Left Wrist Research Articles

Morphometric Analysis of Ulnar Variance and Its Demographic Dynamics Using High Resolution MRI: A Retrospective Study in Indian Population and Review of Literature.

Ulnar variance (UV) is the variation of the level of the distal articulating surface of the radius with respect to the distal articulating surface of the ulna. These variations either positive or negative can predispose to pathologies involving the wrist joint. The aim of this study was to measure the ulnar variance in a subset of Indian population using high-resolution MRI and compare our results with the existing literature. Retrospective analysis of 100 normal wrist MRIs were done performed during November 2020 to November 2021 and the ulnar variance was calculated using the Method of Perpendiculars. All the MRI sequences were performed by an experienced radiologist with prior fixed protocol for the study. The measurements were done on the mid-coronal section based on the Method of Perpendiculars using Meddiff Rispacs software. The average age of the participants was 42years, with Male to female ratio of 0.9:1. 47 MRIs were of the left wrist, while 53 MRIs were of the right wrist. The mean UV was -0.7mm (SD-0.175), ranging from -4.5mm to 3.5mm. There was a significant relationship between ulnar-variance and age, as ulnar-variance increases with the age (p value = 0.039). There was no statistically significant correlation of ulnar-variance with gender distribution and handedness. This study utilized high-resolution MRI for measuring ulnar-variance in a subset of Indian population and disclosed that the ulnar-variance affirms a positive correlation with age, while no specific pattern between the ulnar-variance and gender or handedness could be established.

Impact of Simulation-Based Training on Radiation Exposure of Young Interventional Cardiologists

Reducing radiation exposure during cardiovascular catheterization is of paramount importance to ensure patient and staff safety. Our study aimed to assess the transferability of acquired skills from virtual reality to the real world, including radioprotection measures during mentored simulation training (ST) in coronary angiography. A total of 10 cardiology residents were evaluated during real-life cases in the catheterization laboratory before (group A) and after mentored ST. The educational effect of mentored simulator training on real-life case performance was evaluated at 2 different time points: within the first week (group B) and after 12 weeks (group C). Compared with group A, the total dose area product (DAP) (µGy•m2) and total air kerma (mGy) were lower after ST: group A: 2,633 (1,723 to 3,617) versus group B: 1,618 (1,032 to 2,562), p <0.05 and 214 (136 to 297) versus 135 (84 to 222), p <0.05, respectively. Concerning operator radiation exposure (µSv), left finger dose: 1,090 (820 to 1,460) versus 635 (300 to 900), p=0.028; left leg dose 80 (0 to 110) versus 0 (0 to 0), p=0.027; left eye lens dose: 39 (24 to 69) versus 11 (8 to 20), p <0.0001; and chest dose outside the lead apron: 50 (34 to 88) versus 29 (21 to 50), p <0.003 were significantly lower in the group B than group A. A total of 12 weeks after ST, the total DAP and total air kerma remained stable along with operator exposure except left eye lens dose (µSv): group B: 11 (8 to 20) versus group C: 16 (12 to 27), p=0.02. In addition, left eye lens dose, left wrist dose, and chest dose outside the lead apron were significantly correlated with total DAP (rs=0.635, rs=0.729, and rs=0, 629, respectively) and total air kerma (rs=0.488, rs=0.514, and rs=0.548, respectively) at 12 weeks. In conclusion, ST for coronary angiography may improve radioprotection learning and should be incorporated into training curricula.

To Live Together Is to Move Together: Social Actigraphy Applied to Healthy Elderly People.

(1) Background: Actigraphic methods allow prolonged monitoring of human physical activity (PA) by wearable sensors in a real-life unsupervised context. They generally do not characterize the social context, and nearby persons can have a modulating effect on the performed PA. The present study aims to apply an existing method for bimanual actigraphy to both components of a marital dyad to verify the level of association between the two PA profiles. Other dyad comparisons complete the overall figure. (2) Methods: Seven-day actigraphic recordings collected from both components of 20 married couples of retired, cohabiting, healthy subjects (age ranging from 58 to 87 years) were considered. (3) Results: PA profiles of a marital dyad are significantly more correlated (coefficient: 0.444) than unrelated couples (0.278). Interestingly, participants’ profiles compared with their own recording shifted by 24 h, evidencing an intermediate level of association (0.335). Data from the literature, the high association (0.875) of individual right and left wrist profiles, enforce the analysis. (4) Conclusions: The proposed method, called “social actigraphy”, confirmed that the partner has a relevant effect on one’s PA profile, thus suggesting involving the partner in programs concerning lifestyle changes and patient rehabilitation.

Operator radiation dose during trans-hepatic arterial chemoembolization: different patients' positions via transradial or transfemoral access.

PURPOSE This study aimed to compare the radiation dose received by the operator among different patients' positions via transradial access (TRA) or transfemoral access (TFA) during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS A total of 120 patients with HCC undergoing TACE for the first time between January and November 2019 were randomized into 4 groups with 30 patients in each group. In group A, patients were placed in the foot-first position with the left upper arm abducted, and TACE was performed via the left radial artery. In group B, patients were placed in the conventional headfirst position with the left hand placed at the left groin, and TACE was performed via the left radial artery. In group C, patients were placed in the conventional head-first position, and TACE was performed via the right radial artery. In group D, patients were placed in the conventional head-first position, and TACE was performed via the right femoral artery. Before each procedure, thermoluminescent dosimeters were taped at 7 different body parts of the operator and the radiation dose was measured and collected after the procedure. The normalized radiation dose was also calculated. Procedural parameters included radiation dose, fluoroscopy time (FT), dose-area product (DAP), and air kerma (AK) were recorded. Patients' demographics, tumor baseline characteristics, radiation dose, and procedural parameters were compared between groups. RESULTS No significant differences were found in patients' demographics, tumor baseline characteristics, as well as in total FT, DAP, and AK. However, significant differences were found in the total radiation dose received by the operator and the doses on the pelvic cavity and the right wrist (P < .05). In group C, the radiation doses received on the pelvic cavity, the right wrist, and the total radiation doses were relatively higher. Significant differences were also found in the normalized radiation doses received by the operator on the thyroid, chest, left wrist, right wrist, and pelvic cavity, and the total normalized doses (all P < .05). Similarly, the radiation doses received by the operator at the aforementioned parts in group C were higher, while those in group A were lower. CONCLUSION No statistically significant differences were observed in the FT, DAP, and AK in TACE via TRA when patients were placed in different positions. However, TACE via the left TRA, with patients in the feet-first position, reduced the radiation dose received by the operator, thereby reducing the radiation risk.

A Young Man With Acute-Onset Bilateral Arm Weakness After Traumatic Sciatic Neuropathy: A Clinical Vignette.

A Young Man With Acute-Onset Bilateral Arm Weakness After Traumatic Sciatic Neuropathy: A Clinical Vignette.

Management of a 52-year-old Man Detected to have a Fragility Fracture of the Left Wrist

Fragility fracture is a fracture resulting from mechanical forces that would not ordinarily result in fractures known as low-level trauma. Fragility fracture due to osteoporosis is not so uncommon in men &gt;50 years of age, the prevalence of osteoporosis is approximately 2% at age of 50 years, and the male has a 1:5 chance of osteoporotic fractures. The lifetime risk of fracture in men aged 50 or more is between 13 and 30 %, and out of this 10 % of fractures were at the forearm. As per osteoporosis fragility fracture guidelines should be assessed for risk factors like Previous fragility fracture, Use of glucocorticoids, History of falls, Family history of hip fractures, Low Body mass index i.e. BMI &lt; 18.5 kg/m2, Smoking and alcohol intake history &gt;21 units/ week.

Home office versus ergonomic workstation - is the ergonomic risk increased when working at the dining table? An inertial motion capture based pilot study

BackgroundIn order to reduce the risk of infection with Sars-Cov-2, work practices have been shifted to the home office in many industries. The first surveys concerning this shift indicate an increase in musculoskeletal complaints of many employees. The aim of this study was to compare the ergonomic risk in the upper extremities and trunk of working in a home office with that of working in an ergonomically optimized workplace.MethodsFor this purpose, 20 subjects (13w/7m) aged 18–31 years each performed a 20-minute workplace simulation (10 min writing a text, 10 min editing a questionnaire) in the following set up: on a dining table with dining chair and laptop (home office) and on an ergonomically adjusted workstation (ergonomically optimized workplace). The subjects were investigated using a combined application of a motion capture kinematic analysis and the rapid upper limb assessment (RULA) in order to identify differences in the ergonomic risk.ResultsSignificantly reduced risk values for both shoulders (left: p < 0.001; right: p = 0.02) were found for the ergonomically optimized workstations. In contrast, the left wrist (p = 0.025) showed a significantly reduced ergonomic risk value for the home office workstation.ConclusionThis study is the first study to compare the ergonomic risk between an ergonomically optimized workplace and a home office workstation. The results indicate minor differences in the upper extremities in favor of the ergonomically optimized workstation. Since work-related musculoskeletal complaints of the upper extremities are common among office workers, the use of an ergonomically optimized workstation for home use is recommended based on the results.

Double Dorsal Capsulodesis in the Treatment of Chronic Scapholunate Instability: Description of a New Surgical Technique and Case Report

Introduction: The scapholunate ligament (SLL) injury can cause wrist pain and instability. There is a wide variety of surgical techniques used for the treatment of this lesion, such as dorsal capsulodeses, tenodeses with flexor or extensor tendons, and bone-ligament-bone graft.&#x0D; Objective: To describe a new technique for the treatment of SLL injury aiming to stabilize the dissociated carpus with a double dorsal capsulodesis.&#x0D; Materials and methods: By presenting the case of a 36-year-old male security officer who injured his left wrist in a motorcycle accident, a procedure to align the carpus is proposed. The long-term outcome of this procedure is also described&#x0D; Results: The proposed surgery was successfully performed; it had excellent clinical and functional results, with no complications. Long-term restoration of carpal alignment observed in wrist radiographs was evidenced after two years of follow-up, the patient was asymptomatic and with full functional recovery.&#x0D; Conclusion: The proposed technique appears to be reproducible, effective and easy to perform. Unlike the technique described by Blatt, the aim of this one is to restore the physiological position of the lunate bone by adding a second capsulodesis, as it is believed to be an essential factor in the maintenance of carpal kinematics.

Design of Work Facilities to Reduce Complaints of Musculoskeletal Disorders (MSDS) with an Ergonomic Approach to Coffee Farmers

Complaints on the musculoskeletal system are complaints that are felt by a person in the muscles and skeleton with different levels of complaints, complaints to this damage are usually referred to as musculoskeletal disorders. The purpose of this study was to improve work facilities in the process of picking coffee cherries in Arul Item Village, Central Aceh. This measurement was carried out using the REBA (Rapid Entire Body Assessment) method and using the NBM (Nordic Body Map) questionnaire as the research instrument. The study was conducted using an analytical survey method which aims to see the relationship between work attitudes and musculoskeletal complaints with an ergonomic approach. From the results of the NBM questionnaire on 56 workers, it shows that the musculoskeletal complaints experienced by coffee berry pickers are in the category of pain, most of which are in the upper neck and left wrist as many as 39 (70%). In the very category of pain, the most pain was in the left shoulder 50 (89%) and the right wrist as much as 33 (59). Based on measurements using the REBA method, it is stated that there is an actual REBA score of 4-7 where the risk is at moderate risk for musculoskeletal disorders and on the proposed REBA score there is a score of 2 where the score is in a low risk area, so as to improve work attitudes and work posture which resulted in the emergence of musculoskeletal complaints, a modified work tool design, namely a bag, was proposed to reduce the high number of musculoskeletal complaints in coffee fruit pickers

Acute calcific tendinitis of the FCR tendon in a 24-year-old male: A case report

Acute calcific tendinitis is an acute or chronic condition that typically affects the shoulder joint in patients 40 and older. Specifically caused by the deposition of calcium hydroxyapatite crystals in or around the tendon sheath, the cause is typically unknown but seems to be unrelated to underlying metabolic disturbances and pathologies. In this work, the case of left wrist pain in a 24-year-old male that was initially misdiagnosed but later identified as acute calcific tendinitis is highlighted.

Quantifying drysuit seal pressures in non-immersed scuba divers.

Drysuits use flexible neck and wrist seals to maintain water-tight seals. However, if the seals exert too much pressure adverse physiological effects are possible, including dizziness, lightheadedness, syncope, and paresthesias in the hands. We aimed to quantify the seal pressures of neck and wrist seals in non-immersed divers. We recruited 33 diving volunteers at two dive facilities in High Springs, Florida. After a history and physical exam, we measured vital signs as well as wrist and neck seal pressures using a manometer system. The mean (SD) seal pressure of the right wrist seals was found to be 38.8 (14.9) mmHg, while that of the left wrist seals was 37.6 (14.9) mmHg. The average neck seal pressure was 23.7 (9.4) mmHg. Subgroup analysis of seal material demonstrated higher mean sealing pressure with latex seals compared to silicone; however, this difference was not statistically significant. Drysuit seal pressures are high enough to have vascular implications and even potentially cause peripheral nerve injury at the wrist. Divers should trim their seals appropriately and be vigilant regarding symptoms of excessive seal pressures. Further research may elucidate if seal material influences magnitude of seal pressure.

Pseudo-online detection and classification for upper-limb movements

Objective. This study analyzed detection (movement vs. non-movement) and classification (different types of movements) to decode upper-limb movement volitions in a pseudo-online fashion. Approach. Nine healthy subjects executed four self-initiated movements: left wrist extension, right wrist extension, left index finger extension, and right index finger extension. For detection, we investigated the performance of three individual classifiers (support vector machine (SVM), EEGNET, and Riemannian geometry featured SVM) on three frequency bands (0.05–5 Hz, 5–40 Hz, 0.05–40 Hz). The best frequency band and the best classifier combinations were constructed to realize an ensemble processing pipeline using majority voting. For classification, we used adaptive boosted Riemannian geometry model to differentiate contra-lateral and ipsilateral movements. Main results. The ensemble model achieved 79.6 ± 8.8% true positive rate and 3.1 ± 1.2 false positives per minute with 75.3 ± 112.6 ms latency on a pseudo-online detection task. The following classification gave around 67% accuracy to differentiate contralateral movements. Significance. The newly proposed ensemble method and pseudo-online testing procedure could provide a robust brain-computer interface design for movement decoding.

Smartwatch-based detection of atrial arrhythmia using a deep neural network in a tertiary care hospital

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Smartwatch electrocardiograms (SW ECG) have been identified as a promising noninvasive solution to assess heart rhythm abnormalities, especially atrial arrhythmias (AA) which includes atrial fibrillation, atrial flutter and supraventricular tachycardia. This study evaluates the performance of the detection of AA with a smartwatch and compares the accuracy of two algorithms, the latest version of the original companion application (Apple ECG 2.0 App) and a novel deep neural network (DNN), in a population typical of an electrophysiology department. Purpose Determine if a novel DNN can improve the detection of AA on SW ECG in a tertiary care hospital. Methods 101 patients from the electrophysiology department of one tertiary center were included in this ongoing study. Three simultaneous ECGs were collected for each patient: one 12-lead ECG (Mindray BeneHeart R12) and two SW ECGs (Apple Watch) taken from the left wrist (SWw ECG) and the lower left abdomen (SWa ECG). 12-lead ECGs were adjudicated by a blinded expert electrophysiologist as 52 AA and 49 not AA and considered as gold standard. The SW ECGs were processed by the ECG 2.0 App and the DNN in parallel. The proportions of inconclusive diagnoses returned and the performances were assessed and compared. Results Overall, the ECG 2.0 App yielded inconclusive diagnoses for 19% (19/101) of all SWw ECGs while the DNN reduced that number to 0% (0/101). A similar result holds for SWa ECGs (Figure 1). Regarding the detection of AA from SWw ECGs, the ECG 2.0 App had a sensitivity of 81% (95% CI, 67%-90%), a specificity of 97% (95% CI, 87%-100%) and an accuracy of 89% (95% CI, 80%-94%) while the DNN had a sensitivity of 92% (95% CI, 82%-97%), a specificity of 90% (95% CI, 78%-96%) and an accuracy of 91% (95% CI, 84%-95%). For SWa ECGs (Figure 2), the sensitivity of the DNN was found significantly higher compared to the ECG 2.0 App: 96% (95% CI, 89%-98%) vs 76% (95% CI, 61%-87%). Conclusion(s): A novel DNN algorithm decreased the number of inconclusive diagnostics in the detection of AA from SW ECG from around 20% to 0%, which could help limit the overreading time spent by the physicians. Excluding inconclusive diagnostics, we observed no significant difference in performance between the two algorithms except for the sensitivity for SW ECG taken from the abdomen where the DNN outperforms the ECG 2.0 App. Routine application of this SW ECG analysis in tertiary care hospitals offers significant promise in arrhythmia diagnosis.

Risk factors for work-related musculoskeletal disorders among welders in the informal sector under resource constrained settings.

Welding tasks involve the use of awkward working postures and repetitive movements and therefore pose a risk for developing work-related musculoskeletal disorders (WRMDs). This study aimed to assess the prevalence, severity and risk factors for WRMDs among welders in the informal sector. A total of 128 welders (33±10.5 years) were purposively selected from three urban centers in Zimbabwe. WRMDs were assessed using a Modified Cornell Musculoskeletal Questionnaire (MCMQ). The Quick Exposure Check (QEC) and the Rapid Entire Body Assessment (REBA) were used for postural risk analysis. P < 0.05 was considered significant. Analyses showed a high prevalence of pain in the lower back (78%), right shoulder (66%), left hand wrist (62%) and right hand wrist (61%). With regards to the severity of lower back pain, 4% reported low pain, 24% mild pain and 48% were severe cases of pain. Elevated grand REBA scores were significantly associated with self-reported in various body regions. Multinomial regression analyses showed that smoking, prolonged working hours and not engaging in physical activities were significant predictors for pain. High job satisfaction and taking adequate work-rest breaks were protective factors for WRMDs (p < 0.05). There is a high prevalence of WRMDs among welders due to individual and work-related risk factors. Ergonomics education is required to address the risk factors for and progression of WRMDs among welders.

Investigating the Effect of Keyboard Distance on the Posture and 3D Moments of Wrist and Elbow Joints among Males Using OpenSim.

Musculoskeletal disorders (MSDs) of the upper extremities and computer use are common in modern societies, and both show a growing trend. This study was conducted to determine the posture and 3D moments of wrist and elbow joints at different keyboard distances on a desk. Twelve healthy right-handed male volunteers attended the motion analysis laboratory. A keyboard was placed at three different distances from the participants' bodies while performing a standard computer task. The workstation was adjusted according to ANSI/HFES-100-2007 standard for each participant to maintain a comfortable ergonomic posture for controlling confounding variables. Qualisys motion capture system, OpenSim (Ver. 4.1), and visual analog scale were used to collect and analyze the data. The highest levels of wrist flexion and radial deviation as well as elbow flexion and pronation were observed when the keyboard was at the edge of the desk. When the keyboard was 8 cm away from the edge of the desk, the right wrist flexion and radial deviation decreased 83% and 89%, respectively. In the left wrist, flexion and radial deviation decreased 94%. With increasing the distance of the keyboard from the edge of the desk, the right elbow flexion, pronation, and left elbow flexion decreased, 95%, 76%, and 85%, respectively. No significant difference was found for the left elbow pronation, wrist, and elbow joint moments, in the studied keyboard distances. However, a cut-off point has to be specified because large keyboard distances cause high extension and flexion of the limbs. The keyboard position relative to the body is an important parameter in computer work and has a significant impact on the posture of the upper extremities. A keyboard should be located at a distance that allows the upper extremities to remain in a neutral position so that the risk of MSDs is reduced.

Transoral management of pharyngeal ballistics

ObjectiveTo present a case of a ballistic foreign body in the pharynx after a gunshot wound to the maxillofacial area, an accompanying review of relevant literature, and our approach to management. MethodA 68-year-old male with no prior medical history presented to our trauma center with gunshot wounds to the left chin, left wrist, right chest, and sternum. A CT Angiogram of the neck revealed a bullet fragment left neck and additional fragment adjacent to the L hypopharynx at the level of the hyoid. The patient was taken to the operating room for direct laryngoscopy with foreign body removal and esophagoscopy. ResultsWe document our workup and successful surgical removal of the pharyngeal ballistic foreign body via our video abstract, compiling preoperative imaging, intraoperative imaging, and video. Literature review of the subject accompanying our video abstract highlights the extensive complications that can occur from a retained foreign body in this area, supporting surgical removal of the foreign body if safely possible. ConclusionGiven the demonstrated feasibility and success of endoscopic foreign body removal from the pharyngoepiglottic space, in addition to overwhelming support for removal in the literature we recommend surgical extraction of ballistic foreign bodies located in the upper aerodigestive tract in stable patients to avoid early and long-term complications that can impact swallowing function, airway stability and the vital structures contained within the neck.

Somatosensory evoked magnetic fields caused by mechanical stimulation of the periodontal ligaments

The periodontal ligaments are very important sensory organ for our daily life such as perception of food size or hardness, determination of jaw position, and adjustment of masticatory strength. The sensory properties of the periodontal ligament, especially those of the maxillary and mandibular molars, have not yet been fully investigated. Somatosensory evoked magnetic fields (SEFs) can be measured and evaluated for latency and intensity to determine the sensory transmission characteristics of each body parts. However, previous reports on SEFs in the oral region have only reported differences in upper and lower gingival and lip sensations. In this study, the aim was to clarify these sensory characteristics by measuring SEFs during mechanical stimulation of the periodontal ligament in the maxillary and mandibular first molars. Somatosensory evoked magnetic fields were measured in the contralateral hemispheres of 33 healthy volunteers. Mechanical stimulation of the maxillary and mandibular right first molars, and the left wrist was performed with a specific handmade tool. The first peak latency for the mandibular first molars was 41.7 ± 5.70 ms (mean ± SD), significantly shorter than that for the maxillary first molars at 47.7 ± 7.36 ms. The peak intensity for the mandibular first molars was 13.9 ± 6.06 nAm, significantly larger than that for the maxillary first molars at 7.63 ± 3.55 nAm. The locations in the contralateral hemispheres showed no significant difference between the maxillary first molars and mandibular first molars. These locations were more anteroinferior and exterior than that of the wrist, as suggested by the brain homunculus. Neural signals from the mandibular periodontal ligaments pass faster and more intensely to the central nervous system than those from the maxillary periodontal ligaments, and may preferentially participate in adjustment of the occlusal force and the occlusal position.

PO-639-01 ENHANCED P WAVE RECOGNITION THROUGH RA-XIPHOIDAL LEAD BY HUAWEI WATCH ECG RECORDING

ECG recording through the Huawei watch’s (GT2 pro ECG edition, Huawei Technology Co., Ltd, Shenzhen, PR China) back electrode on the left wrist and the right index finger on the crown simulates the Einthoven’s bipolar ECG lead I (Huawei Watch Lead I ECG, HWIG), which is not a good trace for arrhythmia diagnosis due to its indistinct P wave in some cases. Therefore, additional smartwatch leads such as right arm-left leg lead, right arm-precordial leads are required to get more accurate ECG information.

PO-661-02 INCREASED DIAGNOSTIC ACCURACY OF MYOCARDIAL ISCHEMIA BY HUAWEI WATCH’ S ADDITIONAL BIPOLAR LEAD ELECTROCARDIOGRAPH

The Huawei watch GT2 pro ECG edition (Huawei Technology Co., Ltd, Shenzhen, PR China) is a smartwatch that can record the voltage difference between the right index finger on the crown and the Huawei watch’s back electrode on the left wrist to simulate the Einthoven’s bipolar electrocardiograph (ECG) lead I (HWIG). However, the information of myocardial ischemia is insufficient and additional leads are necessary to increase the detection of ischemia by Huawei watch.

Pediatric Posttraumatic Cystic Bone Lesion

4-year-old girl presented to emergency department with left wrist pain after trauma. Radiographs demonstrated a torus fracture of the distal radius. At the third month following the trauma, a control radiograph is obtained. In the radiograph, a radiolucent lesion close to the former torus fracture site is noticed (Figure 2). Then, CT is performed for further examination (Figure 3). CT demonstrated cortical, well-circumscribed non-expansile subcentimeter lesion.