.

## Which operation unloads the TFCC in ulnar impaction with positive variance?

Ulnar shortening osteotomy.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
discus articulationis radioulnaris distalis TA2 1782

**Official Spanish (DeCS)**
Disco articular de la articulación radioulnar distal; ligamentos radioulnares dorsal y palmar

**English (TA2)**
Triangular fibrocartilage complex

**Also called**
Articular disc of the distal radio-ulnar joint (its main part)

## Related

- [Ulnocarpal ligaments](https://durgical.com/en/anatomy/ulnocarpal-ligaments/)
- [Wrist extensor tendons](https://durgical.com/en/anatomy/wrist-extensor-tendons/)
- [Lunotriquetral ligament](https://durgical.com/en/anatomy/lunotriquetral-ligament/)
- [Lunate](https://durgical.com/en/anatomy/lunate/)
- [Radius](https://durgical.com/en/anatomy/radius/)
- [Ulna](https://durgical.com/en/anatomy/ulna/)

Sources: Terminologia Anatomica (TA2); [Anatomy, Shoulder and Upper Limb, Forearm Triangular Fibrocartilage Complex](https://www.ncbi.nlm.nih.gov/books/NBK554564/); [Anatomy, Shoulder and Upper Limb, Distal Radio-Ulnar Joint](https://www.ncbi.nlm.nih.gov/books/NBK547720/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/triangular-fibrocartilage-complex/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/triangular-fibrocartilage-complex/