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Die Läsionen des Handgelenkdiskus

Pathologie, Diagnostik und Therapie

Lesions of the TFCC

Pathology, diagnosis and treatment

  • Leitthema
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Zusammenfassung

Die Läsionen des Handgelenkdiskus stellen zzt. sowohl ein diagnostisches als auch ein therapeutisches Problem dar. Zum einen werden die Verletzungen des Diskus häufig übersehen, sodass frische Rupturen leider nicht der sofortigen Rekonstruktion zugeführt werden können, andererseits sind die therapeutischen Maßnahmen noch wenig erforscht, und damit können aussagekräftige Ergebnisse noch nicht vorgelegt werden. Sowohl bezüglich der Anatomie als auch bezüglich der Pathologie und der Diagnostik wie auch Therapie sind Vergleiche zu den Menisken des Kniegelenkes möglich.

Abstract

Lesions of the TFCC are currently a diagnostic and therapeutic challenge. Disc-injuries are often not identified and, therefore, acute ruptures are unfortunately not always immediately repaired. Moreover, therapeutic measures are still sparse and informative trial results are lacking. An anatomical, pathological, diagnostic and therapeutic comparison with the meniscus of the knee is possible.

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Literatur

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

    Article  CAS  PubMed  Google Scholar 

  2. Adolfsson L, Jörgsholm P (1998) Arthroscopically assisted reduction of intra-articular fractures of the distal radius. J Hand Surg 23B/3: 391–391

    Google Scholar 

  3. Allieu Y, Garcia-Elias M (2000) Dynamic radial transluation instability of the carpus. J Hand Surg (Br Eur) 25B: 1: 33–37

  4. Arons MS, Fishbone G, Arons JA (1999) Communicating defects of the triangular fibrocartilage complex without of the trianguar fibrocartilage: A report of two cases. J Hand Surg 24A: 148–151

    Article  Google Scholar 

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

  6. Barrachina J, Bosch M, Aguilera JM, Henriquez A (2000) Ulnar compartment syndrome. Arthroscopic treatment. J Hand Surg 25B (Suppl 1): 32

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

  8. Beyermann K, Busse F, Krimmer H, Lanz U (2002) Arthroskopisches Debridement bei Läsionen desTFCC (triangular fibrocartilage complex). Arthroskopie 15: 21–25

    Article  Google Scholar 

  9. Bilos ZJ, Chamberland D (1991) Distal ulnar head shortening for treatment of triangular fibrocartilage complex tears with positive ulnar variance. J Hand Surg 16A: 115–1119

    Google Scholar 

  10. Blackwell RE, Jemison DM, Foy BD (2001) The holmium yttrium-aluminum-garnet laser in wrist arthroscopy: A five-year experience in the treatment of central triangular fibrocartilage complex tears by partial excision. J Hand Surg 26A: 77–84

    Google Scholar 

  11. Blazar PE, Chan PSH, Kneeland JB, Leatherwood D, Bozentka DJ, Kowalchick R (2001) The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions. J Hand Surg 26A: 742–748

    Google Scholar 

  12. Böhringer G, Schädel-Höpfner M, Junge A, Gotzen L (2001) Die arthroskopische Therapie frischer Discus articularis-Verletzungen bei distalen Radiusfrakturen. Handchir Mikrochir Plast Chir 33: 245–251

    Article  PubMed  Google Scholar 

  13. Böhringer G, Schädel-Höpfner M, Petermann J, Gotzen L (2002) A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. J Arthrosc Relat Surg 18/2: 211–213

    Google Scholar 

  14. Breitenseher MJ, Gaebler C (1997) Trauma of the wrist. Eur J Radiol 25: 129–139

    CAS  PubMed  Google Scholar 

  15. Bullough PG, Vigorita VJ (1987) Orthopädische Krankheitsbilder. Pathologie—Radiologie—Klinik. Thieme, Stuttgart

  16. Cantor RM, Stern PJ, Wyrick JD, Michaels SE (1994) The relevance of ligament tears or perforations in the diagnosis of wrist pain: An arthrographic study. J Hand Surg 19A: 945–953

    Google Scholar 

  17. Chou C-H, Lee T-S (2001) Peripheral tears of triangular fibrocarticlage complex: results of primary repair. Orthopaedics (SICO) 25: 392–395

    Google Scholar 

  18. Cooper R, Misol S (1970) Tendon and ligaments insertion. J Bone Joint Surg 52-A: 1–20

    Google Scholar 

  19. Corso SJ, Savoie FH, Geissler WB, Whipple TL, Jiminez W, Jenkins H (1997) Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: A multicenter study. Arthroscopy 13: 78–84

    CAS  PubMed  Google Scholar 

  20. Dailey SW, Palmer AK (2000) The role of arthroscopy in the evaluation and treatment of triangular fibrocartilage complex injuries in athletes. Hand Clinics 16/3

  21. De Araujo W, Poehling GG, Kuzma GR (1996) New tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies. Arthroscopy 12/6: 699–703

    Google Scholar 

  22. Ekenstam FW, Hagert CG (1985) Anatomical studies on the geometry and stability of the distal radioulnar joint. Scand J Plast Reconstr Hand Surg 19: 17–25

    Google Scholar 

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

    Google Scholar 

  24. Feldon P, Terrono AL, Belsky MR (1992) The „wafer“ procedure. Clin Orthop Relat Res 275: 124–129

    Google Scholar 

  25. Fellinger M, Grechenig W, Seibert F.J, Weiglein A, Peicha G, Clement H (1995) Arthroskopische Refixationstechniken des Discus triangularis beim frischen Handgelenkstrauma. Arthroskopie 8: 294–298

    Google Scholar 

  26. Fellinger M, Grechenig W, Seibert F, Seggl W, Peicha A (1998) Die Handgelenksarthroskopie in der Planung von Korrektureingriffen und in der Behandlung posttraumatischer Folgezustände nach Radiusfakturen an typischer Stelle. Acta Chir Austria 30 (Suppl 140) 60: 62

    Google Scholar 

  27. Fischer M, Denzler C, Sennwald G (1996) Begleitene karpale Bandläsionen bei frischen distalen Radiusfrakturen. Arthroskopische Studie über 54 Fälle. Swiss Surg 2: 269–273

    CAS  PubMed  Google Scholar 

  28. Freedman DM, Edwards GS, Willems MJ, Meals RA (1998) Right versus left symmetry of ulnar variance. Clin Orthop Relat Res N354: 153–158

    Article  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  30. Gartland JJ, Werley CW (1951) Evaluation of healed colles fractues. J Bone Joint Surg 33-A: 895–907

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  32. Geissler WB, Freeland AE, Savoie FH, Mcintyre L, Whipple TL (1993) Carpal instability associated with displaced intraarticular distal radius fractures. Arthroscopy 9: 348

    Google Scholar 

  33. Geissler WB, Freeland AE, Savoie FH, Mcintyre LW, Whipple TL (1996) Intracarpal softtissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg 78-A/3, 357–336

  34. Golimbu CN et al. (1989) Tears of triangular fibrocartilage of the wrist: MR imaging. Radiology 173: 731–733

    CAS  PubMed  Google Scholar 

  35. Grechenig W, Tesch NP, Peicha G, Seibert FJ (2002) Ulnar-Impaction-Syndrom. Eur Surg 34 (Suppl 184): 46–50

    Google Scholar 

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

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  38. Haage H (1973) Arthrographie des Handgelenkes. Anatomie. In: Heuck F (Hrsg) Handbuch der Medizinischen Radiologie V, Springer, Berlin Heidelberg New York, S 354–398

  39. Haims AH, Schweitzer ME, Morrison WB et al. (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

    Google Scholar 

  40. Hanker GJ (1991) Diagnostic and operative arthroscopy of the wrist. Clin Orthop 263: 165–174

    PubMed  Google Scholar 

  41. Haugstvedt JR, Husby T (1999) Results of repair of periphral tears in the triangular fibrocartilage complex using an arthroscopic suture technique. Scand J Plast Reconstr Surg Hand Surg 33(4): 439–447

    Article  CAS  PubMed  Google Scholar 

  42. Hempfling H (2001) Unveröffentlichte eigene Ergebnisse

  43. Herold T, Lenhart M, Held P, Babel M, Ruf S, Feuerbach S, Link J (2001) Indirekte MR Arthrographie des Handgelenkes bei TFCC Läsionen. Fortsch Röntgenstr 173: 1006–1011

    Google Scholar 

  44. Hobby JL, Tom BD, Bearcroft PW, Dixon AK (2001) Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol 56: 50–57

    Article  CAS  PubMed  Google Scholar 

  45. Hoffmann S (1958) Der Bau des Discus articularis articulationis radioulnaris distalis. Anat Anz 106: 173–118

    Google Scholar 

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

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

    Google Scholar 

  48. Hulsizer D, Weiss A-P, Akelman E (1997) Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg 11A: 694–698

    Google Scholar 

  49. Husby T, Haugstvedt JR (2001) Long-term results after artroscopic resection of lesions of the triangular fibrocartilage complex. Scand J Plast Reconstr Surg Hand Surg 335(1): 79–83

    Article  Google Scholar 

  50. Imbriglia JE, Clifford JW (2001) Management on the painful distal radioulnar joint. In: Watson HK, Weinzweig J (eds) The wrist. Lippincott Williams & Wilkings, Philadelphia

  51. Jantea C, Baltzre A, Strauss M, Schneider T (1995) Arthroskopische Rekonstruktion radialseitiger Läsionen des Discus ulnocarpalis. Arthroskopie 8: 288–293

    Google Scholar 

  52. Kato H, Nakamura K, Shionoya K, Makino N, Imaeda T (2000) Does high-resolution MR imaging have better accuracy than standard MR imaging for evaluation of the triangular fibrocartilage complex? J Hand Surg (Br Eur) 25B/5: 487–491

    Google Scholar 

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

    Google Scholar 

  54. Martinek H, Spängler H (1977) Zur Traumatologie des Discus articularis des Handgelenkes. 2. Teil: Operative Behandlung und Ergebnisse. Arch Orthop Unfallchir87, 299–308

  55. Meier R, Schmitt R, Christopoulos G, Krimmer H (2003) TFCC-Läsionen. Wertigkeit der Arthro-MRT im Vergleich zur Handgelenksarthroskopie. Unfallchirurg 106/3: 190–194

    Google Scholar 

  56. Milch H (1941) Cuff resection of the ulna for malunited colles fracture. J Bone Joint Surg 23: 311–313

    Google Scholar 

  57. Millants P, De Smet L, Van Ransbeeck H (2002) Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist. Chirurgie de la main 21(5): 298–300

    Article  CAS  PubMed  Google Scholar 

  58. Minami A, Kato H (1998) Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg (23A)5: 904–908

    Google Scholar 

  59. Minami A, Kato H (1998) Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg 23A: 904–908

    Google Scholar 

  60. Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L (1997) MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR; 168: 1513–1518

  61. Osterman AL, Terrill RG (1991) Arthroscopic treatment of tfcc lesions. Hand Clin 7/2, (May)

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

    Google Scholar 

  63. Palmer WK, Werner FW (1984) Biomechanics of the distal radio-ulnar joint. Clin Orthop 187: 26–34

    PubMed  Google Scholar 

  64. Palmer WK, Werner FW, Glisson RR, Murphy DJ (1988) Partial excision of the triangular fibrocartilage complex. J Hand Surg 13-A/3: 391–394

    Google Scholar 

  65. Palmer AK (1989) Triangular fibrocartilage complex lesions: A classification. J Hand Surg 14A: 594–606

    Google Scholar 

  66. Pederzini L et al. (1992) Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthroscopy and magnetic resonance imaging. Arthroscopy 8: 191–197

    CAS  PubMed  Google Scholar 

  67. Peterson RK, Savoie III FH, Field LD (1998) Arthroscopic treatment of sports injuries to the triangular fibrocartilage. Sports Medicine and Arthroscopy Review 6: 262–269

    Google Scholar 

  68. Peterson RK, Savoie FH, Field LD (1998) Arthroscopic treatment of sports injuries of the triangular fibrocartilage. Sports Med Arthrosc Rev 6: 262–269

    Google Scholar 

  69. Poehling GG (1994) Arthroscopy of the wrist and elbow. Raven, New York

  70. Rabinowitz RS, Light TR, Havey RM, Gourineni P, Patwardhan AG, Sartori MJ, Vrbos L (1994) The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg 19-A/3: 385–393

    Google Scholar 

  71. Redler MR, Fries SP, Boros B (2000) Arthroscopic repair of peripheral TFCC tears. Arthroscopy 16/4: 405–438

    Google Scholar 

  72. Richards RS, Bennett JD, Roth JH, Milne K (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg 22A: 772–776

    Google Scholar 

  73. Roth JH, Haddad RG (1986) Radiocarpal arthroscopy and arthrography in the diagnosis of ulnar wrist pain. Arthroscopy 2/4: 234–243

    Google Scholar 

  74. Ruch DS, Anderson SR, Ritter MR (2003) Biomechanical comparison of transosseous and capsular repair of peripheral triangular fibrocartilage tears. J Arthrosc Relat Surg 19/4: 391–396

    Google Scholar 

  75. Ruch DS, Yang CC, Smith BP (2003) Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articualr distal radius fractures. J Arthrosc Relat Surg 19/5: 511–516

    Google Scholar 

  76. Sagerman SD, Short W (1996) Arthroscopic repair of radial-sidid triangular fibrocartilage complex tears. J Arthrosc Relat Surg 12/3: 339–342

    Google Scholar 

  77. Schmitt R, Christopoulos G, Meier R, Coblenz G, Fröhner S, Lanz U, Krimmer H (2003) Direkte MR Arthrographie des Handgelenkes im Vergleich zur Arthroskopie: Eine prospektive Studie an 125 Patienten. Fortschr Röntgenstr 175: 911–919

    Google Scholar 

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

    PubMed  Google Scholar 

  79. Seibert FJ, Fellinger M, Grechenig W, Peicha G, Passler J (1955) Radiusfraktur loco typico. Arthroskopische Diagnose und minimalinvasive Therapie von Zusatzverletzungen. Arthroskopie 8: 273–280

    Google Scholar 

  80. Sennwald DR, Zdravkovic V, Fischer M (1995) Stabilität des Carpus. Arthroscopie 8: 264–267

    Google Scholar 

  81. Sennwald DR, Lauterburg M, Zdravkovic V (1995) A new technique of reattachment after traumatisch avulsion of the TFCC at ist ulnar insertion. J Hand Surg 20B/2: 178–184

    Google Scholar 

  82. Shih J-T, Lee H-M, Tan C-M (2002) Early isolated triangular fibrocartilage complex tears: Management by arthroscopic repair. J Trauma: 53: 922–927

    Google Scholar 

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

    CAS  Google Scholar 

  84. Tomaino MM (1998) Ulnar impaction syndrome in the ulnar negative and neutral wrist. J Hand Surg (Br Eur) 23B/6: 754–757

    Google Scholar 

  85. Tomaino MM (1999) Results of the wafer procedure for ulnar impaction syndrome in the ulnar negative wrist. J Hand Surg (Br Eur)24B/6: 671–675

    Google Scholar 

  86. Tomaino MM, Gainer M, Towers JD (2001) Carpal impaction with the ulnar styloid process: treatment with partial styloid resection. J Hand Surg (Br Eur) 26B/3: 252–255

    Google Scholar 

  87. 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. Am Society Surg Hand 26A: 1047–1052

    Google Scholar 

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

    Google Scholar 

  89. Trumble TE, Gilbert M, Vedder N (1997) Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. Adv Orthop Surg 21/1: 21–22

    Google Scholar 

  90. 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 22A: 807–813

    Google Scholar 

  91. Tünnerhoff HG, Haußmann P (2001) Wann ist die arthroskopische Refixation des Discus ulnocarpalis bei ulnarem Abriss indiziert? Handchir Mikrochir Plast Chir 33: 239–244

    Article  PubMed  Google Scholar 

  92. van Schoonhoven J, Lanz U (1998) „Rund um den Ellenkopf“: Verletzungsmuster und Klassifikationen. Handchir Mikrochir Plast Chir 30: 351–360

    PubMed  Google Scholar 

  93. Watson HK, Weinzweig J (1999) Triquetral impingement ligament tear (TILT). J Hand Surg (Br Eur) 24B/3: 321–324

    Google Scholar 

  94. Werner FW, Glisson RR, Murphy DJ, Palmer AK (1986) Force transmission through the distal radioulnar carpal joint: effect of ulnar lengthening and shortening. Handchir Mikrochir Plast Chir 18: 304–308

    CAS  PubMed  Google Scholar 

  95. Westkaemper JG, Mitsionis G, Giannakopoulos PN, Sotereanos DG (1998) Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries. J Arthrosc Relat Surg 14(5): 479–83

    CAS  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  98. Wright TW, Dobyns JH, Linscheid RL, Macksoud W, Siegert J (1994) Carpal instability non-dissociative. J Hand Surg 19B/6: 763–773

    Google Scholar 

  99. Zachee B, De Smet L, Fabry G (1993) Arthroscopic suturing of TFCC lesions. Arthroscopy 9: 242–243

    CAS  PubMed  Google Scholar 

  100. Zanetti M, Bräm J, Hodler J (1997) Triangular fibrocartilage and intercarpal ligaments of the wrist: Does MR arthrography improve standard MRI? (From Department of Radiology. Orthopedic University Hospital. Balgrist.Forchst.340.CH-8008 Zürich) 7 7/3: 590–594

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

    CAS  PubMed  Google Scholar 

  102. Zlatkin MB et al. (1989) Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology 173: 723–729

    CAS  PubMed  Google Scholar 

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  1. BG-Unfallklinik Murnau

    H. Hempfling

  2. BG-Unfallklinik Murnau, Prof.-Küntscher-Straße 8, 82418, Murnau

    H. Hempfling

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Hempfling, H. Die Läsionen des Handgelenkdiskus. Orthopäde 33, 657–675 (2004). https://doi.org/10.1007/s00132-004-0655-y

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