Triangular fibrocartilage complex injury

Last revised by Joachim Feger on 31 Dec 2023

Triangular fibrocartilage complex (TFCC) injuries may be traumatic or degenerative in nature. The TFCC is a complex structure consisting of the triangular fibrocartilage (TFC) disc properulnomeniscal homologue and numerous ligaments and tendons.

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

Assessing the triangular fibrocartilage disc proper for injury is important but isolated injuries to the ulnomeniscal homologue or radioulnar ligaments can also lead to distal radioulnar joint instability.

Aside from assessing the triangular fibrocartilage disc proper, the following associated injuries should be assessed for 1:

  • Palmer classification: helps for accurate recognition and diagnosis of TFCC injuries, however, injuries outside this classification system can occur 2.

  • Atzei classification: offers a more differentiated approach on a spectrum of peripherally located tears. 

  • CUP classification 7: assesses TFCC injuries based on central, ulnar and peripheral components.

  • triangular fibrocartilage tears 1

    • fluid-intensity signal extending to the surface or along the medial aspect of the ulna

    • usually associated with distal radioulnar joint (DRUJ) effusions (however, these are non-specific in isolation)

    • ulnar styloid process or foveal cystic change or bone marrow edema

    • perifascial fluid and/or edema

  • medial tears are in the vascularized zone and a surgical repair is a treatment option whereas central tears are in the avascular zone and are typically debrided 1

  • TFCC degenerations are intrinsically high signal not extending to the articular surface 3

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Cases and figures

  • Case 1
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  • Case 2: Palmer 1a
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