Ulnar-sided wrist pain. Part I: anatomy and physical examination

Vezeridis, Peter S.; Yoshioka, Hiroshi; Han, Roger; Blazar, Philip E.

doi:10.1007/s00256-009-0775-x

Cited by 72 publications

(56 citation statements)

References 54 publications

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“…A reversed palmaris longus muscle is evident on the volar side compared to the vascular-nervous structures. of the hamate [5]. The ulnar nerve supplies sensory and motor branches to the hand, and very rarely it travels inside the carpal tunnel.…”

Section: Anatomic Variantsmentioning

confidence: 99%

Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique

Presazzi

Bortolotto

Zacchino

et al. 2011

Journal of Ultrasound

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KEYWORDSCarpal tunnel; Ultrasound; Flexor tendons; Median nerve.Abstract The carpal tunnel is an osteofibrous canal situated in the volar wrist. The boundaries are the carpal bones and the flexor retinaculum. In addition to the medial nerve, the carpal tunnel contains nine tendons: the flexor pollicis longus, the four flexor digitorum superficialis and the four flexor digitorum profundus. Ultrasound (US) study of the carpal tunnel generally involves short-axis imaging of the tendons, and in the presence of disease, long-axis imaging and dynamic maneuvers are added. There are numerous reports of anatomical variants of the wrist involving vessels, nerves, tendons and muscles, and they can all be studied by US. Some are particularly relevant from a clinical point of view and will therefore be accurately described. The anatomy is complex, and the US operator should therefore be thoroughly familiar with the normal anatomy as well as the anatomical variants that may have a role in the pathogenesis of carpal tunnel syndrome or influence treatment.Sommario Il tunnel carpale è un canale osteo-fibroso localizzato nella regione volare del polso, delimitato profondamente, medialmente e lateralmente dalle ossa del carpo e superficialmente dal retinacolo dei flessori. Al suo interno decorrono nove tendini: il flessore lungo del pollice, i quattro flessori superficiali delle dita, i quattro flessori profondi delle dita ed un nervo, il mediano. Lo studio ecografico del tunnel carpale avviene generalmente per asse corto rispetto ai tendini ed è completato, almeno in presenza di patologia, da scansioni per asse lungo e manovre dinamiche. A livello del polso esistono poi numerose varianti anatomiche coinvolgenti vasi, nervi, tendini e muscoli, tutte ben valutabili ecograficamente. Alcune hanno una maggior rilevanza clinica e sono pertanto oggetto di una descrizione più accurata. L'anatomia normale è complessa, ma la sua conoscenza è essenziale per lo studio della patologia, come è essenziale la conoscenza delle varianti anatomiche che possono avere un ruolo nella patogenesi della sindrome del tunnel carpale o condizionarne le terapie. ª

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Section: Anatomic Variantsmentioning

confidence: 99%

Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique

Presazzi

Bortolotto

Zacchino

et al. 2011

Journal of Ultrasound

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“…[16][17][18] Our clinical examination of the ulnar wrist is not always sensitive enough to distinguish between many of these diagnoses. 17 It is also reasonable that DRUJ pathology is often accompanied by problems in ulnar length and impaction because the pathology affects all aspects of the ulnar wrist.…”

Section: Discussionmentioning

confidence: 99%

Ulnar sided wrist pain and distal radioulnar joint osteoarthritis; is surgical arthroplasty enough?

et al. 2012

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Distal radioulnar joint (DRUJ) arthritis is a common cause of ulnar wrist pain in rheumatoid and osteoarthritis. Modified arthroplasty for the DRUJ is a minimally invasive procedure for the treatment of isolated DRUJ osteoarthritis. The purpose of this study was to evaluate the efficacy of the procedure and the incidence of related ulnar wrist pathology as well as the incidence of subsequent ulnar wrist surgeries. All patients having modified arthroplasty for the DRUJ between 1994-2008 were retrospectively reviewed. Measurements included range of motion, grip strength, and subjective status. Data regarding other wrist surgeries was recorded. There were 29 patients, 23 of which had a follow-up of over 8 weeks (average 16 months, SD=24). Fourteen patients had no to minimal pain, 6 had pain with heavier activities (2 severe), and 2 reported constant pain at the surgical site. Of the 4 more painful patients, three had additional surgery after the DRUJ arthroplasty. In all 96% of the patients had another procedure involving the ulnar-wrist complex either prior to surgery, at the time of surgery or following surgery for modified arthroplasty. We suggest that pathology involving the ulnar-wrist complex is often a syndrome consisting of multiple related diagnoses including but not limited to arthritis of the DRUJ. Multiple procedures may be needed, or a more aggressive approach such as ulnar head replacement may be indicated so that pathology at both the distal radioulnar and ulnocarpal joints is addressed concomitantly.

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“…DRUJ instability can result in audible clicking and pain during rotation of the forearm (6). Usually patients have dorsal subluxation of the ulnar head on extreme hyperpronation due to disruption of the dorsal radioulnar ligament of the TFCC and dorsal DRUJ capsule (4).…”

Section: Clinical Relevancementioning

confidence: 99%

“…The thickness of the triangular fibrocartilage disc depends on the degree of ulnar variance (6). In the ulnar negative wrist, triangular fibrocartilage disc appears thick and short and lies horizontal.…”

Section: Normal Appearances Of Tfccmentioning

confidence: 99%

MR imaging of the traumatic triangular fibrocartilaginous complex tear

Ng¹,

Griffith²,

Fung³

et al. 2017

Quant. Imaging Med. Surg.

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Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ).However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed.

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Ulnar-sided wrist pain. Part I: anatomy and physical examination

Cited by 72 publications

References 54 publications

Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique

Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique

Ulnar sided wrist pain and distal radioulnar joint osteoarthritis; is surgical arthroplasty enough?

MR imaging of the traumatic triangular fibrocartilaginous complex tear

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