Morphology and Distribution of Nerve Endings in the Human Triangular Fibrocartilage Complex

1998 ◽  
Vol 23 (4) ◽  
pp. 522-525 ◽  
Author(s):  
M. OHMORI ◽  
H. AZUMA

We studied the morphology and distribution of nerve endings in the human triangular fibrocartilage complex using both silver staining and immunohistochemical staining using a protein specific to nerve fibres. Free nerve endings were found in the ulnar side of the triangular fibrocartilage complex, especially in the ulnar collateral ligament, meniscus homologue and the adjacent collagen fibre area of the peripheral part of the ulnar side of the articular disc. Meissner’s and Krause’s corpuscles were observed in the ulnar collateral ligament and meniscus homologue. The fact that free nerve endings were observed in the meniscus homologue and adjacent collagen fibre area of the peripheral part of the ulnar side of the articular disc suggests that this disc may be a source of wrist pain. The presence of nerve end bulbs in the triangular fibrocartilage complex also suggests a possible role for corpuscles as mechanoreceptors.

1996 ◽  
Vol 21 (5) ◽  
pp. 581-586 ◽  
Author(s):  
T. NAKAMURA ◽  
Y. YABE ◽  
Y. HORIUCHI

The functional anatomy of the triangular fibrocartilage complex (TFCC) was investigated in 20 fresh cadavers. Dynamic changes in the TFCC during rotation were also examined from both the proximal and distal aspects. In our analysis, the TFCC was separated into three components. The distal component was stable, functioning like a hammock to suspend the ulnar carpus. The proximal component was the fan-shaped triangular ligament, the true radioulnar ligament. This was found to originate from the fovea of the ulna in a vertical fashion and was easily twisted during rotation. The third component, the ulnar collateral ligament, also twisted during rotation. When analysed by coronal section, the internal portion of the TFCC was found to be loose, and probably serves as a cushion to absorb local deformities in the TFCC during rotation.


2018 ◽  
Vol 08 (05) ◽  
pp. 423-425
Author(s):  
Leen Vanlaer ◽  
Sebastiaan Kellens ◽  
Maarten Van Nuffel

Background Congenital abnormalities of the triangular fibrocartilage complex (TFCC) are rare and could be mistaken for a traumatic lesion. It is important to recognize these anatomical variations and to realize they do not always require treatment. Case Description An incidental finding of an atraumatic bucket handle abnormality of the TFCC in a 15-year-old male, who was treated arthroscopically for dorsal wrist pain. This structure was resected, thus obtaining a normal looking peripheral TFCC. Literature Review Literature regarding congenital abnormalities of the TFCC is limited to a meniscoid articular disc or a congenital perforation. To our knowledge, an atraumatic bucket handle abnormality has not been described yet. Clinical Relevance This congenital abnormality of the TFCC could be mistaken for a traumatic lesion on MRI, or during wrist arthroscopy; therefore, it is important to realize that this entity may occur and does not require treatment.


Hand Surgery ◽  
2003 ◽  
Vol 08 (02) ◽  
pp. 219-226 ◽  
Author(s):  
Saburo Sasao ◽  
Moroe Beppu ◽  
Hitoshi Kihara ◽  
Kazuaki Hirata ◽  
Masayuki Takagi

The ligamentous structures of the triangular fibrocartilage complex (TFCC) and their attachments were examined anatomically and histologically using fresh and embalmed cadavers. The TFCC was observed to have a three-dimensional structure consisting of three palmar ligaments — the short radiolunate (SRL), ulnolunate (UL), and ulnotriquetral (UT) ligaments. In addition, the attachment site of the ulnocarpal ligament (UC), which had been previously unknown, was identified. The dorsal components of the TFCC have been previously reported to consist solely of the extensor carpi ulnaris (ECU) subsheath; however, the ligamentous components running from the ulnar styloid process to the triquetrum were found at a layer deeper than the floor of the ECU subsheath. The UC has been reported previously as a two-dimensional structure, but there has been some disagreement as to its attachment sites.2–6,14,15 It is suggested that the dorsal UT ligament should be considered as a separate ligament, based on its different direction and distal attachment site as compared with those of the ulnar collateral ligament (UCL) and ECU subsheath.


2002 ◽  
Vol 27 (1) ◽  
pp. 86-89 ◽  
Author(s):  
S. NISHIKAWA ◽  
S. TOH ◽  
H. MIURA ◽  
K. ARAI

Triangular fibrocartilage complex (TFCC) injuries were suspected clinically in 22 wrists of 21 patients, but arthrography and MRI assessments of this structure were normal. As conservative therapy for 2 months did not improve their symptoms, wrist arthroscopy was then performed. Although no abnormalities of the TFCC and ligaments were observed, meniscus homologue-like tissue which arose from TFCC was riding on the articular surface of the triquetrum. After resection of this soft tissue with a shaver and a punch, the symptoms disappeared in all cases. The arthroscopic findings suggested that a portion of TFCC that was originally attached to the ulnar side of the triquetrum had become detached.


2009 ◽  
Vol 91-B (8) ◽  
pp. 1094-1096
Author(s):  
S.-J. Kim ◽  
H.-K. Moon ◽  
Y.-M. Chun ◽  
W.-H. Chang ◽  
S.-G. Kim ◽  
...  

Orthopedics ◽  
2010 ◽  
Vol 33 (5) ◽  
pp. 312-316 ◽  
Author(s):  
James S. Starman ◽  
Robert J. Morgan ◽  
James E. Fleischli ◽  
Donald F. D’alessandro

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0005
Author(s):  
Ana Costa Pinheiro ◽  
Filomena Ferreira ◽  
Margarida Areias ◽  
Carolina Oliveira ◽  
Cristina Sousa ◽  
...  

Introduction: Injuries from the athlete’s hand are frequent. We present 2 clinical cases: Stener injury and traumatic dislocation of the metacarpophalangeal joint of the thumb. The “skier’s thumb” is an injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb produced by abduction and hyperextension of the thumb. Dorsal dislocation of the thumb metacarpophalangeal joint (MCP) in children is a rare entity. There are three types of dislocation: incomplete, simple and complete complete complex. Methods: Presentation of 2 clinical cases of injuries of the athlete’s hand: Stener injury and traumatic dislocation of the metacarpophalangeal joint of the thumb. Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: CASE 1: Male 11 years old, put into service urgency by hand trauma during football match. He had pain and swelling at the ulnar rim of the joint of the first metacarpal-phalangeal joint. Radiogram unchanged. Coping with clinical suspicion was carried out ray under stress (radial deviation) showed that this instability of the joint. Ultrasonography confirmed complete rupture of the ulnar side of the attachment with the aponeurosis interposition of the adductor - stener lesion. Surgery decided. Focus through internal and distal reinsertion. 4 weeks immobilization period, followed by a return to activities of daily living. At the last visit, at 6 months after the operation there was no residual instability. CASE 2: Seven-year-old boy put into service urgency for thumb injury in hyperextension during football match. The objective examination shows hyperextension deformity of MCF. The radiological study confirmed complete MCF dorsal joint dislocation diagnosis of the thumb joint. A closed reduction procedure under sedation, by McLaughlin corset technique. Immobilization was performed for two weeks. At six weeks he was asymptomatic, with normal mobilities, symmetrical grip and clamp strength without instability or radiographic changes. Discussion/Conclusion: Lesion of the ulnar side ligament is a possible diagnosis of the pediatric age, even without associated withdrawal. Proper clinical observation and x-rays provide supplemented by ultrasound, often all the information necessary for diagnosis and therapeutic decision. The low frequency relevance of pediatric Stener injuries can damage your diagnosis of the emergency situation. In this clinical case, it is possible to detect this damage. The dislocations dorsal joint MCP thumb are more frequent than flying, lesional mechanism involving the traumatic hyperextension of it. The diagnosis is based on clinical information supplemented by radiography, which allows the differentiation between complete and incomplete dislocations. A complete dislocation can not be reduced by maneuvering bloodless injury is complex and requires surgical treatment. The reduction technique involves MCF hyperextension and replacement of the base of the phalanx. Other gestures should be avoided, and axial traction, risk of joint injury structures, cartilage growth or conversion of a simple dislocation into complex, to determine the need for surgical intervention. After reducing the stability of the collateral ligaments should be evaluated, often directly damaged by trauma or inappropriate gestures reducing the reduction of multiple attempts. Lateral instability may benefit from surgical correction. References STENER, B.: “Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb”. A clinical and anatomical study. J. Bone Jt. Surg. 44-B: 869, 1962. STENER, B.: “Hyperextension injuries to the metacarpophalangeal joint of the thumb. Rupture of ligaments, fracture of sesamoid bones, rupture of flexor pollicis brevis. An anatomical and clinic study”. Acta Chir. Scand. 125: 275, 1963. COONRAD, R.W., GOLDNER, J.L.: “A study of the pathological findings and treatment in soft-tissue injury of the thumb metacarpophalangeal joint”. J. Bone Jt Surg. 59- A: 439, 1968. PARIKH, M., NAHIGIAN, S., FROIMSON, A.: “Gamekeeper’s thumb”. Plast. Reconstr, Surg. 58:24, 1976. STENER, B.: “Entorses récents de la métacarpophalangienne du pource”, en Traité de chirurgie de la main de Tubiana R. Tomo II, pág. 779. París, Masson, 1984. KAPLAN, E.B.: “The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal”. J. Bone Jt Surg. 43-A: 541, 1961. YAMANAKA, K., YOSHIDA, K., INOVE, A., MIYAGI, T.: “Locking of the metacarpophalangeal joint of the thurnb”. J. Bone Jt Surg. 67-A: 782, 1985. NAVES, J., SALVADOR, A., PUIG, M.: “Traumatología del deporte”. Pág. 251. Salvat, Barcelona, 1986, SMITH, R.J.: “Post-traumatic instability of the metacarpophalangeal joint of the thumb”. J. bone Jt Surg. 59-A: 14-21, 1977. Kasuaki M. Dorsal dislocations of the second to fifth carpometacarpal joints: a case report. Hand Surg 2008; 13(2): 129-132. Laforgia R, Specchiulli F, Mariani A. Dorsal dislocation of the fifth carpometacarpal joint. Hand Surg Am 1990; 15: 463-465. Gangloff D, Mansat P, Gaston A, Apredoaei C, Rongières M. Carpometacarpal dislocation of the fifth finger: descriptive study of 31 cases. Chir Main 2007; 26(4-5): 206-213. Epub 2007 Jul 16. Eichhorn-Sens J, Katzer A, Meenen NM, Rueger JM. Carpometacarpal dislocation injuries. Handchir, Mikrochir, Plast Chir 2001; 33(3): 189. Yoshida R, Shah MA, Patterson RM, Buford WL Jr, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 2003; 28(6): 1035-1043.


2013 ◽  
Vol 38 (7) ◽  
pp. 746-750 ◽  
Author(s):  
T. Oda ◽  
T. Wada ◽  
K. Iba ◽  
M. Aoki ◽  
M. Tamakawa ◽  
...  

In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer’s Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.


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