Palmer's 1989 paper presents a classification of TFCC lesions derived from 10 years of clinical experience, anatomic dissection, and biomechanical study, including retrospective review of 525 patients with ulnar wrist pain. It asks: how should TFCC injuries be systematically categorized to guide diagnosis and treatment?
When you see a patient with ulnar wrist pain after a fall on a pronated hand, localize tenderness to the fovea or ulnar styloid base and check for DRUJ instability — a 1B lesion needs repair, not just debridement.
When pain is insidious and the PA film shows positive ulnar variance with subchondral lunate erosion, you are looking at a Class 2 degenerative lesion where ulnar shortening, not TFCC excision, is the operative solution.
Palmer's 1989 paper presents a classification of TFCC lesions derived from 10 years of clinical experience, anatomic dissection, and biomechanical study, including retrospective review of 525 patients with ulnar wrist pain. It asks: how should TFCC injuries be systematically categorized to guide diagnosis and treatment?
When you see a patient with ulnar wrist pain after a fall on a pronated hand, localize tenderness to the fovea or ulnar styloid base and check for DRUJ instability — a 1B lesion needs repair, not just debridement.
When pain is insidious and the PA film shows positive ulnar variance with subchondral lunate erosion, you are looking at a Class 2 degenerative lesion where ulnar shortening, not TFCC excision, is the operative solution.