CASE 84
By: Dr. Aliya Sarhan Al Barwani.
HISTORY: 30-years-old male with Ulnar side wrist pain and clicking.
What is the name of this study?
What are the findings? What is the diagnosis?
What are the indications of this procedure?
FINDINGS:
MRI Arthrogram of the Wrist.
Focal defect at the radial attachment of Triangular fibrocartilage complex (TFCC) with contrast extending from the Radiocarpal space to the distal radioulnar joint.
Diagnosis: Tear of the TFCC along the radial attachment of the distal radioulnar joint (DRUJ).
Indications of MRI Arthrogram of the wrist:
· To rule out tear of TFCC.
· To rule out intrinsic ligaments tear.
DIAGNOSIS:
Tear of the triangular fibrocartilage complex.
PEARLS AND DISCUSSION:
The TFCC functions as a cushion between the ulnar head and carpal bones. It connects the ulna and the radius at their distal edges and separates DRUJ from radio-carpal joint.
Tear of the TFCC should be suspected in patients with Ulnar-sided wrist pain and tenderness. MRI Arthrogram is the modality of choice: Contrast is injected in the radio-carpal space to rule out TFCC injury or intrinsic ligament injury. If the contrast extends from the radio-carpal to DRUJ, suspect TFC injury. If it extends from the radio-carpal to mid-carpal space, suspect intrinsic ligament injury.
The seven components of Triangular fibrocartilage complex (TFCC) are:
· Triangular fibrocartilage disc.
· Volar radioulnar ligament.
· Dorsal radioulnar ligament.
· Ulnar collateral ligament.
· Volar ulnolunate and ulnotriquetral ligament.
· Sheath of the extensor carpi ulnaris (ECU) tendon.
· Meniscal homolog - between the ulna and triquetrum.
FURTHER READING:
1. Rüegger C and Schmid MR. Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol. (2007)
2. Lee RK and Ng AW. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skeletal Radiol. (2013)
3. Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. (2009)
4. Lee RK and Griffith JF. Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage. AJR Am J Roentgenol. (2016).
