Samenvatting
Ulnaire pijn is een frequent voorkomende klacht na een polsfractuur. Van de patiënten met een Colles-fractuur ontwikkelt 35% later ulnaire pijnklachten. De anatomie van de ulnaire zijde van de distale onderarm is complex en bestaat uit het distale radio-ulnaire gewricht, de distale ulna en het triangulaire fibrocartilagineuze complex. Op basis van de anatomie kan ulnaire pijn worden onderverdeeld in ossale, ligamentaire, tendinogene, neurologische of vasculaire pathologie. Een goede anamnese, lichamelijk onderzoek met specifieke tests en aanvullende beeldvorming ondersteunen de diagnose. Voor het stellen van de diagnose ligamentair letsel of artrose van het radiocarpale gewricht wordt artroscopie van de pols beschouwd als de gouden standaard. Gezien de associatie van ulnaire pijn met distale radiusfracturen en bijkomende wekedelenschade pleiten wij voor een multidisciplinaire benadering.
Abstract
Ulnar sided wrist pain is frequently following a distal radius fracture. Of the patients with a Colles fracture 35% will develop ulnar sided wrist pain. The anatomy of the ulnar side of the distal forearm is complex and consists of the distal radioulnar joint, the distal ulna and the triangular fibrocartilagenous complex. Based on the anatomy, ulnar sided wrist pain can be divided into osseous, ligamentous, tendinous, neurological or vascular pathology. Thorough history taking, physical examination with additional specific tests and imaging support the diagnosis. Arthroscopy of the wrist is considered to be the gold standard in diagnosing ligamentous injuries and osteoarthritis of the radiocarpal joint. Considering the association of ulnar sided pain with distal radius fractures and accompanied soft tissue injuries, we advocate a multidisciplinary approach to this condition.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12506-013-0023-9/MediaObjects/12506_2013_23_Fig1_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12506-013-0023-9/MediaObjects/12506_2013_23_Fig2_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12506-013-0023-9/MediaObjects/12506_2013_23_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12506-013-0023-9/MediaObjects/12506_2013_23_Fig4_HTML.jpg)
Literatuur
Tsukazaki T, Iwasaki K. Ulnar wrist pain after Colles’ fracture. 109 fractures followed for 4 years. Acta Orthop Scand. 1993;64:462–4.
Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984;(187):26–35.
Ekenstam F. Osseous anatomy and articular relationships about the distal ulna. Hand Clin. 1998;14:161–4.
Spinner M, Kaplan EB. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res. 1970;68:124–9.
Vezeridis PS, Yoshioka H, Han R, Blazar P. Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal Radiol. 2010;39:733–45.
Kohonen M, Teerenhovi O, Terho T, et al. Is the Allen test reliable enough? Eur J Cardiothorac Surg. 2007;32:902–5.
Linscheid RL. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1992;(275):46–55.
Nakamura R, Horii E, Imaeda T, et al. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br. 1997;22:719–23.
Lichtman DM, Wroten ES. Understanding midcarpal instability. J Hand Surg Am. 2006;31:491–8.
Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg Am. 1984;9:502–14.
Ambrose L, Posner MA. Lunate-triquetral and midcarpal joint instability. Hand Clin. 1992;8:653–68.
DSo S. Guidelines distal radius fractures, diagnosis and treatment. 2010.
Ritt MJ, Linscheid RL, Cooney WP 3rd, et al. The lunotriquetral joint: kinematic effects of sequential ligament sectioning, ligament repair, and arthrodesis. J Hand Surg Am. 1998;23:432–45.
Watanabe A, Souza F, Vezeridis PS, et al. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39:837–57.
Sammer DM, Rizzo M. Ulnar impaction. Hand Clin. 2010;26:549–57.
Meier R, Schmitt R, Krimmer H. Wrist lesions in MRI arthrography compared with wrist arthroscopy. Handchir Mikrochir Plast Chir. 2005;37:85–9.
Hahn P, Hausler A, Bruckner T, Unglaub F. Quality rating of MRI regarding TFCC lesions in the clinical practice. Handchir Mikrochir Plast Chir. 2012;44:310–3.
Shin AY, Battaglia MJ, Bishop AT. Lunotriquetral instability: diagnosis and treatment. J Am Acad Orthop Surg. 2000;8:170–9.
Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am. 2000;25:464–8.
Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin. 2011;27:263–72.
Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (NY). 2007;2:123–6.
Slater RR Jr. The Sauve-Kapandji procedure. J Hand Surg Am. 2008;33:1632–8.
Herbert TJ, Schoonhoven J van. Ulnar head replacement. Tech Hand Up Extrem Surg. 2007;11:98–108.
Schoonhoven J van, Herbert TJ, Fernandez DL, et al. Ulnakopfprothese. Orthopade. 2003;32:809–15.
Kleinman B. The ulnar side. In: Slutsky DJ, Osterman L, eds. Fractures and injuries to the distal radius and carpus. Philadelphia: Saunders Elsevier, 2009.
Author information
Authors and Affiliations
Additional information
1 arts, afdeling Plastische Chirurgie en Handchirurgie, AMC, Amsterdam
2 promovenda en klinisch epidemioloog, afdeling Chirurgie, Trauma Unit, AMC, Amsterdam.
3 plastisch chirurg, afdeling Plastische Chirurgie en Handchirurgie, AMC, Amsterdam
4 traumachirurg en klinisch epidemioloog, afdeling Chirurgie, Trauma Unit, AMC, Amsterdam
Rights and permissions
About this article
Cite this article
Smits, F., Walenkamp, M., Strackee, S. et al. Ulnaire pijn na een polsfractuur. TIJD. TRAUMATOLOGIE 21, 102–106 (2013). https://doi.org/10.1007/s12506-013-0023-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12506-013-0023-9