The dorsal radioulnar ligament is the dorsal deep component of the TFCC, running from the dorsal margin of the sigmoid notch of the radius to the ulna, where it divides into a superficial limb to the ulnar styloid and a deep limb to the fovea. It stabilises the DRUJ, working with the palmar radioulnar ligament to provide circumferential stability as the forearm rotates.
| Origin | Dorsal margin of the sigmoid notch of the radius |
|---|---|
| Insertion | Fovea and base of the ulnar styloid |
Stabilises the DRUJ against palmar ulnar displacement during forearm pronation, complementing the palmar radioulnar ligament which stabilises in supination.
The dorsal radioulnar ligament is typically torn in combination with the palmar ligament in significant DRUJ injuries from falls on an outstretched hand. Isolated dorsal ligament tears are less common and produce more subtle instability. The peripheral TFCC is well vascularised, so peripheral (Palmer 1B) tears can heal after arthroscopic suture repair, while foveal detachment usually needs reattachment to the fovea. The two deep radioulnar ligaments together form the critical DRUJ stabilising complex; both must be assessed at wrist arthroscopy and repaired for complete DRUJ stability restoration. Post-traumatic contracture of the dorsal DRUJ capsule can limit forearm rotation and may be released surgically.
Combined palmar and dorsal radioulnar ligament tears at the ulnar fovea produce complete DRUJ instability requiring repair of both components, performed either arthroscopically through the 6R wrist portal with suture passing at the fovea, or by open approach for better foveal visualisation and anchor placement.
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