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Joseph AT, Toluie A, Hrehorovich PA. Ulnocarpal Abutment Syndrome With Triquetrum Degeneration. Cureus 2024; 16:e59585. [PMID: 38826879 PMCID: PMC11144384 DOI: 10.7759/cureus.59585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
We present the case of a 47-year-old patient with a congenital positive ulnar variance and elucidate its effects on nearby structures in relation to ulnocarpal abutment syndrome (UAS). While magnetic resonance imaging (MRI) helped to identify soft tissue changes in the wrist, the use of an arthrogram, in this case, allowed for a more comprehensive and detailed analysis of the ligaments and soft tissues. Image findings included a complex degenerative tear of the disc of the triangular fibrocartilage (TFCC), a degenerated triquetrum, and partial tears of the scapholunate and lunotriquetral ligaments. Mild dorsal angulation of the lunate was noted, representing dorsal intercalated segmental instability (DISI), suggesting scapholunate ligament injury. Palmar classification was utilized to classify the extent of the TFCC injury as Type IIE. This case shines a light on the presentation of UAS in a patient that was not the usual demographic affected by this pathology, as well as their UAS affecting the triquetrum rather than the more commonly associated lunate.
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Affiliation(s)
- Anthony T Joseph
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Ava Toluie
- Pediatrics, Lake Erie College of Osteopathic Medicine, Bradenton, USA
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Kim KW, Kwak KY, Lee HJ, Kim SW, Shim BJ. Is ulnar shortening osteotomy effective for the treatment of ulnar styloid impaction syndrome compared to ulnar impaction syndrome? INTERNATIONAL ORTHOPAEDICS 2023; 47:2787-2794. [PMID: 37580558 DOI: 10.1007/s00264-023-05928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE This study aimed at evaluating the outcomes of ulnar shortening osteotomy (USO) for the treatment of ulnar styloid impaction syndrome (USIS) and to compare them with those of USO for the treatment of ulnar impaction syndrome (UIS). METHODS We enrolled 144 patients who underwent USO between March 2015 and October 2021. The patients were divided into a UIS group (group I, n = 93) and a USIS group (group II, n = 51). Clinical and radiological parameters, including Disabilities of the Arm, Shoulder, and Hand (DASH) score, ulnar variance, ulnar styloid length, and ulnar styloid process index (USPI), were collected pre-operatively and one year post-operatively, and a comparative analysis was performed. RESULTS The DASH score showed significant improvement in both groups (p < .001 and p < .001), and there was no significant difference between the two groups one year after surgery (p = .143). The USPI was significantly different between the two groups (p < .001). The ulno-lunate and ulno-triquetrum distances showed significant increases in both groups, with significant differences between the two groups (p = .020, and p < .001, respectively). The incidence of post-operative arthritic changes in the distal radioulnar joint was significantly greater in the UIS group than that in the USIS group (21 vs 3, respectively; p = .017). No remarkable differences were observed in the post-operative evidence of chondromalacia at the last follow-up between the two groups. CONCLUSION The USO, which was performed as a treatment for USIS showed reliable outcomes compared to the USO for the treatment of UIS. Therefore, USO is a viable option for the treatment of USIS.
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Affiliation(s)
- Kyung Wook Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, 31116, South Korea
| | - Kwon Young Kwak
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, 31116, South Korea
| | - Hyung Jun Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, 31116, South Korea
| | - Seong Wook Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, 31116, South Korea
| | - Bum-Jin Shim
- Department of Orthopaedic Surgery, College of Medicine, Kyungpook National University, Daegu, 41944, South Korea.
- Department of Orthopaedic Surgery, Kyungpook National University Chilgok Hospital, Daegu, 41404, South Korea.
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Baek JH, Lee JH, Ku KH. Ulnar-Sided Sclerosis of the Lunate Does Not Affect Outcomes in Patients Undergoing Volar Locking Plate Fixation for Distal Radius Fracture. J Clin Med 2023; 12:6003. [PMID: 37762943 PMCID: PMC10532306 DOI: 10.3390/jcm12186003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND AIM Radial shortening after distal radius fracture causes ulnar impaction, and a mild reduction loss of radial height occurs even after volar locking plate fixation. This study aimed to determine whether preoperative ulnar-sided sclerosis affects clinical outcomes after volar locking plate fixation for distal radius fracture (DRF). METHOD Among 369 patients who underwent volar locking plate fixation for DRF, 18 with preoperative ulnar-sided sclerosis of the lunate were included in Group A and compared to a 1:4 age-, sex- and fracture-pattern-matched cohort without sclerosis (72 patients, Group B). The visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and grip strength were assessed as clinical outcomes. Ulnar variance (UV), radial inclination, radial length, and volar tilt at two weeks after surgery and the final follow-up were measured as radiographic outcomes. RESULTS The mean VAS and DASH scores and grip strength did not differ between the two groups. The mean UV at two weeks after surgery and the last follow-up was significantly higher in Group A. The mean changes in UV were +0.62 mm in Group A and +0.48 mm in Group B. There were no significant intergroup differences. Neither UV nor its changes showed any association with DASH and VAS scores. CONCLUSIONS Preoperative ulnar-sided sclerosis of the lunate did not affect clinical outcomes after volar locking plate fixation, even if UV increased postoperatively.
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Affiliation(s)
- Jong-Hun Baek
- Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea;
| | - Jae-Hoon Lee
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon 14555, Republic of Korea;
| | - Ki-Hyeok Ku
- Department of Orthopedic Surgery, Graduate School, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Zaottini F, Picasso R, Pistoia F, Pansecchi M, Tovt L, Macciò M, Sanguinetti S, Martinoli C. Imaging of Anatomical Variants Around the Wrist and Hand. Semin Musculoskelet Radiol 2023; 27:169-181. [PMID: 37011618 DOI: 10.1055/s-0043-1761953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Wrist and hand anatomy may present several clinically relevant variants that involve bones, muscles, tendons, and nerves. Thorough knowledge of these abnormalities and their appearance in imaging studies is useful for proper management. In particular, it is necessary to differentiate the incidental findings that do not represent a trigger for a specific syndrome from those anomalies causing symptoms and functional impairment. This review reports the most common anatomical variants encountered in clinical practice and briefly discusses their embryogenesis, related clinical syndrome if present, and their appearance using different imaging techniques. The information each diagnostic study (ultrasonography, radiographs, computed tomography, and magnetic resonance imaging) may provide is described for each condition.
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Affiliation(s)
- Federico Zaottini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Riccardo Picasso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Pistoia
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Michelle Pansecchi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Tovt
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marta Macciò
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara Sanguinetti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Ryoo HJ, Kim YB, Kwak D, Choi IC, Park JW. Ulnar positive variance associated with TFCC foveal tear. Skeletal Radiol 2023:10.1007/s00256-023-04280-0. [PMID: 36752828 DOI: 10.1007/s00256-023-04280-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The ulnar positive variance (UPV) can be observed on simple radiography due to a triangular fibrocartilage complex (TFCC) foveal tear. This study investigated to identify how much radiographic UPV occurs due to a TFCC foveal tear, which may be misdiagnosed as an ulnar impaction syndrome (UIS). MATERIALS AND METHODS One hundred forty patients who underwent arthroscopic transosseus TFCC foveal repair from March 2013 to March 2019 in our institution were enrolled in this study. Ulnar variances were measured in preoperative, postoperative 6 weeks, 1-year follow-up wrist posteroanterior (PA) radiograph, and power grip PA radiograph of the affected wrist and were compared with those of the same patient's unaffected wrist. RESULTS In the neutral wrist PA radiograph, ulnar variance increased by 0.56 mm (p < 0.001) after TFCC foveal tear compared to the unaffected side. In the power grip view, ulnar variance also increased by 0.39 mm (p < 0.001) in the affected wrist. The preoperative ulnar positive variance was reduced after an arthroscopic transosseous TFCC foveal repair from 0.56 to 0 mm (p < 0.001). No significant statistical difference was observed between an Atzei class 2 and 3 TFCC tear (0.56 mm vs. 0.41 mm, p = 0.263). CONCLUSION This study revealed that TFCC foveal tear induces 0.56 mm of radiologic UPV, which was successfully corrected after arthroscopic transosseous TFCC foveal repair. Therefore, UPV associated with TFCC foveal tear should not be misdiagnosed as an UIS. Also, when ulnar shortening osteotomy is planned in case of UIS combined with TFCC foveal tear, the amount of UPV induced by TFCC foveal tear should be considered to prevent over-shortening.
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Affiliation(s)
- Hyun Jae Ryoo
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Yong Bin Kim
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Donghee Kwak
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea.
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Shin EK. Impaction Syndromes About the Wrist. Curr Rev Musculoskelet Med 2022; 16:1-8. [PMID: 36435859 PMCID: PMC9839928 DOI: 10.1007/s12178-022-09809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Impaction syndromes are frequently a source of ulnar-sided wrist pain and patient disability. Differentiating between these entities can be difficult due to significant overlap in their clinical presentations. This manuscript reviews the diagnosis and treatment of three different impaction syndromes: (1) ulnar impaction syndrome, (2) hamate arthrosis lunotriquetral ligament syndrome, and (3) triquetrohamate impaction syndrome. RECENT FINDINGS While non-operative treatment is always recommended upon initial presentation, the duration and extent of treatment are poorly defined. Diagnostic wrist arthroscopy usually confirms the clinical diagnosis and facilitates appropriate surgical management. Pain from ulnar impaction syndrome can be effectively treated with an ulnar shortening osteotomy, which unloads the ulnar aspect of the carpus, but complications have been reported secondary to hardware prominence and nonunion at the osteotomy site. Hamate arthrosis lunotriquetral ligament syndrome can be addressed by arthroscopically or openly excising the proximal pole of the hamate, while triquetrohamate impaction syndrome demands a debridement procedure with partial excision of the impinging triquetrum or hamate. In summary, impaction syndromes are underappreciated clinical entities but are known causes of ulnar-sided wrist pain. Maintaining a high index of suspicion will help to expedite appropriate non-operative and operative treatment. Surgical intervention-if needed-is often curative.
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Affiliation(s)
- Eon K Shin
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia Hand to Shoulder Center, 1203 Langhorne-Newtown Road, Suite 335, Langhorne, PA, 19047, USA.
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Teunissen JS, Feitz R, Al Shaer S, Hovius S, Selles RW, Van der Heijden B. Return to Usual Work Following an Ulnar Shortening Osteotomy: A Sample of 111 Patients. J Hand Surg Am 2022; 47:794.e1-794.e11. [PMID: 34511292 DOI: 10.1016/j.jhsa.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to analyze the median time until patients performed their usual work following an ulnar shortening osteotomy (USO). The secondary aim was to identify factors influencing the median time until return to their usual work. METHODS We used a retrospective cohort of patients with ongoing data collection from our institution in the Netherlands. Patients with paid employment who underwent USO were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months after surgery. The probability of and median time until return to usual work were assessed using an inverted Kaplan-Meier analysis. Factors influencing the return to usual work were evaluated using multivariable Cox proportional hazard regression. RESULTS In total, 111 patients who underwent USO were included, with a mean age of 46 years. The probability of returning to usual work in the first year was 92%, and the median time was 12 weeks. The type of work was independently associated with a return to work, with median times of 8, 12, and 14 weeks for light, moderate, and heavy physical work, respectively. We did not find differences in return to usual work based on age, sex, duration of complaints until surgery, treatment side, smoking status, the preoperative Patient-Rated Wrist Evaluation score, or whether the osteotomy was performed freehand or with an external cutting device. CONCLUSIONS Half of the patients that underwent USO fully performed their usual work by 12 weeks following surgery. We found that 92% of the patients performed their usual work within 1 year after surgery. We found a large variation in the time until a return to work based on the type of work. Surgeons can use this data to inform patients on the rehabilitation phase after USO. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Joris Sebastiaan Teunissen
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands.
| | - Reinier Feitz
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Sanharib Al Shaer
- Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Steven Hovius
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Brigitte Van der Heijden
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
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Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years. Bone Jt Open 2022; 3:375-382. [PMID: 35514114 PMCID: PMC9134835 DOI: 10.1302/2633-1462.35.bjo-2022-0031.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. Methods Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. Results Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). Conclusion Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.
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Affiliation(s)
- Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Mark J. W. van der Oest
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Steven E. R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Brabant, The Netherlands
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Teunissen JS, Wouters RM, Al Shaer S, Zöphel OT, Vermeulen GM, Hovius SER, Van der Heijden EPA. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients. J Orthop Traumatol 2022; 23:1. [PMID: 34985595 PMCID: PMC8733117 DOI: 10.1186/s10195-021-00621-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence Therapeutic III. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-021-00621-8.
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Affiliation(s)
- J S Teunissen
- Department of Plastic Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.
| | - R M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S Al Shaer
- Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - O T Zöphel
- Hand and Wrist Centre, Xpert Clinic, Amsterdam, The Netherlands.,Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - G M Vermeulen
- Hand and Wrist Centre, Xpert Clinic, Amsterdam, The Netherlands
| | - S E R Hovius
- Department of Plastic Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.,Hand and Wrist Centre, Xpert Clinic, Amsterdam, The Netherlands
| | - E P A Van der Heijden
- Department of Plastic Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.,Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 'S-Hertogenbosch, The Netherlands
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Kreulen RT, Nayar SK, Alfaki Y, LaPorte D, Demehri S. Advanced Imaging of Ulnar Wrist Pain. Hand Clin 2021; 37:477-486. [PMID: 34602127 DOI: 10.1016/j.hcl.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain can be a diagnostic challenge for clinicians and radiologists. The ulnar wrist has complex morphology and is composed of many small bone and soft tissue structures. Within these structures, a wide variety of pathologic conditions can occur. To successfully diagnose and treat these pathologic conditions, clinicians and radiologists must have a strong understanding of the advanced imaging techniques available to them. In this review, the authors present a brief review of the normal ulnar wrist anatomy, discuss the differential diagnosis of ulnar-sided wrist pain, and examine the indications for different advanced imaging modalities.
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Affiliation(s)
- R Timothy Kreulen
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA.
| | - Suresh K Nayar
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Yasmin Alfaki
- Johns Hopkins University, 3400 North Charles Street, Mason Hall, Baltimore, MD 21218, USA
| | - Dawn LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Shadpour Demehri
- Johns Hopkins Department of Musculoskeletal Radiology, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
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11
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[Osseous variations in radiological diagnostics of the wrist]. Radiologe 2021; 61:433-439. [PMID: 33830326 DOI: 10.1007/s00117-021-00838-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
CLINICAL/METHODICAL ISSUE The carpal joint is one of the most complex joints in the body comprising multiple bones that allow flexibility while simultaneously providing stability. Variations in osseous structures that may be either cause or result of pathological changes may make radiological reporting challenging. Only the knowledge of important osseous variations allows a reliable assessment of carpal imaging studies. STANDARD RADIOLOGICAL METHODS The standard imaging technique for evaluation of osseous carpal structures is conventional radiography, which is followed by computed tomography (CT) and-under special circumstances-magnetic resonance imaging (MRI). Other imaging methods such as sonography or nuclear medicine studies do not play a significant role in clinical routine. METHODICAL INNOVATIONS Apart from continuous reduction in effective radiation dose, there have been no significant methodical improvements in the past decade regarding imaging of osseous carpal structures in clinical routine. PRACTICAL RECOMMENDATIONS As the initial diagnostic procedure, conventional radiography usually allows a safe and reliable diagnosis of osseous structures. Unclear or discrepant imaging findings between clinical and imaging assessment should initiate further imaging, preferably with CT. Only for certain questions or to reduce effective radiation dose in children MRI studies should be performed in clinical routine.
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Osseous Pathology on Wrist Magnetic Resonance Imaging. Top Magn Reson Imaging 2021; 29:245-261. [PMID: 33021576 DOI: 10.1097/rmr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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Abstract
Triangular fibrocartilage complex tears are a common source of ulnar-sided wrist pain and distal radioulnar joint instability. Symptoms recalcitrant to conservative management or injuries in high-demand athletes may indicate surgical management. Both open and arthroscopic techniques offer improvements in objective measures, patient-centered outcome scores, and return to work, but may be complicated by nerve irritation, persistent wrist instability, and pain. Recently developed knotless arthroscopic techniques are not well studied but may limit morbidity.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Michael M. Polmear
- William Beaumont Army Medical Center, El Paso, TX, USA,Michael M. Polmear, Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.
| | - Leon J. Nesti
- Walter Reed National Military Medical Center, Bethesda, MD, USA,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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14
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Affiliation(s)
- David M Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard A Berger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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15
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Moser TP, Martinez AP, Andoulsi S, Jeantroux J, Cardinal É. Radiographic/MR Imaging Correlation of the Wrist. Magn Reson Imaging Clin N Am 2019; 27:601-623. [PMID: 31575396 DOI: 10.1016/j.mric.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this review article, the authors discuss the imaging features of the most common pathologic conditions of the wrist by putting the emphasis on radiographic and MR imaging correlations. A topographic approach based on the 3 functional columns of the wrist (radial, central, and ulnar) serves as a framework. The pathologic conditions are classified, based on the structures involved, as fractures, ligament injuries, arthropathies, bone abnormalities, and tendinopathies. The authors describe and evaluate classic radiographic signs and explain how they correlate with MR imaging. The advantages and limitations of each technique are thoroughly discussed as well as other imaging modalities.
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Affiliation(s)
- Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada.
| | - Adriana P Martinez
- Department of Orthopedic Surgery, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Sooheib Andoulsi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada
| | - Jérémy Jeantroux
- Service d'Imagerie Médicale, Clinique St-François, 1-5, rue Colomé, Haguenau 67502, France
| | - Étienne Cardinal
- Medvue, 5811 Côte-des-Neiges Road, Montreal, Québec H3S 1Z2, Canada
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16
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Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse Injuries of the Wrist. Radiol Clin North Am 2019; 57:957-976. [DOI: 10.1016/j.rcl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Roh YH, Song JH, Gong HS, Baek GH. Comparison of clinical outcomes after ulnar shortening osteotomy for ulnar impaction syndrome with or without arthroscopic debridement. J Hand Surg Eur Vol 2019; 44:589-593. [PMID: 30380991 DOI: 10.1177/1753193418808160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Forty-four patients who had been diagnosed with ulnar impaction syndrome and who were scheduled to undergo ulnar shortening osteotomy were randomized into two groups, one treated by ulnar shortening osteotomy alone and the other treated by ulnar shortening osteotomy combined with arthroscopic debridement. The response to treatment, including the pain numeric rating scale in an ulnar provocation test and the Disability of the Arm, Shoulder and Hand score was assessed at 3 and 12 months after surgery. The mean pain and disability scores showed significant clinical improvement at the 12-month follow-up in both groups. The pain scores at 3 months of follow-up were significantly better in the ulnar shortening osteotomy with arthroscopic debridement group. However, no significant differences were observed between the two groups in the disability scores at 3 and 12 months, or in the pain scores at 12-month follow-up. We conclude that similar improvements in symptom severity and hand function occurred in the long term in patients both with and without concomitant arthroscopic debridement. This information regarding concomitant arthroscopy could be used in the informed consent discussion with patients scheduled for ulnar shortening osteotomy. Level of evidence: II.
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Affiliation(s)
- Young Hak Roh
- 1 Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jun Hoe Song
- 1 Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- 2 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Goo Hyun Baek
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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18
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Rhee SM, Lee JY, Song KS, Lee GY, Lee JS. Lunate subchondral cysts: Are there specific radiologic findings for patients with symptomatic ulnocarpal impaction? J Orthop Sci 2019; 24:636-642. [PMID: 30606647 DOI: 10.1016/j.jos.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/16/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are few clinical studies evaluating the relationship between lunate cysts and symptomatic ulnar impaction syndrome (UIS). The purpose of this study was to investigate the prevalence and relationship between lunate cysts and UIS by comparing data from patients with UIS against those without. MATERIALS AND METHODS From March 2012 to January 2015, 375 patients who had undergone MRI or CT for reasons other than ulnar-sided wrist pain were classified into the 'asymptomatic group' (Group I). Thirty three patients who had been diagnosed with UIS were classified in the 'UIS group' (Group II). We determined whether any differences were present between the two groups and evaluated prognostic factors for lunate cysts. RESULTS The prevalence of lunate cysts was significantly higher in Group II but only reached just above 50% (10.4% vs. 57.6%, p < 0.001]. Dorsal-side lunate cysts were more frequent than palmar side in Group I, while Group II had more cysts on the palmar side (74.4% vs. 52.6%, p = 0.001). Logistic regression analysis revealed that UIS and patient age was a significant factor for the presence of lunate cysts (odds ratio: 11.692, p < 0.001; odds ratio: 1.063, p < 0.001, respectively). However, positive ulnar variance or duration of symptom in Group II was not a predisposing factor for lunate cysts (odds ratio: 1.035, p = 0.598; odds ratio: 1.007, p = 0.877, respectively). CONCLUSION Since positive ulnar variance or duration of symptom did not affect the formation of the lunate cyst and only slightly more than 50% (57.6%) of patients with UIS had a lunate cyst, it seems unlikely that these cysts are a pathognomonic finding. Surgeons can obtain some evidence from lunate cysts on radiographic exams, but care must be taken that this diagnosis is not made hastily or without due consideration.
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Affiliation(s)
- Sung-Min Rhee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Jung-Yeop Lee
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea
| | - Geun Young Lee
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea.
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review common hand and wrist injuries experienced by tennis players. RECENT FINDINGS A myriad of different wrist pathologies can be seen in tennis players ranging from metacarpal and carpal stress fractures to triangular fibrocartilage injuries and ulnar impaction. These vary depending upon the nature of the player, stroke mechanics, and time point within the season. A broad differential should guide work-up and management of wrist pain in tennis players.
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Affiliation(s)
- Joseph A Gil
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55901, USA
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55901, USA.
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Ozer K, Zhu AF, Siljander B, Lawton JN, Waljee JF. The Effect of Axial Loading on Ulnar Variance. J Wrist Surg 2018; 7:247-252. [PMID: 29922503 PMCID: PMC6005776 DOI: 10.1055/s-0038-1627458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
Background Forearm rotation results in change in ulnar variance. Axial loading of the wrist is required to maintain daily activities. Change in ulnar variance during axial loading has not been investigated previously. Purpose To measure the change in ulnar variance on axially loaded wrists. Patients and Methods We examined 21 asymptomatic individuals and 24 patients with unilateral ulnar-sided wrist pain. All patients underwent standard neutral posteroanterior wrist radiographs without load and under axial loading on bilateral wrists. Axial loading was standardized at 18.1 kgf using an analog weight scale. A magnetic resonance (MR) arthrogram was obtained only in patients with ulnar-sided wrist pain. Beighton flexibility score was recorded on healthy volunteers. Change in ulnar variance between 0 and 18.1 kgf was compared for each wrist among all subjects. A correlation was sought between the change in ulnar variance, MR arthrogram findings, and physical examination. Results In individuals without wrist pain, on average, 0.4 mm increase in ulnar variance was measured between 0 and 18.1 kgf. There was no difference between the dominant and nondominant side. No correlation was found with increasing age. In contrast, patients with ulnar-sided wrist pain displayed an average increase of 0.8 mm in ulnar variance. Compared with the contralateral wrist, more than 1 mm increase in ulnar variance was correlated with intra-articular pathologies including dorsoulnar ligament disruption, central triangular fibrocartilage complex (TFCC) perforation, and foveal detachment. Conclusion Compared with contralateral side, more than 1 mm increase in ulnar variance is suggestive of longitudinal instability or TFCC pathology. Level of Evidence Level II, diagnostic.
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Affiliation(s)
- Kagan Ozer
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andy F. Zhu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Jeffrey N. Lawton
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer F. Waljee
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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21
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Roh YH, Kim S, Gong HS, Baek GH. Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome. Sci Rep 2018; 8:9891. [PMID: 29959424 PMCID: PMC6026167 DOI: 10.1038/s41598-018-28060-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/14/2018] [Indexed: 11/16/2022] Open
Abstract
Ulnar impaction syndrome (UIS) is a common source of ulnar-sided wrist pain, yet not all cases of radiographic ulnar impaction are symptomatic. We retrospectively analyze clinical or radiologic factors that affect prognoses of conservative treatment for idiopathic UIS. A total of 114 patients who had been diagnosed with UIS were treated with 6 weeks of short arm orthosis followed by formal physiotherapy for 6 weeks, with lifestyle modification to limit aggravating movements. The response to treatment, including pain numeric rating scale on an ulnar provocation test, grip strength, Disability of the Arm, Shoulder, and Hand score (DASH), was assessed at 24-week follow-up. For the 24-week follow-up, 29 patients (25%) underwent ulnar shortening osteotomy due to persistent symptoms after conservative treatment, and 18 (16%) patients had pain scores of greater than 5, but they had not undergone surgery. After controlling for confounding variables, female gender (odds ratio (OR) 1.39), duration of symptom (OR 1.27), high pain NRS score on provocation test (OR 1.45), and enhanced carpal or distal ulna bone on MRI (OR 1.82) were associated with a higher likelihood of treatment failure. Knowledge of the factors offers physicians insight into predicting prognoses and helps patients set realistic expectations.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Sungnam, 13620, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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22
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Abstract
The first imaging modality in patients suspected of distal radioulnar joint pathology should be conventional radiography to exclude or diagnose wrist pathology including osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, (healed) fractures, or impaction syndromes. When conventional radiography is inconclusive, high resolution 3 Tesla magnetic resonance imaging is advised. We provide a broad overview of the literature regarding the use of intra-articular contrast both with computed tomography (CTA) or magnetic resonance imaging (MRA). Conventional arthrography and unenhanced computed tomography are not indicated. This article discusses the most useful imaging techniques in terms of clinical indications, patient positioning, technical imaging requirements, and diagnostic performance in patients with suspected distal radioulnar joint pathology. Furthermore, the most prevalent pathologies are discussed, with the focus on imaging characteristics in both stable and unstable distal radioulnar joints.
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Affiliation(s)
- S Jens
- 1 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - T Luijkx
- 2 Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - F F Smithuis
- 1 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M Maas
- 1 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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23
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Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology 2016; 279:674-92. [PMID: 27183404 DOI: 10.1148/radiol.2016150995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eric Cockenpot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Guillaume Lefebvre
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Xavier Demondion
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Christophe Chantelot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Anne Cotten
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
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24
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KATO H, NAKAMURA R, SHIONOYA K, MAKINO N, IMAEDA T. Does High-Resolution MR Imaging Have Better Accuracy than Standard MR Imaging for Evaluation of the Triangular Fibrocartilage Complex? ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s0266-7681(00)80020-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We compared the findings of high-resolution MR imaging and standard MR imaging in the detection of tears of the triangular fibrocartilage in 33 patients with chronic wrist pain on the ulnar side. With arthroscopy as the standard of reference, sensitivity was 100%, specificity 53%, and accuracy 79% with the high-resolution MR imaging, against 83%, 67%, and 76% with the standard MR imaging. High-resolution MR imaging showed a higher sensitivity, but a decreased specificity in the assessment of the triangular fibrocartilage. The results showed that diagnosis of tears in the triangular fibrocartilage by MR imaging, even high-resolution MR imaging, is unsatisfactory, although further technological advances may well improve the accuracy.
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Affiliation(s)
- H. KATO
- From the Hand Surgery Division, Dept of Orthopaedic Surgery, Nagoya University, School of Medicine, Nagoya, Japan
| | - R. NAKAMURA
- From the Hand Surgery Division, Dept of Orthopaedic Surgery, Nagoya University, School of Medicine, Nagoya, Japan
| | - K. SHIONOYA
- From the Hand Surgery Division, Dept of Orthopaedic Surgery, Nagoya University, School of Medicine, Nagoya, Japan
| | - N. MAKINO
- From the Hand Surgery Division, Dept of Orthopaedic Surgery, Nagoya University, School of Medicine, Nagoya, Japan
| | - T. IMAEDA
- From the Hand Surgery Division, Dept of Orthopaedic Surgery, Nagoya University, School of Medicine, Nagoya, Japan
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25
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Tiedeken NC, Baratz ME. Ulnocarpal Impingement and Triangular Fibrocartilage Complex Tears. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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White C, Benhaim P, Plotkin B. Treatments for Kienböck disease: what the radiologist needs to know. Skeletal Radiol 2016; 45:531-40. [PMID: 26802001 DOI: 10.1007/s00256-016-2332-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/12/2015] [Accepted: 01/06/2016] [Indexed: 02/02/2023]
Abstract
The etiology of Kienböck disease, or avascular necrosis of the lunate, is controversial, and there are a myriad of treatments aimed at correcting the various hypothesized pathologies. Interventions to reduce mechanical stress on the lunate have been used for decades, including radial osteotomy with or without radial shortening, ulnar lengthening and metaphyseal core decompression procedures. However, these procedures require preservation of lunate architecture. Newer procedures to revascularize the lunate bone have emerged in the last 10 years, such as pedicled corticoperiosteal vascularized bone grafting. Once there is collapse of the radiocarpal joint or midcarpal arthrosis, the conventional treatments have included proximal row carpectomy and complete or partial wrist joint arthrodesis. Newer salvage procedures such as lunate excision with autologous or synthetic interposition grafts are now being used when possible. As this disease is relatively rare, radiologists may not be familiar with the expected post-operative radiologic findings and complications, especially of the newer treatments. The goals of this paper are to review the available treatment options and their expected appearance on postoperative imaging, with discussion of possible complications when appropriate.
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Affiliation(s)
- Carissa White
- Department of Radiology, University of California, Los Angeles, 757 Westwood Blvd. Suite 1638, Los Angeles, CA, 90095, USA.
| | - Prosper Benhaim
- Department of Orthopaedic Surgery, University of California, Los Angeles, 10945 Le Conte Ave, Room 33-55 PVUB, Box 957326, Los Angeles, CA, 90095, USA
| | - Benjamin Plotkin
- Department of Radiology, University of California, Los Angeles, 1250 Sixteenth Street, Box 957036, Santa Monica, CA, 90404, USA
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27
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Khanna M, Walker A. Imaging of the wrist. IMAGING 2014. [DOI: 10.1259/img.20110066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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28
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The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna. AJR Am J Roentgenol 2014; 203:146-53. [PMID: 24951208 DOI: 10.2214/ajr.13.11573] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review the anatomy, biomechanics, and multimodality imaging findings of common and uncommon distal radioulnar joint (DRUJ), triangular fibrocartilage complex, and distal ulna abnormalities. CONCLUSION The DRUJ is a common site for acute and chronic injuries and is frequently imaged to evaluate chronic wrist pain, forearm dysfunction, and traumatic forearm injury. Given the complex anatomy of the wrist, the radiologist plays a vital role in the diagnosis of wrist pain and dysfunction.
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Nishizuka T, Tatebe M, Hirata H, Shinohara T, Yamamoto M, Iwatsuki K. Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain. Bone Joint J 2014; 95-B:1687-96. [PMID: 24293601 DOI: 10.1302/0301-620x.95b12.31918] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to evaluate treatment results following arthroscopic triangular fibrocartilage complex (TFCC) debridement for recalcitrant ulnar wrist pain. According to the treatment algorithm, 66 patients (36 men and 30 women with a mean age of 38.1 years (15 to 67)) with recalcitrant ulnar wrist pain were allocated to undergo ulnar shortening osteotomy (USO; n = 24), arthroscopic TFCC repair (n = 15), arthroscopic TFCC debridement (n = 14) or prolonged conservative treatment (n = 13). The mean follow-up was 36.0 months (15 to 54). Significant differences in Hand20 score at 18 months were evident between the USO group and TFCC debridement group (p = 0.003), and between the TFCC repair group and TFCC debridement group (p = 0.029). Within-group comparisons showed that Hand20 score at five months or later and pain score at two months or later were significantly decreased in the USO/TFCC repair groups. In contrast, scores in the TFCC debridement/conservative groups did not decrease significantly. Grip strength at 18 months was significantly improved in the USO/TFCC repair groups, but not in the TFCC debridement/conservative groups. TFCC debridement shows little benefit on the clinical course of recalcitrant ulnar wrist pain even after excluding patients with ulnocarpal abutment or TFCC detachment from the fovea from the indications for arthroscopic TFCC debridement.
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Affiliation(s)
- T Nishizuka
- Nagoya University Graduate School of Medicine, Department of Hand Surgery, 65 Tsurumai-Cho, Showa-Ku, Nagoya 466-8550, Japan
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30
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Abstract
Arthroscopy during ulnar shortening osteotomy for ulnar impaction syndrome is subject to debate regarding its clinical usefulness. The purposes of this study were to analyze the arthroscopic findings in patients who underwent ulnar shortening osteotomy and to assess the role of arthroscopic evaluation during osteotomy. Medical records and arthroscopic findings of 50 consecutive patients who had been diagnosed with idiopathic ulnar impaction syndrome were retrospectively evaluated. Pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL) were evaluated during arthroscopy. Palmer’s classification was used to classify the TFCC lesions. Perforation of the TFCC was observed in 20 patients, and central tears were observed in 10. Thirty-eight patients exhibited chondromalacia of the lunate, including 4 unstable cartilage flaps. Partial tears of the LTIL were detected in 24 patients, including 9 unstable flap tears. In 21 (42%) of 50 patients, arthroscopic findings were not appropriate to define the disease stage with Palmer’s original description. Eight wrists exhibited tears or perforations of the TFCC without evidence of chondromalacia. Seven patients had an LTIL tear without perforation of the TFCC. Lunotriquetral interosseous ligament tears without lunate chondromalacia were found in 7 patients. Arthroscopic debridement was performed in 23 patients based on the clinical judgment that the procedure would help alleviate symptoms postoperatively. Arthroscopy during ulnar shortening osteotomy addresses intra-articular pathologies and may be helpful for symptom improvement.
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32
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Abstract
OBJECTIVE The purpose of this review is to describe the upper extremity injuries that frequently accompany aging, the typical clinical presentations, and the differential diagnoses with an emphasis on the injury most likely encountered with each presentation. CONCLUSION Expectation of continued participation in exercise and sports activities by the baby boomer population has presented new challenges to the medical field. The concepts behind factors that predispose older athletes to certain pathologic conditions that affect the muscles, tendons, and bones of the upper extremity must be understood.
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33
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Cha SM, Shin HD, Kim KC. Positive or negative ulnar variance after ulnar shortening for ulnar impaction syndrome: a retrospective study. Clin Orthop Surg 2012; 4:216-20. [PMID: 22949953 PMCID: PMC3425652 DOI: 10.4055/cios.2012.4.3.216] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/24/2012] [Indexed: 11/18/2022] Open
Abstract
Background The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. Methods Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. Results A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. Conclusions After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.
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Affiliation(s)
- Soo-Min Cha
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2012; 37:1489-500. [PMID: 22721461 DOI: 10.1016/j.jhsa.2012.04.036] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 04/27/2012] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain is a common cause of upper extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilaginous complex injuries, lunotriquetrial ligament injuries, and ulnar impaction syndrome.
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Affiliation(s)
- Kavi Sachar
- Hand Surgery Associates, Denver, CO 80210, USA.
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Radiographic appearance and patient outcome after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. J Hand Surg Am 2012; 37:975-81. [PMID: 22541154 DOI: 10.1016/j.jhsa.2012.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 02/16/2012] [Accepted: 02/22/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Radiographic carpal chondromalacia (RCC) was defined as the presence of cortical sclerosis or subchondral changes, such as a lucent defect or cystic changes in a carpal on plain radiographs. The purpose of this study was to investigate the factors associated with the occurrence of RCC in idiopathic ulnar impaction syndrome and to determine the efficacy of ulnar shortening osteotomy on patient outcome and RCC. METHODS Thirty-nine patients (42 wrists) with idiopathic ulnar impaction syndrome were treated with either ulnar shortening osteotomy or arthroscopic wafer resection. Patients were divided into 2 groups according to the presence (RCC group; 17 patients, 19 wrists) or absence (non-RCC group: 22 patients, 23 wrists) of RCC on preoperative radiographs. To determine the factors associated with RCC, a comparative analysis of these 2 groups was performed with respect to sex, age, duration of symptoms, positive ulnar variance, pain scores, and Chun and Palmer grading system. The RCC area was measured on serial radiographs taken during follow-up. Progressive changes of RCC area and clinical outcomes were evaluated. RESULTS Patients in the RCC group were older, exhibited greater positive ulnar variance, and demonstrated a significantly higher mean pain score before surgery. The RCC was found to reverse over the year following ulnar shortening osteotomy and did not recur up to 2 years after surgery. In 3 wrists, RCC had completely disappeared at the last follow-up. All patients showed improved clinical outcomes. CONCLUSIONS The RCC changes correlated with older age, a positive ulnar variance, and preoperative pain severity. The RCC progressively reversed after ulnar shortening osteotomy, and this reversal of radiographic changes correlated with clinical improvements. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Yoshioka H, Burns JE. Magnetic resonance imaging of triangular fibrocartilage. J Magn Reson Imaging 2012; 35:764-78. [DOI: 10.1002/jmri.22840] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Ulnar impaction syndrome is a common source of ulnar-sided wrist pain. It is a degenerative condition that occurs secondary to excessive load across the ulnocarpal joint, resulting in a spectrum of pathologic changes and symptoms. It may occur in any wrist but is usually associated with positive ulnar variance, whether congenital or acquired. The diagnosis of ulnar impaction syndrome is made by clinical examination and is supported by radiographic studies. Surgery is indicated if nonoperative treatment fails. Although a number of alternatives exist, the 2 primary surgical options are ulnar-shortening osteotomy or partial resection of the distal dome of the ulna (wafer procedure). This article discusses the etiology of ulnar impaction syndrome, and its diagnosis and treatment.
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Affiliation(s)
- Douglas M Sammer
- Division of Plastic Surgery, Washington University School of Medicine, Suite 1150, NW Tower, 660 South Euclid Avenue, Campus Box 8238, St Louis, MO 63110, USA
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Malone WJ, Snowden R, Alvi F, Klena JC. Pitfalls of Wrist MR Imaging. Magn Reson Imaging Clin N Am 2010; 18:643-62. [DOI: 10.1016/j.mric.2010.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Meier R, Jansen H, Uhl M. [Radiological procedures in the traumatised wrist]. DER ORTHOPADE 2010; 39:801-21, quiz 822. [PMID: 20694752 DOI: 10.1007/s00132-010-1660-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Injuries of the wrist are difficult to diagnose because of the complex and narrow anatomic structures. On the basis of precise clinical examination, X-rays, CT and MRI are valuable additional tools that can be used. In the case of bone injury, spiral computer tomography with multiplanar reformatting is currently the method of choice. MRI is indicated for the identification of soft tissue or ligamentous injury and avital fragments or necrosis. Other diagnostic tools for the wrist are currently of minor importance. Technical and methodological innovations allow ever better visualisation and classification of lesions, as well as their extent, thus enabling more targeted therapy. However, prerequisites of effective use include differential assessment and precise knowledge of the procedures.
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Affiliation(s)
- R Meier
- Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Würzburg.
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Meftah M, Keefer EP, Panagopoulos G, Yang SS. Arthroscopic wafer resection for ulnar impaction syndrome: prediction of outcomes. ACTA ACUST UNITED AC 2010; 15:89-93. [PMID: 20672395 DOI: 10.1142/s0218810410004631] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 11/17/2009] [Accepted: 03/01/2010] [Indexed: 11/18/2022]
Abstract
Twenty-six patients with mean age of 38.5 (range 18-59), from 1998 to 2005, with ulnar impaction syndrome who failed nonoperative treatments were included in our study. Patients' age, history of previous wrist fracture, presence of MRI signs and ulnar variance were recorded as variables. Also, patients' postoperative strength (compared to the contralateral wrist) and pain relief were collected as outcome measurements. Twenty-two patients (84.6%) had either good or excellent pain relief (median 4, range 1-4). Significant correlation was found between MRI findings and postop pain relief (r = 0.53, p < or = 0.01). History of previous distal radius fractures was negatively correlated with pain relief (r = -0.50, p < or = 0.01). No correlation was found between postop strength and any of the variables. Presence of MRI signs of UIS is a predictor of good outcome in arthroscopic wafer resection.
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Affiliation(s)
- Morteza Meftah
- Department of Orthopaedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY, USA.
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Yamamoto M, Koh S, Tatebe M, Shinohara T, Shionoya K, Hirata H, Nakamura R. Importance of distal radioulnar joint arthroscopy for evaluating the triangular fibrocartilage complex. J Orthop Sci 2010; 15:210-5. [PMID: 20358334 DOI: 10.1007/s00776-009-1445-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 12/07/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND The present study evaluated the importance of visualizing both sides of the triangular fibrocartilage complex (TFCC) when diagnosing ulnar wrist pain. METHODS A total of 20 patients with ulnar wrist pain who underwent both radiocarpal joint (RCJ) and distal radioulnar joint (DRUJ) arthroscopy were studied retrospectively. TFCC was graded as normal or as having wear or tear. The definitive diagnosis was made by evaluating the TFCC from both joints. The medical records were reviewed to document the preoperative diagnosis, arthroscopic findings, postoperative diagnosis, and operative procedure(s) performed after the arthroscopic examinations. The patients' status at final follow-up was evaluated using the modified Green and O'Brien wrist scoring system. The TFCC grading on RCJ and DRUJ arthroscopies was compared. RESULTS The final diagnosis was modified after arthroscopic examination in three cases (15%). In six patients (30%), DRUJ arthroscopy revealed pathological TFCC findings that could not be detected on RCJ arthroscopy. The DRUJ arthroscopy detected wear or degenerative changes seen only on the proximal aspect of the TFCC in four patients and tear in two patients. On the other hand, in only one patient (5%) were there no pathological findings observed from the DRUJ portal, although RCJ arthroscopy found wear. In eight patients (45%), the arthroscopic grading of TFCC was the same on RCJ and DRUJ arthroscopy; of these, the TFCC was graded as normal in one patient, showing wear in three patients, and with a tear in five patients. For diagnosing TFCC pathology, RCJ arthroscopy had a sensitivity of 68% and a negative predictive value (NPV) of 14%, whereas the sensitivity was 95% and the NPV was 50% for DRUJ. CONCLUSIONS Adding DRUJ arthroscopy to RCJ arthroscopy enables more accurate diagnosis of TFCC pathology because the proximal aspect of the articular disk and the foveal insertion of the distal radioulnar ligament can be visualized.
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Affiliation(s)
- Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
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Faber KJ, Iordache S, Grewal R. Magnetic resonance imaging for ulnar wrist pain. J Hand Surg Am 2010; 35:303-7. [PMID: 20141901 DOI: 10.1016/j.jhsa.2009.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 02/02/2023]
Affiliation(s)
- Kenneth J Faber
- Department of Surgery, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
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Vezeridis PS, Yoshioka H, Han R, Blazar P. Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal Radiol 2010; 39:733-45. [PMID: 19722104 PMCID: PMC2895881 DOI: 10.1007/s00256-009-0775-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 07/26/2009] [Accepted: 07/27/2009] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain.
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Affiliation(s)
- Peter S. Vezeridis
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine, 100 The City Drive, South Building 56, Suite 300, Orange, CA 92868 USA
| | - Roger Han
- Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
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Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39:837-57. [PMID: 20012039 PMCID: PMC2904904 DOI: 10.1007/s00256-009-0842-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 11/14/2009] [Accepted: 11/17/2009] [Indexed: 02/02/2023]
Abstract
Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.
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Affiliation(s)
- Atsuya Watanabe
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Felipe Souza
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter S. Vezeridis
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Hiroshi Yoshioka
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA ,Department of Radiological Sciences, University of California-Irvine, Irvine, CA USA ,Department of Radiological Sciences, UC Irvine Medical Center, 101 City Drive South, Route 140, Orange, CA 92868 USA
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Abstract
OBJECTIVE The aim of this article is to present the imaging patterns of ulnocarpal impaction syndrome (Palmer class II lesions) on MDCT arthrography. CONCLUSION MDCT arthrography is an excellent tool for imaging patients with clinically suspected ulnocarpal impaction syndrome, allowing identification of the spectrum of findings and proper classification according to Palmer class II (degenerative) lesions, which directly affects management.
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Abstract
Injuries of the wrist are difficult to diagnose because of the complex and narrow anatomic structures. On the basis of precise clinical examination, X-rays, CT and MRI are valuable additional tools that can be used. In the case of bone injury, spiral computer tomography with multiplanar reformatting is currently the method of choice. MRI is indicated for the identification of soft tissue or ligamentous injury and avital fragments or necrosis. Other diagnostic tools for the wrist are currently of minor importance. Technical and methodological innovations allow ever better visualisation and classification of lesions, as well as their extent, thus enabling more targeted therapy. However, prerequisites of effective use include differential assessment and precise knowledge of the procedures.
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Affiliation(s)
- R Meier
- Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg.
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48
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Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2008; 33:1669-79. [PMID: 18984356 DOI: 10.1016/j.jhsa.2008.08.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 08/30/2008] [Accepted: 08/30/2008] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain is a common cause of upper-extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with that of low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilage complex injuries, lunotriquetral ligament injuries, and ulnar impaction syndrome.
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Affiliation(s)
- Kavi Sachar
- Hand Surgery Associates, Denver, CO 80210, USA.
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49
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Yoshioka H, Tanaka T, Ueno T, Carrino JA, Winalski CS, Aliabadi P, Lang P, Weissman BN. Study of ulnar variance with high-resolution MRI: correlation with triangular fibrocartilage complex and cartilage of ulnar side of wrist. J Magn Reson Imaging 2007; 26:714-9. [PMID: 17729368 DOI: 10.1002/jmri.21084] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate correlations with ulnar variance and the triangular fibrocartilage complex (TFCC) or cartilage of ulnar side of the wrist on high-resolution MRI with a microscopy coil. MATERIALS AND METHODS We reviewed ulnar variance, TFCC, and cartilage of the ulnar side of the wrist in 93 subjects (29 asymptomatic volunteers and 64 patients with suspected TFCC injury) with high-resolution MRI using a 47-mm microscopy surface coil. All MR images were obtained with a 1.5 T scanner. Coronal 2D gradient recalled echo T(2)*-weighted images were used for analysis. For qualitative analysis we measured ulnar variance, TFCC angle, thickness in the central portion of TFCC disc proper, and cartilage thickness of the lunate and the ulnar head on MRI and calculated the correlation coefficient between measured values. We also examined the relationship between ulnar variance and age or sex. RESULTS High-resolution MR images clearly demonstrated TFCC and cartilage of the wrist and ulnar variance. The mean ulnar variance on MRI was +0.26 mm (range, -4.59 to +3.71 mm). The mean TFCC angle and TFCC thickness were 23.9 degrees (range, -4.6 to +54.1 degrees ) and 1.11 mm (range, 0.4 to 3.22 mm), respectively. Ulnar variance and TFCC angle were positively correlated (r = 0.84), and ulnar variance and TFCC thickness were negatively correlated (r = -0.71). However, ulnar variance and lunate or ulnar head cartilage thickness were not significantly correlated. CONCLUSION High-resolution MRI with a microscopy coil is a useful tool for evaluating the relationship between ulnar variance and ulnar side structures.
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Affiliation(s)
- Hiroshi Yoshioka
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Albastaki U, Sophocleous D, Göthlin J, Pierre-Jerome C. Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex Lesions: A Comprehensive Clinicoradiologic Approach and Review of the Literature. J Manipulative Physiol Ther 2007; 30:522-6. [PMID: 17870421 DOI: 10.1016/j.jmpt.2007.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 05/04/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article illustrates the frequent lesions of the triangular fibrocartilage complex (TFCC) by means of magnetic resonance imaging. METHODS We performed a retrospective chart review of the magnetic resonance images of 109 patients from our database. All subjects had history of trauma, and all underwent both radiographic and magnetic resonance imaging examination of the wrist. The changes (degeneration, tears) of the TFCC were assessed. RESULTS Ten patients were excluded because of incomplete imaging protocol (4 patients) and low-quality images (6 patients). From the 99 wrists remaining, the TFCC was normal in 30 (30.3%). Degenerative changes were found in 40 (40.4%) wrists. Partial and complete tears were present in 17 (17.1%) and 12 (12.1%) wrists, respectively. CONCLUSION The TFCC lesions in acute traumatic wrists should not be overlooked; they may contribute to wrist pain and disability after treatment of existing bone injuries.
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Affiliation(s)
- Usama Albastaki
- Department of Radiology, Sahlgrenska University Hospital, Mölndal, Sweden.
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