Sonographic Anatomy and Imaging of the Triangular Fibrocartilage Complex and the Distal Radio-Ulnar Joint

Ulnar-sided wrist pain is a common clinical problem, which can be difficult to diagnose, manage and treat. Ultrasound imaging can be used to identify structural changes which may contribute to the pain. Knowledge of the associated relative anatomy and intertwining structures which form the triangular fibrocartilage complex (TFCC) and distal radio-ulnar joint (DRUJ), sonographic techniques to image these structures and their normal and abnormal appearances can be underappreciated and are required.

A literature search was conducted to review the current knowledge related to sonographic assessment of the TFCC and DRUJ.

The intertwining components of the DRUJ and TFCC which can be demonstrated sonographically are unpacked with clear supporting figures and videos.

The components of the TFCC, which include the disc proper, meniscus homologue, extensor carpi ulnaris (ECU) sub-sheath, palmar-sided ulno-carpal ligaments and the palmar and dorsal distal radio-ulnar ligaments, can all be individually demonstrated sonographically, in addition to structures which comprise the DRUJ. Normal sonographic images are presented.

Improved understanding of the sonographic anatomy, technique and normal imaging appearances of ulnar-sided wrist structures can enhance the quality of imaging and subsequently the diagnosis of structural causes of pain, which can guide patient management.