Triangular Fibrocartilage Débridement and Arthroscopically Assisted Ulnar Shortening

Published on 11/03/2015 by admin

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Last modified 11/03/2015

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CHAPTER 22 Triangular Fibrocartilage Débridement and Arthroscopically Assisted Ulnar Shortening

A tear of the triangular fibrocartilage complex (TFCC) is one of the most frequent causes of ulnar wrist pain. Ulnar-sided wrist pain associated with a TFCC tear in the presence of an ulnar-neutral or ulnar-plus variance constitutes an ulnar abutment syndrome. Successful treatment of an ulnar abutment syndrome requires débridement of the TFCC tear and ulnar shortening.

PATIENT EVALUATION

Physical Examination

Ulnocarpal palpation can give some insight into the condition of the TFCC. The synovitis associated with a TFCC tear can render simple palpation of the ulnocarpal joint uncomfortable.

The ulnocarpal compression test (Fig. 22-3) is particularly helpful in assessing the patient with a suspected ulnar abutment syndrome. In this test, the patient sits in front of the examiner with the wrist in supination. The wrist is simultaneously ulnarly deviated and axially loaded while the forearm is supinated and pronated. The patient with an ulnar abutment syndrome experiences pain at the ulnocarpal joint, with or without popping and grinding, during this maneuver.

A variation of the ulnocarpal compression test is the Lester press test (Fig. 22-4).3 In this test, the patient sits in a chair with sturdy arms and lifts himself or herself off the chair seat. Pain at the ulnocarpal joint is considered pathognomonic for a TFCC tear.