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At least 19 recordsLinked to original sources

PubMed2006

A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity.

BACKGROUND: Scapholunate advanced collapse wrist deformity is a common pattern of degenerative arthrosis of the wrist. This study prospectively evaluated a series of patients who underwent four-corner fusion using a circular plate internal fixation technique. METHODS: Patients with symptomatic stage II scapholunate advanced collapse wrist deformity were treated with scaphoid excision and four-corner fusion using the Spider Limited Wrist Fusion Plate (KMI, San Diego, Calif.). Patients were prospectively evaluated at 6 months and 1 year using a standard study protocol with radiographs, functional tests, and an outcomes questionnaire. Outcomes were compared with those of historical series from the literature. RESULTS: Eleven patients were enrolled and 10 patients completed their 1-year follow-up. Grip strength, lateral pinch strength, and Jebsen-Taylor test scores at 1 year were not significantly different from preoperative values. Mean active range of motion was 87 degrees preoperatively and 74 degrees at 1-year follow-up (p = 0.19). The Michigan Hand Outcomes Questionnaire showed no significant improvement in function, activities of daily living, work, pain, or patient satisfaction. The mean pain scores decreased from 54 preoperatively to 42 1-year postoperatively (p = 0.30), indicating persistent wrist discomfort. Three patients had broken screws: one was asymptomatic, one required 3 months of strict wrist immobilization, and one was reoperated for symptomatic nonunion. CONCLUSIONS: Four-corner fusion using the first-generation Spider plate technique has the advantage of earlier mobility and more patient comfort from absence of protruding Kirschner wires; however, patients continued to have disabling pain, functional limitations, work impairment, and low satisfaction scores postoperatively. Although limited by a small patient sample, this series presents outcomes data that may be useful in counseling patients who are contemplating four-corner fusion using this internal fixation device. Further investigation is necessary to evaluate the biomechanical properties of the Spider plate. The data suggest that better implants should be designed to avoid implant failure, which occurred in three of the 11 patients in this series.

Activities of Daily Living↗

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↗

PubMed2007

Prognosis of 5-year radiographic erosions of the wrist according to early, late, and persistent wrist swelling or tenderness in patients with early rheumatoid arthritis.

OBJECTIVE: To determine whether early inflammatory activity in the first year of disease compared to persistent or later occurrence of swelling or tenderness in the wrist joints is associated with 5-year erosions in the same joint in patients with early rheumatoid arthritis (RA). METHODS: A cohort of 195 patients with early active RA was enrolled in the Finnish RA Combination Trial. Swelling and tenderness of wrists were assessed at baseline and at 3, 6, 12, 24, 36, and 48 months. Radiographs of the wrists were taken at the baseline and at 5 years. The 237 wrist joints of 125 patients without erosions at baseline were classified according to wrist swelling, i.e., I: never swollen; II: swollen during first year only; III: swollen during the second to fourth year only; and IV: swollen during the first year and followup, and similarly according to tenderness. RESULTS: Thirty percent of the wrists were never swollen in all clinical examinations; 43% were swollen only during the first year; 11% were not swollen in the first year, but were swollen at some time during 24-48 months; and 16% of wrists were swollen during the first year and at some time during 24-48 months. At 5 years, 64% of 237 wrists remained free of erosions. Erosions developed in 82% of wrists that were swollen during both the first year and 24-48 months, versus 56% of wrists that were not swollen at first year but were swollen during 24-48 months, 31% of wrists that were swollen during the first year only, and 11% of wrists that were never swollen. Similar results were seen for joint tenderness. CONCLUSION: Wrist swelling during the first year only is associated with less future wrist radiographic damage than persistent swelling or swelling only during the followup. Our results emphasize the value of early and continuous suppression of inflammatory activity in early RA.

Adult↗

PubMed2005

Effects of wrist position and contraction on wrist flexors H-reflex, and its functional implications.

In order to determine whether joint position exerts a powerful influence on length-tension regulation in multiarticulate wrist flexors, three wrist positions (neutral, flexion and extension) and four levels of flexor contraction [0%, 10%, 20% and 30% maximum voluntary contraction (MVC)] were manipulated. There were significant differences in H-reflex amplitudes according to wrist positions and levels of flexor contraction. H-reflex increased linearly as a function of contraction in all three wrist positions. H-reflex was consistently larger in the wrist flexion than in the wrist extension position. The strength of the relationship (omega2) indicated that wrist position had a greater effect on H-reflex than force of muscle contraction. The interaction between wrist flexors contraction and joint position was significant only in the wrist flexion position. Trend analysis showed that, in the wrist flexion position, a low level of contraction was sufficient to maximally facilitate the H-reflex; however, a quadratic component was seen at higher contraction levels. The above findings may reflect the length-tension relationship of the multiarticulate wrist flexors. Therefore, this paper will discuss the functional implications related to the larger H-reflex in flexion position and the depressed H-reflex in the wrist extension position.

Adaptation, Physiological↗

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↗

PubMed2006

Range of movement in the wrist as a diagnostic tool in radial-sided wrist pain.

Kienböck disease is diagnosed by imaging studies, and is often difficult to diagnose in its early stages. Our clinical impression is that wrist movement is more limited in Kienböck disease than when radial-sided wrist pain is caused by other conditions. The purpose of this study was to determine the use of wrist movement in differentiating between early Kienböck disease and radial-sided sprained wrist. We retrospectively reviewed 62 cases of Kienböck disease and 49 patients with radial-sided wrist sprain. Wrist movement at presentation was recorded. The two groups differed significantly in flexion and extension (p<0.001). The ability of movement of the affected wrist relative to the normal side to distinguish between the groups was excellent (AUC = 0.96, 0.97, respectively). The ability of wrist movement measurements to differentiate between early Kienböck disease and radial-sided wrist sprain emphasises that wrist movement should be measured prior to invasive or expensive testing.

Adult↗

PubMed2005

Special aspects of wrist arthritis management for SLAC and SNAC wrists using midcarpal arthrodesis: results of bilateral operations and conversion to total arthrodesis.

Although midcarpal wrist arthrodesis is recognized as a standard procedure to treat scapholuate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) of the wrist, little has been reported about patients with bilateral involvement and the number, cause, and results of failed cases requiring conversion to total wrist arthrodesis. This study investigated the results of 20 patients with bilateral procedures and of 22 patients who underwent total wrist fusion after failed midcarpal arthrodesis out of an overall group of 907 patients treated by this method during a 12-year period. Of these, 16 bilateral and 20 converted cases were reexamined after an average of 48 months and 42 months, respectively. Patients after bilateral midcarpal arthrodesis experienced a pain reduction by an average of 54% of the preoperative pain values at rest and by 56% at stress on the visual analog scale (scale range: 0 to 100) and from intolerable (3.7) to pain only during stress (1.9) on the verbal scale (scale range: I to 4). A mean arc of wrist extension and flexion of 53 degrees on the right and 49 of the left wrist was preserved. The mean DASH score was 45 points and 70% of the patients felt impaired only during certain activities. Total arthrodesis reduced pain in 18 of 20 reexamined wrists by 67% of the previous values after the failed partial arthrodesis at rest and by 46% at stress on the visual analog scale andfrom intolerable pain (3.7) to pain only during stress (2.1) on the verbal scale. Seven of the 20 reexamined patients noted complete pain relief at rest and two also under stress conditions. The DASH score averaged 39 points. A mean Krimmer score of 46 points and a mean Buck-Gramcko and Lohman evaluation of 6 points represented a satisfactory result. Grip strength of the operated hand averaged 53% of the opposite side. Subjectively, 30% felt impaired only during certain activities, 55%felt considerably and 15% strongly limited in daily life. However, all but two patients were satisfied with the secondary total wrist fusion as pain was considerably reduced. Midcarpal arthrodesis reliably reduced pain and preserved valuable wrist mobility thus improving daily activity and quality of life also in bilateral carpal collapse. In the rare cases when midcarpal arthrodesis failed, total wrist arthrodesis markedly improved the complaints in most patients, but in contrast to other studies complete pain was seldom.

Adult↗

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↗

PubMed2004

Comparison of the Omron HEM-637 wrist monitor to the auscultation method with the wrist position sensor on or disabled.

BACKGROUND: To determine whether the Omron HEM637 wrist model with the wrist positioning sensor turned on (Son) is more accurate relative to upper arm auscultation by trained professionals than when the sensor was manually turned off (Soff). METHODS: Forty-four subjects, at least 30 years old, had repeated, sequential dual-observer upper arm auscultatory measurements (5 to 6 each) and oscillometric Omron HEM637 wrist measurements (4 each). Nineteen subjects were assigned to the wrist sensor On group and 25 were assigned to the wrist sensor Off group. A total of 425 auscultatory and 164 wrist measurements were analyzed. RESULTS: The Omron HEM-637 measured the blood pressure (BP) with equal accuracy to the observers using the auscultatory technique (difference -1.37 +/- 8.51/3.47 +/- 8.07 mm Hg, P =.71/.14). The wrist sensor did improve the accuracy of the measurements compared to the subjects that had the sensor deactivated. The sensor On group (Son) measured the systolic BP (0.82 +/- 9.83 mm Hg) and diastolic BP (-0.72 +/- 9.07 mm Hg) statistically the same as by auscultation (P =.86 for systolic BP and P =.83 for diastolic BP). The sensor Off (Soff) group measured the SBP (-3.03 +/- 7.12 mm Hg) and diastolic BP (-5.56 +/- 6.68 mm Hg) statistically different than auscultation (P =.46 for systolic BP and P =.02 for diastolic BP). The higher (negative) measurement for both the systolic BP and diastolic BP suggests that the average position of the wrist was 1.75 inches (4.4 cm) below the heart level in this group with the sensor off. CONCLUSIONS: This study demonstrated that the Omron HEM-637 monitor with a wrist sensor more accurately measured BP compared to the same model with the sensor turned off.

Adult↗

PubMed2005

[Wrist lesions in MRI arthrography compared with wrist arthroscopy].

BACKGROUND: Wrist arthroscopy is routinely used for diagnosis of ligamentous lesions to the wrist. Although it is very sensitive and specific, it is also more invasive than other available diagnostic techniques. METHOD: In a prospective trial, 125 patients (80 men, 45 women) 37 years old (+/- 12) with clinical evidence of wrist lesions were evaluated with direct wrist arthro MRI. Within 24 hours following direct arthro MRI wrist arthroscopy was performed. The surgeons and radiologists were not aware of the other results until completion of their investigation. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were determined. RESULTS: According to the MRI findings, lesions of the TFCC were suggested in 70 patients (56 % of all patients). In 65 cases this was confirmed by wrist arthroscopy. In the remaining 55 patients no TFCC lesions were detected by MRI. However in three cases TFCC lesions were found by arthroscopy. In the remaining 52 patients MRI accurately excluded TFCC lesions. There was a correlation of MRI and arthroscopy in detecting TFCC lesions in 93.6 %. Sensitivity was 94 %, specificity 89 %, positive predictive value 91 % and negative predictive value 93 %. Complete scapholunate ligament tears were detected by MRI in 12 (9.6 %) cases. Correlation with wrist arthroscopy was 99 %, sensitivity 92 %, specificity 100 %, positive and negative predictive value 100 % and 99 %, respectively. Accuracy for incomplete scapholunate lesions (n = 17, 13.6 %) and lunotriquetral tears (n = 4, 3.2 %) was poor (sensitivity 59 % and 25 %, specificity 100 % and 99 %). CONCLUSION: Though sensitivity of MRI arthrography approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future.

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↗