Ulnar Sided Wrist Pain - An Overview

Описание: Diagnosing ulnar-sided wrist pain requires differentiating between intracapsular and extracapsular pathologies through patient history and physical examination. Key diagnostic maneuvers include the fovea sign for TFCC tears, the ballottement and piano-key tests for distal radioulnar joint (DRUJ) instability, and the ECU synergy test for tendinopathy. Radiographs are essential for assessing ulnar variance, while CT and MRI scans evaluate sigmoid notch congruity and soft tissues. However, arthroscopy remains the "gold standard" for confirming diagnoses. Comprehensive assessment frameworks, such as the Four-Leaf Clover algorithm, guide treatment by systematically checking bone, cartilage, ligaments, and tendons.

Primary Sources for Concepts Discussed

1. Kakar S, Garcia-Elias M. The “Four-Leaf Clover” Treatment Algorithm: A Practical Approach to Manage Disorders of the Distal Radioulnar Joint. J Hand Surg Am. 2016;41(4):e-e.
2. Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg Br. 1996;21(5):587-594. (Cited in source and).
3. Palmer AK. Triangular fibrocartilage complex lesions: A classification. J Hand Surg Am. 1989;14A:594-606.
4. Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg. 2008;12(4):226–235. (Cited in source and).

Textbooks Used for Anatomical and Diagnostic Details

5. del Piñal F, Mathoulin C, Nakamura T, eds. Arthroscopic Management of Ulnar Pain. Springer-Verlag Berlin Heidelberg; 2012.
◦ Note: This text contains Chapter 2 (Anatomy) by Nakamura and Chapter 3 (Clinical Examination) by Garcia-Elias, which detail the physical examination maneuvers discussed.
6. del Piñal F, Mathoulin C, Luchetti R, eds. Arthroscopic Management of Distal Radius Fractures. Springer-Verlag Berlin Heidelberg; 2010.
◦ Note: This text contains Chapter 6 (Arthroscopic Management of DRUJ Instability) by Atzei, which details the management of foveal tears.
Additional Supporting Articles
7. Henry MH. Management of Acute Triangular Fibrocartilage Complex Injury of the Wrist. J Am Acad Orthop Surg. 2008;16(6):320-329.
8. Geissler WB. Arthroscopic knotless peripheral triangular fibrocartilage repair. J Hand Surg Am. 2012;37A(2):350-355.

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