Mild Ulnar Plus Variance with no TFCC tear... questions, treatment?
Sorry this is long..
I'm new to these boards and wondering if someone could enlighten me on this condition as I have not received much help from my family doctor.
I've had thumb side and ulnar (pinky side) wrist pain for a few years.
The pinky side is painful when moving my wrist to the side (moving it towards the pinky side), gripping and there is clicking or clunking sounds at times.
Numerous injuries to both areas of wrist which were never treated. Many of my injuries, source of wrist pain were caused by domestic abuse and I wasn't allowed to get treatment. Not in the relationship now.
The past few years, especially the past 6 months, pain and symptoms are becoming worse.
My family doctor sent me for a regular MRI. This is the radiologist report
Clinical History... De Quervain's versus scapholunate injury. MRI Right Wrist
There is mild plus variance. The TFCC, scapholunate, and lunotriquetral osseous ligaments all appear intact. There is a slight increased signal noted related to the extensor tendons of compartment one.
Features would be consistent with tenosynovitis. Carpal alignment is normal with no acute or healing fracture evident.
Impression.. Tenosynovitis first extensor compartment.
My family doctor received the above report and when I asked him what treatments I should try for Dequervains he didn't tell me what I should do for it.
He gave me a copy of the report, and it was after I left, I noticed the mild ulnar plus variance. I wasn't sure what it meant and looked it up. Because my family doctor didn't bring it up I assumed it meant nothing.
I have some questions...
On the ulnar side of the wrist, the protruding, roundish bone on top or close to the wrist, is that the ulnar bone?
Has anyone experienced pain along the outer side of the pinky finger with this condition?
For mild ulnar plus variance without a tfcc tear should I see a hand specialist?
Anyone here have this condition without tfcc tear and received treatment? What kind of treatment?
The problem is I need a referral from my family doctor to see a hand specialist. Unfortunately I have difficulty as in he doesn't refer easily.
Re: Mild Ulnar Plus Variance with no TFCC tear..questions, treatment?
I had a positive ulnar plus variance with no TFCC tear. I'm not an expert, but I'm happy to share what I've learned through my experience.
Basically the positive ulnar variance means your ulnar bone is a bit longer than the radius. This is "normal" in about 10% of the population. Typically nothing needs to be done and it doesn't cause problems for most people. Depending on the variance, it can have an impact in a couple ways: 1. the forces between the ulnar and radial bones can be thrown off with more force going to the ulnar side than normal; 2. the ulnar bone can "impinge" into the TFCC area (try searching ulnar impaction syndrome or ulnar impingement syndrome for more information).
In my case, I had no problems until last year. I "sprained" my wrist in March 2011. It took about 9 weeks to mostly heal. I "sprained" the same spot at the beginning of September 2011. It never fully healed and I had ulnar sided pain when I did gripping and twisting motions. I tried additional splinting and shots, but the pain never resolved. When I ended up with a hand orthopaedic doctor for a consultation, he said my MRI showed no TFCC tears, but did confirm the Ulnar Impaction Syndrome due to a positive ulnar variance. He indicated that with the bone as long as it was, it was impeding the healing of my TFCC area. In February 2012, I had an ulnar shortening osteotomy where they took out a slice of my ulnar bone and plated it back together. I'm currently in therapy to heal up my ulnar sided wrist pain. I will say that surgery is certainly an extreme step though and not needed by most.
Ironically, I developed the first dorsal compartmental syndrome after my surgery. My therapist said it is due to the imbalance between the ulnar and radial sides and that my radial side is trying to overcompensate for the weak ulnar side. Right now, I'm just adding additional therapy and ultrasound for the DeQuervains.
I'm not sure if that answered all your questions. Let me know if there is any further information I can share. If you are interested, you can see the story of my ulnar shortening osteotomy on a thread on this board. There is a member named booboo who has had a similar journey with me over the last several months.
Re: Mild Ulnar Plus Variance with no TFCC tear.. questions, treatment?
A sports medicine doctor has injected me twice now with cortisone for the Dequervains. I see him in 3-4 weeks time. If my Dequervains hasn't improved by then he will be sending me to a hand surgeon. I will likely need the tendon released. So I plan on bringing up the mild ulnar plus variance problem to the hand specialist when the time is right. The sports medicine doctor didn't give any definite answers to treatment for this problem. I've been slowly reading through the posts with regards to this condition.
Re:Update.. Mild Ulnar Plus Variance with no TFCC tear.. questions, treatment?
My username changed slightly, forgot my old password..
I did see a hand surgeon in September 2012. He operate on the Dequervains in November. That is healing well.
In January I had a follow up for the Dequervains. I brought up the mild ulnar plus variance and showed him the MRI report (MRI was done January 2012) He said he normally doesn't operate unless there is a tfcc tear. However,if I'm having quite a bit of pain he will consider it and discuss it at my next appt.
Today I had a follow up. My Dequervains has healed well (did go for physiotherapy). I brought up the ulnar pain. He did an examination (it hurt when he bent my wrist certain ways and some grinding). However he's not keen on operating and doesn't want to use scoping to look at it. If I continue to have pain or it becomes worse, I can come back, and he will order more tests (MRI, xrays). He said maybe some cortisone injections.
I've read here that some people have injections and splinting.
The hand physiotherapist said there isn't much she can do for this problem, you can't exercise the bone.
Re: Mild Ulnar Plus Variance with no TFCC tear... questions, treatment?
Thanks for your update. I'm glad to hear your dequervains has healed nicely.
I had several orthopedic specialists say that they usually don't worry about surgery for the ulnar variance. In my case, the surgeon finally recommended surgery because I had pain from an injury for 11 months that didn't respond to other less invasive treatments.