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Incidence of partial or total foveal tear of the TFCC on DRUJ arthroscopy
Toshiyasu Nakamura, MD, PhD1; Yukihiko Obara2; Noboru Matsumura, MD, PhD1; Takuji Iwamoto, MD, PhD1; Kazuki Sato, MD, PhD1; Yoshiaki Toyama, MD, PhD1;
1Keio University, 2Saitama Social Insurance Hospital

DRUJ arthroscopy was few reported compared with radiocarpal or midcarpal joint arthroscopy. We describe incidence of foveal tear of the TFCC on DRUJ arthroscopy. Technique: The portal was made a very distal area of the DRUJ, just proximal of the TFCC surface. The 1.9 mm oblique view arthroscope was used. Bended blunt mosquito forceps was firstly inserted to the DRUJ through this portal and the arthroscopy was then introduced. The ulnar head, sigmoid notch of the radius, proximal surface of the TFCC, radioulnar ligament (RUL) origin at the fovea, DRUJ capsule were observed via DRUJ arthroscopy. To check the condition including tension and tear area of the RUL, the 23G needle was used. Patients: Since 2000, we performed DRUJ arthroscopy in 196 wrists of 194 cases who claimed wrist pain due to TFCC tear with moderate to severe DRUJ instability. There were 108 male and 86 female, with an average age of 32 (range, 15 to 63). Right wrists were 109, left 85, and one bilateral. Among these cases, observation at the fovea lesion was completed in 170 wrists. We checked the condition of the RUL through DRUJ arthroscopy. Results: Conditions of the RUL were the absence of the RUL with (15)/without (43) scaring in 58 (34.1%), the partial avulsion of dorsal portion of the RUL in 35 (20.5%), the partial avulsion of the palmar portion of the RUL in 9 (5.3%), relaxed RUL in 32 (18.8%), partial tear on the RUL surface in 20 (11.8%), normal RUL in 16 (9.4%; may be related to the horizontal type tear of the TFCC). Conclusion: In moderate to severe DRUJ instability cases, total or partial avulsion of the RUL was noted in 60%. Other causes of DRUJ instability were relaxed RUL, partial tear on the RUL surface and maybe horizontal tear. Total avulsion was more often than partial tear of the RUL. In partial RUL tear, majority was dorsal portion avulsed.


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