Acute blockage of forearm supination has been reported in a few studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris(ECU) tendon interposition, and distal radioulnar joint(DRUJ) injuries including forearm bones fractures. Especially in DRUJ injuries, some studies reported cases caused by triangular fibrocartilage complex(TFCC) tear. We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains about forearm supination blocking. Also we present a comparison between our case and other reports, about etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings and show specific characteristics of our case.
A 22-year-old male presented with left wrist pain as the chief complaint. He complained about pain mainly in the supination position. He was injured two months ago after pushing his left hand on the floor during exercise. Physical exam showed relative limitation of range of motion(ROM) in the left wrist about 10° in flexion and about 15° in extension compared with the right side. Also, he complained of supination limitation and showed volar side wrist pain in supination. He showed tenderness in the axial compression test. MRI showed a TFCC tear at the central portion. The torn flap of the TFCC was interposed at the volar side of the DRUJ. We took him arthroscopic surgery for left wrist joint. In arthroscopic view, there was a tear of TFCC on radial side. The teared flap was interposed at volar side of DRUJ. We pulled out flap form DRUJ using arthroscopic grasper and partially resected.
Intraoperative test showed that there was no locking and the forearm was well supinated. Two months after surgery, he had no pain and showed full forearm supination.
When acute blockage of forearm supination occurs after minor trauma, DRUJ blocking due to a TFCC tear should be suspected. MRI is helpful for diagnosis, but we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved through surgical treatment using arthroscopy.
