Triangular fibrocartilage complex tear

Case contributed by Dr Joachim Feger

Presentation

Ulnar sided wrist pain since trauma five years ago.

Patient Data

Age: 35 years
Gender: Male

Coronal and axial fat-saturated intermediate weighted images show severely edematous and thickened dorsal radioulnar ligament and signal change of the proximal lamina of the triangular ligament (foveal attachment).

Focal bone marrow edema of the ulnar head, adjacent to the foveal attachment.

The ulnotriquetral ligament is intact.

Sagittal fat-saturated intermediate weighted images indicate detachment of the triangular fibrocartilage complex (TFCC) at the dorsal radioulnar ligament.

Joint effusion in the distal radioulnar joint (DRUJ) with free intra-articular body/fragment within the palmar recess of the distal radioulnar joint visible in axial images.

Fat-saturated T1w images show contrast enhancement of the foveal attachment as well as dorsal radioulnar ligament indicative of reparative fibrovascular tissue.

Additional findings:

Scapholunate and lunotriquetral ligaments are intact.

Key images:

The coronal image demonstrates a severely edematous and thickened dorsal radioulnar ligament (red arrows).

Axial and sagittal images indicate detachment of the triangular fibrocartilage complex (TFCC) at the dorsal radioulnar ligament (blue arrows).

Further proximal axial image shows an intra-articular loose body/fragment (red arrowhead).

Case Discussion

A dorsal-sided, partial triangular fibrocartilaginous complex (TFCC) tear was arthroscopically confirmed and sutured. The intra-articular fragments in the distal radioulnar joint were arthroscopically removed.

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