Diagnosis and Treatment of Symptomatic Carpal Bossing
Context: Carpal bossing is an osseous formation at the dorsal portion of the quadrangular joint, which rarely becomes symptomatic. However, in some patients it causes pain, restricted mobility and can lead to complications like tendon rupture, inflammatory and degenerative joint disease. Aim: I...
Main Authors: | , , , , , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2015-09-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://jcdr.net/articles/PDF/6606/14820_CE(RA1)_F(T)_PF1(PAK)_PFA(AK)_PF2(PAG).pdf |
Summary: | Context: Carpal bossing is an osseous formation at the
dorsal portion of the quadrangular joint, which rarely becomes
symptomatic. However, in some patients it causes pain, restricted
mobility and can lead to complications like tendon rupture,
inflammatory and degenerative joint disease.
Aim: In this article, we present our experiences with this
rare disorder in order to improve diagnostic and therapeutic
proceedings.
Settings Design: This is a multicenter and interdisciplinary
observation made by orthopaedic surgeons and radiologists in
the years 2010 to 2015. Retrospective observational study. The
follow up period was 2 years.
Materials and Methods: In the observed time period, eight
patients were diagnosed with symptomatic carpal bossing.
Symptoms were pain at palmar flexion and limited mobility of
the wrist in combination with a palpable protuberance over the
quadrangular joint. All patients underwent X-ray, CT and MRI
examinations. A conservative treatment strategy was initiated
for 6 weeks in all patients, followed by a wedge resection when
symptoms were persisting and disabling.
Results: After the conservative treatment schedule, five patients
were asymptomatic. Three patients had persisting pain and were
thus recommended for surgery. In the postoperative course, two
patients were asymptomatic. One patient developed a type 1
complex regional pain syndrome (CRPS) in the first postoperative
year, which was successfully treated with pain-adapted
physiotherapy, pharmacotherapy with analgesics and calcitonin,
and a triple CT-guided thoracic sympathetic nerve blockade.
Conclusion: Carpal bossing is a mostly asymptomatic entity,
which in our experience gets symptomatic due to direct trauma or
repetitive stress, especially in competitive racket sports players. It
can be diagnosed by thorough clinical examination and multimodal
diagnostic imaging. Conservative treatment comprises an excellent
prognosis, however surgery, either wedge resection or arthrodesis,
must be considered if the response is not positive after 6 weeks. |
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ISSN: | 2249-782X 0973-709X |