WRIST IMPINGEMENT

There have been various terminologies applied to a varied group of syndromes that cause pain by soft tissue or bony impingement Some are referred to as abutments, some impactions and some impingements The term impingement has come more generally into common usage, largely because of increased awareness of impingements elsewhere, particularily the ankle Syndromes include

• Ulnocarpal abutment • Ulnostyloid abutment • Radioulnar impaction • Dorsal carpal impingement

• Hypothenar Hammer Syndrome The abutment syndromes are covered in their own section Other will be dealt with here

RADIOULNAR IMPACTION

Ulnar impaction syndrome is a different entiity.

This generally arises as a result of arthropathy of the distal radioulnar joint where the articular surface of the ulna impinges against the radius.

It can be mimiced by congenital abnormalities such as Negative ulnar variance and Madelungs deformity

HAMATOLUNATE IMPINGEMENT

Hamatolunate impingement can occur when there is a second articular surface of the distal lunate articulating with the hamate .

This is called a type 2 lunate Many type 2 lunates are asymptomatic but their presence predisposes to HL impingement Pain occurs on axial compression and ulnar deviation Look for chondromalacia, subchondral oedema and eventually subchondral cyst formation

DORSAL IMPINGEMENT

Symptoms of dorsal ganglion can be mimiced by injuries to the scapholunate ligament and Posterior impingement or capsulitis DORSAL CAPSULITIS OR IMPINGEMENT • capsular thickening

• dorsal compartment 2 tenosynovitis • bony fraqmentation • Dorsal osteophytes

HYPOTHENAR HAMMER SYNDROME

Digital ischaemia as a result of acute or repetitive compression of the hypothenar eminence.

The ulnar artery and terminal branches of the ulnar nerve was susceptible to compression against the hook of the hamate Thrombosis of the ulnar artery occur is leading to digital ischemia The superficial branch of the ulnar artery is more susceptible than the deep branch Occasionally aneurysmal dilatatione can occur

Symptoms tend to be worse in smokers