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Case 33 - Triangular fibrocartilage (TFC): tear versus fenestration

from Section 5 - Wrist

Published online by Cambridge University Press:  05 July 2013

D. Lee Bennett
Affiliation:
University of Iowa
Georges Y. El-Khoury
Affiliation:
University of Iowa
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Summary

Imaging description

A triangular fibrocartilage (TFC) tear appears as a linear band of increased signal intensity (Figure 33.1). With complete tears the signal extends to the proximal and distal articular surfaces. MR imaging may demonstrate an asymptomatic defect of the TFC (Figure 33.2).

Importance

With increasing age, defects and central communication within the TFC increase in frequency. Non-communicating TFC defects are worthwhile to record specifically because they can be associated more reliably with symptomatic wrists than communicating TFC defects. Non-communicating and communicating defects of the TFC near the ulnar attachment have a more reliable association with symptomatic wrists than do radial communicating defects.

Typical clinical scenario

Patients with a TFC tear present with ulnar-sided pain. The radial-sided communicating TFC defects are commonly seen bilaterally and in asymptomatic wrists.

Differential diagnosis

Differential diagnosis includes TFC tear, asymptomatic defects, and pseudotear.

Teaching point

There are no specific differentiating features on MR imaging separating a traumatically induced tear of the TFC from one caused by degeneration. The appearance of these lesions may also be similar in symptomatic and asymptomatic individuals; therefore, determining the clinical relevance of these lesions and their correlation with patients’ symptoms may be difficult.

Type
Chapter
Information
Pearls and Pitfalls in Musculoskeletal Imaging
Variants and Other Difficult Diagnoses
, pp. 69 - 70
Publisher: Cambridge University Press
Print publication year: 2013

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References

Metz, VM, Schratter, M, Dock, WI et al. Age-associated changes of the triangular fibrocartilage of the wrist: evaluation of the diagnostic performance of MR imaging. Radiology 1992;184:217–220.CrossRefGoogle ScholarPubMed
Pfirrmann, CW, Zanetti, M.Variants, pitfalls and asymptomatic findings in wrist and hand imaging. Eur J Radiol 2005;56:286–295.CrossRefGoogle ScholarPubMed
Zanetti, M, Linkous, MD, Gilula, LA, Hodler, J.Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists. Radiology 2000;216:840– 845.CrossRefGoogle ScholarPubMed
Zlatkin, MB, Chao, PC, Osterman, AL et al. Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology 1989;173:723–729.CrossRefGoogle ScholarPubMed
Zlatkin, MB, Rosner, J.MR imaging of ligaments and triangular fibrocartilage complex of the wrist. Radiol Clin North Am 2006;44:595–623.CrossRefGoogle ScholarPubMed

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