PDF herunterladen
J Wrist Surg 2018; 07(03): 247-252
DOI: 10.1055/s-0038-1627458
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Axial Loading on Ulnar Variance

Kagan Ozer
1   Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
,
Andy F. Zhu
1   Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
,
Breana Siljander
2   University of Michigan, School of Medicine, Ann Arbor, Michigan
,
Jeffrey N. Lawton
1   Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
,
Jennifer F. Waljee
3   Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
› Institutsangaben Funding None.
Weitere Informationen

Publikationsverlauf

05. Juni 2017

08. Januar 2018

Publikationsdatum:
12. Februar 2018 (online)

    Lizenzen und Reprints

Abstract

Background Forearm rotation results in change in ulnar variance. Axial loading of the wrist is required to maintain daily activities. Change in ulnar variance during axial loading has not been investigated previously.

Purpose To measure the change in ulnar variance on axially loaded wrists.

Patients and Methods We examined 21 asymptomatic individuals and 24 patients with unilateral ulnar-sided wrist pain. All patients underwent standard neutral posteroanterior wrist radiographs without load and under axial loading on bilateral wrists. Axial loading was standardized at 18.1 kgf using an analog weight scale. A magnetic resonance (MR) arthrogram was obtained only in patients with ulnar-sided wrist pain. Beighton flexibility score was recorded on healthy volunteers. Change in ulnar variance between 0 and 18.1 kgf was compared for each wrist among all subjects. A correlation was sought between the change in ulnar variance, MR arthrogram findings, and physical examination.

Results In individuals without wrist pain, on average, 0.4 mm increase in ulnar variance was measured between 0 and 18.1 kgf. There was no difference between the dominant and nondominant side. No correlation was found with increasing age. In contrast, patients with ulnar-sided wrist pain displayed an average increase of 0.8 mm in ulnar variance. Compared with the contralateral wrist, more than 1 mm increase in ulnar variance was correlated with intra-articular pathologies including dorsoulnar ligament disruption, central triangular fibrocartilage complex (TFCC) perforation, and foveal detachment.

Conclusion Compared with contralateral side, more than 1 mm increase in ulnar variance is suggestive of longitudinal instability or TFCC pathology.

Level of Evidence Level II, diagnostic.

Keywords

ulnocarpal abutment - impingement - ulnar variance - TFCC - axial loading

Note

Institutional review board approved this study.


 

  • References

  • 1 Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg Am 1982; 7 (04) 376-379
    CrossrefPubMedGoogle Scholar
  • 2 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14 (04) 607-612
    CrossrefPubMedGoogle Scholar
  • 3 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (02) 295-310
    CrossrefPubMedGoogle Scholar
  • 4 Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy. J Hand Surg [Br] 1998; 23 (06) 754-757
    CrossrefPubMedGoogle Scholar
  • 5 Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973; 32 (05) 413-418
    CrossrefPubMedGoogle Scholar
  • 6 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 7 af Ekenstam FW, Palmer AK, Glisson RR. The load on the radius and ulna in different positions of the wrist and forearm. A cadaver study. Acta Orthop Scand 1984; 55 (03) 363-365
    CrossrefPubMedGoogle Scholar
  • 8 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201 (02) 495-500
    CrossrefPubMedGoogle Scholar
  • 9 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (06) 719-723
    CrossrefPubMedGoogle Scholar
  • 10 Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am 1993; 18 (04) 713-716
    CrossrefPubMedGoogle Scholar
  • 11 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (04) 689-699
    CrossrefPubMedGoogle Scholar
  • 12 Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 2006; 31 (03) 445-451
    CrossrefPubMedGoogle Scholar
  • 13 Moriya T, Aoki M, Iba K, Ozasa Y, Wada T, Yamashita T. Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur Vol 2009; 34 (02) 219-223
    CrossrefPubMedGoogle Scholar
  • 14 Shen J, Papadonikolakis A, Garrett JP, Davis SM, Ruch DS. Ulnar-positive variance as a predictor of distal radioulnar joint ligament disruption. J Hand Surg Am 2005; 30 (06) 1172-1177
    CrossrefPubMedGoogle Scholar