Yesterday, today, and tomorrow: A brief history of the wrist

Abstract

“Mechanically, the wrist is the most complex joint in the body”. So many little bones, so many ligaments, so many tendons, so many nerves, so many potential problems. This profound observation is attributed to Ron Linscheid, MD of the Mayo Clinic way back in the 1980s. Until the 80s hand surgery and therapy had paid little serious attention to the wrist. But in 1984 Orthopaedic Clinics got the ball rolling by publishing an entire issue dedicated to the wrist, with a lead chapter on carpal kinematics by Ed Weber, MD. Soon thereafter two significant textbooks were published, the first by Julio Taleisnik, MD and a second by David Lichtman, MD. Both these authors challenged the traditional mechanical model of two horizontal carpals rows, the one we all learned as students by memorizing some filthy little pneumonic. Old geezers like me and my generation even had to learn it twice because the names of some of the bones changed (eg, the navicular becoming the scaphoid). The critical role of the lunate's position was emphasized by Taleisnik in his so-called Columnar Theory of carpal kinematics wherein he described the carpus as three vertical columns, rather than two horizontal rows with the lunate under the influence of a lateral, or radial, column (ie, the scaphoid) and a medial, or ulnar, column (ie, the triquetrum). The importance of the lunate had already been suggested by the folks at Mayo, affectionately known as “the Wrist Capital of the World” which also gave us the slider crank analogy of carpal kinematics, in referring to it as the intercalated segment. This must have influenced Taleisnik who trained earlier at Mayo. Enter Lichtman who conceptualized the carpus not as two horizontal rows, nor as three vertical columns, but as a single oval ring. The commonality of all three models was the significance of the ligaments acting as primary stabilizers of the entire complex. Likewise, all three models acknowledged that flexion and extension as well as radial and ulnar deviation occurred at the two primary wrist joints, the radio-carpal and mid-carpal joints, with significant intercarpal motion available within the proximal row on either side of the lunate, but no significant motion occurring within the distal row.