Arthroscopic Management of Ulnar Pain PDF
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Arthroscopic Management of Ulnar Pain Francisco del Piñal (Editor in Chief) Christophe Mathoulin and Toshiyasu Nakamura (Co-editors) Arthroscopic Management of Ulnar Pain Editors Illustrator Francisco del Piñal Massimiliano Crespi Private Practice and Hospital Milano Mutua Montañesa Italy Santander Spain Christophe Mathoulin Institut de la main Clinique Jouvenet Paris France Toshiyasu Nakamura Department of Orthopaedic Surgery School of Medicine Keio University Tokyo Japan ISBN 978-3-642-30543-6 ISBN 978-3-642-30544-3 (eBook) DOI 10.1007/978-3-642-30544-3 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2012952731 © Springer-Verlag Berlin Heidelberg 2012 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my kids Lucía, Guiller, Miguel, and Juan To Estíbaliz To the surgeons who are pushing the boundaries of wrist arthroscopy to the unimaginable Paco Piñal “This book is dedicated to all surgeons interested in wrist surgery, and especially to all EWAS members with whom we have made so much progress over the last seven years. Thanks to their contribution, we have been able to change our understanding and treatment of intrinsic ligamentous injuries of the wrist” Christophe Mathoulin Many thanks to my wife Yuzuka and lovely daughter Erie. I sincerely hope this challenging book may be useful for all wrist arthroscopists. May the force be with you! Toshi Nakamura Preface Ulnar pain has been considered the black hole of the wrist. As a matter of fact, one of the main aims when the scope was introduced in the wrist more than 20 years ago was to unravel ulnar pain. Yet, we still have not come up with all the answers! The purpose of this book is to provide an update by renowned specialists in order to improve our understanding of ulnar pain. Some of the conditions can now be treated arthroscopically, and these have been profusely illustrated. Others are still not well understood. Hopefully, this book will assist us in untangling them. Each condition is covered in a fully comprehensive chapter. However, as stressed several times throughout the pages of this book, mixed conditions are frequently seen. I believe that many of our poor results in the early days were due to what is known as “satisfaction of search” (i.e., once an obvious problem is found, no others are sought). A systematic search of pathology is paramount, since combined pathology is the norm in the ulnar side. It is too simplistic to think that a traumatic event may cause j ust a 1A tear. Think about it! How is it that the injuring agent might penetrate the middle of the disc, causing a tear only here, and then leave the joint totally unscathed elsewhere? Does not this seem too simple? I must admit that some of the conditions (if not all) can be treated equally well with open methods and at times faster. Nevertheless, there are several groups pushing hard to develop arthroscopic techniques and to make it simple for us all…. Do not stay out of the groove ladies and gentlemen! Things are changing very fast in wrist arthroscopy, and very much for the good. Think about what hap- pened several years ago in knee meniscectomy, which was carried out open. But who is doing so now? Arthroscopy allows complex operations to be performed not only with perfect illumination and magni fi cation but also with minimal dam- age to the rest of the patient’s body. Who can give more for less? The corollary is that those who are still undecided as to the bene fi t of the scope should not rest on their laurels. What seemed to be a distant future is now a living present. It is just unthinkable what some people can achieve nowadays. If you have not yet done so, jump on the bandwagon because the number is up for open wrist surgery. I hope this book contributes to shedding light into the black hole and helps our community to better understand and treat ulnar pain. Secretary General. The European Wrist Arthroscopy Society Paco Piñal Editor. The Journal of Hand Surgery European Volumen. Chairperson of the IFSSH Scientifi c Committee on Arthroscopy. vii Contents 1 Anatomy of the Ulnocarpal Compartment . . . . . . . . . . . . . . . . . . 1 Hisao Moritomo and Toshiyuki Kataoka 2 Anatomy and Biomechanics of the Distal Radioulnar Joint (DRUJ). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Toshiyasu Nakamura 3 Clinical Examination of the Ulnar-Sided Painful Wrist. . . . . . . 25 Marc Garcia-Elias 4 Setup, Surface Anatomy, and Portals. . . . . . . . . . . . . . . . . . . . . . 45 David J. Slutsky 5 Ulnar Imaging for Arthroscopic Surgeons . . . . . . . . . . . . . . . . . 61 Luis Cerezal and Faustino Abascal 6 The 1B Constellation: An Attempt to Classify Palmer 1B Class. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Francisco del Piñal 7 Central TFCC Debridement: Technique and Indication in the Twenty-First Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Terry L. Whipple 8 Treatment of Stable Peripheral TFC Tears. . . . . . . . . . . . . . . . 111 Max Haerle 9 TFCC: A DRUJ Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Mark Henry 10 DRUJ Instability: Arthroscopic Repair of the Detached TFCC to the Fovea of the Ulna. . . . . . . . . . . . . . . . . . . . . . . . . . 137 Toshiyasu Nakamura 11 DRUJ Instability: Arthroscopic Ligament Reconstruction. . . 147 Andrea Atzei 12 The Carpal Detachment Syndrome . . . . . . . . . . . . . . . . . . . . . . 161 Shinji Nishikawa and Satoshi Toh 13 Ulnocarpal Abutment: State of the Art and the Role of Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Christophe Mathoulin ix
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