Arch Hand Microsurg.  2022 Jun;27(2):105-118. 10.12790/ahm.21.0149.

Ulnar impaction syndrome: how to diagnose and treat?

• Seok HS
• Park JW
• Kang JW

• KMID: 2531916
• DOI: http://doi.org/10.12790/ahm.21.0149

Abstract

Ulnar impaction syndrome (UIS), also called ulnocarpal abutment syndrome, is a degenerative condition induced by repeated loads on the ulnocarpal joint and is a representative cause of ulnar-sided wrist pain. Because of the small, complex, and overlapping anatomy of the ulnar wrist, ulnar wrist pathologies often present very similar symptoms to those of UIS, which causes confusion in diagnosing UIS. Thus, careful history-taking, clinical examinations, and diagnostic imaging are essential for the diagnosis of UIS. As appropriate and effective treatment for UIS, early surgical treatment should be considered if patients cannot reduce their wrist usage in daily living and work and have distal radioulnar instability. There are various surgical techniques for UIS. Surgeons should be deliberate in choosing a technique and pay attention to accompanying disorders around the ulnar wrist to achieve satisfactory treatment outcomes.

Keyword

Wrist; Ulnar impaction syndrome; Ulnar shortening osteotomy; Triangular fibrocartilage complex

Figure

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  Fig. 1. Anatomy of ulnar wrist. Numerous and small anatomical structures overlap each other. Reprinted from Shin et al. [5] with the permission of Wolters Kluwer.

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  Fig. 2. Representative physical examination for the diagnosis of ulnar impaction syndrome. (A) Ulnar foveal sign. (B) Ulnocarpal stress test. (C) Distal radioulnar joint ballottement test. (D) Piano key sign.

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  Fig. 3. Diagnostic images of ulnar impaction syndrome (UIS), showing a cyst, a bruise in the ulnar carpal bone, and triangular fibrocartilage complex wear, which indicate UIS. (A) Simple radiography. (B) T1-weighted coronal magnetic resonance imaging (MRI). (C) T2-weighted MRI.

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  Fig. 4. Difference of the ulnocarpal distance (UCD) in the same patient. Measuring the UCD on 3-dimentional computed tomography (3D CT) can present the most accurate value. (A) Posteroanterior simple radiography. (B) Lateral simple radiography. (C) 3D CT image.

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  Fig. 5. Diagnostic images of ulnar styloid process impaction syndrome. (A) Simple radiograph shows a very large, elongated ulnar styloid process. (B) Magnetic resonance imaging shows the presence of a cyst in the triquetrum. (C) Nuclear scintigraphy (bone scan) reveals hot uptake in the ulnar styloid process and its corresponding triquetrum.

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  Fig. 6. Representative surgical techniques for ulnar shortening. (A) Distal diaphyseal ulnar shortening osteotomy (USO). (B) Distal metaphyseal USO. (C) Wafer resection.

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  Fig. 7. After proximal shortening osteotomy to distal oblique band, the tightened distal oblique band can enhance distal radioulnar joint stability. Reprinted from Cha and Shin [30] according to the Creative Commons license.

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  Fig. 8. Tolat et al.'s [48] three basic distal radioulnar joint configurations on the midcoronal plane. (A) Type 1, parallel type: the apposing joint surfaces are parallel to the longitudinal axis of the ulna. (B) Type 2, oblique type: the apposing joint surfaces are oblique (the sigmoid notch angle being positive). (C) Type 3, reverse oblique type: the apposing joint surfaces are in reverse oblique (the sigmoid notch angle being negative).

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  Fig. 9. Types of the distal radioulnar joint in the axial plane. (A) Linear type. (B) Curved type [51].

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  Fig. 10. Two components of a complex triangular fibrocartilage complex tear in ulnar impaction syndrome. They can induce mechanical irritation and pain in the ulnocarpal joint and need arthroscopic management for satisfactory results. (A) Horizontal tear. (B) Radial tear.

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