University of Oulu

Nevalainen, M.T., Zoga, A.C., Rivlin, M. et al. Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case–control study. Eur Radiol 33, 3172–3177 (2023).

Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI : a case–control study

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Author: Nevalainen, Mika T.1,2,3; Zoga, Adam C.3; Rivlin, Michael4;
Organizations: 1Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, 90029 Oulu, Finland
2Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014 Oulu, Finland
3Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA
4Department of Hand and Orthopaedic Surgery, Rothman Institute of Orthopaedics, Sidney Kimmel Medical College, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Springer Nature, 2023
Publish Date: 2023-09-07


Objectives: To evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears.

Methods: One hundred thirty-three patients (age range 21–75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case–control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy.

Results: On arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone.

Conclusions: ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears.

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Series: European radiology
ISSN: 0938-7994
ISSN-E: 1432-1084
ISSN-L: 0938-7994
Volume: 33
Issue: 5
Pages: 3172 - 3177
DOI: 10.1007/s00330-023-09446-x
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. The authors state that this work has not received any funding.
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