Motion Analysis of Triangular Fibrocartilage Complex by Using Ultrasonography Images: Preliminary Analysis

Abstract

The triangular fibrocartilage complex (TFCC) is a significant stabilizer of the distal radioulnar joint. Diagnosing TFCC injury is currently difficult, but ultrasonography (US) has emerged as a low-cost, minimally invasive diagnostic tool. We aimed to quantitatively analyze TFCC by performing motion analysis by using US. Twelve healthy volunteers, comprising 24 wrists (control group), and 15 patients with TFCC Palmer type 1B injuries (injury group) participated. The US transducer was positioned between the ulnar styloid process and triquetrum and was tilted ulnarly 30° from the vertical line. The wrist was then actively moved from 10° of radial deviation to 20° of ulnar deviation in a 60-rounds-per-minute rhythm that was paced by a metronome. The articular disc displacement velocity magnitude was analyzed by using particle image velocimetry fluid measurement software. The mean area of the articular discs was larger on ulnar deviation in the control group. The mean articular disc area on radial deviation was larger in the injury group. The average articular disc velocity magnitude for the injury group was significantly higher than that for the control group. The results suggest that patients with TFCC injury lose articular disc cushioning and static stability, and subsequent abnormal motion can be analyzed by using US.

Motion Analysis of the Extensor Carpi Ulnaris in Triangular Fibrocartilage Complex Injury Using Ultrasonography Images

“…In all cases, the tendon had a single curve with convexity on the deep side at the level of the articular disk; thus, the results indicated that the apex of the curve of the tendon in the injury group was located on the deeper side during Max UD. This was similar to the movement of the articular disk, which also migrated to the deeper side in the UD position in the TFCC injury group [ 12 ].…”

“…Patients with TFCC injuries other than Palmer type 1B injuries were excluded from the study. The sample size was determined by power analysis based on data from the pilot study [ 12 ], using G*Power 3.1. Prior sample size calculations showed that a difference in velocimetry of ECU was detectable in the two groups with a sample size of 36 participants (18 participants in each group), using the t-test (effect size = 0.99, α = 0.05, power = 0.8).…”

“…We identified the ECU in US long-axis images of the TFCC according to Wu et al’s protocol [ 15 ] ( Figure 1 ). Participants actively moved their wrists from 15° of RD (Max RD) to 25° of UD (Max UD) at a 60-rounds-per-minute rhythm paced by a metronome in a pronation and dorsiflexion neutral position, and we recorded videos at 30 frames per second, as reported previously [ 12 ].…”

“…In recent years, ultrasonography (US) has been increasingly used for diagnosis and treatment because it is a low-cost and minimally invasive modality that enables dynamic evaluation in vivo. To date, there are a few US evaluation reports of ECU tendon dislocation analyzed in the short-axis view [ 9 , 10 , 11 ] and one report that analyzed ECU movement in the long-axis view, which compared a TFCC injury group with a control group [ 12 ]. The study showed that the magnitude velocity of the ECU in TFCC injury patients was significantly higher than that in healthy volunteers.…”

“…PIV has been used to detect a decrease in the gliding properties of the vastus lateralis and subcutaneous tissue in patients with residual pain after trochanteric fracture surgery. Previous studies have reported on the high reliability and reproducibility of the PIV method [ 12 , 13 ].…”