Wrist Pain In Patients Research Articles

Lunate Shift Index (LSI): A New Parameter for the Evaluation of Residual Ulnar Side Wrist Pain in Patients with Wrist Osteoarthritis Undergoing Three-Corners Arthrodesis vs. Four-Corners Arthrodesis-A Retrospective Comparative Study with Minimum 2Years of Follow-up.

Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II-III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint. Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius. A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain.No statistically significant differences were observed between 3 and 4CF in all parameters compared. The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome. Level III, Retrospective comparative study.

Lunate Shift Index (LSI): A new parameter for the evaluation of residual ulnar side wrist pain in patients with wrist osteoarthritis undergoing three-corners arthrodesis vs four-corners arthrodesis. A retrospective comparative study with 2 years follow up

Lunate Shift Index (LSI): A new parameter for the evaluation of residual ulnar side wrist pain in patients with wrist osteoarthritis undergoing three-corners arthrodesis vs four-corners arthrodesis. A retrospective comparative study with 2 years follow up

Clinical significance of quantitative bone SPECT/CT in the evaluation of hand and wrist pain in patients with rheumatic disease

We investigated the diagnostic value of the maximum standardized uptake value (SUV) at hand and wrist joints for differentiating rheumatic diseases via bone single-photon emission computed tomography (SPECT)/computed tomography (CT). A total of 84 patients manifesting hand and wrist pain (58 women; age, 49.8 ± 15.4 years) were finally diagnosed with rheumatoid arthritis (RA, n = 42), osteoarthritis (OA, n = 16), fibromyalgia (FM, n = 2), and other rheumatic diseases (n = 24). The SUV of each patient was measured in 32 joints including the distal interphalangeal (DIP), proximal interphalangeal (PIP), metacarpophalangeal (MCP), and wrist joints bilaterally. Differences in pain and SUVs between specific rheumatic diseases were assessed using the chi-squared test or one-way analysis of variance. Using the highest SUV (hSUV) in each patient, the diagnostic performance in differentiating specific diseases was evaluated by receiver operating characteristic (ROC) curve analysis. Pain symptoms were present in 886 (33.0%) sites in a total of 2688 joints. In four joint groups (DIP, PIP, MCP, and wrist), the SUVs of joints with pain were significantly higher than those of pain-free joints (all P < 0.001). Active joint sites with higher SUVs than the median value of each joint group were the most common in RA (55.1%). RA showed the greatest hSUV in the PIP (3.0 ± 2.4), MCP (3.5 ± 3.4), and wrist (3.3 ± 1.9) joint groups. FM was characterized by the lowest hSUV of all joint groups. In ROC curve analysis, the cumulative hSUV of the PIP, MCP, and wrist joint groups showed good performance for evaluating RA (area under the curve (AUC), 0.668; P = 0.005). The summation of the hSUVs at all joint groups had an excellent predictive performance for FM (AUC, 0.878; P < 0.001). Consequently, the arthritic activity of the hand and wrist joints based on SUV differed according to specific rheumatic diseases. Quantitative SPECT/CT may provide objective information related to arthritic activity for differentiating specific rheumatic diseases.

Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors

IntroductionPerilunate injuries are rare entities which can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). The purpose of treatment is anatomic reduction and stable fixation. We aimed to present the radiologic and functional results of surgically treated dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis. MethodsBetween 2007 and 2013, 17 patients were operated for perilunate fracture-dislocations. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated by comparing with contralateral side on plain x-ray images in terms of radiologic evaluation. ResultsMean follow-up was 37,8 (range, 16–84) months. The average age at surgery was 35.1 (range, 18–51) years. Fifteen patients were male and two were female. Functional results were excellent in four (23.5%), good in two (11.8%), satisfactory in five (29.4%) and poor in six (35.3%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 14 wrists (82.4%). Scapholunate dissociation more than 2 mm was detected in three wrists. In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results. ConclusionDespite anatomic reduction, ligamentous and chondral injuries that occured at the time of trauma may cause persistant wrist pain in patients who suffer perilunate fracture dislocation. Mechanism of injury, presence of soft tissue defects and the time between injury and treatment can affect clinical and radiologic results.

Prophylactic corticosteroid injection in ulnar wrist pain in distal radius fracture.

Background:Ulnar sided wrist pain is one of the most common complications of distal radius fractures. The simplest method for decreasing pain for this affliction is corticosteroid injection. The present study was designed to assess the effect of corticosteroid injection in the prevention of ulnar sided wrist pain.Materials and Methods:In this clinical trial patients with distal radius fractures scheduled for closed reduction and percutaneous pin fixation were divided into control and corticosteroid groups. In the corticosteroid group, the patient received a single betamethasone injection in the dorsoulnar side of the wrist before reduction, while the control group received placebo. The patients were to be followed for at least 6 months.Results:82 patients were followed for 6 months. At the end of the 3 months followup the difference between the two groups about the number of individuals without ulnar sided wrist pain was statistically significant (P = 0.038), so that less patients in the control group were painless, while this was not the case in the 6 months followup (P = 0.507), but in the both time frames the mean grip power, visual analog pain score and the disabilities of the arm, shoulder and hand (DASH) score showed statistically significant difference between the two groups, so that the corticosteroid groups demonstrated greater power grip and less scores in pain and DASH (P < 0.05).Conclusion:Based on the findings of the present study it seems that prophylactic corticosteroid injection will be associated with a decrease in the severity of wrist pain in patients with acute distal radius fractures. With regard to the decrease in the number of painless individuals, it seems that the decrease is not persistent. Overall the need for a study with longer followup is obvious.

The Results of Scaphoid Avascular Necrosis Can Be More Than Just Wrist Pain in Patients with Spinal Cord Injury

The Results of Scaphoid Avascular Necrosis Can Be More Than Just Wrist Pain in Patients with Spinal Cord Injury

The Effect of Prophylactic Corticosteroid Injection in Decreasing the Ulnar Sided Wrist Pain in Patients with Acute Distal Radius Fracture

The Effect of Prophylactic Corticosteroid Injection in Decreasing the Ulnar Sided Wrist Pain in Patients with Acute Distal Radius Fracture

Short-term effects of self-mobilization with a strap on pain and range of motion of the wrist joint in patients with dorsal wrist pain when weight bearing through the hand: A case series

Dorsal wrist pain frequently occurs in weight bearing through the hand in patients with distal radius stress injuries, scaphoid impaction syndrome, and dorsal impingement. To improve the wrist extension motion, joint mobilization has been used. However, there is no report on the effects of mobilization on the range of motion (ROM) and pain onset in patients with dorsal wrist pain when weight bearing through the hand.This study determined the effects of self-mobilization with a strap (SMWS) while weight bearing through the hand on the ROM and force generated at the onset of pain (FGOP) and intensity in the wrist joints of patients with dorsal wrist pain.Fifteen patients (six men, nine women) with dorsal wrist pain during weight bearing through the hand were recruited from a workplace-based work-conditioning center. SMWS was applied during five visits for a 1-week period. Both passive and active wrist extension ROM, FGOP, and pain intensity (PI) while pushing down through the hand were measured before and after SMWS.Passive and active ROM of wrist extension and FGOP increased significantly after the five sessions over 1 week of SMWS (p < 0.05). PI decreased significantly after the five sessions of SMWS (p < 0.05).These results suggest that SMWS can be used to increase wrist extension ROM and decrease wrist pain in patients with dorsal wrist pain during weight bearing through the hand.

THU0482-HPR Comparison of agreement and responsiveness to treatment effects of 100 mm visual analog scale and 11 point numerical rating scale to assess wrist pain in patients with rheumatoid arthritis

BackgroundVisual analog scales (VAS) and Numerical Rating Scales (NRS) are commonly used to measure pain in rheumatoid arthritis.ObjectivesTo examine agreement between measurement of wrist pain by 100mm VAS and 11-point...

Clinical Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on Wrist Pain in Patients with Rheumatoid Arthritis

Clinical Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on Wrist Pain in Patients with Rheumatoid Arthritis

Arthoscopic diagnosis of partial scapholunate ligament tears as a cause of radial sided wrist pain in patients with inconclusive x-ray and mri findings

To clarify the pathology of radial-sided wrist pain with inconclusive X-ray and MRI findings, we performed arthroscopic examinations of 11 wrists in 10 patients. Physical examination and various image investigations could not identify the cause of the pain. Arthroscopy revealed partial to complete tears of the scapho-lunate interosseous ligament and synovitis and/or chondral bone defects at the scaphotrapezio-trapezoidal joint in all 11 wrists. Surgical procedures consisted of eight simple synovectomies, two ligament reconstructions and one percutaneous pinning. Pain relief was achieved in 10 wrists. One wrist which had a simple synovectomy did not recover, so underwent secondary scaphotrapezio-trapezoidal fusion. In conclusion, we found that various degrees of scapholunate interosseous ligament tear and scaphotrapezio-trapezoidal joint osteoarthritis were the main causes of radial-sided wrist pain with inconclusive X-ray and simple MRI findings.

Surgical treatment of scapholunate advanced collapse

This study reports the outcomes of six different reconstructive procedures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. Scaphoid excision and intercarpal arthrodesis was performed in 31 cases: four-corner arthrodesis in 23 cases and capitolunate arthrodesis in 8 cases. Proximal row carpectomy was performed in 12 cases, radioscapholunate arthrodesis in 5 cases, radioscaphoid arthrodesis in 3 cases, and primary total wrist arthrodesis in 4 cases. Following surgical treatment the majority of patients in all groups had less wrist pain. The nonunion rate was four cases for the capitolunate arthrodesis group compared with two for the four-corner arthrodesis group. Six of 51 motion-sparing cases were converted to total arthrodeses. Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with state III SLAC wrist while maintaining a 54° flexion-extension arc. Stage II SLAC wrist can be successfully treated with this procedure, radioscaphoid arthrodesis, or proximal row carpectomy. Of the three procedures, proximal row carpectomy best preserves wrist mobility, with a flexion-extension arc of 71°.