Download PDF
J Wrist Surg 2016; 05(01): 042-046
DOI: 10.1055/s-0035-1570037
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment

Yukio Abe
1   Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
,
Atsushi Moriya
1   Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
,
Yasuhiro Tominaga
1   Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
,
Koji Yoshida
1   Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
› Author Affiliations
Further Information

Publication History

04 August 2015

03 November 2015

Publication Date:
06 January 2016 (online)

    Permissions and Reprints

Abstract

Background Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation.

Methods An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy.

Results The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score.

Conclusions The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury.

Type of study/level of evidence Diagnostic/level IV

Keywords

wrist - triangular fibrocartilage complex - wrist arthroscopy - dorsal tear

Note

This clinical investigation was conducted with the approval of our institutional review board.


 

  • References

  • 1 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (4) 594-606
    CrossrefPubMedGoogle Scholar
  • 2 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (5) 581-586
    CrossrefPubMedGoogle Scholar
  • 3 Nakamura T, Makita A. The proximal ligamentous component of the triangular fibrocartilage complex. J Hand Surg [Br] 2000; 25 (5) 479-486
    PubMedGoogle Scholar
  • 4 Estrella EP, Hung LK, Ho PC, Tse WL. Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy 2007; 23 (7) 729-737 , 737.e1
    CrossrefPubMedGoogle Scholar
  • 5 Abe Y, Tominaga Y, Yoshida K. Various patterns of traumatic triangular fibrocartilage complex tear. Hand Surg 2012; 17 (2) 191-198
    CrossrefPubMedGoogle Scholar
  • 6 Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 2007; 32 (4) 438-444
    CrossrefPubMedGoogle Scholar
  • 7 Cooney WP. Tears of the triangular fibrocartilage of the wrist. In: Cooney WP, Linscheid RL, Dobyns JH, eds. The Wrist. St. Louis, MO: Mosby; 1998: 710-742
    Google Scholar
  • 8 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (6) 719-723
    CrossrefPubMedGoogle Scholar
  • 9 Watson HK, Weinzweig J. Physical examination of the wrist. Hand Clin 1997; 13 (1) 17-34
    PubMedGoogle Scholar
  • 10 Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am 1994; 19 (1) 143-154
    CrossrefPubMedGoogle Scholar
  • 11 Abe Y, Doi K, Hattori Y, Ikeda K, Dhawan V. A benefit of the volar approach for wrist arthroscopy. Arthroscopy 2003; 19 (4) 440-445
    CrossrefPubMedGoogle Scholar
  • 12 Mino DE, Palmer AK, Levinsohn EM. Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint. A prospective study. J Bone Joint Surg Am 1985; 67 (2) 247-252
    CrossrefPubMedGoogle Scholar
  • 13 Geissler WB. Arthroscopic management of peripheral ulnar tears of the triangular fibrocartilage complex. In: Slutsky DJ, ed. Principle and Practice of Wrist Surgery. Philadelphia, PA: Saunders; 2009: 205-212
    Google Scholar
  • 14 Melone Jr CP, Nathan R. Traumatic disruption of the triangular fibrocartilage complex. Pathoanatomy. Clin Orthop Relat Res 1992; (275) 65-73
    PubMedGoogle Scholar
  • 15 Bowers WH. The distal radioulnar joint. In: Green DP, Hotchkiss RN, Pederson WC. eds. Green's Operative Hand Surgery. 2nd ed. New York: Churchill Livingstone; 1988: 939-989
    Google Scholar
  • 16 Chidgey LK. Histologic anatomy of the triangular fibrocartilage. Hand Clin 1991; 7 (2) 249-262
    PubMedGoogle Scholar
  • 17 Abe Y, Yoshida K, Tominaga Y. Incidence and diagnosis of ‘the double lesion’ of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2013; 38 (7) 807-808
    CrossrefPubMedGoogle Scholar