II. Physiology
-
Triangular Fibrocartilage Complex is a pad of connective tissue overlying distal ulna
- Originates at ulnar aspect of the radius
- Two layers
- Deep layer inserts on ulnar fovea at base of ulnar styloid (most important for stability)
- Superficial layer inserts on ulnar styloid process
- Components
- TFCC Disc
- Radioulnar ligaments
- Ulnar collateral ligament
- Ulnocarpal ligaments
-
TFCC Roles
- Anchors articular disc between ulna and proximal Carpal Bones of the wrist
- Cushions weight-bearing forces while grasping
- Helps to stabilize the distal radial-ulnar joint
III. Pathophysiology: Mechanism of injury
- Types
- Acute Traumatic Injury
- Follows injury with hyperpronation and an axial load (e.g. Fall on an outstretched hand)
- Typically affects medial insertion of TFCC at radius
- Chronic degenerative changes
- Typically affects central TFCC
- Inflammatory conditions
- Acute Traumatic Injury
- Examples
- Injury of wrist pronation in Skiing
IV. Symptoms
- Ulnar dorsal Wrist Pain
V. Signs
- Click may be perceived on Forearm rotation
- Weak grip strength
VI. Signs
- Tenderness over Ulnar complex triangle
- Triangle of tissue between ulnar and radius
- Provocative maneuvers
- Provocative range of motion planes (with pain limiting range of motion)
- Pronation and supination (may also result in a painful click at end points)
- Radial and ulnar wrist deviation
- Shuck Test positive for instability (excessive movement) or pain at radial-ulnar joint
- Radial-ulnar compression by squeezing
- Ulnocarpal compression
- Maximal ulnar deviation at full pronation and full supination
- High sensitivity but low Specificity
- Provocative range of motion planes (with pain limiting range of motion)
VII. Imaging
-
Wrist XRay
- Typically normal in TFCC ligament tear
- Ulnar variance may be present where ulna appears longer than radius (PA View)
- MRI Wrist (definitive study)
- Preferred with intraarticular gadolinium for contrast (MR Arthrography)
VIII. Management
- Conservative Therapy (injuries >2 weeks old)
- Hand therapy
- NSAIDs
- Relative rest
- Splint Immobilization for acute injuries or refractory chronic injuries
- Cock-up Wrist Splint for 4-6 weeks
- Surgical repair in refractory cases
IX. References
- Titchner, Morris and Davenport (2021) Crit Dec Emerg Med 35(5): 17-23
- Moore (1997) AAFP Sports Medicine Conference, Lecture
- Morgan (1997) Am Fam Physician 55(3): 857-68 [PubMed]
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Related Studies
| Concepts | Acquired Abnormality (T020) |
| SnomedCT | 202333005 |
| English | Tear triang fibrocart wrist, fibrocartilage tear triangular, fibrocartilage tears triangular, triangular fibrocartilage tear, Tear of triangular fibrocartilage of wrist joint, Triangular fibrocartilage tear, Triangular fibrocartilage tear (disorder) |
| Spanish | desgarro de fibrocartílago triangular (trastorno), desgarro de fibrocartílago triangular |
Ontology: Injury to triangular fibrocartilage of wrist joint (C0559417)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 281524009 |
| English | Inj triangular fibrocart wrist, Injury to triangular fibrocartilage of wrist joint, Injury to triangular fibrocartilage of wrist joint (disorder) |
| Spanish | lesión del fibrocartílago triangular de la articulación de la muñeca (trastorno), lesión del fibrocartílago triangular de la articulación de la muñeca |
