Peripheral Tear of the Triangular Fibrocartilage: Depiction with MR Arthrography of the Distal Radioulnar Joint
Christoph Rüegger1,
Marius R. Schmid1,
Christian W. A. Pfirrmann1,
Ladislav Nagy2,
Louis A. Gilula3 and
Marco Zanetti1
1 Department of Radiology, Balgrist University Hospital, Forchstrasse 340,
CH-8008 Zurich, Switzerland.
2 Department of Orthopedic Surgery, Balgrist University Hospital, CH-8008
Zurich, Switzerland.
3 Mallinckrodt Institute of Radiology, Washington University Medical Center,
Barnes Jewish Hospital, St. Louis, MO 63110.
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Fig. 1A —43-year-old woman with chronic ulnar-sided pain in right
wrist for 3 years and arthroscopically confirmed communicating tear of ulnar
insertion of triangular fibrocartilage. Coronal T1-weighted image obtained
with fat-saturated spin-echo sequence (TR/TE, 525/15) shows communicating tear
(arrows) of ulnar attachment of triangular fibrocartilage.
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Fig. 1B —43-year-old woman with chronic ulnar-sided pain in right
wrist for 3 years and arthroscopically confirmed communicating tear of ulnar
insertion of triangular fibrocartilage. Conventional arthrogram of distal
radioulnar joint shows tear (arrows) of triangular fibrocartilage and
contrast leakage to radiocarpal joint (arrowheads).
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Fig. 2A —19-year-old woman with noncommunicating tear of triangular
fibrocartilage at ulnar insertion in right wrist due to fall off skateboard 5
months before examination. Arthroscopy showed communicating tear of triangular
fibrocartilage at this location. Coronal T1-weighted image obtained with
fat-saturated spin-echo sequence (TR/TE, 525/15) shows noncommunicating defect
(arrow) in ulnar attachment of triangular fibrocartilage.
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Fig. 2B —19-year-old woman with noncommunicating tear of triangular
fibrocartilage at ulnar insertion in right wrist due to fall off skateboard 5
months before examination. Arthroscopy showed communicating tear of triangular
fibrocartilage at this location. Conventional arthrogram of distal radioulnar
joint shows contrast agent pooling in triangular fibrocartilage defect
(arrowheads).
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Fig. 3A —41-year-old man with noncommunicating tear at ulnar insertion
of triangular fibrocartilage, fracture of distal radius, and avulsion of ulnar
styloid process in left wrist due to fall 10 days before examination.
Arthroscopy showed communicating tear of ulnar attachment triangular
fibrocartilage. Proton density-weighted MR image (TR/TE, 2,430/34) (A)
and T1-weighted fat-saturated coronal image (525/15) (B) show diffuse
bone marrow signal alterations in distal radius and distal ulna and avulsion
(arrowhead) of ulnar styloid process. Leaked contrast agent is
evident in ulnar attachment (large straight arrow) of triangular
fibrocartilage and in area (curved arrow) between ulnar styloid
process and ulna. Fluid (small straight arrows) in radiocarpal joint
was interpreted as bloody joint effusion.
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Fig. 3B —41-year-old man with noncommunicating tear at ulnar insertion
of triangular fibrocartilage, fracture of distal radius, and avulsion of ulnar
styloid process in left wrist due to fall 10 days before examination.
Arthroscopy showed communicating tear of ulnar attachment triangular
fibrocartilage. Proton density-weighted MR image (TR/TE, 2,430/34) (A)
and T1-weighted fat-saturated coronal image (525/15) (B) show diffuse
bone marrow signal alterations in distal radius and distal ulna and avulsion
(arrowhead) of ulnar styloid process. Leaked contrast agent is
evident in ulnar attachment (large straight arrow) of triangular
fibrocartilage and in area (curved arrow) between ulnar styloid
process and ulna. Fluid (small straight arrows) in radiocarpal joint
was interpreted as bloody joint effusion.
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Fig. 4A —37-year-old man with painful wrist instability 1 month after
fall resulting in noncommunicating tear of ulnar insertion of triangular
fibrocartilage in right wrist. Coronal T1-weighted image obtained with
fat-saturated sequence (TR/TE, 525/15) shows defect and tear (arrows)
within ulnar attachment of triangular fibrocartilage.
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Fig. 4B —37-year-old man with painful wrist instability 1 month after
fall resulting in noncommunicating tear of ulnar insertion of triangular
fibrocartilage in right wrist. Conventional arthrogram shows no contrast
leakage into radiocarpal joint. Triangular fibrocartilage tear
(arrows) was interpreted as noncommunicating. Communicating tear of
ulnar attachment triangular fibrocartilage was found at arthroscopy.
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Fig. 5A —49-year-old man with chronic ulnar-sided wrist pain without
previous trauma and with arthroscopically confirmed normal ulnar attachment of
triangular fibrocartilage in left wrist. In such cases contrast material in
distal radioulnar joint is clearly separated from styloid process by ulnar
attachment (small straight arrows) of triangular fibrocartilage.
Scapholunate ligament tear (curved arrow) is evident. Proton
density-weighted (TR/TE, 2,430/34) image shows normal triangular
fibrocartilage. Minor increase (large straight arrow) in signal
intensity within ulnar attachment of triangular fibrocartilage is normal.
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Fig. 5B —49-year-old man with chronic ulnar-sided wrist pain without
previous trauma and with arthroscopically confirmed normal ulnar attachment of
triangular fibrocartilage in left wrist. In such cases contrast material in
distal radioulnar joint is clearly separated from styloid process by ulnar
attachment (small straight arrows) of triangular fibrocartilage.
Scapholunate ligament tear (curved arrow) is evident. T1-weighted
fat-saturated coronal image (525/15) shows normal triangular
fibrocartilage.
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Fig. 6A —49-year-old man with increasing ulnar-sided wrist pain and
ulnar attachment tear detected during error analysis. Arthroscopy showed large
communicating central tear of triangular fibrocartilage and tear in dorsal
aspect of ulnar attachment. T1-weighted fat-suppressed coronal image (TR/TE,
525/15) at most dorsal aspect of disk shows noncommunicating tear
(arrow) of ulnar attachment of triangular fibrocartilage. Finding
corresponds to surgical report.
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Fig. 6B —49-year-old man with increasing ulnar-sided wrist pain and
ulnar attachment tear detected during error analysis. Arthroscopy showed large
communicating central tear of triangular fibrocartilage and tear in dorsal
aspect of ulnar attachment. T1-weighted fat-suppressed coronal image (525/15)
at more palmar aspect of disk shows communicating tear (arrowheads)
of radial attachment and of central part of triangular fibrocartilage but no
ulnar-sided tear.
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Fig. 7A —47-year-old man with ulnar-sided wrist pain and no history of
trauma. Coronal T1-weighted fat saturated image (TR/TE, 525/15) (A) and
conventional arthrogram (B) show false-positive noncommunicating tear
(arrow) of ulnar attachment in right wrist. At arthroscopy,
triangular fibrocartilage was considered intact on basis of presence of normal
trampoline effect. During error analysis, hand surgeon agreed tiny lesion
could be missed with arthroscopy.
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Fig. 7B —47-year-old man with ulnar-sided wrist pain and no history of
trauma. Coronal T1-weighted fat saturated image (TR/TE, 525/15) (A) and
conventional arthrogram (B) show false-positive noncommunicating tear
(arrow) of ulnar attachment in right wrist. At arthroscopy,
triangular fibrocartilage was considered intact on basis of presence of normal
trampoline effect. During error analysis, hand surgeon agreed tiny lesion
could be missed with arthroscopy.
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Copyright © 2007 by the American Roentgen Ray Society.
