| Carpal coalition | |
|---|---|
 | |
| An example of a lunotriquetral coalition, the most commonly fused carpal bones | |
| Usual onset | Congenital |
Carpal coalition is the abnormal fusion of two or more carpal bones when they fail to segment during intrauterine development. [1] First described by Eduard Sandifort in 1779, carpal coalitions are often an isolated issue which connect two carpal bones in the same row of the wrist. [2] These issues are congenital and occur at various rates throughout the population. [3]
Patients with carpal coalition often offer no clinical significance and patients rarely have any associated issues. Though infrequent, some patients may complain of pain. [4]
Carpal coalition result from an incomplete separation of a common embryological carpal precursor in utero, during the fifth to eighth weeks. [1]
The lunate and triquetral bones are the most common carpal bones to fuse together, resulting in a lunotriquetral coalition in 1% of people. 60% of patients with a lunotriquetral coalition will have it bilaterally. [1] Among isolated incidents the capitate and hamate bones are the next most common to fuse followed by the pisiform-triquetrum, trapezium-trapezoid, scaphoid-capitate, and triquetrum-hamate. [3]
Carpal coalitions may further be divided into four subtypes: [3]
Generally since carpal-carpal fusions do not cause unease or discomfort for the patient, and do not impair wrist function, treatment is not needed. However, in the minority of cases where carpal coalition causes persistent pain, arthrodesis, or the surgical fusion of a joint, has been proven to be beneficial. [5]
Carpal coalition occurs at a ratio of 2:1 in females, and are considered to have a multifactorial inheritance pattern. [3] Further, the incidence according to race varies, with a rate of 0.1% in Caucasian populations, 1.6% in African American populations, and over 8% in certain West African tribes. [2]
Multiple carpal coalitions, or carpal coalitions that connect the two different rows of carpal muscles, are often associated with other anomalies including: [1] [3]
The carpal bones are the eight small bones that make up the wrist (carpus) that connects the hand to the forearm. The term "carpus" and "carpal" is derived from the Latin carpus and the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the carpal bones is to articulate with the radial and ulnar heads to form a highly mobile condyloid joint, to provide attachments for thenar and hypothenar muscles, and to form part of the rigid carpal tunnel which allows the median nerve and tendons of the anterior forearm muscles to be transmitted to the hand and fingers.
In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.
In human anatomy, the metacarpal bones or metacarpus, also known as the "palm bones", are the appendicular bones that form the intermediate part of the hand between the phalanges (fingers) and the carpal bones, which articulate with the forearm. The metacarpal bones are homologous to the metatarsal bones in the foot.
The capitate bone is a bone in the human wrist found in the center of the carpal bone region, located at the distal end of the radius and ulna bones. It articulates with the third metacarpal bone and forms the third carpometacarpal joint. The capitate bone is the largest of the carpal bones in the human hand. It presents, above, a rounded portion or head, which is received into the concavity formed by the scaphoid and lunate bones; a constricted portion or neck; and below this, the body. The bone is also found in many other mammals, and is homologous with the "third distal carpal" of reptiles and amphibians.
The hamate bone, or unciform bone, Latin os hamatum and occasionally abbreviated as just hamatum, is a bone in the human wrist readily distinguishable by its wedge shape and a hook-like process ("hamulus") projecting from its palmar surface.
The lunate bone is a carpal bone in the human hand. It is distinguished by its deep concavity and crescentic outline. It is situated in the center of the proximal row carpal bones, which lie between the ulna and radius and the hand. The lunate carpal bone is situated between the lateral scaphoid bone and medial triquetral bone.
The triquetral bone is located in the wrist on the medial side of the proximal row of the carpus between the lunate and pisiform bones. It is on the ulnar side of the hand, but does not directly articulate with the ulna. Instead, it is connected to and articulates with the ulna through the Triangular fibrocartilage disc and ligament, which forms part of the ulnocarpal joint capsule. It connects with the pisiform, hamate, and lunate bones. It is the 2nd most commonly fractured carpal bone.
Arthrogryposis (AMC) describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning 'curving of joints'.
Ellis–Van Creveld syndrome is a rare genetic disorder of the skeletal dysplasia type.
Kienböck's disease is a disorder of the wrist. It is named for Dr. Robert Kienböck, a radiologist in Vienna, Austria who described osteomalacia of the lunate in 1910.
The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.
The ulnar canal or ulnar tunnel (also known as Guyon's canal or tunnel) is a semi-rigid longitudinal canal in the wrist that allows passage of the ulnar artery and ulnar nerve into the hand. The roof of the canal is made up of the superficial palmar carpal ligament, while the deeper flexor retinaculum and hypothenar muscles comprise the floor. The space is medially bounded by the pisiform and pisohamate ligament more proximally, and laterally bounded by the hook of the hamate more distally. It is approximately 4 cm long, beginning proximally at the transverse carpal ligament and ending at the aponeurotic arch of the hypothenar muscles.
The intercarpal joints can be subdivided into three sets of joints : Those of the proximal row of carpal bones, those of the distal row of carpal bones, and those of the two rows with each other.
Synostosis is fusion of two or more bones. It can be normal in puberty, or abnormal. When synostosis is abnormal it is a type of dysostosis. Examples of synostoses include:
The midcarpal joint is formed by the scaphoid, lunate, and triquetral bones in the proximal row, and the trapezium, trapezoid, capitate, and hamate bones in the distal row. The distal pole of the scaphoid articulates with two trapezial bones as a gliding type of joint. The proximal end of the scaphoid combines with the lunate and triquetrum to form a deep concavity that articulates with the convexity of the combined capitate and hamate in a form of diarthrodial, almost condyloid joint.
In the human body, the carpal tunnel or carpal canal is a flattened body cavity on the flexor (palmar/volar) side of the wrist, bounded by the carpal bones and flexor retinaculum. It forms the passageway that transmits the median nerve and the tendons of the extrinsic flexor muscles of the hand from the forearm to the hand. The median artery is an anatomical variant. When present it lies between the radial artery, and the ulnar artery and runs with the median nerve supplying the same structures innervated.
An accessory bone or supernumerary bone is a bone that is not normally present in the body, but can be found as a variant in a significant number of people. It poses a risk of being misdiagnosed as bone fractures on radiography.
Radial dysplasia, also known as radial club hand or radial longitudinal deficiency, is a congenital difference occurring in a longitudinal direction resulting in radial deviation of the wrist and shortening of the forearm. It can occur in different ways, from a minor anomaly to complete absence of the radius, radial side of the carpal bones and thumb. Hypoplasia of the distal humerus may be present as well and can lead to stiffness of the elbow. Radial deviation of the wrist is caused by lack of support to the carpus, radial deviation may be reinforced if forearm muscles are functioning poorly or have abnormal insertions. Although radial longitudinal deficiency is often bilateral, the extent of involvement is most often asymmetric.
Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a nerve decompression in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant (not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment. Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.
Wrist osteoarthritis is gradual loss of articular cartilage and hypertrophic bone changes (osteophytes). While in many joints this is part of normal aging (senescence), in the wrist osteoarthritis usually occurs over years to decades after scapholunate interosseous ligament rupture or an unhealed fracture of the scaphoid. Characteristic symptoms including pain, deformity and stiffness. Pain intensity and incapability are notably variable and do not correspond with arthritis severity on radiographs.