Imaging Comparison Study of X-ray Plain Film, CT and MRI in Ulnar Impaction Syndrome_West China Medical Journal

Authors：

 CHENJun-rong , DANQian , ZHANGTao , DAICheng-zhong

Department of Radiology, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

Keywords：

Ulna; Impaction; Semilunar bone; Triquetrum; Osteonecrosis

DOI：

10.7507/1002-0179.20150138

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Objective To discuss the imaging manifestations of ulnar impaction syndrome, and to evaluate the diagnostic value of MR imaging. Methods The clinical data of 18 patients with clinical standard-proved ulnar impaction syndrome between January 2010 and June 2013 were retrospectively reviewed. Results Seventeen cases were diagnosed as ulna positive variation (94.6%), and the range of ulnar variance was 1.5 to 3.8 mm and the average ulnar variance was 2.6 mm. Neutral variance was found in one case. Fourteen cases had avascular necrosis or bone sclerosis of semilunar bone, and avascular necrosis or bone sclerosis of the triquetrum and ulnar was presented in 12 cases and 3 cases respectively on X-ray detection. CT scan showed that 16 cases of semilunar bone abnormalities (6 with ischemic necrosis), triquetrum osteonecrosis in 4 cases, and both necrosis of semilunar bone and triquetrum in 3 cases. On MRI, all cases had different degrees of damage, degeneration of semilunar bone, triquetrum, ulnar and triangular fibocartilage complex (ulnar side of the proximal end of the lunate in 18, radial side of the triquetrum in 17, distal joint surface of ulnar in 12, and triangular fibocartilage complex in 15). In the early stage, lesions were presented as edema of bone marrow and followed as different sizes of cystic change. Articular surface was collapsed later. Conclusion Ulnar positive variance has important reference value in the diagnosis of ulnar impaction syndrome. MRI can show the early change of ulnar impaction syndrome, and provide reliable decision basis for clinical diagnosis and treatment.

Citation： CHENJun-rong, DANQian, ZHANGTao, DAICheng-zhong. Imaging Comparison Study of X-ray Plain Film, CT and MRI in Ulnar Impaction Syndrome. West China Medical Journal, 2015, 30(3): 488-491. doi: 10.7507/1002-0179.20150138 Copy

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2.	Pillukat T, Van Schoonhoven J, Lanz U. Ulnar instability of the carpus[J]. Orthopade, 2004, 33(6):676-684.
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4.	Cerezal L, Del PF, Abascal F, et al. Imaging findings in ulnar-sided wrist impaction syndromes[J]. Radiographics, 2002, 22(1):105-121.
5.	Gelberman RH, Salamon PB, Jurist JM. Ulnar variance in Kienböck's disease[J]. J Bone Joint Surg Am, 1975, 57(5):674-676.
6.	Chun S, Palmer AK. The ulnar impaction syndrome:follow-up of ulnar shortening osteotomy[J]. J Hand Surg Am, 1993, 18(1):46-53.
7.	丛晓斌, 李涛, 季伟, 等. 尺骨短缩截骨治疗特发性尺骨撞击综合征的疗效分析[J]. 中华手外科杂志, 2013, 29(1):7-9.
8.	Bonzar M, Firrell JC, Hainer M, et al. Kienbock disease and negative ulnar variance[J]. J Bone Joint Surg Am, 1998, 80(8):1154-1157.
9.	Tanaka T, Ogino S, Yoshioka H. Ligamentous injuries of the wrist[J]. Semin Musculoskelet Radiol, 2008, 12(4):359-377.
10.	Mikic ZD. Detailed anatomy of the articular disc of the distal radioulnar joint[J]. Clin Orthop Relat Res, 1989, 8(245):123-132.
11.	Nishiwaki M, Nakamura T. Ulnar-shortening effect on distal radio-ulnar joint pressure:a biomechanical study[J]. J Hand Surg Am, 2008, 33(2):198-205.
12.	Palmer AK. Triangular fibrocartilage complex lesions:a classification[J]. J Hand Surg Am, 1989, 14(4):594-606.
13.	Bell MJ, Hill RJ, Mcmurtry RY. Ulnar impingement syndrome[J]. J Bone Joint Surg Br, 1985, 67(1):126-129.
14.	宋海涛, 田万成, 卢全忠, 等. 尺骨撞击综合征的特点及早期诊断[J]. 中华骨科创伤杂志, 2006, 8(8):706-707.
15.	韩悦, 廉宗澂, 刘志强. 尺骨撞击综合征的MRI表现[J]. 中华放射学杂志, 2000, 34(7):46-48.
16.	Ashman CJ, Farooki S, Abduljalil AM, et al. In vivo high resolution coronal MRI of the wrist at 8.0 tesla[J]. J Comput Assist Tomogr, 2002, 26(3):387-391.
17.	Yoshioka H, Tanaka T, Ueno T, et al. Study of ulnar variance with high-resolution MRI:correlation with triangular fibrocartilage complex and cartilage of ulnar side of wrist[J]. J Magn Reson Imaging, 2007, 26(3):714-719.
18.	Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome[J]. J Hand Surg Am, 1992, 17(4):731-737.

1. Sammer DM, Rizzo M. Ulnar impaction[J]. Hand Clin, 2010, 26(4):549-557.
2. Pillukat T, Van Schoonhoven J, Lanz U. Ulnar instability of the carpus[J]. Orthopade, 2004, 33(6):676-684.
3. 顾玉东, 王澍寰, 侍德. 手外科学[M]. 上海:上海科技出版社, 2002:415-417.
4. Cerezal L, Del PF, Abascal F, et al. Imaging findings in ulnar-sided wrist impaction syndromes[J]. Radiographics, 2002, 22(1):105-121.
5. Gelberman RH, Salamon PB, Jurist JM. Ulnar variance in Kienböck's disease[J]. J Bone Joint Surg Am, 1975, 57(5):674-676.
6. Chun S, Palmer AK. The ulnar impaction syndrome:follow-up of ulnar shortening osteotomy[J]. J Hand Surg Am, 1993, 18(1):46-53.
7. 丛晓斌, 李涛, 季伟, 等. 尺骨短缩截骨治疗特发性尺骨撞击综合征的疗效分析[J]. 中华手外科杂志, 2013, 29(1):7-9.
8. Bonzar M, Firrell JC, Hainer M, et al. Kienbock disease and negative ulnar variance[J]. J Bone Joint Surg Am, 1998, 80(8):1154-1157.
9. Tanaka T, Ogino S, Yoshioka H. Ligamentous injuries of the wrist[J]. Semin Musculoskelet Radiol, 2008, 12(4):359-377.
10. Mikic ZD. Detailed anatomy of the articular disc of the distal radioulnar joint[J]. Clin Orthop Relat Res, 1989, 8(245):123-132.
11. Nishiwaki M, Nakamura T. Ulnar-shortening effect on distal radio-ulnar joint pressure:a biomechanical study[J]. J Hand Surg Am, 2008, 33(2):198-205.
12. Palmer AK. Triangular fibrocartilage complex lesions:a classification[J]. J Hand Surg Am, 1989, 14(4):594-606.
13. Bell MJ, Hill RJ, Mcmurtry RY. Ulnar impingement syndrome[J]. J Bone Joint Surg Br, 1985, 67(1):126-129.
14. 宋海涛, 田万成, 卢全忠, 等. 尺骨撞击综合征的特点及早期诊断[J]. 中华骨科创伤杂志, 2006, 8(8):706-707.
15. 韩悦, 廉宗澂, 刘志强. 尺骨撞击综合征的MRI表现[J]. 中华放射学杂志, 2000, 34(7):46-48.
16. Ashman CJ, Farooki S, Abduljalil AM, et al. In vivo high resolution coronal MRI of the wrist at 8.0 tesla[J]. J Comput Assist Tomogr, 2002, 26(3):387-391.
17. Yoshioka H, Tanaka T, Ueno T, et al. Study of ulnar variance with high-resolution MRI:correlation with triangular fibrocartilage complex and cartilage of ulnar side of wrist[J]. J Magn Reson Imaging, 2007, 26(3):714-719.
18. Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome[J]. J Hand Surg Am, 1992, 17(4):731-737.

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Imaging Comparison Study of X-ray Plain Film, CT and MRI in Ulnar Impaction Syndrome

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