Ulnocarpal Impingement Syndrome

- Discussion:
    - impingement of distal ulna on carpi which may arise from positive ulnar variance or non union of distal ulnar frx;
    - positive ulnar varience leads to loading of the ulnocarpal joint and resultant LT disruption, lunate chondral lesion, and TFCC tears;
    - diff dx: (ulnar sided wrist pain) distral radio-ulnar DJD, pisotriquetral DJD, or ECU tendonitis;

- Exam Findings:
    - positive ulnar stress test;
    - tenderness with direct palpation of the ulnar carpal joint;

- Radiographs:
    - radiographic findings may be subtle;
    - may show flattening, subchondral sclerosis, and/or lytic changes in lunate and/or triquetrum with similar changes seen over the distal ulna;
    - patients may have increased ulnar variance;
    - in subtle cases, a pronation grip radiograph may demonstrate ulnar variance;
    - bone scan may be positive;

- Treatment:
    - Waffer Procedure;
           - in the report by Constanine KJ, et al (2000), the authors compared ulnar shortening osteotomy vs the wafer procedure;
                  - 22 patients were followed over a 6 year period (11 patients in each group);
                  - 9 patients w/ ulnar shortening osteotomy had a good to excellent result vs 8 patients w/ good to excellent results in the wafer procedure group;
                  - 5 out of 11 patients required a secondary operative procedure (for either painful hardware or for non union);
    - ulnar shortening osteotomy
    - hemiresection arthroplasty
           - along w/ distal ulnar osteotomy or hemiresection arthroplasty, injury to the TFCC should be addressed w/ repair or debridement
           - Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, December 12, 2012 10:59 am