Triangular fibrocartilage of wrist: presentation on high resolution ultrasonography

The efficiency of bedside ultrasonography in patients with wrist injury and comparison with other radiological imaging methods: A prospective study

STUDY OBJECTIVE

Our aim was to determine the efficiency of ultrasound (US) scanning in patients with wrist trauma admitted to the emergency department and to compare US diagnostic usage with other radiological imaging methods.

METHODS

Patients who presented to the emergency department with wrist injury and who met the inclusion criteria and exclusion criteria were eligible. For all patients, US evaluation of the whole wrist was performed by an emergency physician before other radiological imaging methods (radiographies, computed tomography (CT) and magnetic resonance (MR) imaging). All of the patients included in the study underwent US, radiography, CT, and MR.

RESULTS

During the study, 122 patients were admitted with a wrist injury. After filtering for the exclusion criteria, 80 patients were included in the study. The sensitivity of US scanning in detecting fractures was 95.31% (95% confidence interval [CI]: 87.1-98.39), the specificity was 93.75% (95% CI: 71.67-98.89), and the positive predictive value was 98.39% (95% CI: 91.72-99.85), and the negative predictive value was 83.33% (95% CI: 72.98-90.41). The sensitivity of US scanning in detecting tendon and ligamentous structural injury was 66.67% (95% CI: 41.71-84.82), the specificity was 100% (95% CI: 94.42-100), the positive predictive value was 100% (95% CI: 94.29-99.89), and the negative predictive was 92.86% (95% CI: 84.25-97.14).

CONCLUSION

US scanning is an effective method that can be applied in the emergency department to adult patients to diagnose distal forearm and carpal bones fractures. In soft tissue injuries, US and MR examinations produce similar results.

Sonographically guided distal radioulnar joint injection: technique and validation in a cadaveric model

Distal radioulnar joint (DRUJ) disorders are uncommon but important causes of ulnar-sided wrist pain and disability. Fluoroscopically guided injections may be performed to diagnose or treat DRUJ-related pain or as part of a diagnostic arthrogram. Sonographic guidance may provide a favorable alternative to fluoroscopic guidance for distal DRUJ injections. This report describes and validates a sonographically guided technique for DRUJ injections in an unembalmed cadaveric model. An experienced clinician used sonographic guidance to inject diluted colored latex into the DRUJs of 10 unembalmed cadaveric specimens. Subsequent dissection by a fellowship-trained hand surgeon confirmed accurate injections in all 10 specimens. Two cases of ulnocarpal flow, indicative of triangular fibrocartilage injury, were noted during injection and subsequently confirmed during dissection. Clinicians should consider using sonographic guidance to perform DRUJ injections when clinically indicated. Further research should explore the efficacy of sonographically guided DRUJ injections to treat patients with painful DRUJ syndromes or to evaluate the triangular fibrocartilage complex in patients with ulnar wrist pain syndromes.

Ulnar-sided wrist pain. II. Clinical imaging and treatment

Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.

Normal ultrasound anatomy of the triangular fibrocartilage of the wrist: a study on cadavers and on healthy subjects

PURPOSE

To report the normal sonographic anatomy of the triangular fibrocartilage (TFC) of the wrist in cadavers and volunteers.

METHOD

Five hands from cadavers were examined sonographically before and after wrist dissection, during which the TFC was marked with surgical wires. Twenty volunteers without wrist limitation or pain, and without any history of wrist disease or inflammatory arthritis (mean age, 26 years (range,19-45 years) were also examined.

RESULTS

Sonograms showed that the meniscus and the TFC were clearly separated. The meniscus appeared as a triangular structure that was homogeneous and slightly hyperechoic. Compared with the meniscus, the TFC appeared hypoechoic. The same patterns were observed for cadavers and volunteers. In 3 volunteers (15%), the TFC was not visualized.

CONCLUSIONS

Using high-resolution ultrasound systems, the TFC can be separated from meniscus. However, visualization of the TFC remains limited due to its deep location and the presence of acoustic shadowing from bony structures.

Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk: initial experience and correlation with arthrography and magnetic resonance arthrography

OBJECTIVE

The purpose of this study was to determine the utility of sonography and sonoarthrography in evaluation of dorsal bands of the scapholunate ligament (SLL), lunotriquetral ligament (LTL), and triangular fibrocartilage (TFC) disk in correlation with arthrography and magnetic resonance arthrography (MRA).

METHODS

High-resolution sonography of the SLL, LTL, and TFC disk was performed on symptomatic wrists in 16 patients referred by a hand surgeon for MRA of the symptomatic wrists. All patients then underwent arthrography and an MRA study of the same wrist. After MRA, sonography was repeated. The imaging findings of these different techniques were then compared. Four patients (25%) underwent surgery of their wrists. In these 4 patients, the surgical and imaging findings were correlated.

RESULTS

For the SLL, the results were concordant for all imaging modalities in 15 patients (93.75%) and partially concordant in 1 (6.25%). For the LTL, the results were concordant for all imaging modalities in 12 patients (75%), partially concordant in 3 (18.75%), and discordant in 1 (6.25%). For the TFC disk, the results were concordant for all imaging modalities in 13 patients (81.25%), partially concordant in 2 (12.5%), and discordant in 1 (6.25%). The arthroscopic and imaging findings were concordant for 3 SLLs, 3 LTLs, and 3 TFC disks.

CONCLUSIONS

Our preliminary results are encouraging. Sonography may be used at least as a screening imaging modality in evaluation of the SLL and TFC disk. Sonoarthrography improves evaluation of the LTL.

High-Resolution Sonography of the Triangular Fibrocartilage:Initial Experience and Correlation with MRI and Arthroscopic Findings

OBJECTIVE

The aim of our study was to compare the findings of high-resolution sonography of the triangular fibrocartilage with those of MRI and arthroscopy. SUBJECTS AND METHODS. Thirteen patients with clinically suspected triangular fibrocartilage tears prospectively underwent sonography, followed by MRI, of their wrists. Triangular fibrocartilage tears were classified as predominantly ulnar or predominantly radial. Only the surgeon was aware of the results of both studies, and eight patients subsequently underwent arthroscopy. The findings of the different techniques were compared.

RESULTS

For the presence or absence of a tear, seven (87.5%) of eight sonographic examinations correlated with arthroscopy, and 11 (84.6%) of 13 sonographic examinations correlated with MRI. Sonography missed one small radial tear that was detected at arthroscopy and MRI, but sonography showed an ulnar tear in triangular fibrocartilage that appeared normal on MRI.

CONCLUSION

High-resolution sonography shows good correlation with MRI and arthroscopy for the evaluation of triangular fibrocartilage tears. Sonography has the potential to be a rapid and cost-effective means of diagnosing tears of the triangular fibrocartilage, particularly those involving the ulnar aspect of the cartilage.