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 [1] [2].

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 [3]. Patients usually complain of inefficiency when performing basic tasks, affecting their lifestyle and ability to work [4].

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 [2] [5].

• Pain

  Fifteen patients were restored to normal life and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. [ncbi.nlm.nih.gov]

  Pain is especially pronounced when loading the wrist in extension or when supinating/pronating the wrist. In contrast, loading the wrist in a neutral position does not tend to cause pain. [digitalcommons.wku.edu]

  If the pain is recognized, the wrist ulnar stress test is regarded as positive and further investigations should be performed. [symptoma.com]

  Complete pain relief at 2.3-year follow-up was reported by 12 of the 13 patients. [wristwidget.com]

  Patients with TFCC injuries may present with chronic complaints of ulnar-sided wrist pain. [orthopaedicsone.com]

• Falling

  This type of falling and acute injury is common in many sports. Pain is especially pronounced when loading the wrist in extension or when supinating/pronating the wrist. [digitalcommons.wku.edu]

  Injury was caused by sprain in 12 cases, and by falling in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. [ncbi.nlm.nih.gov]

  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]

  Individuals are most at risk for type 1 traumatic TFCC tears are those who sustained a fall onto an outreached hand, excessive arm rotation or pulling movements such as when using heavy tools, and those who participate in sports that involve a racket [absolutebalance.com.au]

• Swelling

  Immediate examination of the wrist would not present any obvious abnormalities because swelling often recedes quickly. [digitalcommons.wku.edu]

  Symptoms include loss of strength to the hand and wrist, pain, and swelling to the small finger side of the wrist. [joionline.net]

  Take an over-the-counter pain medication such as Ibuprofen or Naproxen for pain or swelling. When conservative treatments are not effective, your doctor may recommend: Bracing, casting, or splinting your wrist. [bonsecours.com]

  Symptoms of a TFCC tear include pain on wrist movement from side to side, pain at the base of the small finger side of the wrist, swelling, and/or loss of grip strength. [handmiami.com]

  Other symptoms include swelling, clicking, snapping, crepitus (crackling), weakness, instability, tenderness and a feeling of something catching inside the wrist joint. [physio.co.uk]

• Weakness

  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. [symptoma.com]

  Deep aching pain with gripping, weakness and mechanical symptoms of clicking with pronation –supination can be experienced. [digitalcommons.wku.edu]

  Some patients also may report a catching or clicking sensation with movement of the wrist and a feeling of weakness. Occasionally, patients note that the bones beneath their little inger have sunken in. [pocayo.com]

  This can lead to pain, weakness and instability. The TFCC can be strained or torn from over-swinging or from grounding the golf club forcefully, causing pain. [hss.edu]

• Inflammation

  TFCC tears can lead to inflammation in the wrist, as well as arthritis and instability of the DRUJ. [rearmyourselftexas.com]

  Reducing Pain and Inflammation Ice packs, or cold compresses should help alleviate the pain and inflammation on the wrist aside from taking pain relievers and anti-inflammatory medication. [raleighortho.com]

  A wrist brace, splint or cast may be used to prevent motion as the inflammation subsides. A corticosteroid injection may also be used to relieve inflammation. [centralcoastortho.com]

  We only act on this process, that is, it becomes pathological, when the rupture generates instability in the wrist or causes pain and inflammation. [drpinal.com]

  A wrist brace, splint or cast may be used to prevent motion as the inflammation subsides. In severe cases with persistent pain or instability, surgery may be required to debride or repair the tear. [cfaortho.com]

• Ulcer

  Differential Diagnosis Hypothenar hammer syndrome: Differentiate because there may be discoloration, fingertip ulcers, or splinter hemorrhages on the fourth or fifth digits. Angiogram may be able to diagnose this condition. [physio-pedia.com]

  Severe cases may lead to trophic changes of the skin and even digital tip ulcerations. [radiologykey.com]

• Fingertip Ulceration

  Differential Diagnosis Hypothenar hammer syndrome: Differentiate because there may be discoloration, fingertip ulcers, or splinter hemorrhages on the fourth or fifth digits. Angiogram may be able to diagnose this condition. [physio-pedia.com]

• Splinter Hemorrhage

  Differential Diagnosis Hypothenar hammer syndrome: Differentiate because there may be discoloration, fingertip ulcers, or splinter hemorrhages on the fourth or fifth digits. Angiogram may be able to diagnose this condition. [physio-pedia.com]

• Wrist Pain

  Fifteen patients were restored to normal life and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. [ncbi.nlm.nih.gov]

  Patients can also complain of pain in the ulnar wrist in supinated and/or pronated positions. [orthopaedicsone.com]

  Are you currently experiencing medial wrist pain or suffered a wrist sprain that never fully recovered? It might be a more complex matter than just a sprain. [absolutebalance.com.au]

  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]

  The most common symptoms of a TFCC problem are wrist pain on the ulna side of the wrist with a clicking or popping sound when moving the wrist or rotating the forearm. [3pointproducts.com]

• Fracture

  الصفحة 94 - Fractures of the distal end of the radius. J Bone Joint Surg [Am] 1991;73A:46l-469. ‏ الصفحة 173 - Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. [books.google.com]

  Torn TFCCs constitute 35% of intra-articular fractures and 53% of extra-articular fractures. There is no correlation between ulnar styloid fractures and TFCC injuries. [wristwidget.com]

  Results: 42 patients, with 43 distal radius fractures, were studied. The average period from injury to the wrist arthroscopy was 12 months. There were 16 extra-articular distal radius fractures. [thieme-connect.com]

  Ulnar anatomy Hastings addressed management issues of ulnar-sided wrist pain subsequent to a distal radius fracture. “Distal radius fractures aren’t just fractures. [healio.com]

  Fractures of the distal radius usually affect the radial side of the TFCC, and the clinical symptoms, as described subsequently, may be less clear-cut. [pocayo.com]

• Short Arm

  The recovery time for the procedure is short, Redler said. The patient is placed in a short-arm cast for 6 weeks postoperatively. [healio.com]

  A short-arm cast is worn for 6 weeks and heavy activities are avoided until the bone is healed, which can take 3-4 months. However, a newer technique of ulnar shortening can be performed through a smaller incision, with a quicker healing time. [tocamd.com]

  Treatment of TFCC Tear Drugs and Immobilization Initial treatment of both symptomatic degenerative and traumatic tears includes NSAIDs, immobilization in slight flexion and ulnar deviation in a short arm cast for 4-6 weeks. [boneandspine.com]

  All patients had been initially treated with a short arm cast for four weeks followed by a removable short arm orthosis for about two weeks or so as required by the patient. [nature.com]

• Wrist Instability

  Instability of the distal radioulnar joint often can be shown by shucking or pressing one's ingers between the distal radius and ulna. Similar instability may be shown between the lunotriquetral interval. [pocayo.com]

  In chronic injuries, pain may still be present with certain wrist movements and a feeling of weakness and/or instability may exist. [handsport.us]

  Imaging X-rays Posteroanterior and lateral x-rays of the wrist would reveal ulnar variance and chondromalacia of the lunate or ulnar head if any. Degeneration of distal radioulnar joint and any wrist instability may be noted. [boneandspine.com]

  In this area, pain can appear combined with instability or appear alone. In instability, the patient has difficulties squeezing and holding objects, feels clicks or cracks inside the wrist, etc. [drpinal.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]

• Suggestibility

  As the name suggests, the TFCC is triangular in shape. [wristwidget.com]

  A case study from 2016 suggests that TFCC tears that do not require surgery can take up to 12 weeks to fully heal. Following surgery, a TFCC tear may take around 3 months to heal completely. [medicalnewstoday.com]

  Several physical exam tests can suggest the diagnosis of TFCC injury. [ncbi.nlm.nih.gov]

• Distractibility

  This pain is associated to a specific occurrence of falling on an outstretched hand, from a forearm hyper rotation or an axial load and distraction injury to the ulnar boarder of the forearm. [digitalcommons.wku.edu]

  Conformational changes in the carpus during finger trap distraction. J Hand Surg Am 2010; 35:237–244 [Google Scholar] 19. Becce F, Richarme D, Omoumi P. [ajronline.org]

  These injuries include falls onto a fully pronated and hyper- extended wrist; waterskiing and horseback riding injuries, in which the patient is dragged by the wrist by a tangled ski rope or reins, causing critical distraction forces to be applied to [pocayo.com]

  Traumatic injury can occur with acute rotational force, for example, a fall on the outstretched hand, or due to an axial compression/distraction force to the ulnar carpus. [vjortho.com]

  Other causes of TFCC injury can include forceful rotation or distraction (pulling) on the wrist joint. [verywellhealth.com]

• Irritability

  The reason it sometimes causes discomfort is usually because there is a flap of tissue causing irritation of the joint. For this problem, there are three modes of treatment: no treatment, conservative treatment, and surgical treatment. [scoi.com]

  Any flap of torn TFCC that is irritating the wrist and causing inflammation, analogous to a pebble in a shoe, can be removed arthroscopically. [rearmyourselftexas.com]

  The reason it is causing discomfort is usually there is a flap of tissue that is flapping back and forth and causes irritation of the joint. For this problem there are three modes of treatment; no treatment, conservative, and surgical. [sporttraumatologie.com]

  […] compared an all-arthroscopic TFCC repair technique with an outside-in technique in 10 matched pairs of fresh-frozen cadaveric wrists and found that the all-arthroscopic technique resulted in decreases in operating time, postoperative immobilizations, and irritation [emedicine.medscape.com]

  Treatments include: A splint or cast to guard your wrist Steroid medicine to lessen swelling, irritation, and pain Surgery to fix the tear Stretching exercises If your wrist is injured, you may suffer from the Kienböck’s disease, a condition in which [jefferybudoff.wordpress.com]

• Tingling

  Other symptoms include: weakness numbness spasm tingling / pins and needles What should I do if I have a triangular fibrocartilage complex tear? If you have torn your triangular fibrocartilage complex, you should begin initial treatment. [physio.co.uk]

  There also can be numbness and tingling radiating toward the small finger. To understand a TFCC injury, you must first understand the different types of TFCC tears. The two principal types of tears are traumatic (Type I) and degenerative (Type II). [flboneandjoint.com]

  […] increase the freedom of movements at the wrist. [110] Carpal tunnel syndrome – ( CTS ), is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. [111] The main symptoms are pain, numbness and tingling [en.wikipedia.org]

• Paresthesia

  Radial tunnel syndrome will have associated tenderness at the radial tunnel with distal radiation but without paresthesias. [radiologykey.com]

  ^ a b " Paresthesia Definition and Origin". dictionary.com. Retrieved 1 August 2015. ^ Church E, Odle T. Diagnosis and treatment of back pain. Radiologic Technology [serial online]. November 2007;79(2):126-204. [en.wikipedia.org]

Triangular fibrocartilage complex disorder is diagnosed by clinical examination and different imaging modalities [2]. 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 [6]. 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 [7]. Abnormalities such as ligament injuries, cartilage lesions, TFCC disconnection, degenerative tears, as well as a proliferation of the synovium, can be distinguished [8] [9].

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 [7].

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 [7]. High-resolution 3T MRI modality is favored if a suspicion of TFCC disorder arises [10]. 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 [11].

CONCLUSION: The wrist arthroscopy not only can definitely diagnose tear of TFCC, but also is useful for treatment. [ncbi.nlm.nih.gov]

Fracture of the carpal navicular: diagnosis, non-operative treatment, and operative treatment. ‏ الصفحة 103 - Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg [Br] I984;66-B:1 14-23. ‏ [books.google.com]

TREATMENT & RETURN TO ACTIVITY : Conservative treatment would consist of rest, immobilization in a wrist splint, nonsteroidal anti-inflammatory medication, corticosteroid injections and change in work environment and sport activity. [digitalcommons.wku.edu]

Complications are rare especially with arthroscopic treatment techniques. Stiffness, sensory nerve injury, persistent wrist pain and infection have all been reported in the literature with surgical treatment of TFCC tears. [raleighhand.com]

Treatment Treatment usually depends on the extent of the injury. Conservative treatment consists of rest, immobilizing the wrist with a splint, applying ice, and taking non-steroidal anti-inflammatory medicines. [hss.edu]

The diagnosis and treatment of these injuries to the TFCC will restore stability, resulting in pain relief and a good prognosis for return of function. [clinicalgate.com]

Prognosis Prognosis for TFCC injury is generally favorable. [ncbi.nlm.nih.gov]

Contributes to ulnocarpal stability[3][4] Etiology 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 [physio-pedia.com]

Epidemiology Attritional tears or degenerative pathology involving the TFCC are common, with a reported incidence of tears in greater than 50% of those over the age of 60 years. [orthopaedicsone.com]

Swenson DM, Yard EE, Collins CL, Fields SK, Comstock RD (2010) Epidemiology of US high school sports-related fractures, 2005-2009. Clin J Sport Med 20: 293-299. Tanaka T, Ogino S, Yoshioka H (2008) Ligamentous injuries of the wrist. [medical-case-reports.imedpub.com]

Epidemiology One study found the prevalence of TFCC injuries increases with age. [ncbi.nlm.nih.gov]

ANATOMY & PATHOPHYSIOLOGY : TFCC is a constellation of many structures that support the triangular fibrocartilage proper, located between the distal ulna and ulnar carpus, arising from the distal aspect of the sigmoid notch of the radius, inserting in [digitalcommons.wku.edu]

Etiology 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 [4] Pathophysiology [physio-pedia.com]

Prevention and Home Remedies Prevention of a TFCC tear includes avoiding excessive and strenuous wrist motions and activity modification to any repetitive painful movement. [joionline.net]

The splint usually involves immobilising your elbow to prevent forearm rotation. [londonupperlimbsurgery.co.uk]

Triangular fibrocartilage complex injury (TFCC) prevention TFCC can be prevented by avoiding repetitive, excessive wrist motions and by modifying movements that cause pain. [bonsecours.com]

How can I help prevent a TFCC injury? Many injuries are caused by falls or blows that can be hard to prevent. If you play a racquet sport, like tennis, using good technique can help prevent injury. Developed by RelayHealth. Published by RelayHealth. [summitmedicalgroup.com]

A well-respected, comprehensive source for evaluating, treating, and rehabilitating orthopaedic patients, the 3rd Edition guides you on the prevention of running injuries, the latest perturbation techniques, and the ACL rehabilitation procedures and functional [books.google.com]

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2. Webb B, Rettig L. Gymnastic wrist injuries. Curr Sports Med Rep. September 2008;7(5):289-295.
3. 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.
4. Hao J, Xu Z, Zhao Z. Ulnar impaction syndrome: Managed by wrist arthroscopy. Indian J Orthop. 2016;50(2):172-176.
5. 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.
6. 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.
7. 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.
8. Araf M, Mattar R. Arthroscopic study of injuries in articular fractures of distal radius extremity. Acta Ortop Bras. 2014;22(3):144-150.
9. Thomas BP, Sreekanth R. Distal radioulnar joint injuries. Indian J Orthop. 2012;46(5):493-504.
10. 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.
11. 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.