Classic history and presentation: Patients with TFCC injuries present with a complaint of ulnar-sided wrist pain. The pain can typically be recreated with ulnar deviation and rotation of the wrist and manifests as wrist pain and difficulty with tasks such as wringing out a towel, opening a jar, or holding heavy objects such as a pan. Examination will demonstrate focal tenderness between the pisiform and ulnar head or a "clicking" sensation with pronosupination. Forced ulnar deviation of the wrist, a "press test" where the patient presses themself up from a chair, and a "piano key test" can all be useful diagnostic maneuvers to suggest TFCC injury.
Prevalence: The likeliness of TFCC injuries increases with age. However, not all TFCC injuries become symptomatic, and the prevalence of TFCC injuries may be under-recognized.
- Forced ulnar deviation of the wrist.
- Positive ulnar variance.
- A history of distal radius fracture may predispose patients to positive ulnar variance, in turn leading to TFCC injury.
Grade / classification system: Palmer classification –
- Class 1 traumatic / acute injuries. Largely influenced by variable blood supply to the injury location.
- 1A: Central perforation or tear
- 1B: Ulnar / peripheral avulsion
- 1C: Distal / volar avulsion
- 1D: Radial avulsion
- Class 2 degenerative / chronic injuries. Progression of degenerative changes.
- 2A: TFCC wear
- 2B: TFCC perforation
- 2C: Lunate or ulnar chondromalacia
- 2D: Ligament disruption
- 2E: Ulnocarpal / distal radioulnar joint (DRUJ) arthritis