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Wrist Osteoarthritis

From: JK Stanley. Current Orthopaedics. 13:290-6.1999.

May be Generalised or Localised (STT, SLAC, SNAC, rhizarthrosis)

Advanced Collapse (SLAC):

  • common pattern of OA
  • may be end-stage of scapho-lunate dissociation
  • The structures maintaining scapho-lunate alignment fail from trauma or degeneration.
  • Lunate extends & scaphoid flexes -> reduces carpal height
  • Later proceeds to radio-carpal OA & lunocapitate & lunohamate OA
  • Treat with scaphoid excision + 4-corner fusion (lunocapitate & triquetrohamate)

:

  • Develops from a longstanding scaphoid non-union.
  • The proximal pole of scaphoid acts like a lunate
  • OA develops betw. distal scaphoid fragment & radial styloid (not between radius & proximal fragment)

Notes on some Treatments:

Neurectomy:

  • Limited neurectomy (Berger technique)
  • 70% of patients have 70% pain relief at 7 years

Arthroplasty:

  • for low demand patients (RA) with good bone stock.
  • metalloplastic
  • Loosening = 15% over 10 years
  • small dislocation rate

Cause

   

Notes

Treatment

1. Idiopathic

      

    

   

2. Mechanical

Malunion distal radius

die punch injury of scaphoid or lunate fossa; 4 part #; pilon injury

fuse scaphoid & lunate to distal radius; radio-lunate fusion; involvement of midcarpal jt. = proximal row carpectomy

Scaphoid nonunion

SNAC wrist

limited wrist fusion = excise distal pole of scaphoid & fuse prox. pole to lunate to capitate (or ? radial styloidectomy?)

Scaphoid malunion

'hump back' deformity = scaphoid united in flexed position; may be rotational malunion also; scaphoid does not support lat. column thus incr. load central & medial columns

osteotomy risky

Carpal bone #'s

medial column injuries -> capito-hamate & hamo-lunate impaction

   

Kienbock's disease

Arthrosis = Lichtman stage 4

prox. row carpectomy or wrist arthrodesis

Preiser's disease

AVN of scaphoid

   

AVN Capitate

   

   

Hamo-lunate Impaction

70% of people have a facet on the medial aspect of the lunate which can impinge on the head of hamate in full ulnar deviation; diagnosed arthroscopically

Hamate head excision (arthroscopic)

STT OA [Radiograph]

ass. with chondrocalcinosis; pain on radial deviation of wrist;

STT arthrodesis

DRUJ OA

from malunion distal radius #s; injury to sigmoid notch

Sauve-Kapandji procedure [Picture]

Carpal instability

SLAC

scaphoid excision & 4 corner fusion (capito-hamo-triquetro-lunate)

Dorsal rim impaction syndrome

from scapho-lunate interosseous lig. incompetence; diagnosed arthroscopically; precursor of SLAC & SNAC

   

Piso-triquetral OA

causes loose bodies in wrist joint

   

3. Metabolic

Gout

   

   

Pseudogout

   

   

4. Inflammatory

RA

   

   

Psoriasis

   

   



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