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First published on September 12, 2005, doi:10.1177/0363546505279577
This version was published on December 1, 2005
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The American Journal of Sports Medicine 33:1910-1913 (2005)
© 2005 American Orthopaedic Society for Sports Medicine

Ulnar Wrist Pain in Athletes Caused by Erosion of the Floor of the Sixth Dorsal Compartment

A Case Series

Ronaldo S. Carneiro, MD*,{dagger}, Rosana Fontana, MD{ddagger} and Nilton Mazzer, MD§

From the {dagger} Cleveland Clinic Florida, Naples, Florida, the {ddagger} Hospital Pompeia, Caxias do Sul, Rio Grande do Sul, Brazil, and the § University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil

* Address correspondence to Ronaldo S. Carneiro, MD, 6101 Pine Ridge Road, Naples, FL 34119 (e-mail: carneir{at}ccf.org).

Background: Ulnar-side wrist pain can be disabling for athletes because of limitation of pronation-supination during sports such as tennis and golf. Erosion of the floor of the sixth dorsal space should be considered for unresponsive ulnar-side wrist pain.

Study Design: Case series; Level of evidence, 4.

Methods: Four athletes with severe unresponsive ulnar-side wrist pain were identified. Because the usual treatment regimens were ineffective in all cases, surgery was indicated to attempt mitigation of symptoms. During surgical exploration, all patients had inflammatory tendon changes and erosions in the floor of the sixth dorsal space, deep to the extensor carpi ulnaris. A soft tissue interposition flap fashioned from the roof of the sixth compartment was used to cover the defect.

Results: Patients were evaluated by reexamination for range of motion, ability to perform daily and sports activities, strength, and residual pain. All patients had relief of their symptoms, had normal range of motion with no residual pain, and returned to tennis and golf. Strength improved a mean of 15 lb after surgery. The follow-up was 19 to 40 months (mean, 33 months).

Conclusion: Erosion of the sixth compartment floor has been given very little attention in the literature. It should be suspected when severe ulnar-side pain persists in athletes after the usual methods of treatment. The interposition surgery described herein has been effective in 4 cases previously unresponsive to the usual methods of treatment for chronic tendinitis of the extensor carpi ulnaris or triangular fibrocartilage rupture.

Key Words: erosion • extensor tendon • wrist • ulna • ulnar-side pain




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