Carpal Instability in Advanced Rheumatoid Arthritis

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Journal of the Korean Society for Surgery of the Hand 2001;6(2):129-134.
Published online December 1, 2001.

Kwang-Hyun Lee, Joung-Uck Na, Duck-Su Kim, Yun-Jae Kim

진행된 류마토이드 관절염 환자에서의 수근부 불안정

이광현, 나정욱, 김덕수, 김윤재

Abstract

Purpose
: The article is on radiological analysis of carpal instability patterns and its frequencies observed in advanced rheumatoid arthritis patients. Materials and Methods : Of the advanced rheumatoid patients (64 wrists) who underwent various upper limb surgeries, 51 patients with the radiological results on carpal instability were evaluated. Every patient’s medical records, including average age and ailing period, were reviewed. We also analyzed carpal instability patterns and its frequencies by measuring the angles such as scapholunate, capitolunate, radiolunate and carpal height ratio. Results : Of 51 patients, every patient was woman except one male patient. Average age was 47 (range of 20 to 63), and the average ailing period was 57 months (ranging from 37 months- 97 months). The patients were classified into class I (2), class II (19), class III (21), class IV(22) according to anatomic grading by American Rheumatism Association. More than one pattern of carpal instability were observed in 20 patients and more than two patterns in 5 patients. DISI (dorsal intercalated segmental instability) was found to be the most common and observed in 10 cases. Ulnar translocation was in five cases and VISI (volar intercalated segmental instability) was observed in one case. Combined form of DISI and scapho-lunate dissociation-which is the most common combined form-was shown in 3 cases. We found 12 (63%) cases of carpal instability out of 19 (30%), which had subluxation or dislocation of distal radioulnar joint. Conclusion : The higher incidence of carpal instability were present in patients with longer ailing period of advanced rheumatoid arthritis and with destructive changes of wrist shown in x-rays.

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