69 y/o M with ulnar sided wrist pain. (Hx – Pinky sided wrist pain).

Thanks to everyone who responded! Was meant to be fun and hopefully was. In that vein, one person suggested syphilis after asking if it was my hand. I chose not to respond.

I’ve included a couple of references at the end. Luis Cerezal’s article on ulnar sided wrist impaction syndromes is a must read.

The article brings up the distinction between ulnar impaction and ulnar impingement. Impaction – A.K.A. Ulno carpal abutment, impingement, ulnolunate impaction as well as others. Usually long ulna (positive variance, TFCC tear and DJD of the proximal ulnar aspect of the lunate although all findings are not necessary).

Ulnar impingement – A.K.A radioulnar abutment is a short ulna with arthrosis of the DRUJ.

Styloid impingement is impingement of the ulnar styloid on the adjacent triquetrum, typically associated with an ununited styloid fracture. Also can happen with a long styloid. Look for DJD of undersurface of the triquetrum.

Adventitial bursitis is inflammation of a non native bursa that develops near a bony or hardware prominence or otherwise us the result of frictional inflammation. I thought this patient had, in addition to everything else, adventitial bursitis adjacent to the styloid and ECU. You could argue against that theory, it’s not a hard fast diagnosis, just an opinion. Either way, if he is treated for inflammation in that area, he will benefit regardless of the exact cause.

Finally how many potential causes of pain varies on if you include related processes such as ECU tendinosis and tenosynovitis as 1 or 2 causes.

As you’ll see, everyone said very similar things.

My answers were 5:

ECU tendinosis and tenosynovitis
Ulno-Lunate impaction (includes TFCC tear)
DRUJ arthrosis (doesn’t look too angry though so probably not an important cause now)
Ulnar styloid impingement (ununited fx with adjacent triquetral change)
Adventitial bursitis

Answers included:

First of all it’s Covid.
Otter differentials are:
Ulnar impsction syndrom
Extensor carpi ulnaris tendinosis and tendovaginitis
Older styloid fracture .
Tfcc degeneration.
Possible rheumatoid degeneration!
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6 possible causes
– ulnar styloid fracture
– TFCC tear
– ulnar carpal impaction syndrome with lunate chondromalacia
– type II lunate
– EUC tenosynovitis and tendinosis
– distal radioulnar impaction syndrome
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Nice case! Not uncommon in my experience.
– ulnocarpal impingement with Palmer 2C lesion complex i.e. TFCC perforation + lunate chondromalacia; LT lig. looks mostly intact; (btw do you use that classification?)
– DRUG osteoarthritis;
– ECU tendinopathy + subluxation.
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ECU Tenosynovitis
Ulnolunate abutment/TFC tear
Ununited ulnar styloid
Ganglion impinging on UN
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Hi Dr Tirman
I counted four.
Best

If you disagree or feel strongly about something on this subject please say so. Discussions based on disagreement can be enlightening.
(reasonable people can disagree except when it comes to American politics.)

Here are the references:

https://pubs.rsna.org/doi/10.1148/radiographics.22.1.g02ja01105

Imaging Findings in Ulnar-sided Wrist Impaction Syndromes
Luis Cerezal, Francisco del Piñal, Faustino Abascal, Roberto García-Valtuille, Teresa Pereda, Ana Canga
Author Affiliations

Published Online:Jan 1 2002https://doi.org/10.1148/radiographics.22.1.g02ja01105

https://radiopaedia.org/articles/adventitious-bursitis?lang=us#:~:text=Adventitious%20or%20adventitial%20bursitis%20refers,to%20high%20pressure%20and%20friction.
Adventitious bursitis
Dr Magdalena Chmiel-Nowak◉ and Dr Yuranga Weerakkody◉ et al.
Adventitious or adventitial bursitis refers to inflammation associated with adventitious bursae.

Adventitious bursae are not permanent native bursae. They can develop in adulthood at sites where subcutaneous tissue becomes exposed to high pressure and friction.