Joe A Shaw PA-C - 11/6/2008

Question
FINDINGS: There is excellent opacification of the joint noted with contrast extending down
into the distal radioulnar joint. There is some thinning of the central disc of the triangular
fibrocartilage present which may be secondary to volume averaging or a very small defect in the
central disc. Clinical correlation is recommended. No obvious triangular fibrocartilage tear is
noted and note is made that a percentage of patient's may have a normal communication with the
radiocarpal and distal radioulnar joint.
The scapholunate and lunatotriquetral ligaments are intact.
Intra-articular contrast collects within a prominent pisiform recess in the area of the patient's
discomfort. The pisiform bone itself demonstrates normal marrow signal without microfracture
or contusion.
The flexor and extensor tendons are intact.
IMPRESSION:
1. Contrast extending down into the distal radioulnar joint worrisome for occult
triangular fibrocartilage tear although this may be seen as a normal variation.
The central disc is somewhat thin but a complete defect is not seen by MRI
criteria
Q:Do i undestand my TFCC is not tear based on this MRI report? Bacause my doc said i do.  if tear, can TFCC healed by anti-inflammatory medicaiton and rest?  how long?  only sugery can be fixed?
thanks

Answer
ysn,
I would definetly get a second opinion from a board certified hand surgeon. Up to 45-50% of wrist MRI's esp if you are 45 yrs or older can have this variant as the report says:
"No obvious triangular fibrocartilage tear is
noted and note is made that a percentage of patient's may have a normal communication with the
radiocarpal and distal radioulnar joint".
True you could have an "occult" tear and this may be what your ortho hand surgeon is possibly referring to since he knows your history and exam results better than anyone on the net would.
Tears cannot be "healed" by medicines. Your own body can form scar tissue and you may get use to the pain somewhat etc..if it is a small tear, but surgery is usually needed for TFCC tears. The problem is you don't have an "obvious" TFCC tear. I would have to be having about 7-8/10 pain that is not getting better w conservative treatment for 2-3 mos before I would have surgery, unless 2-3 ortho hand surgeons agreed that I definetly needed the surgery based on that report.