General:

                   

The Triangular Fibrocartilage (T.F.C.) is a strong ligament type structure in the wrist.

It acts to stabilise the joint between the Radius and Ulna.

It also acts as a spacer between the Ulna head and the wrist joint.

It may cause pain when torn or can result in clicking or catching in the wrist.

                       

It has a poor blood supply and it derives its nutrition largely from the fluid in the wrist joint.

The edge of the TFC has a better blood supply ( Peripheral 10-15%).

                    

The lack of blood supply has implication for healing similar to the menisci in the knee. (“Cartilages in the knee”).

A central tear does not heal when torn but a peripheral tear may heal.

Many people have degenerative tears of the central portion of the TFC as they get older and yet may have no pain at all.

Ulna Length ( Ulna Variance)

On a front view of the wrist the radius and ulna are approximately the same length.

                  

With normal gripping and leaning on the hand 80% of the force passes from the wrist bones to the radius & 20% to the ulna.

Minor changes in length of the ulna variance have profound implications for these forces.

Approx 2mm change in length has a 20% effect on the forces.

                         

A long ulna can cause:
- Tear of the TFC
- Arthritis on the Lunate, Triquetrum
- Tear of the L-T ligament

             

 

Issues:

- Central or Peripheral tear

 

 - Trauma or Degenerative

- Other injuries eg fracture, nerve, ligaments

- Age, Activity Level, General Health

- Non - Dominant Hand

- Risks v Benefits of Surgery

Treatment

1. Activity modification
2. Anti-inflammatory tablets
3. Cast
4. Splint

Surgery

1. Arthroscopy

a. Trim the torn cartilage

 

b. Repair

       

 

2. Arthroscopy & Ulna shortening

3. Plate removal – required in 2/3rds of cases although this figure has dramatically reduced with the use of low profile "Ulnar shortening" plates

Ulna shortening:

– if the ulna is too long
– the bone is cut using a saw and a plate is applied to the bone with 6 - 7 screws
– overnight stay in hospital
– plaster for 6 – 8 weeks or until bone cut has healed
– activity restriction for 3 + months

 

LAST UPDATED ON  12 / 4/ 2015