scholarly journals Conservative Treatment of an Acute Traumatic Extensor Carpi Ulnaris Tendon Subluxation in a Collegiate Basketball Player: A Case Report

2011 ◽  
Vol 46 (5) ◽  
pp. 574-576 ◽  
Author(s):  
Steve M. Patterson ◽  
William J. Picconatto ◽  
Julie A. Alexander ◽  
Rachel L. Johnson
Keyword(s):  
National Collegiate Athletic Association ◽  
Ulnar Collateral Ligament ◽  
Distal Radioulnar Joint ◽  
Basketball Player ◽  
Wrist Flexion ◽  
Joint Injury ◽  
Radial Deviation ◽  
Extensor Carpi Ulnaris ◽  
Slight Extension ◽  
Ulnar Fracture

Objective: To present the case of an acute traumatic extensor carpi ulnaris (ECU) subluxation in a National Collegiate Athletic Association Division II female basketball player. Background: The ECU tendon is stabilized in the ulnar groove by a subsheath located inferior to the extensor retinaculum. The subsheath can be injured with forced supination, ulnar deviation, and wrist flexion, resulting in the ECU tendon subluxing in the palmar and ulnar directions during wrist circumduction. Several methods of intervention exist, but controversy remains on how to best treat this condition. Differential Diagnosis: Distal ulnar fracture, ulnar collateral ligament sprain, triangular fibrocartilage complex lesion, lunotriquetral instability, distal radioulnar joint injury, pisotriquetral joint injury, ECU tendinopathy or subluxation. Treatment: The wrist was placed in a short-arm cast in slight extension and radial deviation for 4 weeks. At that time, the patient was still able to actively sublux the ECU tendon, so a long-arm cast was applied with the wrist in slight extension, radial deviation, and pronation for an additional 4 weeks. The ECU tendon was then found to be stable. She wore a rigid wrist brace for 3 more weeks while she pursued rehabilitation. At the final follow-up appointment, the ECU tendon remained stable, and the wrist was asymptomatic. Uniqueness: Subluxations of the ECU are rare. If the patient does not improve with conservative measures, surgical intervention is warranted to repair the sixth dorsal compartment. Conclusions: A long-arm cast with the elbow flexed to 90° and the wrist in approximately 30° of extension, radial deviation, and pronation was appropriate treatment for this type of injury.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Wrist strength limitations to manual exertion capability

1998 ◽  
Vol 1 (2) ◽  
pp. 107-121
Author(s):  
Khaled W. Al-Eisawi ◽  
Carter J. Kerk ◽  
Jerome J. Congleton
Keyword(s):  
Biomechanical Modeling ◽  
Two Dimensional ◽  
Wrist Flexion ◽  
College Age ◽  
Biomechanical Models ◽  
Radial Deviation ◽  
Flexion Strength ◽  
Made In

This study evaluated wrist strength limitations to manual exertion capability in two-dimensional static biomechanical modeling. The researchers hypothesized that wrist strength does not limit manual exertion capability - an assumption commonly made in many strength biomechanical models. An experiment was conducted on 15 right-handed males of college age. Isometric wrist flexion strength was measured at two elbow angles: 90 degree and 135 degree and in two wrist positions: neutral and 45 degree extended. Isometric wrist radial deviation strength was measured at the same two elbow angles and in two wrist positions: neutral and 30 degree ulnarly deviated. Minimum wrist strength limits for which wrist strength does not limit maximal moments about the elbow in manual hand exertions were calculated and compared to their corresponding measured wrist strength moments using paired t-tests. In general, wrist strength was non-limiting. However, wrist flexion strength in the 45 degree extended wrist posture was limiting. Weak-wrist subjects showed more wrist strength limitations than strong-wrist subjects.

Fibre bundles in the human extensor carpi ulnaris tendon are arranged in a spiral

2011 ◽  
Vol 37 (6) ◽  
pp. 550-554 ◽  
Author(s):  
N. S. Kalson ◽  
P. S. C. Malone ◽  
R. S. Bradley ◽  
P. J. Withers ◽  
V. C. Lees
Keyword(s):  
Polarized Light ◽  
Clinical Importance ◽  
Longitudinal Axis ◽  
Distal Radioulnar Joint ◽  
Forearm Rotation ◽  
Fibre Bundles ◽  
Extensor Carpi Ulnaris ◽  
Dart Throwing ◽  
Dynamic Stabilizer ◽  
Antagonist Action

The extensor carpi ulnaris musculotendinous unit has important agonist and antagonist action in wrist motion, including the dart-throwing action, and is a dynamic stabilizer of the distal radioulnar joint during forearm rotation. Despite its functional and clinical importance, little is known about its internal structure. Investigation of the ultrastructure of the human extensor carpi ulnaris (ECU) tendon was undertaken using plane polarized light microscopy and microcomputer tomography with 3D reconstruction. The study demonstrates that the tendon comprises fibre bundles (fascicles) approximately 0.1 mm in diameter that are arranged in a gradual spiral. The spiralling fibres make an angle of 8º to the longitudinal axis of the tendon. The spiral structure of the human ECU tendon has important biomechanical implications, allowing fascicular sliding during forearm rotation. The observed features may prevent injury.

Quantification of Hand Grip Force under Dynamic Conditions

1993 ◽  
Vol 37 (10) ◽  
pp. 715-719 ◽  
Author(s):  
Katherine R. Lehman ◽  
W. Gary Allread ◽  
P. Lawrence Wright ◽  
William S. Marras
Keyword(s):  
Grip Force ◽  
Wrist Flexion ◽  
Range Of Movement ◽  
Ulnar Deviation ◽  
Dynamic Conditions ◽  
Radial Deviation ◽  
Hand Grip ◽  
Flexion Extension ◽  
Maximum Grip ◽  
Lower Grip

A laboratory experiment was conducted to determine whether grip force capabilities are lower when the wrist is moved than in a static position. The purpose was to determine the wrist velocity levels and wrist postures that had the most significant effect on grip force. Maximum grip forces of five male and five female subjects were determined under both static and dynamic conditions. The dominant wrist of each subject was secured to a CYBEX II dynamometer and grip force was collected during isokinetic wrist deviations for four directions of motion (flexion to extension, extension to flexion, radial to ulnar, and ulnar to radial). Six different velocity levels were analyzed and grip forces were recorded at specific wrist positions throughout each range of movement. For flexion-extension motions, wrist positions from 45 degrees flexion to 45 degrees extension were analyzed whereas positions from 20 degrees radial deviation to 20 degrees ulnar deviation were studied for radial-ulnar activity. Isometric exertions were also performed at each desired wrist position. Results showed that, for all directions of motion, grip forces for all isokinetic conditions were significantly lower than for the isometric exertions. Lower grip forces were exhibited at extreme wrist flexion and extreme radial and ulnar positions for both static and dynamic conditions. The direction of motion was also found to affect grip strength; extension to flexion exertions produced larger grip forces than flexion to extension exertions and radial to ulnar motion showed larger grip forces than ulnar to radial deviation. Although, males produced larger grip forces than females in all exertions, significant interactions between gender and velocity were noted.

Radius and Ulna Trauma

2019 ◽  
pp. 65-67
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Radial Head ◽  
Distal Radioulnar Joint ◽  
Monteggia Fracture ◽  
Radial Head Fractures ◽  
Type Iv ◽  
Ulnar Fracture ◽  
Fracture Dislocations ◽  
Diaphyseal Fractures ◽  
Both Bones ◽  
Essex Lopresti

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.

Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review

2014 ◽  
Vol 40 (5) ◽  
pp. 450-457 ◽  
Author(s):  
B. M. Saltzman ◽  
J. M. Frank ◽  
W. Slikker ◽  
J. J. Fernandez ◽  
M. S. Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grip Strength ◽  
Complication Rate ◽  
Contralateral Side ◽  
Wrist Flexion ◽  
Proximal Row Carpectomy ◽  
Non Union ◽  
Radial Deviation ◽  
Hand Grip ◽  
Flexion Extension

We conducted a systematic review of studies reporting clinical outcomes after proximal row carpectomy or to four-corner arthrodesis for scaphoid non-union advanced collapse or scapholunate advanced collapse arthritis. Seven studies (Levels I–III; 240 patients, 242 wrists) were evaluated. Significantly different post-operative values were as follows for four-corner arthrodesis versus proximal row carpectomy groups: wrist extension, 39 (SD 11º) versus 43 (SD 11º); wrist flexion, 32 (SD 10º) versus 36 (SD 11º); flexion-extension arc, 62 (SD 14º) versus 75 (SD 10º); radial deviation, 14 (SD 5º) versus 10 (SD 5º); hand grip strength as a percentage of contralateral side, 74% (SD 13) versus 67% (SD 16); overall complication rate, 29% versus 14%. The most common post-operative complications were non-union (grouped incidence, 7%) after four-corner arthrodesis and synovitis and clinically significant oedema (3.1%) after proximal row carpectomy. Radial deviation and post-operative hand grip strength (as a percentage of the contralateral side) were significantly better after four-corner arthrodesis. Four-corner arthrodesis gave significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side. Wrist flexion, extension, and the flexion-extension arc were better after proximal row carpectomy, which also had a lower overall complication rate. Level of evidence: Level III (Level I-III studies), Systematic Review. Therapeutic.

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

2021 ◽  
pp. 175319342110636
Author(s):  
Delphine Lambrecht ◽  
Wim Vanhove ◽  
Nadine Hollevoet
Keyword(s):  
Distal Radioulnar Joint ◽  
Mean Value ◽  
Joint Arthroplasty ◽  
Wrist Flexion ◽  
Previous Surgery ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Clinical And Radiological Results

We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed. Level of evidence: IV

scholarly journals Carpal Pronation and Supination Changes in the Unstable Wrist

2018 ◽  
Vol 07 (04) ◽  
pp. 298-302
Author(s):  
Walter Short ◽  
Frederick Werner
Keyword(s):  
Clinical Relevance ◽  
Wrist Flexion ◽  
New Techniques ◽  
Interosseous Ligament ◽  
Wrist Motion ◽  
Extensor Carpi Ulnaris ◽  
Flexion Extension ◽  
Before And After ◽  
Dart Throwing ◽  
Throwing Motion

Background Little is known about changes in scaphoid and lunate supination and pronation following scapholunate interosseous ligament (SLIL) injury. Information on these changes may help explain why some SLIL reconstructions have failed and help in the development of new techniques. Purpose To determine if following simulated SLIL injury there was an increase in scaphoid pronation and lunate supination and to determine if concurrently there was an increase in the extensor carpi ulnaris (ECU) force. Materials and Methods Scaphoid and lunate motion were measured before and after sectioning of the SLIL and two volar ligaments in 22 cadaver wrists, and before and after sectioning of the SLIL and two dorsal ligaments in 15 additional wrists. Each wrist was dynamically moved through wrist flexion/extension, radioulnar deviation, and a dart-throwing motion. Changes in the ECU force were recorded during each wrist motion. Results Scaphoid pronation and lunate supination significantly increased following ligamentous sectioning during each motion. There were significant differences in the amount of change in lunate motion, but not in scaphoid motion, between the two groups of sectioned ligaments. Greater percentage ECU force was required following ligamentous sectioning to achieve the same wrist motions. Conclusion Carpal supination/pronation changed with simulated damage to the scapholunate stabilizers. This may be associated with the required increases in the ECU force. Clinical Relevance In reconstructing the SLIL, one should be aware of the possible need to correct scaphoid pronation and lunate supination that occur following injury. This may be more of a concern when the dorsal stabilizers are injured.

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