Triangular Fibrocartilage Complex Injuries
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Clinically Relevant Anatomy
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The Triangular Fibrocartilage Complex is the ligamentous and cartilaginous structures that separate the radiocarpal from the distal radioulnar joint. The TFCC consists of an articular disc, meniscus homologue, ulnocarpal ligament, dosal & volar radioulnar ligament and extensor carpi ulnaris sheath.
Origin: Medial border of distal radius
Insertion: Base of ulnar styloid
Vascular Supply: central disc is avascular, peripheral blood vessels penetrate TFCC margins
Function of TFCC:
- Main stabilizer of distal radioulnar joint
- Volar portion of TFCC prevents dorsal displacement of ulna and is tight in pronation
- Dorsal portion of TFCC prevents volar displacement of ulna and is tight in supination
2. Contributes to ulnocarpal stability
Mechanism of Injury / Pathological Process
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Mechanism of Injury
- Occurs with compressive load on TFCC during marked ulnar deviation
- Commonly associated with positive ulnar variance (radial shortening, average of 4.5 mm)
- Forced ulnar deviance (i.e. swinging bat, racket, etc) causes increased load on TFCC
Clinical Presentation[edit | edit source]
- Ulnar sided wrist pain often with clicking/grinding
- Weakness
Diagnostic Procedures[edit | edit source]
Physical Examination
- TFCC Compression Test: reproduction of pain/clicking with ulnar deviation of wrist with forearm in neutral
- Piano Key Sign: prominent distal ulna with full pronation
- Ulnar Carpal Sag
- Lunotriquetral interval tenderness
Radiographs: may reveal avulsion of ulnar styloid, scaphoid fracture, distal radial fracture, volar tilt of lunate or triquetrum; ulnar variance
Triple Injection Arthrography: identification of tear (low specificity)
MRI: identification of tear (high sensitivity and specificity)
Outcome Measures[edit | edit source]
- DASH Outcome Measure
- Modified Mayo Wrist Score
- Activities of Daily Living Score
Management / Interventions
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Differential Diagnosis
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