Test Your X-Ray IQ: Chronic Wrist Pain

Why has this patient been experiencing chronic wrist pain?

Dx: Positive Ulnar Variance
Positive ulnar variance describes where the distal articular surface of the ulna is more distal when compared to the articular surface of the radius. (blue lines)
It plays important role in wrist pathology such as ulnar impaction syndromes and thinning of the triangular fibrocartilage complex.
Ulnar-sided pain in athletes that do a lot of wrist extension with impaction (front squats, cleans, handstand pushups etc) can cause irritation to the TFC or even bone bruises because of the variance. This is something to consider in those patients and can help in explaining to them why their wrist always hurts when they do those activities.

Plain film radiography can still be a helpful tool in evaluating for suspected soft tissue injuries (such as ACL tears) if you know what you’re looking for. Of course MRI is a much better modality, but x-ray can help guide you with your clinical evaluation.

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