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.

Comparison between MRI and Arthroscopy of the Wrist for the Assessment of Posttraumatic Lesions of Intrinsic Ligaments and the Triangular Fibrocartilage Complex

2021 ◽  
Author(s):  
Sergio De Santis ◽  
Roberto Cozzolino ◽  
Riccardo Luchetti ◽  
Lucia Cazzoletti
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Ligament Injury ◽  
Wrist Arthroscopy ◽  
Mri Imaging ◽  
Likelihood Ratios ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Predictive Values ◽  
Arthroscopic Findings ◽  
Triangular Fibrocartilage

Abstract Background Magnetic resonance imaging (MRI) has been considered the most appropriate examination for wrist ligament injuries diagnosis, but it frequently fails to assess the intrinsic ligament lesion. Therefore, wrist arthroscopy is required to enhance and define the diagnosis. Purpose We compare the MRI imaging with wrist arthroscopy for intrinsic wrist ligaments (scapholunate [SL] and lunotriquetral [LT]) and triangular fibrocartilage complex (TFCC) injuries detection. Patients and Methods From 2007 to 2014, 532 patients affected by suspected SL, LT, and TFCC posttraumatic ligament injury have been investigated by 1.5-Tesla MRI and wrist arthroscopy. Inclusion and exclusion criteria were adopted. Only for SL ligament injury, the arthroscopic findings of complete (stage IV) and partial (stages I–III) SL ligament injury were compared with MRI findings. Statistical analysis, including sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the diagnostic odds ratio, was used to compare MRI with arthroscopic findings. Results A total of 146 patients were accepted in the study. In 68 cases of arthroscopic SL ligament lesion, MRI confirmed the diagnosis only in 50% of the cases. In partial SL lesions, MRI was positive in 24.3% and in complete SL lesions, MRI was positive in 80.6% of the cases. In 10 cases of arthroscopic LT ligament lesion, MRI was positive in 30.0% of the cases. In 33 patients with arthroscopic TFCC lesion, MRI was positive in 66.7% of the cases. Conclusion 1.5-T MRI demonstrated to fail in confirming the lesion of SL, LP, and TFCC ligaments respectively in 50, 70, and 33.3% of the cases positive at arthroscopy. In complete SL ligament lesion, MRI reaches a higher sensitivity than in partial lesion. Arthroscopy remains the best method to demonstrate the ligament lesion and obtain more information regarding the extent and quality of the ligament damage. Level of Evidence This is a Level II, retrospective comparative study.

scholarly journals The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

2021 ◽  
Author(s):  
Anne-Sophie van der Post ◽  
Sjoerd Jens ◽  
Frank F. Smithuis ◽  
Miryam C. Obdeijn ◽  
Roelof-Jan Oostra ◽  
...  
Keyword(s):  
Signal Intensity ◽  
Sagittal Plane ◽  
Articular Surface ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Observer Agreement ◽  
Mri Findings ◽  
Mri Features ◽  
Triangular Fibrocartilage ◽  
The Individual

Abstract Objective The objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents. Materials and methods Prospectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI). Results The cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components. Conclusion MRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.

The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex

2016 ◽  
Vol 41 (5) ◽  
pp. 516-520 ◽  
Author(s):  
K. Kasapinova ◽  
V. Kamiloski
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Triangular Fibrocartilage Complex ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Wrist Arthroscopy ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage ◽  
A Prospective Study

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. Level of evidence: III

Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

2016 ◽  
Vol 41 (7) ◽  
pp. 732-738 ◽  
Author(s):  
J. K. Andersson ◽  
P. Axelsson ◽  
J. Strömberg ◽  
J. Karlsson ◽  
J. Fridén
Keyword(s):  
Joint Instability ◽  
Clinical Signs ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Level Of Evidence ◽  
Independent Observer ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

scholarly journals Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

2021 ◽  
Vol 49 (02) ◽  
pp. e97-e104
Author(s):  
Ignacio Miranda ◽  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Joan Ferràs-Tarragó ◽  
Francisco J. Miranda
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Anatomic Reconstruction ◽  
Wrist Arthroscopy ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

scholarly journals Atraumatic Bucket Handle Abnormality of the Triangular Fibrocartilage Complex in an Adolescent

2018 ◽  
Vol 08 (05) ◽  
pp. 423-425
Author(s):  
Leen Vanlaer ◽  
Sebastiaan Kellens ◽  
Maarten Van Nuffel
Keyword(s):  
Congenital Abnormalities ◽  
Incidental Finding ◽  
Anatomical Variations ◽  
Review Literature ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Articular Disc ◽  
Traumatic Lesion ◽  
Triangular Fibrocartilage ◽  
Bucket Handle

Background Congenital abnormalities of the triangular fibrocartilage complex (TFCC) are rare and could be mistaken for a traumatic lesion. It is important to recognize these anatomical variations and to realize they do not always require treatment. Case Description An incidental finding of an atraumatic bucket handle abnormality of the TFCC in a 15-year-old male, who was treated arthroscopically for dorsal wrist pain. This structure was resected, thus obtaining a normal looking peripheral TFCC. Literature Review Literature regarding congenital abnormalities of the TFCC is limited to a meniscoid articular disc or a congenital perforation. To our knowledge, an atraumatic bucket handle abnormality has not been described yet. Clinical Relevance This congenital abnormality of the TFCC could be mistaken for a traumatic lesion on MRI, or during wrist arthroscopy; therefore, it is important to realize that this entity may occur and does not require treatment.

scholarly journals A Novel All-Inside Arthroscopic Technique for Radial-Sided Triangular Fibrocartilage Complex Tears: A Case Report and Review of Literature

Hand ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. NP166-NP169 ◽  
Author(s):  
Michael T. Edgerton ◽  
Robert C. Kollmorgen
Keyword(s):  
Case Report ◽  
Range Of Motion ◽  
Single Case ◽  
Excellent Result ◽  
Full Range ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Single Case Report ◽  
Triangular Fibrocartilage

Background: Triangular fibrocartilage complex (TFCC) injuries are a known cause of ulnar-sided wrist pain. Wrist arthroscopy is the gold standard for diagnosis of these lesions and is becoming a more frequent method of treatment. Isolated radial-sided tears are uncommon and treatment of these lesions is controversial. There are few reports on repair techniques. Here we report on a novel arthroscopic, all-inside technique for traumatic radial-sided TFCC tears that resulted in full range of motion, significant improvement in pain, and ultimately return to sport. Methods: This is a single case report describing an all-inside, arthroscopic repair of a radial-sided TFCC tear. The techniques and postoperative protocol are discussed. Clinical outcomes were reported at final follow-up of 3.5 months. Results: At final follow-up, our patient had full wrist range of motion, 95% strength, occasional 1/10 pain, and returned to sport at her previous level of play. There were no complications. Conclusion: Although just a single case report, our patient had an excellent result based on modified Mayo wrist score. When comparing our result and the previous literature, this technique seems to be a valid method for addressing radial-sided TFCC tears.

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.

Morphology and Distribution of Nerve Endings in the Human Triangular Fibrocartilage Complex

1998 ◽  
Vol 23 (4) ◽  
pp. 522-525 ◽  
Author(s):  
M. OHMORI ◽  
H. AZUMA
Keyword(s):  
Collagen Fibre ◽  
Ulnar Collateral Ligament ◽  
Triangular Fibrocartilage Complex ◽  
Nerve Endings ◽  
Articular Disc ◽  
Collateral Ligament ◽  
Peripheral Part ◽  
Ulnar Side ◽  
Fibre Area ◽  
Triangular Fibrocartilage

We studied the morphology and distribution of nerve endings in the human triangular fibrocartilage complex using both silver staining and immunohistochemical staining using a protein specific to nerve fibres. Free nerve endings were found in the ulnar side of the triangular fibrocartilage complex, especially in the ulnar collateral ligament, meniscus homologue and the adjacent collagen fibre area of the peripheral part of the ulnar side of the articular disc. Meissner’s and Krause’s corpuscles were observed in the ulnar collateral ligament and meniscus homologue. The fact that free nerve endings were observed in the meniscus homologue and adjacent collagen fibre area of the peripheral part of the ulnar side of the articular disc suggests that this disc may be a source of wrist pain. The presence of nerve end bulbs in the triangular fibrocartilage complex also suggests a possible role for corpuscles as mechanoreceptors.

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