Wrist Arthrography

2019 ◽  
pp. 153-155
Author(s):  
Matthew DelGiudice
Keyword(s):  
Mr Arthrography ◽  
Joint Space ◽  
Distal Radioulnar Joint ◽  
Routine Clinical Practice ◽  
Younger Patients ◽  
Radioulnar Joint ◽  
Lunotriquetral Ligament ◽  
Radiocarpal Joint ◽  
Triangular Fibrocartilage ◽  
Midcarpal Joint

Chapter 100 describes the indications, the technique, and the imaging findings of wrist arthrography. Wrist arthrography is selectively performed in routine clinical practice for MR arthrography (MRA), typically in younger patients. The main indications include evaluation of the intrinsic interosseous wrist ligaments (scapholunate and lunotriquetral) and triangular fibrocartilage complex (TFCC) injuries. Contrast should easily inject and disperse throughout the radiocarpal joint space. Complications from contrast injection are rare and include infection and bleeding. Full-thickness tearing of any of the 3 components of the scapholunate and/or lunotriquetral ligament allows abnormal communication with the midcarpal joint. Central tearing of the triangular fibrocartilage disc allows abnormal communication with the distal radioulnar joint.

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

2021 ◽  
Author(s):  
Eric Perloff ◽  
Andrew Posner ◽  
Hamza Murtaza ◽  
Khushdeep Vig ◽  
Michael Smith ◽  
...  
Keyword(s):  
Ct Scan ◽  
Distal Radioulnar Joint ◽  
Load Test ◽  
Portal Site ◽  
Radioulnar Joint ◽  
Radiocarpal Joint ◽  
Fresh Frozen ◽  
The Mean ◽  
Midcarpal Joint ◽  
Cadaveric Model

Abstract Background Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. Question/Purpose The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT. Materials and Methods Ten fresh frozen cadavers which had undergone transhumeral amputation were initially used in this study. A baseline CT scan was performed to ensure no intra-articular air existed prior to intervention. After baseline CT, an arthrotomy was created at the 6R radiocarpal portal site. The wrists then underwent a postarthrotomy CT to identify the presence or absence of intra-articular air. Following CT, the wrists were subjected to the SLT to detect the presence of extravasation from the arthrotomy. Results Nine cadavers were included following baseline CT scan. Following arthrotomy, intra-articular air was visualized in eight of the nine cadavers in the postarthrotomy CT scan. Air was seen in the radiocarpal joint in eight of the nine wrists; midcarpal joint in seven of the nine wrists; and distal radioulnar joint in six of the nine wrists. All wrists (nine of the nine) demonstrated extravasation during the SLT. The mean volume of extravasation occurred at 3.7 mL (standard deviation = 2.6 mL), with a range of 1 to 7 mL. Conclusion CT scan correctly identified eight of the nine simulated traumatic arthrotomies. Injection of 7 mL during the SLT was necessary to identify 100% of the arthrotomies. Clinical Relevance CT scan is a sensitive modality for detection of traumatic arthrotomy of the wrist in a cadaveric model.

Reconstruction of the Distal Oblique Bundle for DRUJ Instability

2021 ◽  
Author(s):  
Niels O.B. Thomsen ◽  
Anders Björkman
Keyword(s):  
Ligament Reconstruction ◽  
Treatment Algorithm ◽  
Distal Radioulnar Joint ◽  
Reconstruction Technique ◽  
Salvage Procedure ◽  
Younger Patients ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage ◽  
Forearm Instability ◽  
Essex Lopresti

Abstract Background Treatment algorithm for disruption of the triangular fibrocartilage complex (TFCC) from the ulnar fovea includes direct TFCC repair, tendon reconstruction of the radioulnar ligaments, or a salvage procedure in cases with painful distal radioulnar joint (DRUJ) degeneration. Case Description We describe our surgical technique for reconstruction of the distal oblique bundle (DOB), to attain DRUJ stability in a young man, after failed attempts of direct TFCC reinsertion and radioulnar ligament reconstruction with the Adams procedure. Literature Review Reconstruction of the central band of the interosseous membrane is well recognized for Essex-Lopresti injuries that demonstrate longitudinal forearm instability. The role for reconstruction/reinforcement of the DOB to restore DRUJ stability after TFCC injury has not gained the same recognition and needs further clarification. Clinical Relevance DOB reconstruction technique described is extra-articular and technically straightforward. We believe that the procedure could be considered for patients with an irreparable TFCC injury as a part of the treatment algorithm for younger patients, who otherwise would face a more extensive salvage procedure.

ULNAR-SIDED WRIST PAIN DUE TO ISOLATED DISK TEAR OF TRIANGULAR FIBROCARTILAGE COMPLEX WITHIN THE DISTAL RADIOULNAR JOINT: TWO CASE REPORTS

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 177-180 ◽  
Author(s):  
Yukio Abe ◽  
Yasuhiro Tominaga
Keyword(s):  
Functional Recovery ◽  
Case Reports ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Wrist Arthroscopy ◽  
Radioulnar Joint ◽  
Radiocarpal Joint ◽  
Horizontal Tear ◽  
Triangular Fibrocartilage

Wrist arthroscopy has been successfully used with many modifications and improvements. However, distal radioulnar joint (DRUJ) arthroscopy is still uncommon. We experienced 2 cases of ulnar-sided wrist pain due to isolated triangular fibrocartilage complex (TFCC) disk tear within the DRUJ. DRUJ arthroscopy in these cases showed horizontal tear and fibrillation of TFCC disk without TFCC tear at the radiocarpal joint. Foveal attachment was intact in both cases. These were treated with debridement, which relieved pain after surgery and achieved good functional recovery. Although DRUJ arthroscopy is technically difficult, it is mandatory for making a diagnosis and treating ulnar-sided wrist pain.

Peripheral Tear of the Triangular Fibrocartilage: Depiction with MR Arthrography of the Distal Radioulnar Joint

2007 ◽  
Vol 188 (1) ◽  
pp. 187-192 ◽  
Author(s):  
Christoph Rüegger ◽  
Marius R. Schmid ◽  
Christian W. A. Pfirrmann ◽  
Ladislav Nagy ◽  
Louis A. Gilula ◽  
...  
Keyword(s):  
Mr Arthrography ◽  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

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.

scholarly journals The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study

2018 ◽  
Vol 07 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Peter Tang ◽  
Keiji Fujio ◽  
Robert Strauch ◽  
Melvin Rosenwasser ◽  
Taiichi Matsumoto
Keyword(s):  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Transosseous Repair ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Group 5 ◽  
Bone Tunnels ◽  
Isometric Point ◽  
Suture Placement

Background Transosseous repair of foveal detachment of the triangular fibrocartilage complex (TFCC) is effective for distal radioulnar joint stabilization. However, studies of the optimal foveal and TFCC suture positions are scant. Purpose The purpose of this study was to clarify the optimal TFCC suture position and bone tunnels for transosseous foveal repair. Materials and Methods Seven cadavers were utilized. The TFCC was incised at the foveal insertion and sutured at six locations (TFCCs 1–6) using inelastic sutures. Six osseous tunnels were created in the fovea (foveae 1–6). Fovea 2 is located at the center of the circle formed by the ulnar head overlooking the distal end of the ulna (theoretical center of rotation); fovea 5 is located 2 mm ulnar to fovea 2. TFCC 5 is at the ulnar apex of the TFCC disc; TFCC 4 is 2 mm dorsal to TFCC 5. TFCC 1 to 6 sutures were then placed through each of the six osseous tunnels, resulting in 36 combinations, which were individually tested. The forearm was placed in five positions between supination and pronation, and the degree of suture displacement was measured. The position with the least displacement indicated the isometric point of the TFCC and fovea. Results The mean distance of suture displacement was 2.4 ± 1.6 mm. Fovea 2, combined with any TFCC location, (0.7 ± 0.6 mm) and fovea group 5, combined with TFCC 4 location (0.8 ± 0.8) or with TFCC 5 location (0.9 ± 0.6) had statistically shorter suture displacements than any other fovea groups. Conclusion For TFCC transosseous repair, osseous tunnel position was more important than TFCC suture location.

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.

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