We now have a new prosthesis and method of treating loss of pronation and suppination caused by incongruity of the joint between the radius and ulna (the radioulnar joint ) of the wrist. Movement in the palm up and palm down motion of the wrist is called pronation and suppination. Pronation is when you turn your palm down toward the floor and suppination is when you turn your palm up toward the sky. When patients have an injury or arthritis of the wrist joint between the radius (the larger bone of the forearm behind your thumb) and the ulna (the smaller bone of the forearm behind your little finger portion of the wrist) there can be limitation palm up and palm down motion. The loss of motion in this joint can be very disabling causing the patient to have to use the shoulder to aid in certain activities.
Since about 1933, one method of treatment was to remove a portion of the end of the ulna. This is called the Darrach procedure after the doctor that developed that operation. Another procedure to address the radioulnar joint problem was the hemi-arthroplasty that removed only the articular portion of the R-U joint and left the lateral ligament in place to give more stability. Many other procedures have been used with some success. The Sauve-Kapandji procedure fused the R-L joint but removed about a centimeter of the ulna bone to allow motion. There have been some very good prostheses for the end of the ulna that gave good results.
However, a most troubling situation was when the previous procedures did not relieve pain, allow congruent motion or translated with too much movement especially at the end of the ulna. If a patient had persistent pain, instability or incongruity after failure of the above mentioned procedures, we had few options other than to fuse the forearm into a one bone forearm.
The Scheker Prosthesis
Dr. Luis Scheker who practices in Louisville, Kentucky developed a prosthesis that replaces both the radial side of the joint and the ulnar side of the joint. There have been many attempts to correct this radioulnar joint problem with some good results. In my practice of hand surgery of 37 years, I had not found a total joint for the radioulnar area that I had confidence in providing pain relief, stability and good functional capacity. I was especially reluctant to place a total joint in young people with high functional demands.
Procedure Demonstrates Pain Relief Where Others Fail
I was encouraged when Dr. Scheker demonstrated the total joint he had placed in an 18 year old active female. I had a patient in mind that was 33 years old and had undergone 5 operations with other doctors and had come to me for a solution. The Scheker total joint relieved the 33 year old female’s pain and gave her stability we never thought she could attain.
Since that first patient, I have used the Scheker for active patients of all ages including an 81 year old man that plays tennis every day since his retirement. The Scheker is not the first line of treatment but gives an alternative when other methods have failed.
Google “Scheker Prothesis for radioulnar joint reconstruction” for further information and pictures.
Please note that I have no financial interest in the Scheker prosthesis. I am providing this information to relay my experience and to inform patients of treatment alternatives.
More information on Basal Thumb Arthritis
To obtain more detailed information about conditions of the hand, wrist, forearm and elbow, visit our Patient Education page.
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Please Note: The medical information contained on this website is provided to increase your knowledge and understanding of hand and upper extremity problems or conditions. This information should not be interpreted as the Van Wyk Hand Center’s recommendation for a specific medical or surgical treatment plan.
Material modified from the American Society for Surgery of the Hand.