Central triangular fibrocartilage perforation

Case contributed by Dr Dai Roberts

Presentation

Ulna sided wrist pain after fall.

Patient Data

Age: 35 years
Gender: Male

A 25G needle targets the proximal pole of the scaphoid.  Injection of iodinated contrast confirms an intra-articular needle tip position.  

The images taken during the injection of arthrogram solution show it extends throughout the wrist joint from a radial to ulna direction.  

The final capture is taken after the needle has been removed and dynamic movements performed. It shows contrast within the distal radial ulna joint (DRUJ) indicating a triangular fibrocartilage complex (TFCC) tear. 

This coronal T1 fat saturated weighted sequences confirms a perforation of the central TFC disc proper and redemonstrates contrast within the DRUJ.  

Case Discussion

Different arthrogram techniques are used and described and most have similar outcomes.  An important aspect of performing such injections is knowing the correct total volume of injectate to use in each joint.  This should factor in the volume of the iodinated contrast injected, volume within the extension tubing and volume used of the arthrogram solution. 

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