Osteoarthritis of the Wrist STT Joint and Radiocarpal Joint

Retrospective analysis of scaphoid trapezium pyrocarbon implant intervention in STT arthritis: a 3-year follow-up study

AIM

The purpose of this study was to evaluate clinical, patient rated and radiological outcome of the scaphoid trapezium pyrocarbon implant (STPI) at a minimum of three years follow-up.

METHODS

Consecutive patients operated with the STPI due to scaphotrapeziotrapezoidal (STT) arthritis between 2012 and 2019 were included. Patients were evaluated preoperatively and annually after surgery for range of motion, grip strength, key pinch, quick-DASH, pain, and satisfaction. Radiographs were evaluated for implant position, signs of dorsal intercalated segment instability (DISI), capitolunate (CL) angle, scapholunate (SL) distance, and presence of osteophytes.

RESULTS

Twenty-six patients (29 implants) were included. Seven implants were revised during the follow up, mainly due to pain: three implants were removed, four patients received a new STPI of a different size, leaving 22 implants in 20 patients available for follow up, 9 males and 11 females. Median age was 61.7 years (51-78 years). Median follow-up time was 68 months (37-105 months). Comparing preoperative status to the last follow-up, wrist extension and deviation, thumb abduction, and grip strength did not change. Key Pinch, quick DASH, pain, and patient satisfaction improved significantly at last follow-up. Radiographic signs of DISI were seen in six cases preoperatively and in 12 cases at last follow-up.

CONLUSION

At a minimum of three years follow-up, the STPI used for STT-arthritis improve pain, quick-DASH result, and patient satisfaction significantly. ROM and grip strength did not change compared to preoperative values. Radiographic signs of carpal instability were common at the follow-up and the revision rate was high.

Joint capsule innervation does not explain the difference in symptoms between scaphotrapezial and trapeziometacarpal osteoarthritis

OBJECTIVES

Peritrapezial osteoarthritis (OA) includes scaphotrapezial and trapeziometacarpal OA. In clinical practice, scaphotrapezial OA seems better tolerated than trapeziometacarpal OA, with fewer complaints and better tolerance. The difference in pain could be linked to a difference in joint capsule innervation, perhaps with fewer nerve fibers in the scaphotrapezial than the trapeziometacarpal joint.

MATERIALS AND METHODS

We performed a histologic evaluation of these two joints to compare their respective innervation in 17 cadaveric specimens with peritrapezial OA. Radiographic scoring confirmed the presence of peritrapezial OA. Mean Kellgren-Lawrence score was 2.2 ± 1.1 in the trapeziometacarpal joint and 1.5 ± 0.7 in the scaphotrapezial joint (p = 0.08).

RESULTS

There was no difference between scaphotrapezial and trapeziometacarpal joints in number of neurofilaments: 5.2 ± 3.9 and 4.4 ± 4.5, respectively (p = 0.20). A significant difference was found in S100 staining (myelinated structures), with a higher rate in the scaphotrapezial joint: 11.8 ± 7.5 vs 6.6 ± 5.2 (p = 0.005).

CONCLUSION

The present study suggests that lower tolerance of trapeziometacarpal OA is not due to a difference in joint capsule innervation. On the contrary, we found a higher rate of myelinated tissues in the scaphotrapezial joint. These results suggested other pain pathways to explain clinical observations.

Management of Scaphotrapeziotrapezoid Osteoarthritis: A Critical Analysis Review

» The scaphotrapeziotrapezoid (STT) joint is a common location of degenerative osteoarthritis (OA) in the wrist.» STT OA may occur in isolation or with concomitant thumb carpometacarpal joint (CMCJ) OA or scapholunate advanced collapse (SLAC) and other wrist OA patterns.» Nonoperative management strategies include activity modification, bracing, anti-inflammatory medications, occupational therapy, and injections.» Surgical treatment may be determined by whether the STT OA occurs in isolation or with concomitant thumb CMCJ or SLAC OA and includes STT arthrodesis, distal scaphoid excision with or without interposition or implant arthroplasty, trapeziectomy with proximal trapezoid excision, four-corner fusion in combination with scaphoid/radial column excision, and proximal row carpectomy.

Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term

BACKGROUND

Symptomatic osteoarthritis of the basal joint of the thumb (trapeziometacarpal joint) is a common disabling condition mainly affecting women. It is frequently treated with complete removal of the trapezium with or without soft-tissue interposition. There is limited evidence about whether removal of the trapezium affects stability of the wrist joint and increases the risk of developing wrist osteoarthritis. The aim of this study was to evaluate the long-term prevalence of OA in wrists with previous trapeziectomy compared to wrists with intact trapezium.

METHODS

Patients treated with surgery for trapeziometacarpal osteoarthritis at one orthopedic department were invited 10-29 (mean 17) years postoperatively for bilateral radiographic examination. We included radiographs from 114 hands with trapeziectomy and 46 hands with intact trapezium; 38 patients had unilateral trapeziectomy and intact contralateral trapezium. The radiographs were blinded so that the intact trapezium or the trapezial space after trapeziectomy was not visible. The radiographs were then evaluated for radiocarpal/midcarpal osteoarthritis independently by two assessors using three different osteoarthritis grading systems, including the Kellgren-Lawrence classification. The patients rated their satisfaction with the function of each of their hands on a visual analog scale (VAS) from 0 to 100 (higher score better).

RESULTS

The prevalence of osteoarthritis ranged from 20 to 26%, mostly mild (Kellgren-Lawrence grade 1). The prevalence of osteoarthritis did not differ between wrists with previous trapeziectomy and those with intact trapezium, both in the whole cohort and in the subgroup of patients with unilateral trapeziectomy and intact contralateral trapezium. There was no significant difference in hand function VAS scores between hands with previous trapeziectomy and hands with intact trapezium in the whole cohort or in the subgroup.

CONCLUSIONS

Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term.

Results of treatment of osteoarthritis of the scaphotrapeziotrapezoidal joint with tendon allograft interposition

The aim of the study was to determine if the use of tendon allografts in combination with distal scaphoid resection for the treatment of isolated STT arthrosis is a save procedure. We reviewed the postoperative complications, re-operations, clinical and radiological results of this treatment modality. A retrospective cohort study was conducted. Investigated parameters include wrist mobility (wrist extension and -flexion), strength (grip- and pinch strength), patient-reported outcome scores : Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand score (Q-DASH) and Patient Rated Wrist/Hand Evaluation score (PRWHE) and radiographic measurements : scapholunate (SL) angle, radiolunate (RL) angle and capitolunate (CL) angle. Ten wrists were included in nine patients. No revision surgery was performed. Two patients had transient neuropraxia of the radial nerve. Postoperative flexion-extension arc was 112°. Grip-strength was significantly increased after surgery (20 to 28kg). The average VAS score the past week was 1.75 (range 0-6.7), the average maximum VAS score was 3.0 (range 0-10). The mean PRWHE score was 16.6 (range 0- 69). The mean Q-DASH score was 17.95 (range 0-51). The current study indicates that distal scaphoid resection for isolated STT arthritis is a save procedure with minimal complications. It significantly improves grip strength. Mobility of the wrist was similar to contralateral wrist after surgery. Pain postoperatively was very limited (low VAS scores) and good functional scores (Q-DASH and PRWHE) were noted. Our findings support the prior findings that excisional arthroplasty might worsen carpal instability.

Techniques for Injection of the Scaphotrapezium-Trapezoid Joint Without Image Guidance

Purpose

Scaphotrapezium-trapezoid (STT) joint arthritis is one of the most common forms of wrist arthritis. Conservative management often involves corticosteroid injection. Despite this, there is a scarcity of literature on palpation-guided injection techniques for the STT joint. We aimed to determine a standardized palpation-guided injection method that is easily reproducible and poses minimal risk to local anatomic structures.

Methods

Six fresh-frozen cadaveric upper extremity specimens were tested. Access to the STT joint was attempted with dorsal, volar, and radial approaches. Fluoroscopy was used to confirm accurate placement within the joint. Needle placement was documented in relation to the surrounding soft tissue and bony landmarks were measured with a ruler, and the angle of the needle entry was recorded using a goniometer. The cadavers were carefully dissected to identify the surrounding neurovascular structures at risk of injury.

Results

To access the STT joint with the dorsal approach, the needle was angled at 90º and inserted one-third of the distance from the prominence of the base of the second metacarpal to Lister tubercle. No neurovascular structures were found in the immediate vicinity of the needle. For the volar approach, the needle was angled at 65º and inserted at the distal wrist crease, 1 cm ulnar to the radial border of the wrist, in line with the second metacarpal. The volar branch of the radial artery was at risk with this approach. For the radial approach, the needle was angled at 60º and inserted immediately dorsal to the extensor pollicis brevis tendon, midway between the radial styloid and the prominence of the thumb metacarpal base. The dorsal branch of the radial artery was at risk with this approach.

Conclusions

In a clinical setting where fluoroscopy or ultrasound is not readily available, the dorsal approach may allow for safe and accurate placement of the injectate into the STT joint.

Type of study/level of evidence

Therapeutic IV.

Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (<2 mm scaphoid metacarpal joint space) or less severe (≥2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS >2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg, p = 0.008) and grip strength (15 vs. 21 kg p = 0.002). We conclude that proximal migration most likely does not cause residual or recurrent pain after trapeziectomy.

Scaphotrapeziotrapezoid osteoarthritis: From the joint to the patient

Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid-metacarpal impingement) are the two crucial elements of surgical treatment.

Recent advances in the surgical treatment of malunions in hand and forearm using three-dimensional planning and patient-specific instruments

Malunions of the forearm and hand cause significant disability. Moreover, intraarticular deformities may contribute to early onset osteoarthritis. Such conditions require precise surgical correction in order to improve functional outcomes and prevent early or late complications. The purpose of this study was to describe the technical advantages of accurate anatomical reconstruction using 3D guided osteotomies and patient specific instruments (PSI) in multiple joints of the hand and forearm. Acquisition of three-dimensional (3D) datasets and surgical implementation of PSI was performed in a series of patients between December 2014 and July 2017. Patients had intra- or extra-articular malunions of the forearm, radiocarpal joint, trapeziometacarpal joint, or proximal interphalangeal joint. A previously described 3D surface model that incorporates CT data was used for segmentation (Mimics®, Materialise™, Belgium). For all the cases, CT scans of both forearms were acquired to use the contralateral uninjured side as the anatomic reconstruction template. Computer-assisted assessment of the deformity, the preoperative plan, and the design of PSI are described. Outcomes were determined by evaluating step-off correction, fusion, changes in range of motion (ROM) and grip strength. Six patients were included in the study; all achieved fusion. Improved clinical outcomes including pain reduction, better ROM and grip strength were obtained. Complete correction of intraarticular step-off was achieved in all cases with intraarticular malunions. 3D guided osteotomies are an established surgical treatment option for malunions of the hand and forearm. 3D analysis is a helpful diagnostic tool that provides detailed information about the underlying deformity. PSI can be developed and used for surgical correction with maximal accuracy for both intraarticular step-off and angular deformity.

Surgical Management of Scaphotrapeziotrapezoid Arthritis

Scaphotrapeziotrapezoid (STT) arthritis occurs commonly with basal joint arthritis, but can also occur in isolation or in conjunction with other patterns of wrist arthritis, such as scapholunate advanced collapse. Surgical options depend on the specific clinical scenario encountered. Isolated STT arthritis was classically managed with arthrodesis, but is now often addressed with distal scaphoid resection (open or arthroscopic), trapeziectomy (partial or complete) and partial trapezoid resection, or implant arthroplasty. Development of postoperative dorsal intercalary segment instability is a notable concern with any of these techniques. STT arthritis in conjunction with basal joint arthritis can be managed effectively with trapeziectomy and either partial trapezoid excision or distal scaphoid excision. STT arthritis with scapholunate advanced collapse is uncommon, but can be managed with proximal row carpectomy or scaphoidectomy and four-corner fusion. If basal joint arthritis is also present, trapeziectomy can additionally be performed, but grip strength is likely to be substantially diminished.

A New Technique for Radiographic Visualization of the Scaphotrapeziotrapezoid Joint

Standard radiographs of the wrist do not provide adequate visualization of the scaphotrapeziotrapezoid joint. A radiographic technique that provides an improved and more complete visualization of the joint compared with routine views is described. [Orthopedics. 2020; 43(2):e123-e124.].

Review article: the differential diagnosis of bone marrow edema on wrist MRI

There is a large variety of conditions that can result in 'bone marrow edema' or 'bone marrow lesions' (BML) in the wrist on magnetic resonance imaging (MRI). The combination of clinical history and the distribution of the BML can serve as a valuable clue to a specific diagnosis. This article illustrates the different patterns of BML in the wrist to serve as a useful guide when reviewing wrist MRI studies. Imaging artefacts will also be briefly covered.

Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis

Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.

Scaphoid Motion of the Wrist with Scapho-trapezio-trapezoidal Osteoarthritis-A Pilot Study

BACKGROUND

The purpose of this study was to investigate scaphoid motion within the scapho-trapezio-trapezoidal (STT) joint during wrist motion in the presence of STT joint osteoarthritis (OA).

METHODS

We studied 11 wrists with STT OA and 5 normal wrists. Computed tomography (CT) images were acquired in five wrist positions (maximum active flexion, extension, radial deviation, ulnar deviation, and neutral position). The 3-dimensional surface models of the radius and scaphoid were constructed and the motion of scaphoid relative to the radius was calculated.

RESULTS AND CONCLUSIONS

During wrist flexion/extension motion, the scaphoid rotated mostly in the flexion/extension plane. The angle tended to be smaller in STT OA than in normal. During wrist radioulnar deviation, the scaphoid was in an extended position in neutral wrist in STT OA. The motion of scaphoid in STT OA was divided into two types: a rigid type and mobile type. The mobile type rotated closer to the flexion/extension plane than the rigid type. Taking into account scaphoid motion during wrist movement before surgery may provide better results in the treatment of STT OA.

Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

OBJECTIVE

To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.

DESIGN

Prospective cohort study with propensity score matching.

SETTING

Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands.

PARTICIPANTS

A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes.

INTERVENTIONS

Exercises and orthotics versus orthotics alone.

MAIN OUTCOME MEASURES

Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100).

RESULTS

A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).

CONCLUSIONS

Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.

Obtaining a Reliable Scaphotrapeziotrapezoid Radiograph: Pronation, Ulnar Deviation, and Thumb Abduction

A simple, reproducible technique for assessing the scaphotrapeziotrapezoid joint radiographically is described. In addition to its diagnostic value, the technique is simple to perform with a minifluoroscopy unit, allowing for image-guided injections of the scaphotrapeziotrapezoid joint.

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage

OBJECTIVE

The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage.

MATERIAL AND METHOD

An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed.

RESULTS

The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment.

CONCLUSION

Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results.

Midcarpal and Scaphotrapeziotrapezoid Arthritis in Patients with Carpometacarpal Arthritis

BACKGROUND

Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis.

METHODS

Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis.

RESULTS

Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent.

CONCLUSIONS

The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.

Radiographic prevalence of scaphotrapeziotrapezoid osteoarthrosis

PURPOSE

To define the radiographic prevalence of scaphotrapeziotrapezoid (STT) osteoarthrosis (OA) in a cohort of patients presenting to a hand surgeon for any complaint. The secondary purpose was to evaluate coexisting thumb carpometacarpal (CMC) joint OA.

METHODS

Seven hundred radiographs were evaluated for presence and degree of STT and thumb CMC arthritic changes in consecutive patients presenting to a hand clinic for any chief complaint over the study period.

RESULTS

OA was noted at the STT joint in 111 of the 700 (16%) radiographs reviewed. Increased age, female sex, presence of a scapholunate (SL) ligament gap greater than 3 mm, and presence of radiographic thumb CMC joint OA were all significantly correlated with presence of STT joint OA. However, logistical regression analysis demonstrated that only increasing age, presence of an SL ligament gap greater than 3 mm, and presence of thumb CMC joint OA were strong predictors of STT joint OA.

CONCLUSIONS

STT joint OA is a common finding on hand radiographs of patients presenting to a hand clinic. Its prevalence increases with age, the presence of an SL ligament gap greater than 3 mm, and with the presence of CMC joint OA.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

18F-FDG PET of the hands with a dedicated high-resolution PEM system (arthro-PET): correlation with PET/CT, radiography and clinical parameters

PURPOSE

The aim of this study was to prospectively determine the feasibility and compare the novel use of a positron emission mammography (PEM) scanner with standard PET/CT for evaluating hand osteoarthritis (OA) with (18)F-FDG.

METHODS

Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study in which 14 adults referred for oncological (18)F-FDG PET/CT underwent dedicated hand PET/CT followed by arthro-PET using the PEM device. Hand radiographs were obtained and scored for the presence and severity of OA. Summed qualitative and quantitative joint glycolytic scores for each modality were compared with the findings on plain radiography and clinical features.

RESULTS

Eight patients with clinical and/or radiographic evidence of OA comprised the OA group (mean age 73 ± 7.7 years). Six patients served as the control group (53.7 ± 9.3 years). Arthro-PET quantitative and qualitative joint glycolytic scores were highly correlated with PET/CT findings in the OA patients (r = 0.86. p = 0.007; r = 0.94, p = 0.001). Qualitative arthro-PET and PET/CT joint scores were significantly higher in the OA patients than in controls (38.7 ± 6.6 vs. 32.2 ± 0.4, p = 0.02; 37.5 ± 5.4 vs. 32.2 ± 0.4, p = 0.03, respectively). Quantitative arthro-PET and PET/CT maximum SUV-lean joint scores were higher in the OA patients, although they did not reach statistical significance (20.8 ± 4.2 vs. 18 ± 1.8, p = 0.13; 22.8 ± 5.38 vs. 20.1 ± 1.54, p = 0.21). By definition, OA patients had higher radiographic joint scores than controls (30.9 ± 31.3 vs. 0, p = 0.03).

CONCLUSION

Hand imaging using a small field of view PEM system (arthro-PET) with FDG is feasible, performing comparably to PET/CT in assessing metabolic joint activity. Arthro-PET and PET/CT showed higher joint FDG uptake in OA. Further exploration of arthro-PET in arthritis management is warranted.

Isolated lunocapitate osteoarthritis-an alternative pattern of osteoarthritis

Introduction Osteoarthritis (OA) in the wrist usually develops in a pattern described as scapholunate advanced collapse (SLAC). We observed an alternative pattern of OA that involves the lunocapitate joint in isolation with minimal involvement of the radioscaphoid articulation. Case Series The series was observed from a series of 100 wrist radiographs that were retrospectively reviewed. In order to characterize the alternative pattern of OA, we compared demographic data, presentation, and physical and radiographic examination characteristics between the patients with lunocapitate OA and SLAC wrists. Fifteen radiographs showed OA, nine had a SLAC pattern, and six had lunocapitate OA. The demographics were similar, but the clinical presentation was different. The patients with lunocapitate OA had less tenderness over the snuffbox (P < 0.03), and a lower percentage of a positive scaphoid shift test (P <  0.005). Isolated lunocapitate OA had a higher association with scaphotrapeziotrapezoidal (STT) arthritis (P < 0.004). The SLAC group had an increased scapholunate gap (P = 0.0003). Discussion  The presentation of lunocapitate OA differs from SLAC wrist in a number of ways. Further study is necessary to understand the clinical implications of this pattern. Level IV evidence Case series.

Distribution of primary osteoarthritis in the ulnar aspect of the wrist and the factors that are correlated with ulnar wrist osteoarthritis: a cross-sectional study

OBJECTIVE

The purpose of this cross-sectional study was to identify the distribution of primary osteoarthritis (OA) in the ulnar aspect of the wrist, and analyze the factors correlated with OA at this site.

MATERIALS AND METHODS

A total of 1,128 cases of skeletally mature Japanese patients were collected over a 3-year period. We analyzed the posteroanterior and lateral wrist radiographs of these patients for the presence of primary OA in the ulnar aspect of the wrist, including the distal radioulnar (DRUJ), radiolunate, ulnolunate, lunotriquetral, triquetrohamate, lunohamate, and lunocapitate joints. All joints were examined for the frequency of primary OA. Multivariate logistic regression was used to investigate the factors correlated with the presence of degenerative arthritis in the ulnar aspect of the wrist joint.

RESULTS

Primary OA of the ulnar wrist was identified in 145 out of 1,128 cases (12.8 %). Degenerative changes were most frequently identified in the DRUJ (12.3 %), followed by the ulnolunate joint (8.1 %). Variations in radial inclination (RI), carpal height ratio (CHR), and ulnar variance (UV) correlated with OA of the ulnar aspect of the wrist, with variations in UV showing the highest correlation.

CONCLUSION

Primary OA of the ulnar wrist was most frequent in the DRUJ and second most frequent in the ulnolunate joint. UV correlated most with OA in the ulnar aspect of the wrist.