Anatomy, aetiology, clinical presentation, classification, diagnosis, and non-surgical management of triangular fibrocartilage complex tears: a narrative review

Background Triangular fibrocartilage complex (TFCC) injuries are a common source of ulnar-sided wrist pain and functional impairment, particularly in athletes and individuals engaged in upper-limb-dominant or wrist-loading activities. Despite their prevalence, standardised, non-surgical treatment pathways remain underdeveloped. Hypothesis/purpose This narrative review aims to critically synthesise and discuss current evidence on the non-surgical management of TFCC injuries in physically active adults. Study design Narrative review. Methods A structured literature search was performed in PubMed, Scopus, Web of Science, and the Cochrane Library for English-language studies published from January 2015 to May 2025. The identified studies focusing on the non-surgical management of TFCC injuries were screened and included. Results Current evidence suggests a range of non-surgical interventions for pain reduction and functional improvement in TFCC injuries across different clinical presentations, including rest, splinting, physical therapy, NSAIDs, corticosteroid injections, and progressive functional rehabilitation. Adjunctive modalities such as extracorporeal shock wave therapy and platelet-rich plasma injections also show potential benefits. However, important gaps persist in TFCC classification–specific treatment recommendations, the standardisation of rehabilitation protocols, and the integration of emerging therapies. Conclusion This review synthesises current evidence on the non-surgical management of TFCC injuries. Recognising differences in injury mechanism, particularly between acute trauma-related and repetitive overuse-related degenerative presentations, it proposes a structured, phase-based rehabilitation framework for TFCC lesions with an intact distal radioulnar joint. The framework emphasises presentation-specific early management, progressive tissue loading, and functional reintegration. Clinical relevance This review provides clinicians with a conceptual, non-surgical framework to guide the management of TFCC injuries, aiming to support pain reduction and functional recovery in physically active adults. What is known about this subject While surgical options for TFCC injuries are well established, standardised non-surgical pathways remain underdeveloped and diagnosis can be challenging due to overlapping presentations. What this study adds to existing knowledge This review summarises current evidence on non-surgical TFCC management, including conventional and emerging therapies, and outlines a stage-based approach derived from available literature and clinical reasoning to support individualised non-surgical care.