The Value of the Distal Radioulnar Joint Effusion in Diagnosing Triangular Fibrocartilage Complex Tears on Magnetic Resonance Imaging

Document Type : RESEARCH PAPER

Authors

1 Hooper Hand Unit, St John’s Hospital, Howden West Road, Livingston, UK

2 Department of Radiology, St John’s Hospital, Howden West Road, Livingston, UK

Abstract

Background: A retrospective study was conducted to evaluate the role of distal radioulnar joint (DRUJ) effusion in
aiding the diagnostic accuracy of central triangular fibrocartilage complex (TFCC) tears on non-contrast MRI.
Methods: 89 consecutive patients who had undergone wrist arthroscopy for ulna sided wrist pain in our unit were
identified and their preoperative imaging reviewed. Two consultant musculoskeletal Radiologists independently
reported the presence or absence of a DRUJ effusion and or a TFCC tear. The inter-observer variability was calculated
using weighted Kappa tests. Two by two tables were constructed to calculate the sensitivity and specificity of reported
TFCC tear or DRUJ effusion on MRI in correctly diagnosing central TFCC tears identified at arthroscopy.
Results: Sensitivity of MRI to report a TFCC tear was 0.56 and specificity was 0.79. Sensitivity increased to 0.89
if either a DRUJ effusion or TFCC tear were seen on MRI. When observed together, the presence of both a DRUJ
effusion and a TFCC tear seen on the imaging lead to a sensitivity of 0.74 and PPV of 82% when compared to
findings at arthroscopy. In the absence of both DRUJ effusion and TFCC tear, the specificity of MRI increased to 0.92.
Agreement by the radiologists on the presence of DRUJ effusion was substantial (k value 0.67) and TFCC tear was
moderate (k value 0.58).
Conclusion: The presence of DRUJ effusion on MRI can further improve sensitivity of MRI in diagnosing central TFCC
tears. The sensitivity of detecting a central TFCC tear on MRI scan when both a DRUJ effusion and a TFCC tear were
seen (0.74) is comparable to rates demonstrated on MRA meta-analysis results (0.78). Furthermore, considering the
absence of both a DRUJ effusion and TFCC tear seen on MRI is useful in excluding the presence of a TFCC tear at
arthroscopy.
Level of evidence: III

Keywords

References

1. Saito T, Malay S, Chung KC. A Systematic Review
of Outcomes after Arthroscopic Debridement for
Triangular Fibrocartilage Complex Tear. Plast
Reconstr Surg. 2017;140(5):697e–708e.
2. Chan JJ, Teunis T, Ring D. Prevalence of triangular
fibrocartilage complex abnormalities regardless
of symptoms rise with age: systematic review
and pooled analysis. Clin Orthop Relat Res. 2014;
472(12):3987-94.
3. Smith TO, Drew B, Toms AP, Jerosch-Herold C,
Chojnowski AJ. Diagnostic accuracy of magnetic
resonance imaging and magnetic resonance
arthrography for triangular fibrocartilaginous complex
injury: A systematic review and meta-analysis. J Bone
Joint Surg Am. 2012, 94: 824-32.
4. Treiser MD, Crawford K, Iorio ML. TFCC Injuries:
Meta-Analysis and Comparison of Diagnostic Imaging
Modalities. J Wrist Surg. 2018;7(3):267–272.
5. Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka
H. Ulnar-sided wrist pain. II. Clinical imaging and
treatment. Skeletal Radiol. 2010;39(9):837–857.
6. McHugh ML. Interrater reliability: the kappa statistic.
Biochem Med (Zagreb). 2012;22(3):276–282.
7. Ng AWL, Tong CSL, Hung EHY, Griffith JF, Tse WL, Wong
CWY , et al. Top-Ten Tips for Imaging the Triangular
Fibrocartilaginous Complex. Semin Musculoskelet
Radiol. 2019;23(4):436‐443.
The Archives of Bone and Joint Surgery
Volume 9, Issue 4
July and August 2021
Pages 423-426

Files

History

  • Receive Date: 16 June 2020
  • Accept Date: 24 November 2020

Share

How to cite

Statistics