MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain

Hand ◽  
2020 ◽  
pp. 155894472093736
Author(s):  
Svenna H. W. L. Verhiel ◽  
Julia Blackburn ◽  
Marco J. P. F. Ritt ◽  
Frank J. Simeone ◽  
Neal C. Chen
Keyword(s):  
Patient Characteristics ◽  
Clinical Results ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Bivariate Analysis ◽  
Mri Findings ◽  
Specific Patient ◽  
Control Subjects ◽  
Triangular Fibrocartilage

Background: The clinical picture of ulnar-sided wrist pain is oftentimes confusing because various pathologies may be coexistent. In this study, we aimed: (1) to compare the prevalence of potential causes of ulnar-sided wrist pain on magnetic resonance imaging (MRI) in patients who underwent triangular fibrocartilage complex (TFCC) repair and control subjects: and (2) to evaluate whether inferior clinical results were associated with specific patient characteristics or other potential causes of ulnar-sided wrist pain. Methods: We included 67 patients who underwent a TFCC repair and 67 control subjects. The MRI scans were examined for sources of ulnar-sided wrist pain. After TFCC repair, 42 patients (63%) completed surveys, including Quick Disabilities of the Arm, Shoulder and Hand and pain scores. Bivariate analysis was performed to compare our groups and to identify factors associated with our outcomes. Results: We found significantly higher rates of distal radioulnar joint (DRUJ) arthritis ( P = .033), extensor carpi ulnaris (ECU) pathology ( P = .028), and ulnar styloid fractures ( P = .028) in patients with TFCC repairs. With increasing age, increasing pathology in the pisotriquetral joint ( P = .040), more ulnocarpal abutment ( P = .0081), and more degenerative tears ( P < .001) were seen in both groups. No demographic characteristics or MRI findings were significantly associated with our outcomes. Conclusions: We observed higher rates of DRUJ arthritis and ECU pathology in patients with TFCC tears undergoing repair compared with age- and sex-matched controls. This may be due to damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery.

Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain

2013 ◽  
Vol 38 (7) ◽  
pp. 746-750 ◽  
Author(s):  
T. Oda ◽  
T. Wada ◽  
K. Iba ◽  
M. Aoki ◽  
M. Tamakawa ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Articular Disc ◽  
Ulnar Head ◽  
Dynamic Variations ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Ulnar Wrist Pain ◽  
Triangular Fibrocartilage

In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer’s Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.

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.

Arthroscopic Capsular Repair for Triangular Fibrocartilage Complex Tears

2020 ◽  
Author(s):  
Takehiko Takagi ◽  
Toshiyasu Nakamura ◽  
Masatoshi Fukuoka
Keyword(s):  
Evaluation System ◽  
Clinical Results ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Forearm Rotation ◽  
Radioulnar Joint ◽  
Capsular Repair ◽  
Arthroscopic Findings ◽  
Class 1 ◽  
Triangular Fibrocartilage

Abstract Background The triangular fibrocartilage complex (TFCC) lesions are frequently implicated as a cause of ulnar wrist pain following impact and loading injuries. The objective of this study was to describe the clinical outcomes following TFCC lesion repair with the arthroscopic outside-in technique. Description of Technique We inserted a 21-gauge needle with 4–0 nylon loop perpendicular to the injured triangular fibrocartilage (TFC). We held two 4–0 nylon loops with mosquito forceps, drew them once out of the joint through a 4 to 5 portal, and put both sides through each loop. After that, we pulled out the 21-gauge needles and performed outside-in sutures after making a small incision and tying directly over the capsule. Patients and Methods Twenty-one wrists who underwent arthroscopic capsular repair were included. Arthroscopic findings were evaluated, and we used a distal radioulnar joint (DRUJ) evaluation system to monitor relief of pain, forearm rotation range of motion, and DRUJ stability postoperatively. Results Simple ulnar avulsion (Palmer 1B, Atzei Class 1) was recognized in ten wrists. A combination of the 1B tear with a horizontal TFC tear was noted in five wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in six wrists, including complete dorsal avulsion of the TFC from the capsule. There are significantly better results in the cases whose preoperative periods were 15 months or less. Conclusion The outside-in TFC repair technique produced excellent clinical results for peripheral detachment of the TFC in cases without severe DRUJ instability and with a preoperative period less than 15 months.

scholarly journals Arthroscopic triangular fibrocartilage complex reconstruction with free tendon graft for chronic distal radioulnar joint instability

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kuang-Ting Yeh ◽  
Jui-Tien Shih
Keyword(s):  
Distal Radioulnar Joint ◽  
Rehabilitation Program ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Invasive Technique ◽  
Reconstruction Method ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Ulnar Wrist Pain ◽  
Triangular Fibrocartilage

Abstract Background Tears in the triangular fibrocartilage complex (TFCC) often manifest as ulnar wrist pain and limited wrist function. In chronic cases, the treatment of large tears with irreparable TFCC degeneration combined with distal radioulnar joint (DRUJ) instability is difficult. In the current report, we describe the outcomes of a minimally invasive technique for TFCC reconstruction using the free palmaris longus (PL) tendon via arthroscopy. Methods We examined the cases of 67 adult patients [54 men and 13 women; age range, 19–34 years (mean age, 26.4 years)] treated for chronic and irreparable TFCC tears from 2001 to 2019. We used the arthroscopic TFCC reconstruction method with the free PL tendon for all chronic and irreparable TFCC injuries with DRUJ instability in our clinic. Thereafter, the patients underwent the rehabilitation program, which included wrist motion and occupational therapy. The mean time period from the event causing the tear to the operation was 22.6 months. Results The function results of these patients significantly improved, and the ulnar wrist pain significantly decreased at postoperative follow-up. Of the 67 patients, 38 rated their wrists as “excellent,” 26 as “good,” and 3 as “fair.” None of the patients developed wound infections or complications. Conclusions The results of this study suggest that arthroscopic TFCC reconstruction using the free PL tendon is an effective method for treating chronic and irreparable TFCC tears with DRUJ instability.

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

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.

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.

Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears

2021 ◽  
Vol 103-B (8) ◽  
pp. 1386-1391
Author(s):  
Ji-Yang Xiao ◽  
Bo Liu ◽  
Lily Li ◽  
Hai-Fei Shi ◽  
Feiran Wu
Keyword(s):  
Logistic Regression ◽  
Univariate Analysis ◽  
Treatment Method ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Pain Patient ◽  
Poor Outcome ◽  
Triangular Fibrocartilage ◽  
Manual Occupation ◽  
Viable Treatment

Aims The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis. Methods This was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome. Results In total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome. Conclusion Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity. Cite this article: Bone Joint J 2021;103-B(8):1386–1391.

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.

Sign in / Sign up

Export Citation Format

Share Document