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PubMedDate not supplied

The effect of use of a wrist orthosis during functional activities on surface electromyography of the wrist extensors in normal subjects.

Wrist orthoses are advocated for patients with lateral epicondylitis on the assumption that use of the orthosis decreases muscle activity of the wrist extensors during activities. The purpose of this study was to compare the amount of electrical activity, root mean square (RMS) calculated from surface EMG recorded over the wrist extensors, during activities when applying four conditions of wrist orthoses: dorsal; volar; semicircular; and no orthosis. Thirteen normal subjects (mean age 27.7 years) performed three lifting and two gripping tasks, repeated on three consecutive days under four orthotic conditions. Measured were RMS and maximum voluntary grip strength. Repeated measures ANOVA's indicated a significant decrease of RMS using the semicircular design during lifting (p < .0005). Grip strength decreased significantly using all three orthotic designs, but RMS recorded during gripping did not. It was concluded that application of a wrist orthosis reduces electrical activity of the wrist extensors less than anticipated and only during lifting.

Adult↗
PubMed2001

Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases.

In a 4 year period (1996-1999), 42 total wrist fusions in 25 men and 17 women were performed using the AO/ASIF Titanium wrist fusion plate. The median age of the patients at the time of surgery was 41 (range, 19-72) years. The indication for fusion was post-traumatic arthritis in 29 wrists, Kienböck's disease in eight, rheumatoid arthritis in three, mono-arthritis in one and Volkmann's contracture in one. All patients were reviewed at a median follow-up of 23 (range, 6-50) months. The Buck-Gramcko and Lohmann score for functional evaluation was excellent in 35, good in 5 and satisfactory in 2 patients. We conclude that wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist.

Adult↗
PubMed1999

The effects of circumferential wrist pressure on reproduction accuracy of wrist placement in healthy young and elderly adults.

BACKGROUND: The purpose of this study was to determine the effect of circumferential wrist pressure on reproduction accuracy of wrist placement in healthy young and elderly adults. A convenience sample of 20 young adults having a mean age of 22.9 years and 20 elderly adults with a mean age of 68.2 years participated in the study. METHOD: Blindfolded subjects were asked to actively self-select a neutral wrist position (reference) and then, when signaled, to actively reproduce the previously selected position. Wrist joint reproduction accuracy was assessed under four pressure conditions: no contact, wrist contact, 10 mm Hg, and 20 mm Hg. A single axis dynamic wrist electrogoniometer measured three dependent variables: absolute, constant, and variable errors. Data were analyzed by means of multivariate analysis of variance (MANOVA) for repeated measures. RESULTS: No significant differences in reproduction accuracy under the four pressure conditions for young or elderly adults were found. CONCLUSIONS: Healthy young and elderly adults may utilize existing intrinsic feedback and central control mechanisms to achieve accuracy during a reproduction task. Some subjects in both age groups who entered into the study with high error scores benefited from circumferential pressure by possibly relying on peripheral mechanisms. Further studies are needed to determine the effect of circumferential pressure on subjects with poor reproduction performance.

Adolescent↗
PubMed2002

Motor control impairment of the contralateral wrist in patients with unilateral chronic wrist pain.

OBJECTIVE: Assessment of the quality of fine motor control in patients with unilateral chronic wrist pain seldom focuses on the possibility that control of movements is effector independent at the cerebral level. This mechanism may be involved in an impairment of motor function in the unaffected wrist. We studied the possible motor impairment in the unaffected wrist in patients with chronic wrist pain. DESIGN: Eighteen patients with chronic wrist pain in their dominant hand and 20 healthy controls performed, using their nondominant hand, back-and-forth, left-to-right stroke patterns with a pen on a digital writing tablet connected to a computer. Fluency of movement, defined as the number of zero-crossings of the acceleration curve (pZC), average stroke size, and average velocity were calculated. RESULTS: The controls moved significantly more fluently than the patients (pZC, 0.26+/-0.07 for controls and 0.46+/-0.20 for patients; P < 0.001), suggesting that long-term afferent disturbances may compromise cerebral motor control mechanisms. CONCLUSIONS: This result is in accordance with the view that chronic pain complaints may be maintained by persistently abnormal cerebral motor control. This finding opens a new perspective on the understanding and treatment of chronic wrist pain.

Adolescent↗
PubMed1997

Firing pattern of type-identified wrist extensor motor units during wrist extension and hand clenching in humans.

1. Single motor unit activity was investigated in the extensor carpi radialis muscles during voluntary isometric contraction involving either the coactivation of the wrist agonist extensor muscles (wrist extension) or the coactivation of the wrist and finger antagonist extensor and flexor muscles (hand clenching). 2. The motor units were found to be activated at a similar level of motoneurone pool drive during both wrist extension and hand clenching, as indicated by the fact that the EMG activity at which they were recruited was practically the same in both cases (mean +/- S.D.: 20 +/- 26 and 21 +/- 25 mV, respectively). In addition, the net excitatory drive exerted on the motoneurones, as assessed from the mean interspike intervals, did not differ significantly between the two tasks (mean +/- S.D.: 104.57 +/- 17.24 and 103.01 +/- 16.26 ms, for wrist extension and hand clenching, respectively). 3. However, the discharge variability, in terms of the coefficient of variation of the interspike intervals, was slightly but significantly greater during hand clenching than during wrist extension (0.213 +/- 0.049 and 0.198 +/- 0.045, respectively). This increase involved all types of motor units, regardless of their contractile force. 4. We suggest that the greater motoneurone discharge variability observed during hand clenching may be attributable to an increase in the synaptic noise. This increase might be due to the activation of numerous afferent pathways mediating reciprocal interactions between antagonist motoneurone pools, as well as to the activation of hand cutaneous receptors that play a major role in the regulation of handling and gripping motor activities.

Action Potentials↗
PubMed2002

Injuries initially misdiagnosed as sprained wrist (beware the sprained wrist).

OBJECTIVES: To describe the injuries misdiagnosed as a sprain of the wrist and to determine the approximate incidence of misdiagnosis in patients diagnosed as having a sprain of the wrist. METHODS: All diagnostic errors in an accident and emergency (A&E) department were noted on a computerised database. Injuries initially misdiagnosed as wrist sprain are described and compared with the number of diagnoses of sprained wrist on the A&E department computer. RESULTS: 57 injuries initially diagnosed as a sprained wrist had a different diagnosis (1.76% of all diagnoses of sprained wrists). This is an underestimate of the true incidence of diagnostic error. Forty two per cent of the misdiagnoses were of greenstick or torus fractures of the distal radius. CONCLUSIONS: Training for junior doctors in A&E departments should be improved-especially training in radiological interpretation. Other methods of preventing diagnostic errors by misreading of radiographs, for example, more hot reporting of radiographs by radiologists or radiographers should be considered.

Diagnostic Errors↗
PubMed1996

Surgeons' decision making in patients with chronic wrist pain: role of bilateral three-compartment wrist arthrography--prospective study.

PURPOSE: To determine if wrist arthrography changes surgeons' diagnoses and treatment plans for patients with chronic wrist pain. MATERIALS AND METHODS: Bilateral, three-compartment wrist arthrography was performed in 64 patients. Prospective questionnaires evaluated surgeons' diagnoses and management plans at three stages: before arthrography, after arthrography of the symptomatic wrist, and after arthrography of the asymptomatic wrist. RESULTS: Surgeons tended to plan more conservative management after receiving the results of arthrography. The number of patients for whom the reported treatment plan included surgery dropped from 28 of 64 patients (44%) to 19 of 64 patients (30%) after review of the arthrography results (P = .05). The number of patients for whom the treatment plan included treatment of any kind dropped from 55 of 64 patients (86%) to 49 of 64 patients (77%) after review of the arthrography results (P = .09). An overall change in treatment plan occurred in 29 of 64 patients (45%). CONCLUSION: Wrist arthrography influences surgeons' decision making. After reviewing the results of arthrography, surgeons tended to change treatment plans toward more conservative, less invasive treatment.

Adult↗
PubMed1999

Is a subset of wrist ganglia the sequela of internal derangements of the wrist joint? MR imaging findings.

PURPOSE: To determine if there is an association between wrist ganglia and internal derangements of the wrist joint by reviewing magnetic resonance (MR) images. MATERIALS AND METHODS: Two observers retrospectively reviewed MR images of the wrist obtained in 625 patients at 1.5 T for the presence of ganglia and associated triangular fibrocartilage complex, scapholunate ligamentous, or lunotriquetral ligamentous tears that were within 3 mm of the ganglion. When available, surgery and/or pathology records were reviewed. RESULTS: There were 122 ganglia and 37 internal derangements. Of the 22 ulnar-sided ganglia, 10 (45%) demonstrated associated triangular fibrocartilage complex tears. Of the 97 radial-sided ganglia, 27 (28%) demonstrated ligamentous tears related to the site of the ganglion. The radial-sided tears involved the radial aspect of the triangular fibrocartilage complex in 12 ganglia; the scapholunate ligament, in isolation, in eight ganglia; and both the triangular fibrocartilage complex and the scapholunate ligament in six ganglia. Only one of the ganglia demonstrated an associated lunotriquetral ligamentous tear. Surgical findings confirmed the ligamentous tears in 25 patients. CONCLUSION: Wrist ganglia are associated, not infrequently, with internal derangements of the wrist.

Humans↗
PubMed1990

Roentgenographic examination of the wrist: a systematic study of the normal, lax and injured wrist. Part 2: Stress views.

The standard and positional views of 53 normal wrists have been compared to views taken under stress. The stresses applied can be divided into normal and abnormal ones. All the injured wrists with pathological roentgenographic appearances were operated on and thus the findings confirmed. Roentgenographic examination of the wrist under stress appears to be a valuable and reliable diagnostic aid. Two types of laxity of the wrist and a radio-anatomical classification of wrist instabilities are defined.

Biomechanical Phenomena↗
PubMed1990

Chronic wrist pain: indications for wrist arthroscopy.

Although arthroscopy represents a new and dynamic diagnostic technique for evaluating the wrist, specific indications for arthroscopic intervention in the wrist are not defined. To place this technique in perspective, we review our experience with 54 consecutive arthroscopies of the radiocarpal and midcarpal joints in 53 patients with chronic wrist pain. On the basis of this review, we believe arthroscopy is indicated for the diagnosis of wrist pain of longer than 3 months' duration. Defects of the triangular fibrocartilage and lesions of the articular cartilage, including loose bodies, are detectable and easily treated with wrist arthroscopy.

Adolescent↗
PubMed2003

Wrist arthrodesis using a Synthes wrist fusion plate.

Thirty-nine patients were retrospectively reviewed after a wrist arthrodesis using a Synthes wrist fusion plate and iliac crest bone graft. Information was obtained from review of patient files, a questionnaire to assess pain, function and work status, and clinical assessment of grip strength, forearm rotation and fingers motion. All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. Thirty-seven patients were satisfied with the procedure, noting a reduction in wrist pain after fusion, but all reported some limitation of function. The wrist fusion plate was removed in six patients and a further four patients experienced minor symptoms over the dorsal aspect of the middle finger metacarpal.

Activities of Daily Living↗
PubMed2004

The application of an external wrist extension force reduces electromyographic activity of wrist extensor muscles during gripping.

STUDY DESIGN: Experimental repeated-measures study. OBJECTIVE: To investigate the effect of different extension forces applied to the palm of the hand on electromyographic (EMG) activity of the wrist extensor muscles during hand gripping. BACKGROUND: Lateral epicondylitis is usually caused by repetitive wrist extension that leads to an overuse injury. The current theory is that the process of lateral epicondylitis begins with an overuse injury that leads to microtearing of the extensor carpi radialis brevis muscle and occasionally the extensor digitorum communis muscle. Use of an external wrist extension force might reduce muscle activity during gripping. METHODS: Muscle activity was measured using surface EMG while subjects gripped at an intensity of 10%, 20%, and 30% of the maximum voluntary contraction force without, and with, an applied external wrist extension force of 1%, 2%, and 3% of maximum voluntary contraction. RESULTS: Applying an extension force to the palm of the hand reduced EMG activity of the extensor muscles at the same strength generation during hand gripping. The muscles with the most significant reduction in EMG level, the extensor carpi radialis brevis and extensor digitorum communis, are those muscles that are most often involved with lateral epicondylitis. CONCLUSIONS: This study shows that an external extension force reduces EMG activity of the wrist extensor muscles during gripping in healthy volunteers. As the extension force increased, a greater reduction in muscle activity was noted.

Adult↗
PubMed1984

Changes in reciprocal Ia inhibition from wrist extensors to wrist flexors during voluntary movement in man.

Transmission in the Ia inhibitory pathway from wrist extensor muscles onto flexor MNs was studied at various times after the onset of voluntary wrist extension or flexion. At the very onset of wrist movements Ia inhibition was not changed, as compared to at rest, whereas later it progressively increased during wrist extension and decreased during wrist flexion. These results are discussed in relation to the different inputs converging onto Ia interneurones and it is suggested that their inhibition by Renshaw cells might be responsible for the results found at the onset of contraction.

Anterior Horn Cells↗
PubMed1997

The relative contribution of selected carpal bones to global wrist motion during simulated planar and out-of-plane wrist motion.

The relative contribution of the scaphoid, lunate, triquetrum, and capitate to wrist motion was examined in 6 fresh cadaver forearms. A wrist-joint motion simulator was used to dynamically move each wrist through planar and nonplanar motions. During wrist flexion-extension, the motion of the capitate closely followed the motion of the third metacarpal, while the lunate motion was approximately 50% of the total motion; the triquetrum, 65%, and the scaphoid, 90%. Similar differences in motion for these carpal bones occurred during radioulnar deviation and circumduction and dart-throw motions. This suggests that the scaphoid, lunate, and triquetrum do not normally function as a single unit, but that each bone has an unique arc of motion during global wrist motion.

Biomechanical Phenomena↗
PubMed2001

A comparison of the findings of wrist arthroscopy and magnetic resonance imaging in the investigation of wrist pain.

Between 1996 and 1999, 54 patients with wrist pain had magnetic resonance imaging performed using a 1.5 Tesla scanner without a wrist coil. Wrist arthroscopy was performed using a standard technique. The findings were then compared. Magnetic resonance imaging had a low sensitivity for the detection of triangular fibrocartilage complex injuries (0.44) and scapholunate ligament injuries (0.11) when wrist arthroscopy was used as the standard of reference. We conclude that when a magnetoresonance technique that does not employ a dedicated wrist coil is used, a negative magnetic resonance imaging scan does not exclude these two significant injuries.

Arthroscopy↗
PubMed2002

Reduction of severe wrist injuries in snowboarding by an optimized wrist protection device: a prospective randomized trial.

BACKGROUND: The benefits of sport are well recognized, but many activities carry a sport-specific injury risk. Snowboarding has become an increasingly popular winter sport in Austria in recent years, with an estimated 900,000 participants annually. Roughly 6,000 of these suffer from injury and up to 2,000 sustain moderate or severe wrist injuries (mainly fractures of the distal radius and epiphysiolyses). METHODS: We conducted a prospective, randomized, controlled trial to test the protective effect of a wrist protector, which differs in position, stiffness, length, and fixation from conventional protectors. Seven hundred twenty-one snowboarders were randomized into two groups. The risk factors and the injuries that occurred were registered by questionnaires and, in case of medical treatment, by medical reports. Time until injury (in half-days) was compared by the proportional hazards model. RESULTS: Nine severe wrist injuries were sustained in the unprotected control group and only one in the protected group (hazard ratio, 0.13; 95% confidence limits, 0.02, 1.04). Twelve snowboarders of the protector group secretly discarded their protectors during the trial (including the snowboarder who suffered the one and only severe wrist injury of this group). A per-protocol analysis was therefore performed, which demonstrated a more accentuated result (p = 0.003). There was no statistically significant increase in the incidence of other types of injury. Experience was shown to be a further protective factor. CONCLUSION: We recommend the use of a wrist protector, particularly for novices participating in this sport. As in other domains of medicine, preventive measures can decrease morbidity also in terms of sport injuries.

Adolescent↗
PubMed2005

An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome.

OBJECTIVES: The aim of this study was to evaluate the role of gender, body mass index (BMI), wrist ratio (WR) and wrist circumference as independent risk factors for carpal tunnel syndrome (CTS) and to analyze the strength of association of these factors. METHODS: We have undertaken a case-control study in 128 CTS patients and 109 controls. Based on clinical and electrophysiologic criteria, 109 female and 19 male CTS patients as well as 62 female and 47 male control subjects were selected from patients and their relatives referred to our hospital. In total, 179 hands with CTS in three groups of severity (mild, moderate and severe) were examined. Height, weight, BMI, wrist width, depth, circumference and ratio were measured in all patients and control group. Mean values of different risk factors for CTS group and controls were measured. A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. RESULTS: The mean values for BMI and WR were greater in CTS patients than in the subject group. Thirty-four, 89 and 57 patients had mild, moderate and severe CTS, respectively. Mean age, BMI, wrist circumference and ratio were not statistically significant in the three groups. Female gender, increased BMI and increased WR had odds ratio of 9.95, 1.75 and 1.12, respectively. CONCLUSION: Our study confirms that female gender, obesity and square wrists are independent risk factors for CTS.

Adult↗
PubMed1975

Wrist cysts and fistulae. An arthrographic study of the rheumatoid wrist.

An arthrographic study of the wrist joint, in which 65 rheumatoid wrist joints were satisfactorily shown, gave a high incidence of significant abnormalities even in the absence of clinical signs of wrist involvement. Several synovial protrusion cysts were shown and corresponded to localized clinical swellings on the volar aspect of the wrist joint. These cystic swellings may be apparent before the onset of polyarthritis and may be differentiated from ganglia arthrographically by their association with other features suggesting erosive synovitis. Cystic swelling over the lower end of the ulna is shown to be frequently due to synovial hypertrophy of the inferior radioulnar joint in either a dorsal or volar direction. In one case a fistulous tract was delineated connecting the midcarpal joint with the volar surface of the wrist by a flexor tendon sheath.

Adolescent↗