Sugat sa TFCC Impormasyon

Ano ang nararamdaman mo

Maaaring mararamdaman mo ang sakit sa labas ng iyong pulso, malapit sa base ng iyong maliit na daliri. Dito matatagpuan ang iyong triangular fibrocartilage complex (TFCC). Ang TFCC ay isang grupo ng mga ligamento at cartilage na gumagana bilang shock absorber at stabilizer para sa iyong wrist joint. Kapag nasugatan ang istrukturang ito, maaaring mapansin mo ang mahinang sakit o matulis na sakit na lumalala kapag gumagalaw.

Karaniwang lumala ang sakit kapag ikaw ay nag-iikot ng iyong pulso o naglalagay ng bigat sa iyong kamay. Maaaring maging mahirap ang mga simpleng gawain sa araw-araw. Maaaring mararamdaman mo ang discomfort kapag ikaw ay nagbubukas ng doorknob, nagbubukas ng jar, o gumagamit ng screwdriver. Ang pag-angat ng mga bagay, lalo na kapag ang palad ay nakaharap pababa, ay maaaring mag-trigger ng matulis na sakit. Ang pag-abot sa likod ng iyong likod upang isara ang bra o pagtupi ng isang shirt ay maaari ring mag-strain sa nasugatan na bahagi. Maaaring mapansin mong iwasan mo ang paggamit ng kamay na iyon para sa mabigat na pag-angat o pagtutulak mula sa upuan.

May ilang tao ang nakakapansin na mas malala ang sakit sa gabi, lalo na kung sila ay matutulog sa kanilang gilid at naglalagay ng pressure sa pulso. May iba naman na nararamdaman ang stiffness kapag sila ay gumising sa umaga. Maaaring mag-improve ang discomfort sa pamamagitan ng pahinga ngunit bumalik pagkatapos ng aktibidad. Maaari mo ring maranasan ang pakiramdam ng clicking o catching kapag ikaw ay nag-iikot ng iyong forearm. Nangyayari ito dahil ang nasirang tissue ay hindi na dumudulas nang maayos sa loob ng joint.

Karaniwan ang pagkakaroon ng ilang swelling o tenderness kapag pinindot mo ang labas ng iyong pulso. Maaaring mag-radiate ang sakit pataas sa iyong forearm o pababa sa iyong mga daliri. Maaaring maranasan mong ang iyong pulso ay unstable o mahina, parang ito ay maaaring magbigay ng daan sa ilang mga galaw. Ang mga sintomas na ito ay maaaring gawing frustrating at pagod ang mga pang-araw-araw na gawain. Ang pag-unawa sa mga nararamdaman na ito ay tumutulong sa iyo na protektahan ang iyong pulso at hanapin ang tamang pag-aalaga. Gagamitin ng iyong surgeon ang impormasyong ito upang gabayan ang iyong plano ng paggamot.

Ano ang nangyayari

Ang iyong pulso ay isang kumplikadong bisagra na binubuo ng maliliit na buto at malambot na tisyu na nagtutulungan upang payagan kang iikot ang iyong kamay at magdala ng bigat. Sa gilid ng kasamang ito ay matatagpuan ang triangular fibrocartilage complex (TFCC). Isipin ito bilang isang shock-absorbing gasket o goma na hugis bilog. Nasa pagitan ng iyong mga buto ng braso at mga buto ng pulso ito, na nagbibigay ng katatagan at pagkabuntong sa panahon ng paggalaw.

Kapag nasugatan ang lugar na ito, maaaring magsira o magkasuot ang gasket na ito. Karaniwang nangyayari ito pagkatapos ng pagkabagsak sa isang nakalatag na kamay o mula sa paulit-ulit na pag-ikot. Ang sugat ay nagdudulot ng pagkagambala sa makinis na ibabaw ng kasama. Sa halip na madulas nang malaya, maaaring magkuskos ang mga buto sa isa’t isa o makadikit sa nasirang tisyu. Ito ang dahilan kung bakit nararamdaman mo ang sakit, lalo na kapag nagiikot ang iyong braso o tumatayo mula sa upuan.

Apektado rin ng sugat na ito ang mga nakapaligid na istraktura. Ang joint capsule, na ang mangkok na nag-iingat sa lahat ng nasa loob, ay maaaring magpalumong o mag-stretch. Maaari ka ring magkaroon ng mga sugat sa mga malapit na stabilizing ligaments, tulad ng dorsal radiocarpal ligament. Ang mga ligament na ito ay gumagana tulad ng mga lubid na nagpapanatiling tuwid ang mga buto. Kapag nasira ang mga ito kasama ang TFCC, nararamdaman mo ang hindi katatagan o kahinaan ng iyong pulso.

Minsan, ang sakit ay galing sa panghihikahos ng mga malapit na nerbiyos. Halimbawa, ang posterior interosseous nerve ay dumadaan malapit sa karaniwang mga entry point para sa operasyon. Kung panghihikahos ang nerbiyong ito, maaari nitong magdulot ng matulis o sumusunog na pakiramdam. Gayunpaman, ang karamihan sa iyong mga sintomas ay galing sa mekanikal na isyu: nawala ang pagkabuntong, at hindi tamang dumudulas ang mga ibabaw ng kasama.

Gagamit ang iyong doktor ng isang maliit na kamera, tinatawag na arthroscope, upang tingnan ang loob ng kasama. Ang kasangkapan na ito ay nagbibigay ng malinaw na tanawin ng pinsala. Tumutulong ito upang matukoy hindi lamang ang sugat sa TFCC, kundi anumang ibang sugat sa malambot na tisyu na maaaring mag-ambag sa iyong sakit. Sa pamamagitan ng pagtingin eksaktong ano ang mali, maaari naming magplano ng angkop na paggamot upang ibalik ang katatagan at bawasan ang iyong kahirapan.

Ano ang maaari naming gawin para dito

Ang pamamaraan sa paggamot ng iyong TFCC injury sa aming klinika ay sumasalamin sa paraan ng Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, sa pamamahala ng kondisyong ito. Inililigtas namin ang iyo sa isang malinaw na landas, nagsisimula sa pinakamababang invasive na mga opsyon at lumilipat sa surgery lamang kung kinakailangan. Dumating ang mga pasyente sa aming klinika sa pamamagitan ng referral mula sa GP o physiotherapist. Isang clinic assessment, kasama ang history, examination, at imaging kung kinakailangan, ang nagtatag ng diagnosis. Para sa degenerative o long-standing na mga problema, karaniwang sinusubukan muna namin ang non-operative na paggamot. Para sa structural o acute na mga problema, maaaring irekomenda ang surgery agad-agad.

Maaari kang magsimula sa pagbabago ng paraan ng paggamit ng iyong wrist upang maiwasan ang masasakit na galaw. Ang pagpapahinga ng joint at paggamit ng splint ay tumutulong upang bawasan ang iritasyon. Layunin ng physiotherapy na ibalik ang lakas at flexibility sa iyong wrist at kamay. Ang prosesong ito ay nangangailangan ng oras, kaya hinihingi namin na bigyan mo ang conservative care ng patas na pagsubok bago isaalang-alang ang ibang hakbang.

Kung patuloy ang sakit, maaaring talakayin namin ang medical management. Ang mga gamot pang-sakit at anti-inflammatories ay tumutulong upang kontrolin ang mga sintomas. Ang mga injection, tulad ng cortisone, ay maaaring bawasan ang inflammation at magbigay ng ginhawa para sa isang limitadong panahon. Ang ibang mga opsyon tulad ng hyaluronic acid o PRP (platelet-rich plasma) ay minsan ginagamit upang suportahan ang paggaling, bagama't nag-iiba ang tagal ng benepisyo. Talakayin namin ang mga opsyong ito sa iyo upang desisyunin kung alin ang pinaka-angkop sa iyong sitwasyon.

Kapag ang conservative care ay hindi nagbigay ng sapat na pag-unlad, o kung ang iyong injury ay acute, aalamin namin ang surgery. Ang wrist arthroscopy ay isang mahusay na kasangkapan para sa diagnosis at paggamot ng TFCC pathology. Binibigyan ito ng kakayahan na makita nang malinaw ang loob ng joint at ayusin ang pinsala na may minimal na invasibong proseso. Ang mga kalahok na nasa ilalim ng arthroscopic na imbestigasyon para sa patuloy na sakit sa wrist ay nagkaroon ng pag-unlad sa average na humigit-kumulang 50% sa loob ng isang taon. Gayunpaman, karamihan sa mga pasyente ay patuloy na mayroong ilang sakit at kapansanan pagkatapos ng isang taon. Ipinapakita namin ang data na ito nang direkta upang makagawa ka ng shared decision tungkol sa iyong paggamot.

Ano ang inaasahan

Ang wrist arthroscopy ay isang ligtas na pamamaraan na gumagamit ng maliit na camera upang tingnan ang loob ng iyong pulso. Tumutulong ito sa iyong surgeon na magdiagnose at maggamot ng mga isyu tulad ng TFCC injuries. Karamihan sa mga pasyente ay nakakaranas ng maliit at pansamantalang mga side effect. Karaniwang mabilis itong makakababa. Gayunpaman, ang tunay na rate ng mga komplikasyon ay maaaring mas mataas kaysa sa dati nating iniisip. Ang nerve irritation ay isa sa mga risk na maaaring mangyari sa loob ng mga karaniwang prosedura.

Kung mayroon kang patuloy na sakit sa pulso, inaasahan ang unti-unting pagpapabuti. Sa average, ang mga pasyente ay nakakaranas ng pagpapabuti ng humigit-kumulang 50% sa loob ng isang taon. Ibig sabihin, ang antas ng iyong sakit at kapansanan ay malamang na magiging kalahati lamang ng kung ano ang dating nito bago ang paggamot. Makikita mo ang pagkakaiba sa pakiramdam at pagganap ng iyong pulso.

Mahalagang magkaroon ng realistiko inaasahan. Karamihan sa mga pasyente na dumaraan sa prosedurong ito ay patuloy na nakakaranas ng ilang sakit at kapansanan pagkatapos ng isang taon. Madalas na nananatili ang moderate na antas ng discomfort. Maaaring hindi ka makabalik sa 100% ng iyong dating kakayahan. Ang layunin ay makakuha ng malaking ginhawa, hindi kailanman isang kumpletong paggaling.

Kung maayos na pamamahalaan ang iyong kondisyon gamit ang pamamaraang ito, malamang na makakakita ka ng patuloy na pag-unlad sa loob ng unang taon. Kung iiwan itong walang pag-aalaga, ang patuloy na sakit sa pulso ay madalas na patuloy na nananatili nang walang ganitong estrukturadong pagpapabuti. Ang prosedura ay isang mahalagang kasangkapan sa pagtatasa at paggamot ng mga mahihirap na disorder sa pulso.

Ang mga kamakailang pag-unlad sa teknolohiya ay nagbibigay-daan para sa mas tumpak na mga paggamot. Ang iyong surgeon ay gagamit ng espesyalisadong mga instrumento upang suriin ang mga ibabaw ng kasu-kasuan at malambot na tisyu. Tumutulong ito sa pagtukoy ng anumang ibang mga sugat na maaaring sanhi ng iyong mga sintomas. Ang prosedura ay minimally invasive, na sumusuporta sa mas ligtas na profile ng paggaling kumpara sa open surgery.

Dapat kang magplano para sa isang panahon ng pag-aangkop. Habang mabilis ang prosedura mismo, ang proseso ng paggaling ay nangangailangan ng oras. Malamang na mararamdaman mo ang ilang stiffness at soreness habang nagsisimula kang gumalaw muli ng iyong pulso. Ang consistent na follow-up sa iyong surgeon ay susi sa pagsubaybay sa iyong pag-unlad. Gabay nila ang kailangan mo tungkol sa kailan ligtas na dagdagan ang iyong aktibidad.

Magtiwala sa proseso. Ang pagpapabuti ay sinusukat sa mga buwan, hindi sa mga araw. Sa loob ng isang taon, dapat na mayroon kang mas malinaw na larawan ng iyong long-term outlook. Ang karamihan sa mga pasyente ay nakikita na ang pagbaba ng sakit ay worth ang effort sa paggaling. Magtatrabaho ka sa iyong care team upang pamahalaan ang anumang nananatiling mga sintomas. Ang partnership na ito ay tumutulong sa iyo na makamit ang pinakamainam na posibleng resulta para sa iyong pulso.

Kailan kumonsulta sa doktor

Maghingi ng pagsusuri ng espesyalista kung mayroon kang patuloy na sakit sa pulso na hindi gumagaling kahit pahinga. Humingi ng medikal na atensyon kung napapansin mo ang kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakasara o pagbagsak. Kontakin ang iyong doktor kung ang mga sintomas ay nakakaapekto sa iyong pagtulog o trabaho, o kung may biglaang paglala ng sakit. Ang wrist arthroscopy ay isang mahalagang kagamitan para sa pagdi-diagnose ng mga isyung ito. Habang ang maraming pasyente ay nakakakita ng humigit-kumulang 50% na pagpapabuti sa sakit at kapansanan sa loob ng isang taon, karamihan ay patuloy na nakakaranas ng ilang discomfort. Ang maagang pagsusuri ay tumutulong sa iyong surgeon na matukoy kung ang prosedurang ito ay angkop para sa iyo.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients [1].
Acute TFCC injuries require differentiation between those causing distal radioulnar joint (DRUJ) instability and those that do not [2].
Management of acute TFCC injuries ranges from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability [2].
About 40% of patients sustaining a TFCC tear without DRUJ instability still had pain and disability at 1 year [3].
Arthroscopic-assisted repair techniques provide detailed visualization and facilitate the repair of TFCC injuries and associated pathologies with minimally invasive techniques [5, 6].
Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes [7].
TFCC repair achieves good clinical outcomes with low complication rates [11].
There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair [12].
There is a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears [19].
In high-demand athletes, arthroscopic repair of TFCC tears is becoming the treatment of choice to obtain optimum physiologic strength, complete range of motion, stability, and the shortest possible postoperative period [25].
TFCC repair varies substantially from surgeon-to-surgeon, suggesting repairs are discretionary and preference sensitive [27].

Anatomy & Pathophysiology

The triangular fibrocartilage complex (TFCC) is a key anatomical structure involved in ulnar-sided wrist pain, alongside distal radioulnar joint (DRUJ) disorders and extensor carpi ulnaris (ECU) tendon disorders [16].
Ulnar-sided wrist pain often results from a combination of overuse and acute injury, requiring an understanding of sport-specific injuries and underlying biomechanics for effective diagnosis [32].
Determining the etiology of ulnar-sided wrist pain is challenging due to overlapping history and physical examination findings [38].
A systematic approach to evaluating patients with ulnar-sided wrist pain is imperative [42].
Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection [35].
Deep TFCC fiber tears may contribute to decreased wrist rotational positioning sense [30].
Deep TFCC fiber tears may have biomechanical importance in distal radioulnar joint stability [30].
The intensity of pain produced by stressing the wrist in different positions differs between traumatic tears and degenerative wear [41].
Distal radius fractures are common pediatric injuries with significant remodeling potential depending on age and deformity direction [36].
Associated ulnar styloid fractures and significant radial translation are predictors of distal radioulnar joint instability in the context of distal radius fractures [48].
Statistical analysis did not identify a correlation between any single radiographic parameter of distal radius fractures and associated triangular fibrocartilage complex injuries [45].
Load-bearing radioulnar measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury [18].
Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion [33].
When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of wrist pain [44].

Classification

TFCC injuries are differentiated based on whether they cause distal radioulnar joint (DRUJ) instability [2].
About 40% of patients with a TFCC tear without DRUJ instability still had pain and disability at 1 year [3].
Type 1B TFCC injury is the most common TFCC injury in patients with distal radius fractures (DRF) [8].
The presence of an ulnar styloid fracture associated with a distal radius fracture predicts the presence of traumatic TFCC injury, specifically TFCC type 1B injury [10].
Frykman Type VI and VIII distal radius fractures show a significantly higher incidence of TFCC tears [34].
The Melone classification system does not predict the presence of TFCC lesions after distal radius fractures [34].
Classification of central TFCC lesions as traumatic or degenerative depends on information provided upon viewing the lesion at arthroscopy [13].
Atzei's classification is used for the detailed classification of pc-TFCC tears [21].
The diagnostic accuracy of MRI for detailed TFCC classifications, such as Atzei's classification, is lower compared to wrist arthroscopy [21].
A treatment-oriented classification system categorizes five classes of TFCC peripheral tears based on clinical and arthroscopic criteria [28].
Coexisting type 2 TFCC tears significantly increase the risk of index surgery failure in patients undergoing arthroscopic repair of peripheral ulnar-side TFCC tears [14].

Clinical Presentation

Careful history and physical examination are required to determine whether a TFCC tear is symptomatic [9].
It is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary [9].
Disability outcomes were worse in patients with distal radial fractures where the TFCC was injured [20].
The 1B TFCC injury is the most common type in patients with distal radius fractures (DRF) and concomitant TFCC injury [8].
The presence of an ulnar styloid fracture associated with a distal radius fracture predicts the presence of traumatic TFCC injury, specifically TFCC 1B injury [10].
Classification of central triangular fibrocartilage complex lesions as traumatic or degenerative depends on the information provided upon viewing the lesion at arthroscopy [13].
Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tears [15].
MR arthrography is a more sensitive and specific method for the diagnosis of TFCC tears compared to conventional wrist MRI [22].
Load-bearing radioulnar (RaUl) measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury [18].
Ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, requiring distinction from atypical configuration of the prestyloid recess in CT arthrography [24].
There is a higher frequency of accompanying extensor carpi ulnaris (ECU) tendon and/or DRUJ disorders in patients with chronic TFCC tears compared to controls [23].
Damage to the TFCC itself may alter relationships of the DRUJ and the ECU subsheath, or various pathologies causing ulnar-sided wrist pain may drive patients toward surgery [17].

Investigations

Radiocarpal arthrograms were better at detecting TFCC tears than midcarpal arthrograms [47].
Midcarpal arthrograms were best for detecting lunotriquetral (LT) tears [47].
Arthroscopy remains the gold standard for diagnosis [47].
Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear [15].
CT arthrography and MR arthrography have statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries [53].
The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC are consistently higher compared with those of 1.5T wrist MRI [43].
In detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy [21].
Ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries on CT arthrography [24].
Distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist [24].
The presence of an ulnar styloid fracture associated with distal radius fracture predicts the presence of frequently occurring traumatic TFCC injury and TFCC 1B injury [10].
TFCC 1B injury is the most common type in patients with distal radius fractures (DRF) and concomitant TFCC injury [8].
There is a high incidence of TFCC abnormalities on MRI in asymptomatic subjects, particularly those over the age of 50 [51].
The presence of an abnormal TFCC on MRI may be of questionable clinical meaning due to the high incidence of abnormalities in asymptomatic subjects [51].

Treatment

Non-Operative Management

Nonsurgical treatment is moderately successful for treating patients with TFCC tears without distal radioulnar joint (DRUJ) instability [31].
Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation [46].

Operative Management: Indications and Selection

Acute TFCC injuries require differentiation between those causing DRUJ instability and those that do not, with management ranging from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability [2].
Careful history and physical examination are required to determine whether a TFCC tear is symptomatic, and it is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary [9].

Operative Management: Surgical Techniques and Approaches

Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques [5].
Open and arthroscopic techniques are available for TFCC injuries [4].

Operative Management: Outcomes by Technique

Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates [11].
A systematic review demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears [19].

Operative Management: Specific Populations and Pathologies

Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears [29].
Coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in patients with peripheral ulnar-side TFCC tears [14].
The combined extensor retinaculum capsulorrhaphy and suture repair effectively restores stability to both the DRUJ and ulnocarpal joint (UCJ) in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion [37].

Complications

Approximately 40% of patients sustaining a TFCC tear without distal radioulnar joint instability (DRUJ) instability still had pain and disability at 1 year [3].
Coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in patients undergoing arthroscopic repair of peripheral ulnar-sided TFCC tears [14].

Recovery

TFCC capsular reattachment performed with an arthroscopically assisted technique provides good long-term results [26].
Disability outcomes were worse in patients with distal radial fracture where TFCC was injured [20, 52].
In the first year after open TFCC reinsertion, 91% of patients returned to work, including 50% within 12 weeks [54].
About 40% of patients sustaining TFCC tear without distal radioulnar joint instability still had pain and disability at 1 year [3].

Key Evidence

[L4] Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients. [1] (10.1016/j.jhsa.2019.06.019)
[L5] Acute TFCC injuries require differentiation between those causing distal radioulnar joint instability and those that do not, with management ranging from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability. [2] (10.5435/00124635-200806000-00004)
[L4] About 40% of patients sustaining TFCC tear without DRUJ instability still had pain and disability at 1 year. [3] (10.1016/j.jhsa.2018.06.064)
[L5] The article reviews diagnosis, classification, and treatment options including open and arthroscopic techniques for TFCC injuries. [4] (10.1016/j.hcl.2010.07.003)
[L5] Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. [5] (10.1016/j.jhsg.2025.100857)
[L5] Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. [6] (10.1016/j.jhsg.2024.03.011)
[L4] Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes. [7] (10.1055/s-0039-3400454)
[L3] 1B TFCC injury is most common in patients with DRF and concomitant TFCC injury. [8] (10.1186/s13018-023-04438-5)
[L4] Careful history and physical examination are required to determine whether a TFCC tear is symptomatic, and it is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary. [9] (10.5435/jaaos-d-20-00998)
[L4] The presence of ulnar styloid fracture associated with distal radius fracture predicted the presence of frequently occurring traumatic triangular fibrocartilage complex injury and TFCC 1B injury. [10] (10.1016/j.arthro.2020.05.025)
[L4] Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. [11] (10.1055/s-0040-1718913)
[L3] There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair. [12] (10.1016/j.jhsa.2008.01.020)
[L2] Classification of central triangular fibrocartilage complex lesions as traumatic or degenerative depends on the information provided upon viewing the lesion at arthroscopy. [13] (10.1177/1753193416684658)
[L4] However, coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in these patients. [14] (10.1016/j.arthro.2020.05.012)
[L4] Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear. [15] (10.2174/1874325001711010525)
[L5] The article provides a concise approach to the diagnosis and imaging of ulnar-sided wrist pain, discussing anatomy, pathophysiology, and radiographic appearance of common entities including TFCC tears, DRUJ disorders, and ECU tendon disorders. [16] (10.1016/j.csm.2006.02.008)
[L3] This may be due to the damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery. [17] (10.1177/1558944720937369)
[L2] Load-bearing RaUl measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury. [18] (10.1016/j.jhsa.2022.01.008)
[L4] This SR demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears. [19] (10.1177/1558944718815244)
[L2] Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. [20] (10.1016/j.jht.2017.09.002)
[L4] In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. [21] (10.1186/s12891-023-07140-z)
[L3] MR arthrography is more sensitive and specific method in terms of the diagnosis of TFCC tears compared to conventional wrist MRI. [22] (10.1016/j.injury.2019.07.032)
[L3] We found a higher frequency of accompanying ECU tendon and/or DRUJ disorders in patients with chronic TFCC tears as compared to the control group. [23] (10.1016/j.jhsa.2016.07.040)
[L4] Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist. [24] (10.1186/s12891-022-05241-9)
[L4] In high-demand athletes, arthroscopic repair of TFCC tears is becoming the treatment of choice to obtain optimum physiologic strength, complete range of motion, stability, and the shortest possible postoperative period. [25] (10.1016/j.hcl.2009.05.011)
[L5] TFCC capsular reattachment could be performed with an arthroscopically assisted technique, providing good long-term results. [26] (10.1016/j.hcl.2017.06.005)
[L4] TFCC repair varies substantially from surgeon-to-surgeon, suggesting repairs are discretionary and preference sensitive. [27] (10.1055/s-0038-1625953)
[L2] The classification highlights clinical and arthroscopic criteria to categorize five classes of TFCC peripheral tears on a treatment-oriented system. [28] (10.1177/1753193416687479)
[L3] Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. [29] (10.1302/0301-620x.106b4.bjj-2023-0642.r3)
[L3] Deep TFCC fiber tear may contribute to decreased wrist rotational positioning sense and may have biomechanical importance in distal radioulnar joint stability. [30] (10.1016/j.jhsa.2018.01.022)
[L3] Nonsurgical treatment is moderately successful for treating patients with TFCC tears without DRUJ instability. [31] (10.1097/corr.0000000000000533)
[L5] Ulnar-sided wrist pain in athletes is a common problem often resulting from a combination of overuse and acute injury, requiring careful understanding of sport-specific injuries and underlying biomechanics for effective diagnosis and treatment. [32] (10.1016/j.csm.2019.12.008)
[L4] Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion. [33] (10.1177/17531934251397297)
[L3] The Melone classification system does not predict the presence of TFCC lesions, while Frykman Type VI and VIII fractures show a significantly higher incidence of TFCC tears. [34] (10.1177/1753193408090106)
[L5] Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection. [35] (10.1007/s00402-020-03371-0)
[L5] Distal radius fractures are common pediatric injuries with significant remodeling potential depending on age and deformity direction. [36] (10.1016/j.hcl.2005.09.002)
[L4] The combined HS and suture repair effectively restores stability to both the DRUJ and UCJ in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion. [37] (10.1016/j.jhsg.2025.100806)
[L5] Determining the etiology of ulnar-sided wrist pain is often challenging due to overlapping history and physical examination findings; a detailed history, systematic physical examination with provocative maneuvers, and appropriate diagnostic imaging are essential for diagnosis. [38] (10.5435/jaaos-d-16-00407)
[L3] The intensity of pain produced by stressing the wrist in different positions was different between a traumatic tear and degenerative wear. [41] (10.1177/1753193410377838)
[L4] A systematic approach to evaluating patients with ulnar-sided wrist pain is imperative. [42] (10.1016/j.jhsa.2014.07.004)
[L3] The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC is consistently higher compared with those of 1.5T wrist MRI, suggesting improved capability for detection of TFCC injuries. [43] (10.1016/j.jhsa.2008.02.028)
[L2] When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist. [44] (10.2106/00004623-199711000-00009)
[L3] Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. [45] (10.1177/1753193415624669)
[L3] Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. [46] (10.1302/0301-620x.103b8.bjj-2020-2310.r2)
[L4] Radiocarpal arthrograms were better at detecting TFCC tears and midcarpal arthrograms were best for detecting LT tears, with arthroscopy remaining the gold standard. [47] (10.1016/j.arthro.2020.12.108)
[L3] Associated ulnar styloid fractures and significant radial translation are predictors of DRUJ instability. [48] (10.1055/s-0034-1365825)
[L3] The presence of an abnormal TFCC on MRI may be of questionable clinical meaning, because there is a high incidence of TFCC abnormalities in asymptomatic subjects, particularly those over the age of 50. [51] (10.1016/j.jhsa.2011.10.006)
[L2] Disability outcomes were worse in patients with distal radius fracture where TFCC was injured. [52] (10.1016/j.jht.2017.09.012)
[L1] CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. [53] (10.1055/s-0038-1629911)
[L3] In the first year after open TFCC reinsertion, 91% of the patients returned to work, including 50% within 12 weeks. [54] (10.1016/j.hansur.2021.03.012)

References

[1] Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.06.019

[2] Management of Acute Triangular Fibrocartilage Complex Injury of the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200806000-00004

[3] The Natural Course of Triangular Fibrocartilage Complex Tear without Distal Radioulnar Joint Instability. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.064

[4] Arthroscopic and Open Repair of the TFCC. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.07.003

[5] WITHDRAWN: Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100857

[6] Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.011

[7] Patient-Reported Outcomes following Arthroscopic Triangular Fibrocartilage Complex Repair. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-3400454

[8] Association between imaging parameter changes and triangular fibrocartilage complex injury after distal radius fractures. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04438-5

[9] Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00998

[10] The Presence and the Location of an Ulnar Styloid Fracture Associated With Distal Radius Fracture Predict the Presence of Triangular Fibrocartilage Complex 1B Injury. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.05.025

[11] Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1718913

[12] Clinical Comparison of Arthroscopic Versus Open Repair of Triangular Fibrocartilage Complex Tears. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.020

[13] Diagnosing central lesions of the triangular fibrocartilage as traumatic or degenerative: a review of clinical accuracy. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416684658

[14] What Is the Effect of the Ulnar‐Plus Variance on the Outcomes of Arthroscopic Repair of the Peripheral Ulnar‐Side Triangular Fibrocartilage Complex Tear?. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.05.012

[15] Results of Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tear With Exploration of Dorsal Sensory Branch of Ulnar Nerve. The Open Orthopaedics Journal. 2017. DOI: 10.2174/1874325001711010525

[16] Imaging of Ulnar-Sided Wrist Pain. Clinics in Sports Medicine. 2006. DOI: 10.1016/j.csm.2006.02.008

[17] MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain. HAND. 2020. DOI: 10.1177/1558944720937369

[18] Load-Bearing Radioulnar Distances to Evaluate an Unstable Distal Radioulnar Joint in Patients With Triangular Fibrocartilage Complex Tears. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.01.008

[19] Open Versus Arthroscopic Repair of 1B Ulnar-Sided Triangular Fibrocartilage Complex Tears: A Systematic Review. HAND. 2019. DOI: 10.1177/1558944718815244

[20] Outcomes of surgically treated distal radial fractures with associated triangular fibrocartilage complex injury. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.09.002

[21] Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: a retrospective study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-023-07140-z

[22] Comparison between conventional MRI and MR arthrography in the diagnosis of triangular fibrocartilage tears and correlation with arthroscopic findings. Injury. 2019. DOI: 10.1016/j.injury.2019.07.032

[23] The Factors Correlated with the Extensor Carpi Ulnaris Tendon and Distal Radioulnar Joint Disorder in Patients with Chronic Triangular Fibrocartilage Tears. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.040

[24] Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05241-9

[25] Repair of Arthroscopic Triangular Fibrocartilage Complex Tears in Athletes. Hand Clinics. 2009. DOI: 10.1016/j.hcl.2009.05.011

[26] Arthroscopic Management of Triangular Fibrocartilage Complex Peripheral Injury. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2017.06.005

[27] Variation in Repair of the Triangular Fibrocartilage Complex. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1625953

[28] Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416687479

[29] Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b4.bjj-2023-0642.r3

[30] The Effect of Triangular Fibrocartilage Complex Tear on Wrist Proprioception. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.01.022

[31] What is the Natural History of the Triangular Fibrocartilage Complex Tear Without Distal Radioulnar Joint Instability?. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000533

[32] Ulnar-Sided Wrist Pain in the Athlete. Clinics in Sports Medicine. 2020. DOI: 10.1016/j.csm.2019.12.008

[33] Dynamic CT-based assessment of ulnar-sided wrist kinematics in healthy participants using automated 3-D analysis. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251397297

[34] The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408090106

[35] Distal radioulnar joint instability: current concepts of treatment. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03371-0

[36] Pediatric Distal Radius Fractures and Triangular Fibrocartilage Complex Injuries. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2005.09.002

[37] Extensor Retinaculum Capsulorrhaphy and Suture Repair for Ulnocarpal and Distal Radioulnar Joint Instability: One-Year Results. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100806

[38] Evaluation of Ulnar-sided Wrist Pain. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00407

[41] The Relationship Between Stress Positions and Pain Intensity in Triangular Fibrocartilage Lesions. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410377838

[42] Examination of the Wrist: Ulnar-Sided Wrist Pain Due to Ligamentous Injury. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.004

[43] Diagnostic Comparison of 1.5 Tesla and 3.0 Tesla Preoperative MRI of the Wrist in Patients With Ulnar-Sided Wrist Pain. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.028

[44] The Utility of High-Resolution Magnetic Resonance Imaging in the Evaluation of the Triangular Fibrocartilage Complex of the Wrist. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199711000-00009

[45] The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415624669

[46] Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b8.bjj-2020-2310.r2

[47] Evaluation of Diagnostic Procedures for Ulnar Sided Wrist Pain: 25 Years of Experience. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.108

[48] Radiographic Predictors of DRUJ Instability with Distal Radius Fractures. Journal of Wrist Surgery. 2014. DOI: 10.1055/s-0034-1365825

[51] Prevalence of Triangular Fibrocartilage Complex Abnormalities on MRI Scans of Asymptomatic Wrists. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.006

[52] Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2017.09.012

[53] TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1629911

[54] Factors associated with return to work after open reinsertion of the triangular fibrocartilage. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2021.03.012