Imaging of TFCC Injury of the Wrist

about dynamic cone-beam ct imaging of TFCC wrist injury

It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.

I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a  stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.

TFC Injury

Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).

The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.

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Ulnar Nerve Synovial Impingement

about dynamic ultrasound findings of ulnar nerve synovial impingement

This is the case of a patient suffering for a post-traumatic olecranon bursitis with ulnar nerve entrapment symptoms, one month after an elbow contusion.

A standard plain radiograph was made immediatly after trauma, showing a small bony fragment of the olecranon cortical surface.

Elbow

Olecranon Bursitis

Sagittal T2w (left) and Axial T2w (right) Mri scans (0.3 Tesla).

The Mri exam shows a gross olecranon bursitis, but the inflammatory process involving the ulnar nerve is better appreciated with the dynamic ultrasound examination.

My suggestion is always tha same… Mri and Ultrasound exams complement each other succesfully, so use both togheter in your daily practice.

Patellar Tendon Tear

about dynamic ultrasound and mri evaluation of partial patellar tendon tear

Today I show you the case of a partial tear at proximal insertion of the patellar tendon in a professional football player. The patient refears pain during flexion-extension at inferior patellar pole; hystory of repetitive trauma as usual in football players.

Patellar Tendon Tear

Sagittal Xbone T1w (left) and T1w TSE (right) Mri scan (o.3 Tesla)

The Mri exam shows a partial tear of the patellar tendon proximal insertion. In these kind of injury I always need a dynamic ultrasound exam, both in clino and orthostatic position.

The partial tear is better depicted with the dynamic ultrasound evaluation; the dynamic Mri is also useful to appreciate the tendon relationship with the patella.