Extensor retinaculum capsulorrhaphy for ulnocarpal and distal radioulnar instability: the Herbert sling

Wrist pain and instability are challenging problems that may be the result of pathology at the distal radioulnar (DRUJ) or ulnocarpal joints or both. Instability of the wrist can often be attributed to a compromise of the integrity of the triangular fibrocartilage complex (TFCC), a key soft tissue stabilizer of the DRUJ and ulnocarpal articulations. Subsequently, when surgical reconstruction is indicated, techniques should strive to restore the biarthrodial function of the TFCC. Although anatomic reconstruction of the DRUJ ligaments provides successful stabilization of the radioulnar articulation, those patients who present with concomitant ulnocarpal instability require an alternative technique that addresses both the DRUJ- and ulnocarpal-stabilizing functions of the TFCC. The Herbert sling, which is an extensor retinaculum capsulorrhaphy, is an effective method of creating a strong tether among the distal radius, ulna, and ulnar carpus. Preliminary biomechanical and clinical results have been encouraging.