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Scaphotrapeziotrapezoidal Joint Arthritis

From WikiSM

Other Names

  • Scaphotrapezio-trapezoid joint arthritis
  • Triscaphe Joint Arthritis
  • Scaphotrapeziotrapezoidal Joint Arthritis
  • STT Arthritis
  • Scaphotrapeziotrapezoid osteoarthritis
  • STT OA

Background

History

  • The first case description is attributed to Carstam in 1968[1]

Epidemiology

  • It is the second or third most common site of osteoarthritis of the wrist[2]
  • Occurs on 9% of radiographs[3]
  • Incidence estimated to be approximately 11%[4]
  • Occurs more frequently in women than men by a ratio of 4:1 and is more common after 50 years of age[5]
  • In a cadaveric study of 73 wrists with an average age of 84, STT was present 83% of the time[6]

Introduction

Illustration of the Scaphotrapeziotrapezoidal Joint[7]
Scaphotrapeziotrapezoidal Joint Arthritis[8]

General

  • STT Arthritis is typically a degenerative condition
  • It presents with radial sided wrist pain or base of thumb wrist pain
  • Typically in patients over the age of 50, especially women
  • Frequently occurs with other thumb, hand and wrist disease

Pathophysiology

  • Incompletely understood
  • Typically considered degenerative, i.e. osteoarthritis
  • Trauma has been proposed as a cause[9]
    • Periscaphoid ligament lesions modify the pressure at the distal pole of scaphoid
    • This is followed by arthritic decompensation of the STT joint
  • Multidirectional instability is thought to be a likely cause

Anatomy of the Scaphotrapeziotrapezoidal Joint

Associated Conditions

Risk Factors

  • Age > 40 years
  • Female gender
  • Gentics
  • History of trauma

Differential Diagnosis

Differential Diagnosis Wrist Pain

Clinical Features

History

  • Onset is often insidious without any preceding trauma
  • Pain is radial sided or at the base of thumb
  • Increases progressively at the base of the thumb
  • Loss of grip strength, thumb function
  • Pain/ trouble unscrewing a cap or opening a jar
  • Worse with racket sports or golf
  • Compared to CMC joint OA
    • Pain is more proximal
    • Pain is sharper

Physical Exam: Physical Exam Wrist

  • Anatomic Landmarks
    • Wrist’s distal flexion crease in front
    • Bottom of the anatomical snuffbox laterally
    • Between the 2nd and 3rd extensor compartments in back
  • Pain is volar, reproduced during wrist extension
  • The STT joint line is tender
  • Pain is provoked with radial deviation
  • Pain over volar scaphoid tubercle

Special Tests

Evaluation

Advanced periarticular sclerosis and narrowing of the scaphotrapeziotrapezoid joint. [14]
STT Joint arthritis. The STT joint is analyzed on a radiograph where the wrist is extended and in ulnar deviation, the hand flat on the plate and the x-ray beam coming from the back (top left). These views are used to classify the extent of osteoarthritis; when supplemented with standard AP view (top middle) and lateral view (top right) of the wrist or specific views (Kapandji, Eaton), they make it possible to detect the presence of basal joint arthritis and of DISI; CT scan may be needed to better analyze the bone volumes and their destruction (below)[15]

Radiographs

  • Diagnosis can be made on Standard Radiographs Wrist
  • STT View as described by Wollstein[16]
    • Performed with the patient standing,
    • Wrist in maximal extension and ulnar deviation with the hand an inch above the x-ray

CT

  • Indications
    • Better analyze the bone volumes in case of significant wear
    • Superimposition that prevents one from getting a clear view of the joint spaces

Classification

Crosby Classification System[17]

  • Stage 0
    • Normal radiograph, Normal joint (?)
  • Stage 1
    • Signs of osteoarthritis (sclerosis) with “slight” narrowing of the joint space < 50%
  • Stage 2
    • “Marked” joint space narrowing, “very reduced” > 50%, but still visible
    • Osteophytes < 2 mm
  • Stage 3
    • Nearly complete narrowing (ankylosis), erosion, sclerosis and subchondral cysts, articular irregularities
    • Osteophytes > 2 mm

Goubier Classification System[18]

  • Stage 0: (same as Crosby)
  • Stage 1: (same as Crosby)
  • Stage 2: 2A without carpal misalignment
  • Stage 3: 2B with carpal misalignment

White Classification System[19]

  • Stage 1: Narrowing of joint space compared to other joints in the carpus on the same radiograph, with or without subchondral sclerosis
  • Stage 2: Subchondral cyst with or without osteophytes
  • Stage 3: No visible joint space

Management

Nonoperative

Operative

  • Indications
    • Failure of conservative treatment
  • Technique
    • Scaphotrapeziotrapezoid arthrodesis
    • Trapeziectomy
    • Soft tissue interposition
    • Implant replacement
    • Resection of distal pole of scaphoid
    • STT arthroplasty with a prosthesis

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Prognosis and Complications

Prognosis

  • Needs to be updated

Complications

  • Decreased grip strength
  • Persistent Pain
  • Decreased range of motion at the thumb and wrist

Complications of Operative Treatment

  • Flexor Tendon Rupture
  • Dorsal Intercalated Segment Instability and Midcarpal Misalignment
  • Nonunion
  • Radial Styloid Impingement
  • Adjacent Joint Arthrosis and Degeneration
  • Reflex Sympathetic Dystrophy

See Also

Internal

External

References

  1. ↑ Carstam, N., O. Eiken, and L. Andren. "Osteoarthritis of the trapezio-scaphoid joint." Acta Orthopaedica Scandinavica 39.1-3 (1968): 354-358.
  2. ↑ Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9(3):358–365.
  3. ↑ Berkhout M, Yin Q, Ritt M. Current Trends in Operative Treatment of Scaphotrapeziotrapezoid Osteoarthritis: A Survey Among European Hand Surgeons. J Wrist Surg. 2020;9(2):94-9. doi:10.1055/s-0039-3402796 - Pubmed
  4. ↑ Crosby EB, Linscheid RL, Dobyns JK. Scaphotrapezial trapezoidal arthrosis. J Hand Surg Am. 1978;3(3):223–234.
  5. ↑ Bathia, A., et al. "Incidence and distribution of scaphotrapezotrapezoidal arthritis in 73 fresh cadavers." Ann Chir Main Memb Super 15 (1996): 220-225.
  6. ↑ Bhatia, A., et al. "Incidence and distribution of scaphotrapezotrapezoidal arthritis in 73 fresh cadaveric wrists." Annales de Chirurgie de la Main et du Membre Superieur. Vol. 15. No. 4. Elsevier Masson, 1996.
  7. ↑ Anakwe, R. E., and S. D. Middleton. "Osteoarthritis at the base of the thumb." BMJ 343 (2011).
  8. ↑ Case courtesy of Roberto Schubert, Radiopaedia.org, rID: 15700
  9. ↑ Wilhelm, K., A. Rolle, and A. Hild. "The scaphoid-trapezium-trapezoid arthrosis. A clinical study 1982-1985." Der Unfallchirurg 92.2 (1989): 59-63.
  10. ↑ White L, Clavijo J, Gilula LA, Wollstein R. Classification system for isolated arthritis of the scaphotrapeziotrapezoidal joint. Scand J Plast Reconstr Surg Hand Surg. 2010;44:112–117.
  11. ↑ Miller A, Lutsky K, Shearin J, Cantlon M, Wolfe S, Beredjiklian P. Radiographic Patterns of Radiocarpal and Midcarpal Arthritis. J Am Acad Orthop Surg Glob Res Rev. 2017;1(3):e017. doi:10.5435/JAAOSGlobal-D-17-00017 - Pubmed
  12. ↑ Saffar, P. H. "L'arthrose de la scapho-trapézo-trapézoïdienne." Enseignement de la chirurgie de la main 11 (1999): 53-64.
  13. ↑ Brown III, Gabriel D., et al. "Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis." The Journal of hand surgery 28.5 (2003): 739-743.
  14. ↑ Case courtesy of Roberto Schubert, Radiopaedia.org, rID: 15700
  15. ↑ Obert, L., et al. "Scaphotrapeziotrapezoid osteoarthritis: From the joint to the patient." Hand Surgery and Rehabilitation 40.3 (2021): 211-223.
  16. ↑ Wollstein, Ronit, et al. "A radiographic view of the scaphotrapezium-trapezoid joint." The Journal of hand surgery 30.6 (2005): 1161-1163.
  17. ↑ Crosby, E. Brown, Ronald L. Linscheid, and James H. Dobyns. "Scaphotrapezial trapezoidal arthrosis." The Journal of Hand Surgery 3.3 (1978): 223-234.
  18. ↑ Goubier, J. N., et al. "Scapho-trapezio-trapezoidal arthrodesis for scapho-trapezio-trapezoidal osteoarthritis." Chirurgie de la Main 25.5 (2006): 179-184.
  19. ↑ White, Laura, et al. "Classification system for isolated arthritis of the scaphotrapeziotrapezoidal joint." Journal of Plastic Surgery and Hand Surgery 44.2 (2010): 112-117.
Created by:
John Kiel on 22 January 2024 17:00:58
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Last edited:
26 March 2025 17:00:43
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