Ulnar Wrist Pain Revisited: Ultrasound Diagnosis and Guided Injection for Triangular Fibrocartilage Complex Injuries

Abstract

The triangular fibrocartilage complex (TFCC) serves as the major stabilizer of the wrist. Its injuries can result from trauma or degeneration, both of which are strongly correlated with the loading stress on the ulnar shaft and carpal joints. The TFCC is made of the articular disc, meniscus homologue, ulnocarpal ligament, radioulnar ligament, ulnotriquetral ligament, ulnolunate ligament, and subsheath of the extensor carpi ulnaris tendon. Because of its complexity, it is challenging to confirm the exact component affected in TFCC injuries. The Palmer classification is widely used for investigation of TFCC lesions using magnetic resonance imaging. Recently, high-resolution ultrasound (US) has become more popular in diagnosing musculoskeletal disorders. However, the utility of US imaging in TFCC lesions is less common because its anatomy under US imaging is not described in the current literature. Accordingly, in this review, we aimed to propose a standard US scanning protocol for the TFCC, present relevant images for its pathologies, and illustrate appropriate US-guided injection techniques for their management.

Evaluation of Commercial Ropes Applied as Artificial Tendons in Robotic Rehabilitation Orthoses

“…In addition, there is the presence of spasticity, could cause postural changes in the upper limb, which, if not corrected it generate deformities, affecting even the joints and muscles viscoelastic properties and the tendons integrity. Therefore, based on the studies of Wu et al [43,44], we can use a high resolution ultrasound as an alternative to check these phenomena and select the most suitable cable to be used in robotic orthoses.…”

Sonoanatomy and Stepwise/Systematic Ultrasound Examination of the Extrinsic/Intrinsic Wrist Ligaments

“…Although magnetic resonance imaging has long been considered the gold standard for the evaluation of musculoskeletal injuries, its accessibility, portability, and capability for dynamic assessment are not comparable with those of US [7]. Several previously published US protocols have shown their practicality in scanning wrist tendons [8], nerves [9], and cartilages [10].…”

Artifacts in Musculoskeletal Ultrasonography: From Physics to Clinics

“…Owing to advantages like portability, real-time assessment [ 1 , 2 ], and absence of radiation, high-resolution ultrasound (US) has emerged as the most useful imaging tool [ 3 , 4 ] in the diagnosis [ 5 , 6 , 7 ] and guided treatment [ 8 , 9 ] of musculoskeletal disorders. In addition to getting acquainted with scanning skills and sonoanatomy [ 10 , 11 ], medical professionals should also be aware of basic US physics and avoid or tackle the artifacts occurring during imaging.…”