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Bezirgan U, Yoğun Y, Özgencil B, Dursun Savran M, Genç A, Armangil M. The Effect of Arthroscopic Triangular Fibrocartilage Repair on Accompanying Extensor Carpi Ulnaris Tendinitis and Synovitis in Triangular Fibrocartilage Tears. J Wrist Surg 2024; 13:241-247. [PMID: 38808190 PMCID: PMC11129892 DOI: 10.1055/s-0043-1775802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/05/2023] [Indexed: 05/30/2024]
Abstract
Purpose Management of ulnar-sided wrist pain is difficult due to the complexity of the anatomy and the similarity of the signs and symptoms of possible diagnoses. The study's main purpose is to examine the effect of arthroscopic triangular fibrocartilage (TFC) repair on untreated extensor carpi ulnaris (ECU) tendinitis and synovitis. Methods Thirteen patients who underwent arthroscopic TFC repair in our clinic and preoperatively demonstrated ECU tendon pathology with magnetic resonance imaging (MRI) were included in the retrospective study. Pre- and postoperative visual analog scale (VAS), pre- and postoperative tendinitis and synovitis, postoperative Mayo and patient-rated wrist evaluation score, postoperative grip strength of the operated and control sides, short and long diameters of the ECU tendon in ultrasonography were recorded. Results The mean age of 13 patients (9 females and 4 males) was 39.54 ± 13.54, and the mean follow-up period was 26 ± 7.25 months. While there was no significant difference between pre- and postoperative tendinitis or synovitis levels, VAS decreased significantly (8.46 ± 1.33 vs. 3.00 ± 2.31, p = 0.0016). While the grip strength was 21.78 ± 7.83 on the control side, it was 18.28 ± 7.51 on the surgery side, being significantly lower ( p = 0.0252). Ulnar variance did not affect tendinitis or synovitis. Short and long diameters of ECU were similar for the operated and control sides. While the short diameter did not affect the synovitis-tendinitis score, the bigger the long diameter, the higher the synovitis score (rho = 0.5162). Conclusion In the presence of ECU, tendon pathologies accompanying TFC lesions, additional surgical interventions are mandatory as arthroscopic TFC repair has no significant effect on the healing of ECU. Level of evidence : 4.
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Affiliation(s)
- Uğur Bezirgan
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Yener Yoğun
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Bedir Özgencil
- Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Merve Dursun Savran
- Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Aysun Genç
- Department of Physical Therapy and Rehabilitation, Ankara University Medical Faculty, Ankara, Turkey
| | - Mehmet Armangil
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
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Hur Y, Ahn JM, Kim HJ, Jeon Y, Kang Y, Gong HS. Peripheral tear of the triangular fibrocartilage complex: diagnostic accuracy of magnetic resonance imaging and diagnostic performance of the primary and secondary signs. Skeletal Radiol 2024; 53:1153-1163. [PMID: 38127153 DOI: 10.1007/s00256-023-04517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study is to assess the diagnostic performance of magnetic resonance imaging (MRI) findings for type 1B triangular fibrocartilage complex (TFCC) tear of the wrist. MATERIALS AND METHODS This study retrospectively enrolled 78 patients to examine the diagnostic performance of preoperative MRI examinations in patients with type 1B TFCC tears. Thirty-nine participants had confirmed type 1B TFCC tear. The control group included 39 patients who were randomly selected from 1157 patients who underwent MRI for wrist pain. Both groups underwent a review of 19 MRI findings by two independent radiologists, and the correlation between each diagnostic finding and type 1B TFCC tear was assessed using the chi-squared test. The 19 MRI findings comprised eight primary signs of abnormalities in the distal or proximal lamina, in conjunction with 11 secondary signs suggestive of abnormalities in the surrounding structures. RESULTS The TFCC tear group demonstrated a significantly higher incidence of two primary MRI signs, i.e., fiber discontinuity and signal alteration in the distal lamina, as observed by both readers (R1, 74.4% vs. 38.5%, p = 0.003, and 87.2% vs. 43.6%, p < 0.001; R2, 74.4% vs. 35.9%, p = 0.001, and 87.2% vs. 53.8%, p < 0.003, respectively). Reader 2 identified a higher prevalence of two additional primary MRI signs: fiber discontinuity and signal alteration in the proximal lamina (all p < 0.05). None of the 11 secondary MRI signs demonstrated statistically significant associations with type 1B TFCC. CONCLUSION MRI manifestations of fiber discontinuity and signal alteration in the distal lamina may provide predictive markers for type 1B TFCC wrist tear.
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Affiliation(s)
- Youngjun Hur
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yejin Jeon
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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Portnoff B, Casey JC, Thirumavalavan J, Abbott E, North R, Gil JA. Prevalence of asymptomatic TFCC tears on MRI: A systematic review. HAND SURGERY & REHABILITATION 2024; 43:101684. [PMID: 38493923 DOI: 10.1016/j.hansur.2024.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Recent studies show a high prevalence of triangular fibrocartilage complex (TFCC) tears in asymptomatic wrists. While a TFCC tear may be identified when evaluating ulnar sided wrist pain, this could be incidental and not the true cause of pain. The purpose of this review was to (1) examine the frequency of which TFCC tears are diagnosed on MRI in asymptomatic versus symptomatic wrists and (2) determine whether rates of asymptomatic TFCC tears are higher in two important subgroups commonly at risk for this pathology: elderly patients and high-impact athletes. METHODS Articles of level IV or higher evidence were selected from PubMed, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials Database to compare patient demographics, study parameters, and clinical outcomes. RESULTS Seven studies met inclusion criteria with a total of 501 wrists (205 symptomatic and 296 asymptomatic). All studies included asymptomatic patients with wrist MR imaging and included information on the structural integrity of the TFCC. Variability in outcome measures reported across studies prevented the conduction of a meta-analysis. CONCLUSIONS TFCC abnormalities are present in patients of all ages, symptomatology, and levels of involvement in high-impact sports. Although, there are differences in tear and abnormality prevalence when comparing these three factors, the difference was not significant. Given these findings, using MRI to assess ulnar-sided wrist pain should be fortified with clinical suspicion, physical exam, and physician judgment.
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Affiliation(s)
- Brandon Portnoff
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jack C Casey
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeyvikram Thirumavalavan
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erin Abbott
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel North
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Cho JY, Lee SW, Kim DH, Oh WT, Koh IH, Chun YM, Choi YR. Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex. Bone Joint J 2024; 106-B:380-386. [PMID: 38555934 DOI: 10.1302/0301-620x.106b4.bjj-2023-0642.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims The study aimed to assess the clinical outcomes of arthroscopic debridement and partial excision in patients with traumatic central tears of the triangular fibrocartilage complex (TFCC), and to identify prognostic factors associated with unfavourable clinical outcomes. Methods A retrospective analysis was conducted on patients arthroscopically diagnosed with Palmer 1 A lesions who underwent arthroscopic debridement and partial excision from March 2009 to February 2021, with a minimum follow-up of 24 months. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Wrist Score (MWS), and visual analogue scale (VAS) for pain. The poor outcome group was defined as patients whose preoperative and last follow-up clinical score difference was less than the minimal clinically important difference of the DASH score (10.83). Baseline characteristics, arthroscopic findings, and radiological factors (ulnar variance, MRI, or arthrography) were evaluated to predict poor clinical outcomes. Results A total of 114 patients were enrolled in this study, with a mean follow-up period of 29.8 months (SD 14.4). The mean DASH score improved from 36.5 (SD 21.5) to 16.7 (SD 14.3), the mean MWS from 59.7 (SD 17.9) to 79.3 (SD 14.3), and the mean VAS pain score improved from 5.9 (SD 1.8) to 2.2 (SD 2.0) at the last follow-up (all p < 0.001). Among the 114 patients, 16 (14%) experienced poor clinical outcomes and ten (8.8%) required secondary ulnar shortening osteotomy. Positive ulnar variance was the only factor significantly associated with poor clinical outcomes (p < 0.001). Positive ulnar variance was present in 38 patients (33%); among them, eight patients (21%) required additional operations. Conclusion Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. The presence of positive ulnar variance was associated with poor clinical outcomes, but close observation after arthroscopic debridement is more likely to be recommended than ulnar shortening osteotomy as a primary treatment.
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Affiliation(s)
- Jae-Yong Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Sung-Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Do-Hyun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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Charoenpol T, Tawonsawatruk T. Double lesion of TFCC injury from penetrating wrist trauma: A case report. Trauma Case Rep 2024; 50:100986. [PMID: 38464486 PMCID: PMC10921236 DOI: 10.1016/j.tcr.2024.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
Bony avulsion injuries of the triangular fibrocartilage complex (TFCC) caused by penetrating wrist trauma are rare, and there is limited literature available regarding their treatment. This case report describes a 54-year-old male who sustained a penetrating injury to his right wrist, resulting in "double lesion" of TFCC injury, which are ulnar avulsion (Palmer 1B) and radial avulsion (Palmer 1D) lesion with a sigmoid notch fracture. The patient underwent an arthroscopic examination and a novel arthroscopic technique for fixation and repair of the TFCC injury. The procedure involved debridement, repair of the dorsal radioulnar ligament bony avulsion, and fixation of the foveal bony avulsion of the TFCC. The patient's wrist was immobilized postoperatively, followed by gradual rehabilitation. At the final follow-up of six months, the patient demonstrated improved range of motion and functional outcomes. This case report highlights the successful use of arthroscopic techniques for the treatment of complex TFCC avulsion injuries resulting from penetrating wrist trauma.
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Affiliation(s)
- Thanat Charoenpol
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tulyapruek Tawonsawatruk
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Oliveira RKD, Brunelli JPF, Aita M, Zaidenberg E, Delgado PJ. The "Bubble Test" in the Arthroscopic Diagnosis of Triangular Fibrocartilage Central Lesion: Description and Relevance to Treatment. J Wrist Surg 2024; 13:137-141. [PMID: 38505210 PMCID: PMC10948245 DOI: 10.1055/s-0043-1769791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/09/2023] [Indexed: 03/21/2024]
Abstract
Background Ulnarly sided wrist pain is a common and challenging symptom. Arthroscopy has become a safe and effective tool for the correct diagnosis and treatment, proving to be better than all other clinical and imaging diagnostic methods. Some tests have been described for the diagnosis of triangular fibrocartilage (TFC) lesions, such as the trampoline test for peripheral lesions and the hook, ghost, and suction tests for foveal detachments. In tears at the disc level, when they affect all layers of the TFC (complete lesion) at the same point, testing with the probe will usually suffice for the diagnosis. However, in some apparently partial lesions, the probe cannot pass through all layers because the proximal and distal sites of the lesion are not aligned. There has been no arthroscopic test described for such cases. Case Description We describe a simple and practical test that we have called the "bubble test" in a typical case to diagnose TFC central injuries, aiming to discriminate partial from complete lesions, which are eventually hard to differentiate through direct vision and arthroscopic probing, leading to a direct influence onto the treatment. The bubble test is performed with external compression of the distal radioulnar joint (DRUJ) aspect, with the thumb on the back of the DRUJ and the index and middle fingers onto the volar aspect. The abrupt compression of this region causes the passage of air mixed with synovial fluid from the DRUJ to the radiocarpal joint, generating bubble formation. Clinical Relevance The bubble test should correlate to physical examination and imaging (magnetic resonance imaging [MRI]) findings and is particularly useful in central and degenerative (Type II) TFC lesions in patients complaining of chronic pain on the ulnar region of the wrist, with no history of trauma and with inconclusive MRI findings. Once the diagnosis is confirmed, arthroscopic treatment consists of wide debridement of the lesion with resection of the injured tissue and the local inflammatory reaction. Thus, it is essential for the correct treatment to define the exact location of the lesion and to know whether the disc injury is complete.
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Affiliation(s)
- Ricardo Kaempf de Oliveira
- Department of Hand Surgery, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Department of Hand Surgeon, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - João Pedro Farina Brunelli
- Department of Hand Surgery, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Department of Hand Surgeon, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Márcio Aita
- Department of Hand Surgery, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Ezequiel Zaidenberg
- Department of Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Pedro J. Delgado
- Department of Hand Surgery, Hospital Universitário Madrid Montepríncipe, Universidad CEU San Pablo, Boadilla del Monte, Madrid, Spain
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Zhao X, Yu A, Zhao H, Qiu Y. Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: a retrospective study. BMC Musculoskelet Disord 2024; 25:63. [PMID: 38218805 PMCID: PMC10787402 DOI: 10.1186/s12891-023-07140-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) injuries commonly manifest as ulnar-sided wrist pain and can be associated with distal radioulnar joint (DRUJ) instability and subsequent wrist functional decline. This study aimed to assess the diagnostic value of MRI compared to wrist arthroscopy in identifying traumatic TFCC injuries and to determine the distribution of different TFCC injury subtypes in a normal clinical setting. METHODS The data of 193 patients who underwent both preoperative wrist MRI and wrist arthroscopy were retrospectively reviewed. The analysis focused on the proportion of subtypes and the diagnostic value of MRI in traumatic TFCC injuries, utilizing Palmer's and Atzei's classification with wrist arthroscopy considered as the gold standard. RESULTS The most prevalent subtype of TFCC injuries were peripheral injuries (Palmer 1B, 67.9%), followed by combined injuries (Palmer 1 A + 1B, 14%; Palmer 1B + 1D, 8.3%). Compared with wrist arthroscopy, the diagnostic sensitivity, specificity, negative predictive value (NPV), and Kappa value of MRI was as follows: traumatic TFCC tears 0.99 (95% CI: 0.97-1), 0.90 (0.78-0.96), 0.97 (0.87-1), and 0.93; styloid lamina tears 0.93 (0.88-0.96), 0.53 (0.30-0.75), 0.47 (0.26-0.69), and 0.44; and foveal lamina tears 0.85 (0.74-0.92), 0.38 (0.29-0.49), 0.79 (0.65-0.89), and 0.21. CONCLUSIONS The diagnostic value of MRI in traumatic TFCC injuries has been confirmed to be almost perfect using Palmer's classification. In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. Radiological associated injuries may offer additional diagnostic value in cases with diagnostic uncertainty.
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Affiliation(s)
- Xuanyu Zhao
- Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Fudan University, Shanghai, 200040, China
- Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, 200040, China
| | - Aiping Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine Affiliated 9th People's Hospital, Shanghai, 200011, China
| | - Huali Zhao
- Department of Radiology, Jing'an District Central Hospital, Fudan University, Shanghai, 200040, China
| | - Yanqun Qiu
- Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Fudan University, Shanghai, 200040, China.
- National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, 200040, China.
- Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, 200040, China.
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Kim S, Salloum M, Millrose M, Goelz L, Eisenschenk A, Haralambiev L, Bakir S, Asmus A. Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint. J Hand Ther 2024; 37:38-43. [PMID: 37777442 DOI: 10.1016/j.jht.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PURPOSE In this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. STUDY DESIGN This was a prospective cohort study. METHODS Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. RESULTS Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) CONCLUSIONS: The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without.
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Affiliation(s)
- S Kim
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Leibniz Institut für Plasmaforschung und Technologie (INP Greifswald), Greifswald, Germany.
| | - Mouataz Salloum
- Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Michael Millrose
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany; Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Andreas Eisenschenk
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lyubomir Haralambiev
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sinan Bakir
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Ariane Asmus
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
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Khair Y, Mustafa A, Mestrihi S, Azzam E, Al-Qasaimeh M, Awad D, Ovidiu A. Outcome in TFCC repair using micro anchor and trans‑osseous technique. Exp Ther Med 2023; 26:557. [PMID: 37941586 PMCID: PMC10628646 DOI: 10.3892/etm.2023.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
The triangular fibrocartilage complex (TFCC) is an intrinsic stabiliser of the distal radioulnar joint (DRUJ), which serves an important role in wrist movement, forearm rotation and grip strength. A stable DRUJ is a key requirement for pain-free movement of the wrist. TFCC tears are a common ulnar-sided wrist pain associated with decreased grip strength and impaired function. TFCC tears are classified according to the location and cause. The Palmer classification delineates tears into traumatic type 1 and degenerative type 2. The present study investigated the clinical outcomes of using micro suture anchors in open repair in comparison with trans-osseous TFCC repair. From July 2017 to July 2020, 51 patients underwent open repair of TFCC tear by hand and upper limb surgeons in Royal Rehabilitation Center at King Hussein Medical Center (Amman, Jordan). Stability of DRUJ and tenderness at the ulnar aspect of the wrist were evaluated by Disability of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS) pre- and post-operatively. A total of 38 patients (27 male and 11 females) underwent open repair using micro suture anchors and 13 (7 male and 6 female) by trans-osseous repair. A total of 51 patients in the follow-up 6-48 months had significant improvement in pain and range of motion. A total of 45 patients showed improved grip strength and were pain-free; six patients showed improvement of grip strength and decreased pain. For the patients who underwent TFCC repair by micro suture anchors, there was an improvement of MMWS from 70 to 90%, and for those who underwent TFCC repair by trans-osseous technique, MMWS improved from 65 to 85%. There was also significant improvement in DASH score post-operatively with both techniques, from 60 to 15% in the trans-osseous technique and from 70 to 15% in the suture anchors. Open repair of TFCC tears using either micro anchor or trans-osseous repair led to pain-free range of motion, improved grip strength, stable DRUJ and improvement in DASH and MMWS scores, with no significant differences in clinical outcome between techniques.
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Affiliation(s)
- Yousef Khair
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Ayman Mustafa
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Saab Mestrihi
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Ehab Azzam
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Motaz Al-Qasaimeh
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Dmour Awad
- Department of Orthopaedics, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iasi 700115, Romania
- Orthopaedics Clinic, Clinical Emergency Hospital Sf Spiridon, Iasi 700111, Romania
| | - Alexa Ovidiu
- Department of Orthopaedics, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iasi 700115, Romania
- Orthopaedics Clinic, Clinical Emergency Hospital Sf Spiridon, Iasi 700111, Romania
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10
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Zhao J, Lin Y, Li L, Huang Y. A new arthroscopic repair technique for triangular fibrocartilage complex using an intracapsular suture: an outside-in transfer all-inside repair. J Orthop Surg Res 2023; 18:896. [PMID: 38001524 PMCID: PMC10668466 DOI: 10.1186/s13018-023-04386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Arthroscopic repair is a promising, minimally invasive surgical technique for patients with Palmer type 1B peripheral triangular fibrocartilage complex (TFCC) tears. Although several arthroscopic techniques are effective for repairing Palmer type 1B TFCC tears, some shortcomings remain. So, we report an arthroscopic repair technique for the treatment of Palmer type 1B Atzei class 1 TFCC tears using an intracapsular suture: an outside-in transfer all-inside repair. METHODS A retrospective analysis of 38 Palmer type 1B TFCC injury patients admitted to our hospital were randomly divided into 2 groups. The group A was sutured from the outside to the inside, with a total of 21 cases; the group B was sutured with the new arthroscopic repair technique, with a total of 17 cases. Observe and compare the VAS scores and modified Mayo wrist function scores of all patients before 3, and 6 months after the operation and evaluate the incidence of thread knots in patients with different treatment methods. The methodology was performed an arthroscopic intracapsular suture using an outside-in transfer, all-inside repair technique, which is a modified method of the outside-in and all-inside technique using the needle of a 10-mL sterile syringe, for Palmer type 1B TFCC tears. A No. 2 polydioxanone suture was threaded through the needle and entered the wrist joint. Next, the needle was withdrawn carefully along the suture to the proximal tear ulnar surface of the TFCC and penetrated the TFCC, exiting the articular cavity surface of the ulnar side of the torn TFCC. Finally, arthroscopic knotting was performed. RESULTS This new treatment was as effective as the previously arthroscopic techniques and had the advantages of no additional incision and decreased risk of operation-related complications. The incidence of thread knots in the group A (28.57%) was significantly higher than that in the group B (0%), and the difference was statistically significant (P = 0.024). There was no significant difference in VAS score and modified Mayo wrist function scores between the two groups (P > 0.05). CONCLUSIONS The outside-in transfer, the all-inside repair technique is suitable for Palmer type 1B Atzei class 1 TFCC tears. We recommend this technique as a useful alternative to the conventional methods of repairing Palmer type 1B TFCC tears.
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Affiliation(s)
- Jiasong Zhao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanming Lin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lang Li
- Hospital of Chengdu Office of People's Government of Tibetan. Autonomous Region, Chengdu, China
| | - Yong Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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11
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Harries K, Osmani HT, Patel J, Robinson P, Horwitz MD, Ahmed N. The patient with an acute painful wrist. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 38019207 DOI: 10.12968/hmed.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Patients with wrist pain commonly present to primary care and emergency departments. A detailed history and examination, alongside relevant imaging, will help find the correct diagnosis and ensure that patients receive the correct treatment in a timely manner. This article summarises the key points in history and examination and the role of imaging, including suggestions of which modality should be requested. Finally, important acute pathologies are highlighted, including fractures, soft tissue injuries and infection, with examples of their relevant imaging.
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Affiliation(s)
- Katherine Harries
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Humza T Osmani
- Department of Trauma and Orthopaedics, Addenbrookes Hospital, Cambridge, UK
| | - Jugal Patel
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Philip Robinson
- Department of Radiology, Chapel Allerton Hospital, Leeds, UK
| | - Maxim D Horwitz
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Naeem Ahmed
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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12
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Jin J, Liang K, Wang L, Ye P, Wang J, Shi H. Advances in the Repair of Palmer type IB TFCC Injuries With Wrist Arthroscopy. Sports Med Arthrosc Rev 2023; 31:49-59. [PMID: 37418174 DOI: 10.1097/jsa.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The triangular fibrocartilage complex (TFCC) is essential for maintaining wrist stability. Injury-caused pain is the primary cause of ulnar wrist pain. The TFCC injury refractory to conservative treatment requires further surgical treatment, and because Palmer type IB tears belong to peripheral injuries due to their proximity to the blood supply area, arthroscopic suture repair has become the preferred surgical method for TFCC injury repair, exhibiting strong healing ability. This study reviewed the anatomy of TFCC, injury classification, and advances in arthroscopic suturing for treating Palmer type IB.
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Affiliation(s)
- Jianmiao Jin
- Department of hand and foot surgery, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University, Shaoxing, China
| | - Kejiong Liang
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Luo Wang
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Po Ye
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinzhong Wang
- Department of hand and foot surgery, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University, Shaoxing, China
| | - Haifei Shi
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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13
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Silber ZS, Donnelly JC, Farias MJ, Lama CJ, Luther LI, Kosinski LR, Hoy AE, Gil JA. Return to Activity After Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review. Clin J Sport Med 2023; 33:270-275. [PMID: 36728770 DOI: 10.1097/jsm.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/01/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate patients' ability to return to preinjury activity level after arthroscopically assisted triangular fibrocartilage complex (TFCC) repair. DATA SOURCES The PubMed electronic library was systematically searched from inception to August 2021 for any eligible articles using a combination of the phrases "TFCC," "return to sport," "return to work," and "athlete." RESULTS Studies that evaluated patients who had undergone arthroscopic repair of isolated TFCC injury and reported objective or patient-reported outcome measures were included. Fifteen studies representing 478 patients fulfilled the inclusion criteria. An average of 84% of patients were able to fully return to their previous work or sport activities. Most studies reported that range of motion (ROM) and grip strength (GS) both returned to >90% of the contralateral side, and every study that evaluated pain levels found a significant reduction in pain postoperatively. Mayo Modified Wrist Score was reported as excellent or good in 83% of patients, and the average Disabilities of the Arm, Shoulder, and Hand score was 13.8 postoperatively. CONCLUSION Patients were able to return to their previous work or sport activities at a high rate after TFCC repair, even those participating in more strenuous activities. Measurable functional outcomes of ROM and GS were also reliably restored to near preinjury levels. Patient-reported outcomes of pain and disability were similarly improved after TFCC repair. Current literature has established the long-term success of TFCC repair but is lacking in evaluation of the time points at which patients can expect functional status to be restored.
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Affiliation(s)
- Zachary S Silber
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Joseph C Donnelly
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Michael J Farias
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Christopher J Lama
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Lauren I Luther
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Lindsay R Kosinski
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Austin E Hoy
- Baylor Scott and White Sports and Orthopedic Center, Waco, Texas
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
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14
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Ryoo HJ, Kim YB, Kwak D, Choi IC, Park JW. Ulnar positive variance associated with TFCC foveal tear. Skeletal Radiol 2023:10.1007/s00256-023-04280-0. [PMID: 36752828 DOI: 10.1007/s00256-023-04280-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The ulnar positive variance (UPV) can be observed on simple radiography due to a triangular fibrocartilage complex (TFCC) foveal tear. This study investigated to identify how much radiographic UPV occurs due to a TFCC foveal tear, which may be misdiagnosed as an ulnar impaction syndrome (UIS). MATERIALS AND METHODS One hundred forty patients who underwent arthroscopic transosseus TFCC foveal repair from March 2013 to March 2019 in our institution were enrolled in this study. Ulnar variances were measured in preoperative, postoperative 6 weeks, 1-year follow-up wrist posteroanterior (PA) radiograph, and power grip PA radiograph of the affected wrist and were compared with those of the same patient's unaffected wrist. RESULTS In the neutral wrist PA radiograph, ulnar variance increased by 0.56 mm (p < 0.001) after TFCC foveal tear compared to the unaffected side. In the power grip view, ulnar variance also increased by 0.39 mm (p < 0.001) in the affected wrist. The preoperative ulnar positive variance was reduced after an arthroscopic transosseous TFCC foveal repair from 0.56 to 0 mm (p < 0.001). No significant statistical difference was observed between an Atzei class 2 and 3 TFCC tear (0.56 mm vs. 0.41 mm, p = 0.263). CONCLUSION This study revealed that TFCC foveal tear induces 0.56 mm of radiologic UPV, which was successfully corrected after arthroscopic transosseous TFCC foveal repair. Therefore, UPV associated with TFCC foveal tear should not be misdiagnosed as an UIS. Also, when ulnar shortening osteotomy is planned in case of UIS combined with TFCC foveal tear, the amount of UPV induced by TFCC foveal tear should be considered to prevent over-shortening.
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Affiliation(s)
- Hyun Jae Ryoo
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Yong Bin Kim
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Donghee Kwak
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea.
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15
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Fu J, Zhang H, Wei K, Shi C, Zong W. Design and Performance Analysis of a Dynamic Magnetic Resonance Imaging-Compatible Device for Triangular Fibrocartilage Complex Injury Diagnosis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9688441. [PMID: 35756094 PMCID: PMC9225906 DOI: 10.1155/2022/9688441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022]
Abstract
Pain and injury of the triangular fibrocartilage complex (TFCC) due to overuse or trauma are commonly diagnosed through static MRI scanning, while TFCC is always involved in radial and ulnar deviation of the wrist. To the best of our knowledge, a dynamic MRI diagnostic method and auxiliary tool have not been applied or fully developed in the literature. As such, this study presents the design and evaluation of a dynamic magnetic resonance imaging (MRI) auxiliary tool for TFCC injury diagnosis. First, 3D scanning and Python are used to measure and fit the radial and ulnar deviation trajectories of healthy participants and patients. 3D printing is then used to manufacture the auxiliary tool for dynamic MRI, and dynamic MRI diagnosis is then conducted to explore the clinical effect. The radial and ulnar deviation trajectory is presented as an asymmetric curve without an obvious circular centre, and the results indicate that the designed auxiliary device meets the requirements of the ulnar and radial movements of the human wrist. According to the MRI contrast test results, the image quality score of patients wearing the auxiliary device is higher than for those without. Such devices could assist clinicians in the diagnosis of TFCC damage, and our method could not only serve as the reference standard for clinical noninvasive diagnosis but also help in understanding the disease and improving the accuracy of TFCC diagnosis.
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Affiliation(s)
- Jiayu Fu
- China University of Mining and Technology, College of Architecture and Design, School of Industrial Design, 1 Daxue Road, Xuzhou, Jiangsu, China
| | - Hui Zhang
- Xuzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Radiology, 169 Zhongshan South Road, Xuzhou, Jiangsu, China
| | - Kaiqi Wei
- China University of Mining and Technology, College of Architecture and Design, School of Industrial Design, 1 Daxue Road, Xuzhou, Jiangsu, China
| | - Chao Shi
- Xuzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Orthopedic, 169 Zhongshan South Road, Xuzhou, Jiangsu, China
| | - Wei Zong
- China University of Mining and Technology, College of Architecture and Design, School of Industrial Design, 1 Daxue Road, Xuzhou, Jiangsu, China
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16
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Taljanovic MS, Omar IM, Weaver JS, Becker JL, Mercer DM, Becker GW. Posttreatment Imaging of the Wrist and Hand: Update 2022. Semin Musculoskelet Radiol 2022; 26:295-313. [PMID: 35654096 DOI: 10.1055/s-0042-1743538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.
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Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jennifer S Weaver
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L Becker
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
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17
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Spies CK, Unglaub F, Bruckner T, Müller L, Eysel P, Rau J. Diagnostic accuracy of wrist MRI in comparison to wrist arthroscopy regarding TFCC lesions in clinical practice. Arch Orthop Trauma Surg 2022; 142:879-885. [PMID: 35006371 DOI: 10.1007/s00402-021-04329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purpose of this study was to arthroscopically verify MRI diagnostic accuracy for triangular fibrocartilage complex (TFCC) lesions in a regular clinical environment. METHODS A total of 859 patients' data with both preoperative MRI of the wrist and additional wrist arthroscopy were retrospectively reviewed. Two board-certified hand surgeons and one orthopaedic surgeon executed wrist arthroscopy, whereas more than 100 radiologists examined the MRI of the wrist. The accordance of TFCC lesion classification using MRI in comparison to wrist arthroscopy and diagnostic precision of the former depending on technical details were evaluated. RESULTS Diagnostic accuracy of MRI for TFCC lesions is poor in comparison to wrist arthroscopy as the reference standard. Technical specifications for MRI of the wrist are heterogeneous among the radiologists. These parameters have not improved accuracy of TFCC evaluation at large. CONCLUSION The accuracy of MRI in a regular clinical environment still remains inferior to wrist arthroscopy for detection of TFCC lesions. Development of a standard MRI protocol may be implemented on a regular basis and application of the Palmer classification for TFCC lesion should be sought.
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Affiliation(s)
- C K Spies
- Hand Surgery, Spital Langenthal, Spital Region Oberaargau SRO AG, 4900, Langenthal, Switzerland.
| | - F Unglaub
- Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
- Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - T Bruckner
- Department of Medical Biometry and Informatics, University Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - L Müller
- Department of Orthopaedic Surgery and Traumatology, University Hospital Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - P Eysel
- Department of Orthopaedic Surgery and Traumatology, University Hospital Cologne, Joseph-Stelzmann-Str. 24, 50931, Köln, Germany
| | - J Rau
- Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
- Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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18
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Stabilization of the Distal Radioulnar Joint with or without Triangular Fibrocartilage Complex Tear by an External Wrist Band Brace: A Cadaveric Study. Healthcare (Basel) 2022; 10:healthcare10050828. [PMID: 35627965 PMCID: PMC9142000 DOI: 10.3390/healthcare10050828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to investigate whether a watch-shaped external wrist band brace improves distal radioulnar joint (DRUJ) stability. Seven fresh cadaveric arms were used. Using a customized testing system, volar and dorsal translation forces were applied to the radius externally while the ulna was fixed. The test was performed with the forearm in neutral, 60° pronated, and 60° supinated positions, once without the brace and once with the brace applied. In each condition, the amount of translation was measured. Then, the triangular fibrocartilage complex (TFCC) was detached from the ulnar styloid process and the fovea ulnaris, and the same tests were performed again. Detachment of the TFCC significantly increased volar and dorsal translations in all forearm rotations compared to the intact condition (p < 0.05), except for the pronated dorsal translation of the radius (p = 0.091). Brace application significantly reduced volar and dorsal translations in all forearm rotations both in intact specimens and in TFCC-detached specimens (p < 0.05), except for pronated volar and dorsal translations in TFCC-detached specimens (p = 0.101 and p = 0.131, respectively). With the brace applied, the TFCC-detached specimens showed no significant difference in volar or dorsal translation in all forearm rotations compared to the intact specimens (p > 0.05). The external wrist band brace improved DRUJ stability in both normal and TFCC-torn wrists and reduced the DRUJ instability caused by TFCC tear to a near-normal level.
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19
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Gietzen CH, Kunz AS, Luetkens KS, Huflage H, Christopoulos G, van Schoonhoven J, Bley TA, Schmitt R, Grunz JP. Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist. BMC Musculoskelet Disord 2022; 23:284. [PMID: 35331212 PMCID: PMC8944076 DOI: 10.1186/s12891-022-05241-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/17/2022] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Georgios Christopoulos
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany.,Department of Radiology, University Hospital LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany. .,Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany.
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20
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Nakamoto JC, Martins MDS, Pires AG. Arthroscopic Treatment of Bucket-Handle Triangular Fibrocartilage Complex Injury. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:352-355. [PMID: 35415587 PMCID: PMC8991769 DOI: 10.1016/j.jhsg.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- João Carlos Nakamoto
- Instituto Vita, São Paulo, Brazil
- Hand and Microsurgery Division, the University of Campinas, São Paulo, Brazil
- Corresponding author: João Carlos Nakamoto, MD, PhD, Instituto Vita, Rua Mato Grosso 306, 1º andar, São Paulo 01239-040, Brazil.
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Contrast-enhanced MRI of the wrist: Intravenous application of gadolinium improves diagnosis in ulnar-sided injuries of the TFCC. Eur J Radiol 2021; 143:109901. [PMID: 34392004 DOI: 10.1016/j.ejrad.2021.109901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Although lesions of the triangular fibrocartilage complex (TFCC) frequently induce ulnar-sided wrist pain and potentially distal radioulnar joint instability, diagnosis can pose a challenge due to the intricate anatomy. This study aims to evaluate the benefits of contrast-enhanced sequences for the detection of TFCC injuries in magnetic resonance imaging of the wrist. METHOD 94 patients underwent wrist MRI with intravenous application of gadolinium-based contrast agents. For each patient, two datasets were analysed independently by two board-certified radiologists: One set comprised only plain T1- and fat-saturated proton-density-weighted sequences, while the second dataset included contrast-enhanced T1-weighted images with fat suppression. Arthroscopy or clinical reports served as reference standard with the former being used whenever available. Diagnostic confidence and TFCC component assessability were subjectively evaluated. Contrast-to-noise ratios (CNR) were calculated serve as an objective indicator of image contrast. RESULTS Lesions of the articular disc, the foveal and styloid ulnar attachment were present in 24 (25.5%), 61 (64.9%) and 53 (56.4%) patients. Access to contrast-enhanced T1 images improved the diagnostic accuracy for injuries of the styloid (R1/R2, 0.68/0.73 vs. 0.86/0.88) and foveal attachment (0.68/0.72 vs. 0.90/0.89) substantially compared to plain MRI (all p < 0.001), while no benefits could be identified for lesions of the central disc (0.89/0.90 vs. 0.87/0.90). Readers' diagnostic confidence and CNR for ulnar-sided lesions improved with contrast-enhanced T1 sequences available (p < 0.001). CONCLUSIONS With superior CNR in lesions of the TFCC's foveal and styloid attachment, contrast-enhanced, fat-saturated T1-weighted sequences facilitate higher diagnostic accuracy and confidence than fat-saturated PD- and plain T1-weighted MRI.
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Namazi H, Ghane A, Dehghanian AR, Fereidooni M, Akbarzadeh A. Effectiveness and Safety of Triangular Fibrocartilage Complex Injection Regarding Anatomical Landmarks: A Cadaveric Study. J Wrist Surg 2021; 10:286-289. [PMID: 34381630 PMCID: PMC8328542 DOI: 10.1055/s-0041-1723795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Background Triangular fibrocartilage complex (TFCC) injections can be applied using anatomical landmarks or under the guide of ultrasound (US). US is not always available, and the physician may rely on the anatomical landmarks. Objective The study aims to evaluate the effectiveness and safety of TFCC injection with anatomic landmarks. Methods Forty wrist specimens from cadavers were randomly assigned to four rapid blue stain injection groups as follows: Group A: perpendicular to skin with 5 mm depth; Group B: perpendicular to skin with 10 mm depth; Group C: 45-degree angulation to skin surface, oriented from proximal to distal with 10 mm depth; and Group D: 45-degree angulation to skin surface, oriented from distal to proximal with 10 mm depth. TFCC specimens were excised and evaluated with microscopy, and adjacent neurovascular structures were checked for any injury. Results Injections in group A were more accurate than others, in which 8/10 injections were successful. Group C injections were least accurate in that only 4/10 were successful. The other remaining groups (groups B and D) revealed similar results (5/10 were successful). However, statistical analyses did not show any significant difference ( p -value = 0.35). No injury to neurovascular structures was seen. Conclusion Needle placement perpendicular to skin with 5 mm depth and just medial to ulnar styloid can be used as an accurate method of palpation-guided technique for TFCC injections.
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Affiliation(s)
- Hamid Namazi
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Ghane
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Dehghanian
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Fereidooni
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Armin Akbarzadeh
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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