Updated: 10/4/2016

Wrist Arthritis

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https://upload.orthobullets.com/topic/6056/images/pancapal arthritis.jpg
https://upload.orthobullets.com/topic/6056/images/stt arthritis.jpg
https://upload.orthobullets.com/topic/6056/images/ulnar head replacement.jpg
Introduction
  • Various forms of wrist arthritis based on location
    • SLAC wrist (scapholunate advanced collapse)
      • most common
    • STT arthrosis
      • second most common
    • SNAC (scaphoid nonunion advanced collapse)
    • DRUJ arthrosis
    • Pisotriquetrial arthrosis
  • Mechanism
    • degenerative
      • primary OA
    • posttraumatic
      • leads to SLAC/SNAC/DRUJ
    • inflammatory
      • Rheumatoid arthritis
    • congenital
      • may be secondary to Madelung's deformity
    • idiopathic
      • may secondary to Kienbock's or Preiser's disease
  • Pathoanatomy
    • SLAC
      • Injury to SL ligament --> palmar rotary subluxation of scaphoid --> incongruency of joint surfaces --> arthrosis of radiocarpal joint --> arthrosis of capitolunate joint
      • radiolunate typically spared
    • SNAC
      • proximal portion of scaphoid remains attached to lunate while distal scaphoid flexes
      • leads to early arthritis between radial styloid and distal scaphoid
      • like SLAC, radiolunate typically spared
    • Rheumatoid arthritis
      • wrist becomes supinated, palmarly dislocated, radially deviated, and ulnarly translocated
      • early disruption of DRUJ leads to dorsal subluxation of ulna (Caput-ulna)
Anatomy
  • Wrist ligaments and biomechanics
Imaging
  • Radiographs
    • obtain standard hand series with additional views to visualize specific joints
    • pisotriquetral joint (pisotriquetral arthrosis) obtain lateral in 30 degrees of supination
Treatment
  • Nonoperative
    • NSAIDs, bracing, intra-articular steroid injections
      • indications
        • first line of treatment for mild to moderate symptoms
  • Operative
    • aimed at addressing diseased area
      • SLAC
      • SNAC
      • Pisotriquetrial arthritis
        • excision of pisiform in refractory cases
      • DRUJ abutment syndrome & arthrosis
        • distal ulna resection (Darrach procedure)
        • Sauvé-Kapandji procedure
        • partial ulna resection and interposition
        • ulnar head replacement
          • can be used as primary procedure, or as salvage for failed Darrach
          • early results are promising, long-term results pending
      • Rheumatoid arthritis
 

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