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  • Ulnar Shortening- can anyone give me pros and cons?

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    Old 10-17-2012, 03:46 PM   #1
    Supermeeks
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    Question Ulnar Shortening- can anyone give me pros and cons?

    Greetings! In March of 2011 I was assaulted at work and MRI showed central TFCC tear and anECU tear. I had surgery 7/7/11, completed PT/OT, and returned to work. Dec 2011 MRI showed a peripheral TFCC tear and surgery was done 1/30/12. Did another round of PT/OT and continued having ulnar sided wrist pain. Doc sent me for a second opinion re: ulnar shortening due to ulnar impingement, and I had a bone scan that shows that there's repetitive trauma to the ulnar surface, ulnar head, and the scaphoid bones. My ulnar variance is neutral, but with my continued pain, MRI and bone scan results the dr thinks that ulnar shortening is my next option because I can't live with, let alone work, with the pain I'm having. Can anyone share their experience? Would you do it again?

     
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    Old 10-17-2012, 08:53 PM   #2
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    Re: Ulnar Shortening- can anyone give me pros and cons?

    I've had some wrist issues since March of 2011. I have had ulnar sided wrist pain since I injured it bowling. I went to a couple orthopedic doctors who couldn't find anything wrong other than a significant positive ulnar variance. They thought my inflammation probably wasn't going down from my "sprain" because of the impingement. I had an ulnar shortening osteotomy in February of 2012. My bone healed up as it should. I still haven't gained the ability to fully supinate. I did OT for a couple months, then insurance decided I wasn't making enough progress and cut me off so I never got the chance to complete my rehab. My dr. originally said I would have full use by June (4 months). While my osteotomy appears to have been successful otherwise, I still have had the same ulnar sided pain. I just found out a couple weeks ago that I have a UT split tear that was missed by my two prior orthopedic dr's so I'm going in for surgery to fix it next month. I'm also having part of my ulnar head shaved down and stabilization of some of the bones/ligaments on my ulnar side hand due to a significant laxity my new hand specialist discovered.

    From what I've researched and discussed with my doctors, ulnar shortening does work for many people. By shortening your ulna, it is supposed to "tighten" or stabilize some of those ligaments in the TFCC area. In your case, with the normal ulnar variance, I'd ask the doc if you will have any future problems with load distribution between the ulna and radius. I know mine was off with the positive variance, I'd assume that yours would be off some with a negative one. If you have bones "crashing around" and doing damage to your ulnar head, it might be wise to consider the shortening though.

    You don't say what type of ulnar side pain, but you might want to research UT split tears. They don't show up on any MRI's, x-rays or arthrograms at all. Research on the tears only came out in 2008 so a lot of doctors aren't educated on it. I know it took me 4 doctors to actually get a correct diagnosis.

    If I had it to do again, would I? I'm not sure. I made my decision based upon the best information I had at the time. With the other issues I've discovered with my hand/wrist area, I have a good feeling I would have eventually needed the surgery anyway due to my underlying hypermobility issues. I just wish I'd had a chance to continue with therapy to help me gain that last bit of ROM.

    There is another current board user who had the surgery just after I did. They have had some issues with the plate and are scheduled to have it removed. You can find the information on the ulnar osteotomy thread just below.
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    Old 10-18-2012, 04:34 AM   #3
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    Re: Ulnar Shortening- can anyone give me pros and cons?

    Thanks for responding! I've had an ECU, Dequervain's, scaphoid-lunate ligament, and 2 TFCC tears surgically corrected. My pain is almost constant and increases with any weight bearing, but turning motions and flexion increases my pain significantly. After 3 surgeries I understand that there's always a chance for complications and failure, but for the past year I've been unable to work as a nurse and miss work like crazy. Dr did a cortisone injection in the wrist joint and his thinking is- if there was pain relief, increased ROM, etc it would be an indication that I would benefit from the shortening. 24 hrs later and my ulnar pain has decreased from btwn a 5-6 to at most a two, I have increased flexion and extension, but increased pain on the radial aspect of my wrist (but this is closer to the injection site which is also sore.)

     
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