Sensory innervation of the triangular fibrocartilage complex: a cadaveric study

Area of Science:

• Anatomy
• Wrist Surgery
• Pain Management

Background:

• Recalcitrant wrist pain often stems from triangular fibrocartilage complex (TFCC) injuries.
• Current treatments for TFCC lesions, including arthroscopic debridement, may not resolve persistent pain.
• Understanding TFCC innervation is crucial for developing targeted surgical interventions.

Purpose of the Study:

• To delineate the sensory nerve supply of the TFCC.
• To explore the feasibility of selective denervation for treating TFCC-related pain.
• To provide anatomical data for planning surgical denervation procedures for TFCC injuries.

Main Methods:

• Dissection of 11 fresh cadaveric upper limbs.
• Examination of potential nerve contributions including branches of the ulnar, median, and interosseous nerves.
• Histological analysis using S-100 protein staining to confirm neural continuity with the TFCC.

Main Results:

• The TFCC demonstrated consistent innervation from the dorsal cutaneous branch of the ulnar nerve (100%).
• Other significant nerve contributions included the medial antebrachial cutaneous nerve (91%) and the volar branch of the ulnar nerve (73%).
• Varied but present innervation was also noted from the anterior interosseous (27%), posterior interosseous (18%), and palmar cutaneous branches of the median nerve (9%).

Conclusions:

• This anatomical study provides foundational data for planning selective TFCC denervation.
• The findings suggest that targeted denervation could be a viable option for recalcitrant TFCC IA injuries.
• An algorithm for TFCC nerve blocks can be developed to guide surgical denervation planning.