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So I had a long holiday weekend.

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I had three days. I decided I would come up with my drawing

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of the triangular fibrocartilage complex.

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And so this is what it looks like.

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I'm flexing the proximal carpal row. We're looking dorsally.

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So the first structure I see is the meniscus homo lock.

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And you can see I've rolled the extensor carpi narrows

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tendon and sheath away to show you that that has attachments

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to the sheet of the extensor carpi narrows tendon.

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We follow that out and you can see it goes all the way out.

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As we just described.

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Beneath it, we have the dorsal radial ligament

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with two attachments, we said the deep one to the fovea

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and the superficial one to the styloid.

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Now we have the triangular fibrocartilage disc.

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Then we have the volar radio nerve ligament.

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And as we go further, we see the ul no triquetral

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and all no lunate.

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The volar extrinsic ligaments peeking

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through those in red is the more superficial

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volar all no capitate ligament.

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I included the short radio lunate ligament,

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your friend from my last lecture,

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and I included the lunar triquetral interosseous ligament

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and then the holiday was over.

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So I never finished the scapholunate aspect of this drawing.

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So if you have good images, you can see all

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of these starting dorsally.

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We're looking mainly at meniscus homolog.

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As we go slightly more ly, we can see the dorsal radi

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or attachment.

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This attachment here to the fovea.

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We see the meniscus holog,

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we see the triangular fibrocartilage disc.

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You can see the cartilage separating it

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from the distal radius.

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We go a little bit more ly.

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We can see both lamina proximal and distal.

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We see the presty recess, the meniscus homolog,

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and the triangular fibrocartilage.

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And we go more distally

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and you can appreciate here the TFC, the meniscus homologue.

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And then finally the most lar we're seeing mainly the ul,

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no triquetral and ul, no lunate ligaments.

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The volar radio, no ligaments.

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This is a ulnar sca triquetral ligament as well.

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So you can see these if you know the anatomy

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and it's gonna become important.

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Now we do a lot of arthrograms in many joints, not

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so many in the wrist, as I indicated earlier.

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But there was an article that came out

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and in it it was suggested

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that if you do a radiocarpal arthrogram

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and you fill the pre recess, you will get

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contrast sometimes extending along the medial margin

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of the distal ulnar that's showing it right here.

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And it said, this is never significant.

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And I'm gonna show you a bunch of cases where in fact

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that is an incorrect statement.

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It may occur iatrogenically, yes,

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particularly if you overfill the radiocarpal compartment,

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but it accompanies a lot of pathologic processes.

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Here is an example of one patient who had pain

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over the ulnar cy pre arthrogram.

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That is edema.

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We did a radiocarpal uh injection

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and you can see the contrast leaking

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around the medial aspect.

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And there were significant abnormalities

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of the triangular fibro cartilage complex

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not shown in these images.