Ulnar‐sided wrist pain: a prospective analysis of diagnostic clinical tests

Abstract

Background Identifying the cause of pain on the ulnar side of the wrist can be challenging. The outcome and recovery following surgery can be unpredictable. The aim of this study was to document and analyse the clinical tests used to evaluate the cause of ulnar‐sided wrist pain and determine their diagnostic relevance. Methods This is a prospective evaluation of 110 patients who presented with pain on the ulnar side of the wrist. The clinical evaluation and results from radiological investigations were documented and analysed. Results There were 17 different diagnoses. Eighty‐five percent of the diagnoses were triangular fibrocartilage complex (TFCC) injuries, ulnocarpal abutment syndrome (UCAS), pisotriquetral arthritis (PTA), triquetral fracture or non‐union, distal radioulnar joint arthritis (DRUJ OA) and extensor carpi ulnaris (ECU) pathology. The ulnocarpal stress test and ulnar foveal sign were positive in several diagnoses. The ulnar foveal sign had a sensitivity and specificity of 89% and 48% for TFCC injuries, and 85% and 37% for UCAS, respectively. The sensitivity and specificity of pisotriquetral shear test for PTA was 100% and 92%, respectively. Patients with PTA or ECU pathology localised their pain better on the patient's pain localisation chart. Conclusion Diagnosis of TFCC injuries, UCAS, DRUJ OA and ECU injuries are challenging as the clinical symptoms and signs for the four diagnoses were similar and required either magnetic resonance imaging or computed tomography for diagnostic confirmation after clinical examination. The ulnocarpal stress test and the ulnar foveal sign were not sufficiently specific.

Effect of Acupotomy Combined with Electroacupuncture Therapy on Finger Mobility and Pain Relief in Patients with Carpal Tunnel Syndrome

“…Electroacupuncture promotes the repair of median nerve and the recovery of wrist function and can also dredge local meridian qi [ 24 ]. In contrast, although the treatment plan of hot compress, oral medication, and local injection can reduce the clinical symptoms to a certain extent, the sustained efficacy is short and the disease are easy to relapse [ 25 ]. In terms of pain alleviation and finger mobility, the treatment group did better than the control group, indicating that acupotomy combined with electroacupuncture therapy can promote the finger mobility and relieve the pain efficaciously, so as to achieve the purpose of treating peripheral nerve injuries and restoring their function.…”

“…Electroacupuncture promotes the repair of median nerve and the recovery of wrist function and can also dredge local meridian qi [24]. In contrast, although the treatment plan of hot compress, oral medication, and local injection can reduce the clinical symptoms to a certain extent, the sustained efficacy is short and the disease are easy to relapse [25]. In terms of pain alleviation and finger mobility, the treatment group did better 4…”

Die klinische Diagnostik des Handgelenks

“…Die Sensitivität, um Rupturen im fovealen ulnaren Bereich zu entdecken, liegt bei 95 % und die Spezifität bei 87 % [34]. Für die Detektion von TFCC-Verletzungen liegt die Sensitivität bei 89 % und die Spezifität bei 48 % [28].…”

“…Keiner der oben beschriebenen Tests ist in der Lage, eine TFCC-Läsion und eine damit verbundene Instabilität des distalen Radioulnargelenks sicher aufzudecken 28 , 32 . Auch MRT-Aufnahmen weisen diagnostische Limitationen auf.…”

Ulnar Impaction Syndrome and TFCC Injury: Their Relationship and Management

“…The most common causes of USWP are ulnar impaction syndrome (UIS) and triangular fibrocartilage complex (TFCC) injury. 3 These two etiologies may also appear mixed, but their correlation is not clearly understood. For instance, in Palmer type 2, TFCC injury is considered the only accompanying lesion in the form of disc central perforation in a degenerative pattern in UIS with positive ulnar variance (UV).…”