Ulnar impaction syndrome

Case contributed by Dr Mostafa El-Feky

Presentation

Chronic ulnar-side wrist pain.

Patient Data

Age: 60 years
Gender: Male

Wrist

X-ray

Positive ulnar variance with bony protuberance of the ulnar styloid process. Calcific opacities are noted at the anatomical location of the triangular fibrocartilage complex (TFCC) reflecting underlying pathological changes. 

Wrist

MRI

Positive ulnar variance and elongation of the ulnar styloid process with bony protuberance and perifocal ligamentous hypertrophy.

Few tiny subarticular cystic changes and punctate cortical erosions are noted at the opposing articular surfaces, the ulnar aspect of lunate, the proximal pole of the triquetral bone and ulnar styloid tip, suggestive of ulnar impaction syndrome.

Abnormal signal of triangular fibrocartilage complex, suggestive of chronic degenerative changes. 

Mild wrist effusion.

Case Discussion

The MRI changes are reflecting chronic ulnar impaction syndrome caused by the tip of an oversized ulnar styloid. It results in positive ulnar variance, with osteomalacia of the opposing parts of carpal bones and degenerative changes of the triangular fibrocartilage.

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