Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist

Abstract

Background In wrist arthrograms, aberrant contrast material is frequently seen extending into the soft tissue adjacent to the ulnar styloid process. Since the prestyloid recess can mimic contrast leakage in CT arthrography, this study aims to provide a detailed analysis of its morphologic variability, while investigating whether actual ulnar-sided leakage is associated with injuries of the triangular fibrocartilage complex (TFCC). Methods Eighty-six patients with positive wrist trauma history underwent multi-compartment CT arthrography (40 women, median age 44.5 years). Studies were reviewed by two board-certified radiologists, who documented the morphology of the prestyloid recess regarding size, opening type, shape and position, as well as the presence or absence of ulnar-sided contrast leakage. Correlations between leakage and the presence of TFCC injuries were assessed using the mean square contingency coefficient (rɸ). Results The most common configuration of the prestyloid recess included a narrow opening (73.26%; width 2.26 ± 1.43 mm), saccular shape (66.28%), and palmar position compared to the styloid process (55.81%). Its mean length and anterior–posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively. Ulnar-sided contrast leakage was reported in 29 patients (33.72%) with a mean extent of 12.30 ± 5.31 mm. Leakage occurred more often in patients with ulnar-sided TFCC injuries (rɸ = 0.480; p < 0.001), whereas no association was found for lesions of the central articular disc (rɸ = 0.172; p = 0.111). Conclusions Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist.

Arthroscopically assisted repair of triangular fibrocartilage complex foveal tear using modified “double loop suture” – a retrospective cohort study

“…A systematic review of cadaver studies by Koeyvoets et al, showed that transosseous tunnel repair yielded the highest stability for DRUJ and the strongest TFCC repair in comparison to the suture anchor repair and peripheral capsular repair [18]. Gietzen studied the morphology of the ulna fovea using wrist computed tomography arthrography and found that the mean length and anterior-posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively [19]. They found that v-RUL and d-RUL possess wide and distinct individual insertion areas.…”

Triangular fibrocartilage complex injuries – limitations of the current classification systems and the proposed new ‘CUP’ classification

“…More frequent are ulnodorsal capsular lesions at the triquetral insertion, referred to as ‘Nishikawa injury’ if acute (Nishikawa et al., 2002), or as Triquetral Impingement Ligament Tear (TILT) syndrome if chronic and with interposed synovial tissue (Watson and Weinzweig, 1999). In MR and CT arthrography, these injuries are best visualized in the sagittal plane (Gietzen et al., 2022; Theumann et al., 2011). Tears of the ulnocarpal meniscus with fracture of the tip of the ulnar styloid process usually do not cause instability (Type P1#).…”