The Effect of Axial Loading on Ulnar VarianceFunding None.
05 June 2017
08 January 2018
12 February 2018 (eFirst)
Background Forearm rotation results in change in ulnar variance. Axial loading of the wrist is required to maintain daily activities. Change in ulnar variance during axial loading has not been investigated previously.
Purpose To measure the change in ulnar variance on axially loaded wrists.
Patients and Methods We examined 21 asymptomatic individuals and 24 patients with unilateral ulnar-sided wrist pain. All patients underwent standard neutral posteroanterior wrist radiographs without load and under axial loading on bilateral wrists. Axial loading was standardized at 18.1 kgf using an analog weight scale. A magnetic resonance (MR) arthrogram was obtained only in patients with ulnar-sided wrist pain. Beighton flexibility score was recorded on healthy volunteers. Change in ulnar variance between 0 and 18.1 kgf was compared for each wrist among all subjects. A correlation was sought between the change in ulnar variance, MR arthrogram findings, and physical examination.
Results In individuals without wrist pain, on average, 0.4 mm increase in ulnar variance was measured between 0 and 18.1 kgf. There was no difference between the dominant and nondominant side. No correlation was found with increasing age. In contrast, patients with ulnar-sided wrist pain displayed an average increase of 0.8 mm in ulnar variance. Compared with the contralateral wrist, more than 1 mm increase in ulnar variance was correlated with intra-articular pathologies including dorsoulnar ligament disruption, central triangular fibrocartilage complex (TFCC) perforation, and foveal detachment.
Conclusion Compared with contralateral side, more than 1 mm increase in ulnar variance is suggestive of longitudinal instability or TFCC pathology.
Level of Evidence Level II, diagnostic.
Institutional review board approved this study.
- 1 Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg Am 1982; 7 (04) 376-379
- 2 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14 (04) 607-612
- 3 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (02) 295-310
- 4 Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy. J Hand Surg [Br] 1998; 23 (06) 754-757
- 5 Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973; 32 (05) 413-418
- 6 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
- 7 af Ekenstam FW, Palmer AK, Glisson RR. The load on the radius and ulna in different positions of the wrist and forearm. A cadaver study. Acta Orthop Scand 1984; 55 (03) 363-365
- 8 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201 (02) 495-500
- 9 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (06) 719-723
- 10 Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am 1993; 18 (04) 713-716
- 11 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (04) 689-699
- 12 Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 2006; 31 (03) 445-451
- 13 Moriya T, Aoki M, Iba K, Ozasa Y, Wada T, Yamashita T. Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur Vol 2009; 34 (02) 219-223
- 14 Shen J, Papadonikolakis A, Garrett JP, Davis SM, Ruch DS. Ulnar-positive variance as a predictor of distal radioulnar joint ligament disruption. J Hand Surg Am 2005; 30 (06) 1172-1177