Orthopedics

Tips & Techniques 

A New Technique for Radiographic Visualization of the Scaphotrapeziotrapezoid Joint

Ashley M. Brown, MD; Sarah M. Winfield, AA; Stuart H. Kuschner, MD

Abstract

Standard radiographs of the wrist do not provide adequate visualization of the scaphotrapeziotrapezoid joint. A radiographic technique that provides an improved and more complete visualization of the joint compared with routine views is described. [Orthopedics. 2020; 43(2):e123–e124.]

Abstract

Standard radiographs of the wrist do not provide adequate visualization of the scaphotrapeziotrapezoid joint. A radiographic technique that provides an improved and more complete visualization of the joint compared with routine views is described. [Orthopedics. 2020; 43(2):e123–e124.]

Cadaver studies have reported that scaphotrapeziotrapezoid (STT) osteoarthritis (OA) occurs at a rate as high as 83.3%; however, STT OA is reported on only 15% to 59% of wrist radiographs.1–4 This would suggest that the STT joint is not adequately visualized on routine radiographs of the wrist, indicating the need for a more accurate radiographic view. This report describes a technique, currently used in the authors' practice, for improved visualization of the STT joint.

Technique

The patient is placed in a seated position facing the radiograph detector. The forearm is then placed on a 16° wedge with the wrist overhanging the inclined edge in ulnar deviation (Figure 1). The fingers are extended to rest on the cassette. The beam is shot from directly above, perpendicular to the plate (Video).

Position of the hand for the described view. The hand is draped over the inclined edge (A) and ulnarly deviated (B).

Figure 1:

Position of the hand for the described view. The hand is draped over the inclined edge (A) and ulnarly deviated (B).

Discussion

Routine imaging of the wrist is usually obtained via posteroanterior, lateral, and oblique radiographs, with the oblique view obtained by pronating the wrist 45° from the lateral position.5 However, these views may not provide adequate visualization of the STT joint. Brown et al,6 in a study using cadaveric hands, compared radiographic assessment of the STT joint using routine views of the wrist with gross evaluation of STT OA. They found agreement between gross visual pathology and radiographic OA in only 39% of the STT joints they examined. Their study suggests that the standard series underestimates the prevalence of OA in the STT joint.

Wollstein et al7 noted that a standard posteroanterior view at the wrist failed to adequately visualize the STT joint. They described a radiographic view to give better visualization of the STT joint than standard views. Their technique requires the patient to position the wrist in full ulnar deviation with extension of 60° to 75° while standing. The current authors have found this technique difficult to perform. Some patients, particularly those with wrist pain, cannot extend the wrist this far.

Conclusion

Radiography has had poor dependability in the diagnosis and staging of STT OA. Unlike the techniques currently used, the view described in this report allows for full visualization of the triscaphe joint (Figure 2).

Radiograph obtained using the described technique. The scaphotrapezial, scaphotrapezoidal, and trapeziotrapezoidal joints are well visualized.

Figure 2:

Radiograph obtained using the described technique. The scaphotrapezial, scaphotrapezoidal, and trapeziotrapezoidal joints are well visualized.

References

  1. Bhatia A, Pisho T, Touam C, Oberlin C. Incidence and distribution of scaphotrapezotrapezoidal arthritis in 73 fresh cadaveric wrists. Ann Chir Main Memb Super. 1996;15(4):220–225.
  2. Moritomo H, Viegas SF, Nakamura K, DaSilva MF, Patterson RM. The scaphotrapezio-trapezoidal joint: Part 1. An anatomic and radiographic study. J Hand Surg Am. 2000;25(5):899–910. doi:10.1053/jhsu.2000.4582 [CrossRef]
  3. Viegas SF, Patterson RM, Hokanson JA, Davis J. Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg Am. 1993;18(3):463–475. doi:10.1016/0363-5023(93)90094-J [CrossRef]
  4. Wollstein R, Clavijo J, Gilula LA. Osteoarthritis of the wrist STT joint and radiocarpal joint. Arthritis. 2012;2012:242159. doi:10.1155/2012/242159 [CrossRef]
  5. Yin Y, Mann FA, Gilula LA. Positions and techniques. In: Gilula LA, Yin Y, eds. Imaging of the Wrist and Hand. Philadelphia, PA: Saunders; 1996:93–158.
  6. Brown GD III, Roh MS, Strauch RJ, Rosenwasser MP, Ateshian GA, Mow VC. Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis. J Hand Surg Am. 2003;28(5):739–743. doi:10.1016/S0363-5023(03)00258-2 [CrossRef]
  7. Wollstein R, Wandzy N, Mastella DJ, Carlson L, Watson HK. A radiographic view of the scaphotrapezium-trapezoid joint. J Hand Surg Am. 2005;30(6):1161–1163. doi:10.1016/j.jhsa.2005.05.009 [CrossRef]
Authors

The authors are from the Division of Plastic and Reconstructive Surgery (AMB), Keck School of Medicine, University of Southern California, and the Department of Orthopedic Surgery (SMW, SHK), Cedars-Sinai Medical Center, Los Angeles, California.

The authors have no relevant financial relationships to disclose.

Correspondence should be addressed to: Ashley M. Brown, MD, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Ste 415, Los Angeles, CA 90033 ( doctorashleybrown@gmail.com).

Received: March 16, 2019
Accepted: May 20, 2019
Posted Online: July 29, 2019

10.3928/01477447-20190723-08

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