Orthopedics Book

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Triangular Fibrocartilage Complex Injury

Aka: Triangular Fibrocartilage Complex Injury, TFCC Injury, Ulnar Complex
  1. Physiology
    1. Triangular Fibrocartilage Complex is a pad of connective tissue overlying distal ulna
    2. TFCC Roles
      1. Anchors articular disc between ulna and proximal Carpal Bones of the wrist
      2. Cushions weight-bearing forces while grasping
      3. Helps to stabilize the distal radial-ulnar joint
  2. Pathophysiology: Mechanism of injury
    1. Types
      1. Acute Traumatic Injury
        1. Follows injury with hyperpronation and an axial load (e.g. Fall on an outstretched hand)
        2. Typically affects medial insertion of TFCC at radius
      2. Chronic degenerative changes
        1. Typically affects central TFCC
      3. Inflammatory conditions
    2. Examples
      1. Injury of wrist pronation in skiing
  3. Symptoms
    1. Ulnar dorsal Wrist Pain
    2. Dorsal ulnar Wrist Pain and possibly click on end points of pronation and supination
  4. Signs
    1. Click may be perceived on Forearm rotation
    2. Weak grip strength
  5. Signs
    1. Tenderness over Ulnar Complex triangle
      1. Triangle of tissue between ulnar and radius
    2. Provocative maneuvers
      1. Shuck Test positive for instability (excessive movement) or pain at radial-ulnar joint
      2. Radial-ulnar compression by squeezing
  6. Imaging
    1. Wrist XRay
      1. Typically normal in TFCC ligament tear
      2. Ulnar variance may be present where ulna appears longer than radius (PA View)
    2. MRI Wrist (definitive study)
      1. Consider with intraarticular gadolinium for contrast
  7. Management
    1. Hand therapy
    2. NSAIDs
    3. Relative rest
    4. Splint
    5. Surgical repair in refractory cases
  8. References
    1. Moore (1997) AAFP Sports Medicine Conference, Lecture
    2. Morgan (1997) Am Fam Physician 55(3): 857-68 [PubMed]

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