Triangular Fibrocartilage Complex (TFCC) Emma Galante 1st pd Sports Medicine
TFCC: Structure and Location A cartilage structure located on the ulnar side of the wrist. Triangular shape Biconcave body Periphery is thicker than the center disk
TFCC: Structure and Location (continued) Blood Supply: Center: Little to none Outside: Moderate to good Origin: Sigmoid notch of the radius Insertion: Ulnar styloid process
TFCC: Function Absorbs 20% of an axial load on the wrist joint Cushions/supports carpal bones Stabilizes radius and ulna during pronation, supination, and grasping motions
TFCC Tears: Types, Cause, and Who is Vulnerable Trauma Excessive arm rotation Falling on an outstretched arm Athletes using a bat, racquet, or club Athletes in sports that require weight-bearing Type 2 Degenerative Typically chronic Causes by time, age, and repetitive injury People over 50 Can cause inflammatory disorders (ex. Arthritis)
TFCC Tear Symptoms Pain at base of pinky side of wrist Pair worsens with pronation, supination, and ulnar deviation Swelling Audible, painful “Clicking” or “Grinding” is reported Loss of grip strength Pain both while moving and still Pain with weight-bearing
OUR PATIENT Female 14 years old Severe pain through left wrist Sports: Softball Gymnastics
HOP History Observation Palpation
HOP: History MOI: “Pain for roughly 3 years, worked through it until it got worse and ‘gave out’ one day at practice” Previous injuries: “Broke right wrist as a child, several other injuries but not to left wrist” Location of pain: “From the pinky side of the wrist through to the middle of the anterior side of wrist”
HOP: Observation Swelling: Visible swelling that obscures the ulnar head Discoloration: Slightly red and hot to the touch Carrying angle: Patient guards close to body and avoids deviation from neutral position
HOP: Palpations Palpate scaphoid/snuffbox Slight discomfort, but nothing severe Palpate ulnar styloid and radial sigmoid notch Intense pain with both
Special Tests Press Test Patient sits in a chair and attempts to lift themselves up by providing a downward force through the wrist Positive= ulnar-sided pain Shear Test Provide an axial load while passively pronate, supinate, ulnar deviation Positive = pain/clicking
Neurological Tests Tinel’s Sign Examiner taps over median nerve Positive = tingling through the pinky Phalen’s Test Positive = numbness/tingling
PATH TO RECOVERY Months of physical therapy are prescribed Immobilization is ordered until an MRI is done MRI reveals surgery is needed
Citations https://www.physiopedia.com/Triangular_Fibrocartilage_Complex_ Injuries https://www.rushortho.com/body-part/wrist/triangular- fibrocartilage-complex-tear https://www.physio- pedia.com/Triangular_Fibrocartilage_Complex_Injuries http://www.sportsinjuryclinic.net/sport-injuries/wrist-pain/tfcc-tear https://emedicine.medscape.com/article/1240789-treatment