Download PDF
Radiologie up2date 2024; 24(02): 193-206
DOI: 10.1055/a-2010-0530
Muskuloskelettale Erkrankungen

Der ulnarseitige Handgelenksschmerz

Ulnar wrist pain

Authors

Further Information
Also available at
   Permissions and Reprints All articles of this category
Preview

Ulnarseitige Handgelenkschmerzen sind nicht selten eine diagnostische Herausforderung. Weil die klinische Diagnostik keine eindeutige Diagnose erlaubt, spielt die Bildgebung eine wesentliche Rolle. Dabei müssen an die kontrastmittelverstärkte MRT, die direkte Arthrografie, Ultraschall und Fluoroskopie höchste technische Anforderungen gestellt werden, um die subtilen Pathologien abgrenzen zu können.

Kernaussagen

  • Der ulnarseitige Handgelenkschmerz beschreibt eine komplexe klinische Situation mit einer Vielzahl zugrunde liegender Ursachen, für deren Differenzialdiagnostik ein detailliertes Verständnis von Anatomie, Biomechanik und Pathophysiologie Voraussetzung ist.

  • Der radiologischen Diagnostik kommt beim ulnarseitigen Handgelenkschmerz eine entscheidende Rolle zu. Schnittbildtechniken mit einer hohen räumlichen Auflösung können durch dynamische Verfahren wie Ultraschall und Fluoroskopie ergänzt werden.

  • Verletzungen des ulnokarpalen Komplexes (TFCC) sind die häufigste Ursache der Instabilität im distalen Radioulnargelenk. Die multikompartimentale Injektion von Kontrastmittel mit nachfolgender CT- oder MR-Arthrografie ist der bildgebende Referenzstandard für TFCC-Läsionen.

Schlüsselwörter

Handgelenkschmerz - TFCC - distales Radioulnargelenk - Extensor carpi ulnaris - Arthrografie

Keywords

wrist pain - TFCC - distal radio-ulnar joint - extensor carpi ulnaris - arthrography


Publication History

Article published online:
11 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Kreulen RT, Nayar SK, Alfaki Y. et al. Advanced Imaging of Ulnar Wrist Pain. Hand Clin 2021; 37: 477-486
    Search in Google Scholar
  • 2 Cohen-Tanugi S, Gaston RG. Examination of Ulnar-sided Wrist Pain. Hand Clin 2021; 37: 467-475
    Search in Google Scholar
  • 3 Yamabe E, Nakamura T, Pham P. et al. The athlete’s wrist: ulnar-sided pain. Semin Musculoskelet Radiol 2012; 16: 331-337
    Search in Google Scholar
  • 4 Morway GR, Miller A. Clinical and Radiographic Evaluation of Ulnar-Sided Wrist Pain. Curr Rev Musculoskelet Med 2022; 15: 590-596
    Search in Google Scholar
  • 5 Watanabe A, Souza F, Vezeridis PS. et al. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39: 837-857
    Search in Google Scholar
  • 6 Booij R, Kämmerling NF, Oei EHG. et al. Assessment of visibility of bone structures in the wrist using normal and half of the radiation dose with photon-counting detector CT. Eur J Radiol 2023; 159: 110662
    Search in Google Scholar
  • 7 Booij R, Sandstedt M, Tesselaar E. et al. Photon-counting detector computed tomography (PCD-CT) – an emerging technology in hand and wrist imaging. J Hand Surg Eur Vol 2023; 48: 489-494
    Search in Google Scholar
  • 8 Grunz J-P, Jordan MC, Schmitt R. et al. Gantry-Free High-Resolution Cone-Beam CT: Efficacy for Distal Radius and Scaphoid Fracture Detection and Characterization. Acad Radiol 2023; 30: 1358-1366
    Search in Google Scholar
  • 9 Hesse N, Schmitt R, Luitjens J. et al. Carpal Instability: II. Imaging. Semin Musculoskelet Radiol 2021; 25: 304-310
    Search in Google Scholar
  • 10 Torabi M, Lenchik L, Beaman FD. Expert Panel on Musculoskeletal Imaging. et al. ACR Appropriateness Criteria® Acute Hand and Wrist Trauma. J Am Coll Radiol 2019; 16: S7-S17
    Search in Google Scholar
  • 11 Luetkens KS, Laas SF, Haßler S. et al. Contrast-enhanced MRI of the wrist: Intravenous application of gadolinium improves diagnosis in ulnar-sided injuries of the TFCC. Eur J Radiol 2021; 143: 109901
    Search in Google Scholar
  • 12 Schmitt R, Hesse N, Grunz J-P. Tendons and Tendon Sheaths of the Hand – An Update on MRI. Rofo 2022; 194: 1307-1321
    Search in Google Scholar
  • 13 Omlor G, Jung M, Grieser T. et al. Depiction of the triangular fibro-cartilage in patients with ulnar-sided wrist pain: comparison of direct multi-slice CT arthrography and direct MR arthrography. Eur Radiol 2009; 19: 147-151
    Search in Google Scholar
  • 14 Levinsohn EM, Rosen ID, Palmer AK. Wrist arthrography: value of the three-compartment injection method. Radiology 1991; 179: 231-239
    Search in Google Scholar
  • 15 Huflage H, Luetkens KS, Kunz AS. et al. Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography. Eur Radiol 2021; 31: 9399-9407
    Search in Google Scholar
  • 16 Gitto S, Messina C, Mauri G. et al. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple. Eur J Radiol 2017; 87: 20-35
    Search in Google Scholar
  • 17 Sulkers GSI, Strackee SD, Schep NWL. et al. Wrist cineradiography: a protocol for diagnosing carpal instability. J Hand Surg Eur Vol 2018; 43: 174-178
    Search in Google Scholar
  • 18 Rastogi AK, Davis KW, Ross A. et al. Fundamentals of Joint Injection. AJR Am J Roentgenol 2016; 207: 484-494
    Search in Google Scholar
  • 19 Grunz J-P, Gietzen CH, Luetkens K. et al. The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist. BMC Musculoskelet Disord 2020; 21: 286
    Search in Google Scholar
  • 20 Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin 2011; 27: 263-272
    Search in Google Scholar
  • 21 Nakamura T, Sato K, Okazaki M. et al. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 2011; 27: 281-290
    Search in Google Scholar
  • 22 Atzei A, Luchetti R, Garagnani L. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. J Hand Surg Eur Vol 2017; 42: 405-414
    Search in Google Scholar
  • 23 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14: 594-606
    Search in Google Scholar
  • 24 Bednar MS, Arnoczky SP, Weiland AJ. The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg Am 1991; 16: 1101-1105
    Search in Google Scholar
  • 25 Schmitt R, Grunz JP, Luetkens K. et al. [The ulnocarpal complex: New clinical and radiological considerations]. Radiologe 2021; 61: 343-350
    Search in Google Scholar
  • 26 Stuart PR, Berger RA, Linscheid RL. et al. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25: 689-699
    Search in Google Scholar
  • 27 Spies CK, Müller LP, Oppermann J. et al. [Instability of the distal radioulnar joint – an overview of clinical and radiological procedures regarding their efficacies]. Handchir Mikrochir Plast Chir 2014; 46: 137-150
    Search in Google Scholar
  • 28 Boyd B, Adams J. Distal Radioulnar Joint Instability. Hand Clin 2021; 37: 563-573
    Search in Google Scholar
  • 29 Thirumavalavan J, Ibrahim Z, Byrne RA. et al. Extensor Carpi Ulnaris Instability: A Comprehensive Review of Pathology and Operative Techniques. Hand (N Y) 2023; 15589447231168908
    Search in Google Scholar
  • 30 Garcia-Elias M. Tendinopathies of the Extensor Carpi Ulnaris. Handchir Mikrochir Plast Chir 2015; 47: 281-289
    Search in Google Scholar
  • 31 Byrd JN, Sasor SE, Chung KC. Extensor Carpi Ulnaris Subluxation. Hand Clin 2021; 37: 487-491
    Search in Google Scholar
  • 32 Plotkin B, Sampath SC, Sampath SC. et al. MR Imaging and US of the Wrist Tendons. Radiographics 2016; 36: 1688-1700
    Search in Google Scholar
  • 33 Leibig N, Lampert FM, Haerle M. Ulnocarpal Impaction. Hand Clin 2021; 37: 553-562
    Search in Google Scholar
  • 34 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26: 549-557
    Search in Google Scholar
  • 35 Löw S, Spies CK, Unglaub F. et al. [Diagnosis and treatment of degenerative disc lesions of the wrist]. Orthopade 2018; 47: 670-676
    Search in Google Scholar
  • 36 Bickel KD. Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am 2008; 33: 1420-1423
    Search in Google Scholar
  • 37 Hernández-Cortés P, Catena A, Hernández-Peregrina P. et al. Association between radioulnar impingement and salvage surgical procedures of the distal radioulnar joint: influence of confounding variables. J Hand Surg Eur Vol. 2024; 49: 73-81
    Search in Google Scholar
  • 38 Krimmer H. [Treatment of the ulnar impingement syndrome in the distal radioulnar joint]. Orthopade 2018; 47: 684-687
    Search in Google Scholar
  • 39 Akhbari B, Shah KN, Morton AM. et al. Biomechanics of the Distal Radioulnar Joint During In Vivo Forearm Pronosupination. J Wrist Surg 2021; 10: 208-215
    Search in Google Scholar
  • 40 Farr S, Zlotolow DA, Bachy M. et al. State of the art review: The pathogenesis and management of Madelung deformity. J Hand Surg Eur Vol 2023; 48: 1116-1125
    Search in Google Scholar
  • 41 Grunz J-P, Gietzen CH, Grunz K. et al. Imaging of Carpal Instabilities. Rofo 2021; 193: 139-150
    Search in Google Scholar
  • 42 Wilson MS. Diagnosis and Management of Lunotriquetral Ligament Injuries. Curr Rev Musculoskelet Med 2023; 16: 55-59
    Search in Google Scholar
  • 43 Huflage H, Luetkens KS, Conrads N. et al. Assessing the scapholunate and lunotriquetral interosseous ligament in MR arthrography: Diagnostic advantages of paraxial reformatting. Eur J Radiol 2021; 142: 109860
    Search in Google Scholar
  • 44 Omar-Hossein M, Leung JCK, Munaku J. et al. Outcomes Following Surgical Interventions for Isolated Lunotriquetral Interosseous Ligament Injuries: A Systematic Review. Hand (N Y) 2023; 15589447231198268
    Search in Google Scholar
  • 45 Sivakumar BS, Smith NC. Arthroscopic Bone Grafting and Arthrodesis of Partial Lunotriquetral Coalition. J Wrist Surg 2020; 9: 523-527
    Search in Google Scholar
  • 46 Shulman BS, Rettig M, Sapienza A. Management of Pisotriquetral Instability. J Hand Surg Am 2018; 43: 54-60
    Search in Google Scholar
  • 47 Theumann NH, Pfirrmann CWA, Chung CB. et al. Pisotriquetral joint: assessment with MR imaging and MR arthrography. Radiology 2002; 222: 763-770
    Search in Google Scholar
  • 48 Peters MJ, Mazor A, Glaris Z. et al. Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review. J Wrist Surg 2023; 12: 331-336
    Search in Google Scholar
  • 49 Thurston AJ, Stanley JK. Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy 2000; 16: 540-544
    Search in Google Scholar
  • 50 Malik AM, Schweitzer ME, Culp RW. et al. MR imaging of the type II lunate bone: frequency, extent, and associated findings. AJR Am J Roentgenol 1999; 173: 335-338
    Search in Google Scholar
  • 51 Artuso M, Picard K, Manoukov Y. et al. Hamatolunate impingement syndrome in golfers: results of arthroscopic burring of the apex of the hamate. Hand Surg Rehabil 2022; 41: 452-456
    Search in Google Scholar
  • 52 Wang B, Zhao Y, Lu A. et al. Ulnar nerve deep branch compression by a ganglion: a review of nine cases. Injury 2014; 45: 1126-1130
    Search in Google Scholar
  • 53 Akuthota V, Plastaras C, Lindberg K. et al. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med 2005; 33: 1224-1230
    Search in Google Scholar
  • 54 Shen L, Masih S, Patel DB. et al. MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon’s canal. Clin Imaging 2016; 40: 263-274
    Search in Google Scholar
  • 55 Assmus H, Antoniadis G, Bischoff C. et al. Cubital tunnel syndrome – a review and management guidelines. Cent Eur Neurosurg 2011; 72: 90-98
    Search in Google Scholar
  • 56 Watson HK, Weinzweig J. Triquetral impingement ligament tear (tilt). J Hand Surg Br 1999; 24: 321-324
    Search in Google Scholar
  • 57 Wollstein R, Unadkat J, Grand A. TILT Following a TFCC Tear: A Case Report. J Wrist Surg 2012; 1: 69-72
    Search in Google Scholar
  • 58 Giachino AA, McIntyre AI, Guy KJ. et al. Ulnar styloid triquetral impaction. Hand Surg 2007; 12: 123-134
    Search in Google Scholar