January Answers, Findings and Discussion

What is the salient abnormality?

1. Subperiosteal fluid collection
2. Fluid collection adjacent to the distal ulna
3. Hyperechoic mass adherent to interosseous membrane
4. Perforation of the interosseous membrane

What is the salient abnormality?

1. Subperiosteal fluid collection
2. Heterogeneous appearance in region of triangular fibrocartilage
3. Bone fragmentation
4. Chondrocalcinosis

Summary - Imaging Findings

What is your final diagnosis?

• Avulsion of ulnar styloid process
• Scaphoid fracture/dislocation
• Suspected rupture of TFCC
• Ulnar impaction syndrome

Discussion

Compartments of the Wrist

• Dorsal Extensor Compartments
• Wrist Joint Compartments

Wrist Joint Compartments

• The three sealed compartments:

1. Midcarpal
2. Radiocarpal
3. Distal Radioulnar

• Evaluated with arthrography:

1. Triple injection

Diagnosis of TFCC Injuries

• Radiology
  • Plain films
    • Insensitive
  • Ultrasound
    • Poor at assessing internal architecture of TFCC
    • Secondary signs in the acute setting
  • CT
    • Good
      • Combined with arthrographic technique
        • High rate of false negative and positives
  • MRI
    • Can display morphology of TFCC with high-resolution scans and arthrographic techinque
• Arthroscopy
  • Typically the gold standard

Treatment of TFCC Injuries

• Depends on functional demand
• Surgical for increased occupational and recreational demands

• Boesen M et al. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis. European Journal of Radiology Volume 69, Issue 2, February 2009, Pages 331–338
• Watanabe A et al. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol (2010) 39:837–857