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Old 04-13-2011, 04:22 PM
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mtomaino mtomaino is offline
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Default If you have Ulnar Impaction Syndrome, wrist arthroscopy may be a helpful option

I was stimulated to add this "post" after seeing a patient today who has ulnar wrist pain due to "Ulnar Impaction." He was told that he may benefit from a shortening osteotomy of the ulna---a procedure which involves removing a sliver of bone in order to decrease its length at its distal end. This can shift load away from a torn TFCC ligament and decrease pain---often caused in part due to swelling in the lunate bone ( see xray with red circle delineating the cyst.)

For years I have felt that an ulnar shortening osteotomy is, perhaps, overkill for this problem; thus, I have written about, and clinically assessed the feasibility and efficacy of a less invasive surgery---Arthroscopic TFCC debridement + wafer procedure.

Click on this link for a narrated video: http://www.rearmyourself.com/video/?...0Resection.flv

Why not have an Ulnar shortening osteotomy at the outset?

First--surgery may not be necessary. I have frequently witnessed superb long-term pain relief from 1-2 ulnocarpal cortisone shots. Remember--never just treat the x-ray! What our intervention seeks to provide, fundamentally, is pain relief and improved function. Sometimes "less is more"!

Second, unless you have a prominent ulnar styloid, and concomitant "stylocarpal" impaction--or more than 4-6mm of postive ulnar variance, wrist arthroscopy is an option with fewer potential complications, like nonunion and painful hardware---without burning any bridges. Indeed, as the x-ray attached shows, fixation after osteotomy requires a lengthy plate, which can potentially irritate the soft tissue.

Lastly, if the articular surfaces of the ulnar head and sigmoid notch are not parallel, shortening the ulna can potentially increase joint pain at the distal radioulnar joint (see red and yellow lines on the attached x-ray).

That having been said, if osteotomy is required, newer devices do provide fixation which minimize risk of nonunion and soft tissue discomfort; so if this procedure is needed, it can provide successful resolution of ulnar wrist pain.
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