When the mri is done with a dye injected into the area, however, the test is called an mri arthrogram. In 2006, i noticed a select group of 20 cases that presented with an onset of bilateral ulnar sided wrist pain without any known cause testing revealed significant intestinal issues in 18 of the cases. Factors that infl uence a specifi c sites protocol parameters include the type of equipment available e. I recommend careful consideration of a high protein diet. High power doppler ultrasound score is associated with the. Magnetic resonance imaging of triangular fibrocartilage. Short protocol mri exams, consisting of short tau inversion recovery. Use the mouse scroll wheel to move the images up and down alternatively use the tiny arrows on both side of the image to move the images. Background the triangular fibrocartilage complex tfcc is a complex anatomic and biomechanical structure. The triangular fibrocartilage complex tfcc is a loadbearing structure between the lunate, triquetrum, and ulnar head. Conventional magnetic resonance imaging mri is widely used for diagnosis of tfcc pathology, and demonstrates a high incidence of tfcc degeneration and tears as regions of increased signal intensity. Magnetic resonance imaging mri, arthrogram, and arthroscopy are the methods used to establish the diagnosis. Msk mri protocol overview page 3 of 123 msk mri protocols march 2010 1. Multiple different pulse sequences can be used for imaging the tfcc including spin echo and fat.
An mri with injected contrast would be used to diagnose a possible tear in any of the three locations and should be ordered as an mri arthrogram or, if mri is. Many patients report getting this injury after a high protein diet plus load. Originally described by palmer, in 1981, as a complex of several structures, our understanding of the anatomy and the function of the tfcc has been refined by histologic studies. Ct and mri protocol a practical approach continual hardware and software innovations in computed tomography and magnetic resonance imaging are leading to early and better diagnosis and thus better patient care. Mr morphology of triangular fibrocartilage complex. Over 1600 practice questions also includes a 200 question timed mock exam membership includes. Keep postoperative dressing in place keep dressing clean and dry keep hand elevated above the level of your heart make a fist 5 times an hour while awake. Although several protocols have been published regarding us examination of the wrist and nearby neural structures, there is limited.
Triangular fibrocartilage complex tfcc debridement post. Role of ultrasound versus magnetic resonance imaging in. Chinese medicine shows the heart meridian to connect the tfcc with the small intestine. Mr arthrography versus conventional mri and diagnostic. Using this mri protocol sensitivity and specificity in the detection of tfcc lesions were calculated as 100 % and 77 %. Describe basic scanning protocols and image optimization techniques. The role of wrist magnetic resonance arthrography in. We as diagnostic radiologist must understand to assimilate the new technological revolution and apply them judiciously for the. The radiocarpal articulation is carefully evaluated and the triangular fibrocartilage area and tear are probed. Wall pushup is a good gentle weightbearing exercises for tfcc rehabilitation, try to hold for 5 seconds for each repetition, 10 reps x 3 sets day.
The diagnosis of tfcc lesions is not always simple. One of the most frustrating aspects of this injury is the lack of reliable mri results. Multiple different pulse sequences can be used for imaging the tfcc including spin echo and fatsuppression. Expect a surgical bulky dressing and splint to be kept in place for 1014 days. Degenerative changes in the tfc disc develop as early as the fourth decade, and progress with advancing age. Hip pelvis thigh knee lower extremityshin ankle foot special cases soft tissue mass metal protocol. Mr imaging of the traumatic triangular fibrocartilaginous complex tear. Some authors would agree that the two techniques may be equivalent. The lower circle is of the triangular fibrocartilage complex tfcc. This mri brain cross sectional anatomy tool is absolutely free to use. Highresolution 3t mr imaging of the triangular fibrocartilage.
In this study, higher ra activity including higher das28 and higher pd scores were associated with a risk for tfcc tears. Mris can be useful to detect tfcc injuries even without dye injected. Potter hg, asnisernberg l, weiland aj, hotchkiss rn, peterson mg, mccormack rr jr. Normal tfcc anatomy tfcc is a complex of a fibrocartilaginous disk in association with several ligamentous structures. Imaging technology interventional radiology mnemonics pathology radiography signs staging syndromes. The tfcc plays an important role in load bearing across the wrist as well as. The triangular fibrocartilage complex tfcc is an example of one such structure, for which lesions may be missed unless high. Recently, highresolution ultrasound us has emerged as a useful and valid tool for the diagnosis of musculoskeletal disorders 5,6,7. It is often seen as an area of global signal alteration e. The tfcc is located on the ulnar aspect of the wrist joint between the ulna and the lunate and triquetrum of the proximal carpal row. It has an elongated triangular shape with the apex pointing at the radius 5 and consists of the triangular fibrocartilage disc proper along with 1,2 volar components. Even if you find the best mri with the besttrained radiologist, the tool is limited.
Mr imaging of tfcc, what every radiologist need to know. The entire triangular fibrocartilage complex tfcc sits between the ulna and two carpal bones the lunate and the triquetrum. Discuss spectrum of imaging findings in tfcc injuries and their therapeutic implications. The tfcc makes it possible for the wrist to move in six different directions bending, straightening, twisting, sidetoside. Mri can provide additional information regarding bone edema, cartilage lesions, neuropathy, and bone and muscle injuries. Triangular fibrocartilage complex radiology reference article. Physiotherapy in hamilton for triangular fibrocartilage. The upper right circle is of the scapholunate ligament, while the top left circle is the lunatotriquetral ligament. The tfcc is not visible on an xray, regardless of its condition. Access to these is difficult for most people around the globe. All of the tfcc tears were proven by mri in this study, which is a reliable method to confirm tfcc. Small degenerative changes of the fibres were most. Mild injuries of the tfcc may be referred to as a wrist sprain.
Mucoid degeneration of the triangular fibrocartilage. You will achieve the best rehab outcome if you follow up surgery with a matching course of rehabilitation. Imaging of tfcc injury of the wrist coachingultrasound. If the dye moves from one joint compartment to another, a tear of the soft tissues is suspected. Mor s n d thom asj ef r onu iv ty h p l mri of the wrist. Forced ulnar deviation and positive ulnar variation carry associations with injuries to the tfcc. Unfortunately studies show that almost half the patients with a true tfcc tear have normal arthrograms. Triangular fibrocartilage complex tfcc injuries of the wrist affect the ulnar little finger side of the wrist. Using dedicated wrist coil the examination protocol included coronal, sagittal. Therefore, familiarization with the tfcc anatomy under us imaging and following a systematic imaging protocol are invaluable in clinical practice.
Mri protocoltendon pathologycarpal tunnel syndromeganglion cyst. Illustrate mr imaging anatomy of tfcc including common pitfalls. The first five chapters of the book introduce the reader to the basics of mr imaging, including the relaxation concept, mr pulse sequences, and mr imaging parameters and options. The purposes of this study were to investigate the prevalence of abnormal mri findings in the triangular fibrocartilage complex tfcc in asymptomatic volunteers and to. Axial t1 and pd fs use coronal loc and plane is straight horizontal if the shoulder is markedly angled, you can angle the axial images. Triangular fibrocartilage complex tfcc debridement post operative rehabilitation protocol following surgery. We then performed mri, mdct arthrography, and mr arthrography on a series of 45 patients with posttraumatic wrist pain and determined the diagnostic accuracy of the techniques in. The research below was written in 2005 and discusses mri technology for diagnosing tfcc tears. Patients with tfcc injury will present with ulnarsided wrist pain that may present with. A patients guide to triangular fibrocartilage complex.
The below outlines recommendations of your rehab over the first 3 months following your procedure. Triangular fibrocartilage complex tfcc injuries lopt. As the name suggests, the soft tissues of the wrist are complex. In summary, rehabilitation for tfcc injury should consist of enough resting, appropriate protection, additional supports and strengthening exercises. The function of the tfcc is to act as a stabilizer for the ulnar aspect of the wrist. The 2 entities have distinct characteristics on magnetic resonance mr images. Start treatment protocol depending on your injury mild, moderate, significant. There have been so many positive mris that show tfcc tears yet when surgically treated, later show no pathology to the tfcc, conversely, many actual tfcc tears are missed by mri.
Mri protocolmri protocol z 810 cm fov z dedicated wrist coil z 23 mm slices z 288 x 192 matrix. Triangular fibrocartilage complex radiology reference. Triangular fibrocartilage complex injuries physiopedia. Mri and mra protocols include multiple pulse sequence and planes table 1. To date, the diagnosis of tfcc lesions is still difficult even with the use of magnetic resonance imaging mri. It is not intended to be a clinical book as there are plenty of clinical specialist books on the market. Ct and mri protocol paperback july 30, 2006 by satish. The triangular fibrocartilage complex tfcc plays a major mechanical role in the stability of the distal radioulnar joint. The tfcc inserts into the lunate and triquetrum via the ulnolunate and ulnotriquetral. Several arthroscopic methods of tfcc repair including outsidein, insideout, and all. In such cases, more advanced imaging such as mris can be used to detect ligamentous or other soft tissue damage.
Magnetic resonance imaging mri of the wrist is increasingly used in the diagnosis of ulnarsided wrist pain. Radiographs are useful to diagnose or rule out possible bone fractures, a positive ulnar variance or osteoarthritis. Triangular fibrocartilage complex tfcc tears are a common source of ulnar sided wrist pain. Tfcc anatomy tfc dorsal and volar ru lig ut ligament meniscal homologue ecu sheath. They work together to stabilize the very mobile wrist joint. Noninvasive techniques have been reported to allow for a better understanding and a sharper diagnosis before planning arthroscopy or any other surgical treatment. Triangular fibrocartilage complex injury radiology. The sensitivity, specificity, and accuracy of mri and usg for tfcc tear were. Tfcc tears usually present clinically as ulnarsided wrist pain andor distal. The tfcc is at risk for either acute or chronic degenerative injury.
If it is a peripheral tear, repair is performed by means of arthroscopically placed sutures through a small incision over the extensor carpi ulnaris through the. Mri is accurate for showing complete tears of the tfcc and intrinsic ligament. Tfcc is comprised of the following individual components. The handbook of mri technique provides a guide to the operation of mr systems and to enhance the education of mr users. Stir or ideal for fat sat z 810 cm fov z dedicated wrist coil z 23 mm slices z 288 x 192. The utility of highresolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. Tfcc lesions were the most common pathologic findings in both mri and mra. Triangular fibrocartilage and ligamentous injury of the wrist joint.1068 959 490 142 578 88 164 708 51 1307 369 280 1440 276 1491 626 449 920 1377 1538 1545 974 185 175 92 1614 789 1368 1312 743 616 1586 6 1615 1277 1384 415 1294 445 726 1133 417 793 1258 264 1150