Abstract
The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA) and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93%) and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39), and specificity was 80% (16/20). The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34). These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.
Highlights
The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings
Applications to Patient Care - MRA of the wrist is a valuable tool in the diagnostic evaluation and detection of full-thickness tears of the TFCC. - It is a safe procedure when performed by an expert radiologist and in the presence of a new magnetic resonance imaging machine with retracted small joint coils
TFCC tears were classified according to their locations, and were classified as site 1 if they were at the cartilage attachment to the radius; site 2 if they were pararadial (2–3 mm from the radius); site 3 if they were at the mid-portion; site 4 if they were paraulnar (2–3 mm from the ulnar insertion point of the TFCC); or site 5 if they were at the ulnar insertion point [Figure 4]
Summary
Abstract: Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries. Advances in Knowledge - This was the first study in Jordan to use intra-articular injection magnetic resonance arthrography (MRA) for evaluating injuries of the triangular fibrocartilage complex (TFCC) in the wrist. Lesions of the triangular fibrocartilage complex (TFCC) are a common source of ulnar-sided wrist pain.[2,3] The TFCC consists of the articular disk, dorsal and palmar radioulnar ligaments, the meniscal homologue, the dorsal and palmar ulnocarpal ligaments, the ulnar collateral ligament, the sheath of the extensor carpi ulnaris tendon, and the capsule of the distal radioulnar joint (DRUJ).[5]
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