The Clinical Implications of Scaphotrapezium-Trapezoidal Arthritis With Associated Carpal Instability

doi:10.1016/j.jhsa.2006.10.021

The Journal of Hand Surgery

Volume 32, Issue 1, January 2007, Pages 47-54

https://doi.org/10.1016/j.jhsa.2006.10.021 Get rights and content

Purpose

Common causes of dorsal intercalated segment instability (DISI) include scapholunate dissociations and scaphoid fracture nonunions. Although less common than these, scaphotrapezium-trapezoidal (STT) osteoarthritis (OA) may also be associated with the development of a DISI deformity. The clinical implications of this form of carpal instability in cases of STT arthritis are still unknown. To study the radiographic progression and incidence of this entity, we reviewed our patients and report on 24 wrists with DISI in the presence of STT arthritis.

Methods

A retrospective chart and radiographic review was performed on all patients seen between 1994 and 2004, with the diagnosis of STT arthritis to identify a subgroup of patients with DISI deformity on the presenting radiographs. Patients’ clinical and surgical courses were noted. Postoperative radiographic changes were recorded, as were clinical outcomes.

Results

Sixteen patients with 24 wrists having STT arthritis and DISI deformity on presenting radiographs were identified. The median STT arthritis grade was 3.0 based on a modified Eaton and Glickel grading system. The median radiolunate angle was −21° of dorsal tilt. All patients had normal scapholunate angles. Abnormal scaphoid extension was seen in 19 of 24 wrists as measured by the radioscaphoid angle. Concomitant carpometacarpal arthritis was seen in 67% (n = 16) of the wrists, and midcarpal arthritis was identified in 50% (n = 8) of patients. Fifteen wrists required surgery for the symptoms and were followed up for a mean of 29 months after surgery. In the surgical group the radiolunate angles increased by mean of 6° after surgery. Four of the 15 wrists required revisional surgery for persistent pain.

Conclusions

Patients with STT arthritis may present with carpal instability that is not related to radiographic scapholunate instability. This instability is characterized by a normal scapholunate angle with an extension stance of the scaphoid and lunate. Midcarpal arthritis may be present. Surgical intervention for patients with STT arthritis and DISI deformity may lead to radiographic progression of midcarpal instability.

Section snippets

Materials and Methods

After obtaining institutional review board approval, a retrospective chart and radiographic review was performed. The records of all patients with the clinical diagnosis of STT arthritis seen between the years 1994 and 2004 were examined. Patients were included in the study if they presented with evidence of a DISI deformity on the presenting radiographs in the absence of scaphoid nonunion or SL diastasis. Patient records were reviewed for demographic data, surgical intervention, and any

Results

From the calendar years of 1994 through 2004, 16 patients with 24 wrists showing STT arthritis and DISI deformity on presenting radiographs were available from a total of 36 patients presenting with isolated STT arthritis (Fig. 1). Twenty patients were excluded because they did not fulfill our criteria for DISI deformity on the presenting radiographs. The median age of the included patients was 60 years (range, 44–88 y), with a women-to-men ratio of 10:6. Right-hand dominance was present in 88%

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Cited by (56)

Scapholunate Instability: Diagnosis and Management – Anatomy, Kinematics, and Clinical Assessment – Part I
2023, Journal of Hand Surgery
Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
Prevalence and Associated Factors for Primary Osteoarthritis of the Scaphotrapeziotrapezoid, Radiocarpal, and Distal Radioulnar Joints in the Japanese General Elderly Population
2023, Journal of Hand Surgery
The incidence and etiology of primary osteoarthritis (OA) of the scaphotrapeziotrapezoid joint (STTJ), radiocarpal joint (RCJ), and distal radioulnar joint (DRUJ) remains unknown. The purpose of this study was to evaluate the prevalence and factors associated with primary wrist OA in a cross-sectional study of a basic resident registry.
A total of 1,297 residents between the ages of 50 and 89 years were randomly sampled from the registry of a Japanese town. A questionnaire was administered to all subjects, and each of them underwent radiographs of the bilateral hands, wrists, and elbows. STTJ, RCJ, and DRUJ radiographic osteoarthritis (ROA) were evaluated according to a previously described method. Associated factors for STTJ and DRUJ ROA were recorded. Associations between the incidence of ROA of the DRUJ, ulnar variance, and severity of elbow ROA were investigated.
A total of 676 wrists (162 men and 176 women; mean age of 69.0 years) were investigated. The prevalence of STTJ, RCJ, and DRUJ ROA was 5.3%, 1.5%, and 21.2%, respectively. Factors associated with STTJ ROA were thumb carpometacarpal joint ROA, female sex, and increasing age. Factors associated with DRUJ ROA were elbow ROA, use of vibrating tools, increasing age, and positive ulnar variance. Prevalence of DRUJ ROA was 54.4% in wrists with severe-grade elbow ROA. Ulnar variance of the wrist in severe-grade elbow ROA was significantly larger than that in mild-grade or nonelbow ROA.
The prevalence of ROA was highest in the DRUJ, followed by the STTJ, and lowest in the RCJ. The occurrence of ROA of the STTJ and DRUJ was affected by the presence of ROA of the adjacent joint.
Primary DRUJ ROA occurs at a moderate frequency, similar to primary ROA of other extremity joints; however, primary STTJ and RCJ ROA is rare.
The INCA® implant to treat isolated scaphotrapeziotrapezoid osteoarthritis: Preliminary results at a minimum 2 years’ follow-up
2022, Hand Surgery and Rehabilitation
Citation Excerpt :
However, according to Obert et al., the literature differs as to whether DISI is the cause or consequence of STT osteoarthritis [4]. Either way, it leads to non-dissociative midcarpal instability which implicating pathological extension of the lunate with normal scapholunate angle [21]: i.e., type II carpal instability according to the Mayo classification [22]. Many surgical options have been described to manage STT osteoarthritis [4,6,7].
We report results with the INCA® distal scaphoid pole resurfacing implant anchored within the scaphoid for isolated scaphotrapeziotrapezoid osteoarthritis. Thirty-five implants in 27 patients (mean age, 69 years) were retrospectively included with a minimum follow-up of 2 years. Outcome criteria were pain (VAS), PROMs (QuickDASH, PRWE and MMWS), wrist motion, pinch and grip strength, and radiographic assessment. The average follow-up was 4.6 years. There was a significant improvement in pain, PROMs, grip and pinch strength. Radial deviation and wrist extension showed slight but significant postoperative decrease (−4° for both). Dorsal intercalated segment instability (DISI) was significantly improved postoperatively (7 cases versus 21 preoperatively). There were 2 cases of implant loosening (6%) within the first 10 months: 1 keel malpositioning and 1 insufficient postoperative immobilization. These findings suggest that the INCA® implant is an effective and reliable medium-term solution for isolated scaphotrapeziotrapezoid osteoarthritis. By restoring scaphoid length and gliding on the trapeziotrapezoid surface, the implant contributes to restoring normal bone alignment of the wrist.
Nous rapportons les résultats d'un implant de resurfaçage du pôle distal du scaphoïde avec un ancrage scaphoïdien (INCA®] pour arthrose scapho-trapézo-trapézoïdienne isolée. Trente-cinq implants chez 27 patients, d’âge moyen 69 ans, ont été inclus rétrospectivement avec un suivi minimum de 2 ans. Les critères de jugement étaient la douleur (EVA), les scores fonctionnels (QuickDASH, PRWE et MMWS), les mobilités du poignet, la force de pince et de poigne et l'évaluation radiographique. Le suivi moyen était de 4,6 ans. Il y eut une amélioration significative de la douleur, des scores fonctionnels, et des forces de poigne et de pince. Les mobilités du poignet en inclinaison radiale et en extension ont été légèrement mais significativement diminuées en postopératoire (−4° pour les deux). La DISI a été significativement amélioré en postopératoire (7 cas contre 21 en préopératoire). Nous avons observé 2 cas de descellement de l'implant (6%) dans les 10 premiers mois, secondaires à une malposition de la quille et une immobilization postopératoire insuffisante. Les résultats de notre étude suggèrent que l'implant INCA® est une solution efficace et fiable à moyen terme pour traiter l'arthrose scapho-trapézo-trapézoïdienne isolée. En restaurant la longueur du scaphoïde et le glissement du scaphoïde sur la surface trapézo-trapézoïdienne, l'implant peut contribuer à restaurer l'alignement osseux normal du poignet.
In vivo quantification of the 3D kinematics and coupling of the thumb base joints
2022, Medical Engineering and Physics
Citation Excerpt :
However, in these studies, the kinematics of the TMC joint are quantified without consideration of the kinematics of the more proximal joints of the thumb base, i.e. the scaphotrapezial (ST) and radioscaphoid (RS) joints. Studying the motion in the entire skeletal chain of the thumb is, however, clinically important given that in half of the patients with TMC OA the more proximal scaphotrapeziotrapezoidal (STT) joint is also affected [13,14]. Investigating the thumb base joints remains complicated given their small size and positioning in the carpal region, which makes it difficult to obtain accurate 3D kinematics with optical motion tracking.
Full thumb mobility is required to execute tasks of daily living and results from the combined motions of the thumb joints. In this study, we focus on the coupling between the proximal joints of the thumb, the radioscaphoid (RS), scaphotrapezial (ST) and trapeziometacarpal (TMC) joints. We quantified the 3D kinematics of these joints during maximal thumb extension and abduction in a group of healthy volunteers using an image-based technique. Semi-dynamic CT scans of the dominant hand of 36 healthy subjects with the thumb in different standardized positions were used. The maximal range of motion of each joint in the different planes was calculated using a markerless bone registration method. Inter-joint coupling was assessed by performing a regression analysis between the range of motion of the joints during both thumb movements. Strong inter-joint coupling was found between the RS and ST joints during thumb extension and abduction, whereas coupling between the other joints was moderate to weak. This study provides valuable information on the in vivo 3D kinematics of the RS, ST and TMC joints during thumb movement. This can be used as input for modeling studies, where the coupling between the joints can decrease the degrees of freedom of the model. Moreover, these baseline data of a healthy cohort can be used for comparison with the kinematics of patients with TMC osteoarthritis or other pathologies and aid our understanding of motion deficits resulting from these joint disorders.
Scaphotrapeziotrapezoid Arthrodesis: Systematic Review
2022, Journal of Hand Surgery
Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of complications and outcomes after STT arthrodesis.
Several major databases were used to perform a systematic literature review in order to obtain articles reporting complications and outcomes following STT arthrodesis. The primary purpose was to identify rates of nonunion and conversion to total wrist arthrodesis. Secondary outcomes included wrist range of motion, grip strength, and Disabilities of the Arm Shoulder and Hand scores. A multivariable analysis was performed to evaluate factors associated with the primary and secondary outcomes of interest.
Out of the 854 records identified in the primary literature search, 30 studies were included in the analysis. A total of 1,429 procedures were performed for 1,404 patients. The pooled nonunion rate was 6.3% (95% CI, 3.5–9.9) and the rate of conversion to total wrist arthrodesis following the index STT was 4.2% (95% CI, 2.2–6.7). The mean pooled wrist flexion was 40.7° (95% CI, 30.8–50.5) and extension was 49.7° (95% CI, 43.5–55.8). At final follow-up, the mean pooled grip strength was 75.9% (95% CI, 69.3–82.5) of the nonsurgical contralateral hand. Compared with all other known indications, Kienbock disease had a statistically significant lower nonunion rate (14.1% vs 3.3%, respectively). Mixed-effects linear regression using patient-level data revealed that increasing age was significantly associated with complications, independent of occupation and diagnosis.
Our study demonstrated a low failure rate and conversion to total wrist arthrodesis after STT arthrodesis and acceptable postoperative wrist range of motion and strength when compared to the contralateral hand.
Therapeutic IV.
Traumatic Nondissociative Carpal Instability: A Case Series
2022, Journal of Hand Surgery
Citation Excerpt :
To illustrate dissociative instability, the authors demonstrated that under compression and following detachment or fracture of the stabilizing scaphoid, the dissociated central column “crumpled” into lunate extension or flexion. It is evident that nondissociative instabilities of the entire proximal row exhibit the same crumpling of the central column, but the genesis of the deformity lies not within the ligaments of the proximal row, but in the ligaments spanning the radiocarpal joint, the midcarpal joint, or both.1,2,5–7,13 Multiple ligaments have been implicated in the genesis of both dissociative and nondissociative VISI deformities.
We report 8 cases of acute or subacute unilateral nondissociative carpal instability (CIND) in the context of nondisplaced scaphoid fractures.
Eight patients from 3 centers developed abnormal volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) following the diagnosis of a nondisplaced scaphoid fracture. An operative inspection in each patient confirmed intact scapholunate and lunotriquetral interosseous ligaments. We outline the demographic characteristics of our patient cohort, radiologic and operative findings of CIND-DISI and CIND-VISI, and the outcomes of acute and delayed treatment.
Two patients were diagnosed with CIND-DISI and 6 with CIND-VISI associated with ipsilateral nondisplaced scaphoid fractures. The average time from injury to diagnosis of CIND was 11 weeks, and the mean clinical and radiographic follow-up was 18 months. Rapid healing of the scaphoid fractures was achieved in all patients (4 open reduction internal fixation, 4 cast). All patients underwent surgery to improve proximal carpal row alignment: in 3 of the 4 patients who were diagnosed and treated surgically within 12 weeks of injury, the radiolunate angle (RLA) was successfully restored. A contracture release and ligament repair or reconstruction with tendon graft 12 or more weeks following injury was unsuccessful in restoring proximal row alignment in all 4 patients. Two patients in the delayed treatment group required secondary surgery for partial fusion.
Based on the arthroscopic, imaging, and operative findings, we propose that the ligamentous restraints to CIND-VISI are dorsal at the radiocarpal joint and volar at the midcarpal joint. Conversely, the ligamentous restraints to CIND-DISI are dorsal at the midcarpal joint and volar at both the radiocarpal and midcarpal joints. In our series, a delayed diagnosis and late reconstructive surgery were associated with no improvement in RLA. We recommend early recognition of traumatic CIND and prompt treatment of injured ligaments prior to the development of a fixed deformity.
Therapeutic V.

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WristThe Clinical Implications of Scaphotrapezium-Trapezoidal Arthritis With Associated Carpal Instability

Purpose

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Ann Chir Main Memb Super

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Clin Radiol

J Hand Surg

J Hand Surg

Wrist
The Clinical Implications of Scaphotrapezium-Trapezoidal Arthritis With Associated Carpal Instability