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Anatomie und Biomechanik des distalen Radioulnargelenks

Anatomy and biomechanics of the distal radioulnar joint

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Zusammenfassung

Hintergrund

Die differenzierte Gebrauchsfähigkeit der oberen Extremität basiert entscheidend auf der Umwendbewegung des Unterarms und damit auf dem Bewegungsausmaß des distalen Radioulnargelenks. Die Umwendbewegung des Unterarms ermöglicht erst den vollständigen und sinnvollen Einsatz der Hand, sodass eine reibungslose Bewältigung der alltäglichen Aktivitäten gewährleistet wird. Die Konfiguration des menschlichen distalen Radioulnargelenks ist das Ergebnis einer seit Jahrmillionen ablaufenden Evolution.

Anatomische Gegebenheiten

Der trianguläre fibrokartilaginäre Komplex ist der wichtigste Stabilisator dieses Gelenks, da die knöcherne Führung nur sehr limitiert ausgebildet ist. Zu diesem Komplex gehören die palmaren und dorsalen radioulnaren Ligamente, die durch ihre tiefen und oberflächlichen Bandanteile sowohl zentrisch in der Rotationsachse als auch exzentrisch ansetzen. Damit wird in jeder Rotationstellung eine Stabilisierung des Gelenks gewährleistet. Die Membrana interossea ist zusätzlich zu diesem Komplex ein weiterer relevanter Stabilisator, der auch für eine suffiziente Kraftübertragung von der Speiche auf die Elle verantwortlich ist. Das distale schräge Faserbündel innerhalb der Membrana interossea übernimmt dabei eine herausragende Stellung. Der Musculus pronator quadratus ist der relevante, dynamische Stabilisator. Der zweiköpfige Muskel wirkt aktiv einem Auseinanderweichen der Gelenkpartner entgegen. Der tiefe Muskelkopf ist in jeder Gelenkstellung aktiviert.

Abstract

Background

The functionality of the upper extremity is decisively based on rotation of the forearm. The rotation depends on the extent of motion of the distal radioulnar joint. Rotation enables complete and focused usability of the hand in order to cope with daily activities. The configuration of the distal radioulnar joint has developed over millions of years of evolution.

Anatomic conditions

The triangular fibrocartilage complex is the crucial stabiliser of the latter joint since osseous structures are limited. The palmar and dorsal radioulnar ligaments belong to this complex. The superficial and deep parts of the latter ligaments insert both centrically in accordance to the axis of rotation and eccentrically. This arrangement guarantees stability of the joint throughout pronosupination. The interosseous membrane is a further relevant stabiliser that guarantees sufficient load transmission from radius to ulna. The distal oblique bundle of the interosseous membrane is outstanding in this context. The pronator quadratus muscle is the relevant dynamic stabiliser of the distal radioulnar joint. Contraction of the muscle prevents diastasis of the joint. The deep head of the muscle is always activated during pronosupination.

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Abbreviations

DRUG:

Distales Radioulnargelenk

ECU:

Extensor carpi ulnaris

PRUG:

Proximales Radioulnargelenk

TFCC:

Triangulärer fibrokartilaginärer Komplex

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Authors and Affiliations

  1. Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland

    C. K. Spies & F. Unglaub

  2. Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland

    M. Langer

  3. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland

    L. P. Müller & J. Oppermann

  4. Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland

    S. Löw

  5. Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland

    F. Unglaub

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  1. C. K. Spies
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Correspondence to C. K. Spies.

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C. K. Spies, M. Langer, L. P. Müller, J. Oppermann, S. Löw und F. Unglaub geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Spies, C.K., Langer, M., Müller, L.P. et al. Anatomie und Biomechanik des distalen Radioulnargelenks. Orthopäde 47, 621–627 (2018). https://doi.org/10.1007/s00132-018-3589-5

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