Download PDF
J Wrist Surg 2018; 07(02): 133-140
DOI: 10.1055/s-0037-1607073
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

Steffen Löw
1   Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
,
Alexandra Herold
1   Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
,
Frank Unglaub
2   Department of Hand Surgery, Vulpius Clinic, Bad Rappenau, Germany
,
Kai Megerle
3   Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Holger Erne
3   Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
› Author Affiliations
Further Information

Publication History

28 June 2017

22 August 2017

Publication Date:
26 October 2017 (online)

    Permissions and Reprints

Abstract

Background Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view.

Purpose This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion.

Patients and Methods Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal.

Results In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups.

Conclusion In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure.

Level of Evidence Therapeutic III, case–control study.

Keywords

triangular fibrocartilage - ulnar impaction syndrome - ulnar shortening osteotomy - wafer resection - wrist - arthroscopy

Note

The ethical committee of the University Hospital of Würzburg, Germany approved the clinical review of these patients.


 

  • References

  • 1 Sachar J. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impactions, and lunotriquetral ligament tears. J Hand Surg Am 2012; 37 (07) 1489-1500
    CrossrefPubMedGoogle Scholar
  • 2 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 3 Löw S, Herold A, Eingartner C. Standard wrist arthroscopy: technique and documentation [in German]. Oper Orthop Traumatol 2014; 26 (06) 539-546
    CrossrefPubMedGoogle Scholar
  • 4 Möldner M, Unglaub F, Hahn P, Müller LP, Bruckner T, Spies CK. Functionality after arthroscopic debridement of central triangular fibrocartilage tears with central perforations. J Hand Surg Am 2015; 40 (02) 252-258
    CrossrefPubMedGoogle Scholar
  • 5 Jang E, Danoff JR, Rajfer RA, Rosenwasser MP. Revision wrist arthroscopy after failed primary arthroscopic treatment. J Wrist Surg 2014; 3 (01) 30-36
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Löw S, Spies CK, Unglaub F, van Schoonhoven J, Prommersberger KJ, Mühldorfer-Fodor M. Preventable repeat wrist arthroscopies: Analysis of the indications for 133 cases. J Wrist Surg 2017; 6 (01) 33-38
    PubMedGoogle Scholar
  • 7 Abe Y, Tominaga Y. Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports. Hand Surg 2011; 16 (02) 177-180
    CrossrefPubMedGoogle Scholar
  • 8 Kalb K, Ludwig A, Tauscher A, Landsleitner B, Wiemer P, Krimmer H. Treatment outcome after surgical arthrodesis [in German]. Handchir Mikrochir Plast Chir 1999; 31 (04) 253-259
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Gelberman RH, Salamon PB, Jurist JM, Posch JL. Ulnar variance in Kienböck's disease. J Bone Joint Surg Am 1975; 57 (05) 674-676
    CrossrefPubMedGoogle Scholar
  • 10 Löw S, Erne H, Schütz A, Eingartner C, Spies CK. The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies. Arch Orthop Trauma Surg 2015; 35 (12) 1771-1777
    PubMedGoogle Scholar
  • 11 Löw S, Erne H, Strobl U, Unglaub F, Spies CK. Significance of scapholunate gap width as measured by probe from midcarpal. J Wrist Surg 2017; 6 (04) 316-324
    PubMedGoogle Scholar
  • 12 Schmauss D, Pöhlmann S, Lohmeyer JA, Germann G, Bickert B, Megerle K. Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg 2016; 136 (06) 873-880
    CrossrefPubMedGoogle Scholar
  • 13 Hahn P, Häusler A, Bruckner T, Unglaub F. Quality rating of MRI regarding TFCC lesions in the clinical practice [in German]. Handchir Mikrochir Plast Chir 2012; 44 (05) 310-313
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Löw S, Erne H, Pillukat T, Mühldorfer-Fodor M, Unglaub F, Spies CK. Rating of central lesions of the triangular fibrocartilage complex with respect to a traumatic or degenerative origin. J Hand Surg Eur Vol 2017; 42 (04) 357-362
    CrossrefPubMedGoogle Scholar
  • 15 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 2013; 95 (12) 1687-1696
    PubMedGoogle Scholar
  • 16 Broccoli G, Vaske B, Müller L, Kahmann R, Isenberg J. Limits to arthroscopic treatment of degenerative triangular fibrocartilage complex lesions depending on the ulnar variance [in German]. Handchir Mikrochir Plast Chir 2014; 46 (03) 151-162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Del Gaudio T, Haerle M. Arthroscopic partial resection of the ulnar head for ulnocarpal decompression [in German]. Oper Orthop Traumatol 2016; 28 (04) 263-269
    CrossrefPubMedGoogle Scholar
  • 18 Bernstein MA, Nagle DJ, Martinez A, Stogin Jr JM, Wiedrich TA. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy 2004; 20 (04) 392-401
    CrossrefPubMedGoogle Scholar
  • 19 De Smet L, De Ferm A, Steenwerckx A, Dauwe D, Zachee B, Fabry G. Arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist. Acta Orthop Belg 1996; 62 (01) 8-13
    PubMedGoogle Scholar
  • 20 Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am 2000; 25 (01) 55-60
    CrossrefPubMedGoogle Scholar
  • 21 Griska A, Feldon P. Wafer resection of the distal ulna. J Hand Surg Am 2015; 40 (11) 2283-2288
    CrossrefPubMedGoogle Scholar
  • 22 Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat 1978; 126 (02) 367-384
    PubMedGoogle Scholar
  • 23 Abe Y, Tominaga Y, Yoshida K. Various patterns of traumatic triangular fibrocartilage complex tear. Hand Surg 2012; 17 (02) 191-198
    CrossrefPubMedGoogle Scholar
  • 24 Yamamoto M, Koh S, Tatebe M. , et al. Arthroscopic visualisation of the distal radioulnar joint. Hand Surg 2008; 13 (03) 133-138
    CrossrefPubMedGoogle Scholar
  • 25 Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J. Arthroscopy of the distal radioulnar joint [in German]. Oper Orthop Traumatol 2014; 26 (06) 547-555
    CrossrefPubMedGoogle Scholar