Conclusion
Though the Palmer classification of TFCC tears has added tremendous value in terms of grouping lesions into traumatic and degenerative categories, it is important to remember that it is more useful in terms of differentiating etiology than in designating distinct treatment recommendations. Both Type I and Type II tears may reflect the biomechanical effects of increased ulnar variance, and both, in that light, may require more than simple debridement. Careful examination and the use of preoperative MR imaging and fastidious diagnostic use of the arthroscope may reveal whether an element of ulnar impaction exists and, for that matter, whether other pathology, such as an LT tear, needs to be addressed.
For the most part, however, Type IC tears can be treated effectively with debridement alone and Type IIC tears by debridement and an arthroscopic wafer procedure.
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References
Oneson SR, Timins ME, Scales LM, et al. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. Am J Roentgenol 1997;168:1513–1518.
Cooney WP. Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy. J Hand Surg 1993;18: 815–822.
Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg 1989;14A:594–606
Nakamura R, Horii E, Imaeda T, et al. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg 1997;22B:719–723.
Berger RA. Arthroscopic anatomy of the wrist and distal radioulnar joint. Hand Clin 1999;15:393–413.
Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg 1982;7:376–379.
Tomaino MM, Rubin DA. The value of the pronated grip view radiograph in assessing dynamic ulnar positive variance: a case report. Am J Orthop 1999;3:180–191.
Tomaino MM. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg 2000;25A:352–357.
Imaeda T, Nakamura R, Shionoya K, et al. Ulnar impaction syndrome: MR imaging findings. Radiology 1996;201:495–500.
Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991;7:295–310.
Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg 1993;18A: 46–53.
Friedman SL, Palmer AK, Short WH, et al. The change in ulnar variance with grip. 1993;18A:713–716.
Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist: diagnosis and pathoanatomy. J Hand Surg 1998;23B:754–757.
Tomaino MM. Results of the wafer procedure for ulnar impaction syndrome in the ulnar negative and neutral wrist. J Hand Surg 1999;24B:671–675.
Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop 1984;187:26–35.
Bednar JM. Arthroscopic treatment of triangular fibrocartilage tears. Hand Clin 1999;15:479–488.
Osterman AL. Arthroscopic debridement of triangular fibrocartilage complex tears. Arthroscopy 1990;6:120–124.
Westkaemper JG, Mitsionis G, Giannakopoulos PN, et al. Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries. Arthroscopy 1998;14:479–483.
Minami A, Ishikawa J, Suenaga N, et al. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg 1996;21A:406–411.
Trumble TE, Gilbert M, Vedder N. Ulnar shortening combined with arthroscopic repairs in the delayed management of triangular fibrocartilage complex tears. J Hand Surg 1997;22A: 807–813.
Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg 1994;19A:143–154.
Hulsizer D, Weiss APC, Akelman E. Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg 1997;22A:694–698.
Minami A, Kato H. Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg 1998;23A:904–908.
Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. J Hand Surg 1992;17A:731–737.
Wnorowski DC, Palmer AK, Werner FW, et al. Anatomic and biomechanical analysis of the arthroscopic wafer procedure. Arthroscopy 1992;8:204–212.
Tomaino MM, Weiser RW. Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance. J Hand Surg 2001;26A:1047–1052.
Trumble TE, Gilbert M, Vedder N. Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg 1997;22A:57–65.
Zachee B, DeSmet L, Fabry G. Frayed ulno-triquetral and ulnolunate ligaments as an arthroscopic sign of longstanding triquetro-lunate ligament rupture. J Hand Surg 1994;19B:570–571.
Watson HK, Weinzweig J. Triquetral impingement ligament tear (TILT). J Hand Surg 1999;24B:321–324.
Constantine KJ, Tomaino MM, Herndon JH, et al. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg 2000;25A:55–60.
Tomaino MM, Shah M. Treatment of ulnar impaction syndrome with the wafer procedure. Am J Orthop 2001;30:129–133.
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Tomaino, M.M. (2005). Management of Type C TFCC Tears. In: Geissler, W.B. (eds) Wrist Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/0-387-27087-6_8
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