Zusammenfassung
Die Differenzierung einer traumatischen von einer unfallunabhängigen Schädigung des Lig. scapholunare (SLL) stellt auch weiterhin eine Herausforderung an den Gutachter dar. Der Nachweis einer traumatischen Zerreißung gelingt zuverlässig bei gesichertem, adäquatem Unfallhergang und beim Vorliegen von Begleitverletzungen (weitere Band-Kapsel-Rupturen, knöcherne Verletzungen und/oder einem „bone bruise“). Schwierig gestaltet sich die Zusammenhangsbeurteilung bei unklaren Ereignisabläufen, einer damit verbundenen geringen Krafteinleitung und erst später aufgetretenen, klinischen Symptomen, die dann im Rahmen weiterer Diagnostik die SLL-Ruptur aufzeigen. Hierbei gilt es, nach konkurrierenden Ursachen (angeborene Aplasie des SLL, verschleißbedingter Bandaufbrauch oder weitere traumatische Ereignisse) zu fahnden, die dann aber auch mit Sicherheit nachzuweisen sind. Häufigste Ursache für die traumatische SLL-Ruptur ist der Sturz auf die Handfläche des nach vorn ausgestreckten Armes.
Abstract
The distinction between traumatic and accident-independent damage of the scapholunate ligament (SLL) continues to be a challenge to medical experts. The traumatic tearing of a SLL can reliably be proven when an accident has been adequately documented and concomitant injuries (other ligament capsule ruptures, bony injuries and/or a bone bruise) are present. This decision is difficult in cases of unclear accident mechanisms, low acting forces and later occurring clinical symptoms which then lead through further diagnostics to the discovery of a ruptured SLL. In these cases, it is necessary to search for competing causes (congenital aplasia of the SLL, wear-related ligament damage or other traumatic events), which themselves have to be proven with certainty. The most common cause of traumatic SLL rupture is a fall onto the palm of the hand with an outstretched arm.
Literatur
Akahane M, Ono H, Nakamura T, Kawamura K, Takakura Y (2002) Static scapholunate dissociation diagnosed by scapholunate gap view in wrists with or without distal radius fractures. Hand Surg 7:191–195
Angelides AC, Wallace PF (1976) The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg Am 1A:228–235
Berger RA, Blair WF (1984) The radioscapholunate ligament. A gross and histologic description. Anat Rec 210:393–405
Berger RA, Landsmeer JMF (1990) The palmar radiocarpal ligaments: a study of adult and fetal wrist joints. J Hand Surg Am 15A:847–854
Berger RA (1996) The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 21A:170–178
Berger RA, Imeada T, Berglund L, An K‑N (1999) Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 24A:953–962
Berger RA, Kauer JMG, Landsmeer JMF (1991) Radioscapholunate ligament: a gross anatomic and histologic study of fetal and adult wrists. J Hand Surg Am 16A:350–355
Bickert B, Sauerbier M, Germann G (2000) Scapholunate ligament repair using the Mitek bone anchor. J Hand Surg Am 25B:188–192
Bloom HT, Freeland AE, Bowen V, Mrkonjic L (2003) The treatment of chronic scapholunate dissociation: an evidence-based assessment of the literature (Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center)
Clay NR, Clement DA (1988) The treatment of dorsal wrist ganglia by radical excision. J Hand Surg Am 13B:187–191
Cooney WP, Linscheid RL, Dobyns JH (1998) The wrist. Mosby, Philadelphia
Czitrom AA, Dobyns JH, Linscheid RL (1987) Ulnar variance in carpal instability. J Hand Surg Am 12A:205–212
De Villiers CM, Birnie RH, Pretorius LK (1989) Dorsal ganglion of the wrist—pathogenesis and biomechanics. Operative v. conservative treatment. S Afr Med J 75:214–216
Fischer M, Denzler C, Sennwald G (1996) Begleitende karpale Bandläsionen bei frischen distalen Radiusfrakturen: Arthroskopische Studie über 54 Fälle. Swiss Surg 2:269–273
Fisk GR (1984) The wrist. J Bone Joint Surg 66B:396–407
Gilford WW, Bolton RH, Lambrinudi C (1943) The mechanism of the wrist joint with special reference to fractures of the scaphoid. Guys Hosp Rep 92:52–49
Gilula LA, Hardy DC, Totty WG, Reinus WR (1987) Fluoroscopic identification of torn intercarpal ligaments after injection of contrast material. AJR Am J Roentgenol 149:761–764
Hempfling H, Weise K (2007) Die interkarpalen Bandschäden und ihre Begutachtung. DGU Mitt Nachr 29(Supplement 1):S61–S116
Hixson ML, Stewart CH (1990) Microvascular anatomy of the radioscapholunate ligament of the wrist. J Hand Surg Am 15A:297–282
Kang HS, Kindynis P, Brahme SK, Resnickk D, Haghighi P, Haller J, Sartoris DJ (1991) Triangular fibrocartilage and intercarpal ligaments of the wrist: MR imaging. Cadaveric study with gross pathologic and histologic correlation. Radiology 181:401–404
Kauer JMG, Landsmeer JMF (1981) Functional anatomy of the wrist. In: Tubiana R (Hrsg) The Hand, Bd. 1. W.B. Saunders, Philadelphia
Königsberger H, Goth D, die Perna V‑V (2004) Skapholunäre Dissoziation – Traumafolge oder kongenitale Störung? Handchir Mikrochir Plast Chir 36:A1–A20
Kozin SH (1998) Perilunate injuries: diagnosis and treatment. J Am Acad Orthop Surg 6:114–120
Kutsuna M (1930) Über die Kommunikation der Gelenkhöhlen in der Handwurzelgegend. Jpn J Med Sci 2/3:187–194
Kwon BC, Choi S‑J, Song S‑Y, Baek SH, Baek GH (2011) Modified carpal stretch test as a screening test for detection of scapholunate interosseous ligament injuries associated with distal radial fractures. J Bone Joint Surg Am 93:855–862
Landsmeer JMF (1961) Studies in the anatomy of articulation. I. The equilibrium of the intercalated bone. Acta Morphol Neerl Scand 3:287
Lee B‑J, Kim S‑S, Lee S‑R, Jin J‑M, Yoon M‑G, Moon M‑S (2010) Palmar scaphoid dislocation associated with dorsal perilunate dislocation: case report. J Hand Surg Am 35A:726–731
Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N (2011) Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg Am 36A:1149–1157
Lewis DM, Osterman AL (2001) Scapholunate instability in athletes. Clin Sports Med 20(1):131
Lichtman DM, Schneider JR, Swafford AR, Mac KGR (1981) Ulnar midcarpal instability—clinical and laboratory analysis. J Hand Surg Am 6:515–523
Linscheid RL (1984) Scapholunate ligamentous instabilities (dissociations, subdislocations, dislocations). Ann Chir Main 3:323–330
Linscheid RL, Dobyns JH (1993) Karpale Instabilitäten. Orthopäde 22:72–78
Logan SE, Nowak MD, Gould PL, Weeks PM (1986) Biomechanical behaviour of the scapholunate ligament (ISA, Paper 86–0017)
Manton GL, Schweitzer ME, Weishaupt D, Morrison WB, Osterman AL, Culp RW, Shabshin N (2001) Partial interosseous ligament tears of the wrist. Difficulty in utilizing either primary or secondary MRI signs. J Comput Assist Tomogr 25(5):671–676
Masataka K (1992) Treatment of scaphoid fractures with carpal instability. Osaka City Med J 38:89–109
Mayfield JK, Johnson RP, Kilcoyne RK (1976) The ligaments of the human wrist and their functional significance. Anat Rec 186:417–428
Mayfield JK, Williams WJ, Erdman AG (1979) Biomechanical properties of human carpal ligaments. Orthop Trans 3:143
Mayfield JK (1980) Mechanism of carpal injuries. Clin Orthop 149:45–54
Mayfield JK, Johnson RP, Kilcoyne RK (1980) Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 5:226–241
Mayfield JK (1984) Patterns of injury to carpal ligaments. Clin Orthop Relat Res 187:36–42
Mikic ZD (1978) Age changes in the triangular fibrocartilage of the wrist joint. J Anat 126:367–384
Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF (2004) The role of the dorsal Intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am 29A:279–288
Mugdal C, Hastings H (1993) Scapho-lunate diastasis in fractures of the distal radius. J Hand Surg Am 18B:725–729
Navarro A (1937) Anatomia y fisiologia del carpo. Ann Inst Clin Quir 1:162–250
Omori S, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H (2013) In vivo 3‑dimensional analysis of dorsal intercalated segment instability deformity secondary to scapholunate dissociation: a preliminary report. J Hand Surg Am 38A:1346–1355
Pachucki A (2002) Die karpale Instabilität. Eur Surg 34(Suppl 184):76–78
Pechlaner S, Putz R (1987) Die traumatische skapholunäre Dissoziation – funktionelle Analyse, operative Therapie und Ergebnisse. Aktuelle Traumatol 17:1–8
Prommersberger KJ, Mühldorfer-Fodor M, Kalb K, Schmitt R, Van Schoonhoven J (2014) Die skapholunäre Bandverletzung. Unfallchirurg 117:723–739
Rahmanian-Schwarz A, Schaller H‑E (2010) Bandläsionen am Handgelenk. CHAZ 11(4):237–242
Schädel-Höpfner M, Iwinska-Zelder J, Böhringer G, Braus T, Klose KJ, Gotzen L (2001) Magnetresonanztomographie oder Arthroskopie in der Diagnostik skapholunärer Bandschäden bei distalen Radiusfrakturen? Handchir Mikrochir Plast Chir 33:234–238
Schmidt H‑M, Lanz U (1992) Chirurgische Anatomie der Hand. Hippokrates, Stuttgart
Shigematsu S, Abe M, Onomura T, Kinoshita M, Inoue T (1989) Arthrography of the normal and posttraumatic wrist. J Hand Surg Am 14A:410–412
Shin AY, Horton T, Bishop AT (2005) Acute coronal plane scaphoid fracture and scapholunate dissociation from an axial load. A case report. J Hand Surg Am 30A:366–372
Smith DK, Snearly WN (1994) Lunotriquetral Interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists. Radiology 191:199–202
Sokolow C, Saffar P (2001) Anatomy and histology of the scapholunate ligament. Hand Clin 17(1):77–81
Taleisnik J (1985) The wrist. Churchill Livingstone, New York
Tang JB, Xu J, Xie RG (2011) Scaphoid and lunate movement in different ranges of carpal radioulnar deviation. J Hand Surg Am 36A:25–30
Upal MA, Crisco JJ, Moore DC, Sonenblum SE, Wolfe SW (2006) In vivo elongation of the palmar and dorsal scapholunate Interosseous ligament. J Hand Surg Am 31A:1326–1331
Wallraff J (1967) Leitfaden der Histologie des Menschen. Urban & Schwarzenberg, MĂĽnchen, Berlin, Wien
Wannske M (1995) Komplexe Handverletzungen. Handchir Mikrochir Plast Chir 27:2–10
Weil WM, Slade JF, Trumble TE (2006) Open and arthroscopic treatment of perilunate injuries. Clin Orthop Relat Res 445:120–132
Weiss C, Laskin RS, Spinner M (1970) Irreducible transscaphoid perilunate dislocation: a case report. J Bone Joint Surg 52A:565–568
Wildenauer E (1952) Die Oberfläche der proximalen Carpalreihe. Z Anat Entwicklungsgesch 116:348–350
Willebrand J (1999) Skapholunäre Dissoziationen. Diagnostik – Stadieneinteilung – Therapieschemata. Orthopäde 28:878–882
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
H. Hempfling und M. Wich geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgefĂĽhrten Studien an Menschen oder Tieren.
Additional information
Die Autoren sind Mitglieder des wissenschaftlichen Beirats der Fachgesellschaft für interdisziplinäre medizinische Begutachtung (FGIMB).
Rights and permissions
About this article
Cite this article
Hempfling, H., Wich, M. Ligamentum scapholunare und dessen Begutachtung. Trauma Berufskrankh 20, 278–284 (2018). https://doi.org/10.1007/s10039-018-0395-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10039-018-0395-6