Triangular Fibrocartilage Complex TFCC Emma Galante 1 st

Triangular Fibrocartilage Complex (TFCC) Emma Galante 1 st pd Sports Medicine

1 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

2 TFCC: Structure and Location (continued) ▹ Blood Supply: ▸ Center: Little to none ▸ Outside: Moderate to Sigmoid good notch ▹ Origin: of the radius ▹ Insertion: Ulnar styloid process

3 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

4 TFCC Tears: Types, Cause, and Who is Vulnerable ▹ Type 1 ▸ 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)

6 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

5 OUR PATIENT ▹ Female ▹ 14 years old ▹ Severe pain through left wrist ▹ Sports: ▹ Softball ▹ Gymnastics

8 HOP History Observatio n Palpation

9 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”

10 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

11 HOP: Palpations ▹ Palpate scaphoid/snuffbox ▸ Slight discomfort, but nothing severe ▹ Palpate ulnar styloid and radial sigmoid notch ▸ Intense pain with both

12 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 ▹ Shear Test ▸ Provide an axial load while passively pronate, supinate, ulnar deviation ▸ Positive = pain/clicking

13 Neurological Tests ▹ Tinel’s Sign ▸ Examiner taps over median nerve ▸ Positive = tingling through the pinky ▹ Phalen’s Test ▸ Positive = numbness/tingling

14 PATH TO RECOVERY Immobilizatio n is ordered until an MRI is done MRI reveals surgery is needed Months of physical therapy are prescribe d

16 Citations ▹ https: //www. physiopedia. com/Triangular_Fibrocartilage_Complex_ Injuries ▹ https: //www. rushortho. com/body-part/wrist/triangular-fibrocartilage▹ ▹ ▹ complex-tear https: //www. physiopedia. com/Triangular_Fibrocartilage_Complex_Injuries http: //www. sportsinjuryclinic. net/sport-injuries/wrist-pain/tfcc-tear https: //emedicine. medscape. com/article/1240789 -treatment