Ultrasound-Guided Cortisone Injection for Triangular Fibrocartilage Complex (TFCC)

 

Introduction

The wrist is a highly complex joint, allowing a wide range of motion essential for activities of daily living. Within the wrist, one of the most important stabilising structures is the Triangular Fibrocartilage Complex (TFCC). The TFCC is a collection of cartilage and ligament structures located on the small finger side of the wrist, providing stability and cushioning between the forearm bones (ulna and radius) and the carpal bones.

Injury or degeneration of the TFCC is a frequent cause of ulnar-sided wrist pain. This condition may interfere with simple activities such as twisting a doorknob, turning a key, lifting objects, or bearing weight through the wrist.

At Joint Injections, clinicians utilise advanced interventions such as ultrasound-guided cortisone injections to manage TFCC-related discomfort with accuracy and precision. This blog explores the TFCC in detail, including its anatomy, pathology, clinical presentation, diagnosis, management options, and the role of ultrasound-guided cortisone injections.

Anatomy of the Triangular Fibrocartilage Complex

The TFCC is a sophisticated arrangement of ligaments, tendons, and cartilage structures designed to stabilise the distal radioulnar joint (DRUJ) and cushion the ulnocarpal joint.

The key components include:

  • Articular disc (triangular fibrocartilage): A thin cartilage structure that acts as a cushion between the ulna and carpal bones.
  • Dorsal and volar radioulnar ligaments: Provide stability to the DRUJ.
  • Ulnolunate and ulnotriquetral ligaments: Connect the ulna to the carpal bones.
  • Extensor carpi ulnaris (ECU) tendon sheath: Stabilises the tendon and integrates with the TFCC.
  • Meniscus homologue: A structure that further cushions the joint.

Together, these structures support smooth movement of the wrist and prevent excessive motion at the distal radioulnar joint.

Pathology of TFCC Injuries

Injury or degeneration of the TFCC can arise due to several mechanisms:

  • Traumatic tears: Often occur from falls on an outstretched hand, sudden twisting, or heavy lifting.
  • Degenerative changes: Associated with repetitive use or age-related wear and tear, especially in individuals with longer ulnae (ulnar variance).
  • Instability: Damage to the TFCC may cause instability of the distal radioulnar joint.
  • Inflammation: Secondary inflammation can occur around the structures of the TFCC following injury or overuse.

These changes may result in discomfort, swelling, reduced grip strength, and clicking sensations within the wrist.

Causes and Risk Factors

  • Repetitive wrist motion: Activities such as racket sports, manual labour, or typing.
  • Trauma: Falls, direct blows, or sudden forced rotation of the wrist.
  • Degenerative factors: Age-related wear and anatomical variations such as positive ulnar variance.
  • Arthritis: Co-existing degenerative conditions may predispose to TFCC injuries.

Symptoms of TFCC Injury

The clinical features of a TFCC injury may include:

  • Pain on the ulnar side of the wrist: Worsens with gripping, twisting, or rotational movements.
  • Clicking or popping sensations: Especially with wrist rotation.
  • Weak grip strength: Reduced ability to hold or carry objects.
  • Swelling: Localised around the ulnar side of the wrist.
  • Instability: A sense of looseness at the wrist in some cases.

Diagnosis of TFCC Injuries

Accurate diagnosis is essential for effective management. Clinicians at Joint Injections may use:

  • Clinical assessment: Checking for tenderness over the TFCC, range of motion, grip strength, and provocative manoeuvres such as the ulnar grind test.
  • Imaging:
  • Ultrasound: Can help visualise inflammation and guide injections.

Diagnosis is often based on a combination of history, examination, and imaging findings.

Management of TFCC Injuries

Treatment depends on the severity of injury, symptoms, and patient goals. Options include:

  • Activity modification: Avoiding activities that aggravate symptoms.
  • Analgesia or anti-inflammatory measures: To alleviate discomfort.
  • Injections: Cortisone injections may be considered where conservative approaches have not been sufficient.
  • Surgery: Reserved for persistent or severe cases, including repair or debridement of the TFCC.

Ultrasound-Guided Cortisone Injections

At Joint Injections, ultrasound guidance is used to deliver cortisone injections with precision. Ultrasound allows clinicians to visualise the TFCC and surrounding structures in real time, ensuring that the medication is accurately placed.

Advantages of ultrasound guidance:

  • Real-time imaging of soft tissues.
  • Accurate delivery of medication into the affected area.
  • Reduced risk of injury to nearby tendons, ligaments, or nerves.
  • Improved patient confidence in the procedure.

What is Cortisone?

Cortisone is a corticosteroid with potent anti-inflammatory properties. It is used in injections to reduce inflammation in musculoskeletal conditions, including TFCC-related pain. When precisely injected, cortisone may help reduce swelling and support recovery strategies.

Mechanism of Action of Cortisone

Cortisone acts at multiple levels to manage inflammation:

  • Reduces inflammatory mediators: Suppresses substances that cause swelling and discomfort.
  • Decreases vascular permeability: Minimises fluid leakage into tissues.
  • Dampens immune cell activity: Reduces the cycle of inflammation within the TFCC.
  • Facilitates rehabilitation: By alleviating inflammation, patients can better engage in strengthening and mobility exercises.

At Joint Injections, clinicians perform these injections under ultrasound guidance in a safe and controlled environment.

Why Choose Joint Injections?

  • Expertise: Our clinicians are highly trained in musculoskeletal conditions and guided injection techniques.
  • Tailored care: Each patient receives a personalised management plan based on their individual needs.
  • Precision technology: High-resolution ultrasound ensures accuracy and safety in every procedure.
  • Comprehensive approach: Injections are considered alongside other strategies to provide a complete management pathway.

Summary

The Triangular Fibrocartilage Complex (TFCC) plays a critical role in stabilising the wrist and enabling smooth forearm movement. Injuries or degeneration of the TFCC can lead to persistent ulnar-sided wrist pain, instability, and reduced function.

Management may involve activity modification, splinting, physiotherapy, or injections. At Joint Injections, ultrasound-guided cortisone injections are delivered with accuracy and precision, providing a targeted approach within a comprehensive care pathway.

This evidence-informed strategy allows patients to receive care tailored to their individual needs, delivered by skilled clinicians in a professional setting at Joint Injections.


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