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.

scholarly journals Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome

2021 ◽  
Author(s):  
Kazutoshi Hontani ◽  
Yuichiro Matsui ◽  
Daisuke Kawamura ◽  
Atsushi Urita ◽  
Daisuke Momma ◽  
...  
Keyword(s):  
Stress Distribution ◽  
Distribution Pattern ◽  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Sigmoid Notch ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Type C ◽  
Ulnar Impaction Syndrome

Abstract Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). The aim of this study was to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with USO, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

scholarly journals Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazutoshi Hontani ◽  
Yuichiro Matsui ◽  
Daisuke Kawamura ◽  
Atsushi Urita ◽  
Daisuke Momma ◽  
...  
Keyword(s):  
Stress Distribution ◽  
Distribution Pattern ◽  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Sigmoid Notch ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Type C ◽  
Ulnar Impaction Syndrome

AbstractUlnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain

2013 ◽  
Vol 38 (7) ◽  
pp. 746-750 ◽  
Author(s):  
T. Oda ◽  
T. Wada ◽  
K. Iba ◽  
M. Aoki ◽  
M. Tamakawa ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Articular Disc ◽  
Ulnar Head ◽  
Dynamic Variations ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Ulnar Wrist Pain ◽  
Triangular Fibrocartilage

In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer’s Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.

Distal radioulnar joint configurations in three-dimensional computed tomography in patients with idiopathic ulnar impaction syndrome

2019 ◽  
Vol 44 (5) ◽  
pp. 488-495 ◽  
Author(s):  
Jihyeung Kim ◽  
Jaewoo Cho ◽  
Yo-Han Lee ◽  
Sohee Oh ◽  
Hyun Sik Gong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Joint Space ◽  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Sigmoid Notch ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Ulnar Impaction Syndrome

We retrospectively reviewed 26 patients diagnosed with idiopathic ulnar impaction syndrome and measured the slopes of the sigmoid notch and ulnar head at their centre using their preoperative three-dimensional computed tomography. We found that the slope of the sigmoid notch and that of the ulnar head were not parallel to each other. There was a significant linear relation between the slope of the ulnar head and the changes in the closest joint space of the distal radioulnar joint at the centre of the sigmoid notch after ulnar shortening. We conclude that the slope of the ulnar head is more strongly correlated with changes in the closest joint space in the distal radioulnar joint than that of the sigmoid notch. Our findings suggest that slope of the ulnar head might be as important a predisposing factor as that of the sigmoid notch for the progression of distal radioulnar joint arthritis after ulnar-shortening osteotomy. We should consider the slopes of both the sigmoid notch and ulnar head before the osteotomy. Level of evidence: IV

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.

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