Hand Clinics

SAUNDERS Hand Clin 22 (2006) 539-543 Note Page numbers of article titles are in boldface type. Arthritis, juvenile idiopathic, 457-458, 459 pisotriquetral, clinical and radiologic evaluation of, 524, 525 treatment of, 524-525 arthroscopic radiocarpal and midcarpal joint intrinsic adhesion release in, 531, 532 classification of, 530-531 clinical manifestations of, 530 diagnosis of, 530 dorsal distal radioulnar joint release in, 532 DRUJ silhouette capsulectomy in, 531, 532 etiology and...

References

1 Schrank C, Meirer R, Stabler A, et al. Morphology and topography of intraosseous ganglion cysts in the carpus an anatomic, histopathologic, and magnetic resonance imaging correlation study. J Hand Surg Am 2003 28(1) 52-61. 2 Van den Dungen S, Marchesi S, Ezzedine R, et al. Relationship between dorsal ganglion cysts of the wrist and intraosseous ganglion cysts of the carpal bones. Acta Orthop Belg 2005 71(5) 535-9 in French . 3 Kligman M, Roffman M. Bilateral intraosseous ganglia of the...

Diagnosis

Clinical symptoms of pain, restricted wrist range of motion, swelling, and a plateau in the improvements after at least 6 months of intensive physiotherapy should be considered suspicious for arthrofibrosis. There is frequently a hard endpoint to range of motion. Before a diagnosis of arthrofibrosis can be made, other causes of loss of motion and pain must be ruled out in the differential diagnosis. This includes bony incongruity, arthritis, complex regional pain syndrome, carpal instability,...

Wrist Arthrofibrosis529

Lee, Francesco Gargano, and Michael R. Hausman Wrist arthrofibrosis is a condition of decreased range of wrist motion due to intrinsic adhesions and extrinsic contracture. It is clinically characterized by restricted wrist range of motion, pain, swelling, and a plateau in improvement after at least 6 months of intensive physiotherapy. Other conditions must be excluded, such as articular incongruity, arthritis, spasticity, skin and subcutaneous scarring, and loose bodies. We have...

Chronic with arthritic changes CMC arthrodesis

Scaphoid, capitate, and second metacarpal bones. It is wedge-shaped the dorsal facet is twice the size of the palmar facet, which causes fractures and dislocations to displace dorsally when the second metacarpal is driven into extreme flexion 7,9,93 . In addition to the orientation, the palmar ligaments are stronger than its dorsal attachments, and therefore the bone is susceptible to displacement dorsally. The trapezoid is perfused by separate circulations on the volar and dorsal surfaces,...

Christopher L Forthman MDa Keith A Segalman MDb

ACurtis National Hand Center, Union Memorial Hospital, 3333 North Calvert Street, 2nd Floor, Baltimore, MD 21218, USA hDepartment of Orthopaedic Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Wrist pain is one of the most common complaints seen by a hand or orthopedic surgeon. The proximate cause is often obvious, but a cursory examination may allow the clinician to miss significant underyling pathology Fig. 1 . A careful, thorough examination is warranted, even when the...

Brett Peterson MD Robert M Szabo MD MPH

Lateral View Wrist

Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y Street, Suite 3800 Sacramento, CA 95817, USA Despite improved understanding of carpal mechanics, increased awareness of intercarpal ligament injuries, and improved techniques for treating carpal instability, post-traumatic intercarpal osteoarthrosis remains a common problem. Osteoarthritis of the carpal bones, including scapholunate advance collapse SLAC wrist, scaphotrapeziotrapezoid STT arthritis,...

Box 1 Wrist arthrofibrosis classification

Mri Images Fibrosis Sarcoma

Distal radioulnar joint DRUJ Type II Extrinsic capsular fibrosis C. Distal radioulnar joint DRUJ Fig. 1. Fibrous bands arrow extend from the radius to the carpus Type IA wrist arthrofibrosis . This ''spot welds'' the carpus to the radius. Fig. 1. Fibrous bands arrow extend from the radius to the carpus Type IA wrist arthrofibrosis . This ''spot welds'' the carpus to the radius. through creep, or the permanent deformation of tissue when placed under constant stress for an extended period of...

Scaphotrapeziotrapezoid osteoarthritis

Isolated STT arthritis is less common than SLAC patterns of arthritis 43,44 , and the etiology of STT arthritis is not as well understood. In Watson and Ballet's paper 1 , SLAC wrist accounted for 57 of arthritic wrists, whereas 27 of cases occurred between the scaphoid, trapezium, and trapezoid a combination of these two patterns occurred in 15 1 . Previous studies have associated STT arthritis with isolated sca-pholunate ligament disruption 35 . Cope 45 demonstrated in a cadaveric study that...

Lunotriquetral arthritis

Lunotriquetral Arthritis

Although degenerative problems associated with scapholunate dissociation are a very common cause of wrist arthritis, isolated lunotrique-tral arthritis is rare unless it is encountered as a result of a partial carpal coalition 36 . Coalition of carpal bones is relatively common, and the lu-nate-triquetrum fusion is the most frequent carpal coalition 36,37 . This finding is almost always coincidental and asymptomatic Fig. 5 however, when the coalition is incomplete, patients who have this...

Pisotriquetral arthritis

Symptoms Arthritis Wrist

Chronic pain in the pisiform area may be caused by tendinitis of the insertion of the flexor carpi ulnaris, bony fractures, or osteoarthrosis of the pisotriquetral joint, which some report as a frequent site of osteoarthritis slightly less common than the scaphotrapezial osteoarthrosis 52 . Although pain and tenderness on the palmar and ulnar aspects of the wrist in the area of the pisiform bone is fairly common, refractory pisotri-quetral osteoarthritis was unusual enough for Green to be able...

Box 1 Capitate summary

Transverse proximal pole waist Fig. 1 Type 3. Coronal oblique Type 4. Parasagittal 1. Hyperextension with capitate striking distal radius - Nondisplaced Short arm thumb spica cast x 6-8 weeks - Displaced CRIF vs ORIF K-wires, headless compression screws Abbreviations CRIF, closed reduction internal fixation K-wire, Kirschner wire ORIF, open reduction internal fixation. ligament and the FCU tendon, and the origin of the abductor digiti minimi muscle 45 . The FCU tendon continues distally...

Mordechai Vigler MDa Alberto Aviles MDb Steve K Lee MDa

AHand Surgery Service, New York University Hospital for Joint Diseases Orthopaedic Institute, Department of Orthopaedic Surgery, The New York University School of Medicine, 301 East 17th Street, New York, NY 10003, USA bHand Surgery Service, The Institute of Plastic and Reconstructive Surgery, The New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA According to ICD-9-CM diagnostic codes in 1998, an estimated 188,000 to 226,000 carpal fractures were treated in...

Juvenile idiopathic arthritis

Scaphoid Ischemia

To consolidate terminology for classifying chronic childhood arthritis, the International League Against Rheumatism adopted the term juvenile idiopathic arthritis JIA , which encompasses the diseases previously known as juvenile rheumatoid arthritis and juvenile chronic arthritis 111 . In patients who have JIA, the wrist is a very commonly involved joint, second only to the knee, and is affected in approximately 54 to 59 of patients 112,113 . Initial radiographic Fig. 13. A-C Preiser's disease...

Authors preferred treatment algorithm

Radial Shortening Surgery

The authors' treatment approach is based upon consideration of the natural history of the disease. What is known is that Kienbock's disease exists in diagnosed patients, but the specific natural history in each specific patient is not known. In other words, progression cannot be predicted for an individual patient. Therefore, treatment is predicated on symptom severity and alleviation, with consideration of the stage of disease Table 2 . Cast treatment can be considered in mildly symptomatic...

Classification

Slil Ligament

Three classification systems have been devised for grading scaphoids afflicted with Preiser's disease 8,22 . The first scheme, derived by Herbert and Lanzetta in 1993 8 , is based on the progression of the disease as seen with plain radiographs. Based on four stages, this system Fig. 3. Illustration demonstrating some of the ligamentous attachments of the scaphoid. Note the three segments of the SLIL, including the strong dorsal portion and the weaker membranous and palmar sections. This...

Preiser S Disease

Scaphoid Collapse

Preiser's disease or idiopathic avascular necrosis of the scaphoid is a rare condition that often presents as vague wrist pain with an insidious onset. At this time an etiology has not been elucidated, but there is evidence to suggest that there may be an anatomical or biomechanical basis for the affliction. In all likelihood the etiology is multifactorial. Patients who are predisposed because of anatomic or biomechanical variations need only another, often relatively minor, insult minor...

Malignant bone tumors

Malignant bone tumors of the carpus are extraordinarily uncommon. Osteosarcoma, the most common malignant bone tumor, has only been reported in the carpus twice in the English literature 64,65 . Bickerstaff and colleagues 65 describe a 66-year-old female who had osteosar-coma of the trapezium, causing symptoms similar to arthritis of the thumb carpometacarpal joint. Marcuzzi and colleagues 64 tell of an osteosar-coma of the scaphoid mistaken for a benign lesion and treated with curettage and...

Treatment

Kienbock Disease Stage

The combination of unknown etiology and unknown natural history has led to a large, and sometimes baffling, array of surgical procedures that are difficult to compare. Because of the many surgical options, the authors will first discuss the different procedures based on their underlying principles in regard to how they attempt to remedy the pathogenesis of the disease. Then we will discuss our approach to treatment of patients who have Kienbock's disease. Surgical treatment strategies fall into...

Pauciarticular disease

Approximately 45 of patients who have JIA have arthritis limited to one or only a few joints. Larger joints are typically involved in a nonsymmetric distribution 115 . Pauciarticular disease is associated with ocular involvement, including anterior uveitis and chronic iridocyclitis 115,118 . Because ocular involvement does not usually present until late in the disease process, frequent eye examinations are a critical component of care. Jay and colleagues 115 recommend that children who have...

Intraarticular tumors

Ulnocarpal Calcification

Intra-articular tumors of the wrist should be considered as a possible cause of generalized wrist swelling, pain, and stiffness. Plain radiographs often do not provide many clues to the underlying diagnosis. CT or MRI will show the extent of the disease, but the hand surgeon may still confuse the tumor with an inflammatory process such as rheumatoid arthritis or gout Fig. 8 . The features of the axial images must be reviewed carefully, just as the surgeon would critically examine any abnormal...

Diagnosis and staging

Kienbock's disease affects patients of all ages and either gender. There need not be a history of antecedent trauma or previous wrist problems. Symptoms tend to reflect the severity of the disease, ranging from mild discomfort to debilitating pain however, this is not always the case, because some patients who have radiographic evidence of severe arthrosis remain relatively asymptomatic. Swelling and synovitis is commonly found about the lunate, both on the dorsal as well as the volar side....

Kienbock S Disease

Laurin Sandrow

Congenital abnormalities of the carpus are rare in isolation and typically present as part of a generalized syndrome. Treatment of carpal disorders within these syndromes continues to require an understanding of the influence the wrist's position on overall upper extremity function. In addition, carpal ossification throughout childhood presents a unique set of influences regarding pediatric carpal injury. Although the pediatric carpus is capable of remodeling and revascularization, cases...

Carpal tarsal osteolysis

Carpal tarsal osteolysis CTO is an uncommon condition characterized by the spontaneous resorption of the carpal bones Fig. 5 . Although the cause of osteolysis is still unknown, the condition has shown both autosomal dominant and recessive inheritance patterns in addition to spontaneous occurrence 43 . Several physical findings may be associated with CTO, including abnormal skull shape, micrognathia, high-arched palate, decreased height, and scoliosis 44 . CTO is also frequently associated with...

Idiopathic Avascular Necrosis of the Scaphoid Preisers Disease475

Trumble Preiser's disease, or idiopathic avascular necrosis of the scaphoid, is a rare, albeit often debilitating, condition. Although unknown, the etiology is probably multifactorial, with biomechanical or anatomical variations leading to an ''at risk'' scaphoid. Most commonly the diagnosis is made with the use of plain radiographs, but one should not hesitate to use MRI for both confirming the diagnosis and evaluating the stage of the disease. Current treatment...