The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

A Comprehensive Observation of the Morphology and the Neurovascular Pattern of the Triangular Fibrocartilage Complex [TFCC] of the Wrist Joint

Document Type : RESEARCH PAPER

Authors
Nandini Rajaram
Dinesh Kumar
Department of Anatomy, Junior Resident, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
10.22038/abjs.2025.84143.3824
Abstract
Objectives: This study aims to provide a comprehensive understanding of the unique morphological dimensions and neurovascular pattern of the triangular fibrocartilage complex (TFCC) of the wrist joint, using innovative techniques such as digital Vernier calliper, auramine chloride (Palmgren’s method) and immunohistochemistry.
Methods: Samples were collected from 20 formalin-embalmed human cadavers. The morphometric parameters were measured. After gross examination, tissues were placed in 10% neutral buffered formalin for fixation. Paraffin-embedded blocks were prepared, and tissue sections were taken at 5-7 microns thickness. The slides were subjected to Palmgren’s and immunohistochemistry staining following a standardised protocol.
Results: The morphometric parameters of the articular disc (AD) and neurovascular pattern of the seven components of TFCC were assessed. There was no significant difference in the morphometric parameters between either sides of the limb. The AD had minimal nerve fibre innervation. Periphery of the complex, which consisted of different ligaments, showed higher nerve density comparatively. The distribution of nerve fibres predominated in the proximal portion compared to distal areas of TFCC. The vascular pattern observed in various components showed fewer blood vessels in the AD than in the periphery. Higher vascularity was observed in the proximal portion of the TFCC complex.
Conclusion: The insights gained from this study, particularly the understanding of the innervation and distribution of nerve fibres of TFCC, can significantly enhance the effectiveness of selective denervation procedures during wrist arthroscopy. Moreover, the knowledge about the vascularity of TFCC is a crucial factor that can influence the end outcomes of wrist surgeries.
        Level of evidence: IV
Keywords
Neurovascular pattern
Triangular fibrocartilage complex
Wrist joint
Subjects
  1. Nakamura T, Matsumura N, Iwamoto T, Sato K, Toyama Y. Arthroscopy of the distal radioulnar joint. Handchir Mikrochir Plast Chir. 2014;46(5):295-9. doi: 10.1055/s-0034-1387706.
  2. Ishii S, Palmer AK, Werner FW, Short WH, Fortino MD. An anatomic study of the ligamentous structure of the triangular fibrocartilage complex. J Hand Surg Am. 1998;23(6):977-85. doi: 10.1016/S0363-5023(98)80003-8.
  3. Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39(9):837-57. doi: 10.1007/s00256-009-0842-3.
  4. Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk GR Jr. The Traumatized TFCC: An Illustrated Review of the Anatomy and Injury Patterns of the Triangular Fibrocartilage Complex. Curr Probl Diagn Radiol. 2016;45(1):39-50. doi: 10.1067/j.cpradiol.2015.05.004.
  5. Lee SJ, Bae DS. Triangular Fibrocartilage Complex Injuries in Children and Adolescents. Hand Clin. 2021;37(4):517-526. doi: 10.1016/j.hcl.2021.06.004.
  6. Cavalcante ML, Rodrigues CJ, Mattar R Jr. Mechanoreceptors and nerve endings of the triangular fibrocartilage in the human wrist. J Hand Surg Am. 2004;29(3):432-5. doi: 10.1016/j.jhsa.2004.01.001.
  7. Tiburzi H, Machado CAG, D'Antoni MS, Tubbs RS. Triangular Fibrocartilage Complex: An Anatomical and Medical Illustration Study. Clin Anat. 2025;38:362-69. doi: 10.1002/ca.24261.
  8. Chidgey LK. Histologic anatomy of the triangular fibrocartilage. Hand Clin. 1991;7(2):249-62
  9. Benjamin M, Evans EJ, Pemberton DJ. Histological studies on the triangular fibrocartilage complex of the wrist. J Anat. 1990; 172:59-67.
  10. Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg Br. 1996;21(5):581-6. doi: 10.1016/s0266-7681(96)80135-5.
  11. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am. 1981;6(2):153-62. doi: 10.1016/s0363-5023(81)80170-0.
  12. Mikic ZD. Treatment of acute triangular fibrocartilage complex injuries associated with distal radioulnar joint instability. J Hand Surg Am. 1995;20(2):319-23. doi: 10.1016/S0363-5023(05)80033-4.
  13. Kauer JM. The articular disc of the hand. Acta Anat (Basel). 1975;93(4):590-605. doi: 10.1159/000144537.
  14. Mohiuddin A, Janjua MZ. Form and function of the radioulnar articular disc. Hand. 1982;14(1):61-6. doi: 10.1016/s0072-968x(82)80044-2.
  15. Garcia-Elias M, Domènech-Mateu JM. The articular disc of the wrist. Limits and relations. Acta Anat (Basel). 1987;128(1):51-4. doi: 10.1159/000146314.
  16. Hogikyan JV, Louis DS. Embryologic development and variations in the anatomy of the ulnocarpal ligamentous complex. J Hand Surg Am. 1992;17(4):719-23. doi: 10.1016/0363-5023(92)90323-h.
  17. Kirchberger MC, Unglaub F, Mühldorfer-Fodor M, Pillukat T, Hahn P, Müller LP, Spies CK. Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg. 2015;135:427-37. doi: 10.1007/s00402-015-2153-6.
  18. Semisch M, Hagert E, Garcia-Elias M, Lluch A, Rein S. Histological assessment of the triangular fibrocartilage complex. J Hand Surg Eur. 2016;41(5):527-33. doi: 10.1177/1753193415618391.
  19. Bednar JM, Osterman AL. The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin. 1994;10(4):605-14.
  20. Ohmori M, Azuma H. Morphology and distribution of nerve endings in the human triangular fibrocartilage complex. J Hand Surg Br. 1998;23(4):522-5. doi: 10.1016/s0266-7681(98)80137-x.
  21. Rein S, Semisch M, Garcia-Elias M, Lluch A, Zwipp H, Hagert E. Immunohistochemical Mapping of Sensory Nerve Endings in the Human Triangular Fibrocartilage Complex. Clin Orthop Relat Res. 2015;473(10):3245-53. doi: 10.1007/s11999-015-4357-z.
  22. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14(4):594-606. doi: 10.1016/0363-5023(89)90174-3.
  23. Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (N Y). 2007;2(3):123-6. doi: 10.1007/s11552-007-9034-6.
  24. Hagert E, Lalonde DH. Wide-Awake Wrist Arthroscopy and Open TFCC Repair. J Wrist Surg. 2012;1(1):55-60. doi: 10.1055/s-0032-1312045.
  25. Sarkissian EJ, Burn MB, Yao J. Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair. J Wrist Surg. 2019;8(5):403-407. doi: 10.1055/s-0039-1688949.
  26. Shigemitsu T, Tobe M, Mizutani K, Murakami K, Ishikawa Y, Sato F. Innervation of the triangular fibrocartilage complex of the human wrist: a quantitative immunohistochemical study. Anat Sci Int. 2007;82(3):127-32. doi: 10.1111/j.1447-073X.2007.00173.x.
  27. Bednar JM, Osterman AL. The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin. 1994;10(4): 605-14.
  28. Zhan H, Zhang H, Bai R, Qian Z, Liu Y, Zhang H, et al. High-resolution 3-T MRI of the triangular fibrocartilage complex in the wrist: injury pattern and MR features. Skeletal Radiol. 2017;46(12):1695-1706. doi: 10.1007/s00256-017-2739-x.
  29. Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin. 2011;27(3):263-72. doi: 10.1016/j.hcl.2011.05.014.

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 11
November 2025
Pages 711-719

  • Receive Date 25 November 2024
  • Revise Date 10 April 2025
  • Accept Date 22 April 2025