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Zhi-jieXi,MD2012-09-22TriangularFibrocartilageComplex(TFCC)Tear2026/1/8Lesionsofthetriangularfibrocartilagecomplex(TFCC)areacommonsourceofulnarsidedwristpain.1,2Radialsidetearorperforationstendtobetraumaticandoccursmoreinyoungagegroup,ontheotherhand,centralandulnarsidelesionsaremoreoftendegenerativeandcommonlyseeninolderpatients21.PSMcAlinden,JTeh,.Imagingofthewrist.Imaging2003;15:180-1922.PhilipE.Blazar,PeterS.H.Chan,J.BruceKneeland,DonaldLeatherwood,DavidJ.Bozentka,RomanKowalchick,.TheEffectofObserverExperienceonMagneticResonanceImagingInterpretationandLocalizationofTriangularFibrocartilage.HandSurg2001;26A:742–748AnatomyTFCCTriangularfibrocartilage(articulardisc)MeniscushomologueUCL(ulnarcapsule)VolarandDorsalDRULigamentsECUsubsheathPrestyloidrecess2026/1/8A3DdepictionoftheTFCCArthroscopyMENISCUSHOMOLOGUEULNOLUNATEANDULNOTRIQUETRALLIGAMENTSFromvolaraspectofradioulnarligamenttolunateandtriquetrumPALMERCLASSIFICATIONTFCCTRAUMATICTEAR2026/1/8Anatomy2026/1/8TheulnarportionoftheTFCCisvascularisedbyulnarandposteriorinterosseousartery

brachesThecentralandradialaspectsofthecomplexareavascularVascularsupplyTransmitloadStablisetheDRUJbiomechanicalfunctionsNaturalHistory<20yearsnoTFCperforations>60years50%hadTFCperforationsFallondorsiflexedandulnardeviated

wristAxialloadwithforearminhyperpronationSymptomsUlnarsidedwristpainQuitewelllocalisedUsuallywithulnardeviationSuddenpronationactivityClickingonrotationInstabilityisrareInvestigationsX-rayMRIArthroscopySonographArthroscopy--------goldstandard2026/1/8Usingarthroscopyasthegoldstandard,MRIhasbeenshowntohaveanaccuracyof64–

75%forperforationsortears.1TheinhomogeneoussignalintensityandstriatedappearanceoftheTFCCespeciallytheulnarsidemaymakethesedisruptionsmore

difficulttodetectPSMcAlinden,JTeh,.Imagingofthewrist.Imaging2003;15:180-192MariusRSchmid,ThomasSchertler,ChristianWPfirrmann,NadjaSaupe,MirjanaManestar,SimonWildermuthetal.Interosseousligamenttearsofthewrist:comparisonofmulti-detectorrowCTarthrographyandMRimaging.Radiology2005;237:1008-10132026/1/8arthrogramatearatthepararadialpartoftheTFCC(site2)B:coronalT1WFatSatsequenceconfirmingthearthrogramfindingandclearlyshowthetear(arrow).About60-70%oftheTFCCtearsareassociatedwithulnarstyloidfractureJLJLHobby,BDBDTom,PWPWBearcroft,AKAKDixon.Magneticresonanceimagingofthewrist:diagnosticperformancestatistics.ClinRadiol2001;56:50-57ultra-high-frequencysonographTFCCTRAUMATICTEARTFCCTearImagingPlainfilmsmayshowpositiveulnarvarianceAssessforfractureorulnarsubluxationMRIorArthrographyalargecentraltear(arrow)alongtheradialaspectofthearticulardiscoftheTFCC.Associatedsubchondraldegenerativechangesareevidentwithintheproximallunate2026/1/82026/1/8Atypicaldegenerativecentraltearadiscreteverticaltear(arrow)involvingthethicker,volarradioulnarligamentcomponentoftheTFCC.2026/1/82026/1/8avulsionoftheulnarstyloidattachmentoftheTFC2026/1/8TFCCtearswereclassifiedaccordingtoitslocationas1ifitwasatthecartilageattachmenttotheradius;2,pararadial(2–3mmfromtheradius);3,atthemidportion;4,paraulnar(2–3mmfromtheulnarinsertionpointoftheTFC);or5,attheulnarinsertionpoint(Fig4)2026/1/8locationoftheTFCCtears2026/1/8arelativelybigcommunicatingtear(arrowhead)closetotheradialattachmentoftheTFCCwithmorefatsatsequencesasrequired2026/1/8Asmallcentralperforation(arrow)isseenwithinthecentralportionofthearticulardiscofthetriangularfibrocartilagecomplex.Anadditional,partialthicknessundersurfacetear(arrowhead)isalsopresentatthearticulardisc.ArthroscopicinspectionConservativeActivityavoidanceSteroidinjection(10mgKenolog)SurgeryTreatmentArthroscopicRepairDebridementShaversRadiofrequency(Vapr)–keeptheheatdownOpenRepairUlnarShorteningSurgery2026/1/8TheperipheralandcentraltearsoftheTFCCmustbedifferentiatedasthemodeof

treatmentisdifferentbetweenthetwoconditions,peripheraltearshaveagoodvascularsupplyandarerepairedhowevercentraltearsareavascularandarecommonly

managedwithdebridement.MarcoZanetti,DavidLinkous,LouisA.Gilula,JuergHodler,.CharacteristicsofTriangularFibrocartilageDefectsinSymptomaticandContralateralAsymptomaticWrists.Radiology2000;216:840-845.Arthroscopictreatment2026/1/8Case1,sutureCase2,debridementPearlsPatientswithinjuriestothewrist,particularlydisplaceddistalradiusfractures,shouldbeexaminedafterreductionforinstabilityoftheDRUJ.Themajorityofpatientspresentingwithulnarsidedwristpaincanbemanagednon-operativelyandreturnedtonormalactivities.ThecentralcomponentoftheTFCCcanbeexcisedtoastablerimwithoutcompromisingitsbiomechanicalfunction.2026/1/8

PitfallsThedifferentialdiagnosisofulnarsidedwristpainislengthy.Acarefulexaminationoftheulnarsideofthewristwillfreq