Ulnar Impaction Syndrome

Welcome to Texas State University's Evidence-based Practice project space. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy

add text here related to databases searched, keywords, and search timeline

Definition/Description

add text here

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

add text here

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

add links to outcome measures here (also see Outcome Measures Database)

Examination

To diagnose ulnar impaction syndrome,a comprehensive wrist exam must be completed. Diagnostic imaging should be performed to support the findings from the clinical exam. The physical therapist should pay specific attention to the following:

• Palpation (Vezeridis, Webb)
     o Tenderness dorsally just distal to ulnar head
     o Tenderness just volar to the ulnar styloid process
     o Positive ulnar variance, while static or dynamic

• Range of Motion (Tatebe, Vezeridis, Webb)
     o Painful passive ulnar deviation and forceful pronation
     o Decreased flexion, extension, radial & ulnar deviation

• Strength (Tomaino, Vezeridis, Webb)
     o Decreased grip strength, using dynamometer

• Ulnocarpal stress test (Nakamura)
     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
     NOTE- Test is sensitive for UIS but can get positive with other pathologies, such as LTIL injury, TFCC injury or isolated arthritis.

• Gripping Rotary Impaction Test (GRIT) (LaStayo)
     o Place arm by side and elbow in 90 degrees of flexion
     o Using a grip dynamometer, measure grip in 3 positions: neutral, full supination, full pronation
     o GRIT Ratio=(supinated grip strength)/(pronated grip strength)
           GRIT ratio is greater than 1.0 indicates UIS

- 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

add text here

Physical Therapy Management

add text here

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources

add appropriate resources here

Clinical Bottom Line

add text here

Recent Related Research (from Pubmed)

see tutorial on Adding PubMed Feed

References

see adding references tutorial.