TFCC Injury

The commonest label on the ulnar side of the wrist, and the one most often applied to a scan rather than a patient.

Illness script in one line: ulnar-sided wrist pain after a rotation or axial load — pushing off a chair, a fall on an extended wrist, a racquet — with clicking or catching on pronation and supination and pain on weight-bearing through the hand.

Caseload frequency: common on any sporting or hand caseload. Read further: prevalence and management in racquet sport players [1].

Traumatic and degenerative TFCC are two different problems wearing the same name

This pattern is written for the traumatic one — the fall, the racquet, the gymnast — and for a student caseload that is the right choice. But you will meet the other one, and applying this pattern to it goes wrong.

TFCC lesions have a formal classification [2] and the split that matters to you is traumatic versus degenerative.

One anatomical fact makes this usable: ulnar variance changes with grip and forearm rotation, which is why the pronated grip view matters when a radiologist is assessing it [4]. A wrist that looks ulnar-neutral at rest can be ulnar-positive under the exact load the patient complains about.

Main problem

"It hurts on the little-finger side when I twist or push." Ulnar-sided wrist pain after rotation or axial load (e.g. push off chair, fall).

The two words to listen for are twist and push. If neither is in the story, question the label.

Body chart

Ulnar side, distal to the ulnar styloid, often pointed to with one finger. On examination: tenderness distal to ulnar styloid.

Get them to point with one finger before you palpate. The ulnar side of the wrist is a small postcode with several tenants — the TFCC, the DRUJ, the ECU, the pisotriquetral joint, the lunotriquetral interval, the hamate — and where they point narrows it faster than any test.

Behaviour

Clicking, catching, or instability with pronation–supination. Worse with weight-bearing on extended wrist. Eased by wrist support or avoiding rotation.

Aggs: pushing up out of a chair or off the floor, opening jars and doors, turning a key, a screwdriver, racquet strokes, press-ups, gymnastics weight-bearing, carrying with the wrist deviated.
Eases: a wrist support, avoiding rotation, not bearing weight through the hand.
Severity: VAS 0–10 at best / at worst / right now.

Ask about clicking carefully. A click that hurts and a click that is just noise are different things, and plenty of wrists click without a problem. What you want is: does the click reproduce their pain, and does it come with a sense of the wrist giving way.

The specific question worth adding: "does the door handle hurt?" Turning a handle is near-pure forearm rotation with a small grip load, and it is a clean, repeatable functional item for the whole episode of care.

History

Either a single event, or months of nothing in particular. This is where you sort traumatic from degenerative — go back to section 1.

Ask about a previous distal radius fracture. It changes the whole page — see section 4.

Special / screening questions

Common in racquet sports or gymnastics. Read further: prevalence and management in racquet sport players (Astavans et al. 2026).

• Sport and load history: racquet, gymnastics, CrossFit and calisthenics (weight-bearing on an extended wrist), rowing, golf, throwing.
• Occupational: anything with sustained rotation under load — trades, hairdressing, physiotherapy.
• Previous wrist fracture or surgery. Always ask.

Read further: a systematic clinical approach to ulnar-sided wrist pain and its principles of treatment [5], a diagnostic evaluation approach.

The discriminator that does most of the work: where the one finger points, and whether there was an event.