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

Ciaran F. Keogh1, Anthony D. Wong1, Neil J. Wells2, John E. Barbarie1 and Peter L. Cooperberg1

1 Department of Radiology, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
2 Department of Surgery, St. Paul's Hospital, BC V6Z 1Y6, Canada.



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  		Fig. 1. —Photograph shows technique for scanning triangular fibrocartilage. Oblique longitudinal scans were obtained with patient's hand prone, using extensor carpi ulnaris tendon as acoustic window. Transverse scans were also obtained. This approach differs from approach adopted by Chiou et al. [10].

 


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  		Fig. 2. —Longitudinal sonogram of normal triangular fibrocartilage in 32-year-old healthy male volunteer. Striated appearance of extensor carpi ulnaris tendon (curved solid arrows) is readily apparent. This tendon acts as acoustic window. Homogeneous, hyperechoic triangular fibrocartilage is outlined by straight solid arrows and lies between distal ulna (straight open arrow) and triquetral bones (curved open arrow). Deep radial portion of ligament is poorly visualized, a limitation of this technique.

 


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  		Fig. 3. —34-year-old female golfer with persistent wrist pain. Longitudinal sonogram shows longitudinally orientated irregular hypoechoic line (arrows) within hyperechoic triangular fibrocartilage. Ulnar tear was confirmed at surgery.

 


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  		Fig. 4A. —28-year-old male manual laborer with chronic medial wrist pain after injury at work. Longitudinal sonogram shows transversely orientated hypoechoic line (arrows) extending to distal radial aspect of triangular fibrocartilage.

 


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  		Fig. 4B. —28-year-old male manual laborer with chronic medial wrist pain after injury at work. Coronal MRI shows transversely orientated linear increased signal (arrows) within triangular fibrocartilage similar to sonogram (A).

 


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  		Fig. 5A. —44-year-old man with persistent wrist pain after mountain biking crash. Longitudinal sonogram shows sagittal tear (curved arrow) of triangular fibrocartilage. Extensor carpi ulnaris tendon (straight arrow) also appears focally thickened and heterogeneous.

 


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  		Fig. 5B. —44-year-old man with persistent wrist pain after mountain biking crash. Transverse sonogram shows split within extensor carpi ulnaris tendon (arrow) and hypoechoic fluid within tendon sheath. Findings represent partial tear of tendon with traumatic tenosynovitis.

 

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