The Chinese name of TFCC is triangular fibrocartilage complex. It is a structural complex composed of triangular fibrocartilage and its surrounding ligaments. It is connected between the ulna and radius. It is the most important stable structure of the distal radioulnar joint and the ulnar part of the wrist. , participate in important functional movements such as forearm pronation, supination and wrist radial and ulnar deviation. TFCC injury is one of the most common injuries of the wrist, but it is often ignored. It is easy to injure and difficult to heal. It often has a great impact on the patient's physiology, psychology, life and work.
Anatomical structure and biomechanics of TFCC
TFCC is composed of triangular fibrocartilage of the wrist and its surrounding ligaments. The specific components include the carpal disc, homologue of the disc, distal radioulnar palmar and dorsal ligament, extensor carpi ulnaris tendon sheath, ulnar capsule, ulnar triangular ligament, Radioulnar triangular ligament and ulnolunar ligament. TFCC separates the distal radioulnar joint from the radiocarpal joint, stabilizes the ulnocarpal joint and the distal radioulnar joint, transmits and buffers the pressure between the carpus and ulna, and makes the forearm and wrist more flexible.
The blood supply of TFCC is mainly from the palmar branch and dorsal side of the anterior interosseous artery. Its horizontal cartilage part is called triangular fibrocartilage (TFC) proper. Like other cartilage tissues in the body, it has no blood transport, no lymphatic supply, no innervation, and its self-repair ability is limited. Superficial but not deep and full-thickness defects are difficult to complete self-healing.
What conditions can cause TFCC damage?
1. A clear history of regional trauma, the DRUJ is subjected to rotational shear force or separation external force, which can lead to TFCC injury, or is accompanied by radioulnar palmar and radioulnar dorsal ligament injury;
2. Long-term bad posture, excessive use of the wrist joint, such as frequent flexion, extension, and rotation of the wrist joint (occurring during fitness) lead to degeneration and thinning of the articular disc, cartilage softening, and intra-articular inflammation.
Diagnosis and evaluation of TFCC
1. Observe whether there is obvious swelling and deformity in the affected part, swelling of the ulnar side of the wrist, joint range of motion, pain points, joint range of motion and grip strength, etc., and compare them bilaterally.
2. Pain: Pain on the ulnar side of the wrist, aggravated by ulnar deviation of the wrist joint, which can lead to painful snapping, accompanied by wrist discomfort, especially when the wrist is rotated, the pain is aggravated or accompanied by limited wrist movement.
3. Imaging examinations, including plain X-ray examinations, can observe the lesions of the lunate and distal ulna, and whether the joint space is normal.
4. MRI is an effective means of diagnosing TFCC tears.
Differentiation between TFCC injury and tenosynovitis
Stenosing tenosynovitis is an aseptic inflammation of the tendon sheath and tendon due to long-term overuse, friction, and strain, causing the synovial sheath and tendon sheath around the tendon to thicken and edema, compressing the tendon, resulting in restricted tendon sliding and pain. Commonly seen in the fingers and wrists, mainly manifested as local pain, aggravated during activities with joint movement disorders, especially in the morning, and improved after activities, and aggravated flexion and extension disorders in late-stage patients, with snapping or atresia phenomenon, passive movement after atresia The affected finger is also difficult, with local palpable induration and obvious tenderness.
TFCC's Rehabilitation Treatment
1. Brake, immobilize, take non-steroidal anti-inflammatory drugs orally and reduce wrist joint activity or rest.
2. Equipment and wrist ROM training can solve the problem of joint mobility caused by postoperative fixation and enhance muscle strength.
3. Medium-frequency pulse electrical stimulation can stimulate muscle contraction, prevent muscle atrophy, relieve pain, reduce inflammation, reduce swelling, loosen adhesions, and promote the absorption of scar tissue.
4. Joint mobilization can promote the flow of joint synovial fluid, increase the nutrition of the avascular area of articular cartilage, prevent degeneration caused by reduced activity, and maintain the stretchability of soft tissues.
5. Ultrasonic therapy: it can accelerate tissue circulation and promote wound healing.
