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Upper limb
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The triangular fibrocartilage is a complex consisting of the ulnocarpal ligaments, extensor carpi ulnaris tendon sheath and a meniscus-like structure between the distal ulna and the carpus. It is continuous with the dorsal and volar wrist capsules and stabilises the distal radioulnar joint. It can undergo traumatic or degenerative tears, presenting with ulna-sided wrist pain and distal radioulnar instability. An MR arthrogram or wrist arthroscopy aids diagnosis (Figure34.44). Peripheral tears of the TFCC can be repaired (open or arthroscopically), while central degenerative tears can be arthroscopically debrided.
Musculoskeletal cases
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
CPPD (often referred to as pseudogout when it results in acute pain and swelling) shares many XR features with OA, including loss of joint space and subchondral sclerosis. A key feature is chondrocalcinosis (calcification within cartilaginous structures). Commonly affected areas are the 1st and 2nd metacarpophalangeal (MCP) joints of the hand and the triangular fibrocartilage complex (TFCC) of the wrist (Figure 8.6C).
The wrist
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Special tests are needed to assess stability of the carpal articulations. The lunotriquetral joint is tested by pinching the lunate with one hand, the triquetral–pisiform with the other, and then applying a sheer stress: pain or clicking suggests an incompetent lunotriquetral ligament. The pisotriquetral joint is tested by pushing the pisiform radialwards against the triquetrum. Stability of the scapholunate joint is tested by pressing hard on the palmar aspect of the scaphoid tubercle while moving the wrist alternately in abduction and adduction: pain or clicking on abduction (radial deviation) is abnormal (Watson’s sign). The central portion of the triangular fibrocartilage is tested by pushing the wrist medially then flexing and extending it under load to elicit pain (the grind test). The distal radioulnar joint is tested for stability by holding the radius and then balloting the ulnar head up and down. These tests are mentioned again in the section on carpal instability.
Comparison of maximal isometric forearm supination torque in two elbow positions between subjects with and without limited forearm supination range of motion
Published in Physiotherapy Theory and Practice, 2021
Gyeong-Tae Gwak, Ui-Jae Hwang, Sung-Hoon Jung, Jun-Hee Kim, Moon-Hwan Kim, Oh-Yun Kwon
Forearm supination range of motion is limited by bone deformities, muscle weakness, and muscle stiffness (Neumann, 2010; Yasutomi, Nakatsuchi, Koike, and Uchiyama, 2002). Limited forearm supination range of motion (LSR) is often compensated for in the adjacent shoulder and wrist joint (Murgia, Kyberd, and Barnhill, 2010; Neumann, 2010; Pereira, Thambyah, and Lee, 2012; Sahrmann, 2011; Szekeres, 2017). Sahrmann (2011) suggested that if the pronator teres is stiffer than the other elbow flexors, compensatory shoulder external rotation during forearm supination with the elbow extended may result. In addition, Szekeres (2017) suggested that excessive wrist movement to compensate for LSR may lead to stress on the carpus during functional activities and can cause long-term problems with the triangular fibrocartilage complex or other extrinsic wrist ligaments. These compensatory movements may lead to decreased recruitment, and hence decreased strength due to disuse during activities of daily living, sports, and work (Alizadehkhaiyat et al., 2007; Mackinnon and Novak, 1994; Page, Frank, and Lardner, 2010; Sahrmann, 2011).
A high incidence of extensor pollicis brevis insertion into the distal phalanx in rheumatoid arthritis patients who required the surgical reconstruction for thumb boutonnière deformity
Published in Modern Rheumatology, 2019
Shunji Okita, Keiichiro Nishida, Aiji Ohtsuka, Toshifumi Ozaki
Several studies have described the anatomy of the dorsal fibrous complex of the MCP joint of the thumb [17–19]. Bade et al. [17], in a microscopic study, reported that the dorsal connective tissue of the thumb forms different layers of collagen lamella as a peritendinous system around EPL and EPB. Hunter-Smith et al. [18] described the dorsal triangular fibrocartilage of the MCP joint filling the dorsal space between the proximal phalanx and the metacarpal head to stabilize and match the congruity of the joint. Joshi et al. [19] described loose connective tissue connections between the dorsal triangular fibrocartilage and the extensor tendon. Our histological findings support these studies, and we found the dorsal fibrous complex of the MCP joint of the thumb was mainly composed of three layers: the extensor hood, the tendon, and the fibrous capsule integrated with the dorsal fibrocartilage in the vertical plane. Thus, in this study, we classified the insertion pattern of EPB into three Types; P1, P2, and D.
20-Year outcome of TFCC repairs
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Maria Moloney, Simon Farnebo, Lars Adolfsson
Lesions of the triangular fibrocartilage complex (TFCC) are frequent following wrist trauma. The TFCC contributes both to the stability of the distal radioulnar joint (DRUJ) and to ulno-carpal stability. The palmar and dorsal radioulnar ligaments extend in an angle from radius to ulna and attach in the fovea on caput ulnae and the base of the ulnar styloid process [1]. The attachment in the fovea is the most important for the DRUJ stability in dynamic loading of the wrist [2]. Severe TFCC injuries affecting the foveal fibers typically cause instability of the DRUJ [3], while peripheral lesions mainly affect ulno-carpal stability [4]. It is important to distinguish between a subjective perception of instability and the laxity found at clinical testing since laxity not per definition imply symptoms of instability [4]. TFCC injuries can be found in about 50–60% of patients with a distal radius fracture [5,6] and is almost always present when the fracture is dorsally displaced more than 32° [4].