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Handchir Mikrochir Plast Chir 2014; 46(05): 295-299
DOI: 10.1055/s-0034-1387706
Review
© Georg Thieme Verlag KG Stuttgart · New York

Arthroscopy of the Distal Radioulnar Joint

Arthroskopie des distalen Radioulnargelenkes
T. Nakamura
1   Department of Orthopaedic Surgery, Clinical Research Center, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
,
N. Matsumura
2   Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
,
T. Iwamoto
2   Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
,
K. Sato
2   Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
,
Y. Toyama
2   Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

received 26 June 2014

accepted 17 July 2014

Publication Date:
07 October 2014 (online)

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Abstract

Wrist arthroscopy is now widely indicated for diagnosis and treatment of acute or chronic wrist pain, especially for triangular fibrocartilage complex (TFCC) lesions, as a gold standard. In most cases radiocarpal and midcarpal arthroscopy was performed, while DRUJ arthroscopy has been rarely performed because of its difficulties. Recent anatomic and biomechanical studies demonstrated that the radioulnar ligament (RUL), which is the proximal component of the TFCC facing to the DRUJ, is the primary stabilizer of the distal radioulnar joint (DRUJ). Rupture of the radioulnar ligament (RUL) at the fovea area, where it is the main attaching portion to the ulna and is the isometric point during forearm rotation as the rotation axis passes, is responsible for DRUJ instability. Although physical examination and imaging diagnosis may indicate a foveal detachment of the TFCC, DRUJ arthroscopy is potential for visualizing the RUL at the fovea. Role of DRUJ arthroscopy should be more important not only for diagnosis of rupture of the RUL but also for decision making of treatment option for RUL tear. DRUJ arthroscopy also demonstrates the joint surface of both the sigmoid notch and ulnar head, and the proximal surface of the TFCC.

Zusammenfassung

Die Handgelenksarthroskopie wird heute vielerorts zur Diagnostik und Therapie akuter und chronischer Handgelenksschmerzen verwendet, wobei sie bei der Abklärung von Läsionen des dreieckförmigen Faserknorpels (TFCC) als Goldstandard gilt. Meistens erfolgt eine Arthroskopie des Radio- und Mediokarpalgelenkes, wohingegen das distale Radioulnargelenk (DRUG) aufgrund technischer Schwierigkeiten bisher selten gespiegelt wurde.

Jüngere anatomische und biomechanische Studien haben gezeigt, dass die radioulnaren Zügelbänder (RUL) als proximaler, dem DRUG zugewandter Teil des TFCC der Hauptstabilisator des DRUG sind. Abrisse der RUL an ihrem Ansatz in der Fovea ulnaris, wo ihr Hauptverankerungsstelle an der Ulna und zugleich der isometrische Punkt bei der Unterarmrotation lokalisiert ist, führen zur In­stabilität im DRUG. Während klinische Untersuchung und Bildgebung lediglich einen Abriss des TFCC in der Fovea vermuten lassen, kann man mit einer Arthroskopie des DRUG die RUL in der Fovea direkt einsehen. Die Bedeutung der DRUG-Arthroskopie liegt nicht allein in dem Umstand, dass man die RUL unter Sicht beurteilen kann, sondern vielmehr darin, dass sich abhängig vom Befund ein differenziertes therapeutisches Vorgehen ergibt. Darüber hinaus ist es möglich bei der DRUG-Arthroskopie die Gelenkfläche der Sigmoidnotch als auch des Ulnakopfes und die Unterfläche des TFCC einzusehen.

Key words

arthroscopy - distal radioulnar joint - DRUJ - triangular fibrocartilage complex - TFCC - radioulnar ligaments - instability

Schlüsselwörter

Arthroskopie - distales Radioulnargelenk - DRUG - triangulärer fibrokartilaginärer Komplex - TFCC - radioulnare Bäder - Instabilität
 

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