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J Wrist Surg 2021; 10(04): 286-289
DOI: 10.1055/s-0041-1723795
Scientific Article

Effectiveness and Safety of Triangular Fibrocartilage Complex Injection Regarding Anatomical Landmarks: A Cadaveric Study

Hamid Namazi
1   Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
,
Amir Ghane
1   Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
,
Amir Reza Dehghanian
2   Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
,
Mehran Fereidooni
3   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
,
Armin Akbarzadeh
1   Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
› Author Affiliations Funding The project was financially supported by Shiraz University of Medical Sciences.
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Abstract

Background Triangular fibrocartilage complex (TFCC) injections can be applied using anatomical landmarks or under the guide of ultrasound (US). US is not always available, and the physician may rely on the anatomical landmarks.

Objective The study aims to evaluate the effectiveness and safety of TFCC injection with anatomic landmarks.

Methods Forty wrist specimens from cadavers were randomly assigned to four rapid blue stain injection groups as follows: Group A: perpendicular to skin with 5 mm depth; Group B: perpendicular to skin with 10 mm depth; Group C: 45-degree angulation to skin surface, oriented from proximal to distal with 10 mm depth; and Group D: 45-degree angulation to skin surface, oriented from distal to proximal with 10 mm depth. TFCC specimens were excised and evaluated with microscopy, and adjacent neurovascular structures were checked for any injury.

Results Injections in group A were more accurate than others, in which 8/10 injections were successful. Group C injections were least accurate in that only 4/10 were successful. The other remaining groups (groups B and D) revealed similar results (5/10 were successful). However, statistical analyses did not show any significant difference (p-value = 0.35). No injury to neurovascular structures was seen.

Conclusion Needle placement perpendicular to skin with 5 mm depth and just medial to ulnar styloid can be used as an accurate method of palpation-guided technique for TFCC injections.

Keywords

triangular fibrocartilage - injections - anatomic landmarks - cadaver


Publication History

Received: 22 September 2020

Accepted: 29 December 2020

Article published online:
09 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Casadei K, Kiel J. Triangular Fibrocartilage Complex (TFCC) Injuries. StatPearls [Internet]. StatPearls Publishing; 2020. . Available at: https://www.ncbi.nlm.nih.gov/books/NBK537055/
    Google Scholar
  • 2 Brogan DM, Berger RA, Kakar S. Ulnar-sided wrist pain: a critical analysis review. JBJS Rev 2019; 7 (05) e1
    CrossrefPubMedGoogle Scholar
  • 3 Skalski MR, White EA, Patel DB. et al. The traumatized TFCC: an illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex. Curr Probl Diagn Radiol 2016; 45 (01) 39-50
    CrossrefPubMedGoogle Scholar
  • 4 Jawed A, Ansari MT, Gupta V. TFCC injuries: how we treat?. J Clin Orthop Trauma 2020; 11 (04) 570-579
    CrossrefPubMedGoogle Scholar
  • 5 Waryasz GR, Tambone R, Borenstein TR, Gil JA, DaSilva M. Review of anatomical placement of corticosteroid injections for uncommon hand, wrist, and elbow pathologies. R I Med J (2013) 2017; 100 (02) 31-34
    PubMedGoogle Scholar
  • 6 Boesen M, Jensen KE, Torp-Pedersen S, Cimmino MA, Danneskiold-Samsøe B, Bliddal H. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis. Eur J Radiol 2009; 69 (02) 331-338
    CrossrefPubMedGoogle Scholar
  • 7 Wu W-T, Chang K-V, Mezian K. et al. Ulnar wrist pain revisited: ultrasound diagnosis and guided injection for triangular fibrocartilage complex injuries. J Clin Med 2019; 8 (10) 1540
    CrossrefPubMedGoogle Scholar
  • 8 Nam SH, Kim J, Lee JH, Ahn J, Kim YJ, Park Y. Palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder: a randomized, prospective single-blinded study. Clin Rheumatol 2014; 33 (12) 1807-1814
    CrossrefPubMedGoogle Scholar
  • 9 Smith J, Hurdle M-F, Locketz AJ, Wisniewski SJ. Ultrasound-guided piriformis injection: technique description and verification. Arch Phys Med Rehabil 2006; 87 (12) 1664-1667
    CrossrefPubMedGoogle Scholar
  • 10 Colio SW, Smith J, Pourcho AM. Ultrasound-guided interventional procedures of the wrist and hand: anatomy, indications, and techniques. Phys Med Rehabil Clin N Am 2016; 27 (03) 589-605
    CrossrefPubMedGoogle Scholar
  • 11 Berkoff DJ, Miller LE, Block JE. Clinical utility of ultrasound guidance for intra-articular knee injections: a review. Clin Interv Aging 2012; 7: 89-95
    PubMedGoogle Scholar
  • 12 Ruiz A, Bravo D, Duarte A, Adler R, Raya J. Ultrasound-guided intraarticular injection has higher accuracy than landmark-guided intraarticular injection in rat knee joints. Osteoarthritis Cartilage 2020; 28: S303-S304
    CrossrefPubMedGoogle Scholar
  • 13 Koutsianas C, Klocke R. Efficacy of ultrasound-guided versus landmark-guided injections in rheumatology: a systematic review. Mediterr J Rheumatol 2016; 27 (04) 179-190
    CrossrefPubMedGoogle Scholar
  • 14 Wu T, Song HX, Dong Y, Li JH. Ultrasound-guided versus blind subacromial–subdeltoid bursa injection in adults with shoulder pain: a systematic review and meta-analysis. Semin Arthritis Rheum 2015; 45 (03) 374-378
    CrossrefPubMedGoogle Scholar
  • 15 Hoeber S, Aly A-R, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med 2016; 50 (07) 392-396
    CrossrefPubMedGoogle Scholar
  • 16 Aly A-R, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med 2015; 49 (16) 1042-1049
    CrossrefPubMedGoogle Scholar
  • 17 Gilliland CA, Salazar LD, Borchers JR. Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review. Phys Sportsmed 2011; 39 (03) 121-131
    CrossrefPubMedGoogle Scholar
  • 18 Cunnington J, Marshall N, Hide G. et al. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum 2010; 62 (07) 1862-1869
    PubMedGoogle Scholar
  • 19 Berona K, Abdi A, Menchine M. et al. Success of ultrasound-guided versus landmark-guided arthrocentesis of hip, ankle, and wrist in a cadaver model. Am J Emerg Med 2017; 35 (02) 240-244
    CrossrefPubMedGoogle Scholar
  • 20 Bookman JS, Pereira DS. Ultrasound guidance for intra-articular knee and shoulder injections: a review. Bull Hosp Jt Dis (2013) 2014; 72 (04) 266-270
    PubMedGoogle Scholar
  • 21 Sage W, Pickup L, Smith TO, Denton ER, Toms AP. The clinical and functional outcomes of ultrasound-guided vs landmark-guided injections for adults with shoulder pathology--a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 52 (04) 743-751
    CrossrefPubMedGoogle Scholar