Occupational triangular fibrocartilage complex injury in a sewing machine operator

To explore the effectiveness of anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex (TFCC) injury under wrist arthroscopy. Between March 2018 and March 2020, 16 patients with Atzei-EWAS type 2 TFCC injury were admitted, and the TFCCs were anatomically repaired with a three-dimensional suture with a thread anchor under wrist arthroscopy. There were 10 males and 6 females with an average of 40.2 years (range, 22-54 years). The disease duration ranged from 2 to 9 months (mean, 6.4 months). Preoperative grip strength of the affected limb was (20.06±3.38) kg, wrist range of motion in flexion and extension was (117.19±7.74)°, radial-ulnar deviation was (31.25±5.32)°, forearm rotation range of motion was (137.19±14.83)°, visual analogue scale (VAS) score was 5.6±1.2. At last follow-up, the effectiveness was evaluated by the grip strength of the affected limb, the range of motion of the wrist joint, the VAS score, and the modified Mayo wrist score. All incisions healed by first intention. One case had paralysis of the dorsal branch of the ulnar nerve after operation, and no other complications occurred in other cases. All patients were followed up 12-18 months (mean, 14.5 months). The distal radioulnar joint stability of all patients recovered. At last follow-up, the grip strength of the affected limb was (24.88±3.26) kg, the range of motion in flexion and extension was (146.59±6.49)°, radial-ulnar deviation was (39.38±6.55)°, and forearm rotation range of motion was (152.50±11.55)°, which were significantly higher than those before operation ( P<0.05); the VAS score was 0.9±0.8, which was significantly lower than that before operation ( t=21.029, P=0.000). The modified Mayo wrist score was rated as excellent in 10 cases, good in 5 cases, and fair in 1 case. The excellent and good rate was 93.8%. MRI results showed that TFCC healed in all cases. For Atzei-EWAS type 2 TFCC injury, anatomical repair under wrist arthroscopy can restore the anatomical structure of TFCC, effectively relieve wrist pain, improve function, and obtain good effectiveness.

The Presence and the Location of an Ulnar Styloid Fracture Associated With Distal Radius Fracture Predict the Presence of Triangular Fibrocartilage Complex 1B Injury

The purpose of this article is to illustrate MRI examples of acute triangular fibrocartilage complex (TFCC) injuries following the Palmer classification, including subtypes of the acute traumatic injuries originally described. In the discussion of these athletic TFCC injuries, recent studies and references are discussed with regard to implications in diagnosis and treatment. The article also reviews the role of ulnar abutment in degenerative injury to the TFCC and surgical approaches to correction. Recent findings regarding the role of the TFCC in distal radioulnar joint stability (DRUJ) and the importance of MRI in preoperative planning of the wrist are reviewed. New studies emphasizing the importance of repair of partial tears of the foveal attachment of the TFCC, the association of TFCC tears with distal radius fractures, and wafer procedures are also discussed. Injuries of the triangular fibrocartilage complex (TFCC) are commonplace in athletes across multiple sports. The TFCC acts to cushion forces transmitted from the ulnar side of the wrist to the upper extremity. Athletic activities tend to deliver an increased axial load and greater twisting motion upon the wrist. The Palmer classification system for TFCC injuries was first introduced in 1989, but is still used for both acute traumatic and degenerative injuries of the TFCC. MRI plays a pivotal role in diagnosing and classifying athletic injuries of the TFCC, helping guide orthopedists and hand surgeons in caring for patients with ulnar-sided wrist pain.

The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique. Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panelists consisted of twenty-seven musculoskeletal radiologists. The panelists scored their degree of agreement to each statement on an 11-item numeric scale. Scores of "0," "5," and "10" reflected complete disagreement, indeterminate agreement, and complete agreement, respectively. Group consensus was defined as a score of "8" or higher for 80% or more of the panelists. Three of fourteen statements achieved group consensus in the first Delphi round and ten statements achieved group consensus in the second Delphi round. The third and final Delphi round was limited to the one question that did not achieve group consensus in the previous rounds. Delphi-based agreements suggest that CT with static axial slices in neutral rotation, pronation, and supination is the most useful and accurate imaging technique for the work-up of DRUJ instability. MRI is the most valuable technique in the diagnosis of TFCC lesions. The main indication for MR arthrography and CT arthrography are Palmer 1B foveal lesions of the TFCC. MRI is the method of choice for assessing TFCC lesions, with higher accuracy for central than peripheral abnormalities. The main indication for MR arthrography is the evaluation of TFCC foveal insertion lesions and peripheral non-Palmer injuries. • Conventional radiography should be the initial imaging technique in the assessment of DRUJ instability. CT with static axial slices in neutral rotation, pronation, and supination is the most accurate method for evaluating DRUJ instability. • MRI is the most useful technique in diagnosing soft-tissue injuries causing DRUJ instability, especially TFCC lesions. • The main indications for MR arthrography and CT arthrography are foveal lesions of the TFCC.

Objective To compare direct magnetic resonance(MR)arthrography with arthroscopy of the wrist for evaluation of injury in the triangular fibrocartilage complex(TFCC).Methods Fourteen cases with suspicion of injury of triangular fibrocartilage complex were performed with conventional MR and direct MR arthrography,10 cases were done by arthroscopy.In the direct MR arthrography,needle placement was obtained using clinical landmark under sterile technique and fluoroscopy,intra-articular injection was performed at the radius-scaphoid space with 5-7 ml 0.3%mixture of Gadolinium (0.1 mmol/L)and saline(0.3 ml Gd-DTPA+100 ml saline).The findings of MRI and MR arthrography were analyzed with results of arthroscopy.Resuits (1)Among 14 cases with injury of TFCC,there were ulnar tear in 5cases,radius tear in 4 cases,complete tear in 5 cases(included 2 cases with long term rheumatoid).(2)High signal intensity and isointensity signal of injury of TFCC were revealed on STIR or T2 WI and T1 WIrespectively,normal hypointensity signal of the TFCC was partially or completely absent.Contrast media at the ulnar insertion(5 cases with ulnar tear)or radius attachment of the TFCC(4 cases with radius tear)were seen in the MR arthrography with difierent extent,5 cases with complete tear showed contrast media at the both ulnar insertion and radius attachment of the TFCC.The findings of MR arthrography were well corresponded with results of arthroscopy on the lesion site,including ulnar tear in 3 cases,radius tear in 4cases and complete tear in 3 cases.(3)Among 14 cases with TFCC,8 cases had dislocation of radius-ulnar joint,6 cases had bone contusion of radius or ulnar,synovial reaction was also clearly depicted on conventional MRI and direct MR arthrography in all cases.Conclusion Compared with results of arthroscopy,direct MR arthrography can adequately reveal the injury of the triangular fibrocartilage complex,synovial reaction and edema changes are depicted on conventional MRI. Key words: Wrist injuries; Triangular fibrocartilage; Magnetic resonance imaging; Arthrography

Wrist arthroscopy in extra-articular distal radius fractures: Extra-articular fractures are articular trauma, a prospective series of 35 cases

Cardiopulmonary resuscitation (CPR) is physically demanding and may result in work-related musculoskeletal injuries in healthcare providers. We report a case of triangular fibrocartilage complex (TFCC) and dorsal distal radioulnar ligament injuries sustained by an orthopedic resident during prehospital CPR events, to increase awareness of this underrecognized occupational hazard. A 31-year-old orthopedic resident performed prolonged CPR twice in one shift and subsequently developed marked tenderness, instability, and pain in the left wrist with pronation, as well as a sensation of clicking subluxation. A second physician recalled persistent wrist pain after CPR in previous years. Imaging demonstrated a tear of the TFCC and dorsal distal radioulnar ligament as well as joint effusion and extensor carpi ulnaris sheath edema in the affected wrist. The retrospective magnetic resonance imaging of the second physician indicated chronic TFCC change. Conservative management with nonsteroidal anti-inflammatory drugs, plaster splint immobilization, and subsequent wrist bracing was implemented for the resident; self-treatment with nonsteroidal anti-inflammatory drugs and wrist brace was reported by the second physician. The orthopedic resident achieved resolution of instability after 6 weeks with restoration of full wrist motion and strength by 2 years. The second physician's symptoms persisted for 2 years before mostly resolving. Musculoskeletal injuries, including TFCC and distal radioulnar ligament tears, may occur in CPR providers but are often underrecognized and underreported. Early recognition, appropriate management, and preventive strategies such as alternating roles, prompt initiation of automated compression devices, and ergonomic device placement may mitigate injury risks. Encouraging timely reporting and self-care among healthcare professionals is essential for provider well-being and care quality.

Prevalence of neck-shoulder pain among sewing machine operators is well known. It may be due to the nature and incorrect posture used by sewing machine operators while performing sewing work. However, up till now there is no empirical evidence that can be used to relate the risk factors that would results towards the development of neck and shoulder pain among sewing machine operators. The main objective of this study is to identify and investigate the risk factors that result in neck and shoulder pain among Malaysian sewing machine operators. Twenty female sewing machine operators took part in answering a survey questionnaire to investigate the prevalence of neck and shoulder pain among sewing machine operators. The survey questionnaire was divided into five sections: socio-demographic, work background, workload information, physical exposures and physical musculoskeletal symptoms experienced by workers. Having done that, sewing machine operators who have been screened with neck and/or shoulder pain was evaluated with Rapid Upper Limb Assessment (RULA) to determine the level of workplace risk factors. Subjects without neck and/or shoulder pain were excluded. Results of the study shows that all sewing operators were expose to risk of prolonged sitting, repetitive task and working at high speed. Ninety five percent of sewing machine operators had experienced neck and/or shoulder pain and 80% of them were exposed to high work risk factors that require them to undergo further investigation. Shoulder pain was found to be strongly correlated with high work risk factor among sewing machine operators (p&lt;0.05). In conclusion, occurrence of shoulder pain among sewing operators is due to posture and nature of sewing work.

Introduction Fractures of the distal metaepipheseal fractures of the radius (DMER) have a leading place in the overall structure of upper limb injuries. DMER fractures are frequently associated with soft- tissue injuries of the wrist joint, and namely, the triangular fibrocartilage complex (TFCC). The additional use of arthroscopy of the wrist joint in the treatment of patients with a DMER fractiures reduces the duration of recovery of patients and improves the result of their treatment. The aim of the study was to determine the effect of arthroscopic surgical treatment of TFCC injuries during bone osteosynthesis for DMER fractures on the functions of the upper extremities (extension/flexion of the hand, hand grip strength, pronation/supination of the forearm, DASH index). Materials and methods The study included 68 patients with DMER fractures, who were divided into 2 groups, depending on the treatment of the fracture. After reduction and osteosynthesis, all patients underwent arthroscopy of the wrist joint. If TFCC injury was detected, either a debridement or a TFCC suture was performed. Results TFCC injury was detected in 61.7 % (n = 42). Debridement was performed in 42.9 % (n = 18); suture using the inside-out technique was performed in 47.6 % (n = 20); one patient underwent reinsertion. After 6 months, the function of flexion and extension of the hand was significantly worse in patients with combined TFCC and DMER injuries, but after 12 months, the indicators were similar. The strength of the hand grip and the rotational function of the forearm did not differ between the subgroups. The subjective assessment of DASH after 6 months was worse in the group with TFCC injury, but after 12 months the results were similar. Conclusion Surgical treatment of TFCС injury in intraarticular fractures of the distal radius contributes to the restoration of the upper limb function to a premorbid level 12 months after surgical treatment.

To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05). For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.

Objectives: The aim of this work is to show the value of MRI and MRA in evaluation of patients suffering from wrist pain. Background: Wrist pain is a common clinical complaint. The most common causes of wrist pain are traumatic & non traumatic abnormalities involving avascular necrosis, ganglia, and TFC lesions. MRI serves as a problem solving technique to assess the cause of wrist pain. It also plays an important prognostic role. MRA is an excellent tool in assessing TFC and wrist ligaments injury. Methods: This study was conducted on 60 patients complaining of chronic wrist pain. The patients were referred to the radiology department from the outpatient clinics and the orthopedics department of Menoufia University Hospital. All patients were examined by x-ray and conventional MRI. 15 patients with suspected triangular fibrocartilage complex (TFC) and/or ligament injury underwent MRA as well. Data of soft tissue and osseous lesions were collected and analyzed. Results: There were thirty four males and twenty six females, their ages ranged between 17 & 59 years (mean age, 38 years). Joint effusion, kienbock disease and ganglion cysts were the most common findings in conventional MRI . TFC injury was the most common finding in MRA. Conclusion: MRI has a dramatic impact on the diagnosis and assessment of variety of wrist disorders. It is non invasive and ideal modality to demonstrate the complex anatomy and pathological conditions of the wrist. MRA is an excellent tool in assessing TFC and ligaments injury.

Musculoskeletal disorders are the most common occupational diseases in Estonia and in the European Union as a whole. Sewing machine operators’ work is very monotonous, in continuous sitting position, with repetitive one-side movements of the upper limbs and legs. Working in an awkward posture and doing the same movements for a long period of time increases the risk of musculoskeletal system disorders, and in longer perspective, could cause work disability. The aim of the study was to analyse the prevalence of musculoskeletal disorders, intensity and duration of pain in a different body regions and to assess the changes of the functional status of the musculoskeletal system before and after the intervention among workers with partial work ability. The target group was 57 sewing machine operators, who were presented with an anonymous online questionnaire and agreed to participate in the intervention program. The study group was 12 sewing machine operators with partial work ability. RULA (Rapid Upper Limb Assessment) method was used for evaluating ergonomic workstations. The pain assessment was studied by NPRS, Numeric Pain Rating Scale. Online questionnaires were based on BQ (Baecke Physical Activity Questionnaire) and NMQ (The Nordic Musculoskeletal Questionnaire). The results showed that musculoskeletal status among workers with partial work ability improved after the intervention. Associations between individual and job related factors and musculoskeletal pain were observed. The research allows to make actual proposals for workplace layout of sewing machine operators, to provide ergonomic deployment and offer suitable exercise movements for rest breaks.

삼각 섬유성 연골(TFCC) 손상 환자의 평가를 위하여 fat suppressed 3D fast spoiled gradient recalled T1 기법과 fat suppressed Isotropic 3D fast spin echo T1 기법을 이용하여 영상을 획득하였다. 정량적 평가를 위해 각각의 영상에서 signal to noise ratio 및 contrast to noise ratio 값을 측정하고, Mann-Whitney U 검정으로 두 기법 간의 통계적 유의성을 검증하였다. 또한 정성적 평가를 위해 영상의학의 2명이 각각의 영상을 관찰하여, TFCC의 형태, 영상 내 인공음영, 병변의 묘사 정도의 3가지 항목을 선정한 후 이를 4점 척도(0: 진단 불가, 1: 부족함, 2: 충분함, 3: 좋음)로 평가하였고, Kappa-value 검정을 이용하여 두 관찰자 간의 일치도 검증을 하였다. 영상획득에는 3.0 Tesla MR 장비와 8-channel RF coil을 사용하였다. 정량적 평가 결과, 모든 영상 단면에서 signal to noise ratio 및 contrast to noise ratio 값이 Isotropic 3D fast spin echo T1 기법이 높게 나타났으며, Mann-Whitney U 검정을 이용한 두 영상기법 간의 검증도 통계적으로도 유의하였다(p < 0.05). 정성적 평가 결과, 관찰자 1, 2 모두에서 Isotropic 3D fast spin echo T1 기법의 평가 결과가 더 높게 나타났으며, Kappa-value 검증을 이용한 두 관찰자 간 평가 결과의 일치도 검증도 통계적으로 유의하였다(p < 0.05). 결론적으로 TFCC 손상 환자의 자기공명영상 검사 시 fat suppressed Isotropic 3D fast spin echo T1 기법의 적용은 TFCC 병변의 감별에 보다 유용한 진단적 정보를 제공 할 수 있을 것이라 생각된다. In this study, For assessment of triangular fibrocartilage complex (TFCC) injury, we acquired images by fat suppressed 3D fast spoiled gradient recalled T1 and fat suppressed Isotropic 3D fast spin echo T1 techniques. For quantitative evaluation, measured signal to noise ratio and contrast to noise ratio and verified statistical significance between two imaging techniques by Mann-Whitney U verification. And for qualitative evaluation, marked 4-grade scoring (0: non diagnostic, 1: poor, 2: adequate, 3: good) on shape of TFCC, artifacts by partial volumes, description of the lesions by two radiologist, verified coincidence between 2 observer using Kappa-value verification. We used 3.0 Tesla MR equipment and 8-channel RF coil for imaging acquisition. As quantitative evaluation results, signal to noise ratio and contrast to noise ratio value of Isotropic 3D fast spin echo T1 technique is higher in every image sections, also between two imaging techniques by Mann-Whitney U verification was statistically significant (p < 0.05). As qualitative results, observer 1, 2 marked a higher grade on Isotropic 3D FSE T1 technique, coincidence verification of evaluation results between two observers by Kappa-value verification was statistically significant (p < 0.05). As a result, during MRI examination on TFCC injury, fat suppressed Isotropic 3D fast spin echo T1 technique is considered offering more useful information about abnormal lesion of TFCC.

Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury. Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery. All patients had a mean follow-up of 54months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3months after the initial surgery. The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.

Outcomes of surgically treated distal radial fractures with associated triangular fibrocartilage complex injury