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1.
Bone Joint J ; 105-B(1): 5-10, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36587253

RESUMO

Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.Cite this article: Bone Joint J 2023;105-B(1):5-10.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Traumatismos do Punho , Humanos , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho , Ulna , Artroscopia/métodos , Ruptura
2.
Arthroscopy ; 39(1): 39-40, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36543420

RESUMO

The ulnar-sided wrist contains multiple potential pain generators that may present in isolation. Occasionally, however, wrist trauma results in multiple concurrent and overlapping injuries that make diagnosis and treatment of these conditions challenging. Deep/foveal tears of the triangular fibrocartilage complex (TFCC) may occur in the setting of nonunited ulnar styloid process fractures. Treatment of these injuries has historically included open TFCC repair with fixation or excision of the ulnar styloid fracture nonunion fragment; however, recent literature suggests that addressing the ulnar styloid nonunion fragment may not be as important as we think. Recent research shows that we may not need to excise or repair the ulnar styloid fracture nonunion fragment, which in turn may help preserve the complex ligamentous architecture that stabilizes the ulnar-sided wrist. One thing we know for sure is that foveal tears of the deep fibers of the TFCC, with or without ulnar styloid fracture (Palmer 1B, Atzei class 2 or 3), can produce distal radioulnar joint (DRUJ) instability and wrist dysfunction and should be addressed sooner rather than later to prevent long-term consequences, including DRUJ osteoarthritis. Whether you choose to approach the problem arthroscopically or open, the foveal TFCC tear should be repaired to prevent long-term sequalae.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Fraturas da Ulna , Traumatismos do Punho , Humanos , Fibrocartilagem Triangular/lesões , Resultado do Tratamento , Articulação do Punho , Fraturas da Ulna/complicações , Fraturas da Ulna/cirurgia , Ulna , Traumatismos do Punho/complicações , Traumatismos do Punho/cirurgia , Instabilidade Articular/cirurgia
3.
J Hand Surg Am ; 47(1): 19-30.e8, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34481677

RESUMO

PURPOSE: Pathology of the triangular fibrocartilage complex is a prevalent cause of ulnar-sided wrist pain that presents a diagnostic challenge. We hypothesized that a history and physical examination (H&P) would be more cost-effective alone or with diagnostic injection than with magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) in the diagnosis and treatment of a symptomatic triangular fibrocartilage complex abnormality. METHODS: A simple-chain decision analysis model was constructed to assess simulated subjects with ulnar-sided wrist pain and normal radiographs using several diagnostic algorithms: H&P alone, H&P + injection, H&P with delayed advanced imaging (MRI or MRA), and H&P + injection with delayed advanced imaging (MRI or MRA). Three years after diagnosis, effectiveness was calculated in Disabilities of the Arm, Shoulder, and Hand-adjusted life years. Costs were extracted from a commercial insurance database using US dollars. A probabilistic sensitivity analysis with 10,000 second-order trials with sampling of parameter distributions was performed. One-way and 2-way sensitivity analyses were performed. RESULTS: All strategies had similar mean effectiveness between 2.228 and 2.232 Disabilities of the Arm, Shoulder, and Hand-adjusted life years, with mean costs ranging from $5,584 (H&P alone) to $5,980 (H&P, injection, and MRA). History and physical examination alone or with injection were the most cost-effective strategies. History and physical examination alone was the most preferred diagnostic strategy, though H&P + injection and H&P with delayed MRA were preferred with adjustments in willingness-to-pay and parameter inputs. As willingness-to-pay increased considerably (>$65,000 per Disabilities of the Arm, Shoulder, and Hand-adjusted life year), inclusion of MRA became the most favorable strategy. CONCLUSIONS: Advanced imaging adds costs and provides minimal increases in effectiveness in the diagnosis and treatment of a symptomatic triangular fibrocartilage complex abnormality. The most cost-effective strategy is H&P, with or without diagnostic injection. Magnetic resonance arthrogram may be favored in situations with a high willingness-to-pay or poor examination characteristics. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analysis IV.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Artrografia , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Exame Físico , Fibrocartilagem Triangular/diagnóstico por imagem , Ulna , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
4.
Acta Clin Croat ; 61(1): 129-137, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36398086

RESUMO

The aim was to analyze patients with clinical diagnosis of triangular fibrocartilage complex (TFCC) lesion using standard x-ray, ultrasound, conventional magnetic resonance imaging (MRI) and MR arthrography (MRA); to evaluate the accuracy of MRA compared with MRI in the diagnosis of this lesion; and to evaluate ultrasound as a method of diagnosing TFCC lesion. We analyzed 72 patients (46 female and 26 male; age range, 22-61 years; mean age 37 years; 50 right and 22 left wrists) with suspected TFCC lesion with clinical examination, standard x-rays, and ultrasound. We confirmed patients with traumatic TFCC injury on MRI and MRA. Ultrasound found 13 lesions in 72 patients with suspected TFCC lesions. Conventional MRI found 66 and MRA 68 TFCC lesions. Ultrasound is useful for visualizing intra-articular effusion, soft tissue, bone surface, and for early detection of occult fractures. MRI is a better diagnostic modality, fully able to visualize the TFCC cartilage and ligaments. MRA is consistently and accurately able to visualize structural abnormalities of TFCC.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/patologia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/patologia , Artrografia , Imageamento por Ressonância Magnética/métodos , Ligamentos/diagnóstico por imagem , Ligamentos/lesões , Ligamentos/patologia
5.
Sensors (Basel) ; 22(21)2022 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-36365914

RESUMO

The subsheath of the extensor carpi ulnaris (ECU) tendon, a component of the triangular fibrocartilage complex (TFCC), is particularly important as it dynamically stabilizes the distal radioulnar joint. However, the relationship between TFCC injury and ECU dynamics remains unclear. This study aimed to analyze ECU movement and morphology using ultrasonography (US) images. Twenty wrists of patients with TFCC injury, who underwent TFCC repair, were included in the injury group, and 20 wrists of healthy volunteers were in the control group. For static image analysis, curvature and linearity ratios of the ECU in US long-axis images captured during radioulnar deviation were analyzed. For dynamic analysis of the ECU, the wrist was moved from radial deviation to ulnar deviation at a constant speed, and the velocity of the tendon was analyzed using particle image velocimetry. The static analysis showed that the ECU tendon was more curved in ulnar deviation in the injury group than in the control group, and the dynamic analysis showed that only vertical velocity toward the deep side during ulnar deviation was higher in the injury group. These results suggest that TFCC injury caused ECU curvature during ulnar deviation and increased the vertical velocity of the ECU during wrist deviation.


Assuntos
Fibrocartilagem Triangular , Humanos , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Articulação do Punho/diagnóstico por imagem , Tendões/diagnóstico por imagem , Antebraço , Ultrassonografia
6.
Jt Dis Relat Surg ; 33(3): 658-665, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345195

RESUMO

The stability of distal radioulnar joints is afforded by bony radioulnar articulation and peripheral soft-tissue stabilizers. The primary soft-tissue stabilizers are structures that surround the distal radioulnar joint and are collectively referred to as the triangular fibrocartilaginous complex. Among the stabilizers, the volar and dorsal radioulnar ligaments contribute the most to the stability of distal radioulnar joints. For acute traumatic distal radioulnar joint instability accompanied by purely ligamentous injury, traditional surgical treatments involve the repair or reconstruction of the distal radioulnar ligament; however, these intra-articular procedures are highly invasive and difficult. The extra-articular reconstruction of the secondary stabilizer such as the distal oblique bundle of the interosseous membrane has attracted significant attention in recent years; however, most studies have only conducted cadaveric or laboratory modelbased investigations. In this article, we present three patients who suffered from acute dorsal wrist pain after a trauma event. Radiographic and physical examinations revealed distal radioulnar joint instability. All patients were treated with minimally invasive suture-button suspension augmentation in the direction of distal oblique bundle of the interosseous membrane. The instability was resolved after the surgical procedure, but two patients developed ulnar wrist pain and one patient underwent implant removal. All patients have been continually followed at our outpatient department and exhibited stable wrists, despite mild limitation in the range of motion after the procedure. In conclusion, acute traumatic distal radioulnar joint instability may be sufficiently treated with suture-button suspension for augmentation of the distal oblique bundle; however, some obstacles impede the in vivo adoption of this treatment.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Humanos , Instabilidade Articular/cirurgia , Membrana Interóssea , Fibrocartilagem Triangular/cirurgia , Suturas , Dor
7.
J Hand Surg Eur Vol ; 47(11): 1128-1133, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36071642

RESUMO

Distal oblique bundle (DOB) reinforcement for treatment of post-traumatic bidirectional instability of the distal radioulnar joint (DRUJ) has previously been reported. The objective of the current study was to assess the incidence of symptomatic graft failure and the need for secondary wrist procedures at a longer follow-up in an updated patient cohort of 27 patients with 28 DOB reinforcement procedures. Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and patient-rated wrist/hand evaluation (PRWHE) outcome measures were also evaluated. At median 82 months follow-up, pre- to postoperative QuickDASH score improved from a mean of 62 (SD 14) to 31 (SD 22) (p < 0.01) and PRWHE score from a mean of 67 (SD 17) to 34 (SD 23) (p < 0.01). Symptomatic graft failure with resultant painful DRUJ instability occurred in four out of 28 procedures, which was better than the published results of alternative surgical options for DRUJ instability. DOB reinforcement presents a relatively safe, effective and durable method for treatment of post-traumatic DRUJ instability.Level of evidence: III.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Traumatismos do Punho , Humanos , Articulação do Punho/cirurgia , Instabilidade Articular/etiologia , Estudos de Coortes , Traumatismos do Punho/cirurgia , Fibrocartilagem Triangular/cirurgia
8.
Handchir Mikrochir Plast Chir ; 54(5): 399-408, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-36130598

RESUMO

At the distal radioulnar joint (DRUJ) and the ulnocarpal joint several anatomical structures are in a limited space. Therefore, the operative approach has to consider the pathology to be treated. The DRUJ may be approached from the dorsal or the palmar side. Procedures to treat the arthrotically destroyed DRUJ involving bone resection of the ulnar head and destabilizing ligamentous injuries of the triangular fibrocartilage complex (TFCC) are best approached from the dorsal side. This approach allows excellent visualization of the ulnar head and the ulnar and radial attachment of the TFCC. The arthroscopic, half open refixation of the ulnar avulsion of the TFCC may be performed using a variety of limited and small approaches over the dorsal or lateral ulnar head. Pathologies with an origin at the palmar aspect of the DRUJ as the palmar dislocation of the ulnar head in the DRUJ or the shrinkage and scaring of the palmar capsule with consecutive pronation contracture require a palmar approach. Reduction and osteosynthesis of fractures in the area of the ulnar head are preformed using a lateral approach along the styloid process and the ulnar head between the flexor and the extensor carpi ulnaris tendons. Along the ulnar shaft elective ulnar shortening osteotomy as well as fracture reduction and osteosynthesis are best performed from an ulno palmar approach.


Assuntos
Fraturas do Rádio , Fibrocartilagem Triangular , Fraturas da Ulna , Humanos , Rádio (Anatomia) , Fraturas do Rádio/cirurgia , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/cirurgia , Ulna/cirurgia , Fraturas da Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
9.
JBJS Case Connect ; 12(2)2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099448

RESUMO

CASE: A 34-year-old farmer and railroad worker injured his left wrist when working at a railroad. The resulting dorsal-ulnar wrist blow caused disabling pain. Splits and 2 subsequent surgeries failed, including an arthroscopic triangular fibrocartilage complex (TFCC) debridement and thermal ablation. Subsequently, magnetic resonance imaging documented a rare Palmer type 1C distal TFCC avulsion. Function was restored and return to farming permitted by reconstruction of the ulnotriquetral (UT) ligament using an extensor carpi ulnaris (ECU) slip. CONCLUSION: Chronic Palmer type 1C TFCC injuries can be successfully treated with ECU reconstruction of the UT ligament.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Adulto , Humanos , Imageamento por Ressonância Magnética , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Punho/patologia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/patologia
10.
Arthroscopy ; 38(8): 2425-2426, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940740

RESUMO

Accurate diagnosis of the etiology of ulnar-sided wrist pain and injury to the triangular fibrocartilage complex, particularly Palmar 1B tears, can prove to be challenging. Multiple peer-reviewed studies have demonstrated that accurate diagnosis and treatment of tears of the triangular fibrocartilage complex through nonoperative and operative means, including arthroscopy, can result in improved patient outcomes and function. One of the keys to successful treatment, however, is accurate diagnosis. While our current imaging modalities help to provide additional data for the assessment of this pathology, magnetic resonance imaging and computed tomography scans have limitations. Thus, employing the power of artificial intelligence and deep learning to ultrasound assessment of this injury is appealing. Efficient integration of this technology into daily practice has potential to bolster diagnostics not only in large medical centers but also in underserved areas with limited access to magnetic resonance imaging and computed tomography.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Artroscopia , Inteligência Artificial , Humanos , Imageamento por Ressonância Magnética/métodos , Fibrocartilagem Triangular/lesões , Punho/patologia , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho
11.
J Hand Surg Am ; 47(9): 843-854, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35870958

RESUMO

PURPOSE: Open and percutaneous denervation is an emerging technique for joint pain. This study investigated the course and distribution of the articular branches innervating the triangular fibrocartilage complex (TFCC), distal radioulnar joint (DRUJ), and radiocarpal joint (RCJ) relative to bony and soft tissue landmarks to guide wrist denervation procedures. METHODS: Fourteen formalin-embalmed specimens were serially dissected to expose the origin, course, and distribution of articular branches innervating the TFCC, DRUJ, and RCJ. Bony and soft tissue landmarks to localize each articular branch were documented and visualized on a 3-dimensional reconstruction of the bones of the distal forearm and hand. RESULTS: The TFCC was innervated by articular branches from the posterior interosseus nerve (10 of 14 specimens), dorsal cutaneous branch of the ulnar nerve (14 of 14 specimens), palmar cutaneous branch of the ulnar nerve (12 of 14 specimens), and medial antebrachial cutaneous nerve (9 of 14 specimens). The DRUJ was innervated by the posterior interosseus nerve (9 of 14 specimens) and anterior interosseus nerve (14 of 14 specimens). The RCJ was innervated by the posterior interosseus nerve (14 of 14 specimens), superficial branch of the radial nerve (5 of 14 specimens), lateral antebrachial cutaneous nerve (14 of 14 specimens), and palmar cutaneous branch of the median nerve (10 of 14 specimens). CONCLUSIONS: Multiple nerves were found to innervate the TFCC, DRUJ, and RCJ. The relationship of anatomical landmarks to specific articular branches supplying the TFCC, DRUJ, and RCJ can inform selective denervation procedures based on the structural origin of pain. CLINICAL RELEVANCE: The detailed documentation of the spatial relationship of the nerve supply to the wrist provides clinicians with the anatomical basis to optimize current, and develop new denervation protocols to manage chronic wrist pain.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Artralgia/cirurgia , Denervação/métodos , Humanos , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/cirurgia , Articulação do Punho/inervação , Articulação do Punho/cirurgia
12.
BMC Musculoskelet Disord ; 23(1): 634, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35788222

RESUMO

BACKGROUND: Foveal tears of the traumatic triangular fibrocartilage complex (TFCC) are the most commonly neglected high-energy injuries of the wrist joint, and the patients with such tears often experience unrecovered ulnar-sided wrist pain and poor wrist function. This study investigated the functional outcomes of patients who underwent arthroscopic repair of foveal TFCC tears with suture anchors and adjuvant platelet-rich plasma (PRP) injections after the surgery. METHODS: From September 2014 to August 2018, 156 men and 45 women with diagnoses of foveal TFCC tears without wrist fractures underwent arthroscopic repair by using the outside-in method with 1.3-mm suture anchors and subsequent PRP injection. After surgery, splinting was applied for 6 weeks, and the patients underwent rehabilitation, re-examination, and follow-up at our clinic. The patients' wrist functional scores and grip strength data were retrospectively collected. RESULTS: The mean follow-up period was 32.6 months, and the mean age was 26.7 years. The mean modified Mayo wrist score improved from 48.5 ± 2.6 to 82.4 ± 2.5, whereas the mean Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 39.2 ± 6.7 to 10.6 ± 7.5. Overall, the wrist functions of 186 (92.5%) of the patients were satisfactory according to their modified Mayo wrist scores, and the patients with satisfactory scores returned to sports or work activities. These patients retained normal ranges of motion, and their average grip strength in the affected hand was restored to at least 85% of that of the other hand. CONCLUSIONS: According to the postoperative 25-36 months surgical results of our study, arthroscopic repair with adjuvant PRP injections is a satisfactory method of repairing early foveal tears of the TFCC and can enhance wrist function by relieving pain and increasing tolerance for work or sports.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Adulto , Artroscopia/métodos , Feminino , Humanos , Masculino , Dor , Estudos Retrospectivos , Âncoras de Sutura , Resultado do Tratamento , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/cirurgia
13.
Acta Orthop ; 93: 574-582, 2022 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-35727109

RESUMO

BACKGROUND AND PURPOSE: Foveal triangular fibrocartilage complex (TFCC) lesion may cause distal radioulnar joint (DRUJ) instability. Dynamic radiostereometry (dRSA) has been validated for objective measurement of DRUJ kinematics. We evaluated DRUJ kinematics by dRSA before surgery and 12 months following open foveal reinsertion of the TFCC in comparison with contralateral non-injured DRUJs. PATIENTS AND METHODS: In a prospective cohort study, 21 patients (11 men) of mean age 34 years (22-50) with arthroscopically confirmed foveal TFCC lesion were evaluated preoperatively, and at 6 and 12 months after open foveal TFCC reinsertion with QDASH, PRWE, pain on NRS, and bilateral dRSA imaging during a patient active press test motion cycle, including a force-loaded downstroke and a release phase. RESULTS: Preoperatively, the force-loaded part (> 2.3 kg; 95% CI 1.6-3.0) of the press test motion cycle (from 15% to 75%) revealed a more volar position of the ulnar head in the sigmoid notch (DRUJ position ratio) and increased distance in DRUJs with foveal TFCC lesion compared with the patients' contralateral non-injured DRUJ (p < 0.05). 6 months postoperatively, the DRUJ position was generally normalized and remained normalized at 12 months. However, the DRUJ distance remained higher on the injured side. 12 months postoperatively, patients reported less pain during activities, with improved QDASH and PRWE scores (p < 0.007). INTERPRETATION: DRUJ kinematics during the press test showed increased DRUJ translation to a more volar position of the ulnar head after foveal TFCC lesion compared with the contralateral non-injured DRUJs. Open foveal TFCC reinsertion had a stabilizing effect on DRUJ kinematics towards normalization, and improved patient-reported outcomes 6 and 12 months after surgery.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Traumatismos do Punho , Adulto , Artroscopia/métodos , Fenômenos Biomecânicos , Humanos , Instabilidade Articular/etiologia , Masculino , Dor , Estudos Prospectivos , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/cirurgia , Articulação do Punho
14.
Semin Musculoskelet Radiol ; 26(3): 295-313, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35654096

RESUMO

Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Mãos , Humanos , Punho/diagnóstico por imagem , Punho/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
15.
J Healthc Eng ; 2022: 9688441, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35756094

RESUMO

Pain and injury of the triangular fibrocartilage complex (TFCC) due to overuse or trauma are commonly diagnosed through static MRI scanning, while TFCC is always involved in radial and ulnar deviation of the wrist. To the best of our knowledge, a dynamic MRI diagnostic method and auxiliary tool have not been applied or fully developed in the literature. As such, this study presents the design and evaluation of a dynamic magnetic resonance imaging (MRI) auxiliary tool for TFCC injury diagnosis. First, 3D scanning and Python are used to measure and fit the radial and ulnar deviation trajectories of healthy participants and patients. 3D printing is then used to manufacture the auxiliary tool for dynamic MRI, and dynamic MRI diagnosis is then conducted to explore the clinical effect. The radial and ulnar deviation trajectory is presented as an asymmetric curve without an obvious circular centre, and the results indicate that the designed auxiliary device meets the requirements of the ulnar and radial movements of the human wrist. According to the MRI contrast test results, the image quality score of patients wearing the auxiliary device is higher than for those without. Such devices could assist clinicians in the diagnosis of TFCC damage, and our method could not only serve as the reference standard for clinical noninvasive diagnosis but also help in understanding the disease and improving the accuracy of TFCC diagnosis.


Assuntos
Fibrocartilagem Triangular , Humanos , Imageamento por Ressonância Magnética/métodos , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/patologia , Ulna , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
16.
Arthroscopy ; 38(5): 1463-1465, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35501013

RESUMO

Accumulating knowledge about the anatomy of the triangular fibrocartilage complex (TFCC) and its function has revealed that the foveal insertion of the TFCC plays a key role in distal radioulnar joint stability rather than the superficial fibers that insert into the ulnar styloid. Recently, the interest in torn peripheral TFCC repair has been shifting from capsular repair for Atzei class 1 to foveal repair for Atzei class 2 or 3. Most acute Atzei class 1 tears spontaneously heal without surgical repair; in contrast, in cases of sustained pain and distal radioulnar joint instability even after successful Atzei class 1 repair, the unrecognized proximal component TFCC tear concomitant with a distal component TFCC tear may exist and appropriate treatment for the proximal component TFCC tear should be combined. Although overall successful results have been reported using various repair techniques, the most important consideration is re-establishing biologic regeneration potential at the insertion site of torn TFCC.


Assuntos
Lacerações , Fibrocartilagem Triangular , Traumatismos do Punho , Artroscopia/métodos , Humanos , Fibrocartilagem Triangular/lesões , Punho , Traumatismos do Punho/cirurgia , Articulação do Punho/cirurgia
17.
J Sport Rehabil ; 31(7): 876-884, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35461186

RESUMO

CONTEXT: Weight-bearing test (WBT) is a noninvasive quantitative test which has been used recently to determine loading capability of the individuals. The aim of this study was to strengthen the evidence for using the WBT test for measuring weight-bearing capacity of the upper-extremity with the specific objective of examining the internal and external responsiveness and concurrent validity of the test in patients with triangular fibrocartilage complex injury. DESIGN: Single-group repeated measures. METHODS: Internal responsiveness was assessed using effect size statistics. The correlation coefficient was used to examine external responsiveness by testing 5 hypotheses regarding predefined correlations between the changes in the measurements. Concurrent validity was evaluated by analyzing correlations between the WBT and other measurements. Thirty-one patients with triangular fibrocartilage complex injury were included for the analysis of the concurrent validity. Eighteen patients who completed all measurements at baseline and at 3-month follow-up enrolled for the responsiveness analysis. Measurements included the WBT, pain intensity, grip strength, and upper extremity functional level. RESULTS: The WBT test was able to detect statistically significant changes in weight-bearing capacity between baseline and follow-up (P = .0001). The effect size of the WBT was large. Three out of 5 hypotheses (60%) were confirmed, a good correlation was found between changes scores of the WBT and grip strength (r = .478; P < .05). There were significant correlations between the WBT and other measurements (r value range from -.401 to .742; P < .05). A higher correlation was found between the WBT and grip strength (r = .742; P = .0001). CONCLUSIONS: The responsiveness and concurrent validity of the WBT test confirmed that it is able to measure change in weight-bearing capacity in patients with triangular fibrocartilage complex injury.


Assuntos
Fibrocartilagem Triangular , Artroscopia , Força da Mão , Humanos , Medição da Dor , Fibrocartilagem Triangular/lesões , Extremidade Superior , Suporte de Carga
18.
J Hand Surg Asian Pac Vol ; 27(2): 248-255, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35404212

RESUMO

Background: Symptomatic ulnar styloid non-union can be treated by excision of the ulnar styloid fragment. For combined triangular fibrocartilage complex (TFCC) tears, several repair techniques such as arthroscopic repair, open repair to the fracture site or reconstruction using a tendon graft have been introduced. This study reports the technique and outcomes of open foveal repair of the TFCC with excision of the ulnar styloid fragment in patients with symptomatic ulnar styloid non-union and distal radioulnar joint (DRUJ) instability. Methods: Consecutive patients with symptomatic ulnar styloid non-union with TFCC tears and DRUJ instability who underwent excision of the ulnar styloid fragment and open foveal repair of the TFCC were retrospectively reviewed. After excising the ulnar styloid fragment, a capsular window was created between the triquetrum and TFCC, followed by attaching the TFCC to the fovea using three sutures through a bone tunnel from the ulnar cortex to the fovea. Additional ulnar shortening osteotomies were performed in patients with positive ulnar variance and ulnar impaction test. The outcomes were evaluated in terms of DRUJ stability and the Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: In total, 21 patients with a mean age of 40 were enrolled in the study. All patients demonstrated DRUJ stability at a mean follow-up duration of 14 months. The mean Quick DASH score significantly improved from 18.9 ± 11.7 to 2.5 ± 4.1 (p < 0.05). Eleven patients underwent combined ulnar shortening osteotomies, and no difference in the Quick DASH score was found between patients who underwent ulnar shortening osteotomy and those who did not. Conclusions: This study demonstrates that open foveal repair of the TFCC with ulnar styloid fragment excision is an effective strategy to surgically treat patients with symptomatic ulnar styloid non-union with TFCC tear and DRUJ instability. Level of Evidence: Level III (Therapeutic).


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Traumatismos do Punho , Adulto , Artroscopia/métodos , Humanos , Instabilidade Articular/cirurgia , Estudos Retrospectivos , Fibrocartilagem Triangular/cirurgia , Ulna/diagnóstico por imagem , Ulna/cirurgia , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia
19.
Arthroscopy ; 38(8): 2417-2424, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35447195

RESUMO

PURPOSE: To calculate the diagnostic accuracy from the confusion matrix using deep learning (DL) on ultrasound (US) images of Palmer 1B triangular fibrocartilage complex (TFCC) injury. METHODS: Twenty-nine wrists of 15 healthy volunteers (11 men; mean age, 34.9 years ± 9.7) (control group) and 20 wrists of 17 patients (11 men; mean age 41.0 years ± 12.2) with TFCC injury (Palmer type IB) (injury group) were included in the study. The diagnosis of Palmer 1B TFCC injury was made using magnetic resonance imaging, computed tomography arthrography, and intraoperative arthroscopic findings. In total, 2,000 images were provided to each group, 80% of which were randomly selected by AI and used as training data; the remaining data were used as test data. Transfer learning was conducted using a pretrained 3 separate models (GoogLeNet, ResNet50, ResNet101). Model evaluation was performed using a confusion matrix. The area under a receiver operating characteristic curve was also calculated. The occlusion sensitivity was used to visualize the important features. RESULTS: For the prediction of TFCC injury by the DL model, the best score of accuracy was 0.85 in GoogLeNet, a recall was 1.0 in ResNet50 and ResNet101, and a specificity was 0.78 in GoogLeNet. In predicting the TFCC injury for the test data, the best score of the AUC was 0.97 on ResNet101. Visualization of important features showed that AI predicted the presence of injury by focusing on the morphology of the articular disc. CONCLUSIONS: US images using the DL model predicted Palmer 1B TFCC injury with high accuracy, with the best scores of 0.85 for accuracy on GoogLeNet, 1.00 for sensitivity on ResNet50 and ResNet101, and 0.78 for specificity on GoogLeNet. The use of DL for US imaging of Palmer 1B TFCC injury predicted the injury as well as magnetic resonance imaging and computed tomography arthrography LEVEL OF EVIDENCE: IV; retrospective case series study.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Adulto , Artrografia , Artroscopia/métodos , Inteligência Artificial , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia
20.
JBJS Rev ; 10(4)2022 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-35394979

RESUMO

¼: Ulnar-sided wrist pain is a common cause of debilitating wrist pain in stick-handling athletes. Due to the complexity of surrounding anatomy, the evaluation and diagnosis can be challenging. ¼: Injury of the triangular fibrocartilage complex (TFCC) is the most common cause of ulnar-sided wrist pain. Repetitive, unrestricted pronosupination, wrist deviation, and axial-loading activity, such as in tennis, place substantial stress on the TFCC. ¼: The ulnotriquetral (UT) ligament is a palmar thickening of the ulnar capsule arising from the palmar radioulnar (PRU) ligament of the TFCC. When injured, the UT ligament can be a source of acute or chronic ulnar-sided wrist pain. The ligament can avulse off bone, can rupture completely, or can split longitudinally. ¼: Arthroscopic-assisted repair is a safe, reliable, and effective treatment for UT ligament split tears and peripheral TFCC tears. ¼: Although the benefit of a team-based approach may be realized by most patients, high-performing, stick-handling athletes are part of a unique population who execute repetitive, extraordinary wrist movements. The high demand and functional requirement expected of the wrists require a uniquely tailored approach to return them to the same level of competitive play.


Assuntos
Tênis , Fibrocartilagem Triangular , Traumatismos do Punho , Artralgia , Humanos , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Punho , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/cirurgia
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