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Begutachtung des Diskusschadens am Handgelenk

Expert opinion of triangular fibrocartilage complex lesions

  • Begutachtung
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Bei der Begutachtung des Diskusschadens muss die Diskusverletzung von Normvarianten und verschleißbedingten Schäden abgegrenzt werden. Diagnostisch helfen die Magnetresonanztomographie und insbesondere die Arthroskopie weiter, Klassifikationen der Schäden sind möglich. Entscheidend für die Begutachtung ist aber die Wertung des Unfallmechanismus, geeignet sind das Kompressionstrauma im Sinne eines Sturzes auf die abstützende Hand oder unphysiologische Zug- und Druckbelastungen bei Fehlstellungen am körperfernen Unterarmende. Meist aber entstehen Diskusverletzungen in Verbindung mit distalen Radiusfrakturen und auch beim Hypersupinationstrauma mit Zerreißung der Ligg. radioulnaria. Diagnostisch müssen die Diskusschäden (sowohl Verletzungen als auch Verschleiß) vom Meniskusschaden und auch von pathomorphologischen Veränderungen bei vorbestehendem zentralem Diskusdefekt unterschieden werden. Nach Prüfung des Unfallmechanismus ist die Diskusverletzung im Vollbeweis nachzuweisen, ihre Folgen müssen von der eigentlichen Läsion abgegrenzt werden.

Abstract

An expert opinion on triangular fibrocartilage complex (TFCC) must differentiate between normal variants and damage from wear and tear. Magnetic resonance tomography, and in particular arthroscopy, can help in diagnosis, while classification of damage is possible. Crucial to any expert opinion is an appraisal of the mode of accident, e.g. compression trauma as a result of falling on the supporting hand or non-physiological tensile or compressive stress due to poor positioning on lower arm extremities distant from the body. Generally, however, disc injury occurs in association with distal radius fractures and hypersupination trauma with laceration of the radioulnar ligament. The differential diagnosis of disc damage (both injury and wear and tear) includes meniscus damage and pathomorphologic changes due to an existing central disc defect. Following verification of the mode of accident, the diagnosis of disc injury is established; its effects must be differentiated from the actual lesion.

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Literatur

  1. Abe Y, Kuwata N, Doi K et al. (1999) Wrist pain with triangular fibrocartilage theckening. Arch Orthop Trauma Surg 119: 98–99

    Article  PubMed  CAS  Google Scholar 

  2. Acosta R, Hnat W, Scheker LR (1993) Distal radio-ulnar ligament motion during supination and pronation. J Hand Surg [Br] 18B: 502–505

  3. Adams BD (1993) Partial excision of the triangular fibrocartilage complex articular disk: a biomechanical study. J Hand Surg [Am] 18A: 334–340

  4. Adams BD (2005) Distal radioulnar joint instability. In: Green DP, Hotchkiss RN, Pederson WC et al. (eds) Green’s operative hand surgery. Elsevier, Oxford, pp 605–630

  5. Adams BD, Holley KA (1993) Strains in the articular disk of the triangular fibrocartilage complex: a biomechanical study. J Hand Surg [Am] 18A: 919–925

  6. Aschoff L (1925) Über den Entzündungsbegriff. Vorträge über Pathologie gehalten an den Universitäten und Akademien Japans im Jahre 1924. Fischer, Jena

  7. Baehser-Griffith P, Bednar JM, Osterman AL et al. (1997) Arthroscopic repairs of triangular fibrocartilage complex tears. AORN J 66: 101–102, 105–111, quiz 112: 115, 117–118

    Google Scholar 

  8. Barrachina J, Bosch M, Aguilera JM et al. (2000) Ulnar compartment syndrome. Arthroscopic treatment. J Hand Surg [Br] [Suppl 1] 25B: 32

  9. Bednar JM (1994) Repair of peripheral triangular fibrocartilage lesions. Therapeutic und advanced wrist arthroscopy. American Society for Surgery of Hand, Bermingham, AL, October 1st

  10. Bednar JM, Osterman AL (1994) The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin 10: 605–614

    PubMed  CAS  Google Scholar 

  11. Bednar MS, Arnoczky SP, Weiland AJ (1991) The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg [Am] 16A: 1101–1105

  12. Benjamin M, Evans EJ, Pemberton DJ (1990) Histological studies on the triangular fibrocartilage complex of the wrist. J Anat 172: 59–67

    PubMed  CAS  Google Scholar 

  13. Beyermann K, Krimmer H, Lanz U (1999) TFCC-Läsionen. Diagnostik und Therapie. Orthopäde 28: 891–898

    PubMed  CAS  Google Scholar 

  14. Biyani A, Simison AJM, Klenermann L (1995) Fractures of the distal radius and ulna. J Hand Surg [Br] 20B: 357–364

  15. Blazar PE, Chan PSH, Kneeland JB et al. (2001) The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions. J Hand Surg [Am] 26A: 742–748

  16. Bohndorf K (1996) Injuries at the articulating surfaces of bone (chondral, osteochondral, subchondral fractures and osteochondrosis dissecans). Eur J Radiol 22: 22–29

    Article  PubMed  CAS  Google Scholar 

  17. Bohndorf K (1999) Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures). Skeletal Radiol 28: 545–560

    Article  PubMed  CAS  Google Scholar 

  18. Borisch N, Haußmann P (2004) Das Caput-ulnae-Syndrom. Orthopäde 33: 692–697

    Article  PubMed  CAS  Google Scholar 

  19. Bowers WH (1991) Instability of the distal radioulnar articulation. Hand Clin 7: 311–327

    PubMed  CAS  Google Scholar 

  20. Braun RM (1992) The distal joint of the radius and ulna. Clin Orthop Relat Res 275: 74–78

    PubMed  Google Scholar 

  21. Brown JA, Janzen DL, Adler BD et al. (1994) Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain. J Assoc Can Radiol 45: 292–296

    CAS  Google Scholar 

  22. Bruckner JD, Alexander AH, Lichtman DM (1995) Acute dislocations of the distal radio-ulnar joint. J Bone Joint Surg Am 77A: 958–968

    Google Scholar 

  23. Bullough PG, Vigorita VJ (1987) Orthopädische Krankheitsbilder. Thieme, Stuttgart New York, S 77–186

  24. Buterbaugh GA (1992) Ulnar impaction syndrome: treatment by arthroscopic removal of the distal ulna. Tech Orthop 7: 66–71

    Article  Google Scholar 

  25. Cantor RM, Sren PJ, Wyrick JD et al. (1994) The relevance of ligament tears or perforations in the diagnosis of wrist pain: an arthrographic study. J Hand Surg [Am] 19A: 945–953

  26. Cerezal L, Del Pinal F, Abascal F et al. (2002) Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 22: 105–121

    PubMed  Google Scholar 

  27. Chidgey LK, Dell PC, Bittar ES et al. (1991) Histologic anatomy of the triangular fibrocartilage. J Hand Surg [Am] 16A: 1084–1100

  28. Chun S, Palmer AK (1987) Chronic ulnar wrist pain secondary to partial rupture of the extensor carpi ulnaris tendon. J Hand Surg [Am] 12A: 1032–1035

  29. Chun S, Palmer AK (1998) The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg [Am] 18A: 46–53

  30. Cober SR, Trumble TE (2001) Arthroscopic repair of triangular fibrocartilage complex injuries. Orthop Clin North Am 30: 279–294

    Article  Google Scholar 

  31. Coleman HM (1960) Injuries of the articular disk at the wrist. J Bone Joint Surg Br 42B: 522–529

    Google Scholar 

  32. Dailey SW, Palmer AK (2000) The role of arthroscopy in the evaluation and treatment of triangular fibrocartilage complex injuries in athletes. Hand Clin 16: 461–476

    PubMed  CAS  Google Scholar 

  33. De Smet L (1994) Ulnar variance: facts and fiction. Review article. Acta Orthop Belg 60: 1–9

    Google Scholar 

  34. Ekenstam FW (1992) Anatomy of the distal radioulnar joint. Clin Orthop Relat Res 275: 14–18

    Google Scholar 

  35. Ekenstam F (1998) Osseous anatomy and articular relationships about the distal ulna. Hand Clin 14: 161–164

    PubMed  CAS  Google Scholar 

  36. Felderhoff J, Lehnert M, Mellerowicz H (2003) Das schmerzhafte Handgelenk im Sport: Ulnokarpales Gelenkkompartiment und distales Radioulnargelenk. Dtsch Z Sportmed 54: 27–28

    Google Scholar 

  37. Fick SR (1904, 1910, 1911) Handbuch der Anatomie und Mechanik der Gelenke unter Berücksichtigung der bewegenden Muskeln. In 3 Teilen. Fischer, Jena

  38. Förstner H (1987) Das distale Radio-Ulnargelenk (DRU). Morphologische Überlegung und chirurgisch-orthopädische Konsequenzen. Unfallchirurg 90: 512–517

    PubMed  Google Scholar 

  39. Fortems Y, de Smet L, Fabry G (1994) Cartilaginous and ligamentous degeneration of the wrist. Anatomic study. Ann Chir Main 13: 383–386

    Article  CAS  Google Scholar 

  40. Fortems Y, De Smet L, Dauwe D et al. (1994) Incidence of cartilaginous and ligamentous lesions of the radio-carpal and distal radio-ulnar joint in an eldery population. J Hand Surg 19B: 572–757

    Google Scholar 

  41. Frahm R (2004) Bildgebende Diagnostik des ulnaren Handgelenkschmerzes. Orthopäde 33: 646–656

    Article  Google Scholar 

  42. Frank U (2004) Arthroskopische Therapie des TILT-Syndroms. Handchir Mikrochir Plast Chir 36: A1–A20

    Article  Google Scholar 

  43. Friedman S, Palmer A (1991) The ulnar impaction syndrome. Hand Clin 7: 295–310

    PubMed  CAS  Google Scholar 

  44. Gabl M, Lener M, Pechlaner S (1993) Destabilisierung des Discus articularis mit Abriss der ulnaren Styloidspitze bei distaler Radiusfraktur. Diagnostik und MR Movie. Unfallchirurgie 19: 108–111

    Article  PubMed  CAS  Google Scholar 

  45. Garcia-Elias M, Domènech-Mateu JM (1987) The articular disc of the wrist. Limits and relations. Acta Anat 128: 51–54

    PubMed  CAS  Google Scholar 

  46. Geisl H, Spritzendorfer E (1981) Der Riss des Discus articularis als Ursache des posttraumatischen Handgelenksschmerzes. Unfallheilkunde 84: 55–59

    PubMed  CAS  Google Scholar 

  47. Geisl H, Pühringer A (1989) Das Schicksal des Discus triangularis bei der Unterarmfraktur. Hefte Unfallheilkd 201: 328–332

    Google Scholar 

  48. Giunta RE, Krolak C, Biemer E et al. (2005) Patterns of subchondral bone mineralization in the distal radioulnar joint. J Hand Surg [Am] 30A: 343–350

  49. Graham HK, McCoy GF, Mollan RAB (1985) A new injury of the distal radio-ulnar joint. J Bone Joint Surg Br 67B: 302–304

    Google Scholar 

  50. Grechenig W, Fellinger M, Seibert FJ et al. (1996) Die Arthrographie des Handgelenks beim frischen Trauma. Unfallchirurg 99: 260–266

    PubMed  CAS  Google Scholar 

  51. Grechenig W, Tesch NP, Peicha G et al. (2002) Ulnar-impaction-syndrom. Eur Surg [Suppl 184] 34: 46–50

    Google Scholar 

  52. Haage H (1966) Die Arthrographie des Handgelenkes. I. Mitteilung: Das normale Gelenk und seine Variationen. Radiologie 6: 50

    CAS  Google Scholar 

  53. Haage H, Cornelius H (1966) Die Arthrographie des Handgelenkes, II. Miteilung: Der pathologische Discus articularis. Radiologie 6: 58

    CAS  Google Scholar 

  54. Haas N, Tempka A (1990) Behandlung der distalen Radiusfraktur – Diagnostik und Therapie der örtlichen Begleitverletzungen. Langenbecks Arch Chir Suppl Kongressbd II: 688–692

    Google Scholar 

  55. Haims AH, Schweitzer ME, Morrison WB (2002) Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. AJR Am J Roentgenol 178: 419–422

    PubMed  Google Scholar 

  56. Hauck RM, Skahen J, Palmer AK (1999) Classification and treatment of ulnar styloid nonunion. J Hand Surg [Am] 21A: 418–422

  57. Haugstvedt JR, Berglund LJ, Neale PG et al. (2001) A dynamic simulator to evaluate distal radio-ulnar joint kinematics. J Biomech 34: 335–339

    Article  PubMed  CAS  Google Scholar 

  58. Haugstvedt JR, Berger RA, Berglund LJ (2002) An analysis of the constraint properties of the distal radioulnar ligament attachments to the ulna. J Hand Surg [Am] 27A: 61–67

  59. Hempfling H (1993/1994) Synergistische Gelenkdiagnostik – Arthrographie und Arthroskopie. Chir Prax 47: 65–76

    Google Scholar 

  60. Hempfling H (1998) Bedeutung des Ellengriffels in der Therapie distaler Radiusfrakturen. Trauma Berufskrankh 1: 40–48

    Google Scholar 

  61. Hempfling H (2004) Die Läsionen des Handgelenksdiskus. Orthopäde 33: 657–675

    Article  PubMed  CAS  Google Scholar 

  62. Hempfling H (2004) Klassifikation des Knorpelschadens – traumatisch versus nichttraumatisch –. Orthop Prax 40: 528–541

    Google Scholar 

  63. Henle J (1856) Handbuch der systematischen Anatomie des Menschen. Vieweg, Braunschweig

  64. Hoegen K, Reske W (1956) Veränderungen an der dreieckigen Bandscheibe des distalen Radio-Ulnar-Gelenkes. Z Orthop Ihre Grenzgeb 87: 525–532

    PubMed  CAS  Google Scholar 

  65. Höpker WW (1984) Gelenkzwischenscheiben. In: Dörr W, Seibert G (Hrsg) Pathologie der Gelenke und Weichteiltumoren II. Springer, Berlin Heidelberg New York, S 723–921

  66. Hultén O (1928) Über anatomische Variationen der Handgelenksknochen. Acta Radiol 9: 155–168

    Article  Google Scholar 

  67. Imaeda T, Nakamura R, Shionoya K et al. (1996) Ulnar impaction syndrome: MR imaging findings. Radiology 201: 495–500

    PubMed  CAS  Google Scholar 

  68. Ishii S, Palmer AK, Werner FW (1998) An anatomic study of the ligamentous structure of the triangular fibrocartilage complex. J Hand Surg [Am] 23A: 977–985

  69. Jeffries AO, Craigen MAC, Stanley JK (1994) Wear patterns of the articular cartilage and triangular fibrocartilaginious complex of the wrist: a cadaveric study. J Hand Surg [Br] 19B: 306–309

  70. Kaempffe FA (1997) Central perforation of the articular disc of the triangular fibrocartilage complex in a 17 year old girl: could it be congenital? Am J Orthop 26: 565–567

    PubMed  CAS  Google Scholar 

  71. Kauer JHG (1975) The articular disc of the hand. Acta Anat 93: 590–605

    PubMed  CAS  Google Scholar 

  72. Kauer JHG (1975) Note sure le developement de ligament triangularis chez l‘homme. Bull Aussic Anat 59: 893–898

    CAS  Google Scholar 

  73. Kikuchi Y, Nakamura T (1998) Avulsion fracture at the fovea of the ulna. J Hand Surg [Br] 23B: 176–178

  74. Kim PR, Giachino A, Uhthoff HK (1995) Histologic analysis of fetal ulnar variance. J Hand Surg [Am] 21A: 114–116

  75. Kleinschmidt JT, Kleinschmidt JGM (1992) Die Begutachtung der Discus articularis Verletzung und der karpalen Bandinstabilität nach Handwurzeltrauma. Med Sach 88: 12–14

    Google Scholar 

  76. Ko JS, Shih C, Chang C-Y et al. (1998) Triangular fibrocartilage perforations with bilateral negative ulnar variant wrists: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 61: 556–559

    Google Scholar 

  77. Koebke J, Brade A (1980) Zur Läsion des Discus articularis des Handgelenkes. Z Orthop Ihre Grenzgeb 118: 616

    Google Scholar 

  78. Koebke J, Schlüter M (1987) Zur Lagebezeichnung zwischen distaler Radiusepiphyse und distalem Ende der Ulna. Z Orthop Ihre Grenzgeb 125: 82–84

    Article  PubMed  CAS  Google Scholar 

  79. Kreusch-Brinker R, Zilch H, Sparmann M (1988) Arthrographische Diagnostik isolierter frischer Diskusverletzungen des Handgelenkes. Orthop Prax 5: 280–284

    Google Scholar 

  80. Lang F (1942) Das distale Radio-Ulnargelenk. Monatsschr Unfallheilkd 36: 1–85

    Google Scholar 

  81. Langenberg R (1987) Die Therapie der distalen Radiusfraktur. Orthop Traumatol 34: 571–578

    CAS  Google Scholar 

  82. Lee DH, Dickson KF, Bradley EL (2004) The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study. J Hand Surg [Am] 29A: 676–684

  83. Lewis OJ (1970) The development of the human wrist joint during the fetal period. Anat Rec 166: 499–516

    Article  PubMed  CAS  Google Scholar 

  84. Lichtman DM, Joshi A (2003) Acute injuries of the distal radioulnar joint and triangular fibrocartilage complex. Instr Course Lect 52: 175–183

    PubMed  Google Scholar 

  85. Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. J Hand Surg [Br] 22B: 638–643

  86. Martinek H, Spängler H (1977) Zur Traumatologie des Discus articularis des Handgelenkes. 2. Teil: Operative Behandlung und Ergebnisse. Arch Orthop Unfallchir 87: 299–308

    Article  PubMed  CAS  Google Scholar 

  87. Meier R, Krettek C, Krimmer H (2003) Bildgebende Verfahren am Handgelenk. Unfallchirurg 106: 999–1009

    Article  PubMed  CAS  Google Scholar 

  88. Meier R, Schmitt R, Christopoulos G et al. (2003) TFCC-Läsionen. Wertigkeit der Arthro-MRT im Vergleich zur Handgelenksarthroskopie. Unfallchirurg 3: 190–194

    Article  Google Scholar 

  89. Melone CP, Nathan R (1992) Traumatic disruption of the triangular fibrocartilage complex. Clin Orthop Relat Res 275: 65–73

    PubMed  Google Scholar 

  90. Mikic ZD (1977) Age changes in the triangular fibrocartilage of the wrist joint. J Anat 126: 367–384

    Google Scholar 

  91. Mikic ZD (1988) Detailed anatomy of the articular disc of the distal radioulnar joint. Faculty of Medicine, Novi Sad,

  92. Milch H (1926) Dislocation of the inferior end of the ulna: suggestion for a new operative procedure. Am J Surg 1: 141–146

    Article  Google Scholar 

  93. Milch H (1941) Cuff resection of the ulna for malunited Colles‘ fracture. J Bone Joint Surg 39: 11–13

    Google Scholar 

  94. Moriggl B, Putz RV (1999) Der Carpus im Konflikt zwischen Stabilität und Mobilität. Orthopäde 28: 822–832

    PubMed  CAS  Google Scholar 

  95. Nakamura T, Makita A (2000) The proximal ligamentous component of the triangular fibrocartilage complex. J Hand Surg [Br] 25B: 479–486

  96. Nakamura T, Yabe Y (2000) Histological anatomy of the triangular fibrocartilage complex of the human wrist. Ann Anat 182: 567–572

    PubMed  CAS  Google Scholar 

  97. Nakamura T, Yabe Y, Horiuchi Y (1996) Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 21B: 581–586

  98. Nakamura R, Horii E, Imaeda T et al. (1997) The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 22: 719–723

    Google Scholar 

  99. Nakamura T, Yabe Y, Horiuchi Y (1999) Dynamic changes in the shape of the triangular fibrocartilage complex during rotation demonstrated with high resoluting magnetic resonance imaging. J Hand Surg [Br] 24B: 338–341

  100. Nakamura T, Takayama S, Horiuchi Y et al. (2001) Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg [Br] 26B: 446–454

  101. Nishikawa S, Toh S (2002) Anatomical study of the carpal attachment of the triangular fibrocartilage complex. J Bone Joint Surg Br 84-B: 1062–1065

  102. Nishikawa S, Toh S, Miura H (2002) The carpal detachment injury of the triangular fibrocartilage complex. J Hand Surg [Br] 27: 86–89

    Google Scholar 

  103. Oneson SR, Timins ME, Scales LM et al. (1997) MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol 168: 1513–1518

    PubMed  CAS  Google Scholar 

  104. Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg [Am] 14A: 594–606

  105. Palmer A, Werner F (1981) The triangular fibrocartilage complex of the wrist: anatomy and function. J Hand Surg [Am] 6: 153–162

    Google Scholar 

  106. Palmer AK, Glisson BS, Werner FW (1982) Ulnar variance determination. J Hand Surg [Am] 7: 376–379

    Google Scholar 

  107. Pauwels F (1960) Eine neue Theorie über den Einfluss mechanischer Reize auf die Differenzierung der Stützgewebe. Zehnter Beitrag zur funktionellen Anatomie und kausalen Morphologie des Stützapparates. Z Anat Entwicklungsges 121: 478–515

    Article  CAS  Google Scholar 

  108. Petit JL (1726) in Platt H (1932) Colle’s fracture. BMJ 11: 288

    Google Scholar 

  109. Rabinowitz RS, Light TR, Havey RM et al. (1994) The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg [Am] 19-A: 385–393

  110. Rau WS, Seifert J (1982) Arthrographische Befunde bei Diskusläsionen am Handgelenk. Radiologe 22: 214–221

    PubMed  CAS  Google Scholar 

  111. Rehn J (1965) Behandlungsergebnisse typischer Radiusfrakturen. Chirurg 36: 206–211

    PubMed  CAS  Google Scholar 

  112. Richards RS, Bennett JD, Roth JH et al. (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg [Am] 22A: 772–776

  113. Rosenthal A (1949) Die Verletzung des Discus articularis bei der typischen Radiusfraktur. Arch Klin Chir 262: 390–393

    Article  Google Scholar 

  114. Schmidt HM (1998) Chirurgische Anatomie des distalen Radioulnargelenkes und des ulnokarpalen Gelenkkompartimentes. Handchir Mikrochir Plast Chir 30: 346–350

    PubMed  CAS  Google Scholar 

  115. Schmidt HM (2004) Die Anatomie des ulnokarpalen Komplexes. Orthopäde 33: 628–637

    Article  PubMed  Google Scholar 

  116. Schmidt HM, Schoonhoven J van, Lanz U (1998) Die knorpelig-ligamentäre Zügelung des Ulnakopfes. Handchir Mikrochir Plast Chir 30: 382–386

    PubMed  CAS  Google Scholar 

  117. Schuind F, An K-N, Berglund L et al. (1991) The distal radioulnar ligaments: a biomechanical study. J Hand Surg [Am] 16A: 1106–1112

  118. Schütz K, Middendorp J, Meyer VE (1996) Ulnodorsales Impingementsyndrom: Die Meniskusläsion des Handgelenkes. Handchir Mikrochir Plast Chir 28: 227–232

    PubMed  Google Scholar 

  119. Schuurman AH, Bos KE (1995) The ulno-carpal abutment syndrome. J Hand Surg [Br] 20B: 171–177

  120. Shionoya K, Nakamura R, Imaeda T et al. (1998) Arthrography is superior to magnetic resonance imaging for diagnosing injuries of triangular fibrocartilage. J Hand Surg [Br] 23B: 402–405

  121. Siggelkow G (1984) Schädigung des Discus articularis des Handgelenks nach distaler Radiusfraktur. Zentralbl Chir 109: 750–756

    PubMed  CAS  Google Scholar 

  122. Sik J (1963) Isolierte Sportverletzungen des Discus articularis (Triangularis) im Handgelenk. Klin Med 18: 369–371

    CAS  Google Scholar 

  123. Singh R (1993) Untersuchungen am „ulnokarpalen Komplex“ der menschlichen Hand. Med. Dissertation, Universität Münster

  124. Strassmair M, Wilhelm K (2002) Die Luxation der Extensor-carpi-ulnaris-Sehne. Orthopäde 31: 88–91

    Article  PubMed  CAS  Google Scholar 

  125. Tang JB, Ryu J, Kish V (1998) The triangular fibrocartilage complex: an important component of the pulley for the ulnar wrist extensor. J Hand Surg [Am] 23A: 986–991

  126. Taylor GW, Parson CI (1938) The role of the discus articularis in colles fracture. J Bone Joint Surg 20: 149–152

    Google Scholar 

  127. Terrill RQ (1994) Use of arthroscopy in the evaluation and treatment of chronic wrist pain. Hand Clin 10: 593–603

    PubMed  CAS  Google Scholar 

  128. Terry CL, Waters PM (1998) Triangular fibrocartilage injuries in paediatric an adolescent patients. J Hand Surg [Am] 23A: 626–634

  129. Teurlings L, Miller GJ, Wright TW (2000) Pressure mapping of the radioulnar carpal joint: effects of ulnar lengthening and wrist position. J Hand Surg [Br] 25B: 346–349

  130. Tomaino MM (1998) Ulnar impaction syndrome in the ulnar negative and neutral wrist. J Hand Surg [Br] 23B: 754–757

  131. Tomaino MM, Weiser RW (2001) Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance. J Hand Surg [Am] 26A: 1047–1052

  132. Tomaino MM, Gainer M, Towers JD (2001) Carpal impaction with the ulnar styloid process: treatment with partial styloid resection. J Hand Surg [Br] 26B: 252–255

  133. Trumble TE, Gilbert M, Vedder N (1996) Arthroscopic repair of the triangular fibrocartilage complex. Arthroscopy 12: 588–597

    Article  PubMed  CAS  Google Scholar 

  134. Trumble TE, Gilbert M, Vedder N (1997) Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg [Am] 22A: 57–65

  135. Trumble TE, Gilbert M, Vedder N (1997) Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. Adv Orthop Surg 21: 21–22

    Google Scholar 

  136. Trumble TE, Gilbert M, Vedder N (1997) Ulnar shortening combined with arthroscopic repairs in the delayed management of triangular fibrocartilage complex tears. J Hand Surg [Am] 22A: 807–813

  137. Uchiyama S, Nakatsuchi Y (1994) Anatomical and radiological evaluation of the triangular fibrocartilage complex of the wrist. J Hand Surg [Br] 19B: 319–324

  138. Viegas SF, Patterson RM, Hokanson JA et al. (1993) Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg [Am] 19: 463–475

    Google Scholar 

  139. Ward LD, Ambrose CC, Masson MV et al. (2000) The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg [Am] 25A: 341–351

  140. Watanabe H, Berger RA, An K-N et al. (2004) Stability of the distal radioulnar joint contributed by the joint capsule. J Hand Surg [Am] 29A: 1114–1120

  141. Watson HK, Weinzweig J (1999) Triquetral impingement ligament tear (tilt). J Hand Surg [Br] 24B: 321–324

  142. Weigl K, Spira E (1969) The triangular fibrocartilage of the wrist joint. Reconstr Surg Traumatol 11: 139–153

    PubMed  CAS  Google Scholar 

  143. Whipple TL (1992) The wrist. Lippincott, Philadelphia

  144. Wilhelm K (1986) Läsionen des Discus ulnocarpalis. In: Nigst H (Hrsg) Handgelenksverletzungen. Hippokrates, Stuttgart

  145. Windisch G, Weiglein A, Grechenig W et al. (2001) Anatomie des distalen radioulnaren Gelenkes (DRUG) und des ulnocarpalen Komplexes. Eur J Trauma E [Suppl] 1: S169–S174

  146. Winkel R, Schlageter M (2006) Schmerzhaftes distales radioulnares Gelenk (DRUG). Gibt es die Lösung? Trauma Berufskrankh 8: 136–142

    Article  Google Scholar 

  147. Winter PM (1976) Untersuchungen am Discus articularis ulnae mit Hilfe der Arthrographie des Handgelenkes. Handchirurgie 8: 135–144

    PubMed  CAS  Google Scholar 

  148. Wright TW, Charco M del, Wheeler D (1994) Incidence of ligament lesions and associated degenerative changes in the elderly wrist. J Hand Surg [Am] 19A: 313–318

  149. Wright TW, Dobyns JH, Lindscheid RL et al. (1994) Carpal instability non-dissociative. J Hand Surg [Br] 19B: 763–773

  150. Zanetti M, Linkous MD, Gilula LA et al. (2000) Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists. Radiology 216: 840–845

    PubMed  CAS  Google Scholar 

  151. Ziegler PV (1999) Über die radioulnare Differenz. Med. Dissertation, Universität Ulm

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Correspondence to H. Hempfling.

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Diese Ausarbeitung basiert in Teilen auf einem umfangreichen Text, den der Autor federführend für die Kommission „Gutachten“ der Deutschen Gesellschaft für Unfallchirurgie erstellt hat. An der Ausarbeitung waren beteiligt: Prof. Dr. M. Weber, Freiburg; Dr. A. Schmidt, Murnau; Dr. E. Ludolph, Düsseldorf, und Dr. F. Schröter, Kassel.

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Hempfling, H. Begutachtung des Diskusschadens am Handgelenk. Trauma Berufskrankh 10, 66–76 (2008). https://doi.org/10.1007/s10039-008-1348-2

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