Scaphotrapeziotrapezoid (STT) Joint Osteoarthritis

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Isolated scaphotrapeziotrapezoid (STT) joint osteoarthritis is a fairly common cause of radial sided wrist pain, and it can co-exist with thumb CMC osteoarthritis.

Anatomy and Biomechanics

The scaphotrapeziotrapezoid (STT) joint is also known as the triscaphe joint. It is a joint that is shared between the scaphoid, trapezium and trapezoid bones in the wrist.

The biomechanics of STT joint is not completely understood. It is a dome-shaped joint found on the radial side of the wrist. It is involved with thumb movement and transfer of load from the thumb and radial side of the hand to the scaphoid and the radioscaphoid and scaphocapitate joints.

The STT joint may communicate with the rest of the mid-carpal articulation. In patients with inflammatory or osteoarthritis, the midcarpal articulation (including the STT joint) may communicate with the radiocarpal articulation and/or the flexor carpi radialis sheath.

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  Scaphoid bone

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  Trapezium bone

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  Trapezoid bone

Pathology

STT osteoarthritis changes are more common and more severe on the palmar aspect of the joint.

Epidemiology

STT osteoarthritis is commonly seen on x-rays but most cases are not clinically significant. The STT joint is the second most common site for radiographic OA in the wrist. It is reported in 15-59% of wrist radiographs depending on the clinical context, with a higher occurrence (up to 83.3%) in cadaver studies. Radiographic STT osteoarthritis is inversely proportional to scapholunate advanced collapse (SLAC) wrist. It is rare in young patients.

Clinical Features

History

The clinical symptoms are similar to thumb CMC osteoarthritis. Symptoms include pain at the base of the thumb, distal radial aspect of the wrist, and thenar eminence. There may be pain and/or weakness with pinch and grip.

Examination

First ask the patient to extend their thumb to locate the anatomic snuff box. There is tenderness at the distal end of the anatomic snuff box and just radial to the extensor policis longus.

Then ask the patient supinate their arm and flex their wrist against resistance to identify the flexor carpi radialis tendon. Then ask the patient to relax and feel the scaphoid underneath the tendon, move your finger a little distal to palpate the junction of the scaphoid tuberosity and trapezium.

Tenderness over the STT joint is not associated with radiographic osteoarthritis.

Imaging

An example of STT joint arthritis stage 3 according to the White et al classification system. There is also thumb trapeziometacarpal arthritis and distal radioulnar joint arthritis. There is no evidence of radiocarpal arthritis.

The following is a classification scheme by White et al. It does not include evaluation of the trapeziotrapezoidal joint.It defines the stage by the highest stage regardless of joint (scaphotrapezial/scaphotrapezoidal) and regardless of the view.

• stage 1 = joint narrowing with or without subcortical sclerosis;
• stage 2 = cyst-like lucencies with or without osteophytes
• stage 3 = complete joint space narrowing or bone-bone apposition without evident space within the cartilage.

Differential Diagnosis

Subacute radial wrist pain differential diagnosis

• Scaphoid Fracture (missed)
• Non-union of scaphoid fracture
• De Quervain Tendinopathy
• Scaphoid impaction syndrome
• Intersection Syndrome
• Flexor carpi radialis tendinopathy
• Dorsal pole of lunate impingement on distal radius (gymnasts)
• Scapholunate dissociation
• First Carpometacarpal Joint Osteoarthritis
• Scaphotrapeziotrapezoid (STT) Joint Osteoarthritis
• Osteoarthritis of the radiocarpal joint
• Ganglia
• Radial sensory nerve entrapment in the forearm
• Crystal-induced arthritis
• C6 radicular syndrome

Treatment

Nonoperative options include bracing/orthotics usually at night, NSAIDs, and STT joint injection

Surgical treatment options include

• Resection of the distal pole of scaphoid with tissue interposition and capsulodesis
• STT joint arthrodesis +/- radial styloidectomy
• Arthroscopic debridement +/- silicone or fascial spacer
• Trapeziectomy with partial proximal trapezoid excision (if combined with thumb CMC OA)

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,