Ulnar Impaction Syndrome: Difference between revisions
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== Examination == | == Examination == | ||
To diagnose ulnar impaction syndrome, the | 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:<br> | ||
• Palpation (Vezeridis, Webb)<br> o Tenderness dorsally just distal to ulnar head<br> o Tenderness just volar to the ulnar styloid process<br> o Positive ulnar variance, while static or dynamic | |||
• Range of Motion (Tatebe, Vezeridis, Webb)<br> o Painful passive ulnar deviation and forceful pronation<br> o Decreased flexion, extension, radial & ulnar deviation | |||
• Strength (Tomaino, Vezeridis, Webb)<br> o Decreased grip strength, using dynamometer | |||
• Ulnocarpal stress test (Nakamura)<br> o Place wrist in maximum ulnar deviation<br> o Apply axial load to wrist<br> o Passively rotate forearm through supination and pronation<br> o + Test = reproduction of patient’s pain<br> 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)<br> o Place arm by side and elbow in 90 degrees of flexion<br> o Using a grip dynamometer, measure grip in 3 positions: neutral, full supination, full pronation<br> o GRIT Ratio=(supinated grip strength)/(pronated grip strength)<br> GRIT ratio is greater than 1.0 indicates UIS<br> | |||
<br>- Imaging – check for ulnar variation<br> o Neutral rotation P-A radiograph with elbow in 90° flexion<br> o Pronated grip P-A radiograph<br> o May have subchondral sclerosis, cystic changes, or osteophyte formation<br><br> | |||
== Medical Management <br> == | == Medical Management <br> == |
Revision as of 19:22, 16 November 2011
Original Editors
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Search Strategy[edit | edit source]
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Definition/Description[edit | edit source]
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Epidemiology/Etiology[edit | edit source]
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[edit | edit source]
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Differential Diagnosis[edit | edit source]
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[edit | edit source]
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Examination[edit | edit source]
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
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Physical Therapy Management
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Key Research[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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