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Carpal Impaction Syndromes
Carol L. Andrews, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Ulnar impaction syndrome: Ulnocarpal abutment, ulnocarpal loading, ulnar abutment, ulnolunate abutment
        • Definitions

          • Ulnar impaction syndrome: Ulnar wrist pain related to altered mechanics between ulna, triangular fibrocartilage (TFC), lunate, and triquetrum
          • Ulnar styloid impaction: Excessively long or fractured ulnar styloid impinges triquetrum
          • Radial styloid impingement: Styloid impingement on dorsal scaphoid with forced radial deviation
          • Dorsal impingement: Impingement of distal radius on scaphoid ± lunate
            • Scaphoid impaction syndrome: Impaction of dorsal scaphoid by dorsal radius
          • Hamatolunate impaction: Medial wrist pain related to cartilage loss of proximal hamate

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • Nuclear Medicine Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Sachar K: Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 37(7):1489-500, 2012
                                      2. Sammer DM et al: Ulnar impaction. Hand Clin. 26(4):549-57, 2010
                                      3. Crema MD et al: MDCT arthrography features of ulnocarpal impaction syndrome. AJR Am J Roentgenol. 193(5):1376-81, 2009
                                      4. Greenberg JA: Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis. J Hand Surg Am. 34(2):351-6, 2009
                                      5. Bickel KD: Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. 33(8):1420-3, 2008
                                      6. Henry M: Arthroscopic management of dorsal wrist impingement. J Hand Surg Am. 33(7):1201-4, 2008
                                      7. Webb BG et al: Gymnastic wrist injuries. Curr Sports Med Rep. 7(5):289-95, 2008
                                      8. Rettig AC: Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 32(1):262-73, 2004
                                      9. Steinborn M et al: MR imaging of ulnocarpal impaction after fracture of the distal radius. AJR Am J Roentgenol. 181(1):195-8, 2003
                                      10. Cerezal L et al: Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics. 22(1):105-21, 2002
                                      11. Nakamura K et al: Type I versus type II lunates: Ligament anatomy and presence of arthrosis. J Hand Surg Am. 26(3):428-36, 2001
                                      12. Thurston AJ et al: Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy. 16(5):540-4, 2000
                                      13. Viegas SF et al: Medial (hamate) facet of the lunate. J Hand Surg Am. 15(4):564-71, 1990
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Synonyms

                                              • Ulnar impaction syndrome: Ulnocarpal abutment, ulnocarpal loading, ulnar abutment, ulnolunate abutment
                                            • Definitions

                                              • Ulnar impaction syndrome: Ulnar wrist pain related to altered mechanics between ulna, triangular fibrocartilage (TFC), lunate, and triquetrum
                                              • Ulnar styloid impaction: Excessively long or fractured ulnar styloid impinges triquetrum
                                              • Radial styloid impingement: Styloid impingement on dorsal scaphoid with forced radial deviation
                                              • Dorsal impingement: Impingement of distal radius on scaphoid ± lunate
                                                • Scaphoid impaction syndrome: Impaction of dorsal scaphoid by dorsal radius
                                              • Hamatolunate impaction: Medial wrist pain related to cartilage loss of proximal hamate

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • Nuclear Medicine Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Sachar K: Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 37(7):1489-500, 2012
                                                                          2. Sammer DM et al: Ulnar impaction. Hand Clin. 26(4):549-57, 2010
                                                                          3. Crema MD et al: MDCT arthrography features of ulnocarpal impaction syndrome. AJR Am J Roentgenol. 193(5):1376-81, 2009
                                                                          4. Greenberg JA: Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis. J Hand Surg Am. 34(2):351-6, 2009
                                                                          5. Bickel KD: Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. 33(8):1420-3, 2008
                                                                          6. Henry M: Arthroscopic management of dorsal wrist impingement. J Hand Surg Am. 33(7):1201-4, 2008
                                                                          7. Webb BG et al: Gymnastic wrist injuries. Curr Sports Med Rep. 7(5):289-95, 2008
                                                                          8. Rettig AC: Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 32(1):262-73, 2004
                                                                          9. Steinborn M et al: MR imaging of ulnocarpal impaction after fracture of the distal radius. AJR Am J Roentgenol. 181(1):195-8, 2003
                                                                          10. Cerezal L et al: Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics. 22(1):105-21, 2002
                                                                          11. Nakamura K et al: Type I versus type II lunates: Ligament anatomy and presence of arthrosis. J Hand Surg Am. 26(3):428-36, 2001
                                                                          12. Thurston AJ et al: Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy. 16(5):540-4, 2000
                                                                          13. Viegas SF et al: Medial (hamate) facet of the lunate. J Hand Surg Am. 15(4):564-71, 1990