77th ASSH Annual Meeting - Back to Basics: Practice and Education-IC21: Ulnar Wrist Pain: Demystifying the Black Box of the Wrist (AM22)

Video Transcription

Video Summary

In this video summary, we present a discussion on the diagnosis and treatment of various wrist conditions, specifically focusing on TFCC injuries, ECU instability, ulnar impaction, and DRUJ arthritis. The panel of surgeons outline the key considerations in evaluating and managing these conditions. They emphasize the importance of a thorough history and physical examination in making a diagnosis, with imaging playing a supportive role. For TFCC injuries, the panel suggests that clinical examination is critical, and MRI may not always be reliable, especially for peripheral or foveal tears. Non-operative management is preferred in the initial stages, but arthroscopy may be necessary in cases where the pain persists. In patients with ECU instability, treatment options include splinting, therapy, and injection, with surgical intervention reserved for cases that do not respond to conservative management. Ulnar impaction is often treated with ulnar shortening osteotomy, but the decision to proceed with this procedure depends on factors such as ulnar variance and DRUJ stability. Partial ulnar head arthroplasty may be an option for primary DRUJ arthritis, while total ulnar head arthroplasty is considered in cases where there is bone loss. The panel also discusses the role of the TFCC in ulnar impaction and presents an algorithm for treatment that takes various patient factors into account. Finally, the panel discusses ulnar head arthroplasty as a treatment option for DRUJ arthritis. They highlight the importance of selecting the appropriate procedure based on patient-specific factors, including age, demand, bone loss, and patient expectations. The panel concludes that understanding the patient's expectations and managing them appropriately is critical in achieving successful outcomes for these conditions.

Meta Tag

Session Tracks Arthritis

Session Tracks Skin Soft Tissue

Session Tracks Tendon

Speaker Marc J. Richard, MD

Speaker Robin Neil Kamal, MD

Speaker Sanjeev Kakar, MD, FAOA

Speaker Tamara D. Rozental, MD

Keywords

wrist conditions

TFCC injuries

ECU instability

ulnar impaction

DRUJ arthritis

diagnosis

treatment

arthroscopy

ulnar shortening osteotomy

patient expectations