The Effect of Radioscapholunate Fusion On Wrist Movement and the Subsequent Effects of Distal Scaphoidectomy and Triquetrectomy

2010 ◽  
Vol 35 (9) ◽  
pp. 740-745 ◽  
Author(s):  
M.J. Berkhout ◽  
M.N. Shaw ◽  
L.J. Berglund ◽  
K.N. An ◽  
R.A. Berger ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Surgical Techniques ◽  
Cadaver Study ◽  
Salvage Procedure ◽  
Ulnar Deviation ◽  
Radiocarpal Joint ◽  
Flexion Extension ◽  
Radioscapholunate Fusion ◽  
Tracking Device ◽  
Radioscapholunate Arthrodesis

Radioscapholunate arthrodesis is a salvage procedure indicated for osteoarthritis of the radiocarpal joint involving the lunate facet of the radius. This cadaver study examines changes in wrist motion resulting from radioscapholunate arthrodesis, and the effects of surgical techniques to improve the range of motion. Simulated radioscapholunate arthrodesis, distal scaphoidectomy and triquetrectomy were carried out sequentially on six cadaver forearms and measurements (maximum flexion/extension and radial/ulnar deviation) were taken in the intact situation and after each surgical step using a magnetic tracking device. Radioscapholunate arthrodesis diminishes the amplitudes of movements of the wrist in all directions, but range of motion in the radioscapholunate fused wrist improves after scaphoidectomy and improves further after triquetrectomy (88% of original flexion/extension and 98% of original radial/ulnar deviation). Radioscapholunate arthrodesis causes a significant change in kinematics between the hamate and the triquetrum in flexion/extension.

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 A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females: Wrist Range of Motion and Grip Strength Analysis

2021 ◽  
Vol 2 ◽  
Author(s):  
Alejandra Aranceta-Garza ◽  
Karyn Ross
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Evidence Base ◽  
Secondary Outcome ◽  
Functional Study ◽  
Strength Analysis ◽  
Hand Position ◽  
Ulnar Deviation ◽  
Flexion Extension ◽  
The Impact

Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.Design: Randomised comparative functional study of the wrist/hand with and without WHOs.Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.

RADIOSCAPHOLUNATE ARTHRODESIS — A PROSPECTIVE STUDY

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 73-82 ◽  
Author(s):  
Gregory Ian Bain ◽  
Phillip Ondimu ◽  
Peter Hallam ◽  
Neil Ashwood
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Full Time ◽  
Non Union ◽  
Visual Analogue Pain ◽  
Forefoot Surgery ◽  
Flexion Extension ◽  
Minimal Reduction ◽  
A Prospective Study ◽  
Radioscapholunate Arthrodesis

The purpose of this prospective study was to evaluate pain levels, range of motion, patient activity and satisfaction after radioscapholunate (RSL) arthrodesis. This was in association with distal scaphoid excision and complete resection of the triquetrum. The non-union rate for radioscapholunate arthrodesis was examined and the results compared with previous studies. Twenty-three patients (14 males and nine females) with an average age of 47 (range 26–73) years underwent RSL fusion for post-traumatic osteoarthritis, rheumatoid arthritis and Kienböck's disease of the lunate with a mean follow-up of 32 (range 13–70) months. The absolute prerequisite for any of these groups of patients was a functional midcarpal joint which was assessed pre-operatively with radiographs and intra-operatively prior to RSL fusion. The average flexion to extension motion changed from 66° to 57°. The ulnoradial range of motion also increased to 43° from a pre-operative value of 22°. The patients visual analogue pain scores reduced from an average of 64 to 28 (p = 0.01). Nineteen patients had no restriction in activity and all but one was satisfied with the outcome. All patients remained in full time employment with ten returning to some form of sport. RSL fusion with excision of the distal pole of the scaphoid and the entire triquetrum led to minimal reduction in the flexion-extension arc of motion and an increase in the ulnoradial arc. There was also good pain relief and maintenance of a patient's function. Memory staples are also an effective method of securing fusion in the wrist obtaining similar results to that seen in forefoot surgery.

Effect of Wrist Posture on Discomfort for Simple Repetitive Exertions

2000 ◽  
Vol 44 (30) ◽  
pp. 5-473-5-476 ◽  
Author(s):  
Eilís J. Carey ◽  
Timothy J. Gallwey
Keyword(s):  
Range Of Motion ◽  
The Other ◽  
Maximum Strength ◽  
Angular Deviation ◽  
Ulnar Deviation ◽  
Flexion Extension ◽  
Male Subjects

This study investigated the effects of exertion, pace and level of simple and combined flexion/extension and radial/ulnar deviation of the wrist on discomfort for simple repetitive exertions. Eight male subjects participated in the study and the level of exertion and angular deviation were defined relative to the maximum strength and Range of Motion (ROM) of the subjects respectively. Extreme flexion caused higher discomfort than the other simple types of deviation, and the combination of flexion and ulnar deviation resulted in higher discomfort than the other types of combined deviation. Exertion was the most significant factor, followed by level of deviation.

The Effects of Complex Wrist and Forearm Posture on Wrist Range of Motion

1997 ◽  
Vol 41 (1) ◽  
pp. 629-633
Author(s):  
Matthew M. Marshall ◽  
Jacqueline Reynolds Mozrall ◽  
Jasper E. Shealy
Keyword(s):  
Range Of Motion ◽  
Ulnar Deviation ◽  
Wrist Motion ◽  
Practical Applications ◽  
Motion Data ◽  
Flexion Extension ◽  
Repetitive Trauma

In order to minimize the risk of repetitive trauma injuries, postures or motions that place joints near the limits of their range of motion (RoM) should be avoided. Before it can be determined that a posture or motion approaches the limit of a joint's motion, these limits need to be established. Previous research on wrist functionality has focused almost entirely on RoM in two or three isolated planes (flexion/extension, radial/ulnar deviation, and forearm pronation/supination), without investigating potential effects of complex wrist/forearm posture on RoM. Since most practical applications of this wrist motion data involve more than these isolated planar deviations, the effects of complex wrist/forearm posture on wrist functionality need to be understood.

scholarly journals Comparison of a New Inertial Sensor Based System with an Optoelectronic Motion Capture System for Motion Analysis of Healthy Human Wrist Joints

Sensors ◽  
2019 ◽  
Vol 19 (23) ◽  
pp. 5297 ◽  
Author(s):  
Michael Alexander Wirth ◽  
Gabriella Fischer ◽  
Jorge Verdú ◽  
Lisa Reissner ◽  
Simone Balocco ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Motion Capture ◽  
Inertial Measurement Unit ◽  
Absolute Difference ◽  
Measurement Unit ◽  
Good Precision ◽  
Motion Capture System ◽  
Ulnar Deviation ◽  
Inertial Measurement ◽  
Flexion Extension

This study aims to compare a new inertial measurement unit based system with the highly accurate but complex laboratory gold standard, an optoelectronic motion capture system. Inertial measurement units are sensors based on accelerometers, gyroscopes, and/or magnetometers. Ten healthy subjects were recorded while performing flexion-extension and radial-ulnar deviation movements of their right wrist using inertial sensors and skin markers. Maximum range of motion during these trials and mean absolute difference between the systems were calculated. A difference of 10° ± 5° for flexion-extension and 2° ± 1° for radial-ulnar deviation was found between the two systems with absolute range of motion values of 126° and 50° in the respective axes. A Wilcoxon rank sum test resulted in a no statistical differences between the systems with p-values of 0.24 and 0.62. The observed results are even more precise than reports from previous studies, where differences between 14° and 27° for flexion-extension and differences between 6° and 17° for radial-ulnar deviation were found. Effortless and fast applicability, good precision, and low inter-observer variability make inertial measurement unit based systems applicable to clinical settings.

OUTCOMES OF FOUR-CORNER ARTHRODESIS USING THE HUBCAPTM CIRCULAR PLATE

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 215-220 ◽  
Author(s):  
Sameer K. Khan ◽  
Syed M. Ali ◽  
Andrew McKee ◽  
Jonathan W. M. Jones
Keyword(s):  
Range Of Motion ◽  
Circular Plate ◽  
Functional Outcomes ◽  
Circular Plates ◽  
Ulnar Deviation ◽  
Non Union ◽  
Flexion Extension ◽  
Radiological Union

We present results of four-corner carpal arthrodesis with the Acumed® HubcapTM circular plate performed at our unit. Eight patients underwent eight procedures over five years, for scapholunate advanced collapse (five wrists) and scaphoid non-union advanced collapse (three wrists). Outcomes included range of motion, quickDASH scores, and visual analogue scores for satisfaction. At final follow-up, mean flexion-extension arc was 56°, mean radial-ulnar deviation 29° and mean quickDASH score was 23/100. Mean score for satisfaction was 7.7/10 (77%). Seven out of eight (87.5%) patients said they would have it done again, and would also recommend it to others. Radiological union was achieved in all cases. One screw broke in one arthrodesis without causing symptoms. The functional outcomes with our use of the HubcapTM are comparable to those reported in literature to date with other circular plates (e.g. Spider plate). There were no non-unions, which is the main reported complication with these plates.

scholarly journals RADIOSCAPHOLUNATE (RSL) FUSION ON SECONDARY OA WRIST WITH NEGLECTED DISLOCATION RADIOCARPAL JOINT AND CONTRACTURE DUE TO ENTRAPMENT OF SUPERFICIAL FLEXOR TENDON INDEX FINGER OF LEFT HAND

2021 ◽  
Vol 9 (1) ◽  
pp. 210-214
Author(s):  
Rahmad Rian ◽  
Seti Aji Hadinoto ◽  
Tito Sumarwoto ◽  
Pamudji Utomo ◽  
M qathar RF Tulandi Tulandi
Keyword(s):  
Flexor Tendon ◽  
Index Finger ◽  
Salvage Procedure ◽  
Range Of Movement ◽  
Wrist Arthrodesis ◽  
Left Wrist ◽  
Wrist Motion ◽  
Left Hand ◽  
Radiocarpal Joint ◽  
Radioscapholunate Fusion

ABSTRACT   Background: When pain, deformity and instability compromise wrist function, wrist stabilization by means of fusion is a procedure of recognized validity. The goal of wrist arthrodesis is to provide the patient with a stable wrist for power grip and the predictable relief of pain while sacrificing wrist motion. The radioscapholunate (RSL) fusion is one of salvage procedure indicated in the case of traumatic or degenerative osteoarthritis of the radiocarpal joint, involving the lunate facet of the radius. RSL-fusion reduced total wrist motion (3 MC/Rad) in the F/E axis to an average of 49% of F/E in the unfused wrist but  preserves midcarpal joint motion while alleviating pain. Case Report: We report a 43-year-old male patient with pain on his left wrist. 10 months before admission, he felt down from stairs with his left hand bear his body weight. He broke his wrist and got surgery at that time. Because still feel pain and his index finger can’t fully extensed, he brought to Soeharso orthopaedic hospital. Here, we have done RSL-fusion using cross pinning K-Wire to reduce pain, distal scapoid excision to optimizing radial angulation and release superficial flexor tendon index finger of left hand. Discussion: With Secondary OA of left wrist post traumatic with neglected radiocarpal dislocation and superficial flexor tendon contracture due to entrapment index finger of left hand post RSL-fusion, distal scapoid excision and release contracture can reduce pain at radiocarpal joint and improve range of movement. Conclusion: The goal of Radioscapholunate (RSL) fusion is to optimizing wrist motion and strength while minimizing or eliminating pain   Keywords: Radioscapholunate fusion, partial wrist arthrodesis, limited wrist fusion, reduce pain

FUNCTIONAL AND KINEMATIC ANALYSIS OF A WRIST RADIAL HEMIARTHROPLASTY DESIGN

2018 ◽  
Vol 21 (01) ◽  
pp. 1850005
Author(s):  
Alexander W. Hooke ◽  
Eric Wagner ◽  
Kurt Pettersson ◽  
Per Fischer ◽  
Marco Rizzo
Keyword(s):  
Range Of Motion ◽  
Moment Arm ◽  
Ulnar Deviation ◽  
Functional Changes ◽  
Flexor Carpi Radialis ◽  
Moment Arms ◽  
Flexion Extension ◽  
Flexion Moment ◽  
The Mean ◽  
Extensor Carpi Radialis

Purpose: A biomechanical functional assessment was performed on a newly designed wrist hemiarthroplasty implant with aimed to identifying differences between the native wrist and wrist following the hemiarthroplasty procedure with [Formula: see text] and without a proximal row carpectomy (Hemi). Methods: Six cadaveric wrists were mounted on a custom testing fixture and underwent a series of functional tests to investigate differences in range of motion, muscles moment arms, and axis of rotation between the intact and post-operative wrists. The tested movements included manually-driven flexion-extension, radial-ulnar deviation, dart throwers motion, and circumduction. Results: The only significant change in range of motion was a decrease in flexion between the intact [Formula: see text] and both the Hemi [Formula: see text] and [Formula: see text] [Formula: see text] conditions. Minor differences in the mean position and variability of the axis of rotation’s piercing point were identified. A statistically significant decrease in the flexion moment arm of the flexor carpi radialis was identified between the intact ([Formula: see text][Formula: see text]mm) and [Formula: see text] ([Formula: see text][Formula: see text]mm) conditions. Statistically significant decreases were also identified in the radial deviation moment arms of the extensor carpi radialis brevis’ between the intact ([Formula: see text][Formula: see text]mm) and [Formula: see text] ([Formula: see text][Formula: see text]mm) conditions and the flexor carpi radialis’ between the intact ([Formula: see text][Formula: see text]mm) and Hemi ([Formula: see text][Formula: see text]mm) conditions as well as in the ulnar deviation moment arm of the extensor carpi ulnaris between the intact ([Formula: see text][Formula: see text]mm) and Hemi ([Formula: see text][Formula: see text]mm) conditions. Conclusions: While some statistically significant functional changes were identified between the native and hemiarthroplasty wrist, the findings suggest that post-operative function is equally acceptable in hemiarthroplasty with and without resection of the proximal carpal row.

scholarly journals At Home Photography-Based Method for Measuring Wrist Range of Motion

2017 ◽  
Vol 06 (04) ◽  
pp. 280-284 ◽  
Author(s):  
Samir Trehan ◽  
Schneider Rancy ◽  
Parker Johnsen ◽  
Howard Hillstrom ◽  
Steve Lee ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Digital Images ◽  
Intraclass Correlation ◽  
Office Visits ◽  
Wrist Flexion ◽  
Ulnar Deviation ◽  
Digital Photographs ◽  
Physician Contact ◽  
Flexion Extension ◽  
At Home

Purpose To determine the reliability of wrist range of motion (WROM) measurements based on digital photographs taken by patients at home compared with traditional measurements done in the office with a goniometer. Methods Sixty-nine postoperative patients were enrolled in this study at least 3 months postoperatively. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by one of the two attending surgeons with a 1-degree resolution goniometer at the last postoperative office visit. Patients were provided an illustrated instruction sheet detailing how to take digital photographic images at home in six wrist positions (active and passive flexion/extension, and radial/ulnar deviation). Wrist position was measured from digital images by both the attending surgeons in a randomized, blinded fashion on two separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient to assess agreement between clinical and photography-based goniometry, as well as intra- and interobserver agreement. Results Out of 69 enrolled patients, 30 (43%) patients sent digital images. Of the 180 digital photographs, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was “almost perfect” for passive wrist flexion/extension and “substantial” for active wrist flexion/extension and radial/ulnar deviation. Inter- and intraobserver agreement for the attending surgeons was “almost perfect” for all measurements. Discussion This study validates a photography-based goniometry protocol allowing accurate and reliable WROM measurements without direct physician contact. Passive WROM was more accurately measured from photographs than active WROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients or their families take and submit their own photographs. Clinical Relevance Patient-performed photography-based goniometry represents an alternative to traditional clinical goniometry that could enable longer-term follow-up, overcome travel-related impediments to office visits, improve convenience, and reduce costs for patients.

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