Expert Care for Ulnar-Sided Wrist Pain in San Francisco
Do you have pain on the “pinky side” of your wrist that won’t go away? Does your wrist click or pop when you turn a doorknob? You may have an injury to the TFCC. At California Pacific Orthopaedics in San Francisco, our hand and wrist specialists are experts in diagnosing and treating this common but often overlooked condition.
Overview: What is the TFCC?
The Triangular Fibrocartilage Complex (TFCC) is a small but mighty structure inside your wrist. You can think of it as a “shock absorber” or a hammock located on the ulnar side (the pinky finger side) of your wrist.
It is made of cartilage and ligaments that connect the two long bones of your forearm (the radius and the ulna) to the small bones of your wrist. It has two main jobs:
- Cushioning: It helps your wrist bear weight and absorbs impact.
- Stability: It keeps the forearm bones steady when you rotate your wrist or grip objects.
Because the TFCC is used in almost every movement your hand makes, it is prone to tearing. A tear in this cartilage can make simple daily tasks, like pouring coffee or doing a push-up, painful and difficult.
Common Symptoms
TFCC tears can be tricky because they often feel like a simple wrist sprain. However, the pain usually persists long after a sprain should have healed.
The most common signs of a TFCC injury include:
- Ulnar-Sided Pain: Pain specifically on the pinky side of the wrist. It may feel like a deep ache or a sharp pain.
- Pain with Rotation: It hurts to twist your wrist, such as when turning a doorknob, opening a jar, or using a screwdriver.
- Weight-Bearing Pain: Pushing yourself up out of a chair or doing a push-up causes sharp pain.
- Clicking or Popping: You may hear or feel a “click” in your wrist when you move it.
- Weak Grip: Your hand feels weak, and you may have trouble holding heavy objects.
- Instability: In severe cases, the wrist may feel “loose” or like it is shifting out of place.
Causes: How Do Tears Happen?
There are two main ways the TFCC gets injured. Doctors categorize these as Traumatic (injury-based) or Degenerative (age-based).
1. Traumatic Tears (Injury)
These happen suddenly. The most common cause is falling onto an outstretched hand (often called a “FOOSH” injury). When you land hard on your palm, the impact can tear the cartilage.
- Sports Injuries: Athletes in San Francisco who play tennis, golf, or baseball are at higher risk because these sports involve forceful twisting of the wrist.
- Work Accidents: Sudden forceful twisting, like a drill binding up while you are holding it, can also cause a tear.
2. Degenerative Tears (Wear and Tear)
As we age, the cartilage in the wrist can become thin and frayed, just like fabric that has been washed too many times. These tears occur slowly over time and are often associated with arthritis.
Common Risk Factors
Anyone can injure their wrist, but certain factors make a TFCC tear more likely:
- Age: People over age 50 are more likely to have degenerative tears because cartilage naturally weakens with time.
- Ulnar Variance: This is a term for the length of your arm bones. Some people are born with an ulna bone that is slightly longer than the radius bone (called “positive ulnar variance”). This puts extra pressure on the TFCC, making it easier to tear.
- High-Impact Sports: Gymnastics, tennis, and golf put high stress on the wrist.
- Repetitive Motions: Jobs that require heavy twisting or gripping (like carpentry or assembly line work) can wear down the TFCC over time.
Diagnosis: How We Find the Problem
Because the wrist is complex, diagnosing a TFCC tear requires an expert eye. At California Pacific Orthopaedics, our exams typically include:
- The “Fovea” Sign: Your doctor will press on a specific spot on the outside of your wrist. If it is tender, it is a strong sign of a TFCC injury.
- Load Testing: The doctor may move your wrist in specific ways to see if it clicks or causes pain.
- MRI Scans: X-rays are good for looking at bones, but they cannot see cartilage. Your doctor will likely order an MRI to see the soft tissues of the TFCC clearly.
Treatment Options
Not every TFCC tear needs surgery. Our goal is to get you pain-free with the least invasive treatment possible.
Non-Surgical Treatment
For many patients, especially those with stable tears, the wrist can heal on its own with rest.
- Splinting: You may wear a special brace (often a “sugar tong” or “Munster” splint) that prevents your wrist from rotating. This gives the cartilage time to heal.
- Anti-Inflammatories: Medications like ibuprofen can reduce swelling.
- Steroid Injections: A cortisone shot can provide strong, temporary relief from inflammation.
- Hand Therapy: Specialized exercises can strengthen the muscles around the wrist to take pressure off the TFCC.
Surgical Treatment
If non-surgical treatments don’t work, or if the tear is causing instability, surgery may be needed.
- Wrist Arthroscopy: This is a minimally invasive procedure. The surgeon makes tiny incisions (about the size of a buttonhole) and uses a small camera to look inside the wrist. They can then shave down frayed tissue (debridement) or stitch the torn cartilage back together (repair).
- Ulnar Shortening: If you have “positive ulnar variance” (the long bone mentioned earlier), the surgeon may shorten the bone slightly to permanently relieve pressure on the TFCC.
Why Choose California Pacific Orthopaedics?
Your hands are essential for everything you do. Treating TFCC tears requires a deep understanding of the intricate anatomy of the wrist.
At California Pacific Orthopaedics, our team includes fellowship-trained hand surgeons who are leaders in their field. We treat patients from across the Bay Area—from professional athletes to weekend warriors—helping them return to their active lifestyles without pain.
Don’t ignore that clicking in your wrist. If you have pain on the pinky side of your hand, let us help you find the cause. Schedule an appointment today with our San Francisco hand specialists.
