The palmar radioulnar ligament is one of the two deep components of the triangular fibrocartilage complex (TFCC), running from the palmar margin of the sigmoid notch of the radius to the base of the ulnar styloid and the ulnar fovea. It is the thickest and most robust of the TFCC ligaments and is the primary stabiliser of the distal radioulnar joint against dorsal displacement of the ulna in supination.
Stabilises the DRUJ against dorsal ulnar displacement during forearm supination, when it becomes taut, and contributes to axial load transmission from the ulnocarpal joint to the ulna.
The palmar radioulnar ligament is the primary restraint injured in Palmer class 1B TFCC peripheral tears at the ulnar foveal attachment. DRUJ instability from foveal detachment produces a positive fovea sign (tenderness between the ulnar styloid and pisiform with forearm in neutral) and a piano key sign (dorsal ulnar head prominence with manual reduction). Arthroscopic or open repair of the palmar radioulnar ligament at the fovea restores DRUJ stability. MR arthrography with thin-cut DRUJ sequences best demonstrates the foveal attachment.
Foveal detachment of the palmar (and dorsal) radioulnar ligament produces DRUJ instability with a piano key sign and pain with forearm rotation; arthroscopic repair of the ligament to the ulnar fovea through the 6R portal or open repair restores stability with return to function by 6-12 months.
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