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Arthroscopic Treatment of an Juvenile Idiopathic Arthritis of the Wrist

Juvenile idiopathic arthritis comprises a group of arthritic diseases of various etiologies with onset before 16 years of age. Wrist arthroscopy has become a useful tool for diagnosing and treating adult patients with rheumatoid arthritis with refractory wrist pain. However, the role of arthroscopy in juvenile idiopathic arthritis is ambiguous. This paper presents a rare case of juvenile idiopathic arthritis accompanied by volar intercalated segment instability (VISI) deformity in a 16-year-old woman.

A 16-year-old woman presented with chronic wrist pain associated with volar intercalated segment instability (VISI) deformity. After several initial tests, the patient was suspected of having juvenile idiopathic arthritis, and diagnostic arthroscopy and arthroscopic synovectomy were performed simultaneously. With aggressive synovectomy in the radiocarpal and midcarpal joints, two temporary K-wires were inserted at reduced carpal alignment.

The K-wires were removed 4 weeks postoperatively, and short arm cast immobilization was continued for 12 weeks. Subsequent biopsy and bone scan results verified the diagnosis of juvenile idiopathic arthritis. After 1 year of follow-up, the patient presented with a pain visual analog scale score of 0–1, and the Disability of Shoulder, Elbow, and Hand score was 1.5 without VISI deformity, although the wrist flexion and extension were slightly limited at 60° and 70°, respectively.

Arthroscopic synovectomy with temporary K-wire fixation yielded excellent results in the treatment of juvenile idiopathic arthritis combined with VISI deformity. The wrist scope could be a useful modality in cases such as this in terms of diagnosis, improving symptoms, and correcting alignment.

Wrist, Volar intercalated segment instability, Arthroscopy, Synovectomy, Juvenile Idiopathic Arthritis