scholarly journals Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

2017 ◽  
Vol 07 (02) ◽  
pp. 133-140 ◽  
Author(s):  
Alexandra Herold ◽  
Frank Unglaub ◽  
Kai Megerle ◽  
Holger Erne ◽  
Steffen Löw
Keyword(s):  
Wrist Pain ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Significant Difference ◽  
Triangular Fibrocartilage ◽  
Improved Function ◽  
Ulnar Impaction Syndrome

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.

scholarly journals Significance of Scapholunate Gap Width as Measured by Probe from Midcarpal

2017 ◽  
Vol 06 (04) ◽  
pp. 316-324
Author(s):  
Holger Erne ◽  
Ute Strobl ◽  
Frank Unglaub ◽  
Christian Spies ◽  
Steffen Löw
Keyword(s):  
Hardware Removal ◽  
Ligament Injury ◽  
Dash Score ◽  
Level Of Evidence ◽  
Ulnar Impaction ◽  
Significant Difference ◽  
Triangular Fibrocartilage ◽  
Ulnar Impaction Syndrome ◽  
Probe Insertion ◽  
Gap Width

Background Geissler's classification is widely accepted in arthroscopic diagnostics of scapholunate (SL) ligament injury. Thereby, probe insertion into the SL gap from the midcarpal would indicate treatment necessity in patients with SL tear as seen from radiocarpal view. Purpose In this review, the SL gap width, examined by the probe from midcarpal, was arthroscopically assessed in patients with intact SL ligaments, who were treated for ulnar impaction syndrome. The review examined how often lax SL joints can be found in patients with no complaints with respect to the SL ligaments and in which the SL ligaments were proven to be intact from radiocarpal view. We suspected that probe insertion, as an indicator for a lax joint, does not affect the outcome in ulnar impaction treatment. Patients and Methods A total of 32 patients with clinically diagnosed ulnar impaction syndrome were arthroscopically treated by central resection and debridement of the triangular fibrocartilage; 8 patients underwent concurrent ulnar shortening, and 4 of them finally hardware removal. All patients were examined preoperatively as well as after 3, 6, and 12 months following arthroscopy, respectively, after ulnar shortening or hardware removal. Results In 14 patients, the probe could not, in 18 patients, the probe could be inserted into the SL gap. There was neither any significant difference in the improvement of pain, grip strength, Krimmer, or DASH score, nor for any of the radiographic angles between the two groups. Conclusion Laxity of the SL ligament allows the probe to be inserted into the SL gap from midcarpal in some patients. This finding, therefore, does not necessarily imply the necessity of treatment when there is partial rupture seen from radiocarpal view. Level of Evidence Level III, case–control study.

Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients

2019 ◽  
Vol 44 (6) ◽  
pp. 582-586 ◽  
Author(s):  
Samir K. Trehan ◽  
Gregory Schimizzi ◽  
Tony S. Shen ◽  
Lindley B. Wall ◽  
Charles A. Goldfarb
Keyword(s):  
Parent Satisfaction ◽  
Subsequent Treatment ◽  
Triangular Fibrocartilage Complex ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Adolescent Patients ◽  
Triangular Fibrocartilage ◽  
Complex Surgery

We assessed outcomes of 43 paediatric and adolescent patients (44 wrists) undergoing arthroscopic triangular fibrocartilage complex surgery by a single surgeon between 2003 and 2016. Medical records were reviewed for clinical, imaging, and operative data. Preoperatively, 49% of patients had additional diagnoses and mean QuickDASH was 47. Patients were telephoned to assess current wrist pain, subsequent treatment(s), satisfaction, and to complete QuickDASH and Patient-Rated Wrist Evaluation questionnaires. Twenty-five patients responded with mean follow-up of 70 months (minimum 13 months). In those patients not reached by telephone, mean clinical follow-up was 21 months. Seven patients had subsequent surgery (most commonly ulnar shortening osteotomy); this was associated with lower satisfaction scores. At final follow-up, mean QuickDASH was 4, Patient-Rated Wrist Evaluation 8 and patient and parent satisfaction scores were 9 and 9 out of 10, respectively. In conclusion, arthroscopic triangular fibrocartilage complex treatment in paediatric patients yielded favourable outcomes and patient/parent satisfaction. Level of evidence: IV

scholarly journals Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

2011 ◽  
Vol 3 (4) ◽  
pp. 295 ◽  
Author(s):  
Goo Hyun Baek ◽  
Hyuk Jin Lee ◽  
Hyun Sik Gong ◽  
Seung Hwan Rhee ◽  
Jihyeung Kim ◽  
...  
Keyword(s):  
Long Term Outcomes ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Ulnar Impaction Syndrome

scholarly journals Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hui-Kuang Huang ◽  
Steve K. Lee ◽  
Yi-Chao Huang ◽  
Cheng-Yu Yin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Functional Outcomes ◽  
Functional Evaluation ◽  
Sigmoid Notch ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Ulnar Impaction Syndrome

Abstract Background Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch. Methods We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients. Results We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36–179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o–23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o–11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0–1; SD, 0.4) at rest and 1.3 (range, 0–3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3–34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70–100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength. Conclusions For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.

scholarly journals Changes in Ulnar Variance after a Triangular Fibrocartilage Complex Tear

2018 ◽  
Vol 08 (01) ◽  
pp. 030-036
Author(s):  
Jung-In Shim ◽  
Jin-Hyung Im ◽  
Han-Vit Kang ◽  
Sung-Hyun Cho ◽  
Joo-Yup Lee
Keyword(s):  
Grip Strength ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Group A ◽  
Triangular Fibrocartilage ◽  
Group B ◽  
Ulnar Impaction Syndrome

Purpose The relationship between triangular fibrocartilage complex (TFCC) tear and ulnar impaction syndrome has not been fully understood. We hypothesized that a TFCC tear could change the ulnar variance, which may be the cause of ulnar impaction syndrome. Patients and Methods A total of 72 patients who underwent TFCC foveal repair between January 2011 and June 2016 were included in this retrospective study. Among them, 44 patients diagnosed with TFCC foveal tear with distal radioulnar joint instability and no ulnar impaction syndrome underwent TFCC foveal repair only (group A) and 28 patients diagnosed with TFCC foveal tear with ulnar impaction syndrome underwent TFCC foveal repair and ulnar shortening osteotomy simultaneously (group B). We measured their ulnar variances in preoperative, postoperative, and last follow-up plain radiography. We also compared them with the ulnar variance of the contralateral (uninjured) wrist. Postoperative clinical outcomes, such as range of motions of the wrist, the visual analog scale (VAS) for pain, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, were assessed. Results Ulnar variance increased after TFCC tears compared with that on the uninjured side in both groups (group A: 0.98 vs. 0.52 mm, p = 0.013; group B: 2.71 vs. 2.13 mm, p = 0.001). Once the TFCC was repaired, ulnar variance decreased (group A: 0.98 to 0.01 mm, p < 0.01; group B: 2.71 to 0.64 mm, p < 0.01). However, it was increased on the last follow-up radiograph (group A: 0.01 to 0.81 mm, p < 0.01; group B: 0.64 to 1.05 mm, p = 0.004). There were no significant improvement of range of motion, except for pronation–supination motion (p = 0.04). Mean grip strength increased from 56.8 to 70.8% of the contralateral unaffected hand at the last assessment (p = 0.01). Mean VAS for pain decreased from 7.4 ± 2.5 preoperatively to 2.7 ± 2 postoperatively (p = 0.001). The QuickDASH score significantly improved from 45 to 9 (p = 0.001). Conclusion Ulnar variance may be changed after a TFCC tear. In our study, it decreased after TFCC foveal repair. However, as time went on, the ulnar variance increased again, which could be one of the causes of ulnar impaction syndrome and ulnar-sided wrist pain. Level of Evidence This is a therapeutic Level IV study.

scholarly journals Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study

2021 ◽  
Author(s):  
Hui-Kuang Huang ◽  
Steve K. Lee ◽  
Yi-Chao Huang ◽  
Cheng-Yu Yin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Functional Outcomes ◽  
Functional Evaluation ◽  
Sigmoid Notch ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Ulnar Impaction Syndrome

Abstract Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch.Methods: We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients.Results: We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36–179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o–23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o–11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0–1; SD, 0.4) at rest and 1.3 (range, 0–3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3–34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70–100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.Conclusions: For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.

scholarly journals Arthroscopic Repair of Triangular Fibrocartilage Complex Tear

2020 ◽  
Vol 25 (3) ◽  
pp. 167-174
Author(s):  
Hyunseok Seo ◽  
Joo-Yup Lee
Keyword(s):  
Clinical Outcomes ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Triangular Fibrocartilage ◽  
Ulnar Impaction Syndrome ◽  
Important Structure

Triangular fibrocartilage complex (TFCC) is an important structure for stability of distal radioulnar joint (DRUJ) and shock absorption of ulnocarpal joint. Recent studies on anatomy and biomechanics of TFCC have revealed that the deep fiber of distal radioulnar ligament plays a key role in stabilizing the DRUJ. Clinicians should evaluate the presence of the instability of DRUJ or ulnar impaction syndrome. If necessary, combined TFCC foveal repair and ulnar shortening osteotomy should be performed. This article introduces the authors’ preferred procedure of arthroscopic TFCC repair with satisfactory clinical outcomes.

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