A “Congenitally Adapted” TFCC Tear in Radial Longitudinal Deficiency: Case Report and Review of Literature

Abstract

We present a case of chronic wrist pain in a 14-year-old child with mild radial longitudinal deficiency and radiographic carpal collapse due to the absence of the scaphoid. Wrist arthroscopy demonstrated synovitis and a tear to the TFCC, which would be called “degenerative,” according to the Palmer classification. This was debrided, and the patient is still asymptomatic at long-term follow-up. Review of the literature found one paper with a similar observation in a 17-year-old adolescent. We propose that paediatric “degenerative” tears ought to be called “congenitally adapted” tears.

Keywords

Radial hemimelia - radial longitudinal deficiency - paediatric wrist pain - TFCC tear - TFCC classification

Ethical Approval

The authors confirm that they have adhered to the ethical standards described by the Committee on Publication Ethics and the International Committee of Medical Journal Editors.

Publication History

Received: 14 April 2021

Accepted: 27 July 2021

Article published online:
23 September 2021

• References:

• 1 Geck MJ, Dorey F, Lawrence JF, Johnson MK. Congenital radius deficiency: radiographic outcome and survivorship analysis. J Hand Surg Am 1999; 24 (06) 1132-1144
• 2 van Alphen NA, Moran SL. Radial deficiency. In: Abzug J, Kozin S, Zlotolow D. eds. The Pediatric Upper Extremity. New York, NY: Springer; 2014
• 3 Bayne LG, Klug MS. Long-term review of the surgical treatment of radial deficiencies. J Hand Surg Am 1987; 12 (02) 169-179
• 4 Colen DL, Lin IC, Levin LS, Chang B. Radial longitudinal deficiency: recent developments, controversies, and an evidence-based guide to treatment. J Hand Surg Am 2017; 42 (07) 546-563
• 5 Buck-Gramcko D. Radialization as a new treatment for radial club hand. J Hand Surg Am 1985; 10 (6 Pt 2): 964-968
• 6 Soldado-Carrera FA, Hernandez A, Lluch-Bergueda A, Arcalis A. Letter to the Editor: Scaphotrapeziotrapezoid osteoarthritis associated with minor radial longitudinal deficiency. J Hand Surg [British & European Volume] 2006; 31 (04) 456-457
• 7 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 8 Oestreich K, Jester A, Wen Ching Ting J, Lindau TR. A revolutionary use of wrist arthroscopy in paediatric arthrogryposis? A case report and review of the literature. MOJ Orthop Rheumatol 2019; 11 (06) 204-206
• 9 Tan ABH, Tan SK, Yung SW, Wong MK, Kalinga M. Congenital perforations of the triangular fibrocartilage of the wrist. J Hand Surg [Br] 1995; 20 (03) 342-345
• 10 Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat 1978; 126 (Pt 2(: 367-384
• 11 Kim SJ, Moon HK, Chun YM, Chang WH, Kim SG, Lee SK. Congenital meniscoid articular disc of the triangular fibrocartilage complex. J Bone Joint Surg Br 2009; 91 (08) 1094-1096
• 12 Vanlaer L, Kellens S, Van Nuffel M. Atraumatic bucket handle abnormality of the triangular fibrocartilage complex in an adolescent. J Wrist Surg 2019; 8 (05) 423-425
• 13 Kaempffe FA. Central perforation of the articular disc of the triangular fibrocartilage complex in a 17-year-old girl: could it be congenital?. Am J Orthop 1997; 26 (08) 565-567