Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions

Schmauß, Daniel; Pöhlmann, Sebastian; Lohmeyer, Jörn Andreas; Germann, G.; Bickert, Berthold; Megerle, Kai

doi:10.1007/s00402-016-2441-9

Cited by 43 publications

(27 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In terms of radiologic factors, patients with the signal enhancement of carpal or distal ulna on MRI had higher pain NRS and DASH scores, and this was the only significant prognostic factor; almost none of the radiologic factors including degree of ulnar plus variance, type of TFCC lesion, or arthritis of ulno-carpal or distal radio-ulnar joint had a significant effect on the treatment failure for idiopathic UIS. These results are consistent with previous findings that diagnostic MRI findings and values are limited in TFCC injury 20 , suggesting that the diagnosis of UIS is made on clinical ground and supported by radiographic studies. However, MRI findings are often a precursor to plain radiographic findings 22 and our results suggest that carpal or distal ulna bone enhancement is distinctive and helps to predict the prognosis.…”

Section: Discussionsupporting

confidence: 92%

“…The sex difference in treatment outcomes could in part be explained by higher physical vulnerability 16 or pain sensitivity 17 in women; musculoskeletal pain and disability were found to be more prevalent 18 and more severe in women 19 . The ulno-carpal stress test is reportedly highly sensitive but not specific for UIS; other ulno-capal pathology including lunotriquetral ligament injury or isolated ulno-carpal arthritis will produce positive findings 20 , 21 . However, our results suggests that pain NRS scores on ulno-carpal stress test in the presence of a history of ulnar wrist pain worsened by pronation or ulnar deviation of the wrist and plain radiograph with positive ulnar variance had significant prognostic value for conservative treatment of idiopathic UIS.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome

Roh

Kim

Gong

et al. 2018

Sci Rep

View full text Add to dashboard Cite

Ulnar impaction syndrome (UIS) is a common source of ulnar-sided wrist pain, yet not all cases of radiographic ulnar impaction are symptomatic. We retrospectively analyze clinical or radiologic factors that affect prognoses of conservative treatment for idiopathic UIS. A total of 114 patients who had been diagnosed with UIS were treated with 6 weeks of short arm orthosis followed by formal physiotherapy for 6 weeks, with lifestyle modification to limit aggravating movements. The response to treatment, including pain numeric rating scale on an ulnar provocation test, grip strength, Disability of the Arm, Shoulder, and Hand score (DASH), was assessed at 24-week follow-up. For the 24-week follow-up, 29 patients (25%) underwent ulnar shortening osteotomy due to persistent symptoms after conservative treatment, and 18 (16%) patients had pain scores of greater than 5, but they had not undergone surgery. After controlling for confounding variables, female gender (odds ratio (OR) 1.39), duration of symptom (OR 1.27), high pain NRS score on provocation test (OR 1.45), and enhanced carpal or distal ulna bone on MRI (OR 1.82) were associated with a higher likelihood of treatment failure. Knowledge of the factors offers physicians insight into predicting prognoses and helps patients set realistic expectations.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome

Roh

Kim

Gong

et al. 2018

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Clinical tests were found to have low positive predictive values in the diagnosis of TFC lesions, ranging from 0.53 to 0.55. 12 Accordingly, in this study, TFC perforations were found in half of the patients with clinically diagnosed ulnar impaction syndrome. Diagnoses thereby, deliberately did not rely on MRIs because these demonstrated limited sensitivity and specificity as long as they were not done using a sophisticated technique under study conditions.…”

Section: Discussionmentioning

confidence: 53%

Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

et al. 2017

View full text Add to dashboard Cite

Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view. This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion. Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal. In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups. In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure. Therapeutic III, case-control study.

show abstract

“…In addition to the data presented in table 3, the study of Schmauss et al presented the diagnostic accuracy of their tests separately for different subgroups. 25 These results are summarised in online supplemental appendix 2. Table 4 describes the accuracy of the diagnostic tests for non-chronic hand and finger injuries.…”

Section: Accuracy Of Diagnostic Tests Concerning Wrist Injuriesmentioning

confidence: 97%

“…Eight studies were retrospective [23][24][25][26][27][28][29][30] nine studies were prospective [31][32][33][34][35][36][37][38][39] and six studies [40][41][42][43][44][45] gave no description of the study design. Eight studies 23 25 27 31 33 36 43 45 included more than 60 participants; six of these studies 23 25 27 31 33 36 described wrist pathologies and two 43 45 described hand pathologies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

et al. 2020

View full text Add to dashboard Cite

ObjectiveThe diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist.MethodsMedline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted.ResultsNone of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively.ConclusionsThere is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.

show abstract

Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions

Abstract: According to this study, clinical tests and MR imaging findings are of very limited diagnostic value for the diagnosis of TFCC lesions.

Cited by 43 publications

References 30 publications

Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome

Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome

Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

Contact Info

Product

Resources

About