triangular fibrocartilage complex (dutch)
DESCRIPTION
Dutch presentation about the Triangulair Fibrocartilage Complex.TRANSCRIPT
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Triangulair Fibro-Cartilageneus Complex (TFCC)
Felicia WagenaarMedisch student Erasmus MC
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TFCC
Scheiding radiocarpale van radioulnaire gewricht.
Origo: mediale radius Insertie:basis processus
styloidius ulnae
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Functie
Stabiliteit distale radio-ulnaire gewricht (DRU)
Transmissie axiale kracht carpus naar ulna
Stabiliteit ulnaire zijde carpalen
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Dorsaal FTCC
Discus articularis Meniscal homologue Lig. Collaterale ulnare Peesschede m extensor carpi ulnaris Distale lig radioulnare
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Palmair TFCC
Discus articularis Meniscal homologue
Lig. Ulnotriquetum Lig. Ulnolunatum Distale Lig
radioulnare
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Vascularisatie
Dorsale en palmaire radiocarpale takken a ulnaris en interosseous anterior
10-40% perifeer
Synoviaal vocht
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Anamnese
Leeftijd
Dominante hand
Beroep
Sport
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Anamnese
Traumatisch vs Degeneratief
Hyperextensie
Hyperpronatie
Hypersupinatie
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Anamnese
Pijn bij: Ulnair deviatie Pronatie Rotatie
Klikken Crepitaties
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Lichamelijk Onderzoek
Compleet onderzoek pols, elleboog, hand.
Inspectie: Zwelling ulnaire zijde Prominent caput ulnae
Palpatie: Pijn bij pressie op distale ulna Zwelling
Tests: DRU stress test grind test Piano key test Chair lifting test
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Prominent caput ulnae
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DRU Stress test
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Instabiel TFCC
http://www.youtube.com/watch?v=J2EON1d_viI&NR=1
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Aanvullend onderzoek
X-pols Ulnaire variantie Styloid fractuur ulna Avulsie fractuur fovea vd ulna
X-arthogram Positief als contrast in gewrichten lekt Herkent maar 50% TFCC scheuren
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Aanvullend onderzoek
MRI
MRI-arthrogram
CT-arthrografie
Echografie
Arthroscopie
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Palmer klasse 1 - traumatisch
A centrale perforatie B ulnaire avulsie
Met styloid fractuur Zonder styloid fractuur
C distale avulsie v carpus D radiale avulsie
Met proc sigmoideus frac Zonder proc sigmoideus frac
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Palmer klasse 2 - degeneratief
A: Dunner TFCC B: A + chondromalacie lunatum en/of
caput alnae C: B + volledige scheur discus
articularis D: C + gedeeltelijke scheur lig.
lunatotriq E: D + volledige scheur lig. Lunatotriq
+ arthrose
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Therapie
Conservatief: Rust steroid injectie Gips-immobilisatie
Operatief: Hechten Debridement Ulna verkorting
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Therapie: Palmer 1
Palmer 1A: Debridement
Palmer 1B: Hechten
Palmer 1C: debridement/hechten
Palmer 1D: debridement/hechten
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Therapie: Palmer 2
2A en 2B: non-operatief 2C: debridement
Ulna+ dan ook wafer procedure 2D: ulna verkorting +/- wafer
procedure
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Therapie: operatief
Ulna verkorting
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Literatuur
Tears of the TFCC, The orthopeadic journal at Harvard School, Philip Blazar Meniscus and discus lesions of triangular fibrocartilage complex (TFCC):
treatment by laser-assisted wrist arthroscopy, Infanger et al, Volume 62, Issue 4 Pages 466-471 (April 2009)
Histological studies on the triangular fibrocartilage complex of the wrist, Evans et al, J.Anat (1990), 172, pp 59-67
Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am (1994);19:143–54.
Ulnar-sided wrist pain. II. Clinical imaging and treatment ,Watanabe et al, Skeletal Radiology (2010); 39:837-85
Triangular Fibrocartilage Complex Tears A revieuw, Ahn et al, Bulletin of the NYU Hospital for Joint Diseases,(2006); Vol 64, Nr 3&4.