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Crowe CS, McKenzie GA, Kakar S. Magnetic Resonance Imaging Assessment of Ulnar Wrist Pain: A Practical Guide for Surgeons. J Hand Surg Am 2024:S0363-5023(24)00239-9. [PMID: 38980233 DOI: 10.1016/j.jhsa.2024.05.012] [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: 02/16/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 07/10/2024]
Abstract
Ulnar-sided wrist pain is a challenging clinical scenario due to multiple overlapping pathologies and involved anatomic structures. Advanced imaging such as magnetic resonance imaging can be used as an effective diagnostic adjunct if interpreted correctly. In this article, clinically relevant structures and radiographic correlates of the ulnar wrist are discussed and a corresponding systematic approach to reviewing magnetic resonance imaging is presented.
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Affiliation(s)
- Christopher S Crowe
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | | | - Sanjeev Kakar
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Mayo Clinic, Rochester, MN.
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2
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Lim RQR, Lim LJR, Atzei A, Liu B. Current concepts and new trends in management of isolated triangular fibrocartilage complex injuries. J Hand Surg Eur Vol 2024:17531934241238530. [PMID: 38488619 DOI: 10.1177/17531934241238530] [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] [Indexed: 05/24/2024]
Abstract
The triangular fibrocartilaginous complex is made of multiple components, of which the palmar and dorsal radioulnar ligaments play an important role in distal radioulnar joint stability. The ulnar wrist ligaments may be injured during forearm and wrist trauma. There are several aspects of triangular fibrocartilaginous complex management that are still open to debate. The aim of the present study was to review the current concepts and discuss emerging trends to better elucidate and treat this important ligament complex.Level of evidence: V.
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Affiliation(s)
- Rebecca Q R Lim
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Lincoln J R Lim
- Department of Medical Imaging, Western Health, Footscray Hospital, Victoria, Australia
- Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Andrea Atzei
- Pro-Mano, Hand Surgery and Rehabilitation Team, Treviso, Italy - Ospedale San Camillo, Treviso, Italy
| | - Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Capital Medical University, Beijing, China
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Braig ZV, Dittman LE, Amrami KK, Kakar S. Dynamic Computed Tomography of the Distal Radioulnar Joint Versus Magnetic Resonance Imaging in Detecting Foveal Tears of the Triangular Fibrocartilage Complex. Hand (N Y) 2024:15589447241232012. [PMID: 38385200 DOI: 10.1177/15589447241232012] [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] [Indexed: 02/23/2024]
Abstract
BACKGROUND Diagnosis of foveal triangular fibrocartilage complex (TFCC) tears remains difficult. The purpose of this study was to evaluate whether dynamic computed tomography (CT) of the distal radioulnar joint (DRUJ) has a higher sensitivity in detecting foveal tears of the TFCC when compared with magnetic resonance imaging (MRI). METHODS A database query identified all patients above the age of 18 years with suspected foveal TFCC injuries who underwent bilateral dynamic CT imaging of the DRUJ, static 3T MRI, and subsequent wrist arthroscopy. All patients had evidence of foveal tenderness on clinical examination. The imaging results were validated with wrist arthroscopy. RESULTS Twelve patients with a mean age of 31 years (range, 18-53 years) were identified. Eight patients were diagnosed with a complete foveal detachment of the TFCC on wrist arthroscopy. Of the 8 patients with a foveal tear on DRUJ arthroscopy, only 3 had a preoperative physical examination suggestive of DRUJ instability. Magnetic resonance imaging identified foveal injuries in 4 of these 8 patients (sensitivity, 50%), and 3 of these were identified as only partial tears. Dynamic CT identified instability of DRUJ in 6 of 8 patients (sensitivity, 75%). Seven of 8 patients had imaging findings suggestive of a foveal tear when including either MRI or CT imaging (sensitivity, 88%). Of the 4 patients with an intact foveal attachment on arthroscopy, 3 (specificity, 75%) had a stable DRUJ on CT and all 4 (specificity, 100%) had an intact foveal attachment on MRI. CONCLUSION Sixty-two percent of patients with foveal tears on arthroscopy have a stable DRUJ on clinical examination. When combining MRI and dynamic CT imaging of the DRUJ, the sensitivity of detecting a foveal TFCC tear approaches 88% compared with a gold standard of wrist arthroscopy.
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Affiliation(s)
- Zachary V Braig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lauren E Dittman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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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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5
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Upper Extremity Kinematics and Electromyographic Activity in Uninjured Tennis Players. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There has been an increase in ulnar-sided wrist pain among tennis players. The purpose of this study was to establish a normative dataset of kinematic and electromyography (EMG) data during the forehand and two-handed backhand groundstrokes. In total, 20 adolescent United States Tennis Association (USTA) ranked tennis players (11/20 Male, Age = 15.0 ± 1.8 years, Height = 1.7 ± 1.1 m, BMI = 21.3 ± 3.4 kg/m2, 18/20 right-arm dominant) participated in this study. Kinematics (range of motion and angular velocity) and EMG data were simultaneously acquired during the forehand and two-handed backhand groundstrokes. Minimal differences were found between groupings of age, sex, and USTA ranking. The two-handed backhand groundstroke is characterized by bilaterally flexed elbows and ulnarly deviated wrists, with a flexed wrist and pronated forearm on the non-dominant side and an extended wrist and supinated forearm on the dominant side. EMG activation occurs bilaterally by peak backswing. The forehand groundstroke is characterized by a flexed elbow, pronated forearm, and ulnarly deviated and extended wrist. The wrist is at maximum ulnar deviation at ball impact. This study established an initial foundation for normative data for the forehand and two-handed backhand groundstrokes, which can be used for injury detection, rehabilitation, prevention, and ultimately performance improvement of tennis athletes.
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van der Post A, Jens S, Daams JG, Obdeijn MC, Maas M, Oostra RJ. The Triangular Fibrocartilage Complex In The Human Wrist: A Scoping Review Towards Uniform And Clinically Relevant Terminology. Clin Anat 2022; 35:626-648. [PMID: 35396731 PMCID: PMC9322592 DOI: 10.1002/ca.23880] [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: 02/04/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022]
Abstract
The aim of this scoping review was to assess the composition, terminology, and anatomy of the triangular fibrocartilage complex (TFCC) of the wrist and propose unambiguous terminology regarding the individual components. The review was conducted according to the methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19–32). Electronic databases were searched from inception until September 1, 2021 for original anatomical studies, using MeSH terms and keywords on terminology and anatomy of TFCC components. Studies using gross dissections or macro‐ or microscopic histology were included. Animal studies, fetal studies and studies with unknown disease status, were excluded. A total of 24 studies were included. The articular disc, the radioulnar ligaments, the meniscus homologue and the extensor carpi ulnaris tendon (sub)sheath were unanimously classified as TFCC components. One study did not include the ulnolunate and ulnotriquetral ligaments and only one study did include the ligamentum subcruentum. The largest disagreement existed regarding the inclusion of the ulnar collateral ligament. Terminological ambiguity was seen in “triangular fibrocartilage,” “triangular ligament,” “igamentum subcruentum,” and the “proximal and distal lamina.” Anatomical ambiguity existed especially regarding the radioulnar ligaments, the ulnar attachments of the TFCC and the ulnar collateral ligament. Definitions of the individual TFCC components are redundant, ambiguous, and ill‐defined and therefore subject to different interpretations. In order to preclude confusion, consensus regarding terminology is recommended. We proposed a concise definition of the healthy TFCC that can be used as a starting point for future studies and current clinical practice.
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Affiliation(s)
- A van der Post
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, Netherlands
| | - S Jens
- Rijnstate Arnhem, Department of Radiology and Nuclear Medicine, Arnhem, Netherlands
| | - J G Daams
- Amsterdam UMC, University of Amsterdam, Medical Library, Meibergdreef 9, Amsterdam, Netherlands
| | - M C Obdeijn
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, Amsterdam, Netherlands
| | - M Maas
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, Netherlands
| | - R J Oostra
- Amsterdam UMC, University of Amsterdam, Department of Medical Biology, Section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, Netherlands
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Thillemann JK, De Raedt S, Jørgensen PB, Rømer L, Hansen TB, Stilling M. Distal radioulnar joint stability measured with radiostereometry during the piano key test. J Hand Surg Eur Vol 2020; 45:923-930. [PMID: 32594823 DOI: 10.1177/1753193420934689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal radioulnar joint instability is difficult to grade by clinical examination and interobserver reliability is low. This study used a new and precise radiostereometry method for measurement of distal radioulnar joint translation. Eight human donor arms were positioned in a custom-made fixture and a standardized piano key test was done with pressure on the ulnar head. Examination was done before and after dividing the styloid and foveal insertions of the triangular fibrocartilage complex. In the intact wrists, the piano key test induced a mean 1.36 mm translation of the ulnar head, which increased statistically significantly to 1.96 mm after a lesion of the styloid ligament insertion and to 2.3 mm after combined lesions of the styloid and foveal ligament insertions. This experimental cadaver study demonstrates a radiological method for precise quantification of distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury.
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Affiliation(s)
- Janni Kjærgaard Thillemann
- Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark.,Department of Orthopaedic Surgery, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
| | | | - Peter Bo Jørgensen
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
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Tedesco LJ, Swindell HW, Anderson FL, Jang E, Wong TT, Kazam JK, Kadiyala RK, Popkin CA. Evaluation and Management of Hand, Wrist and Elbow Injuries in Ice Hockey. Open Access J Sports Med 2020; 11:93-103. [PMID: 32425621 PMCID: PMC7196194 DOI: 10.2147/oajsm.s246414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022] Open
Abstract
Ice hockey continues to be a popular, fast-paced, contact sport enjoyed internationally. Due to the physicality of the game, players are at a higher risk of injury. In the 2010 Winter Olympics, men’s ice hockey had the highest injury rate compared to any other sport. In this review, we present a comprehensive analysis of evaluation and management strategies of common hand, wrist, and elbow injuries in ice hockey players. Future reseach focusing on the incidence and outcomes of these hand, wrist and elbow injuries in ice hockey players is warranted.
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Affiliation(s)
- Liana J Tedesco
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hasani W Swindell
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Forrest L Anderson
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Eugene Jang
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Tony T Wong
- Department of Radiology, New York Presbyterian Hospital, New York, NY, USA
| | - Jonathan K Kazam
- Department of Radiology, New York Presbyterian Hospital, New York, NY, USA
| | - R Kumar Kadiyala
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles A Popkin
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
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9
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Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? J Clin Orthop Trauma 2020; 11:570-579. [PMID: 32742122 PMCID: PMC7384326 DOI: 10.1016/j.jcot.2020.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
The triangular fibrocartilage complex (TFCC) is a well defined anatomical entity located on the ulnar aspect of the wrist joint functioning primarily to stabilize the distal radio -ulnar joint (DRUJ) and also to act as a shock absorber across the ulno-carpal joint. Palmer and Werner were first to explain the anatomic details of the TFCC and to describe its biomechanical role at the wrist. The TFCC comprises of the fibro-cartilagenous disc, the dorsal and palmar ligaments spanning across radius and ulna, the ulno-carpal ligaments, a meniscal homolog, and the sub sheath of ulnar extensor of the wrist. The intricate anatomy of this area and complex load transmission kinematics renders it vulnerable to injury and attrition. Both traumatic and degenerative insults produce specific injury patterns which can present as vague ulnar-sided wrist pain particularly during forearm rotation. These injuries are managed initially by modification of daily activities to avoid aggravation of pain and injury, by complete abstinence from sporting/gym/yoga maneuvers which involve stressing the wrist joints, temporary splint or cast immobilisation are also used along with non-steroidal anti-inflammatory medication. Corticosteriod injection are also used in conjunction with physical therapy in grossly symptomatic patients. Surgical treatment is advocated if conservative management fails to provide relief, or in cases presenting initially with frank instability of the DRUJ or with unstable and displaced fractures. Choice of operative treatment is guided by type and extent of injury and may include debridement, repair and in TFCC injuries associated with degenerative changes, ulnar unloading procedures like shortening or Wafer procedure. With current understanding of arthroscopic anatomy of the wrist, availability of instrumentation as well as familiarity of surgeons with this tool, arthroscopic management can be instituted successfully in most if not all conditions afflicting the TFCC.
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Affiliation(s)
- Akram Jawed
- Hand to Shoulder Division, Max Institute of Musculoskeletal Sciences, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Mohammed Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Gupta
- Hand to Shoulder Division, Max Institute of Musculoskeletal Sciences, Max Super Speciality Hospital, Saket, New Delhi, India
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Kim S, Lee GY, Lee JS. Evaluation of the triangular fibrocartilage: comparison of two-compartment wrist CT arthrography using the distal radioulnar and radiocarpal joints and unicompartment wrist CT arthrography using the radiocarpal joint. Br J Radiol 2019; 92:20190298. [PMID: 31295006 DOI: 10.1259/bjr.20190298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance of two-compartment wrist CT arthrography of the distal radioulnar and radiocarpal joints and unicompartment wrist CT arthrography of the radiocarpal joint in depiction of the triangular fibrocartilage tear. METHODS From January 2016 to December 2017, two-compartment CT arthrography of 74 consecutive patients (36 females, 38 males; mean age, 37.2 years) and unicompartment CT arthrography of 51 consecutive patients (18 females, 33 males; mean age, 40.1 years) were obtained. All CT arthrography images were independently and blindly evaluated by two radiologists for the presence of the triangular fibrocartilage tear by grade (partial or full thickness) per its locations: central disc proper, central-peripheral junction, proximal and distal laminae of its ulnar attachment. Fisher's exact test was used for a statistical analysis, and a p-value less than 0.05 was considered as significant. The arthroscopic findings of 47 patients (34 patients with two-compartment CT arthrography and 13 patients with unicompartment CT arthrography) were evaluated for calculating sensitivity, specificity, and accuracy. RESULTS All partial and full thickness triangular fibrocartilage tears were identified more commonly by their location except for distal laminae on two-compartment CT arthrography than were unicompartment CT arthrography (p = 0.001-0.022). Two-compartment CT arthrography had high sensitivity (90.9-100%) and low specificity (33.3-76.5%) for detecting central disc proper and proximal lamina tears, comparing with unicompartment CT arthrography. CONCLUSION Two-compartment wrist CT arthrography is more helpful for detecting triangular fibrocartilage tears than unicompartment wrist CT arthrography. ADVANCES IN KNOWLEDGE It could be important to evaluate the ulnar foveal insertion of the TFCC in clinical practice, which plays the most important role in DRUJ instability and ulnar-sided wrist pain. Two-compartment wrist CTA of the DRUJ and RCJ could improve diagnostic sensitivity in the TFC tear in terms of its location and torn degree over that of unicompartment wrist CTA of the RCJ. Two-compartment wrist CTA of the DRUJ and RCJ may be recommended as a diagnostic imaging, rather than unicompartment wrist CTA of the RCJ, when peripheral foveal tear of TFC is suspected, especially in young patients.
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Affiliation(s)
- Sujin Kim
- Department of Radiology, Chung Ang University Hospital
| | | | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung Ang University Hospital
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11
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Ochman S, Wieskötter B, Langer M, Vieth V, Raschke MJ, Stehling C. High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary? Arch Orthop Trauma Surg 2017; 137:1443-1450. [PMID: 28808768 DOI: 10.1007/s00402-017-2747-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Indexed: 10/19/2022]
Abstract
INTRODUCTION 3T MRI has become increasingly available for better imaging of interosseous ligaments, TFCC, and avascular necrosis compared with 1.5T MRI. This study assesses the sensitivity and specificity of 3T MRI compared with arthroscopy as the gold standard. PATIENTS AND METHODS Eighteen patients were examined with 3T MRI using coronal T1-TSE; PD-FS; and coronal, sagittal, and axial contrast-enhanced T1-FFE-FS sequences. Two musculoskeletal radiologists evaluated the images independently. Patients underwent diagnostic arthroscopy. RESULTS The classifications of the cartilage lesions showed good correlations with the arthroscopy findings (κ = 0.8-0.9). In contrast to the arthroscopy, cartilage of the distal carpal row was very good and could be evaluated in all patients on MRI. The sensitivity for the TFCC lesion was 83%, and the specificity was 42% (radiologist 1) and 63% (radiologist 2). For the ligament lesions, the sensitivity and specificity were 75 and 100%, respectively, with a high interobserver agreement (κ = 0.8-0.9). DISCUSSION 3T MRI proved to be of good value in diagnosing cartilage lesions, especially in the distal carpal row, whereas wrist arthroscopy provided therapeutic options. When evaluating the surgical therapeutical options, 3T MRI is a good diagnostic tool for pre-operatively evaluating the cartilage of the distal carpal row.
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Affiliation(s)
- Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany. .,Department of Trauma-, Hand- and Reconstructive Surgery, Westfälische Wilhelms University of Muenster, Albert Schweitzer Campus 1, Gebäude W1, 48149, Münster, Germany.
| | - B Wieskötter
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - M Langer
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - V Vieth
- Department of Clinical Radiology, University Hospital, Münster, Germany
| | - M J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - C Stehling
- Department of Clinical Radiology, University Hospital, Münster, Germany
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12
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Ng AWH, Griffith JF, Fung CSY, Lee RKL, Tong CSL, Wong CWY, Tse WL, Ho PC. MR imaging of the traumatic triangular fibrocartilaginous complex tear. Quant Imaging Med Surg 2017; 7:443-460. [PMID: 28932701 DOI: 10.21037/qims.2017.07.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ). However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cindy S Y Fung
- Department of Diagnostic Imaging, North District Hospital, Hong Kong, China
| | - Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Clara W Y Wong
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Lim Tse
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak Cheong Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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13
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Estimating Scaphoid Lengths Using Anatomical Measurements in the Wrist. J Hand Surg Am 2016; 41:e279-84. [PMID: 27497802 DOI: 10.1016/j.jhsa.2016.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE In reconstructive surgery of scaphoid nonunions with humpback deformity, some surgeons recommend restoration of the normal scaphoid length whereas others overexpand the normal length to ensure carpal realignment and prevent late collapse. To be able to define overexpansion and investigate which levels of overexpansion yield optimal clinical results, a precise method for estimating the original scaphoid length is required. The purpose of this anatomic study was to investigate the precision of estimating normal scaphoid lengths based on intact adjacent bone dimensions, compared with using the contralateral scaphoid length. METHODS From bilateral computed tomographic scans of 28 healthy wrist pairs, 3-dimensional virtual bone models were created. The left and right scaphoid lengths were determined at the central axis. The capitate length at the central axis and the distal radius width served to derive an ipsilateral scaphoid length estimate. Estimation precision for individual cases was based on the 95% range (±1.96 × SD) of the observed differences between the actual and estimated lengths. RESULTS On average, the capitate length was 10% smaller than the scaphoid length; the radius width was 9% larger. Consequently, we averaged the capitate length and radius width for ipsilateral estimations. The average difference between the scaphoid length and the latter ipsilateral estimate was 0.1 mm. The average contralateral scaphoid length difference was also 0.1 mm. Estimation precisions, however, were ±2.2 and ±1.4 mm, respectively. CONCLUSIONS Scaphoid length estimation based on the contralateral scaphoid is more precise than the estimating scaphoid length using the ipsilateral radius and capitate. CLINICAL RELEVANCE Scaphoid overexpansion can be ensured if the restored length is at least 1.4 mm longer than the contralateral length. This may be valuable information when establishing a target length for reconstruction and investigating the consequences of scaphoid overexpansion on clinical function, such as range of motion, which are currently unknown.
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Radiocarpal Injuries: Cone Beam Computed Tomography Arthrography, Magnetic Resonance Arthrography, and Arthroscopic Correlation among 21 Patients. Scand J Surg 2016; 106:173-179. [DOI: 10.1177/1457496916659226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Patients with acute or chronic wrist pain often undergo wrist arthroscopy for evaluation of chondral and ligamentous abnormalities. The purpose of this study was to compare findings of wrist arthroscopy with cone beam computed tomography arthrography and magnetic resonance arthrography. Materials and Methods: Altogether, 21 patients with wrist pain underwent cone beam computed tomography arthrography, magnetic resonance arthrography, and wrist arthroscopy. Chondral surfaces of the scaphoid, lunate, and radius facing the scaphoid and lunate were evaluated. The scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage complex were classified as either intact or torn. Sensitivity, specificity, positive and negative predictive values, and accuracy with 95% confidence intervals were assessed. Results: For chondral lesions (n = 10), cone beam computed tomography arthrograms showed slightly higher specificity than magnetic resonance arthrography. The sensitivity of cone beam computed tomography arthrography was also better for these lesions, except for those on the chondral surface of the lunate. For triangular fibrocartilage complex injuries (n = 9), cone beam computed tomography arthrography showed a better specificity and sensitivity than magnetic resonance arthrography. For ligamentous injuries (n = 6), cone beam computed tomography arthrograms were more sensitive, but less specific than magnetic resonance arthrography images. However, the number of lesions was very small and the 95% confidence intervals are overlapping. Conclusion: Cone beam computed tomography is an emerging imaging modality that offers several advantages over computed tomography and magnetic resonance imaging. Its usefulness particularly in ligamentous injuries should be further explored in a larger study. Cone beam computed tomography arthrography seems to offer similar sensitivity, specificity, and accuracy compared to magnetic resonance arthrography and therefore serves as a valuable option in evaluating patients with wrist pain.
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Abstract
BACKGROUND The development of handicraft industry and increase of various such works that need a large amount of repeated wrist ulnar deviation strength, the incidence of ulnar impaction syndrome (UIS) is increasing, but the traditional simple ulnar shortening osteotomy has more complications. This study aimed to explore the early diagnostic criteria of UIS and its wrist arthroscopic treatment experience. MATERIALS AND METHODS 9 UIS patients were enrolled in this study. According to magnetic resonance imaging, X-ray and endoscopic features, the diagnostic criteria of UIS were summarized and the individualized treatment schedule was made. If the ulnar positive variance was less than 4 mm, the arthroscopic wafer resection was performed. If the ulnar positive variance was more than 4 mm, the arthroscopic resection of injury and degenerative triangular fibrocartilage complex and ulnar osteotomy were conducted. RESULTS In all patients, the wound healed without any complications. All patients returned to normal life and work, with no ulnar wrist pain again. One patient had wrist weakness. There was a significant difference of the wrist activity between the last followup and before operation (P < 0.05). According to the modified wrist function scoring system of Green and O'Brien, there were 6 cases of excellent, 2 cases of good and 1 case of appropriate and the overall excellent and good rate was 92.3%. CONCLUSION In the treatment of UIS, the arthroscopy can improve the diagnosis rate, optimize the treatment plan, shorten the treatment cycle, with good treatment results.
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Affiliation(s)
- Jiajie Hao
- The Institute of Orthpaedic Trauma Surgery, Eighty-Ninth Hospital of PLA, Weifang, China
| | - Zhijie Xu
- The Institute of Orthpaedic Trauma Surgery, Eighty-Ninth Hospital of PLA, Weifang, China
| | - Zhigang Zhao
- The Institute of Orthpaedic Trauma Surgery, Eighty-Ninth Hospital of PLA, Weifang, China,Address for correspondence: Dr. Zhigang Zhao, Institute of Traumati Orthopedics, Eighty-Ninth Hospital of PLA, No. 256 Beigong Xi Street, Weifang 261021, Shangdong, China. E-mail:
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de Mooij T, Riester S, Kakar S. Key MR Imaging Features of Common Hand Surgery Conditions. Magn Reson Imaging Clin N Am 2015. [DOI: 10.1016/j.mric.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk GR. The Traumatized TFCC: An Illustrated Review of the Anatomy and Injury Patterns of the Triangular Fibrocartilage Complex. Curr Probl Diagn Radiol 2015; 45:39-50. [PMID: 26117527 DOI: 10.1067/j.cpradiol.2015.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022]
Abstract
The triangular fibrocartilage complex (TFCC) plays an important role in wrist biomechanics and is prone to traumatic and degenerative injury, making it a common source of ulnar-sided wrist pain. Because of this, the TFCC is frequently imaged, and a detailed understanding of its anatomy and injury patterns is critical in generating an accurate report to help guide treatment. In this review, we provide a detailed overview of TFCC anatomy, its normal appearance on magnetic resonance imaging, the spectrum of TFCC injuries based on the Palmer classification system, and pitfalls in accurate assessment.
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Affiliation(s)
- Matthew R Skalski
- Department of Radiology, Southern California University of Health Sciences, Whittier, CA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Aaron J Schein
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hector RiveraMelo
- Department of Radiology, Southern California University of Health Sciences, Whittier, CA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Abstract
The optimal imaging protocols for magnetic resonance imaging (MRI) of the wrist ligaments are discussed, including the use of magnetic resonance arthrography, and 3 Tesla (T) versus 1.5 T magnetic field strength. The normal MRI appearance of the triangular fibrocartilage complex, capsular, and interosseous wrist ligaments is briefly covered to point out potential diagnostic pitfalls. Numerous examples of common ligamentous pathology discernible on MRI are provided, along with the latest estimates of diagnostic sensitivity and specificity provided by the literature.
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Affiliation(s)
- Michael D Ringler
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN.
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Assessment of Volar Radiocarpal Ligaments: MR Arthrographic and Arthroscopic Correlation. AJR Am J Roentgenol 2012; 198:423-7. [DOI: 10.2214/ajr.11.6919] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tagliafico AS, Ameri P, Michaud J, Derchi LE, Sormani MP, Martinoli C. Wrist injuries in nonprofessional tennis players: relationships with different grips. Am J Sports Med 2009; 37:760-7. [PMID: 19270188 DOI: 10.1177/0363546508328112] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent advances in tennis teaching techniques have been applied in nonprofessional tennis players to develop a more effective play. Hits with enormous amount of top-spin and lower technical and physical training are responsible for most wrist injuries in nonprofessional tennis players. HYPOTHESIS The use of different grips (Eastern, Western, semi-Western) determines the pattern of wrist injuries in nonprofessional tennis players. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Between January 2006 and August 2007, we evaluated 370 nonprofessional division III and IV tennis players. The screening consisted of a questionnaire appropriately prepared to investigate wrist injuries. Medical records of players who reported a wrist injury were reviewed. Body mass index, years of practice, weekly hours of training, racket weight, grip (Eastern, Western and semi-Western), kind of strings, injury type, time out of competition, and therapy (medical or surgical) were recorded. Statistical analysis was performed to assess the association of different wrist injuries with these variables. RESULTS A total of 320 players reported no injuries in their activity; 50 (13%) reported injuries to the wrist. Medical records of these players were reviewed, and 30 extensor carpi ulnaris lesions, 3 lesions of the extensor tendons, 5 injuries to the flexor carpi radialis, 6 de Quervain diseases, 5 triangular fibrocartilage lesions, and 1 intersection syndrome were found. Ulnar-sided injuries were more frequently associated with Western or semi-Western grips while radial-sided injuries were associated with Eastern grip (chi(2) = 20.7; P < .001). Average time out of competition was 69 days; 4 players underwent surgery; the others received medical and rehabilitative therapy. No differences were observed regarding body mass index, years of practice, weekly hours of training, racket weight, and strings. CONCLUSION In nonprofessional tennis players with wrist injuries, different grips of the racket are related to the anatomical site of the lesion: Eastern grip with radial-side injuries and Western or semi-Western with ulnar-side injuries. Knowledge of this relationship may influence training, prevention, diagnosis, and therapy of wrist problems in nonprofessional tennis players.
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Abstract
A review of the current state of the relevant diagnostic imaging technologies and methods and their clinical application in imaging common conditions of the hand, wrist, and forearm is presented. Evolving and future imaging technologies are also considered.
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