Tears of the Triangular Fibrocartilage Complex

Philip E. Blazar and Scott D. Mair

History and Clinical Presentation

A 19-year-old right hand dominant college student presented for evaluation of left wrist pain 5 months after closed treatment for a distal radius fracture. The pain was ulnar sided and associated with activities, particularly those involving maximal extension or pronation/supination against resistance (e.g., turning a doorknob on a heavy door). There was no clicking. The patient's injury had been treated in a longarm cast for 8 weeks. Office notes from the referring physician document a diagnosis of distal radius fracture and distal radioulnar joint (DRUJ) dislocation reduced and treated in a closed manner. The patient was referred for persistent ulnar sided wrist pain.

Physical Examination

The hand, wrist, elbow, and shoulder were normal to inspection. There was minimal atrophy of the forearm musculature. Active range of motion of all joints was symmetric bilaterally. There was tenderness to palpation radial to the ulnar styloid with the arm in neutral rotation and mild discomfort, but no increased translation with stressing the DRUJ. TFCC grind maneuver produced no pain or clicking. The extensor carpi ulnaris (ECU) tendon did not subluxate out of its groove, and wrist instability maneuvers caused minimal discomfort and no clunking. Neurologic and vascular examinations were normal.

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