gms | German Medical Science

Objectives/Interrogation: To evaluate the clinical results of patients treated by arthroscopic wafer resection for ulnar impaction syndrome

Methods: We retrospectively reviewed the results for 16 patients (5 men, 11 women; mean age, 48 years) who underwent arthroscopic wafer resection for ulnar impaction syndrome at our hospital. The criteria for inclusion were: 1) persistent ulnar-sided wrist pain after conservative treatment over a 3-month period; 2) more than 6 months of follow-up postoperatively. Associated condition was radial head old fracture in 2, triangular fibrocartilage complex (TFCC) foveal avulsion in 2, scapholunate ligament injury in 1, carpal tunnel syndrome in 1, cubital tunnel syndrome in 1, and lateral epicondylitis in 1.

The patients were followed for a mean of 19 months(6~48). The patients symptom was caused by: repetitive overuse (N=8), slip down (N=4), falls (N=3); and sprain (N=1). All the patients underwent MRI. The radiographs for ulnar variance (UV) and ulnar dorsal subluxation and function of the wrist using grip power, DASH score, and Mayo wrist score were examined in all the patients both preoperatively and postoperatively.

Results and Conclusions: For the preoperative MRI all patient had TFCC central wear, a lunate high signal change in 6, triquetrum high signal change in 1. We checked follow up MRI in 3 and CT in 7. The average duration from symptom onset to surgery was 15months. Preoperative ulnar stress test was positive in 14, fovea sign in 2. For working portal, 4-5 portal was used in 12 and distal radioulnar joint portal in 4. In 5 cases ulnar shortening osteotomy(USO) was needed for persistent pain. UV was changed from 1.7 mm preoperatively to 0 mm postoperatively. Dorsal subluxation of the distal ulna was changed from 2.3 mm preoperatively to 1.5 mm postoperatively. Difference in postoperative dorsal subluxation of the distal ulna was significant between wafer only (0.2mm) and secondary USO (2.7mm). Grip power (compared to the uninvolved limb) was 72% preoperatively and 74% postoperatively. The DASH scores were 46 points preoperatively and 35.3 points postoperatively. The Mayo wrist scores improved from 70 to 86 points, excellent in 2, good in 12 and fair in 2. 2nd look arthroscopy was performed in 4 cases and showed fibrocartilage regeneration in resected ulnar head distal pole. Arthroscopic wafer resection is useful procedure for ulnar impaction syndrome. However patients with postoperative dorsal subluxation of the distal ulna may require secondary USO.