Histologic anatomy of the triangular fibrocartilage

Chidgey, Larry K.; Dell, Paul C.; Bittar, Edward S.; Spanier, Susan S.

doi:10.1016/s0363-5023(10)80073-5

Cited by 98 publications

(56 citation statements)

References 16 publications

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“…16 Thus, the dorsal tear can occur between these sections. From our clinical investigations, the physical examinations included tenderness at the dorsal site of the UC joint, pain with UC stress test, a positive fovea sign, and a painful ulnar head ballottement test.…”

Section: Discussionmentioning

confidence: 99%

Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment

et al. 2016

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The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ) and a load absorber of the ulnocarpal (UC) joint. A TFCC injury is also recognized as a major cause of ulnar-sided wrist pain. Palmer has classified traumatic TFCC tears into four subtypes depending on the location of the tear. 1 As more recent studies have clarified the anatomical structure of TFCC 2,3 and through the use of wrist arthroscopy, it has become evident that not all of the TFCC tear patterns are included in Palmer original classification.A dorsal tear of the TFCC was first clearly described by Estrella et al in 2007 4 as being located in the area between the extensor carpi ulnaris (ECU) subsheath and the extensor digiti minimi (EDM)-a precarious site for tear. Abe et al reported AbstractBackground Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation. Methods An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy. Results The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score. Conclusions The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury. Type of study/level of evidence Diagnostic/level IV

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Section: Discussionmentioning

confidence: 99%

Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment

et al. 2016

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“…The differentiation of these peripheral tears of ulnar attachments of the TFC from central tears may be clinically important. Peripheral tears have a good vascular supply and can be associated with instability of the distal radioulnar joint (DRUJ) [38,39] while central lesions are avascular [12,37].…”

Section: Discussionmentioning

confidence: 99%

MR Arthrography of the Wrist: Controversies and Concepts

Maizlin¹,

Brown

Clement

et al. 2008

Hand (New York, N,Y.)

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Magnetic resonance arthrography (MRA) has become the preferred modality for imaging patients with internal derangement of the wrist. However, several aspects of MRA use need to be clarified before a standardized approach to the imaging of internal derangement of the wrist can be developed. The objective of the study is to evaluate the efficiency of different magnetic resonance (MR) sequences in the detection of lesions of the triangular fibrocartilage complex (TFCC) and scapholunate and lunotriquetral ligaments on direct MRA. Thirty-one consecutive direct magnetic resonance arthrographic examinations of the wrist using a wrist surface coil were performed for the assessment of the TFCC and intrinsic ligaments on a 1.5-T MR imaging system (Signa; 16 channel, Excite, GE Healthcare, Milwaukee, WI, USA). All patients had wrist pain, and in six cases, there was associated clinical carpal instability. The presence, location, and extent of TFCC, scapholunate ligament (SLL), and lunotriquetral ligament (LTL) lesions on T1 fat-saturated, multiplanar gradient recalled (MPGR) and short tau inversion recovery (STIR) images were identified, compared, and analyzed. Forty-one lesions of the TFCC, SLL, and LTL were visualized on contrast-sensitive (T1 fat-saturated) images in 23/31 (74.2%) patients. Twenty-one lesions of the TFCC and intrinsic ligaments were visualized on noncontrast-sensitive (MPGR and STIR) images (15 tears of the TFCC and six tears of the SLL and LTL). All of these lesions were seen on T1 fat-saturated images; 48.8% (20/41) lesions seen on T1 fat-saturated images (eight tears of TFCC and 12 tears of SLL and LTT) were not seen on MPGR and/or STIR images. Superior contrast resolution, joint distention, and the flow of contrast facilitate the diagnosis of lesions of the TFCC and intrinsic ligaments on contrast-sensitive sequences making MRA the preferred modality for imaging internal derangements of the wrist. Little agreement exists regarding the value and location of perforations of the intrinsic ligaments given that both traumatic and degenerative perforations may be symptomatic. Noncommunicating defects of the ulnar attachments of the triangular fibrocartilage (TFC), tears of the dorsal segment of the SLL, and defects at the lunate attachment of the SLL have a higher likelihood of being symptomatic and caused by trauma rather than by degenerative perforation. Although no consensus exists, it would appear that most arthrographies should be started with a radiocarpal injection. Injection into the distal radioulnar joint should be added if no communicational defects are visualized following radiocarpal injection in patients with ulnar-sided wrist pain.

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“…Because the central parts of the articular disk are avascular 38,39 there is no healing potential of a 1A lesion and it is accepted generally to treat this lesion with an up to two-thirds excision of the central part of the disk. 2,[40][41][42] The 1A lesion is frequent and in our study we have shown that an experimental equivalent to the standard treatment does not alter the stability of the wrist because we found no impact on wrist stability from either a partial or a total 1A lesion.…”

Section: Discussionmentioning

confidence: 99%