Journal articles on the topic 'Wrist'
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1
Hinds, Richard M., Eitan Melamed, April O’Connell, Francoise Cherry, Monica Seu, and John T. Capo. "Assessment of Wrist Function After Simulated Total Wrist Arthrodesis." HAND 11, no. 4 (July 7, 2016): 464–68. http://dx.doi.org/10.1177/1558944715626930.
Abstract:
Background: There is poor consensus in the literature regarding associated functional limitation and the preferred wrist position for total wrist arthrodesis. The purpose of the current investigation was twofold: (1) to assess the functional limitations of wrist arthrodesis and (2) to determine the optimal position for wrist arthrodesis using a simulated wrist fusion model. Methods: Twenty healthy volunteers underwent simulated wrist arthrodesis in 6 different positions using custom-molded wrist splints: 15° extension with 0° radio-ulnar deviation, 15° extension with 10° ulnar deviation, 15° extension with 10° radial deviation, 0° extension with 0° radio-ulnar deviation, 0° extension with 10° ulnar deviation, and 0° extension with 10° radial deviation. Each volunteer was independently assessed for wrist function using the Jebsen-Taylor hand function test, grip strength, and satisfaction in the simulated wrist fusion positions. Comparisons between all simulated fusion wrists and the baseline unsplinted wrist as well as among the 6 simulated fusion positions were performed. Results: Turning over a card (5.1 vs 4.3 seconds), picking up small objects (7.1 vs 5.8 seconds), and simulated feeding (8.3 vs 7.1 seconds) as well as total Jebsen-Taylor test duration (41.8 vs 37.9 seconds) was significantly longer in simulated fusion wrists. Both grip strength (55.9 vs 80.7 kg) and satisfaction scores (6.4 vs 9.6) were lower in simulated fusion wrists. Wrists in 0° extension also demonstrated significantly shorter durations in stacking checkers than wrists in 15° extension. Conclusion: Our findings suggest that wrist arthrodesis may only compromise select wrist functions. Among the tested wrist fusion positions, wrists fused in neutral may demonstrate better function than wrist fused in slight extension. However, grip strength and satisfaction seem to be unaffected by wrist fusion position.
2
Zijlker, Hero J. A., Ruben K. Fakkert, Annechien Beumer, Cees B. IJsselstein, Mascha Wessels, and Marco J. P. F. Ritt. "Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis." Journal of Hand Surgery (European Volume) 47, no. 3 (November 19, 2021): 302–7. http://dx.doi.org/10.1177/17531934211057389.
Abstract:
A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes. Level of evidence: III
3
FERRERES, A., S. SUSO, J. ORDI, M. LLUSA, and D. RUANO. "Wrist Denervation." Journal of Hand Surgery 20, no. 6 (December 1995): 761–68. http://dx.doi.org/10.1016/s0266-7681(95)80043-3.
Abstract:
In 1966, Wilhelm published a technique of denervation of the wrist joint based on his own anatomical studies of 1958. Other authors have published their experience in wrist denervations with similar results, but there are some discrepancies in descriptions of the innervation of the wrist. We have studied the innervation of the wrist by dissection under magnification on 20 cadaver limbs and by histological examination of five human foetal wrists. Based in our anatomical findings, we have demonstrated that Wilhelm's technique does not achieve total denervation of the wrist.
4
Rizzo, M., D. B. Ackerman, R. L. Rodrigues, and R. D. Beckenbaugh. "Wrist arthrodesis as a salvage procedure for failed implant arthroplasty." Journal of Hand Surgery (European Volume) 36, no. 1 (July 9, 2010): 29–33. http://dx.doi.org/10.1177/1753193410376283.
Abstract:
Salvage of failed total wrist arthroplasty by arthrodesis may be difficult because of bone loss and poor quality of bone and soft tissues. We examined the outcomes of wrist arthrodesis for failed total wrist arthroplasty in a retrospective study of 21 wrists in 17 patients. Clinical data, radiographs, patient-reported outcomes and DASH questionnaires were used. Thirteen women and four men had undergone total wrist arthroplasty at an average age of 55 years. The mode of failure was aseptic loosening in 13 wrists. The average time from the index arthroplasty to wrist arthrodesis was 7.6 years. Autograft and/or allograft bone graft was used in all of the wrists. Arthrodesis was achieved in 11 wrists and ten had a nonunion. Six arthrodeses underwent eight revisions for nonunion, with two achieving union. The mean DASH score was 29 in wrists that fused and 36 in those that did not fuse. Pain scores averaged 2.1 in the wrists that fused and 3.3 in the nonunion group. Most patients had clinical improvement.
5
Yasuda, Masataka, Kazuhiro Masada, and Eiji Takeuchi. "DORSAL WRIST SYNDROME REPAIR." Hand Surgery 09, no. 01 (July 2004): 45–48. http://dx.doi.org/10.1142/s0218810404002054.
Abstract:
Dorsal wrist pain with or without a palpable dorsal wrist ganglion is a common complaint. Watson developed the concept of the dorsal wrist syndrome (DWS) which is an entity encompassing pre-dynamic rotary subluxation of the scaphoid and the overloaded wrist. We reviewed 20 cases of DWS treated surgically. There were nine males (11 wrists) and nine females (nine wrists). Post-operative follow-up ranged from five to 67 months (mean, 37 months). At operation, we observed SLL tears in eight wrists and dorsal ganglia in 12 cases. Following surgery, 12 cases reported being pain free, five had mild pain, two moderate pain and one case reported severe pain. Post-operative extension/flexion was 73/70 average. Post-operative grip strength was 28 kg average. We believe that excision of the posterior interosseous nerve and the dorsal capsule including the ganglion, if present, provides pain relief in DWS.
6
Trabia, M., and J. K. Davidson. "Substitute-Wrists to Aid in the Placing of Tools on Robots With 3-R Spherical Wrists." Journal of Mechanical Design 114, no. 1 (March 1, 1992): 143–52. http://dx.doi.org/10.1115/1.2916908.
Abstract:
This paper treats the three-jointed spherical wrist on which the tool is placed at an angle δ ≠ 0. A two-parameter set of axes is identified for the wrist such that the angular velocities and accelerations at the three joints are within acceptable limits during a 2π-rotation of the end-effector at constant speed about each such axis. This set of axes is compared both to the total set of available axes of full rotation and to the set for which the determinant of the wrist Jacobian is greater than a specified minimum value. For each set of axes, hypothetical substitute-wrists permit the generalization of design conditions for robots with spherical wrists on which δ = 0 to robots with spherical wrists on which δ ≠ 0, and they provide geometrical limits on tool-placement which bound the velocities and accelerations at the wrist joints. Lastly, comments are made about balancing the velocity and acceleration characteristics of the actuators in a spherical wrist.
7
Wagner, Eric R., Megan Conti Mica, and Alexander Y. Shin. "Smartphone photography utilized to measure wrist range of motion." Journal of Hand Surgery (European Volume) 43, no. 2 (September 5, 2017): 187–92. http://dx.doi.org/10.1177/1753193417729140.
Abstract:
The purpose was to determine if smartphone photography is a reliable tool in measuring wrist movement. Smartphones were used to take digital photos of both wrists in 32 normal participants (64 wrists) at extremes of wrist motion. The smartphone measurements were compared with clinical goniometry measurements. There was a very high correlation between the clinical goniometry and smartphone measurements, as the concordance coefficients were high for radial deviation, ulnar deviation, wrist extension and wrist flexion. The Pearson coefficients also demonstrated the high precision of the smartphone measurements. The Bland–Altman plots demonstrated 29–31 of 32 smartphone measurements were within the 95% confidence interval of the clinical measurements for all positions of the wrists. There was high reliability between the photography taken by the volunteer and researcher, as well as high inter-observer reliability. Smartphone digital photography is a reliable and accurate tool for measuring wrist range of motion. Level of evidence: II
8
Kennedy, John W., Andrew Ross, Jonathan Wright, David J. Martin, Marc Bransby-Zachary, and Duncan J. MacDonald. "Universal 2 total wrist arthroplasty: high satisfaction but high complication rates." Journal of Hand Surgery (European Volume) 43, no. 4 (March 8, 2018): 375–79. http://dx.doi.org/10.1177/1753193418761513.
Abstract:
The Universal 2 total wrist arthroplasty is intended to alleviate wrist pain and restore function. There is limited evidence regarding its success and safety. We report outcomes in 48 wrists of 46 patients with Universal 2 arthroplasty between 2006 and 2014. We recorded range of motion of the operated wrist, patient satisfaction, complication and revision rates, and radiological appearances of the wrists with mean follow-up of 7 years (3.5 to 11 years). We found a significant improvement in DASH scores after surgery, with active range of wrist motion being 33° flexion and 24° extension. Thirty-nine patients would undergo the procedure again if he had similar wrist problems. Twenty-three patients had loosening of at least one component of the implant. Complications were found in 13 wrists; seven underwent revision. We conclude that the Universal 2 arthroplasty produces significant improvements in DASH scores and high levels of satisfaction of the patients. However, the surgery has a high complication rate. Level of evidence: IV
9
Reigstad, O., T. Holm-Glad, R. Thorkildsen, C. Grimsgaard, and M. Røkkum. "Successful conversion of wrist prosthesis to arthrodesis in 11 patients." Journal of Hand Surgery (European Volume) 42, no. 1 (October 27, 2016): 84–89. http://dx.doi.org/10.1177/1753193416674929.
Abstract:
From 2001 to 2015, 11 wrists in 11 patients with osteoarthritis of the wrist had failed wrist arthroplasties, which were subsequently converted to arthrodesis using intercalated corticocancellous autograft from the iliac crest and fixation with an arthrodesis plate or a customized peg. Clinical and radiological bone union was achieved in all the operated wrists. At final follow-up of ten patients after 6 years, they had a substantial reduction in pain and improvement in daily function and grip strength compared with those before arthrodesis. We conclude from outcomes of this series that the conversion to arthrodesis after failed wrist arthroplasty is worthwhile and reliably improve wrist function over failed wrist arthroplasty. The results suggest that the patients who will have wrist arthroplasty can be assured that in case of failure the conversion to arthrodesis will produce outcomes comparable with those after primary arthrodesis. Level of evidence: IV
10
SCHERNBERG, F. "Roentgenographic Examination of the Wrist: A Systematic Study of the Normal, Lax and Injured Wrist." Journal of Hand Surgery 15, no. 2 (April 1990): 220–28. http://dx.doi.org/10.1016/0266-7681_90_90127-p.
Abstract:
The standard and positional views of 53 normal wrists have been compared to views taken under stress. The stresses applied can be divided into normal and abnormal ones. All the injured wrists with pathological roentgenographic appearances were operated on and thus the findings confirmed. Roentgenographic examination of the wrist under stress appears to be a valuable and reliable diagnostic aid. Two types of laxity of the wrist and a radio-anatomical classification of wrist instabilities are defined.
11
Mwaturura, Tendai, Frédéric-Charles Cloutier, and Parham Daneshvar. "Analysis of Radiographic Relationship between Distal Radius, Ulna, and Lunate." Journal of Wrist Surgery 08, no. 05 (May 9, 2019): 374–79. http://dx.doi.org/10.1055/s-0039-1688693.
Abstract:
Background Wrist anatomy variability is associated with differing susceptibility to pathology. For example, a flat radial inclination is associated with Kienbock's disease. Lunate facet inclination (LFI) also exhibits variability. Its relationship with other wrist features is poorly documented. Purposes We tested the hypothesis that high LFI is associated with increased uncovering of the lunate, negative ulnar variance (UV), and type 2 lunates to balance forces across wrists. Methods In total, 50 bilateral and 100 unilateral wrist posteroanterior radiographs were reviewed. Lunate type, lunate uncovering index (LUI), lunate tilting angle (LTA), UV, and sigmoid notch angle (SNA) were measured, and correlation with LFI was assessed on 150 right wrist radiographs followed by an assessment of differences based on lunate morphology. Symmetry of 50 bilateral wrists was assessed. Results There was no correlation of LFI with lunate morphology, LUI, and LTA. There was a low correlation of LFI with SNA and UV. There was an inverse relationship between UV and SNA. Wrists with type 2 lunates had more oblique sigmoid notches and higher LTA in comparison to wrists with type 1 lunates. Side-to-side comparison revealed strong correlation except for LUI, which exhibited moderate correlation. Conclusions There is no correlation between LFI, LUI, and lunate morphology. Type 2 lunates are associated with higher LTA and more oblique SNA. Wrists were symmetrical. Clinical Relevance Factors other than lunate morphology are essential in balancing forces across wrists. A better understanding of soft tissue and other factors will improve the understanding of wrist biomechanics and pathology. Contralateral wrist radiographs can guide reconstructive surgery.
12
HONKANEN, P. B., S. MÄKELÄ, Y. T. KONTTINEN, and M. U. K. LEHTO. "Radiocarpal Arthrodesis in the Treatment of the Rheumatoid Wrist. A Prospective Midterm Follow-up." Journal of Hand Surgery (European Volume) 32, no. 4 (August 2007): 368–76. http://dx.doi.org/10.1016/j.jhse.2007.04.006.
Abstract:
This prospective study was performed to evaluate the clinical and radiological results of radiocarpal joint arthrodesis in the treatment of unstable Simmen group III and Larsen grade II or III rheumatoid wrists. Radiolunate arthrodesis was performed in 16 wrists and radioscapholunate arthrodesis in 7 wrists in 20 patients. When they were evaluated at a mean of 5.8 (range 3.5–9.8) years later, flexion was 29° and extension 34°, representing 67% and 92% of the preoperative values, respectively. Patient satisfaction was excellent, or good, for 20 wrists and satisfactory for 1 wrist. In two patients with poor satisfaction, arthritis progressed to the midcarpal joint and necessitated total arthrodesis of the wrist. Radiolunate joint arthrodesis, with inclusion of the scaphoid in the fusion if necessary, is a useful operation in the treatment of this degree of wrist disease as it produces a functional and pain-free wrist at the same time as preserving much of the mobility and bone stock.
13
Zijlker, Hero J. A., Merel J. Berkhout, Marco J. P. F. Ritt, Niels van Leeuwen, and Cees B. IJsselstein. "Universal 2 total wrist arthroplasty for the salvage of failed Biaxial total wrist arthroplasty." Journal of Hand Surgery (European Volume) 44, no. 6 (January 17, 2019): 614–19. http://dx.doi.org/10.1177/1753193418822425.
Abstract:
Universal 2 implants may be an alternative to total wrist arthrodesis for the salvage of failed Biaxial total wrist prostheses. We assessed 40 Universal 2 revision implants retrospectively. Fourteen of these wrists were converted to total wrist arthrodeses, and two wrists received a third total wrist arthroplasty after a mean period of 5.5 years. Twenty-four of the Universal 2 implants that remained in situ after a mean follow-up of 9 years (range 4 to 13 years) were re-examined. Sixteen functioned satisfactorily. Patient-Rated Wrist and Hand Evaluation scores and Quick Disabilities of the Arm, Shoulder and Hand scores were 53 and 47, respectively. Twenty-nine patients would choose the Universal 2 again and would also recommend it to other patients. The survival of the revision implants was 60% at a mean follow-up of 9 years. Level of evidence: IV
14
Kwok, Yan Yan, Pak-Cheong Ho, Guy Feldman, Eugene Lo, Erik Wells, and Ronit Wollstein. "Comparison of Wrist Motion and Grip Strength in a Normal Chinese and Caucasian Population." Journal of Hand Surgery (Asian-Pacific Volume) 21, no. 03 (September 5, 2016): 364–68. http://dx.doi.org/10.1142/s2424835516500351.
Abstract:
Background: Anatomical and functional differences between Asian and Caucasian populations have been described and are important in treatment of wrist pathology. The purpose of this study was to establish and compare normal values in an Asian and Caucasian population. We hypothesized that a normal Asian population will have greater wrist ROM and reduced grip- strength when compared to a normal Caucasian population. Methods: One hundred and–seventy-one normal Asian and 156 normal Caucasian wrists were evaluated. We excluded wrists with current or a history of wrist pathology including past surgery, injury or congenital malformation. We collected demographic information regarding occupation, body mass index (BMI), and previous wrist pathology. The wrist measurements included: wrist extension, flexion, radial, ulnar deviation, and grip strength. Wrists were also evaluated for a mid-carpal clunk, and scaphoid shift test. Mixed models accounted for evaluation of both hands in the same individual and for the relative contribution of different factors to the outcome measures of ROM and grip- strength. Results: The two groups differed in height, BMI and the distribution of occupation. The Asian group had more flexion, less extension and similar radial/ulnar wrist deviation when compared to the Caucasian group. Ethnicity was a significant predictor of wrist joint flexion and extension significantly predicting grip- strength. Age was associated with ROM while occupation, hand side and gender were not significant factors in the mixed model. Conclusions: We found discrete differences between values in the two populations. More study of anatomical morphological patterns may explain the reason for variations in motion and grip- strength. The differences identified in this study between Asian and Caucasian populations should be taken into account when evaluating outcomes of wrist therapeutic procedures and rehabilitation in different communities.
15
Fukui, Akihiro, Hideki Yamada, and Takashi Yoshii. "Effect of Intraarticular Triamcinolone Acetonide Injection for Wrist Pain in Rheumatoid Arthritis Patients: A Statistical Investigation." Journal of Hand Surgery (Asian-Pacific Volume) 21, no. 02 (May 3, 2016): 239–45. http://dx.doi.org/10.1142/s2424835516500259.
Abstract:
Background: A significant number of patients on long-term treatment and users of biologics complain of wrist pain due to synovial proliferation and arthropathic changes. Synovectomy or joint arthroplasty is often indicated for such patients, but many refuse surgery. For these patients triamcinolone acetonide was injected into the dorsum of the wrist, and evaluated the clinical benefit and safety of the wrist joint. Methods: We injected triamcinolone acetonide into the dorsum of the wrist. We evaluated the clinical benefit and safety of intraarticular triamcinolone acetonide by analyzing data on (1) the number of injections, (2) decrease in visual analog scale pain, (3) changes in carpal height ratio, radio carpal distance ratio, and radial rotation angle in X-ray imaging, and (4) the adverse reactions of triamcinolone acetonide injection on the subcutaneous tissue and extensor tendons. Results: 1. The number of injections per patient over 3 years 8 months was 1 for 44 wrists, 2 for 21 wrists, 3 for 17 wrists, 4 for 6 wrists, 5 for 3 wrists, 6 for 3 wrists, 7 for 2 wrists, 9 for 2 wrists, 12 for 4 wrists, and 13 for 1 wrist. 2. The overall mean VAS improved from 79 mm at baseline to 11 mm post-injection. 3. In the grade I and II group, CHS, RCDR and RRA were not statistically significant. In the grade III and IV group, CHR showed a significant decrease. 4. Neither subcutaneous atrophy nor extensor tendon rupture was reported. Conclusions: More than 90% of patients of all disease grades responded to an average of 1 to 4 injections per year.
16
Wollstein, Ronit, Hisao Moritomo, Iida Akio, and Shohei Omokawa. "Scaphoid Motion of the Wrist with Scapho-trapezio-trapezoidal Osteoarthritis-A Pilot Study." Current Rheumatology Reviews 16, no. 3 (September 22, 2020): 206–9. http://dx.doi.org/10.2174/1573397115666190115125430.
Abstract:
Background: The purpose of this study was to investigate scaphoid motion within the scapho-trapezio-trapezoidal (STT) joint during wrist motion in the presence of STT joint osteoarthritis (OA). Methods: We studied 11 wrists with STT OA and 5 normal wrists. Computed tomography (CT) images were acquired in five wrist positions (maximum active flexion, extension, radial deviation, ulnar deviation, and neutral position). The 3-dimensional surface models of the radius and scaphoid were constructed and the motion of scaphoid relative to the radius was calculated. Results and Conclusion: During wrist flexion/extension motion, the scaphoid rotated mostly in the flexion/extension plane. The angle tended to be smaller in STT OA than in normal. During wrist radioulnar deviation, the scaphoid was in an extended position in neutral wrist in STT OA. The motion of scaphoid in STT OA was divided into two types: a rigid type and mobile type. The mobile type rotated closer to the flexion/extension plane than the rigid type. Taking into account scaphoid motion during wrist movement before surgery may provide better results in the treatment of STT OA.
17
TANIGUCHI, Y., M. YOSHIDA, and T. TAMAKI. "X-Ray Characteristics of Wrists in Calcium Pyrophosphate Crystal Deposition Disease." Journal of Hand Surgery 22, no. 5 (October 1997): 659–61. http://dx.doi.org/10.1016/s0266-7681(97)80369-5.
Abstract:
Deposition of calcium pyrophosphate dihydrate (CPPD) crystals has been considered to be a cause of scapholunate advanced collapse (SLAC) wrist. The aim of this study was to look at X-ray changes in wrist joints affected by CPPD crystal deposition disease and to determine whether crystal deposition is a cause of SLAC wrist. A total of 150 wrists of 78 patients with CPPD crystal deposition disease were examined. In our population of Japanese patients with CPPD crystal deposition disease, the incidence of SLAC wrist was very low, and no case of Stage III SLAC wrist was found. We therefore conclude that SLAC wrist is not a radiographic characteristic of CPPD crystal deposition disease and that pyrophosphate crystal deposition cannot be a major cause of SLAC wrist.
18
Oda, T., T. Wada, K. Iba, M. Aoki, M. Tamakawa, and T. Yamashita. "Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain." Journal of Hand Surgery (European Volume) 38, no. 7 (February 6, 2013): 746–50. http://dx.doi.org/10.1177/1753193413476979.
Abstract:
In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer’s Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.
19
ADOLFSSON, L., and M. FRISÉN. "Arthroscopic Synovectomy of the Rheumatoid Wrist." Journal of Hand Surgery 22, no. 6 (December 1997): 711–13. http://dx.doi.org/10.1016/s0266-7681(97)80430-5.
Abstract:
Twenty-four wrists in 19 patients with rheumatoid arthritis affecting the wrist were treated by arthroscopic synovectomy. Range of motion, subjective pain, wrist function and X-ray changes were recorded preoperatively and at an average of 3.8 years after operation. Arthroscopic synovectomy of the rheumatoid wrist reduced pain and improved wrist function in the majority of patients. Progress of arthritic degeneration was significantly less common in patients with no, or very early changes at the time of surgery.
20
Williams, R. L. "Singularities of a Manipulator With Offset Wrist." Journal of Mechanical Design 121, no. 2 (June 1, 1999): 315–19. http://dx.doi.org/10.1115/1.2829461.
Abstract:
The singularities of manipulators with offset wrists are difficult to enumerate. This article presents a numerical study to illuminate singularity problems when using an offset wrist with an articulated regional arm. Ironically, the regional manipulator singularity problem is worsened when using a singularity-free offset wrist. No wrist singularities exist (they are forced by design to lie outside of joint limits). However, the existing regional arm singularities become skewed from the well-known singular configurations of common manipulators. The wrist offset also skews the well-known wrist singularities (though they hopefully still lie outside of joint limits, their locations are no longer easily determined). Thus, a zero-offset singularity-free wrist is preferable with regard to overall manipulator singularities.
21
GILL, D. R. J., and D. C. R. IRELAND. "Limited Wrist Arthrodesis for the Salvage of SLAC Wrist." Journal of Hand Surgery 22, no. 4 (August 1997): 461–65. http://dx.doi.org/10.1016/s0266-7681(97)80267-7.
Abstract:
We report the results of limited wrist arthrodesis, a salvage procedure for SLAC wrist. It involves excision of the scaphoid, radial styloidectomy and fusion of the lunate to the capitate and the triquetrum to the hamate, using cancellous lag screws. Twenty-four wrists in 22 patients were reviewed retrospectively at an average follow-up of 23 months. Seventeen of the 22 patients had no pain or mild pain and had retained a mean arc of motion of 48°. Grip strength was 70% of the other side. Four of the 24 patients developed non-unions, two of which had successful revision to limited wrist arthrodesis. The other two required pan arthrodesis of the wrist. Two other patients with persisting pain in spite of solid fusion were also treated by pan arthrodesis of the wrist. Radial styloidectomy did not result in early failure of this procedure and secondary ulnar translocation of the carpus was not seen.
22
SCHERNBERG, F. "Roentgenographic Examination of the Wrist: A Systematic Study of the Normal, Lax and Injured Wrist." Journal of Hand Surgery 15, no. 2 (April 1990): 210–19. http://dx.doi.org/10.1016/0266-7681_90_90126-o.
Abstract:
The precise appearances and relationships of the carpal bones have been studied in 53 normal wrists, 15 lax wrists, and 80 injured wrists, using frontal and lateral projections with the wrist in neutral and in various other positions. The findings are discussed and analysed.
23
Yoshikawa, Tsuneo, and Shigeo Kiriyama. "Four-Joint Redundant Wrist Mechanism and Its Control." Journal of Dynamic Systems, Measurement, and Control 111, no. 2 (June 1, 1989): 200–204. http://dx.doi.org/10.1115/1.3153037.
Abstract:
It is known that conventional three-joint wrists of robot manipulators have two conical regions of degeneracy in which the ability of the wrist to orient the end-effector is poor, A four-joint wrist mechanism is proposed in this paper as a means of overcoming this degeneracy problem. The manipulating ability of this wrist with respect to the end-effector orientation is analyzed using the manipulability measure. A pseudoinverse control algorithm for this redundant wrist mechanism is developed and its effectiveness is shown by experiments.
24
Abdelaziz, Ashraf M., Wael Aldahshan, Faisal Ahmed Hashem El-Sherief, Yaser El Sayed Hassan Wahd, and Hany Abdel Gawwad Soliman. "Posterior Interosseous Neurectomy Alternative for Treating Chronic Wrist Pain." Journal of Wrist Surgery 08, no. 03 (January 29, 2019): 198–201. http://dx.doi.org/10.1055/s-0039-1677740.
Abstract:
Background Wrist denervation is one of the several available options for treating chronic wrist pain; partial wrist denervation performed through a single dorsal incision by resecting the distal posterior interosseous nerve provides good outcomes. Questions/Purposes This study evaluated the results of posterior interosseous neurectomy (PIN) in patients with chronic wrist pain secondary to scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC). Methods In total, 30 wrists obtained from 28 patients (25 males, 3 females) were assessed. The dominant hands of 25 (right-handed) patients, nondominant hands of 5, and both hands of 2 were considered. The average age at the time of surgery was 35 (range: 19–50) years, and the average follow-up duration was 18 (range: 12–30) months. Fifteen and 13 patients had wrists with SNAC and SLAC, respectively, and all of those underwent PIN performed through the dorsal approach. The pre- and postoperative range of motion, grip strength, and pain relief percentage were recorded for all the 30 wrists. Results The average postoperative Disabilities of the Arm, Shoulder and Hand score was 30 (range: 20–80), and the difference between the pre- and postoperative scores was statistically significant. Ninety percent of the patients were satisfied with the results of PIN and reported improvement in grip strength and pain relief. Conclusions Thus, PIN may be an effective surgical technique for wrist reconstruction. Clinical Relevance To help patients challenge pain and maintain their wrist joint range of motion.
25
Hurter, Liezel, Stuart Fairclough, Zoe Knowles, Lorna Porcellato, Anna Cooper-Ryan, and Lynne Boddy. "Establishing Raw Acceleration Thresholds to Classify Sedentary and Stationary Behaviour in Children." Children 5, no. 12 (December 19, 2018): 172. http://dx.doi.org/10.3390/children5120172.
Abstract:
This study aimed to: (1) compare acceleration output between ActiGraph (AG) hip and wrist monitors and GENEActiv (GA) wrist monitors; (2) identify raw acceleration sedentary and stationary thresholds for the two brands and placements; and (3) validate the thresholds during a free-living period. Twenty-seven from 9- to 10-year-old children wore AG accelerometers on the right hip, dominant- and non-dominant wrists, GA accelerometers on both wrists, and an activPAL on the thigh, while completing seven sedentary and light-intensity physical activities, followed by 10 minutes of school recess. In a subsequent study, 21 children wore AG and GA wrist monitors and activPAL for two days of free-living. The main effects of activity and brand and a significant activity × brand × placement interaction were observed (all p < 0.0001). Output from the AG hip was lower than the AG wrist monitors (both p < 0.0001). Receiver operating characteristic (ROC) curves established AG sedentary thresholds of 32.6 mg for the hip, 55.6 mg and 48.1 mg for dominant and non-dominant wrists respectively. GA wrist thresholds were 56.5 mg (dominant) and 51.6 mg (non-dominant). Similar thresholds were observed for stationary behaviours. The AG non-dominant threshold came closest to achieving equivalency with activPAL during free-living.
26
Traverso, Purnell, Anselm Wong, Ronit Wollstein, Lois Carlson, Duffield Ashmead, and H. Kirk Watson. "Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist." HAND 12, no. 6 (December 5, 2016): 568–72. http://dx.doi.org/10.1177/1558944716681949.
Abstract:
Background: Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function. Methods: A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification. Results: Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction. Conclusions: Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.
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Hetland, M. L., B. Ejbjerg, K. Hørslev-Petersen, S. Jacobsen, A. Vestergaard, A. G. Jurik, K. Stengaard-Pedersen, et al. "MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA)." Annals of the Rheumatic Diseases 68, no. 3 (April 3, 2008): 384–90. http://dx.doi.org/10.1136/ard.2008.088245.
Abstract:
Objective:To identify predictors of radiographic progression in a 2-year randomised, double-blind, clinical study (CIMESTRA) of patients with early rheumatoid arthritis (RA).Methods:Patients with early RA (n = 130) were treated with methotrexate, intra-articular betamethasone and ciclosporin/placebo-ciclosporin. Baseline magnetic resonance imaging (MRI) of the wrist (wrist-only group, n = 130) or MRI of wrist and metacarpophalangeal (MCP) joints (wrist+MCP group, n = 89) (OMERACT RAMRIS), x-ray examination of hands, wrists and forefeet (Sharp/van der Heijde Score (TSS)), Disease Activity Score (DAS28), anti-cyclic citrullinated peptide antibodies (anti-CCP), HLA-DRB1-shared epitope (SE) and smoking status were assessed. Multiple regression analysis was performed with delta-TSS (0–2 years) as dependent variable and baseline DAS28, TSS, MRI bone oedema score, MRI synovitis score, MRI erosion score, anti-CCP, smoking, SE, age and gender as explanatory variables.Results:Baseline values: median DAS28 5.6 (range 2.4–8.0); anti-CCP positive 61%; radiographic erosions 56%. At 2 years: DAS28 2.0 (0.5–5.7), in DAS remission: 56%, radiographic progression 26% (wrist+MCP group, similar for wrist-only group). MRI bone oedema score was the only independent predictor of delta-TSS (wrist+MCP group: coefficient = 0.75 (95% CI 0.55 to 0.94), p<0.001; wrist-only group: coefficient = 0.59 (95% CI 0.40 to 0.77), p<0.001). Bone oedema score explained 41% of the variation in the progression of TSS (wrist+MCP group), 25% in wrist-only group (Pearson’s r = 0.64 and r = 0.50, respectively). Results were confirmed by sensitivity analyses.Conclusion:In a randomised controlled trial aiming at remission in patients with early RA, baseline RAMRIS MRI bone oedema score of MCP and wrist joints (and of wrist only) was the strongest independent predictor of radiographic progression in hands, wrists and forefeet after 2 years. MRI synovitis score, MRI erosion score, DAS28, anti-CCP, SE, smoking, age and gender were not independent risk factors.Trial registration number:NCT00209859.
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Rein, Susanne, Jochen Winter, Thomas Kremer, Frank Siemers, Ursula Range, and Nane Euchner. "Evaluation of proprioception in denervated and healthy wrist joints." Journal of Hand Surgery (European Volume) 45, no. 4 (January 13, 2020): 408–13. http://dx.doi.org/10.1177/1753193419897192.
Abstract:
We recruited 25 patients after complete wrist denervation and 60 healthy adults to investigate conscious and unconscious proprioception of the wrist. Ipsi- and contralateral joint-position sense, force sense, and wrist reflexes were measured. The latter were triggered by a trapdoor, recording electromyographic signals from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles. No significant differences were found for joint position sense, force sense, and wrist reflexes between both groups, except for reflex time of the flexor carpi ulnaris after denervation of the left wrist as compared with the left flexor carpi ulnaris in controls or in right operated wrists. At a mean follow-up of 32 months (range 8 to 133), we found no proprioceptive deficit of the conscious proprioceptive qualities of joint position sense, force sense, and the unconscious proprioceptive neuromuscular control of wrist reflex time for most muscles after complete wrist denervation. We conclude from this study that complete wrist denervation does not affect the proprioceptive senses of joint position, force sense, and reflex time of the wrist.
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VÖGELIN, ESTHER, and LADISLAV NAGY. "Fate of Failed Meuli Total Wrist Arthroplasty." Journal of Hand Surgery 28, no. 1 (February 2003): 61–68. http://dx.doi.org/10.1054/jhsb.2002.0812.
Abstract:
Sixteen Meuli wrist arthroplasties in 13 patients suffering mainly from rheumatoid arthritis were revised for failure. Causes for failure were mechanical problems with the implant in three wrists, soft tissue problems in two wrists and a combination of mechanical failure and soft tissue problems in 11 wrists. Management included 11 revision arthroplasties in ten wrists, four arthrodeses and two primary soft tissue reconstructions. Twenty-six additional soft tissue procedures were required in association with the revision arthroplasties or arthrodeses. Five of the 11 revision arthroplasties had to be converted to arthrodeses after an average of 5 (range 3–8) years. After removal of a failed wrist implant union of the salvage arthrodesis was diffcult to achieve in two of the nine instances. This series demonstrates that revision arthroplasty may be a useful alternative to arthrodesis for the salvage of primary wrist arthroplasties in rheumatoid patients. However, complications and reoperations may occur after both revision arthroplasty and arthrodesis.
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Payne, Russell, Zeinab Nasralah, Emily Sieg, Elias B. Rizk, Michael Glantz, and Kimberly Harbaugh. "The angular course of the median nerve in the distal forearm and its anatomical importance in preventing nerve injury in a modern era of carpal tunnel release." Journal of Neurosurgery 126, no. 3 (March 2017): 979–84. http://dx.doi.org/10.3171/2016.4.jns152672.
Abstract:
OBJECTIVE A thorough understanding of anatomy is critical for successful carpal tunnel release. Several texts depict the median nerve (MN) as taking a course parallel to the long axis of the forearm (LAF). The authors report on their attempt to formally assess the course of the MN as it travels to the carpal tunnel in the distal wrist and discuss its potential clinical significance. METHODS The width of the wrist, the distance from the radial wrist to the MN, and the distance from the distal volar wrist crease to the point where the MN emerges between the flexor carpi radialis (FCR) tendon and the flexor digitorum superficialis (FDS) tendons were recorded during cadaveric dissection of 76 wrist specimens. The presence or absence of palmaris longus was documented. Finally, the angles between the MN and FCR tendon and between the MN and the LAF were measured using ImageJ. RESULTS The relative position of the MN at the distal wrist crease, as determined by the ratio of the distance from the MN to the radial wrist divided by wrist width, revealed a mean value of 0.48, indicating that the nerve was usually located just radial to midline. The mean distance between the distal wrist crease and the MN's emergence was 34.6 mm. The mean angle between the MN and the FCR tendon was 14.1°. The angle between the MN and the LAF had a mean value of 8.8° (range 0.0°–32.2°). The nerve was parallel to the LAF in only 10.7% of the studied wrists. Palmaris longus was absent in 14 (18.4%) of the 76 wrists. CONCLUSIONS The MN takes an angular approach to the carpal tunnel in the distal wrist in the vast majority of cases. This newly described finding will be useful to both clinicians and anatomists.
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Helsper, Elizabeth A., Lisa M. Frantz, Jessica M. Adams, Harry A. Morris, and Bernard F. Hearon. "Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up." Journal of Hand Surgery (European Volume) 45, no. 9 (June 9, 2020): 916–22. http://dx.doi.org/10.1177/1753193420927882.
Abstract:
This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with arthroscopic thermal annealing of the superficial radioulnar ligaments, ulnar palmar wrist ligaments, and dorsoulnar wrist capsule using a radiofrequency probe. Sixty patients (62 wrists) were treated over an 18-year period. At mean follow-up of 10 years (range 3 to 19), 30 of 33 patients were satisfied with their surgical outcomes. There were statistically significant improvements in ulnar-sided wrist pain on a visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test after surgery compared with preoperative status. The modified Mayo Wrist Score and Quick Disabilities of the Arm, Shoulder, and Hand score of the patients were favourable. Early failure occurred in 11 of 62 wrists. Nine of these 11 wrists needed a secondary procedure. We conclude that arthroscopic thermal shrinkage is effective for the majority of the patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up. Secondary open ligament reconstruction is an option in the case of early failure. Level of evidence: IV
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CHANTELOT, C., C. FONTAINE, R. M. FLIPO, H. MIGAUD, F. LE COUSTUMER, and A. DUQUENNOY. "Synovectomy Combined With the Sauvé-Kapandji Procedure for the Rheumatoid Wrist." Journal of Hand Surgery 24, no. 4 (August 1999): 405–9. http://dx.doi.org/10.1054/jhsb.1999.0171.
Abstract:
The aim of synovectomy-stabilization (synovectomy combined with the Sauvé–Kapandji procedure) of the rheumatoid wrist is to obtain a stable painless wrist, retaining enough mobility for function. Thirty-nine wrists were retrospectively examined, at a mean follow up of 64.8 months. The improvement in pain was very significant. We noticed a decrease in wrist motion affecting both flexion and radial deviation. The arthritic change in the wrist continued to increase. We noticed a mean ulnar shift of 2.2 mm and a mean increase in the radial deviation of the wrist of 7°. Only transfer of the extensor carpi radialis longus tendon to the extensor carpi radialis brevis tendon was effective in correcting radial deviation of the carpus. Ninety-seven per cent of patients were very satisfied or satisfied. These encouraging results, even at advanced stages of wrist arthritis, have prompted us to lessen the indications for wrist arthrodesis.
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NAGY, L., and U. BÜCHLER. "Long-Term Results of Radioscapholunate Fusion Following Fractures of the Distal Radius." Journal of Hand Surgery 22, no. 6 (December 1997): 705–10. http://dx.doi.org/10.1016/s0266-7681(97)80429-9.
Abstract:
Fifteen patients with radioscapholunate (RSL) fusion for traumatic lesions of the radiocarpal junction, whose short-term results have been previously reported, were reassessed after an average follow-up time of 8 years. Five patients had undergone wrist fusion because of non-union or early progressive arthritis. Of the ten wrists with retained mobility, eight continued to function satisfactorily. Two wrists were painful for reasons other than secondary midcarpal arthritis. Patient satisfaction was comparable in both groups with the wrist score better for wrists with residual motion. The survival of RSL partial wrist fusion corresponded inversely with the number of preceding operations and the range of motion before partial fusion. Secondary midcarpal arthritis, if present, arose early and was well tolerated. Failures were strongly linked to technical mistakes and complications.
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Reigstad, Ole, and Magne Røkkum. "Wrist arthroplasty using prosthesis as an alternative to arthrodesis: design, outcomes and future." Journal of Hand Surgery (European Volume) 43, no. 7 (July 9, 2018): 689–99. http://dx.doi.org/10.1177/1753193418784707.
Abstract:
We developed an uncemented screw-shaped ball-and-socket wrist prosthesis and modified it during a decade of trails from 1996 to 2005. The final Motec® wrist prosthesis was launched in 2006. Since then we have used this prosthesis in 110 wrists (110 patients) from 2006 to 2018. This article reviews the design, functional outcomes, complications, clinical usefulness and possible future modifications of the Motec® wrist prosthesis.
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Zhu, Andy, Breana Siljander, Jeffrey Lawton, Jennifer Waljee, and Kagan Ozer. "The Effect of Axial Loading on Ulnar Variance." Journal of Wrist Surgery 07, no. 03 (February 12, 2018): 247–52. http://dx.doi.org/10.1055/s-0038-1627458.
Abstract:
Background Forearm rotation results in change in ulnar variance. Axial loading of the wrist is required to maintain daily activities. Change in ulnar variance during axial loading has not been investigated previously. Purpose To measure the change in ulnar variance on axially loaded wrists. Patients and Methods We examined 21 asymptomatic individuals and 24 patients with unilateral ulnar-sided wrist pain. All patients underwent standard neutral posteroanterior wrist radiographs without load and under axial loading on bilateral wrists. Axial loading was standardized at 18.1 kgf using an analog weight scale. A magnetic resonance (MR) arthrogram was obtained only in patients with ulnar-sided wrist pain. Beighton flexibility score was recorded on healthy volunteers. Change in ulnar variance between 0 and 18.1 kgf was compared for each wrist among all subjects. A correlation was sought between the change in ulnar variance, MR arthrogram findings, and physical examination. Results In individuals without wrist pain, on average, 0.4 mm increase in ulnar variance was measured between 0 and 18.1 kgf. There was no difference between the dominant and nondominant side. No correlation was found with increasing age. In contrast, patients with ulnar-sided wrist pain displayed an average increase of 0.8 mm in ulnar variance. Compared with the contralateral wrist, more than 1 mm increase in ulnar variance was correlated with intra-articular pathologies including dorsoulnar ligament disruption, central triangular fibrocartilage complex (TFCC) perforation, and foveal detachment. Conclusion Compared with contralateral side, more than 1 mm increase in ulnar variance is suggestive of longitudinal instability or TFCC pathology. Level of Evidence Level II, diagnostic.
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FARMER, J. E., and T. R. C. DAVIS. "Carpal Tunnel Syndrome: A Case–Control Study Evaluating Its Relationship with Body Mass Index and Hand and Wrist Measurements." Journal of Hand Surgery (European Volume) 33, no. 4 (August 2008): 445–48. http://dx.doi.org/10.1177/1753193408090142.
Abstract:
This case–control study investigated the associations between the body mass index (BMI), hand and wrist measurements and carpal tunnel syndrome (CTS). The hands and wrists of 50 patients with CTS and 50 age- and sex-matched controls were measured. The right and left wrist indices (wrist depth/wrist width) were significantly greater in CTS patients (mean = 0.71. SD = 0.04) than in the controls (mean = 0.69 SD = 0.04). The hand index (hand length/palm width) and BMI were not significantly different in the two groups. The hand, but not the wrist, index was found to correlate with the BMI. These results provide some support for a causative association between wrist morphometry, as measured by the wrist index, and CTS, but this difference is too small to be of diagnostic value in clinical or epidemiological practice. The results could also suggest that the previously reported association between CTS and the hand index may be secondary to differences in the BMI.
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Chen, Guangming, Tao Lin, Shi Ding, Shuang Chen, Aihong Ji, and Gabriel Lodewijks. "Design and Test of an Active Pneumatic Soft Wrist for Soft Grippers." Actuators 11, no. 11 (October 27, 2022): 311. http://dx.doi.org/10.3390/act11110311.
Abstract:
An active wrist can deliver both bending and twisting motions that are essential for soft grippers to perform dexterous manipulations capable of producing a wide range movements. Currently, the versions of gripper wrists are relatively heavy due to the bending and twisting motions performed by the motors. Pneumatic soft actuators can generate multiple motions with lightweight drives. This research evaluates a pneumatic soft wrist based on four parallel soft helical actuators. The kinematics models for predicting bending and twisting motions of this soft wrist are developed. Finite element method simulations are conducted to verify the functions of bending and twisting of this wrist. In addition, the active motions of the soft pneumatic wrist are experimentally demonstrated. Based on sensitivity studies of geometric parameters, a set of parameter values are identified for obtaining maximum bending and twisting angles for a bionic human wrist. Through simulation and experimental tests of the soft wrist for a soft gripper, the desired bending and twisting motions as those of a real human hand wrist are established.
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Swärd, Elin, Inger Nennesmo, and Maria Wilcke. "Structural Changes in the Posterior Interosseous Nerve from Patients with Wrist Osteoarthritis and Asymptomatic Controls." Journal of Wrist Surgery 9, no. 06 (July 29, 2020): 481–86. http://dx.doi.org/10.1055/s-0040-1713655.
Abstract:
Abstract Background Posttraumatic morphological changes have been described in the posterior interosseous nerve (PIN) after mild wrist trauma, and it has been suggested that posttraumatic nerve changes may contribute to wrist pain. PIN excision has shown to relieve pain in some patients with wrist osteoarthritis. However, is not known if PINs from osteoarthritic wrist have pathological features. Objective The aim of this study was to investigate whether PINs from osteoarthritic wrists show morphological changes that are not present in healthy wrists. Materials and Methods PINs resected from 15 osteoarthritic wrists were analyzed with light microscopy regarding morphological changes and compared with five asymptomatic controls without osteoarthritis. Results No significant differences in fascicular area, myelinated fiber density or myelinated fiber diameter were found. However, most patients and controls exhibited some degree of pathology, and a few samples from both groups exhibited severe pathological changes. Conclusions Our findings of morphological changes in both patients with osteoarthritis and asymptomatic controls suggest that pathological changes of unknown significance might exist in the general population in the PIN at wrist level. We believe that the observed structural nerve changes in the PIN are unlikely to contribute to the symptoms of pain. Further studies of the normal histological appearance of the terminal PIN are needed. Level of Evidence This is Level II study.
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Sandow, MJ, C. Howard, and ZX Cheng. "“RULES-BASED MOTION” REANIMATION OF THE CARPUS." Orthopaedic Proceedings 105-B, SUPP_3 (February 2023): 20. http://dx.doi.org/10.1302/1358-992x.2023.3.020.
Abstract:
Using a reverse engineering capability to quantify the factors that control the rigid body mechanics of the wrist, a mathematical forward animation capability and model of wrist motion that allows the carpus to move under its own rules is being developed. This characterises the isometric connections, from which was developed the Stable Central Column Theory of Carpal Mechanics - which incorporates the Law of Rules Based Motion.This work has now advanced to the ability to reapply the extracted rules to allow rules-based rigid body reanimation of an individual wrist. As each wrist is unique, there is a given reality that each reanimation must be based on an individual wrist's unique rules, and the aspiration to create a standard or normal wrist is unrealistic.Using True Life Anatomy (Adelaide, Aust) analysis software, the specific rules (morphology / connectivity / interaction / loading) of individual wrists have been characterised, and then reapplied in a rigid body reanimation environment using Adams (MSC Software, U.S.) software.In the preliminary application of this biomechanics environment, by using the reverse engineering / forward reanimation process, wrist motion can be recreated - based purely on the unique rules, extracted from individual wrists. Instability of the proximal scaphoid was evident in several of the animations, and there was confirmation that the spatial attachment points of the isometric constraints are very exacting. The actual attachment and specific morphology of the carpal bones varied between individual wrists.Using a reverse engineering and then forward reanimation process, we have been able to recreate wrist motion using the rigid body mechanics based on the Law of Rules Based Motion. Further work is required, but the potential to apply “what if” virtual surgery options to an individual injured wrist and more precisely characterise and test solutions to wrist dysfunction are becoming realised.
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Low, Sara L., John D. Jennings, Benjamin B. Clippinger, Germanuel L. Landfair, Katharine T. Criner-Woozley, and Asif M. Ilyas. "Predictors of Septic Wrist: A Dual-Center 10-Year Review of Risk Factors." Journal of Hand and Microsurgery 12, no. 01 (July 7, 2019): 19–26. http://dx.doi.org/10.1055/s-0039-1693068.
Abstract:
Abstract Introduction Expeditious and accurate diagnosis of septic wrist arthritis is essential to prevent further cartilage damage, systemic infection, osteomyelitis, and loss of limb. There is limited literature on the incidence and clinical factors that are predictive of septic wrist arthritis. Objective We aimed to investigate the incidence of septic wrist arthritis and identify risk factors and laboratory values associated with septic wrist arthritis. Materials and Methods Data were collected on adult patients presenting with a painful, swollen wrist to two level 1 urban hospitals from 2004 to 2014. Demographics, comorbidities, and laboratory values of patients who had wrist aspiration were collected. Results There was an overall incidence of 0.4%. Increased synovial white blood cells (WBC), being febrile, positive blood cultures, and smoking were significantly associated with septic wrist arthritis on univariate analysis. Synovial WBC was also found to be significant on multivariate analysis. A synovial WBC of 87,750 cells/µL had an optimal sensitivity and specificity of 73% and 86%, respectively, for diagnosing septic wrist arthritis. Conclusion Synovial WBC can be a useful diagnostic tool for septic wrist arthritis. In addition, positive blood cultures, being febrile, and smoking history can help predict septic wrist arthritis in patients with presenting with painful, swollen wrists.
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ABE, Y., K. KATSUBE, K. TSUE, K. DOI, and Y. HATTORI. "Arthoscopic Diagnosis of Partial Scapholunate Ligament Tears as a Cause of Radial Sided Wrist Pain in Patients with Inconclusive X-ray and Mri Findings." Journal of Hand Surgery 31, no. 4 (August 2006): 419–25. http://dx.doi.org/10.1016/j.jhsb.2006.04.004.
Abstract:
To clarify the pathology of radial-sided wrist pain with inconclusive X-ray and MRI findings, we performed arthroscopic examinations of 11 wrists in 10 patients. Physical examination and various image investigations could not identify the cause of the pain. Arthroscopy revealed partial to complete tears of the scapho-lunate interosseous ligament and synovitis and/or chondral bone defects at the scaphotrapezio-trapezoidal joint in all 11 wrists. Surgical procedures consisted of eight simple synovectomies, two ligament reconstructions and one percutaneous pinning. Pain relief was achieved in 10 wrists. One wrist which had a simple synovectomy did not recover, so underwent secondary scapho-trapezio-trapezoidal fusion. In conclusion, we found that various degrees of scapholunate interosseous ligament tear and scapho-trapezio-trapezoidal joint osteoarthritis were the main causes of radial-sided wrist pain with inconclusive X-ray and simple MRI findings.
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Noback, Peter C., Mani Seetharaman, Jonathan R. Danoff, Michael Birman, and Melvin P. Rosenwasser. "Arthroscopic Wrist Debridement and Radial Styloidectomy for Advanced Scapholunate Advanced Collapse Wrist: Long-term Follow-up." HAND 13, no. 6 (August 20, 2017): 659–65. http://dx.doi.org/10.1177/1558944717725383.
Abstract:
Background: Symptomatic stage 2 or 3 scapholunate advanced collapse (SLAC) wrist is aggressively treated with salvage procedures, such as proximal row carpectomy or partial wrist fusion with resultant pain relief but limited motion. We hypothesize that arthroscopic synovectomy, radial styloidectomy, and neurectomy will preserve wrist motion, relieve pain, and delay or avoid salvage procedures. Methods: We evaluated outcomes in 13 wrists through questionnaires and 11 of these through additional physical examination at a mean follow-up of 5.0 years. Eight wrists were stage 2 and 5 were stage 3. Data at final follow-up included mobility/strength measurements, subjective outcome scores (Disabilities of the Arm, Shoulder, and Hand [DASH] and visual analog scale [VAS] pain), patient satisfaction, and return to work statistics. Results: Patients had an average flexion-extension arc of 88.0° in the treated wrist and an average grip strength that was 95.0% of the contralateral side. No patients required revision surgery at follow-up. The 13 wrists reported an average DASH score of 16.4 and mean VAS pain score at rest and with activity of 17.9 and 31.6, respectively. All patients working prior to the procedure (n = 8) were able to immediately return to work. In all, 84.6% of patients were satisfied. Conclusions: The procedure studied may have advantages in relieving pain, while preserving wrist motion for SLAC stage 2 or 3 disease. This procedure does not preclude future salvage procedures in those patients with severe disease who prefer to maintain wrist motion for the short term. Patients experience good functional outcomes with the majority experiencing a reduction in pain with the ability to return to work.
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Kramer, Aviv, Raviv Allon, Alon Wolf, Tal Kalimian, Idit Lavi, and Ronit Wollstein. "Anatomical Wrist Patterns on Plain Radiographs." Current Rheumatology Reviews 15, no. 2 (April 5, 2019): 168–71. http://dx.doi.org/10.2174/1573397113666170417124711.
Abstract:
Background: Interpreting the structure in the wrist is complicated by the existence of multiple joints as well as variability in bone shapes and anatomical patterns. Previous studies have evaluated lunate and capitate shape in an attempt to understand functional anatomical patterns. Objective: The purpose of this study was to describe anatomical shapes and wrist patterns in normal wrist radiographs. We hypothesized that there is a significant relationship in the midcarpal joint with at least one consistent pattern of wrist anatomy. Methods: Seventy plain posteroanterior (PA) and lateral wrist radiographs were evaluated. These radiographs were part of a previously established normal database, had all been read by a radiologist as normal, and had undergone further examination by 2 hand surgeons for quality. Evaluation included: lunate and capitate shape (type 1 and 2 lunate shape according to the classification system by Viegas et al.), ulnar variance, radial inclination and height, and volar tilt. Results: A significant association was found between lunate and capitate shape using a dichotomal classification system for both lunate and capitate shapes (p=0.003). Type 1 wrists were defined as lunate type1and a spherical distal capitate. Type 2 wrists had a lunate type 2 and a flat distal capitate. No statistically significant associations were detected between these wrist types and measurements of the radiocarpal joint. Conclusion: There was a significant relationship between the bone shapes within the midcarpal joint. These were not related to radiocarpal anatomical shape. Further study is necessary to better describe the two types of wrist patterns that were defined and to understand their influence on wrist biomechanics and pathology.
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Pollock, J., A. A. Giachino, K. Rakhra, G. DiPrimio, H. Hrushowy, A. F. Conway, and M. Andreyechen. "SLAC WRIST IN THE ABSENCE OF RECOGNISED TRAUMA AND CPPD." Hand Surgery 15, no. 03 (January 2010): 193–201. http://dx.doi.org/10.1142/s0218810410004837.
Abstract:
Purpose: This comparative cohort study was designed to determine whether non-traumatic SLAC wrist exists, and is associated with abnormal carpal bone kinematics (specifically, decreased lunate flexion). Methods: SLAC patients with no recognised history of upper extremity trauma were prospectively compared with an age-matched control group. Results: Thirty-five subjects (69 wrists), included 33 non-traumatic SLAC wrists and 36 control wrists. The non-traumatic SLAC group had significantly different radiographic kinematic analysis compared to the control group. Flexion of the asymptomatic non-degenerative wrist of the non-traumatic SLAC group was distributed 70% through the lunocapitate (LC) joint and only 30% through the RL joint (p < 0.05). Conversely, flexion was more evenly distributed in the control group (48% LC and 52% RL). The non-traumatic SLAC group had abnormal wrist kinematics even in the non-involved side. Conclusions: This study suggests that non-traumatic SLAC does exist. We believe that non-traumatic SLAC begins with abnormal wrist kinematics and that the dorsal radiolunate ligament restricts lunate flexion but not scaphoid flexion, leading to increased SL angles and, with years, eventual attrition of the SL ligament. Type of Study/Level of Evidence: Prognostic, Level IV.
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TEURLINGS, L., G. J. MILLER, and T. W. WRIGHT. "Pressure Mapping of the Radioulnar Carpal Joint: Effects of Ulnar Lengthening and Wrist Position." Journal of Hand Surgery 25, no. 4 (August 2000): 346–49. http://dx.doi.org/10.1054/jhsb.2000.0446.
Abstract:
The purpose of this study was to investigate the effects of ulnar lengthening and wrist position on force transmission through the radioulnar carpal joint in a forced dorsiflexed wrist position. Eight cadaveric arms were subjected to a 30 kg compressive load directed down the forearm towards the wrist. A pressure sensor recorded forces across the wrist joint with the triangular fibrocartilage complex intact and excised. The biomechanics of the distal radioulnar joint were altered by changes in ulnar length and wrist position. Pressures at the ulnolunate articulation increased as the ulna was lengthened and were significantly lower when the triangular fibrocartilage complex was excised. An inverse relationship between triangular fibrocartilage complex thickness and ulnar variance was shown. Greater increases in ulnolunate pressure were observed in more positive ulnar variant wrists.
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HOUSHIAN, S., and H. A. SCHRØDER. "Wrist Arthrodesis with the AO Titanium Wrist Fusion Plate: A Consecutive Series of 42 Cases." Journal of Hand Surgery 26, no. 4 (August 2001): 355–59. http://dx.doi.org/10.1054/jhsb.2001.0600.
Abstract:
In a 4 year period (1996–1999), 42 total wrist fusions in 25 men and 17 women were performed using the AO/ASIF Titanium wrist fusion plate. The median age of the patients at the time of surgery was 41 (range, 19–72) years. The indication for fusion was post-traumatic arthritis in 29 wrists, Kienböck’s disease in eight, rheumatoid arthritis in three, mono-arthritis in one and Volkmann’s contracture in one. All patients were reviewed at a median follow-up of 23 (range, 6–50) months. The Buck–Gramcko and Lohmann score for functional evaluation was excellent in 35, good in 5 and satisfactory in 2 patients. We conclude that wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist.
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Athlani, Lionel, Sophie Sabau, Nicolas Pauchard, François Dap, and Gilles Dautel. "Four-corner arthrodesis with a dorsal locking plate: 4–9-year follow-up." Journal of Hand Surgery (European Volume) 45, no. 7 (June 14, 2020): 673–78. http://dx.doi.org/10.1177/1753193420930587.
Abstract:
We report the outcomes of four-corner arthrodesis for advanced wrist collapse in 50 patients (51 wrists) using a dorsal locking plate. At a mean follow-up of 6 years (range 4–9), pain was significantly reduced and wrist function was significantly improved compared with preoperative status. After four-corner arthrodesis, grip strength was 80% of the contralateral side, and wrist motion averaged 50° flexion–extension and 30° radioulnar deviation. Immobilization time was 5 weeks (4–6) and sick-leave was 3 months (2–5) following surgery. There were seven nonunions (14%) that underwent repeat arthrodesis. Three wrists were later converted to total arthrodesis due to persisting pain. Radiographic dorsal impingement was found in five wrists after four-corner arthrodesis and did not require reoperation. The outcomes appear not remarkably different from those reported using other fixation methods other than an apparent earlier return to activities. Level of evidence: IV
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Ichinose, Hirofusa, Etsuhiro Nakao, Takaaki Shinohara, Masahiro Tatebe, Harumoto Yamada, and Ryogo Nakamura. "Wrist Swelling in Kienböck's Disease." Journal of Wrist Surgery 07, no. 05 (July 2, 2018): 389–93. http://dx.doi.org/10.1055/s-0038-1661420.
Abstract:
Background and Purpose Wrist swelling is a frequent clinical manifestation of Kienböck's disease, but no study has reported the site and pathology of wrist swelling in this disease. The aim of this study is to elucidate the site and pathology of wrist swelling in Kienböck's disease. Materials and Methods Dorsal and palmar soft tissue thicknesses of the wrist were measured on standard lateral radiographs of the wrist in 26 patients with Kienböck's disease and 30 subjects without intra-articular lesion. Axial magnetic resonance imaging (MRI) views were examined to detect the site of swelling. The dorsal capsular ligament in three patients with Kienböck's disease underwent histological examination. Results Radiographic study confirmed dorsal wrist swelling in 24 of 26 (92%) patients examined compared with the contralateral unaffected wrists. MRI demonstrated thickening of the dorsal capsular ligament and extensor layer with synovial proliferation. Histological examination revealed nonspecific chronic inflammation. Conclusion Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of pathology of Kienböck's disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck's disease. Level of Evidence This is a Level III study.
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Wollstein, Ronit, Aviv Kramer, Scott Friedlander, and Frederick Werner. "Midcarpal Structure Effect on Force Distribution through the Radiocarpal Joint." Journal of Wrist Surgery 08, no. 06 (July 21, 2019): 477–81. http://dx.doi.org/10.1055/s-0039-1693048.
Abstract:
Abstract Background Wrist structure is complicated by distinct anatomical patterns. Previous studies defined radiographic wrist types based on lunate and capitate shape within the midcarpal joint. We hypothesized that these disparate structural patterns will transfer forces differently through the wrist. Objective This study aims to correlate force transferred to the distal radius and ulna with morphological measurements in cadaver arms. Methods Radiographs from 46 wrists, previously tested for force transfer between the radius and ulna, were examined. The percentage of compressive force through the distal ulna was determined by mounting load cells to the radius and ulna, while 22.2 Newton (N) tensile forces were individually applied to multiple tendons. Each wrist was tested in a neutral flexion–extension and radial-ulnar deviation position. Results Wrist type and lunate type were associated with percentage of force transfer through the ulna (p = 0.002, p = 0.0003, respectively). Percentage of force transfer was correlated with capitate circumference (p = 0.02, r = 0.34). Conclusions This study supports distinct force transfer between morphological wrist types. Clinical Relevance Understanding the mechanical significance of different structural variations in the wrist bones will improve our ability to understand wrist function and the distinctive development of wrist pathology. Level of Evidence This is a Level II study.
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Fan, You-Liang, Hai-Yun Xu, Ming-Yang Xia, Wen Zhang, Hui-Long Wen, Li-Bo Gao, and Yan-Hui Pei. "Biomechanical evaluation of axial-loading simulated experiment in wrist fractures: a finite element analysis." Journal of International Medical Research 48, no. 10 (October 2020): 030006052096688. http://dx.doi.org/10.1177/0300060520966884.
Abstract:
Objective To assess the biomechanical properties that influence wrist fracture, so as to provide the theoretical basis for simulation experiments to aid the optimal design of wrist protectors. Methods Six cadaveric wrists were included as experimental specimens. Wrist specimens wearing wrist protectors formed the experimental group and unprotected wrist specimens formed the control group. The wrist specimens were axially loaded under physiological loads and the stress magnitude and distribution of the experimental and control groups were obtained. A three-dimensional wrist finite element model of a healthy volunteer was developed to verify the rationality and effectiveness of the cadaveric wrist models. Results Under normal physiological loads, the stress on the radioulnar palmar unit was high and manifested in the form of pressure, while the stress on the radioulnar dorsal unit was lower and manifested in the form of tension. The stresses on the radial distal palmar, ulnar distal palmar, radial distal dorsal, ulnar distal dorsal, radial proximal palmar and ulnar proximal palmar units in the experimental group were less than those in the control group. Conclusion Under physiological loads, wearing a wrist protector can reduce the stress on the radioulnar distal palmar, radioulnar proximal palmar and radioulnar distal dorsal units, while having no obvious effect on the radioulnar proximal dorsal units.