Blood supply

• periphery is well vascularized (10-40% of the periphery)

• central portion is avascular

Mechanism of TFCC injury

• Type 1 traumatic injury

  • mechanism

    • most common is fall on extended wrist with forearm pronation 

    • traction injury to ulnar side of wrist

  • traction injury to ulnar wrist

• Type 2 degenerative injury

  • associated with positive ulnar variance

  • associated with ulnocarpal impaction

Imaging : Xrays, MRI, arthroscan. Arthroscopy shows the lesion the best.

Treatment

• immobilization, NSAIDS, steroid injections

  • all acute Type I injuries

  • first line of treatment for Type 2 injuries

• Operative

  • arthroscopic debridement

    • type 1A

    • diagnostic gold standard

  • Arthroscopic repair

    • type 1B, 1C, 1D

    • best for ulnar and dorsal/ulnar tears

    • generally acute, athletic injuries more amenable to repair than chronic injuries

    • patient should expect to regain 80% of motion and grip strength when injuries are classified as acute (<3 months)

  • ulnar diaphyseal shortening

    • Type II with ulnar positive variance is > 2mm

  • Wafer procedure

    • Type II with ulnar positive variance is < 2mm

    • type 2A-C

  • limited ulnar head resection

    • type 2D