Advertisement

Triangular fibrocartilage complex lesions: A classification

  • Andrew K. Palmer
    Correspondence
    Reprint requests: Andrew K. Palmer, MD, Director of Hand Surgery, SUNY Health Science Center, 500 Harrison Center, Syracuse, NY 13202.
    Affiliations
    Department of Orthopaedic Surgery, SUNY Health Science Center, Syracuse, N.Y., USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Based on anatomic and blomechanical studies and review of our clinical experience of the past 10 years, a classification of injuries to the triangular fibrocartilage complex is presented. This classification is based on the clinical examination, routine x-ray films, wrist arthrograms, wrist arthroscopy, and wrist arthrotomy. The classification recognizes both traumatic and degenerative lesions. Traumatic lesions are classified according to their location. Degenerative lesions are classified by the location and severity of degenerative changes of the triangular fibrocartilage complex, ulnar head, ulnocarpal bones and lunotriquetral ligament.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bowers WH
        Problems of the distal radioulnar joint.
        in: Advances in orthopaedic surgery. Williams & Wilkins, Baltimore1984: 289-303
        • Bowers WH
        The distal radioulnar joint.
        in: 3rd ed. Operative hand surgery. Vol II. Churchill Livingstone, New York1988: 939-989
        • Bunnell S
        Surgery of the hand.
        3rd ed. JB Lippincott, Philadelphia1956
        • Cone RO
        • Szabo R
        • Resnick D
        • et al.
        Computed tomography of the normal radioulnar joints.
        Invest Radiol. 1983; 18: 541-545
        • Dameron TB
        Traumatic dislocation of the distal radio-ulnar joint.
        Clin Orthop. 1972; 83: 55-63
        • Destot E
        Injuries of the wrist: a radiologic study.
        (Translated by FRB Atkinson) Paul B. Hoeber, New York1926
        • Geisl H
        • Spritzendorfer E
        Der rib des discus articularis als ursache des posttraumatischen Handgelenk-schmerzes.
        Unfallheilkunde. 1984; 84: 55-59
        • Mino DE
        • Palmer AK
        • Levinsohn EM
        The role of radiography and computerized tomography in diagnosis of subluxation and dislocation of the distal radioulnar joint.
        J Hand Surg. 1983; 8: 23-31
        • Palmer AK
        The distal radioulnar joint.
        in: Lichtman DM The wrist and its disorders. WB Saunders, Philadelphia1988: 220-231
        • Palmer AK
        The distal radioulnar joint.
        in: Taleisnik J Hand clinics—management of wrist problems. WB Saunders, Philadelphia1987: 31-40
        • Palmer AK
        The distal radioulnar joint.
        Orthop Clin North Am. 1984; 15: 321-335
        • Palmer AK
        Symposium on distal ulnar injuries. 2nd ed. Contemp Orthop. 7. 1983: 81
        • Albert WM
        • Wohl MA
        • Reihtman AM
        Treatment of the disrupted radioulnar joint.
        J Bone Surg. 1963; 45A: 1373-1381
        • Bell MJ
        • Hill RJ
        • McMurty RY
        Ulnar impingement syndrome.
        J Bone Joint Surg. 1985; 67B: 126-129
        • Chun S
        • Palmer AK
        Chronic ulnar wrist pain secondary to partial rupture of the extensor carpi ulnaris tendon.
        J Hand Surg. 1987; 12A: 1032-1035
        • Darrach N
        Arterior dislocation of the head of the ulna.
        Ann Surg. 1912; 56: 802-803
        • Darrach W
        Partial excision of lower shaft of ulna for deformity following Colles' fracture.
        Ann Surg. 1913; 57: 764-765
        • Darrow JC
        • Linscheid RL
        • Dobyns JH
        • Mann JM
        • Wood MB
        • Beckenbaugh RD
        Distal ulnar recession for disorders of the distal radioulnar joint.
        J Hand Surg. 1985; 10A: 482-491
        • Eckhardt WA
        • Palmer AK
        Recurrent dislocation of the extensor carpi ulnaris tendon.
        J Hand Surg. 1981; 6: 629-631
        • Goncalves D
        Correction of disorders of the distal radio-ulnar joint by artificial pseudarthrosis of the ulna.
        J Bone Joint Surg. 1974; 56B: 462-464
        • Hagert CG
        Functional aspects on the distal radio-ulnar joint.
        J Hand Surg. 1979; 4: 585
        • Spinner M
        • Kaplan EB
        Extensor carpi ulnaris. Its relationship to stability of the distal radioulnar joint.
        Clin Orthop. 1970; 68: 124-129
        • Coleman HM
        Injuries of the articular disc at the wrist.
        J Bone Joint Surg. 1960; 42B: 522-529
        • Imbriglia JE
        • Boland DS
        Tears of the articular disc of the triangular fibrocartilage complex and results of excision of the articular disc.
        J Hand Surg. 1983; 8 ([Abstract]): 620
        • Martinek H
        Zur traumatologie des discus triangularis.
        Arch Orthop. 1977; 87: 285-297
        • Mohanti RC
        • Kar N
        Study of triangular fibrocartilage of the wrist joint in Colles' fracture.
        Br J Acc Surg. 1979; 11: 321-324
        • Mossing N
        Isolated lesions of the radio-ulnar disk treated with excision.
        Scand J Plast Reconstr Surg. 1975; 9: 231-233
        • Neviaser RJ
        • Palmer AK
        Traumatic perforation of the articular disc of the triangular fibrocartilage complex of the wrist.
        Bull Hosp J Dis Orthop Inst. 1984; 44: 376
        • Osterman AL
        • Bora FW
        • Martin E
        Arthroscopic excision of flap tears of the triangular fibrocartilage.
        in: Presented at the 42nd Annual Meeting of the ASSH, San Antonio, TexasSeptember 1987
        • Redler I
        Meniscoid of the wrist.
        Clin Orthop. 1972; 88: 138-141
        • van der Linden AJ
        Disk lesion of the wrist joint.
        J Hand Surg. 1986; 11A: 490-497
        • Weigl K
        • Spira E
        The triangular fibrocartilage of the wrist joint.
        Reconstr Surg Traumatol. 1969; 11: 139-153
        • Menon J
        • Wood VE
        • Schoene HR
        • Frykman GK
        • Hohl JC
        • Bestard EA
        Isolated tears of the triangular fibrocartilage of the wrist: results of partial excision.
        J Hand Surg. 1984; 9A: 527-530
        • Blair WF
        • Berger RA
        • El-Khoury GY
        Arthrotomography of the wrist: an experimental and preliminary clinical study.
        J Hand Surg. 1985; 10A: 350-359
        • Af Ekenstam F
        The distal radioulnar joint—an anatomical, experimental, and clinical study [Dissertion].
        Uppsala: Acta Univ Abstr Uppsala. 1984; 505: 1-55
        • Lewis OJ
        Evolutionary change in the primate wrist and inferior radio-ulnar joints.
        Anat Rec. 1965; 151: 275-285
        • Lewis OJ
        The hominoid wrist joint.
        Am J Phys Anthropol. 1969; 30: 251-267
        • Mikic ZD
        Age changes in the triangular fibrocartilage of the wrist joint.
        J Anat. 1978; 126: 367-384
        • Mohiuddin A
        • Janjua MZ
        Form and function of radioulnar articular disc.
        Hand. 1982; 14: 61-66
        • Palmer AK
        • Glisson RR
        • Werner FW
        Relationship between ulnar variance and triangular fibrocartilage complex thickness.
        J Hand Surg. 1984; 9A: 681-683
        • Palmer AK
        • Werner FW
        Biomechanics of the distal radioulnar joint.
        Clin Orthop. 1984; 187: 26-34
        • Palmer AK
        • Werner FW
        The triangular fibrocartilage complex of the wrist—anatomy and function.
        J Hand Surg. 1981; 6: 153-162
        • Poehling GG
        • Koman LA
        • Whipple TL
        • Roth JH
        • Kammire G
        Diagnosis and management of articular cartilage lesions of the wrist.
        in: Presented at the 42nd Annual Meeting of the ASSH, San Antonio, TexasSeptember 1987
        • Roth JH
        A review of my first 150 cases of wrist arthroscopy.
        in: Wrist Investigators Workshop, Orlando, FloridaNovember 1987
        • Roth JH
        Wrist arthroscopy.
        in: Lichtman DM The wrist and its disorders. WB Saunders, Philadelphia1988: 220-231
        • Roth JH
        • Haddad RG
        A comparison of arthrography and arthroscopy in the diagnosis of chronic ulnar wrist pain.
        in: Presented at the 41st Annual Meeting of the ASSH, New Orleans, LouisianaFebruary 1986
        • Johnson RK
        Muscle-tendon transfer for stabilization of the distal radioulnar joint.
        J Hand Surg. 1985; 10A: 437
        • Johnson RK
        • Shrewsbury MM
        The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint.
        J Hand Surg. 1976; 1: 205-209
        • Kauer JMG
        The articular disc of the hand.
        Acta Anat. 1975; 93: 590-605
        • Kauer JMG
        Functional anatomy of the wrist.
        Clin Orthop. 1980; 149: 9-20
        • Taleisnik J
        The ligaments of the wrist.
        J Hand Surg. 1976; 1: 110-118
        • Thiru-Pathi RG
        • Ferlic DC
        • Clayton ML
        • McClure DC
        Arterial anatomy of the triangular fibrocartilage of the wrist and its surgical significance.
        J Hand Surg. 1986; 11A: 258-263
        • Werner FW
        • Glisson RR
        • Murphy DJ
        • Palmer AK
        Force transmission through the distal radioulnar carpal joint: effect of ulnar lengthening and shortening.
        Handchirurgie. 1986; 18: 304-308
        • Ekenstam F
        • Palmer AK
        • Glisson RR
        The load on the radius and ulna in different position of the wrist and forearm.
        Acta Ortho Scand. 1984; 55: 363-365
        • Ekenstam FW
        • Hagert CG
        Anatomical studies on the geometry and stability of the distal radioulnar joint.
        Scand J Plast Reconstr Hand Surg. 1985; 19: 17-25
        • Kapandji IA
        The inferior radioulnar joint and pronosupination.
        in: 2nd ed. The Hand. Vol 1. WB Saunders, Philadelphia1981: 121-129
        • Epner RA
        • Bowers WH
        • Guilford WB
        Ulna variance: the effect of wrist positioning and roentgen filming technique.
        J Hand Surg. 1982; 7: 298-305
        • Hardy DC
        • Totty WG
        • Reinas WR
        • Gilula LA
        Posteroanterior wrist radiography: importance of arm positioning.
        J Hand Surg. 1987; 12A: 504-508
        • Hulten O
        Uber anatomische variationen der hand gelenknochen.
        Acta Radiol. 1928; 9: 155-169
        • Palmer AK
        • Glisson RR
        • Werner FW
        Ulnar variance determination.
        J Hand Surg. 1982; 7: 376
        • Levinsohn EM
        • Palmer AK
        Arthrography of the traumatized wrist.
        Radiology. 1983; 146: 647-651
        • Levinsohn EM
        • Palmer AK
        • Coren AB
        • Zinberg E
        Wrist arthrography: the value of the three compartment injection technique.
        Skeletal Radiology. 1987; 16: 539-544
        • Mikic ZD
        Arthrography of the wrist joint. An experimental study.
        J Bone Joint Surg. 1984; 66A: 371-378
        • Palmer AK
        • Levinsohn EM
        • Kuzma GR
        Arthrography of the wrist.
        J Hand Surg. 1983; 8: 15-23
        • Reimas WR
        • Hardy DC
        • Totty WG
        • Gilula LA
        Arthroscopic evaluation of the carpal triangular fibrocartilage complex.
        J Hand Surg. 1987; 12A: 495-503
        • Zinberg EM
        • Palmer AK
        • Coren AB
        • Levinsohn EM
        The triple injection wrist arthrogram.
        J Hand Surg. 1988; 13A: 803-809
        • Wehbe MA
        Surgical approach to the ulnar wrist.
        J Hand Surg. 1986; 11A: 509-512
        • Whipple TL
        Clinical application of wrist arthroscopy.
        in: Lichtman DM The wrist and its disorders. WB Saunders, Philadelphia1988: 118-128
        • Palmer AK
        • Werner FW
        • Glisson RR
        • Murphy DJ
        Partial excision of the triangular fibrocartilage complex: an experimental study.
        J Hand Surg. 1988; 13A: 391-394
        • Palmer AK
        Wafer procedure.
        in: Presented at the Distal Radioulnar Joint Course, Orlando, FloridaNovember 1987
        • Bowers WH
        Distal radioulnar joint arthroplasty: the hemiresection interposition technique.
        J Hand Surg. 1985; 10A: 169-178