scholarly journals Wrist and Hand

2021 ◽  
pp. 41-55
Author(s):  
Omid Khalilzadeh ◽  
Clarissa Canella ◽  
Laura M. Fayad
Keyword(s):  
Soft Tissue ◽  
Diagnostic Yield ◽  
Triangular Fibrocartilage Complex ◽  
Extensor Mechanism ◽  
Traumatic Injuries ◽  
Complex Anatomy ◽  
Triangular Fibrocartilage ◽  
Small Bones ◽  
Thumb Carpometacarpal ◽  
Carpal Ligaments

AbstractThe wrist and hand have complex anatomy with small bones and supporting soft tissue structures, which limits the diagnostic yield for radiologic assessment. Knowledge of anatomy and different clinical entities is key to the radiologic diagnosis. Some of the essential anatomic and clinical topics in radiologic interpretation include knowledge of the topographic tendon anatomy of wrist and hand, the intrinsic and extrinsic carpal ligaments, the thumb ligaments, thumb carpometacarpal ligaments, the triangular fibrocartilage complex, the extensor mechanism, and the flexor tendons and pulleys. In this chapter, common traumatic injuries affecting the wrist and hand are reviewed.

scholarly journals Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Niels Hammer ◽  
Ulrich Hirschfeld ◽  
Hendrik Strunz ◽  
Michael Werner ◽  
Thomas Wolfskämpf ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Three Dimensional ◽  
Triangular Fibrocartilage Complex ◽  
Soft Tissue Reconstruction ◽  
Case Presentation ◽  
Complex Anatomy ◽  
Radiocarpal Joint ◽  
Tissue Reconstruction ◽  
Triangular Fibrocartilage ◽  
Magnetic Resonance Imaging Mri

Introduction. The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods. Microcomputed tomography (μ-CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results. TFCC reconstruction was impossible using μ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach’s usefulness as a diagnostic tool.

The Carpal Detachment Injury of the Triangular Fibrocartilage Complex

2002 ◽  
Vol 27 (1) ◽  
pp. 86-89 ◽  
Author(s):  
S. NISHIKAWA ◽  
S. TOH ◽  
H. MIURA ◽  
K. ARAI
Keyword(s):  
Soft Tissue ◽  
Conservative Therapy ◽  
Articular Surface ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Ulnar Side ◽  
Arthroscopic Findings ◽  
Triangular Fibrocartilage

Triangular fibrocartilage complex (TFCC) injuries were suspected clinically in 22 wrists of 21 patients, but arthrography and MRI assessments of this structure were normal. As conservative therapy for 2 months did not improve their symptoms, wrist arthroscopy was then performed. Although no abnormalities of the TFCC and ligaments were observed, meniscus homologue-like tissue which arose from TFCC was riding on the articular surface of the triquetrum. After resection of this soft tissue with a shaver and a punch, the symptoms disappeared in all cases. The arthroscopic findings suggested that a portion of TFCC that was originally attached to the ulnar side of the triquetrum had become detached.

Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex

2017 ◽  
Vol 42 (6) ◽  
pp. 551-566 ◽  
Author(s):  
C. L. Mathoulin
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Arthroscopic Repair ◽  
Scapholunate Ligament ◽  
Scapholunate Instability ◽  
Triangular Fibrocartilage ◽  
Carpal Ligaments ◽  
Complex Injuries

This review includes updated understanding of the roles of intrinsic and extrinsic carpal ligaments in scapholunate instability and details the author’s experience of indications, arthroscopic repair methods, and outcomes of treating the instability. A classification on triangular fibrocartilage complex injuries is reviewed, followed by author’s indications, methods, and outcomes of arthroscopic repair of triangular fibrocartilage complex injuries.

scholarly journals Reconstruction for DRUJ Instability

Hand ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 123-126 ◽  
Author(s):  
Ericka Lawler ◽  
Brian D. Adams
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Senior Author ◽  
Triangular Fibrocartilage Complex ◽  
Radius Of Curvature ◽  
Anatomical Studies ◽  
Ulnar Head ◽  
Sigmoid Notch ◽  
Triangular Fibrocartilage ◽  
Inherent Stability

The skeletal architecture of the DRUJ provides minimal inherent stability, as the sigmoid notch is shallow and its radius of curvature is 50% greater than that of the ulnar head [Af Ekenstam F, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985;19(1):17–25]. Due to its incongruent articulation, the DRUJ relies strongly on the surrounding soft tissues for stability. The triangular fibrocartilage complex (TFCC) is generally accepted as the major soft tissue stabilizer of the DRUJ of which the volar and dorsal radioulnar ligaments are the primary components. Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints and kinematics. This article presents an update of the procedure developed by the senior author that anatomically reconstructs the palmar and dorsal radioulnar ligaments at their anatomic origins and insertions.

Review of Palmer and Werner (1981) on the triangular fibrocartilage complex of the wrist anatomy and function

2017 ◽  
Vol 2 (6) ◽  
pp. 350-354
Author(s):  
Teun Teunis ◽  
David Ring
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Original Publication ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage ◽  
Wrist Anatomy ◽  
And Function

This classic discusses the original publication by Palmer and Werner (1981) on the anatomy and function of a set of soft tissue stabilising the distal radioulnar joint. They labelled this confluent structure the triangular fibrocartilage complex (TFCC) of the wrist, and concluded that abnormalities were typically degenerative and usually asymptomatic. Eight years later Dr Palmer published a follow-up taking a different perspective. In this article he differentiated between traumatic and degenerative TFCC lesions and outlined surgical treatment for each type. The debate about the diagnosis, interpretation and treatment of TFCC abnormalities today is captured by the contrast between both articles.

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

2021 ◽  
pp. 175319342110241
Author(s):  
I-Ning Lo ◽  
Kuan-Jung Chen ◽  
Tung-Fu Huang ◽  
Yi-Chao Huang
Keyword(s):  
Simple Procedure ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
High Satisfaction ◽  
Ultrasound Assessment ◽  
Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries

Hand Therapy ◽  
2021 ◽  
pp. 175899832110333
Author(s):  
Zhiqing Chen
Keyword(s):  
Grip Strength ◽  
Outcome Measures ◽  
Rating Scale ◽  
Weight Bearing ◽  
Rehabilitation Program ◽  
Triangular Fibrocartilage Complex ◽  
Effect Sizes ◽  
Pronator Quadratus ◽  
Triangular Fibrocartilage ◽  
Wrist Function

Introduction Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Methods Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the ‘push-off’ test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Results Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen’s D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. Discussion WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.

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