Degenerative arthritis at the triscaphe joint

Trapezium Tunnel Syndrome

The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome.

Scaphotrapeziotrapezoid Arthrodesis: Systematic Review

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Ultrasound-Guided Interventional Procedures of the Wrist and Hand: Anatomy, Indications, and Techniques

Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis.

[Anterior traumatic axial disruption of the middle carpal joint. Case report with literature review]

We report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after falling from a height. We performed open reduction and wire fixation. At 12months follow-up, functional outcome was satisfactory with good muscle strength (clamping force, grip strength and pinch grip: 90% compared to the opposite side) and good range of motion was preserved. Work was resumed at the tenth week. Radial midcarpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second and third metacarpal bones from the remaining wrist. This pattern of carpal derangement has not been previously described in the literature. Mechanism of the injury and treatment are discussed.

Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons

PURPOSE

Multiple procedures have been described for trapeziometacarpal (TM) osteoarthritis with varying levels of evidence support. The purpose of this study was to evaluate current trends in the treatment of TM arthritis by surveying active members of the American Society for Surgery of the Hand.

METHODS

We sent an online questionnaire to the e-mail addresses of 2,326 active members of the American Society for Surgery of the Hand, consisting of 5 treatment and 2 demographic questions. Surgeons were contacted twice by e-mail and provided with a link to a de-identified online survey. We performed statistical analysis of correlations between demographics and treatment preferences using chi-square testing.

RESULTS

We received responses from 1,156 out of 2,326 hand surgeons, a response rate of 50%. The vast majority of surgeons use corticosteroid injections for TM arthritis, and 719 out of 1,156 perform trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for common Eaton stage III arthritis. For scaphotrapeziotrapezoid (STT) arthritis, approximately half of respondents also perform trapeziectomy/LRTI, followed by STT fusion. For a younger woman with minimal radiographic change and pain, 535 out of 1,142 surgeon respondents would advocate continued conservative treatment, whereas the remainder chose Eaton ligament reconstruction, arthroscopy, and metacarpal osteotomy.

CONCLUSIONS

This survey study presents the current opinions of a group of hand surgeons who responded to an online questionnaire regarding treatment of TM arthritis. The results show that trapeziectomy/LRTI is the treatment of choice by most respondents. The use of trapeziectomy/LRTI in the treatment of STT arthritis has not been studied in depth, but this procedure was chosen by half the respondents. The process of choosing treatment strategies is a question for future study.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Accuracy of sonographically guided and palpation guided scaphotrapeziotrapezoid joint injections

OBJECTIVES

The purpose of this study was to determine and compare the accuracies of sonographically guided and palpation guided scaphotrapeziotrapezoid (STT) joint injections in a cadaveric model.

METHODS

A clinician with 6 years of experience performing sonographically guided procedures injected 1.0 mL of a diluted latex solution into the STT joints of 20 unembalmed cadaveric wrist specimens using a palmar approach. At a minimum of 24 hours after injection, an experienced clinician specializing in hand care completed palpation guided injections in the same specimens using a dorsal approach and 1 mL of a different-colored latex. A fellowship-trained hand surgeon blinded to the injection technique then dissected each specimen to assess injection accuracy. Injections were graded as accurate if the colored latex was found in the STT joint, whereas inaccurate injections resulted in no latex being found in the joint.

RESULTS

All sonographically guided injections were accurate (100%; 95% confidence interval, 81%-100%), whereas only 80% of palpation guided injections were accurate (95% confidence interval, 61%-99%). Sonographically guided injections were significantly more accurate than palpation guided injections, as determined by the ability to deliver latex into the joint (P < .05).

CONCLUSIONS

Sonographic guidance can be used to inject the STT joint with a high degree of accuracy and is more accurate than palpation guidance within the limits of this study design. Clinicians should consider using sonographic guidance to perform STT joint injections when precise intra-articular placement is desired. Further clinical investigation examining the role of sonographically guided STT joint injections in the treatment of patients with radial wrist pain syndromes is warranted.

A radiographic view of the scaphotrapezium-trapezoid joint

Traditionally the scaphotrapezium-trapezoid joint is imaged through a posteroanterior view of the wrist. We describe an x-ray view that is aimed directly at the joint, which gives better visualization than the standard views.

Scaphotrapeziotrapezoid arthrodesis for arthritis

The main indications for scaphotrapeziotrapezoid (STT) fusion are STT arthritis, rotary subluxation of the scaphoid, and Kienbock disease. The results of this procedure in the literature for each indication are discussed, as are the advantages, disadvantages,and alternative procedures. This article discusses the authors' surgical technique and results. The authors believe this procedure is a viable one in specific clinical scenarios.

Results of arthroscopic debridement for isolated scaphotrapeziotrapezoid arthritis

PURPOSE

Symptomatic isolated scaphotrapeziotrapezoid joint arthritis affects approximately 10% of the population. Investigation of the technique of arthroscopic debridement of this joint was done to assess symptom relief achieved and record any resulting postoperative morbidity.

METHODS

Ten consecutive patients with persistent symptoms were assessed prospectively by a research nurse. Measurements of range of motion and grip strength were obtained before and after surgery. Visual analogue scores for pain and satisfaction levels also were recorded and any limitation to activities of daily living were noted.

RESULTS

Good or excellent subjective results were achieved in 9 patients at final review at an average of 36 months (12-65 mo) after arthroscopic debridement. One patient graded the result as fair owing to failure to achieve normal range of motion. All patients showed a reduction in visual analogue pain scores, which improved from a mean of 86 to 14 points. The mean Green and O'Brien wrist scores improved from 63 to 91.

CONCLUSIONS

Arthroscopic debridement can provide good short-term symptomatic relief for isolated scaphotrapeziotrapezoid arthritis with low risk for surgical complications.

[Traumatic axial separation of the radial mid carpal joint. Case report and review of the literature]

The authors report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after a motorcycle accident. Open reduction and pinning was performed. At three years and six months follow up, clinical exam showed less power thumb pinch than the other side. Arthritic changes were noted on X-rays control, but a good range of motion was preserved. Radial mid carpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second metacarpal bones from the remaining wrist. Only 13 other similar cases were reported in literature for the last three decades. Mechanism of the injury and treatment are discussed.

Resection of the distal scaphoid for scaphotrapeziotrapezoid osteoarthritis

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12-61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119 degrees. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.

Incidence and distribution of scaphotrapezotrapezoidal arthritis in 73 fresh cadaveric wrists

The STT joint was examined in 73 fresh cadaveric specimens (25 male and 48 female with an average age of 84 years) with a view to study the incidence and characteristics of degenerative changes in this joint. The articular degeneration was graded from 0 to 3 according to increasing loss of cartilage and the location of the changes was noted. At the same time, the presence and extent of concomitant trapezio-metacarpal arthritis was noted. 61 of the 73 hands (83.3%) were found to present STT arthritis. Degeneration of the trapezoid articular surface was:- more frequent: 53 hands (72.6%) as compared to 48 (65.7%),-of greater severity: 40 cases (55%) of grades 2/3 as compared to 25 (34%), than that of the trapezium. Concomitant or isolated arthritis in the trapezometacarpal joint (90.4%) was present in 66 of the 73 hands (79%) examined with grade 3 changes in 13 cases. The apparent predominance of degeneration in the scapho trapezoidal articulation could, perhaps, lead us to assume that this might be the site of origin of STT arthritis. It could also explain the persistence of symptoms following prosthetic replacement of the trapezium.

[Tendinitis of the long palmar muscle tendon. Physiopathology and results of surgical treatment. Apropos of 28 cases]

The results of a 27 cases of flexor carpi radialis tenosynovitis, operated between 1984 and 1992 and followed for an average of 30 months, are reported. This study confirms the female predominance of this disease (25 women for two men) and its development mainly after the age of fifty. Pain along the course of the tendon is a constant sign, frequently associated with dysaesthesia in the territory of the palmaris brevis branch of the median nerve as well as synovial swelling. Surgery was indicated because of failure of apparently correctly conducted medical treatment. The technique consists of synovectomy and resection of all sources of irritation of the tendon in its sheath. The development of trapezium or scaphoid osteophytes is a common cause of irritation. The functional result obtained was good or excellent in 22 cases. This study confirmed the existence of a close relationship between the development of flexor carpi radialis tenosynovitis and the presence of external osteoarthritis of the carpus, as this combination of lesions was observed in 20 of the 27 cases. Carpal osteoarthritic lesions appear to be responsible for the great majority of cases of flexor carpi radialis tendinitis observed in women over the age of 50 years. Following failure of medical treatment, surgical treatment is effective provided it includes treatment of any osteoarthritic lesions present.

[Tendinitis of the palmaris longus muscle. Apropos of 24 cases]

Twenty-four cases of flexor carpi radialis tendinitis were diagnosed between 1985 and 1989 by SOS Main Strasbourg. This condition typically occurs in women (75%) with a mean age of 47 years with no particular occupational activity who present with spontaneous and induced pain along the distal part of the tendon. Examination may reveal disturbances of cutaneous sensation in the territory of the palmar cutaneous branch of the median nerve and associated signs: cysts (10/24 cases), scapho-trapezium osteoarthrosis (3 documented cases). Medical treatment provided good results in 7 out of 9 patients reviewed after a mean follow-up of 15 months. In the event of failure, surgical treatment with opening of the compartment, provided 4 good results in 6 patients reviewed after a mean follow-up of 2 years 4 months.