Ulnar Impingement Syndrome

Other Names

• Ulnar Impingement Syndrome
• Ulnar Impaction Syndrome

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Background

• Wrist pain caused by a shortened Ulna impinging upon the distal Radius proximal to the sigmoid notch
• Etiology
  • Most commonly from ulnar resection in the setting of trauma
  • Can also occur due to de novo negative ulnar variance

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Pathophysiology

• Pathophysiology
  • Shortened distal ulna
  • Contraction of: Extensor Pollicis Brevis, Abductor Pollicis Longus, Pronator Quadratus
  • Subsequent convergence of distal radioulnar space and impingement
• Epidemiology
  • Secondary far more common than primary

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Risk Factors

• Trauma
• Rheumatoid Arthritis
• Madelung Deformity

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Differential Diagnosis

• Fractures
  • Distal Radius Fracture
    • Bartons Fracture
    • Chauffers Fracture
    • Colles Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smiths Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
  • Carpal Instability
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Tendinopathy
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
  • Wartenbergs Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Scaphotrapeziotrapezoidal Joint Arthritis (STT Arthritis)
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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Clinical Features

• General: Physical Exam Wrist
• History
  • Patients will report ulnar sided wrist pain
  • Worse with pronation and supination
• Physical Exam
  • DRUJ Compression Test: Compression of DRUJ will exacerbate symptoms

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Evaluation

Radiographs

• Standard Radiographs Wrist
• Features: Ulnar shortening, radioulnar convergence, subchondral sclerosis, bone edema, scalloping of distal radius
• Radiographic features seen in chronic cases

MRI

• More sensitive for early disease

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Classification

• N/A

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Management

Ulnar Gutter Brace

Nonoperative

• Generally considered a surgical problem as disease progression is likely

Operative

• Surgical options which preserve function are limited
• Goals are reduction in pain and unrestricted forearm rotation
• Techniques:
  • Hemiresection arthroplasty of the ulnar head
  • Kapandji-Sauve´ arthroplasty

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Return to Play

• At the discretion of the hand surgeon

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Complications

• Chronic pain
• Loss of ADLs

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Finger Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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