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Results for “Triangular Fibrocartilage”

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At least 217 records · Page 12Linked to original sources

PubMed1996

[Dynamic study of the distal radioulnar joint with computerized tomography].

The authors describe a CT technique which allows the dynamic study of the inferior radioulnar joint. The examination consists of 4 CT slices, three of them acquired at the same level-i.e., the radioulnar joint- in the prone, intermediate and supine positions, respectively. The last slice is acquired, with the patient in the prone position, at the base of the styloid process where the triangular fibrocartilage is demonstrated. The distal radioulnar ligaments are not directly visible. Nineteen patients complaining of painfully impaired pronation and supination because of previous trauma (11 Colles fractures, 7 distortions and 1 Galeazzi lesion) were examined with this technique. In all patients, both wrists were studied to obtain normal parameters. The radioulnar joint was evaluated superimposing a draft on the dynamic images, which demonstrated that, in healthy limbs, during movement the ulnar epiphysis is always contained between two parallel lines drawn on the volar and dorsal surfaces of the radial epiphysis, respectively. It was also confirmed that supination is possible up to 110-135 degrees from the support plane. CT demonstrated different causes of impaired movements in the affected joints: in 12 cases some fibrous density tissue was seen at the ulnar epiphysis on the volar aspect and considered to be the evolution of a traumatic hematoma; 6 patients presented dorsal subluxation of the ulna during movement; finally, volar subluxation was detected only in one case. In 6 patients the triangular fibrocartilage was detached; in 1 patient an intraarticular fluid collection was demonstrated. In 3 patients CT detected no abnormalities. The fibrous tissue is responsible for impaired movements and causes the detached triangular fibrocartilage to shrink. The authors believe that this simple CT technique can yield useful pieces of information for accurate surgical planning.

Female↗

PubMed1990

[A comparison of arthrography and magnetic resonance tomography in painful limited movements of the hand].

In 18 patients with unclear pain in the wrist limiting hand movement, arthrography and magnetic resonance imaging (MRI) were compared. The FISP gradient echo sequence turned out to be superior to the T1 weighted spin-echo sequence in the imaging of the triangular fibrocartilage complex. MRI is very sensitive in detecting triangular fibrocartilage lesions and therefore represents a suitable non-invasive screening method. It is, however, not possible to assess the degree of the lesion. Ruptures in carpal tendons could only be diagnosed by means of arthrography.

Adult↗

PubMed1993

Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis.

We dissected 393 wrists to evaluate the incidence and distribution of anatomic features, arthrosis, chondromalacia, and soft tissue lesions. The data were then analyzed for any statistically significant associations among the different variables. The most common (73%) lunate morphology had a separate medial facet on its distal surface for the hamate. The capitate had a separate facet for the fourth metacarpal in 86% of the wrists. Fourth metacarpals with a dorsal radial facet, either separate from or connected to the rest of the fourth metacarpal base, were the most common types of fourth metacarpal. Cartilage erosion with exposed subchondral bone was identified in 58% of the wrists. It was most commonly at the proximal pole of the hamate (28%). Tears of the ligaments and/or the triangular fibrocartilage complex were identified in 56% of the wrists. The triangular fibrocartilage complex was found torn in 36% of the wrists. The lunotriquetral interosseous ligament was torn in 36% of the wrists, and the scapholunate interosseous ligament was torn in 28% of the wrists. There was a communication between the proximal wrist joint and the pisotriquetral joint in 88% of the 76 wrists, which were further dissected to assess this issue. Statistical analysis of the data found a significant correlation between the presence of cartilage erosion at the proximal pole of the hamate and the presence of a lunate facet. There was also a significant correlation between the presence of a tear in the scapholunate interosseous ligament and the presence of cartilage erosion in the scaphoid-trapezium-trapezoid joint. Analysis of the paired wrists from 169 cadavers revealed that the same soft tissue tear or combination of tears was present bilaterally in 39% of the pairs. Cartilage erosion was present bilaterally in the same location or locations in 27% of the pairs.

Adolescent↗

PubMed2006

Role of MR imaging in chronic wrist pain.

Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienböck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain.

Bone Marrow↗

PubMed1992

Magnetic resonance imaging of the wrist.

Magnetic resonance (MR) imaging has developed rapidly as a diagnostic tool in the evaluation of the wrist. In this article, the authors review simple high-resolution technique and appropriate surface coils to aid in wrist evaluation. Evaluation of the wrist is facilitated by an understanding of the anatomy of the carpal ligaments, the triangular fibrocartilage, and the carpal tunnel, and the anatomic features of the distal radioulnar joint. Triangular fibrocartilage tears, which represent an important cause of ulnar wrist pain, are well evaluated on MR. These appear as a linear band of increased signal on the short repetition time/echo time (TR/TE), proton density weighted spin echo, or gradient echo images. True tears should be differentiated from degenerative changes, which do not demonstrate increase in signal on T2 or T2* weighted images. With good technique, accuracies approaching 90% have been reported. MR is also useful in evaluating injuries of the interosseous ligaments and volar and dorsal radiocarpal ligaments and distal radioulnar joint instability. MR also has a role in evaluating the carpal tunnel syndrome. This is especially true with patients for whom symptoms suggest the diagnosis of carpal tunnel syndrome but for whom few objective findings exist. Findings suggestive of carpal tunnel syndrome include diffuse swelling of the median nerve, flattening of the median nerve at the level of the hamate, and increased signal of the median nerve on the long TR/TE images. MR is also indicated in avascular necrosis of the carpal bones and occult carpal fractures. MR is useful in evaluating bone tumors, particularly with regard to their extent. With the advent of more rapid scanning techniques, kinematic studies are feasible. For these, fast gradient echo techniques are employed and serial images are acquired during radial and ulnar deviation. These images may be helpful in observing integrity of intercarpal ligaments and evaluating dynamic instability. With proper attention to technique, and an understanding of wrist pathophysiology, MR is a valuable diagnostic tool.

Cartilage, Articular↗

PubMed1993

Effects of radial deformity on distal radioulnar joint mechanics.

A cadaver experiment was performed to study the effects of radial deformity on the kinematics of the distal radioulnar joint and the anatomic configuration of the triangular fibrocartilage. Radial shortening caused the greatest disturbance in kinematics and the most distortion of the triangular fibrocartilage. Decreased radial inclination and dorsal angulation caused intermediate changes. Dorsal displacement produced minimal changes. Radial deformity did not produce distal radioulnar joint dislocation. These results provide biomechanical evidence of an important relationship between radial malunion and persistent symptoms in the distal radioulnar joint.

Adult↗

PubMed2000

[Wrist trauma: diagnostic imaging].

Wrist injury is common throughout life and, although history and physical examination provide important information regarding the type of lesion, a radiological study is essential to determine a specific diagnosis. Conventional radiography plays a central role in the wrist injuries but the diffusion of more sensitive methodics offers new possibilities. Our purpose is to evaluate the role of computed tomography (CT), magnetic resonance (MR) and arthrography in wrist trauma. We retrospectively examined the images of 45 patients with wrist injuries: in every patients a radiological examination in 4 standard projections was executed while in 25, 9 and 11 patients CT,MR and arthrography were performed. On the basis of our findings we think that conventional radiography is often sufficient for diagnosis of bone lesions even if CT sometimes is required to detect subtle fractures. MR has an high sensitivity not only for abnormalities of soft tissues, including interosseous ligaments and triangular fibrocartilage, but also bony abnormalities such as occult fractures and early osteonecrosis. Arthrography still remains the best procedure for evaluating lesions of triangular fibrocartilage and intercarpal ligaments especially in a preoperative phase.

Adolescent↗

PubMed1994

The relevance of ligament tears or perforations in the diagnosis of wrist pain: an arthrographic study.

This study was designed to assess the clinical significance of arthrographic abnormalities in the ligaments of a painful wrist. This was accomplished by means of comparison arthrography of the asymptomatic wrist. Fifty-six consecutive patients with unilateral wrist pain underwent selective bilateral arthrography to assess interruptions of continuity of the triangular fibrocartilage, lunotriquetral, and scapholunate ligaments. The prevalence of bilaterally symmetric lesions was high. In patients with ligament defects in the symptomatic wrist, 88% of defects near the radial attachment of the triangular fibrocartilage, 59% of lunotriquetral defects, and 57% of scapholunate defects were bilateral. Furthermore, physical examination was not predictive of specific ligament defects. This study raises questions concerning the relevance of interrupted ligaments in the diagnosis of wrist pain.

Adolescent↗

PubMed1993

Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy.

Arthrography and arthroscopy of the wrist were compared as diagnostic tools in the evaluation of chronic wrist pain. Arthroscopy proved to be a more sensitive procedure than arthrography in 20 consecutive patients with confirmed wrist injuries. There was 86% correlation (the exception--one false negative arthroscopic procedure) between arthroscopy and arthrography in eight patients with triangular fibrocartilage tears. Compared with arthroscopy, there were five false negative and five false positive arthrograms when evaluating interosseous scapholunate and lunotriquetral ligament tears. Arthroscopy more readily identified the location and extent of triangular fibrocartilage and the significance of interosseous ligament tears. Wrist arthrotomy confirmed the findings of wrist arthrography and arthroscopy and demonstrated that arthrography is not as accurate in localizing specific wrist injuries. Furthermore, wrist arthroscopy is a more valuable technique in determining the location, size, and extent of ligament injuries within the wrist.

Adolescent↗

PubMed1993

MR imaging of anatomy and tears of wrist ligaments.

Numerous intrinsic and extrinsic wrist ligaments are visible at magnetic resonance (MR) imaging. Because the previously published descriptions of these ligaments were often conflicting, the authors derived a classification system based on a functional perspective and their experience with MR imaging, arthroscopy, and surgical dissection. This system was used to evaluate MR images of 23 cadaveric wrists for the presence and integrity of 16 wrist ligaments. MR images were prospectively analyzed by two observers, and all findings were correlated with the results of arthroscopy. The best detection rates and diagnostic confidence rates were achieved for the triangular fibrocartilage (100% and 100%, respectively) and the scapholunate ligament (91% and 87%, respectively). Other ligaments were less well seen, partly because of their size and course. Eighty-two percent of the triangular fibrocartilage tears, 50% of the scapholunate tears, and 40% of the lunotriquetral tears seen at arthroscopy were detectable on MR images. Identification of these three types of tears on MR images is important because they are functionally significant and because there are accepted methods of treating them in orthopedic practice.

Aged↗

PubMed1997

A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain.

Forty-three patients with chronic wrist pain have been investigated prospectively with magnetic resonance imaging and arthroscopy. Pathology within the wrist joint was detected in 30 cases with magnetic resonance imaging and 32 cases with arthroscopy. The sensitivity and specificity of magnetic resonance imaging compared with arthroscopy were 0.8 and 0.7 for triangular fibrocartilage complex pathology, 0.37 and 1.0 for scapholunate ligament and 0 and 0.97 for lunotriquetral ligament. It is concluded that magnetic resonance imaging is unhelpful in the investigation of suspected carpal instability. In analysis of the triangular fibrocartilage complex, the results of magnetic resonance imaging should be interpreted with caution.

Adolescent↗

PubMed1986

Radiocarpal arthroscopy and arthrography in the diagnosis of ulnar wrist pain.

The purpose of this prospective study was to compare arthroscopy with arthrography in the diagnosis of ulnar wrist pain. Thirty-seven consecutive patients with ulnar wrist pain but normal routine and stress radiographs had dynamic and static radiocarpal arthrograms (R.G.H.) and arthroscopy (J.H.R.) performed. Sixteen arthrograms demonstrated a leak of contrast into the distal radioulnar joint. Arthroscopy demonstrated a perforation of the triangular fibrocartilage complex in all 16. Seven arthrograms demonstrated a leak of contrast into the midcarpal joint. Arthroscopy demonstrated lunotriquetral instability in two and no abnormality in five. Seventeen arthrograms showed no abnormality. Arthroscopy confirmed no abnormality in nine but also demonstrated seven triangular fibrocartilage perforations and one case of isolated lunate chondromalacia. Arthroscopy findings were confirmed in eight patients who underwent a subsequent arthrotomy. Radiocarpal arthroscopy is superior to arthrography in the diagnosis of chronic ulnar wrist pain.

Adolescent↗

PubMed2004

MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging--preliminary experience.

Institutional review board approval and informed consent were obtained from 25 healthy volunteers and 15 consecutive patients with chronic wrist pain or suspected carpal mass, and 1.5- and 3-T magnetic resonance (MR) imaging of the wrist was prospectively performed with comparable sequence parameters and surface coils of the same geometric design. Imaging protocols at both field strengths included a T1-weighted spin-echo sequence, two intermediate-weighted fast SE sequences with different echo times and with and without fat saturation, and a three-dimensional fast field-echo sequence. The contrast-to-noise ratio (CNR) between muscle and bone and between bone and cartilage was calculated for both field strengths. The visibility of various anatomic structures, including the triangular fibrocartilage complex, carpal ligaments, nerves, and cartilage, was analyzed with a four-point grading scale. CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (P < .001; analysis of variance) for all sequences. Visibility of the triangular fibrocartilage complex and intercarpal ligaments and cartilage was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test).

Adult↗

PubMed1992

The "wafer" procedure. Partial distal ulnar resection.

A technique of partial resection of the distal ulna ("wafer" procedure) for the treatment of patients with symptomatic tears of the triangular fibrocartilage complex or mild ulnar impaction syndrome or both is described. The distal 2-4 mm of the distal ulna is resected while preserving the distal radioulnar joint and the styloid process of the ulna and the ligaments attached to it. The triangular fibrocartilage can be debrided, repaired, or partially excised. The wafer procedure has several advantages and avoids some of the potential complications of other treatment methods.

Adult↗

PubMed1994

Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain.

To determine the significance of arthrographic abnormalities in patients with unilateral wrist pain, the authors compared the prevalence and site of intra-articular ligament perforation in asymptomatic and symptomatic wrists of the same group of patients and correlated asymptomatic perforation with age, hand dominance and hand overuse. Thirty-seven patients (29 men and 8 women ranging in age from 19 to 61 years) who had unilateral wrist pain and positive arthrographic findings for the symptomatic wrist underwent radiocarpal arthrography of the asymptomatic wrist. Three radiologists blinded as to the clinical findings examined the images for perforation in the triangular fibrocartilage complex, the lunotriquetral ligament and the scapholunate ligament. Intra-articular ligament perforations were found in 33 (89%) of the 37 asymptomatic wrists. Seventeen (46%) of the 37 patients had symmetric sites of perforation in the two wrists. Perforation of the triangular fibrocartilage complex occurred in 22 (59%) and 19 (51%) of the symptomatic and asymptomatic wrists respectively, of the lunotriquetral ligament in 13 (35%) and 7 (19%) respectively and of the scapholunate ligament in 13 (35%) and 11 (30%) respectively. No significant correlation between asymptomatic perforation and age or hand overuse was found (chi 2 test, Fisher's exact test). The authors conclude that asymptomatic perforation is common, even in young patients, so ligament perforation is not necessarily the cause of wrist pain in patients with such pain. However, for patients with the appropriate clinical findings, arthrography can be used to confirm or exclude ligament perforation.

Adult↗

PubMed1983

Arthrography of the traumatized wrist. Correlation with radiography and the carpal instability series.

Arthrography with fluoroscopic monitoring was used to assess the soft tissues of the wrist in 100 patients who had chronic traumatic pain but did not have rheumatoid arthritis. Findings were correlated with plain radiographs and the carpal instability series. Arthrograms were normal in 26% of cases and demonstrated perforation of the triangular fibrocartilage in 26%, radiocarpal-midcarpal communication in 30%, capsular lesions in 31%, lymphatic opacification in 12%, and tendon sheath filling in 10%. Communication between the radiocarpal and pisiform-triquetral compartments, a normal finding, was seen in 69%. There was a significant association between perforation of the triangular fibrocartilage and both ulna-plus variance and carpal instability.

Adolescent↗

PubMed1992

Force distribution across wrist joint: application of pressure-sensitive conductive rubber.

A new pressure-sensitive conductive rubber sensor was used for investigation of the pressure distribution through the radio-ulno-carpal joint. Twelve of these transducers were placed in the radio-ulno-carpal joint. Pressure was measured in seven different wrist positions under loads incrementally increasing from 0 to 12 kg. Half of the sensors showed less than 0.5 MPa, even at maximum load, while a high-pressure area was located palmary in each fossa. The peak pressure measured in the wrist neutral position was 2.4 MPa on the scaphoid fossa, 1.5 MPa on the lunate fossa, and 1.1 MPa on the triangular fibrocartilage with a 10 kg load. The peak pressure ratio between the scaphoid and the lunate was 1.7 in the neutral wrist position. This increased in radial deviation to 2.9 and decreased in ulnar deviation to 0.8. The force-transmission ratio was 50% through the scaphoid fossa, 35% through the lunate fossa, and 15% through the triangular fibrocartilage in the neutral position. The advantage of this sensor is that it is thin and flexible and provides reliable reproducible quasi-instantaneous measurements.

Biophysical Phenomena↗

PubMedDate not supplied

Wrist arthroscopy: principles and clinical applications.

With the development of better and smaller equipment, arthroscopy of the wrist offers the same benefits achievable with arthroscopy of the knee, shoulder, or elbow - not only diagnostic information but also a therapeutic option. Standardized techniques of performing wrist arthroscopy have been developed to evaluate the treat various wrist disorders, such as lesions of the triangular fibrocartilage complex, intra-articular distal radius fractures, and scaphoid fractures. Arthroscopy is now performed in the treatment of dorsal-wrist ganglion cysts and interosseous ligament disruptions, as well as for bone incisions, such as radial styloidectomy, distal ulnar excision (wafer procedure), and proximal-row carpectomy. Compared with other techniques, arthroscopic procedures, such as repair of the triangular fibrocartilage complex, demonstrate better results and improved localization of the injury with a low complication rate. In addition, arthroscopic procedures involve lesssurgical dissection, less postoperative pain, a shorter recovery time, and an earlier return to work for the patient.

Arthroscopy↗