Perthes-Like Lesion in Wrist Joint: Stripping of Ulnar Collateral Ligament

Abstract

Background Chronic ulnar-sided wrist pain often proves to be a challenging presenting complaint. A new type of injury to the ulnar collateral ligament (UCL) of the wrist is described in a young female. It is characterized by stripping of UCL from ulnar attachment.

Case Description A 32-year-old female sustained an injury after lifting heavy weight. Examination revealed tenderness to the ulnar styloid, terminal radial deviation was painful and decreased grip strength. The arthro-computed tomography (Arthroscanner) diagnosed stripping of ulnar collateral ligament (UCL). The UCL was refixed with transosseous sutures. At one year follow-up, the patient was pain-free with good range of motion and improved grip strength.

Literature Review After intense literature review, we found this type of injury was not reported, but we found the same type of injury in the shoulder “Perthes lesion.”

Clinical Relevance The UCL stripping of the wrist is a rare entity and undiagnosed on routine investigation. This lesion was only diagnosed on an arthroscanner and was missed on MR study which is commonly used for diagnosed wrist pain. This case is being reported for its rarity and to expand the differential diagnosis of the ulnar-sided wrist pain.

Keywords

wrist joint - ulnar collateral ligament - stripping - perthes lesion

• References

• 1 Lichtman DM, Alexander AH. The Wrist and Its Disorders. 2nd ed. Philadelphia, PA: WB Saunders Co; 1997
• 2 Taleisnik J. Pain on the ulnar side of the wrist. Hand Clin 1987; 3 (01) 51-68
• 3 Denby K, Nelson G, Estrada CA. Bedside hand grip assessment with the sphygmomanometer. J Gen Intern Med 2013; 28 (10) 1381
• 4 Moser T, Dosch JC, Moussaoui A, Buy X, Gangi A, Dietemann JL. Multidetector CT arthrography of the wrist joint: how to do it. Radiographics 2008; 28 (03) 787-800
• 5 Hogikyan JV, Louis DS. Embryologic development and variations in the anatomy of the ulnocarpal ligamentous complex. J Hand Surg Am 1992; 17 (04) 719-723
• 6 Bogumill GP. Anatomy of the wrist. In: Lichtman DM. , ed. The wrist and its disorders. Philadelphia: WB Saunders; 1988: 21
• 7 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (05) 581-586
• 8 Nakamura T, Takayama S, Horiuchi Y, Yabe Y. Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg [Br] 2001; 26 (05) 446-454
• 9 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
• 10 Taleisnik J, Gelberman RH, Miller BW, Szabo RM. The extensor retinaculum of the wrist. J Hand Surg Am 1984; 9 (04) 495-501
• 11 Palmer AK. The distal radioulnar joint. Orthop Clin North Am 1984; 15 (02) 321-335
• 12 Nozaki T, Wu W, Kaneko Y. , et al. High-resolution MRI of the ulnar and radial collateral ligaments of the wrist. Acta Radiol 2017; 58 (12) 1493-1499
• 13 Hobby JL, Tom BD, Bearcroft PW, Dixon AK. Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol 2001; 56 (01) 50-57
• 14 Haims AH, Moore AE, Schweitzer ME. , et al. MRI in the diagnosis of cartilage injury in the wrist. AJR Am J Roentgenol 2004; 182 (05) 1267-1270
• 15 Moser T, Dosch JC, Moussaoui A, Dietemann JL. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol 2007; 188 (05) 1278-1286
• 16 Perthes G. Ueber operationen bei habitueller schulterluxation. Dtsch Z Chir 1906; 85 (05) 199-227