Triangular fibrocartilage complex injury - Palmer 1a

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Sharp wrist pain radiating to elbow.

Patient Data

Age: 20 years
Gender: Female

Normal alignment. No acute fracture, osseous lesion or bone marrow edema. No radiocarpal effusion. Small distal radioulnar joint effusion. No evidence of synovitis. No ganglion cyst.

Intrinsic and extrinsic ligaments are intact. 

Focal perforation of the TFC disc proper. Remainder of the TFCC appears uninjured. 

Partial palmar subluxation of the ECU tendon out of the ulna groove indicating at least a partial subsheath tear. Remaining extensor compartments are intact. In particular, the extensor digiti minimi tendon is unremarkable. Flexor tendons are intact.

Case Discussion

There is a focal perforation TFC disc proper (Palmer 1a) with distal radioulnar joint effusion. This injury is non-surgical. In addition, there is a partial ECU subsheath injury evidenced by partial subluxation of the ECU tendon. 

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