scholarly journals Cine MRI of the Triangular Fibrocartilage Complex during Radial–Ulnar Deviation

2018 ◽  
Vol 07 (04) ◽  
pp. 274-280 ◽  
Author(s):  
Koji Abe ◽  
Nobuki Terada ◽  
Toshiyasu Nakamura
Keyword(s):  
Healthy Volunteers ◽  
Stress Test ◽  
Styloid Process ◽  
Distal Portion ◽  
Triangular Fibrocartilage Complex ◽  
Cine Mri ◽  
Ulnar Styloid ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Triangular Fibrocartilage

Purpose Changes in the shape of the triangular fibrocartilage complex (TFCC) during radial–ulnar deviation were studied using “cine-mode” magnetic resonance imaging (MRI) in 10 right wrists of healthy volunteers, 5 wrists of TFCC tear, and 5 wrists of ulnar styloid nonunion. Subjects and Methods The wrist was fixed in a custom acrylic device, which only allows radial and ulnar deviation. Coronal MR images of nine radial–ulnar deviated positions (every 5 degree from 15 degrees radial deviation to 25 degrees ulnar deviation) were obtained in volunteers and patients. Cine-mode MRI was assembled and was output to MPEG video to observe. Results Cine MRI demonstrated the ulnar side of the TFCC was elongated by average 15 mm in 15 degrees of radial deviation and shortened by average 8 mm in 25 degrees of ulnar deviation in all normal TFCC subjects. Distal portion of the triangular fibrocartilage (TFC) was compressed during radial–ulnar deviation in 10 healthy volunteers and in 3 patients, but proximal portion of the TFC was stable throughout the motion. In contrast, the wavy deformities on the disc in ulnar deviation were observed in three patients with horizontal tear inside the TFCC. In nonunion of the ulnar styloid process, the fragment was snapped in maximum ulnar deviated position or elongation of the space between the styloid fragment and ulna was seen. Conclusion This study indicated normal and abnormal changes in the shape of the TFCC during radial–ulnar deviation motion on cine MRI. The abnormal dynamic changes of the TFCC may be seen in ulnar deviated position in patients, which are related to positive ulnocarpal stress test with the wrist forced ulnar deviated.

Carpal Impaction with the Ulnar Styloid Process: Treatment with Partial Styloid Resection

2001 ◽  
Vol 26 (3) ◽  
pp. 252-255 ◽  
Author(s):  
M. M. TOMAINO ◽  
M. GAINER ◽  
J. D. TOWERS
Keyword(s):  
Physical Examination ◽  
Stress Test ◽  
Styloid Process ◽  
Wrist Arthroscopy ◽  
Radiographic Evaluation ◽  
Ulnar Styloid ◽  
Ulnar Head ◽  
Ulnar Wrist Pain ◽  
Triangular Fibrocartilage ◽  
Ulnar Styloid Process

Carpal impaction with the ulnar styloid process (stylocarpal impaction) occurs less frequently than with the ulnar head (ulnocarpal impaction), and more commonly develops in wrists with negative ulnar variance. Physical examination, radiographic evaluation, and wrist arthroscopy are all helpful in excluding alternative causes of ulnar wrist pain. When an ulnocarpal stress test elicits pain, and radiographs suggest that this is due to carpal impaction with the ulnar styloid, partial resection of the styloid process provides successful treatment, so long as the insertion of the triangular fibrocartilage at the base of the styloid is not disrupted.

scholarly journals Motion Analysis of Triangular Fibrocartilage Complex by Using Ultrasonography Images: Preliminary Analysis

Sensors ◽  
2022 ◽  
Vol 22 (1) ◽  
pp. 345
Author(s):  
Issei Shinohara ◽  
Atsuyuki Inui ◽  
Yutaka Mifune ◽  
Hanako Nishimoto ◽  
Kohei Yamaura ◽  
...  
Keyword(s):  
Motion Analysis ◽  
Triangular Fibrocartilage Complex ◽  
Control Group ◽  
Articular Disc ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Velocity Magnitude ◽  
Injury Group ◽  
Triangular Fibrocartilage ◽  
The Mean

The triangular fibrocartilage complex (TFCC) is a significant stabilizer of the distal radioulnar joint. Diagnosing TFCC injury is currently difficult, but ultrasonography (US) has emerged as a low-cost, minimally invasive diagnostic tool. We aimed to quantitatively analyze TFCC by performing motion analysis by using US. Twelve healthy volunteers, comprising 24 wrists (control group), and 15 patients with TFCC Palmer type 1B injuries (injury group) participated. The US transducer was positioned between the ulnar styloid process and triquetrum and was tilted ulnarly 30° from the vertical line. The wrist was then actively moved from 10° of radial deviation to 20° of ulnar deviation in a 60-rounds-per-minute rhythm that was paced by a metronome. The articular disc displacement velocity magnitude was analyzed by using particle image velocimetry fluid measurement software. The mean area of the articular discs was larger on ulnar deviation in the control group. The mean articular disc area on radial deviation was larger in the injury group. The average articular disc velocity magnitude for the injury group was significantly higher than that for the control group. The results suggest that patients with TFCC injury lose articular disc cushioning and static stability, and subsequent abnormal motion can be analyzed by using US.

AN ANATOMICAL STUDY OF THE LIGAMENTS OF THE ULNAR COMPARTMENT OF THE WRIST

Hand Surgery ◽  
2003 ◽  
Vol 08 (02) ◽  
pp. 219-226 ◽  
Author(s):  
Saburo Sasao ◽  
Moroe Beppu ◽  
Hitoshi Kihara ◽  
Kazuaki Hirata ◽  
Masayuki Takagi
Keyword(s):  
Three Dimensional ◽  
Attachment Site ◽  
Ulnar Collateral Ligament ◽  
Anatomical Study ◽  
Styloid Process ◽  
Dimensional Structure ◽  
Collateral Ligament ◽  
Ulnar Styloid ◽  
Attachment Sites ◽  
Triangular Fibrocartilage

The ligamentous structures of the triangular fibrocartilage complex (TFCC) and their attachments were examined anatomically and histologically using fresh and embalmed cadavers. The TFCC was observed to have a three-dimensional structure consisting of three palmar ligaments — the short radiolunate (SRL), ulnolunate (UL), and ulnotriquetral (UT) ligaments. In addition, the attachment site of the ulnocarpal ligament (UC), which had been previously unknown, was identified. The dorsal components of the TFCC have been previously reported to consist solely of the extensor carpi ulnaris (ECU) subsheath; however, the ligamentous components running from the ulnar styloid process to the triquetrum were found at a layer deeper than the floor of the ECU subsheath. The UC has been reported previously as a two-dimensional structure, but there has been some disagreement as to its attachment sites.2–6,14,15 It is suggested that the dorsal UT ligament should be considered as a separate ligament, based on its different direction and distal attachment site as compared with those of the ulnar collateral ligament (UCL) and ECU subsheath.

Extensor Carpi Ulnaris Problems at the Wrist–Classification, Surgical Treatment and Results

2005 ◽  
Vol 30 (3) ◽  
pp. 265-272 ◽  
Author(s):  
C. ALLENDE ◽  
D. LE VIET
Keyword(s):  
Surgical Treatment ◽  
Grip Strength ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Styloid ◽  
Wrist Motion ◽  
Extensor Carpi Ulnaris ◽  
Lunotriquetral Ligament ◽  
Triangular Fibrocartilage

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

THE BEAUTY OF STABILITY: DISTAL RADIOULNAR JOINT STABILITY IN ARTHROSCOPIC TRIANGULAR FIBROCARTILAGE COMPLEX REPAIR

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 21-26 ◽  
Author(s):  
Chris Tang ◽  
Boris Fung ◽  
Rebecca Chan ◽  
Margaret Fok
Keyword(s):  
Stress Test ◽  
Distal Radioulnar Joint ◽  
Small Sample ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Transosseous Suture ◽  
Sigmoid Notch ◽  
Druj Instability ◽  
Triangular Fibrocartilage

The triangular fibrocartilage complex (TFCC) has an important role in the stability of the distal radioulnar joint (DRUJ) stability. We designed a new method of TFCC tear repair that has satisfactory post-operative DRUJ stability. From May 2004 to August 2010, 14 patients who underwent this operation were reviewed. The average post-operative follow-up period was 8.2 months; 66.7% of the patients with TFCC tear in sigmoid notch had clinical DRUJ instability, while only 50% of tear in fovea and 16.7% of tear in base of ulnar styloid had clinical DRUJ instability. Transosseous suture via inside-outside technique was used for repair. At the final follow-up, all 14 patients have soft end point with < 5 mm translations of the DRUJ shown by the stress test. Based on this small sample with satisfactory outcome assessed by the Mayo modified wrist score and DRUJ stability, we recommend TFCC tear in sigmoid notch, which has a higher chance of DRUJ instability, to be repaired by transosseous suture.

scholarly journals Triangular Fibrocartilage Complex Injury in Professional Cricketers

2015 ◽  
Vol 49 (4) ◽  
pp. 204-208
Author(s):  
Usama Talib ◽  
Sohail Saleem
Keyword(s):  
Sports Injury ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Injury ◽  
Huge Number ◽  
Ulnar Styloid ◽  
Tennis Players ◽  
Ulnar Side ◽  
Complex Injury ◽  
Triangular Fibrocartilage

ABSTRACT Triangular fibrocartilage complex (TFCC) is a complex of multiple ligaments and cartilages at the ulnar end of the wrist. Injury of TFCC is commonly seen in sportsmen such as tennis players, cricketers, golfers and gymnasts. The typical presentation is pain radiating along the ulnar side of the hand, and is often accompanied by fracture of the ulnar styloid. Despite being a common injury, its knowledge remains largely unknown. This leads to a huge number of cases remaining undiagnosed and thus untreated and unreported. The authors report a TFCC injury in a professional Cricketer in an attempt to create awareness of this common sports injury. How to cite this article Talib U, Saleem S. Triangular Fibrocartilage Complex Injury in Professional Cricketers. J Postgrad Med Edu Res 2015;49(4):204-208.

scholarly journals The Diagnostic Value of the Ulnocarpal Stress Test for Differentiating the Symptomatic Triangular Fibrocartilage Complex Tear from the Incidental Tear

2020 ◽  
Vol 25 (4) ◽  
pp. 259-266
Author(s):  
Cheol-U Kim ◽  
Dong Hyun Kim ◽  
Bong Cheol Kwon
Keyword(s):  
Likelihood Ratio ◽  
Predictive Value ◽  
Stress Test ◽  
Positive Likelihood Ratio ◽  
Diagnostic Value ◽  
Triangular Fibrocartilage Complex ◽  
Diagnostic Process ◽  
Symptom Improvement ◽  
Control Group ◽  
Triangular Fibrocartilage

Purpose: The purpose of this study was to determine the diagnostic value of the ulnocarpal stress test (UCST) for differentiating the symptomatic triangular fibrocartilage complex (TFCC) tear from the incidental tear.Methods: From January 2013 to May 2020, a study was performed on 109 patients who underwent wrist arthroscopy and showed TFCC tear. Patients who had ulnar-sided wrist pain along with TFCC tear, and showed postoperative symptom improvement, and those with other lesions excluded were defined as symptomatic tear (experimental group) and the rest were defined as asymptomatic tear (control group). Diagnostic values of the UCST for differentiating the symptomatic TFCC tear from the incidental tear were calculated.Results: The UCST showed a sensitivity of 54%, a specificity of 95%, a positive predictive value of 98%, a negative predictive value of 31%, a positive likelihood ratio of 10.34, a negative likelihood ratio of 0.48, and an overall diagnostic accuracy of 61%. Conclusion: The UCST showed limited diagnostic value for symptomatic TFCC tear. Therefore, this test needs to be regarded as a part of diagnostic process and their results should be interpreted in the context of other relevant clinical information before reaching the diagnosis of symptomatic TFCC tear.

scholarly journals Osteoid Osteoma Mimicking Triangular Fibrocartilage Complex Injury: Diagnosis and Review of Treatment

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
J. M. Lamo-Espinosa ◽  
A. González ◽  
S. Amillo
Keyword(s):  
Osteoid Osteoma ◽  
Articular Surface ◽  
Treatment Algorithm ◽  
Triangular Fibrocartilage Complex ◽  
Review Of The Literature ◽  
Ulnar Styloid ◽  
The Real ◽  
Complex Injury ◽  
Special Behaviour ◽  
Triangular Fibrocartilage

We report the case of osteoid osteoma (OO) with ulnar styloid involvement. A review of the literature has been made with the aim of defining the special behaviour of OO when it is near the articular surface. That behaviour can affect the diagnosis, masking the real etiology of the pain, delaying the diagnosis, missing the diagnosis, or what is more serious, conducting an inadequate treatment. We propose a treatment algorithm conducted based on the localization near or far from articular surface and the superficial or deep localization.

Origins and Insertions of the Triangular Fibrocartilage Complex: A Histological Study

2001 ◽  
Vol 26 (5) ◽  
pp. 446-454 ◽  
Author(s):  
T. NAKAMURA ◽  
S. TAKAYAMA ◽  
Y. HORIUCHI ◽  
Y. YABE
Keyword(s):  
Hyaline Cartilage ◽  
Histological Study ◽  
Dorsal Side ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Styloid ◽  
Broad Area ◽  
Central Transition ◽  
Fresh Frozen ◽  
Triangular Fibrocartilage ◽  
Narrow Area

The origins and insertions of the triangular fibrocartilage complex (TFCC) were examined histologically in serially sectioned fresh-frozen cadaver wrists. The radioulnar ligament arose vertically through Sharpey’s fibres from a broad area in the ulnar fovea and more horizontally from a narrow area at the base of the ulnar styloid. The floor of the extensor carpi ulnaris sheath also originated firmly from the dorsal side of the fovea of the ulna, through an arrangement of Sharpey’s fibres. Loose ulnocarpally oriented fibres, corresponding to a thickened ulnar joint capsule, arose from the hyaline-like cartilage matrix at the tip of the ulnar styloid and inserted onto the triquetrum without Sharpey’s fibres. The ulnolunate and ulnotriquetral ligaments originated not from the ulna, but from the palmar side of the TFCC. The insertion of the TFCC into the sigmoid notch of the radius demonstrated a central transition from the fibrocartilaginous disc into hyaline cartilage and a firmer fibroosseous transition of the dorsal and palmar portions of the radioulnar ligament at the periphery.

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