II. Physiology
- Triangular Fibrocartilage Complex is a pad of connective tissue overlying distal ulna
-
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
- Dorsal ulnar Wrist Pain and possibly click on end points of pronation and supination
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
- Shuck Test positive for instability (excessive movement) or pain at radial-ulnar joint
- Radial-ulnar compression by squeezing
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)
- Consider with intraarticular gadolinium for contrast
VIII. Management
- Hand therapy
- NSAIDs
- Relative rest
- Splint
- Surgical repair in refractory cases
IX. References
- Moore (1997) AAFP Sports Medicine Conference, Lecture
- Morgan (1997) Am Fam Physician 55(3): 857-68 [PubMed]
