n primary f o s i t i r h t r a o e t s o t n i e h a r u l n c t e s p a t f o e h t i s r w and e t h s r o t c a f t

D i s t r i b u t i o

n primary f o s i t i r h t r a o e t s o t n i e h a r u l n c t e s p a t f o e h t i s r w and e t h s r o t c a f t

h a

t e r a d e t a l e r r o c with u l n a r t i s r w : s i t i r h t r a o e t s o a c s s o r l a n o

i t c e s u d y s t

Takeshi Katayama ， MDl; i o s h H i r Ono ， MDl; Daisuke Suzuki ， MDl; Manabu Akahane ， MD2; Shohei Omokawa ， MD3; o u h i t Y a s Tanaka ， MD3

lDepartment O f o d i c r t h o p a e Surgery ， Kokuho l r a e n t C l t a p i o s H

2Department f o i c l b P u Health ， Health Management and y c i l o P ， Nara M e d i c a l U

n i v e r s i t y

3Department O f o d i c r t h o p a e Surgery ， Nara M e d i c a l y i t r s i v e U n

C o r r e s p o n d i n

g : r o h t u a T

a k e s h

i Katayama ， M D

Department f o e d i c t h o p a O r Surgery ， Kokuho l t r a e n C a l i t p o s H ， 404

1 Miyako ， Tawaramoto ， Nara 6 3 6 - 0 3 0 2 ， Japan

T e l

: +81-744

32-8800 F

a x

: +81

744

32

8811 E

: l i a m p j e . n n . o d i . k 4 @ 1 1 k . h i s k e a t

D i s c l a i m e r s

: None

Acknowledgments: None

1 t t r a c A b s

2 : e v i t c e j b O The e p u r p o s f o s i h t l a n o i t c e s - s s o r c s t u d y was o t y f i t n e d i e t h

3 n o i t u b i r t s i d f o primary s i t i r h t r a o e t s o (O A) n i e t h u l n a r c t e p a s f o e t h

4 t s r i w ， and y z e n a l a e t h s r o t c a f d e t a l e r r o c with OA a t s i h t . e t i s

5 s i a l t e r M a and m e t h o d s : A l a t o t f o 1128 s e s a c f o y l l a t e l e k s mature

6 Japanese s t n e t i a p were d e t c e l l o c r v e o a t a r e - y e r e h . d o i r e p We a l y z e d a n

7 h e t r o i e r t n o a r e s t o p and l a r e t a l t s i r w p h s o g r a r a d i f o e e s t h s t n i e t a p r o f

8 h e t e s e n c p r e f o primary OA n i e t h a r u l n t c p e s a f o e t h t s i r w ，

9 n g i u d l n c i e t h l a t s i d a r l n o u d i r a (DRUJ) ， e t n a l u o d i r a ， e n a t o l u l n u ，

1

0 l a r t e u q r i t o n u l ， t e o h a m a u e t r t r i q ， lunohamate and e a t t p i a c n o u l . s t n i o j Al l

1

1 s t n i o j were examined r o f h e t e n c y e q u f r f o primary O . A A m t e a i a r v i t u l

1

2 c i t s i g o l o n i s e s r e g r was used o t e t a g i t s e v n i e t h s r o t c a f d e t a e l r r o c with

1

3 t h e n c e e s e p r f o e i v a t e r e n e g d s i t i r h t r a n i h e t l n a r u c t e s p a f o e t h t s i r w

1

4 . t n i o j

1

5 : s l t u s e R Primary OA o f t h e u l n a r t s i r w was d e i f i t n e d i n i 145 8 . 2 1 ( %)

1

6 f o 1 1 2 8 . s e s a c i v e g e n e r a t D e changes were most y l n t e q u e r f d e i f i t n e d i n i

1

7 e t h DRUJ 1 ( 3 . 2 ， ) % d e w l o l o f by e t h e n a t o l u u l n t n i o j 1 . 8 ( ) . % s n i o t a r i a V

1

8 n i l a i d a r n o i t a n i l c n i ， ( R ) I l a r p a c t g h e i h o i t a r (CHR) ， and a r u l n

1

9 c e a n r i v a (UV) d e t l a e r r o c with OA f o h e t u l n a r c t e s p a f o t h e t s i r w ，

20 with s n i o t a i r a v n i UV showing t h e t e s h i g h . n o i t a l e r r o c

21 : n i o u s c l o n C Primary OA o f h e t u l n a r t s r i w was most e n t q u f r e n i e t h

22 DRUJ and s e c o n d - m o s t i n t h e n a t e n o l u u l . t n i o j UV was t h e most

23 d e t l a e r r o c with OA i n h e t u l n a r t c p e a s f o e t h . t s i r w

24

25 Key s : o r d w s i t i r h t r a o e t s o ， u l n a r t e c p a s ， s t i w r ， r a d i o g r a p h y

26

27 n i o c t d u r o n t I

28 Ul na - r d e i d s s t i r w pain s i a common l a c i n i l c problem and t s e n e s p r a

29 c i s t o n g a d i g e n l e a l h c r o f s t s i g o l o i d a r and hand n s u r g e o s ， b e c a u s e f o e t h

30 complex m i c a l a n a t o s e r u c t u r t s n i s i h t o n g i e r 1 [ ， . ] 2 e r s r d i s o D f o e t h

3

1 u l n a r t i s r w e a r t e d l i c a o m p c ， and e e r t h e a r a number f o v e t i r a n e g e d e

32 s n o t i i d n c o a t h t can d e a l o t pain and . y t i l i b a s i d These s n i o t i d n o c n e t f o

33 t s i s n o c f o l a i r o t c a f i t l u m s e i g o l o i t e ， making t i t l u c i f f i d o t implement

34 a t e r i o p p p r a treatment s e i g e t a r t s . ] 3 [ However t h e

l

n s u s e c a f o

35 ulna - r e d d s i t s i r w r s e d r o s d i d e u c l n i r l a u n g a r i t e g a l i t r a c o r b i f complex

36 (TFCC) s r a e t ， l l a r e t u q i t r o n u l i g a m e n t y t i l i b a t s n i ， e s o r e n x t l p r a c s i r a l n u

37 s i t n i o d n e t and l p a c a r n o u l c t i o n i m p a syndrome 2 [ ， . ] 4 Palmer d e i f i s s a l c

38 e t i v e r a g e n d e TFCC r d e r o i s d o t n i e v i f a d e s g r ， and found t h a t s n o i t a r o f e r p

39 f o h e t TFCC t l u s e r n i a l r p o c a u l n abutment and e g a l i t r a c n o i s o e r ，

40 l y a l t u e n e v n g d i e a l o t l p a a r n o c u l s i t i r h t r a . ] 5 [ l a t s i D n a r u l i o r a d t n i o j

41 (DRUJ) y t i l i b a t s n i e d t a c i o s a s with r n a u l d i o r a l i g a m e n t r a e t may

42 t e a r e l e c c a e g a l i t r a c wear f o h e t t n i o j . ] 6 [ However t h e y g o l o i t e f o

43 n o n - t r a u m a t i c s i t i r h t r a o e t s o (O A ) 也 e t h a r u l n c t p e a s f o h e t s t i r w

44 remains unknown. Frequency and i s n e s o g e a t h p f o a l p a r o c d i a r and l a i d a r

45 midcarpal OA have been y l e v s i n e x t e d e a t g i s t e v i n 7 [ ， ， 8 ] whereas e e r h t

46 has been no h a r c e s e r on h e t n o i t u b i r t s i d f o OA r o h e t importance f o

47 t h e t a l i g n m e n change f o e t h t s i r w and l a p a r c bones n i e t h n a r u l

48 c t e s p a f o h e t t s r i w with O . A

49 h i s T l a n o i t c e s - s s o r c s t u d y g h t s o u o t y f i t n e d i e t h n o i t u b i r t s i d f o

50 primary OA n i h e t r u l n a t e c p a s f o e t h t s i r w ， and o t y z e a n a l e h t

51 s r o t c a f a t h t e a r d e t a l e r r o c with e t h e s e n c p r e f o OA a t s i h t . e t i s We

52 z e d h e s i p o t h y t a t h OA n i h e t n a r u l t c e s p a f o t h e s t i r w would be

53 most l y t e n u q r e f e r v e d o b s n i e t h DRUJ and a t t h OA f o h e t n a r u l

54 t c p e s a f o e t h t s i r w would e t a l e r r o c with h e t a l i g n m e n t and

55 n o i t a u r g i f n o c f o e t h t s r i w and l p a r a c s . e n b o

56

57 l s i a t e r M a and Methods

58 T h i s was a r e v i t c e p s o r t e i c p h r a g i o a d r s t u d y n g u s i r o i e r t n a r o e t s p o p ( A)

59 and l a r e t a l t s r i w . h s a p r o g i a d r i s T h u d y s t was approved by our l a t i s p o h

60 v i e w r e . d r o a b We e d u d c l i n l l a y l l a t e l e k s mature Japanese s t n e i t a p with

61 d s e o l c l e a y s p h p i e s e t a l p who d e t i s i v o u r l r a n e g e c d i e p a h o r t o e c i t c a r p

62 from January 2008 o t December 2010 with s t i r w symptoms. t s n e t i a P

63 n t e d p r e s e o t e t h c i n i l c with trauma . g . e ( ， n i o u s n t c o ， n i r a s p ， tendon r o

64 l i g a m e n t y r u n j i ， n e r v e ) y r u j n i ， inflammation . g . e ( ， s i t i l u l l e c ， l a r p a c e l t u n n

65 syndrome ， s n g s i n o e t s i t v i o n y s o e n t ， pseudo u t g o ， p t r u l e n u ) s i t i r h t r a ， OA

66 . g . e ( ， a l r p c a n o u l abutment syndrome) ， r o tumor . g . e ( ， g n i o g l a n ， lipoma ，

67 . m a ) e r o a t h t s n i e t P a were u d e d e x c l f i they e d p r e s e n t with s e r u t c a r f f o

68 t h e u s d i r a ， ulna ， r o l a r p a c bones ， r o d a r y s e c o n OA f o h e t t i s r w due

69 : o t ) 1 ( s e r u t c a r f r o malunions f o h e t u s d i r a ， ulna ， l a r p a c bones ， and

70 metacarpal s ; e o n b ) 2 ( rheumatoid s i t i r h t r a ， d e t a l e r - s i s y l a i d s i t i r h t r a ， r o

7

1 e r h o t m i c s t e s y c i t i r h t r a ; s n o i t i d n o c ) 3 ( a r u l a s c a v s i s o r c n e f o t h e ; u s p r c a

72 and ) 4 ( a l t n i e n g o c . s e i t i m r o f e d l l A s t n i e t a p were d i a g n o s e d based on

73 both e t h h i c a p g r i o a d r s g n i n d i f and l a c i n i l c d s r c o r e o t d v o i a e a t i p r r o p p n a i

74 l a c i n i l c . s i s o n g a i d

75 Standard PA h s i o g r a p r a d ] 9 [ f o e t h t i s r w were taken with t h e t s i r w

76 n l a n l r a e u t n o i t i s o p between both 1 f n i o x e n o i s e n t x - e and r a n u l - l a d i a r

77 : n o i t a i v e d e t h forearm was n l a n a l r u t e n o i t i s o p f o i o n n a t p r o n o t i a n p i u s - ，

78 with h e t elbow bent n l 90 e s r e e g d f o 1 f o n x i e ， and h e t d e r o u l s h e l d h

79 n l 90 de

s e e f o . n i o t u c d a b Standard PA p h s d i o g r a r a f o h e t s t i w r were

80 d t e a c d i n i when e t h u l n a r d i o l y t s s s e o c r p d e z i l a c o l n l t h e l a r e t a l d e r b o r

8

1 f o e t h ulnar d . e a h Standard l a r e t a l h s g r a p a d i o r ] 0 1 [ f o t h e t i s r w were

82 taken with h e t s t i w r and forearm n l a n l r a u t e n o i t i s o p ， e t h elbow m

83 90 s e e e g r d f o 1 f o n x i e ， and h e t e r u l d s h o n i 0 d g r e e e f o n . o i c t u d a b

84 Standard l a r e t a l p h s d i o g r a r a f o h e t t s r i w were e d t c a i n d i when h e t

85 m o r f i i s p d e z i l a c o l n i between e t h r l a o v margins f o h e t o i d c a p h s e l c r e b u t

86 and t h e . e t a t i p a c R a d i o g r a p h i c exams were c l u d e d e x f i they were f o

87 t n e i c i f f u s n i y t i l u a q r o f n i o a t l u v a e r o f i h e t examination i d d n o t e u d l c i n

88 both f o s e h e t two . s w i e v

89 To y f i r a l c t h e n o i t u b i r t s i d f o primary OA i n h e t n a r u l t e c s p a f o h e t

90 s t r i w u s i n g PA and l a r e t a l t i s r w p h s i o g r a r a d ， t h e u l n a r t i s r w s t n i o j

91 were d e i n e f d s a g n i o w l l o f : s t n i o j DRUJ ， e a t u n o l d i r a ， t e u n a n o l u l ，

92 a l r t e u i q r t o u n l ， h a m a t e q u e t r o t r i ， lunohamate and e a t t p i a o c n u l s t n i o j i F (

e r

93 . ) 1 The PA c h i r a p o g d i r a a i r e t i r c r o f OA f o t h e t i s r w t n i o j were

94 d e i n e f d a s t h e c e p r e s e n f o one r o more f o t h e : g n i w o l l o f t n i o j e a c s p

95 narrowing (where t h e t s e t o r h s e c n t a s i d between each bone must be s s e l

96 than 1 mm) ， e s y t o p h t e o s d e i f i t n e d i ( a s bony e s c e n s c r e c e x t a t n i o j

97 m a r g i n s ) ， s u b c h o n d r a l s i s o r e l c s d e i f i t n e d i ( s a c i t o r e l c s changes o t e t h

98 l a c i t r o c and r l a c u b e r a t bone n i t a c t o n c with e t h ) e g a l i t r a c r o

99 h o n d r a l s u b c s t s y c d e i f i t n e d i ( s a h o n d r a l s u b c bone c y c e n l u n w i t h i s e a a r f o

100 o n d r a l s u b c h ) s i s o r e l c s 8 [ ， 1 1 ， . ] 2 1 The l a r e t a l c h i a p g r i o a d r a i r e t i r c were

1 0

1 e d i n e f d s a t h e s e n c e p r e f o s t e h y o p t e o s n i h e t a r l v o r o a l s r d o e d i s f o

102 e t h DRUJ. A l l j s t n i o n i e t h l a t s i d a r l n o u d i r a ， l p a a r n o c u l and n a r u l

103 m i d c a r p a l a s r e a were examined r o f t h e e n c e p r e s r o a b s e n c e f o s e h e t

104 s e r u a t e f f o OA ， s a d e i n l t o u n i i g u r e F . 1 The t n i o j was e d i n e f d s a

1 0

5 having a p e v i t i s o c i t i r h t r a o e t s o change ， when one r o more s e u r t a e f f o

106 OA were e d i z g n c o r e n i each . t n i o j f I no s e r t u a e f were o b s e r v e d ， e h t

107 t n i o j was e d i n f d e s a v e t i e g a n r o f c i t i r h t r a o e t s o . n g e c h a

b y f i t n e d i e t h

108 e e n c v a l p r e f o s t n i o j with primary OA i n h e t a r u l n t c p e a s f o e t h t s r i w ，

109 l l a f o e t h d e l l r o n e PA and l a r e t a l t i s r w s g r a p h r a d i o were examined.

110 The n c y r e q u e f f o an c i t i r h t r a o e t s o t n i o j was . d e i f i t n e d i

111 Next ， standard PA and l a r e t a l a p h s i o g r r a d f o h e t t s r i w were d s e e s s s a

112 o t y f i t n e d i t h e s r o t c a f a t t h e a r d e t a l r e r o c with OA n l e t h u l n a r

113 t c p e a s f o e t h . t s i r w Based on l a c i n i l c d s r o e c r ， we d e t c e l e s a c l o r t n o

114 group f o t s n e i a t p with no OA m t h e n a r u l t c p e s a f o t h e s t i w r from

115 t h e l a n i g i r o r t o o h c f o 1128 s s e a c ， o t t c a s a an - e g a and

116 gender

matched l o r t n o c r o f t h e s t n e t i a p with O . A The a g e f o l o r t n o c

117 n t e i a t p was t h i n w i 1 year f o age r e d l o ( r o u n g e r ) y o f o t h e OA group

118 e l a b T ( . ) 1 R a d i a l n o i t a n i l c n i ( R ) I 3 1 [ ， ] l a p a r c t e i g h h o i t a r (CHR) 4 1 [ ， ]

119 and u l n a r e n c r l a v a (UV) ] 9 [ were measured on s t a n d a r d PA

120 s g r a p h r a d i o f o e t h . t s i r w The u l n a r n c e r i a v a was measured by e t h

1 2

1 method f o s a r c u l d i e n e r p p : ] 9 [ a l e n i was drawn r u l a n d i c r p e p e o t h e t

122 l a i n d u i t g n l o s i x a f o t h e i u s a d r and through t h e l a t s i d margin f o t h e

123 r l a v o edge f o e t h i g m o i d s h n o t c f o e t h . s u i d a r The c e n t a s d i was

124 measured between s i h t e n i l and h e t l a t s i d l a c i t r o c rim f o t h e ulna o t

125 determine t h e UV ( r e g u i F . ) 2 A p e v i t i s o UV was d n e f i d e s a more than

126 2 mm. Volar t l i t V T ) ( 5 1 [ ， ] t e n a l u o d i r a e g l a n (RLA) 6 1 [ ， ] and

127 o i d a p h o s c a d i r g l e a n (RSA) ] 6 1 [ were measured on s t a n d a r d l a r e t a l

128 a p h s a d i o g r r f o t h e . t s i r w

129 Tw o independent r s v e e r s o b ; K . T ( d e i f i t r e c - d r a o b c d i e o p t h o r surgeon ， and H.O;

130 board d e i f i t

r e c hand n ) e o r g s u r e v i e w e d h s g r a p a d i o r r o f e t h g r o u p s f o

1 3

1 s n t e i t p a with and w i t h o u t O . A One r v e e r o b s . T ( ) . K performed a s e c o n d

132 measurement 1 month r e t f a e t h t s r i f measurement.

133 Al l r s g r a p h a d i o were r e d c q u i a g s i n u l a t i g i d p h y r a d i o g r a and d r e o s t

134 using a Syngo Imaging XS-VA60B system (Siemens ， Erlangen ， Germany).

1

3 5 The measurements f o h e t r a p h s a d i o g r were made u s i n g a s e a r f t w o l o o t

136 f o t h e Syngo Imaging XS-VA60B m . t e y s s 137

138

139

140

1 4 1

1 4 2

143

144

145

146 S t a t i s t i c a

l s i s l y a n a

F a c t o r

s were a l y z e d a n by h e t Pearson n o i t a l e r r o c t n e i c i f f e o c r o f t h g i e

parameters e r n d ( g e ， a g e ， RI ， UV ， CHR ， VT ， RLA ， and RS A) and h e t s e n c e p r e r o

a b s e n c

e f o OA t a h e t u l n a r c t e s p a f o t h e t s r i w . t n i o j A m e t i a r v a i l t u

l o g i s t i

c n i o s e s r e g r s s i y l a n a was then d . r m e r f o p e The t c e j b o e l b i a r a v was

d e f i n e

d a s t h e e s e n c p r e r o a b s e n c e f o OA a t t h e n a r u l t e c p a s f o e t h

w r i s

t . t n i o j The r y a t o p l a n e x s l e b a i a r v were parameters t a t h c o n f i r m e d a

s t a t i s t i c a l l

y t n a c i f i n g i s n o i t a l e r r o c by e t h Pearson n o i t a l e r r o c . s i s y l a n a

The odds o i t a r f o each o r y n a t x p l a e l e b a i r v a was d t e a l u l c a c with a 95%

147

148

c o n f i d e n c

e l a v r e t n i . ) I C ( l a c i t s i t a t S s t l u s e r were a n a l y z e d with e t h

s i g n i f i c a n c

e l e v e l t e s t a P < . 5 0 . 0

149 The e t n i - r and r e v r s e b o - r a t n i y t i l i b a i l e r f o measurements r o f each

150 c h i a p g r i o a d r parameter was d e t a u l c l a c u s i n g h e t s s a l c a r t n i n o i t a l e r r o c

151 t n e i c i f f e o c . ) C C I ( The y t i l i b a i l e r f o a d n o i s i e c r o f r o s t n a i a g e t h

152 n c e r e s e p f o OA n i each t n i o j was d s s e s s e a u s i n g t h e kappa . s e u l a v

153 The n o i t a e t r p r t e n i f o e t h ICC and kappa u e s v a l was based on e t h

154 a i r e t i r c p r o p o s e d by Landis and Koch . ] 7 1 [ ICC and kappa l u e s v a f o

155 0 0 0 . o t 2 0 . 0 e d s e n t r e p r e t h g i l s e m e n t ; a g r e 1 2 . 0 o t 0 4 . 0 r n t e d r e s e e p r i a f

156 a g r e e m e n t ; 0. 4 1 t o 0 6 . 0 t e d s e n p r e r e moderate e e m e n t ; a g r 1 6 . 0 o t 0 8 . 0

157 e n t e d p r e s r e a l i t n a s t b u s e n t ; a g r e e m and r v e o 0 8 0 . t e d e s e n e p r r o s t a l m

158 t c e f r e p a g r e e m e n t .

159

160 s u l t R e s

1 6

1 Of e t h s n t e i a t p g n i t i s i v e t h c i n i l c ， 1408 s t n i e t a p 9 6 0 ( men and 799 women;

162 mean age ， 8 . 5 3 ; s r a e y range ， 19

100 ) s r a e y met t h e o n i s u l c i n a i r e t i r c ， with 280

163 s t n e t i a p u d e d e x c l 2 1 1 ( men and 159 women; mean age ， 1 . 2 5 ; s r a e y range ， 1 9

95

164 . ) s r a e y l l r a v e O ， we n e d b t a i o t n v a l e e r t e n i a t p and c h i a p g r i o a d r i o n m a t f o r i n

1 6

5 from 1128 e i v t c u s e o n c s n t e i a t p 8 8 ( 4 men and 640 women; mean a g e ， 2 . 4 5 ; s r a e y

166 range ， 0 9 - 1 0 1 . ) s r a e y Of s e t h e 1128 s t n i e t a p ， 145 1 ( 8 . 2 %) s s e a c 1 5 ( men

167 and 94 women; mean age ， 6 . 7 6 ; s r a e y range ， 30

100 ) s r a e y s e n t e d p r e with primary

168 OA n l e t h l n a r u t c p e a s f o t h e t s r i w on e t h PA s . p h r a o g d i r a The

169 n c y f r e q u e f o e v i t i s o p uv was found n i 59 f o t h e 145 e s s c a with O A . 170 The

t s t u e n e q f r r e a a o t e v l o v i n i v e a t n e r g e d e c i t i r h t r a changes was

1 7

1 e t h DRUJ ， which was found n l 139 f o e t h 145 s t e n i a t p ， which

172 comprised 12.3% f o t h e l a t o t 1128 . s e s a c y t f i F s e v e n f o 139 s s e a c

173 with OA o f t h e DRUJ had a p e v i t i s o . v u I n h e t 1 4 5 s s e a c with OA 174 f o t h e a r u l n t e c s p a f o h e t s t r i w ， 2 o f 6 c s s e a t h o u t w i OA f o t h e

175 DRUJ had e v i t i s o p . v u The s e c o n d n t e q u e - f r o s t m e a a r with OA was 176 t h e t e l u n a u l n o t n i o j ， which was r v e d o b s e n l 91 1 . 8 ( %) f o e t h 1128

177 . s e s a c In e r r d o f o c e n d i n g d e s n c e a l e e v p r ， 53 e s a s c 7 . 4 ( %) demonstrated

178 v e t i e r a g e n d e changes n l e t h e t t a p i a o c n l u ; t n i o j 46 e s s a c 1 . 4 ( %) n l e t h

179 t e n a l u i o a d r ; t n i o j 40 s e a s c 5 . 3 ( %) n i h e t a t e u e t r o h a m t r i q ; t n i o j 38 s s e a c

180 3 . 3 ( %) n l h e t lunohamate ; t n i o j and 14 s e a s c . 1 ( 2 %) n l t h e

181 l r a t e u i q r t o u n l t n i o j e r g u F i ( . ) 3 On h e t l a r e t a l s g r a p h a d i o r ， o s t e h y o p t e s

182 were e r v e d o b s n l two e s s c a ， which were seen m t e h s i g m o i d h n o t c f o

183 h e t u s a d i r on both PA and l a r e t a l s . h a p g r o d i r a

184 The - e g a and gende - r matched l o r t n o c group comprised 145 s s e a c 2 5 (

185 men and 93 women; mean age ， 3 . 7 6 ; s r a e y range ， 39

85 y ) s r a e from t h e l a n i g i r o

186 t o r h c o f o 1128 e i v u t c s e o n c s s e c a t h a t d i d t n o have OA f o h e t s t i w r

187 ; t n i o j t h e e c n e r e f f i d between s t n e i t a p with and h o u t w i t OA was t o n

188 y l l a c i t s i t a t s t n a c i f i n g i s with t c e s p e r o t a g e 2 ) 3 9 0 . = ( P r o gender 1 ) 0 . 9 0 = ( P

189 usmg independent . s t s e t - t The c y q u e n f r e f o e v i t i s o p uv was found n l 190 33 f o 145 l o r t n o c . s e s a c We then used e e s t h two s g r o u p o t i n e d e t e r m

1 9

1 which s r o t c a f were d e t a l e r r o c with OA n l h e t r u l n a t c p e a s f o h e t

192 . t s i r w b l e T a 1 shows h e t s c i t s i r e t c a r a h c f o each e b l a i r v a between h e t

193 two . s u p o r g Using s e e t h s e l b a i r a v ， a c e v i t a l e r r o s s i y l a n a

s a v c t e d c o n d u ，

194 n g i a l e e v r t a t h h e t e e n c r e s p f o OA t a h e t l n a r u c t e s p a f o h e t t s r i w

195 t n i o j was y l t n a c i f i n g i s e d t a l e r r o c with RI ， ， v u CHR ， and RLA e l b a T ( . ) 2 196 The e t i a r v a i l t u m c i t s i g o l s s e r g e r

n a s i s l y a n d l e e a e v r t a h t RI ， UV ， and

197 CHR were y l l a c i t s i t a t s d e t a l e r r c o with OA f o e t h r u l n a c t e s p a f o e t h

198 t i s w r t n i o j e l b a T ( . ) 3 Among e s h e t s e l b a i r a v ， uv had h e t t s h e g h i 199 t n a c i f i n g i s a l e r r o c n o i t with OA f o e t h u l n a r t e c p s a f o t h e t s r i w t n i o j

200 . ) l O O . O < P (

201 The ICC and kappa s u e a l v r o f e t n i - r and r e v r s e b o - a r n t i agreement

202 were s t a l m o t c e f r e p r o n i l i a t n a t b s u s agreement e l b a ( T ) 4 ， s n g t i e s g g u

203 a t t h t h e measurement methods were . e l b i c u d o r p e r

204

205 o n s s i c u D i s

206 In s i h t u d y s t ， we z e d a n a l y e t h n o i t u b i r t s i d f o primary OA n i e t h

207 u l n a r t e c p a s f o e t h s t i r w and t s o u g h o t d e t e r m i n e e t h s r o t c a f t h a t

208 e t a l e r r o c with l n a r u t s r i w OA ， with e c n e e r f e r o t h e t a l i g n m e n t and

209 n o t i a r u i g f n o c f o h e t t s i w r and l a r p a c s . e n o b

210 From a c t r h o o f o 1128 e v i u t c e n s o c e s s a c ， we d e i f i t n e d i a t t h 12.8%

211 5 4 ( 1 ) s e s a c f o t s n e i t a p i n g n t s e r e p o t o u r e t u t i t s n i showed e i v a t r n e g e e d

212 c i t i r h t r a o e t s o changes n i h e t l n a r u c t e p s a f o e t h t s r i w u s i n g s t a n d a r d

213 PA . s p h a g r o d i a r We d s e r v e o b e s t h y o p t e s o on l a r e t a l a p h s i o g r r a d n i two

214 . s e s a c In e e s t h two s e s c a ， e s t h y o p e s t o were n s e e n i i d s i g m o h n o t c f o

215 e t h s i u d r a on both PA and l a r e t a l s . h a p r g i o d r a As h e t a l p a r c bones

216 l a p p e d o v e r on l a r e t a l a p h s i o g r r a d ， we d l o u c t n o e j u d g e t h s e r u t a f e f o

217 OA ， t e p x c e o t d e t e r m i n e t a t h one was d t e a c o l n i h e t a r e a f o e h t

218 m o i d s i g n o t c h f o t h e . s u i d a r Thus ， we determined e t h n c e r e s e p f o

219 e s y t p h e o s t o r o f e t h n o i t i n i f e d f o OA n g u s i l y o n PA . s w e i v s T h i

220 g e n t a e r c e p 1 ( 8 . 2 %) f o l n a r u t s i r w OA i s o w e r l than t a h t d t e o r e p r by

221 Yamazaki t e al . 8 1 [ ， ] where asymptomatic OA f o e t h DRUJ was

222 d e i f i t n e d i n i 26 % ( 4 3 u t o f o 130 ) s t s i r w from 65 normal . s r e e t n u l o v

223 The e c n e r e f f i d between s t l u s e r l d o u c be d e t b u i r t t a o t a d t n e r e f f i a i r e t i r c

224 f o . n o i s u l c n i We e d u d n c l i h e t s t n e i t a p with t i s r w symptoms; however ，

225 Yamasaki d d e l u n c i normal r s e t e u n l v o and t h e y d n e f i e d more than e g r a d

226 1 o f e t h e u r e n c e n - L a l l g r K e n o i t a c i f i s s a l c ] 9 1 [ s a O . A The n o i t i n i f e d f o

227 t n i o j e p a c s narrowing based on e t h e n c e n - L a u r K e l l g r e n o i t a c i f i s s a l c s i

228 vague ， and h e t c t a e x n o i t i n i f e d f o s t i r w t n i o j a c e s p narrowing has

229 never been h e d b l i s p u o t our k n o w l e d g e . I n our s t u d y ， t h e n c e e s e p r f o

230 one r o more f o s y t e p h e o s t o ， t n i o j e a c s p narrowing ， s u b c h o n d r a l s i s o r e l c s ，

231 r o r a l s u b c h o n d s t s y c was d n e f i d e a s O A . Furthermore ， we y l t c i r t s

232 d n e f i d e t n i o j e a c s p narrowing s a a d e c a n t s i f o s s e l than 1 m m

233 between each bone n i t h e . t n i o j As a r t l u s e ， h e t kappa s u e a l v r o f

234 - r e t n i and r v e r e b s o - r a t n i agreement based on our n o i t i n i f e d f o OA were

235 a b l e . c o m p a r Thus ， e t h y n c e p a c r d i s f o e t h e c e n d c i n i f o OA between o u r

236 study and a t t h f o Yamazaki t e al . s i y l e k i l due o t e t h e c n e r e f f i d n i

237 both e t h a i r e t i r c f o n t a p c i i t a r p n o i s u c l n i and h e t n o i t i n i f e d f o O . A

238 We d t e a i g t e s v i n e t h e l e n c e v a p r f o v e a t i e r g e n d e c i t i r h t r a changes n i e t h

239 ulnar c t p e a s f o t h e t i s w r and found t a t h h e t c y f r e q u e n f o OA was

240 t h e s h i g t a t h e DRUJ ， and t h e e c o n d - m o s t s y l n t u e e q r f d e i f i t n e d i e h t

241 n a t e l n o l u u . t n i o j I n n o t i i d d a ， t h e c y q u e n f r e f o e v i t i s o p UV with OA

242 7 . 0 4 ( ， % 59 o r o 145 f ) s e s a c was y l l a c i t s i t a t s h e r h i g than a t t h f o h e t l o r t n o c

243 group 8 . 2 2 ( ， % r o 33 o 145 f ) s e s a c . ) l O O . O = P ( Nakamura t e al . ] 0 2 [ e d o r t e p r

244 t h a t UV n i 325 Japanese normal s t i s r w e d a s r e n c i with a g e ， and

245 e v i t i s o p UV (more than 1 mm) was t e n r e s p n i 108 e s s c a 2 . 2 3 ( . % )

246 Al though we e d i n e f d e v i t i s o p UV s a more than 2 m m ， h e t c y e q u e n f r

247 f o e v i t i s o p UV i n o u r l o r t n o c g r o u p was r l y e a n a l e q u o t t h a t n i h e t

248 r t o p r e f o e t h Nakamura t e al . and e t h q u e n c y f r e f o e v i t i s o p UV with

249 OA was g h e r h i than a t t h i t h o u t w O . A

250 I n r e r d o o t y f i t n e d i t h e s r o t c a f t a h t e a r d e t a e l r r o c with h e t c e s e n p r e

251 f o OA t a h e t u l n a r t c p e a s f o h e t t i s r w t n i o j ， we d e a t g i t e s v n i var

us

252 s r o t c a f ， n g i u d l n c i a g e ， gender ， and h e t a r g u i f o n c n o i t f o h e t t s i w r and

253 a l p a r c . n t m e g n l i a Of e h e s t s r o t c a f ， e t h r o t c a f most l a i t n e u l f n i o t t h e

254 e n c e s e p r f o OA o f e t h a r u l n c t e p a s f o t h e t i s r w t n i o j was ， v u with 255 an o d d s o i t a r f o . 1 645 ， g n t i a c i d n i t a t h e t h e v i t a l e r k s i r f o OA o f t h e

256 u l n a r c t e s p a f o h e t t i s r w t n i o j d s e a r e n c i by . 1 645 s i m e t when UV

257 d s e e a c r i n by 1 mm. s i o u r e v P a l a n i c m e c h b i o s e i d u t s e a r n i agreement

258 with our s t l u s e r 1 2 [ ， 22 ， . ] 3 2 Werner t e al . ] 1 2 [ d t e p o r r e a t h t l a i d a r

259 g n i n t e o r s h r o n a r u l n g h e n i n g t l e caused a s t n a c i f i n g i s e a e c r n i n i r e s u r e s p

260 t a h e t DRUJ; h e t r e n t e c f o e u r s s r e p was d e t a c o l more y l l a t s i d n i e t h

261 o i d s i g m n o t c h f o t h e u s d i r a ， and moved from t h e l a r t n e c l a s r o d n i o g r e

262 f o e h t s i g m o i d t c h n o o t t h e l a t s i d rim f o e t h . n o i t a l u c i t r a h i s T

263 l a i c g o l o s i y h p n - o n t c a t o n c caused an y t u i r n g o n c i n i h e t n o i t a l u c i t r a f o h e t

264 DRUJ ， l n g d i e a o t O A . Palmer t e al . ] 2 2 [ e d r t e p o r an e a s e c r n i n i

265 r a l u c i t r a e s u r r e s p t a h e t e n a t o l u l n u n o i t a l u c i t r a from . 1 4 N/mm

o t 3 . 3

266 N/mm

， with an r u l n a n i n g g t h e l e n f o 5 . 2 mm. y l a r l m i i S ， Fernandez ] 3 2 [

267 e d r t p o r e t h a t t s p o

aumatic y m i t o r e f d r e t f a a f e r u t c a r n i e t h l a t s i d end

268 f o e h t s i u a d r became symptomatic f i e t h change n i UV was more

269 than 5 m m ， g u s i n c a OA i n e t h DRUJ.

270 T h i s s t u d y had l a r e v e s . s n o i t a t i m i l The t s r i f s i t a t h many f o e t h

271 s t n e i t a p d e l l o r n e n i s i h t u d y s t demonstrated some p e t y f o t s r i w

272 . l e m o b p r e o r r e f h e T ， our s t u d y may be d e t c e f f a by h e t s c i t s i r e t c a r a h c f o

273 e t h s t n e i a t p d e l l o r n e n i s i h t . y d u t s t I s i e r y v t l u c i f f i d o t l l o r n e

274 enough normal s r e e n t l u o v o t t e u a a l e v e t h e n c e d c i n i and n o i t u b i r t s i d f o

275 OA i n h e t a r u l n t e c p a s f o e t h . t s i r w However ， UV ( 1 6 . 0 mm) n i o u r

276 145 t c e l e s l o r t n o c s e a s c t w i t h o u OA was a l m o s t u a l e q o t t a t h f o h e t

277 normal s r e e n t u o l v . ] 0 2 [ As r o f h e t mean u e s v a l f o RI 8 . 5 2 ( ) s e r e g e d ，

278 CHR 4 5 ( 4 . ， ) % VT 1 ( 3 . 2 ) s e e r e g d ， RLA 6 8 . 6 ( ) s e e r g e d ， and RSA 2 5 ( 4 .

279 ) s e e r g e d n i e t h l o r t n o c e s s a c ， normal Japanese s l u e v a have o t n been

280 ; d e t r o p e r however ， our s t l u s e r were s t a l m o t n e t s i n s o c with mean s u e a l v

281 r o f Europeans and Americans 4 2 [ ， 25 ， . ] 6 2 The s e c o n d n o i t a t i m i l f o s i h t

282 study was a t h t our i c h a p g r i o d r a s n i o t u a l v a e were based on c i t a t s

283 . h s p r a g i o a d r n t i o J y t i l i b a t s n i s i one f o t h e s e s p a t h o g e n e f o OA ， and

284 dynamic y t i l i b a t s n i f o h e t t n i o j e d i v r d e from a s t f o e u s s i t r y u j n i ， such

285 s a TFCC y r u n j i cannot be y l t n e i c i f f u s a t e d v a l u e by c i t a t s h s g r a p d i o r a

286 . ] 7 2 [ r e e f o e r T h ， we a n n o t c comment on e t h e c n e u l n f i f o t n i o j y t i l i b a t s n i

287 on OA n i h e t u l n a r t e c s p a f o e t h . t s i r w The d r i h t n o i t a t i m i l was

288 t t h a we i d d o t n e g r a d h e t c h i a p g r i o a d r changes f o OA i n each ; t n i o j

289 r t h e r a ， t h e s e u r t a e f f o OA were . d e a t u l v a e Grading f o e t h c i p h r a o g i a d r

290 changes f o OA would e i d o v p r a more e a t u r c c a n i o a t l u v a e f o OA n i

291 t h e l n a r u c t p e a s f o t h e . t s i r w

292 Further l n a i d u i t g n l o s t u d y s i needed o t e t a g i t s v e n i a t t h h e t e a s c with

293 e v i t i s o p UV p l y e v i c t e p s o r e s s g r r o p o t OA i n h e t u l n a r . t s i r w

294

295 c l u s i o n C o n

296 We found h a t t primary OA n i e h t u l n a r t e c s p a f o e t h t i s r w was

297 i t n e d i

ed n i 145 1 ( 8 . 2 %) f o 1128 s t n i e t a p ， and was t h e most t e n q u r e f

298 i n e t h DRUJ and n d - m o s t s e c o n i e t h e n a t n o l u u l . t n i o j An d UV was

299 t h e most e d t a l e r r o c with OA i n h e t u l n a r c t e s p a f o h e t s t r i w . t n i o j

300 Based on e t h e n t r r c u s t l u s e r ， we would e p r o p o s l y r a e n o i t c e r r o c f o

301 e v i t i s o p UV n i s t n e t i a p with

l n a r u abutment syndrome when

302 v e t i v a e r s o n c treatment s l i a f ， e t y no r a e l c e n c d e e v i s t s i x e o t t p p o r s u o u r

303 . n o i t i s o p o r p Further l a c i n i l c s t u d y h o u l d s be performed o t r m c o n f i a t h t

304 t h e n g t h e n i l e n g c e d u r e p r o s a an ulna - r n g e n i r t s h o osteotomy r o f h e t y l r a e

305 g r a d e s f o u l n a r abutment syndrome t n o l y o n e s e d u c r s t i r w pain and

306 y t i l i b a s i d ， but o s l a e s a s r e e c d e t h u e n c y f r e q f o OA by improving h e t

307 i n c o n g r u e n c e f o e t h l a t s i d r l n a i o u a d r . t n i o j

308

1.2%

• l a t s i d r a n l u o i a d r

・ ^{a t e o l u n u l n}

・ ^{e t a i t p a o c n u l}

・ ^{e t n a u l i o d a r}

・ triquetrohamate

・ ^lunohamate

・ ^{l a r t e u q i r t o n u l}

Table 1 Characteristics of each variable with and without OA Variable Primary OA Control (N=145) (N=145) Gender Male: 51 Male : 52 Female : 94 Female : 93 Age 67.6+13.9 67.3+12.3 Radial inclination 25.3+2.7 25.8+2.2 Ulnar variance 1.37 ::f: 1.5 0.61 土 1.2 Carpal height ratio 53.8+2.6 54.4+2.5 Volar tilt 12.7+4.1 12.3+3.7 Radiolunate angle 5.39+7.7 6.86 ::f: 6.8 Radioscaphoid angle 53.8 ::f: 7.6 52.4+7.1 Values are represented as the mean

standard deviation.

Table 2 Correlation between osteoarthritis of the ulnar aspect of the wrist joint and variables ulnar aspect of the wrist joint Variable Pearsonls R p Value Gender 0.008 0.901 Age 0.005 0.932 Radial inclination

0.137 0.022* Ulnar variance 0.293 <0.001 * Carpal height ratio ー 0.142 0.027* Volar tilt 0.112 0.211 Radiolunate angle ー 0.127 0.037* Radioscaphoid angle | 0.099 0.147 * : Statistically signi

cant.

Table 3 Logistic Regression An alysis: Factors correlated with osteoarthritis of the ulnar aspect of the wrist joint Variable Radial inclination Ulnar variance Carpal height ratio Radiolunate angle

95% Confidence Interval Odds Ratio Lower Upper p Value 0.856 0.765 0.958 0.007* 1.645 1.341 2.018

0.001 * 0.861 0.776 0.956 0.005* 0.921 0.877 0.984 0.21 Object variable: osteoarthritis of the ulnar aspect of the wrist joint * : Statistically significant.

Table 4 1ntraclass correlation coefficient (ICC) and kappa values ( ): 95% confidence interval