Triangular fibrocartilagenous complex tear

Case contributed by Dr Andrew Lawson

Presentation

Young lady with wrist pain, previous trauma.

Patient Data

Age: 25
Gender: Female
Modality: X-ray

Normal.

Modality: MRI

There is an undisplaced fracture through the trapezoid bone with surrounding bone marrow oedema. The fracture is on the lateral aspect of the bone and extends to the carpal and carpometacarpal articulation. There is likely disruption/strain of the extrinsic ligaments of the dorsolateral aspect of the wrist. High grade strain/torn radial collateral ligament. No fracture is identified of the scaphoid or of the proximal metacarpal bones. The dorsal band of the scapholunate ligament is intact with no widening. Alignment at the lunotriquetral joint is normal. Mild ulnar positive variance is noted. There is a tear through the volar component of the radioulnar ligament of the TFCC. There is a radial side tear (3 mm) of the articular disc of the TFCC, with a small amount of fluid within the distal radioulnar joint. Likely old traumatic injury to the ulnar styloid including the attachments of the TFCC. There is scarring within the pre styloid recess and in the region of the meniscal homologue. Scarred ulnar collateral ligament. The ECU tendon demonstrates subluxation and mild tendonosis. A small amount of fluid between the triquetrum and pisiform bones is within normal limits. The carpal tunnel has a normal appearance. Normal appearances of the ulnar nerve and vessels within Guyons canal. The dorsal compartments I-V are unremarkable.

Conclusion: Undisplaced fracture through the trapezoid bone. No fracture identified of the remaining carpal bones or proximal aspects of the metacarpal bones. Injury to the dorsolateral extrinsic ligaments and radial collateral ligament. Likely chronic injury to the TFCC with a full thickness radial side tear of the articular disc and volar band of the radioulnar ligament of the TFCC.

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Case Information

rID: 25623
Case created: 31st Oct 2013
Last edited: 1st Oct 2015
Inclusion in quiz mode: Included

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