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Musculoskeletal Imaging

E2781. Triangular Fibrocartilage Complex Injuries in Athletes

Benton D1,  Boutin R2,  Kiani B1,  Wuertzer S1,  Lenchik L.1 1. Wake Forest School of Medicine, Winston-Salem, NC; 2. University of California , Davis, CA

Address correspondence to L. Lenchik (

Background Information: Triangular fibrocartilage complex (TFCC) injuries are especially common in athletes who subject their wrists to increased load and increased range of motion. Our purpose is to show how MRI of TFCC injuries helps determine optimal patient management.

Educational Goals/Teaching Points: MRI patterns of TFCC injuries help determine diagnosis, prognosis, and patient management. Terminology describing TFCC injuries is often inconsistent. The use of Palmer classification of TFCC injuries is especially important for communicating with orthopedic surgeons. Ulnocarpal abutment is commonly associated with TFCC injuries in athletes. Palmer 1B lesions are most likely to be repaired rather than debrided.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We present easy cases including most Palmer 1As, some Palmer 1Bs, and many Palmer 1Ds, and some not-so-easy cases including Palmer 1B partial tears, Palmer 1Bs with fracture, and Palmer 1Cs. We also present non-Palmers (capsule detachments, meniscal homologue tears, coronal TFC tears, bucket handle TFC tears), and postoperative cases. We explain reporting TFCC injuries in athletes, how to describe TFCC injury (when possible, using Palmer classification). We offer how to help the surgeon decide on operative versus nonoperative management and describe signs of DRUJ instability and how to help the surgeon plan for type of surgery (repair, debridement, wafer), describe location of tear, adjacent chondrosis, length of ulna, and LT ligament injury. We present how to anticipate what else the surgeon needs to know and unexpected causes for ulnar-sided symptoms..

Conclusion: Accurate characterization of TFCC on MRI is important for helping surgeons diagnose and treat athletes with these common injuries.