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Musculoskeletal Imaging

Triangular fibrocartilage

a fibrous and cartilaginous structure that separates the radiocarpal and inferior radioulnar joints of the wrist. When it is considered along with the associated soft tissues, the term triangular fibrocartilage complex TFCC is used.

The triangular fibrocartilage is more often involved by degenerative lesions than by traumatic lesions. Both types may result in full-thickness defects. Arthrography and MR imaging are commonly used in diagnosis and at present these techniques are considered equally accurate (Fig.1) (Fig.2). In young persons usually but not invariably the normal triangular fibrocartilage is of homogeneously low signal intensity on virtually all MR pulse sequences, whereas in older persons, T1-weighted spin-echo MR images regularly show regions of higher signal intensity within the fibrocartilage as a consequence of degenerative histologic changes. The detection of lower signal intensity in the triangular fibrocartilage on T2-weighted spin-echo MR images is useful in differentiating degeneration from perforation, which is characterized by high signal intensity on T2-weighted spin-echo MR images.

In the ulnar impaction syndrome, chronic impaction of the ulnar head against the triangular fibrocartilage (and associated soft tissues) and ulnar-sided carpal bones results in progressive deterioration of the triangular fibrocartilaginous complex and various other abnormalities. On arthrography communicating defects of the triangular fibrocartilage and disruption of the lunotriquetral interosseous ligament are evident. MR imaging also documents these abnormalities.

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Fig.1

Coronal proton-density-weighted (a) and T2-weighted (b) MR images of the wrist demonstrate increased signal intensity fluid within a tear near the radial attachment of the triangular fibrocartilage (arrows). (Courtesy of Michael Zlatkin, MD, Hollywood, FL)
Triangular fibrocartilage, Fig.1 (a)
Triangular fibrocartilage, Fig.1 (b)
Triangular fibrocartilage, Fig.2