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Ulnocarpal Impingement Syndrome

- Discussion:
    - impingement of distal ulna on carpi which may arise from positive ulnar variance or non union of distal ulnar frx;
    - positive ulnar varience leads to loading of the ulnocarpal joint and resultant LT disruption, lunate chondral lesion, and TFCC tears;
    - diff dx: (ulnar sided wrist pain) distral radio-ulnar DJD, pisotriquetral DJD, or ECU tendonitis;

- Exam Findings:
    - positive ulnar stress test;
    - tenderness with direct palpation of the ulnar carpal joint;

- Radiographs:
    - radiographic findings may be subtle;
    - may show flattening, subchondral sclerosis, and/or lytic changes in lunate and/or triquetrum with similar changes seen over the distal ulna;
    - patients may have increased ulnar variance;
    - in subtle cases, a pronation grip radiograph may demonstrate ulnar variance;
    - bone scan may be positive;

- Treatment:
    - Waffer Procedure;
           - in the report by Constanine KJ, et al (2000), the authors compared ulnar shortening osteotomy vs the wafer procedure;
                  - 22 patients were followed over a 6 year period (11 patients in each group);
                  - 9 patients w/ ulnar shortening osteotomy had a good to excellent result vs 8 patients w/ good to excellent results in the wafer procedure group;
                  - 5 out of 11 patients required a secondary operative procedure (for either painful hardware or for non union);
    - ulnar shortening osteotomy
    - hemiresection arthroplasty
           - along w/ distal ulnar osteotomy or hemiresection arthroplasty, injury to the TFCC should be addressed w/ repair or debridement
           - Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome.

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