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Incidental Triangular Fibrocartilage Complex Changes on Wrist MRI
Lilah Fones, MD
1; Molly Milano, BS
2; Sina Ramtin, MD
3; Asif M Ilyas, MD
41Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA; 2Thomas Jefferson University Hospital, Philadelphia, PA; 3Rothman, Philadelphia, PA; 4Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Hypothesis: Triangular fibrocartilage complex (TFCC) changes on wrist magnetic resonance imaging (MRI) may occur in patients without corresponding symptoms and exam consistent with TFCC pathology. This study primarily aims to define the rate of asymptomatic TFCC changes in patients undergoing wrist MRI for indications other than ulnar-sided wrist pain. The secondary aim is to compare this to the rate in ulnar-sided wrist pain patients.
Methods: With institutional review board approval, patients that underwent wrist MRI at a single large academic orthopaedic practice over a two-year period were identified by Current Procedural Terminology code 73221. Patients with an associated diagnosis including "hand”, "wrist”, "radius”, "radial”, "scaphoid”, "navicular”, or "De Quervain”. were retrospectively reviewed for demographics, symptoms, exam, trauma, and MRI findings. Patients with ulnar-sided wrist pain were excluded from the primary cohort and used as the comparison group
Results: Wrist MRIs were available for 132 patients, with 92 in the primary cohort and 40 with ulnar-sided wrist pain forming the comparison group. MRI indications included wrist pain (other than ulnar-sided) (64%), hand/thumb pain (21%), mass (12%), and numbness/tingling (2%). TFCC MRI changes were seen in 44% and abnormal TFCC was positively associated with age. In contrast, 80% of the 40 patients with ulnar-sided wrist pain had abnormal TFCC on MRI.
Summary: There is a high rate of abnormal TFCC identified on MRI in patients without corresponding ulnar-sided wrist symptoms. This highlights the importance of not treating MRI imaging in isolation without correlating with the patient's symptoms while also preparing patients for a high likelihood of asymptomatic TFCC changes on routine wrist MRI.
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