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TFCC Tear S63.599A 842.09

 

synonyms:triangular fibrocartilage complex

TFCC Tear ICD-10

 

A- initial encounter

D- subsequent encounter

S- sequela

TFCC Tear ICD-9

  • 842.09 (Sprains and strains of wrist and hand; distal radioulnar joint)

TFCC Tear Etiology / Epidemiology / Natural History

  • Generally occurs from fall on an outstretched arm with the wrist extended and the forearm pronated.

TFCC Tear Anatomy

  • TFCC consists of: triangular fibrocartilage disk, dorsal and palmar radioulnar ligaments, the meniscus homologue, and sheath of the extensor carpi ulnaris. (Palmar Ak, J Hand Surg 1981;6Am:153)
  • Origin = the junction of the lunate fossa and the sigmoid notch. Insertion = the base of the ulnar styloid.
  • Central 80% of the articular disk is avascular. The remainder of the TFCC is vascular, being supplied by branches of the anterior interosseous artery, ulnar artery, and the medullary interosseous arteries that penetrate throught the ulnar head. (Bednar MS, J Hand Surg 1991;16Am:1101)

TFCC Tear Clinical Evaluation

  • Pain +/- snapping localized to the radioulnar joint exacerbated by forearm rotation.
  • The ulnar head is prominent dorsal, with the forearm in pronation, as compared to the normal side.
  • Piano key sign=patient actively tries to force pisiform into the table using entire extremity.  Distal ulna moves dorsally like a piano key indicating DRUJ instability +/- TFCC tear.  Compare to uninjured side.
  • TFC tenderness=with forearm in neutral palpate area proximal to pisiform between FCU and ulna styloid.  Pain indicates TFC injury.
  • Press-test : patient pushes themself up from a seated position with the affected wrist. Pain suggests that a lesion in the triangular fibrocartilage complex. (Lester B, Ann Plast Surg. 1995;35:41)
  • Shuck test: With the patient’s forearm in supination, the examiner should holds the distal part of the ulna between the thumb and index finger and tests for dorsal and volar displacement of the distal part of the ulna. Increased laxity as compared to the normal side indicates DRUJ instability/peripheral TFCC tears.

TFCC Tear Xray / Diagnositc Tests

  • P/A and lateral wrist xrays
  • Fleck fracture at the base of the ulnar styloid/ulnar fovea indicates TFCC avulsion.
  • Ulnar variance: determined on neutral rotation P/A view. Positive ulnar variance increases with power grip and pronation. Consider pronated grip view. (Tomaino MM, J Hand Surg 2000;25Am:352). Normal = neutral (articular surface of distal ulna and radius equal). Postive (ulna longer) associated with ulnocarpal impaction, lunotriquetral ligament injurie and TFCC tears. Negative (ulna shorter) associated with carpal instability, Keinbock's disease.
  • MRI: 90% accuracy. (Golimbu CN, Radilogy 1989;173:731)
  • Triple-injection arthrography (Levinsohn EM, Radiology 1991;179:231)

TFCC Tear Classification / Treatment

  • Palmer's Classification (Palmar AK, J Hand Surg 1989;14A:594)
  • usually occur in the avalscular origin from the radius.  Arthroscopid debridement is treatment of choice.  Central 2/3 of articular disc may be removed without affecting stability as long as palmar and dorsal radiocarpal ligaments are intact.  73% complete resolution of pain (Osterman, Arthroscopy 6:120;1990)
  • TFCC repair: dorsal incision through the fifth compartment. Reflect extensor digiti minimi radially and the extensor carpi ulnaris ulnarly, TFCC and visualizing the dorsal radioulnar ligament. Repair using nonabsorbable sutures. (Hermansdorfer JD, J Hand Surg 1991;16Am:340)
  • 25107 (arthrotomy, distal radioulnar joint including repair of triangular cartilage complex)
  • 29846 (arthrsocopy wrist with excision or repair of triangular fibrocartilage and/or joint debridement)

TFCC Tear Associated Injuries / Differential Diagnosis

  • Distal radius fracture
  • Ulnar styloid fracture

TFCC Tear Complications


TFCC Tear Follow-up Care


TFCC Tear Review References

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