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
Technique Guide 10/4/2016 Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Four Corner Wrist Fusion Orthobullets Team Hand - SLAC (Scaphoid Lunate Advanced Collapse)
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Chronic wrist pain in a 50M (C2766) Hand - Wrist Arthritis HPI - Pain in wrist for more than 1 year. No history of trauma. What is the likely diagnosis? 2/18/2017 300 3 3 carpal arthritis (C2119) Hand - Wrist Arthritis HPI - 18 months with persistent pain in hand and wrist left. denied history of trauma. What is the most likely diagnosis? 1/20/2015 684 0 11 Possible rheumatoid arthritis affecting the wrist (C1760) Hand - Wrist Arthritis HPI - Patient developed pain and stiffness in the wrist joint 8 yrs back. The pain has gradually increased and so has the deformity. The patient has been on ATT for 2yrs and was also on disease modifying agents for rheumatoid arthritis. Now patient has tenderness at just the distal radio-ulnar articulation which is the only problem that the patient has.She is not worried about the stiffness of the wrist joint or deformity. What should be the treatment plan for this patient? 1/24/2014 252 1 6 See More See Less