Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea.
Medicine (Baltimore). 2024 Apr 19;103(16):e37915. doi: 10.1097/MD.0000000000037915.
Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case.
A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test.
Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ.
Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it.
Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination.
DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.
已有多项研究报道过前臂旋后功能急性受限的情况。这种情况可能由腕关节内游离体、尺侧伸腕肌腱间占位、以及包括前臂骨骨折在内的下尺桡关节（DRUJ）损伤引起。一些研究报告了三角纤维软骨复合体（TFCC）撕裂导致 DRUJ 损伤的病例。我们报告了一例轻微创伤后发生的前臂旋后功能急性受限的病例，并建议当患者出现前臂旋后受限的症状时，应考虑可能存在 TFCC 撕裂。此外，我们比较了本病例与其他病例的病因、磁共振成像（MRI）表现和关节镜检查结果，并展示了本病例的具体特征。
一名 22 岁男性因左腕部疼痛为主诉就诊。他在 2 个月前运动时左手撑地受伤。体格检查发现左侧腕关节屈伸活动度较右侧分别有约 10°和 15°的受限。患者还主诉旋后受限和旋前时腕部疼痛。轴向加压试验时腕部压痛。
X 线片未见异常。MRI 显示中央型 TFCC 撕裂。TFCC 的撕裂瓣突向 DRUJ 的掌侧。
行左侧腕关节关节镜手术。关节镜检查发现桡侧 TFCC 撕裂。撕裂瓣突向 DRUJ 的掌侧。我们使用关节镜抓钳从 DRUJ 上取出瓣，并部分切除。
术中测试无锁定，前臂旋后良好。术后 2 个月，患者无疼痛，可完全旋前。
当轻微创伤后出现急性前臂旋后功能受限时，应怀疑存在 TFCC 撕裂导致的 DRUJ 阻滞。MRI 有助于诊断；然而，我们建议通过关节镜检查来确诊。通过关节镜手术治疗可以缓解症状。
