Kinematics of the Midcarpal and Radiocarpal Joints in Radioulnar Deviation: An In Vitro Study

Abstract

Carpal kinematics have been studied widely yet remain difficult to understand fully. The noninvasive measurement of carpal kinematics through medical imaging has become popular. Studies have shown that with radial deviation the scaphoid and lunate flex whereas the capitate moves radiodorsally relative to the lunate. This study investigated the midcarpal and radiocarpal contributions to radial and ulnar deviation of the wrist. This was accomplished through noninvasive characterization of the scaphoid, lunate, and capitate using 3-dimensional medical imaging of the wrist in radial and ulnar deviation. Eight fresh-frozen and thawed cadaveric wrists were used in an experimental set-up that positioned the wrist through spring-scale actuation of the 4 wrist flexor and extensor tendon groups. The wrists were scanned by computed tomography in neutral and full radial and ulnar deviation. Body mass-based local coordinate systems were used to track the motion of the capitate, lunate, and scaphoid with the radius as a fixed reference. Helical axis motion and Euler angles were calculated from neutral to radial and ulnar deviation for the capitate relative to the radius, lunate, and scaphoid and for the lunate and scaphoid relative to the radius. The capitate, scaphoid, and lunate moved in a characteristic manner relative to the radius and to one another. Radial and ulnar deviation occurred primarily in the midcarpal joint. Midcarpal motion accounted for 60% of radial deviation and 86% of ulnar deviation. In radial deviation the proximal row flexed and the capitate extended; the converse was true in ulnar deviation. Radioulnar deviation (in-plane motion) occurred mostly through the midcarpal joint, with a lesser contribution from the radiocarpal joint. The results of our study agree with previous investigations that found the scaphoid and lunate flex in radial deviation (out-of-plane motion) relative to the radius whereas the capitate extends (out-of-plane motion) relative to the scaphoid/lunate (with the converse occurring in ulnar deviation). Our study shows how these out-of-plane motions combine to produce in-plane wrist radioulnar deviation. The use of 3-dimensional visualization greatly aids in the understanding of these motions. The results of our study may be useful clinically in understanding the consequences of isolated midcarpal fusions in the treatment of wrist instability.