scholarly journals The Effect of Axial Loading on Ulnar Variance

2018 ◽  
Vol 07 (03) ◽  
pp. 247-252
Author(s):  
Andy Zhu ◽  
Breana Siljander ◽  
Jeffrey Lawton ◽  
Jennifer Waljee ◽  
Kagan Ozer
Keyword(s):  
Axial Loading ◽  
Contralateral Side ◽  
Wrist Pain ◽  
Ulnar Variance ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Level Ii ◽  
Triangular Fibrocartilage ◽  
Asymptomatic Individuals ◽  
Ligament Disruption

Background Forearm rotation results in change in ulnar variance. Axial loading of the wrist is required to maintain daily activities. Change in ulnar variance during axial loading has not been investigated previously. Purpose To measure the change in ulnar variance on axially loaded wrists. Patients and Methods We examined 21 asymptomatic individuals and 24 patients with unilateral ulnar-sided wrist pain. All patients underwent standard neutral posteroanterior wrist radiographs without load and under axial loading on bilateral wrists. Axial loading was standardized at 18.1 kgf using an analog weight scale. A magnetic resonance (MR) arthrogram was obtained only in patients with ulnar-sided wrist pain. Beighton flexibility score was recorded on healthy volunteers. Change in ulnar variance between 0 and 18.1 kgf was compared for each wrist among all subjects. A correlation was sought between the change in ulnar variance, MR arthrogram findings, and physical examination. Results In individuals without wrist pain, on average, 0.4 mm increase in ulnar variance was measured between 0 and 18.1 kgf. There was no difference between the dominant and nondominant side. No correlation was found with increasing age. In contrast, patients with ulnar-sided wrist pain displayed an average increase of 0.8 mm in ulnar variance. Compared with the contralateral wrist, more than 1 mm increase in ulnar variance was correlated with intra-articular pathologies including dorsoulnar ligament disruption, central triangular fibrocartilage complex (TFCC) perforation, and foveal detachment. Conclusion Compared with contralateral side, more than 1 mm increase in ulnar variance is suggestive of longitudinal instability or TFCC pathology. Level of Evidence Level II, diagnostic.

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears

2017 ◽  
Vol 42 (4) ◽  
pp. 346-351 ◽  
Author(s):  
R. Luchetti ◽  
A. Atzei
Keyword(s):  
Late Onset ◽  
Tendon Graft ◽  
Triangular Fibrocartilage Complex ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Evaluation Scores ◽  
Complex Reconstruction ◽  
Arthroscopically Assisted ◽  
Triangular Fibrocartilage

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. Level of evidence: IV

scholarly journals Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

2021 ◽  
Vol 10 (11) ◽  
pp. 2363
Author(s):  
Florian Schachinger ◽  
Sebastian Farr
Keyword(s):  
Systematic Review ◽  
Return To Sport ◽  
Sports Participation ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Arthroscopic Treatment ◽  
Wrist Arthroscopy ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage

Introduction: Injury to the triangular fibrocartilage complex (TFCC) may cause chronic wrist pain and instability if left untreated. The current literature of adult cases suggests that arthroscopic treatment offers favorable outcomes and is associated with a low complication rate. This systematic review evaluated the outcomes of arthroscopic TFCC surgery in adolescents. Materials and Methods: A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cochrane Clinical Answers was conducted in May 2020. All studies reporting on (1) arthroscopic TFCC repair or debridement in (2) patients under the age of 19 years with (3) a minimum case number of four patients were extracted by two independent observers. The level of evidence of each study was assessed according to the Oxford Centre for Evidence-Based Medicine, and study quality was graded according to the Modified Coleman Methodology Score and the MINORS criteria. Clinical outcome scores, functional parameters, and any complications were reviewed. Results: The selected search terms initially resulted in a total of 986 possible articles. The authors eventually identified eight papers (all LoE IV) for inclusion in this systematic review. A total of 254 patients with verified TFCC tears and a mean age of 16 years (range, 7–19) received arthroscopic repair (162 patients, 67.1% of total) or debridement (77 patients, 29.7% of total). Arthroscopic treatment resulted in low pain levels, high patient satisfaction, and a fast return to sport. Complications overall were sparse and consisted mainly of persistent wrist pain (n = 31) and temporary paresthesia (n = 6) of the dorsal sensory branch of the ulnar nerve. Recurrent tears were sparse, with only four reported cases due to sports participation. Conclusion: Wrist arthroscopy is a reliable surgical option for treating TFCC tears in adolescents. The results obtained are comparable to those published in the literature. However, the variety of repair techniques and the low level of evidence across all included articles demand further prospective studies.

The Shape of the Triangular Fibrocartilage During Pronation–Supination

2003 ◽  
Vol 28 (6) ◽  
pp. 537-545 ◽  
Author(s):  
A. MAKITA ◽  
T. NAKAMURA ◽  
S. TAKAYAMA ◽  
Y. TOYAMA
Keyword(s):  
Ulnar Variance ◽  
Forearm Rotation ◽  
Triangular Fibrocartilage ◽  
Significant Change ◽  
Ulnar Lengthening

We studied the changes in the shape of the triangular fibrocatilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3 mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation–supination, even with positive ulnar variance.

During forearm rotation the three-dimensional ulnolunate distance is affected more by translation of the ulnar head than change in ulnar variance

2018 ◽  
Vol 44 (5) ◽  
pp. 517-523
Author(s):  
Seung-Han Shin ◽  
Yong-Suk Lee ◽  
Keun-Young Choi ◽  
Dai-Soon Kwak ◽  
Yang-Guk Chung
Keyword(s):  
Linear Relationship ◽  
Three Dimensional ◽  
Ulnar Variance ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Positive Linear Relationship ◽  
Computed Tomographic ◽  
Ulnar Head ◽  
The Mean

Ulnolunate abutment has been thought to be aggravated by pronation because of an increase in ulnar variance. We hypothesized that the ulnolunate distance might be greater in pronation because the ulnar head is dorsally translated. Twenty-one three-dimensional reconstructions of computed tomographic scans of wrists taken in supination and pronation were investigated. The ulnolunate distance was measured in each position, and the change in ulnolunate distance from supination to pronation was calculated. The changes in ulnar variance from supination to pronation and the amount of translation of the ulnar head were measured directly by superimposing three-dimensional reconstructions. The mean ulnolunate distance in pronation was significantly greater than in supination. There was no significant correlation between the changes in ulnolunate distance and in the ulnar variance. The change in ulnolunate distance had a significant positive linear relationship with the amount of translation of the ulnar head. The change in ulnolunate distance during forearm rotation is determined by the amount of translation of the ulnar head rather than by change in ulnar variance. Level of evidence: IV

scholarly journals Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction

2019 ◽  
Vol 08 (03) ◽  
pp. 192-197
Author(s):  
Tendai Mwaturura ◽  
Parham Daneshvar ◽  
Jeffrey Pike ◽  
Thomas Joseph Goetz
Keyword(s):  
Cohort Study ◽  
Wrist Pain ◽  
Level Of Evidence ◽  
Ulnar Side ◽  
Level Ii ◽  
Ulnar Shortening Osteotomy ◽  
Arthroscopic Findings ◽  
Shortening Osteotomy ◽  
Outcome Scores ◽  
Before And After

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.

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.

Ulnar Wrist Pain in Athletes Caused by Erosion of the Floor of the Sixth Dorsal Compartment

2005 ◽  
Vol 33 (12) ◽  
pp. 1910-1913 ◽  
Author(s):  
Ronaldo S. Carneiro ◽  
Rosana Fontana ◽  
Nilton Mazzer
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Wrist Pain ◽  
Level Of Evidence ◽  
Residual Pain ◽  
Ulnar Side ◽  
Treatment Regimens ◽  
Extensor Carpi Ulnaris ◽  
Triangular Fibrocartilage ◽  
Methods Of Treatment

Background Ulnar-side wrist pain can be disabling for athletes because of limitation of pronation-supination during sports such as tennis and golf. Erosion of the floor of the sixth dorsal space should be considered for unresponsive ulnar-side wrist pain. Study Design Case series; Level of evidence, 4. Methods Four athletes with severe unresponsive ulnar-side wrist pain were identified. Because the usual treatment regimens were ineffective in all cases, surgery was indicated to attempt mitigation of symptoms. During surgical exploration, all patients had inflammatory tendon changes and erosions in the floor of the sixth dorsal space, deep to the extensor carpi ulnaris. A soft tissue interposition flap fashioned from the roof of the sixth compartment was used to cover the defect. Results Patients were evaluated by reexamination for range of motion, ability to perform daily and sports activities, strength, and residual pain. All patients had relief of their symptoms, had normal range of motion with no residual pain, and returned to tennis and golf. Strength improved a mean of 15 lb after surgery. The follow-up was 19 to 40 months (mean, 33 months). Conclusion Erosion of the sixth compartment floor has been given very little attention in the literature. It should be suspected when severe ulnar-side pain persists in athletes after the usual methods of treatment. The interposition surgery described herein has been effective in 4 cases previously unresponsive to the usual methods of treatment for chronic tendinitis of the extensor carpi ulnaris or triangular fibrocartilage rupture.

scholarly journals Variation in Repair of the Triangular Fibrocartilage Complex

2018 ◽  
Vol 07 (03) ◽  
pp. 243-246
Author(s):  
Thomas Kootstra ◽  
Wouter van Leeuwen ◽  
Neal Chen ◽  
David Ring
Keyword(s):  
Surgical Repair ◽  
Decision Aids ◽  
Treatment Options ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Mri Scan ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Triangular Fibrocartilage ◽  
Signal Changes

Background There is controversy regarding the value of repair of the triangular fibrocartilage complex (TFCC). Given that an acute tear of the TFCC associated with a displaced distal radius fracture uncommonly benefits from repair, the role of repair in other settings is uncertain. Our impression is that TFCC repair is highly variable from surgeon-to-surgeon. Purpose The purpose of this study is to determine the rate of TFCC repair in patients who had a magnetic resonance imaging (MRI) scan of the wrist obtained for ulnar-sided wrist pain, and that showed signal changes in the TFCC. We tested the primary null hypothesis that there are no demographic or surgeon factors associated with repair of the TFCC. Patients and Methods Three hundred and ninety-four patients with ulnar-sided wrist pain and an MRI scan showing changes in the TFCC were included in this retrospective study. No patients had instability of the distal radioulnar joint (DRUJ) recorded in the medical record. Surgical repair of TFCC tears was used as the primary outcome during statistical analysis to identify factors associated with repair. Results Out of 394 (6%), 25 patients underwent TFCC repair. We found that 10% of the treating surgeons (4 out of 41) performed 80% of the procedures (20 out of 25). Patients who discerned a trauma prior to their symptoms and patients whose MRI showed signal changes primarily in the ulnar portion of the TFCC were more likely to have surgical repair. Conclusion We found that the rate of TFCC repair varies substantially from surgeon-to-surgeon. The observation that repair is more likely to happen when patients perceive themselves as injured suggests that perception of injury affects how patients and surgeons consider treatment options. To help avoid surgeries based on surgeon bias or patient misperception, we suggest studying the effect of tools that provide simple, balanced, dispassionate, and empowering information (e.g., decision aids) that can limit surgeon-to-surgeon variation. Level of Evidence Level IV.

Triangular Fibrocartilage Complex Repair and Ulna Variance: A Systematic Review

2018 ◽  
Vol 23 (03) ◽  
pp. 313-319 ◽  
Author(s):  
Ki Jin Jung ◽  
Jae-Hwi Nho ◽  
Jin Hyeung Kim ◽  
Byung-Sung Kim ◽  
Hyun Sik Gong
Keyword(s):  
Systematic Review ◽  
Clinical Outcome ◽  
Scoring Systems ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Added Value ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Triangular Fibrocartilage

Background: This purpose of the study was to conduct a systematic review of available literature regarding the association between ulnar variance and outcomes after repair of peripheral traumatic tears of the triangular fibrocartilage complex (TFCC). Methods: A systematic literature search of the medical literature about peripheral tears of the TFCC was performed. We selected seven studies comparing clinical outcome and ulnar variance in patients with peripheral TFCC tears. We evaluated quality of the articles using both the Structured Effectiveness Quality Evaluation Scale (SEQES) and Sackett’s Level of Evidence (LOE). The outcomes were objective or self-assessment scoring systems for the function of the hand, wrist, or upper extremity. Results: Seven articles were evaluated. The SEQES scores varied from 19 to 28, with a mean of 23. Five studies reported no association between ulnar variance and clinical outcome, and 2 studies reported an association. The studies reporting no association either excluded or did not mention the cases of unstable distal radioulnar joint (DRUJ). Conclusions: This systematic review did not demonstrate strong evidence regarding the association between ulnar variance and outcomes after TFCC repair. As most of the studies did not distinguish between capsular and foveal tears which can affect DRUJ stability, further studies looking at this point are necessary to determine whether ulnar shortening osteotomy has an added value for better outcomes after TFCC repair.

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

2021 ◽  
pp. 175319342110241
Author(s):  
I-Ning Lo ◽  
Kuan-Jung Chen ◽  
Tung-Fu Huang ◽  
Yi-Chao Huang
Keyword(s):  
Simple Procedure ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
High Satisfaction ◽  
Ultrasound Assessment ◽  
Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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