Wrist and Carpal Joints

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The wrist (radiocarpal) joint is a biaxial and ellipsoid articulation formed between the distal end of the radius and the scaphoid, lunate, and triquetrum with triangular cartilage on the ul-nar side. The joint is lined by synovium and surrounded by fibrous capsule and radiocarpal ligaments. In addition, there are complex inter-carpal joints, interconnecting (a) the proximal carpal bones, (b) the distal carpal bones, and (c) the two carpal bone rows.

Osteoarthritis of the wrist predominantly affects the radial side with the most common sites being the trapeziometacarpal joint and the trapezioscaphoid joint (Fig. 9.33). The involvement of the radiocarpal joint, distal radi-ofibular joint, lunate-triquetal joint, and other intercarpal joints are not rare (Fig. 9.34). Causes are trauma in the majority of cases and calcium deposition disease in occasional cases. Symptoms include pain and tenderness, motion disturbance, and soft-tissue swelling. Osteoarthritis without an obvious or probable etiology is termed idiopathic, but its existence has been challenged.

Radiography is often not helpful in the early stage of the disease, but plays an important role in the intermediate and late stages. Radiographic changes include articular narrowing, sclerosis, osteophytosis, cystic change, bone collapse, and deformity. Characteristically, changes are limited to a single or few small joints of the wrist, and osteoporosis is not a significant feature (Fig. 9.33A). Typically, the osteoarthritis in the wrist occurs on the radial side (Fig. 9.33), but the posttraumatic type involves any joint (Fig. 9.34A). MRI and CT are extremely useful for the specific diagnosis of synovitis, cartilage destruction, and cystic change (Fig. 9.33B). Osteoarthritis of the hands in typists affects the trapeziometatarsal and trapezioscaphoid joints, causing radial subluxation and bayonet deformity in the late stage (Fig. 9.35A). The osteoarthritis secondary to rheumatoid arthritis may show localized sclerosis within diffusely porotic carpal bones (Fig. 9.36A).

Cystic Change Carpal Bones RheumatoidTrapeziometacarpal Ligament

Fig. 9.33A-C Osteoarthritis in the radial side of the wrist. A Dorsopalmar radiograph of the right wrist in a 39-year-old female shows sclerosis in the distal radial epiphysis (arrows) with narrowing of the radiocarpal joint and the trapezioscaphoid and trapeziometacarpal joints (T triquetrum, S scaphoid, M metacarpal). B T2-weighted MRI reveals low signal in osteosclerosis (arrows) and bright signal of effusion in the radiocarpal and scaphotriquetral joints (arrow between S and T). C Dorsal pinhole scan shows intense tracer uptake in the radio-carpal joint (twin arrows) and the trapezioscaphoid and trapeziometacarpal joints (single arrow).

Pinhole scintigraphy plays an important role in the diagnosis of the early osteoarthritis with synovitis of the radiocarpal and trapeziometa-tarsal joints by showing tracer accumulated in the synovium and subchondral bones (Fig. 9.33C). Very subtle pathological changes localized to the proximal carpal bone can often be indicated by obvious uptake (Fig. 9.34B). Scintigraphy can also show the characteristic bayonet deformity produced by the radial subluxation of the trapeziometacarpal joint in the late stage (Fig. 9.35B). It is indeed interesting to note that the degree of tracer uptake parallels the degree of arthritic change: more intense

Trapeziometacarpal Arthrosis

Fig. 9.35A, B Osteoarthritis of the hands in typists. A Dorsopalmar radiograph of both hands in a professional female typist shows osteoarthritis in the trapezio-metatarsal and trapezioscaphoid joints of both hands with radial subluxation and bayonet deformity (arrows). B Dorsal pinhole scan reveals intense tracer uptake in classic bayonet deformity with squaring (arrows)

Fig. 9.35A, B Osteoarthritis of the hands in typists. A Dorsopalmar radiograph of both hands in a professional female typist shows osteoarthritis in the trapezio-metatarsal and trapezioscaphoid joints of both hands with radial subluxation and bayonet deformity (arrows). B Dorsal pinhole scan reveals intense tracer uptake in classic bayonet deformity with squaring (arrows)

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