I think everyone has done a great job describing how they would differentiate these structures.
TFCC:
– I like Matt’s comparison of the meniscus in the knee to the TFCC. However, the TFCC is much more complex than just the meniscus in the knee. The triangular fibrocartilage complex includes structures such as the triangular fibrocartilage disc, ulnocarpal meniscus, dorsal/volar radioulnar ligaments, sheath of the extensor carpi ulnaris, UCL, and ulnolunate and ulnotriquetral ligaments. The TFCC has different functions as well including stabilizing the DRUJ and the ulnar carpal bones, but also transmits load between the ulnar and carpal bones. Due to the many structures within the TFCC and different functions, saying that you have a TFCC injury is similar to saying I have subacromial impingement syndrome in the shoulder – there are too many different structures that make up this complex, and it is hard to tease out which might be the structure at fault. Because of this I would think that you would want to see if this is a compressive issue vs a stability issue or a combination of both when talking about TFCC injuries.
– There are two classifications of TFCC injury type 1 (traumatic) and type 2 (degenerative). Going back to the knee meniscus analogy, an acute meniscus tear can present very differently than a degenerative tear in the meniscus. It was interesting to note that degenerative TFCC injuries can occur as young as 30 years old based on their history. Our individual has been a competitive golfer for a long time but did have a specific traumatic compressive/rotational mechanics that caused his pain, so he could have a presentation of both traumatic and degenerative symptoms.
– TFCC Tests:
o General:
– + pain with Palpation (distal ulna, TFCC – most common), also assess the other surrounding ligaments in that complex
– – atrophy / sensory changes
– + Edema
o Compression/rotation injury
– + press test (compression)
– + Compression / rotation /shearing of TFCC
– + Catching/clicking
– distraction
o Ligamentous TFCC Injury
– DRUJ motion laxity
– Carpal laxity
– Supination test
– Piano key test
– Pain with Distraction, better with compression?
– Shuck test – lunotriquetral ligament injuries
Fracture:
– Intense pain with palpation over bony prominence (hamate, pisiform, triquetrum, distal radius, ulnar styloid process, lunate)
– Tuning fork
– Imaging (XR/MRI)
– Edema
ECU involvement
– APR
– ECU synergy
– Palpation