Chronic Ulnar-sided Wrist Pain Research Articles

Symptomatic Congenital Coalition of the Pisiform and Hamate - A Case Report.

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain. Level of Evidence: Level V (Therapeutic).

Extensor carpi ulnaris longitudinal tear: An overlooked etiology of ulnar-sided wrist pain

The common etiologies of ulnar-sided wrist pain include fracture, triangular fibrocartilage complex injury, ulnocarpal impaction, extensor carpi ulnaris tenosynovitis, and distal radioulnar joint instability. Early and precise diagnosis is the cornerstone for management and early recovery from the disease. A dual-modality approach with X-ray and ultrasound wrist can be used as an efficient and cost-effective screening procedure for ulnar-sided wrist pain in a busy tertiary care setting or where magnetic resonance imaging is not available. We report a case of a 36-year-old male with chronic ulnar-sided wrist pain.

Novel Therapeutic Approach for Extensor Digiti Minimi Tendon Traction in Chronic Ulnar-Sided Wrist Pain Diagnosed as Triangular Fibrocartilage Complex Injury: A Case Report

Novel Therapeutic Approach for Extensor Digiti Minimi Tendon Traction in Chronic Ulnar-Sided Wrist Pain Diagnosed as Triangular Fibrocartilage Complex Injury: A Case Report

The Hook Test Is More Accurate Than the Trampoline Test to Detect Foveal Tears of the Triangular Fibrocartilage Complex of the Wrist

To evaluate the accuracy of the trampoline and hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared with arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ). In total, 135 patients (97 male, 38 female, mean age 43.5 years) were divided into 2 groups: (1) 80 patients with chronic ulnar-sided wrist pain and positive fovea sign and (2) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy and by the trampoline and hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity, and likelihood ratio of the 2 diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference. The trampoline and the hook tests showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the trampoline test was similar for distal (69%), proximal (66%), and complete (73%) TFCC tears. The hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for the trampoline and hook tests was 75.00% and 0.00% (P < .001) for distal tears and 78.85% and 100.00% (P < .001) and 58.33% and 100.00% (P < .001) for complete or isolated proximal tears, respectively. Specificity for the trampoline and hook tests was 67.27% and 96.36% (P < .001) respectively. The trampoline and hook tests can assure accurate diagnosis of peripheral TFCC tear. The hook test shows greater specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a greater probability to detect foveal laceration of peripheral TFCC for the hook test than for the trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal incompetence of the TFCC, if the hook test is positive. Level II, retrospective diagnostic trial.

Pisiform excision is an effective and safe treatment for ulnar-sided wrist pain related to the pisotriquetral joint

Pisotriquetral disorders can cause chronic ulnar-sided wrist pain. When conservative treatment is insufficient, pisiform excision can be a solution. There are reports found in the literature describing variable effects of this procedure in small, descriptive case series. This study included 175 patients who underwent pisiform excision performed in various specialized private hand clinics between 2011 and 2015. Patients were analyzed using standardized outcome measurements. Functionality was improved significantly 3 months postoperative, with a decrease in pain (n = 86) (P < 0.05), mean improvement of 13 degrees in wrist flexion/extension (n = 72) (P < 0.001), and 18% increase in strength (n = 75) (P < 0.001). Twelve months postoperatively, the wrist function (PRWHE-DLV) improved from a mean of 64 to 25 (n = 62) (P < 0.001). The results support pisiform excision as an effective and safe treatment. Significant pain relief can be expected with improvement in wrist function. Unfortunately, a high amount of data was missing. The authors believe that the data presented in the study represents an underestimation of the results. Level of evidence: Level III, therapeutic study.

Ulnocarpal impaction syndrome: treatment with a transverse ulnar shortening osteotomy from an ulnodorsal approach

Ulnocarpal impaction syndrome is a common cause of chronic ulnar-sided wrist pain. The distal ulnar shortening osteotomy addresses the often present positive ulnar variance and therefore relieves the excessive load on the ulnocarpal joint. In the present study, the results of a technique that uses an ulnodorsal approach with a compression device and a transverse osteotomy are presented and compared to other techniques. This retrospective study includes 92 wrists with an ulnocarpal impaction syndrome, which were treated with an ulnar shortening osteotomy. The mean duration of postoperative follow-up was 50 months. The mean ulnar variance was 2.17 ± 1.56 mm preoperatively and after the ulnar shortening osteotomy -1.36 ± 1.67 mm (p < 0.05). Radiological consolidation of the osteotomy could be shown in 91 wrists 6 months postoperatively. Patients rated the preoperative pain level at a VAS 7.9 ± 1.7 which decreased to a of VAS 2.4 ± 2.5 (p < 0.05). 19 patients complained of mechanical irritation. There was no neurological irritation. It could be shown that the distal ulnar shortening osteotomy by a transverse osteotomy using a compression device and an ulnodorsal approach has a low complication rate. It is comparable to the oblique osteotomy in effectiveness and safety.

Comparison of Clinical Results After Pisiformectomy in Patients With Rheumatic Versus Posttraumatic Osteoarthritis

Pisotriquetral osteoarthritis is important to consider in the differential diagnosis of chronic ulnar-sided wrist pain. It can develop following traumatic injury to the pisiform or in rheumatic diseases, such as rheumatoid arthritis or psoriatic arthritis. It has been shown that pisiformectomy can relieve symptoms in cases that have not responded to nonoperative treatment, and the excision does not compromise the function or strength of the wrist. Most studies focus on posttraumatic causes of pisotriquetral osteoarthritis. In the current study, rheumatic causes are also considered and the outcomes are compared. This retrospective study included 35 patients who underwent pisiformectomy for pisotriquetral osteoarthritis. All patients underwent a thorough diagnostic evaluation to exclude other etiologies for ulnar-sided wrist pain. Radiological examinations including posteroanterior and lateral views of the wrist and a tangential view of the pisotriquetral joint were analyzed. All patients had excellent or very good results after pisiformectomy, with a significant reduction in pain. No significant difference was found in the outcomes for patients with rheumatic vs posttraumatic osteoarthritis. Patients with rheumatic causes of pisotriquetral osteoarthritis can be successfully treated with pisiformectomy. With respect to idiopathic causes, these patients need a longer postoperative period to gain full pain relief. It is important to consider the possibility of pisotriquetral osteoarthritis after excluding other diagnoses in patients with rheumatic osteoarthritis.

Douleur chronique du compartiment médial du poignet chez l’adulte : diagnostic et principes du traitement

Adult patients with chronic ulnar wrist pain often seek medical advice. There are a number of diagnoses for chronic ulnar-sided wrist pain. A sound diagnostic strategy is therefore of paramount importance. Patient's history, clinical examination and high quality standard radiographs are the most important part of this strategy. Sophisticated investigations should only be performed to focus on solid clinical hypotheses. The palmar and dorsal aetiologies of ulnar wrist pain are considered as well as their treatment principles.

Arthroscopic Management of Triangular Fibrocartilage Tears in the Athlete

The triangular fibrocartilage complex (TFCC) is a composite of soft tissues extending from the distal ulna to the ulnar carpus. This complex is considered to be the primary stabilizer of the distal radioulnar joint. Additionally, the TFCC stabilizes the ulnocarpal joint, distributes load between the ulna and ulnar carpus, and allows wrist motion in multiple planes. Numerous athletic activities place participants at risk for injuries of the TFCC. If the TFCC is disrupted or altered by acute or chronic injury, the wrist is potentially destabilized, progressive arthritic changes may occur, and athletes may suffer chronic ulnar-sided wrist pain, loss of motion, and loss of grip strength. We summarize current methods of diagnosing, imaging, and arthroscopically treating TFCC injuries in the athlete.

ULNAR-SIDED WRIST PAIN

Ulnar-sided wrist pain has often been equated with low back pain because of its insidious onset, vague and chronic nature, intermittent symptoms, and frustration that it induces in patients. Chronic ulnar-sided wrist pain may be accompanied by a history of workers' compensation claims and unrelenting and irresolvable pain, and it may occur in patients with dfficult personalities. Despite these issues, many patients with ulnar-sided wrist pain have pathologic lesions that may be amenable to surgical treatment.

Golf-Induced Injuries Of The Wrist

Golf injuries of the wrist are rare, but when they occur they can be devastating for the avid golfer, competitive amateur golfer, or the professional golfer, as the hand and wrist are so integral to the game. The majority of golf injuries are overuse injuries of the wrist flexor or extensor tendons. The left wrist (in the right-handed golfer) is the most common location. Analysis of the golf swing finds excessive motion of the left wrist (in the right-handed golfer), along with a catapulting function, accounting for vulnerability of the left wrist to injury. Hyperextension and radial deviation of the right wrist may cause impingement syndrome and injury may also occur during impact of the swing phase. The majority of golf-induced overuse syndromes of the wrist are successfully treated nonoperatively, but may require restriction from golf for an extended period of time. Many of the wrist problems that we see can often be related to a strong grip (left hand positioned clockwise on the golf club handle), overgripping (too tight a grip) golf club grips in poor repair, or poor swing techniques. The most common bony injury of the wrist is fracture of the hook of the hamate. This injury is a source of chronic ulnar-sided wrist pain in the golfer and is often diagnosed late or left undiagnosed. Proper-fitting golf clubs, proper swing technique, and avoidance of obstacles may prevent this injury. Like any other sport, golf requires the use of proper equipment, proper technique, and conditioning to prevent injury.

Diagnosis and treatment of obscure ulnar-sided wrist pain.

Thirty-seven patients were followed for symptoms of chronic ulnar-sided wrist pain in which specific physical examination and standard radiographs were unrevealing. Initial conservative treatment did not relieve the pain. The patients underwent further diagnostic studies including dynamic cineroentgenographic evaluation and radiocarpal arthrography. Nineteen of the 37 patients were demonstrated to have a triangular fibrocartilage complex (TFCC) tear on arthrography; 18 had a normal examination. The average follow up was 23 months. Seven of the 19 patients with TFCC tears have undergone operative treatment, and 5 (71%) remain symptomatic. Of the remaining 12 patients with TFCC tears treated nonoperatively, eight (67%) have persistent symptoms. Of the 18 patients whose arthrograms were normal, five eventually underwent surgical exploration, four of which remain symptomatic. Of the 13 patients without TFCC tears treated nonoperatively, seven (54%) continue to have symptoms. In our experience, both surgical exploration and nonoperative treatment have been less than satisfying. In addition, treatment results could not be correlated with arthrographic findings.