Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

Pang, Eric Quan; Yao, Jeffrey

doi:10.1007/s12178-017-9384-9

Cited by 42 publications

(56 citation statements)

References 80 publications

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“…This combination of wrist positions and forces can also take place in other sports such as golf, and, although not specifically described, DUTL injuries are also potentially possible. [8][9][10] Thus, obtaining the correct diagnosis for ulnar-sided wrist pain, specifically DUTL disruption, is of utmost importance for patients, since this easily overlooked injury may affect the treatment and outcome.…”

Section: Discussionmentioning

confidence: 99%

“Hockey wrist”: dorsal ulnotriquetral ligament injury

Sandman

Boily

Martineau

2018

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Background: Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum. Methods:We performed a biomechanical study on 7 fresh frozen cadaveric upper extremities, with testing done on a wrist-movement stimulator to identify the position (45° of wrist flexion, 45° of wrist extension or neutral) that generated the highest and earliest strain increases in the DUTL. We performed load-to-failure testing, characterized the ligament's pattern of failure, and repaired and retested the DUTL using the same load-to-failure protocol.Results: The DUTL reached 3 N•m the earliest in 45° of wrist flexion (p = 0.02). The native DUTL failed at 0.35 N•m (standard deviation [SD] 0.13 N•m) per degree of angular stiffness, 12.93 N•m of yield strength and with angular deformation of 57.73° (SD 20.62°). There was no significant difference in these variables between the native and repaired DUTL. Tearing occurred at a mean of 10 mm (SD 2 mm) proximal from the triquetrum's insertion in a transverse midsubstance pattern. Conclusion:This study showed a reproducible pattern of injury to the DUTL in a cadaveric model. Additional work is needed to further characterize the pathoanatomy of "hockey wrist." Contexte : La douleur cubitale au poignet, au niveau du triquetrum proximal dorsal, surtout à la pronation, à la flexion et à la déviation radiale du poignet, est fréquente chez les athlètes, particulièrement chez les joueurs de hockey. Le but de cette étude était d'évaluer la position dans laquelle le ligament ulnotriquétral dorsal (LUTD) est soumis à la pression la plus grande, le couple de torsion menant à la défaillance et le mode de blessure. Selon notre hypothèse, le LUTD est soumis au maximum de pression lorsque le poignet est en flexion, pronation et déviation radiale, et au moment de la défaillance, le ligament ulnotriquétral se déchire.

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Section: Discussionmentioning

confidence: 99%

“Hockey wrist”: dorsal ulnotriquetral ligament injury

Sandman

Boily

Martineau

2018

cjs

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“…Ice hockey, a contact sport in which players skate and shoot a rubber puck at high speeds, has one of the highest injury rates in competitive sports 1,2 . Wrist injuries account for 2% to 11% of all injuries related to ice hockey 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, ulnar-sided wrist pain is a common cause of upper-extremity disability in athletes. The most common diagnoses for ulnar-sided wrist pain are injuries to the extensor carpi ulnaris (ECU) and triangular fibrocartilage complex (TFCC), and instability in the distal radioulnar joint (DRUJ) 2,3 . Injury to the complex structures in the ulnar wrist, namely, the ECU tendon and the triangular TFCC, can result in ulnar-sided wrist pain.…”

Section: Introductionmentioning

confidence: 99%

“…even heard2,8 . Some researchers consider that there is a predisposition to this condition, namely, flattening of the distal ulnar sulcus and impaired mechanical properties of the subsheath, which leads to dislocation/subluxation after injury2,8 . However, when the injuries are be-Tamura's classification, obliterating the false pouch and reconstruction with the extensor retinaculum by using trans-osseous suture anchors stabilized the ECU 2 .…”

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confidence: 99%

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Recurrent Dislocation of the Extensor Carpi Ulnaris Tendon with Ulnar-Sided Triangular Fibrocartilage Complex Injury in an Ice Hockey Player: A Case Report

2020

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Ulnar-sided wrist pain is common among athletes who subject their wrists to forceful rotational movements. Injury to the numerous complex structures in the ulnar wrist, including the extensor carpi ulnaris (ECU) tendon and triangular fibrocartilage complex (TFCC), can result in ulnar-sided wrist pain. Although differentiating between ECU tendinitis and TFCC injury is necessary, ECU tendon disorders and TFCC injury occasionally occur concurrently. Subluxation or dislocation of the ECU tendon is rare but may cause symptoms in athletes subjecting their wrists to forceful rotational movements. We present a case of recurrent dislocation of the ECU tendon and ulnar-sided TFCC injury in a 21-year-old male university-league ice hockey player. He initially underwent ECU stabilization; however, his ulnar wrist pain persisted, which adversely affected his athletic performance. He underwent additional surgery to repair the TFCC, which led to definitive resolution of his symptoms and resulted in his return to competitive performance 3 months postoperatively. Treatment of symptomatic dislocation of the ECU remains controversial. In our patient, recurrent dislocation of the ECU tendon with concurrent ulnarsided TFCC injury resulted in ulnar-sided wrist pain. Combined reconstruction of the tendon's subsheath, using the extensor retinaculum, and repair of the TFCC injury was required for full recovery of his athletic performance.

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“…Population averages of ulnar variance vary around neutral and increase with grip [2–4]. Ulnar variance can be used to determine injury prognosis of distal forearm fractures [5] and in diagnosis of conditions like ulnar impaction syndrome and triangular fibrocartilage complex (TFCC) degeneration [6]. In young gymnasts with possible stress injury of the distal radius, ulnar variance is suggested to be on average more positive [7].…”

Section: Introductionmentioning

confidence: 99%

Well-founded practice or personal preference: a comparison of established techniques for measuring ulnar variance in healthy children and adolescents

et al. 2019

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ObjectivesUlnar variance is a clinical measure used to determine the relative difference in length between the radius and ulna. We aimed to examine consistency in ulnar variance measurements and normative data in children and adolescents using the perpendicular and the Hafner methods.MethodsTwo raters measured ulnar variance on hand radiographs of 350 healthy children. Participants’ mean calendar and skeletal ages were 12.3 ± 3.6 and 12.0 ± 3.7 years, 52% were female. Raters used the perpendicular method, an adapted version of the perpendicular method (in which the distal radial articular surface is defined as a sclerotic rim) and the Hafner method, being the distance between the most proximal points of the ulnar and radial metaphyses (PRPR) and the distance between the most distal points of both (DIDI). Intraclass correlation coefficients (ICCs) for intermethod consistency and inter- and intrarater agreement were calculated using a two-way ANOVA model. Variability and limits of agreement were determined using the Bland-Altman method.ResultsThe interrater ICC was 0.75 (95% CI, 0.61–0.84) for the adapted perpendicular method, 0.88 (95% CI, 0.80–0.93) for PRPR, and 0.94 (95% CI, 0.90–0.97) for DIDI. The intermethod consistency ICC was 0.60 (95% CI, 0.48–0.70) for perpendicular versus PRPR and 0.60 (95% CI, 0.49–0.70) for perpendicular versus DIDI. The intrarater ICC was 0.88 (95% CI, 0.70–0.95) for perpendicular, 0.90 (95% CI, 0.83–0.94) for PRPR, and 0.81 (95% CI, 0.69–0.89) for DIDI. The perpendicular method was not useable in 38 cases (skeletal age ≤ 9 years) and the Hafner method in 79 cases (skeletal age ≥ 12 years).ConclusionsThe perpendicular and Hafner methods show moderate intermethod consistency. The Hafner method is preferred for children with skeletal ages < 14 years, with good to excellent inter- and intrarater agreement. The adapted perpendicular method is recommended for patients with skeletal ages ≥ 14 years.Key Points• The perpendicular method for measuring ulnar variance requires extended instructions to ensure good interrater agreement in pediatric and adolescent patients. • The Hafner method is recommended for ulnar variance measurement in children with unfused growth plates and up to a skeletal age of 13 years, and the perpendicular method is recommended for children with fused growth plates and from skeletal age 14 and older. • The mean ulnar variance measured in this study for each skeletal age group (range, 5–18 years) is provided, to serve as a reference for future ulnar variance measurements using both methods in clinical practice. Electronic supplementary materialThe online version of this article (10.1007/s00330-019-06354-x) contains supplementary material, which is available to authorized users.

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Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

Cited by 42 publications

References 80 publications

“Hockey wrist”: dorsal ulnotriquetral ligament injury

“Hockey wrist”: dorsal ulnotriquetral ligament injury

Recurrent Dislocation of the Extensor Carpi Ulnaris Tendon with Ulnar-Sided Triangular Fibrocartilage Complex Injury in an Ice Hockey Player: A Case Report

Well-founded practice or personal preference: a comparison of established techniques for measuring ulnar variance in healthy children and adolescents

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