Demmer Wolfram, Fialka Lia K, Waschke Jens, Mesas Aranda Irene, Haas-Lützenberger Elisabeth, Giunta Riccardo, Reidler Paul
Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstraße 5, 80336 Munich, Germany.
Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, 80336 Munich, Germany.
J Funct Morphol Kinesiol. 2025 Apr 23;10(2):141. doi: 10.3390/jfmk10020141.
Hamate-lunate impingement or osteoarthritis can be a cause of ulnar-sided wrist pain. In the literature, the lunate has commonly been classified according to the configuration of its distal articular surface into type 1 and type 2, as described by Viegas. A type 1 lunate possesses only a distal articular surface for the capitate, while a type 2 lunate shows an additional medial facet articulating directly with the hamate. Type 2 lunates have been identified as a risk factor for ulnar-sided wrist pain and the development of osteoarthritis in the midcarpal wrist. However, this does not sufficiently explain all arthritic changes between the hamate and lunate. In this prospective anatomical-radiological cadaver study, 60 wrists were examined. The midcarpal articulation was documented using conventional X-ray, CT arthrography, and anatomical dissection. The study specifically analyzed the positioning of the lunate relative to the hamate apex and its association with the development of hamate-lunate osteoarthritis. For this purpose, the classification by Viegas was refined. Based on posterior-anterior (p.a.) X-ray examinations of the wrist lunates were divided into type 1a, type 1b, and type 2. The type 1a lunate articulates only with the capitate in the midcarpal joint. The type 1b lunate also articulates only with the capitate; however, medially, the apex of the hamate protrudes beyond a Differentiation Line (D-line), which extends from the radial border of the trapezium or the ulnar border of the lunotriquetral (LT) space, without forming a facet with the lunate. A type 2 lunate articulates distally with the capitate and has an additional medial facet with the hamate. Osteoarthritis between the hamate and lunate was observed in both Viegas type 1 and type 2 lunates. According to our refined lunate classification, both in situ and radiologically, type 1b and type 2 lunates showed a substantially higher prevalence and severity of hamate-lunate osteoarthritis compared to type 1a lunates. However, there was no significant difference in the prevalence of hamate-lunate osteoarthritis between type 1b and type 2 lunates. Assessing lunate type and signs of osteoarthritis is essential when evaluating patients with ulnar-sided wrist pain. Our study demonstrates that osteoarthritis in Viegas type 1 lunate is influenced by the position of the hamate apex relative to the D-line. The refined lunate classification, based on correlated radiological and anatomical studies of the wrist, provides a straightforward method for identifying a potential cause of ulnar-sided wrist pain on p.a. X-rays. This classification can help guide further diagnostic and therapeutic decisions, such as wrist arthroscopy with possible resection of the hamate apex.
钩骨-月骨撞击或骨关节炎可能是尺侧腕关节疼痛的一个原因。在文献中，月骨通常根据其远侧关节面的形态分为1型和2型，如维加斯所描述的那样。1型月骨仅具有与头状骨的远侧关节面，而2型月骨显示有一个额外的内侧小关节面直接与钩骨相连。2型月骨已被确定为尺侧腕关节疼痛和腕中关节骨关节炎发展的一个危险因素。然而，这并不能充分解释钩骨和月骨之间的所有关节炎变化。在这项前瞻性解剖-放射学尸体研究中，对60个腕关节进行了检查。使用传统X线、CT关节造影和解剖 dissection记录腕中关节。该研究特别分析了月骨相对于钩骨尖的位置及其与钩骨-月骨骨关节炎发展的关联。为此，对维加斯的分类进行了细化。根据腕关节的前后位（p.a.）X线检查，月骨被分为1a型、1b型和2型。1a型月骨在腕中关节仅与头状骨相连。1b型月骨也仅与头状骨相连；然而，在内侧，钩骨尖突出超过一条分化线（D线），该线从大多角骨的桡侧边界或月三角（LT）间隙的尺侧边界延伸，且未与月骨形成小关节面。2型月骨在远侧与头状骨相连，并有一个与钩骨的额外内侧小关节面。在维加斯1型和2型月骨中均观察到钩骨和月骨之间的骨关节炎。根据我们细化的月骨分类，无论是在原位还是放射学上，1b型和2型月骨与1a型月骨相比，钩骨-月骨骨关节炎的患病率和严重程度都显著更高。然而，1b型和2型月骨之间钩骨-月骨骨关节炎的患病率没有显著差异。在评估尺侧腕关节疼痛的患者时，评估月骨类型和骨关节炎体征至关重要。我们的研究表明，维加斯1型月骨中的骨关节炎受钩骨尖相对于D线位置的影响。基于腕关节相关放射学和解剖学研究的细化月骨分类，为在前后位X线上识别尺侧腕关节疼痛的潜在原因提供了一种直接的方法。这种分类有助于指导进一步的诊断和治疗决策，如腕关节镜检查及可能的钩骨尖切除术。
