The Change of the Ulnar Variance in Accordance with the Wrist Position in Ulnocarpal Impaction Syndrome

Wan-Sun Choi; Kwang-Hyun Lee; Chang-Hun Lee; Hun-Chul Kim

doi:10.12790/jkssh.2014.19.1.1

Journal List > J Korean Soc Surg Hand > v.19(1) > 1106454

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Lee, Lee, and Kim: The Change of the Ulnar Variance in Accordance with the Wrist Position in Ulnocarpal Impaction Syndrome

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2014;19(1):1-6.

Published online: 11 March 2014

DOI: https://doi.org/10.12790/jkssh.2014.19.1.1

The Change of the Ulnar Variance in Accordance with the Wrist Position in Ulnocarpal Impaction Syndrome

Wan-Sun Choi¹, Kwang-Hyun Lee^1,, Chang-Hun Lee², Hun-Chul Kim¹

¹Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea

²Department of Orthopedic Surgery, KEPCO Medical Center, Seoul, Korea

Correspondence to: Kwang-Hyun Lee, Department of Orthopedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea, TEL: +82-2-2290-8482, FAX: +82-2-2299-3774, E-mail: leegh@hanyang.ac.kr

Received 18 November 201318 February 2014 Accepted 26 February 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

We evaluated the change of the ulnar variance (UV) as forearm rotation in patients with ulnocarpal impaction syndrome (UIS).

Methods:

Twenty patients who suffered from ulnar side pain of the wrist and had abnormal lesions at ulno-basal side of the lunate in the radiologic examinations were included in this study. Their UVs in six wrist position (neutral, supination, pronation, neutral and grip, supination and grip, pronation and grip) were measured by the method of perpendiculars. UVs and the maximum change of UV in patients with UIS were compared with those of control group statistically.

Results:

There were statistically significant differences in UVs of all forearm rotation and grip status. The maximum change of UV was in supination position to pronation and grip status for all cases. The mean maximum change of UV in patients with UIS was 2.03±1.03 mm, and that of control group was 1.86±0.86 mm. But there was no significant difference between them. The ulnar shortening osteotomy was performed for thirteen UIS patients, and one patient with osteoarthritis at distal radio-ulnar joint was operated with Darrach procedure. Six patients underwent conservative treatment.

Conclusion:

There were no significant differences in the maximum change of UV as forearm rotation between UIS patients and control group.

Keywords: Ulna, Ulnocarpal joint, Impaction syndrome, Forearm rotation, Ulnar variance

REFERENCES

1. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984; (187):26–35.

2. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist: anatomy and function. J Hand Surg Am. 1981; 6:153–62.

3. Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am. 1984; 9:681–2.

4. Jung JM, Baek GH, Kim JH, Lee YH, Chung MS. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br. 2001; 83:1029–33.

5. Tomaino MM. The importance of the pronated grip X-ray view in evaluating ulnar variance. J Hand Surg Am. 2000; 25:352–7.

6. Yeh GL, Beredjiklian PK, Katz MA, Steinberg DR, Bozentka DJ. Effects of forearm rotation on the clinical evaluation of ulnar variance. J Hand Surg Am. 2001; 26:1042–6.

7. Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am. 1989; 14:607–12.

8. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979; 86:420–8.

9. Park JC, Sur YJ, Rhee SK, Song SW, Lee SM, Han SH. Ulnar shortening osteotomy for the treatment of ulnar impaction syndrome. J Korean Soc Surg Hand. 2009; 14:172–8.

10. Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am. 1993; 18:713–6.

11. Makita A, Nakamura T, Takayama S, Toyama Y. The shape of the triangular fibrocartilage during pronation-supination. J Hand Surg Br. 2003; 28:537–45.

12. Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg Am. 2005; 30:719–26.

13. Lee JS, Park MJ. Diagnostic usefulness of ulnocarpal stress for triangular fibrocartilage lesions. J Korean Soc Hand Surg. 2006; 11:1–6.

Fig. 1.

The method of perpendiculars is used to measure the ulnar variance. The two lines perpendicular to the long axis of the radius are drawn through the distal ulnar aspect of radial volar cortical rim and the dorsal rim of the distal ulna respectively. The distance between these lines is measured as the ulnar variance.

Fig. 2.

(A) Maximum ulnar variance is measured when gripping in pronation. (B) Minimum ulnar variance is measured when relaxed in supination.

Table 1.

The comparison of demographics between UIS group and control group

Demographic findings	UIS group	Control group	p-value
Age (yr)	49	45.4	0.398^*
Sex (M:F)	11:09	13:07	0.519^†
Dominant hand	13/20	16/20	0.288^†
Supination	79.50±6.30	80.25±4.60	0.659^*
Pronation	77.50±4.33	75.30±4.33	0.121^*

UIS, ulnocarpal impaction syndrome.

^* Mann-Whitney U test;

^† Chi-square test.

Table 2.

The ulnar variances (mm) of various forearm rotation and grip status

UV of forearm rotation and grip status	UIS group	Control group
Neutral	2.87±1.39	0.48±1.35
Neutral and grip	3.73±1.53	1.02±1.22
Pronation	3.48±1.55	0.99±1.28
Pronation and grip	3.95±1.45	1.56±1.53
Supination	2.4±1.47	-0.30±1.74
Supination and grip	2.53±1.45	0.17±1.60
p-value^*	<0.001	<0.001
p-value^†	0.654

UV, ulnar variance; UIS, ulnocarpal impaction syndrome; ANOVA, analysis of variance.

^* Repeated measures ANOVA for the UVs in accordance with the 6 wrist positions;

^† Repeated measures ANOVA for the difference between UIS group and control group.

TOOLS

Similar articles