TFCC Injuries in Climbers

Rachel Rubin-Sarganis MScPT | Physiotherapist | Parkway Physiotherapy Tuscany Village

What Is the TFCC?

The Triangular Fibrocartilage Complex (TFCC) is a group of structures located on the small-finger (ulnar) side of the wrist that help stabilize and cushion the joint between the ulna (one of the forearm bones) and the carpal bones (small wrist bones).

• A triangular pad of fibrocartilage with surrounding ligaments and the extensor carpi ulnaris (ECU) tendon sheath
• Lives on the pinky (ulnar) side of your wrist
• Functions like a shock absorber + seatbelt
  • Cushions the ulna and carpal bones
  • Keeps the radius and ulna aligned as you rotate, pull, or push

Climbing load points: slopers, underclings, gastons, twisting pinches, dynamic mantles.

Early Clues You Might Have a TFCC Injury

• Deep ache or sharp pain on the wrist’s pinky side
• Clicking or a “giving way” feeling with rotation or weight bearing
• Pain with heavy pronation/supination or when leaning hard on slopers and gastons
• Local tenderness or swelling in the hollow beside the ulna

Diagnosis Pathway

Sports medicine and climbing-health literature recommend a stepwise algorithm:

1. Clinical Assessment

• History of climbing loads and any traumatic fall
• Palpation and specific tests: TFCC load test, ulnar fovea sign, piano-key sign

2. Imaging

• X-ray: rules out fractures and checks ulna length (positive ulnar variance increases TFCC stress)
• MRI or MR arthrogram: gold standard to see tears or degeneration
• Diagnostic arthroscopy: used when MRI is inconclusive or surgery is considered

Your Recovery Map

Think three overlapping goals, not just time off.

Stabilize & Protect

• Wrist brace or splint for 4–6 weeks if pain is significant
• Gentle motion (pain-free) to maintain circulation

Rebuild Motion & Strength

• Controlled pronation–supination and ulnar/radial deviation drills
• Isometric wrist holds in neutral and slight ulnar deviation
• Gradual grip and forearm strengthening

Return to Climbing Skills

• Begin with easy climbs and open-hand grips
• Slowly add twisting and compression moves, then underclings and gastons
• Expect 8–12 weeks or longer for a full return depending on tear size and demands

Long-Term Wrist Care for Climbers

• Warm up every session with wrist circles and progressive hangs
• Mix grips—avoid overloading the ulnar side day after day
• Build scapular and core strength so wrists aren’t the first structure to fail
• Respect fatigue: most TFCC injuries occur late in sessions

Quick Exercise Guide

Exercise	Purpose	Frequency
Pronation–Supination with light weight	Restore rotation control	2–3×/week
Ulnar/Radial Deviation with band	Strengthen ulnar stabilizers	2–3×/week
Isometric Wrist Holds	Build joint stability	2×/week
Scapular Stability Drills	Offload the wrist	2–3×/week

Bottom Line

The TFCC is the wrist’s main shock absorber and stabilizer.
Early recognition, stepwise imaging, and progressive reloading let most climbers return to pain-free, powerful movement—without chronic wrist trouble.

Parkway Physiotherapy Tuscany Village
1646 McKenzie Ave #101, Victoria, BC V8N 0A3
Tel. 778-432-3333
Book with Rachel: parkwayphysiotuscanyvillage.janeapp.com/Rachel