Triangular fibrocartilage complex disorder is a lesion of the anatomical structure called the articular disc and adjacent ligaments connecting the radioulnar and ulnocarpal joints. These structures are included in wrist movements, cushioning, and stabilization of the joints.
Triangular fibrocartilage complex (TFCC) disorder is distinguished by symptoms of pain on the ulnar side of the wrist, uncomfortable rotation of the wrist, or strain during movements against resistance. These clinical clues propose a possibility of injury in the TFCC. This is most commonly caused by events of mechanical trauma, degenerative processes, and ulnocarpal impaction  .
Chronic overburdening of the radioulnar and ulnocarpal joints may be the reason for impaired blood supply which results in a degeneration of the joint structures. Subsequently, restriction of mobility, pain, and weakness of wrist is noted . Patients usually complain of inefficiency when performing basic tasks, affecting their lifestyle and ability to work .
Physical examination is useful in identifying the severity of TFCC damage. A wrist ulnar stress test comprises the act of a physician which apply an axial force on the radioulnar and ulnocarpal joints, perform rotatory movements, and observe the patients for symptoms and signs of pain or discomfort. If the pain is recognized, the wrist ulnar stress test is regarded as positive and further investigations should be performed. The palpation of the inner part of the affected wrist will reveal tenderness associated with triangular fibrocartilage complex disorder  .
Entire Body System
It occurs most often in those who fall on an outstretched hand. Athletes are at risk, especially those who use a racquet, bat or club and those who put a lot of pressure on the wrist such as gymnasts. [rushortho.com]
Causes of triangular fibrocartilage complex (TFCC) tears or sprains There are many causes of triangular fibrocartilage complex (TFCC) tears or sprains including: Falls — triangular fibrocartilage complex (TFCC) tears can occur if someone falls on their [mercy.com]
For example, if someone was to fall on an outstretched hand, damage to cartilage, tendons or ligaments may occur. Type 2 tears are caused by a slow breakdown of the cartilage in the TFCC. [mcboh.com]
Wrist injuries from falling can vary in severity as well. [orthoneuro.com]
Fractures 223 Chapter 29 Arthroscopic Treatment of Metacarpophalangeal Joint Fractures in the Hand 235 Wrist and Hand Arthroscopy Reconstruction 239 Chapter 31 Minimally Invasive Treatment of Arthritis Associated with Scapholunate Scaphoid Nonunion Advanced Collapse [books.google.com]
Just as importantly, the wrist must be strong and stable, so that when we grasp an object, the joint does not collapse or flop around. The TFCC has a hard job. The TFCC is formed as a ring of cartilage, much like the meniscus of the knee. [verywellhealth.com]
The most common finding is amorphous calcifications within the triangular fibrocartilage complex (TFCC) of the wrist, radiocarpal narrowing and in advanced cases scapholunate advanced collapse. [cedars-sinai.edu]
FIGURE 14.8 T1 coronal MRI demonstrating Kienböck’s disease with low signal intensity and early collapse of the lunate. [radiologykey.com]
But, with a TFCC injury, the patient most often experiences: Loss of grip strength-unable to grasp Wrist pain when rotating the forearm Hand pain or wrist pain when bearing weight on the wrist and forearm Hand pain or wrist pain when bending the hand [orthoneuro.com]
Pain that is worse with twisting, or rotational movements e.g. opening a door handle, using a screwdriver, or lifting heavy objects TFCC injury is a common injury seen in many sports such as gymnastics, boxing, hockey, golf and tennis. [portmelbournephysio.com.au]
Two patients developed reflex sympathetic dystrophy, and one patient had a localized wound infection through the skin because of the PDS suture knot. A 0-Vicryl suture is now used for all repairs. [healio.com]
Although rehab therapy has shifted away from prolonged immobilization, even for many fractures, there is a “Tea Party” faction in every group. [rockandice.com]
An x-ray will rule out fractures and dislocation, while also providing information on potential wrist instability. When there is concern for a complete tear, an MRI will allow visualization of the TFCC. [handsport.us]
A clicking sensation may be appreciated by the examiner on range of motion and depression or sag of the carpals on the ulnar side of the unsup- ported wrist. [pocayo.com]
Degeneration of distal radioulnar joint and any wrist instability may be noted. [boneandspine.com]
Injury to the components of the TFCC complex may cause ulnar-sided wrist instability, pain, and clicking, which may lead to disability [ 4 ]. [medical-case-reports.imedpub.com]
Minimally Invasive Hand and Wrist Surgery is the only book devoted exclusively to these exciting new percutaneous and minimal access techniques for the treatment of chr ما يقوله الناس - كتابة مراجعة لم نعثر على أي مراجعات في الأماكن المعتادة. [books.google.com]
Other measures that increase the SNR include use of a long TR and short TE, appropriate coil selection (see below), increasing the number of excitations (NEX), decreased receiver bandwidth, and using a 90 flip angle. [onlinelibrary.wiley.com]
Coronal and axial fast spin-echo T1-weighted (TR/TE, 550/10; number of excitations [NEX], 2) and axial, coronal, and sagittal fast spin-echo fat-saturated intermediate-weighted (3,000/50; NEX, 3) sequences with a field of view of 10 cm on all images were [ajronline.org]
Ulnar Shortening Osteotomy Ulnar shortening osteotomy is considered for patients with ulnar positive variance, failure of debridement and neglected cases presenting late. [boneandspine.com]
Triangular fibrocartilage complex disorder is diagnosed by clinical examination and different imaging modalities . After the imaging findings give ground for the diagnosis of TFCC disorder, an arthroscopy with an evacuation of injured tissues and the treatment of affected ligaments is performed . An arthroscopy provides an opportunity to examine the joint in situ, rendering it the most valued method of examination and the main method in a making of a final diagnosis . Abnormalities such as ligament injuries, cartilage lesions, TFCC disconnection, degenerative tears, as well as a proliferation of the synovium, can be distinguished  .
Imaging studies include computer tomography (CT) and magnetic resonance imaging (MRI). CT could reveal displacements of the bones involved in the ulnocarpal and radioulnar joints which commonly accompany TFCC disorder. Axial plane is used for such purposes .
MRI examination in a coronal plane is advantageous when investigating specific areas and the intricate anatomy of the injured TFCC. An exclusion is a dorsal tear, which is better observed in sagittal and axial planes . High-resolution 3T MRI modality is favored if a suspicion of TFCC disorder arises . Although magnetic resonance imaging is a very useful procedure, it can be difficult for specialists to determine the correct diagnosis based exclusively on the imaging findings. Misdiagnosed TFCC disorder may lead to serious problems, thus appropriate diagnosis confirmed by arthroscopy is of immense importance .
- Dy CJ, Ouellette EA, Makowski A-LH, Milne E, Latta LL. Peripheral Triangular Fibrocartilage Complex Tears Cause Ulnocarpal Instability: A Biomechanical Pilot Study. Clin Orthop Relat Res. 2012;470(10):2771-2775.
- Webb B, Rettig L. Gymnastic wrist injuries. Curr Sports Med Rep. September 2008;7(5):289-295.
- Sachar K. Ulnar-sided wrist pain: Evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 2012:1489–500.
- Hao J, Xu Z, Zhao Z. Ulnar impaction syndrome: Managed by wrist arthroscopy. Indian J Orthop. 2016;50(2):172-176.
- Vezeridis PS, Yoshioka H, Han R, Blazar P. Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal Radiol. 2010;39(8):733-745.
- Shih JT, Lee HM, Hou YT, Tan CM. Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius. Hand Surg. 2001;6(2):127–135.
- Abe Y, Moriya A, Tominaga Y, Yoshida K. Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment. J Wrist Surg. 2016;5(1):42-46.
- Araf M, Mattar R. Arthroscopic study of injuries in articular fractures of distal radius extremity. Acta Ortop Bras. 2014;22(3):144-150.
- Thomas BP, Sreekanth R. Distal radioulnar joint injuries. Indian J Orthop. 2012;46(5):493-504.
- Fotiadou A, Patel A, Morgan T, Karantanas AH. Wrist injuries in young adults: The diagnostic impact of CT and MRI. Eur J Radiol. 2011;77:235–239.
- Zhan H-L, Li W-T, Bai R-J, et al. High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy. Chin Med J. 2017;130(7):817-822.