Young patient with carpal instability [Helio Polido Garcia - 2019]
Young Patient with carpal instability
I need your help with a totaly atypical carpal instability in a very young male
I would appreciate very much your attention and opinion
Attached is the case summary
Thank you very much!!
I don´t think this is a posttraumatic wrist disease. It looks like systemic problém, my suspition would be some kind of HLA B 27 positive trouble or parainfection reactive artritis. Reiter??? There are changes in CMC area and after trauma (if not infected) you don´t see changes there. My approach would be firts find out why this happened and then just wait and see ev. denervation or synovectomy??? It will finish with stiff wrist anyway but you have to know why.
It looks like a volar midcarpal instability… But I don’t understand so fast destruction…infection but why ? The situation is critical. The arthroscopic capitate/hamate resection won’t work. I suggest you to perform, only iof he is really painful a partial arthrodesis (hamato, capito,triquetro, luno, scaphoid) with distal scaphoid resection. If you operate on him, don’t forget to make anatomopathological exam
I also think it’s a systemic disease. IN MRI especially n radial side we see a lot of synovitis.
Ask the radiologist again for systemic disease. DO you have any blood samples for /against RA?
If so, he need some medical treatment, but anyway I think he need a midcarpal fusion.
I have seen a few cases with that problem, and it was usually related to juvenile rheumatoid arthritis, which progresses rapidly. I would therefore scope and take a specimen for histopathology and check if the radius/lunate cartilage is still viable and intact.
For me it is an arthritis case, not a trauma. All the joint are involved. Even carpometacarpal one.
Looks to me , more of an erosive arthropathy than a post traumatic osteoarthritis. Hx of trauma might be a red herring.
It is not a post traumatic problem. This young patient needs a complete examination (rheumatologist, ophthalmologist) before any surgery It will probably be useful to perform arthroscopic biopsy with anatomopathology exam and bacteriology
Thank you very much for all opinions. Very helpful. I’ll work on that and keep close to rheumatologist
Hélio Polido Garcia