Triangular fibrocartilage complex injury
Triangular
fibrocartilage complex injury • TFCC disc injury and UCCL complete tear (wrist MRI arthrogram) - Ganzer Fall bei Radiopaedia
Triangular
fibrocartilage complex injury • Triangular fibrocartilage complex injury - Palmer 1a - Ganzer Fall bei Radiopaedia
Sports-related
wrist and hand injuries: a review. a A T2-weighted coronal sequence of a wrist MRI revealing an ulnar-sided peripheral tear of the TFCC (yellow arrow). b Arthroscopy view from the three to four portal showing the peripheral tear (red arrow). c Intraoperative arthrosopic image during an arthroscopic-assisted outside-in repair using PDS suture (blue arrow)
The
importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist. Left side: Schematic coronal display of the triangular fibrocartilage complex (TFCC). While both TFCC layers originate from the sigmoid notch of the radius, the superficial (light grey) and deep (dark grey) layer of the TFCC insert at the ulnar styloid process and ulnar fovea, respectively. Right side: Schematic axial display of the dorsal and palmar radioulnar ligaments during forearm pronation (upper right), neutral position (middle right) and supination (lower right) from an axial perspective
The
importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist. 35-year-old man with ulnar-sided wrist pain. Axial planes of the distal radioulnar joint illustrate the difference between multiplanar reconstructions after CT arthrography. a coronal reconstruction. b radial reconstruction with the rotating center atop the ulnar styloid process. c radial reconstruction with the rotating center in the ulnar fovea
The
importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist. Left side: Schematic illustration of the Atzei classification for peripheral lesions of the triangular cartilage complex (TFCC). Right side: Radially reconstructed CT images from different patients depicting the corresponding ulnar-sided TFCC pathologies. Additional central discus alterations are present in the images for stages 3A and 5
Triangular fibrocartilage complex (TFCC) injuries may be traumatic or degenerative in nature. The TFCC is a complex structure consisting of the triangular fibrocartilage (TFC) disc proper, ulnomeniscal homologue and numerous ligaments and tendons.
Clinical presentation
Traumatic injuries are usually symptomatic whereas degeneration of the TFCC is usually asymptomatic . Patients may present with ulnar-sided wrist pain, that is exacerbated by supination, pronation and/or ulnar deviation .
Pathology
Assessing the triangular fibrocartilage disc proper for injury is important but isolated injuries to the ulnomeniscal homologue or radioulnar ligaments can also lead to distal radioulnar joint instability.
Aside from assessing the triangular fibrocartilage disc proper, the following associated injuries should be assessed for :
- ulnar styloid avulsion fracture
- distal radial sigmoid notch fracture
- dorsal and volar distal radioulnar ligaments
- ulnotriquetral and ulnolunate ligament injuries
- lunotriquetral ligament injury
- extensor carpi ulnaris tendinopathy (including tendinosis, tear and/or instability)
- ulnar collateral ligament injury
- ganglion cyst formation (may be soft tissue or intraosseous)
Classification
- Palmer classification: helps for accurate recognition and diagnosis of TFCC injuries, however, injuries outside this classification system can occur .
- Atzei classification: offers a more differentiated approach on a spectrum of peripherally located tears.
Radiographic features
MRI
- triangular fibrocartilage tears
- fluid-intensity signal extending to the surface or along the medial aspect of the ulna
- usually associated with distal radioulnar joint (DRUJ) effusions (however, these are non-specific in isolation)
- ulnar styloid process or foveal cystic change or bone marrow edema
- perifascial fluid and/or edema
Practical points
- medial tears are in the vascularized zone and a surgical repair is a treatment option whereas central tears are in the avascular zone and are typically debrided
- TFCC degenerations are intrinsically high signal not extending to the articular surface
Siehe auch:
Assoziationen und Differentialdiagnosen zu Triangular fibrocartilage complex injury:
triangulärer
fibrokartilaginärer Komplex
