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

Iris-M. Nöbauer-Huhmann; Michael Pretterklieber; Jochen Erhart; Peter Bär; Pavol Szomolanyi; Claudia Kronnerwetter; Susanna Lang; Klaus M. Friedrich; Siegfried Trattnig

doi:10.1055/s-0032-1311761

Seminars in Musculoskeletal Radiology, Table of Contents

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

¹Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.

²Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.

,

Michael Pretterklieber

³Department of Applied Anatomy, Medical University of Vienna, Vienna, Austria.

,

Jochen Erhart

⁴Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.

,

Peter Bär

⁵Siemens AG, Siemens Deutschland, Healthcare Sector, Erlangen, Germany.

,

Pavol Szomolanyi

¹Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.

⁶Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia.

,

Claudia Kronnerwetter

¹Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.

,

Susanna Lang

⁷Department of Pathology, Medical University of Vienna, Vienna, Austria.

,

Klaus M. Friedrich

¹Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.

²Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.

,

Siegfried Trattnig

¹Department of Radiology, MR Centre-Highfield MR, Medical University of Vienna, Vienna, Austria.

²Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.

› Author Affiliations

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

Full Text

References

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
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
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
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
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
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
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
8 Schwartz AM, Ruby LK. Wrist arthrography revisited. Orthopedics 1982; 5: 883-888
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
10 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (4) 594-606
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
12 Henle J. Handbuch der systematischen Anatomie des Menschen. Vol 1. Braunschweig, Germany: Druck und Verlag von Friedrich Vieweg und Sohn; 1871
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
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
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
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
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
18 Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat 1978; 126 (Pt 2) 367-384
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
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
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
22 Lewis OJ, Hamshere RJ, Bucknill TM. The anatomy of the wrist joint. J Anat 1970; 106 (Pt 3) 539-552
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
24 Garcia-Elias M. Soft-tissue anatomy and relationships about the distal ulna. Hand Clin 1998; 14 (2) 165-176
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
26 Resnick DL, Kang HS, Pretterklieber ML. Internal Derangements of Joints. Vol 2. Philadelphia, PA: Elsevier; 2006
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
28 De Smet L. Ulnar variance: facts and fiction review article. Acta Orthop Belg 1994; 60 (1) 1-9
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
30 De Smet L. Ulnar variance and its relationship to ligament injuries of the wrist. Acta Orthop Belg 1999; 65 (4) 416-417
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
32 Green DP, Hotchkiss RN, Pederson WC. Green's operative hand surgery. New York, NY: Churchill Livingstone; 1999
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
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
35 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201 (2) 495-500
36 Levinsohn EM, Rosen ID, Palmer AK. Wrist arthrography: value of the three-compartment injection method. Radiology 1991; 179 (1) 231-239
37 Escobedo EM, Bergman AG, Hunter JC. MR imaging of ulnar impaction. Skeletal Radiol 1995; 24 (2) 85-90
38 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (1) 126-129
39 Zlatkin MB, Greenan T. Magnetic resonance imaging of the wrist. Magn Reson Q 1992; 8 (2) 65-96
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