SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case of calcium hydroxyapatite deposition in the triangular fibrocartilage of the wrist is presented. The deposit took the more unusual form of a tumor, posing diagnostic difficulties. Magnetic resonance imaging was helpful in delineating the lesion, but could not identify its nature. Surgical excision resulted in resolution of symptoms.
Twenty-five patients with triangular fibrocartilage complex (TFCC) tears associated with ulnar positive variance who did not respond to conservative management were treated by ulnar shortening. The follow-up period averaged 35 months. All patients complained of pain, restricted forearm rotation, and weakness of grip. Arthroscopy was performed in 23 of 25 wrists to assess the status of the TFCC and the degree of the degenerative change of the proximal aspect of the lunate and triquetrum. Arthroscopic findings consisted of 15 class 1 and 8 class 2 tears according to Palmer's classification. When the TFCC showed a traumatic flap tear, only the torn flap was removed arthroscopically. Ulnar shortening averaged 3 mm. Transverse osteotomies healed in all patients at a mean postoperative time of 7 weeks. Twenty-three patients had either complete relief or occasional mild pain of the wrist. Two patients with persistent pain had additional procedures performed. Postoperative x-ray films revealed slight degenerative changes at the distal radioulnar joint in 7 patients. Complications included 1 reflex sympathetic dystrophy and 2 fractures through the osteotomy site after early plate removal. Ulnar shortening is a useful procedure for TFCC tears associated with ulnar positive variance.
Thirty-five patients with central and radial lesions of the triangular fibrocartilage complex (TFCC) were treated by arthroscopic resection and debridement. Their median age was 36 years (range 11-52), and preoperative duration of symptoms 18 months (range 4-132). Fall on a hyperextended wrist was the most common injury (n = 15), and nine patients had had a previous fracture of the radius. Eighteen patients had an additional arthroscopic debridement of coexisting chondral lesions. There were no complications. At a median follow up time of 39 months (range 18-58), grip strength was recorded as a median of 94% (range 4-164), flexion-extension sector as 94% (range 50-107), and pronation and supination sector as 100% (range 50-112) of the uninjured side. At follow up eight patients were free of pain, 14 much better, eight somewhat better, five unchanged, and no patient had got worse. The Mayo Modified Wrist Score assessed 13 patients as excellent, 14 good, four fair, and one poor. Thirty-one patients returned to full-time work, and four were unemployed (partly because of reasons not relevant to the operation). Thirty-three patients reported they would have had the same procedure if they had known the outcome of the surgery. We find arthroscopic debridement of central or radial lesions of the TFCC to be safe and reliable with good pain relief.
From September 1996 to September 2001, 37 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulnar joint (DRUJ) instability in our clinic. They had all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) combined with or without ulnar shortening. There were 36 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 25 to 48 months with a mean of 36.2 months. All patients received the rehabilitation programme and were re-examined at our outpatient department. The results were graded according to the Mayo Modified Wrist Score. Eleven of the 37 patients rated their wrists "excellent", 22 rated "good", and four rated "fair". Overall, a total of 33 patients (89%) rated satisfactorily and returned to work or sport activities. Therefore, TFCC reconstruction with partial ECU tendon combined with or without ulnar shortening procedure is an effective method for post-traumatic chronic TFCC tears with DRUJ instability suggested by this study.
The distal radio-ulnar ligaments (DRUL) are key components of the triangular fibrocartilage complex (TFCC). The dorsal DRUL tightens during pronation of the forearm and helps to stabilize this motion. 12 women and three men at our clinic have been treated for DRUJ instability secondary to dorsal DRUL rupture or attenuation. Their chief complaint was pain. The dorsal DRUL was reconstructed using a tendon graft, the ends of which were anchored in the bone of the radius and ulna. This technique has been shown to correct dynamic DRUJ instability in carefully selected patients, decreasing or eliminating pain and restoring normal function.
We studied the changes in the shape of the triangular fibrocartilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation-supination, even with positive ulnar variance.
The anatomy and function of the triangular fibrocartilage complex (TFCC) of the wrist was studied through anatomic dissections and biomechanical testing of 61 specimens. The TFCC was found to be a homogenous structure composed of, but not dissectable into, the articular disc, the dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnar collateral ligament, and the sheath of the extensor carpi ulnaris. The TFCC was found to be perforated in 53% of specimens dissected, and all of the wrists with a demonstrable perforation showed evidence of damage or erosion of the cartilage of the lunate and/or distal ulna. Biomechanical studies suggest that the TFCC functions both as a cushion for the ulnar carpus and as a major stabilizer of the distal radioulnar joint. Perforations of the TFCC can result in the ulna-lunate abutment and cartilage erosion. Since excision of the TFCC may lead to ulnolunate abutment, chronic wrist pain, and/or instability of the distal radioulnar joint, it is not recommended.
This vascular injection study of the triangular fibrocartilage (TFC) was carried out in 12 fresh cadaver arms--eight adults and four infants--with Ward's blue latex. The TFC receives its blood supply from (1) the ulnar artery through its palmar and dorsal radiocarpal branches, (2) the dorsal branch of the anterior interosseous artery, and (3) the palmar branch of the anterior interosseous artery. These vessels are arranged in a radial fashion in relation to the fibrocartilage. Histologic sections of the TFC reveal vascularity in the outer 15% to 20% of the disc, and the rest is avascular. On the basis of these findings, we feel that tears of the TFC in its vascular zone have the potential to heal if repaired and those in the central avascular zone do not have this potential.
Ulnar wrist pain due to a lesion of the triangular fibrocartilage complex (TFCC) is frequent. Based on studies of the vascularity, (traumatic) ulnar avulsions can be sutured. Arthroscopic techniques have been designed but results are scarcely published. This is a follow-up study of 52 patients with an ulnar avulsion of the TFCC. All patients were treated with an arthroscopic technique. Evaluation was directed to the subjective outcome, functionality ( using the DASH score) and objective parameters. The mean DASH score was 17.3. Pain was absent or minimal in 47 patients. The grip force was 80% of the contralateral side. Based on these findings, arthroscopic repair of the TFCC appears to be a reliable technique.
Isolated perforation of the articular disc portion of the triangular fibrocartilage complex has been successfully treated by simple excision of the free flap at the site of the tear. This approach is useful in the patient with neutral ulnar variance and no significant articular surface changes on the proximal carpal row or distal ulna.
The aim of this study was to assess the value of direct magnetic resonance (MR) arthrography of the wrist for detecting full-thickness tears of the triangular fibrocartilage complex (TFCC). Twenty-four consecutive patients who had ulnar-sided wrist pain and clinical suspicion of TFCC tear were included in the study. All patients underwent direct MR arthrography and then wrist arthroscopy, and the results of MR arthrography were compared with the arthroscopic findings. The positive predictive value of MR arthrography in detecting TFCC full-thickness tear was 0.95, and the negative predictive value was 0.50. The sensitivity of MR arthrography in detecting a TFCC full-thickness tear was 74% (15/19), and specificity was 80% (4/5). The overall accuracy of MR arthrography in detecting a full-thickness tear of the TFCC in our study was 79% (19/24). We believe that diagnosis of tears in the TFCC by direct MR arthrography is not entirely satisfactory, although MR arthrography has a high positive predictive value for detecting TFCC tears. Negative results of MR arthrography in patients with clinical suspicion of TFCC tear should be interpreted with caution.
To evaluate the efficacy of arthroscopic repair of the triangular fibrocartilage complex (TFCC) tears treated within 4 months after injury, functional outcome after repair was determined following arthroscopic repair in 24 patients. The patients' average age was 31 years (range, 22-38 years); the average follow-up period was 34 months (range, 26-48 months). All patients had wrist pain limiting their participation in work prior to surgery. Patients with central attrition tears identified by arthroscopy were excluded from the study. Twenty-three patients had a preoperative arthrogram. Twelve of the patients with positive arthrogram findings had an avulsion of the TFCC from the sigmoid notch (Palmer type 1D tears). Of the eleven patients with negative arthrograms, 10 had ulnar tears in capsular attachments of the TFCC. The ulna variance averaged 0.2 mm +/- 0.6 mm. Separate arthroscopic techniques were developed for reattaching the TFCC to the radius (nine patients) versus to the peripheral capsule on the volar or ulnar side of the wrist (eight patients). Postoperatively, there was a significant relief of pain (p < .01). Postoperative range of motion averaged 89% +/- 9% SD of the contralateral side, and grip strength averaged 85% +/- 20% SD of the contralateral side. Thirteen of the 19 patients returning to work did so in their original jobs.
To define the patterns of calcium pyrophosphate dihydrate (CPPD) crystal deposition in the triangular fibrocartilage complex (TFCC), we examined the wrists of five adult, fresh-frozen cadavers using light and scanning electron microscopy and the wrist radiographs of 10 patients with a clinical diagnosis of CPPD disease. The radiographs consistently showed mineral deposits near or on the proximal and distal surfaces of the radial half of the TFCC. Light and electron microscopy showed that CPPD crystals formed distinct clusters sharply demarcated from uninvolved fibrocartilage. The density of crystal packing within clusters varied with the sharpness of demarcation of the clusters from the surrounding tissue. TFCC defects were consistently found in the vicinity of CPPD crystals, and degeneration of the articular cartilage on the ulnar half of the proximal surface of the lunate was associated with CPPD crystal deposition in the radial half of the TFCC. These observations suggest that degenerative tears of the TFCC and degeneration of the articular cartilage of the lunate are associated with CPPD crystal deposits in the TFCC.
The present investigator has studied the degenerative changes in the triangular fibrocartilage (TFC), the articular cartilage of the wrist joint, and the carpal interosseous ligament. Moreover, the possibility of the healing of the TFC was examined. The materials were 162 wrist joints obtained from 99 cadavers (5; fresh, 94; preserved) and were studied radiographically, anatomically, pathologically and immunohistochemically. TFC perforation was correlated with ulnar variance. Cartilaginous changes were mainly found around the lunotriquetral interosseous ligament. There was a correlation between the TFC perforation and degenerative changes of the articular cartilage. The pathological finding showed the degenerative changes on the ulnar head side of the TFC, which were much more severe than the carpal side of the TFC. On the other hand, the cartilaginous changes were more severe in the carpal bones than in the distal ulnar head. The finding that central portion of the TFC was found to be avascular, as confirmed by the immunohistochemical method would indicate little possibility of healing of the central portion of the TFC.
This prospective study, begun in 1984, involves 52 consecutive patients treated arthroscopically for triangular fibrocartilage complex (TFCC) tears. Wrist arthrography showed the tear on the initial radiocarpal injection in 86%, and only on the post-stress films in 14%. Triple-phase bone scan was positive in only 66%. Diagnostic arthroscopy showed linear defects in 34%, a central perforation in 46%, and ulnar or peripheral perforations in 20%. However, 11 patients proved to have no visible TFCC tear (9% false-positive arthrography rate, or 9% false-negative rate for arthroscopy). Of the 41 patients followed for 13-42 months, 88% considered the procedure worthwhile, and 73% had complete relief of pain. The authors conclude that arthroscopic debridement of TFCC tears (often with removal of 2-3 mm of ulnar head) may be of benefit in reducing symptoms without increasing clinical ulnar instability. Wrist arthrography is useful in diagnosing perforations but not useful in evaluating the type, size, or significance of the tear.
The thickness of the thinnest aspect of the articular disc portion of the triangular fibrocartilage complex (TFCC) was experimentally measured and compared with ulnar variance. There is an inverse relationship between positive ulnar variance and TFCC thickness.
Sixteen patients who underwent partial excision of the triangular fibrocartilage (TFC) to treat chronic wrist pain were studied retrospectively. Eleven patients (69%) had no symptoms at follow-up: Five other patients later underwent distal ulnar resection. All patients over 40 years of age did poorly after the operation. The patients who had no symptoms showed no significant alteration in wrist function after partial excision of the TFC. Removal of a perforated TFC is contraindicated in the presence of radiocarpal or distal radioulnar arthritis.
A cadaver model was used to evaluate the effect of partial excision of the triangular fibrocartilage complex (TFCC) on ulnar wrist kinetics. Excision of less than two thirds of the horizontal portion of the TFCC was found to have no statistical effect experimentally on forearm axial load transmission. This data supports, from a biomechanical standpoint, partial excision of the central portion of the TFCC--a procedure advocated clinically by some for treatment of a central TFCC perforation.