Anatomy:Click here
Causes:
Traumatic: axial loading and/or rotation or , or wrist distraction
Degenerative: excessive ulnocarpal impaction, ulnar variance, age
Clinical features:
Ulnar sided wrist pain, swelling, pain on gripping and forearm rotation, crepitus, snapping
Tender ulnar wrist,
TFCC grinding test
Lunotriquetral ballotment
Pisotriquetral shear test
DRUJ stability test
Radiograph:
PA zero rotation view to assess ulnar variance
Clenched fist ulnar deviation for impingement
Palmar classification:
Class 1 traumatic:
1A central perforation - traumatic tears of the articular disc dorsal to palmar
1B ulnar avulsion - distal ulna avulsion injuries
1C distal avulsion - traumatic disruption of the ulnolunate or ulnotriquetral ligaments
1D radial avulsion with or without traumatic avulsion from sigmoid notch of radius.
Class 2 spectrum from mild cartilage bruising to full thickness perforation and impaction.
2A wear - chondromalacia of articular disc
2B wear with lunate and/or ulnar chondromalacia
2C full thickness perforation with lunate and/or ulnar chondromalacia
2D - 2C + lunotriquetral ligament disruption
2E - 2C + ulnocarpal arthrotis
MR:
Peripheral tears (ulnar) have poor sensitivity due to striated fascicles
References:
1. Haims AH et al. Limitations of MR Imaging in the Diagnosis of Peripheral Tears of the Triangular Fibrocartilage of the Wrist. AJR 2002; 178:419-422
