Chronic wrist pain • Xray of the Week
Ulnar impingement syndrome also known as Radial Ulnar Abutment is caused by a shortened distal ulna that impinges on the distal radius proximal to the sigmoid notch. Patients with ulnar impingement syndrome have pain with pronation and supination of the forearm due to distal radioulnar contact. Compression of the distal radioulnar joint on forearm rotation increases the symptoms or produces grating in affected patients. Most often, a markedly shortened distal ulna results from any of the surgical procedures that involve resection of the distal ulna secondary to prior wrist trauma, rheumatoid arthritis, or correction of Madelung deformity. Less commonly, ulnar impingement may be present in de novo cases of negative ulnar variance or premature fusion of the distal ulna secondary to prior trauma.
If impingement is due to prior distal ulnar resection, treatment with aggressive ulnar shortening or ulnar head prostheses can be considered. Distraction lengthening of the ulna is the first consideration in for de novo negative ulnar variance as this can restore the normal anatomy.
Note the scalloping of the distal medial radius on this case of chronic impingement.
A vitamin E capsule is at the site of the patient’s pain. There is significant increased signal on the T2 weighted images in the adjacent soft issues due to chronic inflammation.
Phillip Tirman, MD is the Medical Director of Musculoskeletal Imaging at the Renaissance Imaging Center in Westlake Village, California. A nationally recognized expert in the applications of MRI for evaluating MSK and spine disorders, Dr. Tirman is the co-author of three textbooks, including MRI of the Shoulder and Diagnostic Imaging: Orthopedics. He is also the author or co-author on over sixty original scientific articles published in the radiology and orthopedic literature.
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Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator.
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