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Carpal instability in rheumatoid wrists.

Keiichi Muramatsu1, Koichiro Ihara, Hiroshi Tanaka

  • 1Department of Orthopedic Surgery and Rheumatology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505 Yamaguchi, Japan. muramatu@po.cc.yamaguchi-u.ac.jp

Rheumatology International
|November 18, 2003
PubMed
Summary

Rheumatoid arthritis commonly causes carpal instability in the wrist, with volar intercalated segmental instability and scapholunate dissociation being frequent patterns. This instability results from complex ligament laxity, worsening with disease duration.

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Area of Science:

  • Orthopedics
  • Rheumatology
  • Radiology

Background:

  • Rheumatoid arthritis frequently affects the wrist joint.
  • Carpal instability is a common complication in rheumatoid arthritis patients.
  • Understanding instability patterns is crucial for effective management.

Purpose of the Study:

  • To identify and characterize patterns of carpal instability in rheumatoid wrists.
  • To correlate radiographic findings with disease duration and severity.

Main Methods:

  • 100 patients with rheumatoid arthritis underwent posteroanterior and lateral wrist radiography.
  • Radiographs were analyzed for specific instability patterns like volar intercalated segmental instability and scapholunate dissociation.
  • Larsen grading scores were used to assess disease severity and correlate with radiographic measurements.

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Main Results:

  • Volar intercalated segmental instability was the most common pattern (16 wrists), followed by scapholunate dissociation (9 wrists).
  • Disease duration correlated significantly with carpal height ratio and ulnar translocation index.
  • Early disease showed increased scapholunate angle and volar lunate rotation; later stages presented increased capitolunate angle and dorsal capitate rotation.

Conclusions:

  • Carpal instability in rheumatoid wrists is complex, involving both intrinsic and extrinsic carpal ligament laxity.
  • Instability patterns evolve with disease progression.
  • Radiographic assessment aids in understanding the biomechanics of rheumatoid wrist instability.