MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain

Abstract

Background: The clinical picture of ulnar-sided wrist pain is oftentimes confusing because various pathologies may be coexistent. In this study, we aimed: (1) to compare the prevalence of potential causes of ulnar-sided wrist pain on magnetic resonance imaging (MRI) in patients who underwent triangular fibrocartilage complex (TFCC) repair and control subjects: and (2) to evaluate whether inferior clinical results were associated with specific patient characteristics or other potential causes of ulnar-sided wrist pain. Methods: We included 67 patients who underwent a TFCC repair and 67 control subjects. The MRI scans were examined for sources of ulnar-sided wrist pain. After TFCC repair, 42 patients (63%) completed surveys, including Quick Disabilities of the Arm, Shoulder and Hand and pain scores. Bivariate analysis was performed to compare our groups and to identify factors associated with our outcomes. Results: We found significantly higher rates of distal radioulnar joint (DRUJ) arthritis ( P = .033), extensor carpi ulnaris (ECU) pathology ( P = .028), and ulnar styloid fractures ( P = .028) in patients with TFCC repairs. With increasing age, increasing pathology in the pisotriquetral joint ( P = .040), more ulnocarpal abutment ( P = .0081), and more degenerative tears ( P < .001) were seen in both groups. No demographic characteristics or MRI findings were significantly associated with our outcomes. Conclusions: We observed higher rates of DRUJ arthritis and ECU pathology in patients with TFCC tears undergoing repair compared with age- and sex-matched controls. This may be due to damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery.

Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case–control study

“…Zhan et al (2020) reported three patients with peripheral (Palmer 1B) TFCC injuries and additional ECU pathology but did not study the association between these findings in their small sample [ 4 ]. Verhiel et al (2020) assessed 67 patients with TFCC tears and 67 controls with MRI and arthroscopy, concluding that ECU pathology and distal radioulnar joint arthritis are associated with TFCC tears [ 15 ]. In the most recent work, Kim et al (2021) studied the ECU tendon subluxation with 297 MRI cases; out of these, 111 cases had arthroscopic evaluation of TFCC.…”

A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders

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