Triangular fibrocartilage complex (TFCC) tear with avulsion fracture of the ulnar styloid process

Case contributed by Dr Mohammad A. ElBeialy


Pain at the medial/ulnar side of the arm following lifting a heavy object.

Patient Data

Age: 30 years
Gender: Male
  • The ulnar styloid process as well as the distal medial ulnar epiphysis shows marrow edema signal with patchy areas of low T1 and high PDFS signals.
  • The ulnar attachment of the triangular fibro-cartilage shows increased signal intensity with partial thickness tear. Edema signal of the ulnar carpal collateral ligament and ulno-meniscal homologue is noted as well.
  • The extensor carpi ulnaris tendon shows mild thickening with increased signal intensity around the ulnar styloid process.
  • A well-defined lobulated cystic structure is seen overlying the dorsal aspect of the mid carpal bones, intimately related to the dorsal inter-carpal ligament deep to extensor tendons, namely extensor carpi radialis brevis, extensor indicis and extensor digitorum tendons. It elicits low T1 and bright T2/PD signals and measures 2 X 1.8 X 1.1 cm.
  • Subcentimetric bone cystic lesion is noted within the mid posterior aspect of the lunate bone, with evident communication with the previously described lobulated cystic lesion.
  • Intact other tendons around the wrist.
  • No other area of marrow signal abnormality.
  • No free joint effusion.

A small bone fragment related to the ulnar styloid process; consistent with  avulsion fracture.

Case Discussion

  • The above described findings are consistent with triangular fibrocartilage complex (TFCC) tear with avulsion fracture of the ulnar styloid process and marrow edema of the distal ulna as well as post-traumatic extensor carpi ulnaris tendinosis and edema of the ulnar carpal collateral ligament and ulno- meniscal homologue as described.
  • Dorsal carpal ganglion cyst with intra-lunate extension as described.

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Case information

rID: 29463
Published: 27th May 2014
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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