Best Practice Case Studies-Trriangular Fibrocartilage Complex (TFCC) Tear

Video Transcription

This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 20-year-old male with diffuse swelling and limited range of motion secondary to pain  after a fall on an outstretched hand, concerned for triangular fibrocartilage tear. The patient in this case presented with this wrist radiograph, which is normal, which is  usually the case in setting of triangular fibrocartilage tear. However, radiograph could be obtained to exclude any other bony abnormality or malalignment.  This is the same patient who underwent ultrasound of the dorsal wrist. Here we can see that there is an echogenic cortex right here, and then in this region  we can see that there is a cortical step-off at the waist of the scaphoid, concerning for scaphoid avulsion injury.  However it is good to note that ultrasound is not typically part of the workup in evaluating triangular fibrocartilage tear.  So this is just on a different patient, so we have an MRI wrist without contrast. MRI is the preferred modality for evaluating the triangular fibrocartilage.  The triangular fibrocartilage is a complex with multiple components in it, but today  we will be talking about the triangular fibrocartilage disc proper and also its triangular ligament.  So in here we have the body or the disc proper, which attaches to the radius right here at the articular cartilage, and then we have the triangular ligament, which has two lamina.  We have the proximal lamina attaching to the fovea of the ulna, and then we also have the distal attachment, which attaches to the ulnar styloid.  A normal triangular fibrocartilage is hypo-intense on all sequences such as this. This is on a different patient with a triangular fibrocartilage tear.  Here we can see the disc proper of the triangular fibrocartilage, and within the disc proper we can see this increased signal within it.  Also on this side, on our coronal PD, these findings are consistent with triangular fibrocartilage tear.

Video Summary

Barry Belosis, a radiology fellow at Stanford, discusses a 20-year-old male with wrist pain and suspected triangular fibrocartilage tear following a fall. The patient's radiograph appeared normal, typical in such tears, but could rule out bone issues. An ultrasound of another patient showed potential scaphoid avulsion, though ultrasound isn’t standard for fibrocartilage tears. MRI, preferred for these injuries, highlighted details of the triangular fibrocartilage, including the disc and ligaments. Normal triangular fibrocartilage appears hypo-intense on MRI, but increased signal in the disc indicates a tear.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 18

Topic Hand and Wrist

Keywords

2nd Edition, CASE 18

2nd Edition

Hand and Wrist

triangular fibrocartilage tear

wrist pain

MRI

radiology

scaphoid avulsion