Search Results (4)

Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after surgery. Post-operative MR imaging can reveal potential pathologies but it needs to be assessed whether depicted changes are normal or whether these findings have a clinical significance. Therefore, the purpose of this study was to evaluate postoperative MR imaging and the function of the patients’ wrists in order to assess which postoperative changes are correlated with pain. Patients and Methods: All patients with a TFCC lesion who were treated arthroscopically at our hospital between January 2012 and December 2016 were retrospectively enrolled. Seventeen patients with complete data sets were enrolled. Post-operative MRI examinations needed to be performed within 24 months after arthroscopy. The mean magnet resonance imaging (MRI) follow-up was 22 months. The average clinical follow-up was 27.3 months. Age, gender, pain level, PROM scores (Munich Wrist Questionnaire, MWQ), follow-up interval, and TFCC classification (Palmer) were documented. The patients underwent a clinical examination and MR imaging. Results: Ten patients (59%) had scar tissue at the triangular fibrocartilaginous complex (TFCC) and nine (53%) had an effusion in the ulnar recess. These findings were not necessarily associated with pain, as six patients without pain and four with pain had scar tissue at the TFCC and six patients without pain and three with pain showed an effusion in the ulnar recessus. Bone marrow edema could be found in the lunate of five patients (29%) (three with pain, two without pain) and in the distal radial ulnar joint (DRUJ) of one patient (6%) with pain. However, typical degenerative changes were not necessarily associated with pain. Conclusions: This present study is the first study correlating postoperative MRI findings after arthroscopic assisted TFCC surgery with both pain and function. Bone edema seems to be associated with pain, whereas scarring at the TFCC is visible on MRI but is not necessarily associated with pain. Full article

Background: Hamate-lunate impingement or osteoarthritis can be a cause of ulnar-sided wrist pain. In the literature, the lunate has commonly been classified according to the configuration of its distal articular surface into type 1 and type 2, as described by Viegas. A type 1 lunate possesses only a distal articular surface for the capitate, while a type 2 lunate shows an additional medial facet articulating directly with the hamate. Type 2 lunates have been identified as a risk factor for ulnar-sided wrist pain and the development of osteoarthritis in the midcarpal wrist. However, this does not sufficiently explain all arthritic changes between the hamate and lunate. Methods: In this prospective anatomical-radiological cadaver study, 60 wrists were examined. The midcarpal articulation was documented using conventional X-ray, CT arthrography, and anatomical dissection. The study specifically analyzed the positioning of the lunate relative to the hamate apex and its association with the development of hamate-lunate osteoarthritis. For this purpose, the classification by Viegas was refined. Based on posterior-anterior (p.a.) X-ray examinations of the wrist lunates were divided into type 1a, type 1b, and type 2. The type 1a lunate articulates only with the capitate in the midcarpal joint. The type 1b lunate also articulates only with the capitate; however, medially, the apex of the hamate protrudes beyond a Differentiation Line (D-line), which extends from the radial border of the trapezium or the ulnar border of the lunotriquetral (LT) space, without forming a facet with the lunate. A type 2 lunate articulates distally with the capitate and has an additional medial facet with the hamate. Results: Osteoarthritis between the hamate and lunate was observed in both Viegas type 1 and type 2 lunates. According to our refined lunate classification, both in situ and radiologically, type 1b and type 2 lunates showed a substantially higher prevalence and severity of hamate-lunate osteoarthritis compared to type 1a lunates. However, there was no significant difference in the prevalence of hamate-lunate osteoarthritis between type 1b and type 2 lunates. Conclusions: Assessing lunate type and signs of osteoarthritis is essential when evaluating patients with ulnar-sided wrist pain. Our study demonstrates that osteoarthritis in Viegas type 1 lunate is influenced by the position of the hamate apex relative to the D-line. The refined lunate classification, based on correlated radiological and anatomical studies of the wrist, provides a straightforward method for identifying a potential cause of ulnar-sided wrist pain on p.a. X-rays. This classification can help guide further diagnostic and therapeutic decisions, such as wrist arthroscopy with possible resection of the hamate apex. Full article

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education. Full article

There has been an increase in ulnar-sided wrist pain among tennis players. The purpose of this study was to establish a normative dataset of kinematic and electromyography (EMG) data during the forehand and two-handed backhand groundstrokes. In total, 20 adolescent United States Tennis Association (USTA) ranked tennis players (11/20 Male, Age = 15.0 ± 1.8 years, Height = 1.7 ± 1.1 m, BMI = 21.3 ± 3.4 kg/m², 18/20 right-arm dominant) participated in this study. Kinematics (range of motion and angular velocity) and EMG data were simultaneously acquired during the forehand and two-handed backhand groundstrokes. Minimal differences were found between groupings of age, sex, and USTA ranking. The two-handed backhand groundstroke is characterized by bilaterally flexed elbows and ulnarly deviated wrists, with a flexed wrist and pronated forearm on the non-dominant side and an extended wrist and supinated forearm on the dominant side. EMG activation occurs bilaterally by peak backswing. The forehand groundstroke is characterized by a flexed elbow, pronated forearm, and ulnarly deviated and extended wrist. The wrist is at maximum ulnar deviation at ball impact. This study established an initial foundation for normative data for the forehand and two-handed backhand groundstrokes, which can be used for injury detection, rehabilitation, prevention, and ultimately performance improvement of tennis athletes. Full article