UW MSK Resident Projects
University of Washington, UWMC Roosevelt Clinic, Musculoskeletal Radiology



TFCC tears and Ulnocarpal Impaction

Print-friendly version of this page

Posted by azuarmd@yahoo.com, 6/26/04 at 4:03:02 PM.


TFCC was first described in 1981 by Werner and Palmer as the ligamentous and cartilaginous structures that suspend the distal radius and ulnar carpus from the distal ulna. It is the the major ligamentous stabilizer of the distal radioulnar joint (DRUJ) and the ulnar carpals. 


-    Provides for a continuous gliding surface for flexion-extension and translational movements of the forearm and for stable rotational movements of the radiocarpal unit about the ulnar axis.

-    Suspends the ulnar carpus from the dorsal ulnar face of the radius and cushions the forces directed through the ulnocarpal axis.



-    falls onto pronated hyperextended wrist

-    twisting w/ palmar rotation

-    forced ulnar deviance, such as batting a baseball, subjects the TFC  to heavy loads

-    associated with distal radius fractures

-   ulnocarpal impaction syndrome (see below)

SYMPTOMS: TFCC injuries cause ulnar-sided wrist pain, frequently with clicking or crepitus and tenderness between the ulna and triquetrum.

ULNOCARPAL IMPACTION SYNDROME is impingement of distal ulna on carpi which may arise from positive ulnar variance or non union of distal ulnar fracture. It is a common inciting cause of degenerative tears. (Note: those with positive ulnar variance can develp TFCC tears, and those with TFCC tears often demonstrate positive ulnar variance.) Patients with a torn TFCC display positive ulnar variance (radial shortening) on average 4.6 mm versus 2.5 mm for no tear and dorsal angulation of 24° versus 12° for no tear.

-     increased ulnar variance leads to loading of the ulnocarpal joint and resultant lunotriquetral disruption, lunate chondral lesion, and triangular fibrocartilage complex tears

 - during marked ulnar deviation, compressive load on TFCC, particularly w/ positive ulnar  variance, may increase markedly                      


- may show flattening, subchondral sclerosis or cysts, and/or lytic changes in lunate and/or triquetrum with similar changes  seen over the distal ulna

- patients may have positive ulnar variance

 - in subtle cases, a pronation grip radiograph may demonstrate ulnar variance


Ulnar impaction syndrome:   Ulnar impaction arthrogram with TFCC tear:

Note the positive ulnar variance  and lunotriquetral impaction on this patient. There are subchondral cysts in the ulnar styloid, indicating degenerative changes from chronic impaction. Subsequent contrast injection into the DRUJ has extravasated into the radialcarpal joint, indicating TFCC tear.

TFCC tear conventional arthrogram:

Note in this patient that the contrast injected into the midcarpal joint has extravasated into the radialcarpal joint and DRUJ, indicating tear of the TFCC.

Ulnar impaction 2:

Another patient with ulnar impaction syndrome. Note the degenerative changes (osteophytes and subchondral cysts) in the distal ulna, scaphoid and lunate (white arrows), along with positive ulnar variance.







This page was last updated: Thursday, August 4, 2005 at 12:39:08 PM
Copyright 2005 UW MSK Resident Projects
Create your own Manila site in minutes. Everyone's doing it!

This site is using the Default theme.