[Indications for diagnostic and therapeutic arthroscopy of "small joints" (elbow, upper ankle joint, wrist joint, hip joint].
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Ankle Injuries↗
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[Distorsion of the wrist joint].
Wrist hyperextension is a common injury. However, obvious ligamentous ruptures are apparently seldom. The intracarpal locking phenomenon, allowing for correct load transmission, or overlooked pathology might explain this remarkable discrepancy. If the muscle tension fails, i.e., no locking phenomenon happens, and the ligaments are put under abnormal constraints with a high risk of secondary rupture. Such constraints might also appear secondary to bony alteration or previous ligamentous weakening. Patient history allows to define the pathophysiology of the accident, examination will locate the points of maximal tenderness whereas radiology allows to detect malalignment, step-off or bony anomaly. To be valid, radiology must be standardized. Accordingly we describe the radiological techniques. Scintigraphy will show if the lesion is focal (mainly osseous) or not (dystrophy). Arthrography helps to find out which group of ligaments are torn, whereas arthroscopy will quantify the tears and find out additional chondromalacia or synovitis. Magnetic resonance imaging remains limited to vascular trouble shooting. We propose a diagnostic and therapeutical scheme that will help the physician in advising the patient.
Diagnostic Imaging↗
Vascularization and innervation of the canine wrist joint synovial membrane.
The correlation between vascular distribution and synovial structures was investigated using corrosion cast of the synovial fold of the dog antebrachiocarpal joint (wrist joint) under scanning electron microscopy. Arterial branches arose from a main artery deep in the subsynovial layer, ascended toward the free margin of the fold, dividing into several branches, and finally formed a dense capillary network beneath the lining layer. Immunohistochemical study and a retrograde axonal tracing experiment revealed that almost all nerve fibers were associated with the arterial tree and that: (1) proximal parts of the arterial tree were innervated with neuropeptide Y (NPY)-containing noradrenergic sympathetic fibers, vasoactive intestinal peptide-containing non-catecholaminergic sympathetic fibers from the stellate ganglion and substance P (SP)- and calcitonin gene-related peptide (CGRP)-containing sensory fibers from the C7-T1 segments of the dorsal root ganglia; (2) more distal parts of the arterial branches were associated with NPY-immunoreactive sympathetic fibers and SP- and CGRP-immunoreactive sensory fibers; and (3) the most peripheral precapillary arterioles were accompanied by only SP- and CGRP-containing sensory fibers. These results indicate that synovial blood flow is regulated by at least three different nerve systems which possess regional differences.
Animals↗
[The wrist joint].
The wrist joint is involved in a great majority of cases of rheumatoid arthritis. Tenosynovitis and synovitis can lead to severe destruction of the joint and to spontaneous ruptures of the tendons. Therefore, early tenosynovectomy and wrist-joint synovectomy are required. At the advanced stage of the disease, arthroplasty is necessary. Arthrodesis is rarely indicated in the treatment of severe wrist destruction in rheumatoid arthritis.
Arthritis, Rheumatoid↗
[Clinical experiences with Wilhelm's method of wrist joint denervation].
Wrist joint denervation for treatment of painful arthrosis was carried out in 36 patients in the last five years. 33 Patients could be followed up. Besides subjective reports on pain and maximum stress, strength, mobility and the X-ray of the wrist-joint were also considered in the evaluation of the results. As a whole, a success rate of 84% could be attained. We have not observed disorders of sensitivity or trophic alterations. An increase of symptoms after the second postoperative year was noteworthy.
Adolescent↗
[Stress on the normal and pathologic wrist joint].
The wrist joint is generally stressed by external forces. The resultant of these external forces produces the pressure in the joint which evokes pressure stresses within the supporting tissues of the joint. As was shown by Pauwels (1973) the density of the subchondral bone is adapted to articular stress distribution. The zone of subchondral bone can be seen as the morphological equivalent of the specific joint stress. This paper shows by means of density analyses and pressure measurements that in contrast to earlier opinions joint pressure is transmitted both by the lunate and the scaphoid bones. It seems that the physiological stress is even higher in the scaphoid than in the lunate bone. The force transmission between the lunate and the ulnar disc is less pronounced. The analysis of the lunatal trabecular architecture leads to the suggestion that the lunate is stressed differentially in the radio-ulnar plane. In pathological conditions of the wrist joint (perforation of the disc, ulnar shift, Kienböck's disease, ulna minus variant) the pressure and the density distribution are adapted to the pathomorphology in each case.
Aged↗
Long-term results of denervation of the wrist joint for chronic wrist pain.
The results have been evaluated of 29 patients who had wrist denervation for chronic wrist pain between 1979 and 1987. Follow-up ranged from 22 to 86 months (mean 51 months). 17 patients had denervation without a concurrent procedure. Of these, 12% became pain-free and 71% had pain with all activities or had additional surgery; 24% said they were satisfied with their treatment. The results were worse in those who had partial denervation than those who had total denervation. 12 patients had denervation performed concurrently with another pain-relieving procedure. Denervation alone was not reliable in resolving chronic wrist pain.
Adult↗
Characteristics of sensory DRG neurons innervating the wrist joint in rats.
BACKGROUND: Wrist pain can be the result of trauma, or inflammatory processes such as arthritis or synovitis. There is evidence that sensory nerve fibers are present in the wrist joints of animals and humans; however, the sensory innervation pattern of the wrist, as well as the types of nerves innervating it, have not been clarified. The purpose of this study was to characterize the types of sensory dorsal root ganglion (DRG) neurons innervating the wrist joint in the rat. METHODS: In this study, retrograde neurotransport was combined with lectin affinity histochemistry and immunohistochemistry to characterize DRG neurons innervating the wrist joint in rats. We used 3 markers: calcitonin gene-related peptide (CGRP) as a marker of small, peptide-containing neurons associated with inflammatory pain; the glycoprotein binding the isolectin from Griffonia simplicifolia (IB4) for small, non-peptide-containing neurons related to transmission of pain following nerve injury; and neurofilament 200 (NF200) for small and large myelinated fibers. IB4-binding and CGRP-containing neurons are typically involved in pain sensation, whereas NF200 is associated with pain and proprioception. RESULTS: Neurons innervating the wrist joints, retrogradely labeled with fluoro-gold (FG), were distributed throughout DRGs from C6 to T1. Of all of the FG labeled neurons, the percentage of NF200 immunoreactive (IR) neurons and CGRP-IR neurons were 26% and 45%, respectively. The percentage of IB4-binding neurons was 3%, significantly less than the ratio of CGRP-IR neurons to the total FG labeled neurons. CONCLUSION: Under physiological conditions in rats, DRG neurons transmit several types of sensation from the wrist joint including proprioception and pain. Most of the labeled neurons were CGRP-IR peptide containing neurons. It is likely that these neurons are the predominant afferents for inflammatory pain signals from the wrist. Because peptide-containing neurons are associated with inflammatory pain, it is likely that the inflammation in the wrist joint causes wrist joint pain.
Animals↗
[Anatomy of the wrist joint and carpus].
A systematic anatomical representation of the carpal area is not an adequate means to show its way of function. This paper describes the functional correlations between the distal radio-ulnar joint and the wrist joint. The proximal wrist joint is composed of two mechanically equivalent compartments. Within the ulnocarpal joint, the disk fulfills a most important function as a surface adapting and pressure transmitting element. Its perforation is a pre-arthrotic deformity. The column conception of the carpus is supported by cinematic studies as well as by analyses of the subchondral bone density and the spongy structure of the ossa carpi. This conception presumes a radial scaphoid column, a central lunate column, and an ulnar triquetrum column.
Carpal Bones↗
The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint.
This paper presents the wrist joint MR images of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Reference images for scoring synovitis, bone oedema, and bone erosions according to the OMERACT RA MRI scoring (RAMRIS) system are provided. All grades (0-3) of synovitis are illustrated in each of the three wrist joint areas defined in the scoring system--that is, the distal radioulnar joint, the radiocarpal joint, and the intercarpal-carpometacarpal joints. For reasons of feasibility, examples of bone abnormalities are limited to five selected bones: the radius, scaphoid, lunate, capitate, and a metacarpal base. In these bones, grades 0-3 of bone oedema are illustrated, and for bone erosion, grades 0-3 and examples of higher grades are presented. The presented reference images can be used to guide scoring of wrist joints according to the OMERACT RA MRI scoring system.
Arthritis, Rheumatoid↗
[Instability of the wrist joint--diagnosis and therapy].
Wrist-joint instability can be caused by injuries to ligaments or bones, it can be intermittent or permanent. Clinical symptoms and pain sensations are non-characteristic. The X-ray findings are the clue to the diagnosis. In this article recommendations are given for exact X-ray positions of the hand and their evaluation. The classification of instability is corresponding to the X-ray findings. Further investigations like radiographs under stress, dynamic investigations or the arthrography of the wrist-joint can be helpful to find out the exact pathologic changes. They are variable and are ranging from dysharmonic movement to a complete destruction of the carpal bones. Treatment is according to the pathologic changes and their causes. Fresh ligamentous injuries (e.g. additional injuries to a Colles' fracture or a perilunate luxation) should not be discarded lightly. Most cases we saw presented very late, the patients showed already osteoarthritic changes of the carpal bones with destruction of the cartilage. The late results of ligamentous reconstructions have not fulfilled their expectations, the current trend is towards a partial arthrodesis of the carpal joints in order to reconstruct the joint stability under preservation of partial mobility. This method of treatment has certain disadvantages: Pathologic wrist-joint movements, impingement syndromes and undue stress reactions within the neighbouring joints. Recommendations for the different indications are given.
Arthrodesis↗
[Is resection-interposition arthroplasty in chronic polyarthritis an alternative to alloarthroplastic replacement of the wrist joint?].
Rheumatoid arthritis involving the wrist joint frequently causes destruction and subsequent dislocation of the radio-carpal joint. The resultant loss of function requires a stabilisation procedure to correct it. In order to preserve function, various types of prosthesis for the wrist joint have been developed and their values are discussed. The resection interposition arthroplasty described here not only improves stability but also appearance and function. The operative procedure and results are presented.
Adult↗
Functional morphology of the lemuriform wrist joints and the relationship between wrist morphology and positional behavior in arboreal primates.
A comparative study of carpal joint structure and function in six Malagasy lemuriforms was undertaken to test predicted morphoclines in carpal joint morphology between pronograde and orthograde arboreal primates. Patterns of movement at the wrist during locomotion were observed and described for the lemuriform species Lemur fulvus and Propithecus verreauxi. Lemur fulvus, which assumes a pronograde posture during locomotion, extends and pronates the wrist during the support phase of quadrupedal walking and running stride cycles. Furthermore, the forearm of this species exhibits some transverse movement across the proximal wrist joint during the support phase. In contrast, the indriid Propithecus maintains the hand and wrist in a flexed and partially supinated position during vertical clinging and suspensory postures. Habitual quadrupedal and vertical postures in Malagasy primates are in turn related to very different patterns of carpal joint morphology and articular mechanics. Those lemurs which are predominantly pronograde share a series of structural features related to stabilizing the antebrachiocarpal joint during extension and mediolateral deviation and the midcarpal joint during pronation: an intraarticular labrum is present on the inner portion of the radiocarpal ligament, the radiocarpal articular surface is quite flat dorsoventrally, the capitate-trapezoid embrasure is expanded dorsally, and development of the radial and ulnar styloids is more pronounced. The wrists of Propithecus, Avahi, and Lepi-lemur (vertical clingers) differ from those of quadrupedal lemuriforms in possessing a suite of morphological features related to stabilizing the wrist during antebrachiocarpal flexion and midcarpal supination: the radiocarpal articular surface is deeply curved and tilted anteriorly, the dorsal radiocarpal ligament is very broad, thick, and fibrous, the hamate's triquetral facet is directed proximodistally, and the capitate-trapezoid embrasure is dorsally constricted and expanded palmarly. These observed contrasts in carpal form and function are used to define further the morphological features related to orthograde posture in several lineages of arboreal primates.
Animals↗
[A case from practice (349). Calcium-pyrophosphate arthropathy with acute pseudogout and involvement of the large joints with bilateral preference of wrist joint and knee joint].
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Adult↗
Computer-based methods for measuring joint space and estimating erosion volume in the finger and wrist joints of patients with rheumatoid arthritis.
OBJECTIVE: This study was conducted 1) to determine the feasibility of using computer programs to measure radiographic joint space width and estimate erosion volume in the hands of patients with rheumatoid arthritis (RA), and 2) to compare the new computer-based methods with established scoring methods. METHODS: To measure the joint space width in the finger and wrist joints of RA patients, hand and wrist radiographic films were scanned using a tabletop scanner and analyzed with programs written using the "macro" capabilities of NIH Image software. Estimation of erosion volume was determined by utilizing gray-scale intensity to calibrate bone density units per mm3, which made possible comparisons between the erosions and noneroded, anatomically similar sites. RESULTS: In 3 sets of duplicate measurements of joint space width on 79, 48, and 48 finger and wrist joints, the mean absolute deviation from the mean of the 2 measurements was 0.036 mm (SD 0.034), 0.032 mm (SD 0.049), and 0.021 mm (SD 0.016), respectively. Joint space measurements and scoring of joint space narrowing both demonstrated a difference between active treatment and placebo in an old trial set on gold therapy (P = 0.03 and P = 0.01, respectively). Two repeated measurements of bone density units in the bones of 3 different hands differed from the mean of the measurement by 2.29-4.04%. In 2 experiments, estimates of erosion volume showed a greater difference between gold therapy and placebo than did erosion scores in the trial set (P = 0.049 and P = 0.016 versus P = 0.27). CONCLUSION: Computer-based methods for measuring finger and wrist joint spaces and estimating erosion volume in patients with RA agree with the results of radiographic scoring of erosions and joint space narrowing.
Arthritis, Rheumatoid↗
Development of the human wrist joint ligaments.
BACKGROUND: Many studies have been published on the development of the human wrist joint, but scant attention has been given to the development of the wrist joint ligaments. Moreover, traditional description of wrist anatomy usually depict only the superficial capsular fibers of the wrist joint. The only ligamentous structure to receive much attention is the articular disc of the wrist joint, which has been described as a fibrocartilaginous structure extending from the medial edge of the lower end of the radius to the ulnar styloid process. METHODS: In the present report, we synthesize our observations in the wrist joint ligaments in 35 serially sectioned human embryonic and fetal hands (16 embryos and 19 fetuses). RESULTS: The interosseous intercarpal ligaments are organized from the mesenchyme, which, until O'Rahilly's stage 23, fills the intercarpal spaces. These ligaments are not individually distinguishable until the 9th week of development. The collateral ligaments begin to form in O'Rahillys's stage 22 and are completely formed by the end of week 10. The palmar radiocarpal and ulnocarpal ligaments (beginning with the palmar radiocarpal ligament) begin to form in O'Rahilly's stage 23 and are fully developed by the end of week 10. At this time, development of the dorsal radiocarpal ligament begins; this process is completed by the end of week 13. The articular disc which is initially formed of a single element, first appears in O'Rahilly's stage 23 and its organization is completed at week 10 of development. CONCLUSIONS: We establish the morphogenetic time-table of the wrist joint ligaments. Our descriptive findings may help explain carpal motion and the origin of wrist injuries.
Carpal Bones↗
[Wrist joint arthrodesis. Technique and outcome].
Arthrodesis of the wrist joint is indicated in degenerative joint desease, instability and restricted and painful range of motion. Further indications are: failed reconstruction, partial arthrodesis or arthroplasty/total joint replacement. The surgical technique depends mainly on the quality of bone substance and degree of joint degeneration. Differences can be made concerning the type of bone graft and osteosynthesis being used. The aim is to create, a stable joint in a good functional position. The position of arthrodesis depends on the patients needs. In patients with rheumatoid arthritis a straight position is generally accepted, where as in patients with degenerative joint desease, a slight wrist extension and ulnar deviation is preferred. A stable osteosynthesis with plates is reliable and allows early rehabilitation. We present 28 cases of arthrodesis with intramedullary rods and 61 cases of arthrodesis with plates. The complication rate was low, the functional results were good. We saw significant reduction of pain, increase of strength and handfunction. Arthrodesis of the wrist joint has proven to be a long term reliable and safe procedure. Loss of motion is accepted to obtain sufficient pain relief.
Arthritis, Rheumatoid↗
[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↗