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TFCC Injuries (Triangular Fibrocartilage Complex)

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 34-year-old tennis player presents with 4 months of ulnar-sided wrist pain after a fall onto his outstretched hand. Pain is worse with gripping and rotation, especially on his backhand stroke. On examination, there is tenderness at the ulnar fovea and positive DRUJ ballottement. The piano key sign is positive. Ulnar variance appears neutral. MRI shows a tear at the ulnar attachment of the TFCC.
Coronal MRI demonstrating a peripheral TFCC tear (Palmer 1B) with high signal within the triangular fibrocartilage near the ulnar attachment. The arthroscopic image shows the corresponding tear at the fovea attachment with a positive trampoline test (loss of bounce). Peripheral tears (1B) are repairable with good healing potential, while central tears (1A) are debrided.
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Coronal MRI demonstrating a peripheral TFCC tear (Palmer 1B) with high signal within the triangular fibrocartilage near the ulnar attachment. The arthroscopic image shows the corresponding tear at the fovea attachment with a positive trampoline test (loss of bounce). Peripheral tears (1B) are repairable with good healing potential, while central tears (1A) are debrided.

Source: TFCC Tear MRI (Sports Wrist Injuries Review) • PMC5025579 • CC-BY

Questions

Question 1 (4 marks)

Describe the anatomy of the TFCC and its function.

Question 2 (5 marks)

How do you clinically assess TFCC injuries?

Question 3 (6 marks)

Describe the Palmer classification and its treatment implications.

Question 4 (5 marks)

What is the arthroscopic technique for TFCC repair?

Question 5 (4 marks)

Discuss ulnar impaction syndrome and its relationship to TFCC.

Question 6 (4 marks)

What are the outcomes and complications of TFCC surgery?

Exam Day Cheat Sheet

Must Mention

  • •TFCC = TFC + radioulnar ligaments + meniscus homologue
  • •Peripheral 10-40% = vascularized (repair)
  • •Central = avascular (debride)
  • •1A central, 1B peripheral, 1C ulnocarpal, 1D radial
  • •Fovea test = deep DRUJ stabilizer
  • •Trampoline test = arthroscopic

Common Pitfalls

  • •Wrong treatment by type
  • •Missing TFCC components
  • •Wrong vascularity
  • •Missing fovea test
  • •Wrong repair technique
  • •Missing Class 2