الفهرس 
ANATOMY
Biomechiancs of the Distal Radioulnar JointOnly 14 pages are availabe for public view
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Abstract
the ulnar sided wrist pain is one of the common wrist problems nowadays, the presence of many important structures at the ulnocarpal joint make it difficult to detect the actual cause of the ulnar-sided wrist pain.
Accurate history taking followed by proper clinical examination and investigation play important role in the diagnosis of ulnar-sided wrist pain.
TFCC is considered the most important structure at the ulnar side of the wrist and it plays a key role in the stability of the DRUJ, due to the complexity of the TFCC and being formed of 6 structures, it is considered the most common cause of ulnar sided wrist pain.
In this study, most of the cases of ulnar sided wrist pain were due to TFCC lesions, whether the traumatic or the degenerative type.
Testing the DRUG stability is very crucial to detect the method of treatment of the TFCC traumatic tears. So DRUJ Stability test should be done in both pronation and supination and compared with the normal side.
X-ray AP view and lateral view are the primary diagnostic investigations. Fist view is very important to detect ulnar impaction syndrome. MRI plays a very important role also in evaluating the ulnocarpal structures. Good quality MRI and experienced radiologist are very important to detect the type of the TFCC lesions.
Arthroscopy is considered the golden way to detect the cause of the ulnar-sided wrist pain, evaluate the TFCC, the scapholunate ligament, the lunotriquetral ligament, the dorsal wrist capsule and the articular cartilage of the lunate. So wrist arthroscopy helps us to complete the evaluation of the wrist joint and together with the clinical examination and investigation give us full details in order to plan for the proper surgical management.
In this study there were fifty cases, wrist arthroscopy was used in all the cases, twenty patients with traumatic IB lesions which were treated with Transcapsular or transosseus fixation, twelve cases with traumatic IA, C, and D. Eight cases had degenerative TFCC lesion which were treated with debridement. We had five cases of ulnocarpal synovitis that were treated with debridement. Three cases of Scapholunate ganglion and one case of pisotriquetral arthritis and one case of ostoid osteoma of the hamate.
Patients were divided into 2 groups and were assessed according to DASH score, Mayo Modified Wrist Score, Visual Pain Analogue Score. The Range of motion and power grip was compared to the opposite side.
The patients treated with TFCC fixation:
This group was treated with either transcapsular fixation in case of stable DRUJ or transosseus fixation in case of unstable DRUJ.
This group showed pain improvement, the DASH score also improved postoperatively compared to the preoperative value. Mayo Modified Wrist score was also good and excellent in more than 80% of the cases.
The two methods of fixation showed good results as long as the proper method was done to the proper patient. Two patients with poor results in this group were due to inaccurate identification of DRUJ stability therefore preoperative identification of instability by DRUG provocative test in supination and pronation and comparing to the opposite is of great value.
Postoperative splint for 6 weeks lead to decrease in the range of motion specially supination, pronation, which is improved later with physiotherapy. Another problem was caused by the irritating PDS suture which is also improved in 4-6 months. Patient should be informed about this preoperatively inorder to be more cooperative in the postoperative management.
The patients treated with TFCC or other lesions debridement:
This group includes many varieties with different pathology, due to the limited number of cases; these different lesions were grouped together.
There was pain improvement in the patients in this group, the DASH score also showed improvement compared to the preoperative value, and the MAYO Modified Wrist Score showed 60% excellent and good results.
The lesions in this group can be further divided into traumatic TFCC lesions IA, C, D and degenerative lesions caused mainly by ulnar impaction syndrome. In both groups the management was debridement. In traumatic lesions, debridement was enough to improve pain but more cases are needed to get solid results due to varieties of traumatic lesions. Regarding the degenerative lesions of the TFCC, there were 2 patients not satisfied with the debridement alone and ulnar shortening osteotomy was done. Longer follow up is needed to detect the improvement in these 2 patients.
Complications in this study were few, some patients showed limitation of the range of motion for few months after the TFCC fixation which is attributed to the long time of splinting. One case suffers from superficial branch of ulnar nerve injury, but careful skin incision and blunt dissection would decrease the incidence of this nerve injury. Persistence of instability after transcapsular fixation in two patients draws attention to the important deep layer of the TFCC in the stability of the DRUJ