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At least 37 records · Page 2Linked to original sources
PubMed1992

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

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

Adult↗
PubMed2006

Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist).

UNLABELLED: Outcome evaluation of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist). PURPOSE: Scaphoid nonunion or scapholunate ligament instability results in carpal collapse and subsequent arthrosis. These conditions, termed SLAC-wrist and SNAC-wrist, are the most common patterns of arthrosis in the wrist. The purpose of this retrospective study was the evaluation of functional outcomes following midcarpal arthrodesis and of patients' satisfaction with these outcomes. METHODS: Forty-nine patients were reexamined at a mean follow-up time of 47 months. Active range of motion (AROM) was verified with a goniometer; grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) for stress and under resting conditions. Patients' upper-extremity functioning was captured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Radiographic evaluation of bony consolidation was verified by conventional x-ray. RESULTS: Postoperative AROM was 56% and grip strength was 76% compared with the contralateral side. The DASH score was 29 points. Pain relief was 34% at rest and 31% after stress. Forty-five patients demonstrated bony consolidation in x-ray control. Six patients (12%) further required a total arthrodesis of the wrist because of pain or absence of bony consolidation. CONCLUSION: Our data demonstrate that midcarpal arthrodesis is a reliable procedure for treating SLAC- and SNAC-wrists in stages II and III and, furthermore, one which preserves some range of motion. Total wrist fusion should only be used in exceptional circumstances.

Adult↗
PubMedDate not supplied

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

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

Biomechanical Phenomena↗
PubMed1999

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

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

Adult↗
PubMedDate not supplied

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

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

Adult↗
PubMed1995

Wrist arthroplasty with the trispherical total wrist prosthesis.

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

Adult↗
PubMed1993

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

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

Adult↗
PubMed1995

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

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

Adolescent↗
PubMed1999

The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy.

We assessed the value of three-compartment magnetic resonance (MR) wrist arthrography in comparison with non-enhanced magnetic resonance imaging (MRI) for the evaluation of 13 individual wrist ligaments in 35 patients with refractory wrist pain. In 20 of these patients MR findings were correlated with the findings from multiportal wrist arthroscopy. For MR imaging (1.5-T magnet) a three-dimensional volume acquisition with a gradient-recalled echo sequence and 0.6-1.0 mm effective slice thickness was used. The delineation of individual wrist ligaments was rated as "good" in 10% of non-enhanced MR and 90% of MR arthrography images. Ligament evaluation was possible with high diagnostic confidence in 11% by non-enhanced MR imaging and 90% by MR arthrography. With wrist arthroscopy as the standard of reference, average sensitivities/specificities/accuracies for the diagnosis of full-thickness ligamentous defects were 0.81/0.75/0.77 for non-enhanced MR imaging and 0.97/0.96/0.96 for MR arthrography. Our findings suggest that MR arthrography is more accurate than standard MRI in delineating and evaluating the ligaments of the wrist.

Adolescent↗
PubMed1997

The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy.

OBJECTIVE: To compare three-compartment MR wrist arthrography with non-enhanced MRI in correlation with wrist arthroscopy, and to evaluate the potential of MR arthrography for consistently visualizing all parts of the scapholunate interosseous ligament of the wrist (SLIL) and exactly diagnosing the site and extent of SLIL defects. DESIGN AND PATIENTS: In 41 patients with wrist pain (34 patients with wrist pain for more than 6 months) plain radiographs, stress views, non-enhanced MRI and three-compartment MR arthrography were done within 2 h of each other, using three-dimensional volume acquisition (0.6-1.0 mm effective slice thickness) with a gradient-recalled echo sequence and a 1.5-T magnet. The MR arthrography findings were compared with the findings from non-enhanced MRI and correlated with the arthroscopic findings in all patients. RESULTS: The dorsal, central and palmar segments of the SLIL could be delineated exactly by MR arthrography in 95% of the patients; with non-enhanced MRI only 28% of SLIL segments were seen consistently. Demonstration of SLIL defects was possible with high diagnostic confidence in 42% of SLIL segments by non-enhanced MRI and in 94% by MR arthrography. With wrist arthroscopy as the standard of reference, sensitivity and specificity values for SLIL perforations were 52%/34% for non-enhanced MRI and 90%/87% for MR arthrography. CONCLUSIONS: MR arthrography, using three-dimensional volume acquisition with thin slices (0.6-1.0 mm), combines the advantages of three-compartment arthrography and non-enhanced MRI. It shows the precise location and magnitude of ligamentous defects of all parts of the SLIL, correlates well with wrist arthroscopy and has potential implications for diagnosis and treatment planning.

Adult↗
PubMed1998

Wrist arthrodesis after failed wrist implant arthroplasty.

Wrist arthroplasty has not achieved large success to date, and there are patients with failures in their procedures who will need arthrodesis. We review our experience in revising a wrist implant arthroplasty to an arthrodesis with a block graft of fresh-frozen allograft femoral head or iliac crest bone graft. Fixation was achieved with an intramedullary Steinmann pin. Ten patients with 12 failed wrist implants required wrist arthrodesis; 7 had wrist arthrodesis with a bulk allograft femoral head, 4 with an iliac crest bone autograft, and 1 without a bone graft. After an average follow-up period of 5 years, all patients were pain free and fusion had been achieved. Complications included 1 patient with acute carpal tunnel syndrome, 2 patients with nonunions requiring secondary bone grafting procedures, and 2 patients requiring revisions of their intramedullar pins. In both nonunions, iliac crest bone graft was used for the initial arthrodesis. All the patients were satisfied. Arthrodesis after failed wrist implant arthroplasty is a satisfactory procedure, and a fresh-frozen allograft can be used effectively in wrist fusion.

Adult↗
PubMed1996

Current status of wrist arthrodesis and wrist arthroplasty.

A variety of techniques are available for reconstruction of the wrist. The efficacy of wrist arthroplasty, however, is met with narrowed indications and does not enjoy the success that total joint replacement in other joints, such as the hip and knee, has enjoyed. With design improvements during the last decade, good short-term results from total wrist arthroplasty can be expected in the low-demand patient with rheumatoid arthritis. Wrist arthrodesis, either pancarpal or limited, is considered the primary surgical alternative in patients with most arthritic conditions of the wrist. The pancarpal arthrodesis is a predictable, durable alternative to a variety of post-traumatic, degenerative, or neoplastic conditions of the wrist; however, some authors report that complications may be prevalent. This procedure also may be modified and applied to the destroyed rheumatoid wrist. Overall, selection of fixation mode depends on bone quality. In an attempt to preserve motion, various limited arthrodeses of the carpus have been described. Although technically demanding, successful results may be expected, especially in conditions of carpal instability. With the current wide array of surgical alternatives, the surgeon must consider each case carefully and select the procedure that best applies to each particular situation. Furthermore, it is extremely important that the surgeon educate the patient on the limitations of each procedure.

Arthrodesis↗
PubMed2003

Carpal bone kinematics in combined wrist joint motions may differ from the bone kinematics during simple wrist motions.

Present in-vivo carpal kinematic studies have been limited to flexion-extension and radio-ulnar deviation. However these simple motions do not represent the full range of wrist motion employed during activities of daily living. In this study, we investigated combined carpal bone motions for one normal subject. A healthy left wrist from a 48 year old female was CT scanned in three positions: the clinical neutral position of the forearm, the pronated and maximum extended wrist posture, and the supinated and maximum flexed wrist posture. The scans were obtained using a GE8800 scanner at 120 kV and 40 mA. The voxel size was 0.234 mm X0.234 mm X1.0 mm. Principal axes registration methods were used to quantify the carpal bone kinematics. The movement of the carpal bones were described by the means of helical axis parameters. Our subject's carpal bone kinematics in the complex motions differed from the previously studied simple motions. For example, published studies have found that the primary motion of the capitate follows the global motion of the wrist during simple wrist flexion-extension. However, for the complex pronation and extension motion, the capitate rotated ulnarly out of the plane of motion. The only previous study of pisiform motion has shown that during flexion-extension the pisiform moves in the plane of motion. However during pronation and extension, the pisiform rotated ulnarly; while in flexion, the rotation was a combination of flexion and supination.

Carpal Bones↗
PubMed1996

Functional morphology of the lemuriform wrist joints and the relationship between wrist morphology and positional behavior in arboreal primates.

A comparative study of carpal joint structure and function in six Malagasy lemuriforms was undertaken to test predicted morphoclines in carpal joint morphology between pronograde and orthograde arboreal primates. Patterns of movement at the wrist during locomotion were observed and described for the lemuriform species Lemur fulvus and Propithecus verreauxi. Lemur fulvus, which assumes a pronograde posture during locomotion, extends and pronates the wrist during the support phase of quadrupedal walking and running stride cycles. Furthermore, the forearm of this species exhibits some transverse movement across the proximal wrist joint during the support phase. In contrast, the indriid Propithecus maintains the hand and wrist in a flexed and partially supinated position during vertical clinging and suspensory postures. Habitual quadrupedal and vertical postures in Malagasy primates are in turn related to very different patterns of carpal joint morphology and articular mechanics. Those lemurs which are predominantly pronograde share a series of structural features related to stabilizing the antebrachiocarpal joint during extension and mediolateral deviation and the midcarpal joint during pronation: an intraarticular labrum is present on the inner portion of the radiocarpal ligament, the radiocarpal articular surface is quite flat dorsoventrally, the capitate-trapezoid embrasure is expanded dorsally, and development of the radial and ulnar styloids is more pronounced. The wrists of Propithecus, Avahi, and Lepi-lemur (vertical clingers) differ from those of quadrupedal lemuriforms in possessing a suite of morphological features related to stabilizing the wrist during antebrachiocarpal flexion and midcarpal supination: the radiocarpal articular surface is deeply curved and tilted anteriorly, the dorsal radiocarpal ligament is very broad, thick, and fibrous, the hamate's triquetral facet is directed proximodistally, and the capitate-trapezoid embrasure is dorsally constricted and expanded palmarly. These observed contrasts in carpal form and function are used to define further the morphological features related to orthograde posture in several lineages of arboreal primates.

Animals↗
PubMed2002

[Partial Fusion of the wrist - an alternative procedure to the total wrist arthrodesis].

Despite the important observations that have been made concerning biomechanics and function of the wrist joint in recent years, the surgeon is still confronted with a huge number of delayed posttraumatic disorders of this joint. In the past, total wrist fusion was the leading salvage procedure, whereas today several salvage procedures are available to solve these problems. Partial wrist fusions are supposed to stabilize the carpus, immobilize destroyed articulating surfaces while allowing motion in the unharmed parts of the wrist. Acknowledging pathobiomechanical laws, they have been used for a growing number of indications with a large benefit. The patients profit of better functional results than can be observed in patients with total arthrodesis of the wrist. Furthermore, partial wrist fusion provides a more stable situation and the absence of pain for a longer period of time. However, further studies evaluating the clinical outcome of these salvage procedures are necessary and to be expected in the near future.

Arthrodesis↗
PubMed1994

Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?

Proximal row carpectomy (PRC) and limited intercarpal arthrodesis with scaphoid excision (LWF) are useful alternatives to wrist arthrodesis for treatment of degenerative wrist disorders secondary to scapholunate advanced collapse. Because consensus regarding the ideal motion-preserving option is lacking, we sought to better define the indications for and relative merits of PRC versus LWF. Twenty-four wrists treated for symptomatic scapholunate advanced collapse arthritis between 1980 and 1990 with either PRC or LWF were retrospectively reviewed at an average of 5.5 years postoperatively. At follow-up evaluation, satisfactory pain relief, grip strength, and functional performance were observed except in three patients with PRC, one of whom had developed symptomatic radiocarpal arthritis requiring conversion to arthrodesis. Differences in subjective and objective results between the two treatment groups were not statistically significant except for residual range of motion. Incomplete correction of lunate extension when LWF was performed resulted in diminished wrist extension, compared to PRC. Improvements in grip strength and range of motion were noted for at least 1 year after both procedures, and neither declined with time. A stage-dependent surgical approach to the symptomatic scapholunate advanced collapse wrist is advocated in light of comparable outcomes following both PRC and LWF. For wrists without capitolunate arthritis, PRC avoids the technical demands, lengthy postoperative immobilization, and risk of nonunion associated with LWF, but for stage III disease (capitolunate arthritis) pain relief may be unsatisfactory, and LWF is recommended.

Adult↗
PubMed2006

Maximal dynamic grip force and wrist torque: the effects of gender, exertion direction, angular velocity, and wrist angle.

The objective of this study was to examine the effects of gender, exertion direction, angular velocity and wrist angle on simultaneous grip force and wrist torque under the isokinetic condition. The study used 20 participants (10 males and 10 females) and included 6 angular velocities (15, 30, 45, 60, 75, and 90 degrees /s) and 2 wrist exertion directions (flexion and extension) over the wrist range of motion of 70 degrees flexion to 60 degrees extension in 5 degrees increments. Similar to other studies, males and flexion exertion produced larger forces than females and extension exertion, respectively. However, the largest forces were generated at near extreme flexion of the wrist and the dependent variable of angular velocity was not practically significant. These results can contribute to the evaluation of cumulative trauma syndromes, but there is a need for more research on the dynamic measures of the hand and wrist complex and for standard development for dynamic force measurement.

Adult↗
PubMed1997

Wrist arthrodesis for failed wrist implant arthroplasty.

Thirteen wrist arthrodeses were performed for failed wrist implant arthroplasties between 1984 and 1992. Twelve patients were available for review, with an average follow-up period of 28 months. The original arthroplasties consisted of 8 silicone implants and 4 metal-plastic total wrist implants. The surgical method involved a tricortical iliac bone graft and an intramedullary Steinmann pin. There were 7 excellent results, 4 good results, and 1 poor result. All but 1 patient had markedly improved function with no or mild pain. Seven patients had solid fusions and 5 patients had pseudarthroses. Four pseudarthroses occurred at the graft-metacarpal junction and 1 occurred at the graft-radius junction. Each patient with a solid fusion had an excellent result. All graft-metacarpal pseudarthroses were painless and did not limit the patients' activities. There were 17 complications in 9 patients. Wrist arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty in patients with rheumatoid arthritis. However, the complication rate can be high. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, we recommend using more rigid fixation techniques in patients with failed wrist arthroplasties.

Adult↗