scholarly journals Distinct Wrist Patterns Founded on Measurements in Plain Radiographs

2018 ◽  
Vol 07 (05) ◽  
pp. 366-374
Author(s):  
Aviv Kramer ◽  
Raviv Allon ◽  
Frederick Werner ◽  
Idit Lavi ◽  
Alon Wolf ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Three Dimensional ◽  
Diagnostic Study ◽  
Scapholunate Ligament ◽  
Level Of Evidence ◽  
Radial Inclination ◽  
Level Ii ◽  
Joint Contact ◽  
Midcarpal Joint

Background In joints, structure dictates function and consequently pathology. Interpreting wrist structure is complicated by the existence of multiple joints and variability in bone shapes and anatomical patterns in the wrist. Previous studies evaluated lunate and capitate shape in the midcarpal joint, and two distinct patterns have been identified. Purpose Our purpose was to further characterize the two wrist patterns in normal wrist radiographs using measurements of joint contact and position. Our hypothesis was that we will find significant differences between the two distinct anatomical patterns. Patients and Methods A database of 172 normal adult wrist posteroanterior (PA) radiographs was evaluated for radial inclination, height, length, ulnar variance, volar tilt, radial-styloid-scaphoid distance, and lunate and capitate types. We measured and calculated percent of capitate facet that articulates with the lunate, scapholunate ligament, scaphoid, and trapezoid. These values were compared between the wrist types and whole population. Results Type-1 wrists (lunate type-1 and spherical proximal capitate) were positively associated with a longer facet between capitate and distal lunate (p = 0.01), capitate and base of middle metacarpal (p = 0.004), and shorter facet between the capitate and hamate (p = 0.004). The odds ratio of having a type-1 wrist when the interface between the capitate and lunate measures >8.5 mm is 2.71 (confidence interval [CI] 1.07, 6.87) and when the line between the capitate and the base of middle metacarpal >9.5 mm is 3.5 (CI 1.38, 9.03). Conclusion We characterized the two-wrist patterns using intracarpal measurements. Translating these differences into three-dimensional contact areas may help in the understanding of biomechanical transfer of forces through the wrist. Level of Evidence This is a Level II, diagnostic study.

scholarly journals Midcarpal Structure Effect on Force Distribution through the Radiocarpal Joint

2019 ◽  
Vol 08 (06) ◽  
pp. 477-481
Author(s):  
Ronit Wollstein ◽  
Aviv Kramer ◽  
Scott Friedlander ◽  
Frederick Werner
Keyword(s):  
Compressive Force ◽  
Structural Variations ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Level Ii ◽  
Force Transfer ◽  
Radiocarpal Joint ◽  
Flexion Extension ◽  
Tensile Forces ◽  
Midcarpal Joint

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.

scholarly journals Saline Load Test for Detecting Traumatic Arthrotomy in the Wrist

2019 ◽  
Vol 08 (03) ◽  
pp. 221-225
Author(s):  
Nitin Goyal ◽  
Daniel D. Bohl ◽  
Rachel M. Frank ◽  
William Slikker ◽  
John J. Fernandez ◽  
...  
Keyword(s):  
Wrist Joint ◽  
Load Test ◽  
Saline Infusion ◽  
Wrist Arthroscopy ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Level Ii ◽  
Appropriate Treatment ◽  
Sterile Normal Saline ◽  
Open Injuries

Background Open injuries communicating with the wrist joint are essential to detect to facilitate timely, appropriate treatment. While the saline load test to detect traumatic arthrotomy has been well studied in the knee and ankle, it has not been studied in the wrist, and therefore the appropriate volume of saline infusion to detect traumatic arthrotomy is not known. Purpose The purpose of this study was to utilize wrist arthroscopy to determine the saline infusion volume necessary to achieve 99% sensitivity in detecting traumatic arthrotomy. Methods Twenty consecutive patients undergoing elective wrist arthroscopy were prospectively enrolled. A 5-mm arthrotomy was established between the third and fourth dorsal extensor compartments. An 18-gauge needle was inserted into the 6R portal on the radial side of the extensor carpi ulnaris. Sterile normal saline was injected into the wrist joint through the needle at a rate of 0.1 mL per second until extravasation from the 3–4 portal was visualized. Saline volumes required for extravasation were analyzed. Results The mean saline volume required for extravasation was 0.8 mL. The volume of saline needed to achieve sensitivities of 50, 90, 95, and 99% were 0.4, 2.2, 2.3, and 2.5 mL respectively. Conclusions The saline infusion volume required to detect a dorsal radiocarpal arthrotomy with 99% sensitivity was 2.5 mL. We recommend using at least 2.5 mL when performing the saline load test to rule out a potential arthrotomy to the wrist in the traumatic setting. Level of Evidence: This is a Level II, diagnostic study.

The Radial Synergy Test: An Aid to Diagnose de Quervain’s Tenosynovitis

Hand ◽  
2021 ◽  
pp. 155894472110572
Author(s):  
Chihua Lee ◽  
Phillip N. Langford ◽  
Graham E. Sullivan ◽  
Matthew A. Langford ◽  
Christopher J. Hogan ◽  
...  
Keyword(s):  
Corticosteroid Injection ◽  
Retrospective Chart Review ◽  
High Specificity ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
De Quervain’S Tenosynovitis ◽  
Asymptomatic Patients ◽  
Level Ii ◽  
Sensitivity Evaluation ◽  
Synergy Test

Background: Diagnosis of de Quervain’s tenosynovitis is made clinically. Finkelstein’s and Eichoff’s tests are commonly utilized examination maneuvers. Their specificity has been questioned due to a propensity to provoke pain in asymptomatic patients. Using the principle of synergism, the novel radial synergy test takes advantage of isometric contraction of the first dorsal compartment with resisted abduction of the small finger. Methods: Electromyography was performed on 3 authors and the first dorsal compartment sampled during the maneuver. Sensitivity evaluation was performed via retrospective chart review for patients diagnosed with de Quervain’s from 2013 to 2018. Inclusion criteria were documented radial synergy test, Eichoff’s test, and ≥90% pain relief after lidocaine/corticosteroid injection. We enrolled 222 patients with 254 affected extremities. Specificity evaluation was performed via a prospective cohort of volunteers undergoing radial synergy and Eichoff’s tests. Inclusion criterion was lack of preexisting wrist pain. Score > 0 on Visual Analog Scale was considered positive. We enrolled 48 volunteers with 93 tested extremities. Results: Electromyography revealed positive recruitment of the first dorsal compartment. Sensitivity of the radial synergy test was inferior to Eichoff’s test (97% vs 91%, relative risk [RR] = 0.93 [95% confidence interval [CI] = 0.89-0.97], P < .01). Specificity of the radial synergy test was superior to Eichoff’s test (99% vs 74%, RR = 1.33 [95% CI = 1.18-1.51], P < .001). Conclusions: We describe and evaluate the radial synergy test, a novel examination maneuver to aid the diagnosis of de Quervain’s. This serves as an adjunct for future diagnostic evaluations with its high specificity. Level of Evidence: Level II, diagnostic study.

Three-Dimensional Analysis of Scapular Kinematics During Arm Elevation in Baseball Players With Scapular Dyskinesis: Comparison of Dominant and Nondominant Arms

2020 ◽  
Vol 29 (1) ◽  
pp. 93-101 ◽  
Author(s):  
Jin-Young Park ◽  
Junhyun Kim ◽  
Beom Ho Seo ◽  
Ho Dong Yu ◽  
Ju Hyun Sim ◽  
...  
Keyword(s):  
Pathological Condition ◽  
Three Dimensional ◽  
Diagnostic Study ◽  
Scapular Dyskinesis ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Baseball Players ◽  
3 Dimensional ◽  
Scapular Kinematics ◽  
Arm Elevation

Background: The knowledge of 3-dimensional scapular kinematics is essential for understanding the pathological lesions of the shoulder and elbow in throwing athletes. Many studies about alterations of the resting scapular position, dynamic scapular motion, or scapular dyskinesis (SD) have been conducted, yet none of them have identified a consistent pattern of altered scapular kinematics in throwing athletes. Hypothesis/Purpose: To analyze the 3-dimensional scapular kinematics of dominant and nondominant arms in baseball players with a pathological condition of the shoulder or elbow. Study Design: Cross-sectional study. Methods: Bilateral scapular positions, consisting of upward rotation (UR), superior translation (ST), internal rotation (IR), protraction (PRO), and anterior tilting (AT) with an arm at rest and at 150° forward elevation, were measured among 319 baseball players with SD using 3-dimensional computed tomography. Angular values of scapula were compared between dominant and nondominant arms with statistical analysis. Level of Evidence: Level III, diagnostic study. Results: The scapular position of dominant arms showed significantly more AT, less ST at rest and more UR and IR and less ST, PRO, and AT at 150° full forward elevation compared with the nondominant arms. The magnitude of mean change of UR, IR, PRO, and AT during arm elevation increased significantly between the paired arms (P value: UR, ST, PRO, and AT: <.001 and IR: .001). Conclusion: When compared with the nondominant arms, UR, AT, and PRO with the arm at 150° forward elevation of dominant symptomatic arms in baseball players tilted toward positive compensation, whereas IR altered toward negative decompensation. In addition, the angular increment of the scapula increased significantly in dominant symptomatic arms compared with the nondominant arms.

Patterns of Nodal Metastases and Predictors of Occult Disease in HPV-Associated Oropharynx Cancer

2020 ◽  
pp. 019459982095147
Author(s):  
Gaelen Britton Stanford-Moore ◽  
Edgar Ochoa ◽  
Andrew Larson ◽  
Mary Han ◽  
Kathryn Hoppe ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Lymphovascular Invasion ◽  
Nodal Disease ◽  
Multivariate Logistic Regression ◽  
Level Of Evidence ◽  
Papilloma Virus ◽  
Level Ii ◽  
Occult Disease ◽  
Level I ◽  
Oropharynx Squamous Cell Carcinoma

Objective For human papilloma virus–associated oropharynx squamous cell carcinoma (HPV+ OPSCC), we evaluated the distribution of neck-level lymph node (LN) metastasis, based on postsurgical histopathology, and the incidence of and risk factors for occult LN metastases, as these patterns need clarification for this newer cancer subset. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB). Methods We analyzed 2358 patients in the NCDB with HPV+ OPSCC who underwent neck dissection (ND) from 2010 to 2015. Incidence and distribution of LN metastases were calculated for neck levels I to V. Variables associated with occult LN metastasis were assessed by multivariate logistic regression. Results In therapeutic NDs (n = 1935), the following proportions of positive LNs were found: level I, 9.0% (n = 175); level II, 81.0% (n = 1568); level III, 29.6% (n = 573); level IV, 11.9% (n = 230); and level V, 4.9% (n = 95). In elective NDs (n = 423), occult-positive LNs were found in 35.8% (n = 152), with the following proportions by level: level I, 3.3% (n = 14); level II, 26.9% (n = 114); level III, 8.7% (n = 37); level IV, 4.0% (n = 17); and level V, 0.2% (n = 1). The presence of occult LNs was independently associated with a Charlson-Deyo score of 1 (odds ratio, 2.26; 95% CI, 1.18-4.31; P = .014) and lymphovascular invasion (odds ratio, 5.91; 95% CI, 3.21-11.18; P < .001). Occult LN metastases were not significantly associated with pT classification, primary site, or number of LNs resected. Conclusion For HPV+ OPSCC, occult nodal disease is common. Therapeutic NDs should encompass at least levels II, III, and IV and possibly I, whereas elective NDs could possibly encompass levels II and III. Level of Evidence 4.

scholarly journals Volume of the Thumb Carpometacarpal Joint

2019 ◽  
Vol 09 (01) ◽  
pp. 019-021
Author(s):  
Kevin F. Lutsky ◽  
Fred Liss ◽  
Jack Graham ◽  
Pedro K. Beredjiklian
Keyword(s):  
Fluid Injection ◽  
Diagnostic Study ◽  
Limited Capacity ◽  
Carpometacarpal Joint ◽  
Maximum Volume ◽  
Level Of Evidence ◽  
Thumb Carpometacarpal Joint ◽  
Level Ii ◽  
The Mean ◽  
Thumb Carpometacarpal

Background The volume of the carpometacarpal joint of the thumb (TCMC) and its capacity to accommodate fluid injection is unknown. Questions/Purpose The purpose of the present study is to assess the volume of the TCMC. Methods Forty-two thumbs undergoing surgical treatment for symptomatic TCMCJ osteoarthritis (OA) were evaluated. Prior to the start of the surgical procedure saline was injected into the TCMC until resistance was felt and no further saline could be injected. The maximum volume (MaxVol) of injectate was measured and recorded. Results Mean MaxVol among all patients was 0.9 cc (range: 0.2–3.0 cc). There were 15 patients with 1 cc or more injected, the rest were less than 1 cc. The mean MaxVol for Eaton 2 thumbs was 1.5 cc, for Eaton 3 thumbs 0.9 cc, and for Eaton 4 thumbs 0.7 cc, with negative correlation between Eaton stage and MaxVol. Conclusion TCMC has limited capacity for injected fluid. Level of Evidence This is a Level II, diagnostic study.

scholarly journals The personalized Berger method is usable to solve the problem of tibial rotation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Gömöri András ◽  
Gábor Németh ◽  
Csaba Zsolt Oláh ◽  
Gábor Lénárt ◽  
Zsanett Drén ◽  
...  
Keyword(s):  
Tibial Component ◽  
Reference Points ◽  
Tibial Tuberosity ◽  
Ct Scans ◽  
Diagnostic Study ◽  
Tibial Rotation ◽  
Level Of Evidence ◽  
Level Ii ◽  
Preoperative Ct ◽  
Total Knee

Abstract Purpose The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case. Methods Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks. The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated. Results A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°). Conclusion The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component. Level of evidence Level II, Diagnostic Study (Methodological Study).

A Preliminary Model of the Wrist Midcarpal Joint

2021 ◽  
Author(s):  
Martin Pendola ◽  
Catherine Petchprapa ◽  
Ronit Wollstein
Keyword(s):  
Ex Vivo ◽  
Three Dimensional ◽  
Ct Scans ◽  
Ex Vivo Model ◽  
Carpometacarpal Joints ◽  
Force Transfer ◽  
Midcarpal Joint

Abstract Background A challenge to deciphering the effect of structure on function in the wrist involves difficulty in obtaining in-vivo information. To provide a platform to study wrist mechanics using in vivo acquired forces, we developed a model of the midcarpal joint based on computed tomography (CT) scans of normal wrists. Finite element analysis (FEA) can enable application of in vivo collected information to an ex vivo model. Objectives The objectives of this study are to (1) create a three-dimensional model of the midcarpal joint of the wrist based on CT scans and (2) generate separate models for the midcarpal joint based on two distinct wrist types and perform a pilot loading of the model. Methods CT scans from a normal patient database were converted to three-dimensional standard template library (STL) files using OsiriX software. Five type 1 and five type 2 wrists were used for modeling. A simulated load was applied to the carpometacarpal joints in a distal-to-proximal direction, and FEA was used to predict force transfer in the wrist. Results There were 33% type 1 and 67% type 2 wrists. The midcarpal joint dimensional measurements estimated from the model had intermediate agreement between wrist type as measured on CT scan and as predicted by the model: 56% Cohen's kappa (95% confidence interval) = 0.221 (0.05–0.5). Surface stress on the carpometacarpal joints is different in type 1 and type 2 wrists. On loading the neutral wrist, the capitolunate angle was 90 degrees in type 1 wrists and 107 degrees in type 2 wrists (p < 0.0001). Conclusions The model predicted differences in movement and force transfer through the midcarpal joint dependent on structural type. This knowledge can improve our understanding of the development of disparate patterns of degeneration in the wrist.

A blinded, randomized trial comparing bicolumnar arthrodesis to radioscapholunate arthrodesis in scapholunate advanced collapse II arthritis: a pilot study

2018 ◽  
Vol 43 (8) ◽  
pp. 813-819
Author(s):  
Simon S. M. Chan ◽  
Sheena Sikora ◽  
Jason N. Harvey ◽  
Stephen K. Y. Tham
Keyword(s):  
Primary Outcome ◽  
High Rate ◽  
Scapholunate Ligament ◽  
Level Of Evidence ◽  
Linear Mixed Effects ◽  
Wrist Function ◽  
Ligament Disruption ◽  
Radioscapholunate Arthrodesis ◽  
Midcarpal Joint ◽  
To Receive

The purpose of this study was to compare the outcome of scaphoid excision with capitolunate and triquetrohamate arthrodesis (bicolumnar arthrodesis) to radioscapholunate arthrodesis in patients with scapholunate advanced collapse (SLAC) II wrist arthritis. Twelve patients with symptomatic SLAC II arthritis were recruited and randomized to receive either bicolumnar arthrodesis or radioscapholunate arthrodesis. The primary outcome was wrist function as assessed by the patient rated wrist evaluation. Secondary outcomes included range of motion, grip strength and the Mayo wrist score. A linear mixed-effects model was used to evaluate the effects of bicolumnar arthrodesis and radioscapholunate arthrodesis in treating SLAC II arthritis. Patients receiving bicolumnar arthrodesis had more improvement in their wrist function compared with patients receiving radioscapholunate arthrodesis. A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis. In SLAC II arthritis, the expected benefit of preserving the midcarpal joint was not observed. Scapholunate ligament disruption makes radioscapholunate arthrodesis a technically challenging operation. Level of evidence: I

scholarly journals The Prevalence of Cam Morphology: A Cross-Sectional Evaluation of 3,558 Cadaveric Femora

2021 ◽  
Vol 7 ◽  
Author(s):  
Shane Hanzlik ◽  
Andrew J. Riff ◽  
Thomas H. Wuerz ◽  
Michael Abdulian ◽  
Danielle Gurin ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Diagnostic Study ◽  
Direct Visualization ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Cam Deformity ◽  
Population Prevalence ◽  
Level Ii ◽  
Bilateral Lesions ◽  
Cam Morphology

Purpose: We sought to determine (1) the prevalence of cam deformity in the population and that of bilateral cam deformity, (2) the typical location of a cam lesion, and (3) the typical size of a cam lesion by direct visualization in cadaveric femora.Methods: Two observers inspected 3,558 human cadaveric femora from the Hamann–Todd Osteological Collection from the Cleveland Museum of Natural History. Any asphericity &gt;2 mm from the anterior femoral neck line was classified as a cam lesion. Once lesions had been inspected, the prevalence in the population, prevalence by gender, and prevalence of bilateral deformity were determined. Additionally, each lesion was measured and localized to a specific quadrant on the femoral neck based upon location of maximal deformity.Results: Cam lesions were noted in 33% of males and 20% of females. Eighty percent of patients with a cam lesion had bilateral lesions. When stratified by location of maximal deformity, 90.9% of lesions were in the anterosuperior quadrant and 9.1% were in the anteroinferior quadrants. The average lesion measured 17 mm long × 24 mm wide × 6 mm thick in men and 14 mm × 22 mm × 4 mm in women (p &lt; 0.05).Conclusions: The population prevalence of cam deformity determined by direct visualization in cadavers may be higher than has been suggested in studies utilizing imaging modalities.Level of Evidence : Level II, diagnostic study.

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