Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists.
ABSTRACT To characterize triangular fibrocartilage (TFC) defects in symptomatic and contralateral asymptomatic wrists.
Communicating and noncommunicating defects of the TFC were depicted on bilateral wrist arthrograms in 56 patients with unilateral wrist pain and without associated lesions of the scapholunate or lunotriquetral ligaments. The exact location of each TFC lesion was noted.
Communicating defects were noted in 36 (64%) of 56 symptomatic and in 26 (46%) of 56 asymptomatic wrists. Twenty-five (69%) of 36 communicating defects were bilateral. Except for one defect in each group of symptomatic and asymptomatic wrists, all communicating defects were noted radially. Noncommunicating defects were noted in 28 (50%) of 56 symptomatic wrists and in 15 (27%) of 56 asymptomatic wrists. Eleven (39%) of 28 noncommunicating defects were bilateral. On the symptomatic side, 28 of 36 noncommunicating defects (including eight multiple defects) were located proximally at the ulnar side. On the asymptomatic side, 11 of 17 noncommunicating defects (including two multiple defects) were at or near the ulna.
Noncommunicating TFC defects, which typically are located on the proximal side of the TFC near its ulnar attachment, have a more reliable association with symptomatic wrists than do communicating defects. Radial-sided communicating defects described in the literature (Palmer type 1A and 1D) as posttraumatic commonly are seen bilaterally and in asymptomatic wrists.
Article: MRI of Wrist Ligaments.[Show abstract] [Hide abstract]
ABSTRACT: The optimal imaging protocols for magnetic resonance imaging (MRI) of the wrist ligaments are discussed, including the use of magnetic resonance arthrography, and 3 Tesla (T) versus 1.5 T magnetic field strength. The normal MRI appearance of the triangular fibrocartilage complex, capsular, and interosseous wrist ligaments is briefly covered to point out potential diagnostic pitfalls. Numerous examples of common ligamentous pathology discernible on MRI are provided, along with the latest estimates of diagnostic sensitivity and specificity provided by the literature.The Journal of hand surgery 05/2013; · 1.33 Impact Factor
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ABSTRACT: Wrist magnetic resonance imaging (MRI) has established utility in the diagnosis of wrist ligament tears, including complete tears of the ulnotriquetral ligament (UTL) and other components of the triangular fibrocartilage complex. A new type of longitudinal split tear of the UTL has recently been described with no imaging correlate. Our aims were to describe putative MRI findings associated with longitudinal UTL split tears and to assess diagnostic accuracy. We randomly selected 40 patients with arthroscopically proven longitudinal UTL split tears and 20 patients with intact UTLs, all of whom had preoperative 3 T MRI of the same wrist performed, from a list of operative notes spanning from January 1997 through October 2011, filtered with the terms "ulnotriquetral ligament" and "ulnar triquetral ligament." Two musculoskeletal radiologists who were blinded to surgical results and clinical information independently reviewed the exams. They recorded the degree of certainty of whether a longitudinal UTL split tear was present and whether several other hypothesized associated abnormalities were present. Overall sensitivity for definitive longitudinal UTL split tear detection on MRI was 58% for reader 1 and 30% for reader 2. Specificity was 60% for both. There were no statistically significant discriminatory findings. Among a selected group of patients who all had wrist arthroscopy, preoperative noncontrast 3 T wrist MRI had poor sensitivity and specificity for detection of the longitudinal split type of UTL tear. To date, MRI may be more helpful to exclude potential alternative diagnoses in the patient with ulnar wrist pain. Diagnostic III.The Journal of hand surgery 07/2013; · 1.33 Impact Factor
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ABSTRACT: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA) and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93%) and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39), and specificity was 80% (16/20). The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34). These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.Sultan Qaboos University medical journal 05/2013; 13(2):280-6.