Triangular Fibrocartilage Complex Injury

Abstract

The triangular fibrocartilage complex (TFCC) is a crucial stabilizer that allows unrestricted pronation and supination of the wrist. It is composed of the articular disk, dorsal and volar radioulnar ligaments, meniscus homologue, ulnar collateral ligament, and sheath of the extensor carpi ulnaris. The microvasculature has a rich peripheral supply; however, the inner portion is avascular so healing on the periphery is more likely. Patients with TFCC injury may have a history of fall onto pronated, outstretched extremity, repetitive use (gymnast), or insidious onset. Most common site of tenderness is between the flexor carpi ulnaris and extensor carpi ulnaris, distal to the ulnar styloid and proximal to the pisiform. The ulnar grind test is a provocative test that encompasses dorsiflexion of the wrist, axial load, and ulnar deviation or rotation. Imaging can include posterior/anterior x-ray to check ulnar variance, tri-compartment arthrogram, or MRI/MRA. Initial treatment includes wrist splint for 4 weeks, but if symptoms are refractory, then surgical debridement or ulnar shortening may be warranted.