Ulnar Impaction Syndrome

Synonyms

  • Ulnar abutment
  • Ulnocarpal loading
  • Impingement syndrome

Ulnar Impaction Syndrome is a degenerative wrist condition caused by the ulnar head impacting upon the ulnar-sided carpus and triangular fibrocartilcage complex resulting in degeneration of these structures.

Causes

The syndrome occurs in people with positive ulnar variance which may occur because of

  • Distal radius fracturs with radial shortening
  • Radial head excision
  • Essex Lopresti fracture
  •  Galeazzi fracture
  • Ecessive repeated loading of the ulnar-carpus in daily activities
  • Madelung deformity

Clinical presentation

  • Ulnar impaction syndrome mostly affects the  commonly presents in middle-aged patients.
  • Patients present with chronic or sub-acute ulnar-sided wrist pain
  • Pain is  exacerbated by activity
  • Swelling and limitation of forearm and wrist movement.
  • Firm grip, pronation and ulnar deviation of the wrist, can exacerbate the symptoms. {These movements cause increase in ulnar variance}

Imaging

Xrays are  normal in early disease. A positive ulnar variance may be noted. Degnerative changes in ulnar side of the carpal bones may be noted when the condition advances.

MRI shows signal changes in  ulnar side of proximal part of lunate , radial side of proximal part of triquetrum. the changes noted may be

  • Subchondral sclerosis
  • Bone oedema
  • Subchondral cyst
  • Chondromalacia of distal ulnar cartilage
  • Increase in central TFCC signal
  • Lunotriquetral ligament tear

Treatment

Treatment varies depending on the amount of ulnar variance, and the severity of pathological changes, the contour of the distal ulnar and the presence of lunotriquetral instability.

Mild cases may be treated with analgesics and local therapy including heat and analgesic gel

Surgical treatement options include

Open Wafer Procedure

  • Surgical resection of the distal 2–3 mm of the dome of the ulnar head

Ulnar Shortening

Excision of a 2-3mm slice of the ulnar shaft followed by ?xation

Arthroscopic Wafer Procedure

Minimally invasive and allows rapid return to normal activities.

Darrach Procedure

Complete or partial ulnar head resection. Done in advanced lesions

Sauve´ – Kapandji procedure

Arthrodesis of the distal radioulnar joint with distal ulnar pseudoarthrosis

Radial Osteotomy

When ulnocarpal impaction occurs following fractures of radius, the procedure can restore normal joint anatomy

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