Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation

PURPOSE: Chronic scapholunate dissociation is the most common cause of symptomatic wrist instability. In an attempt to restore normal carpal mechanics and prevent wrist arthrosis, we developed and tested biomechanically the dorsal intercarpal ligament capsulodesis (DILC). Previously, we reported good early clinical results for this procedure at an average follow-up period of 25 months. Here, we report on the functional and radiographic outcomes at a longer follow-up period of a minimum of 5 years. METHODS: Records of patients undergoing the DILC for chronic (greater than 6 weeks), flexible, static scapholunate dissociation were reviewed. Only patients with follow-up evaluation of greater than 60 months were included. Physical examination, radiographs, and validated outcome instruments were used to evaluate the patients. RESULTS: Twenty-one patients (22 wrists) met the inclusion criteria. Fifteen of 21 patients (16 wrists) were available for follow-up evaluation. Average follow-up period was 86 months. Physical examination revealed average wrist flexion and extension of 50 degrees and 55 degrees , respectively, radial and ulnar deviation of 17 degrees and 36 degrees , respectively, and grip strength of 43 kgf. Disabilities of the Arm, Shoulder and Hand, Short Form-12, and Mayo wrist scores averaged 19, 78, and 78, respectively. Radiographs revealed an average scapholunate angle and gap of 62 degrees and 3.5 mm, respectively. Eight of the 16 wrists in our study demonstrated arthritic changes on radiographs. CONCLUSIONS: The DILC does not consistently prevent radiographic deterioration and the development of arthrosis in the long-term; however, the level of functionality and patient satisfaction remained relatively high in 58% of our patients, suggesting a lack of correlation between the radiographic findings and development of arthrosis and the functional outcomes and patient satisfaction. We believe that the DILC is still a reasonable option for treating flexible static scapholunate dissociation in patients without radiographic signs of arthritis presenting with wrist pain despite conservative treatment. Prevention of radiographic deterioration and arthrosis remains an unsolved problem.     

软组织重建舟月骨间韧带治疗慢性舟月分离的影像学改变

目的 观察背侧腕骨间韧带关节囊固定术和3-韧带肌腱固定术治疗慢性舟月分离术后腕关节的影像学改变,明确术后舟月分离复发的比例及时间.方法 自2008年1月至2011年1月,共治疗慢性舟月分离患者23例,19例行背侧腕骨间韧带关节囊固定术,4例行3-韧带肌腱固定术.平均随访10.1个月.分别记录术前、拔针后1个月和末次随访时的影像学和临床结果.在手术前后采用疼痛视觉模拟评分(visual analog scale,VAS)和DASH表格问卷评估主观的疼痛程度、功能改善和患者满意度.结果 影像学结果显示,所有患者腕骨的排列异常在手术中均获得完全纠正.拔针后1个月,舟月间隙平均为4 mm、舟月角平均为75°,舟月间隙和舟月角较术前改善,但61％患者的舟月间隙、52％患者的舟月角恢复至术前水平.末次随访时,舟月间隙平均为4,3 mm、舟月角平均为78°,舟月间隙和舟月角较拔针后1个月时畸形加重,但与术前比较差异无统计学意义.临床结果显示,腕关节屈曲和背伸分别从术前为健侧的66％和69％降至术后的52％和50％.握力从健侧的71％降至66％.结论 背侧腕骨间韧带关节囊固定术和3-韧带肌腱固定术后慢性舟月分离多在短期内复发,拔针后1个月时超过半数病例的舟月分离恢复至术前水平,治疗慢性舟月分离的理想手术方式仍不得而知.     

Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model

The purpose of this study was to evaluate in cadavers a new method for treating scapholunate dissociations, dorsal intercarpal ligament capsulodesis (DILC), and to compare its performance with that of a previously described soft tissue reconstruction, Blatt capsulodesis (BC). A cadaver model was used to simulate normal and abnormal wrist motions. The positions of the scaphoid and lunate and their changes with wrist motion and ligament condition were recorded using biplanar radiographs taken posteroanteriorly and laterally. The scapholunate gap was measured on the posteroanterior radiographs and the scapholunate angle was measured on the lateral view radiographs. Following scapholunate interosseous ligament sectioning, a diastasis developed between the scaphoid and lunate that was maximum in the clenched fist position 2.1 +/- 0.33 mm (mean +/- SEM) with the ligament intact versus 8.0 +/- 1.74 mm after the ligament was sectioned. Dorsal intercarpal ligament capsulodesis reduced gap formation more than BC, including when the specimens were in the clenched fist position: increased gap versus intact specimens equals 1.0 mm for DILC versus 3.7 mm for BC. The differences in diastasis were statistically significant between BC and DILC when the wrist was in extension, radial deviation, and clenched fist positions. After the scapholunate interosseous ligament was divided, the scaphoid flexed relative to the lunate. Both capsulodeses improved scapholunate alignment and there was a trend for DILC to correct the scapholunate angle more than BC. The results demonstrate that DILC is an attractive alternative to BC ex vivo. Because DILC does not tether the scaphoid to the distal radius, as BC does, improved wrist motion, especially flexion, might be possible in vivo. The use of DILC in the treatment of scapholunate dissociation warrants further investigation and clinical trials.     

Ligamentous reconstruction of scapholunate dislocation through a double dorsal and palmar approach

Six patients were treated for scapholunate dissociation by reconstruction of both the palmar and dorsal parts of the scapholunate interosseous ligament through a combined palmar and dorsal approach. The mean active range of motion of the wrist at final follow-up was 44 degrees of flexion and 58 degrees of extension and the mean hand grip strengths was 88% of that of the contralateral hand. The average time to return to work was 105 days and the mean DASH score at a mean follow-up of 32 months was 18. At follow-up, radiographs showed maintenance of the anatomical reduction of the scapholunate articulation in all cases and the scapholunate angle was normal in five patients.     

Blatt's capsulodesis for chronic scapholunate dissociation.

We have reviewed prospectively 44 cases of chronic scapholunate dissociation treated by Blatt's dorsal capsulodesis. The diagnosis was based on clinical and arthroscopic criteria. The minimum follow-up was 2 years. The results were analysed clinically and radiologically. Postoperatively statistically significant reductions in wrist movements and grip strengths were noted. Delay in surgery and presence of compensation claims were also statistically significant factors. Patients with a high column/row index had higher overall good and excellent results. The scapholunate gap, scapholunate angle, carpal height and the type of instability as diagnosed on arthroscopy and cineradiography did not affect the outcome significantly. The scapholunate gap, scapholunate angle and the carpal height did not change significantly after operation.     

Long-term Outcomes of Arthroscopic Debridement and Thermal Shrinkage for Isolated Partial Intercarpal Ligament Tears

A retrospective analysis was performed based on the medical records and imaging studies of 16 wrists (14 patients) with isolated partial intercarpal ligament tears (scapholunate ligament: 6 wrists, lunotriquetral ligament, 10 wrists) treated with arthroscopic debridement and thermal shrinkage. Three wrists had Geissler grade 1 tears and 13 wrists had grade 2 tears. Mean follow-up was 52.8 months. Overall pain visual analog scale scores improved significantly (P<.05) at rest and during activities of daily living and heavy manual work. Mean flexion-extension arc was 136.5°. Mean postoperative grip strength was 106 lb, which was significantly better than preoperative grip strength. Mean modified Mayo wrist score was 70 preoperatively and 94.7 postoperatively, a significant improvement. Overall functional outcomes according to the modified Mayo wrist score were rated as excellent in 13 wrists and good in 3. No patient had radiographic evidence of instability or arthritic changes. The scapholunate and lunotriquetral intervals in all patients were less than 3 mm on neutral and pronation grip radiographs. On lateral radiographs, no signs of intercalated segmental instability were seen, with a mean scapholunate angle of 55.3°.The results of this study suggest that arthroscopic debridement and thermal shrinkage provide symptomatic pain relief and prevention of intercarpal instability for a significant period of time in patients with partial intercarpal ligament tear.     

Proximal row carpectomy: a worthwhile salvage procedure.

After proximal row carpectomy 11 patients were evaluated in the six ensuing years for pain relief, satisfaction, ranges of movement, grip and precision grip strength, and radiographic picture. The median follow-up period was 3.1 years (range 4 months to 6 years). They were operated on for scaphoid non-union with radiocarpal arthritis, late stage Kienb?ck's disease, chronic scapholunate dissociation and scapholunate advanced collapse wrist deformity. The mean disabilities of the arm, shoulder and hand (DASH) scoring list, which indicates the patient's degree of disability 28% (range 2%-64%) of maximum disability for the function and symptom score. Flexion, extension, and radial and ulnar deviation of the wrist improved to 47% (range 21%-76%), 67% (range 41%-81%), 39% (range 25%-55%), and 81% (range 44%-90%) of the opposite wrist. Mean grip strength, 70% (range 22%-117%) of the opposite site, while the three precision grips improved between 72% and 79%. A review of previous studies of proximal row carpectomy showed results comparable with those of our study. Compared with other treatments, it is a dependable, relatively-simple procedure that gives reliable relief of pain, preserves functional ranges of movement and grip strength, and allows most patients to return to work.     

Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist)

SUMMARY: Outcome evaluation of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist). PURPOSE: Scaphoid nonunion or scapholunate ligament instability results in carpal collapse and subsequent arthrosis. These conditions, termed SLAC-wrist and SNAC-wrist, are the most common patterns of arthrosis in the wrist. The purpose of this retrospective study was the evaluation of functional outcomes following midcarpal arthrodesis and of patients' satisfaction with these outcomes. METHODS: Forty-nine patients were reexamined at a mean follow-up time of 47 months. Active range of motion (AROM) was verified with a goniometer; grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) for stress and under resting conditions. Patients' upper-extremity functioning was captured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Radiographic evaluation of bony consolidation was verified by conventional x-ray. RESULTS: Postoperative AROM was 56% and grip strength was 76% compared with the contralateral side. The DASH score was 29 points. Pain relief was 34% at rest and 31% after stress. Forty-five patients demonstrated bony consolidation in x-ray control. Six patients (12%) further required a total arthrodesis of the wrist because of pain or absence of bony consolidation. CONCLUSION: Our data demonstrate that midcarpal arthrodesis is a reliable procedure for treating SLAC- and SNAC-wrists in stages II and III and, furthermore, one which preserves some range of motion. Total wrist fusion should only be used in exceptional circumstances.     

Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.     

Proximal Row Carpectomy: A Worthwhile Salvage Procedure

After proximal row carpectomy 11 patients were evaluated in the six ensuing years for pain relief, satisfaction, ranges of movement, grip and precision grip strength, and radiographic picture. The median followup period was 3.1 years (range 4 months to 6 years). They were operated on for scaphoid non-union with radiocarpal arthritis, late stage Kienbo¨ck's disease, chronic scapholunate dissociation and scapholunate advanced collapse wrist deformity. The mean disabilities of the arm, shoulder and hand (DASH) scoring list, which indicates the patient's degree of disability 28% (range 2%-64%) of maximum disability for the function and symptom score. Flexion, extension, and radial and ulnar deviation of the wrist improved to 47% (range 21%- 76%), 67% (range 41%-81%), 39% (range 25%-55%), and 81% (range 44%-90%) of the opposite wrist. Mean grip strength, 70% (range 22%-117%) of the opposite site, while the three precision grips improved between 72% and 79%. A review of previous studies of proximal row carpectomy showed results comparable with those of our study. Compared with other treatments, it is a dependable, relatively-simple procedure that gives reliable relief of pain, preserves functional ranges of movement and grip strength, and allows most patients to return to work.     

腕关节镜辅助下修复舟月韧带治疗腕关节不稳定

目的分析腕关节镜辅助下利用骨锚修复腕舟月韧带的疗效。方法自2008年10月一2011年4月,对6例腕关节损伤患者通过腕关节镜探查舟月韧带,确定损伤部位后,应用Mitek骨锚重建舟月韧带,术后石膏托固定腕关节于功能位4周后开始患腕被动活动,6周后开始主动运动。术后随访6个月,测定患腕术前及术后的握力、应用改良Mayor评分法对腕关节功能进行客观评分、患者源性调查表（disabilityofarm-shoulder-hand,DASH）问卷法进行主观评分,以及术前与术后的x片检查对比。并与健侧腕关节x片进行对比。结果术后6例患者腕关节疼痛均有缓解．握力明显改善。按照改良Mayor评分：优2例,良3例,可1例,优良率为83．3％,与术前评分的差异有统计学意义（P〈O．01）。术后DASH分值平均为（14．6±7．0）,与术前评分差异有统计学意义（P〈O．01）。结论舟月韧带损伤是导致腕关节不稳定的重要原因之一,在腕关节镜辅助下利用骨锚修复舟月韧带是一种微创、实用的方法。     

Soft tissue stabilization in the management of chronic scapholunate instability without osteoarthritis. A 15-year series

Management of chronic scapholunate instability without osteoarthritis remains controversial. Some surgeons favor partial wrist arthrodesis; others, soft tissue stabilization. Many techniques for soft tissue repair have been described but with few or unpredictable results. We reviewed all our cases of scapholunate instability without osteoarthritis treated by soft tissue stabilization. Since 1979, 37 soft tissue stabilization procedures have been performed to correct dynamic (25) or static (12) scapholunate instability without osteoarthritis. The average time from injury to surgical treatment was 7.2 mos. (range 0.25 to 36 mos.). Three cases were treated within the first month of injury. The choice of repair was determined intraoperatively. The scaphoid shift must be easily reducible to make the case eligible for soft tissue repair. The scapholunate ligament was usually disrupted from palmar to dorsal, and the average amount of disruption was 74%. When scapholunate ligament remnants were of sufficient quality, secondary repair was performed; but if not, ligament reconstruction using tendon grafts or capsulodesis was performed. The procedures used were secondary ligamentous repair in 16 (by direct suture, reinsertion using anchor and/or transosseous reattachment), ligament reconstruction using tendon grafts in 6, capsulodesis in 7 and a combination of these procedures in 8. The mean follow-up was 27 mos. (range 2 to 62 mos.). Postoperatively, there was an 83% decrease in pain. The average wrist motion was 60 degrees extension, 47 degrees flexion, 18 degrees radial deviation and 28 degrees ulnar deviation (92%, 84%, 106% and 88% of preoperative values and 88%, 75%, 78% and 76% of the uninvolved wrists, respectively), and the grip strength was 28 kg (117% of preoperative value and 78% of the uninvolved wrists). On roentgenograms, the mean static scapholunate distance was 4.2 mm (a 26% loss of reduction compared to the early postoperative gap), but scapholunate and radiolunate angles were within normal values (58 degrees and 9 degrees, respectively). At follow-up, one patient presenting a small zone of chondromalacia on the scaphoid at the time of secondary ligamentous repair developed severe radioscaphoid arthritis 15 months postoperatively. The results were further assessed according to the form of instability, delay before surgery, severity of disruption and type of repair. Patients with static instability showed worse clinical and radiological findings than those with dynamic instability. Surgical delay did not influence the outcome. The more severe the ligament disruption was, the poorer were the results. All types of repair had a comparable outcome except those treated by ligament reconstruction using tendon grafts. The results in the latter group were unsatisfactory in terms of motion, grip strength and radiological findings. This technique has been abandoned by the group. In conclusion, soft tissue stabilization is part of the armamentarium in the management of reducible chronic scapholunate instability without osteoarthritis. Ligament reconstruction using tendon grafts gave, in our hands, unsatisfactory results. Otherwise, all types of repair achieved a relatively pain-free wrist, with acceptable motion, grip strength, scapholunate and radiolunate angles but with a wider than normal static scapholunate distance. A longer follow-up is needed to assess the effect of this abnormal gap. Factors that favorably affected the outcome were: dynamic type of instability and partial disruption of the ligament.     

Static scapholunate dissociation: a new reconstruction technique using a volar and dorsal approach in a cadaver model

We used 4 fresh-frozen cadaver arms to assess a method of reconstruction we designed for static scapholunate dissociation. The dorsal scapholunate ligament, scapholunate interosseous ligament, radioscapholunate, and radioscaphocapitate ligaments were sectioned. Radiographs were taken before sectioning, after sectioning, and after reconstruction. Passive motion was also measured before sectioning and after the repair. The dorsal scapholunate ligament was repaired directly; the palmar radioscapholunate and radioscaphocapitate ligaments were reconstructed using a free flexor carpi radialis tendon autograft and Mitek mini suture anchors (1.8-mm diameter and 5.4-mm length; Mitek Products, Norwood, MA) for anatomic fixation. An independent board-certified hand surgeon analyzed the radiographs of the wrists taken before and after sectioning and after reconstruction. Assessment of the unsectioned wrists revealed an average scapholunate angle of 45 degrees. After scapholunate dissociation was created the average scapholunate angle was 71 degrees. Repair of the dorsal scapholunate ligament alone did not improve the scapholunate angle. Average scapholunate angle after repair of the dorsal scapholunate ligament and reconstruction of the palmar ligaments was 43 degrees. Average range of motion on flexion, extension, and radial and ulnar deviation before ligament sectioning and after reconstruction was unchanged at 54 degrees, 59 degrees, 19 degrees, and 40 degrees respectively. This technique shows an improvement in scapholunate angle on lateral radiographs, and passive motion remained relatively unchanged.     

Blatt's capsulodesis for chronic scapholunate instability

Nineteen patients underwent a scapholunate interosseous ligament repair combined with a Blatt's capsulodesis for scapholunate instability between 1994 and 1999. The diagnosis was based on clinical, radiographic and arthroscopic assessments. Mean follow-up was 22 months (range: 8 months to 5 years). Fifteen patients were available for follow-up. Most (13 of 15) of the patients presented with predynamic or dynamic instability. Results were analysed clinically and radiologically. Thirteen patients showed good or excellent clinical result. There was statistically significant improvement in pain relief (VAS scores) and grip strength (58% of the opposite side). Mean extension and ulnar deviation were significantly improved (62% and 53% of the opposite side respectively) and there was significant reduction in wrist flexion (49% of the opposite side). Thirteen patients returned to their original level of activity. There was no significant change in the mean scapholunate gap and angle after surgery. Thirteen patients would recommend this operation. We believe that this procedure can produce encouraging results in cases of predynamic and dynamic instability in a patient population with low-demand wrists. Larger caseloads and more complete follow-ups would be desirable to derive strong evidence-based conclusions.     

Early results of reconstruction of the dorsal scapholunate ligament

We present the clinical results of a study of chronic dynamic scapholunate (SL) dissociation treated by reconstruction of the dorsal SL ligament. A total of 35 patients who presented with chronic dynamic SL instability had the scapholunate ligament reconstructed with a tendon graft. Twenty-nine patients were available for follow-up evaluation after a minimal interval of 17 months (range 17-72). Patients' satisfaction was good in 26/29 patients. Postoperative range of movement was reduced in extension and improved for flexion and ulnar deviation. Mean wrist movements were 75% of those on the opposite side. Most patients had good pain relief and recovered their grip strength, and returned to their regular employment. Follow-up stress radiographs showed a reduction in the SL angle and gap. Reconstruction of the dorsal SL ligament provides sufficient restoration of stability, pain relief, and functional improvement of the wrist for patients with dynamic SL instability. Although the short-term results are encouraging, we think that this method should be verified by longer follow-up.     

Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis longus tenodesis

This study investigates the results of a technique using an extensor carpi radialis longus (ECRL) tenodesis for symptomatic scapholunate instability. Symptomatic scapholunate instability has been corrected so far either by limited wrist fusion or by various techniques of soft tissue repair. Limited wrist fusion greatly reduces wrist motion and increases the probability of osteoarthritis in the remaining mobile wrist segments. On the other hand, most types of soft tissue repair are technically difficult to perform and have disappointing results due to the inherent laxity. The presented dynamic approach was used in 20 wrists of 19 patients with static scapholunate instability. Preoperative evaluation included in all patients clinical examination, radiologic evaluation, and arthroscopy for establishing the diagnosis of static scapholunate instability. The technique involves the fixation of the ECRL tendon on the dorsal aspect of the scaphoid by means of a cancellous screw and a special washer. Dynamic ECRL tenodesis of the scaphoid is a safe and simple procedure that enhances the extension forces on the scaphoid in all wrist positions. The results of this preliminary report in 20 wrists showed dynamic ECRL tenodesis to be an effective treatment option for treating symptomatic static scapholunate instability.     

Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability

PURPOSE: The ideal treatment for scapholunate (SL) instability has not yet been established. This study examined the results of 2 procedures for the primary treatment for chronic SL dissociation of dorsal capsulodesis and flexor carpi radialis tenodesis. METHODS: A retrospective analysis was conducted that examined dorsal capsulodesis and tenodesis procedures performed for chronic SL instability between January 1995 and February of 2003. Twenty-nine patients were identified with isolated chronic SL instability. Of the 29 patients, 14 had a dorsal capsulodesis procedure and 15 had a tenodesis procedure. The follow-up period averaged 38 months in the capsulodesis group and 36 months in the tenodesis group. Results were reviewed clinically and radiographically. Groups were compared with a Student t test. RESULTS: Postoperative wrist motion decreased in both groups after surgery. Final wrist range of motion was 64% of the unaffected side in the capsulodesis group and 63% of the unaffected side in the tenodesis group. Postoperative grip strength remained unchanged in both groups; grip strength measured 91% of the unaffected side in the capsulodesis group and 87% of the unaffected side in the tenodesis group. The average Mayo wrist scores were 77 in the capsulodesis group and 74 in the tenodesis group. One frank failure occurred in the tenodesis group resulting in a wrist fusion. There was no statistical difference in the overall wrist motion, grip strength, or wrist scores between the capsulodesis and tenodesis groups. CONCLUSIONS: Dorsal capsulodesis and tenodesis provided improvement in symptoms for patients with chronic SL instability. Both procedures appear to provide similar results in the treatment of this difficult problem.     

Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid

Twenty-two patients had scapholunate ligament repairs combined with a new augmentation ligamentoplasty for chronic scapholunate dissociation. All were evaluated by physical and radiologic examination after a mean postoperative follow-up period of 63 months (range, 12-134 mo). According to Green and O'Brien and Johnson and Carrera scores 5/8 had excellent, 13/12 good, and 4/2 fair results. Thirteen were free of pain; 6 had mild pain and 3 had moderate pain. Nineteen returned to their original occupation. There was an average loss of 10 degrees of flexion, 9 degrees of extension, and 11% of grip force compared with the opposite wrist. Radiologic examination showed an average decrease of 12 degrees of the scapholunate and 10 degrees of the radiolunate angles compared with the levels before surgery. No signs of degenerative osteoarthritis were found in 16 (73%) cases. Five wrists showed a distinct pattern of midcarpal degeneration correlating with notable dorsal intercalated segment instability after surgery, and 2 cases had signs of radioscaphoid degeneration.     

Intravenous regional administration of corticosteroids in juvenile chronic arthritis

Background?Treatment of juvenile chronic arthritis patients with longstanding multiple joint or tendon involvement that is resistant to medication remains a challenge. For 20 years, we have been treating these severely ill patients with intravenous regional glucocorticoids (a modified Bier's block).Patients and methods?Since 1996, all juvenile chronic arthritis patients have been followed prospectively by an occupational therapist who has registered the grip strength and range of motion at an average of 6 months after treatment.Results?In 22/40 wrists and hands, increased grip strength was recorded. The mean grip strength increased for the whole group from 47 to 59?N and the flexion lag decreased.Interpretation?The effect of intravenous regional steroid treatment may be limited from a long-term perspective, but in our series, half of the patients showed a considerable improvement after 6 months. Surgical synovectomy can be postponed and perhaps even be omitted.