Wrist MRI Report Template: Normal Example and TFCC Checklist

Complete normal routine wrist MRI report

This example is for a conventional wrist MRI without intravenous or intra-articular contrast. Specify the side, field of view, sequences, comparison, and any technical limitation. A normal template should not be used when a structure was not adequately visualized.

Examination: MRI of the [right/left] wrist without intravenous contrast.

Technique: Multiplanar, multisequence images of the wrist were obtained. No intra-articular contrast was administered.

Comparison: [Date and examination / None available].

Findings: Carpal alignment is maintained. The distal radius, distal ulna, and carpal bones demonstrate normal marrow signal without fracture or focal osseous lesion. The articular surfaces are preserved. The triangular fibrocartilage complex is intact in appearance. The distal radioulnar joint is congruent. The scapholunate and lunotriquetral ligaments are intact in appearance. The flexor and extensor tendons are intact without tenosynovitis. No focal ganglion or significant joint effusion is identified. The visualized median and ulnar nerves are unremarkable.

Impression: No significant abnormality of the [right/left] wrist on MRI.

Adapt each statement to the actual images and clinical question. “Intact in appearance” describes the visible MRI findings; it does not guarantee that every small or partial ligament injury is excluded.

Systematic review by compartment

Bone, alignment, and cartilage

Review the distal radius and ulna, carpal bones, marrow, cortical contours, and carpal alignment. Check for occult fracture, osteonecrosis, marrow edema, focal lesion, subchondral change, and articular cartilage loss. State which bones are involved and whether there is a fracture line, displacement, or adjacent soft-tissue reaction when visible.

TFCC and distal radioulnar joint

Assess the central disc and visible peripheral attachments of the triangular fibrocartilage complex (TFCC), together with the distal radioulnar joint (DRUJ). Describe a defect or abnormal signal by location and morphology, and note associated DRUJ effusion, synovitis, or alignment abnormality. Ulnar variance can be sensitive to wrist position and measurement method; include a value only when the acquisition and local practice support a reliable measurement.

Intrinsic and extrinsic ligaments

Review the scapholunate and lunotriquetral ligaments, including their visible components, as well as the dorsal and volar extrinsic ligaments. Describe a suspected tear, discontinuity, abnormal signal, or associated malalignment. Routine MRI is static and may not demonstrate dynamic carpal instability.

Tendons, nerves, and soft tissues

Trace the flexor tendons and the six dorsal extensor compartments. Specifically inspect the extensor carpi ulnaris tendon and its sheath, while considering its position and the wrist’s rotation. Review the carpal tunnel, Guyon canal, visible median and ulnar nerves, subcutaneous tissues, joint fluid, and possible ganglia or other masses.

Compact checklist

• Correct side and examination protocol; distinguish routine MRI from arthrography
• Distal radius, ulna, carpal bones, marrow, and alignment
• Cartilage and joint surfaces
• TFCC: central disc, visible attachments, and DRUJ
• Scapholunate and lunotriquetral ligaments
• Flexor tendons and each extensor compartment, including ECU
• Carpal tunnel, Guyon canal, and visible nerves
• Effusion, synovitis, ganglion, or other soft-tissue finding
• Comparison and technical limitation
• Impression focused on the clinical question

Selected abnormal wording

Use these as modules only when the described feature is present and supported by the images.

Central TFCC defect

A focal central defect of the TFCC is present, with fluid signal traversing the disc. The ulnar attachments are not confidently characterized on this examination. Correlate with the site of symptoms and clinical assessment of DRUJ stability.

A central defect may be degenerative or incidental. Do not infer symptomatic instability from this appearance alone.

Scapholunate ligament

There is abnormal signal and partial fiber discontinuity in the scapholunate ligament. No static carpal malalignment is identified. MRI does not assess dynamic instability.

Occult scaphoid injury

Patchy marrow edema is present in the scaphoid waist without a discrete fracture line or displacement. Correlate with the site of tenderness and the clinical history; an occult fracture cannot be excluded solely on the basis of absent cortical displacement.

Fictional worked example

This fictional teaching case illustrates how to report a central TFCC defect without overstating its clinical significance.

Examination: MRI of the right wrist without intravenous contrast.

Technique: Multiplanar, multisequence images were obtained. No intra-articular contrast was administered.

Comparison: Wrist radiographs dated [date].

Findings: Carpal alignment is maintained. No acute fracture or focal marrow lesion is identified. There is a small central perforation of the TFCC with fluid signal traversing the disc. The peripheral and foveal attachments are not clearly disrupted. The distal radioulnar joint remains congruent, without a significant effusion. The scapholunate and lunotriquetral ligaments are intact in appearance. The flexor and extensor tendons are intact. No ganglion or significant joint effusion is identified.

Impression:
1. Small central TFCC perforation. The peripheral/foveal attachments appear preserved on this routine MRI.
2. No static DRUJ malalignment.

The report names the finding and its visible extent. It does not label the finding as the cause of pain or equate a static MRI with a complete assessment of DRUJ stability.

Routine MRI and MR arthrography are different examinations

Routine wrist MRI uses no injected joint contrast. Direct MR arthrography introduces dilute contrast into the joint before imaging and may be selected for a specific unresolved question about the TFCC or intrinsic ligaments. These tests are not interchangeable report labels. The ACR chronic wrist pain criteria list noncontrast MRI and MR arthrography as usually appropriate alternatives for particular scenarios after radiographs; the choice depends on the clinical question and local practice. A negative routine study should not be used to claim that every subtle ligament lesion is excluded.

For a focused discussion of DRUJ and TFCC assessment, see Distal Radioulnar Joint: Anatomy, Instability, and MRI and TFCC, DRUJ Instability, and Ulnar Variance on MRI and CT.

Reporting pitfalls

• Calling a wrist examination “normal” while omitting the TFCC, intrinsic ligaments, tendons, or carpal alignment.
• Treating subtle signal within the TFCC or a ligament as a definite tear without checking morphology, location, and sequence quality.
• Calling a static MRI a test for dynamic instability.
• Reporting ulnar variance as definitive without a reproducible measurement method and suitable positioning.
• Assuming that an MRI abnormality explains symptoms. TFCC and other findings require clinical correlation, especially when the location does not match the complaint.
• Describing a study as arthrographic when no intra-articular contrast was used.

References

• American College of Radiology. ACR–SABI–SPR–SSR Practice Parameter for the Performance of MRI of the Wrist (opens in a new tab), revised 2022.
• American College of Radiology. ACR Appropriateness Criteria®: Chronic Hand and Wrist Pain (opens in a new tab), revised 2023.
• Ng WHA, Griffith JF, Ng ISH. How to Report: Wrist MRI (opens in a new tab). Seminars in Musculoskeletal Radiology. 2021;25(5):670–680. doi:10.1055/s-0041-1736313.
• Treiser MD, Crawford K, Iorio ML. TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities (opens in a new tab). Journal of Wrist Surgery. 2018;7(3):267–272. doi:10.1055/s-0038-1629911.
• Fones L, Kasper A, Milano M, Ilyas AM. Incidental Triangular Fibrocartilage Complex Changes on Wrist MRI (opens in a new tab). Hand (N Y). 2025;20(8):1292–1297. doi:10.1177/15589447241277846.

This educational framework does not replace patient-specific interpretation, the current local protocol, or clinical judgment.