Wrist Tendon Research Articles

Evaluation of a cadaveric wrist motion simulator using marker-based X-ray reconstruction of moving morphology.

Surgical intervention is a common option for the treatment of wrist joint arthritis and traumatic wrist injury. Whether this surgery is arthrodesis or a motion preserving procedure such as arthroplasty, wrist joint biomechanics are inevitably altered. To evaluate effects of surgery on parameters such as range of motion, efficiency and carpal kinematics, repeatable and controlled motion of cadaveric specimens is required. This study describes the development of a device that enables cadaveric wrist motion to be simulated before and after motion preserving surgery in a highly controlled manner. The simulator achieves joint motion through the application of predetermined displacements to the five major tendons of the wrist, and records tendon forces. A pilot experiment using six wrists aimed to evaluate its accuracy and reproducibility. Biplanar X-ray videoradiography (BPVR) and X-Ray Reconstruction of Moving Morphology (XROMM) were used to measure overall wrist angles before and after total wrist arthroplasty. The simulator was able to produce flexion, extension, radioulnar deviation, dart thrower's motion and circumduction within previously reported functional ranges of motion. Pre- and post-surgical wrist angles did not significantly differ. Intra-specimen motion trials were repeatable; root mean square errors between individual trials and average wrist angle and tendon force profiles were below 1° and 2 N respectively. Inter-specimen variation was higher, likely due to anatomical variation and lack of wrist position feedback. In conclusion, combining repeatable intra-specimen cadaveric motion simulation with BPVR and XROMM can be used to determine potential effects of motion preserving surgeries on wrist range of motion and biomechanics.

Combined Wrist Extensor Tenodesis and Tendon Transfers for Severe Spastic Flexed Wrist Deformity: Surgical Technique and Case Series.

Spastic wrist flexion deformities both limit the functional use of the hand for grasp and pinch producing a stigmatizing appearance. Tendon transfers and total wrist arthrodesis are treatment options for this condition depending on the patient's characteristics, the latter the most commonly used in patients with severe wrist flexion deformities. Tendon transfers alone in this scenario have the tendency for recurrent deformity due to tenorrhaphy failure or soft tissue creep and resultant loss of tension. Total wrist arthrodesis is a more invasive procedure, which can have hardware or fusion problems and that is irreversible. We propose a novel technique that incorporates a distally based wrist extensor tendon slip and suture tape tenodesis to the distal radius. The rationale of this technique is to act as a protective, internal splint to prevent recurrent deformity after primary or revision tendon transfer for moderate to severe spastic flexed wrist deformities, avoiding the need to perform a total wrist arthrodesis.

Short-Term Postoperative Complications in Flexor Tendon Repair: A Subcategory Analysis by Surgical Specialty.

Introduction: We aimed to investigate and compare the 30-day postsurgical complication rates and total operative times for hand or wrist flexor tendon injury repair procedures. Methods: We performed a retrospective cohort analysis of the American College of Surgeon National Quality Improvement Program database between 2015 and 2019. Patients were included in our study if they were 18 years or older and underwent surgical repair of a wrist or hand flexor tendon by a plastic surgeon, general surgeon, or orthopedic surgeon. Primary endpoint of the study was 30-day postsurgical complications. Secondary endpoint included subcategory analysis of 30-day postsurgical complications. Another variable of interest included total operative time. Results: There were 2614 surgeries performed for wrist or hand flexor tendon injury repair during the 5-year period. Orthopedic surgeons performed the majority of the operations (1548, 59.2%). Repair or advancement of the flexor tendon zone 2 without grafts (1284, 49.1%) were the most common surgeries performed. Overall surgical site complication rate was 2%, with no significant associations between the complication and the surgical specialty performing the operation. A significant difference in total operative time between surgical specialties was only found in single flexor tendon repairs (P < .001). Conclusions: Surgical repair for hand and wrist flexor tendon injury is a safe surgical procedure with a low short-term postoperative complication rate. Despite variations in training, complications remain similar between specialties for flexor tendon repairs.

High-Accuracy Hand Gesture Recognition on the Wrist Tendon Group Using Pneumatic Mechanomyography (pMMG)

Hand gesture recognition has received considerable attention as an intuitive interaction method in recent years. This research introduces a new wearable hand gesture recognition system that employs pneumatic mechanomyography (pMMG) to directly monitor the wrist tendon group, which transmits muscle force to the fingers. The experimental findings demonstrate that the proposed method provides raw observations proportional to the finger flexion force, with high R-squared values exceeding 0.94. The performance of the proposed system was evaluated by conducting a hand gesture experiment consisting of 28 hand gestures. The proposed method achieved an average accuracy of 98.12%, surpassing the surface electromyography (sEMG) system's accuracy of 93.89%. Furthermore, the fusion of pMMG and sEMG sensors yielded an accuracy of 99.18%. The results suggest that the proposed approach exhibits the potential to enhance the accuracy and efficiency of hand gesture recognition systems.

A Case Report of Giant Tuberous Xanthoma with Type IIa Familial Hypercholesterolemia

Abstract Tuberous xanthomas are nontender, yellow to red papules to nodules that occur on the extensor surface, and trauma-prone areas such as the elbows, knees, Achilles tendon, and buttocks. A 10-year-old female child born out of second-degree consanguineous marriage presented with multiple skin-colored nodular lesions on axillary folds, both elbows, cubital fossa, medial side of the wrist, interphalangeal joints, buttocks, knees, popliteal fossa, and Achilles tendons. After complete evaluation, diagnosis of familial hypercholesterolemia type IIa with tuberous xanthoma was made. Tuberous xanthoma usually presents in combined type III dyslipidemias, but in our case, it is presented in type IIa familial hypercholesterolemia. Early diagnosis and treatment of familial hypercholesterolemia are important for preventing complications.

Synergistic Illusions: Enhancing Perceptual Effects of Pseudo-Attraction Force by Kinesthetic Illusory Hand Movement.

We investigated the enhancement of the perceived force strength in force feedback devices by combining the pulling illusion with kinesthetic illusions. The pulling illusion (i.e., a sensation of being pulled or pushed) is induced by asymmetric vibrations applied to the fingertips, enabling the implementation of small, lightweight, and ungrounded force feedback devices. However, the perceived force intensity is limited. We focused on the kinesthetic illusion, a phenomenon in which the movement of a limb in the direction of muscle extension is illusively perceived by presenting vibrations to tendons or muscles as an illusion that could enhance the perceived strength of the pulling illusion. Moreover, we investigated the perceptual characteristics of force sensation by combining a kinesthetic illusion induced by wrist tendon vibration stimulation with a pulling illusion. The findings demonstrate that the direction of the pulling illusion was accurately perceived, even with simultaneous wrist tendon vibration stimuli. Importantly, the results suggest that tendon vibration on the wrist, rather than cutaneous vibration on the wrist, enhances the perceived force intensity of the pulling illusion at the fingertips. These findings indicate the potential for expanding the expressive capability of the pulling illusion.

Optimization of wrist tendon detection in virtual monochromatic images using dual energy-computed tomography.

To evaluate the depiction of wrist tendons in virtual monochromatic images (VMIs) during a dual-energy CT (DE-CT) with the VMI image of conventional equivalent to 120kVp. Using Catphan600 and phantom analysis software for CT evaluation, measurements of VMI in a DE-CT were performed corresponding to the tube voltages of single-energy CT at 120kVp. Using a Discovery CT750 HD CT scanner (GE Healthcare) with DE-CT technology, 73 patients were scanned. We calculated the CT number, image noise, visual score, and contrast noise ratio (CNR) at the extensor pollicis tendon, extensor digitorum tendon, and flexor tendon in 11 VMIs from the DE-CT and VMI image of conventional equivalent to 120kVp. The results from the optimal VMIs were then compared with that of the VMI image of the conventional equivalent to 120kVp. The highest CT number and CNR for the tendon were for the 140keV VMI in the DE-CT compared to the other energy levels. There were significantly higher CT numbers, CNR values, and visual scores for each tendon at 140keV VMI with the DE-CT (p < 0.01) compared with a VMI image of conventional equivalent to 120kVp. Energy level of the VMIs during DE-CT for the best wrist tendon delineation was 140keV. This value of 140keV for the DE-CT was significantly higher than the CT number and CNR for the extensor pollicis, extensor digitorum, and flexor tendon compared with a VMI image of conventional equivalent to 120kVp.

Distally-extending muscle fibers across involved joints: study of long muscles and tendons of wrist and ankle in late-term fetuses and adult cadavers.

It is unclear whether forearm and crural muscle fibers extend distally across the wrist and ankle joints, respectively. We hypothesized, in late-term fetuses, an over-production of muscle bellies extending over the joint. Muscle fibers in histological sections from unilateral wrists and ankles of 16 late-term fetuses (30-40 weeks) were examined and compared with 15 adult cadavers. Muscle fibers of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in fetuses, especially muscle bellies to the third and fourth fingers, were found to extend far distally beyond the radiocarpal joint. The extensor digitorum and extensor pollicis longus on the extensor side of the wrist were found to carry distally-extending muscle fibers, but these fibers did not extend beyond the distal end of the radius. In the ankle, most muscle bundles in the flexor hallucis longus (FHL), fibularis brevis (FB) and extensor digitorum longus extended distally beyond the talocrural joint, with most FB muscle fibers reaching the level of the talocalcaneal joint. In adult cadavers, muscle fibers of the FDP and FHL did not reach the levels of the radiocarpal and talocrural joints, respectively, whereas the FB muscle belly always reached the talocalcaneal joint. Similarly, some of the FDS reached the level of the radiocarpal joint. Generally, infants' movements at the wrist and ankle could result in friction injury to over-extended muscle. However, the calcaneal and FDP tendons might protect the FB and FDS tendons, respectively, from friction stress.

Postoperative Nursing and Functional Rehabilitation of Ultrasound Diagnosis of Lower Rotator Cuff Injury.

In order to explore the postoperative nursing effect and functional rehabilitation of rotator cuff repair under ultrasound diagnosis, a method of nursing and rehabilitation functional training for athletes' wrist injury under the assistance of microscopic B-ultrasound was proposed. This study retrospectively analyzed the therapeutic effect of tendon anastomosis in 237 patients with wrist tendon injury, adopted nursing measures such as health education and functional exercise, and observed its clinical effect. The results showed that after 3-6 months of follow-up, all patients had satisfactory recovery of tendon function. Of these, 132 patients recovered well. 84 patients recovered well. The excellent and good rate of patients was 91%. Ultrasound diagnosis of rotator cuff repair combined with functional exercise promotes good recovery of shoulder joint function in patients.

Normal ultrasonographic picture of the tendons of the hand

The potentialities of ultrasonography for the imaging of wrist tendons is shown. Normal sonographic appearance of flexor wrist tendons as well as extensor wrist tendons is given in longitudinal and transverse scanning. The causes of artifacts have been analysed and the methods for their elimination are given. Elaborated protocol and technique of ultrasonographic investigation of wrist tendon at rest and in dynamics under real time condition are presented.

Ultrasonographic diagnosis of hand tendon injuries

Ultrasonographic examination was performed in 106 patients with clinical manifestations of wrist tendon injuries and their sequelae (in 54 patients prior to specialized treatment, in 90 - in the postoperative period and in conservative treatment). In 63 patients flexor tendons, in 36 extensor tendons, in 5 both flexors and extensors were examined. In 106 patients 139 tendons (445 ultrasonographies) were examined. Real-time Sonoline SL-1 scanner (Siemens) with 5 and 7.5 MHz linear and sector transducers was used. The examination was performed in transverse and longitudinal planes both at rest and dynamics. In 75 patients (70.8%) scan allowed to correct the preoperative protocol, tactics of conservative treatment and postoperative management as well as to choose the adequate individual duration of immobilization. Techniques of ultrasonographic examination of the wrist soft tissues in tendon injuries is elaborated. Indications for ultrasonographic examination are determined and sonographic picture of fresh and old tendon injuries and their sequelae is described.

Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures.

Describe tendon injuries and their structural causes seen on ultrasound in wrists with distal radius fractures and estimate the accuracy of ultrasound and its impact on clinical management. Ultrasounds of 226 wrists (221 patients) with distal radius fractures were retrospectively reviewed. Ultrasound findings of tendon injuries and their structural causes were correlated with surgery and clinical outcome. Accuracy and inter- and intra-observer reproducibilities were calculated. Twenty-five wrists were treated non-operatively while 201 underwent surgery. Ultrasound demonstrated hardware contact with flexor pollicis longus (FPL) in 76 wrists, extensor pollicis longus (EPL) in 21, and other tendons in 94. Ultrasound identified tendon ruptures in 23 wrists (13 EPL/8 FPL/2 extensor indicis proprius (EIP)), most of which were surgically confirmed. Among 12 wrists with confirmed EPL ruptures, distal radius fracture had been treated with volar plating in 6 and non-operatively in 6, and ultrasound showed osseous irregularity at the rupture site in 8. All FPL ruptures occurred in wrists with volar plating. Ultrasound findings were concordant with subsequent clinical management in most. In 2, ultrasound findings led to the decision to remove hardware despite lack of symptoms. Ultrasound had sensitivity/specificity/accuracy of 88/99/98% for identifying a specific tendon as ruptured and 88/87/88% for tendon abnormalities in general. Inter- and intra-observer reproducibilities were excellent (kappa = 0.85 ~ 1.0). Certain wrist tendons, particularly EPL and FPL, are vulnerable after distal radius fractures. Ultrasound is accurate and useful for detecting tendon injury and sources of tendon irritation and can guide clinical management.

The MCP2 and the wrist plus two extensor compartments are the most affected and responsive joints/tendons out of the US7 score in patients with rheumatoid arthritis-an observational study

BackgroundThere is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score.MethodsRA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA.ResultsA total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information.No major differences between the groups of early and established RA could be detected.ConclusionsThe wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.

Sonography of tendon pathology in the hand and wrist.

Traumatic and non-traumatic tendon lesions are common at the wrist and hand. For the diagnosis, therapy management, and long-term prognosis of tendon lesions, a detailed understanding of the complex anatomy and knowledge of typical injury patterns is crucial for both radiologists and clinicians. Improvements in high-resolution ultrasound are producing high-quality images of the superficial tendinous and peritendinous structures. Thus, ultrasound is a valuable first-choice tool for visualizing traumatic, inflammatory, and degenerative conditions of the extensor and flexor tendons, particularly with the advantage of possible dynamic examination. The additional use of duplex-Doppler and power Doppler ultrasound imaging is recommended for detection of tenosynovitis in overuse injury, inflammatory disease, infection, and after traumatic conditions. In traumatic tendon injuries, knowing the precise injury zone is important for treatment decision-making. In cases of tendon rupture, the radiologist should report the tear type (i.e., complete or partial-thickness) and assess the degree of tendon retraction and associated avulsion injury, including the degree of fragment displacement. The function of intact flexor tendons may be impaired by thickening, strain, or rupture of corresponding annular pulleys. This review describes in detail the typical ultrasound imaging features of common pathologies of hand and wrist tendons, including annular pulley lesions.

Creation of 3D anatomical models illustrating an intact and centrally torn triangular fibrocartilage complex for patient education prior treatment

BackgroundThe triangular fibrocartilage complex (TFCC) is a composite structure located in the human wrist and is made up from fibrocartilage and ligaments. It consists of eight distinct structures, with the ligamentous structures acting as the major stabilizer of the distal radioulnar joint and with the articular disc acting as a shock absorber at the ulnocarpal joint. The articular disc can be called the triangular fibrocartilage (TFC). Thus, traumatic injuries of the TFCC ligamentous structures cause instability of the joint and a centrally torn TFC disc causes ulnar sided wrist pain. TFCC pathologies can be difficult for patients to understand in clinic, due to their complex three-dimensional (3D) nature. The purpose of this study was to produce 3D anatomical models illustrating the normal anatomy of the wrist joint with the TFCC structure and a pathological model with a centrally torn TFC. These models would be used in a hand clinic to aid explanation of this complex three-dimensional anatomical structure and their injury to patients and trainee doctors. MaterialsThree fresh frozen forearm and hand specimens were dissected, 3D scanned, 3D printed and painted. These models were introduced into a hand clinic to aid explanation of the complex anatomical structures, with the first 50 patients being asked, on a visual analog scale of 0–10, to state how much the models helped their understanding of the condition. ResultsThree 3D printed anatomical models were produced to illustrate the (1) forearm muscles and wrist tendons, (2) an intact TFC and (3) a centrally torn TFC. 48 of 50 patients surveyed completed the scale, with an average rating of 8.7 increase in understanding with the models. ConclusionPatient education and understanding is crucial as it enhances decision making between surgeon and patient. These 3D anatomical models were shown to increase patient’s understanding of the pathology. This should consequentially improve discussions on corresponding treatment options during consultation.

Sonoanatomy and Stepwise/Systematic Ultrasound Examination of the Extrinsic/Intrinsic Wrist Ligaments.

Ultrasound has emerged as the most useful imaging tool for investigating wrist and hand disorders, with several published ultrasound protocols having demonstrated their practicality in scanning the wrist tendons and nerves. However, ligaments of the wrist are networked in a complex manner, deterring sonographers from examining them with an organized strategy. Furthermore, because of the non-parallel alignment between the radiocarpal, mid-carpal, and carpal–metacarpal joints, precise recognition of the carpal bones is challenging, although ultrasound is paramount for visualizing the wrist ligaments. In this regard, the current article for point of view aims to elaborate sonoanatomy of the carpal bones and to present a stepwise systematic approach for navigating the extrinsic and intrinsic wrist ligaments.

A Study on Effectiveness of Exercise Program on Improvement of Hand Function Following Wrist Tendon Transfer Surgery for Spastic Hemiplegic Cerebral Palsy Children

A Study on Effectiveness of Exercise Program on Improvement of Hand Function Following Wrist Tendon Transfer Surgery for Spastic Hemiplegic Cerebral Palsy Children

Force Sensation Induced by Electrical Stimulation of the Tendon of Biceps Muscle

Many wearable interfaces have been proposed to present force to the upper limb and elbow joint. One way to achieve a compact wearable haptic interface is to use electrical stimulation, and we have suggested that transcutaneous electrical stimulation above the wrist tendon can produce force a sensation in the direction of the muscle stretching; however, it has not been investigated in detail whether the force sensation presented by the electrical stimulation of the tendon occurs in the upper limb joints. In this study, to investigate whether the force sensation is generated when applying electrical stimulation of the skin at the tendon or at the muscle belly of the biceps brachii muscle, we quantitatively evaluated the direction and amount of the force sensation under the aforementioned conditions. The results showed that the electrical stimulation of the tendon produced significant force sensation in the direction of elbow extension. On the other hand, in some participants, the electrical stimulation of the muscle belly worked as a supporting force, resulting in the sensation of weakened force perception. In general, we concluded that the sensation produced by muscle stimulation was different from that produced by stimulation of the tendon.

Role of Ultrasonography and Magnetic Resonance Imaging (MRI) in Evaluation of the Tendons of the Wrist and Hand

Abstract Background: Variable abnormalities of the tendons of the wrist and hand including injury, inflammation, tumors & anatomical variants used to be evaluated with MRI as a standard modality. Owing to MRI relative limited availability and its high cost, ultrasonography (US) considered a valuable tool in assessment of wrist and hand tendons. Aim of Study: To assess the ultrasonography (US) results in comparison with MRI results which is used as gold standard in assessment of variable wrist and hand tendon abnormalities. Patients and Methods: One hundred patients with different wrist and hand complaints were enrolled in our study, 43 females and 57 males their age between 8-82 years with a median age 45 years. All patients were subjected to history taking and full clinical examination of the wrist and hand. Each patient underwent the ultrasound first before the MRI examination. Results: Near equal results were observed between US findings and MRI findings indicating that we can use both examinations to evaluate the wrist and hand tendons, and that US can be used as initial tool in assessment of the wrist and hand tendon abnormalities. According to our study, sonography exhibited 99% diagnostic accuracy for ganglion cysts, 100% for solid masses of tendon sheath & tendinosis/tenosynovitis, 97% for tendon injury & 98% for anatomical variants of the wrist and hand tendons. Conclusion: Our study demonstrated that ultrasonography and MRI are comparable and closely related as regards detec-tion of different pathological changes in hand and wrist tendons. Further studies are needed to confirm the findings in larger groups of patients and to evaluate the role of Ultra-sonography (US) in assessment of the other structures of the wrist and hand.

Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children

Ganglion cysts are the most common mass of the hand or wrist. In adults, ganglions have a female predilection and are commonly located in the dorsal wrist. However, their presentation in children has not been well reported. This investigation sought to describe the presentation of pediatric ganglion cysts in a prospective cohort. A multicenter prospective investigation of children (aged ≤18 years) who presented with ganglion cysts of the hand or wrist was conducted between 2017 and 2019. The data collected included age, sex, cyst location, hand dominance, pain, and patient-reported outcomes measurement information system (PROMIS) scores for upper-extremity (UE) function. The patients were divided into cohorts based on age, cyst location, and cyst size. Multivariable analyses were performed to identify factors predictive of worse UE function and higher pain scores. A total of 173 patients with a mean age of 10.1 ± 5.3 years and female-to-male ratio of 1.4:1 were enrolled. The dorsal wrist was the most commonly affected (49.7%), followed by the volar wrist (26.6%) and flexor tendon sheath (18.5%). In older patients, dorsal wrist ganglions were more common than tendon sheath cysts (11.9 ± 4.1 years vs 6.2 ± 5.8 years) and were larger (86.7% were >1 cm) than cysts in other locations (34.5% were >1 cm). Patients aged >10 years reported higher pain scores, with 21.5% of older patients reporting moderate/severe pain scores versus 5.0% of younger children. This cohort of patients had an average PROMIS UE function score of 47.4 ± 9.5, and lower PROMIS scores were associated with higher pain scores. Ganglions in pediatric populations, which most commonly affect the dorsal wrist, demonstrate a female predilection. In younger children, cysts are smaller and more often involve the volar wrist or flexor tendon sheath. Older children report higher pain scores. Pediatric ganglion cysts do not appear to result in a clinically meaningful decrease in UE function. Diagnostic II.