Wrist arthro-CT: don't forget to check the foveal attachment

The aim of this study was to demonstrate that foveal lesions of the triangular fibrocartilage complex (TFCC) are underreported on wrist arthro-CT and to compare imaging review data with clinical and surgical findings to assess their impact on patient management.

One hundred forty-nine wrist arthro-CTs were reviewed by two musculoskeletal radiologists, who were blinded to the surgical data and initial reports. Discrepancies between TFCC lesions and the initial reports were analysed and compared with the clinical and surgical data.

TFCC lesions were identified in 59% of patients, including 43% ulnar, 33% central, and 3% radial lesions. A comparison with the initial reports revealed 45 underreported lesions, 89% of which involved ulnar lesions, including 69% affecting the foveal bundle. Patients with complete ulnar TFCC lesions reported significantly more ulnar-sided pain and radioulnar instability than those without TFCC lesions (p < 0.0001). Isolated foveal lesions were significantly associated with ulnar-sided pain (p = 0.0201), but not with radioulnar instability (p > 0.99). Among the 149 patients, 12 underwent TFCC surgery. In 8 patients, the lesions were identified in the initial radiological reports and confirmed intraoperatively. In 4 patients, surgery was performed despite negative initial reports. A retrospective imaging review confirmed the lesions, which were in agreement with the surgical findings.

The application of new classifications and recent knowledge enabled the identification of previously unreported lesions in 28% of cases, including 69% involving the foveal attachment, highlighting the diagnostic challenges of this type of injury.

This study shows that foveal TFCC lesions are frequently underreported on wrist arthro-CT and that a structured review, incorporating recent classifications and multiplanar reconstructions, significantly improves lesion detection, particularly for foveal involvement.

Foveal TFCC lesions are difficult to identify on wrist arthro-CT because of their subtle and variable imaging appearance. Re-evaluation of arthro-CT scans and comparison with initial reports, which used recent classifications and multiplanar reconstructions, revealed that 28% of the lesions were underreported. Improved detection of foveal involvement may lead to more accurate management of ulnar-sided wrist pain.