Palmer set out to classify injuries of the triangular fibrocartilage complex (TFCC), separating traumatic tears from degenerative wear.
Classification built on anatomic and biomechanical work plus 10 years of clinical records, 525 patients with ulnar wrist pain, 75 surgically treated patients whose charts were available.
Methods
Design
Classification drawn from anatomic and biomechanical studies
Review of 10 years of clinical experience
Patients
525 patients with ulnar wrist pain (records reviewed)
75 treated surgically
Basis
Clinical examination
Plain radiographs
Wrist arthrography
Wrist arthroscopy
Wrist arthrotomy
Key Findings
Palmer split TFCC lesions into traumatic Class 1, typed A to D by where the tear lies, and degenerative Class 2, staged A to E by how far wear has spread.
In the author's experience, degenerative lesions were far more common than traumatic ones.
Degenerative lesions result from repetitive loading of the ulnar wrist and are variants of ulnar impaction syndrome.
The author's impression was that traumatic tears occur more often in wrists with neutral or positive ulnar variance.
Board pearl
In the degenerative series, lunotriquetral ligament disruption first appears at 2D, and 2E adds ulnocarpal arthritis.
Palmer classification of TFCC lesionsPalmer, J Hand Surg Am 1989
Class 1: Traumatic, typed by location
1A
Central tear of the horizontal disc, usually a 1 to 2 mm dorsal‑palmar slit 2 to 3 mm medial to the radial attachment
Lies in the relatively avascular disc. Debrided if conservative care fails.
1B
Avulsion from the ulna, with or without distal ulna fracture
Lies in the well‑vascularized periphery. Amenable to repair.
1C
Distal avulsion at the ulnolunate or ulnotriquetral ligament
1D
Avulsion from the radial attachment at the sigmoid notch, with or without fracture
Class 2: Degenerative, staged as progressive ulnocarpal abutment
2A
TFCC wear, no perforation
2B
TFCC wear plus chondromalacia of the lunate or ulnar head
2C
TFCC perforation plus chondromalacia
2D
Perforation and chondromalacia plus lunotriquetral ligament disruption
2E
All 2D changes plus ulnocarpal arthritis
Final stage. The disc is usually absent and the lunotriquetral ligament fully torn. The DRUJ is occasionally arthritic as well.
Palmer set out to classify injuries of the triangular fibrocartilage complex (TFCC), separating traumatic tears from degenerative wear.
Classification built on anatomic and biomechanical work plus 10 years of clinical records, 525 patients with ulnar wrist pain, 75 surgically treated patients whose charts were available.
Methods
Design
Classification drawn from anatomic and biomechanical studies
Review of 10 years of clinical experience
Patients
525 patients with ulnar wrist pain (records reviewed)
75 treated surgically
Basis
Clinical examination
Plain radiographs
Wrist arthrography
Wrist arthroscopy
Wrist arthrotomy
Key Findings
Palmer split TFCC lesions into traumatic Class 1, typed A to D by where the tear lies, and degenerative Class 2, staged A to E by how far wear has spread.
In the author's experience, degenerative lesions were far more common than traumatic ones.
Degenerative lesions result from repetitive loading of the ulnar wrist and are variants of ulnar impaction syndrome.
The author's impression was that traumatic tears occur more often in wrists with neutral or positive ulnar variance.
Board pearl
In the degenerative series, lunotriquetral ligament disruption first appears at 2D, and 2E adds ulnocarpal arthritis.
Palmer classification of TFCC lesionsPalmer, J Hand Surg Am 1989
Class 1: Traumatic, typed by location
1A
Central tear of the horizontal disc, usually a 1 to 2 mm dorsal‑palmar slit 2 to 3 mm medial to the radial attachment
Lies in the relatively avascular disc. Debrided if conservative care fails.
1B
Avulsion from the ulna, with or without distal ulna fracture
Lies in the well‑vascularized periphery. Amenable to repair.
1C
Distal avulsion at the ulnolunate or ulnotriquetral ligament
1D
Avulsion from the radial attachment at the sigmoid notch, with or without fracture
Class 2: Degenerative, staged as progressive ulnocarpal abutment
2A
TFCC wear, no perforation
2B
TFCC wear plus chondromalacia of the lunate or ulnar head
2C
TFCC perforation plus chondromalacia
2D
Perforation and chondromalacia plus lunotriquetral ligament disruption
2E
All 2D changes plus ulnocarpal arthritis
Final stage. The disc is usually absent and the lunotriquetral ligament fully torn. The DRUJ is occasionally arthritic as well.