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At least 289 records · Page 16Linked to original sources

PubMed2005

Arthroscopic dorsal radiocarpal ligament repair.

PURPOSE: The goal of this study was to determine if arthroscopic repair of a dorsal radiocarpal ligament (DRCL) tear is effective in ameliorating wrist pain. TYPE OF STUDY: Retrospective study. METHODS: A chart review was performed of 53 patients (56 wrists) who underwent wrist arthroscopy with use of a volar radial portal. There were 21 patients with DRCL tears. Mean follow-up was 16 months. Thirteen patients underwent arthroscopic DRCL repair and/or thermal shrinkage (5 repairs, 6 repair plus shrinkage, and 2 shrinkage). Lunotriquetral tears were treated with debridement and pinning. Triangular fibrocartilage (TFC) tears were debrided or repaired. Scapholunate ligament tears/instability were treated with capsulodesis. RESULTS: The 4 patients who underwent repair of an isolated DRCL tear had excellent results with no or mild pain. All returned to their previous occupation. Dorsal capsulodesis was performed in 7 patients with 4 fair/poor results. Nine DRCL repairs/shrinkage were in association with other procedures for ulnar-sided pathology with 6 fair/poor results. CONCLUSIONS: Tears of the DRCL are more common than previously suspected. They are best seen through a volar radial portal and are amenable to arthroscopic repair. DRCL tears appear to be part of a spectrum of radial and ulnar-sided carpal instability as evidenced by the frequent association with scapholunate ligament tears/instability or ulnar-sided pathology. Isolated DRCL tears can be solely responsible for wrist pain. Good results are obtained with arthroscopic repair of isolated DRCL tears. The presence of a DRCL tear when seen in combination with a scapholunate, lunotriquetral, or TFC tear connotes a greater degree and/or duration of carpal instability, and portends a poorer prognosis following treatment. Recognition of this condition and further research into treatment methods is needed. LEVEL OF EVIDENCE: Level IV.

Adult↗

PubMed2006

Arthroscopic excision of ulnar styloid in stylocarpal impaction.

Stylocarpal impaction is an uncommon cause of ulnar-sided wrist pain in which the long ulnar styloid affects the triquetrum. Previous authors have described an open excision of the ulnar styloid. We present a new technique for arthroscopic identification and subsequent excision of the ulnar styloid. The diagnosis was suspected on plain radiographs and was confirmed by dynamic fluoroscopy. Four patients with ulnar styloid impaction were successfully managed. A diagnostic arthroscopy was performed. With the arthroscope in the 4-5 portal, a 3.5-mm burr was introduced into the 6 U portal. By palpation, the burr was placed onto the tip of the ulnar styloid and confirmed with fluoroscopy. Sufficient ulnar styloid was removed to prevent impingement; this was confirmed on fluoroscopy. We undertook resection of the ulnar styloid to 3 mm (normal, 3 to 6 mm). Adjacent soft tissue structures were not violated. Arthroscopic ulnar styloid identification and excision is a relatively simple procedure. Disruption of the triangular fibrocartilage, dorsal ulnar capsular ligament, and volar ulnar carpal ligament is avoided. Fluoroscopy is valuable in providing preoperative and intraoperative identification of the ulnar styloid and impingement. Postoperatively, patients can recommence activities of daily living as comfort allows.

Arthroscopy↗

PubMed2006

Sports-related injuries of the wrist: an approach to MRI interpretation.

Sports-related injuries to the wrist range from minor sprains to severe soft tissue disruption that can pose a risk to the normal function of the upper extremity. It is important to identify the specific nature of such injuries so as to establish an accurate diagnosis and deliver appropriate treatment. MRI of the wrist has greatly benefited from the use of dedicated surface coils, which allow fine depiction of soft tissue and cartilaginous structures. A review of the normal anatomy, MR interpretation pitfalls, and most common abnormalities of the tendons, ligaments, triangular fibrocartilage complex, and nerves of the wrist are presented.

Athletic Injuries↗

PubMed2006

Imaging of ulnar-sided wrist pain.

Ulnar-sided wrist pain has long been a diagnostic problem, partly because of the complex anatomy and many possible causes of pain in this region. This article discusses anatomy, pathophysiology, and imaging appearance of the more common causes, including tears of the triangular fibrocartilage complex, disorders of the distal radioulnar joint, tears of the lunotriquetral ligament, disorders of the extensor carpi ulnaris tendon, disorders of the pisotriquetral joint, the impingement and impaction syndromes, and ulnar wrist masses. Along with clinical history and physical examination, imaging is important in evaluation of ulnar-sided wrist pain. Conventional radiographs, conventional arthrography, CT, MRI, and MR arthrography are useful modalities that are often used in concert to help guide diagnosis and treatment.

Arthralgia↗

PubMed2005

Variants, pitfalls and asymptomatic findings in wrist and hand imaging.

Anatomic variants of the bones, ligaments, tendons and muscles are frequent findings in imaging of the wrist and hand. Many findings especially changes in the triangular fibrocartilage (TFC) and the interosseous ligaments are asymptomatic, their incidence is increasing with age, and they are frequently found bilaterally. Abnormalities such as increased signal within tendons are common in asymptomatic subjects. They may be explained by normal physiology, anatomical variability, MR artifacts or true abnormalities without clinical importance. Although it is not always possible to differentiate variants and artifacts from clinically relevant findings it is important to know their potential etiology and clinical importance and not to over report them as abnormality requiring additional imaging or treatment.

Artifacts↗

PubMed2006

An overview of MR arthrography with emphasis on the current technique and applicational hints and tips.

Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however, direct MR arthrography using diluted gadolinium as the contrast agent is the most commonly used technique and is the most reliable of all. MR arthrography is useful for demonstrating labrocapsular-ligamentous abnormalities and distinguishing partial thickness rotator cuff tears from focal full thickness tears in the shoulder, identifying or excluding recurrent tears following meniscal operations in the knee, demonstrating perforations of the triangular fibrocartilage complex (TFCC) and ligaments in the wrist, showing labral tears in the hip, diagnosing ligament tears in the ankle and identifying osteochondral lesions or loose bodies in any of the aforementioned joints. In this article, an overview of techniques of MR arthrography is provided with emphasis on direct MR arthrography using diluted gadolinium as the contrast agent. The current applications of the technique in major peripheral joints are reviewed, with emphasis given to the shoulder joint where the role of this technique has become well established.

Arthrography↗

PubMed2004

Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study.

PURPOSE: Distal radioulnar joint (DRUJ) stability is dependent on osseous anatomy, soft-tissue stabilizers, and muscle activity. The relative importance of DRUJ soft-tissue stabilizers remains controversial and has not been examined in the more physiologic setting of simulated muscle loading in the intact specimen. The purpose of this study was to examine the role of static stabilizers on the kinematics of the DRUJ during active simulated motion. METHODS: Twelve cadaveric upper extremities underwent computer-controlled, simulated, active forearm rotation. Joint kinematics were measured in the intact specimen and after sequential sectioning of soft-tissue stabilizers including the dorsal and palmar radioulnar ligaments (RULs) and the triangular fibrocartilage (TFC), dorsal and palmar capsule, ulnocarpal ligaments (UCL), extensor carpi ulnaris (ECU) subsheath, pronator quadratus (PQ), and the interosseous membrane (IOM). RESULTS: After sectioning of soft tissues significant changes in the DRUJ kinematics were observed. With a distal to proximal sectioning sequence significant alterations in kinematics were not identified until sectioning of the IOM; with a proximal to distal sectioning sequence intact DRUJ kinematics were maintained until the final soft-tissue (RULs and TFC) sectioning. CONCLUSIONS: Sectioning of all soft-tissue stabilizers produced significant DRUJ instability and abnormal joint kinematics. The RULs and TFC play a key role in DRUJ kinematics because they can help to maintain normal joint rotation in the absence of all other soft-tissue stabilizers. With the preservation of other soft-tissue stabilizers, however, the RULs and TFC are not essential for the maintenance of normal kinematics of the DRUJ.

Adult↗

PubMed2005

Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study.

PURPOSE: Ulnar impaction syndrome is commonly the result of a naturally occurring ulnar-positive condition, distal radius fracture malunion, or collapse of a fractured radial head. The Feldon wafer procedure and the Bowers distal hemiresection procedure are designed to decrease force transmitted through the distal ulna. The purpose of this study was to measure the effects of these procedures on distal ulnar loading with varying degrees of ulnar positivity at the wrist. METHODS: Using a specially designed miniature load cell distal ulnar force was measured in 20 fresh-frozen cadaveric forearms as the wrist was loaded axially to 134 N in neutral forearm rotation; tests were performed in valgus alignment with the elbow flexed to 90 degrees . Ulnar positivity (0 mm, +2 mm, +4 mm, and +6 mm) was created by incremental shortening of the distal radius using a sliding plate. The radial neck was sectioned transversely and the radial head fragment was fixed in its anatomic position using cemented metal prongs connected to a rigid bar; this allowed the radial head to be disconnected and tilted out of the loading pathway to simulate an excised radial head. Loading tests (with and without the radial head in place) were repeated after removal of a 3-mm wafer of bone beneath the triangular fibrocartilage complex, and again after a hemiresection of the distal ulna to the base of the ulnar styloid process. RESULTS: For each ulnar status condition (intact, wafer removal, hemiresection) the mean distal ulnar force generally increased as the wrist became more ulnar positive. Both wafer removal and hemiresection significantly decreased mean distal ulnar forces under all conditions of ulnar variance, with or without the radial head in place. With the radial head in place the mean distal ulnar forces (expressed as a percentage of applied wrist force) for the 0-mm condition were 16.9% (intact), 3.8% (wafer removal), and 3.5% (hemiresection); corresponding values for the +6-mm condition were 61.6% (intact), and 39.8% (wafer removal), 15.1% (hemiresection). With the radial head removed the mean distal ulnar forces for the 0-mm condition were 31.7% (intact), 4.6% (wafer removal), and 4.4% (hemiresection); corresponding values for the +6-mm condition were 96.4% (intact), 71.6%, (wafer removal), and 27.2% (hemiresection). The decrease of distal ulnar force resulting from hemiresection was significantly greater than that for wafer removal for all ulnar-positive conditions; force reductions were not significantly different between the 2 procedures with neutral ulnar variance. CONCLUSIONS: The results of the present study can help to offer a biomechanical basis for choosing between a Feldon wafer procedure and a Bowers hemiresection procedure in patients with ulnocarpal impaction syndrome. Both procedures produced equal decreases of distal ulnar force in the intact forearm. With an ulnar-positive wrist, the condition for which the procedure would be performed commonly, the hemiresection was more effective in decreasing force transmitted through the distal ulna.

Adult↗

PubMed2005

Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study.

PURPOSE: The ulnar-shortening procedure has been adopted widely to reduce pressure between the ulna and ulnar carpus in ulnocarpal abutment syndrome. The hammock-like structure of the triangular fibrocartilage complex (TFCC), which supports and connects the ulnocarpal and distal radioulnar joint (DRUJ), variably is torn in this condition. The degree to which the torn TFCC may be tensioned to restabilize the DRUJ with ulnar recession is uncertain. This study examined changes in the stabilizing effect of the ulnar-shortening procedure in several TFCC tear conditions. METHODS: Six fresh-frozen cadaver arms amputated at the midportion of the humerus were used. The skin, muscles, and capsuloligamentous structures below the elbow all were preserved. The ulna and humerus were affixed firmly to a custom mount that allowed 60 degrees of forearm rotation. An external fixator was attached to the distal ulna leaving space for a 10-mm resection of the ulna to allow progressive shortening. The radius was attached to a materials testing machine. The load-displacement curves were obtained while translating the distal radius dorsally or palmarly with respect to the ulna at 1.25 mm/s. Stiffness in dorsopalmar displacement was recorded at 1-mm intervals through 6 mm of length. These measurements then were compared with controls (0 mm shortening of the intact specimens) at 60 degrees pronation, neutral position, and 60 degrees supination. The tests then were repeated after sectioning either the dorsal or palmar portion of the radioulnar ligament (RUL) and then after complete sectioning of the RUL. Each portion was sectioned at its attachment to the ulnar fovea. RESULTS: The stiffness of the DRUJ increased significantly in all 3 rotatory positions after shortening the ulna. A shortening of 6 mm resulted in a 26% to 44% increase in DRUJ stiffness. The stiffness decreased after partial sectioning of the RUL but increased with further ulnar shortening in all 3 positions. The DRUJ stiffness with the partially sectioned RUL after a shortening of 3 to 6 mm was as large as that of the intact specimens. The stiffness of the DRUJ after the complete section of the RUL was significantly smaller than that of the intact specimens even after shortening of 6 mm. CONCLUSIONS: The ulnar-shortening procedure can stabilize the DRUJ by increasing intrastructural tension of the TFCC, only when the RUL is attached totally or partially to the ulnar fovea. If the RUL is avulsed completely then stability of the DRUJ no longer is obtained by the ulnar-shortening procedure.

Aged↗

PubMed2005

Ulnar-positive variance as a predictor of distal radioulnar joint ligament disruption.

PURPOSE: Previous cadaveric data show that disruption of the triangular fibrocartilage complex (TFCC) at the wrist allows 0.5 to 3.0 mm of proximal radius migration. Anatomic studies have documented the presence of superficial and deep fibers of both the palmar and the dorsal distal radioulnar joint (DRUJ) ligaments. The aim of this study was to determine the contribution of the superficial and deep fibers of the DRUJ ligaments to longitudinal forearm stability as measured by ulnar-positive variance. METHODS: Eight fresh-frozen cadaver specimens were included in this study. Each specimen was secured with external fixation clamps to a sequential loading frame with the elbow in 90 degrees of flexion and the forearm and wrist in neutral pronation supination, neutral ulnar-radial deviation, and neutral volar-dorsal angulation. The radial head was resected and a force gauge was applied to the proximal radius. The peripheral TFCC was identified through an incision between the fifth and sixth extensor compartments and the dorsal capsulotomy of the DRUJ capsule. After baseline measurement sequential transection of the superficial and deep fibers of the TFCC was performed. Before and after each step load application and removal were performed by attaching an 88.90-N weight to the end of a force gauge and via longitudinal traction on the proximal part of the radius, and ulnar variance was measured with wrist fluoroscopy. RESULTS: Transection of the superficial TFCC fibers resulted in radius migration of 0.70 mm. This migration, however, was not significantly different from that observed at baseline. After both the superficial and deep TFCC fibers were transected the radius migrated proximately with load. This change of ulnar variance was significantly greater than that observed at baseline or after transection of only the superficial TFCC fibers. CONCLUSIONS: Traumatic injury to the TFCC with radiographic evidence of ulnar-positive variance may be an indication of disruption of the deep TFCC fibers.

Aged↗

PubMed2006

Sigmoid notch osteotomy for posttraumatic dorsal dislocation of the distal radioulnar joint: A case report.

Instability of the distal radioulnar joint (DRUJ) is associated most commonly with injury to the soft-tissue restraints of that joint, particularly the triangular fibrocartilage complex. The dorsal rim of the sigmoid notch, however, also plays an important role as a bony restraint to dorsal subluxation. We report a case of posttraumatic dorsal dislocation of the DRUJ associated with a depressed fracture of the dorsal rim of the sigmoid notch. This was treated with soft-tissue release and corrective osteotomy of the dorsal rim of the sigmoid notch to restore DRUJ stability and congruency.

Adult↗

PubMed2004

Chondrocalcinosis of the wrist.

Calcium Pyrophosphate Dihydrate Deposition (CPDD) disease has characteristic radiographic features including soft tissue calcification, joint space narrowing, bone sclerosis, subchondral cyst formation without osteophyte formation, and large intraosseous geodes. Triangular fibrocartilage calcification is frequently found and isolated scapho-trapezio-trapezoid (STT) arthritis is specific for CPDD. Distal radio-ulnar (DRUJ), isolated midcarpal joint and piso-triquetral joint involvement also occur. 127 patients were reviewed. Seventy-eight had symptomatic STT joint arthritis, for which 36 underwent surgery. Twenty-two patients had a SLAC wrist deformity for which ten underwent surgery. Eight patients had isolated midcarpal arthritis for which three midcarpal arthrodeses, two four-bone arthrodeses and two carpal tunnel releases were performed. Nineteen patients had a generalized arthritis and seven of the patients underwent surgery: four-corner arthrodesis+scaphoidectomy (one case), carpal tunnel release (two cases) extensor synovectomy (two cases) and trigger finger release (two cases).

Chondrocalcinosis↗

PubMed2005

Staged reconstruction for malunited fractures of the distal radius.

This prospective study assessed the outcomes of 26 symptomatic malunited distal radial fractures which were treated with an opening wedge corrective osteotomy and bone grafting with rigid fixation. An ulnar shortening osteotomy was subsequently required as a second-stage operation in five cases to restore normal ulnar variance. A wrist arthroscopy was indicated as a third stage procedure with persistent ulnar sided wrist pain in order to address central tears of the triangular fibrocartilage. Satisfactory functional scores were achieved by 20 of the 26 patients after distal radial osteotomy alone and, 24 of the 26 after subsequent ulnar shortening osteotomies and arthroscopy when necessary. The one, two or three stage concept of reconstructing the malunited distal end radius could optimise the outcome rather than using a single-stage strategy.

Adult↗

PubMed2005

Extensor carpi ulnaris problems at the wrist--classification, surgical treatment and results.

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

Adolescent↗

PubMed2004

[Wrist arthroscopy. Current indications and results].

Arthroscopy of the wrist is a recent technique but already validated for many indications. It rarely gives rise to complications but requires a learning curve just like any other endoscopic procedure. It allows complete visualization of the osseous, articular, synovial and ligamentous structures of the different joints comprising the wrist. There are two main indications for wrist arthroscopy: i) Diagnostic; when other investigations have proved inconclusive (assessment of carpal instabilities, osteochondral fractures and certain synovial pathologies...); ii) therapeutic; these have recently widened in terms of carpal pathology. Lesions of the triangular fibrocartilage complex (traumatic or degenerative) are best diagnosed and treated arthroscopically. Arthroscopic treatment is the least invasive, most effective and safest means of performing procedures such as debridement, TFCC reattachment, and ulna shortening. Other conditions can benefit greatly from wrist arthroscopy such as certain wrist ganglions, rheumatoid synovitis, radiocarpal fractures and some scaphoid fractures. Degenerative pathology of the wrist also presents opportunities for articular debridement ("shaving"), synovectomy or even various "ectomies".

Arthroscopy↗

PubMed1998

Imaging the problem scaphoid.

Scaphoid fractures can be difficult to diagnose on X-ray, even at 2 weeks. We have compared prospectively bone scanning versus MRI scanning in 22 patients with persistent signs and symptoms suggestive of a scaphoid fracture at 2 weeks and found both methods to be sensitive, but MRI to be more specific, particularly in diagnosing soft tissue injuries like scapho-lunate ligament ruptures and triangular fibrocartilage tears. An early MRI scan at 2 weeks allows the clinician to make the appropriate decision in this group of patients whose diagnoses include; occult scaphoid fractures, other occult carpal and radial fractures, ligamentous injuries and those without apparent injuries. MRI has also been useful in defining the group of injuries which may imitate a clinically occult scaphoid fracture.

Adolescent↗

PubMed2000

Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure.

We describe a case of infected nonunion of the radius with extensive bone loss in an 11-year-old boy treated by centralization of the ulna. The technique used differs from the original Hey Groves procedure in that it preserves the distal end of the ulna with its important triangular fibrocartilage complex, thereby retaining stability and contour of the wrist joint. Our patient obtained a functionally and cosmetically satisfactory, stable forearm and wrist. We present the technique as a useful armament in the management of extensive bony defect of the radius arising from trauma or infection.

Child↗

PubMed1995

A new technique of reattachment after traumatic avulsion of the TFCC at its ulnar insertion.

One female and seven male patients (median age 25.5) presented with traumatic avulsion of the triangular fibrocartilage complex (TFCC), type 1B according to Palmer's classification. Reattachment of the TFCC near its anchoring point was combined with an intraarticular shortening osteotomy of the ulnar head. This provides an excellent approach to the TFCC and a well vascularized anchoring surface. The mooring point is biomechanically appropriate and the tissues with the best biomechanical properties are used. The functional results with a mean follow-up of 3 years were encouraging, as demonstrated by the significant improvement of pain (P = 0.017). All patients were able to return to their previous occupation; no further surgery was necessary to the distal radio-ulnar joint and no impairment of pronation and supination was detected. The final wrist score reflects the subjective results defined by the patient. However the correlation is not linear and the wrist scores are superior to the degree of satisfaction defined by the patient.

Adolescent↗