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Semin Musculoskelet Radiol 2012; 16(02): 093-103
DOI: 10.1055/s-0032-1311761
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anatomy and Variants of the Triangular Fibrocartilage Complex and Its MR Appearance at 3 and 7T

Iris-M. Nöbauer-Huhmann
1   Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.
2   Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
,
Michael Pretterklieber
3   Department of Applied Anatomy, Medical University of Vienna, Vienna, Austria.
,
Jochen Erhart
4   Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
,
Peter Bär
5   Siemens AG, Siemens Deutschland, Healthcare Sector, Erlangen, Germany.
,
Pavol Szomolanyi
1   Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.
6   Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia.
,
Claudia Kronnerwetter
1   Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.
,
Susanna Lang
7   Department of Pathology, Medical University of Vienna, Vienna, Austria.
,
Klaus M. Friedrich
1   Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.
2   Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
,
Siegfried Trattnig
1   Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.
2   Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
› Author Affiliations
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Publication History

Publication Date:
30 May 2012 (online)

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Abstract

Due to the small size and complexity of its constituents, the triangular fibrocartilage complex (TFCC) has been a challenging structure for magnetic resonance (MR) imaging. Higher-field MR units, at 3T and 7T, with increased spatial resolution and the development of novel MR sequences, are promising tools for an improved visualization of the ulnocarpal complex. Anatomically, the TFCC consists of the TFC proper, the ulnomeniscal homolog, the ulnar collateral ligament, the ulnotriquetral and ulnolunate ligament, and radioulnar ligaments at the volar (palmar) and the dorsal side, as well as the sheath of the extensor carpi ulnaris tendon and the capsule of the distal radioulnar joint. This article describes the normal anatomy of the TFCC and its appearance on high-field MRI. Anatomical variants, such as the positive ulnar variance, and changes during pronation and supination are addressed.

Keywords

triangular fibrocartilage complex - TFCC - anatomy - 7 Tesla - MRI
 

  • References

  • 1 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am 1981; 6 (2) 153-162
    CrossrefPubMedGoogle Scholar
  • 2 Lenk S, Ludescher B, Martirosan P, Schick F, Claussen CD, Schlemmer HP. 3.0 T high-resolution MR imaging of carpal ligaments and TFCC. Rofo 2004; 176 (5) 664-667
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Stehling C, Bachmann R, Langer M, Nassenstein I, Heindel W, Vieth V. High-resolution magnetic resonance imaging of triangular fibrocartilage complex lesions in acute wrist trauma: image quality at different field strengths. J Comput Assist Tomogr 2009; 33 (4) 579-583
    CrossrefPubMedGoogle Scholar
  • 4 Anderson ML, Skinner JA, Felmlee JP, Berger RA, Amrami KK. Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. J Hand Surg Am 2008; 33 (7) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 5 Pfirrmann CWA, Theumann NH, Chung CB, Botte MJ, Trudell DJ, Resnick D. What happens to the triangular fibrocartilage complex during pronation and supination of the forearm? Analysis of its morphology and diagnostic assessment with MR arthrography. Skeletal Radiol 2001; 30 (12) 677-685
    CrossrefPubMedGoogle Scholar
  • 6 Guntern D, Becce F, Richarme D, Palhais NS, Meuli R, Theumann N. Direct magnetic resonance arthrography of the wrist with axial traction: a feasibility study to assess joint cartilage. J Magn Reson Imaging 2011; 34 (1) 239-244
    CrossrefPubMedGoogle Scholar
  • 7 Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 2009; 192 (1) 80-85
    CrossrefPubMedGoogle Scholar
  • 8 Schwartz AM, Ruby LK. Wrist arthrography revisited. Orthopedics 1982; 5: 883-888
    PubMedGoogle Scholar
  • 9 Gilula LA, Hardy DC, Totty WG, Reinus WR. Fluoroscopic identification of torn intercarpal ligaments after injection of contrast material. AJR Am J Roentgenol 1987; 149 (4) 761-764
    CrossrefPubMedGoogle Scholar
  • 10 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (4) 594-606
    CrossrefPubMedGoogle Scholar
  • 11 Totterman SMS, Miller RJ. Triangular fibrocartilage complex: normal appearance on coronal three-dimensional gradient-recalled-echo MR images. Radiology 1995; 195 (2) 521-527
    PubMedGoogle Scholar
  • 12 Henle J. Handbuch der systematischen Anatomie des Menschen. Vol 1. Braunschweig, Germany: Druck und Verlag von Friedrich Vieweg und Sohn; 1871
    Google Scholar
  • 13 Metz VM, Mann FA, Gilula LA. Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications. AJR Am J Roentgenol 1993; 160 (4) 819-822
    CrossrefPubMedGoogle Scholar
  • 14 Metz VM, Mann FA, Gilula LA. Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography. AJR Am J Roentgenol 1993; 160 (6) 1239-1243
    CrossrefPubMedGoogle Scholar
  • 15 Bednar MS, Arnoczky SP, Weiland AJ. The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg Am 1991; 16 (6) 1101-1105
    CrossrefPubMedGoogle Scholar
  • 16 Jantea CL, Baltzer A, Rüther W. Arthroscopic repair of radial-sided lesions of the triangular fibrocartilage complex. Hand Clin 1995; 11 (1) 31-36
    PubMedGoogle Scholar
  • 17 Friedrich KM, Chang G, Vieira RLR , et al. In vivo 7.0-tesla magnetic resonance imaging of the wrist and hand: technical aspects and applications. Semin Musculoskelet Radiol 2009; 13 (1) 74-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat 1978; 126 (Pt 2) 367-384
    PubMedGoogle Scholar
  • 19 Zlatkin MB, Rosner J. MR imaging of ligaments and triangular fibrocartilage complex of the wrist. Radiol Clin North Am 2006; 44 (4) 595-623 , ix
    CrossrefPubMedGoogle Scholar
  • 20 Zlatkin MB, Chao PC, Osterman AL, Schnall MD, Dalinka MK, Kressel HY. Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology 1989; 173 (3) 723-729
    PubMedGoogle Scholar
  • 21 Ishii S, Palmer AK, Werner FW, Short WH, Fortino MD. An anatomic study of the ligamentous structure of the triangular fibrocartilage complex. J Hand Surg Am 1998; 23 (6) 977-985
    CrossrefPubMedGoogle Scholar
  • 22 Lewis OJ, Hamshere RJ, Bucknill TM. The anatomy of the wrist joint. J Anat 1970; 106 (Pt 3) 539-552
    PubMedGoogle Scholar
  • 23 Nishikawa S, Toh S. Anatomical study of the carpal attachment of the triangular fibrocartilage complex. J Bone Joint Surg Br 2002; 84 (7) 1062-1065
    CrossrefPubMedGoogle Scholar
  • 24 Garcia-Elias M. Soft-tissue anatomy and relationships about the distal ulna. Hand Clin 1998; 14 (2) 165-176
    PubMedGoogle Scholar
  • 25 Buck FM, Gheno R, Nico MA, Haghighi P, Trudell DJ, Resnick D. Ulnomeniscal homologue of the wrist: correlation of anatomic and MR imaging findings. Radiology 2009; 253 (3) 771-779
    CrossrefPubMedGoogle Scholar
  • 26 Resnick DL, Kang HS, Pretterklieber ML. Internal Derangements of Joints. Vol 2. Philadelphia, PA: Elsevier; 2006
    Google Scholar
  • 27 Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am 1984; 9 (5) 681-682
    CrossrefPubMedGoogle Scholar
  • 28 De Smet L. Ulnar variance: facts and fiction review article. Acta Orthop Belg 1994; 60 (1) 1-9
    PubMedGoogle Scholar
  • 29 Cerezal L, del Piñal F, Abascal F, García-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002; 22 (1) 105-121
    CrossrefPubMedGoogle Scholar
  • 30 De Smet L. Ulnar variance and its relationship to ligament injuries of the wrist. Acta Orthop Belg 1999; 65 (4) 416-417
    PubMedGoogle Scholar
  • 31 Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy. J Hand Surg [Br] 1998; 23 (6) 754-757
    CrossrefPubMedGoogle Scholar
  • 32 Green DP, Hotchkiss RN, Pederson WC. Green's operative hand surgery. New York, NY: Churchill Livingstone; 1999
    Google Scholar
  • 33 Epner RA, Bowers WH, Guilford WB. Ulnar variance—the effect of wrist positioning and roentgen filming technique. J Hand Surg Am 1982; 7 (3) 298-305
    PubMedGoogle Scholar
  • 34 Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am 1993; 18 (4) 713-716
    CrossrefPubMedGoogle Scholar
  • 35 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201 (2) 495-500
    PubMedGoogle Scholar
  • 36 Levinsohn EM, Rosen ID, Palmer AK. Wrist arthrography: value of the three-compartment injection method. Radiology 1991; 179 (1) 231-239
    PubMedGoogle Scholar
  • 37 Escobedo EM, Bergman AG, Hunter JC. MR imaging of ulnar impaction. Skeletal Radiol 1995; 24 (2) 85-90
    PubMedGoogle Scholar
  • 38 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (1) 126-129
    PubMedGoogle Scholar
  • 39 Zlatkin MB, Greenan T. Magnetic resonance imaging of the wrist. Magn Reson Q 1992; 8 (2) 65-96
    PubMedGoogle Scholar
  • 40 Chiang CC, Chang MC, Lin CF, Liu Y, Lo WH. Computerized tomography in the diagnosis of subluxation of the distal radioulnar joint. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61 (12) 708-715
    PubMedGoogle Scholar