Predictors of Pain Intensity and Functional Limitation After Conservative Treatment in Idiopathic Ulnar Impaction Syndrome: High Work-Related Exposure or Degenerative Complex TFCC Tear Inevitably Results in Surgical Treatment of Idiopathic Ulnar Impaction Syndrome

2021 ◽  
Author(s):  
Dong Hun Suh ◽  
Jong Woong Park ◽  
In Cheol Choi ◽  
Jung Ho Park ◽  
Jong woo Kang
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Pain Intensity ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Distal Radioulnar Joint ◽  
Work Related ◽  
Ulnar Impaction ◽  
Ulnar Impaction Syndrome ◽  
Objective Functional

Abstract Background: This study aimed to identify predictors of pain intensity and functional limitation after conservative treatment in idiopathic ulnar impaction syndrome (UIS).Methods: One hundred seventy-seven patients with UIS who inevitably underwent ulnar shortening procedures because of considerable pain or functional limitation despite at least 6 months of conservative treatment were included. To identify the predictors of pain intensity and functional limitation after appropriate conservative treatment in UIS, pain intensity was estimated using the visual analog scale (VAS)score, while functional limitations of the wrists were evaluated by the Disabilities of the Arm, Shoulder, and Hand score (DASH; subjective functional limitation), wrist range of motion, and grip strength (objective functional limitation) just before surgery. We considered sex, age, dominance of the affected wrist, work-related exposure, length of ulnar variance, types of distal radioulnar joint (DRUJ) on the coronal, degree of ulnocarpal degeneration, presence of degenerative complex triangular fibrocartilaginous complex (TFCC) tear, and presence of bony lesions (cyst or sclerosis or erosion of lunate or triquetrum or ulnar head) as possible predictors of pain intensity and functional limitations of the wrists. The relationship between pain intensity and functional limitation and the possible predictors were statistically analyzed using a linear regression test.Results: Only work-related exposure was positively correlated with pain intensity and subjective functional limitation. The degenerative complex TFCC tear was a common predictor of an objective functional limitation.Conclusions: Patients with unavoidable excessive wrist use and degenerative complex TFCC tears tended to have more significant pain intensity and functional limitations despite at least 6 months of conservative treatment. Early surgical treatment should be considered for these patients.

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 Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up

2018 ◽  
Vol 10 (3) ◽  
pp. 59-65 ◽  
Author(s):  
M. A. Ivanova ◽  
V. A. Parfenov ◽  
A. I. Isaikin
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Pain Intensity ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Leg Pain ◽  
Antiinflammatory Drugs ◽  
Lumbosacral Radiculopathy

Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

scholarly journals A Case of Pincer Nail Successfully Treated with Tazarotene 0.1% Gel

2020 ◽  
Vol 12 (2) ◽  
pp. 114-118 ◽  
Author(s):  
Laura Vollono ◽  
Ester Del Duca ◽  
Sara Mazzilli ◽  
Luca Bianchi ◽  
Terenzio Cosio ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Therapeutic Agent ◽  
Functional Limitation ◽  
Common Condition ◽  
Invasive Procedures ◽  
Nail Bed ◽  
Temporary Relief ◽  
First Case

Pincer nail is a common condition characterized by excessive transverse nail curvature, progressively pinching the nail bed distally, resulting in cosmetic discomfort, pain and functional limitation. Treatment is difficult and often unsatisfactory. Surgical treatment performed by experienced physicians provides good outcomes. However, patients usually hesitate to undergo invasive procedures, preferring conservative treatments. Unfortunately, these mainly offer only temporary relief and recurrence rate is high. Topical tazarotene has been used in several nail conditions, but its potential remains not fully elucidated. We herewith present a case of pincer nails in a 35-year-old woman successfully treated with tazarotene 0.1% gel applied topically twice a day for 3 months who did not experience recurrence at 1-year follow-up. At 1-year follow-up, no recurrence has been observed. To our knowledge, this is the first case of pincer nails successfully treated with tazarotene 0.1% gel. With our report, we suggest topical tazarotene as a novel, effective conservative treatment of milder cases of this common, albeit disturbing condition. Although our report may not be sufficient to generalize the results, it paves the way for larger studies investigating the potential of this fast, noninvasive therapeutic agent.

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 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.

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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