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Ulnocarpal abutment syndrome
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Ulnocarpal abutment syndrome

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Contributors: Michael Catanzaro MD, Danielle Wilbur MD
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Synopsis

Causes / typical injury mechanism: Ulnocarpal abutment syndrome, also known as ulnar impaction syndrome and ulnar abutment syndrome, is a chronic degenerative process secondary to compressive overload and shear forces at the articular surface of the ulnocarpal joint.

Classic history and presentation: Patients typically present with ulnar-sided wrist pain. Pain occurs with active and passive ulnar deviation of the wrist as well as with axial loading of the wrist.

Risk factors:
Pathophysiology: Ulnocarpal abutment syndrome is secondary to excessive stress between the ulna and the carpus. The relationship between the radius and ulna at the distal radial ulnar joint (DRUJ) is such that there can be ulnar variance from -2 mm to +2 mm when compared to the radius in the typical wrist. In patients with ulnar neutral or ulnar negative variance, 80% of the carpal load is transferred to the radius and 20% is transferred to the ulna. In a patient with ulnar positive variance (+2 mm or greater), that ratio shifts and 60% of the load lies with the radius while 40% lies with the ulna. This increased load over time leads to degenerative changes in the ulnocarpal joint that cause the symptoms seen in ulnocarpal abutment syndrome.

Codes

ICD10CM:
M24.839 – Other specific joint derangements of unspecified wrist, not elsewhere classified

SNOMEDCT:
472328003 – Ulnar impaction syndrome

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Extensor carpi ulnaris (ECU) tendonitis
  • Lunotriquetral tears
  • TFCC tears
  • Distal radioulnar joint (DRUJ) arthritis
  • Pisotriquetral arthritis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:11/14/2021
Last Updated:11/21/2021
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Ulnocarpal abutment syndrome
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