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 TFC 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 TFC disc proper, the following associated injuries should be assessed for 1:
- ulnar styloid avulsion fracture
- 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)
The Palmer classification helps for accurate recognition and diagnosis of TFCC injuries, however, injuries outside this classification system can occur 2.
- triangular fibrocartilage tears 1
- medial tears are in the vascularized zone and surgical repair is a treatment option whereas central tears are in the avascular zone and are typically debrided 1
- TFCC degeneration is intrinsic high signal not extending to the articular surface 3
- 1. Oneson SR, Scales LM, Timins ME, Erickson SJ, Chamoy L. MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions. (1996) Radiographics : a review publication of the Radiological Society of North America, Inc. 16 (1): 97-106. doi:10.1148/radiographics.16.1.97 - Pubmed
- 2. 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. (2016) Current problems in diagnostic radiology. 45 (1): 39-50. doi:10.1067/j.cpradiol.2015.05.004 - Pubmed
- 3. Burns JE, Tanaka T, Ueno T, Nakamura T, Yoshioka H. Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging. (2011) Radiographics : a review publication of the Radiological Society of North America, Inc. 31 (1): 63-78. doi:10.1148/rg.311105114 - Pubmed
- 4. Ng AWH, Griffith JF, Fung CSY, Lee RKL, Tong CSL, Wong CWY, Tse WL, Ho PC. MR imaging of the traumatic triangular fibrocartilaginous complex tear. (2017) Quantitative imaging in medicine and surgery. 7 (4): 443-460. doi:10.21037/qims.2017.07.01 - Pubmed
- 5. Mark D. Miller, Timothy G. Sanders. Presentation, Imaging and Treatment of Common Musculoskeletal Conditions. (2011) ISBN: 9781437709148