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PubMed1997

[Clinical examination of the injured wrist].

A highly differentiated clinical examination of the wrist joint has been established in the past years. The history of the accident is usually unreliable, but patient's statement of a hyperflexion injury should alert for a fracture of the scaphoid tubercle. First of all, X-rays of the wrist indicate therapy in the case of fractures and gross dislocations. Only after some days of reduction of pain and swelling, a thorough clinical examination will be possible, which consists of: localizing points of tenderness, in particular the scapho- lunate, lunato-triquetal and the scapho-trapezio-trapezoid (SL-, LT- and STT-) joints and the triangular fibrocartilage (TFC); testing for abnormal dorso-palmar shifts of the carpus and the ulnar head; provoking catch up clunks by radio-ulnar movements of the clenched fist; provoking subluxations, in particular of the scaphoid in Watson's test; provoking pain in the discuss grinding test. Comparing clinical diagnosis with arthroscopic findings in 37 patients, the results for ligamentous lesions in general, SL ligament lesions in particular and for TFC lesions were as follows: sensitivity 100%, 91% and 69%, resp.; specificity 77%, 77% and 67%, resp.; positive predictive values 75%, 62% and 61%, respectively. In conclusion, exact clinical examination is a reliable tool to determine further diagnostics and therapy of wrist injuries.

Arthroscopy↗
PubMed1998

Osseous anatomy and articular relationships about the distal ulna.

The distal radio-ulnar joint (DRUJ) has a bony anatomy that contributes very little to stability. This article discusses the osseous anatomy about the distal end of the ulna. The structures that support the stability of the DRUJ, such as the triangular fibrocartilage complex, the tendon sheath of the extensor carpi ulnaris, the pronator quadratus muscle, and other tendons on the ulnar side of the wrist are reviewed.

Cartilage, Articular↗
PubMed1998

Soft-tissue anatomy and relationships about the distal ulna.

The author investigates the complex anatomic relationship between the ulnar head and adjacent osseous structures (radius and carpus). Special attention is directed to the orientation and shape of the articular surfaces the constraining effects of specific membranes and ligaments (radio-ulnar and ulnocarpal), the shock-absorbing function of the triangular fibrocartilage, and the dynamic action of specific muscles (pronator quadratus and extensor carpi ulnaris) The anatomy of other nonstabilizing structures (meniscus homologue and prestyloid recess) is also discussed.

Biomechanical Phenomena↗
PubMed1998

The role of operative arthroscopy for the diagnosis and treatment of lesions about the distal ulna.

Operative arthroscopy of the wrist compliments the physical examination and radiographic imaging to improve diagnosis and treatment of lesions about the distal ulna. This article reviews the relevant anatomy, biomechanics, and classification of acute and degenerative lesions of the triangular fibrocartilage complex (TFCC). Minimally invasive diagnostic and management techniques for TFCC tears are described in detail.

Arthroscopy↗
PubMed1998

The phylogeny of the wrist.

The phylogeny, or evolutionary development, of the wrist can be traced from its origin as a pectoral fin of a fish living 400 million years ago. As species became more terrestrial, the wrist evolved into a weight-bearing joint, with syndesmotic attachment of the distal radius and ulna, the ulnar styloid articulating with the pisiform and triquetral bones. With the appearance of primates, the wrist took its present form, with no ulnocarpal articulation but with a synovially lined distal radioulnar joint and triangular fibrocartilage complex, allowing for wrist mobility.

Animals↗
PubMed1997

-Arthrography and computed tomography arthrography of the wrist-.

After a brief review of the pertinent anatomy of joint compartments and main ligaments of the wrist, the authors present the technique of wrist arthrography and CT arthrography. They discuss the normal and pathological patterns. The main indications are the chronic painful wrist and posttraumatic wrist. Imaging can reveal ligament defects (particularly scapholunate ligament, or lunotriquetral ligament), triangular fibrocartilage tears, capsular defects, cartilage thinning, foreign bodies, synovial ganglia or synovitis of the wrist.

Arthrography↗
PubMed1976

Acute carpal tunnel syndrome secondary to pseudogout: case report.

Acute carpal tunnel syndrome secondary to chondrocalcinosis seems not to have been previously reported. In a 75-year-old woman, with arthropathy and calcification of the triangular fibrocartilage of the wrist, hyperparathyroidism was suspected, but not proven. Hydroxyapatite and calcium pyrophosphate crystals were found together in the pathological specimen. The patient obtained complete relief from sectioning of the transverse carpal ligament.

Aged↗
PubMed1998

[Ulna impaction syndrome therapy: decompressive surgical procedures of the head of the ulna].

The ulnar impaction syndrome can be defined as the impaction of the ulnar head against the triangular fibrocartilage complex and ulnar carpus. As a result of this pattern, painful degeneration of the TFCC occurs. Wrist arthroscopy offers a certain diagnostic tool. In addition, arthroscopic debridement of the TFCC shows a high success rate of 70 to 80 percent. After failed arthroscopic debridement, ulnar shortening osteotomy reduces ulnar load significantly. Malunion of the radius resulting in posttraumatic ulna-plus variance should be treated by correction osteotomy with lengthening of the radius. If arthrosis of the distal radioulnar joint is combined with ulnar impaction syndrome, the hemiresection procedure of Bowers or the method of Kapandji-Sauvé are the methods of choice.

Arthroscopy↗
PubMed2005

Ulnar impaction syndrome.

Although Palmer's classification of TFCC lesions differentiates post-traumatic central perforations (IA tears) from degenerative tears secondary to ulnocarpal impaction (IIC) [3], the distinction is not always clear clinically. In the final analysis, the literature suggests that as many as 25% of wrists with TFCC tears have residual symptoms following arthroscopic debridement alone [23], and it is likely that static or dynamic ul-nar positive variance plays a role [2,5,17,25]. The authors' results suggest that combined arthroscopic TFCC debridement and wafer resection are feasible and efficacious as treatment for all stages of ulnar impaction syndrome. When class II A and B changes are observed, that is, when a TFCC perforation has not yet developed, the authors have observed favorable results in most patients following arthroscopic TFCC central disc excision and wafer resection as an alternative to ulnar shortening osteotomy [33] or open wafer excision [10].

Arthralgia↗
PubMed2006

Arthroscopic management of distal radius fractures.

Arthroscopy has the advantage of providing a direct and accurate assessment of the articular surfaces and detecting the presence of injuries associated with distal radius fractures. Current indications, although numerous and potentially expanding, also are controversial. This report presents a global view of the current status of arthroscopy in the management of distal radius fractures. The rationale of arthroscopic treatment, the available evidence, and finally the diagnosis and treatment are discussed.

Arthroscopy↗
PubMed2006

Dorsal capsulodesis for scapholunate instability--effect on patient disability and wrist pain.

Twenty cases of scapho-lunate instability have been reviewed, to determine the effect of dorsal capsulodesis on disability and wrist pain. The average follow-up was 41 (range 13-63) months. There was a significant improvement in the pre-operative Patient Rated Wrist Evaluation score from 108 (range 18-150) to a postoperative score of 60 (range 0-132). All wrist movements and grip strength were reduced postoperatively but only the reductions in flexion and radial deviation were statistically significant. Seventeen (85%) patients were satisfied with the operation. One patient remained unemployed after surgery. Five patients returned to their normal jobs. This study shows that dorsal capsulodesis should remain an important option in the treatment of scapholunate instability.

Adolescent↗
PubMed2006

Uses and abuses of wrist arthroscopy.

PURPOSE OF REVIEW: The use of wrist arthroscopy in the diagnosis and treatment of carpal pathology continues to expand. The purpose of this paper is to summarize recent advances in the utility of this diagnostic, therapeutic, and research tool. RECENT FINDINGS: The indications for wrist arthroscopy are growing with the description of volar portals for the radiocarpal and scaphotrapezial trapezoid joint. Arthroscopic assistance in the treatment of distal radius and scaphoid fractures is also becoming more feasible. Arthroscopic excision of dorsal carpal ganglions has met with considerable success. In addition, the application of electrothermal collagen shrinkage is an exciting new frontier in arthroscopic wrist procedures. SUMMARY: Wrist arthroscopy has evolved to be an essential diagnostic and therapeutic tool in the armamentarium of every surgeon treating disorders of the wrist.

Arthroscopy↗
PubMed2003

[The development of the wrist joint in the fetal period].

OBJECTIVES: This study was designed to investigate the development and anatomical features of the wrist joint, particularly the scapholunate ligament and triangular disc in the fetal period and to identify possible congenital variations. METHODS: The study included 16 wrist joints of eight fetuses aborted at ages 8 to 14 weeks. The samples had no macroscopically discernible anomalies. Tissue specimens were fixed in 10% formalin solution, embedded in paraffin, and mounted on a microtome to obtain 5-micron sections in the coronal plane. Following staining with hematoxylin and eosin, conventional light microscopic examinations were performed. RESULTS: Organization of the carpal ligaments in the wrist joint began on the radial side in the 9th week. In the 10th week, the scapholunate ligament was formed; a membranous structure was observed, which lied from the interfacet prominence of the radius to the scapholunate ligament and divided the wrist joint into two cavities. The triangular disc formation began to appear at this stage. During the 11th and 12th weeks, the membranous structure underwent regression from the dorsal to the volar aspects, and at the end of the 14th week, the wrist joint became a single cavity. Also noted was the development of fibrous appearance of the scapholunate ligament and the triangular disc into fibrocartilage. Vascular areas were identified on the radial rather than the ulnar side of the scapholunate ligament, but vice versa for the triangular disc. Bicompartmental structure seemed to persist in the wrist joint of a 14-week-old fetus. CONCLUSION: In this study, we demonstrated that the scapholunate ligament and the triangular disc were not homogeneous in the fetal period in terms of vascularity and cellularity. We speculate that a plica-like membranous structure may persist in the wrist joint as a remnant of the fetal life. An accurate knowledge of the anatomy is necessary for the treatment planning and arthroscopic interpretation of the wrist joint.

Carpal Bones↗
PubMed1976

Hemochromatosis: a disease often silent but not invisible.

Hemochromatosis is a disorder characterized by the association of portal cirrhosis with deposition of excess amounts of iron in the parenchymal cells of many organs. Arthralgia and arthritis occur in about 50% of patients. The role of the radiologist is often significant in the recognition of this condition because hemochromatosis may be unsuspected clinically since the hepatic cirrhosis is frequently inactive at the time the arthritis develops. The possibility of hemochromatosis should be considered when the characteristic involvement of the metacarpophalangeal, radiocarpal, and proximal interphalangeal joints of the hand and wrist is present. In addition, articular and fibrocartilage calcification is often noted, particularly in the knee, triangular cartilage of the wrist, hip, elbow, symphysis pubis, and shoulder. Although localized chondrocalcinosis may be seen in association with many disorders, as well as in asymptomatic elderly persons, generalized chondrocalcinosis is a significant finding and is commonly associated with hemochromatosis. Recognition of the typical distribution of the arthropathy plus its characteristic roentgenographic features should aid in the identification of patients with the disorder who do not demonstrate the typical clinical features of hemochromatosis.

Arthritis↗
PubMed2001

Evaluation of the rat stifle joint after transection of the cranial cruciate ligament and partial medial meniscectomy.

Osteoarthritis (OA) was induced in the rat stifle joint by partial medial meniscectomy (PMM) and transection of the cranial cruciate ligament (CCL). At 10 weeks after destabilization, joint morphologic and pathologic changes were observed, scored, and compared. The intact rat stifle joint was observed in a mid-saggital plane. Articular cartilage of the distal portion of the femur and proximal portion of the tibia had thicker and thinner sites, and the thicker sites were located caudally on the distal portion of the femur and centrally on the proximal portion of the tibia. The two separate triangular portions of the medial meniscus observed in the mid-saggital plane contained a center of ossification in the cranial portion and fibrocartilage in the caudal portion. The synovium was one to three cells thick, and contained rare inflammatory cells. Although lesions were more severe in stifles after PMM, both treatments produced OA lesions that closely simulated OA lesions of other species. Lesions consistent with idiopathic OA included chondrocytic clones with increased metachromasia around them, chondrocytic death, loss of metachromasia, fibrillation, fissuring, erosion of articular cartilage, osteophyte formation, and variable synovial inflammation. The results indicate that PMM and CCL transection in the rat are useful in vivo models for study of the etiopathogenesis of OA and therapeutic efficacy of anti-arthritic drugs and treatment concepts.

Animals↗