Peripheral Triangular Fibrocartilage Complex Tears

Abstract

A 49-year-old man presents with 7 months of atraumatic, ulnar-sided right wrist pain that hinders his bowling and persists despite a cortisone shot and 6 weeks of immobilization. Physical examination reveals tenderness to palpation between the ulnar styloid and flexor carpi ulnaris tendon, as well as pain with forearm rotation while applying an axial load on the ulnar deviated wrist. There is no appreciable increased dorsal–palmar translation when compared to the contralateral side (negative “piano key” or “ballottement” test). Grip strength on the right is 65% of that of his unaffected left side. Radiographs are normal and demonstrate a 1-mm ulnar negative variance with the wrist in pronation. A magnetic resonance arthrogram shows an area of high signal intensity near the foveal insertion of the triangular fibrocartilage complex (TFCC), which was interpreted as a “peripheral TFCC tear,” and he was sent to a hand specialist for repair. Educational Objectives •State the classification of triangular fibrocartilage complex (TFCC) lesions. •List the nonoperative measure to treat an acute TFCC tear. •Discuss the incidence of TFCC tears with reference to age. •Describe the implication of the “piano key” and “ballottement test.” •State the relationship between ulnar styloid fractures and distal radioulnar joint stability. •Summarize the role of ulnar variance with reference to outcome after TFCC repair. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month's test, visit http://www.jhandsurg.org/CME/home. •State the classification of triangular fibrocartilage complex (TFCC) lesions. •List the nonoperative measure to treat an acute TFCC tear. •Discuss the incidence of TFCC tears with reference to age. •Describe the implication of the “piano key” and “ballottement test.” •State the relationship between ulnar styloid fractures and distal radioulnar joint stability. •Summarize the role of ulnar variance with reference to outcome after TFCC repair. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month's test, visit http://www.jhandsurg.org/CME/home. Letter Regarding “Peripheral Triangular Fibrocartilage Complex Tears”Journal of Hand SurgeryVol. 36Issue 12PreviewIt was with great interest that we read Roenbeck and Imbriglia's article1 in the Evidence-Based Medicine section of your journal. In this article, the authors outline the many challenges that, to this day, remain in the treatment of triangular fibrocartilage complex (TFCC) injuries. We entirely agree with the authors' clinical concept, call for clarification of the distal radioulnar joint definition and measurement, and demand for more studies regarding associated wrist pathology and operative technique. Full-Text PDF Journal CME QuestionsJournal of Hand SurgeryVol. 36Issue 10Preview Full-Text PDF