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Scigliano NM, McSweeny KF, Garcia Fleury I, Buckwalter JA. Ulnar Variance in Athletes: A Scoping Review. Sports Health 2024; 16:581-587. [PMID: 37681664 PMCID: PMC11195860 DOI: 10.1177/19417381231195527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
CONTEXT Ulnar variance (UV) is a measurement of the relative locations of the radius and ulna that may become perturbed in athletic populations. Positive UV can be associated with wrist pathologies often treated conservatively or surgically and may result in interruption of sports participation. OBJECTIVE This scoping review aims to summarize diagnostic measures of UV in athletes, describe its relation to separate wrist conditions, and present treatment strategies for symptomatic UV. DATA SOURCES A systematic search was created and modified for PubMed, CINAHL, Embase, and SPORTDiscus including articles from inception until February 2, 2022. STUDY SELECTION Articles including UV characterization, imaging modality style, and an athletic population were searched across multiple databases. STUDY DESIGN A scoping review was designed to identify the methods for imaging UV in athletic populations following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). LEVEL OF EVIDENCE Level 4. DATA EXTRACTION The specific athletic population, imaging modality, measurement style, wrist pathology association, and surgical management of UV were extracted. RESULTS A total of 4321 records were screened independently for eligibility: 22 met inclusion criteria. Eight sports comprised the analysis. All studies referenced conventional radiography to diagnose UV; 50% specified the posteroanterior, 18.2% anteroposterior, and 13.6% pronated, gripping radiographs. Hafner's method (7×), Palmer's technique (2×), and the method of perpendiculars (3×) were used to measure UV. Athletes displayed more positive UV than nonathletes and UV became more positive over time in longitudinal studies. Triangular fibrocartilage complex tears, focal lunate necrosis, and ulnar abutment were associated with positive UV. Ulnar shortening osteotomy was the most performed operation for positive UV. CONCLUSION Conventional radiography is the gold standard for imaging UV in athletes. Hafner's method is the most commonly used radiograph measurement technique. Wrist pathology in athletic populations may indicate positive UV in need for operative management.
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Affiliation(s)
- Noah M. Scigliano
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kareena F. McSweeny
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ignacio Garcia Fleury
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Joseph A. Buckwalter
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Thillemann JK, De Raedt S, Petersen ET, Puhakka KB, Hansen TB, Stilling M. Normal Values of Distal Radioulnar Joint Kinematics during a Dynamic Press Test. J Wrist Surg 2022; 11:406-415. [PMID: 36339081 PMCID: PMC9633146 DOI: 10.1055/s-0041-1740486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022]
Abstract
Background Measurement of in vivo distal radioulnar joint (DRUJ) pathomechanics during simple activities can represent the disability experienced by patients and may be useful in diagnostics of DRUJ instability. A first step is to describe the physiological normal limits for DRUJ kinematics in a reproducible and precise test setup, which was the aim of this study. Methods DRUJ kinematics were evaluated in 33 participants with dynamic radiostereometry (RSA) while performing a standardized press test examination. AutoRSA software was used for image analyses. Computed tomography (CT) forearm bone models were generated, and standardized anatomical axes were applied to estimate kinematic outcomes including, DRUJ translation, DRUJ position ratio, and changes in ulnar variance. Repeatability of dynamic RSA press test double examinations was evaluated to estimate the precision and intraclass correlation coefficient (ICC) test-retest agreement. Results The maximum force during the press test was 6.0 kg (95% confidence interval [CI]: 5.1-6.9), which resulted in 4.7 mm (95% CI: 4.2-5.1) DRUJ translation, DRUJ position ratio of 0.40 (95% CI: 0.33-0.44), and increase in ulnar variance of 1.1 mm (95% CI: 1.0-1.2). The mean maximum DRUJ translation leveled off after a 5 kg force application. The DRUJ translation ICC coefficient was 0.93 within a prediction interval of ± 0.53mm. Conclusions This clinical study demonstrates the normal values of DRUJ kinematics and reports excellent agreement and high precision of the press tests examination using an automated noninvasive dynamic RSA imaging method based on patient-specific CT bone models. The next step is the application of the method in patients with arthroscopic verified triangular fibrocartilage complex injuries. Level of Evidence This is a Level IV, case series study.
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Affiliation(s)
- Janni Kjærgaard Thillemann
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Sepp De Raedt
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- NRT X-RAY A/S, Hasselager, Denmark
| | - Emil Toft Petersen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Katriina Bøcker Puhakka
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Radiology, Regional Hospital Horsens, Horsens, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University, Aarhus N, Denmark
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Wang J, Yin Y, Sun C, Wu R, Luo T, Che J, Bu J. The association of three anatomical factors with ulnar-sided wrist pain: a radiological study. Acta Radiol 2022; 64:250-256. [PMID: 35108123 DOI: 10.1177/02841851221076331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ulnar-sided wrist pain is associated with the development of multiple wrist pathologies. But the anatomical etiologies have not been fully understood. PURPOSE To determine the association of three anatomical factors with ulnar-sided wrist pain, including ulnar variance (UV), distal ulnar volar angle (DUVA), and pisiform-ulnar distance (PUD). MATERIAL AND METHODS A total of 64 patients who had ulnar-sided wrist pain associated with training injuries were retrospectively studied. A control group included 64 healthy athletes from the same unit. The UV, DUVA, and PUD of each individual was measured on radiographs. RESULTS The average UV and DUVA of those in the ulnar-sided pain group were 0.84 mm and 174.65°, respectively; the control group values were 0.39 mm and 175.11°. The differences between the two groups had no statistical significance (P > 0.05). The average PUD of the ulnar-sided wrist pain group was shorter than that of the control group (2.37 cm vs. 2.65 cm); the difference had statistical significance (P < 0.05). PUD had a negative correlation with ulnar-sided pain; it was an anatomical protective factor (odds ratio = 0.01; P < 0.00; 95% confidence interval=0.00-0.05). Both UV and DUVA had no significant correlations with ulnar-sided wrist pain (P > 0.05). CONCLUSION PUD has a significant correlation with ulnar-sided wrist pain. It is the anatomical protective factor. Both the UV and DUVA have no statistical association with ulnar-sided wrist pain, but we cannot ignore their potential pathogenic effects on wrists, and further studies are needed to confirm the results.
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Affiliation(s)
- Jiangtao Wang
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Yu Yin
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Cheng Sun
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Ruimin Wu
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Tao Luo
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Jianwei Che
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Jianli Bu
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
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Bayav M. Investigation of the Relationship Between Wrist Ganglion Cysts and the Ulnar Variance Using 3-Tesla Magnetic Resonance Imaging. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2022.7788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Asmus A, Salloum M, Medeiros W, Millrose M, Obladen A, Goelz L, Diehl J, Eisenschenk A, Ekkernkamp A, Kim S. Increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace. J Hand Ther 2021; 35:575-580. [PMID: 34011468 DOI: 10.1016/j.jht.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/07/2020] [Accepted: 03/21/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional case series. BACKGROUND Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ. PURPOSE In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint. METHODS Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values. RESULTS The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p <0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29 with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative). CONCLUSION The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.
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Affiliation(s)
- A Asmus
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - M Salloum
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - W Medeiros
- Wendy Medeiros, Pahoa, HI, United States
| | - M Millrose
- Department of Trauma Surgery and Sports Orthopaedics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - A Obladen
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - L Goelz
- Institut für Radiologie und Neuroradiologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - J Diehl
- Institut für Mathematik und Informatik, Greifswald, Germany
| | - A Eisenschenk
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany; Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - A Ekkernkamp
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - S Kim
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Leibniz Institut für Plasmaforschung und Technologie (INP Greifswald), Greifswald, Germany.
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Joni SS, Yavari P, Tavakoli P, Tavoosi P, Mohammadsharifi G. Treatment of unstable extra-articular distal radius fractures using locked volar plating and percutaneous pinning without external fixation. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:113-120. [PMID: 32934865 PMCID: PMC7486567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION One of the most common fractions is distal radius fracture, and various treatments have been suggested for this. The purpose of this study, is comparison of Open reduction and internal fixation by using a locked volar plating compared to percutaneous pinning by cast immobilization under the elbow in patients less than 60 years with good bone density that had unstable extra-articular distal radius fracture or UDRF. METHODS This study was clinical trial. 88 patients with closed UDRF who were referred for surgical treatment entered the study. Patients were randomized into two groups: group 1 had open reduction and internal fixation by using a locked volar plating and the other group had percutaneous pinning by cast immobilization surgeries. Amount of pain [by using Visual analog scale or VAS] and functional results of two methods were compared 3 and 12 month after surgeries. FINDINGS The intensity of pain was higher in the pinning group 3 and 12 month after treatment (P=0.001 and P=0.390 respectively). The range of motions in the plating group was significantly better (P<0.001). There was a significant difference in performing daily activities 3 month after treatment between the two groups, but a significant limitation in daily activities, observed 12 months after surgery in pinning group (P=0.004). CONCLUSION Bone fixation, using locked volar plating, can be a better modality with regard to postsurgical pain and also the wrist range of motion than percutaneous pinning with cast immobilization in patients younger than 60 years sustaining unstable, closed extra-articular, distal radius fracture.
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Affiliation(s)
- Saeid Sadeghi Joni
- Department of Radiology, Razi Hospital, Guilan University of Medical SciencesRasht, Iran
| | - Pedram Yavari
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Peyman Tavakoli
- School of Medicine, Tehran University of Medical SciencesTehran, Iran
| | - Pedram Tavoosi
- Department of Civil Engineering, School of Engineering, Islamic Azad University Khorasgan (Isfahan) BranchIsfahan, Iran
| | - Ghasem Mohammadsharifi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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