Can a 4 month old tfcc tears heal on its own without surgery?

Unlikely if 4mos: It is already likely to be healed at this point.

Prob not: Tfcc tears that are chronic will most likely not heal on their own, sometimes proper immobilization will help. But, most likely a wrist scope and repair is in your future. Get checked by your hand surgeon.

Treat the symptoms: Tfcc tears are notoriously slow to heal. However, many never heal, but symptoms can subside. Healing is better defined by resolution of pain & return to normal function, not necessarily in this situation by appearance on an mri. If you wish to avoid surgery, then you have to be avoid exacerbating activities & consider rehab with a physical or occupation therapist with possible intermittent bracing.

TFCC tears: That are not fresh and either several months old or chronic will not lilkey heal but some tears will be less symptomatic with conservative ( non surgical rx ) that may include a corticosteroid injection and splinting. But even if operatd upon many tears oare not repaired and are just debrided to make them more stable and less symptomatic, so i often will try non operative rx for many types of tear.

Chronic Injury: Tfcc injuries are by definition difficult to heal without surgical intervention. The reason is that central portion of the tfcc has a very poor blood supply. Once injured, it remains frayed and jagged. With wrist motions it causes inflammation. Surgery can help to clean up the torn tissue and get you on the road to recovery.