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At least 73 records · Page 4Linked to original sources
PubMed1994

Scapholunate interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists.

PURPOSE: To determine if the carpal scapholunate ligament (SLL) can be consistently visualized with commercial magnetic resonance (MR) imaging techniques and to establish the normal range of MR appearances of the SLL as a basis for comparison with SLL tears. MATERIALS AND METHODS: MR imaging helped identify and characterize the appearance of the SLL in 80 wrists with presumably normal SLLs (54 wrists in 27 asymptomatic volunteers and 26 patients with normal arthrograms). A dual-echo, gradient-echo technique was used. RESULTS: The SLL was visible in all 80 wrists and was seen on an average of almost four sections. It was delta-shaped in 72 wrists and linear in eight; there was absent signal intensity in 63% or intermediate signal intensity traversing all or part of the SLL in 37%. Distribution and extent of hyaline cartilage signal intensity at the insertion sites into the scaphoid and lunate bones were variable but related to the location within the SLL. CONCLUSION: The SLL can be consistently identified, but the normal variation in the MR appearance of the lunotriquetral ligament must be appreciated when evaluating wrists with suspected SLL tears.

Adolescent↗
PubMed1999

Wrist arthrodesis using a wrist fusion plate.

All wrist arthrodeses done between 1990 and 1996 using a Synthes wrist fusion plate were reviewed. Independent assessment done by a certified hand therapist included a patient survey, standardized Jebsen-Taylor hand function test and activities of daily living test, and a Buck-Gramcko and Lohmann evaluation. We evaluated 13 wrists in 11 patients. Overall satisfaction was 100% of patients (mean follow-up, 31.5 months; range, 13 to 61 months). Mean preoperative and postoperative pain scores improved from 7.2 to 0.8, respectively, and functional scores improved from 5.0 to a postoperative mean value of 7.4. Jebsen-Taylor scores were virtually identical for fused and uninvolved wrists. There were no pseudarthroses, no plate failures, no tendon ruptures, and no significant postoperative infections; there was a single plate removal because of tenuous skin coverage. Short-term results using a comprehensive assessment of a custom plate designed for wrist arthrodesis show promising clinical outcomes.

Activities of Daily Living↗
PubMed1991

Normal bone density of the wrist and spine and increased wrist fractures in girls with Turner's syndrome.

Turner's syndrome is associated with multiple skeletal abnormalities, including osteoporosis. We evaluated the hypothesis that girls with Turner's syndrome may have deficient bone density before the expected age of pubertal onset (9-13 yr) by comparing the bone mineral content of the wrist and lumbar spine in 78 girls with Turner's syndrome (4-13 yr old) and 28 normal prepubertal girls who were matched for age, bone age, body mass index, or height age. The bone mineral content of the wrist and spine was measured by single photon absorptiometry (SPA) and dual photon absorptiometry (DPA), respectively. SPA values for girls with Turner's syndrome vs. normal subjects (4-6.9, 7-9.9, and 10-12.9 yr old) were (mean +/- SD) 0.27 +/- 0.05 vs. 0.36 +/- 0.05, 0.35 +/- 0.06 vs. 0.41 +/- 0.06, and 0.41 +/- 0.05 vs. 0.45 +/- 0.03 g/cm2, respectively. SPA values in the Turner's syndrome girls were decreased compared to those in normal prepubertal girls, matched for age (P less than 0.0001), bone age, (P less than 0.001), and body mass index (BMI; P less than 0.0001), but not for height age. DPA values for girls with Turner's syndrome vs. normal girls in the same age categories were 0.65 +/- 0.06 vs. 0.70 +/- 0.09, 0.77 +/- 0.08 vs. 0.79 +/- 0.09, and 0.83 +/- 0.12 vs. 0.78 +/- 0.07 g/cm2. DPA values in Turner's syndrome girls (as a group) were decreased compared to those in normal prepubertal girls matched for age (P less than 0.05) and BMI (P less than 0.02), but not for bone age or height age. The annual incidence rate of wrist fractures in Turner's syndrome girls (9.1 of 1000) was significantly increased compared to the reported annual incidence rate in normal children (3.5 of 1000; P less than 0.003). We conclude that prepubertal-aged girls with Turner's syndrome (less than 13 yr old) have normal bone density for height age, but significantly decreased bone density of the wrist for chronological age, bone age, and BMI. They also have significantly more wrist fractures than normal girls, but it is not clear that this is related to their bone density.

Absorptiometry, Photon↗
PubMed1977

Neuronal activity in cortical efferent zones projecting to wrist extensors during voluntary wrist extension in the monkey.

Three monkeys were trained to make rapid wrist extension on presentation of a cue light. After training the animal sufficiently, unit activity was recorded from the cortical efferent zones corresponding to the wrist extensors. Most neurons in the wrist extensor zone were increased in their discharge rate during the wrist extension. Their activation pattern, especially the onset time, varied among different neurons. The earliest neuron was activated 65 msec before the EMG onset of the wrist extensors, while the latest did 30 msec after the EMG onset. About 80% of them activated before the EMG onset. In contrast, variation of the discharge onset of each neuron was rather small and 5-15 msec in quartile deviation. These findings may suggest that each neuron in the cortical efferent zone functions in different timing in the voluntary phasic contraction of the target muscle.

Animals↗
PubMed1991

The rheumatoid wrist: patterns of disease progression. A review of 50 wrists.

50 wrists in 28 patients have been followed in a retrospective radiographic review for a mean period of 9.56 years. Patterns of disease and the rates of change in the severity of the disease have been determined, with particular reference to the changing relationship in time between involvement of the wrist and hand. In the wrist, there was relative sparing of the mid-carpal joint, with a significant correlation between a high incidence of triquetro-lunate disease and changes in the ulnar styloid. Wrist disease was found to "protect" the hand for the first five years but not after this time. On the basis of these results, earlier surgical intervention is proposed, with the intention of shifting the emphasis of surgery from salvage to prophylactive or reconstructive procedures.

Arthritis, Rheumatoid↗
PubMed1994

The early history of arthroplasty of the wrist. From amputation to total wrist implant.

During the past 3 decades implant arthroplasty of the destroyed wrist has become a reliable and satisfying procedure. However, the first total wrist replacement was performed in Berlin as early as 1890. This paper describes the history of resection and interposition arthroplasty of the wrist leading to the first total wrist implant arthroplasty performed by Themistocles Gluck. An overview of recent designs is given, and the relevant historical cases are reported.

Amputation, Surgical↗
PubMed1994

Tensions in the palmar ligaments of the wrist. I. The normal wrist.

We developed a method for measurement of the in situ tensions in the ligaments of the palmar side of the wrist in cadaver specimens. The technique is based on deflecting the ligaments transversely (i.e., perpendicular to their longitudinal axis) using an instrumented probe. Based on measurement of the load required to deflect the ligament, magnitude of the transverse deflection, and axial length of the ligament, the axial tension in the ligament can be determined without otherwise disturbing it. The tensions in 8 palmar ligaments in 10 functional positions of the wrist in each of 5 fresh cadaver specimens were assessed. The position of the wrist was monitored, but the specimen was not loaded. We concluded that (1) the palmar ligaments are in tension, even with the wrist in neutral position and unloaded; (2) the following ligaments act as passive stabilizers: in neutral the triquetrocapitate and distal part of the radioscaphocapitate, in radial deviation the radiolunate, in ulnar deviation the ulnolunate, in pronation the proximal part of the radioscaphocapitate, in supination the ulnolunate, and in extension the ulnolunate, radiolunate, and radioscaphocapitate; (3) in any position some ligaments are in a state of greater tension than others. The radiolunate, ulnolunate, radioscaphocapitate had the greatest tension; and the lunotriquetral, trapeziocapitate, and scaphocapitate had the least.

Aged↗
PubMed2005

Differences in the presence of mechanoreceptors and nerve structures between wrist ligaments may imply differential roles in wrist stabilization.

The purpose of this study was to analyze human wrist ligaments with regard to presence of general innervation and mechanoreceptors. The ligaments studied were: dorsal radiocarpal (DRC), dorsal intercarpal (DIC), long radiolunate (LRL), radioscaphocapitate (RSC), ulnocarpal (UC), scapholunate interosseous (SLI) and lunotriquetral interosseous (LTI) ligaments. Specific immunohistochemical markers were used to target neural/perineurial structures. Both Ruffini and Pacini-like mechanoreceptors (sensory corpuscles) as well as nerve fascicles/free nerve fibers were identified. Ruffini corpuscles were primarily identified via their dendritic intracapsular nerve endings, whereas the Pacini-like corpuscles were identified through their thick perineurial capsules with marked p75 immunoreaction. The wrist ligaments were found to vary in innervation, the DIC, DRC and SLI being richly innervated, whereas the LRL being almost without innervation. The difference in innervation between the ligaments might reflect differential function. Ligaments without innervation might act as structures of passive restraint, whereas ligaments with rich innervation are proposed to also provide proprioceptive information. Wrist ligament injuries should, therefore, be regarded as a disturbance not only of the intrinsic carpal kinematics, but also of the coordination and proprioception of the entire wrist joint.

Adult↗
PubMed1995

Evaluating dorsal wrist pain: MRI diagnosis of occult dorsal wrist ganglion.

Fourteen patients with chronic dorsal wrist pain of unknown etiology underwent high-resolution magnetic resonance imaging (MRI) examination formatted to evaluate the scapholunate interval. Ten had MRI evidence that was diagnostic for an occult dorsal wrist ganglion. The average measured 4.7 mm at greatest diameter. Eight of 10 patients had the diagnosis confirmed, 7 at the time of surgery, and 1 at follow-up examination when the ganglion enlarged and was no longer occult. The other two opted for nonoperative management. The positive predictive value of a positive MRI finding for occult dorsal wrist ganglion was 100% in this small series. The use of a properly formatted high-resolution MRI in this patient population was diagnostic for occult dorsal wrist ganglion.

Diagnosis, Differential↗
PubMed1988

Preliminary results of total wrist arthroplasty in rheumatoid arthritis using the Trispherical total wrist arthroplasty.

Thirty-two patients underwent 38 arthroplasties for advanced rheumatoid arthritis and marked soft tissue losses. Seven wrists required repair or transfer of at least one tendon for rebalancing. All patients were improved by the implants. Thirty-four of the 38 patients were improved beyond the functional level of a painless wrist arthrodesis. Overall, there were 23 excellent, 10 good, 3 fair, and 2 poor results. The average wrist score was 90.3 points, and the average arc of motion was 38 degrees. There were three cases of migration of the third metacarpal stem and nine cases of lucency about the stems, three of which were progressive or greater than 1 mm. There were no deep infections. There was one reoperation for persistent pain and one for component loosening. There were no cases of implant failure. These results indicate that this total wrist arthroplasty is a safe, reproducible procedure for radiographic class III and IV rheumatoid disease and should be considered a first line of therapy for that group.

Adult↗
PubMed2002

Results of treatment of the extensive volar wrist lacerations: 'the spaghetti wrist'.

'Spaghetti wrist' describes a volar wrist laceration in which at least 10 structures, inclusive of tendons, at least one major nerve and usually one major vessel are divided. This retrospective study, was performed between January 1990 and December 1995 at the Department of Orthopaedic and Traumatology of Erciyes University Medical School. The outcome of 21 patients who sustained simultaneous laceration of the median and ulnar nerves as well as flexor tendons at the wrist is described. The mean follow-up was 6.4 years. The flexor tendons were assessed using criteria from Lister et al. Vascular status was assessed clinically. Ulnar and median nerve repair results at the final control were assessed according to Seddon's criteria. Furthermore, the ulnar nerve was assessed according to the power of the first dorsal interosseous muscle, and the median nerve assessed by the function of abductor pollicis brevis and sensory function modality. Primary nerve repair yielded satisfactory results, the median nerve repair achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement at the final control.

Adolescent↗
PubMed2005

Do wrist guards have the potential to protect against wrist injuries in bicycling, micro scooter riding, and monkey bar play?

OBJECTIVE: To test the potential of wrist guards to prevent wrist injury in recreational activities that require good grip strength and hand dexterity. METHODS: Forty eight children aged 5-8 years from one Melbourne school volunteered for tests chosen or devised following a review of the literature on the effects of orthoses use and hand function. RESULTS: Wrist guard wearing significantly degraded grip strength, bicycle steering, and performance on a monkey bar. Micro scooter steering was not significantly affected by their use. CONCLUSION: Wrist guards designed for skating are not recommended for bicycle riding and playing on climbing apparatus, and their suitability for scooter riding requires further investigation.

Bicycling↗
PubMed1994

Lunotriquetral interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists.

PURPOSE: To determine whether the carpal lunotriquetral ligament (LTL) can be consistently seen and to establish the normal range of LTL appearances at magnetic resonance (MR) imaging as a basis for comparison with LTL tears. MATERIALS AND METHODS: MR imaging was used to identify and characterize the LTL in 75 wrists with normal LTLs (54 in 27 asymptomatic volunteers, 21 in patients with normal arthrograms). RESULTS: The LTL was identified in all wrists and was linear in 63% and delta-shaped in 35%. The LTL had homogeneous low signal intensity in 73% and linear intermediate signal intensity traversing all or part of the LTL in 25%. Fluid signal intensity traversed the LTL in only one wrist. MR appearance of the osseous insertion sites varied. Distribution of hyaline cartilage signal was related to location within the LTL. CONCLUSION: The LTL can be consistently identified at MR imaging, but its appearance varies, which must be appreciated when evaluating wrists with suspected LTL tears.

Adolescent↗
PubMedDate not supplied

Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist.

Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses briefly the causes of hand and wrist injuries in sports and discusses pertinent biomechanical findings regarding the range of motion required in different sports activities. The bulk of the review discusses specific traumatic and overuse injuries to the hand and wrist commonly seen in the athlete. Emphasis is placed on problematic traumatic injuries such as carpal scaphoid fractures and hook of the hamate fractures, as well as ligament injuries to the wrist with regard to diagnosis, treatment, and return to athletic competition.

Athletic Injuries↗
PubMed1986

Cost effectiveness of wrist fluoroscopy and arthrography in the evaluation of obscure wrist pain.

The cost effectiveness of wrist fluoroscopy and arthrography was evaluated in patients with obscure wrist pain. Dynamic fluoroscopy was performed in 91 cases and was positive in 54 (59%). Radiocarpal arthrography was performed in 60 of these cases in which further information was desired. Arthrography increased the diagnostic yield to 62 of 91 cases (68%). Diagnoses included ligament and cartilage tears, and dynamic intercarpal instability. The cost per positive examination for fluoroscopy, based on total cost for fluoroscopy in 91 patients divided by number of positive cases, is $126. The cost per positive examination by arthrography alone is $377. When arthrography is done only when fluoroscopy is equivocal or negative, the cost per positive examination (fluoroscopy plus arthrography) drops to $280. Wrist arthrography is only cost effective if done after dynamic fluoroscopy fails to answer the clinical questions. When done together in this setting, the two procedures are most cost effective than arthrography alone. Based on current costs, conservative treatment of carpal instability costs about $1,500, and surgical therapy costs about $4,000. Thus, fluoroscopy and arthrography may further reduce the cost of management of obscure wrist pain by identifying those patients who would not benefit from surgical exploration.

Arthrography↗
PubMed1996

A modified dorsal approach to the wrist for arthrodesis of the non-rheumatoid wrist. An anatomical study.

Fourteen cadaveric wrists were dissected to investigate a modified dorsal approach that involved osteotomy of the small and dorsal tubercles without opening the third compartment. This approach could be safely made with good exposure of the dorsum of the wrist. The mean normal angle formed by the extensor pollicis longus tendon at the level of the dorsal tubercle was 144 degrees. An approach that involves division of the third compartment may lead to effective lengthening of the extensor pollicis longus musculotendinous unit by 8 to 17 mm with corresponding decrease in the tension generated by its contraction. The modified approach permits restoration of the normal alignment of the extensor pollicis longus tendon, and may be useful for performing arthrodesis of the non-rheumatoid wrist in young manual workers.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Reliability of isometric wrist extension torque using the LIDO WorkSET for late follow-up of postoperative wrist patients.

The objectives of this study were to determine interobserver, intraobserver, and overall reliability of isometric wrist extension torque using the LIDO WorkSET and then to estimate the minimal level of detectable change using the standard error of measurement. A generalizability study was conducted on 18 postoperative patients. Primary outcome was mean torque of three trials. Variance components were used to calculate generalizability coefficients for intraobserver (G = 0.96), interobserver (G = 0.94), and overall reliability (G = 0.92). When the same therapist is evaluating a patient on different days, a change of more than 16 inch-lb is needed to be 90% confident that true change has occurred. A greater value for change (23 inch-lb) is required when different therapists evaluate a patient on different days. The LIDO WorkSET measures wrist torque in a reproducible manner in an applied setting. The testing protocol is sensitive to differences in wrist torque between individuals and tolerated in the late postoperative period.

Adult↗