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Handchir Mikrochir Plast Chir 2014; 46(03): 137-150
DOI: 10.1055/s-0033-1363662
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Die Instabilität des distalen Radioulnargelenks – Zur Wertigkeit klinischer und röntgenologischer Testverfahren – eine Literaturübersicht

Instability of the Distal Radioulnar Joint – an Overview of Clinical and Radiological Procedures Regarding their Efficacies
C. K. Spies
1   Handchirurgie, Vulpiusklinik, Bad Rappenau
,
L. P. Müller
2   Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln, Köln
,
J. Oppermann
2   Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln, Köln
,
P. Hahn
1   Handchirurgie, Vulpiusklinik, Bad Rappenau
,
F. Unglaub
1   Handchirurgie, Vulpiusklinik, Bad Rappenau
3   Medizinische Fakultät Mannheim der Universität Heidelberg
› Author Affiliations
Further Information

Publication History

eingereicht 29 September 2013

akzeptiert 25 November 2013

Publication Date:
18 February 2014 (online)

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Zusammenfassung

Das distale Radioulnargelenk (DRUG) hat eine herausragende Bedeutung für die Funktionalität der oberen Extremität. Verletzungen bzw. Einschränkungen des DRUG können entscheidend die Gebrauchsfähigkeit der oberen Extremität limitieren. Zahlreiche klinische und röntgenologische Testverfahren zur DRUG-Instabilität wurden beschrieben. Es besteht allerdings noch keine Standardisierung der Evaluation einer Instabilität. Der TFCC (trianguläre fibrokartilaginäre Komplex) mit seinen Verankerungen über das Ligamentum subcruentum in der Fovea ulnaris und an der Basis des Processus styloideus ulnae stellt neben der Membrana interossea zweifelsohne einen wichtigen Stabilisator des DRUG dar. Oftmals führt ein Sturz auf die ausgestreckte und extendierte Hand oder eine forcierte Rotationsbewegung unter Last zu Verletzungen der Stabilisatoren. Klinisch zeigen sich in der Regel ein ulnarseitiger Schmerz, eine eingeschränkte Umwendbewegung und ein Kraftverlust. Sowohl die klinischen Testverfahren als auch die röntgenologischen Untersuchungen müssen nach den Gütekriterien der Validität und Reliabilität beurteilt werden. Es zeigen sich sehr variierende Ergebnisse, die sich mit dem Goldstandard der Handgelenksarthroskopie messen lassen müssen. Für sich genommen kann kein einzelner Test verlässlich eine DRUG-Instabilität beweisen. Die Einführung einer standardisierten Untersuchungsmethodik, die mit der Anamnese des Patienten beginnen sollte und sowohl spezifische klinische als auch röntgenologische Untersuchungsverfahren beinhaltet, wäre an zu streben. Die Standardisierung sollte konsequent umgesetzt werden, damit durch den Übungseffekt der Untersucher eine zunehmende Diagnosesicherheit aufbauen kann. Letztlich kann nur eine differenzierte Untersuchung, die komplementäre klinische und röntgenologische Untersuchungsverfahren beinhaltet, die Diagnosesicherheit erhöhen.

Abstract

The distal radioulnar joint (DRUJ) plays a tremendous role regarding the functionality of the upper extremity. Lesions of the DRUJ can limit the functionality of the upper extremity decisively. Many clinical and radiological procedures are used to diagnose instability of the DRUJ. Up to now, there has not been a general consensus concerning the standardisation of the evaluation of DRUJ instability. The TFCC (triangular fibrocartilage complex) with its ligamentum subcruentum insertions at the fovea ulnaris and at the basis of the processus styloideus ulnae is in conjunction with the membrana interossea a very important stabiliser of the DRUJ. A fall on the extended hand or a forceful wrist rotation can usually cause injuries to the stabilisers. Ulnar-sided pain, limited pronosupination and loss of grip strength are clinically apparent. Both clinical tests and radiological procedures should be judged regarding their specific efficacies. These tests have to be evaluated in comparison to the gold standard of wrist arthroscopy. Each test alone is not able to verify DRUJ instability on a regular basis. The introduction of a standardised diagnostic procedure including anamnesis and specific clinical and radiological tests should be established. The standardisation ought to be maintained strictly in order to guarantee a growing test efficacy. Finally, high diagnostic reliability is based on a thorough examination which includes complementary clinical and radiological procedures.

Schlüsselwörter

distales Radioulnargelenk - bildgebende Verfahren - Luxation - Instabilität

Key words

distal radio-ulnar joint - imaging - dislocation - instability
 

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