gms | German Medical Science

Objectives/Interrogation: To propose a novel surgical technique to treat patients with wrist stiffness due to a soft tissue contracture in flexion-pronation after injuries or cast immobilisation.

Methods: Lack of extension and radial deviation, presented as a form of wrist stiffness, is related to multiple entities and has its own pathomechanics (ligament injury, tendon injury, pronator quadratus muscle disruption, scar retraction) that originate in the volar-ulnar compartment of the wrist (Figure 1 [Fig. 1]).

Indeed, no soft-tissue release will ever correct bone deformity or joint incongruity, which is the most common cause of pronosupination loss, and must be corrected prior to addressing soft tissue contractures.

Not infrequently, however, there is a concomitant soft-tissue contracture that causes pain which should not be underestimated, and this is the object of our technique.

Lee et al. classified wrist stiffness into intrinsic and extrinsic aetiology. Most intrinsic adhesions are best managed arthroscopically while multilevel extrinsic contractures are more complex and require an open approach.

Once an extrinsic mechanism has been recognised the anteromedial release has been tested in some patients by our group and has been shown to safely improve range of motion without destabilising or dennervating the joint.

It requires minimal postoperative immobilisation, permitting rehabilitation in two weeks with good results.

Results and Conclusions: We have observed that stiffness limiting extension and radial deviation comes from the volar-ulnar compartment. It is a rare occurrence after wrist injury but can result in significant disability if it persists despite conservative management. In these cases, surgery is indicated.

We propose a safe and predictable technique to access the volar-ulnar corner, not only the distal radioulnar but also the ulnocarpal and midcarpal Space of Poirier. This approach offers a good therapeutic option for this particular form of extrinsic stiffness of the wrist. It is important to protect the surrounding anatomy in order to avoid further injury.