Debridement of Central TFCC Tears

Abstract

The radiocarpal and midcarpal components of the wrist joint are capable of significant freedom of movement and act as a universal joint. The forearm architecture and distal radial ulnar joint (DRUJ) allow rotation through 180 degrees of pronation and supination to further enhance the arm’s ability to position the hand in a vast array of functional positions. The triangular fibrocartilage complex (TFCC) extends the articular surface of the concave distal radius over the convex head of the distal ulna. The motion of each component of this multifaceted joint is extremely complex. Movements involve rotation, translation with shifting axis of movement, and changing points of load transmission. Further, because no muscle is attached to the carpal bones, they are loaded by the geometry of the distal radius and ulna. Stability is provided instead by the intrinsic and extrinsic ligaments, and motion is generated by the carpal bones being pushed or pulled into position. Wrist arthroscopy has made a significant contribution to the diagnosis and treatment of injury to the wrist. With minimal incision and no disruption to the major ligaments of the wrist, the arthroscope provides an unparalleled view of the interior of the wrist joint. Injury of the TFCC can affect the function of both radiocarpal and distal radial ulnar joints. Arthroscopy is especially useful in both the diagnosis and treatment of injury to the TFCC.