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Ulnar Impingement Syndrome
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Contents
Other Names
- Ulnar Impingement Syndrome
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
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
Risk Factors
Differential Diagnosis
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
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
Evaluation
Radiographs
- Standard Radiographs Wrist
- Features: Ulnar shortening, radioulnar convergence, subchondral sclerosis, bone edema, scalloping of distal radius[1]
- Radiographic features seen in chronic cases
MRI
- More sensitive for early disease
CT
Classification
- N/A
Management
Nonoperative
- Generally considered a surgical problem as disease progression is likely
Operative
- Surgical options which preserve function are limited[2]
- Goals are reduction in pain and unrestricted forearm rotation
- Techniques:
- Hemiresection arthroplasty of the ulnar head
- Kapandji-Sauve´ arthroplasty
Return to Play
- At the discretion of the hand surgeon
Complications
- Chronic pain
- Loss of ADLs
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ https://radiopaedia.org/articles/ulnar-impingement-syndrome?lang=us
- ↑ Krimmer, Hermann, et al. "The distal radial decompression osteotomy for ulnar impingement syndrome." Archives of orthopaedic and trauma surgery 136.1 (2016): 143-148.
Created by:
John Kiel on 1 November 2019 17:01:06
Authors:
Last edited:
13 October 2022 21:57:44
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