Osteoarthritis and rheumatoid arthritis of the carpus

Arthritis can be idiopathic or caused by inflammatory disease (for instance rheumatoid arthritis), posttraumatic, congenital, or as a resultant of avascular necrosis of one of the carpal bones. The common factor in all these causes is that the normal biomechanics are disturbed, either by disturbance of the joint surface or by instability of the ligaments. Prevention of further deterioration in the early stages is aimed at restoring the normal biomechanics; correction malunion, restoring ligaments, improving vascularity. If the patient is seen at a later stage or early treatment has failed salvage procedures can be an option, but they sacrifice or replace part of the joints.
In part 1 is described how according to literature, rheumatoid arthritis leads to instability which results in a destruction of the wrist, how it is diagnosed and what the treatment options are(chapter 2). Further it is demonstrated that the DASH can be used in rheumatoid arthritis (chapter 3) and that the radio-scapholunate arthrodesis is a good option in rheumatoid arthritis of the wrist (chapter 4 and 5).
In part 2 the outcome is described of the radial shortening osteotomy for Kienböck’s disease, which is also a cause of joint degeneration through osteonecrosis of the lunate (chapter 6). Osteoarthritis of the trapeziometacarpal joint which is most often idiopathic can be treated with simple resection as shown in Chapter 7. The short term outcome as well as the pitfalls when using the Nugrip CMC implant as an alternative to simple resection are described in Chapter 8.