|3475 Torrance Blvd., Ste F
Torrance, CA 90503
Office hours: M-F, 9am
– 5 pm
Worker’s compensation, Medicare
and most insurance plans accepted.
In September 2008, we will be moving to a beautiful new 4,400 sq ft,
state of the art dedicated hand center located at 2808 Columbia Ave
in Torrance, CA., which will feature onsite nerve conduction studies,
occupational hand therapy and digital x-ray.
Radial styloidectomy is an early salvage procedure that may provide short
term relief of mechanical pain from radial styloid impingement. This is
a form of wrist osteoarthritis that can arise due to a longstanding scaphoid
nonunion or due to a chronic scapholunate ligament tear (link to styloidectomy
1). Definitive treatment for these conditions consist of resecting the
scaphoid and performing a partial wrist fusion, or removing all 3 bones
in the proximal carpal row. A styloidectomy is an acceptable alternative
to more aggressive procedures in patients with low functional demands
or those who wish to defer more definitive treatment.
The main risk following a radial styloidectomy is ulnar translocation
of the carpus. Nakamura et al observed significantly increased radial
translation with ulnar and palmar carpal displacement after 6- and 10-mm
radial styloidectomies and therefore recommended a styloidectomy of no
more than 3 to 4 mm. Ulnar translocation is a frequent sequella of longstanding
rheumatoid disease hence any patient with chronic wrist involvement is
a poor candidate for this procedure.
Surgical Technique (link to radial styloidectomy video).
This is one procedure where the 1-/,2 portal is particularly helpful for
debridement (link to styloidectomy 2). The author also uses the VR portal
interchangeably with the 3-/,4 portal in order to gain complete access
to the dorsoradial aspect of the styloid. The marked cartilage loss can
be seen on the adjacent surfaces of the scaphoid and radius (link to styloidectomy
3). The diameter of the burr will give a rough guide as to the amount
of bony resection, but this needs to be confirmed fluoroscopically (link
to styloidectomy 4-6). Enough bone should be resected so that there is
no residual impingement between the scaphoid and the radial styloid when
the wrist is radially deviated with the traction released.
Postoperatively the patient is splinted for the first week followed by
progressive wrist motion and strengthening. This is a temporizing procedure
and may provide some limited pain relief for a few years. A more definitive
procedure is often necessary over time.