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

Introduction

The wrist is a highly complex joint, responsible for a wide range of movements that are essential for daily activities. Among its many structures, the Triangular Fibrocartilage Complex (TFCC) plays a vital role in stability and function. Injuries or degenerative changes within the TFCC can lead to persistent wrist pain, loss of grip strength, and difficulty performing routine tasks.

At Alton Pain Clinic, we provide detailed information about TFCC conditions and the role of ultrasound-guided cortisone injections as one of the available treatment options. These injections are delivered with precision under imaging guidance, allowing clinicians to target specific sites within the wrist.

Anatomy of the TFCC

The TFCC is located on the small finger side of the wrist and acts as a stabiliser of the distal radioulnar joint (DRUJ) and the ulnar side of the wrist. Its anatomy includes:

  • Triangular fibrocartilage disc – a cushioning structure between the ulna and carpal bones.

  • Dorsal and volar radioulnar ligaments – provide stability to the DRUJ.

  • Ulnolunate and ulnotriquetral ligaments – stabilise connections to the carpal bones.

  • Sheath of the extensor carpi ulnaris (ECU) tendon – closely associated with TFCC function.

This combination of ligaments, tendons, and cartilage enables smooth wrist motion, load-bearing across the joint, and stabilisation during gripping or twisting activities.

Pathology of TFCC

TFCC injuries can occur due to both acute trauma and gradual degenerative changes.

  • Traumatic injuries often result from falls on an outstretched hand, sports injuries, or sudden twisting movements of the wrist.

  • Degenerative changes are more common with ageing or repetitive wrist strain, particularly in individuals who perform tasks involving heavy or repetitive use of the wrist.

Common pathological findings include:

  • Tears of the fibrocartilage disc.

  • Stretching or rupture of the supporting ligaments.

  • Degeneration associated with ulnar variance (when the ulna is longer than the radius, increasing pressure on the TFCC).

Symptoms of TFCC Injuries

Patients with TFCC pathology may experience:

  • Pain on the ulnar (small finger) side of the wrist.

  • Clicking, grinding, or catching sensations during movement.

  • Swelling and tenderness in the wrist.

  • Weakness in grip strength.

  • Exacerbation of discomfort during pronation-supination (twisting) movements of the forearm.

These symptoms often interfere with everyday activities such as lifting, typing, gripping, or turning keys.

Diagnosis of TFCC Conditions

Diagnosis begins with a thorough clinical examination, during which a clinician will assess for tenderness, stability, and range of motion. Special wrist manoeuvres may be used to reproduce symptoms.

Investigations that may assist in diagnosis include:

  • Ultrasound – helpful in guiding injections and detecting certain soft tissue issues.

Management of TFCC Conditions

Management is based on the severity of symptoms, the underlying cause, and individual patient needs.

  • Activity modification – avoiding movements that aggravate the wrist.

  • Injections – ultrasound-guided cortisone injections may be considered to target inflammation.

Ultrasound-Guided Cortisone Injections for TFCC

Ultrasound guidance allows clinicians to visualise the anatomy of the wrist in real-time, ensuring accurate placement of the injection. This is particularly useful given the complexity and small size of the TFCC region.

Cortisone injections are sometimes used in managing TFCC conditions. Cortisone is a corticosteroid designed to address inflammation within joints and soft tissues. By targeting the affected area, it can help reduce swelling and associated discomfort.

At Alton Pain Clinic, injections are performed under ultrasound guidance, which helps clinicians position the needle with precision, avoiding surrounding structures and delivering the medicine exactly where intended.

Mechanism of Action of Cortisone

Cortisone works by interfering with the inflammatory process at a cellular level. Its actions include:

  • Reducing the production of inflammatory mediators.

  • Decreasing capillary permeability, limiting swelling.

  • Modulating the immune response in the targeted tissues.

This combination of effects helps lower local inflammation in the wrist, supporting improved mobility and reduction in pain signals.

Benefits of Ultrasound Guidance

The use of ultrasound guidance in TFCC injections provides several benefits:

  • Real-time imaging for accuracy.

  • Improved needle placement into small and complex spaces.

  • Avoidance of blood vessels, nerves, and tendons.

  • Enhanced confidence in the procedure for both clinician and patient.

Why Choose Alton Pain Clinic

At Alton Pain Clinic, patients are offered a professional and individualised approach to wrist conditions such as TFCC pathology. The clinic prioritises:

  • Precision – with ultrasound-guided techniques.

  • Expertise – from clinicians experienced in musculoskeletal injections.

  • Personalised care – tailored to each patient’s symptoms and needs.

The aim is to support improved function and quality of life by using targeted treatment approaches.

Conclusion

The Triangular Fibrocartilage Complex is a crucial component of wrist stability and function. Injuries or degeneration of this structure can lead to persistent and limiting wrist pain. Management options are varied, and ultrasound-guided cortisone injections represent one potential part of a comprehensive care plan.

At Alton Pain Clinic, emphasis is placed on accurate diagnosis, advanced image-guided procedures, and personalised management for those experiencing wrist pain related to TFCC conditions.

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