Clinical significance of quantitative bone SPECT/CT in the evaluation of hand and wrist pain in patients with rheumatic disease

We investigated the diagnostic value of the maximum standardized uptake value (SUV) at hand and wrist joints for differentiating rheumatic diseases via bone single-photon emission computed tomography (SPECT)/computed tomography (CT). A total of 84 patients manifesting hand and wrist pain (58 women; age, 49.8 ± 15.4 years) were finally diagnosed with rheumatoid arthritis (RA, n = 42), osteoarthritis (OA, n = 16), fibromyalgia (FM, n = 2), and other rheumatic diseases (n = 24). The SUV of each patient was measured in 32 joints including the distal interphalangeal (DIP), proximal interphalangeal (PIP), metacarpophalangeal (MCP), and wrist joints bilaterally. Differences in pain and SUVs between specific rheumatic diseases were assessed using the chi-squared test or one-way analysis of variance. Using the highest SUV (hSUV) in each patient, the diagnostic performance in differentiating specific diseases was evaluated by receiver operating characteristic (ROC) curve analysis. Pain symptoms were present in 886 (33.0%) sites in a total of 2688 joints. In four joint groups (DIP, PIP, MCP, and wrist), the SUVs of joints with pain were significantly higher than those of pain-free joints (all P < 0.001). Active joint sites with higher SUVs than the median value of each joint group were the most common in RA (55.1%). RA showed the greatest hSUV in the PIP (3.0 ± 2.4), MCP (3.5 ± 3.4), and wrist (3.3 ± 1.9) joint groups. FM was characterized by the lowest hSUV of all joint groups. In ROC curve analysis, the cumulative hSUV of the PIP, MCP, and wrist joint groups showed good performance for evaluating RA (area under the curve (AUC), 0.668; P = 0.005). The summation of the hSUVs at all joint groups had an excellent predictive performance for FM (AUC, 0.878; P < 0.001). Consequently, the arthritic activity of the hand and wrist joints based on SUV differed according to specific rheumatic diseases. Quantitative SPECT/CT may provide objective information related to arthritic activity for differentiating specific rheumatic diseases.

The Prevalence and Risk Factors of Wrist Pain among Young Adults in UTAR during Movement Control Order: A Cross-Sectional Study

Introduction: For the past few years wrist pain has been related to repetitive movement of the hand, and the cases has been increasing dramatically. There are numerous factors that causes wrist pain especially occupational factors. Different population has been investigated regarding work-related wrist pain such as, factory workers, programmers, and even gamers. Up to now, there is no data baseline about the prevalence and risk factors of wrist pain among young adults. Objectives: To investigate the prevalence and risk factors of risk pain among young adults in University Tunku Abdul Rahman (UTAR) during Movement Control Disorder. Methods: Questionnaire was adapted from Patient Rated Wrist Evaluation Score (PRWE), Self-Developed Demographic Data was used to determine prevalence and potential risk factors for wrist pain on young adults in UTAR during Movement Control Disorder, by using convenient sampling method. Results: A total number of 144 participants had completed the questionnaire. Most of the participants were 20-25 years old. There are 100 female participants (69.4%) and 44 male participants (29.9%) who enrolled in this research. The prevalence of wrist pain among young adults in UTAR during Movement Control Disorder is relatively high according to PRWE score (71.53%) while according to self-modified questionnaire there are 33 participants who felt the pain at the wrist (22.92%). Conclusion: Repetitive movement of the wrist and poor ergonomics of the hand are the factors that cause of wrist pain among young adults in UTAR. Key words: Prevalence, risk factors, wrist pain, young adults, Movement Control Disorder.

Arthroscopic triangular fibrocartilage complex reconstruction with free tendon graft for chronic distal radioulnar joint instability

Background Tears in the triangular fibrocartilage complex (TFCC) often manifest as ulnar wrist pain and limited wrist function. In chronic cases, the treatment of large tears with irreparable TFCC degeneration combined with distal radioulnar joint (DRUJ) instability is difficult. In the current report, we describe the outcomes of a minimally invasive technique for TFCC reconstruction using the free palmaris longus (PL) tendon via arthroscopy. Methods We examined the cases of 67 adult patients [54 men and 13 women; age range, 19–34 years (mean age, 26.4 years)] treated for chronic and irreparable TFCC tears from 2001 to 2019. We used the arthroscopic TFCC reconstruction method with the free PL tendon for all chronic and irreparable TFCC injuries with DRUJ instability in our clinic. Thereafter, the patients underwent the rehabilitation program, which included wrist motion and occupational therapy. The mean time period from the event causing the tear to the operation was 22.6 months. Results The function results of these patients significantly improved, and the ulnar wrist pain significantly decreased at postoperative follow-up. Of the 67 patients, 38 rated their wrists as “excellent,” 26 as “good,” and 3 as “fair.” None of the patients developed wound infections or complications. Conclusions The results of this study suggest that arthroscopic TFCC reconstruction using the free PL tendon is an effective method for treating chronic and irreparable TFCC tears with DRUJ instability.