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TFCC Injury
From WikiSM
Other Names
- Triangular Fibrocartilage Complex Injury
- Triangular Fibrocartilage Complex Tear
- TFCC Tear
Background
- This page refers to injuries of the Triangular Fibrocartilage Complex, more commonly termed TFCC
History
Epidemiology
- Needs to be updated
Introduction
Anatomy of the TFCC[1]
Axial diagram of the triangular fibrocartilage complex depicting normal anatomy. [2]
General
- Injuries to the TFCC can occur from either trauma or degeneration
- Class 1 (traumatic): Fall on extended wrist with pronated forearm
- Class 2 (degenerative): Associated with ulnar variance, ulnocarpal impaction
Anatomy
- The Triangular Fibrocartilage Complex is a load-bearing structure
- Anchors on the Lunate, Triquetrum and Ulnar head
- Also includes triangular fibrocartilage disc, Extensor Carpi Ulnaris tendon subsheath, ulnotriquetral and ulnolunate ligaments, dorsal and volar distal radioulnar ligaments, meniscal homolog, and the ulnocarpal collateral ligament [3]
- Acts as a stabilizer on the ulnar side
Etiology
- 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
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
Clinical demonstration of the TFCC Stress test or Compression test[4]
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
- Fovea Sign: ttp between ulnar styloid and FCU tendon
- TFCC Stress Test: pain with ulnar deviation
- TFCC Tension Test: pain with radial deviation
- Supination Lift Test: Attempt to lift table off ground with supinated hand
- Sharpeys Test: Pain with compression and rotation
- Piano Key Test: May be positive if DRUJ instability
- Press Test: Pain when lifting themselves out of an arm chair
Evaluation
Radiographs
- Standard Radiographs Wrist
- Generally normal
MRI
- Typically with arthrogram[5]
- Up to 100% sensitive
Arthroscopy
- Gold standard for diagnosis, most accurate
Classification
Class 1: Traumatic TFCC Injuries
- 1A: Central perforation or tear [6]
- 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
- Typically first line in type 2 injuries and acute type 1
- Immobilization: Ulnar Gutter Cast, Short Arm Cast or pre-fab
- Analgesia
- Wrist Injection with corticosteroids among other injectates
Operative
- Indications
- DRUJ Instability
- Arthroscopy
- Diagnostic gold standard
- Debridement: 1A
- Repair: 1B, 1C, 1D
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/Work
- Driven by degree of pain
- In surgical cases, at discretion of surgeon
Prognosis and Complications
Prognosis
- Needs to be updated
Complications
- Ulnocarpal Arthritis
- Chronic pain
See Also
Internal
External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Image courtesy of https://musculoskeletalkey.com/, Triangular Fibrocartilage Complex Injuries
- ↑ Case courtesy of Matt Skalski, Radiopaedia.org, rID: 30416
- ↑ 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.
- ↑ Waterbrook, Anna, ed. Sports Medicine for the Emergency Physician. Cambridge University Press, 2016.
- ↑ 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.
- ↑ https://www.orthobullets.com/hand/6047/tfcc-injury
Created by:
John Kiel on 18 June 2019 23:24:00
Authors:
Last edited:
10 June 2023 06:25:19
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