Top-Ten Tips for Imaging the Triangular Fibrocartilaginous Complex

2019 ◽  
Vol 23 (04) ◽  
pp. 436-443
Author(s):  
Alex W.H. Ng ◽  
Cina S.L. Tong ◽  
Esther H.Y. Hung ◽  
James F. Griffith ◽  
W.L Tse ◽  
...  
Keyword(s):  
Complex Structure ◽  
Axial Loading ◽  
Distal Radioulnar Joint ◽  
Resonance Imaging ◽  
Joint Injury ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage ◽  
Magnetic Resonance Imaging Mri ◽  
The Stability ◽  
Chronic Wrist Pain

AbstractThe triangular fibrocartilage complex (TFCC) is a crucial structure for both maintaining the stability of the distal radioulnar joint (DRUJ) and acting as a cushion for axial loading of the ulnocarpal joint. Injury to the TFCC can lead to early degeneration of the DRUJ and ulnocarpal joint, with resultant chronic wrist pain and weakness. The TFCC is a moderately complex structure with several attachments to the adjacent bony and cartilaginous structures. Familiarity with the anatomy of the TFCC is a prerequisite for identification of TFCC tears. Several pitfalls can occur while assessing the TFCC on magnetic resonance imaging (MRI) if one is not familiar with the MRI appearances. This article illustrates key tips for diagnosing TFCC tears on MRI.

scholarly journals Prevalence of triangular fibrocartilage complex injuries in patients with distal radius fractures: a 3.0T magnetic resonance imaging study

2019 ◽  
Vol 47 (8) ◽  
pp. 3648-3655
Author(s):  
Bingshan Yan ◽  
Zhaoning Xu ◽  
Yanchao Chen ◽  
Wangping Yin
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Resonance Imaging ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Radioulnar Joint ◽  
Ulnar Styloid Fracture ◽  
Triangular Fibrocartilage ◽  
3.0T Mri

Objective This study was performed to determine the prevalence of triangular fibrocartilage complex (TFCC) injuries as shown by 3.0T magnetic resonance imaging (MRI) in patients with distal radius fractures. Methods In total, 57 patients with distal radius fractures underwent 3.0T MRI examinations to observe the incidence of TFCC injuries after manual reduction and cast fixation. The fracture type was categorized by the AO classification, and the TFCC injury pattern was evaluated using the Palmer classification. The correlation between the location of the TFCC injury and the distal radius fracture pattern, distal radioulnar joint instability, or ulnar styloid fracture was analyzed. Results Fifty-five TFCC injuries were diagnosed. There was no significant relationship between the TFCC injury pattern and the type of distal radius fracture, distal radioulnar joint instability, or ulnar styloid fracture. Conclusions This study revealed a high prevalence of TFCC injuries in patients with distal radius fractures. The 3.0T MRI examination helps to assess TFCC injuries in patients with distal radius fractures. Clinical Trial Registration ChiCTR1800017101.

ARTHROSCOPIC VISUALISATION OF THE DISTAL RADIOULNAR JOINT

Hand Surgery ◽  
2008 ◽  
Vol 13 (03) ◽  
pp. 133-138 ◽  
Author(s):  
Michiro Yamamoto ◽  
Shukuki Koh ◽  
Masahiro Tatebe ◽  
Takaaki Shinohara ◽  
Kaori Shionoya ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Wrist Pain ◽  
Wrist Arthroscopy ◽  
Pathological Findings ◽  
Success Rates ◽  
Radioulnar Joint ◽  
Proximal Surface ◽  
Ulnar Head ◽  
Triangular Fibrocartilage ◽  
Chronic Wrist Pain

The diagnosis of chronic wrist pain is challenging and wrist arthroscopy has been recognised as the "gold standard". The present study investigated the efficacy of adding distal radioulnar joint (DRUJ) arthroscopy to routine wrist arthroscopy. The records of 67 patients who underwent DRUJ arthroscopy were reviewed, and the success rates for visualisation of intra-articular structures were determined. Pathological findings were correlated with ulnar-side wrist pain. In seven patients, pre-operative diagnoses were altered after DRUJ arthroscopy. The ulnar head and proximal surface of the triangular fibrocartilage complex (TFCC) were visualised in 100% and 99% of patients, respectively, while the foveal insertion of TFCC and sigmoid notch were visualised in 57% and 69%, respectively. Pathological findings of the proximal surface of TFCC tended to relate to ulnar wrist pain (p = 0.06). DRUJ arthroscopy should be included in routine wrist arthroscopy to enhance the accuracy of diagnosis.

Distal radioulnar joint: functional anatomy, including pathomechanics

2017 ◽  
Vol 42 (4) ◽  
pp. 338-345 ◽  
Author(s):  
J. R. Haugstvedt ◽  
M. F. Langer ◽  
R. A. Berger
Keyword(s):  
Functional Anatomy ◽  
Tendon Sheath ◽  
Distal Radioulnar Joint ◽  
Review Article ◽  
Joint Capsule ◽  
Pronator Quadratus ◽  
Radioulnar Joint ◽  
Stable Part ◽  
Triangular Fibrocartilage ◽  
The Stability

The distal radioulnar joint allows the human to rotate the forearm to place the hand in a desired position to perform different tasks, without interfering with the grasping function of the hand. The ulna is the stable part of the forearm around which the radius rotates; the stability of the distal radioulnar joint is provided by the interaction between ligaments, muscles and bones. The stabilizing structures are the triangular fibrocartilage complex, the ulnocarpal ligament complex, the extensor carpi ulnaris tendon and tendon sheath, the pronator quadratus, the interosseous membrane and ligament, the bone itself and the joint capsule. The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of this joint.

Desmoid tumour of the distal forearm involving the distal radioulnar joint

2020 ◽  
Vol 13 (11) ◽  
pp. e237097
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Avijeet Prasad ◽  
Manoj Bhagirathi Mallikarjunaswamy
Keyword(s):  
Distal Radioulnar Joint ◽  
Treatment Modalities ◽  
Desmoid Tumour ◽  
X Rays ◽  
Distal Forearm ◽  
Left Wrist ◽  
Radioulnar Joint ◽  
Magnetic Resonance Imaging Mri ◽  
Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

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

TREATMENTS OF OSTEOARTHRITIS OF THE DISTAL RADIOULNAR JOINT: LONG-TERM RESULTS OF THREE PROCEDURES

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 243-248 ◽  
Author(s):  
Akio Minami ◽  
Norimasa Iwasaki ◽  
Jun-ichi Ishikawa ◽  
Naoki Suenaga ◽  
Kazunori Yasuda ◽  
...  
Keyword(s):  
Grip Strength ◽  
Statistical Significance ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Long Term Results ◽  
Interposition Arthroplasty ◽  
Secondary Osteoarthritis ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

Sixty-one wrists in 61 patients with osteoarthritis of the distal radioulnar joint treated by three consecutive procedures (20 Darrach, 25 Sauvé-Kapandji and 16 hemiresection-interposition arthroplastic procedures) were retrospectively evaluated. We preferred to perform Darrach's procedure in even the early stages of osteoarthritis of the distal radioulnar joint prior to introduction of Sauvé-Kapandji and hemirestion-interposition arthroplastic procedures. Subsequently the hemirestion-interposition arthroplasty was indicated when the triangular fibrocartilage cartilage was intact or could be reconstructed and the Sauvé-Kapandji when the triangular fibrocartilage complex could not be reconstructed or there was positive ulnar variance of more than 5 mm even though the triangular fibrocartilage complex was functional. Patient's age at operation averaged 59.8 years. There were 36 men and 25 women. There were 38 primary and 23 secondary osteoarthritis cases. Post-operative pain, range of motion, grip strength, return to work status; and radiographic results were evaluated. At the five- to 14-year (average, ten years) follow-up evaluation, relief of pain from Darrach procedure was inferior to the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty although this was not statistically significant. After both the Sauvé-Kapandji procedure and hemiresection-inteposition arthroplasty, post-operative improvements in flexion and extension of the wrist had statistical significance. Post-operative improvements in pronation and supination of the forearm showed statistical significances after all procedures. Improvements of post-operative grip strength and return to an original job in the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty were statistically superior to those with a Darrach's procedure. There were many post-operative complications following the Darrach's procedure. Darrach's procedure is better indicated for severe osteoarthritic changes of the distal radioulnar joint in elderly patients. We believe the operative indications between the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty are best determined prior to surgery by the existence and status of the triangular fibrocartilage complex and the amount of the positive ulnar variance.

scholarly journals The Effect of Dorsal Angulation on Distal Radioulnar Joint Arthrokinematics Measured Using Intercartilage Distance

2018 ◽  
Vol 08 (01) ◽  
pp. 010-017
Author(s):  
Emily Lalone ◽  
Masao Nishiwaki ◽  
Ryan Willing ◽  
James Johnson ◽  
Graham King ◽  
...  
Keyword(s):  
Distal Radius ◽  
Contact Area ◽  
Three Dimensional ◽  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Motion Data ◽  
Contact Patterns ◽  
Dorsal Angulation ◽  
Triangular Fibrocartilage

Background The effects of dorsal angulation deformity on in vitro distal radioulnar joint (DRUJ) contact patterns are not well understood. Purpose The purpose of this study was to utilize intercartilage distance to examine the effects of forearm rotation angle, distal radius deformity, and triangular fibrocartilage complex (TFCC) sectioning on DRUJ contact area and centroid position. Methods An adjustable implant permitted the creation of simulated intact state and dorsal angulation deformities of 10, 20, and 30 degrees. Three-dimensional cartilage models of the distal radius and ulna were created using computed tomography data. Using optically tracked motion data, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. Results DRUJ contact area was highest between 10 and 30 degrees of supination. TFCC sectioning caused a significant decrease in contact area with a mean reduction of 11 ± 7 mm2 between the TFCC intact and sectioned conditions across all variables. The position of the contact centroid moved volarly and proximally with supination for all variables. Deformity had a significant effect on the location of the contact centroid along the volar–dorsal plane. Conclusion Contact area in the DRUJ was maximal between 10 and 30 degrees of supination during the conditions tested. There was a significant effect of simulated TFCC rupture on contact area in the DRUJ, with a mean contact reduction of 11 ± 7 mm2 after sectioning. Increasing dorsal angulation caused the contact centroid to move progressively more volar in the sigmoid notch.

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