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 proper, ulnomeniscalulnomeniscal homologue and numerous ligaments and tendons.
Clinical presentation
Traumatic injuries are usually symptomatic whereas degeneration of the TFCC is usually asymptomatic 1.
Pathology
Assessing the triangular fibrocartilage for tears is important but isolated injuries to the ulnomeniscal homologue or radioulnar ligaments can lead to distal radioulnar joint instability. Associated injuries that should be assessed include 1:
- ulnar styloid avulsion fracture
- extensor carpi ulnaris tendinopathy (including tendinosis, tear and/or instability)
- ulnar collateral ligament injury
- ganglion cyst formation (may be soft tissue or intraosseous)
Classification
Radiographic features
MRI is the modality used for assessment of TFCC tears.
MRI
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TFCCtriangular 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
- ulnar styloid process or foveal cystic change or bone marrow oedema
- perifascial fluid and/or oedema
Practical points
- medial tears are in the vascularised zone and surgical repair is a treatment option whereas central tears are in the avascular zone and are typically debrided 1
-<p>Triangular fibrocartilage complex (TFCC) injuries may be traumatic or degenerative in nature. The <a title="TFCC" href="/articles/triangular-fibrocartilage-complex">TFCC</a> is a complex structure consisting of the triangular fibrocartilage proper, ulnomeniscal homologue and numerous ligaments and tendons.</p><p><strong style="font-size:1.5em; font-weight:bold">Clinical presentation</strong></p><p>Traumatic injuries are usually symptomatic whereas degeneration of the TFCC is usually asymptomatic <sup>1</sup>. </p><h4>Classification</h4><ul><li><a title="Palmer classification of TFCC abnormalities" href="/articles/palmer-classification-of-tfcc-abnormalities">Palmer classification</a></li></ul><h4>Radiographic features</h4><p>MRI is the modality used for assessment of TFCC tears.</p><h5>MRI</h5><ul><li>-<strong>TFCC tears</strong> <sup>1</sup><ul>-<li>fluid-intensity signal extending to the surface or along the medial aspect of the <a title="Ulna" href="/articles/ulna">ulna</a>- +<p><strong>Triangular fibrocartilage complex (TFCC) injuries </strong>may be traumatic or degenerative in nature. The <a href="/articles/triangular-fibrocartilage-complex">TFCC</a> is a complex structure consisting of the triangular fibrocartilage proper, <a title="Ulnomeniscal homologue" href="/articles/ulnomeniscal-homologue">ulnomeniscal homologue</a> and numerous ligaments and tendons.</p><h4>Clinical presentation</h4><p>Traumatic injuries are usually symptomatic whereas degeneration of the TFCC is usually asymptomatic <sup>1</sup>. </p><h4>Pathology</h4><p>Assessing the triangular fibrocartilage for tears is important but isolated injuries to the ulnomeniscal homologue or radioulnar ligaments can lead to distal radioulnar joint instability. Associated injuries that should be assessed include <sup>1</sup>:</p><ul>
- +<li><a title="Ulnar styloid fracture" href="/articles/ulnar-styloid-fracture-2">ulnar styloid avulsion fracture</a></li>
- +<li>
- +<a title="Extensor carpi ulnaris tendinopathy" href="/articles/extensor-carpi-ulnaris-tendinopathy">extensor carpi ulnaris tendinopathy</a> (including tendinosis, tear and/or instability)</li>
- +<li>ulnar collateral ligament injury</li>
- +<li>
- +<a title="Ganglion cyst" href="/articles/ganglion-cyst">ganglion cyst</a> formation (may be soft tissue or intraosseous)</li>
- +</ul><h4>Classification</h4><ul><li><a href="/articles/palmer-classification-of-tfcc-abnormalities">Palmer classification</a></li></ul><h4>Radiographic features</h4><p>MRI is the modality used for assessment of TFCC tears.</p><h5>MRI</h5><ul><li>
- +<strong>triangular fibrocartilage tears</strong> <sup>1</sup><ul>
- +<li>fluid-intensity signal extending to the surface or along the medial aspect of the <a href="/articles/ulna">ulna</a>
-<li>usually associated with <a title="distal radioulnar joint (DRUJ)" href="/articles/distal-radioulnar-joint-druj">distal radioulnar joint (DRUJ)</a> effusions</li>- +<li>usually associated with <a href="/articles/distal-radioulnar-joint-druj">distal radioulnar joint (DRUJ)</a> effusions</li>
References changed:
- 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. <a href="https://doi.org/10.1148/radiographics.16.1.97">doi:10.1148/radiographics.16.1.97</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10946693">Pubmed</a> <span class="ref_v4"></span>
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TFCC injury
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