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TFCC Injury

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Other Names

  • Triangular Fibrocartilage Complex Injury
  • Triangular Fibrocartilage Complex Tear
  • TFCC Tear

Background

  • Class 1 (traumatic)
    • Fall on extended wrist with pronated forearm
  • Class 2 (degenerative)
    • Assocated with ulnar variance, ulnocarpal impaction

Pathophysiology

  • Anatomy
  • Mechanism
    • Typically a load compressed on the TFCC while wrist is in ulnar deviation
    • Examples include swinging a racket or bat

Risk Factors

  • Intrinsic
    • Ulnar variance
    • Ulnocarpal impaction
    • Forced ulnar deviation
  • Extrinsic

Differential Diagnosis


Clinical Features

Clinical demonstration of the TFCC Stress test or Compression test[2]
  • History
    • Wrist pain on ulnar side
    • Worse with activities such as turning keys, opening doors painful
  • Physical Exam: Physical Exam Wrist
    • Swelling may or may not be present
    • Often tender at the ulnocarpal space
    • Need to exclude muscle related etiology (i.e. FCU, ECU, etc)
  • Special Tests

Evaluation

Radiographs

MRI

  • Typically with arthrogram[3]
  • Up to 100% sensitive

Arthroscopy

  • Gold standard for diagnosis, most accurate

Classification

Class 1 - Traumatic TFCC Injuries

  • 1A: Central perforation or tear [4]
  • 1B: Ulnar avulsion (w/o ulnar styloid fx)
  • 1C: Distal avulsion (origin of UL and UT ligaments)
  • 1D: Radial avulsion

Class 2 - Degenerative TFCC Injuries

  • 2A: TFCC wear and thinning
  • 2B: Lunate and/or ulnar chondromalacia + 2A
  • 2C: TFCC perforation + 2B
  • 2D: Ligament disruption + 2C
  • 2E: Ulnocarpal and DRUJ arthritis + 2D

Management

Nonoperative

Operative

  • DRUJ Instability
  • Arthroscopy
    • Diagnostic gold standard
    • Debridement: 1A
    • Repair: 1B, 1C, 1D

Return to Play

  • Driven by degree of pain
  • In surgical cases, at discretion of surgeon

Complications

  • Ulnocarpal Arthritis
  • Chronic pain

See Also


References

  1. Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk GR. The Traumatized TFCC: An Illustrated Review of the Anatomy and Injury Patterns of the Triangular Fibrocartilage Complex. Curr Probl Diagn Radiol. 2016 Jan-Feb;45(1):39-50.
  2. Waterbrook, Anna, ed. Sports Medicine for the Emergency Physician. Cambridge University Press, 2016.
  3. Pederzine, L., et al. "Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging." Arthroscopy: The Journal of Arthroscopic & Related Surgery 8.2 (1992): 191-197.
  4. https://www.orthobullets.com/hand/6047/tfcc-injury
Created by:
John Kiel on 18 June 2019 23:24:00
Authors:
Last edited:
27 January 2023 10:22:01
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