Wrist Research Articles

Surgeon Upper Extremity Kinematics During Error and Error-Free Retropubic Trocar Passage.

Surgeon kinematics play a significant role in the prevention of patient injury. We hypothesized that elbow extension and ulnar wrist deviation are associated with bladder injury during simulated midurethral sling (MUS) procedures. We used motion capture technology to measure surgeons' flexion/extension, abduction/adduction, and internal/external rotation angular time series for shoulder, elbow, and wrist joints. Starting and ending angles, minimum and maximum angles, and range of motion (ROM) were extracted from each time series. We created anatomical multibody models and applied linear mixed modeling to compare kinematics between trials with versus without bladder penetration and attending versus resident surgeons. A total of 32 trials would provide 90% power to detect a difference. Out of 85 passes, 62 were posterior to the suprapubic bone and 20 penetrated the bladder. Trials with versus without bladder penetration were associated with more initial wrist dorsiflexion (-27.32 vs -9.03°, p = 0.01), less final elbow flexion (39.49 vs 60.81, p = 0.03), and greater ROM in both the wrist (27.48 vs 14.01, p = 0.02), and elbow (20.45 vs 12.87, p = 0.04). Wrist deviation and arm pronation were not associated with bladder penetration. Compared with attendings, residents had more ROM in elbow flexion (14.61 vs 8.35°, p < 0.01), but less ROM in wrist dorsiflexion (13.31 vs 20.33, p = 0.02) and arm pronation (4.75 vs 38.46, p < 0.01). Bladder penetration during MUS is associated with wrist dorsiflexion and elbow flexion but not internal wrist deviation and arm supination. Attending surgeons exerted control with the wrist and forearm, surgical trainees with the elbow. Our findings have direct implications for MUS teaching.

Faster perfusate instillation time results in more systemic leakage of amikacin sulfate when performing intravenous regional limb perfusion in horses.

To evaluate if a difference in synovial amikacin concentrations exists in the radiocarpal joint (RCJ) following different durations of instillation of an IV regional limb perfusion (IVRLP) perfusate. 7 healthy horses. Horses received 2 IVRLPs with 2 g amikacin diluted to 60 mL with 0.9% NaCl via the cephalic vein in a crossover study design with a wash-out period between procedures. Instillation of the perfusate was administered over a 1-minute (technique 1) and 5-minute (technique 5) period. Concentrations of amikacin within the RCJ were measured at time (T) 5, 10, 15, 20, 25, and 30 minutes after instillation of the perfusate. Systemic concentrations of amikacin were measured at T0, 5, 10, 15, 20, 25, 29 minutes, and 1 minute after tourniquet removal (T31). Amikacin concentrations were determined by fluorescence polarization immunoassay. The median maximum concentration (CMAX) of amikacin within the RCJ for technique 1 was 338.4 µg/mL (range, 60 to 4,925 µg/mL), while the median CMAX for technique 5 was higher at 694.8 µg/mL (range, 169.2 to 3,410 µg/mL; P = .398). There was a higher amikacin blood concentration over time for technique 1 compared to technique 5 (P = .004). Administration of perfusate at different rates did not significantly affect synovial concentration of amikacin within the RCJ when performing IVRLP. However, increased systemic leakage was noted when the perfusate was administered over 1 minute, which might affect synovial concentrations in a larger group of horses.

Exploring Age-Related Variations in Carpal Bone Volume: Implications for Clinical Practice and Anatomical Understanding.

Clinically recognizing the changes in carpal bone volumes and understanding their implications in predicting osteoarthritis (OA) is crucial in clinical practice This study aimed to explore age-related differences in carpal bone volumes across genders, leveraging computed tomography (CT) wrist scans to create 3D surface models of these bones. Carpal bone volumes were calculated using the 3D Slicer software from CT scans obtained from Frankston Hospital and additional datasets from Brown and Auckland Universities. The data were statistically processed using Stata V13. Double-sided P-values < .05 were considered statistically significant. The study was conducted in accordance with the ethical standards laid out in the Declaration of Helsinki. A total of 181 patients were analyzed, and 48% of whom were female. A statistically significant positive Spearman correlation (rho = 0.37-0.611, P <.05) was observed between increasing age and the volume of all surveyed carpal bones (scaphoid, lunate, triquetrum, pisiform, hamate, capitate, and trapezium) across genders. Intrauser and interuser reliabilities for 3D Slicer-generated volumes of trapezium and pisiform bones were statistically significant, with Interclass Correlation Coefficient (ICC) values of 0.86 and 0.95, respectively. Trapezial volumes increase with age, potentially due to the presence of OA and consequent osteophyte formation. This pattern is more prevalent among older individuals and women. However, the positive correlation between carpal bone volume and age was consistent across all carpal bones and both genders, regardless of OA presence. These findings suggest that carpal bone volume may naturally increase with age, independent of OA-related changes. III, cohort study.

Motion Analysis of the Wrist and Finger Joints in Sport Climbing.

Climbing is a fast-growing sport, with one of the most common injuries being a rupture of the finger flexor tendon pulley. The strain on pulleys increases as finger joints flex. However, to our knowledge, no study has conducted a kinematic analysis of climbers' fingers. Thus, this study aimed to examine finger kinematics during typical climbing tasks. Eleven elite climbers performed a sequence of four climbing moves, which were recorded by an optical motion capture system. Participants used crimp, half-crimp, and open-hand grips for three trials each, with the fourth condition involving campusing using any grip except crimp. Mean proximal interphalangeal joint (PIP) flexion during the holding phase was 87° (SD 12°), 70° (14°) and 39° (27°) for the crimp, half-crimp and open-hand grip, respectively. Hence, inter-individual PIP flexion ranges overlap between different gripping conditions. Two different movement patterns emerged in the open-hand grip, possibly influenced by the use of the little finger, leading to varying degrees of flexion in the middle and ring fingers. Avoiding little finger usage in the open-hand grip may reduce load during pulley rupture rehabilitation. The implications of PIP joint angle variability on individual pulley injury risk or prevention warrant further investigation. Motion capture proved effective for understanding finger kinematics during climbing and could guide future studies on pulley injury risk factors.

The Validity and Reliability of a Smartphone Application for Measuring Wrist and Metacarpophalangeal Joint Motion.

Background Accurate measurement of the range of motion (ROM) is crucial for guiding upper extremity rehabilitation. Inaccurate measurements can mislead clinicians and harm patient compliance. This study aimed to evaluate the validity and reliability of a smartphone application (Angulus) for measuring wrist and metacarpophalangeal (MCP) joint ROM. Methodology This study included 64 volunteers with no prior wrist injuries. Thewrist flexion/extension, radial/ulnar deviation, and MCP joint flexion/extension ROM were assessed by an experienced physiotherapist (Assessor 1) using the Angulus and a standard two-arm goniometer. The validity of Angulus was evaluated by correlating it with the goniometer measurements using the Pearson correlation coefficient. For the reliability analysis, an inexperienced biomedical engineer (Assessor 2) performed the same measurements using Angulus twice in different sessions, in addition to Assessor 1. The intra-rater and inter-rater reliability were tested using the intraclass correlation coefficient. Results The mean age of the participants was 29.5 ± 8.2 years, with 62% being female. The validity of the Angulus app measurements was indicated by the adequate to excellent correlation between the Angulus and goniometer measurements (ranging from 0.44 to 0.81). The intra-rater reliability of the Angulus app was excellent for Assessor 1 (ranging from 0.76 to 0.90) and adequate to excellent for Assessor 2 (ranging from 0.71 to 0.88). The inter-rater reliability of Angulus was excellent (ranging from 0.91 to 0.96). Conclusions Angulus is a valid and reliable method to measurethe wrist and MCP joint ROM.

Clinical and genetic characteristics of multicentric carpotarsal osteolysis syndrome

BACKGROUND: Multicentric carpotarsal osteolysis (MCTO) syndrome is a rare autosomal dominant disease of skeletal dysplasias caused by heterozygous missense variants in MAFB. Clinical manifestations of the disease are characterized by pain, swelling, and hand and foot deformities as a result of progressive osteolysis of the carpal and tarsal bones. Kidney insufficiency also developed in some patients.&#x0D; CLINICAL CASES: Three Russian patients aged 2–39 years with MCTO syndrome caused by pathogenic variants c.176CT, c.184AG, c.203CT in MAFB are presented. All cases were sporadic. Two of our patients with MCTO were typically observed for several years with a diagnosis of juvenile idiopathic arthritis. All patients underwent phenotypic analysis using standard methods, radiography of the upper and lower extremities, ultrasonography of the kidneys, blood and urine tests to assess renal function, and molecular tests to clarify the diagnosis. Molecular genetic analysis included direct automatic Sanger sequencing of MAFB (NM_005461.5).&#x0D; DISCUSSION: The clinical manifestations of the disease in the patients included deformities and shortening of the hands and feet and typical signs of osteolysis of the metacarpal and metatarsal bones on radiographs. One of the examined patients had proteinuria in early childhood. Considering the rarity of MCTO syndrome, a description of the clinical and radiological characteristics of newly identified cases of the disease will help optimize its diagnosis and multidisciplinary observation of patients and improve the quality of medical and genetic counseling for affected families.&#x0D; CONCLUSIONS: The first clinical manifestations of MCTO syndrome are characterized by significant similarities with those of juvenile arthritis. For their differential diagnosis, a thorough radiographic analysis of the hands and feet for osteolysis is necessary. Early diagnosis of MCTO syndrome is essential because in recent years intensive research aimed at developing therapy for diseases caused by dysfunction of the RANK/RANKL signaling pathway, in which the protein product of MAFB functions.

Radiocarpal Osteochondral Allografts for Wrist Pain Postproximal Row Carpectomy

Abstract Background Surgical options for patients with recurrent wrist pain after salvage procedures, such as proximal row carpectomy (PRC), are limited and primarily result in total wrist arthrodesis (TWA). Osteochondral allografting (OCA) offers an additional option to address refractory wrist pain due to arthritis while preserving some range of motion. Case Description A 65-year-old, right hand dominant male developed chronic wrist pain, secondary to untreated scapholunate and triangular fibrocartilage complex ligament tears. The patient underwent a PRC, radial styloidectomy, and partial wrist denervation with good initial pain relief. Two years later, symptoms returned with radiographs demonstrating capitate sclerosis. A salvage arthroplasty with OCA produced relief of symptoms. Literature Review Refractory wrist pain after salvage procedures have traditionally been managed with TWA or less commonly, wrist arthroplasty. Capitate resurfacing and interposition have expanded indications for PRC. OCA is a chondral replacement procedure that utilizes cadaveric cartilage allograft plugs to replace damaged cartilage in various articular joint surfaces. Although OCA used in the lower extremity and shoulder has demonstrated improved pain relief and return of function, it has not been reported in the wrist. Clinical Relevance There are limited options for refractory wrist pain after salvage procedures. We present an additional alternative to TWA, by resurfacing the radiocarpal joint affected by chondromalacia after a PRC. This option offers another treatment modality for recurrent wrist pain while still preserving some element of range of motion.

Effectiveness of manual therapy to the Cervical Spine on clinical outcomes and electrodiagnostic tests in people with carpal tunnel syndrome: A randomized controlled trial

ObjectiveTo determine if cervical spine manual therapy (CMT) plus conventional physical therapy (PT) optimizes clinical objective and self-reported outcomes, compared to PT alone, in people with carpal tunnel syndrome (CTS). MethodForty-eight patients with the diagnosis of CTS were randomly divided into conventional PT (control group) and conventional PT plus cervical spine manual therapy (intervention group). All patients received 10 sessions of supervised conventional physical therapy (wrist splint, electrotherapy and wrist joint mobilization). Patients in the cervical spine manual therapy group also had manual therapies techniques given to their neck. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were assessed at three points: baseline, post-intervention, and six months later. ResultsThe cervical spine manual therapy group showed significantly greater improvement in VAS, DASH score, mMDL, and mSNCV in post-intervention and follow-up compared to the conventional group. There was no significant difference in two subscales of BCTQ at post-intervention for two groups, whereas these two subscales showed a significant difference in favor of the cervical manual therapy group at follow-up. ConclusionThe analysis of results showed that conventional CMT combined with PT could be more effective in improving the clinical outcomes and electrodiagnostic findings of patients with CTS compared to conventional PT only in the long term. Therefore, it can be suggested as a proper therapeutic method in CTS.

Concomitant injuries of the wrist, distal ulna and distal radioulnar joint in distal radius fractures : Primary operative cotreatment vs. healing with no additional treatment

Distal radius fractures are the most common fractures in adults and account for one quarter of all fractures, with increasing incidence. The number of patients and the requirement of an exact treatment are high. Continuous developments in diagnostic and operative possibilities enable in many cases a high-quality treatment with good clinical outcome; however, radius fractures rarely occur alone but in combination with additional fractures or ligamentous injuries. The frequency and extent of these injuries are not linked to the complexity of the primary injury. The aim is to recognize and correctly diagnose potential concomitant injuries. Many injuries do not need immediate treatment but heal without additional treatment after the radius has been treated. It is important to recognize those injuries which can cause severe complications if untreated; however, exactly this is often difficult. In many cases there is still no consensus if and how concomitant injuries should be treated. This article highlights the most frequent concomitant injuries in distal radius fractures with the possible advantages and disadvantages of cotreatment in order to facilitate decision making.

Quantitative analysis of the morphing wing mechanism of raptors: Bionic design of Falco Peregrinus wing skeleton.

The wing is one of the most important parts of a bird's locomotor system and is the inspiration origination for bionic wing design. During wing motions, the wing shape is closely related to the rotation angles of wing bones. Therefore, the research on the law of bone movement in the process of wing movement can be good guidance for the design of the bionic morphing wing. In this paper, the skeletal posture of the peregrine falcon wing during the extension/flexion is studied to obtain critical data on skeletal posture. Since an elbow joint and a wrist joint rotate correlatively to drive a wing to flex/extend, the wing skeleton is simplified as a four-bar mechanism in this paper. The degree of reproduction of wing skeleton postures was quantitatively analyzed using the four-bar mechanism model, and the bionic wing skeleton was designed. It is found that the wing motions have been reproduced with high precision.

Anatomical and topographic substantiation of biopsy of intraarticular structures in infectious polyarthritis of cats

Currently, infectious polyarthritis in cats is a very urgent problem in veterinary medicine. Worldwide, one of the most common causes of cat euthanasia is polyarthritis of unexplained etiology, which is not amenable to empirical and symptomatic treatment. The difficulty in diagnosing polyarthritis in cats lies in the large number of infectious agents that can penetrate into joint tissues with blood and lymph flow, while not all regions of the world have a full-fledged diagnosis of these diseases. The second reason complicating the diagnosis of polyarthritis in cats is the absence of infectious agents in the synovial fluid during its examination by various methods such as PCR, bacteriological culture, and ELISA diagnostics. The aim of the study was to consider an open method of biopsy of intraarticular structures in cats with infectious polyarthritis and to identify the safest places of material selection for patients with anatomical and topographic justification. The study was conducted in the Network of veterinary centers "Kotonai" and at the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine. The object of the study was cats in the number of six individuals. The average age of the patients ranged from 3 months to 9 years. There were no severe postoperative complications requiring repeated treatment in the studied patients. The clinical result in these cases can be called positive, despite the presence of minor complications in the early postoperative period. The diagnosis in most patients was established on the basis of examination of biopsies of the articular capsule and articular cartilage. For the collection of material in cats with polyarthritis and altered anatomy in the joint area, the safest localization is craniolateral access to the wrist joint, caudolateral access to the hock joint and cranial access to the hock joint.

Monogenic Autoinflammatory Disease Due to Blau Syndrome with Nucleotide Oligomerization Domain 2 Gene Mutation in an Indian Family

Background: Blau syndrome is a monogenic disease resulting from mutations in nucleotide oligomerization domain 2 (NOD2) and is phenotypically characterized by a triad of dermatitis, arthritis, and uveitis. We report Blau syndrome in a child who had been symptomatic for years, without the typical clinical triad. Clinical Description: A 7-year-old girl child presented with bilateral knee, wrist, and ankle joint swelling since the age of 2 years. She had recently developed a rash on the body. Her mother, mother’s identical twin sister, and the latter’s 5-year-old daughter had similar joint pain and swellings since childhood. In view of the strong positive family history of polyarthritis, monogenic cause of arthritis was suspected. Management and Outcome: Complete blood count was unremarkable. Erythrocyte sedimentation rate was 20 mm at C-reactive protein was 36 mg/L, antinuclear antibody and rheumatoid arthritis factor were negative. X-ray of the knee joints and wrist joints showed soft-tissue swellings around the knee and lumbar scoliosis. A heterozygous pathogenic variant in NOD2 gene confirmed the diagnosis of Blau syndrome. After receiving the genetic report, the girl was started on prednisolone and weekly methotrexate. Conclusion: Early-onset arthritis, with recurrent episodes of fever, is not to be ignored if autoimmune markers are negative. Knowledge about the clinical features of autoinflammatory diseases and the spectrum of NOD2 variants will enable physicians to carry out specific investigations, especially genetic analysis for confirmation of the diagnosis and hence administer the right treatment.

The Miocene primate Pliobates is a pliopithecoid

The systematic status of the small-bodied catarrhine primate Pliobates cataloniae, from the Miocene (11.6 Ma) of Spain, is controversial because it displays a mosaic of primitive and derived features compared with extant hominoids (apes and humans). Cladistic analyses have recovered Pliobates as either a stem hominoid or as a pliopithecoid stem catarrhine (i.e., preceding the cercopithecoid–hominoid divergence). Here, we describe additional dental remains of P. cataloniae from another locality that display unambiguous synapomorphies of crouzeliid pliopithecoids. Our cladistic analyses support a close phylogenetic link with poorly-known small crouzeliids from Europe based on (cranio)dental characters but recover pliopithecoids as stem hominoids when postcranial characters are included. We conclude that Pliobates is a derived stem catarrhine that shows postcranial convergences with modern apes in the elbow and wrist joints—thus clarifying pliopithecoid evolution and illustrating the plausibility of independent acquisition of postcranial similarities between hylobatids and hominids.

3D MRI of the Wrist: Anatomy and Clinical Applications With Comparison to 2D MRI

The wrist joint has complex anatomy and is commonly involved in traumatic injuries. Magnetic resonance imaging (MRI) is routinely used to evaluate various wrist structures including the ligaments, triangular fibrocartilage complex (TFCC), tendons, and articular cartilage. While the 2D (2-dimensional) MR imaging offers high spatial resolution, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), it has some limitations due to relatively thick slices, limited fluid contrast, and the need for image acquisition in multiple planes. Isotropic 3D MR imaging can overcome these limitations by acquiring a volumetric dataset with thin contiguous slices enabling multiplanar reconstructions in arbitrary, though structure-specific planes. Recent advances have reduced the acquisition duration of 3D imaging datasets making them more time efficient than 2D MRI thus enabling clinical implementation. In this article, we will review the main concepts on wrist anatomy and imaging, present illustrative cases using recent technical advances of 3D MRI and compare 2D vs. 3D benefits for various wrist structures and their pathologies.

High prevalence of radiographic erosions in early, untreated PsA: results from the SpARRO cohort

AimsTo investigate the prevalence and distribution of bone erosions in an early psoriatic arthritis (PsA) population using conventional radiography (CR) and to explore the agreement between CR and ultrasound (US)...

Perilunate Dislocations: Cadaveric Model K-Wire Versus Compression Staple Fixation

Repair of perilunate dislocations requires stabilization of the carpal bones, although there is limited research on the preferred method(s) of stabilization. We compared the biomechanical characteristics of K-wire versus staple fixation of scapholunate (SL) and lunotriquetral (LT) intervals in the wrist. After creating a grade IV instability model, 20 cadaver wrists were randomized into 2 stabilization model groups using K-wires or surgical staples across the SL and LT intervals. For each ligament, two K-wires or one surgical staple was used to stabilize the proximal carpal row. Each wrist was loaded with 15 N of force and cycled 5,000 times at an angular velocity of 10 rpm. Displacement between bones was measured at different cycles (10, 100, 500, 1,000, 2,000, 3,000, 4,000, and 5,000). A t test was used for comparisons. For the LT K-wire group, the average displacement at 10 cycles was 0.08 mm, and at 5,000 cycles, 0.163 mm. For the SL K-wire group, the average displacement at 10 cycles was 0.025 mm, and at 5,000 cycles, 0.129 mm. For the LT and SL staple fixation models, the average shifts at 10 cycles were 0.029 and 0.063 mm, and at 5,000 cycles, 0.098 and 0.176 mm, respectively. No significant difference between the fixation models was found at any interval. Notably, in each group, a similar number of small outliers with higher amounts of displacement was observed. Either K-wire or surgical staple stabilization is suitable for perilunate dislocations. The surgical method should be selected based on patient-specific circumstances and the provider's judgment. Therapeutic III.

Thirty-Three-Year Follow-up Following Silicone Scaphoid Arthroplasty: A Case Report.

A 64-year-old man presented with a 3-year history of right wrist pain and swelling 33 years after a silicone scaphoid arthroplasty for chronic scaphoid nonunion. Radiographs demonstrated a deformed scaphoid implant, carpal and distal radius cysts, and mild carpal collapse. He elected to undergo a wrist arthrodesis with a dorsal fusion plate after failing conservative management. Although carpal bone silicone implant arthroplasties of the wrist have long been abandoned, our patient was pain free and fully functional for 3 decades. He was pleased to undergo serial examinations with radiographs for 30 years without any therapeutic intervention.

Combined Effect of Shock Wave to Conventional Physical Therapy Program on Wrist Joint Pain Intensity in Treatment of Triangular Fibrocartilage Complex

Combined Effect of Shock Wave to Conventional Physical Therapy Program on Wrist Joint Pain Intensity in Treatment of Triangular Fibrocartilage Complex

СПОСОБ ЛЕЧЕНИЯ ЛОЖНЫХ СУСТАВОВ ЛАДЬЕВИДНОЙ КОСТИ ПУТЕМ ПРИМЕНЕНИЯ НАДКОСТНИЧНЫХ ЛОСКУТОВ НА МЕТАКАРПАЛЬНЫХ АРТЕРИЯХ

The purpose of the study: to improve the method of surgical treatment of patients with scaphoid nonunion. Material and methods: the results of treatment of 30 patients operated on for scaphoid nonunion of the hand, which arose after conservative treatment (not treatment) of fractures, surgical treatment for 2018-2021 were analyzed. The patients were divided into two groups: 15 patients with scaphoid nonunion who underwent free bone autoplasty as a surgical aid, fixation of bone fragments with a headless screw – a control group; 15 patients with fscaphoid nonunion, who underwent free bone autoplasty as surgical treatment, supplemented with non-free plastic surgery with a periosteal flap on the metacarpal artery – the main (experimental) group of patients. The possibility of using periosteal flaps isolated from the first and second metacarpal bones was evaluated. To assess the results of treatment, X-ray monitoring of scaphoid nonunion consolidation was used at 8, 12 weeks and 6 months after surgery; computed tomography of wrist joints was performed at 4 months after surgery in order to assess the degree of bone graft reconstruction. Hand function was assessed before and after surgery using the DASH Upper Limb Disability Questionnaire and the Visual Analog Pain Scale (VAS). Results of the study: in the experimental group, scaphoid nonunion consolidation was achieved in 13 out of 15 patients (86.6%) compared with the control group (10 out of 15 patients – 66.7%). According to the severity of the pain syndrome and the final functional result, comparable indicators were obtained in both groups. Discussion: given the small sample of patients who participated in the work, the study has moderate reliability. However, the data obtained allow us to hope for the effectiveness of the proposed method of surgical treatment used in patients of the main study group.

A CASE REPORT ON JUVENILE XANTHOGRANULOMA

Introduction: Juvenile Xanthogranuloma is a rare, benign, asymptomatic and commonly self-healing histiocytic disorder. It is a type of Non-Langerhans cell histiocytosis affecting primarily first two decades of life as a solitary cutaneous lesion occurring most frequently on trunk and upper extremities. There can also be involved internal organs such as lungs, kidney, gastrointestinal tract etc. Most common extracutaneous location is eye. Case presentation: Here presenting case of 5 month old male child with complain of firm, mobile, non-tender swelling just proximal to the left wrist joint since 4 months. Conclusion: Cytomorphological diagnosis of benign fibrohistiocytic lesion with possibility of Juvenile Xanthogranuloma was made &amp; later confirmed by histological examination.