Arthroscopic excision of ulnar styloid in stylocarpal impaction

Abstract

Stylocarpal impaction is an uncommon cause of ulnar-sided wrist pain in which the long ulnar styloid affects the triquetrum. Previous authors have described an open excision of the ulnar styloid. We present a new technique for arthroscopic identification and subsequent excision of the ulnar styloid. The diagnosis was suspected on plain radiographs and was confirmed by dynamic fluoroscopy. Four patients with ulnar styloid impaction were successfully managed. A diagnostic arthroscopy was performed. With the arthroscope in the 4-5 portal, a 3.5-mm burr was introduced into the 6 U portal. By palpation, the burr was placed onto the tip of the ulnar styloid and confirmed with fluoroscopy. Sufficient ulnar styloid was removed to prevent impingement; this was confirmed on fluoroscopy. We undertook resection of the ulnar styloid to 3 mm (normal, 3 to 6 mm). Adjacent soft tissue structures were not violated. Arthroscopic ulnar styloid identification and excision is a relatively simple procedure. Disruption of the triangular fibrocartilage, dorsal ulnar capsular ligament, and volar ulnar carpal ligament is avoided. Fluoroscopy is valuable in providing preoperative and intraoperative identification of the ulnar styloid and impingement. Postoperatively, patients can recommence activities of daily living as comfort allows.