Fact-sheet: Triangular fibrocartilage complex tear
Updated on 09/01/2022 at 5:03 PM
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Definition
The triangular fibrocartilage complex of the carpus connects the ulna to the ulnar aspect of the carpus. It therefore belongs to the extrinsic ligaments of the carpus.
It is composed of:
- articular disc (or triangular fibrocartilage)
- meniscus homolog
- radioulnar ligaments
- palmar ulnocarpal ligaments
- ulnar collateral ligament
- fibrous sheath of the extensor carpi ulnaris tendon
Radiography
Search for bony avulsions or fractures.
Normal radiographs +++
Ultrasound
The articular disc appears damaged, thinned, or torn +/- synovial cyst
CT
Arthro-CT can be used to look for:
- non-transfixing perforation of the articular disc
- central transfixing perforation of the articular disc
- tear of the radial insertion of the articular disc
- ulnar avulsion of the TFCC
- distal tear of the palmar ulnocarpal ligaments
- perforation of the lunotriquetral ligament
- extravasation of contrast material (capsular or ulnar collateral ligament lesion)
- cartilaginous and osseous lesions
MRI
MRI can be used to look for:
- traumatic perforation of the articular disc
- degenerative lesions of the articular disc
- cartilaginous lesions
Arthro-MRI has excellent sensitivity and specificity
Management
Stable lesions:
- Pain management with orthosis
Unstable lesions:
- Arthroscopic treatment
Classification
Palmer classification of TFCC tears:
Class I lesions (traumatic)
- Class IA: isolated central perforation of the articular disc
- Class IB: ulnar avulsion, with or without associated fracture of the ulnar styloid process
- Class IC: distal avulsion/tear involving the lunate (ulnolunate ligament) or the triquetrum (ulnotriquetral ligament)
- Class ID: radial avulsion, with or without associated fracture of the sigmoid notch of the radius
Class II lesions (degenerative)
- Class IIA: degeneration without perforation
- Class IIB: degeneration without perforation with chondromalacia of the lunate and/or ulna
- Class IIC: perforation with chondromalacia of the lunate and/or ulna
- Class IID: perforation, chondromalacia of the lunate and/or ulna, and perforation of the lunotriquetral ligament
- Class IIE: perforation of the lunotriquetral ligament and osteoarthritis
ulnocarpal