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]

  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]

• Asymptomatic

  The MRI scans showed higher prevalence for the incidental TFCC findings among asymptomatic individuals. [medical-case-reports.imedpub.com]

  They labelled this confluent structure the triangular fibrocartilage complex (TFCC) of the wrist, and concluded that abnormalities were typically degenerative and usually asymptomatic. [jisakos.bmj.com]

  Traumatic injuries are usually symptomatic whereas degeneration of the TFCC is usually asymptomatic 1. Patients may present with ulnar-sided wrist pain, that is exacerbated by supination, pronation and/or ulnar deviation 5. [radiopaedia.org]

  IMAGE From left to right: Asymptomatic CPPD: The patient can have crystals in joint in laboratory test, but be clinically asymptomatic and radiographically normal. In this subtype of CPPD the patient may not event have chondrocalcinosis. [cedars-sinai.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]

• Disability

  NRS = numeric rating score, DASH = Disability of the Arm, Shoulder, and Hand score. [nature.com]

  Mean scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) scale decreased from 42 to 28. The pain was considered severe in 12 patients; 32 patients were satisfied. [emedicine.medscape.com]

  Treatments may include: At initial stages, treatment include observation or immobilization Hand therapy to help minimizing the disability from the problem For more advanced stages, surgery is usually considered to restore blood supply [jefferybudoff.wordpress.com]

• Surgical Procedure

  There are several surgical procedures available ranging from key hole surgery to full open surgery to repair your TFCC. [triangularfibrocartilagecomplextear.blogspot.com]

  SURGICAL TECHNIQUES: If conservative treatment techniques fail then the patient has to be taken for surgical treatment methods which include Wrist Arthroscopy: A minimally invasive procedure with small incisions which are made on the patient’s wrist and [hand2shoulderclinic.in]

  The surgical procedure that is chosen and the incision made depend on the location of the TFCC lesion. [physio.co.uk]

  However, in our case, as I mentioned, it is different since we usually see patients without a clear diagnosis or already operated unsuccessfully, with provokes the frequency of surgical procedures to increase. [drpinal.com]

  Surgical Centers Resurgens Surgery Centers focus on offering a high quality, service oriented environment for your surgical procedure. [resurgens.com]

• Acne Vulgaris

  Acne – a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. [5] Acne vulgaris – see Acne Acupressure – an alternative medicine technique where pressure is applied to acupuncture points. [en.wikipedia.org]

• 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]

• 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]

• Contusion

  Diagnosis Ulnocarpal impaction syndrome Lunotriquetral ligament tears Distal radioulnar joint (DRUJ) subluxation Guyon’s canal/Ulnar canal syndrome Hook of hamate fracture ECU tenosynovitis/tendinosis ECU subluxation/snapping tendon Pisiform fracture/contusion [sportmedschool.com]

  All patients had wrist pain after contusion or sprain injury, and one of four orthopedic surgeons (8–20 years of experience) suspected the presence of TFCC or intrinsic ligament injury. [ajronline.org]

• Morning Stiffness

  The classic diagnostic criteria for rheumatoid arthritis are morning stiffness of longer than 1 hour; involvement of three or more joints simultaneously; symmetric joint involvement; arthritis of the wrist, MCP, or PIP joints for longer than 6 weeks; [radiologykey.com]

• Burning Sensation

  After a distal radius fracture, orthopedic surgeons should be aware of symptoms like unexplained wrist pain or swelling, or a burning sensation in the hand, which could indicate complex regional pain syndrome or ulnar-sided wrist pain. [healio.com]

  The pain may be characterized as a dull ache, shooting or piercing pain, or a burning sensation. Discomfort can radiate into the arms and hands as well as the legs or feet, and may include numbness, [53] or weakness in the legs and arms. [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]

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.