Research Day
ATRAUMATIC LUNATE DISCLOCATION IN THE SETTING OF RHEUMATOID ARTHRITIS: A SMALL CASE SERIES AND LITERATURE REVIEW
Document Type
Abstract
Date
2021
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by widespread joint destruction and instability leading to progressive loss of function. The wrist is particularly vulnerable and is commonly the first body part to exhibit symptoms. Chronic inflammation of the wrist results in the progressive degeneration of carpal ligaments and ultimately, disruption of load distribution and motion across the wrist joint. Individually, the pathologic manifestations of RA-associated carpal instability and lunate dislocations (generally a high-energy injury) have been well-described. However, literature discussing the sequalae of atraumatic lunate dislocation in the setting of RA remains limited to a small number of case reports making it a difficult entity to both recognize and treat. Here, we discuss the presentation and treatments of 3 rheumatoid arthritis patients with atraumatic lunate dislocation.
Case Descriptions: 80 yo female presents with chronic right wrist pain and swelling found to have chronic anterior lunate dislocation on imaging. Due to chronicity and adequately controlled symptoms with medical management, patient elected for non-operative treatment.
74 yo female presents with approximately 4 months of painful mass in volar right wrist. Volar dislocation with proximal migration of lunate seen on imaging and she was subsequently treated with lunate resection.
64 yo male with history of Parkinson's Disease and recurrent falls presents with chronic bilateral wrist pain and left wrist swelling of at least two weeks. Dorsal dislocation of left lunate demonstrated on imaging and he underwent left wrist proximal row carpectomy.