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Triangular Fibrocartilage Complex Disorder

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.


Presentation

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].

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]
  • Disorders of the TFCC are responsible for the ulnar-sided wrist symptoms of pain, weakness, and instability that affect function.[clinicalgate.com]
  • Symptoms include pain on the ulnar side of the wrist, clicking, snapping, weakness and swelling. If you think you have an injury to the TFCC, getting a correct diagnosis is important.[genesisortho.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]
  • In chronic injuries, pain may still be present with certain wrist movements and a feeling of weakness and/or instability may exist.[handsport.us]
Physician
  • 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.[symptoma.com]
  • The orthopedic physician will perform special tests which moves and places stress on the TFCC during their physical examination.[ampmontana.com]
  • ) Diagnosis: imaging studies Tricompartiment Wrist arthrogram MRI arthrogram (high resolution) CT scan in neutral and pronation and supination Wrist arthroscopy Diagnosis: arthroscopy Advantage - Diagnostic - Therapeutic Diagnosis and Treatement The physician[giannirigoni.ch]
  • It is important for a patient to see a board certified physician specializing in treating wrist conditions soon after a traumatic injury. WHAT ARE THE TREATMENTS FOR TFCC TEAR? Treatment of a TFCC tear depends on stage of severity.[tocamd.com]
Collapse
  • 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]
  • 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]
Wrist Instability
  • 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]
Long Arm
  • After a TFCC repair a long-arm splint or cast is applied since the repair must be protected for 6 weeks.[pittsburghfootandhand.com]
  • . - Non Operative Treatment of TFC Injuries: - w/ an acute injury placement of forearm in neutral rotation in long arm cast places TFCC in the best alignment for healing; - marked pronation is to be avoided, because this inclines the ulnar head to displace[wheelessonline.com]
  • Acute isolated triangular fibrocartilage complex disruption with dislocation or instability of the distal radioulnar joint is treated with reduction and then the forearm is immobilized in a long arm cast in the position of stability for 4-6 weeks.[boneandspine.com]
  • ., long arm removable splint or Munster cast. For persistent symptoms, corticosteroid injection of the ulnocarpal joint or therapeutic modalities may be considered.[orthopaedicsone.com]
Excitement
  • 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]
Neglect
  • Ulnar Shortening Osteotomy Ulnar shortening osteotomy is considered for patients with ulnar positive variance, failure of debridement and neglected cases presenting late.[boneandspine.com]

Workup

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].

Treatment

  • 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]
  • 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.[symptoma.com]
  • Conclusion: In the treatment of UIS, the arthroscopy can improve the diagnosis rate, optimize the treatment plan, shorten the treatment cycle, with good treatment results.[ijoonline.com]
  • : arthroscopic debridement Palmer 1B Treatment: artroscopic repair Palmer 1C Treatment: repair of ulnocarpal ligaments open or arthroscopicaly Palmer 1D Treatment: arthroscopic repair (?)[giannirigoni.ch]
  • WHAT ARE THE TREATMENTS FOR TFCC TEAR? Treatment of a TFCC tear depends on stage of severity.[tocamd.com]

Prognosis

  • 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]
  • This classification provides an accurate anatomic description of tears, it does not guide treatment or indicate prognosis. [1] Class 1 Traumatic A. Central perforation B. Ulnar avulsion - With styloid fracture - Without styloid fracture C.[en.wikipedia.org]
  • The method of surgery should be discussed with the surgeon, and they will also be able to give a better idea of prognosis. In general, arthroscopic repair of a TFCC tear achieves “good to excellent” results in 63% of cases (Reiter, et al., 2008).[thesportsphysiotherapist.com]

Etiology

  • While TFCC injury may present with ulnar‐sided or diffuse wrist pain, it is helpful to keep other etiologies or clinical mimics of TFCC injury in mind.[onlinelibrary.wiley.com]

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • "Stability of the Distal Radioulna Joint: Biomechanics, Pathophysiology, Physical Diagnosis, and Restoration of Function What We Have Learned in 25 Years". The Journal of Hand Surgery. 32 (7): 1086–106. doi : 10.1016/j.jhsa.2007.06.014.[en.wikipedia.org]
  • Basic vascular pathophysiology of the hand, wrist, and forearm. In: Berger RA, Weiss AC. eds. Hand Surgery. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004:49–67. 42. Burton RI, Pellegrini VD Jr.[radiologykey.com]

Prevention

  • 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]
  • 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]
  • 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. Written by Pierre Rouzier, MD, for RelayHealth.[kpjampang.com]
  • Injury Prevention • Warm up with dynamic stretches, static stretching should be reserved for post-exercise • Completion of a thorough rehabilitation program and resolution of pain with activity prior to return to play will reduce the likelihood of repeat[sportsmedtoday.com]
  • Ultimately all management strategies for TFCC tears aim to restore the greatest amount of function back to your injured wrist whilst preventing any further or future injury.[triangularfibrocartilagecomplextear.blogspot.com]

References

Article

  1. 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.
  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.

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Last updated: 2019-07-11 19:56