Healthcare and Medicine Reference
In-Depth Information
Chapter 52
S ignS and S ympTomS
Physical examination of patients with triangular fibrocartilage
tear syndrome reveals pain on rotation of the wrist with a marked
exacerbation of this pain with stress loading of the distal radioul-
nar joint with the wrist in pronation and supination. A clicking
sensation may be appreciated by the examiner on range of motion
and depression or sag of the carpals on the ulnar side of the unsup-
ported wrist. Instability of the distal radioulnar joint often can be
shown by shucking or pressing one's ingers between the distal
radius and ulna. Similar instability may be shown between the
lunotriquetral interval. A positive piano key sign is often present
and can be elicited by pressing down on the ulnar styloid as if it
ICD-9 CODE 718.03
ICD-10 CODE M24.139
T he C liniCal S yndrome
Triangular fibrocartilage tear syndrome, also known as trian-
gular fibrocartilage complex (TFCC) lesion, is caused by trauma
or degenerative changes to the wrist. The TFCC is a group or
complex of ligament and cartilage structures that together serve
four major functions related to the function of the human wrist,
as follows: (1) The TFCC helps suspend the distal radius and
ulnar carpus from the distal ulna; (2) the TFCC is the major lig-
amentous stabilizer of the distal radioulnar joint; (3) the TFCC
provides a continuous gliding surface across the entire distal
face of the radius and ulna to allow smooth flexion/extension
and translational movements of the wrist; and (4) the TFCC
acts a shock absorber for forces transmitted over the ulnocarpal
axis ( Figure 52-1 and Table 52-1 ).
Degeneration of the TFCC begins to occur as part of the
natural aging process in the third decade. This degenerative pro-
cess predisposes the TFCC to traumatic injury. Common inju-
ries that lead to TFCC tear syndrome are listed in Table 52-2 .
These injuries include falls onto a fully pronated and hyper-
extended wrist; waterskiing and horseback riding injuries, in
which the patient is dragged by the wrist by a tangled ski rope or
reins, causing critical distraction forces to be applied to the volar
forearm and wrist; power drill injuries, in which the drill bit
binds and the drill handle forcibly rotates the wrist rather than
the drill bit; and distal radius fractures ( Figure 52-2 ). Fractures
of the distal radius usually affect the radial side of the TFCC,
and the clinical symptoms, as described subsequently, may be
less clear-cut.
Patients with triangular fibrocartilage tear syndrome usu-
ally give a history of trauma to the affected wrist, although older
patients may report ulnar-side wrist pain in the absence of trauma,
often attributing their symptoms to arthritis. Reports of increased
pain when stirring coffee or other activities that require rotation
of the distal radioulnar joint are common with triangular fibro-
cartilage tear syndrome. Some patients also may report a catching
or clicking sensation with movement of the wrist and a feeling
of weakness. Occasionally, patients note that the bones beneath
their little inger have sunken in. This finding is due to the loss of
support of the carpal bones on the ulnar side of the wrist resulting
from disruption of the TFCC.
Triangular fibrocartilage
FIGURE 52-1 Anatomy of the triangular fibrocartilage complex.
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