In rheumatoid arthritis of the wrist, the specific deformity of the carpus on X-ray showing volar subluxation and ulnar translation of the carpus on the distal radius is described as:

• A Madelung's deformity
• B DISI (Dorsal Intercalated Segment Instability) pattern
• C Radial translocation of the carpus
• D Palmar intercalated segment instability (VISI) with carpal collapse ✓

Explanation

In rheumatoid arthritis of the wrist, synovitis destroys the stabilising ligaments (radioscaphocapitate and palmar radiocarpal ligaments). The carpus migrates ulnarward and palmarly — ulnar translocation is the most characteristic RA carpal collapse pattern. This results in a VISI (PISI — palmar intercalated segment instability) pattern where the lunate tilts palmarly. This is distinct from DISI (seen in scaphoid non-union or scapholunate ligament disruption where the lunate extends dorsally). Madelung's is a congenital/developmental deformity of the distal radius.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.