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.

scholarly journals Arthroscopic Repair of Triangular Fibrocartilage Complex Tear

2020 ◽  
Vol 25 (3) ◽  
pp. 167-174
Author(s):  
Hyunseok Seo ◽  
Joo-Yup Lee
Keyword(s):  
Clinical Outcomes ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Triangular Fibrocartilage ◽  
Ulnar Impaction Syndrome ◽  
Important Structure

Triangular fibrocartilage complex (TFCC) is an important structure for stability of distal radioulnar joint (DRUJ) and shock absorption of ulnocarpal joint. Recent studies on anatomy and biomechanics of TFCC have revealed that the deep fiber of distal radioulnar ligament plays a key role in stabilizing the DRUJ. Clinicians should evaluate the presence of the instability of DRUJ or ulnar impaction syndrome. If necessary, combined TFCC foveal repair and ulnar shortening osteotomy should be performed. This article introduces the authors’ preferred procedure of arthroscopic TFCC repair with satisfactory clinical outcomes.

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.

scholarly journals Ulnar Shortening Osteotomy for Ulnar Wrist Pain.

1992 ◽  
Vol 41 (1) ◽  
pp. 143-146
Author(s):  
Manabu Kushida ◽  
Kotaro Imamura ◽  
Yoshifumi Nagatani ◽  
Eiji Hirano
Keyword(s):  
Wrist Pain ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Ulnar Wrist Pain

Distal radioulnar joint stability measured with radiostereometry during the piano key test

2020 ◽  
Vol 45 (9) ◽  
pp. 923-930 ◽  
Author(s):  
Janni Kjærgaard Thillemann ◽  
Sepp De Raedt ◽  
Peter Bo Jørgensen ◽  
Lone Rømer ◽  
Torben Bæk Hansen ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Distal Radioulnar Joint ◽  
Cadaver Study ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Human Donor ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Custom Made ◽  
Triangular Fibrocartilage

Distal radioulnar joint instability is difficult to grade by clinical examination and interobserver reliability is low. This study used a new and precise radiostereometry method for measurement of distal radioulnar joint translation. Eight human donor arms were positioned in a custom-made fixture and a standardized piano key test was done with pressure on the ulnar head. Examination was done before and after dividing the styloid and foveal insertions of the triangular fibrocartilage complex. In the intact wrists, the piano key test induced a mean 1.36 mm translation of the ulnar head, which increased statistically significantly to 1.96 mm after a lesion of the styloid ligament insertion and to 2.3 mm after combined lesions of the styloid and foveal ligament insertions. This experimental cadaver study demonstrates a radiological method for precise quantification of distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury.

Application of force-monitor ultrasonography to assess distal radioulnar joint instability in patients with triangular fibrocartilage complex injury

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110383
Author(s):  
Hiroshi Yuine ◽  
Yuichi Yoshii ◽  
Koichi Iwai ◽  
Tomoo Ishii ◽  
Hideki Shiraishi
Keyword(s):  
Dorsal Surface ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Healthy Controls ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Force Ratio ◽  
Triangular Fibrocartilage ◽  
Relationship Of ◽  
Force Displacement

Introduction In this study, we evaluated the differences and measurement accuracy in the force–displacement relationship of the distal radioulnar joint (DRUJ) between patients with triangular fibrocartilage complex (TFCC) injury and healthy controls using force-monitor ultrasonography. Methods This study included 11 TFCC injury patients and 22 healthy controls. We evaluated differences in the force–displacement relationship of the DRUJ in these patients using force-monitor ultrasonography. Cyclic compression was applied to the dorsal surface of the ulnar head. Distance between the dorsal surface of the distal radius and ulnar head at the DRUJ level was measured in the initial and pressed-down positions. Changes in radioulnar displacement, applied force, and displacement-to-force ratio were measured. Furthermore, we compared the parameters between the affected and unaffected wrists and between TFCC injury patients and controls. Results The radioulnar displacement and displacement-to-force ratio were significantly larger in the affected wrists than in the unaffected wrists ( P =  0.003 and P =  0.02). The affected/unaffected side ratio of radioulnar displacement and displacement-to-force ratio were significantly larger in the TFCC injury patients than in the controls ( P =  0.003 and P =  0.02). The area under the curve was 0.82 for the affected/unaffected ratio of the radioulnar displacement. The optimal cutoff value indicated by the receiver-operating characteristic curve for the affected/unaffected ratio of the radioulnar displacement was 1.71; the sensitivity and specificity were 82% and 86%, respectively. Conclusions Assessing the DRUJ instability with force-monitor ultrasonography may help identify TFCC-injured wrists.

Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients

2019 ◽  
Vol 44 (6) ◽  
pp. 582-586 ◽  
Author(s):  
Samir K. Trehan ◽  
Gregory Schimizzi ◽  
Tony S. Shen ◽  
Lindley B. Wall ◽  
Charles A. Goldfarb
Keyword(s):  
Parent Satisfaction ◽  
Subsequent Treatment ◽  
Triangular Fibrocartilage Complex ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Adolescent Patients ◽  
Triangular Fibrocartilage ◽  
Complex Surgery

We assessed outcomes of 43 paediatric and adolescent patients (44 wrists) undergoing arthroscopic triangular fibrocartilage complex surgery by a single surgeon between 2003 and 2016. Medical records were reviewed for clinical, imaging, and operative data. Preoperatively, 49% of patients had additional diagnoses and mean QuickDASH was 47. Patients were telephoned to assess current wrist pain, subsequent treatment(s), satisfaction, and to complete QuickDASH and Patient-Rated Wrist Evaluation questionnaires. Twenty-five patients responded with mean follow-up of 70 months (minimum 13 months). In those patients not reached by telephone, mean clinical follow-up was 21 months. Seven patients had subsequent surgery (most commonly ulnar shortening osteotomy); this was associated with lower satisfaction scores. At final follow-up, mean QuickDASH was 4, Patient-Rated Wrist Evaluation 8 and patient and parent satisfaction scores were 9 and 9 out of 10, respectively. In conclusion, arthroscopic triangular fibrocartilage complex treatment in paediatric patients yielded favourable outcomes and patient/parent satisfaction. Level of evidence: IV

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.

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