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Abstract
PURPOSE OF REVIEW Multicentric carpotarsal osteolysis (MCTO) is an ultra-rare disorder characterized by osteolysis of the carpal and tarsal bones, subtle craniofacial deformities, and nephropathy. The molecular pathways underlying the pathophysiology are not well understood. RECENT FINDINGS MCTO is caused by heterozygous mutations in MAFB, which encodes the widely expressed transcription factor MafB. All MAFB mutations in patients with MCTO result in replacement of amino acids that cluster in a phosphorylation region of the MafB transactivation domain and account for a presumed gain-of-function for the variant protein. Since 2012, fewer than 60 patients with MCTO have been described with 20 missense mutations in MAFB. The clinical presentations are variable, and a genotype-phenotype correlation is lacking. Osteolysis, via excessive osteoclast activity, has been regarded as the primary mechanism, although anti-resorptive agents demonstrate little therapeutic benefit. This paper appraises current perspectives of MafB protein action, inflammation, and dysfunctional bone formation on the pathogenesis of the skeletal phenotype in MCTO. More research is needed to understand the pathogenesis of MCTO to develop rational therapies.
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Affiliation(s)
- Nina S Ma
- Section of Pediatric Endocrinology, Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave, B265, Aurora, CO, 80045, USA.
| | - S Mumm
- Division of Bone and Mineral Diseases, Washington University School of Medicine and Center for Metabolic Bone Disease and Molecular Research, Shriners Children's, St. Louis, MO, USA
| | - S Takahashi
- Laboratory Animal Resource Center in Transborder Medical Research Center, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - M A Levine
- Center for Bone Health and Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia and the Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Lee JK, Kwon YW, Shim JC, Kang YK, Cho WM, Park JW, Han SH. Similar appearance of different multifocal carpal bone destructing disease entities in 3 patients: A case report. Medicine (Baltimore) 2021; 100:e26445. [PMID: 34260526 PMCID: PMC8284703 DOI: 10.1097/md.0000000000026445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Several diseases feature tumors, or tumor-mimicking lesions, that further invade the bone and surrounding joints of the wrist region. Here, we describe 3 rare cases of multiple destructed carpal bones and adjacent joints in different disease entities confirmed via pathologic diagnosis. PATIENT CONCERNS All 3 cases were examined between January 2016 and December 2019. Three patients presented with similar clinical manifestations and radiographic features, with multiple osteolytic lesions in the carpal bones and metacarpal bone base. DIAGNOSES The 3 cases were diagnosed as diffuse type tenosynovial giant cell tumor, calcifying aponeurotic fibroma, and rheumatoid arthritis. INTERVENTIONS Separate, experienced radiologist and pathologist took part in the interpretation and compartmentalization of radiographs and pathological findings, respectively. Even magnetic resonance imaging could not achieve a diagnosis; surgical excision was therefore required, with subsequent pathological assessment for treatment and final diagnosis. OUTCOMES functional outcomes also differed among patients, poorest in rheumatoid arthritis patient. LESSONS We report 3 rare disease entities, presenting with multifocal osteolytic lesions in the wrist. They all presented with similar clinical manifestations, and the final diagnoses were made via pathological evaluation. Compared with tenosynovial giant cell tumor and calcifying aponeurotic fibroma, rheumatoid arthritis had the poorest outcome.
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Affiliation(s)
- Jun-Ku Lee
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang
| | - Young Woo Kwon
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbu-si Gyeonggi-do
| | | | - Yun Kyung Kang
- Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Weon Min Cho
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do
| | - Jong Woong Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Soo-Hong Han
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do
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Shiraishi K, Burghardt AJ, Osaki M, Khosla S, Carballido-Gamio J. Global and Spatial Compartmental Interrelationships of Bone Density, Microstructure, Geometry and Biomechanics in the Distal Radius in a Colles' Fracture Study Using HR-pQCT. Front Endocrinol (Lausanne) 2021; 12:568454. [PMID: 34122326 PMCID: PMC8187761 DOI: 10.3389/fendo.2021.568454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bone parameters derived from HR-pQCT have been investigated on a parameter-by-parameter basis for different clinical conditions. However, little is known regarding the interrelationships of bone parameters and the spatial distribution of these interrelationships. In this work: 1) we investigate compartmental interrelationships of bone parameters; 2) assess the spatial distribution of interrelationships of bone parameters; and 3) compare interrelationships of bone parameters between postmenopausal women with and without a recent Colles' fracture. METHODS Images from the unaffected radius in fracture cases (n=84), and from the non-dominant radius of controls (n=98) were obtained using HR-pQCT. Trabecular voxel-based maps of local bone volume fraction (L.Tb.BV/TV), homogenized volumetric bone mineral density (H.Tb.BMD), homogenized μFEA-derived strain energy density (H.Tb.SED), and homogenized inter-trabecular distances (H.Tb.1/N) were generated; as well as surface-based maps of apparent cortical bone thickness (Surf.app.Ct.Th), porosity-weighted cortical bone thickness (Surf.Ct.SIT), mean cortical BMD (Surf.Ct.BMD), and mean cortical SED (Surf.Ct.SED). Anatomical correspondences across the parametric maps in the study were established via spatial normalization to a common template. Mean values of the parametric maps before spatial normalization were used to assess compartmental Spearman's rank partial correlations of bone parameters (e.g., between H.Tb.BMD and L.Tb.BV/TV or between Surf.Ct.BMD and Surf.app.Ct.Th). Spearman's rank partial correlations were also assessed for each voxel and vertex of the spatially normalized parametric maps, thus generating maps of Spearman's rank partial correlation coefficients. Correlations were performed independently within each group, and compared between groups using the Fisher's Z transformation. RESULTS All within-group global trabecular and cortical Spearman's rank partial correlations were significant; and the correlations of H.Tb.BMD-L.Tb.BV/TV, H.Tb.BMD-H.Tb.1/N, L.Tb.BV/TV-H.Tb.1/N, Surf.Ct.BMD-Surf.Ct.SED and Surf.Ct.SIT-Surf.Ct.SED were significantly different between controls and fracture cases. The spatial analyses revealed significant heterogeneous voxel- and surface-based correlation coefficient maps across the distal radius for both groups; and the correlation maps of H.Tb.BMD-L.Tb.BV/TV, H.Tb.BMD-H.Tb.1/N, L.Tb.BV/TV-H.Tb.1/N, H.Tb.1/N-H.Tb.SED and Surf.app.Ct.Th - Surf.Ct.SIT yielded small clusters of significant correlation differences between groups. DISCUSSION The heterogeneous spatial distribution of interrelationships of bone parameters assessing density, microstructure, geometry and biomechanics, along with their global and local differences between controls and fracture cases, may help us further understand different bone mechanisms of bone fracture.
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Affiliation(s)
- Kazuteru Shiraishi
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrew J. Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Julio Carballido-Gamio,
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Hao PY, Chokuwa S, Xie XH, Wu FL, Wu J, Bai C. Skeletal bone age assessments for young children based on regression convolutional neural networks. Math Biosci Eng 2019; 16:6454-6466. [PMID: 31698572 DOI: 10.3934/mbe.2019323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pediatricians and pediatric endocrinologists utilize Bone Age Assessment (BAA) for in-vestigations pertaining to genetic disorders, hormonal complications and abnormalities in the skeletal system maturity of children. Conventional methods dating back to 1950 were often tedious and suscep-tible to inter-observer variability, and preceding attempts to improve these traditional techniques have inadequately addressed the human expert inter-observer variability so as to significantly refine bone age evaluations. In this paper, an automated and efficient approach with regression convolutional neu-ral network is proposed. This approach automatically exploits the carpal bones as the region of interest (ROI) and performs boundary extraction of carpal bones, then based on the regression convolutional neural network it evaluates the skeletal age from the left hand wrist radiograph of young children. Experiments show that the proposed method achieves an average discrepancy of 2.75 months between clinical and automatic bone age evaluations, and achieves 90.15% accuracy within 6 months from the ground truth for male. Further experimental results with test radiographs assigned an accuracy within 1 year achieved 99.43% accuracy.
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Affiliation(s)
- Peng Yi Hao
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou, China
| | - Sharon Chokuwa
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou, China
| | - Xu Hang Xie
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou, China
| | - Fu Li Wu
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou, China
- Real Doctor AI Research Center, Zhejiang University, Hangzhou, China
| | - Jian Wu
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
- Real Doctor AI Research Center, Zhejiang University, Hangzhou, China
| | - Cong Bai
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou, China
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Tesi C, Giuffra V, Fornaciari G, Larentis O, Motto M, Licata M. A case of erosive polyarthropathy from Medieval northern Italy (12th-13th centuries). Int J Paleopathol 2019; 25:20-29. [PMID: 30927654 DOI: 10.1016/j.ijpp.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/21/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017. MATERIALS Skeletal remains of a well-preserved skeleton dating to the 12th-13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy). METHODS Macroscopic and radiographic imaging. RESULTS Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55-75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints. CONCLUSIONS A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy. SIGNIFICANCE This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas. LIMITATIONS Small sample size limits discussion of the scope of the disease in antiquity. SUGGESTIONS FOR FURTHER RESEARCH This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492.
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Affiliation(s)
- Chiara Tesi
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Gino Fornaciari
- Department of Civilizations and Forms of Knowledge, University of Pisa, Italy
| | - Omar Larentis
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Monica Motto
- Society of archaeological research "Archeostudi di Bergamo" s.r.l., Italy
| | - Marta Licata
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Abstract
RATIONALE Fibroma of tendon sheath is a rare entity that is typically attached to the tendon sheath. PATIENT CONCERNS A 43-year-old man presented with a painful mass in his right wrist, which was initially misdiagnosed as an enchondroma. DIAGNOSIS Fibroma embedded into carpal bones, which exhibited lytic radiographic features similar to those of enchondroma. Excisional biopsy demonstrated spindle-shaped cells and collagen-like stroma. INTERVENTIONS The patient underwent lesion resection surgery. OUTCOMES The patient recovered well and showed no signs of recurrence at 6-month follow-up. LESSONS This case provides valuable insights for hand surgeons. While radiograph is helpful in multiple diseases, histological examination is indispensable for establishment of final diagnosis.
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Affiliation(s)
- Zhuo Fu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Jianfeng Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Dongxu Huang
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Xiaoyan Jia
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Zhigang Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Bin Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
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Lai S, Zhang K, Li J, Fu W. Carpal tunnel release with versus without flexor retinaculum reconstruction for carpal tunnel syndrome at short- and long-term follow up-A meta-analysis of randomized controlled trials. PLoS One 2019; 14:e0211369. [PMID: 30689656 PMCID: PMC6349326 DOI: 10.1371/journal.pone.0211369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/11/2019] [Indexed: 02/05/2023] Open
Abstract
Background Carpal tunnel syndrome is a common neuropathy disorder for which surgical treatment consists of release and reconstruction of the flexor retinaculum. Reports of postoperative clinical outcomes after carpal tunnel release with or without flexor retinaculum reconstruction in several studies are controversial. This meta-analysis aimed to compare the efficacy and safety of carpal tunnel release with or without flexor retinaculum reconstruction. Methods The PubMed, EMBASE, Web of Science, Ovid, Cochrane Library and Clinical Tri Org databases were searched for randomized controlled trials that compared carpal release with and without transverse carpal ligament reconstruction for carpal tunnel syndrome. Outcomes included postoperative Boston Carpal Tunnel Questionnaire Symptom Severity Scale (SSS), Functional Status Scale (FSS), grip strength and complications. The follow-up time was categorized into short-term (0-3mon) and long-term(>3mon). Results A total of 7 studies with 613 patients met the inclusion criteria and were analyzed in detail. Statistical analysis showed no significant difference between two groups on postoperative long-term grip strength (MD 5.85, 95% CI -1.05 to 12.76) long-term SSS (MD -0.31, 95% CI -0.75 to 0.13) and occurrence of complications (RR 1.14, 95% CI 0.84 to 1.54), whereas statistically significant difference was found between groups regarding short-term grip strength (MD 1.51, 95% CI 0.86 to 2.17) and long-term FSS (MD -0.34, 95% CI -0.47 to -0.21). Conclusion Carpal tunnel release with flexor retinaculum reconstruction for carpal tunnel syndrome may result in improved long-term functional status while there’s no advantage regarding grip strength, symptom severity and safety over individual carpal tunnel release in short- and long-term outcomes.
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Affiliation(s)
- Sike Lai
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Kaibo Zhang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jian Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Weili Fu
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- * E-mail:
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Abstract
RATIONALE Preiser disease or avascular necrosis (AVN) of the scaphoid causes intolerable wrist pain and malalignment of the carpal bones. In previously reported cases, patients have had a history of steroid use for systemic illness such as autoimmune hemolytic anemia, systemic lupus erythematosus, or renal transplantation, or have had other risk factors, such as smoking, alcoholism, or infection. In particular, systemic glucocorticoid therapy has been most commonly associated with the disease. Although there are reports of AVN of the scaphoid induced by systemic glucocorticoids, no prior report has associated AVN of the carpal bones with repeated local injections of glucocorticoids. PATIENT CONCERNS We present a case in which it was strongly suspected that AVN of the scaphoid was induced by repeated local glucocorticoid injections. The patient had no history of excessive alcohol use, smoking, or trauma, except for local repeated steroid injections. DIAGNOSES Initially, she had diagnosed with de Quervain's disease and was treated by repeated local glucocorticoid injections followed by surgery for de Quervain's disease. Five years after surgery for de Quervain's disease, the patient presented at our hospital with sudden onset of intolerable pain in her right wrist without a history of trauma. In spite of nonsurgical treatment with rest, immobilization, analgesia, and surgery, her wrist pain was not improved. After further repeated local steroid injections in her wrist, radiographs, and magnetic resonance imaging of her wrist showed the AVN of the scaphoid. INTERVENTIONS Surgery was performed and the fragmented proximal scaphoid and the entire lunate were resected. OUTCOMES The diagnosis was confirmed according to the histopathological examination of the proximal scaphoid bone, which showed the characteristic of AVN of the scaphoid. At follow-up evaluation, radiographs of the right wrist showed no progression of osteoarthritis. The patient had no tenderness or residual pain at the wrist and had no desire to pursue additional surgery. LESSONS We have presented a case with AVN of the scaphoid, which was strongly suspected to be associated with the repeated local steroid injections. Further studies are required to more fully elucidate the association between AVN of the scaphoid and repeated local steroid injections.
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Affiliation(s)
| | - Norio Motoda
- Department of Pathology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
| | - Ryuji Ohashi
- Department of Pathology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
| | - Takuya Sawaizumi
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Švarc A, Pilný J, Repko M, Kastenberger T, Eichinger M. [Proximal Row Carpectomy - Five-Year Results]. Acta Chir Orthop Traumatol Cech 2018; 85:120-124. [PMID: 30295598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY This study aims to evaluate the results of patients treated by proximal row carpectomy at a follow-up of at least 5 years after the surgery. MATERIAL AND METHODS A total of 25 patients were treated by proximal row carpectomy for degenerative changes of the wrist as a consequence of the previous trauma or avascular necrosis of the lunate bone, of whom 21 patients underwent a follow-up examination at least 5 years postoperatively. Proximal row carpectomy was indicated in 15 patients for SLAC wrist, in 4 patients for avascular necrosis of the lunate bone, in 1 patient for SNAC wrist, and in 1 patient for inveterate dislocation of the wrist. The follow-up clinical and radiological examinations were performed at least 5 years after the surgery. The range of wrist motion, grip strength, presence of pain at rest or pain under loads, total clinical score according to the Green and O'Brien scoring system, patient satisfaction with the outcome of surgery were assessed. By fluoroscopy the range of wrist motion, degenerative changes of the radiocapitate joint, and translation of the capitate bone with respect to the distal radius were evaluated. RESULTS Postoperative improvements in the range of motion and grip strength were confirmed. Also, the pain relief at rest and under loads was achieved. Five years after the surgery, most of the patients (85.6%) reported an overall improvement. The total clinical score according to the Green and O'Brien scoring system improved from 35.8 preoperatively to 63.1 postoperatively. DISCUSSION The advantage of this procedure is a low percentage of complications, relative technical simplicity, maintenance of functional motion of the wrist, satisfactory grip strength, and pain relief. There are no complications related to the implant, no risk of a non-union. CONCLUSIONS As shown by our results obtained 5 years after the surgery as well as the published data, in the indicated cases the proximal row carpectomy is an appropriate surgical technique to treat the degenerative changes of the wrist. In most of the patients, favourable functional results and pain relief can be expected. Key words:proximal row carpectomy, SLAC wrist, SNAC wrist, avascular necrosis of the lunate bone, dislocation of the wrist.
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Affiliation(s)
- A Švarc
- Ortopedické oddělení, Nemocnice Pardubice
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10
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Abstract
We studied the changes in the shape of the triangular fibrocatilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3 mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation–supination, even with positive ulnar variance.
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Affiliation(s)
- A Makita
- Biomechanics Laboratory, Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Lutz M, Rudisch A, Kralinger F, Smekal V, Goebel G, Gabl M, Pechlaner S. Sagittal Wrist Motion of Carpal Bones Following Intraarticular Fractures of the Distal Radius. ACTA ACUST UNITED AC 2016; 30:282-7. [PMID: 15862369 DOI: 10.1016/j.jhsb.2004.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2003] [Accepted: 12/29/2004] [Indexed: 10/25/2022]
Abstract
Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6°, a mean ulnar tilt of 18° and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23°, lunate flexion of 15°, capitate extension of 62°, capitate flexion of 40°. There was a significant correlation between articular surface depth and radiocarpal motion.
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Affiliation(s)
- M Lutz
- Department of Trauma Surgery, University of Innsbruck, Austria.
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Borisch N, Lerch K, Grifka J, Haussmann P. A Comparison of Two Indices for Ulnar Translation and Carpal Height in the Rheumatoid Wrist. ACTA ACUST UNITED AC 2016; 29:144-7. [PMID: 15010160 DOI: 10.1016/j.jhsb.2003.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Accepted: 10/20/2003] [Indexed: 11/30/2022]
Abstract
The indices for ulnar translation described by Chamay et al. (1983 , Annales de Chirurgie de la Main, Vol. 2, pp. 5–17), and Bouman et al. (1994 , Journal of Hand Surgery Vol. 19B, pp. 325–329), and for carpal height described by Youm et al. (1978 , Journal of Bone and Joint Surgery, Vol. 40A, pp. 423–431) and Bouman et al. (1994) were compared in pre- and postoperative wrist X-rays of 91 patients with rheumatoid arthritis undergoing radiolunate arthrodesis. Both indices described by Bouman had a higher applicability and sensitivity than the Chamay and Youm indices and are recommended for use with the rheumatoid wrist. However false-negative values may result when the Bouman index for ulnar translation is used to follow up radiolunate arthrodesis.
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Affiliation(s)
- N Borisch
- Department of Hand Surgery, Plastic and Reconstructive Surgery, DRK - Hospital, Baden - Baden and the Orthopaedic Department of Regensburg University, Germany.
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Terng SCA, Kuypers KC, Koch AR. Inter-Carpal Soft Tissue Entrapment. A Possible Explanation for Chronic Dorsal Wrist Pain. ACTA ACUST UNITED AC 2016; 31:41-6. [PMID: 16221514 DOI: 10.1016/j.jhsb.2005.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
This retrospective study evaluates the surgical treatment of a group of patients with unknown chronic dorsal wrist pain. The cause of their symptoms was interpreted as a painful entrapment of fibrous tissue in the radio-carpal and inter-carpal joints during specific movements. Between 1997 and 2001, 30 patients were treated by surgical excision of this tissue and 26 patients were traced for follow-up. Twenty-three patients were symptom free, or experienced major benefit from surgery. Wrist function measurements using the VAS scale showed improvement in 24 patients. Microscopic examination of the removed specimen shows fibrous tissue with non-specific changes. Inter-carpal soft tissue entrapment can explain the typical clinical findings in some patients with unknown chronic dorsal wrist pain. After careful selection, surgical excision of all entrapped tissue in the radio-carpal and mid-carpal joint may give relief of pain and improvement of wrist function.
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Affiliation(s)
- S C A Terng
- Department of Plastic, Reconstructive and Hand Surgery, Haga Hospital, Leyenburg, Leyweg 275, 2545 CH The Hague, The Netherlands.
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Lowden CM, Attiah M, Garvin G, Macdermid JC, Osman S, Faber KJ. The Prevalence of Wrist Ganglia in an Asymptomatic Population: Magnetic Resonance Evaluation. ACTA ACUST UNITED AC 2016; 30:302-6. [PMID: 15862373 DOI: 10.1016/j.jhsb.2005.02.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 02/28/2005] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) was performed on the wrists of 103 asymptomatic volunteers. The images were evaluated independently by two musculoskeletal radiologists and one orthopaedic surgeon. Wrist ganglia were identified in 53 out of the 103 wrists. The average long and short axes measurements were 8 mm (range 3–22) and 3 mm (range 2–10), respectively. Seventy per cent of the ganglia originated from the palmar capsule in the region of the interval between the radioscaphocapitate ligament and the long radiolunate ligament. Fourteen per cent of the ganglia were dorsal and originated from the dorsal, distal fibres of the scapholunate ligament. Two ganglia had surrounding soft tissue oedema and one had an associated intraosseous component. Unlike previous surgical and pathological series, our study showed that palmar wrist ganglia are more common than dorsal wrist ganglia. The vast majority of these asymptomatic ganglia occur without associated ligamentous disruption, soft tissue oedema or intraosseous communication.
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Affiliation(s)
- C M Lowden
- Hand and Upper Limb Centre, St. Joseph's Health Care, London, UK
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15
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Pownder SL, Cooley S, Hayashi K, Bezuidenhout A, Koff MF, Potter HG. Non-invasive magnetic resonance imaging diagnosis of presumed intermedioradial carpal bone avascular necrosis in the dog. Can Vet J 2016; 57:879-881. [PMID: 27493290 PMCID: PMC4944568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 5-year-old, spayed female Weimaraner dog was evaluated for progressive left forelimb lameness localized to the carpus. Magnetic resonance imaging (MRI) was used to arrive at a presumptive diagnosis of intermedioradial carpal (IRC) bone fracture with avascular necrosis (AVN). To the authors' knowledge, this is the first report of naturally occurring AVN of the canine IRC diagnosed using MRI.
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16
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Gologan R, Ginter VM, Haeffner A, Obertacke U, Schreiner U. 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg 2016; 136:425-32. [PMID: 26620044 DOI: 10.1007/s00402-015-2357-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ligamentous lesions are concomitant to dislocated distal radius fractures in a high percentage. The purpose of this study was to evaluate the relevance of intracarpal lesions. METHODS Seventy eight of an original cohort of 104 distal radius fractures (74%) were studied over a follow-up period of one year after surgery with complete data (X-rays, CT, MRI, follow-up X-rays and questionnaire). RESULTS Most of our radius fractures (AO 23 type: A 39, B 9, C 30) present additional lesions: 97%. One-year evaluation showed an average Castaing score of 4.5 ± 2.5 points, means a "good" result of a scale of 0-27. Fifty five of seventy eight had an "excellent" or "good" result (<6 points). No patient had more than 12 points ("fair"). CONCLUSIONS The dislocated distal radial fracture implies severe and complex injury to the whole wrist, mostly concerning intracarpal concomitant lesions (MRI). Surgical therapy of dislocated radius fractures followed by 6 weeks relief through thermoplastic splint seems to be sufficient to achieve good 1-year results. MRI-detectable carpal lesions at the time of the radial fracture are common, but only a few of them seem to decompensate later, give symptoms and became of therapeutic relevance.
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Affiliation(s)
- Renata Gologan
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - V M Ginter
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Haeffner
- Alameda County Medical Center, Oakland, CA, USA
| | - U Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - U Schreiner
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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17
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Joshi AA, Leahy RM, Badawi RD, Chaudhari AJ. Registration-Based Morphometry for Shape Analysis of the Bones of the Human Wrist. IEEE Trans Med Imaging 2016; 35:416-426. [PMID: 26353369 PMCID: PMC4779077 DOI: 10.1109/tmi.2015.2476817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a method that quantifies point-wise changes in surface morphology of the bones of the human wrist. The proposed method, referred to as Registration-based Bone Morphometry (RBM), consists of two steps: an atlas selection step and an atlas warping step. The atlas for individual wrist bones was selected based on the shortest ℓ2 distance to the ensemble of wrist bones from a database of a healthy population of subjects. The selected atlas was then warped to the corresponding bones of individuals in the population using a non-linear registration method based on regularized ℓ2 distance minimization. The displacement field thus calculated showed local differences in bone shape that then were used for the analysis of group differences. Our results indicate that RBM has potential to provide a standardized approach to shape analysis of bones of the human wrist. We demonstrate the performance of RBM for examining group differences in wrist bone shapes based on sex and between those of the right and left wrists in healthy individuals. We also present data to show the application of RBM for tracking bone erosion status in rheumatoid arthritis.
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18
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Bonilla AG, Santschi EM. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy. Can Vet J 2015; 56:157-161. [PMID: 25694665 PMCID: PMC4298268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging.
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19
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Isidro A, Díez-Santacoloma I, Méndez-López J. Approach to the diagnosis of unusual carpal ankylosis from ancient Egypt. Clin Exp Rheumatol 2015; 33:50-55. [PMID: 25437122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Carpal fusion is not an uncommon finding in archaeological bones. The majority of cases are due to inflammatory or infectious diseases and those are usually associated with other major alterations in the skeleton. METHODS Two distinct individual cases, both adult females recovered from the Necropolis of Sharuna in the Middle Egypt from the Ptolemaic Period (IV to I BC) are presented in this study. Specimen 4323/1 shows a fusion of the scaphoid, lunate and triquetral bones in the right wrist. Specimen 4323/2 is a very rare fusion of a dysplastic lunate bone with the radius in the left wrist. In the proximal end of that left wrist, two possible remains of the flattened scaphoid and triquetral bones are also present. RESULTS A differential diagnosis of both abnormalities as well as broad research into similar paleopathological cases were carried out: the most probable diagnosis for the specimen 4323/1 is an uncommon carpal coalition of three bones from the same row; the diagnosis of the specimen 4323/2 is more dubious with both rheumatoid arthritis and septic arthritis being strong candidates. CONCLUSIONS In archaeological remains, carpal fusion should be thoroughly studied in order to ensure an accurate differential diagnosis.
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Affiliation(s)
- Albert Isidro
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Museu Egipci de Barcelona, Spain
| | - Ivan Díez-Santacoloma
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Jose Méndez-López
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Hand Unit, M.C. Mutual, Barcelona, Spain
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20
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Abstract
We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure-morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p < 0.001), with an increase of >62 mm(2) at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p < 0.05). As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery.
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Affiliation(s)
- Dong Hee Kim
- Hand Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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21
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Dunda SE, Kauczok J, Demir E, Braunschweig T, Pallua N. A rare case of massive carpal osteoblastoma requiring complex reconstructive surgery. J Plast Reconstr Aesthet Surg 2013; 66:e193-6. [PMID: 23490981 DOI: 10.1016/j.bjps.2013.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/17/2013] [Accepted: 02/21/2013] [Indexed: 11/18/2022]
Abstract
An osteoblastoma is a rare, commonly benign, osteoid-producing neoplasm of the bone with an incidence of 2% of all primary bone tumours. We present a case of a 54-year-old patient with persisting carpal pain and massive swelling of the hand for a period of 4 years. Incision biopsies revealed the histopathological finding of a carpal osteoblastoma. After complete tumour excision, including the carpal and, in parts, metacarpal bones, reconstructive surgery was performed with a free osteocutaneous iliac crest flap to obtain a natural hand contour and the best possible hand function. Follow-up revealed improvement of the hand function in terms of flexion, extension and strength without discomfort or further pain. Thus, ongoing carpal pain should lead to an intensive search with further diagnostic measures such as magnetic resonance imaging (MRI) scan as well as biopsies, if necessary, to obtain the correct diagnosis.
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Affiliation(s)
- S E Dunda
- Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, University Hospital Aachen, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
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22
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Mizia E, Tomaszewski K, Depukat P, Klimek-Piotrowska W, Pasternak A, Mroz I, Bonczar T. Median nerve (anatomical variations) and carpal tunel syndrome - revisited. Folia Med Cracov 2013; 53:37-46. [PMID: 25556510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Carpal tunnel syndrome belongs to the most common causative factors of surgical interventions in the wrist region. Anatomy of carpal tunnel and median nerve is a subject of current revision. Authors paid attention to etiology of the syndrome based on review of literature and their own anatomical studies. They remind basic knowledge on the median nerve and indicate that only based on number of dissections a good orthopedic surgeon may acquire experience necessary to perform procedures in a most appropriate way.
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Affiliation(s)
- Ewa Mizia
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | | | - Pawel Depukat
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Artur Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Izabela Mroz
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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23
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Iskra T, Mizia E, Musial A, Matuszyk A, Tomaszewski KA. Carpal tunnel syndrome - anatomical and clinical correlations. Folia Med Cracov 2013; 53:5-13. [PMID: 24858452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Carpal tunnel syndrome (CTS) is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed. Common symptoms of CTS involve the hand and result from compression of the median nerve within the carpal tunnel. In general, CTS develops when the tissues around the median nerve irritate or compress on the nerve along its course through the carpal tunnel, however often it is very difficult to determine cause of CTS. Proper treatment (conservative or surgical) usually can relieve the symptoms and restore normal use of the wrist and hand.
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Affiliation(s)
- Tomasz Iskra
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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24
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van de Giessen M, Foumani M, Vos FM, Strackee SD, Maas M, Van Vliet LJ, Grimbergen CA, Streekstra GJ. A 4D statistical model of wrist bone motion patterns. IEEE Trans Med Imaging 2012; 31:613-625. [PMID: 22057049 DOI: 10.1109/tmi.2011.2174159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Direct imaging of ligament damage in the wrist remains a challenge. Still, such damage can be assessed indirectly through the analysis of changes in wrist pose and motion pattern. For this purpose we built a statistical reference model that describes healthy motion patterns. We show that such a model can also be used to detect and quantify pathologies. A model that only describes the global translations and rotations of the carpal bones is insufficiently accurate due to size and shape variations of the bones. We present a local statistical motion model that minimizes the influence of size and shape differences by analyzing the coordinate differences of pairs of points on adjacent bone surfaces. These differences are determined in a set of 14 healthy example wrists imaged in a range of poses by means of 4D-RX imaging. The distribution of the differences as a function of the pose form the local statistical motion model (LSMM). Translations of 2 mm and rotations of 20° with respect to the healthy example wrists are detected as outliers in the point pair distributions. An evaluation involving wrists with a damaged ligament between scaphoid and lunate shows that not only joint space widenings can be detected, but also shifts of congruent bone surfaces. The LSMM is also used to perform a virtual reconstruction of the most likely healthy wrist after a simulated perturbation of bones. The reconstruction precision is shown to be about 1 mm. Therefore, the presented 4D statistical model of wrist bone movement may become a valuable clinical tool for diagnosis and surgical planning.
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Monacelli G, Rizzo MI, Spagnoli AM, Monarca C, Scuderi N. Ulnar artery thrombosis and nerve entrapment at Guyon's canal: our diagnostic and therapeutic algorithm. In Vivo 2010; 24:779-782. [PMID: 20952749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hypothenar hammer syndrome is a rare condition of ulnar artery aneurysm or thrombosis, which can be associated with a neuropathy of the ulnar nerve. There is no agreement regarding an optimal diagnosis and treatment for this syndrome. Most authors suggest angiography as the gold standard for diagnosis and recommend observation for the thrombotic type, and reconstructive surgery for the aneurysmal type. We report here our diagnostic and therapeutic algorithm, reviewing 9 patients with ulnar artery thrombosis and nerve entrapment at Guyon's canal; and an evaluation of the type of management including: anamnesis, diagnostic tests, and reconstructive surgery. We consider resection of the arterial thrombotic segment as the treatment of choice, due to the fact that ulnar arterial thrombosis can induce severe chronic inflammation into Guyon's canal and ulnar nerve sufferance. Therefore, we propose a planned approach, including 3 steps: clinical evaluation with Tinel and Allen's tests; magnetic resonance and ultrasound images; ulnar nerve decompression and arterial reconstruction. We believe that this practice is important for the early therapy of ulnar arterio-neuropathy in affected patients.
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Affiliation(s)
- G Monacelli
- Plastic Surgery of Emergency and Hand Surgery, Sapienza University of Rome, Rome, Italy
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26
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Wurapa RK, Bickel BA, Mayerson J, Mowbray JG. Metastatic esophageal adenocarcinoma of the carpus. Am J Orthop (Belle Mead NJ) 2010; 39:283-285. [PMID: 20631927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report on a rare case of metastatic esophageal adenocarcinoma to the wrist developing years after diagnosis and treatment of the primary lesion. Awareness of the potential for developing these lesions should be raised, particularly in the absence of systemic symptoms.
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Affiliation(s)
- Raymond K Wurapa
- The Cardinal Orthopaedic Institute, Mount Carmel Medical Center, Columbus, OH 43213, USA.
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27
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Steel CM, Hopper BJ, Richardson JL, Alexander GR, Robertson ID. Clinical findings, diagnosis, prevalence and predisposing factors for lameness localised to the middle carpal joint in young Standardbred racehorses. Equine Vet J 2010; 38:152-7. [PMID: 16536385 DOI: 10.2746/042516406776563332] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Lameness related to the middle carpal joint (MCJ) occurs in up to 30% of young Standardbred horses in race training and the incidence increase with radiographic severity of third carpal bone (C3) sclerosis on DPr-DDIO (skyline) view of the carpus. Factors predisposing horses to carpal injury have not been well investigated. OBJECTIVES To determine the importance of MCJ lameness as a cause of wastage in young Standardbred racehorses, stage of training at which it occurs and predisposing factors, and to describe clinical findings and diagnosis. METHODS Standardbred horses (n = 114) entering their first year of race training were examined at approximately 3-month intervals over 12-18 months. For 87 of the horses, a training diary was available and these horses were trained at 3 different stables, each using a different exercise regime. At each examination, forelimb conformation, MCJ effusion, MCJ lameness and radiographic findings were graded, and training history and reasons for lost training days recorded. Nuclear scintigraphy and exploratory arthroscopy were performed on a limited selection of horses. Results for horses that developed MCJ lameness during the study period were compared statistically with results for horses that did not. RESULTS Carpal lameness occurred in 28% of horses and was present in 56% with forelimb lameness. In most cases lameness was mild, bilateral and with little or no MCJ effusion and was attributed to subchondral bone pain associated with radiographic evidence of C3 sclerosis. Carpal lameness was the most common reason for >1 month's rest during the study period. It occurred at any stage of training but, in most cases, some speed training had begun. Of the variables studied, poor forelimb conformation and more intense speed training were predisposing factors. CONCLUSIONS AND POTENTIAL RELEVANCE The information gained should assist in making recommendations regarding training young Standardbreds to reduce the incidence of MCJ lameness. However, further investigations to determine the optimal training regime are warranted.
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Affiliation(s)
- C M Steel
- Division of Veterinary and Biomedical Sciences, School of Veterinary Clinical Science, Murdoch University, Murdoch, Western Australia, Australia
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28
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Affiliation(s)
- N Y Jones
- O'Gorman, Slater and Main, Donnington Grove Veterinary Surgery, Oxford Road, Newbury, Berkshire RG14 2JB, UK
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29
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Hopper BJ, Steel C, Richardson JL, Alexander GR, Robertson ID. Radiographic evaluation of sclerosis of the third carpal bone associated with exercise and the development of lameness in Standardbred racehorses. Equine Vet J 2010; 36:441-6. [PMID: 15253087 DOI: 10.2746/0425164044868341] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Sclerosis of the third carpal bone is a common radiographic finding in both lame and sound racehorses, but there are no guidelines correlating degree of sclerosis and incidence of lameness. OBJECTIVES To develop a protocol for describing subchondral bone sclerosis in C3 on dorsoproximal-dorsodistal oblique (DPr-DDiO) radiographs of the carpus and to correlate these changes with exercise history and carpal lameness. METHODS One hundred and six Standardbreds entering their first year of training (exercise group) and 7 age-matched Standardbreds at pasture (controls) were examined at approximately 3 month intervals over 12-18 months. Examinations consisted of lameness evaluation and carpal radiographs (DPr-DDiO and flexed lateromedial projections). A grading system (very mild, mild, moderate and severe) for C3 sclerosis seen on the DPr-DDiO radiograph was developed that utilised a combination of the criteria of trabecular thickening (trabecular score; TS) and total percent area of the C3 radial facet affected (TAA). RESULTS Exercise group horses showed significant increase in TS and TAA throughout training compared to control horses. Middle carpal joint lameness developed in 32/106 (30%) exercise group horses and none of the control horses. Incidence of middle carpal joint (MCJ) lameness was lower in horses with mild (2/30, 6.7%) than moderate (10/32, 31.2%) and severe (20/44, 45.4%) sclerosis throughout training. CONCLUSIONS Horses with higher grades of sclerosis, as defined by this novel grading system, were more likely to develop MCJ lameness at some point of training. The proposed grading system gave a quantitative assessment of radiographic sclerosis that could then be used to correlate increasing severity of sclerosis with increasing incidences of lameness. POTENTIAL RELEVANCE These results serve as a basis for further investigation into determining the degree of C3 sclerosis at which pathological changes and lameness can be expected.
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Affiliation(s)
- B J Hopper
- Division of Veterinary and Biomedical Sciences, School of Veterinary Clinical Science, Murdoch University Veterinary Hospital, Murdoch Drive, Murdoch, Western Australia 6150, Australia
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30
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Takase K. Pathology and therapeutic results in patients with intraosseous ganglia of the carpal bone. W INDIAN MED J 2010; 59:55-58. [PMID: 20931915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.
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Affiliation(s)
- K Takase
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, 671 Nishishinjuku, Shinjuku, Tokyo, Japan 060-0023.
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31
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Affiliation(s)
- Nader Paksima
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY 10016, USA.
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32
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Mogk JPM, Keir PJ. The effect of landmarks and bone motion on posture-related changes in carpal tunnel volume. Clin Biomech (Bristol, Avon) 2009; 24:708-15. [PMID: 19656596 DOI: 10.1016/j.clinbiomech.2009.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 02/10/2009] [Accepted: 05/07/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deviated wrist postures have been linked to carpal tunnel syndrome development, yet the effect of posture on carpal tunnel volume remains unclear. The purposes of this study were (i) to evaluate the effect of boundary definitions on tunnel volume estimates in neutral and non-neutral (30 degrees flexion, 30 degrees extension) wrist postures and (ii) to develop a biomechanical wrist simulation to predict posture-related changes in tunnel volume. METHODS Two carpal tunnel volume measures were calculated using (i) ulnar bony landmarks and (ii) radial and ulnar bony landmarks identified directly from magnetic resonance imaging (MRI) scans. A third volume measure combined computerized tunnel reconstructions with modelled bone surfaces to calculate an anatomically landmarked volume. Six individual simulations were then generated to predict volume in the flexed and extended postures based on individual carpal bone motions. FINDINGS Boundary definitions influenced the absolute volume in each posture and the relative changes between postures. Relative to fully reconstructed volumes, radial and ulnar landmarked volumes were 15-25% larger across postures (681 (SD 467) mm(3); P=0.01), while the ulnar-only landmarked volumes were 10-20% smaller (562 (343) mm(3); P<0.01). Simulation predicted volumes were not significantly different from the reconstructed anatomically landmarked volumes, with less inter-individual variability between postures compared to MRI-based volumes. INTERPRETATION Comparison of volume measures indicated the importance of capturing posture-related changes in the orientation of the proximal and distal tunnel boundaries, and revealed potential sources of error associated with volume reconstruction. Simulations can enable changes in tunnel dimensions to be related to bone movements throughout a range of motion.
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Affiliation(s)
- Jeremy P M Mogk
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
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Shigematsu K, Yajima H, Kobata Y, Kawamura K, Nakanishi Y, Takakura Y. Treatment of Kienböck disease in an 11-year-old girl with temporary fixation of the scaphotrapeziotrapezoidal joint. ACTA ACUST UNITED AC 2009; 39:60-3. [PMID: 15848968 DOI: 10.1080/02844310410017988] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An 11-year-old girl with Kienböck disease (stage IIIA) was treated by temporary scaphotrapeziotrapezoidal fixation. It was fixed in a cast for four weeks and wires removed after eight weeks. Follow up examinations showed that movement of the wrist and grip strength were improved, and she had no pain while revascularisation of the lunate could be seen on magnetic resonance imaging.
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Affiliation(s)
- Koji Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
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34
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Abstract
Fifty-one patients who had had proximal row carpectomy between 1992 and 2002 with a minimum follow-up of one year were followed up clinically and radiologically retrospectively. Their diagnoses included Kienböck disease (n=21), avascular necrosis of the scaphoid (n=4), nonunion of the scaphoid with osteoarthritis (n=9), and scapholunate advanced collapse (n=17). The mean follow-up was 5 years, 8 months. The mean "disabilities of the arm, shoulder and hand" (DASH) score was 18. The mean patient-rated wrist evaluation (PRWE) score list was 25% of maximum disability for the function and pain score. Thirty-four patients (87%) were able to return to work a mean of six months after operation (range 3 weeks - 35 months). Nine patients (11%) required arthrodesis of the wrist and are considered as failures. Mean flexion of the wrist was 66%, extension 73%, radial deviation 74%, ulnar deviation 76%, and grip force 70% of the opposite side. Excision of the proximal row provided predictable and durable pain relief, restored functional movement and grip strength, and allowed returned to gainful employment in most of the patients.
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Affiliation(s)
- Luc De Smet
- Department of Orthopaedic Surgery, U.Z. Pellenberg, Lubbeek, Pellenberg, Belgium.
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35
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Abstract
Intraosseous ganglions often arise in the foot and ankle but are less common within the carpal bones. We present a case of an intraosseous ganglion of the capitate bone associated with compression of the median nerve that was seen on plain radiographs and magnetic resonance images.
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Affiliation(s)
- Peter F Darcy
- Department of Orthopaedic Surgery, University Hospital Lewisham, London, UK.
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36
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Stiris MG. [MR examination of carpal fractures]. Tidsskr Nor Laegeforen 2009; 129:648. [PMID: 19337343 DOI: 10.4045/tidsskr.09.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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37
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Abstract
Idiopathic carpal tarsal osteolysis (ICTO) is a rare congenital disorder that results in the destruction and resorption of bone, leading to severe functional deficits and cosmetic deformities. This report includes a literature review describing the orthopedic and renal manifestations of ICTO. An additional case report of ICTO with atypical features is included.
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Affiliation(s)
- Kelly D Carmichael
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas 77555-0165, USA.
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38
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McDonald K, Toms AP, Armon K, Johnson K, Marshall TJ. Carpal-tarsal osteolysis with elbow involvement. Skeletal Radiol 2007; 36:1097-101. [PMID: 17618432 DOI: 10.1007/s00256-007-0346-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 04/01/2007] [Accepted: 05/30/2007] [Indexed: 02/02/2023]
Abstract
Carpal-tarsal osteolysis is a rare condition that manifests as the progressive resorption of carpal and tarsal bones in young children. The diagnosis of this condition is often difficult and delayed as the initial clinical presentation is non-specific. Radiographic changes occur gradually, are often not seen at presentation and depend on recognising loss of bone in the ossification centres of the carpus and tarsus. MRI demonstrates morphological abnormalities in the cartilaginous, as well as the osseous components, of the developing carpal and tarsal bones and therefore may be helpful in predating the radiographic changes. Ultrasound appears to contribute little to the diagnosis and may be misleading. Exclusion of other conditions, particularly juvenile idiopathic arthritis, is important in making the diagnosis. MRI can be useful in excluding an inflammatory arthropathy, and suggesting the diagnosis of carpal-tarsal osteolysis.
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Affiliation(s)
- Kirsteen McDonald
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK
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39
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Connor A, Highton J, Hung NA, Dunbar J, MacGinley R, Walker R. Multicentric carpal-tarsal osteolysis with nephropathy treated successfully with cyclosporine A: a case report and literature review. Am J Kidney Dis 2007; 50:649-54. [PMID: 17900466 DOI: 10.1053/j.ajkd.2007.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Accepted: 06/01/2007] [Indexed: 11/11/2022]
Abstract
Multicentric carpal-tarsal osteolysis is a rare skeletal disorder characterized by osteolysis of the metacarpal, carpal, and tarsal bones and leading to crippling joint deformities. Progressive nephropathy occurs in more than half the cases. All previously reported series with renal biopsies showed only end-stage renal disease on histological examination because of the late presentation to nephrologists. Accurate diagnosis of the underlying renal pathological state therefore has not been possible. We report the first case in which early and sequential renal biopsies were performed. These show the renal lesion to be focal and segmental glomerulosclerosis, which was treated successfully with cyclosporine A.
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Affiliation(s)
- Andrew Connor
- Department of Medical and Surgical Sciences, University of Otago School of Medicine, Dunedin, New Zealand.
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40
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Arimitsu S, Murase T, Hashimoto J, Oka K, Sugamoto K, Yoshikawa H, Moritomo H. A three-dimensional quantitative analysis of carpal deformity in rheumatoid wrists. ACTA ACUST UNITED AC 2007; 89:490-4. [PMID: 17463118 DOI: 10.1302/0301-620x.89b4.18476] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have measured the three-dimensional patterns of carpal deformity in 20 wrists in 20 rheumatoid patients in which the carpal bones were shifted ulnarwards on plain radiography. Three-dimensional bone models of the carpus and radius were created by computerised tomography with the wrist in the neutral position. The location of the centroids and rotational angle of each carpal bone relative to the radius were calculated and compared with those of ten normal wrists. In the radiocarpal joint, the proximal row was flexed and the centroids of all carpal bones translocated in an ulnar, proximal and volar direction with loss of congruity. In the midcarpal joint, the distal row was extended and congruity generally well preserved. These findings may facilitate more positive use of radiocarpal fusion alone for the deformed rheumatoid wrist.
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Affiliation(s)
- S Arimitsu
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka 565-0871, Japan.
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41
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Affiliation(s)
- Neal C Chen
- Yawkey Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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42
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Abstract
Dysplasia epiphysealis hemimelica most commonly presents as an overgrowth of the epiphysis in the lower limb. We report two cases, one a classical form involving the lower limb, and the other in a relatively rarer location in the wrist. Both cases were treated surgically by excision of the masses. We recommend excision of symptomatic intra-articular lesions by using MRI, which provides additional information concerning physeal line and extension of the mass, to prevent the development of angulation and to keep the range of motion.
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Affiliation(s)
- Hasan Bombaci
- Haydarpasa Numune Education and Research Hospital, 1st Orthopaedics and Traumatology Department, Uskudar, Turkey.
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43
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Freeston JE, Olech E, Yocum D, Hensor EMA, Emery P, Conaghan PG. A modification of the Omeract RA MRI score for erosions for use with an extremity MRI system with reduced field of view. Ann Rheum Dis 2007; 66:1669-71. [PMID: 17616555 PMCID: PMC2095331 DOI: 10.1136/ard.2007.072561] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop and test the reliability of a modified version of the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for erosions using extremity MRI (eMRI) with reduced field of view (RAMRIS-RV). METHODS Using a MagneVu 0.2 T machine, the preliminary RAMRIS-RV assessed erosions in metacarpophalangeal (MCP) joints 2-3, bases of metacarpal (MC) 2-5, and all wrist bones excluding base MC 1, pisiform and trapezium. T1 weighted images of >/=500 MCP and wrist bony sites from a mixed severity RA and control cohort were evaluated. An inter-reader reliability study evaluating 300 wrist and 160 MCP bony sites was then performed. RESULTS Mean per cent exact (and close) agreement results were as follows: MCP proximal sites 83.5 (96.2), MCP distal 54.4 (77.2), bases MC 2-4 85.2 (96.7), carpal bones 79.0 (92.1), distal radius/ulna 66.4 (87.8). The base of MCP 5 was visualised in </=50% cases (13/25) and was removed from the final RAMRIS-RV. CONCLUSIONS The RAMRIS-RV is a practical tool that can be used with eMRI with a reduced field of view. This study shows excellent inter-reader reliability for erosion assessment, albeit in a reduced number of bony sites.
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Affiliation(s)
- Jane E Freeston
- Academic Unit of Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
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44
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Abstract
The number of carpal bones may be increased or decreased by the fact of anatomical variants or true congenital anomalies. Numerical increment arises from additional or from split bones. Over twenty accessory carpal bones have been described but the commonest are the os centrale carpi, the os radiale externum, the triangular bone and the styloideum bone. Additional carpal bones usually result from a failure of fusion of their ossification centers. A congenital origin is not clearly established for all these ossicles. The scaphoid and lunate may split into two or three bones and several cases of bipartite hamulus of the hamatum have been reported. A carpus with only seven bones results from the congenital absence of a normal bone, which mainly affects the scaphoid, lunate and triquetrum, or from a synostosis between two carpal bones, usually the lunate and triquetrum. Congenital fusions originate from an absence of joint cavitation into the embryo and chondrification of the joint interzone. Numerical carpal variants are uncommon as independent entities but occur with a relative high frequency in association with complex malformations of the hand. These anomalies are detectable on plain radiographs of the wrist, but CT-scan and MR-Imaging are useful to differentiate bipartite and accessory bones from carpal fractures or posttraumatic injuries, carpal fusions having to be distinguished from bony ankylosis.
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Affiliation(s)
- B Senecail
- Laboratoire d'anatomie, faculté de médecine et des sciences de la santé de Brest, 20, avenue Camille-Desmoulins, 29200 Brest, France.
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45
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Glodny B, Bendix N, Trieb T, Gassner E, Gruber H, Petersen J. Congenital proximal radioulnar synostosis associated with bilateral hypoplasia of the scaphoid bone, bilateral os lunatotriquetrum, and anomalies of the carpometacarpal complex. Clin Imaging 2006; 31:62-6. [PMID: 17189852 DOI: 10.1016/j.clinimag.2006.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 10/02/2006] [Indexed: 11/17/2022]
Abstract
We describe a unique case of bilateral os lunatotriquetrum associated with bilateral hypoplasia of the scaphoid bone. On both sides, the medial carpi were in a single row. The capitate bone occupied the lunate position, whereas the lunatotriquetral bone was displaced ulnarly and tilted. The capitate thus articulated with the radius and metacarpal bones, consistent with carpal collapse. In addition, there was congenital proximal radioulnar synostosis on the left side.
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Affiliation(s)
- Bernhard Glodny
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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46
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Thomas CW, Bisset AJ, Sampson MA, Armstrong RD. Case report: Multicentric carpal/tarsal osteolysis: imaging review and 25-year follow-up. Clin Radiol 2006; 61:892-5. [PMID: 16978987 DOI: 10.1016/j.crad.2006.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 01/31/2006] [Accepted: 03/06/2006] [Indexed: 11/28/2022]
Affiliation(s)
- C W Thomas
- Southampton General Hospital, Tremona Road, Southampton, Hampshire, UK
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47
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De Smet L, Degreef I, Robijns F, Truyen J, Deprez P. Salvage procedures for degenerative osteoarthritis of the wrist due to advanced carpal collapse. Acta Orthop Belg 2006; 72:535-40. [PMID: 17152415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Arthrodesis of the wrist has been considered as the gold standard for osteoarthritis of the wrist. In 1984 Watson and Ballet identified a specific pattern of carpal collapse (scapholunate advanced collapse = SLAC) with progressive osteoarthritis. In order to preserve some motion, other alternative procedures have been proposed: proximal row carpectomy (PRC) and scaphoidectomy combined with a four-corner arthrodesis (4CA). In this cohort of 63 patients, three types of surgical treatment were performed (arthrodesis in 19, PRC in 26 and scaphoidectomy with 4CA in 18). The DASH questionnaire was used to evaluate the residual disability. PRC had a significantly better outcome (DASH=16), while there were no significant differences between full arthrodesis (DASH=45) and four corner arthrodesis (DASH=39). In PRC and in four corner arthrodesis a functional range of motion could be preserved (resepectively 44 degrees and 52 degrees flexion/extension arc). Gripping force remained inferior to the non operated side. There was a significant increase in gripping force in the PRC group, but not in the others. The final gripping force was not significantly different in the three treatment regimes.
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Affiliation(s)
- Luc De Smet
- University Hospital Pellenberg, Leuven, Belgium.
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48
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Abstract
Reports of simultaneous carpal avascular necrosis in more than 1 bone are rare. This is a report of simultaneous Kienböck's disease and Preiser's disease in a 50-year-old woman with a remote history of steroid use but without a history of trauma or systemic illness.
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Affiliation(s)
- Jeffrey E Budoff
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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49
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Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, Weber M, Aldrian S, Gäbler C, Prokop M. Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience. Radiology 2006; 240:169-76. [PMID: 16793977 DOI: 10.1148/radiol.2401050412] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging in patients clinically suspected of having a scaphoid fracture and who had normal initial radiographs, with radiographs obtained 6 weeks after trauma as the reference standard. MATERIALS AND METHODS The ethics committee approved the study, and all patients gave written informed consent. Twenty-nine patients (17 male, 12 female; age range, 17-62 years; mean age, 34 years +/- 13) underwent multidetector CT and MR imaging within 6 days after trauma. CT data were obtained with 0.5-mm collimation. For image review, 0.7-mm-thick multiplanar reformations were performed in transverse, coronal, and sagittal planes relative to the wrist. The 1.0-T MR examination consisted of coronal and transverse short inversion time inversion-recovery, coronal and transverse T1-weighted spin-echo, and coronal volume-rendered T2-weighted gradient-echo sequences. Two radiologists analyzed the CT and MR images. A binomial test was used to evaluate the significance of the differences between MR imaging and CT in detection of scaphoid fractures and cortical involvement (P < .05). RESULTS The 6-week follow-up radiographs depicted a scaphoid fracture in 11 (38%) patients. Eight patients had a cortical fracture, while three patients had only a bandlike lucency within the trabecular portion of the scaphoid. MR imaging depicted all 11 fractures but only three [corrected] cortical fractures. Multidetector CT depicted all eight cortical fractures but failed to depict trabecular fractures. No false-positive fractures were seen on MR or CT images. Differences between MR imaging and CT were not significant for the detection of scaphoid fractures (P = .25) but were significant for cortical involvement (P = .03). CONCLUSION Multidetector CT is highly accurate in depicting occult cortical scaphoid fractures but appears inferior to MR imaging in depicting solely trabecular injury. MR imaging is inferior to multidetector CT in depicting cortical involvement.
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Affiliation(s)
- Mazda Memarsadeghi
- Department of Radiology, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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50
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Abstract
BACKGROUND Scaphoid fractures are commonly seen in orthopedic practice. An organized and thoughtful approach to diagnosis and treatment can facilitate good outcomes. However, despite optimal treatment, complications may ensue. In the setting of nonunion or an avascular proximal pole, vascularized bone grafting may be needed. METHODS AND RESULTS In this article we review the literature regarding these injuries and describe an approach to diagnosis, treatment, and management of scaphoid fractures and nonunions. CONCLUSION Scaphoid fractures and nonunions may present as challenging problems in practice, but a systematic and deliberate approach can facilitate optimal results.
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Affiliation(s)
- Scott P Steinmann
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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