Ulnar wrist pain (ulnar shortening)

Ulnar shortening is one of the most common procedures used to treat ulnar wrist disorders. We have developed an algorithm for the treatment of ulnar disorders in which the final decision is based on the findings of wrist arthroscopy. In this report, we describe the clinical results of our algorithm.

Our algorithm: All patients were to be treated with a 3-month splint regardless of acute or chronic conditions. We confirmed ulnar impaction by arthroscopy (at least one chondral or osteochondral lesion on the ulnar carpus). Once we confirmed ulnar impaction syndrome, ulnar shortening osteotomy was performed. The surgeon evaluated the stability of the DRUJ after USO using the DRUJ ballottement test, without traction. In cases of DRUJ instability, arthroscopic TFCC repair was performed.

We treated 170 patients with ulnar wrist disorders according to the algorithm, including 65 patients who underwent ulnar shortening, excluding those in whom the DRUJ scopy video could not be verified. Clinically, 31 patients had preoperative DRUJ instability; 3 patients also had intraoperative instability after ulnar shortening and procedures (scopic sutures) to the TFCC. The most cases had a good clinical results, and none of the patients had DRUJ instability at final follow-up.

Our study showed that ulnar shortening osyteotomy could tighten the DRUJ even with a TFCC foveal injury in most cases. There was no significant correlation between history of trauma and TFCC injuries. This study showed that if DRUJ stability was obtained during surgery, ulnar shortening osyteotomy could tighten the secondary stabilizers of the DRUJ or partial tear of primary stabilizers; thus, good clinical results were obtained regardless of whether the TFCC foveal insertion injury was present or absent.