Outcomes and challenges in ulnar-sided wrist surgery

The findings in this thesis underlined the confounding nature of ulnar-sided wrist pain. It is crucial to be aware of the complex overlap and interaction of the pathologies at the ulnar wrist, to guide accurate diagnosis. Relevant diagnostic imaging can assist in establishing the right diagnosis and exclude other pathology. However, it must be noted that each modality has its own specific indications and set of advantages and disadvantages. Furthermore, it may be difficult to differentiate structural sources of ulnar-sided wrist pain from unrelated incidental findings, which once again highlights the importance of taking a thorough history and performing a detailed physical examination. We stated that PROMs can assist in the development of a treatment plan to meet the specific preferences and needs of a particular patient, as they quantify care from the patient’s perspective. In this thesis we found relatively high rates of complications and reoperations after ulnar-sided wrist surgery. However, these high rates did not always necessarily lead to inferior patient-reported outcomes. We believe that psychological factors and coping strategies have a great influence on level of pain and physical functioning. Advances in medical imaging technology with the use of artificial intelligence (AI) in radiology and new techniques such as 4D-CT, may allow improved assessment of wrist kinematics and pathology in ulnar-sided wrist pain. Furthermore, there is growing evidence for a strong influence of psychosocial factors on PROMs across a range of upper-extremity disorders. We believe that that there is more to generating optimal outcomes than resolving pathophysiology, restoring anatomy, and focusing on the technical components alone. More large-scale and prospective studies are required to compare several ulnar-sided wrist procedures, ideally with implementation and a great focus on the influence of psychological and social factors.