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Der ulnokarpale Komplex

Neue klinische und radiologische Überlegungen

The ulnocarpal complex

New clinical and radiological considerations

  • Leitthema
  • Published:
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Zusammenfassung

Klinisches Problem

Der trianguläre fibrokartilaginäre Komplex (TFCC) ist eine anatomisch komplex aufgebaute Struktur, die in der Bildgebung hohe Ansprüche an die Orts- und Dichteauflösung stellt.

Radiologische Verfahren

Unterschieden werden der zentrale, weitgehend avaskuläre Discus ulnocarpalis von der ligamentären, vaskularisierten Peripherie. An radiologischen Methoden stehen die Magnetresonanztomographie (MRT, bevorzugt kontrastverstärkt) sowie die MR- und CT-Arthrographie zur Verfügung.

Methodische Innovation

Während die hochaufgelöste MRT die diagnostische Basis am TFCC darstellt, sollten die arthrographischen Schnittbildverfahren zur dezidierten Frage nach dem Zustand der fovealen (proximalen) Lamina des TFCC eingesetzt werden. Die Konvergenz der TFCC-Peripherie auf den Processus styloideus ulnae und die Fovea capitis ulnae muss in der Befundung berücksichtigt werden.

Bewertung

Für Läsionen des Discus ulnocarpalis besitzt die Palmer-Klassifikation Vorteile, für Läsionen an den ulnaren Insertionen dagegen die Atzei-Klassifikation.

Empfehlung für die Praxis

Für eine sichere MRT-Diagnostik des TFCC sind eine hochaufgelöste Untersuchungstechnik und eine anatomiebasierte Bildinterpretation wichtig.

Abstract

Clinical issue

The triangular fibrocartilage complex (TFCC) is an anatomically complex structure with high demands on spatial and contrast resolution in imaging.

Radiological methods

The central, predominantly avascular articular disc can be distinguished from the ligamentous, vascularized periphery. Imaging methods include magnetic resonance imaging (MRI, preferably contrast-enhanced) as well as MR and computed tomography (CT) arthrography.

Diagnostic innovations

While high-resolution MRI represents the standard diagnostic tool for the TFCC in general, arthrographic imaging is particularly useful for assessment of the foveal (proximal) lamina of the TFCC. In radiological reporting, the convergence of the TFCC periphery towards the ulnar styloid process and the ulnar fovea must be considered.

Achievements

The Palmer classification is suitable for evaluating lesions of the articular disc, whereas the Atzei classification is superior for lesions of the ulnar TFCC insertions.

Practical recommendation

Use of a high-resolution examination technique and anatomy-based image interpretation are important for reliable MRI of the TFCC.

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, Nußbaumstraße 20, 80336, München, Deutschland

    R. Schmitt & N. Hesse

  2. Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    R. Schmitt, J. P. Grunz & K. Luetkens

  3. Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München, Deutschland

    E. Haas-Lützenberger

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Correspondence to R. Schmitt.

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Interessenkonflikt

R. Schmitt, J.P. Grunz, K. Luetkens, E. Haas-Lützenberger und N. Hesse geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schmitt, R., Grunz, J.P., Luetkens, K. et al. Der ulnokarpale Komplex. Radiologe 61, 343–350 (2021). https://doi.org/10.1007/s00117-021-00824-4

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