J Wrist Surg 2019; 08(03): 192-197
DOI: 10.1055/s-0038-1677534
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction

Tendai Mwaturura
1   Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
,
Parham Daneshvar
1   Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
,
Jeffrey Pike
1   Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
,
Thomas Joseph Goetz
1   Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
› Author Affiliations
Further Information

Publication History

28 July 2018

03 December 2018

Publication Date:
06 February 2019 (online)

Abstract

Background Ulnocarpal impaction (UCI) is a described cause of ulnar side wrist pain.

Questions Does absolute ulnar variance (UV) or change in UV with grip affect patient-rated outcome scores (PROS) in patients with symptomatic UCI undergoing surgery? Does UV differ between symptomatic and contralateral wrists? Does arthroscopic grade of triangular fibrocartilaginous complex (TFCC) tears and lunotriquetral (LT) ligament tears influence PROS? Do PROS improve following ulnar shortening osteotomy (USO) or wafer procedures and does improvement depend on the amount of shortening or achievement of negative UV?

Patients and Methods We analyzed information on patients undergoing USO or wafer procedures for UCI as recorded in a database of prospectively collected information on individuals with ulnar side wrist pain. This included (1) patient-rated wrist evaluation and QuickDASH scores on enrolment, 3 and 12 months postoperatively; (2) standardized bilateral posteroanterior (PA) wrist radiographs, including PA grip views of the symptomatic wrist; and (3) arthroscopic findings.

Results Larger changes in UV between PA neutral and grip views prior to surgery were associated with smaller improvements in PROS, 12 months after surgery. Actual UV value before and after surgery did not affect PROS. There was no difference in UV between symptomatic and contralateral wrists. The presence of TFCC or LT ligament tears did not influence PROS. Mean PROS improved postoperatively.

Conclusions Ulnar shortening procedures result in improvement in PROS in patients with UCI. Variation in UV with rotation and grip results in variable outcomes.

Level of Evidence This is a Level II, cohort study.

Ethical Review Committee Statement

Approval for this work was provided by the University of British Columbia Providence Health Care Research Ethics Board.


 
  • References

  • 1 Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am 1993; 18 (04) 713-716
  • 2 Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am 1990; 15 (04) 564-571
  • 3 Antuna Zapico JM. Malacia del semilulnar. Tesis doctoral, Universidad de Valladolid; 1996
  • 4 Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head. Long-term follow-up of seventeen cases. J Bone Joint Surg Am 1987; 69 (03) 385-392
  • 5 Linscheid RL, Dobyns JH. Radiolunate arthrodesis. J Hand Surg Am 1985; 10 (6 Pt 1): 821-829
  • 6 Garcia-Elias M. Dorsal fractures of the triquetrum-avulsion or compression fractures?. J Hand Surg Am 1987; 12 (02) 266-268
  • 7 Thienpont E, Mulier T, De Smet L. Radiographic analysis of anatomic risk factors for scapholunate dissociation. Acta Orthop Belg 2003; 69 (03) 246-251
  • 8 Parker AS, Nguyen M, Minard CG, Guffey D, Willis MH, Reichel LM. Measurement of ulnar variance from the lateral radiograph: a comparison of techniques. J Hand Surg Am 2014; 39 (06) 1114-1121
  • 9 Kim JK, Park ES. Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res 2013; 471 (05) 1406-1411
  • 10 Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006; 7: 44 . Doi: 10.1186/1471-2474-7-44
  • 11 Boyd JH, Weissman MM, Thompson WD, Myers JK. Screening for depression in a community sample. Understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psychiatry 1982; 39 (10) 1195-1200
  • 12 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
  • 13 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
  • 14 Available at. https://srs-mcmaster.ca/wp-content/uploads/2015/05/English-PRWE-User-Manual.pdf
  • 15 Tatebe M, Nakamura R, Horii E, Nakao E. Results of ulnar shortening osteotomy for ulnocarpal impaction syndrome in wrists with neutral or negative ulnar variance. J Hand Surg [Br] 2005; 30 (02) 129-132
  • 16 Tomaino MM. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg Am 2000; 25 (02) 352-357
  • 17 Gemmill JF. On the movement of the lower end of the radius in pronation and supination, and on the interosseous membrane. J Anat Physiol 1900; 35 (Pt 1): 101-109
  • 18 McDougall A, White J. Subluxation of the inferior radio-ulnar joint complicating fracture of the radial head. J Bone Joint Surg Br 1957; 39-B (02) 278-287
  • 19 Tsuge S, Nakamura R. Anatomical risk factors for Kienböck's disease. J Hand Surg [Br] 1993; 18 (01) 70-75
  • 20 Mirza A, Mirza JB, Shin AY, Lorenzana DJ, Lee BK, Izzo B. Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy. J Hand Surg Am 2013; 38 (08) 1492-1497
  • 21 Lozano Calderón SA, Paiva A, Ring D. Patient satisfaction after open carpal tunnel release correlates with depression. J Hand Surg Am 2008; 33 (03) 303-307
  • 22 Maia MVP, de Moraes VY, Dos Santos JBG, Faloppa F, Belloti JC. Minimal important difference after hand surgery: a prospective assessment for DASH, MHQ, and SF-12. SICOT J 2016; 2: 32 . Doi: 10.1051/sicotj/2016027