Archive for July, 2015
‘Ulnar sided wrist pain’ is an umbrella term that covers several diagnoses. Specifically diagnosing why someone is having ulnar sided wrist pain can be difficult. Even with advances in imaging, thorough clinical exams, and detailed histories it can leave a clinician scratching their head because often times all tests will come back negative (normal), yet the patient has ongoing complaints. Not only is it difficult to pinpoint the exact cause of the pain, it is difficult to treat.
Most commonly ulnar sided wrist pain is a result of either a TFC(C) injury and/or Ulnar Abutment Syndrome; though there are many other less common culprits.
TFCC or TFC is short for Triangular Fibrocartilage Complex. As the name suggests, the TFCC is a complex structure composed of ligament and cartilage material that stabilizes the wrist at the distal radioulnar joint (DRUJ). It is triangular in shape and is housed on the ulnar side of the wrist between the distal ulna and the carpal bones. The TFCC is most commonly injured during a fall on an outstretched hand. Repetitive pronation with grip is a risk factor for degeneration of the tissue, as is age. As the tissues soften and thin, risk of tear increases with minimal trauma. Anatomy can also pose a risk for TFCC injuries, which leads us to Ulnar Abutment Syndrome (UAB). UAB is a result of a length discrepancy between the two long bones of the wrist (radius and ulna), usually an elongated ulna. This abnormal length discrepancy, usually quite small, is referred to ulna plus variance or as ‘ulnar positive’. The cause may be congenital, due to previous fracture, premature growth plate closure, or radial head resection.
Symptoms of both problems can mimic one another and may include, but are not limited to pain and/or swelling along the outside of the wrist, difficulty with twisting and turning motions, and pain with palm down gripping activities. They may experience ‘crackling’ or ‘popping’ of the wrist and a sense of instability. Because diagnosis can be difficult, treatment is equally as hard. There are a variety of surgical procedures available to fix a torn TFCC or to shorten the ulna when a length discrepancy is apparent, but none of the surgeries are ‘easy’ or a ‘quick fix’ and most surgeons want to exhaust all conservative options before going down the operative path. Conservative treatment includes the use of anti-inflammatories, splinting, localized injections, hand therapy, and activity modification. Historically, splinting for ulnar sided wrist pain has been limited to using a wrist splint to rest and protect the wrist. Unfortunately, rarely does a wrist splint offer the patient the kind of relief that they need and they forego the splint all together. Neoprene wrist wraps are sometimes used, but rarely offer enough support to overcome symptoms, though the heat and compression is usually comforting. Hand therapists will sometimes fabricate a custom splint specifically designed to help support the DRUJ by building in some bolstering on the ulnar side of the wrist, but they are usually bulky and so rigid that compliance again becomes an issue.
The Ulnar Abutment Brace is several splints in one that make it ideal for treating ulnar sided wrist pain. It is a neoprene wrist wrap with a removable stay so that the degree of rest and immobilization can be tailored specifically to the patient’s needs. It includes a customizable gel buttress to support and/or capture the ulnar head to offer external stability. It is comfortable and compressive. Because it crosses the wrist and has rigid support, it is reimbursable. A hurdle no other brace for this specific problem has overcome. The UAB is universal in size, specify right or left.
Learn more about the Ulnar Abutment Brace.
A knee brace for osteoarthritis doesn’t have to cost over $200. The one pictured above is only $149.95 (L-1843). The New Option OA Brace from Heritage Medical Equipment is a cost-effective treatment option to help reduce the knee pain associated with unicompartmental osteoarthritis.
Knee braces for osteoarthritis, sometimes called off loading knee braces, were originally made from heavy carbon graphite – 20 years ago. Carbon graphite unloading knee braces are still available but are best for patients with unique anatomy, those that are obese, or athletes who engage in contact sports. Just about everyone else can get effective pain relief from a neoprene brace with some gentle unloading provided by a simple hinge.
The brace pictured above is sold through a few different manufacturers and distributors. So beware of being overcharged by bloated companies looking to gouge the public, and the orthotic and prosthetic community. If you visit an orthotist, which is exactly how we recommend you obtain a knee brace for osteoarthritis, they will charge your insurance company about $750. This is fair and reasonable. Built into the billing is the measuring, fitting, and follow up an unloading knee brace requires to be most effective. As a patient you are covered to go see your orthotist for up to two years, depending on what state you live in, for fitting and adjustments. The gouging we’re warning about takes place when a distributor or manufacturer overcharges the orthotist, or the public if they’re buying direct, for a product that is usually reasonably priced.
Learn more about the cost-effective knee brace for osteoarthritis – an active reliever of knee pain.