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OnFindingstheradiographs
( performed in a pronated position for the frontal view), there is neutral to minimal positive ulnar variance and questionably, very subtle lucency at the ulnar border of the lunate. These findings would be extremely difficult to pick up in a prospective fashion. The MRI demonstrates degeneration and tearing of the articular disc of the TFCC and a defect of the central portion of the articular disc. Edema and subchondral cystic change are present along the ulnar border of the proximal lunate.
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Although there are many cause of ulnar sided wrist pain, this is one of the most common. Positive ulnar variance precipitates abnormal loading along the ulnar aspect of the wrist leading to degeneration and tearing of the TFCC (triangulofibrocartilage complex) and secondary degenerative changes of the carpal bones. The degenerative findings are most commonly found of the lunate but may also be seen of the triquetrum. As in this case, the radiographs may not be as demonstrable as one may hope. The positive ulnar variance can be intermittent, related to positioning such as extreme pronation and when a grip is performed. As such, the non-stressed radiographs may be somewhat underwhelming. The MRI findings are as shown in this case, degenerative tearing and defect of the TFCC and degenerative changes of the carpal Asbones.istypical, more conservative measures were attempted to mitigate the patient’s symptoms. These included wearing a brace, oral anti-inflammatory medication, and then a corticosteroid injection. As the patient’s symptoms did not abate, surgical intervention was ultimately necessary. There are many surgical procedures that can be utilized to help address this pathology including osteotomy, arthroscopic debridement, resection, and fusion. The extent of the surgical procedures goes beyond the scope of this case presentation.
Diagnosis: Ulnolunate Abutment/Impaction Syndrome
Diagnosis Case
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Epub 2020 Jan 30. Advanced Imaging of Ulnar Wrist Pain. R Timothy Kreulen, Suresh K Nayar, Yasmin Alfaki, Dawn LaPorte, Shadpour Demehri. Hand Clin. 2021 Nov;37(4):477-486. doi: 10.1016/j.hcl.2021.06.012.
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UlnarReferencesAbutment
Syndrome in the Athlete. Thomas R Acott, Jeffrey A Greenberg. Orthop Clin North Am. 2020 Apr;51(2):227-233. doi: 10.1016/j.ocl.2019.11.007.