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Conservative treatment improves outcomes of ulnar impaction syndrome at short-term follow-up
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Although conservative treatment of idiopathic ulnar impaction syndrome yielded improvements in objective and patient-reported outcomes, results published in Scientific Reports showed several nonmodifiable patient factors lead to a higher likelihood of treatment failure.
At 24-weeks follow-up, Young Hak Roh, MD, PhD, and colleagues assessed response to treatment, including pain numeric rating scale on an ulnar provocation test, grip strength and DASH score, among 114 patients who underwent conservative treatment for idiopathic ulnar impaction syndrome.
Results showed significant clinical improvement in mean pain numeric rating scale score and DASH score at 24-weeks follow-up. Due to persistent symptoms after conservative treatment, researchers noted 25% of patients underwent ulnar shortening osteotomy. According to results, 16% of patients had pain scores greater than 5 at 24-weeks follow-up; however, these patients did not undergo surgery.
Multivariable logistic regression model showed an association of higher likelihood of treatment failure with female sex, duration of symptom, high pain numeric rating scale score on provocation test and enhanced carpal or distal ulna bone on MRI.
“Ulnar impaction syndrome is a common source of ulnar-sided wrist pain, yet not all cases of radiographic ulnar impaction are symptomatic. In this study, approximately two-thirds of patients showed improvements in both objective and patient-reported outcomes after conservative treatment for this condition,” Roh told Healio.com/Orthopedics. “However, female gender, long symptom duration, initial high pain [numeric rating scale] NRS score on ulnar provocation test and enhancement of carpal or distal ulna bone on MRI were associated with a higher likelihood of treatment failure. Knowledge of the factors offer physicians insight into predicting prognoses and can help patients set realistic expectations.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Kevin J. Renfree, MD
This level 2, retrospective prognostic study attempts to assess prognosis after nonoperative treatment of ulnar impaction syndrome (UIS). The study is limited by a very short follow-up (6 months), during which time patients were restricted from performing normal work or recreational activities that might elicit pain (6 weeks immobilization, 6 weeks physiotherapy and then 3 months of activity restrictions).
Therapeutic studies, in contrast, typically have a minimum 1 to 2-year follow-up period. Since ulnar positive variance is common in the general population and often asymptomatic, the diagnosis of UIS is made clinically. Extensor carpi ulnaris tendinopathy, for example, mimics most of the symptoms and physical exam findings of UIS, and MRI may not be diagnostic. Therefore, diagnostic injections are very important in making a specific diagnosis in patients with ulnar wrist pain.
Since these were not done, one is left to wonder whether all the patients in the cohort truly had isolated UIS in the first place. Nonetheless, the authors are to be congratulated for contributing additional needed research of this common condition. Hopefully this will lead to motivate future studies, especially prospective ones comparing non-operative to operative treatment.
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