Definition

By Gregory R. Waryasz, MD

The triangular fibrocartilagenous complex of the musculoskeletal system is characterized by being composed of different structures.

It is part of the distal radioulnar joint. It consists of fibrocartilage and ligament.

Its unique structural feature is that it is an articular disc (triangular fibrocartilage), meniscus homologue (lunocarpal), dorsal and volar radioulnar ligaments, floor of the extensor carpi ulnaris tendon sheath, and the volar ulnocarpal ligaments.  It spans from the radial border of the distal radius and inserts into the ulnar styloid base and the through the ligamentum subcruatum into the distal ulna.  The TFCC is approximately 5 mm on the ulnar side and 2 mm thick at the radial side.

The central disc is avascular, but the peripheral vessels can penetrate the margins of the TFCC.

The TFCC as well as all other bones, muscles, and ligaments of the body are derived of mesodermal origin in the embryo.

The function of the TFCC is to be a stabilizer of the distal radioulnar joint and to help stabilize the ulnocarpal articulations.

Common diseases include TFCC tears.

Tears of the TFCC can occur leading to instability of the wrist and pain.

Commonly used diagnostic procedures include clinical history, physical exam, x-ray, and MRI.

It is usually treated with physical therapy, steroid injections, and NSAIDs. Surgery can be performed either with an open incision or performed with arthroscopy for tears.

References

Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.

Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.

Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.

Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.

Wheeless’s Textbook of Orthopaedics: Triangular Fibrocartilage Complex (http://www.wheelessonline.com/ortho/triangular_fibrocartilage_complex)