From the Guidelines
To identify a TFCC injury, a combination of physical examination, including specific provocative tests, and imaging studies such as MRI or MR arthrography is recommended, with MR arthrography being the most sensitive and specific method for detecting TFCC lesions, as supported by the most recent study 1. When suspecting a TFCC injury, it is crucial to recognize specific symptoms such as pain on the ulnar side of the wrist, clicking or popping sensations, swelling, and decreased grip strength.
Key Symptoms and Signs
- Pain on the ulnar (pinky) side of the wrist, especially during activities that involve twisting the wrist or gripping
- Clicking or popping sensations
- Swelling
- Decreased grip strength
- Pain typically worsens with rotation of the forearm or when bearing weight on the extended wrist If a TFCC injury is suspected, consulting a healthcare provider for a physical examination, including specific provocative tests such as the ulnar fovea test, piano key test, or TFCC compression test, is essential.
Diagnostic Approach
- Physical examination
- Imaging studies:
- X-rays to rule out fractures
- MRI as the gold standard for visualizing soft tissue structures of the TFCC
- MR arthrography for its higher sensitivity and specificity in detecting TFCC lesions, as shown in the study 1
- CT arthrography as an alternative, with high sensitivity, specificity, and accuracy for TFCC complex tears, intrinsic ligament tears, and articular cartilage abnormalities, as reported in the study 1 TFCC injuries often result from falls onto an outstretched hand, repetitive wrist motions, or degenerative changes over time.
Importance of Early Diagnosis
Early diagnosis is vital as it allows for appropriate treatment, which may include rest, immobilization, anti-inflammatory medications, physical therapy, or in severe cases, surgical repair, ultimately improving morbidity, mortality, and quality of life outcomes. The most recent and highest quality study 1 supports the use of MR arthrography for the diagnostic workup of ligamentous and early cartilage defects, providing better diagnostic accuracy than MRI alone.
Recommendation
MR arthrography is the recommended imaging modality for identifying TFCC injuries due to its high sensitivity and specificity, as demonstrated in the study 1.
From the Research
Identifying TFCC Injury
To identify a TFCC (Triangular Fibrocartilage Complex) injury, several methods can be employed, including:
- Clinical examination: A diligent clinical examination is essential for diagnosing TFCC pathologies, as it facilitates specific tests that help allocate symptoms to the pathology 2.
- Diagnostic imaging: Various imaging modalities can be used, including:
- Magnetic Resonance Imaging (MRI): MRI is a better diagnostic modality for visualizing the TFCC cartilage and ligaments 3.
- Magnetic Resonance Arthrography (MRA): MRA is consistently and accurately able to visualize structural abnormalities of the TFCC 3, 4.
- Computed Tomography (CT) and Computed Tomographic Arthrography (CTA): CTA has been shown to have high sensitivity and specificity for diagnosing TFCC injuries, particularly for central lesions 4.
- Ultrasound: While ultrasound can be useful for visualizing intra-articular effusion, soft tissue, and bone surface, it is not as effective as MRI or MRA for diagnosing TFCC lesions 3.
- Wrist arthroscopy: Considered the "gold standard" for diagnosing TFCC pathologies, wrist arthroscopy provides a direct visualization of the TFCC and its constituent structures 2.
Diagnostic Considerations
When diagnosing TFCC injuries, it is essential to consider the following:
- Classification of TFCC lesions: The Palmer and Atzei classifications are commonly used to categorize TFCC lesions 2.
- Location of the lesion: Central TFCC lesions tend to have higher diagnostic accuracy than peripheral lesions 4.
- Imaging modalities: The choice of imaging modality depends on the specific clinical presentation and the availability of resources 4, 5.