Ulnar variance
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View Sonam Vadera's current disclosures- Hulten variance
Ulnar variance (also known as Hulten variance) refers to the relative lengths of the distal articular surfaces of the radius and ulna and is primarily a plain radiographic determination.
Ulnar variance may be:
neutral (both the ulnar and radial articular surfaces at the same level)
positive (ulna projects more distally)
negative (ulna projects more proximally)
Variance is independent of the length of the ulnar styloid process.
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Images:
Pathology
Etiology
-
trauma or mechanical
distal radius/ulnar fractures with shortening (e.g. impaction) and angulation
distal radioulnar joint ligamentous injuries (e.g. Galeazzi and Essex-Lopresti-fracture dislocations)
surgical shortening of ulna or radius
growth arrest (e.g. previous Salter-Harris fracture)
-
congenital
Associations
positive ulnar variance is associated with ulnar impaction syndrome
negative ulnar variance is associated with Kienbock disease and ulnar impingement syndrome
Radiographic assessment
Ulnar variance changes with wrist position (more positive with maximum forearm pronation and negative with maximum forearm supination) and increases significantly during a firm grip 1.
To determine ulnar variance on radiographs, the generally accepted standard view is a posteroanterior view obtained with the wrist in neutral forearm rotation, the elbow flexed 90° and the shoulder abducted 90°.
Positive variance occurs when the level of the ulna is >2.5 mm beyond the radius margin at the distal radioulnar joint (DRUJ). Negative variance is when the ulna is ≤2.5 mm than the radius at the DRUJ 1.
MRI
MRI can estimate, but cannot reliably quantify, the degree of ulnar variance because the specific wrist position usually cannot be duplicated with MR imaging.
See also
Quiz questions
References
- 1. Cerezal L, Del piñal F, Abascal F et-al. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics. 22 (1): 105-21. Radiographics (full text) - Pubmed citation
- 2. Greenspan A. Orthopedic imaging, a practical approach. Lippincott Williams & Wilkins. (2004) ISBN:0781750067. Read it at Google Books - Find it at Amazon
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