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Lari A, Burhamah W, Alherz M, Prada C. Operative Management of Extensor Carpi Ulnaris Instability: A Systematic Review. J Wrist Surg 2024; 13:272-281. [PMID: 38808191 PMCID: PMC11129889 DOI: 10.1055/s-0043-1764354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/03/2023] [Indexed: 05/30/2024]
Abstract
Background Posttraumatic extensor carpi ulnaris (ECU) instability is an increasingly recognized cause of ulnar-sided wrist pain that occurs when the ECU subsheath is disrupted. Purpose The purpose of this systematic review was to assess outcomes of operatively treated posttraumatic ECU instability. Methods A systematic search of Medline, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was performed using "extensor carpi ulnaris" as the keyword. Studies were systematically screened and data extracted independently by two reviewers. Results Eight retrospective studies met the inclusion criteria with a total of 97 wrists. The mean age was 32 years (13-61). Patients underwent either primary repair (40%) using sutures and anchors, or reconstruction (60%) using extensor retinaculum flaps. One study performed deepening of the osseous ulnar groove. Two studies compared preoperative and postoperative values. They both reported a significant improvement in pain scores, functional scoring instruments, satisfaction, and grip strength. The rest of the studies reported similarly favorable outcomes across the same outcomes. Concomitant pathologies were identified in 66% of the study population. Complications occurred in 9% of the sample size, including ECU tendinitis, ulnar sensory nerve irritation, and reintervention for concomitant pathology. None of the studies reported recurrence or reruptures. However, five patients (6.7%) did not return to their previous activity level. Conclusion Patients can expect favorable outcomes with a potentially low complication rate. Nevertheless, the heterogeneity of the sample population, operative techniques, and outcome measures warrant further standardized studies. Level of Evidence IV.
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Affiliation(s)
- Ali Lari
- Department of Orthopaedic Surgery, Al Razi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Waleed Burhamah
- Department of Surgery, Jaber Al Ahmad Al Sabah Hospital, Kuwait City, Kuwait
| | | | - Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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2
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Bezirgan U, Yoğun Y, Özgencil B, Dursun Savran M, Genç A, Armangil M. The Effect of Arthroscopic Triangular Fibrocartilage Repair on Accompanying Extensor Carpi Ulnaris Tendinitis and Synovitis in Triangular Fibrocartilage Tears. J Wrist Surg 2024; 13:241-247. [PMID: 38808190 PMCID: PMC11129892 DOI: 10.1055/s-0043-1775802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/05/2023] [Indexed: 05/30/2024]
Abstract
Purpose Management of ulnar-sided wrist pain is difficult due to the complexity of the anatomy and the similarity of the signs and symptoms of possible diagnoses. The study's main purpose is to examine the effect of arthroscopic triangular fibrocartilage (TFC) repair on untreated extensor carpi ulnaris (ECU) tendinitis and synovitis. Methods Thirteen patients who underwent arthroscopic TFC repair in our clinic and preoperatively demonstrated ECU tendon pathology with magnetic resonance imaging (MRI) were included in the retrospective study. Pre- and postoperative visual analog scale (VAS), pre- and postoperative tendinitis and synovitis, postoperative Mayo and patient-rated wrist evaluation score, postoperative grip strength of the operated and control sides, short and long diameters of the ECU tendon in ultrasonography were recorded. Results The mean age of 13 patients (9 females and 4 males) was 39.54 ± 13.54, and the mean follow-up period was 26 ± 7.25 months. While there was no significant difference between pre- and postoperative tendinitis or synovitis levels, VAS decreased significantly (8.46 ± 1.33 vs. 3.00 ± 2.31, p = 0.0016). While the grip strength was 21.78 ± 7.83 on the control side, it was 18.28 ± 7.51 on the surgery side, being significantly lower ( p = 0.0252). Ulnar variance did not affect tendinitis or synovitis. Short and long diameters of ECU were similar for the operated and control sides. While the short diameter did not affect the synovitis-tendinitis score, the bigger the long diameter, the higher the synovitis score (rho = 0.5162). Conclusion In the presence of ECU, tendon pathologies accompanying TFC lesions, additional surgical interventions are mandatory as arthroscopic TFC repair has no significant effect on the healing of ECU. Level of evidence : 4.
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Affiliation(s)
- Uğur Bezirgan
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Yener Yoğun
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Bedir Özgencil
- Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Merve Dursun Savran
- Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Aysun Genç
- Department of Physical Therapy and Rehabilitation, Ankara University Medical Faculty, Ankara, Turkey
| | - Mehmet Armangil
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
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3
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Zarro M, Goel R, Bickhart N, May CC, Abzug JM. Extensor Carpi Ulnaris Tendinopathy in Athletes: A Review of the Conservative and Rehabilitative Options. Hand (N Y) 2024; 19:407-413. [PMID: 36250572 PMCID: PMC11067837 DOI: 10.1177/15589447221127331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Extensor carpi ulnaris (ECU) tendinopathy is characterized by pain along the dorsal and ulnar aspect of the wrist and distal forearm. It is common in athletes who play stick and racquet sports due to repetitive motion and axial-loading through the wrist and forearm. Conservative therapeutic options include rest, the use of anti-inflammatory medications, and various injections. Rehabilitation via occupational or physical therapy includes therapeutic exercise, splinting, activity modification, manual therapy, and modalities. METHODS A narrative review of the literature on ECU tendinopathy is presented, and a case study approach is used to highlight the clinical management of this condition in an elite athlete. RESULTS An approach of medical management and rehabilitation allowed this patient to successfully return to play. CONCLUSIONS A combination of conservative measures and rehabilitation can be used to treat ECU tendinopathy and permit patients to be symptom-free and return to their desired activities.
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Affiliation(s)
- Michael Zarro
- University of Maryland School of Medicine, Baltimore, USA
| | - Ritu Goel
- University of Maryland Faculty Physicians, Inc., Baltimore, USA
| | - Nicole Bickhart
- University of Maryland Faculty Physicians, Inc., Baltimore, USA
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4
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Shoap SC, Dennis ER, Lombardi JM, Wilkerson J, Wahood M, Rosenwasser MP. An Analysis of Extensor Carpi Ulnaris Groove Morphology and Tendon Instability. Hand (N Y) 2024; 19:400-406. [PMID: 35815616 PMCID: PMC11067848 DOI: 10.1177/15589447221105539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The extensor carpi ulnaris (ECU) tendon has a distinct subsheath at the distal ulna. Symptomatic tears of this subsheath and subluxation of the ECU tendon often require reconstruction. We sought to determine the anatomical constraints of the ECU subsheath. METHODS The ECU subsheath was exposed on 12 fresh-frozen upper extremities. The tip of the ulnar styloid, the distal ulnar joint surface, and the proximal extent of the distal radio-ulnar joint were identified and dimensions measured. Subluxation of the tendon was then assessed with and without an intact subsheath in 9 specimens. The travel of the tendon was measured in pronation through supination and flexion before and after sectioning of the subsheath. RESULTS The ECU subsheath is 8.9 mm (standard deviation [SD] = 0.8 mm) wide proximally and 9.0 mm (SD = 1.2 mm) distally. The distal ulnar insertion is 0.5 mm (SD = 0.8 mm) proximal to the tip of the styloid, and stretches 10.2 mm (SD = 2.7 mm) proximally. From maximum pronation to maximum supination and flexion, the ECU tendon traveled 3.32 mm (SD = 4.24) medially when the subsheath was intact and 5.42 mm (SD = 5.0 mm) after sectioning. The maximum depth of the ulnar groove was 2.5 mm (1.59-3.56 mm). There was no significant association between changes in ECU subluxation and the depth of the ECU groove (Spearman's rho = 0.25). CONCLUSION The ECU subsheath is roughly 1 cm square stretching proximally from the ulnar styloid. ECU groove depth is not a significant independent predictor of tendon subluxation.
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Affiliation(s)
- Seth C. Shoap
- Columbia University Irving Medical Center, New York City, NY, USA
| | | | | | - James Wilkerson
- Columbia University Irving Medical Center, New York City, NY, USA
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5
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Postle RD, Ahmad G, Forster BB. Extensor carpi ulnaris (ECU) tenosynovitis. Br J Sports Med 2024; 58:401-402. [PMID: 38050013 DOI: 10.1136/bjsports-2023-107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Ryan D Postle
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gulraiz Ahmad
- Radiology Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bruce B Forster
- Department of Radiology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Hemmati S, Ponich B, Lafreniere AS, Genereux O, Rankin B, Elzinga K. Approach to chronic wrist pain in adults: Review of common pathologies for primary care practitioners. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:16-23. [PMID: 38262758 PMCID: PMC11126282 DOI: 10.46747/cfp.700116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To develop an approach for identifying, investigating, and initially managing common causes of chronic wrist pain seen by primary care practitioners. SOURCES OF INFORMATION Relevant clinical evidence and literature were identified using the PubMed database. MAIN MESSAGE Chronic wrist pain is a common presentation in the primary care setting. The complex anatomy of the wrist leads to a broad differential diagnosis. Elements of history, findings of physical examinations and investigations, and management relevant to the following pathologies are discussed, including scaphoid fracture nonunion, thumb carpometacarpal joint osteoarthritis, scapholunate ligament instability, triangular fibrocartilage complex injuries, de Quervain tenosynovitis, extensor carpi ulnaris tendinopathy, carpal tunnel syndrome, and ganglion cysts. When evaluating chronic wrist pain, diagnostic imaging with x-ray scans can serve as an important ancillary investigation tool but should not override clinical suspicion. Advanced imaging (computed tomography or magnetic resonance imaging) is generally best ordered by a hand surgeon when it will help clarify a diagnosis and guide treatment. CONCLUSION Chronic wrist pain is a functionally limiting problem best managed with timely diagnosis and treatment. A thorough history and physical examination are the cornerstones of an effective evaluation. When diagnosis is delayed, some wrist pathologies can lead to relatively poor outcomes, such as a scaphoid fracture nonunion resulting in diffuse wrist osteoarthritis.
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Affiliation(s)
- Shayan Hemmati
- Third-year medical student, at the University of Calgary in Alberta
| | - Brett Ponich
- Second-year plastic surgery resident, at the University of Calgary in Alberta
| | | | - Olivia Genereux
- Second-year otolaryngology resident, at the University of Calgary in Alberta
| | - Brian Rankin
- Second-year dermatology resident, at the University of Calgary in Alberta
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [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: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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8
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Hemmati S, Ponich B, Lafreniere AS, Genereux O, Rankin B, Elzinga K. Approche de la douleur chronique au poignet chez les adultes: Revue des pathologies courantes à l'intention des praticiens des soins primaires. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:e1-e9. [PMID: 38262752 PMCID: PMC11126291 DOI: 10.46747/cfp.7001e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIF Élaborer une approche pour déterminer, investiguer et initialement prendre en charge les causes courantes de la douleur chronique au poignet que voient les professionnels des soins primaires. SOURCES DE L'INFORMATION Les données probantes et la littérature scientifique pertinentes ont été recensées à l'aide de la base de données PubMed. MESSAGE PRINCIPAL Les consultations pour une douleur chronique au poignet sont fréquentes en soins primaires. L'anatomie complexe du poignet est propice à la multiplicité des diagnostics différentiels. Les éléments de l'anamnèse, les constatations aux examens physiques et aux investigations, et la prise en charge qui sont applicables aux pathologies suivantes sont présentés : pseudarthrose du scaphoïde, arthrose de l'articulation carpométacarpienne du pouce, instabilité du ligament scapholunaire, lésions au complexe triangulaire fibrocartilagineux, ténosynovite de De Quervain, tendinopathie de l'extenseur ulnaire du carpe, syndrome du tunnel carpien et kystes ganglionnaires. Lors de l'évaluation de la douleur chronique au poignet, l'imagerie diagnostique par radiographies peut servir d'outil auxiliaire important, mais ne devrait pas l'emporter sur la suspicion clinique. L'imagerie avancée (tomodensitométrie ou imagerie par résonance magnétique) devrait généralement être plus judicieusement prescrite par un chirurgien de la main, lorsqu'il s'agit de préciser le diagnostic et d'orienter le traitement. CONCLUSION La douleur chronique au poignet est un problème invalidant sur le plan fonctionnel, dont la prise en charge optimale est un diagnostic et un traitement sans délai. Une anamnèse et un examen physique rigoureux sont les pierres angulaires d'une évaluation efficace. Lorsque le diagnostic est tardif, certaines pathologies du poignet peuvent entraîner des issues relativement défavorables, comme la pseudarthrose du scaphoïde causant une arthrose diffuse du poignet.
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Affiliation(s)
- Shayan Hemmati
- Étudiante en 3 année de médecine, à l'Université de Calgary (Alberta)
| | - Brett Ponich
- Résident de 2 année en chirurgie plastique, à l'Université de Calgary (Alberta)
| | | | - Olivia Genereux
- Résidente de 2 année en oto-rhino-laryngologie, à l'Université de Calgary (Alberta)
| | - Brian Rankin
- Résident de 2 année en dermatologie, à l'Université de Calgary (Alberta)
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9
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Colberg RE, Maisel BC, Fleisig GS. Treatment of Chronic Extensor Carpi Ulnaris Stenosing Tenosynovitis Using Ultrasound-Guided Retinaculum Release: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00013. [PMID: 38241430 DOI: 10.2106/jbjs.cc.23.00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
CASE A 65-year-old man with chronic extensor carpi ulnaris (ECU) stenosing tenosynovitis who had failed treatments for 3 years was successfully treated with an ultrasound-guided retinaculum release of the sixth dorsal compartment. CONCLUSION There are limited options in the literature for treating chronic, recalcitrant ECU tenosynovitis. We describe a novel technique in which the retinaculum overlying the ECU tendon was successfully incised under ultrasound guidance to release the sixth dorsal compartment stenosis. There was no recurrence of symptoms in the following 2 years of follow-up.
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Affiliation(s)
- Ricardo E Colberg
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama
- American Sports Medicine Institute, Birmingham, Alabama
| | - B C Maisel
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama
- American Sports Medicine Institute, Birmingham, Alabama
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10
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Nagore A, Samal S, Thakre VM. Effectiveness of Active Release Technique With Conventional Therapy in the Management of Lateral Epicondylitis: A Case Report. Cureus 2023; 15:e50926. [PMID: 38249180 PMCID: PMC10800006 DOI: 10.7759/cureus.50926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
The condition known as tendonitis, tennis elbow, lateral epicondylalgia, or lateral epicondylitis affects the radiohumeral joint and causes persistent, severe discomfort in the elbow. It commonly affects those who work in professions that need repetitive forearm motions, like athletes who play on courts, computer operators, and woodworkers. It tends to originate from additional rapid, tiresome, recurring eccentric contractions and activities that grab gliding joints. It commonly affects the dominant hand. This case report describes the author's seven years of experience living with lateral epicondylitis, including functional disability in day-to-day life, and then physiotherapy management was started. Mill's and Cozen's tests were performed, and lateral epicondylitis was confirmed. From 2023, the physiotherapy session, including active release technique and conventional therapy, was taken regularly for four weeks. The outcome measure score of the Visual Analog Scale (VAS) was 7/10 pre-treatment and 2/10 post-treatment, and for the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, it was 50/100 pre-treatment and 25/100 post-treatment. The results that are reported from this particular case study suggest that physiotherapy has a significant effect in improving muscle strength, increasing range of motion, improving activities of daily living, and enhancing the overall quality of life. The study concludes a physiotherapist is crucial in treating these overuse injuries and returning the patient to their daily activities.
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Affiliation(s)
- Aditi Nagore
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Subrat Samal
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaishnavi M Thakre
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Flores DV, Murray T, Jacobson JA. Diagnostic and Interventional US of the Wrist and Hand: Quadrant-based Approach. Radiographics 2023; 43:e230046. [PMID: 37498783 DOI: 10.1148/rg.230046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Diagnostic and interventional US of the wrist and hand can be challenging due to the small size and superficial location of structures and various disorders that need to be considered. A quadrant-based approach (volar, ulnar, dorsal, and radial) provides a rational method for performing a focused examination and joint positioning during both diagnostic imaging and intervention. Volar wrist disorders primarily involve the median nerve and the digital flexor system comprised of the flexor tendons and pulleys. The ulnar nerve and extensor carpi ulnaris tendon are chiefly responsible for ulnar-sided wrist pain. The differential diagnosis for dorsal-sided symptoms typically involves the extensor tendon compartments and includes distal intersection syndrome, extensor pollicis longus tear, and digital extensor apparatus injury. The soft-tissue ganglion is the most common abnormality in the dorsal wrist, typically associated with wrist ligaments or joint capsule. Radial-sided pain may be secondary to de Quervain tenosynovitis and must be differentiated from the more proximal intersection syndrome. US is an important tool for assessing the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb and differentiating between displaced and nondisplaced tears, thereby influencing management. Despite the complexity of the anatomy and potential pathologic features within the wrist, a focused quadrant-based examination can permit the sonologist to focus on the structures of relevance. In conjunction with a systematic approach, this can aid in precise and efficient diagnostic scanning and intervention of the wrist and hand. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Timothy Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Jon A Jacobson
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
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12
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Mastroianni MA, Leibman M, Belsky M, Vitale MA, Ruchelsman DE. Radially Based Extensor Retinacular Sling Reconstruction for Extensor Carpi Ulnaris Subsheath Injuries in Elite Athletes. Hand (N Y) 2023:15589447231151433. [PMID: 36779484 DOI: 10.1177/15589447231151433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Extensor carpi ulnaris (ECU) subsheath injuries are an increasingly recognized cause of ulnar-sided wrist pain in elite athletes. There is a lack of surgical outcome data in elite athletes, and unique considerations exist for these patients. METHODS We performed a retrospective review of our hand center experience of 14 elite professional or collegiate athletes who prospectively underwent radially based extensor retinacular sling ECU subsheath reconstruction by 3 hand surgery-fellowship-trained surgeons between April 2011 and April 2021. Clinical, magnetic resonance imaging (MRI), and intraoperative findings were cataloged. Subgroup analyses of elite hockey players and acute subsheath injuries were also conducted. Statistical analysis was performed via a 2-tailed paired t test. RESULTS Mean age at the time of surgery was 21.3 years (range, 18-34). Mean time from symptom onset to surgery was 102.1 ± 110.7 days. All 14 patients underwent preoperative MRI. Five patients (35.7%) had intrinsic ECU tendinopathy, 9 patients (64.3%) had ECU tenosynovitis, 6 patients (42.9%) had triangular fibrocartilage complex tears, and 9 patients (64.3%) had ulnocarpal synovitis. Mean postoperative pain on a Visual Analog Scale was 0.25 ± 0.43. Grip strength (P = .001), wrist flexion-extension (P = .037), and pronosupination arcs (P = .093) showed excellent recovery postoperatively. Mean time to unrestricted return to sports was 92.5 ± 21.0 days. There were no complications. Subgroup analyses found similar functional improvement and characterized injury patterns. CONCLUSIONS Overall, our findings suggest surgical management of ECU subsheath injuries is a viable option in both acute and chronic settings in elite athletes and may be favorable compared with nonoperative management.
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Affiliation(s)
| | - Matthew Leibman
- Newton-Wellesley Hospital, MA, USA
- Hand Surgery, PC, Newton, MA, USA
| | - Mark Belsky
- Newton-Wellesley Hospital, MA, USA
- Hand Surgery, PC, Newton, MA, USA
| | - Mark A Vitale
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT, USA
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13
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Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal Radioulnar Joint: Normal Anatomy, Imaging of Common Disorders, and Injury Classification. Radiographics 2023; 43:e220109. [DOI: 10.1148/rg.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dyan V. Flores
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Kawan S. Rakhra
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Zaid Jibri
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Gonzalo A. Serrano Belmar
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
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14
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Swinging injuries in competitive baseball players. Skeletal Radiol 2022; 52:1277-1292. [PMID: 36542131 DOI: 10.1007/s00256-022-04261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Injuries are common in competitive baseball players and can occur in all facets of the game. The majority of the existing literature on injuries in baseball players has focused on injuries secondary to the overhead throw with very little attention given to injuries sustained while batting. The baseball swing is a complex, often violent, motion that predisposes batters to a variety of injuries affecting the spine, trunk, pelvis, and extremities. Knowledge of injury patterns that commonly occur during the baseball swing and radiologic findings important to the treating physician can help radiologists provide accurate imaging interpretations that appropriately guide patient management.
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Tanaka S, Inui A, Mifune Y, Nishimoto H, Yoshikawa T, Shinohara I, Furukawa T, Kato T, Kusunose M, Kuroda R. Motion Analysis of the Extensor Carpi Ulnaris in Triangular Fibrocartilage Complex Injury Using Ultrasonography Images. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22218216. [PMID: 36365914 PMCID: PMC9657429 DOI: 10.3390/s22218216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 05/14/2023]
Abstract
The subsheath of the extensor carpi ulnaris (ECU) tendon, a component of the triangular fibrocartilage complex (TFCC), is particularly important as it dynamically stabilizes the distal radioulnar joint. However, the relationship between TFCC injury and ECU dynamics remains unclear. This study aimed to analyze ECU movement and morphology using ultrasonography (US) images. Twenty wrists of patients with TFCC injury, who underwent TFCC repair, were included in the injury group, and 20 wrists of healthy volunteers were in the control group. For static image analysis, curvature and linearity ratios of the ECU in US long-axis images captured during radioulnar deviation were analyzed. For dynamic analysis of the ECU, the wrist was moved from radial deviation to ulnar deviation at a constant speed, and the velocity of the tendon was analyzed using particle image velocimetry. The static analysis showed that the ECU tendon was more curved in ulnar deviation in the injury group than in the control group, and the dynamic analysis showed that only vertical velocity toward the deep side during ulnar deviation was higher in the injury group. These results suggest that TFCC injury caused ECU curvature during ulnar deviation and increased the vertical velocity of the ECU during wrist deviation.
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Affiliation(s)
| | | | - Yutaka Mifune
- Correspondence: ; Tel.: +81-78-382-5111; Fax: +81-78-351-6944
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16
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Lee YK. Treatment of subacute/chronic ECU tendinopathy using wrist arthroscopy and open surgical repair. J Orthop Surg (Hong Kong) 2022; 30:23094990211067009. [PMID: 34986044 DOI: 10.1177/23094990211067009] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report the arthroscopic and clinical findings of patients with extensor carpi ulnaris (ECU) tendinopathy treated with wrist arthroscopy and open surgical repair. METHODS We retrospectively reviewed the medical records of seven patients with chronic ECU tendinopathy who were treated with diagnostic wrist arthroscopy and open surgical repair between 2010 and 2017. Seven cases diagnosed with ECU tendinopathy had undergone open procedure for the ECU tendinopathy, as well as wrist arthroscopy in the same session. Any pathology of the triangular fibrocartilage complex (TFCC) diagnosed by wrist arthroscopy were treated simultaneously with open procedure for the ECU tendinopathy. The functional outcome was evaluated by comparing the preoperative and final follow-up values of range of motion (ROM), grip strength, visual analog scale (VAS) for pain, modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) score. RESULTS TFCC tears were identified in four patients of which repair was performed concomitantly. The average follow-up period was 39 months (range, 25-49 months). At the final follow-up, all the outcomes including average VAS score (6.4→1), the ROM (173→192°), quick DASH score (42.5→18.2), and modified Mayo wrist score (48.6→79.3) improved significantly. CONCLUSION When treating patients with ECU tendinopathy, the possibility of TFCC combined injury should always be considered. If surgical treatment is planned, we suggest a wrist arthroscopy for more accurate diagnosis an intra-articular pathology, particularly for patients whose MRI findings suggest a degenerative tear or degeneration at the periphery of the TFCC. Additionally, if ECU and DRUJ stability is obtained by repair or reconstruction of the concurrent pathologies in the ECU subsheath, TFCC and other intra-articular structures, the results will be favorable.
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Affiliation(s)
- Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
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17
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Öztürk T, Burtaç Eren M. Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)? Acta Orthop Belg 2021. [DOI: 10.52628/87.2.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The extensor carpi ulnaris (ECU) tendon is in the sixth extensor compartment of the wrist and is isolated from other tendons by a different sheath. Extensor carpi ulnaris pathologies are characterized by pain locally localized to the wrist ulnar side. Outpatient records and wrist MRI (magnetic resonance imaging) tests were retrospectively scanned between January 2018 and July 2019. By examining the anamnesis and examination notes of the patients in the outpatient clinic records, patients with wrist ulnar side pain, pain or sensitivity on the ulnar styloid and provocation test (synergy) were assigned to the first study group (Group 1).The second study group was composed of patients who underwent wrist MR for the diagnosis or differential diagnosis of a synovial cyst around the wrist, without ulnar side pain (Group 2).While evaluating MR images in the axial plane, the depth and width of the ulnar groove, thickness of the ECU tendon were measured. The position of the ECU tendon relative to the ulnar groove and the forearm rotation during the shooting were recorded.105 cases evaluated, there were 41 cases in the symptomatic subgroup and 64 cases in the asymptomatic subgroup. Among all patients, the mean patient age was 38.05.In the evaluation according to whether cases were symptomatic or not, there was no significant relationship between being symptomatic and the degree of instability and MR withdrawal position.
Our study suggests that ECU instability in MR is not a specific condition, and detection of MR in instability may not be associated with a patient’s symptoms.
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18
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Rios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W. Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options. Curr Sports Med Rep 2021; 20:312-318. [PMID: 34099609 DOI: 10.1249/jsr.0000000000000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.
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Affiliation(s)
- Jose L Rios-Russo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - Lianette S Lozada-Bado
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - Sandra de Mel
- Ponce Health Sciences School of Medicine, Ponce Health Sciences University, Ponce, PUERTO RICO
| | - Walter Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - William Micheo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
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Abstract
Magnetic resonance imaging (MRI) is frequently used in the imaging evaluation of wrist pain. The complex anatomy of the wrist can be demonstrated by MRI. Three tesla (3 T) MRI offers increased signal-to-noise ratio relative to 1.5 T MRI allowing for higher soft tissue contrast and better spatial resolution. The resulting increase in conspicuity of fine anatomic detail may improve the detection and characterization of wrist pathology. In this article, we will review the anatomy, normal variants, and common pathologies of the wrist tendons as evaluated on 3 T MRI.
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Shannon N, Cable B, Wood T, Kelly J. Common and Less Well-known Upper-limb Injuries in Elite Tennis Players. Curr Sports Med Rep 2021; 19:414-421. [PMID: 33031207 DOI: 10.1249/jsr.0000000000000760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.
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Affiliation(s)
| | - Brian Cable
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Timothy Wood
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - John Kelly
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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21
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An Evidence-Based Review of Overuse Wrist Injuries in Athletes. Orthop Clin North Am 2020; 51:499-509. [PMID: 32950219 DOI: 10.1016/j.ocl.2020.06.007] [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: 02/02/2023]
Abstract
Overuse wrist injuries are a common problem in athletes and can be related to tendinopathies or osteoarticular pathology. Fortunately, athletes rarely miss time from their sport due to these conditions because many can be treated nonoperatively. For refractory cases, there often is a curative surgical procedure that can be done during the off-season.
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22
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Tomori Y, Nanno M, Takai S. Recurrent Dislocation of the Extensor Carpi Ulnaris Tendon with Ulnar-Sided Triangular Fibrocartilage Complex Injury in an Ice Hockey Player: A Case Report. J NIPPON MED SCH 2020; 87:233-239. [DOI: 10.1272/jnms.jnms.2020_87-410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yuji Tomori
- Department of Orthopedic Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Mitsuhiko Nanno
- Department of Orthopedic Surgery, Nippon Medical School Hospital
| | - Shinro Takai
- Department of Orthopedic Surgery, Nippon Medical School Hospital
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Levy SM, Reid M, Montgomery AM, Botterill E, Kovalchik SA, Omizzolo M, Malara F, Wood TO, Hoy GA, Rotstein AH. Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players? Skeletal Radiol 2020; 49:407-415. [PMID: 31401682 DOI: 10.1007/s00256-019-03285-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI). MATERIALS AND METHODS Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists. RESULTS Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls. CONCLUSIONS Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.
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Affiliation(s)
- Sidney M Levy
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia.
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.
| | - Machar Reid
- Tennis Australia, Melbourne, Victoria, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Elissa Botterill
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia
| | - Stephanie A Kovalchik
- Tennis Australia, Melbourne, Victoria, Australia
- Institute of Exercise, Sport and Active Living, Victoria University, Melbourne, Victoria, Australia
| | | | - Frank Malara
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia
| | | | - Gregory A Hoy
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Andrew H Rotstein
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia
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Reid M, Wood T, Montgomery AM, Botterill E, Kovalchik S, Omizzolo M, Malara F, Rotstein A, Hoy G. MRI does not effectively diagnose ulnar-sided wrist pain in elite tennis players. J Sci Med Sport 2020; 23:564-568. [PMID: 32081605 DOI: 10.1016/j.jsams.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/06/2019] [Accepted: 01/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players using a double-handed backhand technique. This study investigated the radiological changes of the non-dominant wrist in elite symptomatic and asymptomatic players using this technique as well as healthy controls. We compared clinical findings to radiological abnormalities. DESIGN Cross-sectional design with blinded radiological assessment, and contemporaneous clinical assessment of symptomatic players. METHODS Magnetic resonance images (MRI) of wrists related to non-dominant ulnar-sided pain, were taken in 14 symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls which were then independently reviewed for abnormalities by blinded radiologists. Total abnormalities and global between-group differences in the triangular fibrocartilage complex (TFC), ulnar collateral ligament (UCL), extensor carpi ulnaris (ECU) and supporting structures, osseous-articular lesions and ganglia were assessed. These were then compared to clinical examinations of the symptomatic players to assess agreement. RESULTS Symptomatic players reported a mean 3.64 abnormalities, being exactly 1 abnormality greater than asymptomatic players (2.64) and controls (2.50), suggesting similar asymptomatic lesions in all three groups. Players with pain reported significantly more osseous-articular lesions, ECU tendon and dorsal radio-ulnar ligament abnormalities, while changes to the UCL may reflect an isolated problem in specific wrists. There were no between-group differences in the presence of ganglia, most TFC structures nor ECU subsheath tear and subluxation. CONCLUSIONS Clinicians should carefully consider radiological changes alongside their clinical diagnosis of non-dominant wrist pain in tennis players due to possible tennis-related changes and/or asymptomatic findings.
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Affiliation(s)
- Machar Reid
- Tennis Australia, Australia; University of Western Australia, Australia.
| | | | | | | | - Stephanie Kovalchik
- Tennis Australia, Australia; Institute of Exercise, Sport and Active Living, Victoria University, Australia
| | | | | | | | - Gregory Hoy
- Melbourne Orthopaedic Group, Monash University, Department of Surgery, Australia
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26
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VIDEO: Dynamic Ultrasound Evaluation for Soft-Tissue Injuries of the Extremities: Hand, Wrist, and Ankle. AJR Am J Roentgenol 2020; 214:871. [PMID: 32045309 DOI: 10.2214/ajr.19.22040] [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: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.
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Long-Term Outcomes After Extensor Carpi Ulnaris Subsheath Reconstruction With Extensor Retinaculum. Tech Hand Up Extrem Surg 2019; 24:2-6. [PMID: 31343594 DOI: 10.1097/bth.0000000000000257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study assessed the long-term outcomes and complications of patients that underwent operative treatment for extensor carpi ulnaris subluxation. Fifteen patients underwent extensor carpi ulnaris subsheath reconstruction at a median of 5.9 weeks nonoperative treatment interval (interquartile range: 2.4 to 13). Reconstruction consisted of using the extensor retinaculum as a sling reconstruction. We found that about 1 in 3 patients had a complication or reoperation. At a median of 8 years follow-up, many patients had some residual symptoms, but in general, most patients were satisfied.
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29
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Sandman E, Boily M, Martineau PA. "Hockey wrist:" dorsal ulnotriquetral ligament injury. Can J Surg 2019; 61:398-404. [PMID: 30265639 DOI: 10.1503/cjs.012917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum. METHODS We performed a biomechanical study on 7 fresh frozen cadaveric upper extremities, with testing done on a wrist-movement stimulator to identify the position (45° of wrist flexion, 45° of wrist extension or neutral) that generated the highest and earliest strain increases in the DUTL. We performed load-to-failure testing, characterized the ligament's pattern of failure, and repaired and retested the DUTL using the same load-to-failure protocol. RESULTS The DUTL reached 3 N∙m the earliest in 45° of wrist flexion (p = 0.02). The native DUTL failed at 0.35 N∙m (standard deviation [SD] 0.13 N∙m) per degree of angular stiffness, 12.93 N∙m of yield strength and with angular deformation of 57.73° (SD 20.62°). There was no significant difference in these variables between the native and repaired DUTL. Tearing occurred at a mean of 10 mm (SD 2 mm) proximal from the triquetrum's insertion in a transverse midsubstance pattern. CONCLUSION This study showed a reproducible pattern of injury to the DUTL in a cadaveric model. Additional work is needed to further characterize the pathoanatomy of "hockey wrist."
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Affiliation(s)
- Emilie Sandman
- From the Université de Montréal, Montréal, Que. (Sandman); the Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Sandman); McGill University, Montréal, Que. (Boily, Martineau); and the Departments of Radiology (Boily) and Orthopedic Surgery (Martineau), Montreal University Health Centre, Montréal, Que
| | - Mathieu Boily
- From the Université de Montréal, Montréal, Que. (Sandman); the Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Sandman); McGill University, Montréal, Que. (Boily, Martineau); and the Departments of Radiology (Boily) and Orthopedic Surgery (Martineau), Montreal University Health Centre, Montréal, Que
| | - Paul A Martineau
- From the Université de Montréal, Montréal, Que. (Sandman); the Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Sandman); McGill University, Montréal, Que. (Boily, Martineau); and the Departments of Radiology (Boily) and Orthopedic Surgery (Martineau), Montreal University Health Centre, Montréal, Que
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30
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Abstract
This study determined the effect of skill level (ITN 3 vs. ITN 8) on the tennis serve biomechanics and analysed the impact of forearm fatigue on dominant arm mechanisms between the two groups (expert vs. non-expert tennis players). The motion capture system with 17 reflective markers attached on anatomic landmarks of the participant was used for data collection. A total of 12 expert and 11 non-expert tennis players performed the required serving tasks. The ball speed of the expert group was significantly faster than that of the non-expert group during non-fatigued and fatigued states (p < 0.001). The wrist radial/ulnar deviation angle at impact was significantly different between non-fatigued and fatigued states for top-spin (p = 0.030) and flat serves (p = 0.018). A significant increase in extensor carpi ulnaris (ECU) and extensor carpi radialis (ECR) muscle activity during extension (p < 0.010) was observed, with that of the ECU being an ulnar deviation. Both the ECU and ECR might contribute to wrist joint and racket handle stability for the coming acceleration and impact while fatigue occurs. Fatigue might substantially influence non-experts' dominant forearms because of the significantly different elbow joint angles and dominant arm syndromes they displayed as compared with the experts.
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Affiliation(s)
- Lin-Hwa Wang
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Cheng Lo
- Physical Education Office, Kun Shan University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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31
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Shrier I, Morrison DR, Hawkes R. Looking Further When Symptoms Are Disproportionate to Physical Findings. Med Sci Sports Exerc 2018; 51:1-3. [PMID: 30095741 DOI: 10.1249/mss.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 36-yr-old man presents with left ulnar-side wrist pain during an ice hockey game that prevented him from playing hockey or golf. There was no acute mechanism of injury. The usual clinical examination revealed only minimal tenderness and minimal pain with resisted wrist extension. Careful attention to precipitating factors led to testing resisted wrist extension with the forearm fully supinated, which reliably reproduced the intensity of the patient's symptoms, and a diagnosis of extensor carpi ulnaris tendinopathy. A literature review suggested three additional special tests (two were positive) and management. However, a standard of care has yet been established because neither the tests nor the management has been properly validated through research, thus leaving the management of this condition as an art.
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Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, CANADA
| | - David R Morrison
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, CANADA
| | - Roger Hawkes
- European Tour Performance Institute, European Tour, UNITED KINGDOM
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32
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Stuelcken M, Mellifont D, Gorman A, Sayers M. Wrist Injuries in Tennis Players: A Narrative Review. Sports Med 2018; 47:857-868. [PMID: 27699697 DOI: 10.1007/s40279-016-0630-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The wrist/hand complex forms the crucial final link in the kinetic chain between the body and the racquet and therefore has a number of important roles in the production of all tennis strokes. However, the internal and external loads that are created at the wrist during these strokes have the potential to contribute to pain and injury. Therefore, the purposes of this narrative review are to (1) determine the extent of the problem of wrist pain/injury in tennis players, (2) identify bony and soft tissue structures of the wrist that are susceptible to damage as a result of tennis play and (3) explore factors that may influence the development of wrist pain/injury in tennis players. The epidemiological data revealed two important points. First, some evidence suggests wrist pain/injury accounts for a higher percentage of total injuries in more recent studies (2014-2015) than in early studies (1986-1995). Second, the relative frequency of wrist pain/injury compared with other well-recognized problem areas for tennis players such as the shoulder complex, elbow and lumbar spine is noticeably higher in more recent studies (2014-2015) than in early studies (1986-1995), particularly among females. Collectively, this would seem to indicate that the problem of wrist pain/injury has increased in the modern game. In fact, some wrist injuries appear to be related to the use of certain forehand grip types and the predominant use of the two-handed backhand. While the loads experienced at the wrist during tennis stroke production seem to be below threshold levels for a single event, the cumulative effects of these loads through repetition would appear to be an important consideration, especially when inadequate time is allowed to complete normal processes of repair and adaptation. This is supported by the evidence that most wrist injuries in tennis are associated with overuse and a chronic time course. The complex interaction between load, repetition, and training practices in tennis, particularly among young developing players who choose a path of early specialization, needs to be further explored.
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Affiliation(s)
- Max Stuelcken
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia.
| | - Daniel Mellifont
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Adam Gorman
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Mark Sayers
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
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Quadlbauer S, Pezzei C, Hintringer W, Hausner T, Leixnering M. Klinische Untersuchung des distalen Radioulnargelenks. DER ORTHOPADE 2018; 47:628-636. [DOI: 10.1007/s00132-018-3584-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shin SH, Lee YS, Kang JW, Noh DY, Jung JY, Chung YG. Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist. Clin Orthop Surg 2018; 10:80-88. [PMID: 29564051 PMCID: PMC5851858 DOI: 10.4055/cios.2018.10.1.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. Methods Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between “the line of humeral long axis projected on the axial plane of the ulna” and “the line passing the center of the ulnar head and the center of the ulnar styloid” was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of “the volar-dorsal diameter of the ulnar head” and “the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid” was calculated (ulnar styloid location ratio). Results The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. Conclusions The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated position on an axial CT/magnetic resonance imaging scan or a lateral radiograph of the wrist.
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Affiliation(s)
- Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Suk Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Woo Kang
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Young Noh
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gitto S, Draghi AG, Draghi F. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:51-68. [PMID: 28708327 DOI: 10.1002/jum.14313] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.
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Affiliation(s)
- Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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Kohyama S, Tanaka T, Okano E, Naoyuki O. Anatomical Variations of the Extensor Carpi Ulnaris Groove: A New Computed Tomography-based Evaluation. J Hand Surg Asian Pac Vol 2017; 22:281-285. [PMID: 28774256 DOI: 10.1142/s0218810417500307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to develop a classification that precisely describes the extensor carpi ulnaris (ECU) groove morphology. METHODS Reconstructed axial plane computed tomography scans of the wrists of 200 patients were reviewed. Three groups of groove shape were created based on the position of the deepest point: deviated to the ulnar side (Type U), in the middle of the groove (Type M), and deviated to the radial side (Type R). Groove depth, width, carrying angle, and radius of the curvature were measured using the Picture Archiving and Communication System in a slice in which the ulnar head was the largest. RESULTS Type U was present in 88 patients (44%), Type M in 74 patients (37%), and Type R in 38 patients (19%). The average depth, width, carrying angle, and radius of curvature were 2.2 mm, 9.2 mm, 135.8° and 7.0 mm, respectively. Depth, width, and carrying angle were normally distributed. Both depth and width were statistically correlated with the carrying angle; groove depth and width were not correlated. ECU groove shape and depth showed excellent intra- and inter-observer reliabilities; the reliabilities for the width were poor. Therefore, depth subgroups were defined using cutoffs of ±2 standard deviations (SD): d1 (≤-2 SD), ≤1.0 mm; d2 (±SD), 1.1-3.3 mm; and d3 (≥+2 SD), ≥3.4 mm. The 200 wrists were classified as follows: 0.5% Ud1, 40.2% Ud2, 1.3% Ud3, 0.8% Md1, 38.3% Md2, 0.8% Md3, 1.5% Rd1, 16.4% Rd2, and 0.2% Rd3. CONCLUSIONS The detailed morphology of the ECU groove was classified using three major types and depth subgroups. The Type R ECU groove, which lacks a medial bony buttress, might be more prone to ECU-related injuries. This classification helps to understand the ECU tendon-related injury pathologies and may provide valuable information for treatment decisions; however, further research is necessary.
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Affiliation(s)
- Sho Kohyama
- 1 Department of Orthopedic Surgery, Kikkoman General Hospital, Noda, Chiba, Japan
| | - Toshikazu Tanaka
- 1 Department of Orthopedic Surgery, Kikkoman General Hospital, Noda, Chiba, Japan
| | - Eriko Okano
- 1 Department of Orthopedic Surgery, Kikkoman General Hospital, Noda, Chiba, Japan
| | - Ochiai Naoyuki
- 1 Department of Orthopedic Surgery, Kikkoman General Hospital, Noda, Chiba, Japan
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Abstract
Determining the etiology of ulnar-sided wrist pain is often challenging. The condition may be acute or chronic, and differential diagnoses include injuries to the ulnar carpal bones, ligament tears, tendinitis, vascular conditions, osteoarthritis and systemic arthritis, and ulnar nerve compression. An anatomically based, methodical physical examination coupled with provocative maneuvers, including piano key, ulnar impaction, shuck, foveal stress, and extensor carpi ulnaris synergy tests, further defines the differential diagnosis. Diagnostic imaging used in the evaluation of ulnar-sided wrist pain includes plain radiographs and MRI with or without arthrography. Wrist arthroscopy is becoming increasingly important in the diagnosis and management of ulnar-sided intra-articular wrist pathology.
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Abstract
PURPOSE OF REVIEW The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. RECENT FINDINGS Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients. In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.
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Abstract
A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal antiinflammatory drug medication with corticosteroid injection and swing modification. Pisiform excision is the best treatment of the most severe chronic cases of pisiform ligament complex syndrome. Delayed diagnosis of hook of hamate fracture may lead to complications, including flexor tendon rupture. Prompt surgical resection is recommended to hasten return to sport and to prevent further complications.
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Affiliation(s)
- Sang-Hyun Woo
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-Gu, Daegu 42642, Korea
| | - Young-Keun Lee
- Department of Orthopaedic Surgery, Chonbuk National University Hospital, 93, Changpo-gil, Deokjin-gu, Jeonju, Jeollabuk-do 54896, Korea.
| | - Jong-Min Kim
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-Gu, Daegu 42642, Korea
| | - Ho-Jun Cheon
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-Gu, Daegu 42642, Korea
| | - William H J Chung
- Comprehensive Hand Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 14 G200, Ann Arbor, MI 48109, USA
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El-Gohary R, Khalil A, El-Gendy H. Beneath a Dimple. J Med Ultrasound 2016. [DOI: 10.1016/j.jmu.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ruchelsman DE, Vitale MA. Extensor Carpi Ulnaris Subsheath Reconstruction. J Hand Surg Am 2016; 41:e433-e439. [PMID: 27653142 DOI: 10.1016/j.jhsa.2016.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/19/2016] [Indexed: 02/02/2023]
Abstract
Acute extensor carpi ulnaris (ECU) subsheath injury and chronic subsheath insufficiency may result in symptomatic ECU instability at the level of the distal ulna osseous sulcus. Associated ulnocarpal (ie, triangular fibrocartilage complex) and ECU intrinsic tendinopathic changes may accompany subsheath pathologies and require concomitant treatment. Surgical treatment is indicated in refractory cases despite nonoperative treatment and may consist of repair of the torn edge of the ECU subsheath or, more frequently, reconstruction utilizing a radially based extensor retinacular sling. An ECU subsheath reconstructive technique is detailed.
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Affiliation(s)
- David E Ruchelsman
- Division of Hand Surgery, Newton-Wellesley Hospital, Department of Orthopaedic Surgery, Tufts University School of Medicine, Hand Surgery Research and Education Foundation, Newton, MA.
| | - Mark A Vitale
- Orthopaedic & Neurosurgery Specialists, ONS Foundation for Clinical Research and Education, Greenwich, CT
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Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res 2016; 11:99. [PMID: 27633260 PMCID: PMC5025579 DOI: 10.1186/s13018-016-0432-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population. Main body The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided. Conclusion Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
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Affiliation(s)
- Daniel M Avery
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA.
| | - Craig M Rodner
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
| | - Cory M Edgar
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
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O'Connor PJ, Campbell R, Bharath AK, Campbell D, Hawkes R, Robinson P. Pictorial review of wrist injuries in the elite golfer. Br J Sports Med 2016; 50:1053-63. [DOI: 10.1136/bjsports-2016-096149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 11/04/2022]
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ECU tendon "dislocation" in asymptomatic volunteers. Skeletal Radiol 2016; 45:805-12. [PMID: 26980226 DOI: 10.1007/s00256-016-2352-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Assess extensor carpi ulnaris (ECU) tendon position in the ulnar groove, determine the frequency of tendon "dislocation" with the forearm prone, neutral, and supine, and determine if an association exists between ulnar groove morphology and tendon position in asymptomatic volunteers. MATERIALS AND METHODS Axial proton density-weighted MR was performed through the distal radioulnar joint with the forearm prone, neutral, and supine in 38 asymptomatic wrists. The percentage of the tendon located beyond the ulnar-most border of the ulnar groove was recorded. Ulnar groove depth and length was measured and ECU tendon signal was assessed. RESULTS 15.8 % of tendons remained within the groove in all forearm positions. In 76.3 %, the tendon translated medially from prone to supine. The tendon "dislocated" in 0, 10.5, and 39.5 % with the forearm prone, neutral and supine, respectively. In 7.9 % prone, 5.3 % neutral, and 10.5 % supine exams, the tendon was 51-99 % beyond the ulnar border of the ulnar groove. Mean ulnar groove depth and length were 1.6 and 7.7 mm, respectively, with an overall trend towards greater degrees of tendon translation in shorter, shallower ulnar grooves. CONCLUSIONS The ECU tendon shifts in a medial direction when the forearm is supine; however, tendon "dislocation" has not been previously documented in asymptomatic volunteers. The ECU tendon medially translated or frankly dislocated from the ulnar groove in the majority of our asymptomatic volunteers, particularly when the forearm is supine. Overall greater degrees of tendon translation were observed in shorter and shallower ulnar grooves.
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Conroy C, Ruchelsman DE, Vitale MA. Extensor Carpi Ulnaris Instability in Athletes - Diagnosis and Treatment. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Karakostis FA, Lorenzo C. Morphometric patterns among the 3D surface areas of human hand entheses. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:694-707. [DOI: 10.1002/ajpa.22999] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/20/2016] [Accepted: 04/09/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Fotios Alexandros Karakostis
- Senckenberg Center for Human Evolution and Palaeoenvironments; Eberhard Karls University at Tübingen; Rumelinstrasse 23 Tübingen 72070 Germany
| | - Carlos Lorenzo
- Area de Prehistoria; Universitat Rovira i Virgili; Av. Catalunya 35 Tarragona 43002 Spain
- Institut de Paleoecologia Humana i Evolució Social (IPHES); Campus Sescelades (Edifici W3) Tarragona 43007 Spain
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Sato J, Ishii Y, Noguchi H. Diagnostic Performance of the Extensor Carpi Ulnaris (ECU) Synergy Test to Detect Sonographic ECU Abnormalities in Chronic Dorsal Ulnar-Sided Wrist Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:7-14. [PMID: 26589644 DOI: 10.7863/ultra.15.01055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The extensor carpi ulnaris (ECU) tendon synergy test is a simple and unique diagnostic maneuver for evaluation of chronic dorsal ulnar-sided wrist pain, which applies isolated tension to the ECU without greatly stressing other structures. This study aimed to investigate the diagnostic performance of the ECU synergy test to detect ECU abnormalities on sonography. METHODS Forty affected wrists from 39 consecutive patients with chronic dorsal ulnar-sided wrist pain that continued for greater than 1 month were examined with the ECU synergy test and sonography. The sensitivity, specificity, positive predictive value, and negative predictive value of the ECU synergy test to detect ECU abnormalities were evaluated. We compared the results of the ECU synergy test between groups with and without ECU abnormalities and also compared the ages, sexes, and symptomatic durations of the patients between groups with positive and negative ECU synergy test results and between the groups with and without ECU abnormalities. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value were 73.7%, 85.7%, 82.4%, and 78.3%, respectively. There was significant difference in the ECU synergy test results between the groups with and without ECU abnormalities (P < .01). There was no significant difference in age, sex, or symptomatic duration between any of the groups. CONCLUSIONS The results of this prospective study support the hypothesis that the ECU synergy test could be a useful provocative maneuver to detect ECU abnormalities in patients with chronic dorsal ulnar-sided wrist pain.
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Affiliation(s)
- Junko Sato
- Ishii Orthopedic and Rehabilitation Clinic, Saitama, Japan.
| | | | - Hideo Noguchi
- Ishii Orthopedic and Rehabilitation Clinic, Saitama, Japan
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Abstract
Tendinopathies involving the hand and wrist are common. Many are diagnosed easily, and in many cases, the management is straightforward, provided the pathology and principles are understood. Common conditions involving the tendons of the hand and wrist include trigger finger, tenosynovitis of the first through sixth dorsal extensor compartments, and flexor carpi radialis tendonitis. Management strategies include nonsurgical treatments, such as splinting, injection, or therapy, and surgical techniques such as tendon release.
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49
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Olchowy C, Łasecki M, Zaleska-Dorobisz U. Wrist ultrasound examination - scanning technique and ultrasound anatomy. Part 1: Dorsal wrist. J Ultrason 2015; 15:172-88. [PMID: 26675810 PMCID: PMC4579750 DOI: 10.15557/jou.2015.0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/09/2015] [Accepted: 01/29/2015] [Indexed: 11/26/2022] Open
Abstract
Ultrasound imaging of the musculoskeletal system is superior to other imaging methods in many aspects, such as multidimensional character of imaging, possibility of dynamic evaluation and precise assessment of soft tissues. Moreover, it is a safe and relatively inexpensive method, broadly available and well-tolerated by patients. A correctly conducted ultrasound examination of the wrist delivers detailed information concerning the condition of tendons, muscles, ligaments, nerves and vessels. However, the knowledge of anatomy is crucial to establish a correct ultrasound diagnosis, also in wrist assessment. An ultrasound examination of the wrist is one of the most common US examinations conducted in patients with rheumatological diseases. Ultrasonographic signs depend on the advancement of the disease. The examination is equally frequently conducted in patients with pain or swelling of the wrist due to non-rheumatological causes. The aim of this publication was to present ultrasound images and anatomic schemes corresponding to them. The correct scanning technique of the dorsal part of the wrist was discussed and some practical tips, thanks to which highly diagnostic images can be obtained, were presented. The following anatomical structures should be visualized in an ultrasound examination of the dorsal wrist: distal radio-ulnar joint, radiocarpal joint, midcarpal joint, carpometacarpal joints, dorsal radiocarpal ligament, compartments of extensor tendons, radial artery, cephalic vein, two small branches of the radial nerve: superficial and deep, as well as certain midcarpal ligaments, particularly the scapholunate ligament and lunotriquetral ligament. The paper was distinguished in 2014 as the “poster of the month” (poster number C-1896) during the poster session of the European Congress of Radiology in Vienna.
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Affiliation(s)
- Cyprian Olchowy
- Division of General and Pediatric Radiology, Department of Radiology, Medical University of Wroclaw, Poland
| | - Mateusz Łasecki
- Division of General and Pediatric Radiology, Department of Radiology, Medical University of Wroclaw, Poland
| | - Urszula Zaleska-Dorobisz
- Division of General and Pediatric Radiology, Department of Radiology, Medical University of Wroclaw, Poland
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50
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Kollitz KM, Iorio ML, Huang JI. Assessment and Treatment of Extensor Carpi Ulnaris Tendon Pathology: A Critical Analysis Review. JBJS Rev 2015; 3:01874474-201506000-00003. [PMID: 27490014 DOI: 10.2106/jbjs.rvw.n.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kathleen M Kollitz
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105
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