Foveal TFCC tear classification and treatment.

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Abstract

[Indexed for MEDLINE] 2. J Clin Orthop Trauma. 2020 Jul-Aug;11(4):570-579. doi: 10.1016/j.jcot.2020.06.001. Epub 2020 Jun 9. TFCC injuries: How we treat? Jawed A(1), Ansari MT(2), Gupta V(1). Author information: (1)Hand to Shoulder Division, Max Institute of Musculoskeletal Sciences, Max Super Speciality Hospital, Saket, New Delhi, India. (2)Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India. The triangular fibrocartilage complex (TFCC) is a well defined anatomical entity located on the ulnar aspect of the wrist joint functioning primarily to stabilize the distal radio -ulnar joint (DRUJ) and also to act as a shock absorber across the ulno-carpal joint. Palmer and Werner were first to explain the anatomic details of the TFCC and to describe its biomechanical role at the wrist. The TFCC comprises of the fibro-cartilagenous disc, the dorsal and palmar ligaments spanning across radius and ulna, the ulno-carpal ligaments, a meniscal homolog, and the sub sheath of ulnar extensor of the wrist. The intricate anatomy of this area and complex load transmission kinematics renders it vulnerable to injury and attrition. Both traumatic and degenerative insults produce specific injury patterns which can present as vague ulnar-sided wrist pain particularly during forearm rotation. These injuries are managed initially by modification of daily activities to avoid aggravation of pain and injury, by complete abstinence from sporting/gym/yoga maneuvers which involve stressing the wrist joints, temporary splint or cast immobilisation are also used along with non-steroidal anti-inflammatory medication. Corticosteriod injection are also used in conjunction with physical therapy in grossly symptomatic patients. Surgical treatment is advocated if conservative management fails to provide relief, or in cases presenting initially with frank instability of the DRUJ or with unstable and displaced fractures. Choice of operative treatment is guided by type and extent of injury and may include debridement, repair and in TFCC injuries associated with degenerative changes, ulnar unloading procedures like shortening or Wafer procedure. With current understanding of arthroscopic anatomy of the wrist, availability of instrumentation as well as familiarity of surgeons with this tool, arthroscopic management can be instituted successfully in most if not all conditions afflicting the TFCC. © 2020 Delhi Orthopedic Association. All rights reserved. DOI: 10.1016/j.jcot.2020.06.001 PMCID: PMC7384326