Causes and findings:
• Osteoarthritis or rheumatoid arthritis
• Trauma: fall on outstretched hand or strong traction or twisting movement
• Pain at end of forearm on ulnar side
• Painful limitation in the capsular pattern: passive pronation and supination at end-range
• For meniscal tear: passive and resisted wrist flexion, with resisted and passive ulnar deviation, plus 'scoop' test (see below)
Equipment:
Syringe - 2ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 1ml 2%
Total volume - 1.25 ml
Anatomy:
The inferior radioulnar joint is an L-shaped joint about a finger's width in length and includes a triangular cartilage, which separates the ulna from the
carpus. With the palm facing downwards, the joint runs one-third across the wrist just medial to the bump of the end of the ulna. The joint line is identified by gliding the ends of the radius and ulna against each other or by palpating the space between the styloid process of the ulna and the triquetral.
Technique:
• Patient sits with hand palm down
• Identify styloid process of ulnar
• Insert needle just distal to styloid aiming transversely towards radius, passing through the ulnar collateral ligament to penetrate capsule
• Inject solution as a bolus
Aftercare:
Advise rest for 1 week with avoidance of flexion/ulnar deviation activities. Mobilization with distraction can be effective in meniscal tears.
Comments:
Tears of the cartilage are relatively common, especially after trauma such as falling on the outstretched hand, a traction injury or after Colles' fracture. The most pain-provoking test is the scoop test - compressing the supinated wrist into ulnar deviation and scooping it in a semi-circular movement towards flexion. The patient often complains of painful clicking and occasionally the wrist locks. Mobilization helps relieve the pain but an injection can be given in the acute phase. Often an explanation of the condition and reassurance, together with advice on avoidance, is sufficient.
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