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Ulnar Variance
B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Abnormal length of ulna relative to distal radius → adjacent soft tissue and osseous abnormalities
          • Related to abnormal load-bearing through ulna
          • Measurement of ulnar length
            • Ulnar neutral: Ulna 0-2 mm shorter than radius
            • Ulnar negative: Ulna > 2 mm shorter than radius
            • Ulnar positive: Ulna longer than radius

      IMAGING

      • General Features

        • Imaging Recommendations

          • Radiographic Findings

            • MR Findings

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Staging, Grading, & Classification

                    • Microscopic Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Chang CY et al: Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology. Skeletal Radiol. 43(6):793-800, 2014
                              2. Katayama T et al: Distribution of primary osteoarthritis in the ulnar aspect of the wrist and the factors that are correlated with ulnar wrist osteoarthritis: a cross-sectional study. Skeletal Radiol. 42(9):1253-8, 2013
                              3. Unglaub F et al: Cartilage cell proliferation in degenerative TFCC wrist lesions. Arch Orthop Trauma Surg. 130(8):953-6, 2010
                              4. Takahara M et al: Long-term follow-up of radial shortening osteotomy for Kienbock disease. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:184-90, 2009
                              5. Bickel KD: Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. 33(8):1420-3, 2008
                              6. Reiter A et al: Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy. 24(11):1244-50, 2008
                              7. Unglaub F et al: Correlation of ulnar length and apoptotic cell death in degenerative lesions of the triangular fibrocartilage. Arthroscopy. 24(3):299-304, 2008
                              8. Saffar P: The pathology of the long ulna: anatomy and treatment. J Hand Surg Eur Vol. 32(6):608-19, 2007
                              9. DiFiori JP et al: Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast. Am J Sports Med. 34(5):840-9, 2006
                              10. Markolf KL et al: Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study. J Hand Surg Am. 30(2):351-8, 2005
                              11. Tomaino MM et al: Ulnar impaction syndrome. Hand Clin. 21(4):567-75, 2005
                              12. Zenzai K et al: Long-term outcome of radial shortening with or without ulnar shortening for treatment of Kienbock's disease: a 13-25 year follow-up. J Hand Surg Br. 30(2):226-8, 2005
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  TERMINOLOGY

                                  • Definitions

                                    • Abnormal length of ulna relative to distal radius → adjacent soft tissue and osseous abnormalities
                                      • Related to abnormal load-bearing through ulna
                                      • Measurement of ulnar length
                                        • Ulnar neutral: Ulna 0-2 mm shorter than radius
                                        • Ulnar negative: Ulna > 2 mm shorter than radius
                                        • Ulnar positive: Ulna longer than radius

                                  IMAGING

                                  • General Features

                                    • Imaging Recommendations

                                      • Radiographic Findings

                                        • MR Findings

                                          DIFFERENTIAL DIAGNOSIS

                                            PATHOLOGY

                                            • General Features

                                              • Staging, Grading, & Classification

                                                • Microscopic Features

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          Selected References

                                                          1. Chang CY et al: Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology. Skeletal Radiol. 43(6):793-800, 2014
                                                          2. Katayama T et al: Distribution of primary osteoarthritis in the ulnar aspect of the wrist and the factors that are correlated with ulnar wrist osteoarthritis: a cross-sectional study. Skeletal Radiol. 42(9):1253-8, 2013
                                                          3. Unglaub F et al: Cartilage cell proliferation in degenerative TFCC wrist lesions. Arch Orthop Trauma Surg. 130(8):953-6, 2010
                                                          4. Takahara M et al: Long-term follow-up of radial shortening osteotomy for Kienbock disease. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:184-90, 2009
                                                          5. Bickel KD: Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. 33(8):1420-3, 2008
                                                          6. Reiter A et al: Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy. 24(11):1244-50, 2008
                                                          7. Unglaub F et al: Correlation of ulnar length and apoptotic cell death in degenerative lesions of the triangular fibrocartilage. Arthroscopy. 24(3):299-304, 2008
                                                          8. Saffar P: The pathology of the long ulna: anatomy and treatment. J Hand Surg Eur Vol. 32(6):608-19, 2007
                                                          9. DiFiori JP et al: Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast. Am J Sports Med. 34(5):840-9, 2006
                                                          10. Markolf KL et al: Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study. J Hand Surg Am. 30(2):351-8, 2005
                                                          11. Tomaino MM et al: Ulnar impaction syndrome. Hand Clin. 21(4):567-75, 2005
                                                          12. Zenzai K et al: Long-term outcome of radial shortening with or without ulnar shortening for treatment of Kienbock's disease: a 13-25 year follow-up. J Hand Surg Br. 30(2):226-8, 2005