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Ulnar Sided Wrist Pain (USWP): Sensitivity and Specificity of Diagnostic Tests and Outcomes after Treatment with Ulnar Shortening Osteotomy (USO)

M. Ather Mirza, MD; Mary Kate Reinhart, MS, CNP
Smithtown, NY

Background: The differential diagnosis for ulnar sided wrist pain (USWP) can be a daunting task even for the seasoned physician. The purpose of this paper was to evaluate the diagnostic tests for USWP and then to examine the efficacy of ulnar shortening osteotomy (USO) as treatment for triangular fibrocartilage complex (TFCC) tears, lunotriquetral ligament (LT) tears and ulnocarpal impaction syndrome (UIS).

Methods: 147 cases were included in the diagnostic group of the study. Sensitivity and specificity values were used to analyze the efficacy of the following diagnostic tests: ulnocarpal tenderness, LT laxity, bonescan, midcarpal arthrogram, and radiocarpal arthrogram. 50 cases comprised the USO treatment group and were evaluated for outcomes by the Modified Gartland and Werley Wrist Grading System.

Results: The ulnocarpal tenderness test showed sensitivity, specificity of 0.72, 1.0; the LT laxity test 0.57, 0.41; Bone scan 0.73, 0.27; the radiocarpal arthrogram for TFCC tears 0.93, 0.98; the radiocarpal arthrogram for LT tears 0.53, 0.97; the midcarpal arthrogram for LT tears 0.84, 0.85. The average pre-op Gartland and Werley score was 61.5 8.0, with 13 rated fair and 37 poor increasing significantly at final follow up to 94.1 6.6, with 33 rated excellent, 12 good, 5 fair, and 0 poor. Significant changes were observed with ulnar variance and grip strength as well.

Conclusions: In our study, ulnocarpal tenderness and LT laxity were good for suspecting a diagnosis of USWP, but were not useful for ruling it out. Bone scans were sensitive, but not specific. Radiocarpal arthrograms were better at detecting TFCC tears and midcarpal arthrograms were best for detecting LT tears. USO proved to be effective in treating TFCC tears, LT tears, and UIS whether isolated or in combination.

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