Symptomatic Scaphotrapeziotrapezoid Carpal Coalition: The Natural History and a Surgical Option for Treatment

Abstract

Carpal coalitions are uncommon and are frequently asymptomatic. 15 Patients with persistent symptomatic scaphotrapeziotrapezoid (STT) carpal coalitions unresponsive to six months of conservative treatment with no history of trauma went for further investigations. CT scans and bone scans revealed that coalition was the only abnormality to account for the patient's ongoing problems. The senior authors explored the carpal coalition surgically excising the affected region and interposing capsular fibrous tissue. Histologically partial bony and cartilaginous bridging was evident with no features of degenerative arthritis being noted. Good or excellent subjective results were achieved in all patients at final review an average of 2.7 (1.0 -4.2) years after surgery. All patients described significant reduction in visual analogue pain scores from an average of 71.5 to 18.4 points. The Green and O'Brien wrist scores improved from a mean of 58.2 to 94.2, with all patients returning to work with improved function. Normally carpal coalition is treated with arthrodesis or excision of part of the carpus. A further treatment option is outlined here with recreation of the joint space in symptomatic, isolated, nonsyndromic scaphotrapezio-trapezoidal coalition.