Intraosseous ganglion
The most common carpal lesion is the intra-osseous ganglion IOG . Also known as a subchon-dral bone cyst, the IOG is a benign, mucin-filled, cystlike lesion that arises within the subchondral medullary bone. IOGs are regularly seen on wrist radiographs obtained to evaluate wrist pain or other problems. In a radiographic study of 280 cadaveric wrists, Schrank and colleagues 1 identified an overall 9.6 incidence of carpal ganglion cysts. In patients who have dorsal wrist ganglions, the prevalence...
Ryan J Grabow MDa Louis Catalano III MDb
aNevada Orthopedic amp Spine Center, 2650 North Tenaya Way, Suite 301, Las Vegas, NV 89128, USA bC.V. Starr Hand Surgery Center, Saint Luke's-Roosevelt Hospital, 1000 Tenth Avenue, New York, NY 10019, USA Carpal dislocations are rare injuries. They most often occur from high-energy trauma such as motor vehicle accidents, falls from a height, or industrial-related accidents. Usually occurring in young males in their twenties or thirties, these injuries may be missed initially because of...
Anthony J Lauder MD Thomas E Trumble MD
Hand and Microvascular Surgery Program, University of Washington Hand Surgery Institute, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, USA Idiopathic avascular necrosis of the bones making up the carpus is a relatively rare, albeit often debilitating, condition that most frequently affects the lunate. In 1910, Robert Kienbock 1 initially described a classic case of lunatomalacia, which he believed was caused...
Mitsuhiko Nanno MD PhDa Rita M Patterson PhDb Steven F Viegas MDb
aDivision of Hand Surgery, Department of Orthopaedic Surgery, Nippon Medical School, Musashikosugi Hospital 1-396, Kosugicho, Nakahara-ku, Kawasaki 211-8533, Japan bDepartment of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0165, USA Although many articles have examined the anatomy and function of the carpal ligaments 1-20 , these remain incompletely understood. Visualization all of the ligaments of the wrist during...
Pauciarticular disease
Approximately 45 of patients who have JIA have arthritis limited to one or only a few joints. Larger joints are typically involved in a nonsymmetric distribution 115 . Pauciarticular disease is associated with ocular involvement, including anterior uveitis and chronic iridocyclitis 115,118 . Because ocular involvement does not usually present until late in the disease process, frequent eye examinations are a critical component of care. Jay and colleagues 115 recommend that children who have...
References Jvl
1 Kienb ck R. ber traumatische Malazie des Mondbeins und ihre Folgezustande Entartungsformen und Kompressionsfrakturen. Fortschr Roetgenstr 1910 16 78-103 in German . 2 Peltier LF. The classic. Concerning traumatic mala-cia of the lunate and its consequences degeneration and compression fractures. Privatdozent Dr. Robert Kienbock. Clin Orthop Relat Res 1980 149 4-8. 3 Wagner JP, Chung KC. A historical report on Robert Kienbock 1871-1953 and Kienbock's Disease. J Hand Surg Am 2005 30 6 1117-21....
Madelungs deformity
Madelung's deformity reflects asymmetric growth of the distal radial physis. As the radial and dorsal portions of the physis continue to grow, several abnormalities manifest. Increased palmar and ulnar tilt of the distal radial articular surface leads to volar translation of the hand and wrist. Although the reduction of growth is most prominent along the ulnar and volar distal radial physis, an overall reduction of growth occurs along the entire physis compared with normal, resulting in a...
Dysplasia epiphysealis hemimelica Trevor disease
Dysplasia epiphysealis hemimelica DEH , or Trevor disease, is a developmental disorder of unknown origin characterized by osteocartilaginous Fig. 6. Radiocarpal dislocation in a patient who has Morquio's wrist. Fig. 6. Radiocarpal dislocation in a patient who has Morquio's wrist. overgrowth of one or more epiphyses. Common sites of presentation include the distal tibia, distal femur, and talus 49-52 . Although upper extremity involvement is rare, several cases of DEH were reported involving the...
Intraarticular tumors
Intra-articular tumors of the wrist should be considered as a possible cause of generalized wrist swelling, pain, and stiffness. Plain radiographs often do not provide many clues to the underlying diagnosis. CT or MRI will show the extent of the disease, but the hand surgeon may still confuse the tumor with an inflammatory process such as rheumatoid arthritis or gout Fig. 8 . The features of the axial images must be reviewed carefully, just as the surgeon would critically examine any abnormal...
Approach to distal radioulnar joint specific
The distal radioulnar joint can be exposed dorsally through a 4 cm longitudinal skin incision made between the fifth and sixth extensor Fig. 15. A Skin incision for volar exposure of the scaphoid angled line is centered around the scaphoid tuberosity circle . B The superficial branch of the radial artery and its venae comitantes will cross the incision and will require division. C The superficial surface of the flexor carpi radialis tendon sheath is incised longitudinally dashed line to allow...
Diagnosis
By definition, patients who have Preiser's disease will not have a significant history of wrist trauma or prior scaphoid fracture or surgery however, patients will frequently relay a history of prior wrist hyperextension or heavy labor. Clinically, the vast majority of patients will present with pain that is insidious and worsening in nature. The pain is often present for months to years before presentation, and it typically localizes to the dorso-radial aspect of the wrist. On examination,...
Diagnosis and staging
Kienbock's disease affects patients of all ages and either gender. There need not be a history of antecedent trauma or previous wrist problems. Symptoms tend to reflect the severity of the disease, ranging from mild discomfort to debilitating pain however, this is not always the case, because some patients who have radiographic evidence of severe arthrosis remain relatively asymptomatic. Swelling and synovitis is commonly found about the lunate, both on the dorsal as well as the volar side....
Summary Whg
Congenital abnormalities of the carpus are rare in isolation and typically present as part of a generalized syndrome. Treatment of carpal disorders within these syndromes continues to require an understanding of the influence the wrist's position on overall upper extremity function. In addition, carpal ossification throughout childhood presents a unique set of influences regarding pediatric carpal injury. Although the pediatric carpus is capable of remodeling and revascularization, cases...
Patricia A Hsu MD Terry R Light MD
Loyola Department of Orthopaedic Surgery and Rehabilitation, 2160 South First Avenue, Maguire, Room 1700, Carpal disorders in children are often associated with developmental abnormalities of structures surrounding the wrist. Conditions that alter the function and position of the arm, forearm, and hand will also ultimately influence carpal development and function. Because the immature carpus is composed of unossified cartilage, carpal abnormalities in young children are frequently undetectable...
The dart throwers motion
Considerable controversy remains and conflicting reports exist regarding carpal bone motion in the traditional planes of FEM and RUD. Although some of the discrepancy may be related to variations in measurement techniques and anatomic variability among human subjects, no clear unifying theory has explained carpal kinematics in the planes of flexion-extension and radioulnar deviation. The vision of carpal kinematics may be obscured by the constraint of carpal motion into arbitrary and orthogonal...
Carpal tarsal osteolysis
Carpal tarsal osteolysis CTO is an uncommon condition characterized by the spontaneous resorption of the carpal bones Fig. 5 . Although the cause of osteolysis is still unknown, the condition has shown both autosomal dominant and recessive inheritance patterns in addition to spontaneous occurrence 43 . Several physical findings may be associated with CTO, including abnormal skull shape, micrognathia, high-arched palate, decreased height, and scoliosis 44 . CTO is also frequently associated with...
Fracture
The scaphoid is the most commonly injured carpal bone in children, followed by the capitate 81 . Combined injury of these carpal bones is a well-documented entity in children and is referred to as scaphocapitate syndrome. The most common mechanism of injury, which is the same for children and adults, is a fall onto an outstretched hand. Because the carpus is unossified through most of childhood, MRI may be needed in addition to plain radiographs to detect injuries of the immature carpus Fig....
Volar carpal exposure carpal tunnel approach
There are essentially two types of volar carpal exposures, one that divides the transverse carpal ligament and one that uses a modified Henry approach. The volar carpal exposure is most commonly used to reduce difficult carpal dislocations perilunar and for repair or reconstruction of the palmar wrist capsule and the palmar carpal ligaments. Volar approaches are also useful for reduction and fixation of palmar fragments of difficult distal radius fractures. The volar approach is often used in...
Accessory carpal bones
Because true accessory carpal bones are uncommon, with an incidence of 0.4 -1.6 17,18 , these small bones are often mistaken for fractures of normal carpal bones 2,19,20 . Accessoria have been given various names eg, os triangulare, os epitriquetrum, os hypotriquetrum, os lunatotri-quetrum, os centrale, os ulnostyloideum to reflect either the shape or presumed phylogenic derivation of the bone 2 . Disorders that have been associated with accessory carpals include Holt-Oram syndrome 21 ,...
Benign bone tumors
Primary bone tumors of the carpus are rare 14 . The two most common lesions, osteoid oste-oma and enchondroma, may be easily misdiag-nosed as IOG. Enchondromas may cause pathologic fractures, especially of the scaphoid, just as they do in the phalanges. The giant cell tumor, although more often originating from the distal radius instead of the carpus, routinely causes carpal destruction. Other benign bone tumors, including osteochondroma, chrondroblas-toma, chondromyxoid fibroma, hemangioma,...
Preisers disease scaphoid ischemic necrosis
Although Preiser 100 has been criticized for including patients who have a history of trauma in his original 1910 publication 101 , scaphoid is-chemic necrosis without trauma is still commonly referred to as Preiser's disease. Although atrau-matic ischemic necrosis of the scaphoid has been associated with systemic lupus erythematosus, systemic sclerosis, steroid ingestion, and cytotoxic chemotherapy 102-105 , several cases have been reported in which no apparent cause could be identified...
Idiopathic Avascular Necrosis of the Scaphoid Preisers Disease475
Anthony J. Lauder and Thomas E. Trumble Preiser's disease, or idiopathic avascular necrosis of the scaphoid, is a rare, albeit often debilitating, condition. Although unknown, the etiology is probably multifactorial, with biomechanical or anatomical variations leading to an ''at risk'' scaphoid. Most commonly the diagnosis is made with the use of plain radiographs, but one should not hesitate to use MRI for both confirming the diagnosis and evaluating the stage of the disease. Current treatment...
Ulnar dimelia
Ulnar dimelia is a very rare congenital abnormality with approximately 60 cases documented worldwide 59 . Also known as ''mirror hand,'' the forearm and hand are essentially symmetrical about the mid-line with duplication of the ulna and ulna rays and an absence of the radius and radial rays. The condition is typically unilateral, although instances of bilateral ulnar dimelia have been documented 60,61 . No specific genetic abnormality has been linked to ulnar dimelia. Spontaneous mutation has...
Clinical implications
The clear and comprehensive derivation of normal carpal kinematics has potentially significant implications in pathologic and postsurgical states. For example, to evaluate the effects of external fixation and traction on carpal kinematics, Ishikawa and colleagues 20 applied a cadaver model that was used previously to study normal wrist kinematics. They found that wrist extension under traction had a greater effect on the proximal radiocarpal ligaments, which limited scaphoid and overall wrist...
A more detailed ligament anatomy
Using 3-D digitization and CT reconstructions with careful dissection, researchers were recently able visualize and quantify the anatomy and specific area and locations of ligament attachments on the individual carpal bones, metacar-pals, and distal radius. Nagao and colleagues 3 and Nanno and colleagues 22,23 took CT images of the hands they researched and then recreated the bone structure in a 3-D image. They also rendered the ligament attachment sites and areas in 3-D. The images of the bone...
Shian Chao Tay MDa b Alexander Y Shin MDa
aDepartment of Orthopaedic Surgery, Division of Hand Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA bDepartment of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608 Nowhere else in the body are the general principles of surgical exposures which include adequate access, extensibility, preservation of vital structures, minimizing collateral tissue trauma to reduce the healing load , maximizing primary wound healing, and cosmesis more...
Volar carpal exposure modified Henry approach
The modified Henry or trans-flexor carpi radialis FCR approach is a popular approach for exposure of the volar surface of the distal radius. Appropriate capsulotomies from the origins of the radiocarpal ligaments could also provide access to the radiocarpal joint, proximal scaphoid, and lunate. A longitudinal incision over the FCR tendon is carried proximally for 3 to 4 cm. Care must be taken not to cross the ulnar border of the FCR tendon, because the palmar cutaneous branch of the median...