Wrist In Patients Research Articles

ТREATMENT STRATEGY OF FLEXION CONTRACTURE OF THE WRIST JOINT IN CHILDREN WITH CEREBRAL PALSY

Objectives. The objective of study was to assess the effectiveness of transplantation of m. flexor carpi ulnaris tendon on the place of m. extensor carpi radialis brevis / longus (Green operation) to eliminate the deficit of active wrist joint extension in children with cerebral palsy. Materials and methods. The present study is based on a survey of children with cerebral palsy with affected upper limb. The main criterion for selection of patients was the presence of active extension deficit in the wrist joint, both isolated and in combination with other contractures of the upper limb joints. Total 22 patients with spastic forms of cerebral palsy were examined. Results and conclusions. Green operation is a good method of surgical treatment of active extension deficit in the wrist joint in patients with cerebral palsy. In the presence of moderately severe contractures in the wrist joint, serial casting can eliminate them completely. Presence of a fixed pronation contracture of the forearm is a factor that reduces the effectiveness of FCU transplantation. Pronation contracture should be corrected before or during Green surgery. FCU transplantation is effective for children of any age, but its effectiveness is reduced from 12 years old.

Analytical model for real time, noninvasive estimation of blood glucose level.

The paper presents an analytical model to estimate blood glucose level from measurements made non-invasively and in real time by an antenna strapped to a patient's wrist. Some promising success has been shown by the RIT ETA Lab research group that an antenna's resonant frequency can track, in real time, changes in glucose concentration. Based on an in-vitro study of blood samples of diabetic patients, the paper presents a modified Cole-Cole model that incorporates a factor to represent the change in glucose level. A calibration technique using the input impedance technique is discussed and the results show a good estimation as compared to the glucose meter readings. An alternate calibration methodology has been developed that is based on the shift in the antenna resonant frequency using an equivalent circuit model containing a shunt capacitor to represent the shift in resonant frequency with changing glucose levels. Work under progress is the optimization of the technique with a larger sample of patients.

FRI0486 Analysis of Wrist Joints in Patients with Systemic Sclerosis Using Magnetic Resonance Imaging

BackgroundSystemic sclerosis (SSc) is a systemic inflammatory autoimmune disease characterized by fibrosis and involvement in the small vessels, skin, joints, and multiple internal organs. Although joint involvement is common in...

Correlations of morphological parameters for lesions of the wrist joint in patients with posttraumatic nonunion of the navicular bone

Among the causes of development of posttraumatic wrist joint osteoarthrosis (WJOA) they consider the consequences of scaphoid bone (SB) fractures which are clinically manifesting by pain especially when wrist loading, inflammation of capsule and biomechanic disturbances of wrist joint.Рurpose: to determine pathomorphological changes in tissues of wrist joint underlying of WJOA development, and correlations between some morphological data of wrist joint lesion in patients with consequences of SB fractures.Materials: with using of pathomorphological, biometrical and statistical analysis we investigated 94 resected fragments of the tissues forming a wrist joint, in particular SB (39 objects), semilunar and some other bones (12 objects), joint capsule (43 objects) obtained during fulfillment of corrective interventions according to indications in 55 patients at which WJOA has been connected with consequences of nonunion after SB fracture.Results: it was established that in wrist joint tissues there are various pathological changes with signs of discirculatory, chronic dystrophic-destructive, inflammatory and reparative processes in SB and wrist joint capsule, and the degree of expressiveness and frequency occurrence of distinct gradations of which vary.SB pseudarthrotic surface finds out considerable heterogeneity of pathological changes: along with cases in which deformed surface contains sites formed by reparative chondroid tissue (the most frequent variant), there are cases of pseudarthrotic surface covering with a fibrous tissue or sclerosed spongy bone denudation (the most rare variant).The SB articular surfaces removed in patients with SB pseudarthrosis approximately with identical frequency find out degree of prevailing dystrophic-destructive changes which correspond to distinct stages WJOA. In spongiosa of the SB one meets osteonecroses of different size: small and large interstitial, and also large focal frequencies of occurrence of which are comparable in biopsy-histological material.Morphological parameters of wrist joint tissues condition find out correlations of different force and significance degree among themselves. There are pairs of indices that are the most closely connected: "hypertrophy and hyperplasia of the joint capsule synovial layer villi" and "activity of synovitis" as well as "dystrophic-destructive changes of SB articular surface" and "hypertrophy and hyperplasia of the joint capsule synovial layer villi".Conclusion. Morphological parameters which reflect the tissues conditions of SB, other bones of the wrist, joint capsule in patients with consequences of SB fractures, are notable by considerable variability and stay among themselves in correlations of different closeness, sign and significance (within the scope of research performed).

Short-term effects of self-mobilization with a strap on pain and range of motion of the wrist joint in patients with dorsal wrist pain when weight bearing through the hand: A case series

Dorsal wrist pain frequently occurs in weight bearing through the hand in patients with distal radius stress injuries, scaphoid impaction syndrome, and dorsal impingement. To improve the wrist extension motion, joint mobilization has been used. However, there is no report on the effects of mobilization on the range of motion (ROM) and pain onset in patients with dorsal wrist pain when weight bearing through the hand.This study determined the effects of self-mobilization with a strap (SMWS) while weight bearing through the hand on the ROM and force generated at the onset of pain (FGOP) and intensity in the wrist joints of patients with dorsal wrist pain.Fifteen patients (six men, nine women) with dorsal wrist pain during weight bearing through the hand were recruited from a workplace-based work-conditioning center. SMWS was applied during five visits for a 1-week period. Both passive and active wrist extension ROM, FGOP, and pain intensity (PI) while pushing down through the hand were measured before and after SMWS.Passive and active ROM of wrist extension and FGOP increased significantly after the five sessions over 1 week of SMWS (p < 0.05). PI decreased significantly after the five sessions of SMWS (p < 0.05).These results suggest that SMWS can be used to increase wrist extension ROM and decrease wrist pain in patients with dorsal wrist pain during weight bearing through the hand.

AB0727 Ultrasonography and magnetic resonance imaging of hands and wrists in patients with rheumatoid arthritis in clinical remission

BackgroundPatients with rheumatoid arthritis (RA) in clinical remission may still show progression of radiologic joint damage, possibly due to subclinical inflammation. In comparison to clinical examination, ultrasonography (US) and magnetic...

AB0332 An audit to examine whether there is a correlation between levels of anti-cyclic citrullinated peptide (CCP) antibody titres and joint findings on musculoskeletal ultrasound scan in rheumatoid arthritis

BackgroundAnti-CCP antibodies (Abs) currently make an important part of the workup in patients with suspected rheumatoid arthritis (RA) and can be detected prior to the development of symptoms [1]. They...

SAT0389 Color or power doppler - which is more sensitive and do machine settings matter?

BackgroundThe sensitivity of Doppler to detect slow blood flow in inflamed joints is of utmost importance. This may be influenced by factors such as Doppler modality, machine and settings. Power...

Quantitative and Semiquantitative Bone Erosion Assessment on High-resolution Peripheral Quantitative Computed Tomography in Rheumatoid Arthritis

To develop novel quantitative and semiquantitative bone erosion measures at metacarpophalangeal (MCP) and wrist joints in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT), and to correlate these measurements with disease duration and bone marrow edema (BME) patterns derived from magnetic resonance imaging (MRI). Sixteen patients with RA and 7 healthy subjects underwent hand and wrist HR-pQCT and 3-Tesla MRI. Bone erosions of the MCP2, MCP3, and distal radius were evaluated by measuring maximal erosion dimension on axial slices, which is a simple and fast measurement, and then were graded (grades 0-3) based on the maximal dimension. Correlation coefficients were calculated between (1) sum maximal dimensions, highest grades, and sum grades of bone erosions; (2) erosion measures and the clinical evaluation; (3) erosion measures and BME volume in distal radius. The inter- and intrareader agreements of maximal erosion dimensions were excellent (intraclass correlation coefficients 0.89, 0.99, and root mean square error 9.4%, 4.7%, respectively). Highest grades and sum grades were significantly correlated to sum maximal dimensions of all erosions. Number of erosions, sum maximal erosion dimensions, highest grades, and sum grades correlated significantly with disease duration. Number of erosions, sum maximal dimensions, and erosion grading of the distal radius correlated significantly with BME volume. HR-pQCT provides a sensitive method with high reader agreement in assessment of structural bone damage in RA. The good correlation of erosion measures with disease duration as well as BME volume suggests that they could become feasible measures of erosions in RA.

Insidious onset of wrist pain in a young male: Case report and a brief review of the literature

Summary In this report we present the case of a 25-year-old man with an insidious onset of wrist pain. The pain was constant and appeared to be work related where, as a packaging operator, the patient's wrist was exposed to repetitive trauma. Imaging studies revealed an avascular necrosis (AVN) of the capitate bone. The avascular necrosis (AVN) of the capitate is a rare finding with less than 20 cases having been reported in the literature thus far. There may be a multitude of causes for the development of this condition; however, minor repetitive trauma appears to be one of the most common reasons for the development of AVN.

Alternative site for median nerve blockade allowing early functional rehabilitation after hand surgery

In this report we describe an alternative approach to catheter placement for continuous selective median nerve blockade. It spared the finger movements and therefore allowed early postoperative rehabilitation in a patient who underwent surgical repair of the index finger flexor tendon. A patient with a complicated history of traumatic index finger flexor tendon rupture, surgical repair, failed rehabilitation due to poor postoperative pain control, adhesion formation, and subsequent rerupture due to tenolysis was admitted for reconstructive surgery. This time, a continuous regional block was used. Although the insertion of a catheter at the wrist level would have spared the anterior interosseous branch of the median nerve and preserved finger movements, a more distant site had to be chosen to avoid proximity to the surgical wound. Therefore, under combined ultrasonography and neurostimulation guidance, the catheter was inserted in the proximal one-third of the patient's forearm distal to the branching-off point of the anterior interosseous nerve. Continuous ropivacaine infusion was initiated and maintained until being stopped on the afternoon of the third postoperative day, providing good analgesia without interfering with postoperative physiotherapy, which was successfully completed during this hospitalization. Placement of a catheter for continuous median nerve blockade in the proximal one-third of the forearm for effective postoperative pain-free rehabilitation after hand surgery should be considered in cases in which the surgical incision extends toward the patient's wrist. The block site can be readily identified by a combined use of ultrasonography and neurostimulation guidance.

Quantitative characterization of bone marrow edema pattern in rheumatoid arthritis using 3 tesla MRI

To develop imaging techniques that provide quantitative characterization of bone marrow edema pattern (BME) in wrist joints of patients with rheumatoid arthritis (RA), including volume, signal intensity changes, and perfusion properties. Fourteen RA patients and three controls were scanned using 3 Tesla MR. BME was semi-automatically segmented in water images obtained from iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) sequences. BME perfusion parameters (enhancement and slope) were evaluated using three-dimensional (3D) dynamic enhanced MRI (DCE-MRI). Experimental reproducibility, inter- and intra-observer reproducibility of BME quantification were evaluated using root mean square coefficients of variation (RMS-CV) and intraclass correlation (ICC). The RMS-CV for BME volume quantification with repeated scans were 6.9%. The inter-observer ICC was 0.993 and RMS CV was 5.2%. The intra-observer ICC was 0.998 and RMS CV was 2.3%. Both maximum enhancement and slope during DCE-MRI were significantly higher in BME than in normal bone marrow (P < 0.001). No significant correlation was found between BME quantification and clinical evaluations. A highly reproducible semi-automatic method for quantifying BME lesion burden in RA was developed, which may enhance our capability of predicting disease progression and monitoring treatment response.

Recent Papers Summarised by Adrian White

### Intensive care ▶ 1. Pfab F, 2. Winhard M, 3. Nowak-Machen M, 4. et al . Acupuncture in critically ill patients improves delayed gastric emptying: a randomized controlled trial. Anesth Analg 2011;112:150–5. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Randomised controlled trial (RCT) of PC6 stimulation to promote gastric emptying (n=30). ### Methods Thirty mechanically ventilated neurosurgical intensive care unit (ICU) patients were recruited who had delayed gastric emptying, defined as a gastric residual volume (GRV) >500 ml for ≥2 days, after surgery for subarachnoid haemorrhage, intracranial haemorrhage or traumatic injury. They were randomised to two groups. The ‘acupuncture stimulation’ group had bilateral transcutaneous electrical acupuncture point stimulation at PC6 at 7 Hz and 7–13 mA depending on the patient's wrist size. This was given for one 30-min period daily then 5-min periods every 2 h. The conventional promotility drug treatment group (DTG) were given metoclopramide initially, followed, if unresponsive, with cisapride (until this drug was withdrawn from the market, after which erythromycin) over a period of 6 days. Patients in the stimulation group did not receive any conventional promotility drugs. Successful treatment (ie, tolerance of feeding) was defined as GRV <200 ml per 24 h. ### Results Demographic and haemodynamic data were similar in both groups. After 5 days of treatment, 80% of patients in the PC6 stimulation group successfully developed feeding tolerance compared with 60% in the DTG group. GRVs are shown in figure 1 and there were significant differences between the groups (eg, p = 0.005 on day 1). Overall, the feeding balance in the PC6 stimulated group improved significantly on all days of treatment in comparison with the DTG group. Patients in the DTG group did not show an increase in feeding balance until day 6. Figure 1 Gastric residual volume per day. ### Comment Malnutrition remains a severe problem in the recovery of critically ill patients and leads to increased in-hospital morbidity and in-hospital stay. Even though early enteral nutrition has been shown to improve overall patient outcomes in the ICU, tubefeed administration is often complicated by delayed gastric emptying and … [1]: {openurl}?query=rft.jtitle%253DAnesth%2BAnalg%26rft_id%253Dinfo%253Adoi%252F10.1213%252FANE.0b013e3181fdfac8%26rft_id%253Dinfo%253Apmid%252F21081772%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1213/ANE.0b013e3181fdfac8&link_type=DOI [3]: /lookup/external-ref?access_num=21081772&link_type=MED&atom=%2Facupmed%2F29%2F2%2F154.atom [4]: /lookup/external-ref?access_num=000285454300024&link_type=ISI

Ultrasound Doppler Score Correlates with OMERACT RAMRIS Bone Marrow Oedema and Synovitis Score in the Wrist Joint of Patients with Rheumatoid Arthritis

MRI is considered the standard of reference for advanced imaging in rheumatoid arthritis (RA). However, in daily clinical practice ultrasound (US) imaging with Doppler information is more versatile and often used for fast and dynamic assessment of joint inflammation. The aim was to compare low-field MRI scores with the US Doppler measurements in the wrist joint of patients with RA. Fifty consecutive patients with RA (46 women & 4 men) completed both low-field dedicated extremity MRI (E-scan®, Esaote) and a high-end US (Sequioa®, Siemens) imaging of the wrist before initiating either biological treatment (n=26) or intraarticular injection of Depomedrole® (n=24). Mean age was 56 years (range 21-83 years); mean disease duration 87.2 months (range 4-349 months), mean DAS 28 4,8 (range 2-7). MRI was scored according to the OMERACT RAMRIS recommendations and US Doppler colour-fractions were determined. Using Spearman's rho, we found a relatively good to moderate correlation between the US colour-fraction and the total OMERACT bone marrow oedema and synovitis scores on MRI (r=0.6; p<0.001 and r=0.4; p<0.006 respectively). There was a trend but no significant correlation with the total OMERACT erosion score (r=0.3; p=0.06). Within limits, the OMERACT RAMRIS scores of inflammation in RA patients (bone marrow oedema and synovial enhancement) are comparable to the US colour-fraction measurements using a high-end US scanner. Both imaging modalities detect inflammation although showing different aspects of the inflammatory process in the wrist joint. The higher correlation between US colour-fractions and MRI bone marrow oedema indicates a potential importance of US Doppler in monitoring inflammatory disease changes in RA.

Clinical and functional evaluation of wrist joint in patients with rheumatoid arthritis under biologic therapy

Clinical and functional evaluation of wrist joint in patients with rheumatoid arthritis under biologic therapy

Accuracy of the visomat handy wrist blood pressure measuring device according to the International Protocol

The objective of this study is to determine the accuracy of the UEBE visomat handy device for blood pressure measurement in the wrist of patients tested according to the requirements of the International Protocol of the European Society of Hypertension (ESH). Device evaluation was done in 33 patients whose age and blood pressure were within the intervals required by the ESH protocol. Their mean±standard deviation age was 53.8±16.5 years (range 30-86 years), systolic blood pressure (SBP) was 143.5±20.2 mmHg (range 110-180 mmHg), diastolic blood pressure (DBP) was 87.4±12.9 mmHg (range 68-110 mmHg), arm circumference was 29.0±3.7 cm (range 21-38 cm), and wrist circumference was 17.3±1.5 cm (range 14.0-21.0 cm). During the measurements, which were taken in a sitting position, the patient's wrist was kept extended at the heart level putting a support under the forearm. In total, 45 measurements were available for analysis in the first phase of the validation process, and 99 measurements in the second phase. The visomat handy device passed all three phases of the ESH protocol for SBP and DBP. Mean blood pressure differences for the visomat handy monitor (device-observer) were -2.0±8.1 mmHg for SBP and -0.9±4.1 mmHg for DBP. These data show that the UEBE visomat handy wrist monitor met the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

Role of the PAG in the Exercise Pressor Reflex during Varying Intensity of Activity

Emerging evidence reports that the periaqueductal grey (PAG) in humans could be a major site for controlling the cardiovascular response to exercise. We previously hypothesised that the PAG is part of the subcortical neurocircuitry involved in the exercise pressor reflex. It is well known that as exercise intensity increases, the magnitude of the elevation of blood pressure from resting levels also increases. In order to identify whether the PAG has a role in controlling the magnitude of this increase, we assessed the spectral changes in local field potentials (LFPs) recorded from both the PAG and the thalamus in a patient who had undergone neurosurgery for the implantation of deep brain stimulating electrodes for the treatment of chronic pain. The patient was asked to perform light exercise (bicep curls), followed by arterial occlusion of the exercised limb in order to artificially stimulate the pressor response. The protocol was performed with a 2kg weight attached to the patient's wrist, and was then repeated with a 4kg weight. The PAG was compared to the thalamus i.e. the control area. The PAG showed significant increases in LFP power at frequencies from 4–12Hz (p&lt;0.001) during occlusion following both 2kg exercise and 4kg exercise. However, in this case study, there did not appear to be a direct relationship between exercise intensity and neural activity. No change in thalamus activity was observed during occlusion.

Giant-Cell Tumor of the Distal Ulna Treated by Wide Resection and Ulnar Support Reconstruction: A Case Report

Giant-cell tumor of bone occurred in the distal end of the ulna is extremely uncommon. A 23-year-old male had a giant-cell tumor occurred in the distal end of the ulna. After wide resection of the distal segment of the ulna including giant-cell tumor, ulnar components of the wrist joint were reconstructed with modified Sauvé-Kapandji procedure using the iliac bone graft, preserving the triangular fibrocartilage complex and ulnar collateral ligament in order to maintain ulnar support of the wrist, and the proximal stump of the resected ulna was stabilized by tenodesis using the extensor carpi ulnaris tendon. One year after operation, the patient's wrist was pain-free and had a full range of motion. Postoperative X-rays showed no abnormal findings including recurrence of the giant-cell tumor and ulnar translation of the entire carpus. The stability of the proximal stump of the distal ulna was also maintained.

Complex regional pain syndrome type I: efficacy of stellate ganglion blockade

BackgroundThis study was performed to evaluate the treatment of complex regional pain syndrome (CRPS) type I with stellate ganglion blockade.Materials and methodsWe performed three blockades at weekly intervals in 22 patients with CRPS type I in one hand. The patients were divided into two groups depending on the time between symptom onset and treatment initiation. Group 1and 2 patients had short and long symptom-onset-to-treatment intervals, respectively. Pain intensity, using a visual analog score (VAS), and range of motion (ROM) for the wrist joint were assessed before and 2 weeks after treatment and were compared using nonparametric statistical analysis.ResultsTreatment produced a statistically significant difference in wrist ROM for all patients (P < 0.001). VAS values showed an overall decrease from 8 ± 1 to 1 ± 1 following treatment, and there was a significant difference in VAS value between groups 1 and 2 (P < 0.05).ConclusionsWe concluded that stellate ganglion blockade successfully decreased VAS and increased ROM of wrist joints in patients with CRPS type I. Further, the duration between symptom onset and therapy initiation was a major factor affecting blockade success.

Hand in Glove

Kinking of the radial artery line is a common problem with malpositioning of the hand in the anaesthetised patient during surgery. Line kinking can cause digital ischaemia1 and altered arterial blood pressure readings. Repositioning the line whilst the patient's hand is under sterile drapes is difficult, disrupts surgery and can prolong the duration of anaesthesia. A simple and cheap solution is to use an inflated latex glove and position the patient's hand with interlocking fingers around it as shown in Figure 1, thus maintaining dorsiflexion of the patient's wrist and so preventing arterial line kinking. Figure 1 Hand positioned around inflated latex glove avoids kinking of the radial artery line.