Sensory innervation of the triangular fibrocartilage complex: a cadaveric study.
OBJECTIVE
To describe the sensory innervation of the triangular fibrocartilage complex (TFCC) to understand the potential for selective denervation as an alternative treatment for recalcitrant pain from stable TFCC IA lesions after failed nonsurgical treatment.


METHODS
Eleven fresh cadaveric limbs were dissected with × 3.2 loupe magnification in a proximal to distal manner. The candidate nerves were the dorsal cutaneous branch of the ulnar nerve, volar sensory branch of the ulnar nerve, anterior interosseous nerve, posterior interosseous nerve, medial antebrachial cutaneous nerve, and palmar cutaneous branch of the median nerve. We identified neural continuity to the TFCC histologically with S-100 protein antibody staining.


RESULTS
In the 11 specimens, the TFCC was innervated by the dorsal cutaneous branch of the ulnar nerve (100%), medial antebrachial cutaneous nerve (91%), volar branch of the ulnar nerve (73%), anterior interosseous nerve (27%), posterior interosseous nerve (18%), and palmar branch of the median nerve (9%).


CONCLUSIONS
These results provide an initial step in planning an operative partial TFCC denervation for recalcitrant TFCC IA injuries that fail nonsurgical treatment and possibly also arthroscopic debridement.


CONCLUSIONS
Based on the results of this anatomic study, it is possible to create an algorithm for performing nerve blocks of the TFCC that would aid in planning a surgical denervation procedure.
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Nerve, Bone, and Joint Institute, Washington, DC. Electronic address: dlaport1@jhmi.edu.
Dawn M
DM
LaPorte
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Nerve, Bone, and Joint Institute, Washington, DC.
S Shar
SS
Hashemi
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Nerve, Bone, and Joint Institute, Washington, DC.
A Lee
AL
Dellon
D002102:Cadaver; D004210:Dissection; D006801:Humans; D008023:Ligaments, Articular / Q000294:innervation; D010525:Peripheral Nerves / Q000033:anatomy & histology*; D051478:Triangular Fibrocartilage / Q000294:innervation*; D014955:Wrist Joint / Q000294:innervation
Partial denervation; TFCC IA injuries; triangular fibrocartilage complex; ulnar wrist pain