Does ulnar positive variance require treatment?

From the Guidelines

Ulnar positive variance does not necessarily require treatment unless it is symptomatic or causes functional limitations. When considering treatment for ulnar positive variance, it is essential to assess the patient's symptoms and functional limitations, as many individuals with this condition remain asymptomatic and do not require intervention 1.

Key Considerations

• Ulnar positive variance can cause ulnar-sided wrist pain, clicking, limited range of motion, or weakness due to impingement of the ulnar head on the triangular fibrocartilage complex (TFCC) or lunate.
• Treatment is typically recommended when patients experience these symptoms, and the goal is to alleviate pain, improve function, and enhance quality of life.
• Conservative management includes:
  • Activity modification
  • Wrist splinting
  • Anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks
  • Corticosteroid injections for temporary relief
• Physical therapy focusing on wrist strengthening and proprioception can help manage symptoms and improve functional outcomes.

Treatment Approach

If conservative measures fail after 3-6 months or in cases with significant functional impairment, surgical options may be considered, including:

• Ulnar shortening osteotomy to reduce the variance
• Wafer procedure to remove a portion of the distal ulna
• Arthroscopic TFCC debridement The decision for treatment should be individualized based on symptom severity, functional limitations, and the patient's activity demands, as emphasized in the evaluation of chronic wrist pain 1.

From the Research

Ulnar Positive Variance Treatment

• Ulnar positive variance can be a source of ulnar-sided wrist pain and may require treatment, especially if it is causing symptoms such as pain, restricted forearm rotation, and weakness of grip 2, 3, 4.
• Treatment options for ulnar positive variance include ulnar shortening osteotomy, which has been shown to be a successful therapy for this condition, both congenital or posttraumatic 2, 4, 5.
• Arthroscopic debridement for decompression of the TFCC may also be performed, especially in cases of congenital positive variance 2.
• The goal of treatment is to correct the length of the ulna and alleviate symptoms, while also avoiding overcorrection, which can lead to disorders of the distal radioulnar joint 2, 4.

Indications for Treatment

• Ulnar positive variance is often associated with wrist pathologies such as triangular fibrocartilage complex tears, ulnar impaction syndrome, and degenerative changes at the distal radioulnar joint 3, 6, 4, 5.
• Athletes with ulnar positive variance may be at risk for interruption of sports participation and may require treatment to alleviate symptoms and prevent further injury 5.
• The decision to treat ulnar positive variance surgically or conservatively depends on the severity of symptoms and the presence of underlying wrist pathologies 2, 3, 4, 5.

Surgical Treatment Options

• Ulnar shortening osteotomy is a common surgical treatment for ulnar positive variance, and has been shown to be effective in alleviating symptoms and improving function 2, 4, 5.
• Other surgical treatment options may include arthroscopic debridement, TFCC repair, and distal radioulnar joint reconstruction, depending on the underlying wrist pathology 2, 4.