Beware of Unhealed Disruptions

​A middle-aged man came to the ED for a separate complaint, but his wife was very concerned about his wrist. He said he had injured it several years earlier but never followed up on the injury. Since then, he had been experiencing increasing stiffness and pain. His wife said he could hardly move his wrist. She wanted an x-ray and hoped that something could be done.My first thought as the image appeared on the screen was, "That's not normal." It was difficult even to identify where the lunate was. The capitate also seemed to have driven its way down through the proximal row. There was a massive disruption of Gilula's first and second arc lines. This man had scapholunate advanced collapse of the wrist.In fact, it was significantly advanced. Hand surgeons and radiologists may use the Watson stages to classify the injury and determine treatment:Stage I: Osteoarthritis of the scaphoid and radial styloid articulationStage II: Osteoarthritis of the entire articular surface of the radius and scaphoidStage III: Osteoarthritis of lunate and capitate articulation as well as the radius and scaphoidStage IV: Osteoarthritis of radiocarpal joint with or without involvement of the distal radioulnar jointThis most definitely was at least a stage III.My next thought was, "What happened before? Do we have x-rays from years ago when he first got his injury?"​Scapholunate advanced collapse of the wrist is thought to be the most common degenerative arthr...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs