Wrist Flexion Test Research Articles

Reinnervation of spinal cord anterior horn cells after median nerve repair using transposition with other nerves.

Our previous studies have confirmed that during nerve transposition repair to injured peripheral nerves, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively repair distal nerve and target muscle tissue and restore muscle motor function. To observe the effect of nerve regeneration and motor function recovery after several types of nerve transposition for median nerve defect (2 mm), 30 Sprague-Dawley rats were randomly divided into sham operation group, epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group. Three months after nerve repair, the wrist flexion test was used to evaluate the recovery of wrist flexion after regeneration of median nerve in the affected limbs of rats. The number of myelinated nerve fibers, the thickness of myelin sheath, the diameter of axons and the cross-sectional area of axons in the proximal and distal segments of the repaired nerves were measured by osmic acid staining. The ratio of newly produced distal myelinated nerve fibers to the number of proximal myelinated nerve fibers was calculated. Wet weights of the flexor digitorum superficialis muscles were measured. Muscle fiber morphology was detected using hematoxylin-eosin staining. The cross-sectional area of muscle fibers was calculated to assess the recovery of muscles. Results showed that wrist flexion function was restored, and the nerve grew into the distal effector in all three nerve transposition groups and the epineurial neurorrhaphy group. There were differences in the number of myelinated nerve fibers in each group. The magnification of proximal to distal nerves was 1.80, 3.00, 2.50, and 3.12 in epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group, respectively. Nevertheless, axon diameters of new nerve fibers, cross-sectional areas of axons, thicknesses of myelin sheath, wet weights of flexor digitorum superficialis muscle and cross-sectional areas of muscle fibers of all three groups of donor nerves from different anterior horn motor neurons after nerve transposition were similar to those in the epineurial neurorrhaphy group. Our findings indicate that donor nerve translocation from different anterior horn motor neurons can effectively repair the target organs innervated by the median nerve. The corresponding spinal anterior horn motor neurons obtain functional reinnervation and achieve some degree of motor function in the affected limbs.

A comparison of wrist isokinetic muscle strength in wheelchair table tennis and wheelchair basketball players

Aim:The aim of this study was to compare isokinetic muscle strength of wrist flexor and extensor muscles in paralympic athletes.Methods:This study was carried out with the participation of 9 (4 females and 5 males) wheelchair (WC) table tennis players aged 24+3 and 8 male WC basketball players aged 26+3, met the criteria and voluntarly participate in the study. Body weight, height, body mass index and dominant extremity of the study subjects were recorded. İsokinetic measurement were performed with Isomed 2000® device. İsokinetic testing protocol; before the test all players performed the wrist flexion and extension isokinetic test with the 5 repeating at 90º/sec as a warm-up and comprehending the test. Then, wrist flexion and extension concentric-concentric strength measurements were performed with the 5 repeating at 60º/sec and with the 15 repeating at 240º/sec with the angle between 50 degrees of wrist flexion and 60 degrees of wrist extension and peak torque, peak torque/kg values and flexion/extension ratios were recorded. Mann-Whitney U test was used to compare isokinetic muscle strength quantitative variables in athletes.Findings:Isokinetic muscle strength of wrist flexors and extensors was higher in both sides in WC table tennis players with 60º/sec speed (p<0,05). İsokinetic muscle strength of wrist flexors and extensors was higher in both sides in WC basketball players with 240º/sec speed (p<0,05). There was no significant difference statistically between the groups in isokinetic wrist flexion and extansion peak torque/kg ratio in all speeds (p>0,05). Wrist flexion/extension peak torque ratios were similar in both groups. When examining the athletes flexion/extension ratios, wrist extensor muscles were weaker than flexor muscles and flexor muscles were average twice stronger than extensor muscles in both sports (Table1).Table 1.Comparison of wrist flexion and extension isokinetic muscle strength, peak torque/kg and agonist/antagonist ratio of wc basketball and wc table tennis playersWheelchair table tennis(N=9)X±SDWheelchair basketball(N=9)X±SD p* Flexion 60°/sec Dominant sidePT(Nm)23.41±11.138.87±1.650.001PT/Kg (Nm/Kg)0.39±0.130.42±0.100.499Non-dominant sidePT(Nm)20.26±9.268.26±3.110.001PT/Kg (Nm/Kg)0.34±0.120.46±0.110.048 Flexion 240°/sec Dominant sidePT(Nm)18.36±8.5123.87±3.670.034PT/Kg (Nm/Kg)0.31±0.100.33±0.030.772Non-dominant sidePT(Nm)16.20±6.9025.45±8.160.021PT/Kg (Nm/Kg)0.27±0.080.35±0.100.162 Extension 60°/sec Dominant sidePT(Nm)10,463.8612.03±3.420.289PT/Kg (Nm/Kg)0.18±0.050.16±0.040.440Non-dominant sidePT(Nm)8.11±3.2413.47±3.460.007PT/Kg (Nm/Kg)0.14±0.040.18±0.040.091 Extension 240°/sec Dominant sidePT(Nm)7.11±2.5630.78±8.890.001PT/Kg (Nm/Kg)0.12±0.040.12±0.020.961Non-dominant sidePT(Nm)6.06±2.7832.82±9.080.001Pt/Kg (Nm/Kg)0.10±0.030.11±0.030.560 Flexion/extension 60°/sec Dominant sideRatio52.16±15.6660.10±8.710.386Non-dominant sideRatio58.06±9.4158.10±6.860.923 Flexion/extension 240°/sec Dominant sideRatio58.43±14.4462.38±6.490.773Non-dominant sideRatio61.45±8.3267.42±5.990.083* Mann-Whitney U TestiResults:We thought that imbalance of muscle strength in the wrist may have occurred because of the use of a WC and requiring the intensive wrist flexors in playing sports. In both groups wrist ekstansor muscles were found to be weaker than wrist flexors and flexor/extensor ratio was found to be imbalance. We believe that all athletes using WC such as WC table tennis and WC basketball players have a strenght imbalance in the muscle of the wrist and as a result, this situation will increase the possibility of injury. Therefore, our study showed that weakness of wrist extensors and imbalance of muscle stenght should be taken into account in WC athletes in athletic training and exercise programs.

Determination of the relationship between the wrist isokinetic muscle strenght and the grip strength in tennis players aged between 12-14

Aim:The purpose of this study is to determine the relationship between isokinetic wrist muscle strenght and grip strength in tennis players aged between 12-14.Methods:This study was carried out with the participation of 9 (3 female and 6 male) tennis players aged between 12-14 (means 13,22±0,83). Weight, height, body mass index and dominant extremity of the players were recorded. İsokinetic measurement was performed with Isomed 2000® device. İsokinetic testing protocol; before the test all players performed the wrist flexion and extension isokinetic test with the 5 repeating at 90 º/sec as a warm-up and for comprehenting the test. Then, wrist flexion and extension concentric-concentric strength measurements were performed with the 5 repeating at 60 º/sec and with the 15 repeating at 240 º/sec with the angle between 50 degrees of wrist flexion and 60 degrees of wrist extension and peak torque values were recorded. Standard Jamar® Dynamometer was used for grip strength measurements. Grip strenght was performed firstly in sitting position, which is the position of standard measurement. Secondly, in standing position, the elbow was in full ekstansion and the forearm was in neutral position. Thirdly, in standing position the wrist was positioned approximately 30° extension and 10° ulnar deviation. This test was repeated 3 times in all test position and the mean of three scores were recorded. Firstly, the dominant hand, then the non-dominant hand was evoluated. They were allowed to rest for 30 seconds between each grip measurement. Correlation between peak tork of isokinetic muscle strenght and grip strength was done having been used Spearman correlation test.Findings:It was determined that there was a significant positive relation between wrist flexion-extension isokinetic muscle strength and grip strenght in tennis players aged between 12-14. Clinically, grip strength measured in the standard sitting position was found more as compared to the other positions but these values were not statistically significant (p>0,05). Accordingly, grip strength measured in the standard sitting position correlated with much more of the parameters which we evaluated for isokinetic muscle strength comparing to grip strenght measured in the other two positions (p<0,05).Results:It was concluded that isokinetic muscle strength of wrist can be affected by grip strength, therefore measurement needs to be done in the sitting position which maximum grip strength may reveal.The relation of isokinetic muscle strength and grip strength in tennis playersStanding positionAnatomical positionSitting position(Dominant side)(N)(Non-dominant side)(N)(Dominant side)(N)(Non-dominant side)(N)(Dominant side)(N)(Non-dominant side)(N) r p r p r p r p r p r p Dominant wrist flexion 60°/sec (Nm)0.4440.2320.3780.3160.4020.2840.1920.6200.3040.4270.5230.148Non-dominant wrist flexion 60°/sec (Nm)0.727 0.027* 0.6480.0590.795 0.010* 0.3550.3490.793 0.011* 0.5350.138Dominant wrist extension 60°/sec (Nm)0.8280.006**0.4960.175 0.837** 0.0050.2090.5890.802 0.009** 0.4220.258Non-dominant wrist extension 60°/sec (Nm)0.6030.0850.5040.1660.5570.1190.2660.4890.2940.4430.672 0.047* Dominant wrist flexion 240°/sec (Nm)0.2260.5590.2520.5130.1510.6990.1090.7810.1180.7620.2870.454Non-dominant wrist flexion 240°/sec (Nm)0.2180.5720.1940.6170.1090.7800.0630.8720.1690.6630.2330.546Dominant wrist extension 240°/sec (Nm)0.753 0.019* 0.6300.069 0.854** 0.0030.3180.4040.7430.022*0.5490.126Non-dominant wrist extension 240°/sec (Nm)0.4220.2580.712 0.031* 0.6160.0770.5700.1090.3190.4030.877 0.002** *p<0.05; **p<0.001; p= significant level; r= Spearman coefficient value

Modification of Phalen's wrist-flexion test

Phalen's test, with more than 100° of elbow flexion, is not always comfortable for patients with elbow pathology. Therefore, we suggest a modification of the test with the patient having both arms resting on a pillow or arm-holders in a relaxed position, the hands floating at the end, and the examiner passively flexing (or reversed: extending) the hands up to 90°.

A systematic review of the clinical diagnostic tests for carpal tunnel syndrome.

The purpose of this report was to critically review studies of the clinical diagnostic tests for carpal tunnel syndrome. The reports were located through Medline, Current Contents, related readings, and the reference lists of the articles. They all explored the use of clinical diagnostic tests for carpal tunnel syndrome compared with the results of NCS. Criteria for systematically reviewing the studies were developed, tested for reliability, and applied to the studies. Many studies did not have sufficient detail to allow repetition of the protocol by other researchers. The sensitivities and specificities reported for each can be compared with the quality criteria ratings they each received. The literature supports the use of the wrist flexion and carpal compression test and suggests that 2-point discrimination has low sensitivity for diagnosing carpal tunnel syndrome. Many reports do not include methodology, which makes the results difficult to reproduce and to apply to other populations. (J Hand Surg 2000; 25A:120-127.

A new provocative test for carpal tunnel syndrome

To establish the value of median nerve compression with wrist flexion as a provocative test for carpal tunnel syndrome (CTS), we performed a prospective study of 64 patients (95 hands) with CTS confirmed by electrodiagnostic studies and 50 normal subjects (96 hands). We recorded results for the common provocative tests (Tinel’s percussion test, Phalen’s wrist flexion test and the carpal compression test) and the new test which combines wrist flexion with median nerve compression. Using a receiver operator characteristic curve (ROC) technique, we found that the optimal cut-off time for the wrist-flexion and median-nerve compression test was 20 s, giving a sensitivity of 82% and a specificity of 99%. These results were significantly better than for Phalen’s wrist flexion test (61% and 83%, respectively) and for the sensitivity of Tinel’s test (74%). The positive predictive values of the wrist flexion and median-nerve compression test, which is more important clinically, were 99%, 95% and 81% at population prevalences of 50%, 20% and 5%, respectively. These were significantly better than those of the three other provocative tests at each prevalence. Electrodiagnostic studies have significant false-positive and false-negative rates in CTS, and therefore provocative tests remain important in its diagnosis. We have shown that wrist flexion combined with the median-nerve compression test at 20 s, is significantly better than the other methods, and may thus be clinically useful.

A new provocative test for carpal tunnel syndrome. Assessment of wrist flexion and nerve compression.

To establish the value of median nerve compression with wrist flexion as a provocative test for carpal tunnel syndrome (CTS), we performed a prospective study of 64 patients (95 hands) with CTS confirmed by electrodiagnostic studies and 50 normal subjects (96 hands). We recorded results for the common provocative tests (Tinel's percussion test, Phalen's wrist flexion test and the carpal compression test) and the new test which combines wrist flexion with median nerve compression. Using a receiver operator characteristic curve (ROC) technique, we found that the optimal cut-off time for the wrist-flexion and median-nerve compression test was 20 s, giving a sensitivity of 82% and a specificity of 99%. These results were significantly better than for Phalen's wrist flexion test (61% and 83%, respectively) and for the sensitivity of Tinel's test (74%). The positive predictive values of the wrist flexion and median-nerve compression test, which is more important clinically, were 99%, 95% and 81% at population prevalences of 50%, 20% and 5%, respectively. These were significantly better than those of the three other provocative tests at each prevalence. Electrodiagnostic studies have significant false-positive and false-negative rates in CTS, and therefore provocative tests remain important in its diagnosis. We have shown that wrist flexion combined with the median-nerve compression test at 20 s, is significantly better than the other methods, and may thus be clinically useful.

Value of the carpal compression test in the diagnosis of carpal tunnel syndrome

In order to determine the efficacy of the carpal compression test (CCT) in the diagnosis of the carpal tunnel syndrome (CTS), we conducted a prospective study on 200 consecutive hands diagnosed as having CTS. A control group of 100 healthy volunteers with no symptoms of CTS were also assessed. The results of the CCT in the patients and controls were compared with those obtained with Phalen's and Tinel's tests. CCT achieved a sensitivity of 87%, and a specificity of 95%. It is a simple, fast and very reliable provocative test, and should be routinely used in the diagnosis of CTS. This test is also an appropriate manoeuvre in wrists with limited range of motion or pain that cannot be assessed with Phalen's wrist flexion test.

Inter-rater agreement and accuracy of clinical tests used in diagnosis of Carpal Tunnel Syndrome

A sample of 42 subjects (84 hands) with complaints of pain, numbness and/or tingling were used to study the inter-rater agreement and accuracy of seven clinical tests which can be used to assist in the diagnosis of carpal tunnel syndrome (CTS). A 'gold standard diagnosis', defined as a clinical diagnosis of CTS rendered by one of two hand surgeons and supported by electrodiagnostic evidence of CTS, was used to classify the 84 hands as to the presence of CTS. Two therapists were blinded to patient history, electrophysiology, diagnosis and all evaluations performed by the other therapist, until clinical testing was completed. Tests performed included: wrist flexion, wrist extension, Tinel's, tethered median nerve (TMN), pinch, vibration and Semmes-Weinstein monofilament (SWMF) tests. Substantial inter-rater agreement was observed between the two therapists for five of the clinical tests (k > 0.71) with SWMF and TMN having lower agreement. The most accurate test was Phalen's wrist flexion test. Good accuracy was demonstrated by pinch and vibration tests. Tinel's test was characterized by lower sensitivity, but false positives were rare. Wrist extension and TMN tests had poor sensitivity. SWMF testing was very sensitive, but a high number of false positives occurred when 'normal' was classified as 2.83. Reliability and accuracy of these tests supports their use as components of a clinical diagnosis of CTS.

Metabolic Adaptations to Endurance Training in Older Individuals

The purpose of this study was to describe the effects of moderate intensity exercise training on the muscle energy utilization, blood flow, and exercise performance of four sedentary older individuals (58 +/- 4 yrs). Subjects trained the dominant forearm each day for 12 weeks. The nondominant arm was not trained and served as a within-subject control. 31P nuclear magnetic resonance spectroscopy (31P NMRS) was used to identify the power output in watts (W) at the onset, or threshold, of intracellular acidosis (IT) in the exercising muscle during progressive exercise tests to fatigue. After 6 weeks of training, power output at the IT increased by 14% (p < 0.05) in the dominant arm; however, an additional 6 weeks of the same exercise program failed to produce a further increase in IT power. IT power of the nondominant forearm was not changed. In the dominant forearm, endurance time for a submaximal wrist flexion test was increased 34% and 58% at 6 and 12 weeks, respectively. Maximal voluntary strength was not affected by training, nor was resting or exercising blood flow. The training program delayed the onset of intracellular acidosis during progressive exercise and increased the capacity for submaximal work. These effects did not appear to depend on an increase in muscle blood flow.

Recurrent carpal tunnel syndrome: Clinical testing indicating incomplete section of the flexor retinaculum

Based on five observations of recurrent carpal tunnel syndrome, a distally incomplete section of the flexor retinaculum can be identified on clinical grounds: the wrist flexion test becomes negative and the tourniquet test still remains positive.

MEDIAN NERVE COMPRESSION AT THE WRIST

Median nerve decompression at the wrist is one of the most common operative procedures performed by hand surgeons, yet studies report surgical failure rates of 7% to 20%. Symptoms must be coordinated with diagnostic studies. Initial paresthesias should be documented with delayed sensory conduction time. Threshold tests of sensibility, such as the Semmes-Weinstein monofilaments, are more consistent and reliable tests of decreased sensibility than innervation density tests, such as the Weber two-point discrimination test. Thenar atrophy should be documented with electromyographic studies. The median nerve should be evaluated from the fingertips to the cervical spine. Basic laboratory studies should test for collagen disease, thyroid or renal disorders, and diabetes mellitus. Appropriate roentgenograms must be obtained. Patients with normal laboratory and diagnostic studies should be offered nonoperative treatment. Factors that are important in predicting the patient's response to nonoperative treatment include: age over 50 years, constant paresthesias, intermittent paresthesias of more than 10 months duration, stenosing flexor tenosynovitis, and a wrist flexion test (Phalen) that is positive in less than 30 seconds. Fewer than 10% of patients with three or more of these factors present have been cured by nonoperative management. Surgical decompression of the carpal tunnel is done with tourniquet control and optical magnification. A longitudinal "zig-zag" incision is preferred that extends along the thenar crease, then proceeds ulnarly to reach the distal palmar crease at a point in line with the long axis of the ring finger, and then proceeds radially to the tendon of the palmaris longus. After release of the transverse carpal ligament, the motor branch should be explored and decompressed.(ABSTRACT TRUNCATED AT 250 WORDS)

A new diagnostic test for carpal tunnel syndrome.

A new test, called the carpal compression test, consists of application of direct pressure on the carpal tunnel and the underlying median nerve. The results of the Tinel percussion test, the Phalen wrist-flexion test, and the new test were evaluated in thirty-one patients (forty-six hands) in whom the presence of carpal tunnel syndrome had been proved electrodiagnostically, as well as in a control group of fifty subjects. For the diagnosis of carpal tunnel syndrome, the carpal compression test was found to be more sensitive and specific than the Tinel and Phalen tests.

Study on the changes of nerve conduction with wrist fixation in carpal tunnel syndrome

The author studied 20 healthy adults (20 hands) as a control and 30 patients (40 hands) with carpal tunnel syndrome to evaluate the clinical usefulness of measuring nerve conduction velocity after wrist fiexion in diagnosis of carpal tunnel syndrome. The median nerve conduction velocity over wrist to finger segment was measured before and after wrist flexion for 1, 2 and 5 minutes, using belly-tendon method for motor nerve distal latency(MNDL) and antidromic method for sensory nerve conduction velocity(SNCV). The results were as follows : 1. In control froup, MNDL increased in 1 hand and SNCV decreased in 2 hands after wrist flexion. In patient group, MNDL increased in 2 hands and SNCV decreased in 3 hands after wrist flexion. 2. In both control and patient group, there were no significant changes in mean values of SNCV and MNDL between before and after wrist flexion. 3. Phalen's wrist flexion test was positive in 5 percent of control and 60 percent of patient group. 4. Tinel's sign was present in 10 percent of control and 33 percent of patient group.

Carpal Tunnel Syndrome

A diagnostic test combining the sensitivity of the Semmes-Weinstein monofilament measurement and the specificity of the wrist flexion provocational test has been evaluated in a group of 21 patients (33 hands) with electrodiagnostically verified carpal tunnel syndrome and 30 asymptomatic hands (controls). Semmes-Weinstein monofilament testing consisted of several sensory threshold measurements obtained by the application of force-calibrated Semmes-Weinstein monofilaments to each digit in the hand with the wrist in neutral position. The quantitative provocational diagnostic test employed Semmes-Weinstein measurements obtained with the wrist both in the neutral and flexed positions. The sensitivity (82%) and specificity (86%) of the combined test were calculated. It was more sensitive and specific than the wrist flexion test alone and more specific than the Semmes-Weinstein sensibility test. The combined test is recommended as the most accurate and sensitive quantitative clinical test for median nerve compression evaluated by the authors to date.

Phalen's test in the diagnosis of carpal tunnel syndrome

The wrist flexion test of Phalen has been studied in 127 patients with carpal tunnel syndrome and 20 control subjects, all of whom also had nerve conduction studies. There was a statistically significant relationship between the severity of electrical changes and the probability of a positive Phalen's test. However 34% of patients had a negative test and 20% of control subjects a a positive one.

Phalen's test in the diagnosis of carpal tunnel syndrome.

The wrist flexion test of Phalen has been studied in 127 patients with carpal tunnel syndrome and 20 control subjects, all of whom also had nerve conduction studies. There was a statistically significant relationship between the severity of electrical changes and the probability of a positive Phalen's test. However 34% of patients had a negative test and 20% of control subjects a positive one.

Carpal tunnel syndrome. An evaluation of the provocative diagnostic tests.

In order to evaluate the usefulness of provocative tests (wrist-flexion test, nerve-percussion test, and tourniquet test) in the diagnosis of carpal tunnel syndrome, the results of provocative testing were evaluated in a group of patients (sixty-seven hands) with electrodiagnostically proved carpal-tunnel syndrome and in a group of fifty control subjects. The sensitivity and specificity of each test were calculated. The wrist-flexion test was found to be the most sensitive while the nerve-percussion test, although least sensitive, was most specific. The tourniquet test was quite insensitive and not very specific, and should not be used as a routine screening test in the diagnosis of carpal tunnel syndrome.

Sensibility testing in patients with carpal tunnel syndrome.

We evaluated the sensibility of the hand preoperatively and at intervals postoperatively in twenty-three hands of twenty patients with idiopathic carpal-tunnel syndrome who underwent carpal tunnel release. Tests of sensibility included the threshold tests (vibrometry, 256-cycles-per-second vibration, and Semmes-Weinstein monofilaments) and one innervation-density test (two-point discrimination). In addition the wrist-flexion test, nerve-percussion test, and tourniquet test were performed preoperatively. Only five of the twenty-three hands had abnormal two-point discrimination and each of these also had markedly abnormal threshold-test values. Nineteen of twenty-three hands preoperatively had decreased sensibility detected by both Semmes-Weinstein monofilament testing and vibrometry. Six weeks after carpal tunnel release, all of the hands demonstrated improvement on threshold testing, and 65 per cent had normal values.

Slowed nerve conduction with wrist flexion in carpal tunnel syndrome.

Phalen's wrist flexion test may reproduce the sensory symptoms of carpal tunnel syndrome (CTS). We have used this test in conjunction with motor and sensory latency studies in 20 patients with symptomatic CTS in one or both hands. The test caused an increase in the motor or sensory latency in half the patients. In 2 patients the latencies were abnormal only after wrist flexion. The test may thus be useful in diagnosis of borderline cases.