Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Triangular Fibrocartilage”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1999

[Biomechanical aspects of malunited distal radius fracture. A review of the literature].

BACKGROUND: One of the most common injuries in orthopaedics is the distal radius fracture. Malunion may lead to pain, limited motion, and loss of grip strength. Presently there is no consensus concerning the indications for corrective surgery after malunion. Studies concerning the biomechanics of the wrist in cases of malunited radius fracture can be helpful. METHOD: Analysis of the literature of the last ten years. RESULTS: In laboratory studies, malalignment of the radius caused alterations of the distal radioulnar joint (anatomically: reduction of the radioulnar contact area, disruption of the deep portion of the dorsal radioulnar ligament, tightness of the triangular fibrocartilage complex; functionally: limited forearm pronation and supination). Further alterations have been found concerning the carpal kinematics, the force transmission through the wrist, the pressure distribution on the articular surface of the radius and the median nerve. CONCLUSION: Attempts should be made to obtain an anatomic reduction of all acute distal radius fractures. Posttraumatic disability of the wrist following malunion in radius fractures should accordingly be treated by a corrective osteotomy of the radius at the original fracture site.

Biomechanical Phenomena↗
PubMed2001

High-resolution outpatient imaging of the wrist.

The authors describe their experience with magnetic resonance imaging (MRI) in the evaluation of pathologic conditions of the wrist in an outpatient setting. In that setting, because time and quality are both important factors, they have concentrated on developing protocols that will allow effective, time-efficient, high-resolution MRI of the wrist. With these wrist imaging protocols, they have evaluated the majority of commonly encountered pathologic conditions of the wrist. They have found that high-resolution images, which can be acquired in a very timely fashion when fast spin echo sequences are used in imaging protocols, will demonstrate the most common pathologic conditions, including triangular fibrocartilage and ligament tears in the wrist. They present the practical issues of patient position and imaging sequences as well as the imaging findings in those pathologic conditions.

Ambulatory Care↗
PubMed2001

Magnetic resonance imaging of the wrist.

Optimal magnetic resonance (MR) imaging of the wrist requires a high field strength magnet and a dedicated wrist coil to achieve high-resolution images. Using current MR sequences, detailed images of articular cartilage and the supporting ligaments and tendons can be obtained. Evaluation of the triangular fibrocartilage as well as the extrinsic and intrinsic ligaments of the wrist is possible with thin-slice three-dimensional volumetric gradient recalled sequences. Fast inversion recovery sequences, used to achieve fat suppression in peripheral joints such as the wrist, allow for detection of acute osseous trauma, which is often radiographically occult. Cartilage-sensitive imaging allows for evaluation of conditions in the skeletally immature patient, such as chronic physeal loading in the adolescent gymnast, as well as detection of the sequelae of altered biomechanics in the adult, as in the ulnolunate impaction syndrome. Moreover, contrast-enhanced magnetic resonance angiography permits a relatively noninvasive evaluation of peripheral vascular disease, obviating the need for an intraarticular injection.

Adolescent↗
PubMed2003

[Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients].

OBJECTIVE: In literature the diagnostic value of MRI for detecting lesions of the carpal ligaments and the TFCC is judged controversially. The aim of the following study is to determine the diagnostic accuracy of direct MR arthrography for depicting and staging of intraarticular lesions of the wrist. MATERIAL AND METHODS: One day before undergoing arthroscopy, 125 patients suffering from wrist pain were examined with direct MR arthrography in a prospective and blinded study. A mixture of contrast medium (iodine-containing contrast medium and gadopentetate in relation 200 : 1) was injected into both radiocarpal and midcarpal joints. The following sequences were acquired on a 1.5T scanner: coronal T1-weighted SE, coronal fat-saturated T1-weighted SE, coronal T1-/T2*-DESS-3D, and sagittal T2*-weighted MEDIC. MRI results were compared with arthroscopic findings using statistical analysis (SEN = sensitivity, SPE = specificity, PPV = positive predictive value, NPV = negative predictive value, ACC = accuracy). RESULTS: In comparison to arthroscopy as the accepted diagnostic gold standard, the following results were found for MR arthrography. Detection of TFCC lesions: SEN 97.1 %, SPE 96.4 %, PPV 97.1 %, NPV 96.4 %, ACC 96.8 %. Detection of complete tears of the scapholunate ligament: SEN 91.7 %, SPE 100 %, PPV 100 %, NPV 99.1%, ACC 99.2%. Detection of partial tears: SEN 62.5 %, SPE 100 %, PPV 100 %, NPV 94.8 %, ACC 95.2 %. Detection of cartilage defects: SEN 84.2 %, SPE 96.2 %, PPV 80 %, NPV 97.1 %, ACC 94.4 %. In total, only three lesions of the lunotriquetral ligament were present. CONCLUSION: Direct MR arthrographic imaging is well suited for detecting intraarticular lesions of the wrist. The presented diagnostic results of MR arthrography are superior to the results of unenhanced MRI reported in the literature. Direct MR arthrography as a reliable diagnostic tool is strongly recommended if lesions of the scapholunate ligament and the triangular fibrocartilage complex are suspected. In contrast, an attitude of caution must be adopted in diagnosing lesions of the articular cartilage of the wrist.

Adolescent↗
PubMed2003

[Dynamic palmar instability of the ulnar head].

Despite obvious clinical symptoms, dynamic, palmar instability of the ulnar head remains a diagnostic and therapeutic problem. This is demonstrated by a case of chronic, palmar instability of the ulnar head after a tear of the triangular fibrocartilage complex (TFCC). A concomitant, minimal dorsal angulation of the radius after a fracture in childhood and a general capsulo-ligamentous laxity possibly were predisposing factors. Aspects of diagnostic and therapeutic options are discussed. In our case, due to secondary arthrosis, an arthrodesis of the distal radioulnar joint combined with a stabilization of the TFCC was opted for. Although the patient is painfree and mobile, she complains of a loss of power in supination. This salvage procedure probably could have been avoided by an earlier diagnosis.

Adult↗
PubMed2003

[Direct MR arthrography of the wrist- value in detecting complete and partial defects of intrinsic ligaments and the TFCC in comparison with arthroscopy].

PURPOSE: To assess the value of two-compartment magnetic resonance (MR) wrist arthrography in comparison with diagnostic arthroscopy for the evaluation of defects of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments in patients with refractory wrist pain. The direct MR arthrographies were evaluated following arthroscopic classification with consideration of complete and partial defects. The distinction between these types of lesions has clinical implications for treatment procedures such as cast immobilization, arthroscopic debridement, surgical repair or partial intercarpal arthrodesis. MATERIALS AND METHODS: Seventy-five patients (25 female, 50 males, mean age 38.3 years) who suffered from refractory wrist pain without radiography evidence of carpal instability underwent two-compartment wrist MR arthrography. Under aseptic conditions a solution of gadopentate dimeglumine and iodinated contrast agent (concentration 2.5 mmol/l) was injected into the radiocarpal and midcarpal joints under fluoroscopy guidance. Using a scanner of 1.5 T field strength and a wrist-coil following sequences were acquired: coronary and sagittal T (1)-weighted spin-echo (SE) sequences (TR 500 ms, TE 25 ms, matrix 512 x 512.3 mm) and coronary fast low angle shot (FLASH) 3D sequences (TR 24 ms, TE 11 ms, matrix 256 x 256, 1.5 mm, flip angle 50 degrees). All patients underwent subsequent arthroscopy of the wrist. The direct MR arthrographies were evaluated retrospectively by two observers experienced in the diagnosis of wrist pathology. They were not aware of the clinicial, arthrographic and arthroscopic findings. Pathology of the scapholunate ligament was classified according to the guidelines of the German Society of Hand Surgery (DGH), lesions of the lunotriquetral ligament according to Hempfling and lesions of the TFCC according to Palmer. RESULTS: Twenty-five complete and 47 partial defects were detected arthroscopically (TFCC: 21/20, scapholunate ligament: 3/18, lunotriquetral ligament: 1/9). The TFCC showed a higher prevalence for degenerative lesions (11 type 2C-lesions and 20 type 2A/B lesions) than for traumatic lesions (5 type 1A lesions, 5 type 1D lesions). For direct MR arthrography, the obtained sensitivities and specificities in assessing complete defects were 96 % and 99.6 % (T (1)-weighted SE) and 92 % and 100 % (FLASH 3D), respectively. For all partial defects, sensitivities and specificities were 68.1 % and 93.3 % (T (1)-weighted SE) and 63 % and 96.1 % (FLASH 3D), respectively. For depicting partial defects of the scapholunate ligament the T (1)-weighted SE sequence (83.3/95.5 %) was superior to the FLASH 3D sequence (64.7/96.6 %), p < 0.05. For the evaluation of the TFCC (T (1)-weighted SE: 65/94.4 %, FLASH 3D: 70/94.6 %) and the lunotriquetral ligament (T (1)-weighted SE: 44/89.4 %, FLASH 3D: 44 /96.7 %), direct MR arthrography showed an insufficient correlation with arthroscopy. CONCLUSION: Direct MR arthrography proved to be of equal value compared with diagnostic arthroscopy in detecting complete defects of the intrinsic ligaments and the TFCC. The method has the potential of replacing diagnostic arthroscopy for the evaluation of the intrinsic ligaments and the TFCC. The T (1)-weighted SE sequence appeared to be superior to the FLASH 3D sequence in evaluating partial defects of the scapholunate ligament. Direct MR arthrography did not reliably detect partial defects of the TFCC and the lunotriquetral ligament.

Adult↗
PubMed2004

3.0 T high-resolution MR imaging of carpal ligaments and TFCC.

PURPOSE: To determine the diagnostic value of 3.0 Tesla MRI for imaging carpal ligaments and triangular fibrocartilage complex (TFCC). Image quality of different optimized MRI sequences is evaluated for high resolution wrist anatomy. MATERIALS AND METHODS: Ten healthy volunteers were examined at 3.0 T and 1.5 T using following sequences: T1 SE, fat-saturated PD-/T2-TSE, TIRM, 3D T1/T2* DESS, 3D-CISS, 2D and 3D T2* MEDIC. Voxel size varied from 0.2 x 0.2 x 1.5 mm (2D sequences) to 0.33 mm (3) and 0.26 mm (3) (3D sequences). Image quality (signal-to-noise-ratio, contrast-to-noise-ratio, artifacts) and carpal ligament/TFCC detection rate were judged by a score. The results obtained from the 3.0 T and 1.5 T devices were compared. RESULTS: With identical voxel size, image matrix and FOV, 3.0 T MRI provided significantly better image quality and ligament detection rates for all sequences in comparison with 1.5 T. The 2D and 3D MEDIC sequences yielded best image quality and detection rates. Excellent image quality and visualization of ligament structures by the fat-suppressed PD-TSE sequence were compromised by a relatively high susceptibility to pulsation and motion artifacts. T1 SE and 3D DESS sequences gave moderate image quality and allowed only partial differentiation between ligament structures. TIRM, T2-TSE and 3D-CISS sequence proved to be unsuitable for examining ligaments at 3.0 T due to their poor image quality and detection rate. CONCLUSION: 3.0 T MRI of the wrist proved to be superior to 1.5 T MRI for high-resolution imaging of carpal ligaments and TFCC using 2D and 3D T2* MEDIC sequences. Clinical studies investigating ligament injuries or carpal instability are recommended for evaluating clinical relevance of high-resolution MRI of the wrist.

Cartilage, Articular↗
PubMed1990

[Arthrographic imaging of ganglions of the hand].

In the genesis of ganglions synovial herniation is discussed with an existence of a valve mechanism which prevents the synovial fluid from returning into the joint space. Arthrography of the wrist was performed in 34 patients with suspicion of ganglions on the dorsal and volar aspect of the wrist. By injection of contrast medium in 6 cases directly into the ganglion no connection with the carpal joint cavity was seen. On the contrary, wrist arthrography with examination of the midcarpal and radiocarpal joint showed regularly a communication by a torturous narrow duct between the midcarpal joint and the dorsal ganglion and the radiocarpal joint and the volar ganglion. Other pathologic findings were seen, like tears of the scapholunate ligament and of the triangular fibrocartilage. The consequences for surgical therapy and conclusions for the aetiology of the ganglions are shown.

Adolescent↗
PubMed1998

Sonography of the Wrist and Hand.

With the advent of new technical improvements and innovations, sonography is gaining ground in use and acceptance as a highly useful modality to diagnose a variety of diseases involving the wrist and the hand. Common ailments such as tendinitis and tenosynovitis can be diagnosed easily, and the diagnosis of small soft tissue masses such as ganglia has become almost routine. Sonography holds great promise in the evaluation of disease involving the median and the ulnar nerves, the ligaments of the wrist, and the triangular fibrocartilage. It is the ideal modality in the diagnosis of intra-articular loose bodies.

Journal Article↗
PubMed1995

New dorsal capsulotomy for the surgical exposure of the wrist.

A reliable, safe approach to the wrist through fiber-splitting dorsal capsulotomies has been developed. The dorsal wrist capsule is exposed by subperiosteally elevating the fourth and fifth extensor compartments ulnarly and translocating the extensor pollicis longus tendon with the radial wrist extensor tendons radially. The midcarpal joint and the radial half of the radiocarpal joint are exposed by longitudinally splitting the dorsal radiocarpal and dorsal intercarpal ligaments, with the apex at the triquetrum. The flap created is elevated radially, detaching the dorsal capsule from the radius to the level of the styloid process. For exposure of the ulnocarpal joint, the dorsal radiocarpal ligament is split longitudinally, and the capsule is incised along the extensor carpi ulnaris tendon subsheath proximally to the level of the triangular fibrocartilage, with the apex at the triquetrum. The flap created is elevated proximally. Exposure of the wrist is excellent, stability of the carpal bones is maintained, and closure is simplified using this approach.

Carpal Bones↗
PubMed1997

Chronic wrist pain.

Nonarticular chronic wrist pain continues to be a challenging subject in which interest and knowledge are increasing. Although many more excellent articles could have been included in this review, an attempt is made to discuss papers that have impact on the recognition, diagnosis, and treatment of various wrist problems. Developments in diagnostic algorithms and refinements in the use of imaging and arthroscopic tools are reviewed. Arthroscopy provides exciting direct visual information and therapeutic opportunities for triangular fibrocartilage complex disruptions and lunatotriquetral ligament pathology. A new carpal instability analysis system is proposed to allow better comparison of results reported in the literature. Comprehensive evaluation and treatment of the rheumatoid wrist are revisited. The effectiveness of operative treatment for midcarpal instability and distal radioulnar joint osteoarthritis continues to be assessed. Sports-related chronic wrist injuries from golf, trampolining, and gymnastics, as well as newer recreational activities such as in-line skating, are rapidly gaining the recognition they deserve.

Algorithms↗
PubMed1992

Meniscus-like synovial fold in the atlantoaxial (C1-C2) joint.

Some of the synovial joints in the human body have a fibrocartilaginous disc interposed between the joint surfaces to absorb or evenly distribute loads. Examples of fibrocartilagenous discs include the intervertebral disc, knee joint meniscus, and triangular fibrocartilages in the distal radioulnar joint and the acromioclavicular joints. The joint capsule and the surrounding tissue from nine cervical spines (18 C1-C2 joints) were dissected and prepared for gross examination and histology. We found meniscus-like synovial folds in 13 of the 18 atlantoaxial joints. These folds were located at the anteromedial and posteromedial aspect of the joint. Each synovial fold was of semilunar shape, with a thickened outer edge and thin inner edge giving a wedge-shape cross section. In one case, the synovial fold was grossly similar in appearance to a knee joint meniscus, and on histological examination there was evidence of cartilagenous metaplasia in part of the fold. The findings are compared with the limited data reported in the literature.

Aged↗
PubMed1996

A modified darrach procedure for treatment of the painful distal radioulnar joint.

Controversy exists regarding the best treatment for pain and instability of the distal radioulnar joint. Until recently, the Darrach distal ulnar resection had been the standard procedure for this disorder. The Bowers hemiresection interposition arthroplasty, however, and the Watson matched distal ulna resection have been developed to preserve the styloid attachment of the triangular fibrocartilage complex. This article presents a retrospective chart review of a consecutive series of patients who had painful distal radioulnar joints which were treated with a modified Darrach procedure. This procedure was performed to alleviate the problems of impingement and styloid carpal abutment during grip, and provide stabilization. Fifteen patients (16 wrists) were seen during followup for an average of 37 months after resection arthroplasty of the distal ulna was performed; 6 procedures were revisions. The results were uniformly good with marked alleviation of pain in all but 1 patient. Patients experienced consistent improvement toward pain-free pronation/supination and increased grip strength.

Adolescent↗
PubMed1998

Wrist arthrography after acute trauma to the distal radius: diagnostic accuracy, technique, and sources of diagnostic errors.

RATIONALE AND OBJECTIVES: The objective of this investigation was to determine the diagnostic accuracy of wrist arthrography in the detection of interosseous ligament disruptions and of triangular fibrocartilage complex (TFCC) lesions in patients after acute wrist trauma and to define the sources of diagnostic error of wrist arthrography after recent trauma. METHODS: Twenty-two patients with radial fractures after acute wrist trauma underwent arthrography and arthroscopy of the wrist. Arthrography was performed in a standardized manner by two- or three-compartment injection technique. Subsequently wrist arthroscopy was performed within the same session. Image analysis included the evaluation of interosseous carpal ligaments, the TFCC, and the osseous structures. RESULTS: In 22 patients, 11 injuries of the intrinsic ligaments and the TFCC were diagnosed by arthroscopy, of which 9 had been diagnosed correctly with arthrography before surgery. One scaphoid fracture previously missed on conventional radiographs also could be diagnosed by arthrography. CONCLUSION: Arthrography of the posttraumatic wrist is a valuable tool in the diagnostic evaluation of interosseous carpal ligaments and the TFCC.

Adult↗
PubMed2002

Condylar Stabilizing Technique with AO/ASIF Distal Radius Plate for Colles' Fracture Associated with Osteoporosis.

The author established a new reduction and fixation technique for osteoporotic distal radius fracture with a use of AO/ASIF volar distal radius plate, referring to the condylar plating technique in distal femoral fracture. This technique is performed in three steps. First, distal fixation is through the insertion of buttress pins just beneath the subchondral bone with a convergent angle of 10 degrees to the articular surface under fluoroscopic assistance. Second, the proximal limb of the plate is lined up with the radius shaft so that the fracture is reduced automatically and anatomically. Third, by rotating the proximal limb of the plate ulnarly and lifting up the ulnar border of the articular surface, the fracture is fixed less than the contralateral ulnar variance, to apply an adequate tension on the triangular fibrocartilage complex (TFCC). This method represents a valuable treatment modality for the most frequent types of unstable distal radius in elderly women.

Journal Article↗
PubMed2004

The dorsal approach to the distal radioulnar joint.

A number of different disorders or injuries require surgical intervention at the distal radioulnar joint. Depending on the underlying condition, the distal radioulnar joint is traditionally exposed via a dorsal or, less commonly, a palmar approach. Occasionally, as in the case of fractures of the distal ulna or ulnar styloid process, a lateral approach may be chosen. We describe an operative technique for a dorsal approach to the distal radioulnar joint that we have found to be extremely useful for a wide range of different pathologies. This technique not only allows excellent visualization of the head of the ulna and the distal radioulnar joint, but also the triangular fibrocartilage complex and the ulnocarpal joint as well. Furthermore, it provides a simple means of restoring normal alignment and stability to the distal radioulnar joint and the ulnar side of the carpus.

Journal Article↗
PubMed2004

Ligamentous stabilization of the distal radioulnar joint.

Instability of the distal radioulnar joint results from fracture and/or malunions of the forearm bones, disruption, or laxity of the ligaments of the triangular fibrocartilage. Such instability often-times is not diagnosed acutely and presents as a chronic problem. When these ligaments fail to heal adequately after injury, distal radioulnar joint instability develops into mechanical problems resulting in pain, limited range of motion, and decreased grip strength. In this case, reconstruction of the disrupted distal radioulnar joint ligaments is essential to restore proper function. In this presentation, a technique of ligament reconstruction using palmaris longus, plantaris, or toe extensor tendon graft is outlined with mid-term functional results.

Journal Article↗
PubMed2004

Assessment of articular displacement of distal radius fractures.

Intraarticular step and gap displacements represent the most common indication for surgical treatment of distal radius fractures. Most often, treatment decision making relies only on good-quality plain radiographs taken before and after reduction with measurement accuracy maximized by using the longitudinal axis method. When plain radiographs alone prove insufficient, CT scans or tomograms will significantly improve interobserver and intraobserver reliability of measurements, especially when evaluated using the arc method. Tomography is an effective method for postoperative evaluation of fractures immobilized in splints or casts. The role of MRI in assessing intraarticular distal radius fractures is limited to confirming injuries to carpal ligaments or the triangular fibrocartilage complex. Intraoperatively, we use fluoroscopy to obtain 30 degrees cephalad posteroanterior views and as 22 degrees lateral views to best observe articular surface reduction. Our current operative indications include fractures with radiocarpal or distal radioulnar joint step or gap deformities greater than 1-2 mm, gross distal radioulnar joint instability, or those with extensive metaphyseal comminution rendering them particularly unstable after closed reduction. In general, we tend to lean toward operative fixation in younger, more active patients.

Arthroscopy↗