Triangular Fibrocartilage Complex Injury
What is it: The triangular fibrocartilage complex is a cartilage and ligament complex between the distal ulna and carpal bones that provides stabilization of the distal radioulnar joint.
How does it present: The patient will often present with pain along the ulnar side of the wrist. The pain may be worse with activities that require ulnar deviation and twisting of the wrist. Injuries that cause a compression of the wrist, especially with a twisting motion or ulnar deviation may be the cause of the injury. These types of injuries may occur with a fall onto the hand or commonly in sports such as gymnastics.
Common exam findings: The exam often will show tenderness at the area of the TFCC just distal to the distal ulna. Dorsiflexion and ulnar deviation motions commonly aggravate the pain and these motions may cause a clicking sensation in the wrist.
Tests and treatment: X-rays may be done to evaluate for other associated bony injuries. A positive ulnar variance (the ulna is longer than the radius) may predispose to TFCC injury, as this length tends to cause impingement of the TFCC with ulnar deviation. To fully evaluate the TFCC MRI arthrogram would be the preferred test. Arthrogram with radiographs or CT could also be considered. Treatment includes avoidance of aggravating factors, short-term immobilization and can include physical therapy. Arthroscopy can be considered in resistant cases.