Ulnar impaction syndrome with Palmer 2E injury

Case contributed by Dr Matt Skalski


Ulnar sided wrist pain. Positive ulnar variance on radiographs. Assess for TFCC injury.

Patient Data

Age: 50
Gender: Female

MR arthrogram of the left wrist. There is poor distension of the wrist joint, with extravasation of much of the intraarticularly injected contrast. The contrast seen within the tendon sheath of the second and third extensor compartments, is likely related to inadvertent injection during the arthrogram procedure.

There is mild positive ulnar variance with subchondral cystic changes and edema along the ulnar aspect of the lunate and the radial aspect of the triquetrum. There is loss of cartilage in these regions as well. Dorsal subluxation of the ulna relative to the radius is noted. There is a large defect with maceration of the central portion of the triangular fibrocartilage as well as the volar aspect of the TFC complex (including the ulnolunate and ulnotriquetral ligaments). There linear area of contrast signal within the proximal portion of the lunotriquetral ligament suggesting a tear. 

Case Discussion

The findings in this case are typical of ulnar impaction syndrome with mild positive ulnar variance, a large defect of the TFC proper, edema and cystic changes of the lunate and triquetrum, and loss of their overlying cartilage. The TFC abnormalities fit a Palmer 2E classification.

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Case information

rID: 30793
Case created: 4th Sep 2014
Last edited: 9th Jan 2016
Inclusion in quiz mode: Included

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