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J Wrist Surg 2025; 14(01): 001
DOI: 10.1055/a-2508-8924
Editorial

Ulnocarpal Impaction Syndrome

Toshiyasu Nakamura
1   Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
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Impingement, impaction, or abutment are similar but confusing words in the wrist field. The ulnar impingement syndrome was first reported by Bell et al,[1] which introduced ulnar wrist pain due to impingement of the ulnar shaft stump on the radius after resection of the ulnar head in the Darrach procedure. A similar symptom occurred in the Sauvé–Kapandji procedure. The ulnocarpal abutment syndrome demonstrates impingement of the ulnar head to the ulnar carpus due to positive ulnar variance that indicates the longer ulna relative to the radius.[2] The name ulnar impaction syndrome is also used in the same pathology.[3] Ulnar styloid impaction syndrome was reported by Topper et al in 1997[4] and indicated impaction of the ulnar styloid onto the triquetrum. Recently, to avoid any confusion, ulnar impingement syndrome is known as radioulnar impingement syndrome.

The degenerative tears of the triangular fibrocartilage complex (TFCC) are normally associated with the ulnocarpal abutment or impaction syndrome. Infamous Palmer's classification,[5] Palmer described his Class 2 tears as a classification of ulnocarpal abutment syndrome. MRI indicates signal intensity changes on the ulnar carpus in ulnocarpal abutment syndrome. Even in the neutral variance wrist, an unstable ulnar head produces shearing stress onto the ulnar carpus through TFCC, indicating a similar pathology of the ulnocarpal syndrome, and that is called “dynamic ulnocarpal impaction.” We still did not know the precise pathology of the ulnocarpal impaction or abutment syndrome.

This issue includes the “special review” of “Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)” described by Xu et al.[6] This guideline demonstrated multiple questions and answers for pathology, conservative, and surgical treatments with the level of evidence. The first step of the guideline for ulnar impaction syndrome aimed to standardize clinical practices, enhance diagnostic accuracy, and improve treatment outcomes for individuals.

This issue includes interesting wrist papers, such as the ulnar impaction syndrome, TFCC injuries in Galeazzi fracture, de Quervain's tenosynovitis, distal radius fracture, procedures, meta-analysis of four-corner fusion and proximal row carpectomy, and interesting case reports. Don't miss it.



Publication History

Article published online:
30 January 2025

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