Purpose
Carpal coalitions are common and usually incidental to the indication for wrist radiographs.
It is not clear if, or when, carpal coalitions cause pain. The aim of this study was
to assess the prevalence of incidental carpal coalitions by evaluating radiographs
taken for various indications and to test the association of demographic variables
and ordering indications with the finding of a carpal coalition.
Methods
We reviewed 1,119 posteroanterior wrist radiographs for the presence of carpal coalition.
We used bivariate and multivariate analyses to assess demographic factors for their
independent associations with the presence of carpal coalitions and to compare the
difference in the prevalence of carpal coalitions between radiographs obtained to
evaluate traumatic wrist pain (623 wrists), nontraumatic wrist pain (175 wrists),
and other reasons (321 wrists).
Results
Radiographs of 98 out of 1,119 patients (8.8%) showed a carpal coalition. Carpal coalitions
were equally likely on radiographs obtained for traumatic wrist pain and nontraumatic
wrist pain. Patients with no wrist trauma or wrist pain were less likely to have a
carpal coalition on their radiograph.
Conclusions
We consider carpal coalitions an unlikely cause of wrist pain. The lower prevalence
in radiographs obtained for causes other than wrist trauma or wrist pain remains unexplained,
although it may be spurious. In the evaluation of a patient with nonspecific wrist
pain, clinicians should be careful ascribing symptoms to anatomical variations on
radiographs. These incidental findings should not usually affect management.
Type of study/level of evidence
Diagnostic III.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Carpal coalition: a review of current knowledge and report of a single institution's experience with asymptomatic intercarpal fusion.Hand (N Y). 2013; 8: 157-163
- Carpal coalitions.J Hand Surg Am. 1992; 17: 28-31
- Osseous anatomic variants of the wrist: findings on MR imaging.AJR Am J Roentgenol. 1999; 173: 339-344
- Radiolunate coalition: a case report and literature review.Eur J Orthop Surg Traumatol. 2012; 22: 79-83
- Analysis of triquetral-lunate fusion.Am J Phys Anthropol. 1971; 34: 431-433
- Hamate-pisiform coalition: morphology, clinical significance, and a simplified classification scheme for carpal coalition.Clin Anat. 2011; 24: 188-196
- Incomplete carpal coalition.AJR Am J Roentgenol. 1986; 147: 301-304
- Intercarpal fusion—a review.J Anat Soc India. 2003; 52: 183-188
- Carpal coalition: symptomatic incomplete bony coalition of the capitate and trapezoid—case report.J Hand Surg Am. 2011; 36: 1313-1315
- Minnaar type 1 symptomatic lunotriquetral coalition: a report of nine patients.J Hand Surg Am. 2001; 26: 261-270
- Symptomatic carpal coalition.J Hand Surg Am. 1985; 10: 190-193
- Symptomatic congenital coalition of the pisiform and hamate.J Hand Surg Am. 1991; 16: 646-650
- Congenital fusion of the lunate and triquetral bones in South African Bantu.J Bone Joint Surg Br. 1952; 34B: 45-48
Article info
Publication history
Published online: March 09, 2017
Accepted:
February 1,
2017
Received:
October 24,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
The work was performed at the Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
