Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome

Roh, Young Hak; Kim, Sang Woo; Gong, Hyun Sik; Baek, Goo Hyun

doi:10.1038/s41598-018-28060-2

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…However, some other studies did not show any association between ulnar variance and sex (2,29,30). The association between ulnar variance and sex may in part explain that idiopathic ulnar impaction syndrome is more prevalent in women (31), whereas Kienböck's disease shows a male predominance (32,33). Although previous studies have suggested an association between negative ulnar variance and Kienböck's disease (2,3,26), the causality is uncertain (4).…”

Section: Discussionmentioning

confidence: 99%

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers

Waris,

Höglund,

Sippo

et al. 2023

Acta Radiol

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Background Several carpal pathologies are considered to be related to ulnar variance. Recently, computer-aided computed tomography (CT) analysis software was introduced to quantify three-dimensional (3D) carpal alignment with high accuracy and reliability. Purpose To determine the association of ulnar variance with 3D carpal alignment and demographics. Material and Methods A wrist of 121 asymptomatic volunteers (69 men, 52 women; mean age = 38 ± 10.4 years) was imaged in the neutral wrist position with cone-beam CT. Computer-aided CT analysis software (Bonelogic), based on segmentation and numerical modelling, was used to define ulnar variance and standardized 3D axes for all carpal bones. The association of ulnar variance with 3D carpal alignment, age of the volunteer, and side and dominance of the imaged wrist was assessed. Results The mean ulnar variance was −1.6 ± 1.5 mm (range = −5.3 to 2.4 mm). The mean ulnar variance was −1.9 mm and −1.1 mm in men and women ( P = 0.007), respectively. Of the imaged 121 wrists, 18 (15%) had positive and 103 (85%) negative ulnar variance. There was no association between ulnar variance and any of the radio- or intercarpal angle values in either the sagittal or coronal plane (ρ = −0.16…0.17, r = −0.13….0.12). The ulnar variance showed no association with side ( P = 0.51) or dominance ( P = 0.27) of the imaged wrist. Conclusion 3D carpal alignment is not affected by ulnar variance. The association of ulnar variance with sex may in part explain the difference in reported prevalence of some carpal pathologies, such as ulnar impaction syndrome and Kienböck’s disease.

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Section: Discussionmentioning

confidence: 99%

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers

Waris,

Höglund,

Sippo

et al. 2023

Acta Radiol

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“…The conservative treatment regimen typically involves continuous splint fixation for 4 weeks and intermittent wear for 2 weeks, followed by 6 weeks of rehabilitation after the splint removal. 23 For patients experiencing significant ulnar-sided wrist pain, oral nonsteroidal anti-inflammatory drugs (NSAIDs) can be administered for symptomatic relief. In cases of severe ulnar-sided pain, especially when NSAIDs are not sufficiently effective, localized pain point blockade on the ulnar side of the wrist may be considered.…”

Section: Imaging Examinationmentioning

confidence: 99%

“…Conservative treatment for patients with UIS often spans a lengthy period, typically extending beyond 6 weeks, with a success rate usually <60%. 23,24 Identifying high-risk patients and reducing the time cost of awaiting surgery are crucial for an early return to daily life.…”

Section: Imaging Examinationmentioning

confidence: 99%

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Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)

Xu,

Ho,

Nakamura

et al. 2024

J Wrist Surg

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Background: Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes. Purposes: This paper underscores the necessity of developing evidence-based clinical guidelines for UIS to guide clinicians in their diagnostic and therapeutic approaches. Methods: In collaboration with the Asian Pacific Wrist Association, a team of experts from various fields within the Hand Surgery Department at Huashan Hospital has collectively formulated the “Clinical Practice Guidelines for Ulnar Impaction Syndrome (2024)” (hereinafter referred to as the “Guidelines”). The development process adhered to the guidelines outlined in the World Health Organization's handbook for guideline development. Results: Ten key questions and 21 recommendations are formed. The Guidelines provide recommendations for UIS diagnosis, criteria for selecting conservative or surgical interventions, options for surgical procedures, and address various related issues. Conclusions: The collaborative effort aims to standardize clinical practices, enhance diagnostic accuracy, and improve treatment outcomes for individuals affected by UIS, with these recommendations intended to serve as a valuable reference for healthcare professionals.

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“…5 In the absence of DRUJ instability, treatment approaches typically begin with conservative strategies employing immobilization as the primary treatment modality for 4 to 12 weeks. 1,[6][7][8][9][10][11] Although such initial nonoperative management is the conventional approach, 6,8 evidence has shown that up to 43% of patients with acute, stable TFCC tears managed by immobilization for a minimum of 4 weeks will eventually require surgery. 11 Furthermore, a recent study on the natural course of TFCC tears without DRUJ instability, in which patients were managed nonoperatively with 4 to 12 weeks of immobilization, found a 30% rate of complete recovery at 6 months and 50% at 1 year.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Early versus Late Debridement of Superficial Triangular Fibrocartilage Complex Tears

Zhuang

Shapiro

et al. 2024

Journal of Hand and Microsurgery

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Background While initial nonoperative management is the conventional approach for superficial triangular fibrocartilage complex (TFCC) tears, a substantial portion of these cases go on to require surgery, and the optimal duration of nonoperative treatment is unknown. In this study, we evaluate the cost-effectiveness of early versus late arthroscopic debridement for the treatment of superficial TFCC tears without distal radioulnar joint (DRUJ) instability. Methods We created a decision tree to compare the following strategies from a healthcare payer perspective: immediate arthroscopic debridement versus immobilization for 4 or 6 weeks with late debridement as needed. Costs were obtained from the Centers for Medicaid and Medicare Services and a national administrative claims database. Probabilities and health-related quality-of-life measures were obtained from published sources. We conducted sensitivity analyses on model inputs, including a probabilistic sensitivity analysis consisting of 10,000 Monte Carlo simulations. Results Immobilization for 6 weeks while reserving arthroscopic debridement for refractory cases was both the least costly and most effective strategy. Immediate arthroscopic debridement became cost-effective when success rates of immobilization for 4 or 6 weeks were less than 7.7 or 10.5%, respectively. Our probabilistic sensitivity analysis showed that immobilization for 6 weeks was preferred 97.6% of the time, and immobilization for 4 weeks was preferred 2.4% of the time. Conclusion Although various early and late debridement strategies can be used to treat superficial TFCC tears without DRUJ instability, immobilization for 6 weeks while reserving arthroscopic debridement for refractory cases is the optimal strategy from a cost-effectiveness standpoint.

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Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome

Cited by 7 publications

References 21 publications

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers

Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)

Cost-Effectiveness Analysis of Early versus Late Debridement of Superficial Triangular Fibrocartilage Complex Tears

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