Ulnar-sided wrist pain. II. Clinical imaging and treatment

Abstract

Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.

Ulnar impaction syndrome: A case series and imaging approach

“…1,6,11,12,13 Ulnar impaction syndrome is associated with positive ulna variance but may occur with neutral or negative variance. 1,6,8,14 Only one patient described in our series had a mildly positive ulnar variance. All other patients had a neutral variance.…”

“…firm gripping, pronation and ulnar deviation of the wrist, cause exacerbation of pain due to the relative increase in ulnar variance. 1,[6][7][8][9][10] The disease process, however, develops over time and patients may have radiological features while being asymptomatic. 1 A sequence of pathological features of ulnar impaction syndrome occurs depending on the degree and duration of chronic impaction between the ulnar head, the interpositioned TFCC and the ulnar carpus.…”

“…Other conditions creating positive ulnar variance include previous distal radius fracture or surgery with foreshortening or premature distal radius physeal arrest. 1,6,8 Pronated grip radiography was described by Tomaino to demonstrate increased variance and the subsequent impaction. 8,14 The Palmer classification describes the mechanism and degree of injury in the event of TFCC injuries.…”

High-resolution 3 T MRI of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities using Palmer and Outerbridge classifications

“…1,2 The Palmer classification has been widely used for diagnosis of traumatic or degeneration abnormalities of the triangular fibrocartilage complex (TFCC), including evaluation of carpal bone cartilage 3 ; however, it is often difficult and challenging to differentiate between traumatic injury and degenerative change at magnetic resonance imaging (MRI) because of complex ulnar-sided wrist anatomy and limited published knowledge or experience on MRI findings of degenerative changes. 4,5 Degeneration of the wrist articular cartilage is described according to the subtypes of Palmer class 2 injury.…”

SPECT/CT arthrography of the wrist in ulnocarpal impaction syndrome

“…Along with the clinical history and physical examination, imaging is important in the evaluation of ulnar-sided wrist pain [1][2][3][4]. Ulnocarpal impaction syndrome can lead to severe damage to the cartilage, triangular fibrocartilage complex (TFCC) and bone.…”