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Ulnar Wrist Pain: Why Ulnar Shortening Osteotomy Is Not Ideal?

By Last updated on September 11, 2020 Last updated on September 11, 2020 No Comments

DO YOU HAVE WRIST PAIN?

Ulnar-sided wrist pain is difficult to diagnose and even more difficult to treat. Upsetting the fragile biomechanics of the many bones of the ulnar side of the wrist can lead to grave consequences including pain, reduced range of motion, and loss of grip strength. Although conventional treatments exist and prove effective in some cases, their effects may be amplified through the use of Regenerative therapies.

Anatomy of the Wrist

Anatomy of the wrist

The wrist is composed of a puzzle-like assortment of small bones that have very delicate interactions. To understand the causes of ulnar wrist pain, it is noteworthy to know these bones and their functions:

  • Scaphoid
    • One of the two bones at the base of the wrist. Found between the trapezium and the radius bone of the forearm.
    • Covered with cartilage in order to provide smooth movements between it and five other bones in the wrist and forearm.
    • Difficult to heal if injured.
  • Lunate
    • Another of the base-bones of the wrist which sits directly next to the scaphoid and on top of the radius.
    • Rarely injured, but can be involved in wrist dislocations and may rub against the ulna of the forearm if the ulna is too long compared to the radius bone.
  • Triquetrum
    • Arched above the lunate and under the hamate on the small finger side of the wrist.
    • Gives the wrist stability and creates a joint in the wrist with other carpal bones.
  • Trapezoid
    • Sits above the scaphoid and below the bones of the index finger.
    • Uncommonly injured.
  • Trapezium
    • Sits above the scaphoid and below the thumb.
    • It allows for lateral movements of the thumb and provides stability to it.
    • Injures and develops arthritis easily.
  • Capitate
    • Located under the middle finger, between the trapezoid and the hamate.
  • Hamate
    • Supports the ring and little fingers.
    • Frequently broken.
    • An attachment point for the ligament involved in carpal tunnel syndrome.
  • Pisiform
    • Nestled directly above the triquetrum and lies within a tendon.
    • Occasionally breaks or develops arthritis in the joint it makes with the triquetrum.

Also of note are the two bones of the forearm:

  • Radius
    • Sits under the thumb-side of the wrist.
  • Ulna
    • Sits under the little-finger side of the wrist.
    • The root cause of ulnar-sided wrist pain.

A healthy interaction between all of these bones is critical to preventing ulnar-sided wrist pain.

Signs and Symptoms

Ulnar wrist pain can be an indication of various medical conditions. Common signs an individual may have a deeper wrist issue include:

  • Ulna (pinkie) sided pain in the wrist.
  • Popping or clicking which induces pain throughout the base of the hand.
  • Reduction of grip strength or pain when gripping.
  • Reduced range-of-motion for the wrist or motion induces a pain response.
  • Hand often goes numb or falls asleep

If these signs are a daily occurrence, it may be a sign that the damage is becoming progressively worse and that it may be time to consult a physician for help.

Causes and Diagnosis

Doctors may have a difficult time identifying the cause of a patient’s pain due to the many individual bones which make up the wrist. Typically, a consultation will involve range of motion exercises and palpation of the wrist by a physician or their assistant. This examination will most likely be followed by an X-Ray, MRI, CT scan, or in rare cases, a micro-invasive procedure using a small guided camera within the wrist.

Some of the most probable causes a doctor will look out for in order to diagnose a patient’s ulnar-sided wrist pain include:

  • Past medical history including wrist and forearm fractures
  • Arthritis of the joint(s) between the wrist bones
  • Ulnar impaction syndrome (caused by an elongated ulna which causes erratic wrist mechanics)
  • Inflammation or irritation of the tendons that bend and extend the wrist
  • Triangular Fibrocartilage Complex Injury (TFCC) (when the connection between the ulna bone and other structures in the wrist is torn by an injury or frayed over time)
  • Nerve damage or compression

Once a doctor understands the root cause of the ulnar-sided wrist pain, they will provide their treatment options. These may include simple physical therapy routines which may be done at home, medication to reduce inflammation or pain response, or, in some cases, an invasive procedure known as ulnar shortening. Whatever the case may be, regenerative therapy may be applied to help reduce recovery time or eliminate pain.

Ulnar Shortening Osteotomy and its Complications

A healthy interaction between the ulna of the forearm and the bones of the wrist helps ensure an individual has pain free, normal hand motion. When the ulna pushes on the wrist, or if there has been past injury to the ulnar-sided wrist bones, normal motions of the hand can induce pain. Over time this pain can reduce grip strength, causes numbness or pain, and reduce the range of motion of the wrist to nil. If these complications become severe and conventional treatment options do not help, doctors will typically recommend ulnar shortening surgery.

By reducing the length of the ulna, surgeons can relieve compression of the nerves in the wrist, thereby reducing pain. This shortening is achieved by making incisions in the ulna and grafting the two separate piece back together using metal plates to hold them in place.

While initial recovery is short, patients typically take four or more months before returning to work. Patients are also required to take physical therapy post-surgery in order to gradually return wrist strength and may require prolonged use of medication in order to treat post-surgical pain.

In addition to lengthy recovery periods, complications with the mechanics of ulnar shortening surgeries exist. One study which spanned over 10 years reported that over half (51%) of their patients described metalwork irritation from the plates attached in the procedure. Other complications included non-union or misalignment (6.1%), refracture (1.6%), and chronic regional pain (1.6%).

While symptoms did improve in many patients, the risks inherent to ulnar shortening surgery may outweigh the benefits for individuals looking for treatment options for their ulnar-sided wrist pain. For individuals looking for immediate relief and minimal downtime, they may find a solution in regenerative therapies.

Regenerative Therapy and Ulnar-Sided Wrist Pain

By extracting some of the body’s tissues, processing them, and reinjecting them into a patient, regenerative therapies help to boost the body’s natural healing factors. PRP and stem cell therapies use blood, fat, or bone marrow taken from a patient to create an environment suitable for repair of damaged tissue within the body. These therapies can be applied to a range of injuries, including ulnar-sided wrist pain.

PRP Therapy and Ulnar-Sided Wrist Pain

Platelet Rich Plasma, or PRP, therapy is the process of harvesting blood from a patient and filtering it to platelets and other growth factors for reinjection into a site of injury. Once inside the body, the platelets latch onto an injury and send out chemical signals to call the body’s natural healing mechanisms to an injured wrist. Using the chemical signals from PRP, the body can more accurately and quickly repair the damaged cartilage, ligament, bone and muscle within the wrist and reduce pain. PRP is said to help reduce pain for upwards of 6 months.

Stem Cell Therapy and Ulnar-Sided Wrist Pain

The initial mechanics of stem cells are much the same as PRP. Tissues are extracted from a patient (either bone marrow or fat), processed (although instead of filtration, they are induced into an infantile state where they become what are known as “mesenchymal” stem cells), and then reinjected into the patient at the site of their injury. Stem cells not only call on the body’s healing and growth factors, they also create an environment around the site of injury which is suitable for repairs. This extra cushion acts as a buffer from further injury and allows the body’s healing mechanisms to work more quickly than if left alone. Results from stem cells typically last from 6 months to upwards of a year.

Both regenerative therapies are outpatient procedures with short recovery periods. Side effects of PRP and stem cells are minimal and usually include some type of swelling and soreness at the site of injection which typically lasts from a few days to a week. Once the swelling goes down, the therapies are believed to continue repairing damaged tissues anywhere from 6 months to a year, though some patients experience even longer relief when the therapies are applied in unison.

Conclusion

Ulnar-sided wrist pain is caused by a disturbance in the delicate play of small bones within the wrist. Conventional treatment options such as ulnar shortening osteotomy, physical therapy, and medication are time-consuming, at times ineffective, and potentially dangerous.

By using regenerative therapies such as stem cells and PRP, an individual may reduce the risk of complications after surgery, reduce their recovery periods, avoid medication, or avoid these treatments altogether. If you are experiencing ulnar-sided wrist pain and wish to learn more about how regenerative therapies may help, contact CELLAXYS today to set up a consultation and discuss treatment options.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Regenerative Orthopedic and Sports Medicine
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan State University Alumni

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