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Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review.

Raven EE, van den Bekerom MP, Beumer A, van Dijk CN - Open Orthop J (2015)

Bottom Line: Results.In the search 108 articles were found, of these 12 studies were included for this review.A strong correlation was found between instability, duration of RA and Larsen score.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology of the Gelre Hospitals, Postbus 9014, 7300 DS Apeldoorn, The Netherlands.

ABSTRACT

Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in rheumatoid arthritis RA).

Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in patients with RA are described. All with their own indications and limitations.

Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability dynamic radiographs are needed.

Level of evidence: Level IV.

No MeSH data available.


Related in: MedlinePlus

SCA – scapho capitate angle [26].
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Figure 6: SCA – scapho capitate angle [26].

Mentions: The Simmen classification [19]; this is not a true radiographic classification it is merely a classification of the changing of the X-ray in time. The late stage of wrist destruction in rheumatoid arthritis was classified into three groups. I Ankylosis, II osteoarthritis and III disintegration Larsen scoring system (Table 2 and Fig. 2) [20] is based on the severity of joint space narrowing of the wrist and erosions of the wrist and the ulnar head. Carpal height ratio (CHR: Fig. 3) [21], is calculated by dividing the length of the third metacarpal by the height of the Carpus. Carpal Translation Index (CTI: Fig. 4) [22], is calculated by dividing the ulnar distance (distance from centre of the Capitate tot the centre axis of the Ulna) by the length of the third metacarpal. Radial Rotation Index (RRI: Fig. 5) [23]: The angle is measured between a line which is drawn in the longitudinal axis of the second metacarpal shaft at the radial cortex. A second line is drawn from the tip of the radial styloid at the radial limit of the articular surface to the ulnar limit on the volar side of the distal radius. Scaphocapitate angle (SCA: Fig. 6) [24]; the angle between the lines drawn at the longitudinal axis of the Scaphoid and the longitudinal axis of the Scaphoid on a lateral radiograph of the wrist Scapholunate angle (SLA: Fig. 7) [24], the angle between the lines drawn at the longitudinal axis of the Scaphoid and the longitudinal axis of the Lunate on a lateral radiograph of the wrist Capitolunate angles (CLA: Fig. 8) [24], the angle between the lines drawn at the longitudinal axis of the Capitate and the longitudinal axis of the Lunate on a lateral radiograph of the wrist. Ulnar Carpal translation (UCT: Fig. 9) [25]; this is the distance from the centre of the proximal Capitate to the line bisecting the longitudinal axis of the radius. For compensation of hand size the distance is dived by the length of the third metacarpal. Ulnar translation Index (UTI: Fig. 10) [26] Parameters for measuring collapse and translation of the Carpus. Centre of rotation of the Carpus. L1 length of the 3rd metacarpal, L2 height of the carpus, L3 carpo-stylo-radial distance. L3/L1 index of carpal translation.


Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review.

Raven EE, van den Bekerom MP, Beumer A, van Dijk CN - Open Orthop J (2015)

SCA – scapho capitate angle [26].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591907&req=5

Figure 6: SCA – scapho capitate angle [26].
Mentions: The Simmen classification [19]; this is not a true radiographic classification it is merely a classification of the changing of the X-ray in time. The late stage of wrist destruction in rheumatoid arthritis was classified into three groups. I Ankylosis, II osteoarthritis and III disintegration Larsen scoring system (Table 2 and Fig. 2) [20] is based on the severity of joint space narrowing of the wrist and erosions of the wrist and the ulnar head. Carpal height ratio (CHR: Fig. 3) [21], is calculated by dividing the length of the third metacarpal by the height of the Carpus. Carpal Translation Index (CTI: Fig. 4) [22], is calculated by dividing the ulnar distance (distance from centre of the Capitate tot the centre axis of the Ulna) by the length of the third metacarpal. Radial Rotation Index (RRI: Fig. 5) [23]: The angle is measured between a line which is drawn in the longitudinal axis of the second metacarpal shaft at the radial cortex. A second line is drawn from the tip of the radial styloid at the radial limit of the articular surface to the ulnar limit on the volar side of the distal radius. Scaphocapitate angle (SCA: Fig. 6) [24]; the angle between the lines drawn at the longitudinal axis of the Scaphoid and the longitudinal axis of the Scaphoid on a lateral radiograph of the wrist Scapholunate angle (SLA: Fig. 7) [24], the angle between the lines drawn at the longitudinal axis of the Scaphoid and the longitudinal axis of the Lunate on a lateral radiograph of the wrist Capitolunate angles (CLA: Fig. 8) [24], the angle between the lines drawn at the longitudinal axis of the Capitate and the longitudinal axis of the Lunate on a lateral radiograph of the wrist. Ulnar Carpal translation (UCT: Fig. 9) [25]; this is the distance from the centre of the proximal Capitate to the line bisecting the longitudinal axis of the radius. For compensation of hand size the distance is dived by the length of the third metacarpal. Ulnar translation Index (UTI: Fig. 10) [26] Parameters for measuring collapse and translation of the Carpus. Centre of rotation of the Carpus. L1 length of the 3rd metacarpal, L2 height of the carpus, L3 carpo-stylo-radial distance. L3/L1 index of carpal translation.

Bottom Line: Results.In the search 108 articles were found, of these 12 studies were included for this review.A strong correlation was found between instability, duration of RA and Larsen score.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology of the Gelre Hospitals, Postbus 9014, 7300 DS Apeldoorn, The Netherlands.

ABSTRACT

Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in rheumatoid arthritis RA).

Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in patients with RA are described. All with their own indications and limitations.

Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability dynamic radiographs are needed.

Level of evidence: Level IV.

No MeSH data available.


Related in: MedlinePlus