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Etiology Mechanism of TFCC injury Type 1 traumatic injury Type 2 degenerative injury Anatomy dorsal and volar radioulnar ligaments central articular disc meniscus homolog ulnar collateral ligament origin of ulnolunate and ulnotriquetral ligaments Blood supply periphery is well vascularized (10-40% of the periphery) central portion is avascular Origin dorsal and volar radioulnar ligaments originate at the sigmoid notch of the radius dorsal and volar radioulnar ligaments converge at the base of the ulnar styloid Classification Presentation Symptoms wrist pain turning a door key often painful Physical exam positive "fovea" sign pain elicited with ulnar deviation (TFCC compression) or radial deviation (TFCC tension) Imaging Radiographs usually negative zero rotation PA view evaluates ulnar variance dynamic pronated PA grip view may show pathology Arthography joint injection shows extravasation MRI has largely replaced arthrography tear at ulnar part of lunate indicates ulnocarpal impaction sensitivity = 74-100% Arthroscopy most accurate method of diagnosis indicated in symptomatic patients after failing several months of splinting and activity modification Differential Ulnocarpal abutment syndrome Ulnar styloid impaction syndrome Pisotriquetral arthritis Treatment Nonoperative immobilization, NSAIDS, steroid injections Operative arthroscopic debridement arthroscopic repair ulnar diaphyseal shortening Wafer procedure limited ulnar head resection Darrach procedure Techniques approach technique pros & cons Arthroscopic repair approach technique pros & cons complications Ulnar diaphyseal shortening approach technique pros & cons complications Wafer procedure approach technique pros & cons Limited ulnar head resection approach technique pros & cons approach technique pros & cons complications Create a free account or log in to see the cards.

A layered, gradual approach is generally best