Triangular fibrocartilage complex injury
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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 proper, ulnomeniscal 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:
distal radial sigmoid notch fracture
dorsal and volar distal radioulnar ligaments
ulnotriquetral and ulnolunate ligament injuries
lunotriquetral ligament injury
extensor carpi ulnaris tendinopathy (including tendinosis, tear and/or instability)
ulnar collateral ligament injury
ganglion cyst formation (may be soft tissue or intraosseous)
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
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