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
I tend to keep TFCC injuries quite mobile, making sure the patient avoids high-risk activities, like big-game hunting with Tasers. [rockandice.com]
- Wound Infection
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]
- Chronic Fatigue Syndrome
ISBN 0-07-249585-5. ^ Guideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). London: National Institute for Health and Clinical Excellence. 2007. [en.wikipedia.org]
- Prolonged Immobilization
Although rehab therapy has shifted away from prolonged immobilization, even for many fractures, there is a “Tea Party” faction in every group. [rockandice.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]
A long arm cast is used for a month to prevent rotation. A brace that limits rotation to a small arc is then used for another month. [flboneandjoint.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]
Immobilization is typically done above the elbow with limitation of pronation/supination of the wrist, i.e., long arm removable splint or Munster cast. [orthopaedicsone.com]
- Wrist Instability
In chronic injuries, pain may still be present with certain wrist movements and a feeling of weakness and/or instability may exist. [handsport.us]
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]
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]
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]
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 .
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]
NEXT: Treatment Options › Treatment Options Non-surgical treatment options for triangular fibrocartilage complex (TCFF) tears include: Immobilization Anti-inflammatory medication Cortisone injection Surgery may be the best treatment option when non-surgical [mdmercy.com]
Treatment will depend on the severity of the damage and may involve conservative treatment, arthroscopy, or surgical repair. Conservative treatment consists of rest and change in activity in order to reduce the stress on the affected hand. [davidhildrethmd.com]
Treatment options for this injury often depend upon the severity and stage of the disease. [jefferybudoff.wordpress.com]
There are some scenarios where surgery may be considered for treatment. [verywellhealth.com]
Contributes to ulnocarpal stability 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  Pathophysiology [physio-pedia.com]
The splint usually involves immobilising your elbow to prevent forearm rotation. [londonupperlimbsurgery.co.uk]
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]
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]
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- 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.