20231208 Wrist disorders p4 - Dr Ku

A 37-year-old man has a 2-year history of increasing right wrist pain that is worse at night and aggravated by activity. He denies systemic symptoms, history of trauma, or recent weight loss. On physical exam he has tenderness over the dorsal radiocarpal joint. Radiographs of the right wrist are shown in Figure below. Which of the following imaging studies would be most sensitive for determining the stage of this patient's underlying condition?

• Ultrasound

• Angiography

• CT scan of wrist

• Clenced fist AP radiograph of wrist

• Bone scan wrist

A 39-year-old male presents with longstanding right wrist pain. He has failed conservative measures including prolonged immobilization. His radiographs and MRI are seen in figures A and B. Which of the following options is an accepted treatment option?

• Ulnar shortening osteotomy

• TFCC repair

• Radial shortening osteotomy

• Arthroscopic lunate chondroplasty and debridement

• Scapholunate ligament reconstruction

A 32-year-old gentleman who is left hand dominant, who is a professional dart thrower, presented to orthopedic outpatient clinic with progressive wrist pain for the past 6 months. He had a motor vehicle injury 1 year ago with wrist fracture. The pain was aggravated during dart throwing. Otherwise, there was no limitation in his other daily activity. The clincial examination noted swelling at dorsum and ulnar aspect of wrist joint. Tenderness only at the ulnar wrist region with no instability. These are the radiographs on the first visit. What is the best management advice would you give to him?

• Stop the sport

• Wrist splint

• Removal of radius plate with radial corrective osteotomy

• Removal of radius plate with ulnar shortening osteotomy

• Ulnar shortening osteotomy

A 32-year-old carpenter has a 6-month history of ulnar-sided wrist pain that is worsened opening a jar, squeezing a wet towel, typing, or changing a gearshift. Radiograph and MRI images are detailed in Figures A through C. All of the following concerning ulnar shortening osteotomy are true EXCEPT:

• Care should be taken to avoid the dorsal sensory branch of the ulnar nerve

• Results are encouraging even for those with degenerative changes in the distal radioulnar joint

• Placement of the plate to the dorsal surface of the ulna can cause tendinitis of the extensor carpi ulnaris

• Concomitant arthroscopy may be indicated for patients with concurrent tears of the triangular fibrocartilage complex

• Degenerative cystic changes of the ulnar carpal bones can resolve after the ulnar shortening osteotomy

An ulnar shortening osteotomy would be MOST indicated for which of the following patients presenting with longstanding ulnar sided wrist pain refractory to conservative measures?

• 34-year-old female with an ulnar neutral wrist and distal radioulnar joint incongruity

• 34-year-old female with an ulnar positive wrist and distal radioulnar joint incongruity

• 34-year-old female with an ulnar negative wrist and distal radioulnar joint incongruity

• 78-year-old female with ulnar positive wrist and distal radioulnar joint arthritis

• 78-year-old female with ulnar negative wrist and distal radioulnar joint arthritis