Clinical, Radiographical, and Arthroscopic Features of Dorsal Tears of the TFCC

Despite evolving understanding of triangular fibrocartilage complex (TFCC) anatomy, dorsal-ulnar TFCC lesions remain underrecognized, with limited studies addressing this subset. This study presents our experience with dorsal-ulnar TFCC lesions and provides a comprehensive analysis of their clinical presentation, imaging findings, and arthroscopic characteristics.

We retrospectively reviewed the medical records of adult patients treated by a single senior surgeon across two metropolitan hospitals who underwent wrist arthroscopy for ulnar-sided wrist pain between February 2022 and August 2024. From this cohort, we included only those who had an arthroscopically assisted repair of a dorsal TFCC tear. Patients with a history of prior TFCC surgery were excluded. Clinical, radiological, and arthroscopic features were subsequently analyzed.

During the study period, a total of 185 patients underwent wrist arthroscopy for ulnar-sided pain. Of these, 44 wrists from 42 patients were diagnosed with dorsal TFCC tears. The mean age at the time of surgery was 34.1 years (SD 11.7). The dominant hand was affected in 70.5% of cases. All patients reported ulnar-sided pain during prono-supination, and 86% had volar distal radioulnar joint (DRUJ) laxity. MRI reports accurately identified dorsal TFCC tears in 14% of cases. In 48% of cases, the MRI findings falsely reported no abnormalities in the TFCC. Arthroscopy revealed synovitis in 100% of cases. While the foveal hook test was negative in all of the patients, the dorsal hook test was positive in every case, serving as a consistent diagnostic feature. Associated scapholunate instability (European Wrist Arthroscopy Society 3B, 3C, or 4) was observed in 55% of patients.

Patients presenting with persistent ulnar-sided wrist pain with negative MRI findings should still be offered arthroscopic evaluation, especially those who have volar laxity of the DRUJ on examination.