Ulnar Impaction Syndrome

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Original Editors

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Search Strategy

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Definition/Description

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Epidemiology/Etiology

Asians have a higher incidence of ulnar variance than Whites, and since ulnar variance is a risk factor for ulnar impaction, ulnar impaction syndrome may be present more often in Asians. However, ulnar impaction is more commonly from an acquired variance rather than congenital. Acquired variance can be due to distal radial fracture malunion, radial head excision, premature physeal closure of the radius, and increased ulnar length. Any of these predisposing factors can lead to excess load across the ulnocarpal joint, resulting in ulnar impaction syndrome.

Characteristics/Clinical Presentation

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Differential Diagnosis

Differential Diagnosis:
- Pisotriquetral arthritis
- Distal radioulnar joint arthrosis
- Extensor carpi ulnaris subluxation or tendonitis
- Neuritis of dorsal cutaneous branch of ulnar nerve
- Lunotriquetra-Interval (LTIL) injury
     o Hogar shuck test
     o Kleinman shear test
- Triangular Fibrocartilage Complex (TFCC) injury
- Distal radioulnar joint instability and pain

Outcome Measures

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Examination

To diagnose ulnar impaction syndrome, the PT can perform the following:
- Complete wrist exam
- Palpation
      o Look for tenderness dorsally just distal to ulnar head
      o Look for tenderness just volar to the ulnar styloid process
- Ulnocarpal stress test
      o Place wrist in maximum ulnar deviation
      o Apply axial load to wrist
      o Passively rotate forearm through supination and pronation
      o + Test = reproduction of patient’s pain
- Compare to contralateral wrist
- Imaging – check for ulnar variation
      o Neutral rotation P-A radiograph with elbow in 90° flexion
      o Pronated grip P-A radiograph
      o May have subchondral sclerosis, cystic changes, or osteophyte formation

Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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