MANUAL MINORS
A triangular fibrocartilage complex (TFCC) injury affects a structure composed of ligaments and fibrocartilage, located on the ulnar side of the wrist (pinky side), which is responsible for the stability between the ulna and the carpal bones. It is common in athletes or after falls onto an outstretched hand. Symptoms include pain on the ulnar side of the wrist, worsened by rotational movements (pronation-supination) or weight-bearing, as well as clicking or a sensation of instability.
Diagnosis
The diagnosis is based on the patient’s medical history and physical examination, including manoeuvres such as the ulnar load test (pain induced by twisting the wrist). X-rays are used to rule out fractures, while MRI is essential for assessing damage to the TFCC and determining the extent of the injury.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Wrist sprain | Generalised pain after trauma, without clicking or specific pain on the ulnar side. |
Ulnar tendinitis | Localised pain in the extensor or flexor tendons, without TFCC involvement. |
Distal ulna fracture | Acute pain, deformity, and radiological confirmation of bone fracture. |
Wrist dislocation | Severe pain with visible deformity and loss of mobility, confirmed by X-ray. |
Emergency Management
Initial management involves immobilising the wrist with a splint or bandage to limit movement and prevent further damage. Pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs) should be administered to alleviate pain. Ice application and restricting activities involving the wrist are essential in the early stages.
Definitive Treatment
Conservative treatment includes immobilisation with splints for several weeks, physiotherapy to restore range of motion and strength, and the use of NSAIDs. If the injury is severe or does not improve with conservative treatment, an arthroscopy may be necessary to repair or debride the injured TFCC.
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