Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report. 2024

Ji Woong Ho, and Jee Yune Kim, and Young-Keun Lee
Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea.

BACKGROUND Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. METHODS A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. METHODS Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. METHODS Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. RESULTS Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. CONCLUSIONS DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D008297 Male Males
D010146 Pain An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS. Suffering, Physical,Ache,Pain, Burning,Pain, Crushing,Pain, Migratory,Pain, Radiating,Pain, Splitting,Aches,Burning Pain,Burning Pains,Crushing Pain,Crushing Pains,Migratory Pain,Migratory Pains,Pains, Burning,Pains, Crushing,Pains, Migratory,Pains, Radiating,Pains, Splitting,Physical Suffering,Physical Sufferings,Radiating Pain,Radiating Pains,Splitting Pain,Splitting Pains,Sufferings, Physical
D005542 Forearm Part of the upper extremity in humans and primates extending from the ELBOW to the WRIST. Antebrachium,Antebrachiums,Forearms
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070600 Tibial Meniscus Injuries Injuries to the TIBIAL MENISCUS of the leg. Bucket Handle Tears,Flap Tears,Tibial Meniscus Tears,Torn Tibial Meniscus,Bucket Handle Tear,Flap Tear,Injuries, Tibial Meniscus,Injury, Tibial Meniscus,Meniscus Injuries, Tibial,Meniscus Injury, Tibial,Meniscus Tear, Tibial,Meniscus Tears, Tibial,Meniscus, Torn Tibial,Tear, Tibial Meniscus,Tears, Flap,Tears, Tibial Meniscus,Tibial Meniscus Injury,Tibial Meniscus Tear,Tibial Meniscus, Torn
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001182 Arthroscopy Endoscopic examination, therapy and surgery of the joint. Arthroscopic Surgical Procedures,Surgical Procedures, Arthroscopic,Arthroscopic Surgery,Surgery, Arthroscopic,Arthroscopic Surgeries,Arthroscopic Surgical Procedure,Arthroscopies,Procedure, Arthroscopic Surgical,Procedures, Arthroscopic Surgical,Surgeries, Arthroscopic,Surgical Procedure, Arthroscopic
D013484 Supination Applies to movements of the forearm in turning the palm forward or upward. When referring to the foot, a combination of adduction and inversion movements of the foot. Supinations
D014954 Wrist Injuries Injuries to the wrist or the wrist joint. Injuries, Wrist,Injury, Wrist,Wrist Injury

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