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At least 19 recordsLinked to original sources

PubMed2002

Maintaining wrist function in severe rheumatoid arthritis: a case study of revision Swanson wrist arthroplasty staged via a wrist fusion in rheumatoid arthritis.

We present a case of revision Swanson wrist arthroplasty staged via a wrist fusion in a patient with rheumatoid arthritis. Due to extensive bone loss in the rheumatoid patient, it may not be possible initially to revise a wrist arthroplasty; however after fusion with a bone graft to regain bone stock we have demonstrated that this is possible. It may even be possible to convert such a fusion to a total wrist arthroplasty.

Aged↗

PubMed1996

Evaluation of selective wrist arthrography of contralateral asymptomatic wrists for symmetric ligamentous defects.

OBJECTIVE: The objective of this investigation was to study the role of selective wrist arthrography of the asymptomatic wrists of patients with unilateral wrist pain and the efficacy of three-compartment and selective-compartment injections of contrast medium into the asymptomatic wrist in demonstrating symmetric and asymmetric intercarpal ligament and triangular fibrocartilage communicating defects. SUBJECTS AND METHODS: Wrist arthrography with bilateral three-compartment injections was performed for 62 patients with unilateral wrist pain. The numbers of bilateral intercarpal ligament and triangular fibrocartilage communicating defects were recorded. The results obtained with three-compartment injections in each wrist of these patients were compared with those obtained with single-compartment injections. RESULTS: Bilateral three-compartment injections identified 110 communicating defects (59 in the symptomatic and 51 in the asymptomatic wrists). Midcarpal injections showed all 36 scapholunate and lunatotriquetral ligament defects that were also shown by three-compartment injections in asymptomatic wrists. However, only 26 (72%) of these 36 ligament defects were shown by radiocarpal injections. No single-compartment injection showed all triangular fibrocartilage defects that were shown by three-compartment injections. Ten bilateral symmetric triangular fibrocartilage communicating defects were shown by three-compartment injections. All 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by radiocarpal injections. However, only five of the 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by injection of the distal radioulnar joints. CONCLUSION: Selective midcarpal injection of an asymptomatic wrist showed all matching defects in that wrist when only intercarpal ligament defects were found in the symptomatic wrist. Similarly, selective radiocarpal injection of an asymptomatic wrist showed all matching defects of the triangular fibrocartilage in that wrist. In either situation, routine injection of all three compartments of the asymptomatic wrist should not be necessary.

Adolescent↗

PubMed1990

Activity of identified wrist-related pallidal neurons during step and ramp wrist movements in the monkey.

1. The activity of globus pallidus (GP) neurons (n = 1,117) was studied in two monkeys to reexamine the relation of neuronal activity to movement type (slow vs. fast) while they performed both a visually guided step and ramp wrist tracking task. To select neurons specifically related to wrist movements, we employed both a somatosensory examination of individual body parts and a statistical analysis of the strength of temporal coupling of neuronal discharges to active wrist movement. 2. Neuronal responses to somatosensory stimulation were studied in 1,000 high-frequency GP neurons, of which 686 exhibited clear responses to manipulation of body parts. Of the latter, 336 responded to passive manipulation of forelimb joints and 58 selectively to passive flexion or extension of the wrist. 3. In the external segment of GP (GPe), most neurons responding to passive wrist movement were found to be clustered in four to five adjacent, closely positioned (separated by 200 microns) tracks in single coronal planes. The clusters were irregular in shape with a maximal width of 800-1,000 microns. Separate clusters of neurons responsive to passive wrist movement were identified in planes 3 mm apart in one monkey and in planes 500 microns apart in the other. Multiple clusters of neurons were also found for neurons responsive to joints other than the wrist. These findings suggest a more discrete and complex representation of individual joints in the primate GP than previously conceived. 4. During the performance of the wrist flexion and extension task, 92 neurons showed clear and consistent changes in activity. For these neurons we measured, with a statistical method on a trial-by-trial basis, the strength of temporal coupling between the onset of active wrist movement and the onset of change in neuronal discharge rate. Fifteen neurons showed changes in activity time-locked to the onset of active wrist movement. 5. Twelve pallidal neurons were classified as "wrist-related" based on their movement-locked changes in discharge during task performance and their clear responses to passive wrist joint rotation on examination. All of these neurons exhibited statistically significant modulation of their discharge rate during both fast (peak velocity 97-205 degrees/s) and slow (peak velocity 20-62 degrees/s) wrist movements in the task. The amplitudes of modulation were larger during fast wrist movement than slow movement. These results suggest that the basal ganglia motor circuit plays a similar, rather than an exclusive, role in the control of slow and fast limb movements.

Animals↗

PubMed1998

[Perilunate progressive instability of the wrist: a study of wrist dynamics].

OBJECTIVE: To study the changes in dynamics of wrist motor tendons after perilunate instability of the wrist. METHODS: 14 cadaver upper extremities were used. Excursions of the principle wrist and finger motor tendons were measured during wrist flexion-extension and radiolunar deviation was determined. Data were collected in the intact wrist, then in the wrist with stage I, II and III perilunate instability. The average moment arms of the tendons during wrist motion were calculated. RESULTS: The moment arms of the wrist flexors increased and those of the finger flexors decreased after instability. Increase in the moment arms dominated changes of radial side wrist motors, while decrease in the moment arms dominated ulnar wrist motors. Moment arms of the flexor carpi radialis tendon showed a consistent increase during wrist motion. CONCLUSION: The changes in wrist dynamics play an important role in clinical manifestations of perilunate instability. The significance of kinetic information on principle of treatment of the instability is discussed.

Biomechanical Phenomena↗

PubMed1999

Changes in geometry of the finger flexor tendons in the carpal tunnel with wrist posture and tendon load: an MRI study on normal wrists.

OBJECTIVES: (1) To develop a methodology to determine the trajectories of the digital flexor tendons using MRI. (2) To examine changes in tendon trajectories due to wrist posture, with and without pinch force. (3) To calculate the radius of curvature of the flexor tendons and note implications for contact forces on the median nerve. (4) To assess the use of Landsmeer's models at the wrist. DESIGN: Finger flexor tendon centroids were digitized from magnetic resonance images of the carpal tunnel and the tendon paths were determined analytically. Radii of curvature were calculated from the tendon paths. BACKGROUND: Landsmeer's models of joint-tendon interaction (Landsmeer, 1961) have been used to determine moment arms and radius of curvature of the tendon paths about articulations. An explanation for a biomechanical cause of work-related carpal tunnel syndrome originated from these models. METHODS: Three healthy male participants had their right wrist scanned while splinted in four wrist postures (flexed to 20 degrees, 45 degrees, neutral, extended to 20 degrees ) with and without maintaining a 10 N pinch grip. 20-24 cross-sectional images were used for each condition. RESULTS: Volar movement of the tendons was seen with wrist flexion and the opposite was true with extension. Tendon intersection angles were calculated between the tendon as it entered the carpal tunnel and as it exited the tunnel and were 50-65% of the wrist angle (R(2)=0.81-0.96). The radius of curvature was smallest (mean=82-127 mm) with an active pinch grip with the wrist splinted at 45 degrees of flexion (mean actual wrist angle 37 degrees ). CONCLUSIONS: The radius of flexor tendon curvature is not constant as previously assumed and is larger than previous estimates. The addition of tendon force with the wrist flexed acts to reduce the radius of curvature which further increases the contact stress on the median nerve and other wrist structures. The use of MRI to determine the tendon paths has provided new insight into the relationships between the finger flexor tendons and other structures at the wrist. RELEVANCE: These findings provide data for biomechanical models of the carpal tunnel and predict the possible pathophysiology of work-related carpal tunnel syndrome.

Adult↗

PubMed2002

Vascularized fibular graft after excision of giant-cell tumor of the distal radius: wrist arthroplasty versus partial wrist arthrodesis.

Several reconstructive procedures have been described for the complete defect of the distal radius that is created after a wide excision of a giant-cell tumor of bone, including hemiarthroplasty using the vascularized fibular head and partial wrist arthrodesis between a vascularized fibula and the scapholunate portion of the proximal carpal row. The objectives of this study are to compare clinical and radiographic results between the partial wrist arthrodesis and the wrist arthroplasty, and to discuss which procedure is superior. Four patients with giant-cell tumors involving the distal end of the radius were treated with en bloc resection and reconstruction with a free vascularized fibular graft. The wrists in two patients were reconstructed with an articular fibular head graft and the remaining two patients underwent partial wrist arthrodesis using a fibular shaft transfer. There was radiographic evidence of bone union at the host-graft junctions in all cases. In the newly reconstructed wrist joint, there was palmar subluxation of the carpal bones and degenerative changes in both patients. Local recurrence was seen in one patient. According to the functional results described by Enneking et al., the mean functional score was 67 percent. The functional scores including wrist/forearm range of motion in the cases with partial wrist arthrodesis were superior to those with wrist arthroplasty. A partial wrist arthrodesis using a vascularized fibular shaft graft appears a more useful and reliable procedure for reconstruction of the wrist after excision of the giant-cell tumor of the distal end of the radius than a wrist arthroplasty using the vascularized fibular head, although our study includes only a small number of patients.

Adult↗

PubMed2003

Wrist kinematic characterization of wheelchair propulsion in various seating positions: implication to wrist pain.

OBJECTIVE: To investigate wrist kinematic characterization at various wheelchair seat positions. DESIGN: A comparative study using a repetitive measures design. BACKGROUND: People who use wheelchairs often sit on pressure-relief cushions, increasing the seat height. Wrist kinematic properties during manual propulsion could be altered. Wrist kinematics from a clinical perspective has not been previously investigated. This study characterizes wrist kinematic performance of subjects during manual wheelchair propulsion at various seat positions. METHODS: Subjects for this investigation were 11 people with disabilities who use wheelchairs. Combinations of horizontal positions of the rear wheel and vertical seat height were evaluated. Consecutive EMG, wrist joint angle, and trigger signals were collected. RESULTS: Altered seat height resulted in significant changes to temporal phases and wrist kinematic parameters; however, altered horizontal seat position did not cause significant variations. For all seat positions investigated, wrist extensor and flexor EMG signals maintained a similar level of contraction. CONCLUSION: During wheelchair propulsion, seat height was found to be a critical factor affecting the temporal parameters of movement and wrist kinematic properties of the subjects. Wrist joint angles and wrist flexion-extension range of motion all varied according to seat height. Observations and statistical analysis of the results provided useful information; however, an ideal seat position was not indicated. RELEVANCE: Study results have enhanced our understanding of wheelchair design, and should aid in development of future designs. In addition, the results may provide a strategy for dealing with the onset of arm/wrist pain and the prevention of carpal tunnel syndrome and other soft tissue injuries in people who use wheelchairs.

Adolescent↗

PubMed1994

Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain.

To determine the significance of arthrographic abnormalities in patients with unilateral wrist pain, the authors compared the prevalence and site of intra-articular ligament perforation in asymptomatic and symptomatic wrists of the same group of patients and correlated asymptomatic perforation with age, hand dominance and hand overuse. Thirty-seven patients (29 men and 8 women ranging in age from 19 to 61 years) who had unilateral wrist pain and positive arthrographic findings for the symptomatic wrist underwent radiocarpal arthrography of the asymptomatic wrist. Three radiologists blinded as to the clinical findings examined the images for perforation in the triangular fibrocartilage complex, the lunotriquetral ligament and the scapholunate ligament. Intra-articular ligament perforations were found in 33 (89%) of the 37 asymptomatic wrists. Seventeen (46%) of the 37 patients had symmetric sites of perforation in the two wrists. Perforation of the triangular fibrocartilage complex occurred in 22 (59%) and 19 (51%) of the symptomatic and asymptomatic wrists respectively, of the lunotriquetral ligament in 13 (35%) and 7 (19%) respectively and of the scapholunate ligament in 13 (35%) and 11 (30%) respectively. No significant correlation between asymptomatic perforation and age or hand overuse was found (chi 2 test, Fisher's exact test). The authors conclude that asymptomatic perforation is common, even in young patients, so ligament perforation is not necessarily the cause of wrist pain in patients with such pain. However, for patients with the appropriate clinical findings, arthrography can be used to confirm or exclude ligament perforation.

Adult↗

PubMed1989

Electromyographic reflexes evoked in human wrist flexors by tendon extension and by displacement of the wrist joint.

1. The electromyographic (EMG) reflexes evoked in the wrist flexor muscle, flexor carpi radialis (FCR), by percutaneous extension of its tendon and by forcible extension of the wrist joint have been studied. Reflexes were elicited during steadily maintained voluntary flexor contraction of 10% of each subject's maximum. 2. Tendon extension, using 'ramp and hold' displacements, evoked fairly prolonged (ca 50 ms) increases in EMG activity. These responses were usually subdivided into two main excitatory peaks of respectively short (SL, ca 20 ms) and long (LL, ca 45 ms) latency. This pattern contrasted with that observed following brief tendon taps when only a single, SL peak was elicited. 3. 'Stretch' reflexes evoked by 'ramp and hold' wrist extensions, as has been noted by numerous earlier investigators, were also protracted and comprised two main excitatory components. These responses resembled those produced by tendon extension both in their general form and in their behaviour upon altering the velocity of mechanical stimuli. Quantitatively, however, two main differences were evident. The reflexes evoked by wrist extension, including their SL and LL peaks, were generally somewhat larger. Additionally, when parameters of the two modes of stimulation were adjusted to elicit SL responses of equivalent amplitude, the LL responses elicited by tendon extension were regularly smaller and of shorter duration than those elicited by wrist extension. 4. Termination of the two forms of mechanical stimulation, by releasing tendon or wrist extension, each elicited a SL reduction in EMG activity. Such troughs were more pronounced and more consistently observed upon release of wrist extension. 5. Neither local anaesthesia of the skin overlying the flexor tendons at the wrist nor ischaemia of the hand and lower forearm produced any systematic modification of reflex response patterns. 6. It is concluded that intramuscular receptors (presumably muscle spindles) in FCR mediate both the SL and LL reflexes evoked in this muscle by extension of its tendon. Intramuscular receptors also seem certain to be very largely responsible for the EMG responses generated in this muscle by wrist extension.

Action Potentials↗

PubMed1994

Outcome assessment following limited wrist fusion: objective wrist scoring versus patient satisfaction.

Eighteen nonrheumatoid patients were reviewed an average of 4.4 years following limited wrist fusion to evaluate whether patient satisfaction or objective wrist scoring more closely correlated with functional outcome. Range of motion, grip strength, pain relief, radiographs, and patient satisfaction were assessed by examination and interview, and each wrist was scored based on a clinical scoring system described by Cooney. Twelve patients (67%) were very satisfied with their results, and six (33%) were dissatisfied. Thirteen (72%) experienced good pain relief, 12 of whom denied functional restrictions. Six patients (33%) reported suboptimal wrist function, and four indicated they had inadequate pain relief. Despite high levels of satisfaction in 12 patients, the objective wrist scores were only fair and poor. These low wrist scores unreliably reflected functional outcome. Patient self-assessment of wrist performance, however, was uniformly predictive. Pain relief was more critical to patient satisfaction than residual range of motion. Therefore, compared to objective wrist scoring, consideration of patient satisfaction may allow more accurate prediction and assessment of functional outcome following limited wrist fusion. Satisfactory postoperative function appears to be more dependent on pain relief than residual motion.

Adolescent↗

PubMed1993

[Arthrodesis of the wrist. Indication, technique and functional consequences for the hand and wrist].

Three studies conducted in our center demonstrated an improved technical success rate and elimination of preoperative pain in patients undergoing wrist fusions, with no significant difference in the ability to perform rapid movements requiring manual dexterity in the course of activities of daily living compared with patients who had undergone motion-preserving limited arthrodeses. The only absolute drawback of wrist fusion is that it obviously does not allow for any wrist motion at all. Limited intercarpal arthrodesis preserves some motion, but according to our results never leads to increased motion postoperatively. Several specific skills were found to present difficulty in patients who had undergone total wrist fusion. These included those requiring volar flexion in a limited space, where it would be difficult to have recourse to compensatory motion imparted by the shoulder and elbow, and those requiring forceful pronation and supination with simultaneous strong grasping. For patients involved in certain occupations requiring fine manual dexterity in tight spaces, wrist fusion might not be the most appropriate procedure. It is interesting that there appears to be a learning curve to the patient's ability to undertake specific activities postoperatively. A strong practice effect is present for the first 3-6 postoperative months, during which time a significant improvement in the patient's overall function is noted. Total wrist arthrodesis gives highly predictable results in the treatment of wrist pain and instability. The ability to perform normal activities of daily living and strenuous manual tasks was comparable to that after alternative motion-preserving procedures. We have not observed improved wrist motion after any wrist motion-preserving procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1992

Rheumatoid wrists treated with synovectomy of the extensor tendons and the wrist joint combined with a Darrach procedure.

Forty-three rheumatoid wrists in 43 patients with bilateral wrist involvement were treated with synovectomy of the extensor tendons and wrist joint combined with a Darrach procedure in the period from 1966 to 1986. Clinical and radiologic assessment of the wrists was carried out after an average follow-up period of 11 years, with comparison of the treated and the opposite untreated wrists. The authors confirmed what others have concluded regarding the operation: pain was generally decreased, forearm rotation increased, and wrist extension and palmar flexion changed little. Radiologically, carpal collapse and palmar carpal subluxation progressed nearly parallel to the opposite wrists, but ulnar carpal shift was much greater in the surgically treated wrists. Therefore it is suggested that some measure to prevent ulnar carpal shift, such as Clayton's tendon transfer or radiolunate arthrodesis, should be included in this operation.

Adult↗

PubMedDate not supplied

Biomechanical analysis of the effectiveness of in-line skating wrist guards for preventing wrist fractures.

The purpose of this investigation was to determine the effectiveness of commercially available wrist guards in preventing wrist fractures. Forty arms were harvested from 20 cadaveric specimens. The forearms from each cadaver, one with a wrist guard and one without a wrist guard, were then fractured using an instron Servohydraulic Material Testing System. The group of forearms tested to failure without wrist guards failed at an average force of 2245 N, while the group tested with wrist guards fractured at an average force of 2285 N, revealing no statistical difference. Similarly, observed fracture patterns were not noted to be different in the two groups. The in-line skating wrist guards tested were not effective in preventing wrist fractures under the experimental conditions of our study.

Biomechanical Phenomena↗

PubMed1999

The effects of complex wrist and forearm posture on wrist range of motion.

Previous research on wrist functionally has focused almost entirely on range of motion (ROM) in 2 or 3 isolated planes (flexion/extension, radial/ulnar deviation, and forearm pronation/supination), without investigating the potential effects of complex wrist/forearm posture on ROM. A quantitative analysis of these effects on wrist ROM was performed. ROM was measured in one plane using both a manual method and an electrogoniometer while the participant maintained a fixed, secondary wrist and forearm posture. The study revealed that combinations of wrist/forearm postures have significant effects on wrist ROM; the largest effects are those of wrist flexion/extension on radial deviation ROM. The study also found that, consistent with previous research, wrist deviation measurements obtained with an electrogoniometer were significantly different from those obtained manually. Biomechanical theories for the results obtained are discussed. This research could be used to enhance ergonomic evaluation techniques by providing a more accurate risk assessment of certain complex wrist postures, particularly those in which wrist flexion/extension is combined with radial deviation.

Adult↗

PubMedDate not supplied

Range of motion at the wrist: a comparison study of four wrist extension orthoses and the free hand.

OBJECTIVE: This study compared the total wrist range of motion permitted by four different styles of wrist extension orthoses and the free hand. METHOD: Using a repeated-measures, counterbalanced design, 40 healthy female volunteers 20 to 39 years of age shot a basketball while free handed and while wearing each of four wrist extension orthoses: AlignRite; Rolyan D-Ring Long; Rolyan D-Ring Short; and a custom-made, thumb hole design orthosis. The motion at the wrist was measured by an electrogoniometer. RESULTS: No significant differences were found in total wrist motion permitted among the four orthotic conditions. Analyses revealed that the custom-made orthosis allowed significantly less palmar flexion and significantly more dorsiflexion than the three commercially available orthoses. All orthoses significantly restricted wrist movement compared with the free hand. CONCLUSION: The commercially available wrist extension orthoses offered little difference in the amount of restriction they provided. The custom orthosis restricted movement to a different portion of the available range than did the commercial orthoses. Future research should examine how different strapping techniques on custom-made orthoses affect total range of motion permitted at the wrist. Knowledge of patterns of restriction among various styles of orthoses will help therapists to select the most appropriate orthosis for a client's individual needs.

Adult↗

PubMed1995

Wrist arthroplasty with the trispherical total wrist prosthesis.

The clinical results and long-term implant survival of wrist arthroplasty with the Trispherical total wrist prosthesis was evaluated in patients with inflammatory arthritis. Using the Hospital for Special Surgery wrist scoring system, the clinical evaluation of 35 Trispherical total wrist arthroplasties showed an excellent result in 20, good result in 8, fair result in 3, poor result in 2, and failed result requiring revision in 2 wrists at an average follow-up of 9 years. Cumulative implant survival in 67 consecutive Trispherical total wrist arthroplasties was 97% at 5 years and 93% at 10 and 12 years postoperatively. Patient satisfaction with wrist arthroplasty using the Trispherical prosthesis was excellent. We attribute the favorable long-term results obtained with the use of this prosthesis to its inherent design that allows for accurate restoration of the center of rotation of the wrist.

Adult↗

PubMed1993

Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography.

OBJECTIVE: Communicating defects shown by wrist arthrography often correlate poorly with the location of the patient's symptom(s). No study of wrist arthrography in which noncommunicating defects have been isolated, described, and correlated with the site of patients' symptoms has been reported. The aim of this study was to correlate the site(s) of patients' pain and the location(s) of noncommunicating defects shown by wrist arthrography. MATERIALS AND METHODS: One hundred noncommunicating capsular defects and incomplete defects of the interosseous ligaments and triangular fibrocartilage in 82 patients were identified from 462 three-compartment wrist arthrograms. Correlation between the sites of pain and sites of the noncommunicating defect was described as: (1) exact correlation, (2) ulnar/radial side correlation, (3) ambiguous correlation, or (4) no correlation. Statistical analysis was performed for each type of defect separately, in aggregate for patients who had more than one defect, and by separate analysis using patients' age (less than or greater than 30 years old). RESULTS: Capsular defects were detected in 65 patients, incomplete perforations of the triangular fibrocartilage in 28 patients, and incomplete defects of the scapholunate and lunotriquetral ligament in three patients each. No statistically significant correlation was found between individual defects and symptoms or between the site(s) of symptoms and patterns of multiple noncommunicating defects. Further, age did not influence the degree of correlations (chi 2 = 0.000-0.476, p values = 0.49-1.00). CONCLUSION: Attribution of patient's symptoms to noncommunicating defects shown by wrist arthrography is not reliable. Cases in which site-specific arthrographic defects directly correlate may be fortuitous. Additional studies will be necessary to determine the future role of wrist arthrography in the evaluation of the painful wrist.

Adult↗

PubMed1995

Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management.

Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral posttraumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18-55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown.

Adolescent↗