0:00

Now let's talk about its lesions.

0:03

Okay? And if we talk about its, uh, lesions,

0:07

we go back to this particular article by Palmer

0:12

back 1989.

0:14

He divided the lesions into two categories.

0:18

One, traumatic, less common, more significant,

0:21

two more common degenerative, less significant.

0:25

Let's look at these. His traumatic central perforation is

0:29

called A one A lesion.

0:30

I'm drawing it in these diagrams as these blue structures.

0:34

It's a, he calls it a central perforation. It's common.

0:38

It doesn't cause instability of the distal radial,

0:42

the joint, typically conservative treatment

0:45

or arthroscopic debridement.

0:47

Although it is central perforation, it is not central.

0:51

This particular lesion is located close to,

0:54

but not at the attachment of the disc

0:58

to the articular cartilage of the radius one A.

1:02

The most important lesion is one B, a proximal detachment.

1:07

We're gonna spend some time on this.

1:10

It's common, it's associated with radial fractures.

1:13

It's characterized by soft tissue or bone avulsions,

1:16

or sometimes both.

1:18

All right? It does cause,

1:19

or in most cases, instability

1:22

of the distal radial in the joint.

1:24

And it may require arthroscopic or open repair.

1:28

But as I'll show you later, it,

1:30

certain lesions require salvage procedures if

1:34

they're treated.

1:35

That's proximal detachment.

1:37

The third is the one C lesion,

1:40

A distal attachment out distally.

1:42

You can see it here. And with this blue band,

1:44

this is uncommon.

1:46

I've only seen a few cases through the years.

1:49

Generally it's not isolated.

1:50

There are other abnormalities going on when you see this

1:54

particular lesion.

1:55

And then finally, the 1D. Uh, not common, not rare.

2:00

It's somewhere kind of a little less than common, right?

2:04

Not quite uncommon. It's so radial avulsion.

2:07

And this is partial

2:08

or complete meaning it may involve only the disc

2:11

or the adjacent ligaments.

2:14

Remember, we have ligament attachments

2:16

to the radius as well.

2:17

So it's in this area.

2:20

It is associated with radial fractures,

2:22

typically does not cause instability

2:25

of the distal radial in the joint.

2:27

Okay? But may in certain uh, cases

2:31

cause such instability.

2:33

And then we have the degenerative lesions.

2:35

They tend to be more medial or more nar.

2:39

They tend to be more circular or oval rather than linear.

2:44

There is a system for these type two lesions that

2:49

identifies them further as A, B, C, D, E.

2:52

I don't think those letters are of great importance,

2:56

although some people use them. They relate to

2:59

Progressive abnormalities, not only of the disc,

3:01

but of articular cartilage, subc chondral bone,

3:04

and of the adjacent luno, triquetral interosseous ligaments.

3:09

And with the real bad ones,

3:11

the mid carpal compartment may also be involved.

3:15

These degener lesions type two increase in frequency

3:19

and severity with advancing age

3:22

and with ulnar positive variants or a long ness.

3:26

Here's a case note.

3:28

The failure is not close to the articular cartilage.

3:32

It's further away when dealing

3:33

with degenerative lesions in the mr.

3:37

Okay? In a patient, there's an nar, positive variance.

3:41

There is cartilage loss and cystic change.

3:44

There is a degenerative perforation of this.

3:48

A luno triquetral interosseous ligament

3:50

might be torn, I'm not sure.

3:52

But there's cartilage loss involving the tri creature.