TFCC: A DRUJ Perspective

  • Mark Henry


The triangular fibrocartilage complex represents the distal boundary of the distal radioulnar joint. Two fundamental pathologies of this complex are best managed by arthroscopic techniques performed from the distal radioulnar joint perspective. Chronic attrition of the undersurface of the fibrocartilage disc rubbing against the ulnar head leads to a degenerative pattern of horizontal and multiplanar tearing of the disc substance as well as synovitis in the sigmoid notch. Simple debridement of the tear and the synovitis can be combined with arthroscopic resection of the distal ulna for a complete management of this chronic pattern. Acute avulsion of the radioulnar ligament from the fovea can be diagnosed by clinical examination but confirmed by distal radioulnar joint arthroscopy. The torn and retracted edge of the radioulnar ligament can be arthroscopically reattached to the prepared base of the fovea.


Ulnar Nerve Ulnar Styloid Arthroscopic Repair Ulnar Head Flexor Carpus Ulnaris 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Anderson ML, Larson AN, Moran SL et al (2008) Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg 33:675–682CrossRefGoogle Scholar
  2. 2.
    Atzei A, Rizzo A, Luchetti R et al (2008) Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 12:226–235PubMedCrossRefGoogle Scholar
  3. 3.
    Bernstein MA, Nagle DJ, Martinez A et al (2004) A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy 20:392–401PubMedCrossRefGoogle Scholar
  4. 4.
    Constantine KJ, Tomaino MM, Herndon JH et al (2000) Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg 25:55–60CrossRefGoogle Scholar
  5. 5.
    Del Pinal T, Garcia-Bernal FJ, Cagigal L et al (2010) A technique for arthroscopic all-inside suturing in the wrist. J Hand Surg 35E:475–479Google Scholar
  6. 6.
    DiTano O, Trumble TE, Tencer AF (2003) Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments. J Hand Surg 28:622–627CrossRefGoogle Scholar
  7. 7.
    Estrella EP, Hung LK, Ho PC et al (2007) Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy 23:729–737PubMedCrossRefGoogle Scholar
  8. 8.
    Haugstvedt JR, Berger RA, Nakamura T et al (2006) Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg 31:445–451CrossRefGoogle Scholar
  9. 9.
    Henry MH (2008) Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg 16:320–329PubMedGoogle Scholar
  10. 10.
    Henry MH (2009) Sub-capital ulnar shortening osteotomy. J Hand Microsurg 1:103–107CrossRefGoogle Scholar
  11. 11.
    Henry MH, Smith DW, Masson MV (2004) Reconstruction of distal radioulnar joint instability. J Am Soc Surg Hand 4:35–41CrossRefGoogle Scholar
  12. 12.
    Iwasaki N, Nishida K, Motomiya M et al (2011) Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2 to 4 year follow-up study. Arthroscopy 27:1371–1378PubMedCrossRefGoogle Scholar
  13. 13.
    Kihara H, Short WH, Werner FW et al (1995) The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg 20:930–936CrossRefGoogle Scholar
  14. 14.
    Minami A, Ishikawa J, Suenaga N et al (1996) Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg 21:406–411CrossRefGoogle Scholar
  15. 15.
    Moritomo H, Masatomi T, Murase T et al (2010) Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism. J Hand Surg 35:1955–1963CrossRefGoogle Scholar
  16. 16.
    Nakamura T, Nakao Y, Ikegami H et al (2004) Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg 8:116–123PubMedCrossRefGoogle Scholar
  17. 17.
    Nakamura T, Takayama S, Horiuchi Y et al (2001) Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg 26B:446–454Google Scholar
  18. 18.
    Nishikawa S, Toh S (2002) Anatomical study of the carpal attachment of the triangular fibrocartilage complex. J Bone Joint Surg 84B:1062–1065CrossRefGoogle Scholar
  19. 19.
    Papapetropoulos PA, Wartinbee DA, Richard MJ et al (2010) Management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening osteotomy. J Hand Surg 35:1607–1613CrossRefGoogle Scholar
  20. 20.
    Ruch DS, Papadonikolakis A (2005) Arthroscopically assisted repair of peripheral triangular fibrocartilage complex tears: factors affecting outcome. Arthroscopy 21:1126–1130PubMedCrossRefGoogle Scholar
  21. 21.
    Slade JF 3rd, Gillon TJ (2007) Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg 11:74–82PubMedCrossRefGoogle Scholar
  22. 22.
    Slutsky DJ (2007) Distal radioulnar joint arthroscopy and the volar ulnar portal. Tech Hand Up Extrem Surg 11:38–44PubMedCrossRefGoogle Scholar
  23. 23.
    Slutsky DJ (2011) Arthroscopic evaluation of the foveal attachment of the triangular fibrocartilage. Hand Clin 27:255–261PubMedCrossRefGoogle Scholar
  24. 24.
    Smith DW, Henry MH (2002) Comprehensive management of associated soft tissue injuries in distal radius fractures. J Am Soc Surg Hand 2:153–164CrossRefGoogle Scholar
  25. 25.
    Stuart PR, Berger RA, Linscheid RL et al (2000) The dorsopalmar stability of the distal radioulnar joint. J Hand Surg 25:689–699CrossRefGoogle Scholar
  26. 26.
    Yao J, Lee AT (2011) All-arthroscopic repair of palmer 1B triangular fibrocartilage complex tears using the Fas T-Fix device. J Hand Surg 36:836–842CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Hand and Wrist Center of HoustonHoustonUSA

Personalised recommendations