TRIANGULAR FIBROCARTILAGE COMPLEX AND DISTAL RADIOULNAR JOINT


The human forearm has the ability to rotate and place the hand in space. In addition, the wrist can move in different directions, interdependently. The rotation of the forearm is made possible by the joints between the radius and ulna, the two forearm bones, and more specifically the joint at the lower end, called the distal radioulnar joint (DRUJ).

This joint is essentially part of the wrist joint and the stability of this joint is reliant on a specialised structure called the triangular fibrocartilage complex (TFCC), which also forms an integral part of the wrist joint. This TFCC transmits approximately 20% of the load of the forearm to the wrist bones.

It has been compared to the meniscus of the knee that is also closely involved in the load distribution of the knee. Interestingly, a meniscal homolog is commonly seen as part of the anatomy of the TFCC.

It is therefore easy to understand, that any problems with the distal radioulnar joint or the TFCC, will manifest with ulnar sided (side of little finger) pain when the wrist is loaded with body weight or when the forearm is rotated. This can manifest as an instability of the distal radioulnar joint which might create a popping sensation or pain. The TFCC might get traumatic tears that create mechanical symptoms, very much like the meniscus in the knee.

There are many other things that can create pain in the same area and should be investigated by a hand surgeon who can systematically exclude other causes. To make things more complex, there are some normal anatomical variations that might become important and should also be considered when investigating ulnar sided wrist pain.

It is also important to understand that the TFCC cannot be visualised on x-rays. It is a ligamentous/cartilage-like structure and the radiological investigation of choice is a MRI scan.

TRIANGULAR FIBROCARTILAGE COMPLEX AND DISTAL RADIOULNAR JOINT


The human forearm has the ability to rotate and place the hand in space. In addition, the wrist can move in different directions, interdependently. The rotation of the forearm is made possible by the joints between the radius and ulna, the two forearm bones, and more specifically the joint at the lower end, called the distal radioulnar joint (DRUJ).

This joint is essentially part of the wrist joint and the stability of this joint is reliant on a specialised structure called the triangular fibrocartilage complex (TFCC), which also forms an integral part of the wrist joint. This TFCC transmits approximately 20% of the load of the forearm to the wrist bones.

It has been compared to the meniscus of the knee that is also closely involved in the load distribution of the knee. Interestingly, a meniscal homolog is commonly seen as part of the anatomy of the TFCC.

It is therefore easy to understand, that any problems with the distal radioulnar joint or the TFCC, will manifest with ulnar sided (side of little finger) pain when the wrist is loaded with body weight or when the forearm is rotated. This can manifest as an instability of the distal radioulnar joint which might create a popping sensation or pain. The TFCC might get traumatic tears that create mechanical symptoms, very much like the meniscus in the knee.

There are many other things that can create pain in the same area and should be investigated by a hand surgeon who can systematically exclude other causes. To make things more complex, there are some normal anatomical variations that might become important and should also be considered when investigating ulnar sided wrist pain.

It is also important to understand that the TFCC cannot be visualised on x-rays. It is a ligamentous/cartilage-like structure and the radiological investigation of choice is a MRI scan.

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