The initial recovery from a wrist fracture can take 3 to 4 months or more. You may need physical therapy. You should start working with a physical therapist as soon as your provider recommends. The work may seem hard and at times ...
MANAGEMENT OF OSTEOPOROSIS. Alan D Rothberg, Patrick K Matshidze. Objective. Review of Medscheme's administrative databases to study the relationship between hip fracture and previous wrist fracture in peri- and postmenopausal women. Design. Retrospective analysis of 1995 - 1998 data for women aged 50 ...
bone mass by means of calcium and vitamin D intake, exercise and maintenance of ... therefore develop reliable and appropriate methods for screening patients to determine their risk and need for a bone density test.'o In determining such risk, clinical guidelines .... history of wrist fracture, and bone mineral density in those.
Full Text Available Compound fracture dislocations of proximal carpal bones are very rare. We report a 26-year-old male, Defense personnel by profession, who sustained a compound Gustilo Anderson type IIIA transstyloid, transscaphoid, perilunate dislocation. The patient underwent primary proximal row carpectomy and stabilization with uni-planar, uni-lateral external fixator, and K-Wires. On follow-up after a year, the patient had almost negligible range of motion around wrist without any significant discomfort.
Fei, Jun-Liang; Wang, Li-Ming; Jiang, Chun-Zhi
To investigate the influence of wrist joint stability of patients with diversified fracture of the distal radius, and to find out the difference of the clinical effect between the patients with surgical treatment and non-surgical treatment. From January 1999 to September 2006 a total of 200 cases with the fracture of the distal radius were reviewed according to the AO classification, the radiolunate angle, scapholunate angle, palmar tilt angle and the length of the radial shorting and step-off of the articular surface were measured by the standard X-ray. Gartland and Werley as modified by Sarmiento evaluation system was used, and the results were statistically analyzed. The average follow-up period was 5 years and 2 months. The follow-ups revealed 5 types of carpal instability: scapholunate dissociation, volar intercalated segment instability, dorsal intercalated segment instability and palmar or dorsal shift of the carpus. Functional results were excellent and good in 78% of the total patients. The increasing of the length of the radial shorting and step-off of the articular surface was found to be associated with greater risk of carpal instability. Based on the results of the study, wrist articular surface and radial shortening and palmar tilt angle should be considered as the most important factors of the healing effect after the fracture of the distal radius. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Carpal instability wound leads to significantly effect on the wrist. And surgery was necessary to severe intra-articular fracture of the distal radius.
Full Text Available The scaphoid is an uncommon site for tuberculous infection. Clinical features and radiographic findings are not necessarily helpful and may lead to a delay in diagnosis and therefore poor treatment results. We report here a case of scaphoid tuberculosis, which presented as a scaphoid fracture, but then progressed to wrist arthritis. The patient was treated conservatively and had good functional outcome. To the best of our knowledge, such presentation has not been documented.
Ackermann, O; Kaminski, A
A case of a patient with a combined wrist injury is presented, where a scaphoid fracture was overlooked in the computed tomography scan. The case emphasizes the value of the x‑ray control in ulnar abduction for all wrist lesions which need to be operatively stabilized.
Arnold, Catherine M; Dal Bello-Haas, Vanina P M; Farthing, Jonathan P; Crockett, Katie L; Haver, Charlene R A; Johnston, Geoffrey; Basran, Jenny
Women experience a rapid rise in the incidence of wrist fracture after age 50. Accordingly, this study aimed to (1) determine the internal and environmental fall-related circumstances resulting in a wrist fracture, and (2) examine the relationship of functional status to these circumstances. Women aged 50 to 94 years reported on the nature of the injury (n = 99) and underwent testing for physical activity status, balance, strength, and mobility (n = 72). The majority of falls causing wrist fracture occurred outdoors, during winter months, as a result of a slip or trip while walking. Half of these falls resulted in other injuries including head, neck, and spine injuries. Faster walking speed, lower grip strength, and higher balance confidence were significantly associated with outdoor versus indoor falls and slips and trips versus other causes. This study provides insights into potential screening and preventive measures for fall-related wrist fractures in women.
Conclusion: Based on the findings of the present study it seems that prophylactic corticosteroid injection will be associated with a decrease in the severity of wrist pain in patients with acute distal radius fractures. With regard to the decrease in the number of painless individuals, it seems that the decrease is not persistent. Overall the need for a study with longer followup is obvious.
Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)
Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)
Those identified were subjected to further review to establish rates of osteoporosis and/or hip fracture. Osteoporosis and/or hip fracture rates were also determined for a control population. Main outcome measures: Osteoporosis investigation and management rates in controls v, subjects who had experienced a previous ...
Full Text Available Background. The use of orthoses is a questionable rehabilitation method for patients with the distal radius fracture at typical site. The aim of this study was to compare the effects of the rehabilitation on patients with radius fracture at the typical site, who wore circumferential static wrist orthoses, with those who did not wear them. Methods. Thirty patients were divided into 3 equal groups, 2 experimental groups, and 1 control group. The patients in the experimental groups were given the rehabilitation program of wearing serially manufactured (off-the-shelf, as well as custom-fit orthoses. Those in the control group did not wear wrist orthoses. Evaluation parameters were pain, edema, the range of the wrist motion, the quality of cylindrical, spherical, and pinch-spherical grasp, the strength of pinch and hand grasp, and patient's assessment of the effects of rehabilitation. Results. No significant difference in the effects of rehabilitation on the patients in experimental groups as opposed to control group was found. Patients in the first experimental group, and in control group were more satisfied with the effects of rehabilitation, as opposed to the patients in the second experimental group (p<0,05. Conclusion. The effects of circumferential static wrist orthoses in the rehabilitation of patients with distal radius fracture at the typical site were not clinically significant. There was no significant difference between the custom and off-the-shelf orthoses.
de Bruijn, Berry; Cranney, Ann; O'Donnell, Siobhan; Martin, Joel D; Forster, Alan J
The authors performed this study to determine the accuracy of several text classification methods to categorize wrist x-ray reports. We randomly sampled 751 textual wrist x-ray reports. Two expert reviewers rated the presence (n = 301) or absence (n = 450) of an acute fracture of wrist. We developed two information retrieval (IR) text classification methods and a machine learning method using a support vector machine (TC-1). In cross-validation on the derivation set (n = 493), TC-1 outperformed the two IR based methods and six benchmark classifiers, including Naive Bayes and a Neural Network. In the validation set (n = 258), TC-1 demonstrated consistent performance with 93.8% accuracy; 95.5% sensitivity; 92.9% specificity; and 87.5% positive predictive value. TC-1 was easy to implement and superior in performance to the other classification methods.
Krischak, Gert D; Krasteva, Anna; Schneider, Florian; Gulkin, Daniel; Gebhard, Florian; Kramer, Michael
To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program. Randomized controlled cohort study. Hospital-based care, primary center of orthopedic surgery. Volunteers (N=48) with fractures of the distal radius after internal fixation with locking plates. There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol. Not applicable. Evaluation of grip strength using a Jamar dynamometer, range of motion (ROM), and Patient Related Wrist Evaluation (PRWE). After a 6-week period of postoperative treatment, the patients (n=23) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist. Grip strength reached 54% (P=.003), and ROM in extension and flexion 79% (Pwrist function with a nearly 50% lower value (Pwrist fractures, instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment.
Herzberg, Guillaume; Burnier, Marion; Marc, Antoine; Izem, Yadar
Background Volar plating for acute distal radius fractures (DRF) in the elderly has been recommended. Some studies have suggested that open reduction with internal fixation (ORIF) in this situation results in frequent complications. Our purposes were to provide a definition of irreparable DRF in independent elderly patients and to review the results of a preliminary retrospective series of wrist hemiarthroplasty (WHA) in this patient population. Materials Between 2011 and 2014, 11 consecutive independent elderly patients (12 wrists) with irreparable intra-articular DRF were treated with primary WHA at the acute stage. A resection of the ulnar head was associated in nine wrists. A total of 11 wrists with more than 2 years of follow-up form the basis of this paper. Description of Technique The approach was dorsal longitudinal. An osteotome longitudinally entered the dorsal aspect of the fracture medial to the Lister tubercle. Two thick osteoperiosteal flaps were elevated radially and ulnarly in a fashion similar to opening a book. The distal radius articular surface was excised. The implant was pressed into the radial canal with attention to restoring distal radius length. The two osteoperiosteal flaps were brought back together and sutured so as to close, again like a book, the osseous and soft tissues around the implant. Results At mean follow-up of 30 months, average visual analog scale (VAS) pain was 1/10. Mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 32, and mean Patient-Rated Wrist Evaluation (PRWE) score was 24. Mean forearm rotation arc was 151°. Mean active flexion-extension arc was 60°. Mean active extension was 34°. Mean grip strength was 14 kg (64% of contralateral wrist). Mean Lyon wrist score was 73%. Bone healing around the implants was satisfactory in all but one case. Conclusions Out data suggest that treatment of irreparable DRF in the independent elderly patient with a bone-preserving WHA may be a viable
Englund, U; Nordström, P; Nilsson, J; Hallmans, G; Svensson, O; Bergström, U; Pettersson-Kymmer, U
Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus. Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture. The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years. Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk. This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.
Hundrup, Yrsa Andersen; Høidrup, Susanne; Ekholm, Ola
To examine the effect of oestrogen alone and in combination with progestin on the risk of low-energy, hip, wrist, and upper arm fractures. Additionally, to examine to what extent previous use, duration of use as well as recency of discontinuation of hormone replacement therapy (HRT) influences...... the fracture risk....
Sloots, C.E.J.; Frolke, J.P.M.
A 44-year-old multiple injured patient presented with several fractures including a dislocated, comminuted radial head fracture after a 4 meter fall from a ladder. He was treated with radial head resection. However, at routine follow-up he indicated pain and loss of function of his wrist due to a
Friesgaard, K D; Gromov, K; Knudsen, Lisbeth F.
BACKGROUND: Substantial literature documents that persistent postsurgical pain is a possible outcome of many common surgical procedures. As fracture-related surgery implies a risk of developing neuropathic pain and complex regional pain syndrome (CRPS), further studies investigating the prevalence...... and pain characteristics are required. METHODS: All patients undergoing primary surgery because of ankle or wrist fracture at Hvidovre and Odense University Hospitals, Denmark, between April 15, 2013 and April 15, 2014, were identified from the Danish Fracture Database. A questionnaire regarding pain...... characteristics was sent to patients 1 yr after primary surgery. RESULTS: Replies were received from 328 patients, of whom 18.9% experienced persistent postsurgical pain defined as pain daily or constantly at a level that interfered much or very much with daily activities, 42.8% reported symptoms suggestive...
Costantino, Cosimo; Pogliacomi, Francesco; Passera, Francesco; Concari, Galeazzo
The Authors, after having defined the phenomenon and the biological characteristics of natural magnets, evaluate their ability in accelerating the formation of bone callus in hand and wrist fractures compared to treatment with immobilization in a plaster cast. Forty patients (4 females and 37 males) between 20 and 86 years of age were treated. A small natural magnet was inserted in each of the plaster casts (diameter: 2cm, height: 0.5cm) made of 4 blocks in Neodymium-Iron-Boron, capable of generating 4 magnetic poles (2 positive and 2 negative) of diagonal alternate polarity that produced a symmetric, quadruple static magnetic field. The created magnetic flow was wavelike, concentrated in one direction, and developed a force up to 12,500 gauss. From this study it has emerged that inserting a quadruple magnet in a plaster cast in hand and wrist fractures results in the formation of bone callus in an average time that is 35% inferior to the "standard" time. Accelerating the healing of the fracture is important since it reduces immobilization time for the joints involved, avoiding subsequent weakness and stiffness and allowing the patient to begin rehabilitative physiotherapy sooner, which permits a faster functional recovery.
Jarus, T; Shavit, S; Ratzon, N
The use of computers as a treatment modality in the occupational therapy hand clinic is, as yet, not common practice. A computer interface for wrist movements was developed, and a study to justify the application of such a device is presented. Forty-seven patients in a day hand clinic who had traumatic fracture of one hand with limitation of wrist mobility participated in the study. Participants were divided into two treatment groups: computer-aided treatment (high technology) and traditional brush machine treatment (low technology). A device was developed based on the brush machine in which the brush machine's mechanism was converted into a medial-lateral joystick. Right-to-left movements were digitally transformed for the use of a computer game. Participants were treated for 5 weeks, and outcome measures included range of motion (ROM), grip strength, edema, and level of interest. Results showed significant improvement in ROM, grip strength, and edema across 5 weeks for all participants. Although no significant differences were found between the two groups in ROM, grip strength, and edema, the computer-aided group showed significantly more interest in treatment than did the brush machine group. Finally, the interaction between treatment group and the attitude toward computers was not significant. These results indicate the potential for more interesting motor treatment and rehabilitation of the wrist through the use of computer games. The efficacy of using computers in occupational therapy clinics needs further investigation.
Karagiannopoulos, Christos; Sitler, Michael; Michlovitz, Susan; Tucker, Carole; Tierney, Ryan
Prospective cohort study. The active wrist joint position sense (JPS) test has been determined to be a clinically useful test for assessing wrist sensorimotor (SM) status after distal radius fracture (DRF). Its responsiveness is yet to be determined. Primary study aim was to determine the active wrist JPS test responsiveness to detect change in wrist SM status at 8 and 12 weeks after DRF treatment intervention. Secondary aims were to compare group (nonsurgical, surgical, high, and low pain) test responsiveness; compare pain-level group participants test scores; determine the relationship between test minimal clinically important difference (MCID) value and function; compare functional outcomes across assessment times; and determine the Patient Global Impression of Change Scale intrarater reliability. A total of 33 male and female participants were tested at baseline, 8, and 12 weeks after nonsurgical (n = 13) and surgical (n = 20) DRF treatment interventions. Distribution-based analysis encompassed both group- (ie, effect size, standardized response mean) and individual-based (ie, minimum detectable change) statistical indices. Anchor-based analysis determined the MCID value by linking test scores to the Patient Global Impression of Change Scale. The active wrist JPS test is highly responsive based on effect size (8 weeks = 1.53 and 12 weeks = 2.36) and standardized response mean (8 weeks = 1.57 and 12 weeks = 2.14). Statistically significant minimum detectable change values were 4.28° and 4.94° at 8 and 12 weeks, respectively. Clinically meaningful MCID values were 5.00° and 7.09° at 8 and 12 weeks, respectively. Between treatment type and pain-level group responsiveness levels were not significantly different. High-pain participants demonstrated significantly greater JPS deficit. Test MCID values and function were significantly associated. This is the first study to determine the active wrist JPS test responsiveness as reflected by its group- and
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Karagiannopoulos, Christos; Sitler, Michael; Michlovitz, Susan; Tierney, Ryan
Descriptive cross-sectional design. Wrist and hand sensori-motor impairment have been observed after distal radius fracture (DRF) treatment. This impairment and its relationship to function lack research. The primary aim of this exploratory study was to determine the magnitude of wrist and hand sensori-motor impairment following surgical and non-surgical treatment among older patients following DRF. Secondary aims were to determine the relationship between wrist and hand sensori-motor impairment with function and pain as well as the relationships among wrist and hand sensori-motor impairment and function and age following DRF. Ten Test (TT), active joint position sense (JPS), electromyography (EMG), computerized hand-grip dynamometer (CHD), and the Patient-Rated Wrist Evaluation (PRWE) were used to assess twenty-four female participants 8 weeks following DRF treatment and their 24 matched-control healthy counterparts on wrist and hand sensibility, proprioception, muscle recruitment, grip force, muscle fatigue, and functional status. Participants following DRF demonstrated significantly (p wrist and hand sensori-motor impairment and functional deficits among older females 8 weeks following DRF surgical and non-surgical interventions were revealed. JPS and total grip force were the most clinically meaningful tests for assessing the sensori-motor status as well as explaining functional disability and pain levels for these patients. 2c. Copyright © 2013 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Li, Gang-Jian; Ren, Wen-Jie; Min, Qi
To investigate the clinical effects of wrist joint fixation in flexion-ulnar position for the treatment of Colles fracture. From January 1998 to June 2008,120 patients with Colles fracture were treated with wrist joint fixation with plaster in flexion-ulnar position. There were 52 males and 68 females with an average age of 57.6 years (ranged, 22 to 90); 41 cases were left, 69 cases were right, and 10 cases were hibateral. All of them were fresh closed fractures. According to fracture displacement to typing, type I of 34 cases, type II of 36 cases, type III of 32 cases, type IV of 18 cases. With dislocated (II-IV type) 86 patients were followed up for 10 months in average. 86 cases with displaced fragments achieved clinical bony union. According to standard of Dienst, 59 cases got excellent results, 12 good, 10 fair, and 5 poor. The wrist fixation with plaster in flexion-ulnar position in treating Colles fracture may maintain good fixation after reduction and obtain better functional recovery.
Full Text Available Objective: This study was designed to evaluate anatomical and functional results of closed reduction-long arm cast treatment for distal radius fractures and compared other healthy wrist in the adults. Methods: 77 patients with distal radius fracture were treated conservatively between January 2010 and December 2010. The fractures were classified according to AO and Frykman classification system and investigated prospectively. The radiological and anatomical results were assessed by the Stewart score criteria. The functional results were assessed by Quick-Disability of Arm, Shoulder and Hand questionnaire (Q-DASH and the Stewart II score criteria. The mean follow-up of patients was 12 months. Results: The forty patients had right wrist fractured, 37 patients had left wrist fractured. According to Frykman classification 46 patients were type I-II fractured, according to AO classification 59 patients were type 23,A2,1 and 23,A2,2 fractured. According to Stewart the radiological and anatomical, the result were excellent in 57, good in 17, fair in 3. According to Stewart II functional criteria, the results were assessed excellent in 57, good in 8, fair in 12 The mean Q-DASH score was 6,37. The overall complication rate was 12.98%. Mild Carpal tunnel syndrome was observed in the two patients, ulna styloid nonunion in the four patients, pain of distal radioulnar joint in the one patient, mild carpal tunnel syndrome and tenderness of distal radioulnar joint in the three patients. Conclusion: Closed reduction and cast immobilization is still an effective and inexpensive treatment method in distal radial fractures. J Clin Exp Invest 2014; 5 (3: 403-409
Zhang, Xing-ping; Xu, Gen-rong; Xu, Shan-qiang; Lu, Ze-ming; Huang, Lei
To evaluate efficacy and safety of Baimai ointment (see symbol in text) in the treatment of wrist-dysfunction after distal radius fracture. From April, 2011 to June, 2012, 43 patients with distal radius fracture were treated with plaster fixation. All the patients were divided into two group: test group and control group. Twenty-one patients in test group and 22 in control group, and the baseline was balance (P > 0.05). The 21 patients in test group were treated with Baimai ointment (see symbol in text), fomentation, functional exercises. The 22 patients in control group were treated with placebo, fomentation, functional exercises. Foment affected side wrist with wet towel in 20 min before medication, with the temperature between 50 degrees C and 60 degrees C. Smear drugs uniformly in range of 3 cm in the vicinity of palm stripes after drying (about 3 g) and take functional exercises for the activities of wrist and hand. Continuous follow the program per 8 hours once and follow-up for 8 weeks. The Wrist's pain was assessed with VAS. The wrist's activities were measured with the protractor of orthopedic. Measure The grip strength was measured with dynamometer. The wrist's function were assessed with the table of Cooney. The test group had a significantly better results than those of control group in the extent of wrist's pain throughout the treatment (P Wrist's activities had no significane difference throughout the 8 weeks (P > 0.05). There were no drug adverse reactions occurred. Tibetan Baimai ointment (see symbol in text) has the treatment of wrist-dysfunction after distal radius fracture for external use, which can reduce the extent of wrist's pain, promote grip strength recovery in the middle and late of process, promote wrist's function recovery latterly, and safety for external use.
Chou, Po-Hsin; Feng, Chi-Kuang; Chiu, Fang-Yao; Chen, Tain-Hsiung
Muscle disability is a common sequel after fracture management. Previous research has shown divergent results concerning muscle-power recovery after bone healing. This study has investigated the muscle function of wrist extensors after lateral condylar fracture in children, as evaluated by a hand-held dynamometer and compared with sex- and age-matched children. From 1999 to 2004, 20 patients (13 boys and seven girls; mean age: 9 years and 4 months) with displaced lateral condylar fracture of the humerus were treated by open reduction and internal fixation with Kirschner wires (K-wire). The duration of K-wire fixation was 35 days and the mean follow-up time was 50 months. A total of 180 healthy age-, sex- and weight-matched children were used as control groups. A paired Student's test was applied for the analysis of statistical significance. The range of motion of the elbow and radiographic findings were not significantly different between the injured limb and normal control groups. The maximum isometric power of wrist-extensor muscles after surgical treatment of lateral condylar fracture of the humerus in final follow-up was not statistically different from that in the normal control children. Muscle power therefore recovers to its normal status after the healing of lateral condylar fracture of the humerus in children.
Majumdar, Sumit R; Rowe, Brian H; Folk, Deb; Johnson, Jeffrey A; Holroyd, Brian H; Morrish, Donald W; Maksymowych, Walter P; Steiner, Ivan P; Harley, Charles H; Wirzba, Brian J; Hanley, David A; Blitz, Sandra; Russell, Anthony S
Despite the high risk for future fractures and the availability of effective treatments, fewer than 10% to 20% of patients who sustain a fragility fracture are tested or treated for osteoporosis. To improve rates of testing and treatment for osteoporosis in patients with wrist fractures who are seen in the emergency department. Nonrandomized, controlled trial with blinded ascertainment of outcomes. Emergency departments in Edmonton, Alberta, Canada. Persons 50 years of age or older who were treated for a wrist fracture and their physicians. Patients admitted to the hospital or treated for osteoporosis were excluded. Overall, 572 consecutive patients with fractures were screened, and 102 patients (55 intervention, 47 control) and 101 physicians were studied. The primary end point was the prescription of osteoporosis treatment 6 months after fracture. Secondary end points included rates of testing for bone mineral density and patients' knowledge, satisfaction, and quality of life. Faxed physician reminders that contained osteoporosis treatment guidelines endorsed by local opinion leaders and patient education. Control patients received usual care and information about falls and home safety. The median patient age was 66 years. Most patients were female (78%) and white (79%); 70% of patients reported a previous fracture, and 22% had a fall with injury in the previous year. The intervention increased the rates of testing for bone mineral density to 62% (vs. 17% for controls; adjusted relative increase, 3.6 [P Intervention patients were more likely to report a diagnosis of osteoporosis, but other patient-reported outcomes did not differ significantly between groups. This was a small, nonrandomized, controlled study with process-based outcomes. In a multifaceted intervention directed at patients and their physicians, the rates of testing and treatment for osteoporosis after emergency department care for a fragility fracture were more than 3 times those of controls.
Arun Kumar Agnihotri
ABSTRACT: Isolated fracture of the pisiform is an extremely rare injury. Generally fractures of the pisiform are associated with fractures of other carpal bones or the distal radius. Fractures of the carpals and metacarpals account for roughly 6% of all fractures. The average incidence of pisiform fractures is 0.2% of all carpal ...
Javadzadeh, Hamid Reza; Davoudi, Amir; Davoudi, Farnoush; Ghane, Mohammad Reza; Khajepoor, Hojatolla; Goodarzi, Hasan; Faraji, Mehrdad; Mahmoudi, Sadrollah; Shariat, Somayeh Sadat; Emami Meybodi, Kazem
Bedside ultrasonography (BUS) has been widely used in many emergency evaluations, but the technique was not thoroughly evaluated for use in adult fractures. The water bath technique (WBT) is a modality which overcomes some important limitations of using BUS in extremity fractures. The study aims to evaluate and compare diagnostic values of BUS and WBT. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-), and accuracy of BUS and WBT were calculated and compared by the McNemar chi-square test. BUS had the highest sensitivity, specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of BUS were seen in phalangeal and wrist injuries, respectively. The WBT examination had the highest sensitivity in phalangeal injuries and the highest specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of the WBT examination were seen in phalangeal and wrist injuries, respectively. The McNemar χ (2) values for the comparison of BUS and WBT indicate that the two techniques provide statistically different results. The ultrasound revealed excellent diagnostic values which make it a favorable alternative in evaluating upper extremity fractures in adults. The WBT provides even better results.
Wrist surgery; Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release ... you will have regional anesthesia. Your arm and wrist area will be numbed so that you do ...
Nanno, Mitsuhiko; Kodera, Norie; Tomori, Yuji; Takai, Shinro
We investigated the movement of the flexor pollicis longus (FPL) tendon on the distal radius during wrist and finger motions using transverse ultrasound in patients with distal radius fractures who underwent volar locking plating. Both wrists of 39 distal radius fracture patients with volar locking plate fixation were evaluated by transverse ultrasound to examine the location of the FPL tendon on the distal radius at varied wrist positions in full finger extension and flexion. At all wrist positions during finger motion, the FPL tendon shifted significantly more dorsally on the affected side than on the unaffected side. Additionally, at the wrist dorsal flexion position with finger flexion, the FPL tendon moved significantly the most dorsally, and the distance between the FPL tendon and the plate or the radius was the smallest among all wrist positions during finger motion. This study showed that the wrist dorsal flexion position with finger flexion could be the appropriate position to examine FPL tendon irritation after plating. Moreover, it would be effective for preventing FPL rupture to cover the FPL transverse gliding area approximately 10 mm radial to the vertex of the palmar bony prominence of the distal radius with the pronator quadratus and the intermediate fibrous zone.
Full Text Available To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT and to radiography equivalent dose cone beam computed tomography (RED-CBCT for wrist fractures.As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100 were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care, RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT.Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004. No significant differences were detected concerning the modalities' specificities (with values between P = .98. Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001.The diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.
Lewandowski, Beth E.; Myers, Jerry G.; Sulkowski, C.; Ruehl, K.; Licata, A.
The possibility of bone fracture in space is a concern due to the negative impact it could have on a mission. The Bone Fracture Risk Module (BFxRM) developed at the NASA Glenn Research Center is a statistical simulation that quantifies the probability of bone fracture at specific skeletal locations for particular activities or events during space exploration missions. This paper reports fracture probability predictions for the proximal femur and wrist resulting from a fall to the side during an extravehicular activity (EVA) on specific days of lunar and Martian exploration missions. The risk of fracture at the proximal femur on any given day of the mission is small and fairly constant, although it is slightly greater towards the end of the mission, due to a reduction in proximal femur bone mineral density (BMD). The risk of wrist fracture is greater than the risk of hip fracture and there is an increased risk on Mars since it has a higher gravitational environment than the moon. The BFxRM can be used to help manage the risk of bone fracture in space as an engineering tool that is used during mission operation and resource planning.
Griffin, M; Malahias, M; Hindocha, S; Khan, W
Compound lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone injury and potential vascular compromise. These fractures require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties, to ensure good clinical outcomes. Extensive research has improved the outcomes of compound lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of compound tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, antibiotic regime and soft tissue coverage will be outlined as well as the indications for amputation.
Neubauer, Jakob; Benndorf, Matthias; Reidelbach, Carolin; Krauß, Tobias; Lampert, Florian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Fiebich, Martin; Goerke, Sebastian M
To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures. As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT. Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = radiography (P radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.
Walenkamp, Monique M J; de Muinck Keizer, Robert-Jan; Goslings, J Carel; Vos, Lara M; Rosenwasser, Melvin P; Schep, Niels W L
The Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable change (MDC). The MCID of an outcome tool like the PRWE is defined as the smallest change in a score that is likely to be appreciated by a patient as an important change, while the MDC is defined as the smallest amount of change that can be detected by an outcome measure. A numerical change in score that is less than the MCID, even when statistically significant, does not represent a true clinically relevant change. To our knowledge, the MCID and MDC of the PRWE have not been determined in patients with distal radius fractures. We asked: (1) What is the MCID of the PRWE score for patients with distal radius fractures? (2) What is the MDC of the PRWE? Our prospective cohort study included 102 patients with a distal radius fracture and a median age of 59 years (interquartile range [IQR], 48-66 years). All patients completed the PRWE questionnaire during each of two separate visits. At the second visit, patients were asked to indicate the degree of clinical change they appreciated since the previous visit. Accordingly, patients were categorized in two groups: (1) minimally improved or (2) no change. The groups were used to anchor the changes observed in the PRWE score to patients' perspectives of what was clinically important. We determined the MCID using an anchor-based receiver operator characteristic method. In this context, the change in the PRWE score was considered a diagnostic test, and the anchor (minimally improved or no change as noted by the patients from visit to visit) was the gold standard. The optimal receiver operator characteristic cutoff point calculated with the Youden index reflected the value of the MCID. In our study, the MCID of the PRWE was 11.5 points
Larsen, C F; Lauritsen, Jens
Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....
... Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Sprains Email to a friend * required fields From * ... most common ligament to be injured in the wrist is the scapho-lunate ligament (see Figure 2). ...
Luek, Jenna L; Gonsior, Michael
High volume hydraulic fracturing (HVHF) of shale to stimulate the release of natural gas produces a large quantity of wastewater in the form of flowback fluids and produced water. These wastewaters are highly variable in their composition and contain a mixture of fracturing fluid additives, geogenic inorganic and organic substances, and transformation products. The qualitative and quantitative analyses of organic compounds identified in HVHF fluids, flowback fluids, and produced waters are reviewed here to communicate knowledge gaps that exist in the composition of HVHF wastewaters. In general, analyses of organic compounds have focused on those amenable to gas chromatography, focusing on volatile and semi-volatile oil and gas compounds. Studies of more polar and non-volatile organic compounds have been limited by a lack of knowledge of what compounds may be present as well as quantitative methods and standards available for analyzing these complex mixtures. Liquid chromatography paired with high-resolution mass spectrometry has been used to investigate a number of additives and will be a key tool to further research on transformation products that are increasingly solubilized through physical, chemical, and biological processes in situ and during environmental contamination events. Diverse treatments have been tested and applied to HVHF wastewaters but limited information has been published on the quantitative removal of individual organic compounds. This review focuses on recently published information on organic compounds identified in flowback fluids and produced waters from HVHF. Copyright © 2017 Elsevier Ltd. All rights reserved.
Laulan, J; Marteau, E; Bacle, G
Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Walenkamp, Monique M. J.; de Muinck Keizer, Robert-Jan; Goslings, J. Carel; Vos, Lara M.; Rosenwasser, Melvin P.; Schep, Niels W. L.
The Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable
Strobel, U; Tami, I; Andreisek, G; Giovanoli, P; Calcagni, M
The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE). In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS. Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results. MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid
Kekacs, Daniel; Drollette, Brian D; Brooker, Michael; Plata, Desiree L; Mouser, Paula J
Little is known of the attenuation of chemical mixtures created for hydraulic fracturing within the natural environment. A synthetic hydraulic fracturing fluid was developed from disclosed industry formulas and produced for laboratory experiments using commercial additives in use by Marcellus shale field crews. The experiments employed an internationally accepted standard method (OECD 301A) to evaluate aerobic biodegradation potential of the fluid mixture by monitoring the removal of dissolved organic carbon (DOC) from an aqueous solution by activated sludge and lake water microbial consortia for two substrate concentrations and four salinities. Microbial degradation removed from 57 % to more than 90 % of added DOC within 6.5 days, with higher removal efficiency at more dilute concentrations and little difference in overall removal extent between sludge and lake microbe treatments. The alcohols isopropanol and octanol were degraded to levels below detection limits while the solvent acetone accumulated in biological treatments through time. Salinity concentrations of 40 g/L or more completely inhibited degradation during the first 6.5 days of incubation with the synthetic hydraulic fracturing fluid even though communities were pre-acclimated to salt. Initially diverse microbial communities became dominated by 16S rRNA sequences affiliated with Pseudomonas and other Pseudomonadaceae after incubation with the synthetic fracturing fluid, taxa which may be involved in acetone production. These data expand our understanding of constraints on the biodegradation potential of organic compounds in hydraulic fracturing fluids under aerobic conditions in the event that they are accidentally released to surface waters and shallow soils.
... wrist. These can include football, bowling, golf, gymnastics, snowboarding and tennis. Repetitive work. Almost any activity that ... guards for high-risk activities, such as football, snowboarding and rollerblading. Pay attention to ergonomics. If you ...
Martin, Jennifer L.; Hakim, Alex D.
To record sleep, actigraph devices are worn on the wrist and record movements that can be used to estimate sleep parameters with specialized algorithms in computer software programs. With the recent establishment of a Current Procedural Terminology code for wrist actigraphy, this technology is being used increasingly in clinical settings as actigraphy has the advantage of providing objective information on sleep habits in the patient’s natural sleep environment. Actigraphy has been well valid...
Case 1: A 25 year old right handed male soldier who was referred to Kenyatta National Hospital (KNH) in February 2008, from Burundi, with non-union of the left humerus and wrist drop. He sustained a compound fracture of the humerus and wrist drop following a gunshot injury a year earlier. Open reduction, plating of the ...
Thorpe, Donna L; Knutsen, Synnove F; Beeson, W Lawrence; Rajaram, Sujatha; Fraser, Gary E
Evidence suggesting that a diet high in fruits and vegetables may be beneficial to bone health has sparked interest in the potential benefit of a vegetarian diet. However, other studies have raised a question regarding the adequacy of protein in such a diet. The aim of the present study was to take a whole foods approach in examining the effects of foods high in protein on the risk of wrist fracture (WF) in a cohort with a significant proportion consuming a meat-free diet. A cohort study of women who completed two lifestyle surveys 25 years apart. One thousand eight hundred and sixty-five peri- and postmenopausal women at the time of the first survey. There was a significant interaction between meat consumption and foods high in vegetable protein. Among vegetarians, those who consumed the least vegetable protein intake were at highest risk for fracture. However, increasing levels of plant-based high-protein foods decreased WF risk, with a 68% reduction in risk (hazard ratio (HR) = 0.32, 95% confidence interval (CI) 0.13-0.79) in the highest intake group. Among those with lowest vegetable protein consumption, increasing meat intake decreased the risk of WF, with the highest consumption decreasing risk by 80% (HR = 0.20, 95% CI 0.06-0.66). The finding that higher consumption frequencies of foods rich in protein were associated with reduced WF supports the importance of adequate protein for bone health. The similarity in risk reduction by vegetable protein foods compared with meat intake suggests that adequate protein intake is attainable in a vegetarian diet.
Onuma, Kenji; Shintani, Ryosuke; Fujimaki, Hisako; Sukegawa, Koji; Kenmoku, Tomonori; Uchida, Kentaro; Takahira, Naonobu; Takaso, Masashi
This study aims to retrospectively review the short-term surgical outcome of wrist fusion using wrist fusion rod (WFR). Six wrists of four female patients (mean age 56 years; range 51 to 62 years) with advanced stage rheumatoid arthritis of Larsen IV or V were performed total wrist fusion using WFR. Clinical outcome was assessed using a numeric rating scale of pain satisfaction level. Bony fusion, correction of palmar subluxation and ulnar deviation, rod bending angle, wrist fusion angle, and complications were assessed from radiographs. All wrists achieved painless wrist stability with bony fusion of the radiocarpal joint. Both the palmar subluxation and ulnar deviation were corrected in all patients. Two radiographic complications were observed: rod fracture in one patient and a radiolucent line in proximal metacarpal bone in another patient. Both complications might have occurred as a result of instability of the third carpometacarpal joint, but neither influenced clinical outcome. Wrist fusion angle was smaller than rod bending angle at final observation. Wrist fusion using WFR is an option for the treatment of advanced stage rheumatoid arthritis of wrist. According to our experience, the stability of third carpometacarpal joint should be assessed before surgery, and this joint should be fused if required. The bending angle of the intramedullary rod does not directly form the wrist fusion angle in contrast to the case with a dorsal wrist fusion plate.
Plata, D.; Shregglman, K.; Elsner, M.; Getzinger, G.; Ferguson, L.; Drollette, B.; Karatum, O.; Nelson, R. K.; Reddy, C. M.
Current hydraulic fracturing technologies rely on organic chemicals to serve multiple critical functions, including corrosion inhibition, in situ gel formation, and friction reduction. While industrial users have disclosed several hundreds of compound and mixture identities, it is unclear which of these are used and where, in what proportion, and with what frequency. Furthermore, while flowback and production waters contain both fracturing additive and geogenic compounds, they may contain potential reaction byproducts as well. Here, we identified several hundred organic compounds present in six hydraulic fracturing flowback waters over the Fayetteville shale. Identifications were made via non-target analysis using two-dimensional gas chromatography with time of flight mass spectrometry for hydrophobic organic compounds and liquid chromatography- orbitrap mass spectrometry. Compound identities were confirmed using purchased standards when available. Using the SkyTruth database and the Waxman list of disclosed compounds, we assigned compounds as either fracturing-fluid-derived or geogenic (or both), or a putative transformation products thereof. Several unreported halogenated compounds were detected, including chlorinated, brominated, and iodated species that have no known natural sources. Control studies indicated that these could not be formed under typical laboratory or field storage conditions, suggesting that halogenation reactions may give rise to novel compounds in the subsurface, presumably via reaction between fracturing fluid additives and shale-derived brines. Further, the six samples were strikingly heterogeneous, reflecting the diversity in fracturing fluid composition and flowback handling procedures at the time of the study.
Full Text Available We report about a dorsal dislocation of the lunate accompanied by a trapezoid fracture in a 41-year old male patient after a motorcycle accident. The lunate dislocation with no dorsal or volar intercalated segment instability (DISI, VISI was diagnosed by x-ray whereas the trapezoid fracture was only diagnosable by computed tomography. A closed reduction and internal fixation of the lunate by two Kirschner wires was performed, the trapezoid fracture was conservatively treated. Surgery was followed by immobilization, intense physiotherapy and close follow-up. Even though complaints such as swelling and pain subsided during the course of rehabilitation, partial loss of strength and range of motion remained even after 16 months. In conclusion, a conservative treatment of trapezoid fractures seems to be sufficient in most cases. Closed reduction with Kwire fixation led to an overall satisfactory result in our case. For dorsal lunate dislocations in general, open reduction should be performed when close reduction is unsuccessful or DISI/VISI are observed in radiographs after attempted close reduction.
Bickel, Kyle D
This article reviews the superficial, skeletal, and ligamentous anatomy of the wrist. Standard and alternative exposures of the wrist joint and the distal radioulnar joint are discussed, emphasizing the importance of avoiding nerve injury. Standard exposure of the wrist joint is used in the treatment of carpal ligament injuries, fractures, and dislocations. Case presentations illustrate these techniques. Copyright © 2014 Elsevier Inc. All rights reserved.
... Therapist? Media Find a Hand Surgeon Home Anatomy Hand Tumors and Wrist Tumors Email to a friend * ... are seen commonly. CAUSES Common Types of Wrist Hand Tumors Ganglion Cysts (Figure 1): This is the ...
... this page: //medlineplus.gov/ency/patientinstructions/000568.htm Wrist sprain - aftercare To use the sharing features on ... that hold bones together. When you sprain your wrist, you have pulled or torn one or more ...
... a compartment called the carpal tunnel in the wrist. The ligaments that transverse the nerve are not ... flexible. If there is any swelling within the wrist compartment excessive pressure can be put on structures ...
Full Text Available Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95% treated by unreamed and 19 (95% fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate
Vulava, Vijay M; McKay, Larry D; Broholm, Mette M; McCarthy, John F; Driese, Steven G; Sayler, Gary S
We investigated the dissolution and transport of organic contaminants from a crude coal tar mixture in a monolith of fractured clay-rich residuum. An electrolyte solution was eluted through the residuum monolith containing a small emplaced source of coal tar under biologically inhibited and mildly acidic conditions. Concentrations of 10 coal tar compounds, representing mono-, poly-, and heterocyclic aromatic hydrocarbons that constitute crude coal tar were monitored in the effluent over a period of 377 days. Most compounds appeared in the effluent within the first 0.1 pore volume eluted indicating the importance of rapid dissolution and transport through the fracture networks. The concentrations continued to rise but did not reach the corresponding effective solubility limit in most cases. Compounds that were less soluble and those that were more susceptible to sorption or matrix diffusion eluted at a much slower rate. Analysis of contaminant concentrations in microcore residuum samples indicated that all 10 compounds had spread throughout the entire monolith and had diffused into the fine-grained matrix between fractures. These data suggest that the predominantly fine pore structure did not appear to inhibit coal tar dissolution and subsequent transport, even though only a small portion of tar was in direct contact with fractures and macropores that control most flow. Copyright © 2011 Elsevier B.V. All rights reserved.
Luek, Jenna L; Schmitt-Kopplin, Philippe; Mouser, Paula J; Petty, William Tyler; Richardson, Susan D; Gonsior, Michael
Large volumes of water return to the surface following hydraulic fracturing of deep shale formations to retrieve oil and natural gas. Current understanding of the specific organic constituents in these hydraulic fracturing wastewaters is limited to hydrocarbons and a fraction of known chemical additives. In this study, we analyzed hydraulic fracturing wastewater samples using ultrahigh resolution Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) as a nontargeted technique to assign unambiguous molecular formulas to singly charged molecular ions. Halogenated molecular formulas were identified and confirmed using isotopic simulation and MS-MS fragmentation spectra. The abundance of halogenated organic compounds in flowback fluids rather than older wastewaters suggested that the observed molecular ions might have been related to hydraulic fracturing additives and related subsurface reactions, such as through the reaction of shale-extracted chloride, bromide, and iodide with strong oxidant additives (e.g., hypochlorite, persulfate, hydrogen peroxide) and subsequently with diverse dissolved organic matter. Some molecular ions matched the exact masses of known disinfection byproducts including diiodoacetic acid, dibromobenzoic acid, and diiodobenzoic acid. The identified halogenated organic compounds, particularly iodinated organic molecules, are absent from inland natural systems and these compounds could therefore play an important role as environmental tracers.
Full Text Available Objective: Patients often reach the hospital late after passage of golden hours (initial 6 hours after sustaining high-velocity injuries. The decision of internal fixation in Gustilo′s Type IIIA and IIIB fractures becomes a formidable challenge in patients reaching late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients. Materials and Methods: Sixty-three patients, having 70 compound fractures (46 Type IIIA and 24 IIIB, which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged from 18 to 48 months with mean of 28 months. Result: Overall infection rate noted was (n = 11 15.71% (8.7% in IIIA, and 29.16% in IIIB. The difference in deep infection rate between Type IIIA and Type IIIB was found to be statistically significant ( P value < 0.01. Nonunion was seen in five fractures. Functional evaluation using Katenjian′s criteria, showed 62.85% (44 fractures of 70 good to excellent results. Conclusion: Satisfactory results may be obtained in Gustilo′s Type IIIA and IIIB fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged.
Shin, Joong-Il; Park, Soo-Hee
[Purpose] This study aimed to investigate the degree of straightness of the wrist joint, depending on the use of a wrist splint while opening a bottle cap. Its results may provide data for later studies on preventing accidents at workplaces and improving efficiency. [Subjects and Methods] Thirty Male and Female in their twenties who did not have hand-related diseases, fractures, or history that included neurological impairments associated with the hand were selected as subjects of the study. Wrist splints were made to fit the hand and lower arm of each subject. Evaluation assignments were carried out without and with the splints after 10 minutes of rest. To analyze the wrist movement in opening the bottle cap, a three-dimensional movement analyzing system by Zebris was used. [Results] Wrist angle decreased while opening caps of four different diameters while wearing splints, but not when splints were not worn. This means that wearing a splint may aid weakened wrist muscles. [Conclusion] Future studies should be conducted among subjects with damaged wrist muscles and evaluate the subjects in actual workplaces to obtain more objective and more valid data.
The subject of this thesis is an initiative for improving the education of residents in surgical skills and knowledge by using the current technical possibilities. The choice of wrist arthroscopy was driven by the fact that novel techniques have recently been developed within hand and wrist surgery
Full Text Available Fractures of the carpal bones are quite rare in skeletally immature patients. The diagnosis is difficult in young children since ossification of the carpal bones is not complete, and the majority of them are cartilaginous. Conventional radiography may be inadequate for the diagnosis or may lead to misdiagnosis. Therefore, computed tomography (CT and magnetic resonance imaging (MRI are quite important in establishing the diagnosis and planning treatment especially in suspected cases, in which direct radiography is inadequate. We decided on a treatment with the help of CT and MRI for a 7-year-old pediatric case who has simultaneous capitate and hamate fractures which is very rare combination of childhood carpal bone injuries. Consequently, we practised treatments successfully by conservative methods. By presenting this case, we emphasised the diagnosis and treatment of the carpal bone fractures, by CT and MRI at the skeletally immature patients. [Hand Microsurg 2012; 1(1.000: 33-36
Strunk, S; Bracker, W
The advantage of wrist arthroplasty remains controversial, primarily due to the high complication rate. For this reason it seems sensible to monitor the results of different types of prostheses even with small numbers of cases. We were particularly interested to see if wrist joint arthroplasty is a useful alternative for patients with rheumatoid arthritis, and which of the types we used shows the best results. In our hospital, 41 wrist joint prostheses (15 Meuli, 16 BIAX and 10 Universal 2) were implanted in 36 patients from 1992 until 2005 (follow-up 1 to 14 years, mean 5.3 years). 33 patients had rheumatic destruction of the wrist, two had osteoarthritis following fracture of the scaphoid, and one pseudarthrosis after failed arthroplasty and arthrodesis for Kienböck's disease. Mean age was 54 years, ranging from 34 to 73 years. 14 patients had had surgery on this wrist before. The patients were sent a questionnaire including the DASH score, and a clinical evaluation and X-rays were performed. 33 patients with 38 wrist arthroplasties answered the questionnaire, 34 wrist joint prosthesis of 29 patients could be evaluated. 6 prostheses had to be removed because of complications (3 arthrodeses were performed after removal, 3 prostheses were exchanged). There were 4 dislocations (3 times with the Meuli type, once with the BIAX type). There was one case of CRPS type I. But subjectively, in answering our questionnaire, 31 of 38 patients claimed to be very satisfied or satisfied with the result of the operation, only 6 were less satisfied or not satisfied at all. An improvement of pain was found by all but one patient. An increase in strength or range of movement was found more rarely. The mean postoperative DASH score was 61 points. Mean wrist joint mobility was 50 degrees for extension/flexion, and 20 degrees for radial- and ulnar abduction. The result of total wrist joint arthroplasty depends very much on a careful patient selection. A preoperative bony malposition
Brutus, J P; Chahidi, N
An unusual fracture of the scaphoid occurred in an otherwise healthy young badminton player, caused by a violent movement of extension/flexion of the wrist while performing a smash. There was no direct blow or fall on the wrist, nor history of wrist pain prior to the fracture. No underlying pathology was identified. Conservative treatment failed and surgical stabilization was required to achieve bone union. The diagnosis of stress fracture was suggested. The characteristics of these uncommon fractures are reviewed.
Kersten, L.; Johnson, J. D. (Inventor)
A wrist joint assembly is provided for use with a mechanical manipulator arm for finely positioning an end-effector carried by the wrist joint on the terminal end of the manipulator arm. The wrist joint assembly is pivotable about a first axis to produce a yaw motion, a second axis is to produce a pitch motion, and a third axis to produce a roll motion. The wrist joint assembly includes a disk segment affixed to the terminal end of the manipulator arm and a first housing member, a second housing member, and a third housing member. The third housing member and the mechanical end-effector are moved in the yaw, pitch, and roll motion. Drive means are provided for rotating each of the housings about their respective axis which includes a cluster of miniature motors having spur gears carried on the output drive shaft which mesh with a center drive gear affixed on the housing to be rotated.
Ihrke, Chris A. (Inventor); Bridgwater, Lyndon (Inventor); Reich, David M. (Inventor); Wampler, II, Charles W. (Inventor); Askew, Scott R. (Inventor); Diftler, Myron A. (Inventor); Nguyen, Vienny (Inventor)
A humanoid robot includes a torso, a pair of arms, a neck, a head, a wrist joint assembly, and a control system. The arms and the neck movably extend from the torso. Each of the arms includes a lower arm and a hand that is rotatable relative to the lower arm. The wrist joint assembly is operatively defined between the lower arm and the hand. The wrist joint assembly includes a yaw axis and a pitch axis. The pitch axis is disposed in a spaced relationship to the yaw axis such that the axes are generally perpendicular. The pitch axis extends between the yaw axis and the lower arm. The hand is rotatable relative to the lower arm about each of the yaw axis and the pitch axis. The control system is configured for determining a yaw angle and a pitch angle of the wrist joint assembly.
Faraquddin Ahamed, Mohamed Athiq
Robo-wrist controller is a Graphical User Interface (GUI) based application designed and developed to control, and monitor a wrist exoskeleton driven by micro-controllers. The software application is developed to better assist a physiotherapist in administering physical therapy to stroke patients with the help of the exoskeleton. Since the micro-controller device that directly controls the exoskeleton is not very intuitive to use and lacks visual feedback, a software application fills these g...
Dick, Elizabeth A. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)], E-mail: firstname.lastname@example.org; Burnett, Carole; Gedroyc, Wladyslaw M.W. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)
Magnetic resonance imaging of the wrist is increasingly recognised as the imaging modality of choice in wrist disorders as image resolution improves and clinicians realise its potential. Consequently the ability to confidently interpret such imaging will become more important to both general and musculoskeletal radiologists. This article reviews current optimal imaging protocols and describes common abnormalities with a particular emphasis on less well understood topics such as intercalated segment instability, the triangular fibrocartilage complex and carpal tunnel syndrome.
M.M.J. Walenkamp (Monique); A. Bentohami (Abdelali); A. Slaar (Annelie); M.S.H. Beerekamp (Suzan); M. Maas (Mario); L.C. Jager (L. Cara); N.L. Sosef (Nico L.); R. van Velde (Romuald); J.M. Ultee (Jan); E.W. Steyerberg (Ewout); J.C. Goslings (Carel); N.W.L. Schep (Niels)
textabstractBackground: Although only 39 % of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma
Anyanechi, Charles E.; Saheeb, Birch D.
Objective The aim of this study was to evaluate the relationship between the degree of preoperative pain and trismus with the development of complications following the repair of isolated unilateral compound mandibular body fractures using a closed reduction technique. Subjects and Methods This was a 7-year prospective study carried out at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria. Of a total of 97 patients, 83 (85.6s%) subjects (66 males, 17 females, ratio 5:1) were preoperatively evaluated for trismus and pain in a blinded manner by a single examiner, and complications were recorded postoperatively. The data obtained were statistically analyzed with EPI Info 2008 software. Results Of the 83 patients treated, 13 (15.7s%) developed complications. The fractures were most common in the age range of 21–40 years (n = 45, 54.2s%). The age (p = 0.02) and gender (p = 0.01) distribution of the subjects was significant. The more severe the limitation of mouth opening (p = 0.03) and pain (p = 0.04) before treatment, the more complications developed, and these significantly affected treatment outcome. Impaired mastication and facial asymmetry (n = 17, 41.5s%) were the most common complications. Conclusion This study showed that posttrauma pain and trismus due to unilateral mandibular body fractures may be associated with the development of complications. An adequately powered prospective study treating patients at 5 or 7 days is required in order to make the case for later intervention. PMID:25791420
Sánchez León, Belisario; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...
Shapiro, Allen M; Tiedeman, Claire R; Imbrigiotta, Thomas E; Goode, Daniel J; Hsieh, Paul A; Lacombe, Pierre J; DeFlaun, Mary F; Drew, Scott R; Curtis, Gary P
A mass balance is formulated to evaluate the mobilization of chlorinated ethene compounds (CE) from the rock matrix of a fractured mudstone aquifer under pre- and postbioremediation conditions. The analysis relies on a sparse number of monitoring locations and is constrained by a detailed description of the groundwater flow regime. Groundwater flow modeling developed under the site characterization identified groundwater fluxes to formulate the CE mass balance in the rock volume exposed to the injected remediation amendments. Differences in the CE fluxes into and out of the rock volume identify the total CE mobilized from diffusion, desorption, and nonaqueous phase liquid dissolution under pre- and postinjection conditions. The initial CE mass in the rock matrix prior to remediation is estimated using analyses of CE in rock core. The CE mass mobilized per year under preinjection conditions is small relative to the total CE mass in the rock, indicating that current pump-and-treat and natural attenuation conditions are likely to require hundreds of years to achieve groundwater concentrations that meet regulatory guidelines. The postinjection CE mobilization rate increased by approximately an order of magnitude over the 5 years of monitoring after the amendment injection. This rate is likely to decrease and additional remediation applications over several decades would still be needed to reduce CE mass in the rock matrix to levels where groundwater concentrations in fractures achieve regulatory standards. © 2017, National Ground Water Association.
Eckmann, Johan Høising; Brix, Lau; Nielsen, Randi
by X-ray (Fractured radius = 12, fractures carpalbones = 3, bone bruise = 4, fractured scaphoid = 3, other pathology = 3, noappreciable disease = 15). Discussion:The standard strategy for unraveling wrist injuries is by conventional X-ray.This approach is fast, economically feasible and is able...... strength, lower mobility andincreased risk of degenerative joint disease. The standard approach fordiagnosing fractures or injuries of the ligaments is by conventional X-ray. Ifno pathology can be established and there is a suspected scaphoid bone fracturea supplemental MRI of the wrist is performed....... The MRI often show pathology inthe wrist which is not visible on X-ray. The purposeof this project was to evaluate how often the supplemental MRI of the wrist wasable to demonstrate pathology which was invisible using standard X-ray. Subjects& Methods: Forty women were included in the study (mean age...
capsular) and 10 extra capsular)., 5 fractures of the distal wrist and 8 humeral fractures, 4 rib fractures, 6 pelvic fractures, 2 sternal fractures and 6 tibial fractures. Twenty six (40%) of the above fractures namely the vertebral, ribs, pelvis and sternum ...
Compliant element for robot wrist accepts small displacements in one direction only (to first approximation). Three such elements combined to obtain translational compliance along three orthogonal directions, without rotational compliance along any of them. Element is double-blade flexure joint in which two sheets of spring steel attached between opposing blocks, forming rectangle. Blocks moved parallel to each other in one direction only. Sheets act as double cantilever beams deforming in S-shape, keeping blocks parallel.
This animated gif shows a series of images taken by Phoenix's Stereo Surface Imager (SSI) on Sol 3. It illustrates the actions that Phoenix's Robotic Arm took to deploy its wrist. The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.
Does Total Wrist Arthroplasty for Treatment of Posttraumatic Wrist Joint Osteoarthritis in Young Patients Always Lead to Restriction of High-demand Activities of Daily Living? Case Report and Brief Review of Recent Literature.
Posttraumatic ulnar carpal translocation is a very rare condition that is caused either by fracture-dislocation injury or by purely ligamentous injury of the wrist. Its prognosis is poor and development of posttraumatic pancarpal wrist joint osteoarthritis is inevitable, and options for treatment are total wrist fusion or total wrist arthroplasty. A 24-year-old male sustained a fracture-related injury in his left wrist that was accompanied with a second ligamentous distorsion-related injury 1 year later in the same wrist. Seven years after first injury, a posttraumatic pancarpal wrist joint osteoarthritis has developed that was caused by posttraumatic ulnar carpal translocation. The patient was treated by total wrist arthroplasty with use of the Maestro(TM) Wrist Reconstructive System. With our patient, it is unclear whether posttraumatic ulnar carpal translocation occurred either as result of the first fracture-related injury or as result of the second ligamentous distorsion-related injury or as result of both injuries. The 31-year-old patient could be reemployed completely in his original occupation as a mechanic for big agriculture machines and load his wrist with more than 10 pounds. In order to preserve motion, the patient reported that he would undergo the same total wrist arthroplasty a second time were it necessary. We report on a young male receiving total wrist arthroplasty and resulting in good restoration of his high-demand claims in activities of daily living, respectively. However, it cannot be concluded that total wrist arthroplasty is to be preferred generally over total wrist fusion in young patients. Essential prerequisite for this motion-preserving procedure is the compliance of patients.
Stringfellow, William T; Domen, Jeremy K; Camarillo, Mary Kay; Sandelin, Whitney L; Borglin, Sharon
Hydraulic fracturing (HF), a method to enhance oil and gas production, has become increasingly common throughout the U.S. As such, it is important to characterize the chemicals found in HF fluids to evaluate potential environmental fate, including fate in treatment systems, and human health impacts. Eighty-one common HF chemical additives were identified and categorized according to their functions. Physical and chemical characteristics of these additives were determined using publicly available chemical information databases. Fifty-five of the compounds are organic and twenty-seven of these are considered readily or inherently biodegradable. Seventeen chemicals have high theoretical chemical oxygen demand and are used in concentrations that present potential treatment challenges. Most of the HF chemicals evaluated are non-toxic or of low toxicity and only three are classified as Category 2 oral toxins according to standards in the Globally Harmonized System of Classification and Labeling of Chemicals; however, toxicity information was not located for thirty of the HF chemicals evaluated. Volatilization is not expected to be a significant exposure pathway for most HF chemicals. Gaps in toxicity and other chemical properties suggest deficiencies in the current state of knowledge, highlighting the need for further assessment to understand potential issues associated with HF chemicals in the environment. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available INTRODUCTION : Whether to ream the compound tibia fr actures witle intramedullary interlocking nailing or not has been an eternal debate. So we have conducted a study to compare the functional outcomes, rate of infection and time needed for union in reamed and unreamed interlocking nailing on open tibia frac tures. METHODOLOGY: This study was carried out as a prospective, comparative study. 100 patients with open fractures of tibial shaft admitted in our hospital between J une 2011 and January 2013 were enrolled in the study. Patients outside the age group of 20 - 50years of age, severely ommuniated fractures and fractures classified under Gustilo Anderson type III b and IIIc were excluded. 100 fractures were divided into two groups (reamed nailing and unreamed nailing n=50 in each with simple randomization techn ique. Evaluation in the form of radiological union was done with serial x - rays and functional grading according to Klemm & Borner’s criteria for tibial shaft fractures was done at the end of 6 months. RESULTS: A verage fracture healing time was 16 - 20 weeks in both in undreamed nailing radiologically. Also, differences in rates of clinical union, clinical outcome, time for weight bearing and complication in both groups were not significant. Post - operative infection was found in 5 cases in reamed group and 3 c ases in unreamed group. CONCLUSION: There are no clear indications or contraindications or advantage/disadvantage to favour either reamed or unreamed nailing over each other. Fracture union, functional outcome and rate of complications are similar in both groups
noweeas ebb a -a" neeem ideotify by block nbo~hr) Using a piezo-electric transducer, wrist activity was recorded simultaneousll with EEG, EOG, and EKG to...wrist activity alone was used to estimate Sleep Time. Blind inde- pendent scoring of the EEG-EOG- EKG records was also done for Sleep and Wakeful- ness...recordings for estimating sleep, parietal-occipital EEG, submental electromyogram (EMG), *and electro - occulogram (EOG) were recorded with wrist activity. A
This animation shows what happened underneath Phoenix's Robotic Arm wrist on Sol 3. The pin that goes through the loop is what holds the wrist in place. The rotation of the wrist pops the pin free. The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer prosthesis...
Drury, Benjamin Todd; Lehman, Thomas P; Rayan, Ghazi
Hand and wrist injuries in martial arts are typically a reflection of the combat nature of this discipline. In striking sports, the axial load mechanism of injury is common and causes fractures and dislocations; in grappling sports, sprain injuries and degenerative changes predominate. There is clear evidence to support that hand protection reduces the risk of hand injury. Traditional training in martial arts on proper technique and target selection in striking sports reduces the risk of hand injury, and is an important component of hand and wrist injury prevention. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Kawashima, Hiroki; Tada, Kaoru; Suganuma, Seigo; Tsuchiya, Hiroyuki; Sanada, Shigeru
We hypothesized that wrist joint motion involves a "wrist rhythm" similar to the scapulohumeral rhythm. Therefore, we used a flat-panel detector to evaluate the ratio of radiolunate and capitolunate joint motions during wrist joint motion by dynamic radiography. The subjects were 20 healthy men. Dynamic imaging of the wrist joint was performed during active exercise for a total of ten seconds. In this study, we defined the radiocarpal (RL angle) and midcarpal joint angle (CL angle) as the wrist joint angle in the obtained images and measured the variation of these angles. The average curve was plotted and regression lines calculated from the average curve. The ratio was calculated from the slopes of the regression lines of the RL CL angles. These findings indicated that the ratio of the RL and CL angle motions was approximately 1:4 during palmar flexion and approximately 2:1 during dorsiflexion.
Full Text Available Tuberculosis (TB has been a major health concern since decades, and millions continue to be afflicted with this disease. Extrapulmonary sites of TB must not be neglected as there is paucity of systemic manifestations and absence of distinct clinical features which delay its diagnosis and can lead to functional disability and severe infirmities. Osteoarticular TB is an infrequent form of the disease and monoarthritis of the wrist accounts for 1% of all cases of skeletal involvement. Hereby, we report a 45-year-old female patient with history of progressive pain and swelling of right wrist joint which is refractory to analgesics and anti-inflammatory drugs. She was diagnosed to have tubercular monoarthritis after synovial fluid analysis and radiographic findings. Standard antitubercular treatment for 6 months was given. The joint was salvaged after 9 months from the start of the treatment. Pain and swelling of joint were subsided and joint was rehabilitated with full range of motion and weight bearing.
Knobloch, K; Krämer, R; Redeker, J; Spies, M; Vogt, P M
Motocross racing is a demanding motorcycling discipline with significant physiological and psychological demands. Upper extremity injuries are frequently encountered. Interestingly, motocross riders present with a significantly stronger left arm, even if the left hand is not dominant. This difference is attributed to the use of the clutch lever with the left hand, which is more frequent in motocross than in Enduro or desert rally. The wrist has been reported to be involved especially among motocross racers in contrast to road racing. Besides wrist fractures, scaphoid fractures have been previously without a detailed analysis of the injury mechanism. We report on three patients suffering scaphoid fractures caused by extreme hyperextension of the wrist during landing after a motocross jump. Two patients presented late three months following the initial trauma (both Herbert type C fractures), while one motocross athlete with a B 2-type scaphoid fracture was admitted to wrist surgery within a week. The B 2-type fracture was treated with open reduction and Herbert-screw fixation, while the C-type fractures were treated by Herbert-screw fixation in addition to a cortico-cancellous bone graft. Within ten weeks after the surgery the patients were back in sport at their given preoperative level. Hyperextension rather than wrist flexion appears as the predominant mechanism of wrist injuries in motocross riders. A more axial impact on the wrist is more likely to produce a radial fracture during the landing phase. Preventive strategies are internal muscular wrist stabilisation using eccentric training and external stabilisation by rigid gloves allowing only limited hyperextension.
Miao, Z.; Aravena, R.; Parker, B. L.; Cherry, J. A.; Meyer, J. R.; Hunkeler, D.
A study was carried out in the sedimentary fractured rock site located in Mid West, US, which was impacted by a DNAPL spill estimated to occur in the 1950's and 1960's. The majority of the DNAPL has accumulated in the upper portion of the Lone Rock Formation (referred to as Layer 5) and a VOC plume of more than 3km long has formed. The DNAPL is mainly composed of 1,1,1-TCA, PCE, TCE and BTEX, while large amounts of degradation products such as cis-DCE and 1,1-DCA have been found in the plume. Detailed geochemical and carbon isotope analysis in September 2007 showed that complete degradation of PCE and TCE to cis-DCE in Layer 5 had been achieved from the source to the middle of the plume and the dechlorination reaction stalled at cis-DCE, which is in agreement with the redox condition in this part of the plume. On the other hand, degradation of 1,1,1-TCA to 1,1-DCA was incomplete. The fringes of the plume are characterized by the presence of PCE and TCE in agreement with aerobic conditions in this part of the plume. A historical data review from 1992 to 2006 revealed two phases of degradation in Layer 5. The first phase corresponded with the period before 2001, when there was no significant degradation, while the second phase corresponded with the period after 2001, when significant degradation occurred. The occurrence of the second phase was related to a large scale DNAPL pumping in the source zone during 1999 to 2002, which caused a great increase of contaminant concentrations in the plume including large amounts of ketones and BTEX serving as electron donors and substrates for microbial dechlorination. Thus, subsequent degradation of chlorinated compounds occurred extensively in the plume. The contaminant concentration and the shape of the plume has been modified since 2003 by a hydraulic barrier system. This case study shows that the long term degradation pattern and contaminant distribution at the site has been controlled by plume management practices including
Bourdin, Blaise; Francfort, Gilles A.
These notes begin with a review of the mainstream theory of brittle fracture, as it has emerged from the works of Griffi th and Irwin. We propose a re-formulation of that theory within the confi nes of the calculus of variations, focussing on crack path prediction. We then illustrate the various possible minimality criteria in a simple 1d-case as well as in a tearing experiment and discuss in some details the only complete mathematical formulation so far, that is that where global minimality ...
Ma, Jin-Xing; Xu, Yong-Qing
Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis. This article will list the main reasons that cause the failure of the prosthesis. Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems. And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA). Summarize and find out what the real problem is and how we can find a way to fix it.
Uebbing, Claire M
Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.
De Filippo, Massimo [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy)], E-mail: email@example.com; Pogliacomi, Francesco [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Bertellini, Annalisa [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Araoz, Philip A. [Department of Radiology, Division of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (United States); Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Corradi, Maurizio; Costantino, Cosimo [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Zompatori, Maurizio [Department of Radiological and Histopathological Sciences, Policlinic S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna (Italy)
Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.
Sarabia Condés, J M; Ibañez Martínez, L; Sánchez Carrasco, M A; Carrillo Julia, F J; Salmerón Martínez, E L
The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.
... done, you'll be asked to wear a lead apron to protect certain parts of your body. Your child's reproductive organs will also be protected with a lead shield. The technician will position your child's wrist, ...
Vulava, Vijay M.; McKay, Larry D.; Broholm, Mette Martina
We investigated the dissolution and transport of organic contaminants from a crude coal tar mixture in a monolith of fractured clay-rich residuum. An electrolyte solution was eluted through the residuum monolith containing a small emplaced source of coal tar under biologically inhibited and mildly...
Under a Langley Research Center Small Business Innovation Research (SBIR) contract, Ross-Hime Designs, Inc. Minneapolis, MN, developed the Omni-Wrist actuator, which has a 25-pound capacity, 180 degrees of pitch/yaw, and 360 degrees of roll. Company literature calls it "the first successful singularity-free high-precision (robotic) wrist." Applications include spray painting, sealing, ultrasonic testing, welding and a variety of nuclear industry, aerospace and military uses.
Xing, Shu Guo; Chen, Yan Rong; Xie, Ren Guo; Tang, Jin Bo
To determine whether distal radioulnar joint (DRUJ) contact characteristics were altered in patients with malunited distal radius fractures. We obtained computed tomography scans at 5 positions of both wrists of 6 patients who had unilateral malunited distal radius fractures with dorsal angulation from 10° to 20° and ulnar variance less than 3 mm. We reconstructed 3-dimensional images and mapped contact regions of DRUJ by calculating the shortest distance between the 2 opposing bones. The contact areas of the DRUJ were measured and the contact region centers were calculated and analyzed. The values of the malunited side were compared with those of the contralateral uninjured side. In the uninjured wrist, the contact areas of the DRUJ increased slightly from wrist flexion to extension and ulnar deviation. In the malunited wrist, we found the contact areas of DRUJ to be progressively reduced from 20° flexion to neutral, 40° extension, and 20° extension, to ulnar deviation. The centroid of this area on the sigmoid notch moved to distal from flexion to extension. Compared with the contralateral uninjured wrist, the contact area significantly decreased during wrist extension and ulnar deviation, and significantly increased during wrist flexion. The centroids of this area on sigmoid notch all moved volarly in all selected wrist positions. The contact areas of the DRUJ and the centroid of contact area on sigmoid notch are altered in patients with malunited distal radius fractures. The contact area of the DRUJ increases during wrist flexion and decreases during wrist extension and ulnar deviation. The centroids of the contact area on sigmoid notch move volarly during wrist flexion-extension and ulnar deviation. The in vivo findings suggest that alterations in joint mechanics may have an important role in the dysfunction associated with these injuries. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Use of proprietary mixtures of reagents in fracing fluids injected in deep zones, has led to controversy over potential contamination of drinking water aquifers. This presentation focuses on the different classes of compounds identified in fracing fluids.
Conclusion: Concomitant hip and distal radius fractures were generally ipsilateral and involved the femoral neck after a backward fall. These patients were younger than and not more osteoporotic than the population with isolated hip fractures; however, the hospital stay was significantly increased. The functional outcome was not influenced by concomitant wrist fracture.
Ringler, Michael D; Murthy, Naveen S
This article discusses the normal anatomy and pathologic appearances of the intrinsic and extrinsic wrist ligaments using MR Imaging. Technological advances in surface coil design and higher magnetic field strengths have improved radiologists' ability to consistently visualize these small ligaments in their entirety. Wrist ligament anatomy, in the context of proper physiologic function, is emphasized, including common normal variants, and their appearances on MR imaging. The spectrum of disorders, incorporating overlapping appearances of senescent degenerative changes, and destabilizing ligament tears, is outlined. The diagnostic performance of MR imaging to date for various ligament abnormalities is discussed, along with significant limitations. Copyright © 2015 Elsevier Inc. All rights reserved.
Alphen, N.A.; van Doorn-Loogman, M.H.; Maas, H.; van der Sluijs, J.A.; Ritt, M.J.P.F.
Wrist extension is essential in the development of motor skills in young children. Adequate wrist extension is important for good grip function of the hand, as a slightly extended wrist Results in a better and stronger grip. This retrospective study reviews the transfer of the flexor carpi ulnaris
UV-vis spectra showing solvent effects on compounds (6). Figure S4. UV-vis spectra showing solvent effects on compounds (9). Figure S5. UV-vis spectra showing solvent ___, acidic--- and basic -□- effects on compound (8) in CH2Cl2 solution. Table S1. 1H and 13C NMR spectral data of salicylaldimine Schiff bases (5-8).
The aim of this study was to assess the radiological results of Colles’ fractures treated with Kapandji wiring and to determine the frequency of postoperative anterior fracture displacement. The X-rays of 89 fractures in women over 59 years of age were evaluated. Five weeks after injury, palmar shift of the distal fracture fragments and/or palmar tilt of more than 20° were observed in 26 patients. In ten wrists dorsal tilt was not sufficiently corrected and measured more than 10°. Increase in ulnar variance was more than 2 mm in 37 wrists and more than 5 mm in six wrists; this was more pronounced when the palmar tilt was not corrected properly or when anterior fracture displacement was present. We conclude that Kapandji wiring may not be able to prevent anterior fracture displacement in almost one-third of Colles’ fractures in osteoporotic elderly patients. PMID:16865364
Nazri Bajuri, Mohd
This book presents an analysis of the stress distribution and contact stresses in severe rheumatoid wrist after total wrist arthroplasty. It assesses and compares the load transfer throughout the joint and contact pressure at the articulations. The data obtained from this study is of importance as this provide greater evidence to the benefits of total wrist arthroplasty in rheumatoid arthritis patients.
Van de Giessen, M.; Streekstra, G.J.; Strackee, S.D.; Maas, M.; Grimbergen, K.A.; Van Vliet, L.J.; Vos, F.M.
Comparing wrist shapes of different individuals requires alignment of these wrists into the same pose. Unconstrained registration of the carpal bones results in anatomically nonfeasible wrists. In this paper, we propose to constrain the registration using the shapes of adjacent bones, by keeping the
van de Giessen, M.; Streekstra, G.J.; Strackee, S.D.; Maas, M.; Grimbergen, K.A.; van Vliet, L.J.; Vos, F.M.
Comparing wrist shapes of different individuals requires alignment of these wrists into the same pose. Unconstrained registration of the carpal bones results in anatomically nonfeasible wrists. In this paper, we propose to constrain the registration using the shapes of adjacent bones, by keeping the
Veeger, H E J; Meershoek, L S; van der Woude, L H; Langenhoff, J M
Prevalence rates of carpal tunnel syndrome (CTS) in the wheelchair user population are high. One of the possible causes of CTS in this population is the movement pattern of the wrist during handrim wheelchair propulsion, which could include large wrist joint angles and wrist/finger flexor activity.
Slaar, Annelie; Maas, Mario; Rijn, Rick R. van [University of Amsterdam, Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam (Netherlands); Walenkamp, Monique M.J.; Bentohami, Abdelali; Goslings, J.C. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Steyerberg, Ewout W. [Erasmus MC - University Medical Centre, Department of Public Health, Rotterdam (Netherlands); Jager, L.C. [University of Amsterdam, Emergency Department, Academic Medical Centre, Amsterdam (Netherlands); Sosef, Nico L. [Spaarne Hospital, Department of Surgery, Hoofddorp (Netherlands); Velde, Romuald van [Tergooi Hospitals, Department of Surgery, Hilversum (Netherlands); Ultee, Jan M. [Sint Lucas Andreas Hospital, Department of Surgery, Amsterdam (Netherlands); Schep, Niels W.L. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Maasstadziekenhuis Rotterdam, Department of Surgery, Rotterdam (Netherlands)
In most hospitals, children with acute wrist trauma are routinely referred for radiography. To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required. (orig.)
Wrange, Erik Kristian Maurice; Brix, Lau
Keywords Extremities, Musculoskeletal bone, Trauma, Conventional radiography, MR, Outcomes analysis, Acute, Osteoporosis Aims and objectives The purpose of this study was to compare diagnostic X-rays and MRI of the injured wrist in female patients aged 50 years or more. Methods and materials Fift...
Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.
Alam, F.; Schweitzer, M.E. (Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology); Li Xiaoxian (Dept. of Radiology, Tangshan Gongren Hospital, Tangshan (China)); Malat, J. (Department of Radiology, Naples Radiologists, Naples (Italy)); Hussain, S.M. (Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology Rijksuniversiteit Leiden (Netherlands). Dept. of Diagnostic Radiology)
Objective. To describe the frequency of marrow abnormalities on wrist MR imaging and the MR findings of these various abnormalities.Design and patients. Five hundred and nineteen patients were studied at 1.5 T. Two observers recorded the presence and location of avascular necrosis, occult fractures and arthritic edema [focal osteoarthritis, ulnolunate abutment, rheumatoid arthritis, septic arthritis, gouty arthritis and scapholunate advanced collapse (SLAC)].Results and conclusion. One hundred and eighty-seven (36%) patients demonstrated marrow abnormalities in the wrist, of which 101 were diagnosed as arthritis [64 (34%) as focal osteoarthritis, 17 (9%) as ulnolunate abutment, 15 (8%) as rheumatoid arthritis, 2 as septic arthritis, 2 as SLAC, and 1 as gouty arthritis]. Seventy-two patients had occult fractures and in 27 patients avascular necrosis was seen. MR imaging can reveal various abnormalities in bone marrow of the wrist when findings on radiography are normal or equivocal. (orig.) With 17 figs., 13 refs.
Singh, H P; Bhattacharjee, D; Dias, J J; Trail, I
Our aim was to assess the outcome in patients with total wrist arthroplasty performed for end stage wrist osteoarthritis. We analysed the ranges of motion of operated and un-operated wrists using a flexible electrogoniometer during the Sollerman hand function test. We assessed grip strength with a digital dynamometer and completed patient reported outcome scores more than one year post-operatively. We reviewed 12 patients with a mean age of 64 (range 48-82) years. The flexion-extension arc was 72% and radioulnar deviation arc was 53% of the un-operated side but the total range of motion (area of circumduction) was 43% of the un-operated side and only 20% of the circumduction in age and gender-matched normal volunteers. Peak grip strength was 68% of the un-operated side. The patients reported good outcome with mean Michigan Hand Questionnaire (MHQ) scores of 56 (range 25-84) and mean Patient Evaluation Measure (PEM) scores of 39 (range 20-68). Patients completed the activities of Sollerman hand function test in twice the time (6 min) as required for a normal volunteer (2.8 min). The circumduction ellipses were narrow and central with limited radio-ulnar deviation and small mean areas of motion during activities of daily living.
Orbay, Jorge L; Feliciano, Eric; Orbay, Carolina
Total wrist arthrodesis is commonly performed using fixation plates, which can produce soft tissue irritation, often require removal, and limit the ability to position the hand in space. The Skeletal Dynamics IMPLATE is an intramedullary total wrist fusion device designed to provide stable fixation while avoiding the problems associated with plates. Radial and metacarpal locked intramedullary nails are inserted and joined by a connector. Desired hand placement is achieved by selecting the proper connector length and angle, then orienting it appropriately. Fusion mass compression is obtained by virtue of longitudinal threads on the radial nail that allow for length adjustment. Seven wrists in three men and four women were treated with this device and followed for a minimum of 24 weeks. In all cases, local cancellous bone graft was used and the third carpometacarpal (CMC) joint incorporated into the fusion. The median age was 49 (range, 28-71) years. Indications for fusion were two posttraumatic arthritides, three rheumatoid arthritides, one spastic deformity, and one infection. Patients were evaluated before surgery and at final follow-up using the Fernandez pain score and grip strength measurements using a hand-held dynamometer. All patients improved their grip strength and decreased their pain scores. All fusions united, and none of the patients presented dorsal soft tissue problems or required implant removal. One rheumatoid patient required secondary surgery for removal of a retained palmar osteophyte. This device delivers stable fixation, facilitates hand placement, and does not require removal.
Kapandji, A I
At the present time, in disorders of the wrist, avulsion of the first carpal row is the most commonly used technique as a last resort. However, there are many wrist prostheses, which are reviewed here. Roughly, they belong to two families: the three axis prostheses (spherical) that cannot transmit to the hand the pronation supination torque, because of their geometrical characteristics, and the two axis prostheses (universal joint) that are able to transmit this movement. The characteristics of future prostheses must include: based on the "universal joint" principle, occupy minimum space, isometric, maintain tendon tension, an axis identical to the true axis of the wrist, to maintain the hand in line with the forearm, fixed without cement but, not shortened with time, possibilities of mechanical flexibility immediately and lastingly stable, to be easily replaced modularly. This ideal prosthesis will certainly exist one day and will take the place of the first carpal row avulsion. In the meantime, this technique will still have a long use.
Ashish R. Agarwal
Full Text Available BACKGROUND Delayed wound healing is a significant health problem, particularly in patients with compound fractures. It still remains a challenging task in orthopaedic surgery, which in addition to the pain and suffering, failure of the wound to heal, also imposes social and financial burdens. The aim of the study is to evaluate the results of vacuum-assisted wound therapy in patients with open musculoskeletal injuries. MATERIALS AND METHODS 30 patients of open musculoskeletal injuries underwent randomised trial of vacuum-assisted closure therapy versus standard wound therapy around the upper limb and lower limb. Mean patient age was 39 ± 18 years necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. Data Management and Statistical Analysis- The results obtained were subjected to statistical analysis. RESULTS Granulation tissue status and skin healing is better in patients undergoing VAC therapy. Hospital stay of patients undergoing VAC therapy was also less. CONCLUSION Vacuum-assisted wound therapy was better method of wound management.
Shim, Jae Woo; Park, Min Jong
Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist. Copyright © 2017 Elsevier Inc. All rights reserved.
Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.
Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles.
Boeckstyns, Michel E H; Herzberg, Guillaume
The results of wrist arthroplasty for severely destroyed and painful wrists are generally good in pain reduction, increased grip strength, and upper limb function. The wrist range of motion is usually preserved but not improved. Implant survival seems better than it was with earlier implant designs; however, there are problems of carpal component loosening. Patient selection plays an important role, requiring experience, careful patient information, and discussing the pros and cons of arthroplasty and partial or total wrist arthrodesis. Copyright © 2017 Elsevier Inc. All rights reserved.
Goode, Daniel J; Imbrigiotta, Thomas E; Lacombe, Pierre J
Synthesis of rock-core sampling and chlorinated volatile organic compound (CVOC) analysis at five coreholes, with hydraulic and water-quality monitoring and a detailed hydrogeologic framework, was used to characterize the fine-scale distribution of CVOCs in dipping, fractured mudstones of the Lockatong Formation of Triassic age, of the Newark Basin in West Trenton, New Jersey. From these results, a refined conceptual model for more than 55years of migration of CVOCs and depth- and strata-dependent rock-matrix contamination was developed. Industrial use of trichloroethene (TCE) at the former Naval Air Warfare Center (NAWC) from 1953 to 1995 resulted in dense non-aqueous phase liquid (DNAPL) TCE and dissolved TCE and related breakdown products, including other CVOCs, in underlying mudstones. Shallow highly weathered and fractured strata overlie unweathered, gently dipping, fractured strata that become progressively less fractured with depth. The unweathered lithology includes black highly fractured (fissile) carbon-rich strata, gray mildly fractured thinly layered (laminated) strata, and light-gray weakly fractured massive strata. CVOC concentrations in water samples pumped from the shallow weathered and highly fractured strata remain elevated near residual DNAPL TCE, but dilution by uncontaminated recharge, and other natural and engineered attenuation processes, have substantially reduced concentrations along flow paths removed from sources and residual DNAPL. CVOCs also were detected in most rock-core samples in source areas in shallow wells. In many locations, lower aqueous concentrations, compared to rock core concentrations, suggest that CVOCs are presently back-diffusing from the rock matrix. Below the weathered and highly fractured strata, and to depths of at least 50 meters (m), groundwater flow and contaminant transport is primarily in bedding-plane-oriented fractures in thin fissile high-carbon strata, and in fractured, laminated strata of the gently
Goode, Daniel J.; Imbrigiotta, Thomas E.; Lacombe, Pierre J.
Synthesis of rock-core sampling and chlorinated volatile organic compound (CVOC) analysis at five coreholes, with hydraulic and water-quality monitoring and a detailed hydrogeologic framework, was used to characterize the fine-scale distribution of CVOCs in dipping, fractured mudstones of the Lockatong Formation of Triassic age, of the Newark Basin in West Trenton, New Jersey. From these results, a refined conceptual model for more than 55 years of migration of CVOCs and depth- and strata-dependent rock-matrix contamination was developed. Industrial use of trichloroethene (TCE) at the former Naval Air Warfare Center (NAWC) from 1953 to 1995 resulted in dense non-aqueous phase liquid (DNAPL) TCE and dissolved TCE and related breakdown products, including other CVOCs, in underlying mudstones. Shallow highly weathered and fractured strata overlie unweathered, gently dipping, fractured strata that become progressively less fractured with depth. The unweathered lithology includes black highly fractured (fissile) carbon-rich strata, gray mildly fractured thinly layered (laminated) strata, and light-gray weakly fractured massive strata. CVOC concentrations in water samples pumped from the shallow weathered and highly fractured strata remain elevated near residual DNAPL TCE, but dilution by uncontaminated recharge, and other natural and engineered attenuation processes, have substantially reduced concentrations along flow paths removed from sources and residual DNAPL. CVOCs also were detected in most rock-core samples in source areas in shallow wells. In many locations, lower aqueous concentrations, compared to rock core concentrations, suggest that CVOCs are presently back-diffusing from the rock matrix. Below the weathered and highly fractured strata, and to depths of at least 50 meters (m), groundwater flow and contaminant transport is primarily in bedding-plane-oriented fractures in thin fissile high-carbon strata, and in fractured, laminated strata of the gently
Goode, Daniel J.; Imbrigiotta, Thomas E.; Lacombe, Pierre J.
Synthesis of rock-core sampling and chlorinated volatile organic compound (CVOC) analysis at five coreholes, with hydraulic and water-quality monitoring and a detailed hydrogeologic framework, was used to characterize the fine-scale distribution of CVOCs in dipping, fractured mudstones of the Lockatong Formation of Triassic age, of the Newark Basin in West Trenton, New Jersey. From these results, a refined conceptual model for more than 55 years of migration of CVOCs and depth- and strata-dependent rock-matrix contamination was developed. Industrial use of trichloroethene (TCE) at the former Naval Air Warfare Center (NAWC) from 1953 to 1995 resulted in dense non-aqueous phase liquid (DNAPL) TCE and dissolved TCE and related breakdown products, including other CVOCs, in underlying mudstones. Shallow highly weathered and fractured strata overlie unweathered, gently dipping, fractured strata that become progressively less fractured with depth. The unweathered lithology includes black highly fractured (fissile) carbon-rich strata, gray mildly fractured thinly layered (laminated) strata, and light-gray weakly fractured massive strata. CVOC concentrations in water samples pumped from the shallow weathered and highly fractured strata remain elevated near residual DNAPL TCE, but dilution by uncontaminated recharge, and other natural and engineered attenuation processes, have substantially reduced concentrations along flow paths removed from sources and residual DNAPL. CVOCs also were detected in most rock-core samples in source areas in shallow wells. In many locations, lower aqueous concentrations, compared to rock core concentrations, suggest that CVOCs are presently back-diffusing from the rock matrix. Below the weathered and highly fractured strata, and to depths of at least 50 meters (m), groundwater flow and contaminant transport is primarily in bedding-plane-oriented fractures in thin fissile high-carbon strata, and in fractured, laminated strata of the gently
Andersson, J K; Lindau, T; Karlsson, J; Fridén, J
This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) joint instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ instability were Salter-Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusion, late DRUJ instability due to wrist fractures or isolated TFCC tears was found to be common in children and adolescents. IV. © The Author(s) 2014.
Seegmiller, Daniel B; Eggett, Dennis L; Charles, Steven K
Wrist orthoses (also known as splints, braces, or supports) are commonly used to support or restrict the motion of a weak or injured wrist. These orthoses generally function by stiffening the wrist joint. Therefore, choosing the proper orthosis (or improving orthoses) requires that we understand their stiffness properties. In this study, we present a method for measuring the stiffness of wrist orthoses, and we apply this method to 12 of the most common wrist orthoses. We found similarities and differences between these orthoses, indicating that different orthoses have different effects on the wrist joint and, presumably, on wrist behavior. In particular, all six orthoses with a stay on the volar side or the volar and dorsal sides added a significant amount of stiffness to the wrist joint. In contrast, only one of three orthoses with a stay on the dorsal side and none of the three orthoses without stays exhibited a significant amount of stiffness, calling into question their ability to support the wrist joint. This work lays a foundation for future studies investigating the effect of wrist orthosis stiffness on wrist behavior and how wrist orthosis stiffness can be designed to produce behavior that facilitates healing.
Full Text Available Abstract Background Hamate hook fracture is a common fracture in golfers and others who play sports that involve rackets or sticks such as tennis or hockey. This patient had a previous hamate fracture in the opposing wrist along with potential features of hamate bipartite. Case presentation A 19 year old male presented with a complaint of right wrist pain on the ulnar side of the wrist with no apparent mechanism of injury. The pain came on gradually one week before being seen in the office and he reported no prior care for the complaint. His history includes traumatic left hamate hook fracture with surgical excision. Conclusion The patient was found to have marked tenderness over the hamate and with a prior fracture to the other wrist, computed tomography of the wrist was ordered revealing a fracture to the hamate hook in the right wrist. He was referred for surgical evaluation and the hook of the hamate was excised. Post-surgically, the patient was able to return to normal activity within eight weeks. This case is indicative of fracture rather than hamate bipartite. This fracture should be considered in a case of ulnar sided wrist pain where marked tenderness is noted over the hamate, especially after participation in club or racket sports.
Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren
Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007....... The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination...
Dua, Karan; Abzug, Joshua M; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O
Distal radius fractures are the most common orthopaedic injury that occur in the pediatric population. The annual incidence of distal radius fractures has increased as a result of earlier participation in sporting activities, increased body mass index, and decreased bone mineral density. Most distal radius fractures are sustained after a fall onto an outstretched arm that results in axial compression on the extremity or from direct trauma to the extremity. Physeal fractures of the distal radius are described based on the Salter-Harris classification system. Extraphyseal fractures of the distal radius are described as incomplete or complete based on the amount of cortical involvement. A thorough physical examination of the upper extremity is necessary to rule out any associated injuries. PA and lateral radiographs of the wrist usually are sufficient to diagnose a distal radius fracture. The management of distal radius fractures is based on several factors, including patient age, fracture pattern, and the amount of growth remaining. Nonsurgical management is the most common treatment option for patients who have distal radius fractures because marked potential for remodeling exists. If substantial angulation or displacement is present, closed reduction maneuvers with or without percutaneous pinning should be performed. Patients with physeal fractures of the distal radius that may result in malunion who present more than 10 days postinjury should not undergo manipulation of any kind because of the increased risk for physeal arrest.
Pezent, Evan; Rose, Chad G; Deshpande, Ashish D; O'Malley, Marcia K
Robotic devices have been clinically verified for use in long duration and high intensity rehabilitation needed for motor recovery after neurological injury. Targeted and coordinated hand and wrist therapy, often overlooked in rehabilitation robotics, is required to regain the ability to perform activities of daily living. To this end, a new coupled hand-wrist exoskeleton has been designed. This paper details the design of the wrist module and several human-related considerations made to maximize its potential as a coordinated hand-wrist device. The serial wrist mechanism has been engineered to facilitate donning and doffing for impaired subjects and to insure compatibility with the hand module in virtual and assisted grasping tasks. Several other practical requirements have also been addressed, including device ergonomics, clinician-friendliness, and ambidextrous reconfigurability. The wrist module's capabilities as a rehabilitation device are quantified experimentally in terms of functional workspace and dynamic properties. Specifically, the device possesses favorable performance in terms of range of motion, torque output, friction, and closed-loop position bandwidth when compared with existing devices. The presented wrist module's performance and operational considerations support its use in a wide range of future clinical investigations.
Mulders, Marjolein A M; Walenkamp, Monique M J; Dubois, Bente F H; Slaar, Annelie; Goslings, J Carel; Schep, Niels W L
Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients. Secondarily, we aimed to compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules. We included all studies that proposed a clinical prediction or decision rule in children presenting at the emergency department with acute wrist trauma. We performed external validation within a cohort of 379 children. We also calculated the sensitivity, specificity, negative predictive value and positive predictive value of each decision rule. We included three clinical decision rules. The sensitivity and specificity of all clinical decision rules after external validation were between 94% and 99%, and 11% and 26%, respectively. After external validation 7% to 17% less radiographs would be ordered and 1.4% to 5.7% of all fractures would be missed. Compared to the Amsterdam Pediatric Wrist Rules only one of the three other rules had a higher sensitivity; however both the specificity and the reduction in requested radiographs were lower in the other three rules. The sensitivity of the three non-validated clinical decision rules is high. However the specificity and the reduction in number of requested radiographs are low. In contrast, the validated Amsterdam Pediatric Wrist Rules has an acceptable sensitivity and the greatest reduction in radiographs, at 22%, without missing any clinically relevant fractures.
Erhart, Stefanie; Lutz, Martin; Arora, Rohit; Schmoelz, Werner
Pathologies of the wrist, such as fractures or instabilities, can lead to alterations in joint biomechanics. Accurate treatment of these pathologies is a frequent challenge for the surgeon. For biomechanical investigations, a test-setup that applies physiological loading of the wrist joint is necessary. A force controlled test-bench with agonistic and antagonistic muscle forces was built to move six fresh frozen human upper extremities through flexion and extension of the wrist joint. Tendon forces, range of motion, intraarticular contact area and contact pressure of the lunate and scaphoid facet as well as tendon excursion were investigated and compared with the current literature. During wrist motion the extensors exerted double the force of the flexors. Capsulotomy and sensor insertion decreased the range of motion from 63.4° (SD 14.1) to 45.9° (SD 23.7). The ratio of force transmitted through the radius and ulna was 77:23 and pressure distribution between the scaphoid and lunate facet showed a 70:30 relationship. The obtained data indicate a good agreement with the available literature. Therefore, the force controlled test-bench in combination with intraarticular radiocarpal measurements can be used to investigate the influence of wrist pathologies on joint biomechanics. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.
Shefer Eini, Dalit; Ratzon, Navah Z; Rizzo, Albert A; Yeh, Shih-Ching; Lange, Belinda; Yaffe, Batia; Daich, Alexander; Weiss, Patrice L; Kizony, Rachel
Cross sectional. Measuring wrist range of motion (ROM) is an essential procedure in hand therapy clinics. To test the reliability and validity of a dynamic ROM assessment, the Camera Wrist Tracker (CWT). Wrist flexion and extension ROM of 15 patients with distal radius fractures and 15 matched controls were assessed with the CWT and with a universal goniometer. One-way model intraclass correlation coefficient analysis indicated high test-retest reliability for extension (ICC = 0.92) and moderate reliability for flexion (ICC = 0.49). Standard error for extension was 2.45° and for flexion was 4.07°. Repeated-measures analysis revealed a significant main effect for group; ROM was greater in the control group (F[1, 28] = 47.35; P < .001). The concurrent validity of the CWT was partially supported. The results indicate that the CWT may provide highly reliable scores for dynamic wrist extension ROM, and moderately reliable scores for flexion, in people recovering from a distal radius fracture. N/A. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Akman, Yunus Emre; Sukur, Erhan; Senel, Ahmet; Oztas Sukur, Nur Ece; Talu, Canan Kelten; Ozturkmen, Yusuf
The aim of this experimental study was to investigate the impact of HA-CS-NAG compound (hyaluronate, sodium chondroitin sulfate, N-acetyl-d-glucosamine) on the quality of repair tissue after micro-fracture and to compare it with HA (hyaluronat), in a rat full-thickness chondral defect model. Full-thickness chondral defects were created in a non-weight bearing area by using a handle 2.7-mm drill bit, in the right knees of 33 Sprague-Dawley rats. Each specimen then underwent micro-fracture using a needle. Two weeks after surgery, 3 groups were randomly formed among the rats (n = 33). In Group 1, 0.2 mL of sterile saline solution (0.9%) was injected. In Group 2, 0.2 mL HA with a mean molecular weight of 1.2 Mda was injected. In Group 3, 0.2 mL of HA-CS-NAG compound (hyaluronate, sodium chondroitin sulfate, N-acetyl-d-glucosamine) was injected. The injections were applied on the 14th, the 21st and the 28th postoperative days. All rats were sacrificed on the 42nd postoperative day. Histological analysis of the repair tissue was performed for each specimen by two blinded observers using Wakitani scoring system. There was significantly improved repair tissue in both Group 3 and Group 2 when compared with Group 1. Group 3 showed statistically significant improvement in terms of 'cell morphology' and 'integration of donor with host' when compared to Group 2 (p < 0.001). Intra-articular injection of HA-CS-NAG compound after micro-fracture results in significantly improved repair tissue in rats' chondral defects when compared to HA regarding the donor integration and cell morphology. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.
Mason, John S; Crowell, Michael S; Goss, Donald L
The patient was a 21-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of left wrist pain that began 1 day after injuring his wrist while performing a bench-press exercise. Due to concern for a scaphoid fracture and because radiographic imaging was not immediately available, a physical therapist credentialed to utilize fluoroscopy evaluated the left wrist. Radiographs were subsequently ordered, which confirmed a mid-waist, nondisplaced scaphoid fracture.
Williams, Robert L., II
A robot wrist consisting of two universal joints can eliminate the wrist singularity problem found on many individual robots. Forward and inverse position and velocity kinematics are presented for such a wrist having three degrees of freedom. Denavit-Hartenberg parameters are derived to find the transforms required for the kinematic equations. The Omni-Wrist, a commercial double universal joint robot wrist, is studied in detail. There are four levels of kinematic parameters identified for this wrist; three forward and three inverse maps are presented for both position and velocity. These equations relate the hand coordinate frame to the wrist base frame. They are sufficient for control of the wrist standing alone. When the wrist is attached to a manipulator arm; the offset between the two universal joints complicates the solution of the overall kinematics problem. All wrist coordinate frame origins are not coincident, which prevents decoupling of position and orientation for manipulator inverse kinematics.
Cha, Y J
The study was conducted to provide basic data to develop a system that distributes pressure over a broader area by measuring and analyzing pressures in various wrist angles and hand positions while wearing a wrist splint. With 0, 15, 30, and 45 degrees of wrist extension, full-finger extension and finger flexion, pressure distribution changes were measured three times. Average peak pressure was analyzed and mean value picture (MVP) in zones 3-5 was calculated. A one-way Anova was conducted to identify changes in pressure distribution by wrist angle and hand position. Mean peak pressure values (kPa) in zones 3-5 changed depending on the wrist angle. Peak pressures (kPa) changed significantly in 15, 30, and 45 degrees wrist extension, depending on the hand position. Since pressure distributions differ depending the wrist angle and hand position (finger flexion), it is necessary to consider how pressure varies in each wrist position and to provide information on postures that should be avoided during tasks and occupational activities based on various wrist angles or hand positions. Copyright © 2017. Published by Elsevier Masson SAS.
Peaden, Allan W; Charles, Steven K
Human movement generally involves multiple degrees of freedom (DOF) coordinated in a graceful and seemingly effortless manner even though the underlying dynamics are generally complex. Understanding these dynamics is important because it exposes the challenges that the neuromuscular system faces in controlling movement. Despite the importance of wrist and forearm rotations in everyday life, the dynamics of movements involving wrist and forearm rotations are currently unknown. Here we present equations of motion describing the torques required to produce movements combining flexion-extension (FE) and radial-ulnar deviation (RUD) of the wrist and pronation-supination (PS) of the forearm. The total torque is comprised of components required to overcome the effects of inertia, damping, stiffness, and gravity. Using experimentally measured kinematic data and subject-specific impedance parameters (inertia, damping, and stiffness), we evaluated movement torques to test the following hypotheses: the dynamics of wrist and forearm rotations are (1) dominated by stiffness, not inertial or damping effects, (2) significantly coupled through interaction torques due to stiffness and damping (but not inertia), and (3) too complex to be well approximated by a simple, linear model. We found that (1) the dynamics of movements combining the wrist and forearm are similar to wrist rotations in that stiffness dominates over inertial and damping effects (pwrist and forearm are significantly coupled through stiffness, while interactions due to inertia and damping are small, and (3) despite the complexity of the exact equations of motion, the dynamics of wrist and forearm rotations are well approximated by a simple, linear (but still coupled) model (the mean error in predicting torque was less than 1% of the maximum torque). The exact and approximate models are presented for modeling wrist and forearm rotations in future studies. Copyright © 2014 Elsevier Ltd. All rights reserved.
Zemirline, Ahmed; Hoël, Gérard; Naïto, Kiyohito; Uguen, Arnaud; Liverneaux, Philippe; Le Nen, Dominique
The dorsal approach to the wrist is the exposure of choice for most of the surgical procedures on the radiocarpal and intercarpal joints. Contrary to the volar approach, it encounters neither the main arteries nor the motor nerve branch. However, the dorsal approach goes necessarily through the extensor retinaculum. We describe two transseptal dorsal approaches that pass through the extensor retinaculum in the thickness of a septum between two compartments. A virtual space was developed beneath the infratendinous retinaculum (which is a deep layer covering the floor of the extensor compartments) to expose the periosteum, the ligaments and the joint capsule without opening the extensor compartments. Twenty cadaveric wrists have been dissected to study the feasibility of the two transseptal approaches. Ten wrists were exposed through a 3-4 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the third and fourth compartments. Ten wrists were exposed through a 4-5 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the fourth and fifth compartments. The extent of violations of extensor compartments and joint capsule, and the exposed anatomical structures were noted. At the end of each dissection, the whole extensor system was outrightly removed for histological study. The feasibility of the transseptal approaches was demonstrated for all the dissected wrists. The dissection plane beneath the infratendinous retinaculum was macroscopically and microscopically highlighted. The transseptal approaches provide a good exposure to the dorsal side of the wrist joint, without opening the extensor tendon compartments.
Eschweiler, J; Allmendinger, F; Stromps, J P; Nick, H E; Pallua, N; Radermacher, K
The hand represents one of the most complex joint mechanisms of the human body. The hand is also an important communication medium. The spectrum of today's hand injuries reaches from minor damage up to complex traumata with loss of several functional aspects. Enormous subsequent economic costs result. The therapeutic re-establishment of the equilibrium between maximum stress and the actual applied stress is the condition for a lifelong joint function. A literature review about biomechanical wrist models was realised. The previous models found in the literature were systematically analysed as well as verifying their suitability for clinical use regarding pathological changes, therapy approaches and modelling/simulation approaches, respectively, of wrist injuries. The return of the wrist joint biomechanics to the normal condition is a key factor for a successful therapy. Furthermore, it is important for the re-establishment of an unimpaired joint function. Currently, there exist only simplified descriptions and models of the wrist joint, approximated by technical joints and furthermore, they are partially contradictory. Therefore, no uniform validated biomechanical wrist model exists as yet. Regarding the arising complex clinical problems, however, a valid biomechanical wrist joint model would be necessary as assistance, in order to improve the success of systematised therapies on the basis of computer-aided model-based planning and intervention. Georg Thieme Verlag KG Stuttgart · New York.
Dinges, H; Fürst, M; Rüther, H; Schill, S
The wrists are affected in the long-term in 90% of people with rheumatism and are often (42%) the first manifestation of a destructive disease. The functionality of the wrist and the whole hand is of great importance because in many cases loss of function of the wrists leads to severe limitations. Local and operative treatment of the wrist in rheumatoid arthritis (RA) is one of the main duties in rheuma-orthopaedics. For operative treatment there is a finely tuned differential therapeutic spectrum available. The diagnostic indications take the local and total pattern of affection, the current systemic therapy as well as patient wishes and patient compliance into consideration. In the early stages according to LDE (Larsen, Dale, Eek), soft tissues operations such as articulo-tenosynovectomy (ATS) are most commonly carried out. In further advanced stages osseus stabilisation must often be performed. At this point a smooth transition from partial arthrodesis to complete fixation is possible. After initial euphoria, arthroplasty of the wrist is being increasingly less used for operative treatment due to the unconvincing long-term results and high complication rate. With reference to the good long-term results of all operative procedures, in particular early ATS with respect to pain, function and protection of tendons, after failure of medicinal treatment and persistence of inflammatory activity in the wrist, patients should be transferred to an experienced rheuma-orthopaedic surgeon.
Siegrist, R.L. [Oak Ridge National Lab., TN (United States)]|[Colorado School of Mines, Golden, CO (United States). Environmental Science and Engineering Div.; Lowe, K.S. [Oak Ridge National Lab., Grand Junction, CO (United States). Life Sciences Div.; Murdoch, L.D. [FRx, Inc., Cincinnati, OH (United States)]|[Clemson Univ., SC (United States); Slack, W.W. [FRx, Inc., Cincinnati, OH (United States); Houk, T.C. [Lockheed Martin Energy Systems, Piketon, OH (United States)
The overall goal of the program of activities is to demonstrate robust and cost-effective technologies for in situ remediation of DNAPL compounds in low permeability media (LPM), including adaptations and enhancements of conventional technologies to achieve improved performance for DNAPLs in LPM. The technologies sought should be potential for application at simple, small sites (e.g., gasoline underground storage tanks) as well as at complex, larger sites (e.g., DOE land treatment units). The technologies involved in the X-231A demonstration at Portsmouth Gaseous Diffusion Plant (PORTS) utilized subsurface manipulation of the LPM through soil fracturing with thermally enhanced mass recovery or horizontal barrier in place destruction. To enable field evaluation of these approaches, a set of four test cells was established at the X-231A land treatment unit at the DOE PORTS plant in August 1996 and a series of demonstration field activities occurred through December 1997. The principal objectives of the PORTS X-231A demonstration were to: determine and compare the operational features of hydraulic fractures as an enabling technology for steam and hot air enhanced soil vapor extraction and mass recovery, in situ interception and reductive destruction by zero valent iron, and in situ interception and oxidative destruction by potassium permanganate; determine the interaction of the delivered agents with the LPM matrix adjacent to the fracture and within the fractured zone and assess the beneficial modifications to the transport and/or reaction properties of the LPM deposit; and determine the remediation efficiency achieved by each of the technology strategies.
Soman, Shardul Madhav; Patel, Bhavik Nandubhai; Shah, Pratik Dineshbhai
It is uncommon for hand surgeons to diagnose and treat persistent post-traumatic radius fracture on the lines of tuberculosis infection even in developing countries especially when the clinical picture resembles more of a complex regional pain syndrome (CRPS). Although it works for many patients, some conditions that affect the wrist don't fall in this category and worsen with this treatment practice. We present a patient who had an extra articular distal radius fracture treated initially with percutaneous pinning and was treated as CRPS for the next ten months by local physician. He was eventually diagnosed with advanced tuberculosis of the wrist and a total wrist arthrodesis was performed. Only one such case was ever reported in literature. A 50-year-old male, came to our institute with the history of pain and fullness in the wrist since one year. One year ago he had developed an extra articular fracture of the distal radius which was initially treated with percutaneous pinning and a below elbow cast for six weeks. On removal of the cast one pin was found loose and the other removed eventually after two more weeks of immobilization. Patient continued to have pain with fullness around the wrist which was treated at local place with anti inflammatory agents and ice application. Patient had complaint of other constitutional symptoms. Initially patient had full range of motion which gradually decreased. X-ray showed characteristic signs suggesting of extensive tuberculosis of distal radius which was operated with wrist arthrodesis. Per operatively, fine rice granular granulation tissue was found, histopathological examination of which confirmed the diagnosis of tuberculosis. Though rare, every case of distal radius fracture complaining of chronic pain and signs suggestive of CRPS should have tuberculosis as one of the differential diagnosis, even if patient does not present any signs of tuberculosis or any primary focus is not identified. Even though skeletal
Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It most ... occurs with other fractures of the face. Nose injuries and neck ...
Full Text Available Tuberculosis (TB is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. A 57 years old male presented with swelling over the left wrist since 3 years Three swellings over dorsal aspect of the left wrist Soft in consistency Non tender Non compressible Mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigations were normal. Ultrsonography showed giant cell tumor of Extensor Digitorum sheath. X-ray: soft tissue swelling and MRI was suggestive of extensor tendon sheath extraskeletal synovial Koch’s, or giant cell tumor of tendon sheath. Excision of swelling was planned and intraoperatively, rice bodies were seen inside it. Histopathological examination showed caseous necrosis with granuloma formation. Patient was put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise. Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with extensive curettage lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia.
Ilyas, Asif M; Ilyas, Asif; Ast, Michael; Schaffer, Alyssa A; Thoder, Joseph
De quervain disease, or stenosing tenosynovitis of the first dorsal compartment of the wrist, is a common wrist pathology. Pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendons in the fibro-osseus canal. de Quervain tenosynovitis of the wrist is more common in women than men. Diagnosis may be made on physical examination. Radiographs are helpful in ruling out offending bony pathology. Nonsurgical management, consisting of corticosteroid injections and supportive thumb spica splinting, is usually successful. In resistant cases, surgical release of the first dorsal compartment is done, taking care to protect the radial sensory nerve and identify all accessory compartments. Repair of the extensor retinaculum by step-cut lengthening or other techniques is rarely required.
Boeckstyns, Michel E H; Herzberg, Guillaume; Merser, Søren
Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007. The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier generations of total wrist arthroplasty. PMID:23848216
Read, M. T. F.
Adolescent girl gymnasts sustained stress fractures of the distal end of the radius in the wrist on which a rotational vault was performed. The history and clinical progress were typical of stress fractures. Imagesp272-aFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:7317727
Wagner, Eric R; Conti Mica, Megan; Shin, Alexander Y
The purpose was to determine if smartphone photography is a reliable tool in measuring wrist movement. Smartphones were used to take digital photos of both wrists in 32 normal participants (64 wrists) at extremes of wrist motion. The smartphone measurements were compared with clinical goniometry measurements. There was a very high correlation between the clinical goniometry and smartphone measurements, as the concordance coefficients were high for radial deviation, ulnar deviation, wrist extension and wrist flexion. The Pearson coefficients also demonstrated the high precision of the smartphone measurements. The Bland-Altman plots demonstrated 29-31 of 32 smartphone measurements were within the 95% confidence interval of the clinical measurements for all positions of the wrists. There was high reliability between the photography taken by the volunteer and researcher, as well as high inter-observer reliability. Smartphone digital photography is a reliable and accurate tool for measuring wrist range of motion. II.
Frederico Barra de Moraes
Full Text Available ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.
Basilar skull fracture; Depressed skull fracture; Linear skull fracture ... Skull fractures may occur with head injuries . The skull provides good protection for the brain. However, a severe impact ...
Charles, Steven K.; Zollo, Loredana; Guglielmelli, Eugenio; Hogan, Neville; Krebs, Hermano I.
Because wrist rotation dynamics are dominated by stiffness (Charles SK, Hogan N. J Biomech 44: 614–621, 2011), understanding how humans plan and execute coordinated wrist rotations requires knowledge of the stiffness characteristics of the wrist joint. In the past, the passive stiffness of the wrist joint has been measured in 1 degree of freedom (DOF). Although these 1-DOF measurements inform us of the dynamics the neuromuscular system must overcome to rotate the wrist in pure flexion-extension (FE) or pure radial-ulnar deviation (RUD), the wrist rarely rotates in pure FE or RUD. Instead, understanding natural wrist rotations requires knowledge of wrist stiffness in combinations of FE and RUD. The purpose of this report is to present measurements of passive wrist stiffness throughout the space spanned by FE and RUD. Using a rehabilitation robot designed for the wrist and forearm, we measured the passive stiffness of the wrist joint in 10 subjects in FE, RUD, and combinations. For comparison, we measured the passive stiffness of the forearm (in pronation-supination), as well. Our measurements in pure FE and RUD agreed well with previous 1-DOF measurements. We have linearized the 2-DOF stiffness measurements and present them in the form of stiffness ellipses and as stiffness matrices useful for modeling wrist rotation dynamics. We found that passive wrist stiffness was anisotropic, with greater stiffness in RUD than in FE. We also found that passive wrist stiffness did not align with the anatomical axes of the wrist; the major and minor axes of the stiffness ellipse were rotated with respect to the FE and RUD axes by ∼20°. The direction of least stiffness was between ulnar flexion and radial extension, a direction used in many natural movements (known as the “dart-thrower's motion”), suggesting that the nervous system may take advantage of the direction of least stiffness for common wrist rotations. PMID:22649208
Yamamoto, Ikuo; Inagawa, Naohiro; Matsui, Miki; Hachisuka, Kenji; Wada, Futoshi; Hachisuka, Akiko
Compact rehabilitation robot system which can support movement of the wrist of patients has been developed. The robot system can detect and analyze the patient's intention to move the wrist by such a biological signal as muscle potential, then, assist the wrist exercise of patients. Also, both-wrist rehabilitation robot system by mirror effect has been successfully developed for practical use in the hospital and at home.
Thomsen, J. F.; Mikkelsen, S.; Andersen, JH
OBJECTIVES: To identify the risk of hand-wrist disorders related to repetitive movements, use of hand force and wrist position in repetitive monotonous work. METHODS: Using questionnaires and physical examinations, the prevalence and incidence of hand-wrist pain and possible extensor tendonitis (...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...
A method of fracturing a subterranean porous formation penetrated by a well bore consists of injecting down the well and into the formation, at a pressure sufficient to fracture the formation, a fracturing fluid comprising an aqueous gel. This gel is composed of water to which there has been added: a water-thickening amount of a water-dispersible polymer selected from the group consisting of polyacrylamides and polymethacrylamides; crosslinked polyacrylamides and crosslinked polyacrylamides; polyacrylic acid and polymethacrylic acid; polyacrylates; polymers of N-substituted acrylamides; copolymers of acrylamide with another ethylenically unsaturated monomer copolymerizable therewith; mixtures of the polymers; a water-soluble compound of a polyvalent metal which is capable of gelling the water when the valence of the metal is reduced to a lower valence state; and a water-soluble reducing agent. (31 claims)
Martinez, John A; Ng, Paul; Lu, Son; Campagna, McKenzie S; Celik, Ozkan
In this paper, we present design, implementation and specifications of the Wrist Gimbal, a three degree-of-freedom (DOF) exoskeleton developed for forearm and wrist rehabilitation. Wrist Gimbal has three active DOF, corresponding to pronation/supination, flexion/extension and adduction/abduction joints. We mainly focused on a robust, safe and practical device design to facilitate clinical implementation, testing and acceptance. Robustness and mechanical rigidity was achieved by implementing two bearing supports for each of the pronation/supination and adduction/abduction axes. Rubber hard stops for each axis, an emergency stop button and software measures ensured safe operation. An arm rest with padding and straps, a handle with adjustable distal distance and height and a large inner volume contribute to ease of use, of patient attachment and to comfort. We present the specifications of Wrist Gimbal in comparison with similar devices in the literature and example data collected from a healthy subject.
Khan, Yasmin; Konan, Sujith; Sorene, Elliot
This study reports a case of revision of a failed Swanson silastic interpositional wrist replacement to a Universal 2 (KMI Medical Inc., San Diego, CA, Jan 2009) total wrist arthroplasty, in a 68-year-old woman with rheumatoid arthritis and pyrophosphate arthropathy. At the 2-year follow-up, the patient was pain-free and was able to perform all activities of daily living, documented by subjective assessment and objective scores. The disabilities of the arm, shoulder, and hand (DASH) scores improved from 98.3 preoperatively to 55.1 postoperatively. A failed Swanson silastic interpositional wrist replacement may be successfully revised to an uncemented primary wrist replacement with good functional results at early follow-up.
Neumann, K. [Universitaetsklinikum Essen (Germany). Zentralinstitut fuer Roentgendiagnostik; Langer, R. [Universitaetsklinikum Essen (Germany). Zentralinstitut fuer Roentgendiagnostik
Plain X-ray films including some special radiographic views are still the basis of the radiological evaluation of injuries of the distal forearm, the wrist, and the hand. Especially, in the diagnosis of fractures of the distal radius the exact positioning of the arm and hand is essential. For the description of fractures of the distal forearm the AO classification of fractures should be used, which is comprehensive and universally applicable. Conventional tomography and computed tomography (CT) of the radio-ulnar joint and the wrist are used in patients with persisting complaints or equivocal findings on plain radiographs, and difficult anatomical situations. Suspected ligamentous injuries of the wrist including tears of the triangular fibrocartilage complex (TFCC) are evaluated by wrist arthrography or magnetic resonance imaging (MRI), the latter requiring a highly skilled imaging and interpretation technique. MRI is the method of choice for the detection of osteonecrosis. Ultrasound examinations are of minor importance in the work up of wrist and hand injuries. (orig.) [Deutsch] Fuer die radiologische Beurteilung von Verletzungen des distalen Unterarmes, des Handgelenkes und der Hand steht die konventionelle Roentgenuntersuchung einschliesslich einiger Spezialeinstellungen nach wie vor im Vordergrund. Bei der Beschreibung insbesondere der distalen Radiusfrakturen sollten die historische Benennung oder aeltere Einteilungen zugunsten der allgemeingueltigen und umfassenderen AO-Klassifikation verlassen werden. Die Computertomographie und Magnetresonanztomographie kommen in der Frakturdiagnostik bei unklaren anatomischen Verhaeltnissen oder konventionell nicht zufriedenstellend erklaerbaren Beschwerden zur Anwendung. Vermutete ligamentaere Verletzungen der Handwurzel lassen sich arthrographisch oder magnetresonanztomographisch abklaeren. (orig.)
Boeckstyns, Michel E H; Herzberg, Guillaume
Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose...
Jebson, P J; Adams, B D
Wrist arthrodesis is a well-established procedure that predictably relieves pain and provides a stable wrist for power grip. Although a variety of techniques for achieving a solid fusion have been described, the combination of rigid stabilization with a dorsal plate and autogenous cancellous bone grafting results in a high fusion rate and obviates the need for prolonged postoperative cast immobilization. Successful results with dorsal plating with or without local bone graft have recently been reported for patients with posttraumatic conditions. Rod or pin fixation is an established procedure for patients with inflammatory arthritis or a connective tissue disorder; however, plate fixation for these conditions is becoming a more acceptable alternative. Complications are relatively common and range from minor transient problems to major problems, such as wound dehiscence, infection, extensor tendon adhesions, and plate tenderness, which may require implant removal. Preoperatively, patients should be assessed for the presence of carpal tunnel syndrome, distal radioulnar joint arthritis, or ulnocarpal impaction syndrome, which may become or remain symptomatic after arthrodesis. Wrist arthrodesis results in a high degree of patient satisfaction with respect to pain relief and correction of deformity. Patients are able to accomplish most daily tasks and activities by learning to adapt to, and compensate for, the loss of wrist motion.
Full Text Available Ultrasound imaging of the musculoskeletal system is an important element of the diagnostic and therapeutic protocol. Clinical decisions, including those regarding surgical procedures, are often based solely on ultrasound imaging. However, detailed knowledge on the anatomy and a correct scanning technique are crucial for an accurate diagnosis. Modern ultrasonographic equipment allows obtaining detailed anatomical images of muscle tendons, ligaments, nerves and vessels of the carpal area. Ventral wrist ultrasound is one of the most common diagnostic procedures in patients with suspected carpal tunnel syndrome. Ventral wrist evaluation is also often performed in patients with wrist pain of unclear etiology, rheumatic diseases, wrist injuries or symptoms of ulnar neuropathy. The aim of this paper is to present ultrasound images with corresponding anatomical schemes. The technique of ultrasound examination of the ventral wrist along with practical guidance to help obtain highly diagnostic images is also discussed. The present paper is the second part of an article devoted to ultrasound anatomy and wrist ultrasound technique – the part discussing the dorsal side of the wrist was published in the Journal of Ultrasonography, Vol. 15, No 61. The following anatomical structures should be visualized during an ultrasound examination of the ventral wrist, both in the carpal tunnel as well as proximally and distally to it: four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, flexor pollicis longus, flexor carpi radialis tendon, median nerve and flexor retinaculum; in the carpal tunnel as well as proximally and distally to it: the ulnar nerve, ulnar artery and veins; the tendon of the flexor carpi ulnaris muscle; carpal joints.
Balasubramaniam, Srikant; Tyagi, Devendra K; Savant, Hemant V
Skull bone fractures are common in trauma. They are usually linear undisplaced or depressed; however, a distinct possibility of elevated fracture remains. We describe an entity of everted fracture skull in which the fracture segment is totally everted. The nature of trauma, management, and complications of this unique case are discussed. A 21-year-old woman involved in a railway accident presented to us with a primary dressing on her wound. Investigations revealed an everted fracture skull. She underwent surgery with good results. We would like to add everted fracture skull to the nomenclature describing skull fractures in addition to elevated compound fracture skull as a new entity. Copyright © 2011 Elsevier Inc. All rights reserved.
Full Text Available History of present illness: A 7-year-old left-handed male presented with left arm pain and deformity after being tackled while playing. On exam, there appeared to be dorsal displacement of the distal segment of the upper extremity. He had two-plus radial and ulnar pulses, and normal capillary refill. Sensation was intact to axillary, radial, ulnar, and median nerve distributions. Compartments were soft. Significant findings: Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture. Discussion: Supracondylar fractures are the most common pediatric elbow fracture.1 Approximately 95% are due to a fall onto an outstretched hand while the elbow is in extension. Direct trauma to the posterior aspect of a flexed elbow accounts for the remainder.2 There are three classifications of supracondylar fractures: type 1 is non-displaced, type 2 is displaced, but has an intact posterior periosteum, and type 3 is displaced with disrupted anterior and posterior periostea. Careful examination assessing for pulses, perfusion, neurologic integrity, and elevated compartment pressures are important in the evaluation.3 The brachial artery is often injured in posterior lateral displaced fractures.4 Neurologic deficits to the median, ulnar, or radial nerves are seen in as many of 49% of Type 3 supracondylar fractures; however, neuropraxias often resolve within two to three months.5 Untimely treated compartment syndrome may lead to Volkmann ischemic contractors, which are characterized by flexion of the elbow, pronation of the forearm, flexion of the wrist, and extension of the metacarpal phalangeal joints.6 Plain film radiography oriented in the anterior-posterior (AP and lateral fashions are typically sufficient for diagnosis; however, a fracture may exist without overt signs on X-ray.7 Given the high morbidity associated with Type 3 fractures, emergent Orthopedic
Hsieh, Wei-Min; Hwang, Yuh-Shyan; Chen, Shih-Ching; Tan, Sun-Yen; Chen, Chih-Chen; Chen, Yu-Luen
[Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods] Wrist injuries caused by fatigue at work, improper exercise, and other conditions are very common. Therefore, the reconstruction of wrist joint function is an important issue. The efficacy of a newly developed integrated wrist joint rehabilitation game using a Blobo bluetooth ball with C# software installed was tested in wrist rehabilitation (Flexion, Extension, Ulnar Deviation, Radial Deviation). [Results] Eight subjects with normal wrist function participated in a test of the system's stability and repeatability. After performing the Blobo bluetooth ball wrist physical therapy training, eight patients with wrist dysfunction experienced approximately 10° improvements in range of motion (ROM) of flexion extension, and ulnar deviation and about 6° ROM improvement in radial deviation. The subjects showed progress in important indicators of wrist function. [Conclusion] This study used the Blobo bluetooth ball in wrist physical therapy training and the preliminary results were encouraging. In the future, more diverse wrist or limb rehabilitation games should be developed to meet the needs of physical therapy training.
Demehri, Shadpour; Hafezi-Nejad, Nima; Morelli, John N.; Thakur, Uma; Eng, John [Johns Hopkins University, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Lifchez, Scott D.; Shores, Jaimie T. [Johns Hopkins University, Department of Plastic and Reconstructive Surgery, Baltimore, MD (United States); Means, Kenneth R. [MedStar Union Memorial Hospital, The Curtis National Hand Center, Baltimore, MD (United States)
Using four-dimensional CT scan (4DCT), we aimed at showing the kinematics of scapholunate (SL) interval in asymptomatic wrists in comparison with symptomatic contralateral wrists with inconclusive radiographic findings. This is an IRB approved, HIPPA compliant, retrospective study. Patients suspected of SL interosseous ligament (SLIL) injuries were referred for further evaluation of chronic wrist pain (>3 months). Twelve wrists (11 subjects) with chronic symptoms and inconclusive plain radiographs and 10 asymptomatic wrists (in 10 different subjects) were scanned using 4DCT. The minimum SL interval was measured during three wrist motions: relaxed-to-clenched fist, flexion-to-extension, and radial-to-ulnar-deviation. Changes were recorded using double-oblique multiplanar reformation technique. We extracted the normal limits of the SL interval as measured by dynamic CT scanning during active motion in asymptomatic wrists. In asymptomatic wrists, the average SL interval was observed to be smaller than 1 mm during all motions. In symptomatic wrists, during exams performed with clenched fist (SL interval (mean ± SD) = 2.53 ± 1.19 mm), extension (2.54 ± 1.48 mm) or ulnar deviation (2.06 ± 1.12 mm), the average SL interval was more than 2 mm. In contrast to symptomatic wrists, no significant change in SL interval measurements was detected during wrist motions in asymptomatic wrists. There was a mild to moderate correlation between SL interval change and presence/absence of symptoms (point-biserial correlation coefficients: 0.29-0.55). In patients with wrist pain suspicious for SLIL injury and inconclusive radiographs, SL interval increase can be detected with 4DCT in the symptomatic wrist compared to the asymptomatic wrist. (orig.)
Tessaro, Mark O; McGovern, Terrance R; Dickman, Eitan; Haines, Lawrence E
In cases of traumatic wrist pain, emergency physicians must maintain a high index of suspicion for scaphoid fractures due to their potential for serious complications. A growing body of literature supports the use of point-of-care ultrasonography by emergency physicians in the evaluation of potential fractures. We report a case of a pediatric scaphoid fracture that was initially not visualized on x-ray and was subsequently detected using point-of-care ultrasound in the ED.
Full Text Available Introduction. Impaired proprioception severely affects the control of gross and fine motor function. However, clinical assessment of proprioceptive deficits and its impact on motor function has been difficult to elucidate. Recent advances in haptic robotic interfaces designed for sensorimotor rehabilitation enabled the use of such devices for the assessment of proprioceptive function.Purpose. This study evaluated the feasibility of a wrist robot system to determine proprioceptive discrimination thresholds for two different DoFs of the wrist. Specifically, we sought to accomplish three aims: first, to establish data validity; second, to show that the system is sensitive to detect small differences in acuity; third, to establish test-retest reliability over repeated testing.Methodology. Eleven healthy adult subjects experienced two passive wrist movements and had to verbally indicate which movement had the larger amplitude. Based on a subject’s response data a psychometric function was fitted and the wrist acuity threshold was established at the 75% correct response level. A subset of five subjects repeated the experimentation three times (T1, T2 and T3 to determine the test-retest reliability.Results. Mean threshold for wrist flexion was 2.15°± 0.43° and 1.52°± 0.36° for abduction. Encoder resolutions were 0.0075° (flexion-extension and 0.0032° (abduction-adduction. Motor resolutions were 0.2° (flexion-extension and 0.3° (abduction-adduction. Reliability coefficients were rT2-T1=0.986 and rT3-T2=0.971.Conclusions. We currently lack established norm data on the proprioceptive acuity of the wrist to establish direct validity. However, the magnitude of our reported thresholds are physiological plausible and well in line with available threshold data obtained at the elbow joint. Moreover, system has high resolution and is sensitive enough to detect small differences in acuity. Finally, the system produces reliable data over repeated
Lüthje, Peter; Helkamaa, Teemu; Kaukonen, Juha-Pekka; Nurmi-Lüthje, Ilona; Kataja, Matti
To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort. Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures. The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Chopra, Annu; Rowbotham, Emma L
The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image-guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image-guided intervention of the hand and wrist was conducted. During this search, it became clear that there is little consensus regarding all aspects of image-guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence-based reference point which can be utilized by radiologists and to describe the most commonly employed techniques. PMID:26313500
Meals, Clifton G; Saunders, Rebecca J; Desale, Sameer; Means, Kenneth R
No goniometric technique is both maximally convenient and completely accurate, although photogoniometry (ie, picture taking to facilitate digital angle measurement) shows promise in this regard. Our purpose was to test the feasibility and reliability of a photogoniometric protocol designed to measure wrist and digit range of motion in general. Two independent observers examined a sample of joints in both normal and abnormal hands according to a photogoniometric protocol. Interrater and intrarater correlation were calculated, and these measurements were compared with measurements made by a third independent examiner with a manual goniometer. The photo-based measurements were reliable within and between observers; however, only a minority of these measurements were in agreement with manually collected values. At present, photogoniometry is not an acceptable alternative to manual goniometry for determining wrist and digit range of motion in general. Joint-specific photogoniometry should be the subject of future study, as should relevant imaging and software technology.
Song, Rong; Tong, Kai-yu; Hu, Xiaoling; Zhou, Wei
Robot-assisted rehabilitation is an advanced new technology in stroke rehabilitation to provide intensive training. Post-stroke motor recovery depends on active rehabilitation by voluntary participation of patient's paretic motor system as early as possible in order to promote reorganization of brain. However, voluntary residual motor efforts to the affected limb have not been involved enough in most robot-assisted rehabilitation for patients after stroke. The objective of this study is to evaluate the feasibility of robot-assisted rehabilitation using myoelectric control on upper limb motor recovery. In the present study, an exoskeleton-type rehabilitation robotic system was designed to provide voluntarily controlled assisted torque to the affected wrist. Voluntary intention was involved by using the residual surface electromyography (EMG) from flexor carpi radialis(FCR) and extensor carpi radialis (ECR)on the affected limb to control the mechanical assistance provided by the robotic system during wrist flexion and extension in a 20-session training. The system also applied constant resistant torque to the affected wrist during the training. Sixteen subjects after stroke had been recruited for evaluating the tracking performance and therapeutical effects of myoelectrically controlled robotic system. With the myoelectrically-controlled assistive torque, stroke survivors could reach a larger range of motion with a significant decrease in the EMG signal from the agonist muscles. The stroke survivors could be trained in the unreached range with their voluntary residual EMG on the paretic side. After 20-session rehabilitation training, there was a non-significant increase in the range of motion and a significant decrease in the root mean square error (RMSE) between the actual wrist angle and target angle. Significant improvements also could be found in muscle strength and clinical scales. These results indicate that robot-aided therapy with voluntary participation of
Gray, Jason; Zuhlke, Todd; Eizember, Shane; Srinivasan, Ramesh
Ganglions are common soft tissue masses of the hand. High recurrence rates are associated with nonsurgical treatment; thus, excision is often indicated. Arthroscopic excision and open excision have similar recurrence rates; however, the latter is associated with prolonged healing time and increased scarring. Recently, dry wrist arthroscopic techniques have been used. This technique allows easier confirmation of complete ganglion removal, easier conversion to open surgery, earlier return of mo...
Shah, Darshan S; Middleton, Claire; Gurdezi, Sabahat; Horwitz, Maxim D; Kedgley, Angela E
Although the orientations of the hand and forearm vary for different wrist rehabilitation protocols, their effect on muscle forces has not been quantified. Physiologic simulators enable a biomechanical evaluation of the joint by recreating functional motions in cadaveric specimens. Control strategies used to actuate joints in physiologic simulators usually employ position or force feedback alone to achieve optimum load distribution across the muscles. After successful tests on a phantom limb, unique combinations of position and force feedback - hybrid control and cascade control - were used to simulate multiple cyclic wrist motions of flexion-extension, radioulnar deviation, dart thrower's motion, and circumduction using six muscles in ten cadaveric specimens. Low kinematic errors and coefficients of variation of muscle forces were observed for planar and complex wrist motions using both novel control strategies. The effect of gravity was most pronounced when the hand was in the horizontal orientation, resulting in higher extensor forces (pforces were also affected by the direction of rotation during circumduction. The peak force of flexor carpi radialis was higher in clockwise circumduction (p=0.017), while that of flexor carpi ulnaris was higher in anticlockwise circumduction (p=0.013). Thus, the physiologic wrist simulator accurately replicated cyclic planar and complex motions in cadaveric specimens. Moreover, the dependence of muscle forces on the hand orientation and the direction of circumduction could be vital in the specification of such parameters during wrist rehabilitation. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Nichols, Jennifer A; Bednar, Michael S; Havey, Robert M; Murray, Wendy M
At the wrist, kinematic coupling (the relationship between flexion-extension and radial-ulnar deviation) facilitates function. Although the midcarpal joint is critical for kinematic coupling, many surgeries, such as 4-corner fusion (4CF) and scaphoidexcision 4-corner fusion (SE4CF), modify the midcarpal joint. This study examines how 4CF and SE4CF influence kinematic coupling by quantifying wrist axes of rotation. Wrist axes of rotation were quantified in 8 cadaveric specimens using an optimization algorithm, which fit a 2-revolute joint model to experimental data. In each specimen, data measuring the motion of the third metacarpal relative to the radius was collected for 3 conditions (nonimpaired, 4CF, SE4CF). The calculated axes of rotation were compared using spherical statistics. The angle between the axes of rotation was used to assess coupling, as the nonimpaired wrist has skew axes (ie, angle between axes approximately 60°). Following 4CF and SE4CF, the axes are closer to orthogonal than those of the nonimpaired wrist. The mean angle (±95% confidence interval) between the axes was 92.6° ± 25.2° and 99.8° ± 22.0° for 4CF and SE4CF, respectively. The axes of rotation defined in this study can be used to define joint models, which will facilitate more accurate computational and experimental studies of these procedures.
Bulut, Gul Tugba; Caglar, Nil Sayiner; Aytekin, Ebru; Ozgonenel, Levent; Tutun, Sule; Demir, Saliha Eroglu
The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS). The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS. Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later. At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance. The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS.
Sirola, J; Salovaara, K; Tuppurainen, M; Jurvelin, J S; Alhava, E; Kröger, H
The present study investigated the effects of first degree relatives' fractures on fracture incidence after the menopause. Sister's, but not other relatives', wrist or hip fracture history was associated with increased risk of fragility fractures after the menopause. This suggests genetic predisposition to bone fragility among postmenopausal women. The aim of the present study was to investigate the association between first degree relatives' fractures and perimenopausal bone fragility. The study sample of 971 perimenopausal women was extracted from randomly selected Kuopio Osteoporosis Risk Factor and Prevention cohort and measured with dual X-ray absorptiometry in femoral neck (FN) in baseline (1989-1991), in 5 years (1994-97), and in 10 years (1999-2001). All low-trauma energy fractures during the 10-year follow-up were recorded based on self-reports and validated from medical records. First degree relatives' history of life-time hip and wrist fractures (exact classification or trauma energy not specified) was questioned by postal inquiries. There was a significant correlation between fathers' vs. brothers' and mothers' vs. sisters' fractures (p fractures were associated with significantly lowered 10-year fragility fracture-free survival rate (HR = 0.56, p = 0.006). Sisters' or other relatives' fractures were not associated with FN bone loss rate or bone mineral density (BMD) in the follow-up measurements (p = NS in ANCOVA). The predictive power of BMD for fragility fractures differed according to sisters' fracture history: Baseline FN T score predicted fracture-free survival only among women without sisters' fracture history (HR 0.62, p fracture in Cox regression). In conclusion, sisters' fracture history is associated with 10-year fracture-free survival in perimenopausal women but not with BMD or its changes. Predictability of fragility fracture risk with BMD may depend on sister's fracture history. This may indirectly suggest genetic predisposition to bone
Jose Luis Ramos Martin
Full Text Available Motocross is a popular sport that requires both physical and mental dexterity. We have observed that 52% of the most frequent injuries in motocross affect the upper extremity. Some of these injuries are unilateral compartment syndrome in the flexors of the forearmwhich requires subcutaneous fasciotomy–, bilateral osteochondritis dissecans of the elbow and, very frequently, scaphoid fracture due to falls. The wrist is very often involved in injuries related to this sport. The main of the present study is to study the mechanism of action of scaphoid fractures in motocross and find preventive measures that can be applied to motocross athletes against scaphoid fracture. A systematic review was carried out in Pubmed and Cochrane Library Plus using the kew words mentioned below as a search strategy. We then selected 13 articles, reviewed them, compiled the data and analysed it afterwards. We have found that the main trigger for scaphoid fracture is the hyperextension and hyperflexion of the wrist. A correct wrist immobilization as well as exercising the forearm muscles would lead to a better control of stabilization during the following seconds of a fall. Useful exercises include for example eccentric contraction during 12 weeks. An important aspect of prevention is always regarding the equipment. Wrist guards should always be worn as they significantly reduce the risk of injuries during a fall. A wrist guard can limit hyperextension to an extent with the help of an external stabilizer.
Hannemann, P.; Gottgens, K.W.; Wely, B.J. van; Kolkman, K.A.; Werre, A.J.; Poeze, M.; Brink, P.R.
BACKGROUND: The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor
Pehlivan, Ali Utku; Rose, Chad; O'Malley, Marcia K
Rehabilitation of the distal joints of the upper extremities is crucial to restore the ability to perform activities of daily living to patients with neurological lesions resulting from stroke or spinal cord injury. Robotic rehabilitation has been identified as a promising new solution, however, much of the existing technology in this field is focused on the more proximal joints of the upper arm. A recently presented device, the RiceWrist-S, focuses on the rehabilitation of the forearm and wrist, and has undergone a few important design changes. This paper first addresses the design improvements achieved in the recent design iteration, and then presents the system characterization of the new device. We show that the RiceWrist-S has capabilities beyond other existing devices, and exhibits favorable system characteristics as a rehabilitation device, in particular torque output, range of motion, closed loop position performance, and high spatial resolution.
Biddulph, S L
In a study to assess the effects of the Futuro wrist brace (Adcock-Ingram) in 22 patients with osteoarthritis, rheumatoid arthritis, tenosynovitis and gout of the wrist, grip and pinch dynamometers were used to measure improvement in function. The study confirmed the efficacy of the wrist brace by demonstrating an average of 23.7% improvement in grip strength over the 10-day study, as well as a significant average improvement in pinch strength of 14.8% (P less than 0.05). In the subgroup of 8 rheumatoid arthritis patients a significant average increase in grip strength of 48.9% (P less than 0.025) was obtained. Both day and night pain was reduced and there was improvement in patients' ability to carry out their daily activities. The brace was found to be comfortable and easy to use.
Holley, Devon; Johnson, Michelle; Harris, Gerald; Beardsley, Scott
Children with Cerebral Palsy (CP) often exhibit impairments in the coordination of the grip and lift phases of arm movements that directly impact their ability to perform activities of daily living (ADLs). The application of assistive robotic therapy to children with spastic hemiplegic CP has shown that augmented movement training can lead to improved functional outcomes and improved arm kinematics. Assistive robotic therapy of the wrist has been shown to help improve motor skills in stroke patients, but the devices employed are often large and obtrusive, focusing on a repeated motion rather than a task-based itinerary. Here, we propose a lightweight low clearance wrist orthosis for use in children with Cerebral Palsy that actuates pronation/supination and flexion/extension of the wrist.
Junqueira, Giovanna Damm Raphael; Lima, André Luiz Machado; Boni, Robison; Almeida, Joelmar César DE; Ribeiro, Rafael Souza; Figueiredo, Leandro Azevedo DE
A retrospective statistical data gathering of wrist and hand complaints assisted over two years in the orthopedic emergency department of a regional referral hospital, seeking to know the profile of these patients. Information obtained by analysis of 31.356 orthopedic visits from May 2013 to April 2015, of which 6.754 related to hand complaints and/or wrist, at the Hospital Estadual Doutor Jayme dos Santos Neves (HDJSN) and analyzed by IBM SPSS Statistics software version 21. The data revealed that the average age was 37,5 ± 15,7 years and the male gender was predominant (60,72%). Bruises (52,58%) and fractures (30,49%) were the most common diagnoses. The complaints of wrist and hand accounted for 21,44% of all orthopedic emergency room visits. Detailed data description and correct definition of the International Classification of Diseases (ICD-10) are needed to better define the epidemiological profile of patients seeking orthopedic emergency. Level of Evidence III, Retrospective Study.
Selvaraj, Venkatesh; Buhari, Faiza Sulaiman
Successful arterial cannulation requires wide and patent arterial lumen. A recent study has shown that success rate of radial arterial cannulation at first attempt is more at 45° angle of wrist extension in both young and elderly patients. No study has reasoned whether these high success rates at 45° is because of less compression of the radial artery at this particular angle of wrist extension. Hence, we attempted to study whether the radial artery dimensions changes with increasing angles of wrist extension in young, healthy female volunteers using ultrasound examination. To investigate the effect of increasing angle of wrist extension of 0, 15, 30, 45, 60, and 75° on radial artery dimensions at the level of the wrist joint using ultrasound examination. A prospective single blinded study in volunteers. Sonographic measurements of radial artery dimension at the wrist level were performed in 48 young, healthy female subjects. Height (anteroposterior in mm), width (mediolateral in mm) and depth (skin to artery) were measured at wrist extension of 0, 15, 30, 45, 60, and 75°. The dimensions at each angle are compared with 0° as the control and statistical analysis done. One-way analysis of variance test. No statistically significant change in dimension of the radial artery is observed with increasing angle of wrist extension. Ultrasound evaluation showed that increasing angle of wrist extension does not significantly change the dimensions of radial artery at the wrist joint level in young healthy female volunteers.
Nichols, Jennifer A.; Bednar, Michael S.; Havey, Robert M.; Murray, Wendy M.
Background Proximal row carpectomy and scaphoid-excision four-corner fusion are salvage procedures that relieve pain by removing arthritic joint surfaces. While numerous studies have examined how these procedures affect joint motion, few have examined how they influence muscle mechanical actions. This study examines whether muscle moment arms change after these procedures. Methods Moment arms of primary wrist muscles were measured in 8 cadaveric specimens using the tendon excursion method. In each specimen, moment arms were measured for two degrees of freedom (flexion-extension and radial-ulnar deviation) and three conditions (nonimpaired, scaphoid-excision four-corner fusion, and proximal row carpectomy). For each muscle and degree of freedom, moment arm versus joint angle curves for the three conditions were statistically compared. Findings Wrist salvage procedures significantly alter moment arms of the primary wrist muscles. Proximal row carpectomy primarily alters flexion-extension moment arms, while scaphoid-excision four-corner fusion primarily alters radial-ulnar deviation moment arms. Both procedures also alter the balance between agonist and antagonist wrist muscles. Following proximal row carpectomy, wrist extensors have smaller moment arms in extended postures. Following scaphoid-excision four-corner fusion, radial deviators have larger moment arms throughout radial-ulnar deviation. Interpretation Different moment arms indicate that different forces are required to complete the same tasks in nonimpaired and surgically altered wrists. The altered muscle moment arms likely contribute to post-operative impairments. Understanding how salvage procedures alter muscle mechanical actions is a critical first step toward identifying the cause of post-operative impairments and is necessary to develop effective interventions to augment deficient muscles and improve overall function. PMID:25843482
Full Text Available Ultrasound imaging of the musculoskeletal system is superior to other imaging methods in many aspects, such as multidimensional character of imaging, possibility of dynamic evaluation and precise assessment of soft tissues. Moreover, it is a safe and relatively inexpensive method, broadly available and well-tolerated by patients. A correctly conducted ultrasound examination of the wrist delivers detailed information concerning the condition of tendons, muscles, ligaments, nerves and vessels. However, the knowledge of anatomy is crucial to establish a correct ultrasound diagnosis, also in wrist assessment. An ultrasound examination of the wrist is one of the most common US examinations conducted in patients with rheumatological diseases. Ultrasonographic signs depend on the advancement of the disease. The examination is equally frequently conducted in patients with pain or swelling of the wrist due to non-rheumatological causes. The aim of this publication was to present ultrasound images and anatomic schemes corresponding to them. The correct scanning technique of the dorsal part of the wrist was discussed and some practical tips, thanks to which highly diagnostic images can be obtained, were presented. The f ollowing anatomical structures should be visualized in an ultrasound examination of the dorsal wrist: distal radio-ulnar joint, radiocarpal joint, midcarpal joint, carpometacarpal joints, dorsal radiocarpal ligament, compartments of extensor tendons, radial artery, cephalic vein, two small branches of the radial nerve: superfi cial and deep, as well as certain midcarpal ligaments, particularly the scapholunate ligament and lunotriquetral ligament. The paper was distinguished in 2014 as the “poster of the month” (poster number C-1896 during the poster session of the European Congress of Radiology in Vienna.
Atesok, Kivanc; Doral, M Nedim; Whipple, Terry; Mann, Gideon; Mei-Dan, Omer; Atay, O Ahmet; Beer, Yiftah; Lowe, Joseph; Soudry, Michael; Schemitsch, Emil H
the purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures.
Prakash, Jatin; Mehtani, Anil
Skeletal tuberculosis (TB) of the hand and wrist is rare, accounting for less than 1% of all osteoarticular TB. Although rare, TB of the hand and wrist is a cause of major morbidity. A common feature among all available reports on TB of the hand and wrist was a delay in diagnosis, causing residual stiffness and pain after treatment. Minimal initial symptoms, rarity of the lesion and ability of wrist TB to mimic more common pathologies account for the delay. Skeletal TB may behave differently in this age compared with the adult population. Further, the disease may affect the growing bone, causing residual deformities. The paucity of studies from different countries, coupled with a difficulty in diagnosis resulting in major morbidity, led us to carry out a study on this topic. A total of 44 patients with skeletal lesions in the hand and wrist were studied. The diagnosis was confirmed by biopsy. Patients were started on multidrug antitubercular treatment (ATT). Those not responding were scheduled for debridement. All patients were assessed using the Green O'Brian scoring system. All these patients were studied separately for clinical presentation, nutritional status (Rainey-Mcdonald nutritional index), time from onset of symptoms to presentation, treatment required, prognosis and complications. The proximal phalanx of the fourth digit and the metacarpal of the fifth digit were the most commonly involved bones in our series, with five cases of each. The capitate was the most common carpal bone, followed by the lunate. The duration of symptoms ranged from 5 weeks to 24 weeks (mean: 7.6 weeks). Most of these patients presented with complaints of pain, followed by swelling. 13 patients did not respond favourably to ATT over an 8-week period and were scheduled for surgery. Three of these patients had multidrug resistance. There was one case of a pathological fracture in our series and seven cases of arthritis/residual significant pain at the end of follow-up. For all the
Full Text Available The aim of this paper is to design a human–interface system, using EMG signals elicited by various wrist movements, to control a robot. EMG signals are normalized and based on joint torque. A three-layer neural network is used to estimate posture of the wrist and forearm from EMG signals. After training the neural network and obtaining appropriate weights, the subject was able to control the robot in real time using wrist and forearm movements.
Pando, Autumn L; Lee, Hyunglae; Drake, Will B; Hogan, Neville; Charles, Steven K
Because the dynamics of wrist rotations are dominated by stiffness, understanding wrist rotations requires a thorough characterization of wrist stiffness in multiple degrees of freedom. The only prior measurement of multivariable wrist stiffness was confined to approximately one-seventh of the wrist range of motion (ROM). Here, we present a precise nonlinear characterization of passive wrist joint stiffness over a range three times greater, which covers approximately 70% of the functional ROM of the wrist. We measured the torque-displacement vector field in 24 directions and fit the data using thin-plate spline smoothing optimized with generalized cross validation. To assess anisotropy and nonlinearity, we subsequently derived several different approximations of the stiffness due to this multivariable vector field. The directional variation of stiffness was more pronounced than reported previously. A linear approximation (obtained by multiple linear regression over the entire field) was significantly more anisotropic (eigenvalue ratio of 2.69 ± 0.52 versus 1.58 ± 0.39; ) though less misaligned with the anatomical wrist axes (12.1 ± 4.6° versus 21.2 ± 9.2°; ). We also found that stiffness over this range exhibited considerable nonlinearity-the error associated with a linear approximation was 20-30%. The nonlinear characterization over this greater range confirmed significantly greater stiffness in radial deviation compared to ulnar deviation. This study provides a characterization of passive wrist stiffness better suited to investigations of natural wrist rotations, which cover much of the wrist's ROM. It also provides a baseline for the study of neurological and/or orthopedic disorders that result in abnormal wrist stiffness.
Martins Roberto S.; Siqueira Mario G.; Simplício Hougelli
This prospective study evaluates the possible advantages of wrist imobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuosly for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment...
Schuhl, J F; Leroy, B; Comtet, J J
A study of 126 normal wrists has allowed us to determine the normal laxity of the scapholunate complex (36 degrees) by measuring and comparing the range of movement of each of these two bones on sagittal views on x-ray films. There was no difference between dominant and nondominant hands. A study of eight cadaver wrists and 13 pathologic wrists has shown greater SL in the presence of scapholunate ligament lesions. The measurement of SL on dynamic sagittal views on x-ray films can detect a pathologic laxity between these two bones. A minimal 15 degrees difference between a normal and a pathologic wrist is reliable.
Arner, M; Hagberg, L
Diseases of the pisiform triquetral (P-T) joint and the pisiform itself are often treated with excision of the pisiform bone. The flexor carpi ulnaris (FCU) tendon inserts on the volar aspect of the pisiform, suggesting a loss of strength in wrist flexion following excision of the bone. Isometric and dynamic, isokinetical measurements were made using a strain-gauge dynamometer (Cybex II). Slight postoperative reduction of wrist flexion strength, compared with the contralateral wrist, was noted but not of clinical significance. It is concluded that one should not refrain from excision of the pisiform bone for fear of considerable strength loss in wrist joint flexion.
Narrative review. Recent years have brought new research findings on the subject of wrist joint proprioception, which entails an understanding of the wrist as part of a sensorimotor system where afferent information from nerve endings in the wrist joint affects the neuromuscular control of the joint. An understanding of proprioception is also essential to adequately rehabilitate patients after wrist injuries. The aim of this narrative review was to give the reader a background of proprioception as it relates to neuromuscular control and joint stability, what is presently known in relation to the wrist joint and how these findings may be applied to the field of wrist rehabilitation. 5. Copyright (c) 2010 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Di Monaco, Marco; Castiglioni, Carlotta; Vallero, Fulvia; Di Monaco, Roberto; Tappero, Rosa
The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.
Becker, Anton S; Martini, Katharina; Higashigaito, Kai; Guggenberger, Roman; Andreisek, Gustav; Frauenfelder, Thomas
The purpose of this study was to quantitatively and qualitatively determine the impact of radiation dose reduction on the image noise and quality of tomosynthesis studies of the wrist. Imaging of six cadaver wrists was performed with tomosynthesis in anteroposterior position at a tube voltage of 60 kV and tube current of 80 mA and subsequently at 60 or 50 kV with different tube currents of 80, 40, or 32 mA. Dose-area products (DAP) were obtained from the electronically logged protocol. Image noise was measured with an ROI. Two independent and blinded readers evaluated all images. Interreader agreement was measured with a Cohen kappa. Readers assessed overall quality and delineation of soft tissue, cortical bone, and trabecular bone on a 4-point Likert scale. The highest DAP (3.892 ± 0.432 Gy · cm(2)) was recorded for images obtained with 60 kV and 80 mA; the lowest (0.857 ± 0.178 Gy · cm(2)) was recorded for images obtained with 50 kV and 32 mA. Noise was highest when a combination of 50 kV and 32 mA (389 ± 26.6) was used and lowest when a combination of 60 kV and 80 mA (218 ± 12.3) was used. The amount of noise on images acquired using 60 kV and 80 mA was statistically significantly different from the amount measured on all other images (p wrist is possible while image quality and delineation of anatomic structures remain preserved.
Contu, Sara; Marini, Francesca; Cappello, Leonardo; Masia, Lorenzo
Proprioception is essential for planning and controlling limb posture and movement. In our recent work, we introduced a standardized robot-aided method for measuring proprioceptive discrimination thresholds at the wrist to obtain reliable and accurate measures of proprioceptive acuity. Weber's law defines discrimination thresholds as a constant ratio between the just noticeable difference and the reference or standard stimulus. Reporting Weber's fractions thus provides the possibility of comparing results with the reports of others collected worldwide. This work aims to determine that Weber's Law holds for proprioceptive discrimination thresholds and to provide Weber's fraction for wrist joint proprioception. To this end, eight healthy subjects experienced two passive wrist movements of different amplitude and verbally indicated which was larger. An adaptive psychophysical procedure established the amplitude of the largest stimulus according to participants' responses. This comparison stimulus was then compared to a standard stimulus amplitude of 10°, 20°, 30° or 40°. The discrimination thresholds for each standard stimulus were established at the 75% correct response level. The obtained thresholds followed Weber's Law indicating that larger amplitudes were associated with higher discrimination thresholds. Based on a linear regression function the overall Weber's fraction, defined as the slope of the line, was computed to be 0.09. This result expands the present limited knowledge on wrist proprioception showing that its proprioceptive acuity follows Weber's law.
Smeulders, MJC; Kreulen, M; Hage, JJ; Ritt, MJPF; Mulder, T
Objective: Assessment of the quality of fine motor control in patients with unilateral chronic wrist pain seldom focuses on the possibility that control of movements is effector independent at the cerebral level. This mechanism may be involved in an impairment of motor function in the unaffected
Zesiewicz, Theresa; Vu, Tuan; Carranza, Michael A.; Appelbaum, Rachel; Snyder, Madeline; Staffetti, Joseph S.; Allison, Kevin G.; Shimberg, William R.; Louis, Elan D.
Background Tremors may be difficult to classify. Case Report An 83-year-old male presented with an unusual left wrist tremor. The tremor could be reproducibly elicited by making a fist or carrying a weighted object (e.g., a shopping bag, bottle of water) of approximately 1 lb or more, and it intensified with heavier weights. The tremor was difficult to classify, although it shared features with isometric tremor. Discussion This specific presentation of tremor has not been reported previously. We hope that the detailed description we provide will aid other neurologists who encounter this or similar tremors in their clinics. PMID:24455450
Hansen, John Paulin; Lund, Haakon; Biermann, Florian
This paper addresses gaze interaction for smart home control, conducted from a wrist-worn unit. First we asked ten people to enact the gaze movements they would propose for e.g. opening a door or adjusting the room temperature. On basis of their suggestions we built and tested different versions...... selection. Their subjective evaluations were positive with regard to the speed of the interaction. We conclude that gaze gesture input seems feasible for fast and brief remote control of smart home technology provided that robustness of tracking is improved....
Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.
Gehlbach, Stephen; Saag, Kenneth G; Adachi, Jonathan D; Hooven, Fred H; Flahive, Julie; Boonen, Steven; Chapurlat, Roland D; Compston, Juliet E; Cooper, Cyrus; Díez-Perez, Adolfo; Greenspan, Susan L; LaCroix, Andrea Z; Netelenbos, J Coen; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Sambrook, Philip N; Silverman, Stuart; Siris, Ethel S; Watts, Nelson B; Lindsay, Robert
Previous fractures of the hip, spine, or wrist are well-recognized predictors of future fracture, but the role of other fracture sites is less clear. We sought to assess the relationship between prior fracture at 10 skeletal locations and incident fracture. The Global Longitudinal Study of Osteoporosis in Women (GLOW) is an observational cohort study being conducted in 17 physician practices in 10 countries. Women aged ≥55 years answered questionnaires at baseline and at 1 and/or 2 years (fractures in previous year). Of 60,393 women enrolled, follow-up data were available for 51,762. Of these, 17.6%, 4.0%, and 1.6% had suffered 1, 2, or ≥3 fractures, respectively, since age 45 years. During the first 2 years of follow-up, 3149 women suffered 3683 incident fractures. Compared with women with no previous fractures, women with 1, 2, or ≥3 prior fractures were 1.8-, 3.0-, and 4.8-fold more likely to have any incident fracture; those with ≥3 prior fractures were 9.1-fold more likely to sustain a new vertebral fracture. Nine of 10 prior fracture locations were associated with an incident fracture. The strongest predictors of incident spine and hip fractures were prior spine fracture (hazard ratio [HR] = 7.3) and hip (HR = 3.5). Prior rib fractures were associated with a 2.3-fold risk of subsequent vertebral fracture, and previous upper leg fracture predicted a 2.2-fold increased risk of hip fracture. Women with a history of ankle fracture were at 1.8-fold risk of future fracture of a weight-bearing bone. Our findings suggest that a broad range of prior fracture sites are associated with an increased risk of incident fractures, with important implications for clinical assessments and risk model development. © 2012 American Society for Bone and Mineral Research
Choung, Sung-Dae; Park, Kyue-Nam; Kim, Si-Hyun; Kwon, Oh-Yun
Overuse of the extensor carpi radialis (ECR) may play a role in the development of lateral epicondylitis (LE). However, no studies have investigated the muscle activity ratio between the ECR and extensor carpi ulnaris (ECU) associated with the kinematics during wrist extension in workers with LE. We compared the ratio (ECR/ECU) of muscle activity between the ECR and ECU and the kinematics of the wrist during wrist extension between workers with and without LE. Fifteen automobile assembly line workers with LE and 15 workers without LE participated in this study. The ratio of muscle activity was measured using surface electromyography, and wrist kinematics were measured by a three-dimensional motion analysis system while the workers extended their wrists actively to the maximum range to which they did not feel uncomfortable. Significantly greater ratios of muscle activity, ranges of radial deviation, and combined motion of radial deviation and extension (CMDE) were shown in workers with LE compared to those without LE. Also, the range of wrist extension was significantly lower in workers with LE than in those without LE. Quantifying the ratio of muscle activity with altered kinematics of wrist extension may help researchers to understand why overuse of ECR is occurring and explain LE development in automobile assembly line workers.
... AFFAIRS Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity... disability benefits related to a claimant's diagnosis of wrist conditions. DATES: Written comments and... . Please refer to ``OMB Control No. 2900-NEW (Wrist Conditions Disability Benefits Questionnaire)'' in any...
... AFFAIRS Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity... disability benefits related to a claimant's diagnosis of wrist conditions. DATES: Written comments and... . Please refer to ``OMB Control No. 2900--NEW (Wrist Conditions Disability Benefits Questionnaire)'' in any...
Munk, Bo; Jensen, Steen Lund; Olsen, Bo Sanderhoff
The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions.......The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions....
Simkin, P.A.; Benedict, R.S. (Univ. of Washington, Seattle (USA))
The clearance rates of free iodide and of radioiodinated serum albumin were measured in the knee and wrist joints of 9 normal adult dogs. Iodide clearance from the knee was 3 times greater than that from the wrist. In contrast, radioiodinated serum albumin clearance from the knee was only slightly greater than that from the wrist. Interpreted as respective indices of effective synovial plasma flow and lymphatic drainage, these values indicate that the filtration fraction is normally greater in microvessels of the wrist than in those of the knee. These findings complement the results of companion studies of Starling forces that indicate a higher pressure microvascular bed in the wrist than in the knee.
Shimose, Ryota; Matsunaga, Atsuhiko; Muro, Masuo
Gripping force is produced by co-contraction of forearm flexors and extensors. Activation of extensors is important for stabilizing the wrist during gripping. However, forearm muscle function is complicated and the neurophysiological mechanism responsible for the gain in gripping force is unclear. Therefore, the purpose of this study was to investigate whether increasing forearm extensor activation with isometric wrist extension training has an effect on gripping force. Thirteen healthy subjects participated in this study. Maximal voluntary contraction of gripping was measured using a piezosensor (MVC(grip)) and EMG of forearm muscles at every wrist angle (from 70° flexion to 80° extension with 10° intervals) were measured simultaneously at baseline, 4 weeks, and 8 weeks after training. Training consisted of 30 repetitions equal to 70% MVC of isometric wrist extension for 8 weeks (5/week) on the right side. Gripping force was measured on both sides using a grip dynamometer without wrist angle restriction. Gripping force, EMG, maximal wrist extension force, and wrist angle-gripping force curve were investigated after training. After training, maximal wrist extension force increased significantly. Gripping force on the trained side also increased significantly. The training changed wrist angle at peak of MVC(grip). EMG activation of forearm extensors increased and that of flexors decreased during gripping. These results suggest that wrist extension training leads to an increase in gripping force and changes the balance of EMG activation between forearm flexors and extensors during gripping. Therefore, this training method should be useful as a therapeutic strategy for increasing grip strength.
O'Driscoll, S W; Horii, E; Ness, R; Cahalan, T D; Richards, R R; An, K N
In the first part of this study, the position assumed by a normal wrist during unconstrained maximal grip and the relationship between wrist position and grip strength were investigated in 20 healthy subjects. Grip strength and wrist position were recorded in the self-selected position and then again while the subjects voluntarily deviated the wrist randomly into flexion, extension, or radial or ulnar deviation of 10 to 15 degrees. The self-selected position was 35 degrees of extension and 7 degrees of ulnar deviation. Grip strength was significantly less in any position of deviation from this self-selected position, even after accounting for fatigue. With the wrist in only 15 degrees of extension or in neutral radio-ulnar deviation, grip strength was reduced to two thirds to three fourths of normal. Sex did not affect wrist position. The dominant wrists were within 5 degrees of the nondominant ones but were relatively less extended and in more ulnar deviation. Grip strength is significantly reduced when wrist position deviates from this self-selected optimum position. In the second part of the study, the effect of grasp size on this self-selected position was studied in 21 subjects. The degree of wrist extension was inversely and linearly related to how large a setting on the Jamar dynamometer was used. This was true regardless of hand size, although the effect was more significant for smaller hands. Radial and ulnar deviations were not affected by handle position. A minimum of 25 degrees of wrist extension was required for optimum grip strength.(ABSTRACT TRUNCATED AT 250 WORDS)
Mühldorfer, M; Hohendorff, B; Prommersberger, K-J; van Schoonhoven, J; van Schoonhofen, J
What are the medium-term results after a radioscapholunate fusion in the treatment of a post-traumatic osteoarthtritis of wrist? Between 1/92 and 8/04 73 Patients with post-traumatic radiocarpal osteoarthritis (mostly following an intra-articular distal radius fracture) were treated by radioscapholunate (RSL) fusion. These patients were retrospectively evaluated with a minimum follow-up period of 18 months. In 16 of the 73 patients (22%) the RSL fusion was converted to a complete wrist arthrodesis at an average of 9 (3-69) months after the partial fusion. Of the remaining 57 patients 39 returned for a clinical and radiological examination at an average of 59 (19-140) months postoperatively. Pain, functional limitations, range of motion, grip strength, return to work, and patient satisfaction were evaluated. Non-union of the fusion and carpal osteoarthritis were assessed radiologically. The DASH score averaged 39 points (3-80). 7 patients (18%) had no pain. 19 patients (49%) had pain only with activities. 13 patients (32%) complained of pain at rest, but 38 of 39 patients reported an improvement in comparison to the preoperative situation. 28 patients (72%) returned to work. 38 of 39 patients would have the operation done again (97%). Wrist extension averaged 31 degrees and flexion 29 degrees , ulnar deviation was 20 degrees and radial deviation 14 degrees on average, pronation averaged 81 degrees and supination 71 degrees . Grip strength was 32 kg on average (72% of the opposite side). The radiological assessment showed in 8 patients (21%) a radiocarpal non-union (7 RS, 1 RL). Arthritic changes of the adjacent carpal joints (STT, SC, LC or LT) were found in 20 patients (51 %) without a significant effect on the clinical outcome. Radioscapholunate fusion is a treatment option for radiocarpal osteoarthritis to preserve a functional range of motion. Patient satisfaction is high although functional limitations and residual pain can exist. A progressive arthrosis of the
Polovinets, Olga; Wolf, Alon; Wollstein, Ronit
Cross-sectional cohort. Push-ups are used ubiquitously to evaluate and strengthen the upper body. They are usually performed in 1 of 2 main ways: with the wrist in hyperextension and with the wrist in a neutral position. The purpose of our study was to compare the dynamic forces in the wrist during the 2 push-up styles. Fourteen volunteers performed push-ups in 2 different patterns: on a hyperextended wrist and a neutral wrist (NW). Two force plates and a motion capture system were used to measure the ground reaction forces (GRFs) and the kinematics of the upper extremity during push-ups. Kinematic and kinetic analyses were performed using Matlab software (Mathworks, Natick, MA). The GRF vector was distributed differently during the different types of push-ups. For both methods, the total GRF carried by the upper dominant extremity was larger than those of the nondominant extremity. In the NW configuration, the GRF vector was more uniform throughout the push-up in the vertical direction. The horizontal distance between the capitate bone location and the GRF origin was smaller in hyperextension. The forces traveled more dorsally over a wider area and more ulnarly in the hyperextended wrist. Forces are transmitted differently through the wrist in the 2 methods. Push-ups on an NW are likely safer because ligaments may be preferentially loaded in hyperextension. Further study may delineate the differences in the anatomic location of force transmission and the long-term clinical effect on the wrist. This study supports the performance of push-ups on a wrist in neutral flexion extension; both to enable patients after surgery or injury to strengthen the upper body and prevent injury and long-term wear in the wrist. The knowledge gained from this study may assist in outlining guidelines for push-up performance. Diagnostic level 2a. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
OBJECTIVE: To report bilateral simultaneous fractures of the carpal scaphoid bones and their successful treatment with bilateral thumb spacia casts. METHODS: A 28-year-old medical practitioner presented with a day history of painful swollen wrists following a fall on both outstretched hands. He was fully examined and ...
CONCLUSION: External fixation and ligamentotaxis provide better functional and anatomical results in comminuted intra-articular and unstable extra-articular wrist injuries. The functional result of treatment of distal radius fractures not only depends on the anatomical restoration of the articular surface but also depends on the associated soft tissue injuries and articular damage.
Theresa A. Zesiewicz
Full Text Available Background: Tremors may be difficult to classify.Case Report: An 83‐year‐old male presented with an unusual left wrist tremor. The tremor could be reproducibly elicited by making a fist or carrying a weighted object (e.g., a shopping bag, bottle of water of approximately 1 lb or more, and it intensified with heavier weights. The tremor was difficult to classify, although it shared features with isometric tremor.Discussion: This specific presentation of tremor has not been reported previously. We hope that the detailed description we provide will aid other neurologists who encounter this or similar tremors in their clinics.
Bracken, Jennifer; Bartlett, Murray [Royal Children' s Hospital, Medical Imaging Department, Melbourne, VIC (Australia)
The majority of published literature on ganglion cysts in children has been from a surgical perspective, with no dedicated radiologic study yet performed. Our aim was to assess the magnetic resonance (MR) imaging appearance of ganglion cysts in a series of paediatric MR wrist examinations. Ninety-seven consecutive paediatric MR wrist examinations were retrospectively reviewed for the presence of ganglion cysts. Only those studies with wrist ganglia were included. Cysts were assessed for location, size, internal characteristics and secondary effect(s). Forty-one ganglion cysts (2-32 mm in size) were seen in 35/97 (36%) patients (24 female, 11 male), mean age: 13 years 11 months (range: 6 years 3 months-18 years). The majority were palmar (63.4%) with the remainder dorsal. Of the cysts, 43.9% were related to a wrist ligament(s), 36.6% to a joint and 17.1% to the triangular fibrocartilage complex. Of the patients, 91.4% had wrist symptoms: pain (n=29, 82.9%), swelling (n=7, 20%) and/or palpable mass (n=4, 11.4%); 71.4% patients had significant additional wrist abnormalities. Ganglion cysts were frequently found in children referred for wrist MRI. (orig.)
Skeete, Kshamata; Hess, Erik P; Clark, Tod; Moran, Steven; Kakar, Sanjeev; Rizzo, Marco
To determine the cumulative prevalence of septic arthritis presenting to the emergency department of an academic medical center and evaluate the use of clinical data to diagnose infection versus inflammation. We conducted a records review of a single institution with 80,000 annual emergency room visits. We included a consecutive series of patients with suspected wrist infection from January 1, 2007, to December 31, 2008. Adults complaining of atraumatic wrist pain with either erythema or swelling on physical examination or a final diagnosis of septic arthritis, gout, pseudogout, cellulitis, wrist hematoma/edema, or wrist arthritic flare were suspected to have infection. We collected data using a standardized data abstraction form. We reviewed 804 patient records. A total of 104 patients meeting inclusion criteria for suspected wrist joint infection during the 2-year study period were included. Mean age was 62.5 years (SD, 20.2 y); 63 were men. There were 12 patients with a history of gout, 4 with a history of pseudogout, and 19 with a history of diabetes. Wrist arthrocentesis was performed in 31 patients, and 11 underwent surgical treatment. There were 16 patients with a final diagnosis of gout, 11 with pseudogout, 43 with cellulitis, 13 with upper extremity hematoma/edema, and 15 with wrist arthritic flare. The cumulative prevalence of septic arthritis was 5%. In this series of emergency department patients with suspected wrist joint infection, gout, pseudogout, and cellulitis were the most common etiologies. The cumulative incidence of septic wrist arthritis was low. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Esmaeili, Mohammad; Jarrassé, Nathanaël; Dailey, Wayne; Burdet, Etienne; Campolo, Domenico
Increasing the level of transparency in rehabilitation devices has been one of the main goals in robot-aided neurorehabilitation for the past two decades. This issue is particularly important to robotic structures that mimic the human counterpart's morphology and attach directly to the limb. Problems arise for complex joints such as the human wrist, which cannot be accurately matched with a traditional mechanical joint. In such cases, mechanical differences between human and robotic joint cause hyperstaticity (i.e. overconstraint) which, coupled with kinematic misalignments, leads to uncontrolled force/torque at the joint. This paper focuses on the prono-supination (PS) degree of freedom of the forearm. The overall force and torque in the wrist PS rotation is quantified by means of a wrist robot. A practical solution to avoid hyperstaticity and reduce the level of undesired force/torque in the wrist is presented, which is shown to reduce 75% of the force and 68% of the torque.
Evgeniya A Kochenova
Conclusions: Patients with segmental lesions of the spinal cord at the С6-С7 and С5-С8 level were associated with restoration of active wrist extension up to the neutral position or more and were expected to achieve significant improvement of hand function. Patients with spinal cord lesions at the C5-Th1 level exhibited significant lesions of the muscles, along with bone deformities. Consequently, surgical treatment could only achieve functional wrist position with minimal improvement of hand function. Using differential approaches in the treatment of wrist contracture that are selected by determining the level of spinal cord lesion will enable physicians to predict the outcome and improve the function and appearance of the wrist.
To compare the diagnostic effectiveness of post-arthro-CT (PACT) and 3-compartment wrist arthrography (AG) both separate and combined versus wrist arthroscopy for scapho-lunate ligament (SLL), luno-triquetral ligament (LTL) and triangular fibrocartilage (TFC) defects and chondromalacia of the carpal bones. Material and methods: in 58 patients (16-69 years) the affected wrist was examined initially by conventional 3-compartment wrist arthrography with digital subtraction technique during injection followed by digital stress images. Afterwards spiral arthro-CT was performed in the semi-coronal and axial plane with 1 mm slice thickness and secondary true-coronal and sagittal reconstructions. Within 1 month arthroscopy was performed in general anesthesia utilizing standard joint entry points combined with routine digital picture archiving. All examinations were evaluated for SLL, LTL and TFC defects, PACT and AS for ChM too. Results: AG versus AS: the following detection rates were observed (AG and AS positive/AG...
Sbai, Mohamed Ali; Benzarti, Sofien; Msek, Hichem; Boussen, Monia; Khorbi, Adel
Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein-Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery. Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
Yoshimoto, Shunsuke; Kawaguchi, Junki; Imura, Masataka; Oshiro, Osamu
Hand motion capture is an important yet challenging topic for biomechanics and human computer interaction. We proposed a novel electrical sensing technology for capturing the finger angles from the variation of the wrist shape. The proposed device detects the signal related to the wrist-electrode contact resistances, which change according to the variation of the wrist shape accompanying finger movements. The developed sensing device consists of a wrist band, sixteen electrodes and a sensing circuit of contact resistances. We investigated the relationships between the finger angles and the system outputs by using a glove-type joint angle sensor. As a result, we confirmed high correlations of the system outputs with the finger angles for several electrodes. Therefore, we conclude that the proposed system can be used for the estimation of the finger joint angles.
WEI-MIN HSIEH; YUH-SHYAN HWANG; SHIH-CHING CHEN; SUN-YEN TAN; CHIH-CHEN CHEN; YU-LUEN CHEN
Abstract. [Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods...
The reliability tests developed for controlling wrist watch movements and their casements are summarized. For controlling the watch movements, ageing accelerated tests and impact tests were performed. Testing the performance of a wrist watch casement is of great importance: since it is this which is initially attacked by the environment. The casement is submitted to impact, fatigue, vibration, and corrosion tests. The waterproof capabilities and ageing behavior of the casements are examined.
Imai, Shinji; Kodama, Narihito; Matsusue, Yoshitaka
Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.
Penčić, M.; Rackov, M.; Čavić, M.; Kiss, I.; Cioată, V. G.
This paper presents the development of a wrist mechanism for humanoid robots. The research was conducted within the project which develops social humanoid robot Sara – a mobile anthropomorphic platform for researching the social behaviour of robots. There are two basic ways for the realization of humanoid wrist. The first one is based on biologically inspired structures that have variable stiffness, and the second one on low backlash mechanisms that have high stiffness. Our solution is low backlash differential mechanism that requires small actuators. Based on the kinematic-dynamic requirements, a dynamic model of the robot wrist is formed. A dynamic simulation for several hand positions was performed and the driving torques of the wrist mechanism were determined. The realized wrist has 2 DOFs and enables movements in the direction of flexion/extension 115°, ulnar/radial deviation ±45° and the combination of these two movements. It consists of a differential mechanism with three spur bevel gears, two of which are driving and identical, while the last one is the driven gear to which the robot hand is attached. Power transmission and motion from the actuator to the input links of the differential mechanism is realized with two parallel placed identical gear mechanisms. The wrist mechanism has high carrying capacity and reliability, high efficiency, a compact design and low backlash that provides high positioning accuracy and repeatability of movements, which is essential for motion control.
Pham, T T; Lenoir, H; Coulet, B; Wargny, M; Lazerges, C; Chammas, M
Advanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. We hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities. In 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices. After a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0-7), the mean PRWE score was 21 (range: 0-80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected. Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height. IV, retrospective study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Kilic, Ergin; Dogan, Erdi
People who perform excessive wrist movements throughout the day because of their professions have a higher risk of developing lateral and medial epicondylitis. If proper precautions are not taken against these diseases, serious consequences such as job loss and early retirement can occur. In this study, the design and control of an active wrist orthosis that is mobile, powerful and lightweight is presented as a means to avoid the occurrence and/or for the treatment of repetitive strain injuries in an effective manner. The device has an electromyography-based control strategy so that the user's intention always comes first. In fact, the device-user interaction is mainly activated by the electromyography signals measured from the forearm muscles that are responsible for the extension and flexion wrist movements. Contractions of the muscles are detected using surface electromyography sensors, and the desired quantity of the velocity value of the wrist is extracted from a fuzzy logic controller. Then, the actuator system of the device comes into play by conveying the necessary motion support to the wrist. Experimental studies show that the presented device actually reduces the demand on the muscles involved in repetitive strain injuries while performing challenging daily life activities including extension and flexion wrist motions.
F.J.B. Lötters (Freek); J.P.W. van den Bergh (Joop); F. de Vries (Frank); M.P.M.H. Rutten-van Mölken (Maureen)
textabstractThis study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were derived
F.J.B. Lötters (Freek); J.P.W. van den Bergh (Joop); F. de Vries (Frank); M.P.M.H. Rutten-van Mölken (Maureen)
markdownabstractThis study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were
Full Text Available A study was designed to determine which wrist scoring system best correlates with patient satisfaction and which individual variables predict a satisfactory outcome. We looked at forty-five females and 5 males with wrist fractures at 12 weeks after injury and compared their level of satisfaction with various respected outcome measures. The mean age was 66 years. Multivariate regression analysis was carried out using a statistical software package. Patient satisfaction correlated best with the MacDermid, Watts, and DASH scores. The variables in these scoring systems that predicted satisfaction were pain and ability to perform household chores or usual occupation, open packets, and cut meat. The four most important questions to ask in the clinic following wrist fractures are about severity of pain and ability to open packets, cut meat, and perform household chores or usual occupation. This may provide simple and more concise means of assessing outcome after distal radial fractures. Level of evidence is level 4.
Jessica M. Kohring
Full Text Available Scaphoid stress fractures are rare injuries that have been described in young, high-level athletes who exhibit repetitive loading with the wrist in extension. We present a case of an occult scaphoid stress fracture in a 22-year-old female Division I collegiate shot-putter. She was successfully treated with immobilization in a thumb spica splint for 6 weeks. Loaded wrist extension activities can predispose certain high-level athletes to sustain scaphoid stress fractures, and a high index of suspicion in this patient population may aid prompt diagnosis and management of this rare injury.
Monk, T. H.; Buysse, D. J.; Rose, L. R.
STUDY OBJECTIVES: To determine whether wrist actigraphy is useful as a tool for space-based sleep research. Specifically, to determine whether bedtimes and waketimes can be identified from the actigraphic record, and whether actigraphic measures of sleep in space are related to polysomnographic (PSG) ones. DESIGN AND SETTING: Actigraphy, sleep diary, and Polysomnographic (PSG) measures of sleep were obtained from four subjects in two 72h measurement blocks occurring 2d and 12d into a 17d Space Shuttle mission in orbiting the earth in microgravity. PATIENTS: Four healthy male astronauts aged 38y - 47y. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Sleep onset and offset at "night" could be quite clearly identified from the actigraphic record and were better estimated by actigraph than by diary. There was a high correlation between actigraphic and PSG estimates of sleep duration (r = 0.96) and sleep efficiency (r = 0.88), and a similarity in the mean estimates obtained. On a minute-by-minute basis, there was a good correlation between sleep stage and actigraphic movement counts, with a higher level of counts per minute recorded in epochs with lighter PSG sleep stages. There was also a high correlation (r = 0.90) between minutes of stage 0 (wake) occurring between bedtime and wake time, and number of non-zero actigraph epochs during the same interval. CONCLUSIONS: Actigraphy worked well in space both as a way of detecting bedtimes and waketimes, and as an indicant of sleep restlessness.
Full Text Available Abstract Background To compare the effectiveness of a custom-made leather wrist splint (LS with a commercially available fabric splint (FS in adults with chronic wrist pain. Methods Participants (N = 25, mean age = 54 were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN, the Canadian Occupational Performance Measure (COPM and Jamar dynamometer by an observer blinded to treatment allocation. Results Both styles of wrist splint significantly reduced pain (effect size LS 0.79, FS 0.43, improved hand function and increased grip strength compared to baseline (all p Conclusion Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction.
LaStayo, P; Hartzel, J
The synergistic relationship between wrist/forearm range of motion (ROM) and grip strength (GS) is arguably one of the most important aspects of hand function. Clinically, GS is measured with the wrist in a standardized static position, and the results of such tests have been deemed valid and reliable. The question remains, however, whether this static GS (SGS) measurement is an accurate indication of how an individual functionally grips objects--that is, most functional tasks require the fingers to grasp an object forcibly while moving the proximal joints such as the wrist and forearm. Therefore, further analysis of an individual's dynamic GS (DGS) during wrist/forearm movements may improve the clinician's understanding of hand function and provide more pertinent guidelines for assessing functional gripping, e.g., for vocational and avocational tasks and in designing workstations. The purpose of this study is twofold: to describe and assess a DGS testing device that utilizes optically encoded gyroscopes and a strain-gauge dynamometer to simultaneously measure GS and wrist/forearm position over real time; and to assess and compare grip force production differences in SGS and DGS in uninjured wrists, using this novel device. Twenty-nine uninjured wrists of men (n = 15) and women (n = 14)--age range, 21 to 43 years--were tested with the DGS device. Subjects were excluded if they had any previous wrist/forearm fracture, pain, or limitation of motion. The DGS device was designed and fabricated with two optically encoded gyroengines, a vertical gyroscope with two axes for measuring flexion/extension and radial/ulnar deviation, and a directional gyroscope with one axis for measuring supination/pronation, mounted on a strain-gauge dynamometer. The signals from the gyroscopes and dynamometer were processed by means of a data aquisition board and analog-to-digital circuitry and collected on a 486-MHz computer. The methods included repeated testing of each gyroscope axis to
Full Text Available Carla Caffarelli, Chiara Alessi, Ranuccio Nuti, Stefano Gonnelli Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy Abstract: Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density observed in overweight individuals. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures. The effect of obesity on fracture risk is site-dependent, the risk being increased for some fractures (humerus, ankle, upper arm and decreased for others (hip, pelvis, wrist. Moreover, the relationship between obesity and fracture may also vary by sex, age, and ethnicity. Risk factors for fracture in obese individuals appear to be similar to those in nonobese populations, although patterns of falling are particularly important in the obese. Research is needed to determine if and how visceral fat and metabolic complications of obesity (type 2 diabetes mellitus, insulin resistance, chronic inflammation, etc are causally associated with bone status and fragility fracture risk. Vitamin D deficiency and hypogonadism may also influence fracture risk in obese individuals. Fracture algorithms such as FRAX® might be expected to underestimate fracture probability. Studies specifically designed to evaluate the antifracture efficacy of different drugs in obese patients are not available; however, literature data may suggest that in obese patients higher doses of the bisphosphonates might be required in order to maintain efficacy against nonvertebral fractures. Therefore, the search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with obesity might be considered a clinical priority which could improve the prevention of fracture in obese individuals. Keywords: bone mineral density, BMI
Thiele, Jill; Nimmo, Rachel; Rowell, Wendy; Quinn, Stephen; Jones, Graeme
Abstract Background To compare the effectiveness of a custom-made leather wrist splint (LS) with a commercially available fabric splint (FS) in adults with chronic wrist pain. Methods Participants (N = 25, mean age = 54) were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the ...
El Moumni, Mostafa; Van Eck, Merit E.; Wendt, Klaus W.; Reininga, Inge H. F.; Mokkink, Lidwine Brigitta
Background. Hand and wrist injuries are one of the most common injuries seen in adults. The Patient-Rated Wrist Evaluation (PRWE) questionnaire has been developed as a patient report outcome measure of pain and disability to evaluate the outcome after hand and wrist injuries. Objective. The aims of
Mehta, Saurabh P; Mhatre, Bhavna; MacDermid, Joy C; Mehta, Amita
The purpose of this study was to perform cross-cultural adaptation and Hindi translation of the patient-rated wrist evaluation (PRWE) and assess psychometric properties of the PRWE-Hindi. Cross-cultural adaptation and Hindi translation of the PRWE was performed using standardized guidelines. Intraclass correlation coefficient (ICC) was used for assessing test-retest reliability, and Cronbach's alpha (CA) was used for assessing the internal consistency of the PRWE-Hindi. Construct validity was assessed by examining the correlations between the PRWE-Hindi and grip strength, wrist range of movements, and self-reported pain and disability. A total of 50 patients with distal radius fracture were recruited and assessed three times (baseline, two to three days later, and four to five weeks later). PRWE-Hindi demonstrated excellent test-rest reliability (ICC=0.81) and internal consistency (CA=0.89). Moderate to low correlations (rHindi and other measures of pain and disability. Our results indicated that PRWE-Hindi is a reliable and valid tool and can be used in patients with wrist/hand injuries whose primary language is Hindi. N/A. Copyright © 2012 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Gatt, Ian; Smith-Moore, Sophie; Steggles, Charlie; Loosemore, Mike
The aim of this article was to explore retrospectively the Takei dynamometer as a valid and reliable outcome measure tool for hand and wrist pathology in the Great Britain amateur boxing squad between 2010 and 2014. Longitudinal retrospective injury surveillance of the Great Britain boxing squad was performed from 2010 to 2014. The location, region affected, description, and duration of each injury were recorded by the team doctor and team physiotherapists. For each significant injury, we recorded hand grip scores using the Takei handheld dynamometer and compared the scores with baseline measures. At the hand, fractures and dislocations were highly detected with an average difference of 40.2% ( P wrist, carpometacarpal and carpal joint injuries were highly detected with an average difference of 32.6% ( P 20% should be highly considered for significant pathology. The Takei dynamometer is a valid and reliable outcome measure tool for hand and wrist pathologies in boxing. Our study highlights the importance of appropriate clinical tools to guide injury management in this sport.
Bach-Mortensen, Pernille; Hyldstrup, Lars; Appleyard, Merete
.7, and the OR in the entire fracture group was 1.6. Age, fracture, and smoking were negatively correlated with DXR-BMD, whereas BMI, age at menopause, hormone replacement therapy, and physical fitness and muscle strength were positively correlated with DXR-BMD. In conclusion, BMD estimated by DXR of the metacarpals predicts......Using digital X-ray radiogrammetry (DXR) on hand radiographs from a large population-based study, 1,370 postmenopausal women were evaluated in a prospective fashion; fracture occurrence was compared with DXR measurements of historic radiographs. Further, the aim of the study was to evaluate factors...... suffered a fracture. Odds ratios (ORs) per 1 standard deviation decline in DXR-BMD were statistically significant for fracture in the groups of wrist fractures, proximal humerus fractures, vertebral fractures, and other fractures as well as in the total fracture group. In the hip fracture group, the P...
Lee, Sang Ki; Kim, Kap Jung; Park, Ju Sang; Choy, Won Sik
The significance of distal ulna fractures is often undermined, which can result in inadequate treatment compared with fractures of the radius, the ulna's larger counterpart. However, little guidance exists in the current literature on how to manage distal ulna head or neck fractures and intra-articular ulna head fractures. Therefore, the purpose of this retrospective study was to evaluate the outcomes of distal ulna hook plate fixation for the treatment of an unstable distal ulna fracture associated with a distal radius fracture. Twenty-five patients with unstable distal ulna fractures who underwent stable fixation for an associated distal radius fracture were included in the study. All patients achieved satisfactory reduction and bony union. Average final motion was as follows: wrist flexion, 72° (range, 60°-85°); extension, 69° (range, 65°-80°); pronation, 77° (range, 55°-95°); supination, 82° (range, 65°-90°); ulnar deviation, 35° (range, 15°-50°); and radial deviation, 24° (range, 10°-40°). Average postoperative grip strength was 28 kg (range, 22-30 kg) and was 91% (range, 71%-100%) in the cases in which the dominant hand was injured and 80% (range, 65%-100%) in the cases in which the nondominant hand was injured. Average postoperative modified Mayo wrist score and Disabilities of the Arm, Shoulder and Hand score was 87 points (range, 65-100 points) and 14 points (range, 0-54 points), respectively. Chronic instability of the distal radioulnar joint was not encountered in any patient. Thus, the study demonstrated that distal ulna hook plate fixation for the treatment of unstable distal ulna fractures can achieve healing with good alignment, satisfactory function, and minimal transient morbidity. Copyright 2012, SLACK Incorporated.
Full Text Available Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported. Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.
Full Text Available In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS and gray scale ultrasound (GSUS with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP. The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546, GSUS of right wrist and swelling of left wrist (r = 0.511, PDUS of right wrist and pain in left wrist (r = 0.436, PDUS of right wrist and C-reactive protein (r = 0.466. Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.
Trost, Stewart G; Zheng, Yonglei; Wong, Weng-Keen
Wrist-worn accelerometers are associated with greater compliance. However, validated algorithms for predicting activity type from wrist-worn accelerometer data are lacking. This study compared the activity recognition rates of an activity classifier trained on acceleration signal collected on the wrist and hip. 52 children and adolescents (mean age 13.7 ± 3.1 year) completed 12 activity trials that were categorized into 7 activity classes: lying down, sitting, standing, walking, running, basketball, and dancing. During each trial, participants wore an ActiGraph GT3X+ tri-axial accelerometer on the right hip and the non-dominant wrist. Features were extracted from 10-s windows and inputted into a regularized logistic regression model using R (Glmnet + L1). Classification accuracy for the hip and wrist was 91.0% ± 3.1% and 88.4% ± 3.0%, respectively. The hip model exhibited excellent classification accuracy for sitting (91.3%), standing (95.8%), walking (95.8%), and running (96.8%); acceptable classification accuracy for lying down (88.3%) and basketball (81.9%); and modest accuracy for dance (64.1%). The wrist model exhibited excellent classification accuracy for sitting (93.0%), standing (91.7%), and walking (95.8%); acceptable classification accuracy for basketball (86.0%); and modest accuracy for running (78.8%), lying down (74.6%) and dance (69.4%).Potential Impact: Both the hip and wrist algorithms achieved acceptable classification accuracy, allowing researchers to use either placement for activity recognition.
Stobaugh, D J; Deepak, P; Ehrenpreis, E D
We sought to determine whether patients with irritable bowel syndrome (IBS) have an increased risk of osteoporosis and related fractures using the Nationwide Emergency Department Sample (NEDS). Patients with IBS had increased adjusted odds of osteoporosis and osteoporotic fractures compared to the non-IBS control group, controlling for known risk factors for osteoporosis. Screening measures to identify osteoporosis in this group are advised. Ulcerative colitis, Crohn's disease, and celiac disease have well-described augmented risk of osteoporosis and related fractures. We sought to determine whether IBS also indicates an increased risk of osteoporosis and related fractures. The 2008 NEDS database was used to determine the adjusted odds of osteoporosis and related fractures in IBS patients. Only fractures (pathologic wrist (733.12), vertebrae (733.13), and femur fractures (733.14), traumatic wrist (813.x), vertebrae (805.x-806.x), and hip fractures (820.x-821.x)) with a secondary diagnosis of osteoporosis (733.0x) were included in the analysis. A multivariate logistic regression analysis was performed, controlling for known risk factors for osteoporosis and related fractures. We identified 317,857 ED visits in patients with a diagnosis of IBS. Of these, 17,752 carried a diagnosis of osteoporosis and 694 IBS patients had a concurrent diagnosis of a pathologic fracture of the wrist, hip, or vertebrae. A total of 1,503 IBS patients had a concurrent diagnosis of a traumatic fracture of the wrist, hip, or vertebra. Overall, patients with IBS had an increased adjusted odds of osteoporosis (odds ratio (OR) 4.28, 95% confidence interval (CI) 4.21-4.35) and osteoporotic fractures (OR 2.36, CI 2.26-2.47) compared to the non-IBS control group. The highest adjusted odds of fracture was seen at the wrist (OR 2.41, CI 2.10-2.77 compared to controls). IBS patients are at an increased risk of osteoporosis and related fractures. Screening measures to identify osteoporosis and
Background: Calvarial fractures may be linear, depressed or ping-pong, and each can be compound (open) or simple (closed). When depressed fractures become compound, they cause contamination, resulting in intracranial sepsis. All depressed fractures with scalp breach are considered compound, whether or not the ...
Bevel-gear-type robotic wrist mechanisms are commonly used in industry. The reasons for their popularity are that they are compact, light-weight, and relatively inexpensive. However, there are singularities in their workspace, which substantially degrade their manipulative performance. The objective of this research is to develop an atlas of three-degree-of-freedom bevel-gear-type wrist mechanisms, and through dimensional synthesis to improve their kinematic performance. The dissertation contains two major parts: the first is structural analysis and synthesis, the other is kinematic analysis and dimensional synthesis. To synthesize the kinematic structures of bevel-gear-type wrist mechanisms, the kinematic structures are separated from their functional considerations. All kinematic structures which satisfy the mobility condition are enumerated in an unbiased, systematic manner. Then the bevel-gear-type wrist mechanisms are identified by applying the functional requirements. Structural analysis shows that a three-degree-of-freedom wrist mechanism usually consists of non-fractionated, two degree-of-freedom epicyclic gear train jointed with the base link. Therefore, the structural synthesis can be simplified into a problem of examining the atlas of non-fractionated, two-degree-of-freedom epicyclic gear trains. The resulting bevel-gear-type wrist mechanism has been categorized and evaluated. It is shown that three-degree-of-freedom, four-jointed wrist mechanisms are promising for further improving the kinematic performance. It is found that a spherical planetary gear train is necessarily imbedded in a three-degree-of-freedom, four-jointed wrist mechanism. Therefore, to study the workspace and singularity problems of three-degree-of-freedom four-jointed spherical wrist mechanisms, we have to study the trajectories of spherical planetary gear trains. The parametric equations of the trajectories and some useful geometric properties for the analysis and synthesis of
The selfie phenomenon has exploded worldwide over the past two years. Selfies have been linked to a large number of mortalities and significant morbidity worldwide. However, trauma associated with selfies including fractures, is rarely publicised. Here we present a case series of upper extremity trauma secondary to selfies across all age groups during the summer period. Four cases of distal radius and ulna trauma in all age groups were reported. This case series highlights the dangers associated with taking selfies and the trauma that can result.
Lyona, R F; Kelly, J C; Murphy, C G
The selfie phenomenon has exploded worldwide over the past two years. Selfies have been linked to a large number of mortalities and significant morbidity worldwide. However, trauma associated with selfies including fractures, is rarely publicised. Here we present a case series of upper extremity trauma secondary to selfies across all age groups during the summer period. Four cases of distal radius and ulna trauma in all age groups were reported. This case series highlights the dangers associated with taking selfies and the trauma that can result.
Park, Kyungbin; Chang, Pyung-Hun; Kang, Sang Hoon
It is important to estimate the 3 degree-of-freedom (DOF) impedance of human forearm and wrist (i.e., forearm prono-supination, and wrist flexion-extension and radial-ulnar deviation) in motor control and in the diagnosis of altered mechanical resistance following stroke. There is, however, a lack of methods to characterize 3 DOF impedance. Thus, we developed a reliable and accurate impedance estimation method, the distal internal model based impedance control (dIMBIC)-based method, to characterize the 3 DOF impedance, including cross-coupled terms between DOFs, for the first time. Its accuracy and reliability were experimentally validated using a robot with substantial nonlinear joint friction. The 3 DOF human forearm and wrist impedance of eight healthy subjects was reliably characterized, and its linear behavior was verified. Thus, the dIMBIC-based method can provide us with 3 DOF forearm and wrist impedance regardless of nonlinear robot joint friction. It is expected that, with the proposed method, the 3 DOF impedance estimation can promote motor control studies and complement the diagnosis of altered wrist and forearm resistance post-stroke by providing objective impedance estimates, including cross-coupled terms.
Johansson, Lena; Björing, Gunnar; Hägg, Göran M
A general hypothesis is that a wrist orthosis reduces the wrist extensor muscle load. The aim of this study was to investigate the effects of a completely stiff wrist orthosis (SO) and a commercially available wrist orthosis (CO) on flexor and extensor electromyographic (EMG)-activity in a standardised intermittent gripping task and during standardised manual work tasks. Surface EMG from two forearm flexor and two extensor muscles was recorded. The target grip forces were 5%, 20% and 40% of maximal voluntary contraction (MVC). During the grip contraction phase CO had no effect on the EMG-readings. SO resulted in higher EMG activity than when gripping with CO and with no orthosis (NO), especially when gripping with 40% MVC. During the relaxation phase neither CO nor SO had any effect on the extensors. For the flexors the SO gave higher EMG-readings than when gripping with CO and NO, especially at 40% MVC. In conclusion the wrist orthoses tested did not reduce the EMG-activity from the flexors or the extensors during gripping or manual tasks.
Vanessa Luzia Barros de Andrade
Full Text Available Pinch grip is used in a large number of handling activities that require precision and control of an object. The position of the upper arm joints affects the fingers force production in order to handle the object. This study aimed to verify the influence of the wrist position in the production of maximum strength and in the control fingers grip pinch submaximum strength control. Participants were 21 right handed adults (10 male, 18-26 years old. They made two attempts of maximum force production and eight attempts of submaximal force production (four at 20% and four at 40% of maximum strength for pinch grip in three wrist positions: neutral, flexion and extension. The results showed that the production of maximum strength is higher in neutral position compared to wrist flexion and extension and higher for men compared to women. In addition, there was a positive correlation between the length of the hand and the production of maximum strength. The results also indicated that the wrist position did not interfere in the submaximum force control during this task. However, participants showed more difficulty controlling 20% than 40% of maximum strength. The present study showed evidence that the motor units used to produce grip pinch maximum strength cross the wrist joint but those used for the 20% and 40% of maximum strength are present only in the fingers and hand.
Fracture in metallic glasses. What are the connections between nano- and micro- mechanisms and toughness? Metallic glasses are schizophrenic in the fracture sense. PDF Create! 5 Trial www.nuance.com ...
... arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus ... age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is ...
... lead to arthritis down the road. In addition, fractures in children occasionally affect future growth of that bone. Figure 1: Examples of fractures in fingers Figure 2: Examples of plates, pins ...
de Miranda luzo, Maria Candida; Pereira, Cesar Augusto Martins; Pessa, Mariana Miranda Nicolosi; Mattar, Rames; de Paula, Emygdio Jose Leomil
Objective: The authors have developed a prosthesis for hand amputees or malformations that can be activeted mecanically through the moviment of the wrist using the wrist tenodesis pattern and not the the wrist...
Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios
The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....
York, Peter A.; Swaney, Philip J.; Gilbert, Hunter B.; Webster, Robert J.
The needle-sized surgical tools used in arthroscopy, otolaryngology, and other surgical fields could become even more valuable to surgeons if endowed with the ability to navigate around sharp corners to manipulate or visualize tissue. We present a needle-sized wrist design that grants this ability. It can be easily interfaced with manual tools or concentric tube robots and is straightforward and inexpensive to manufacture. The wrist consists of a nitinol tube with several asymmetric cutouts, actuated by a tendon. Perhaps counter-intuitively, within this seemingly simple design concept, design optimization is challenging due to the number of parameters available and nonlinearities in material properties. In this paper, we examine a subset of possible geometries and derive kinematic and static models. Experimental results with a 1.16 mm diameter prototype validate the models. Lastly, we provide a discussion summarizing the lessons learned in our early experience designing and fabricating wrists of this type. PMID:26405562
Lambelet, Charles; Lyu, Mingxing; Woolley, Daniel; Gassert, Roger; Wenderoth, Nicole
Chronic wrist impairment is frequent following stroke and negatively impacts everyday life. Rehabilitation of the dysfunctional limb is possible but requires extensive training and motivation. Wearable training devices might offer new opportunities for rehabilitation. However, few devices are available to train wrist extension even though this movement is highly relevant for many upper limb activities of daily living. As a proof of concept, we developed the eWrist, a wearable one degree-of-freedom powered exoskeleton which supports wrist extension training. Conceptually one might think of an electric bike which provides mechanical support only when the rider moves the pedals, i.e. it enhances motor activity but does not replace it. Stroke patients may not have the ability to produce overt movements, but they might still be able to produce weak muscle activation that can be measured via surface electromyography (sEMG). By combining force and sEMG-based control in an assist-as-needed support strategy, we aim at providing a training device which enhances activity of the wrist extensor muscles in the context of daily life activities, thereby, driving cortical reorganization and recovery. Preliminary results show that the integration of sEMG signals in the control strategy allow for adjustable assistance with respect to a proxy measurement of corticomotor drive.
Thiele, Jill; Nimmo, Rachel; Rowell, Wendy; Quinn, Stephen; Jones, Graeme
To compare the effectiveness of a custom-made leather wrist splint (LS) with a commercially available fabric splint (FS) in adults with chronic wrist pain. Participants (N = 25, mean age = 54) were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Canadian Occupational Performance Measure (COPM) and Jamar dynamometer by an observer blinded to treatment allocation. Both styles of wrist splint significantly reduced pain (effect size LS 0.79, FS 0.43), improved hand function and increased grip strength compared to baseline (all p wrist stiffness. There was a consistent trend for the LS to be superior to the FS but this was statistically significant only for patient perceived occupational performance (p = 0.008) and satisfaction (p = 0.015). Lastly, 72% of patients preferred the custom-made leather splint compared to the commercially available splint. Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction.
Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...
Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel
Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the
Full Text Available Sarcopenia might be associated with bone fragility in elderly individuals. This study aimed to investigate the prevalence of sarcopenia and its association with fragility fracture sites in elderly Chinese patients.Patients (322 men and 435 women aged 65-94 years and with a history of fragility fractures in the ankle, wrist, vertebrae or hip, and healthy men (n = 1263 and women (n = 1057 aged 65-92 years without a history of fractures were enrolled. Whole-body dual energy X-ray absorptiometry was used to analyze skeletal muscle mass index (SMI, fat mass and bone mineral density. Sarcopenia was defined as SMI less than two standard deviations below the mean of a young reference group.Sarcopenia occurrence varied with fracture location. Sarcopenia was more common in females with vertebral and hip fractures and in men with hip and ankle fractures than in the non-fracture group. Sarcopenia was significantly more prevalent in men with wrist, hip and ankle fractures than in women. SMI was correlated with BMD in different fracture groups. Logistic regression analyses revealed that lower SMI was associated with an increased risk of hip fracture both in men and women and ankle fracture in men.Sarcopenia may be an independent risk factor for hip and ankle fractures in men, and for hip fractures in women.
Tarantino, Umberto; Capone, Antonio; Planta, Marco; D'Arienzo, Michele; Letizia Mauro, Giulia; Impagliazzo, Angelo; Formica, Alessandro; Pallotta, Francesco; Patella, Vittorio; Spinarelli, Antonio; Pazzaglia, Ugo; Zarattini, Guido; Roselli, Mauro; Montanari, Giuseppina; Sessa, Giuseppe; Privitera, Marco; Verdoia, Cesare; Corradini, Costantino; Feola, Maurizio; Padolino, Antonio; Saturnino, Luca; Scialdoni, Alessandro; Rao, Cecilia; Iolascon, Giovanni; Brandi, Maria Luisa; Piscitelli, Prisco
We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies.
Bulthaup, S; Cipriani, 3rd, D J; Thomas, J J
This study examined the effect of commonly used long and short styles of commercially produced wrist extension orthoses on the activity of the proximal muscles of the shoulder and elbow and on wrist...
Domizio, Jennifer Di; Mogk, Jeremy P M; Keir, Peter J
Wrist splints are commonly prescribed to limit wrist motion and provide support at night and during inactive periods but are often used in the workplace. In theory, splinting the wrist should reduce wrist extensor muscle activity by stabilizing the joint and reducing the need for co-contraction to maintain posture. Ten healthy volunteers underwent a series of 24 10-s gripping trials with surface electromyography on 6 forearm muscles. Trials were randomized between splinted and nonsplinted conditions with three wrist postures (30 degrees flexion, neutral, and 30 degrees extension) and four grip efforts. Custom-made Plexiglas splints were taped to the dorsum of the hand and wrist. It was found that when simply holding the dynamometer, use of a splint led to a small (wrist against external loading, but appears counterproductive when exerting maximal forces. Wrist bracing should be limited to periods of no to light activity and avoided during tasks that require heavy efforts.
Adenike A Adewuyi; Levi J Hargrove; Todd A Kuiken
... that it is suitable for partial-hand amputees, who often possess a functional wrist. This study’s objective was to evaluate strategies that allow partial-hand amputees to control a prosthetic hand while allowing retain wrist function...
Kitsoulis, Panagiotis; Paraskevas, Georgios; Iliou, Kalliopi; Kanavaros, Panagiotis; Marini, Aikaterini
The radioulnar carpal joint is critical for hand and wrist function. Radioulnar deviation indicates distal radioulnar joint flexibility and reflects the structure and function of the carpal bones, ulna, radius and ligaments. The present study examined whether radioulnar deviation is affected by gender, manual labor, playing a musical instrument, playing sport, handedness, previous fracture or prior inflammation. The study used clinical findings based on anatomical landmarks The ulnar, radial and total deviations for both left and right hands were measured in 300 subjects (157 men and 143 women) of mean age 21.7 years. Measurements were made with the forearm in a fixed pronated position using a novel specially designed goniometer. The gender of each subject was recorded, and information on playing of sport, playing a musical instrument, manual labor, handedness, and history of fracture or inflammation was sought. Data were analyzed using a multifactor ANOVA test. No statistically significant difference (p-value > 0.05) was found between those comparing groups except the total deviation of athletes' left hand versus the total deviation of non athletes' left hand (p-value 0.041 < 0.05) and the radial deviation of manual workers' left hand and non manual workers' left hand (p-value 0.002 < 0.05). This study was based on clinical findings using anatomical landmarks. We found that manual workers and athletes showed greater left hand flexibility. This suggests that activities that place chronic stress on the radiocarpal joint can independently affect radioulnar deviation.
Sale, Joanna E M; Frankel, Lucy; Thielke, Stephen; Funnell, Larry
Our objective was to examine the experience of pain after a fracture beyond the conventional healing duration of 6 months. We conducted a phenomenological study in participants who were deemed high risk for future fracture and recruited through an urban fracture clinic in Toronto, Canada. In-depth interviews were conducted with questions addressing the experience of pain, the status of recovery from the fracture, ways in which the fracture affected one's daily activities, and interactions with health care providers. Two researchers coded the transcripts within the phenomenological perspective to develop a structure of the pain experience, promoting rigour through the use of multiple analysts, searching for negative cases, and supporting claims with direct quotations from participants. We interviewed 21 participants who had sustained fractures of the wrist (n = 4), hip (n = 6), vertebrae (n = 2), and multiple or other locations (n = 9). All patients were ambulatory, had a range of socioeconomic status, and lived in the community. Eleven of the 21 participants reported persistent pain at the site of the fracture. Of the 10 participants who reported no pain, four indicated they had ongoing difficulties with range of motion and specific activities and two others described persistent pain from a previous fracture or reliance on a scooter for mobility. Our study demonstrated that over two-thirds of older adults reported fracture-related pain and/or limitations at, or beyond, 6 months post-fracture. We suggest that health care providers ask questions about post-fracture pain and/or limitations when assessing fracture status beyond 6 months.
de Bruin, Marije; Smeulders, Mark J. C.; Kreulen, Michiel
Flexor carpi ulnaris muscle tenotomy and transfer to the extensor side of the wrist are common procedures used to improve wrist position and dexterity in patients with cerebral palsy. Our aim was to determine whether this muscle still influences wrist torque even after tenotomy of its distal tendon.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3770 Wrist joint carpal trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3760 Wrist joint carpal scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...
... AFFAIRS Agency Information Collection (Wrist Conditions Disability Benefits Questionnaire) Under [email protected] . Please refer to ``OMB Control No. 2900- NEW (Wrist Conditions Disability Benefits...-7492 or email [email protected] . Please refer to ``OMB Control No. 2900-NEW (Wrist Conditions...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal lunate polymer prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3750 Wrist joint carpal lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...
Full Text Available Avulsion fractures of the radial wrist extensor from the metacarpal base are rare injuries, and have previously been reported in only a few papers. Although 2 cases of closed rupture of the extensor carpi ulnaris (ECU were mentioned in 1 report, no case of avulsion fracture of the ECU from its insertion was found in the literature. We recently encountered such a case. The patient, a machine operator, suffered multiple fractures of his forearm, wrist and hand when his left hand was caught in a machine roller. He immediately underwent emergency operation, during which we found the avulsed bone fragment from the ECU insertion. This fragment was retracted to the ECU groove of the ulna, and was located beside the fracture fragment of the ulnar styloid on X-ray. The avulsed fragment was reattached to the base of the fifth metacarpal with Kirschner wires and wire loop, and the patient returned to work 4 months after the operation.
Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - ...
Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior
Ahlawat, S; Corl, F M; LaPorte, D M; Fishman, E K; Fayad, L M
Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Deep hand infections are located deep to the tendon sheaths and include synovial space infections, such as infectious tenosynovitis, deep fascial space infections, septic arthritis, necrotising fasciitis, and osteomyelitis. Knowledge of hand and wrist compartmental anatomy is essential for the accurate diagnosis and management of hand infections. Although early and superficial infections of the hand may respond to non-surgical management, most hand infections are surgical emergencies. Multidetector computed tomography (MDCT), with its muliplanar reformation (MPR) and three-dimensional (3D) capabilities, is a powerful tool in the emergency setting for the evaluation of acute hand and wrist pathology. The clinical and imaging features of hand and wrist infections as evident on MDCT will be reviewed with emphasis on contiguous and closed synovial and deep fascial spaces. Knowledge of hand compartmental anatomy enables accurate characterisation of the infectious process and localise the extent of disease in the acute setting. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Bajuri, M N; Kadir, Mohammed Rafiq Abdul; Amin, Iskandar M; Ochsner, Andreas
The wrist is the most complex joint for virtual three-dimensional simulations, and the complexity is even more pronounced when dealing with skeletal disorders of the joint such, as rheumatoid arthritis (RA). In order to analyse the biomechanical difference between healthy and diseased joints, three-dimensional models of these two wrist conditions were developed from computed tomography images. These images consist of eight carpal bones, five metacarpal bones, the distal radius and ulna. The cartilages were developed based on the shape of the available articulations and ligaments were simulated via mechanical links. The RA model was developed accurately by simulating all ten common criteria of the disease related to the wrist. Results from the finite element (FE) analyses showed that the RA model produced three times higher contact pressure at the articulations compared to the healthy model. Normal physiological load transfer also changed from predominantly through the radial side to an increased load transfer approximately 5% towards the ulnar. Based on an extensive literature search, this is the first ever reported work that simulates the pathological conditions of the rheumatoid arthritis of the wrist joint.
Martins, Roberto S; Siqueira, Mario G; Simplício, Hougelli
This prospective study evaluates the possible advantages of wrist immobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuously for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment was done pre-operatively and at 2 weeks follow-up and included the two-point discrimination test at the second finger and two questionnaires as an outcome measurement of symptoms severity and intensity. All the patients presented improvement in the postoperative evaluations in the three analyzed parameters. There was no significant difference between the two groups for any of the outcome measurements at the final follow-up. We conclude that wrist immobilization in the immediate post-operative period have no advantages when compared with no immobilization in the end result of carpal tunnel release.
An, Yeong Yi; Kim, Jee Young; Kang, Seok Jin; Kang, Yong Koo; Baik, Jun Hyun [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)
Synovial chondrosarcoma is extremely rare and arises de novo or from malignant transformation of synovial chondromatosis. It commonly involves large joints, such as the knee or hip. Here, we present an unusual case of synovial chondrosarcoma from synovial chondromatosis in the hand and wrist, clearly demonstrating the characteristic findings on plain radiograph and MR imaging.
Oblak, Jakob; Cikajlo, Imre; Matjacić, Zlatko
In this paper we present a universal haptic drive (UHD), a device that enables rehabilitation of either arm ("ARM" mode) or wrist ("WRIST" mode) movement in two degrees-of-freedom. The mode of training depends on the selected mechanical configuration, which depends on locking/unlocking of a passive universal joint. Actuation of the device is accomplished by utilizing a series elastic actuation principle, which enables use of off-the-shelf mechanical and actuation components. A proportional force control scheme, needed for implementation of impedance control based movement training, was implemented. The device performance in terms of achievable lower and upper bound of viable impedance range was evaluated through adequately chosen sinusoidal movement in eight directions of a planar movement for the "ARM" mode and in eight directions of a combined wrist flexion/extension and forearm pronation/supination movement for the "WRIST" mode. Additionally, suitability of the universal haptic drive for movement training was tested in a series of training sessions conducted with a chronic stroke subject. The results have shown that reliable and repeatable performance can be achieved in both modes of operation for all tested directions.
Full Text Available Background: It is widely recognized that neuromuscular function is temperature sensitive. Changes in muscle temperature may affect muscle force development. The aim of this study was to investigate the effects of temperature on wrist flexor muscles endurance. Methods: Fifteen healthy subjects (mean age 21.13±1.30 years participated in the present study. The wrist flexor muscles endurance was measured before and after applying ice and hot packs over the forearm for 15 minutes. Paired t tests were used to compare differences between pre and post intervention endurance. Results: The results showed a significant increase in wrist flexor muscles endurance after heating. (P=0.04. We also found that, cooling the forearm muscles leaded to significant decrease of wrist flexor muscles endurance (P=0.01. Conclusion: These results suggest that hand function is temperature sensitive. Therefore, further studies are needed to evaluate the effects of cold on muscular function in people working in workplaces with extreme temperature.
Obdeijn, M. C.; Bavinck, N.; Mathoulin, C.; van der Horst, C. M. A. M.; Schijven, M. P.; Tuijthof, G. J. M.
Arthroscopy has assumed an important place in wrist surgery. It requires specific operative skills that are now mainly acquired in the operating room. In other fields of endoscopic surgery, e-learning and virtual reality (VR) have introduced new perspectives in teaching skills. This leads to the
Infanger, Manfred; Grimm, Daniela
Meniscus and disc lesions in the triangular fibrocartilage complex (TFCC) are generally caused by falling accidents with pronated, hyperextended wrists, or by distraction injuries that pull the ulnar side of the wrist out of place. Characteristic clinical signs are swelling and pain in the distal radioulnar joint (DRUJ) and a 'clicking' noise in the meniscus lesion. If untreated, loss of mobility and grip strength as well as progressive arthritic changes ensue. We investigated in this study the laser-assisted arthroscopic debridement of the central TFCC and meniscus to compare the advantages and disadvantages of such treatment to conventional arthroscopic debridement. Seventy-two patients underwent laser-assisted arthroscopic debridement of traumatic TFCC tears (meniscus and disc). Patients with TFCC tears that were associated with fractures, significant bone or neurovascular pathology or DRUJ instability were excluded from the study. The mean age was 32.4 years; 28 female and 51 male patients were included in the study. The mean follow up was 25.6 months. First of all, we evaluated the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. We then applied the range of motion of the hand (ROM) as second variable during statistical analysis to identify outcome. There were no complications after surgery. No instabilities or dislocations of the DRUJ were noted. The postoperative DASH score indicated that the laser-assisted arthroscopic repair of traumatic peripheral TFCC tears resulted in a very good functional outcome. All patients with isolated meniscus homologue tears were without pain after the operation. At final follow up, the ROM was equal to or greater than that of the contralateral side. We have demonstrated that the TFCC laser debridement technique is easy and safe to perform. The outcome was excellent with less pain and good ROM. In particular, the laser technique enabled a good intra-articular haemostasis and allowed an exact tear debridement.
Marini, Francesca; Squeri, Valentina; Morasso, Pietro; Campus, Claudio; Konczak, Jürgen; Masia, Lorenzo
Several neurodevelopmental disorders and brain injuries in children have been associated with proprioceptive dysfunction that will negatively affect their movement. Unfortunately, there is lack of reliable and objective clinical examination protocols and our current knowledge of how proprioception evolves in typically developing children is still sparse. Using a robotic exoskeleton, we investigated proprioceptive acuity of the wrist in a group of 49 typically developing healthy children (8-15 years), and a group of 40 young adults. Without vision participants performed an ipsilateral wrist joint position matching task that required them to reproduce (match) a previously experienced target position. All three joint degrees-of-freedom of the wrist/hand complex were assessed. Accuracy and precision were evaluated as a measure of proprioceptive acuity. The cross-sectional data indicating the time course of development of acuity were then fitted by four models in order to determine which function best describes developmental changes in proprioception across age. First, the robot-aided assessment proved to be an easy to administer method for objectively measuring proprioceptive acuity in both children and adult populations. Second, proprioceptive acuity continued to develop throughout middle childhood and early adolescence, improving by more than 50% with respect to the youngest group. Adult levels of performance were reached approximately by the age of 12 years. An inverse-root function best described the development of proprioceptive acuity across the age groups. Third, wrist/forearm proprioception is anisotropic across the three DoFs with the Abduction/Adduction exhibiting a higher level of acuity than those of Flexion/extension and Pronation/Supination. This anisotropy did not change across development. Proprioceptive development for the wrist continues well into early adolescence. Our normative data obtained trough this novel robot-aided assessment method provide a
Ong, Michael T Y; Ho, P C; Wong, Clara W Y; Cheng, Sally H S; Tse, Wing-Lim
Purpose wrist arthroscopy is typically performed under general or regional anesthesia with the aid of a tourniquet to maintain a bloodless field. We have been using portal site local anesthesia (PSLA) for wrist arthroscopy without a tourniquet since 1998. The aim of the study was to assess the efficacy, safety, and complications of PSLA and whether this can be recommended for routine wrist arthroscopy. Method We conducted a retrospective study, identifying 111 consecutive cases of wrist arthroscopies performed from January 2007 to December 2009. All cases were performed under PSLA. The effectiveness of PSLA was assessed by analyzing whether the procedure required adjuvant forms of anesthesia. The subjective effectiveness was assessed via phone questionnaires. Results Sixty-eight male and 43 female patients were identified. The average age was 43.2 (range 16-77). The indications included chronic wrist pain of unknown origin (30), posttraumatic arthritis (27), rheumatoid arthritis (5), ganglion (30), triangular fibrocartilage complex (TFCC) injury (14), infectious (1), and carpal instability (4). The average duration of the procedures was 73 minutes (range 20-255 minutes). Therapeutic procedures were performed in all 111 cases in addition to a routine diagnostic assessment. These included arthroscopic debridement (82) synovectomy (6), ganglionectomy (30), TFCC repair (3), TFCC debridement (11), radial styloidectomy (2), wafer procedure (4), thermal shrinkage (2), distal scaphoidectomy (1), and synovial biopsy (4). All procedures could be completed uneventfully. Most patients tolerated the procedure well throughout the operation, and the satisfaction level was high. No complication was encountered. Discussions We concluded that PSLA technique is a feasible mode of anesthesia in selected patients. Level IV.
Shah, Darshan S; Kedgley, Angela E
The presence of muscle redundancy and co-activation of agonist-antagonist pairs in vivo makes the optimization of the load distribution between muscles in physiologic joint simulators vital. This optimization is usually achieved by employing different control strategies based on position and/or force feedback. A muscle activated physiologic wrist simulator was developed to test and iteratively refine such control strategies on a functional replica of a human arm. Motions of the wrist were recreated by applying tensile loads using electromechanical actuators. Load cells were used to monitor the force applied by each muscle and an optical motion capture system was used to track joint angles of the wrist in real-time. Four control strategies were evaluated based on their kinematic error, repeatability and ability to vary co-contraction. With kinematic errors of less than 1.5°, the ability to vary co-contraction, and without the need for predefined antagonistic forces or muscle force ratios, novel control strategies - hybrid control and cascade control - were preferred over standard control strategies - position control and force control. Muscle forces obtained from hybrid and cascade control corresponded well with in vivo EMG data and muscle force data from other wrist simulators in the literature. The decoupling of the wrist axes combined with the robustness of the control strategies resulted in complex motions, like dart thrower׳s motion and circumduction, being accurate and repeatable. Thus, two novel strategies with repeatable kinematics and physiologically relevant muscle forces are introduced for the control of joint simulators. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Feydy, Antoine; Pluot, Etienne; Guerini, Henri; Drapé, Jean-Luc
Osteoarthritis (OA) of the wrist is mainly secondary to traumatic ligamentous or bone injuries. Involvement of the radiocarpal joint occurs early on in the disease, whereas the mediocarpal joint is involved at a later stage. Metabolic diseases may also involve the wrist and affect specific joints such as the scapho-trapezio-trapezoid joint. Although OA of the wrist is routinely diagnosed on plain films, a thorough assessment of cartilage injuries on computed tomographic arthrography, magnetic resonance imaging (MRI), or MR arthrography remains necessary before any surgical procedure. OA of the fingers is frequently encountered in postmenopausal women. Distal interphalangeal joints and trapezio-metacarpal joint are the most frequently involved joints. Whereas the clinical diagnosis of OA of the wrist and hand is straightforward, the therapeutic management of symptomatic forms remains unclear, with no clear guidelines. OA of the spine is related to degenerative changes of the spine involving the disc space, vertebral endplates, the facet joints, or the supportive and surrounding soft tissues. The sequelae of disc degeneration are among the leading causes of functional incapacity in both sexes, and are a common source of chronic disability in the working years. Disc degeneration involves structural disruption and cell-mediated changes in composition. Radiography remains usually the first-line imaging method. MRI is ideally suited for delineating the presence, extent, and complications of degenerative spinal disease. Other imaging modalities such as computed tomography, dynamic radiography, myelography, and discography may provide complementary information in selected cases, especially before an imaging-guided percutaneous treatment or spinal surgery. The presence of degenerative changes on imaging examinations is by no means an indicator of symptoms, and there is a high prevalence of lesions in asymptomatic individuals. This article focuses on imaging of OA of the
Full Text Available BACKGROUND: The incidence of humeral fracture has significantly increased during the present years due to the population growth and road traffic, domestic, industrial, automobile accidents & disasters like tsunami, earthquakes, head-on collisions, polytrauma etc. In order to achieve a stable fixation followed by early mobilization, numerous surgical implants have been devised. PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of proximal 2/3rd humeral shaft fractures using an unreamed interlocking intramedullary nail. INTRODUCTION: In 40 skeletally matured patients with fracture shaft of humerus admitted in our hospital, we used unreamed antegrade interlocking nails. MATERIAL: We carried out a prospective analysis of 40 patients randomly selected between 2001 to 2014 who were operated at JNMC Belgaum, MMC Mysore & Navodaya Medical College, Raichur. All cases were either RTAs, Domestic, Industrial, automobile accidents & also other modes of injury. METHOD: Routine investigations with pre-anaesthetic check-up & good quality X-rays of both sides of humerus was taken. Time of surgery ranged from 5-10 days from the time of admission. Only upper 1/3rd & middle 1/3rd humeral shaft fractures were included in the study. In all the cases antegrade locked unreamed humeral nails were inserted under C-arm. Patient was placed in supine position & the shoulder was kept elevated by placing a sandbag under the scapula. In all patients incision taken from tip of acromion to 3cm over deltoid longitudinally. Postoperatively sling applied with wrist & shoulder movements started after 24 hours. All the patients ranged between the age of 21-50 years. RESULTS: Total 40 patients were operated. Maximum fracture site were in the middle third- 76%, 14% upper 1/3rd. All 40 patients achieved union. The average time of union was 8-10 weeks. All patients regained full range of movements except in few cases, where there was shoulder
Fukuda, Koji; Fujioka, Hiroyuki; Fujita, Ikuo; Uemoto, Harunobu; Hiranaka, Takafumi; Tsuji, Mitsuo; Kurosaka, Masahiro
We present a rare case of stress fracture of the second metacarpal bone. A14-year-old girl felt pain on the dorsal aspect of the right wrist without any history ofmajor trauma, when she played a smash during a game of badminton. On theradiographs, periost
Goslings, J. C.; Ferguson, S. J.; Perren, R. A.; Tepic, S.
Several dynamic external fixation devices have been introduced to permit early functional treatment of unstable distal radial fractures. An intact cadaver wrist was spanned by a dynamic external fixator. Forces between the fixator and the radius were recorded during passive motion using a single,
Jose Luis Ramos Martin; Roberto Seijas; Pedro Álvarez-Díaz; Oscar Ares; Andrea Sallent; Ramon Cugat
Motocross is a popular sport that requires both physical and mental dexterity. We have observed that 52% of the most frequent injuries in motocross affect the upper extremity. Some of these injuries are unilateral compartment syndrome in the flexors of the forearmwhich requires subcutaneous fasciotomy–, bilateral osteochondritis dissecans of the elbow and, very frequently, scaphoid fracture due to falls. The wrist is very often involved in injuries related to this sport. The...
Ramponi, Denise R; Kaufmann, Judith; Drahnak, Gwendolen
Hip fractures are associated with significant morbidity and mortality and a major health problem in the United States (). Eighty percent of hip fractures are experienced by 80-year-old women. Plain radiographs usually confirm the diagnosis, but if there is a high level of suspicion of an occult hip fracture, magnetic resonance imaging or bone scan is the next step to confirm the diagnosis. Areas of the hip bone have varied bone strength and blood supply, making the femoral neck one of the most vulnerable areas for fracture. A consultation to an orthopedic surgeon will determine surgical interventions.
Si, Lei; Winzenberg, Tania M; Chen, Mingsheng; Jiang, Qicheng; Palmer, Andrew J
To determine the residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women. A validated state-transition microsimulation model was used. Microsimulation and probabilistic sensitivity analyses were performed to address the uncertainties in the model. All parameters including fracture incidence rates and mortality rates were retrieved from published literature. Simulated subjects were run through the model until they died to estimate the residual lifetime fracture risks. A 10 year time horizon was used to determine the 10 year fracture risks. We estimated the risk of only the first osteoporotic fracture during the simulation time horizon. The residual lifetime and 10 year risks of having the first osteoporotic (hip, clinical vertebral or wrist) fracture for Chinese women aged 50 years were 40.9% (95% CI: 38.3-44.0%) and 8.2% (95% CI: 6.8-9.3%) respectively. For men, the residual lifetime and 10 year fracture risks were 8.7% (95% CI: 7.5-9.8%) and 1.2% (95% CI: 0.8-1.7%) respectively. The residual lifetime fracture risks declined with age, whilst the 10 year fracture risks increased with age until the short-term mortality risks outstripped the fracture risks. Residual lifetime and 10 year clinical vertebral fracture risks were higher than those of hip and wrist fractures in both sexes. More than one third of the Chinese women and approximately one tenth of the Chinese men aged 50 years are expected to sustain a major osteoporotic fracture in their remaining lifetimes. Due to increased fracture risks and a rapidly ageing population, osteoporosis will present a great challenge to the Chinese healthcare system. While national data was used wherever possible, regional Chinese hip and clinical vertebral fracture incidence rates were used, wrist fracture rates were taken from a Norwegian study and calibrated to the Chinese population. Other fracture sites like tibia, humerus, ribs and pelvis were not included in the analysis, thus these
Full Text Available Abstract Background The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%, non-union (5-21% and early osteo-arthritis (up to 32% which may seriously impair wrist function. Impaired consolidation of scaphoid fractures results in longer immobilization and more days lost at work with significant psychosocial and financial consequences. Initially Pulsed Electromagnetic Fields was used in the treatment of tibial pseudoarthrosis and non-union. More recently there is evidence that physical forces can also be used in the treatment of fresh fractures, showing accelerated healing by 30% and 71% reduction in nonunion within 12 weeks after initiation of therapy. Until now no double blind randomized, placebo controlled trial has been conducted to investigate the effect of this treatment on the healing of fresh fractures of the scaphoid. Methods/Design This is a multi center, prospective, double blind, placebo controlled, randomized trial. Study population consists of all patients with unilateral acute scaphoid fracture. Pregnant women, patients having a life supporting implanted electronic device, patients with additional fractures of wrist, carpal or metacarpal bones and pre-existing impairment in wrist function are excluded. The scaphoid fracture is diagnosed by a combination of physical and radiographic examination (CT-scanning. Proven scaphoid fractures are treated with cast immobilization and a small Pulsed Electromagnetic Fields bone growth stimulating device placed on the cast. Half of the devices will be disabled at random in the factory. Study parameters are clinical consolidation
Kim, Byeong-Jo; Lee, Jung-Hoon
[Purpose] The aim of this paper was to report the efficacy of kinesiology taping for recovery from wrist pain and limited range of motion (ROM) in a physical therapist with repetitive strain injuries. [Subjects] A 32 year-old male physical therapist developed recurring severe pain in the dominant wrist and limited active ROM with extremely painful supination. [Methods] The kinesiology tape was applied to the lumbricals, musculi interossei dorsales, palmares, the wrist extensor and flexor muscles, and the wrist joint for 3 weeks for an average of 10 h/day. [Results] After application of the kinesiology tape, the Numeric Pain Rating Scale and Patient-rated Wrist Evaluation scores decreased, and the Patient-Specific Functional Scale score increased in comparison with the initial score. [Conclusion] Repeated kinesiology taping of the wrist muscles and joint could be an effective method for recovery from occupational wrist disorders experienced by physical therapists.
Zukowski, Lisa A; Roper, Jaimie A; Shechtman, Orit; Otzel, Dana M; Hovis, Patty W; Tillman, Mark D
Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression.
Zukowski, Lisa A.; Roper, Jaimie A.; Shechtman, Orit; Otzel, Dana M.; Hovis, Patty W.; Tillman, Mark D.
Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression. PMID:25856042
Dinesh K Dhanwal
Full Text Available Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of hip fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of hip fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher hip fracture incidence reported from industrialized countries as compared to developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate hip fracture rates. There is also a north-south gradient seen in European studies, and more fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of hip fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.
Kirschenbaum, D; Sieler, S; Solonick, D; Loeb, D M; Cody, R P
Fifty-two asymptomatic adults who were between twenty and thirty-five years old had arthrography of the wrist with use of a single injection into the radiocarpal joint. The purpose of the study was to evaluate the integrity of the triangular fibrocartilage, the scapholunate ligament, and the lunotriquetral ligament. Contrast medium was injected under fluoroscopic guidance, and posteroanterior and lateral radiographs of the wrist were made after the subjects had performed exercises of the wrist. No patient who had a history of trauma to the wrist, pain in the wrist, or inflammatory arthritis was included in the study. All of the subjects had an examination of both upper extremities that included measurement of the active motion of the wrist with a goniometer, strength-testing with a Jamar dynamometer, ballottement and testing for impingement, and palpation for tenderness. Plain radiographs were evaluated, and the ulnar variance was recorded. The arthrograms revealed an abnormal communication of the contrast medium in fourteen wrists (27 per cent), and four of the fourteen had multiple areas of communication. The abnormal communication was through the triangular fibrocartilage alone in six wrists, the scapholunate ligament alone in two wrists, the lunotriquetral ligament alone in two wrists, and in more than one of these areas in four wrists. A positive arthrogram was associated with a greater positive ulnar variance. All of the subjects had symmetrical motion of the wrists and grip strength, and none of them had tenderness in the wrist. There were no complications related to the arthrography. Perforation of a ligament in the wrist is common in young asymptomatic adults.(ABSTRACT TRUNCATED AT 250 WORDS)
Ortega, Henry W; Velden, Heidi Vander; Lin, Chia-Wei; Reid, Samuel
Previous studies have shown that regular pain measurement improves pain management. As the diversity of patients seeking emergency care continues to grow, a better understanding of the potential differences in pain perception and analgesic needs among various cultural groups will be required. The purpose of this study was to describe the differences in pain scores reported among ethnic groups treated for a long-bone fracture. A retrospective review of patients with a long-bone fracture treated in an urban pediatric emergency department during a 12-month period was performed. Pain scores were assessed using previously validated pain scales. Eight hundred eighty patients met our inclusion criteria. Wrist fracture was the most common type of fracture in our study. There were significant differences noted in reported pain scores. Patients identified as Hmong had the highest pain scores, and patients identified as Somali had the lowest pain scores reported. Patients with wrist fractures had the highest average pain score when compared with other types of fractures. Children with fractures requiring reduction in the emergency department had higher pain scores than those who had a fracture that did not require reduction. To our knowledge, this is the first study to investigate the relationships between ethnicity and pain scores reported in children treated emergently for a long-bone fracture.
Tarantino, U.; Capone, A.; Planta, M.; D’Arienzo, M.; Letizia, M. G.; Impagliazzo, A.; Formica, D.; Pallotta, F.; Patella, V.; Spinarelli, A.; Pazzaglia, U.E.; Zarattini, G.; Roselli, M.; Montanari, G.; Sessa, G.; Privitera, M.; Verdoia, C.A.; Corradini, C.; Feola, M.; Padolino, A.; Saturnino, L.; Scialdoni, A.; Brandi, M.L.; Piscitelli, P.
Introduction: We aimed to assess the incidence and hospitalisation rate of hip fractures and “minor” fragility fractures and their incidence in the Italian population. Methods: We conducted a three-year survey at 10 major Italian emergency departments in order to evaluate the hospitalisation rate for hip, forearm, humeral, ankle, and vertebral fragility fractures occurring in people aged ≥45 years between 2004 and 2006, both men and women. These data were compared to those recorded in the national hospitalisations database (SDO) in order to assess the overall incidence of hip fractures and minor fragility fractures, also including those events not resulting in hospital admissions. Results: We have estimated that a total of 430,000 new hip, humeral, wrist, ankle and vertebral fragility fractures occur in Italy each year. Hospitalisation rates, referring to a total of 29,017 fractures, were the following: 92.7% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed on the SDO database, we estimated an annual incidence of 100,000 hip (0.40 per 100 adults), 39,000 humeral (0.15 per 100), 47,000 ankle (0.18 per 100), 73,000 wrist (0.21 per 100) and 190,000 (0.76 per 100 adults) vertebral fragility fractures in people aged >45 years. Clinical vertebral fractures were computed as 56,000 events per year (0.22 per 100). Conclusion: A national registry of fragility fractures is needed in order adequately to assess the incidence of osteoporotic fractures in the Italian population.
... small, "green" branch on a tree. Most greenstick fractures occur in children younger than 10 years of age. This type ... mistaken for sprains or bruises. More-severe greenstick fractures may cause an obvious ... your doctor if your child has persistent pain in an injured limb. Seek ...
Zehnder, Alan T
Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering. He teaches applied mechanics and his research t...
Dhesi, J K; Allain, T J; Mangoni, A A; Jackson, S H D
Fractures are common in elderly subjects, disabling and occasionally fatal. Their incidence increases exponentially with age, with the commonest affected sites being the wrist, vertebrae, hip and humerus. Of these, hip fractures are the most relevant in terms of morbidity and financial cost. The increase in fracture rate with age is believed to result predominantly from age-related increases in the incidence of osteoporosis and falls. This article reviews the evidence for the use of vitamin D...
Malleolar fracture; Tri-malleolar; Bi-malleolar; Distal tibia fracture; Distal fibula fracture; Malleolus fracture ... Some ankle fractures may require surgery when: The ends of the bone are out of line with each other (displaced). The ...
Klarlund, Mette; Østergaard, Mikkel; Gideon, P
-FLASH, fat-saturated-T1-SE, STIR and 3D-DESS. RESULTS: Bone erosions were found by MR compared to radiography in 261 versus 85 bones of the wrist (ratio 3.1) and 59 versus 21 MCP joint quadrants (ratio 2.81). MR and radiography interobserver agreements were both approximately 90%. Likewise, MR scored......PURPOSE: To elaborate the best MR imaging protocol for studies in rheumatoid arthritis (RA) and to evaluate the sensitivity and interobserver agreement with respect to detection of bone erosions (MR and radiography) and grading of synovial membrane hypertrophy (MR imaging only). MATERIAL...... synovial membrane hypertrophy in wrist and MCP joints with a high interobserver agreement. The most informative MR sequence appeared to be contrast-enhanced T1-SE MR, preferably with fat saturation. A STIR sequence or T2-weighted fat saturation sequence was useful in screening for joint disease. CONCLUSION...
Feydy, Antoine; Pluot, Etienne; Guerini, Henri; Drapé, Jean-Luc
Although osteoarthritis (OA) of the wrist and fingers is routinely diagnosed using plain film, a thorough assessment of cartilage injuries using CT-arthrography, MR imaging, or MR-arthrography remains necessary before any surgical procedure. MR imaging is ideally suited for delineating the presence, extent, and complications of degenerative spinal disease, including OA of the spine involving the disk space, vertebral endplates, facet joints, or supportive and surrounding soft tissues. Other imaging modalities such as CT, dynamic radiography, myelography, and discography may provide complimentary information in selected cases. This article focuses on imaging of OA of the wrist and hand and the lumbar spine, with an emphasis on current MR imaging grading systems available for the assessment of discovertebral lesions.
Bolton, Frank; Jalaliniya, Shahram; Pederson, Thomas
the negative influence on the ongoing activity is minimal. In this article we present our self-mitigated interruption concept (essentially a symbiosis of artificial external stimuli tuned to existing human attention management mechanisms) and perform a pilot study laying the ground for using a wrist......-Aware-systems-inspired approach “Egocentric Interaction” aimed at supporting the design of envisioned Wearable Personal Assistants intended to, among other things, help human perception and cognition with the management of interruptions....
This paper introduces an asymmetrical parallel robotic wrist, which can generate a decoupled unlimited-torsion motion and achieve high positioning accuracy. The kinematics, dexterity, and singularities of the manipulator are investigated to visualize the performance contours of the manipulator....... Using the method of Lagrange multipliers and considering all the mobile components, the equations of motion of the manipulator are derived to investigate the dynamic characteristics efficiently. The developed dynamic model is numerically illustrated and compared with its simplified formulation to show...
Full Text Available Mechanical perturbations applied to the wrist joint typically evoke a stereotypical sequence of cortical and muscle responses. The early cortical responses (<100 ms are thought be involved in the “rapid” transcortical reaction to the perturbation while the late cortical responses (>100 ms are related to the “slow” transcortical reaction. Although previous studies indicated that both responses involve the primary motor cortex, it remains unclear if both responses are engaged by the same effective connectivity in the cortical network. To answer this question, we investigated the effective connectivity cortical network after a “ramp-and-hold” mechanical perturbation, in both the early (<100 ms and late (>100 ms periods, using dynamic causal modeling. Ramp-and-hold perturbations were applied to the wrist joint while the subject maintained an isometric wrist flexion. Cortical activity was recorded using a 128-channel electroencephalogram (EEG. We investigated how the perturbation modulated the effective connectivity for the early and late periods. Bayesian model comparisons suggested that different effective connectivity networks are engaged in these two periods. For the early period, we found that only a few cortico-cortical connections were modulated, while more complicated connectivity was identified in the cortical network during the late period with multiple modulated cortico-cortical connections. The limited early cortical network likely allows for a rapid muscle response without involving high-level cognitive processes, while the complexity of the late network may facilitate coordinated responses.
Jackson, Keith; Ramadorai, Uma; Abell, Brian; Devine, John
Background Charcot arthropathy is a cascade of destructive changes that can effect joints of both the axial and appendicular skeleton. The pathogenesis of this condition centers around the accumulation of minor traumatic events after the loss of normal joint sensation. The most frequently cited cause of Charcot arthropathy of the upper extremity is syringomyelia, and magnetic resonance imaging of the cervical spine should be obtained at presentation. Case Report A 72-year-old woman presented with a painless right wrist deformity. Radiographs demonstrated advanced destructive changes of the radiocarpal joint. Magnetic resonance imaging of the cervical spine revealed multilevel cervical spondylotic stenosis with cord deformation, but no evidence of syringomyelia. Neurological examination confirmed the presence of myelopathy. Literature Review The most frequently cited cause of Charcot arthropathy of the upper extremity is syringomyelia, although pathologies such as diabetes mellitus, tabes dorsalis, leprosy, and other disorders affecting the nervous system have been reported to lead to this condition. Neuropathic arthropathy involving the wrist is a rare phenomenon with fewer than 20 published reports in modern literature. Clinical Relevance Charcot arthropathy of the wrist is a rare but potentially disabling condition. The diagnosis of spondylotic myelopathy should be considered when evaluating a patient with this presentation. Evaluation consisting of a detailed neurological examination and advanced imaging of the cervical spine is warranted to identify the etiology.
Rasquinha, Brian J; Rainbow, Michael J; Zec, Michelle L; Pichora, David R; Ellis, Randy E
An electromagnetic (EM) surgical tracking system was used for a functionally calibrated kinematic analysis of wrist motion. Circumduction motions were tested for differences in subject gender and for differences in the sense of the circumduction as clockwise or counter-clockwise motion. Twenty subjects were instrumented for EM tracking. Flexion-extension motion was used to identify the functional axis. Subjects performed unconstrained wrist circumduction in a clockwise and counter-clockwise sense. Data were decomposed into orthogonal flexion-extension motions and radial-ulnar deviation motions. PCA was used to concisely represent motions. Nonparametric Wilcoxon tests were used to distinguish the groups. Flexion-extension motions were projected onto a direction axis with a root-mean-square error of [Formula: see text]. Using the first three principal components, there was no statistically significant difference in gender (all [Formula: see text]). For motion sense, radial-ulnar deviation distinguished the sense of circumduction in the first principal component ([Formula: see text]) and in the third principal component ([Formula: see text]); flexion-extension distinguished the sense in the second principal component ([Formula: see text]). The clockwise sense of circumduction could be distinguished by a multifactorial combination of components; there were no gender differences in this small population. These data constitute a baseline for normal wrist circumduction. The multifactorial PCA findings suggest that a higher-dimensional method, such as manifold analysis, may be a more concise way of representing circumduction in human joints.
Costa, Pedro; Rosas, Maria José; Vaz, Rui; Cunha, João Paulo
Parkinson's Disease (PD) patients often need Deep Brain Stimulation (DBS) surgery when they become intolerant to drugs or these lose efficiency. A stimulation electrode is implanted in the basal ganglia to promote the functional control of the deregulated dopaminergic motor pathways. The stimulation target is defined by medical imaging, followed by electrophysiological inspection for fine electrode position trimming and electrical stimulation tuning. Intra-operative stimulation of the target and the evaluation of wrist rigidity allows to choose the stimulation parameters which best alleviate PD symptoms without side effects. Neurologists impose a passive wrist flexion movement and qualitatively describe the perceived decrease in rigidity under different voltages, based on its experience and with subjectivity. We designed a novel, comfortable and wireless wearable motion sensor to classify the wrist rigidity by deriving a robust signal descriptor from angular speed values and a polynomial mathematical model to classify signals using a quantitative continuous scale. The descriptor significantly (pwrist rigidity, improving upon the inherent subjective clinical evaluation while using small, simple and easy to use motion sensor.
Klarlund, Mette; Østergaard, Mikkel; Gideon, P
AND METHODS: MR imaging and conventional radiography of wrist and metacarpophalangeal (MCP) joints were performed in 41 RA patients and 3 healthy controls. The following pulse sequences were applied: T1-weighted spin-echo (T1-SE) with and without contrast enhancement, T2-SE, T2-turbo-SE, T1-2D-FLASH, T1-3D......-FLASH, fat-saturated-T1-SE, STIR and 3D-DESS. RESULTS: Bone erosions were found by MR compared to radiography in 261 versus 85 bones of the wrist (ratio 3.1) and 59 versus 21 MCP joint quadrants (ratio 2.81). MR and radiography interobserver agreements were both approximately 90%. Likewise, MR scored...... synovial membrane hypertrophy in wrist and MCP joints with a high interobserver agreement. The most informative MR sequence appeared to be contrast-enhanced T1-SE MR, preferably with fat saturation. A STIR sequence or T2-weighted fat saturation sequence was useful in screening for joint disease. CONCLUSION...
Skinner, Thomas M
Patient histories that include wrist pain can be pivotal in the distinction between intersection syndrome (IS) and the more common de Quervain's tenosynovitis (DQT). Presented here is a 26-year-old pregnant woman with a history of rowing who developed left radial/dorsal wrist pain and a rubbing/squeaking sensation. Nine months of conservative DQT therapy and a landmark-guided corticosteroid injection failed to relieve her symptoms. An in-clinic ultrasound showed tenosynovitis at the intersection of the first and second compartments, confirming a diagnosis of IS. She found immediate relief with ultrasound-guided saline hydrodissection, the injection of saline into the intercompartmental space to reduce adhesions. Both DQT and IS are overuse injuries caused by repetitive wrist extension, as occurs in rowing, and either condition can worsen after pregnancy. Distinguishing the subtleties between DQT and IS can be challenging. Close attention to the patient's description of the pain can guide treatment, potentially expediting recovery. In addition, saline hydrodissection can be both a diagnostic tool and a potentially therapeutic alternative to steroid injections for such tendinopathies. © Copyright 2017 by the American Board of Family Medicine.
Yamamoto, Ikuo; Matsui, Miki; Inagawa, Naohiro; Hachisuka, Kenji; Wada, Futoshi; Hachisuka, Akiko; Saeki, Satoru
The authors have developed a practical wrist rehabilitation robot for hemiplegic patients. It consists of a mechanical rotation unit, sensor, grip, and computer system. A myoelectric sensor is used to monitor the extensor carpi radialis longus/brevis muscle and flexor carpi radialis muscle activity during training. The training robot can provoke training through myoelectric sensors, a biological signal detector and processor in advance, so that patients can undergo effective training of extention and flexion in an excited condition. In addition, both-wrist system has been developed for mirror effect training, which is the most effective function of the system, so that autonomous training using both wrists is possible. Furthermore, a user-friendly screen interface with easily recognizable touch panels has been developed to give effective training for patients. The developed robot is small size and easy to carry. The developed aspiring interface system is effective to motivate the training of patients. The effectiveness of the robot system has been verified in hospital trails.
Sobky, Kareem; Baldini, Todd; Thomas, Kenneth; Bach, Joel; Williams, Allison; Wolf, Jennifer Moriatis
The purpose of this study was to compare the biomechanical properties of four volar fixed-angle fracture fixation plate designs in a novel sawbones model as well as in cadavers. Four volar fixed angle plating systems (Hand Innovations DVR-A, Avanta SCS/V, Wright Medical Lo-Con VLS, and Synthes stainless volar locking) were tested on sawbones models using an osteotomy gap model to simulate a distal radius fracture. Based on a power analysis, six plates from each system were tested to failure in axial compression. To simulate loads with physiologic wrist motion, six plates of each type were then tested to failure following 10,000 cycles applying 100N of compression. To compare plate failure behavior, two plates of each type were implanted in cadaver wrists and similar testing applied. All plate constructs were loaded to failure. All failed with in apex volar angulation. The Hand Innovations DVR-A plate demonstrated significantly more strength in peak load to failure and failure after fatigue cycling (p value biomechanical testing and indicates that volar fixation of unstable distal radius fractures with a fixed angle device is a reliable means of stabilization.
Kyberd, Peter J
The addition of a passive wrist to a single degree of freedom prosthesis has an effect on its functionality. The amount of impact is undetermined. To measure the grasping function of a commercial single degree of freedom hands with and without two forms of passive wrist flexor. Form-board and timed tasks. Repeated measures with a single subject using a validated assessment tool. The test measured the function of one conventional, single axis, powered hand controlled by the same myocontroller format. It was used in conjunction with a passive three position wrist flexor, a wrist with compliance in the flex/extend and radial/ulnar deviation and compared with a hand without these axes. The overall functional score of the hand alone was 80 out of 100. The use of a wrist flexion unit resulted in a higher score (83) and the compliant wrist achieved a score of 79. The addition of a wrist allowed improved performance in Power, Lateral and Tips grips for both wrist designs, in addition the Extension grip was improved with the compliant wrist. Wrist flexion had a positive impact on the functional score. It enabled some tasks to be performed quicker and with less difficulty.
This meta-analysis aims to assess an association between wrist ratio (wrist thickness/wrist width) and carpal tunnel syndrome (CTS). Sixteen studies qualified for a random-effects meta-analysis. Mean wrist ratio was higher in individuals with CTS compared with those without CTS [pooled mean difference 0.036, 95% confidence interval (CI) 0.025-0.046]. Pooled odds ratio (OR) of CTS for mean wrist ratio was 4.56 (95% CI 2.97-6.99), and for wrist ratio ≥0.70 vs. <0.70 it was 2.73 (95% CI 1.49-5.01). In addition, the pooled OR for a 1-unit (0.01) increase in wrist ratio was 1.12 (CI 1.09-1.16). The association between wrist ratio and CTS did not differ between men and women. Moreover, there was no evidence of publication bias. This meta-analysis suggests that a square-shaped wrist is a predictor for CTS in both men and women. Future studies should explore whether a square-shaped wrist can potentiate the adverse effects of obesity and occupational workloads on CTS. © 2015 Wiley Periodicals, Inc.
Walsh, Lee D; Proske, Uwe; Allen, Trevor J; Gandevia, Simon C
Recent studies have suggested that centrally generated motor commands contribute to the perception of position and movement at the wrist, but not at the elbow. Because the wrist and elbow experiments used different methods, this study was designed to resolve the discrepancy. Two methods were used to test both the elbow and wrist (20 subjects each). For the wrist, subjects sat with their right arm strapped to a device that restricted movement to the wrist. Before each test, voluntary contraction of wrist flexor or extensor muscles controlled for muscle spindle thixotropy. After relaxation, the wrist was moved to a test angle. Position was indicated either with a pointer, or by matching with the contralateral wrist, under two conditions: when the reference wrist was relaxed or when its muscles were contracted isometrically (30% maximum). The elbow experiment used the same design to measure position sense in the passive elbow and with elbow muscles contracting (30% maximum). At the wrist when using a pointer, muscle contraction altered significantly the perceived wrist angle in the direction of contraction by 7 deg [3 deg, 12 deg] (mean [95% confidence interval]) with a flexor contraction and 8 deg [4 deg, 12 deg] with an extensor contraction. Similarly, in the wrist matching task, there was a change of 13 deg [9 deg, 16 deg] with a flexor contraction and 4 deg [1 deg, 8 deg] with an extensor contraction. In contrast, contraction of elbow flexors or extensors did not alter significantly the perceived position of the elbow, compared with rest. The contribution of central commands to position sense differs between the elbow and the wrist. PMID:24099798
Taljanovic, Mihra S; Jones, Marci D; Ruth, John T; Benjamin, James B; Sheppard, Joseph E; Hunter, Tim B
The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation. Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint. External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator. The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods. Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used. Copyright RSNA, 2003
Dacho, Andreas K; Baumeister, Steffen; Germann, Guenter; Sauerbier, Michael
Traumatic instability of the proximal carpal row is based either on a scaphoid fracture or a scapholunate dissociation. Long-standing scaphoid nonunion or scapholunate ligament insufficiency may lead to a carpal collapse and subsequent arthrosis. Controversy exists regarding the appropriate salvage procedure for patients with scapholunate advanced collapse (SLAC)- or scaphoid nonunion advanced collapse (SNAC)-wrist in stage II. Proximal row carpectomy (PRC) and midcarpal arthrodesis (MCA) are two commonly used options. The purpose of this retrospective study was to evaluate the functional outcome and pain relief in SNAC-SLAC-wrist stage II after MCA, compared to PRC in a long term follow up. In the MCA group 17 patients, nine SLAC- and eight SNAC-wrists, with an average age of 47 years at surgery and a mean follow up of 42 months were examined. The PRC group consisted of 30 patients, seven SLAC- and 23 SNAC-wrists, with an average age of 39 years at surgery and a mean follow up of 27 months. Active range of motion (AROM) was verified with a goniometer, grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) under resting and stress conditions. Patients' upper extremity disability was measured with the DASH questionnaire. Radiographic evaluation was carried out by conventional X-ray to verify bony consolidation. Mean values of postoperative AROM in extension/flexion was 61 degrees in MCA, and 75 degrees in PRC patients; radial/ulnar deviation was 32 degrees and 33 degrees, respectively. Mean DASH-score was 21 in the MCA and 25 in the PRC group. Pain relief was 54% in MCA and 77% in PRC during resting conditions and 22% and 42% during stress conditions. Static grip strength was significantly higher following MCA than PRC (72% to 50%). Among both the MCA and PRC groups three patients required further treatment with total arthrodesis due to persisting pain or absence of bony consolidation. Our
FitzGerald, Gordon; Boonen, Steven; Compston, Juliet E; Pfeilschifter, Johannes; LaCroix, Andrea Z; Hosmer, David W; Hooven, Frederick H; Gehlbach, Stephen H
The purposes of this study were to examine fracture risk profiles at specific bone sites, and to understand why model discrimination using clinical risk factors is generally better in hip fracture models than in models that combine hip with other bones. Using 3-year data from the GLOW study (54,229 women with more than 4400 total fractures), we present Cox regression model results for 10 individual fracture sites, for both any and first-time fracture, among women aged ≥55 years. Advanced age is the strongest risk factor in hip (hazard ratio [HR] = 2.3 per 10-year increase), pelvis (HR = 1.8), upper leg (HR = 1.8), and clavicle (HR = 1.7) models. Age has a weaker association with wrist (HR = 1.1), rib (HR = 1.2), lower leg (not statistically significant), and ankle (HR = 0.81) fractures. Greater weight is associated with reduced risk for hip, pelvis, spine, and wrist, but higher risk for first lower leg and ankle fractures. Prior fracture of the same bone, although significant in nine of 10 models, is most strongly associated with spine (HR = 6.6) and rib (HR = 4.8) fractures. Past falls are important in all but spine models. Model c indices are ≥0.71 for hip, pelvis, upper leg, spine, clavicle, and rib, but ≤0.66 for upper arm/shoulder, lower leg, wrist, and ankle fractures. The c index for combining hip, spine, upper arm, and wrist (major fracture) is 0.67. First-time fracture models have c indices ranging from 0.59 for wrist to 0.78 for hip and pelvis. The c index for first-time major fracture is 0.63. In conclusion, substantial differences in risk profiles exist among the 10 bones considered. Copyright © 2012 American Society for Bone and Mineral Research.
Full Text Available Background and Objective: Osteoporosis afflicts a large number of populations in the world and is featured by systemic impairment of bone mass and strength which may further trigger an increase in the risk of fragile fractures. This network meta-analysis (NMA is designed to distinguish therapies more preferable than others with respect to efficacy and safety. Methods: We searched the medical literature for relevant studies systematically. Both direct and indirect evidence were synthesized to compare the efficacy, described by odds ratios (OR and 95% credible intervals (CrI. Moreover, the surface under cumulative ranking curve was calculated to rank probabilities with respect to clinical outcomes. The new non-vertebral fractures, hip and wrist fractures, and adverse events were evaluated in this NMA. Results: Patients treated by alendronate, denosumab, teriparatide were associated with a reduced risk of new non-vertebral fractures compared to those treated by placebo. Alendronate, denosumab and zoledronic acid had better efficacy in preventing hip fractures. With respect to wrist fractures prevention, no significant difference was observed. Zoledronic acid exhibited significantly increased risk of adverse events than placebo, alendronate, denosumab, and raloxifene. According to SUCRA, teriparatide ranked highest in new non-vertebral fractures prevention, etidronate and denosumab balanced safety and efficacy well. Conclusion: In summary, teriparatide appeared to be the most efficacious drug for preventing new non-vertebral fractures, while etidronate and denosumab were preferable for balancing safety and efficacy well.
The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...
Full Text Available History of present illness: A 15-year-old male presented to the emergency department with right elbow pain after falling off a skateboard. The patient denied a decrease in strength or sensation but did endorse paresthesias to his hand. On exam, the patient had an obvious deformity of his right elbow with tenderness to palpation and decreased range of motion at the elbow. Sensation, motor function, and pulses were intact. Radiographic imaging was obtained. Significant findings: The pre-reduction films show a type III supracondylar fracture. There is complete displacement of the distal humerus anteriorly. Specific findings for supracondylar fracture include: a posterior fat pad (red arrow and a displaced anterior humeral line (yellow line.1 When no fracture is present, the anterior humeral line should intersect the middle third of the capitellum; in this X-ray, it does not intersect the capitellum at all. This X-ray demonstrates a normal radiocapitellar line (blue line that intersects the capitellum. The presence of a narrow anterior fat pad aka “sail sign” can be normal. Discussion: Supracondylar fractures of the humerus occur at the distal portion of the humerus without involving the growth plate.2 This is the second most common fracture in children overall. In children, it is the most common fracture of the elbow.3 This injury has a high risk of neurovascular compromise, such as compartment syndrome or ischemic contracture, and thus the clinician must perform immediate and frequent neurovascular assessments focusing on the distributions of the brachial artery in addition to the median, ulnar, and radial nerves.4 Hyperextension injuries that typically occur following a fall onto an outstretched arm are responsible for 95% of supracondylar fractures.1 A type I supracondylar fracture is non-displaced and can be treated with immobilization through a posterior splint and sling5 with close follow-up, type II is angulated but with an intact
Golnaz Ghayyem Hassankhani
Full Text Available Background: The patient-rated wrist evaluation (PRWE score is one of the most common clinical instruments usedas an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of thisstudy was to translate the PRWE into its Persian version and to evaluate its validity and reliability in patients with upperextremity conditions.Methods: One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical boardapproved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, allpatients filled out the PRWE in addition to the VAS (Visual analogue scale and DASH questionnaires. For evaluatingreliability, after three days the researchers called back some of the patients who did not receive treatment or anychanges in symptoms and asked them to complete the PRWE retest (104 patients.Results: Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each itemdeletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936. Intraclass correlation coefficient was 0.952and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores wasstrong. Multivariable analysis showed an association between the PRWE and years educated.Conclusion: Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upperextremity conditions.
Hu, X L; Tong, K Y; Li, R; Xue, J J; Ho, S K; Chen, P
An electromyography (EMG)-driven electromechanical robot system integrated with neuromuscular electrical stimulation (NMES) was developed for wrist training after stroke. The performance of the system in assisting wrist flexion/extension tracking was evaluated on five chronic stroke subjects, when the system provided five different schemes with or without NMES and robot assistance. The tracking performances were measured by range of motion (ROM) of the wrist and root mean squared error (RMSE). The performance is better when both NMES and robot assisted in the tracking than those with either NMES or robot only (Probot helped improve the movement accuracy; and the NMES helped increase the muscle activation for the wrist joint and suppress the excessive muscular activities from the elbow joint. The NMES-robot assisted wrist training could improve the hand, wrist, and elbow functions. Copyright © 2011 Elsevier Ltd. All rights reserved.
Kim, Byeong-Jo; Lee, Jung-Hoon
[Purpose] The aim of this paper was to report the efficacy of kinesiology taping for recovery from wrist pain and limited range of motion (ROM) in a physical therapist with repetitive strain injuries. [Subjects] A 32 year-old male physical therapist developed recurring severe pain in the dominant wrist and limited active ROM with extremely painful supination. [Methods] The kinesiology tape was applied to the lumbricals, musculi interossei dorsales, palmares, the wrist extensor and flexor musc...
Lai, Eddie Hsiang-Hua; Liu, Jen-Pei; Chang, Jenny Zwei-Chieng; Tsai, Shih-Jaw; Yao, Chung-Chen Jane; Chen, Mu-Hsiung; Chen, Yi-Jane; Lin, Chun-Pin
The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals. Methods: The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and ...
This presentation is a progress report on the analysis of Hydraulic Fracturing Fluids for regulatory compounds outlined in the various US EPA methodologies. Fracturing fluids vary significantly in consistency and viscosity prior to fracturing. Due to the nature of the fluids the analytical challenges will have to be addressed. This presentation also outlines the sampling issues associated with the collection of dissolved gas samples.
Bégué, T; Judet, T; de Thomasson, E; Rouvreau, P; de Cheveigné, C; Garreau de Loubresse, C; Boury, G
Goals for treatment of comminutive fractures of the distal radius include restoration of the articular profile of the proximal part of the joint, while axial loading forces must be avoided as much as possible to prevent secondary displacement. The choice of an internal fixation protected by an external wrist distractor-fixator, with early activo-passive mobilisation, seems to achieve the goal. Twelve patients with a comminuted fracture of the distal radius, including axial articular impigment displacement were reviewed for this study. All fractures were Frykman's type III, IV, VII or VIII. Distraction was done with a specific external apparatus, allowing an internal fixation, using an anterior plate and posterior Kirschner wires for the more complex cases. Distraction was released at the end of the surgical procedure, while the distractor was left in place. The wrist was mobilised early in the post-operative period, and the distractor was removed two months later. At a mean follow-up of 8.5 months, two patients were still painful. Mean motion of the wrist joint was 115 degrees for flexion-extension and 35 degrees for radio-ulnar deviation. Radiological results were good (10 cases), in both planes sagittal and frontal, and stable with time. The radio-ulnar index was correct in 11 cases. Only two cases of Sudeck's atrophy were noted. Authors use a specific external wrist distractor to obtain and maintain reduction in comminuted fractures of the distal end of the radius, using internal fixation in combination. Early motion of the wrist, protected by the wrist distractor seems to lower rates of Sudeck's atrophy.
Bernardo Barcellos Terra
Full Text Available ABSTRACT Fractures of the radial head and radial neck correspond to 1.7-5.4% of all fractures and approximately 30% may present associated injuries. In the literature, there are few reports of radial head fracture with posterior interosseous nerve injury. This study aimed to report a case of radial head fracture associated with posterior interosseous nerve injury. CASE REPORT: A male patient, aged 42 years, sought medical care after falling from a skateboard. The patient related pain and limitation of movement in the right elbow and difficulty to extend the fingers of the right hand. During physical examination, thumb and fingers extension deficit was observed. The wrist extension showed a slight radial deviation. After imaging, it became evident that the patient had a fracture of the radial head that was classified as grade III in the Mason classification. The patient underwent fracture fixation; at the first postoperative day, thumb and fingers extension was observed. Although rare, posterior interosseous nerve branch injury may be associated with radial head fractures. In the present case, the authors believe that neuropraxia occurred as a result of the fracture hematoma and edema.
Bock, G.W.; Resnick, D. (Dept. of Radiology, Univ. of California, San Diego, CA (United States) Veterans Administration Center, San Diego, CA (United States)); Cohen, M.S. (Dept. of Orthopaedics, Univ. of California San Diego Medical Center, CA (United States))
We describe two patients with an Essex-Lopresti fracture dislocation in association with a dislocation of the elbow. This combination of injuries has not been previously reported. The Essex-Lopresti fracture is a rare injury, and the associated distal radioulnar dislocation is often missed. Meticulous radiographic evaluation of the wrist, including dynamic stress radiographs of the forearm, can lead to an earlier diagnosis and improved care of these patients. (orig.).
Wang, Qiong; Zhou, Qinghui
The theory of wrist-ankle acupuncture is consistent with traditional meridian-collateral theory. For example, the body divisions of wrist-ankle acupuncture are corresponding to the distribution of 12 cutaneous regions of meridians, the needling sites of it are to the running courses of 12 meridians; the indications of it are to those of 12 meridians. The needling sites of wrist-ankle acupuncture are relevant with some special acupoints of acupuncture theory. For example, the 12-needling sites of wrist-ankle acupuncture are located similar to those of 12 meridian points and have very similar indications. The needling sites of it are located in the wrist and ankle regions, in which the five- shu points are located nearby, for meridian disorders. Most luo -connecting points are located near to the needling sites of wrist-ankle acupuncture or the needle tip points to. Additionally, the needling method of wrist-ankle acupuncture is consistent with some of the subcutaneous needling methods in traditional acupuncture therapy. On the basis of the aspects mentioned above, it is explained that wrist-ankle acupuncture is the development of traditional acupuncture and cannot be independent from the traditional theories of acupuncture and meridians. It is necessary to seek for the evidence from the traditional theories of TCM. The traditional theories of TCM are summarized from clinical practice, which can be newly verified from the practice of wrist-ankle acupuncture.
Papaioannou, A; Kennedy, C C; Ioannidis, G; Cameron, C; Croxford, R; Adachi, J D; Mursleen, S; Jaglal, S
In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures
Full Text Available The full-Automatic Quick Hitch Coupling Device (full-AQHCD for short is used as the starting point, key technologies in a large-scale rescue robot wrist, which is constituted by integrating a quick hitch coupling device, a turning device, and a swaying device together, are reviewed respectively. Firstly, the semi-AQHCD made domestically for the main-Arm Claw Wrist (main-ACW for short is introduced, and the full-AQHCD imported from Oil Quick company in Sweden for the vice-Arm Cutter Wrist (vice-ACW for short is presented. Secondly, aiming at three key technologies in the full-AQHCD including rotary joint technology, automatic docking technology and precise docking technology for quick action coupling, are concisely expressed. Thirdly, the hydraulic motor driving gear type slewing bearing technology of the turning device made domestically for the main-ACW is introduced, and the hydraulic motor driving worm type slewing bearing technology of the turning device imported from HKS company in Germany for the vice-ACW is presented, especially, the existing gap in the similar domestic technology is discussed. Subsequently, the hydraulic cylinder driving 4-bar linkage technology of the swaying device made domestically for the main-ACW is introduced, and the hydraulic double spiral swing cylinder technology of the swaying device imported from HKS company in Germany for the vice-ACW is presented, especially, the existing gap in the similar domestic technology is discussed. Finally, it is emphasized that these technological gaps have seriously restricted the ability of the vice-ACW to successfully work in future actual rescue combats, therefore, it must be highly valued in the follow-up research and development (R&D through cooperating with professional manufacturers in China, thereby making technological advances.
Tiel-van Buul, M.M.C. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Roolker, W. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Verbeeten, B.W.B. Jr. [Dept. of Radiology, Academic Medical Center, Univ. of Amsterdam (Netherlands); Broekhuizen, A.H. [Dept. of Traumatology, Academic Medical Center, Univ. of Amsredam (Netherlands)
Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy. (orig.)
Wuttge, R.; Kueffer, G.; Hahn, D.; Bauer, J.; Wilhelm, K.
Arthrography was performed during the last 12 months in 14 patients who had 2 months to 10 years after implantation of a silicone-elastomere- or fascia-lata-prosthesis recurrent complaints in their operated wrists. Following an extensive radiological native examination either midcarpal or radiocarpal arthrography was performed in dependence of the site of carpal-bone-substitute. Inflammatory changes of the prosthetic bed, missing penetration of contrast medium into the periprosthetic space and other less common additional findings showed the advantages of the relatively handsome procedure.
Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula
tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO. METHODS: Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow...... of the radiolucent zone. The blood levels of chrome and cobalt ions were normal. There was no evidence of infectious or rheumatoid activity. CONCLUSIONS: Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty, and metallic debris has also been cited to be an underlying cause...
Sung, Ho Jin [Dept. Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Han, Jae Bok; Song, Jong Nam; Choi, Nam Gil [Dept. of Radiological Science, Dongshin University, Naju (Korea, Republic of)
This study were compared with the direct measurement and indirect dose methods through various dose calculation in head and wrist. And, the modified equation was proposed considering equipment type, setting conditions, tube voltage, inherent filter, added filter and its accompanied back scatter factor. As a result, it decreased the error of the direct measurement than the existing dose calculation. Accordingly, diagnostic radiography patient dose comparison would become easier and radiographic exposure control and evaluation will become more efficient. The study findings are expected to be useful in patients' effective dose rate evaluation and dose reduction.
Mondal, Surojit; Chowdhury, Aniket
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually occurs in the mucous membranes of nose, nasopharynx, and eyes, and less commonly in extra nasal sites such as skin, bones, genitalia, and even the internal organs. Rhinosporidiosis occurs in the wrist joint with isolated bony involvement is rare. We report one such case in a 50-year-old man who presented with a non-tender, fixed swelling over his anterolateral aspect of left forearm. Radiography and computed tomography showed a lytic destructive lesion involving the distal radius, ulna, carpals, and base of metacarpals. Biopsy revealed features of rhinosporidiosis. The patient underwent below-elbow amputation.
Leng, Shuai; Zhao, Kristin; Qu, Mingliang; An, Kai-Nan; Berger, Richard; McCollough, Cynthia H
To develop a 4D [three-dimensional (3D) + time] CT technique to capture high spatial and temporal resolution images of wrist joint motion so that dynamic joint instabilities can be detected before the development of static joint instability and onset of osteoarthritis (OA). A cadaveric wrist was mounted onto a custom motion simulator and scanned with a dual source CT scanner during radial-ulnar deviation. A dynamic 4D CT technique was utilized to reconstruct images at 20 equidistant time points from one motion cycle. 3D images of carpal bones were generated using volume rendering techniques (VRT) at each of the 20 time points and then 4D movies were generated to depict the dynamic joint motion. The same cadaveric wrist was also scanned after cutting all portions of the scapholunate interosseus ligament to simulate scapholunate joint instability. Image quality were assessed on an ordinal scale (1-4, 4 being excellent) by three experienced orthopedic surgeons (specialized in hand surgery) by scoring 2D axial images. Dynamic instability was evaluated by the same surgeons by comparing the two 4D movies of joint motion. Finally, dose reduction was investigated using the cadaveric wrist by scanning at different dose levels to determine the lowest radiation dose that did not substantially alter diagnostic image quality. The mean image quality scores for dynamic and static CT images were 3.7 and 4.0, respectively. The carpal bones, distal radius and ulna, and joint spaces were clearly delineated in the 3D VRT images, without motion blurring or banding artifacts, at all time points during the motion cycle. Appropriate viewing angles could be interactively selected to view any articulating structure using different 3D processing techniques. The motion of each carpal bone and the relative motion among the carpal bones were easily observed in the 4D movies. Joint instability was correctly and easily detected in the scan performed after the ligament was cut by observing the
Rubio-Sastre, Patricia; Gómez-Abellán, Purificación; Martinez-Nicolas, Antonio; Ordovás, José María; Madrid, Juan Antonio; Garaulet, Marta
The adequate time to perform physical activity (PA) to maintain optimal circadian system health has not been defined. We studied the influence of morning and evening PA on circadian rhythmicity in 16 women with wrist temperature (WT). Participants performed controlled PA (45 min continuous-running) during 7 days in the morning (MPA) and evening (EPA) and results were compared with a no-exercise-week (C). EPA was characterized by a lower amplitude (evening: 0.028 ± 0.01 °C versus control: 0.03...
Harris-Adamson, Carisa; You, Doohee; Eisen, Ellen A; Goldberg, Robert; Rempel, David
The objective was to evaluate the effect of wrist posture on incidence of wrist tendinosis in a prospective cohort of blue-collar workers. Previous studies have identified awkward wrist posture as a risk factor for wrist tendinosis, though the magnitude of the relationship is unclear. Workers (N = 413) at four industries were followed for up to 28 months with questionnaires and physical examinations every 4 months. Individualized exposure assessments of wrist posture were based on video analysis to determine the wrist extension/flexion angle for up to four tasks. Posture measures were calculated while in "heavy pinch" (> 1 kg force), "heavy power grip" (> 4 kg force), and across "all grips." A proportional hazards model estimated the relationship between time-weighted average posture measures and incidence of dominant-side wrist tendinosis. In a model based on tertiles of exposure, adjusted for age, gender, hand force, and repetition of exertions, risk of tendinosis more than doubled in the highest category (HR = 2.69, 95% CI = 1.01-7.21) across all grips. The relative risk was highest during heavy pinch (HR = 5.03, 95% CI = 0.74-34.05), though not statistically significant. Increased median wrist extension while in heavy power grip was protective (HR = 0.24, 95% CI = 0.06-0.94). In this study of production workers, median wrist flexion of more than 70, across all grips, was associated with an increased risk of tendinosis. The protective findings on median wrist extension during power grip deserve further investigation. Work tasks and tools should be designed to prevent sustained wrist flexion, especially during tasks involving forceful pinch.
Boutin, Robert D; Buonocore, Michael H; Immerman, Igor; Ashwell, Zachary; Sonico, Gerald J; Szabo, Robert M; Chaudhari, Abhijit J
Non-invasive imaging techniques such as magnetic resonance imaging (MRI) provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist--occurring during joint motion--is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability. A 3-Tesla "active-MRI" protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, "clenched-fist", and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ) congruity, extensor carpi ulnaris (ECU) tendon translation, the scapholunate (SL) interval, and the SL, radiolunate (RL) and capitolunate (CL) angles from the resulting images. The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished. This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo.
Boutin, Robert D.; Buonocore, Michael H.; Immerman, Igor; Ashwell, Zachary; Sonico, Gerald J.; Szabo, Robert M.; Chaudhari, Abhijit J.
Background Non-invasive imaging techniques such as magnetic resonance imaging (MRI) provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist – occurring during joint motion – is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability. Methods A 3-Tesla “active-MRI” protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, “clenched-fist”, and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ) congruity, extensor carpi ulnaris (ECU) tendon translation, the scapholunate (SL) interval, and the SL, radiolunate (RL) and capitolunate (CL) angles from the resulting images. Results The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished. Conclusion This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo. PMID:24391865
Werner, Frederick W.; Sutton, Levi G.; Allison, Mari A.; Gilula, Louis A.; Short, Walter H.; Wollstein, Ronit
Purpose The two purposes of this study were a) to determine the amount of scaphoid and lunate translation that occurs in normal cadaver wrists during wrist motion and b) to quantify the change in ulnar translation when specific dorsal and volar wrist ligaments were sectioned. Methods The scaphoid and lunate motion of 37 cadaver wrists were measured during wrist radioulnar deviation and flexion-extension motions using a wrist joint motion simulator. The location of centroids of the bones were quantified during each motion in the intact wrists and after sectioning either two dorsal ligaments along with the scapholunate interosseous ligament or two volar ligaments and the scapholunate interosseous ligament. Results In the intact wrist the scaphoid and lunate statistically translated radially with wrist ulnar deviation. With wrist flexion the scaphoid moved volarly and the lunate dorsally. After sectioning either the dorsal or volar ligaments, the scaphoid moved radially. After sectioning the dorsal or volar ligaments, the lunate statistically moved ulnarly and volarly. Conclusion These results indicate that measureable changes in the scaphoid and lunate translation occur with wrist motion and change with ligament sectioning. However, for the ligaments that were sectioned, these changes are small and an attempt to clinically measure these translations of the scaphoid and lunate radiographically may be limited. The results support the conclusion that ulnar translocation does not occur unless multiple ligaments are sectioned. Injury of more than the scapholunate interosseous ligament along with either the dorsal intercarpal and dorsal radiocarpal or the radioscaphocapitate and scaphotrapezial ligaments are needed to have large amounts of volar and ulnar translation. PMID:21276893
Robert D Boutin
Full Text Available Non-invasive imaging techniques such as magnetic resonance imaging (MRI provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist--occurring during joint motion--is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability.A 3-Tesla "active-MRI" protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, "clenched-fist", and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ congruity, extensor carpi ulnaris (ECU tendon translation, the scapholunate (SL interval, and the SL, radiolunate (RL and capitolunate (CL angles from the resulting images.The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished.This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo.
Bone stress injuries are due to repetitive mechanical overuse of the skeleton and occur as a result of microscopic lesions sustained when bone is subjected to repeated submaximal stress. Over time accumulation of such injuries can lead to bone failure and fractures. Stress-related bone injuries are relatively common among otherwise healthy persons who have recently started new or intensified forms of physical training activities. Stress injuries lead to typical findings on radiography, bone scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) and need to be discriminated from other conditions, in particular infections and neoplasms. Stress fractures must be differentiated from insufficiency fractures that occur in bones with reduced mechanical resistance or disturbed structure.
Xu, J; Li, Q; Chen, S
To evaluate and analyze the long-term results of all the operation mordalities practised at present of late hand function reconstruction in patients with severe electrical injury of the wrists. Forty-seven cases with late electrical injury of the wrists were followed up and comprehensively analyzed in terms of the long-term results of morphological reconstruction and functional restoration. In addition to cutaneous tissue repair and functional training of the joints of the wrists, the flexor digitorum reconstruction with auto free tendon grafting gave a poor result (only 33.4% of the cases with function above medium level). In one case, the wrist function was rebuilt by compound plantaris tendon free flap with leg deep facia and posterior tibial artery, resulting in the restoration of thumb flexor function, with shorter treating time and less postoperative adhesion. Median and ulnar nerves were repaired with free auto nerve grafting with no obvious effects. Two cases were repaired by compound tissue grafting of sural nerve and deep facia carried by small saphenous veins with uncertain result. In another 3 cases, with the aid of retrograde evoked potential (REP), a proximal anastomosis of nerves was done with fairly good result. Insufficient blood supply and scar formation were the major causes of poor results of the tendon and nerve grafting. It was recommended that the graft should carry sufficient blood supply to improve the blood supply of the recipient bed in order to improve the therapeutic effects. The selection of proximal nerve segment should include the functional examination.
Klomp, Asbjorn; de Groot, Jurriaan H; de Vlugt, Erwin; Meskers, Carel G M; Arendzen, J Hans; van der Helm, Frans C T
System identification techniques have been used to separate intrinsic muscular and reflexive contributions to joint impedance, which is an essential step in the proper choice of patient specific treatment. These techniques are, however, only well developed for linear systems. Assuming linearity prescribes the neuromuscular system to be perturbed only around predefined operating points. In this study, we test the validity of a commonly used linear model by analyzing the effects of flexion-extension displacement amplitude (2(°), 4(°), and 8(°)) on damping, stiffness, and reflex gain of the wrist joint, at different background torque levels (0, 1, and 2 N · m). With displacement amplitude, intrinsic damping increased, while intrinsic stiffness and reflex gains decreased. These changes were dependent on the level of wrist torque. The dependency of the neuromuscular system properties on even small variations in angular displacement is evident and has to be accounted for when comparing different studies and clinical interpretations using linear identification techniques. Knowledge of the behavior of the neuromuscular system around operating points is an essential step toward the development of nonlinear models that allow for discrimination between patients and controls in a larger range of loading conditions.
Chowdhury, Alok Kumar; Tjondronegoro, Dian; Chandran, Vinod; Trost, Stewart G
To investigate whether the use of ensemble learning algorithms improve physical activity recognition accuracy compared to the single classifier algorithms, and to compare the classification accuracy achieved by three conventional ensemble machine learning methods (bagging, boosting, random forest) and a custom ensemble model comprising four algorithms commonly used for activity recognition (binary decision tree, k nearest neighbor, support vector machine, and neural network). The study used three independent data sets that included wrist-worn accelerometer data. For each data set, a four-step classification framework consisting of data preprocessing, feature extraction, normalization and feature selection, and classifier training and testing was implemented. For the custom ensemble, decisions from the single classifiers were aggregated using three decision fusion methods: weighted majority vote, naïve Bayes combination, and behavior knowledge space combination. Classifiers were cross-validated using leave-one subject out cross-validation and compared on the basis of average F1 scores. In all three data sets, ensemble learning methods consistently outperformed the individual classifiers. Among the conventional ensemble methods, random forest models provided consistently high activity recognition; however, the custom ensemble model using weighted majority voting demonstrated the highest classification accuracy in two of the three data sets. Combining multiple individual classifiers using conventional or custom ensemble learning methods can improve activity recognition accuracy from wrist-worn accelerometer data.
Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo
The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.
Krebs, Hermano Igo; Volpe, Bruce T; Williams, Dustin; Celestino, James; Charles, Steven K; Lynch, Daniel; Hogan, Neville
In 1991, a novel robot, MIT-MANUS, was introduced to study the potential that robots might assist in and quantify the neuro-rehabilitation of motor function. MIT-MANUS proved an excellent tool for shoulder and elbow rehabilitation in stroke patients, showing in clinical trials a reduction of impairment in movements confined to the exercised joints. This successful proof of principle as to additional targeted and intensive movement treatment prompted a test of robot training examining other limb segments. This paper focuses on a robot for wrist rehabilitation designed to provide three rotational degrees-of-freedom. The first clinical trial of the device will enroll 200 stroke survivors. Ultimately 160 stroke survivors will train with both the proximal shoulder and elbow MIT-MANUS robot, as well as with the novel distal wrist robot, in addition to 40 stroke survivor controls. So far 52 stroke patients have completed the robot training (ongoing protocol). Here, we report on the initial results on 36 of these volunteers. These results demonstrate that further improvement should be expected by adding additional training to other limb segments.
Herzberg, G; Burnier, M
The authors report their experience with wrist hemiarthroplasty for acute irreparable distal radius fractures in independent elderly patients (12 women, mean age 76years) and following failed initial treatment in the same population (5 women, mean age 75years). The first 11 cases have a mean follow-up of 30months. No complications requiring implant removal were reported. At follow-up, the mean VAS for pain was 1/10, the mean flexion-extension arc was 60°, the Lyon Wrist score was 73 % and the PRWE (Patient-Related Wrist Evaluation) was 22 points. The five patients who had secondary procedures and were reviewed at mean of 16months' follow-up did not require implant removal but there was one complete forearm rotational ankylosis with ossification. At follow-up, the mean VAS for pain was 3/10, the mean flexion-extension arc was 56°, the Lyon Wrist score was 65 % and the PRWE was 45 points. The authors believe that hemiarthroplasty is a useful salvage procedure for irreparable wrist fractures in the emergency room and after failed initial treatment in active elderly patients. Copyright Â© 2016. Published by Elsevier Masson SAS.
When classifying fracturing fluids and their additives, it is important that production, operation, and completion engineers understand which chemical should be utilized in different well environments. A user's guide to the many chemicals and chemical additives used in hydraulic fracturing operations, Hydraulic Fracturing Chemicals and Fluids Technology provides an easy-to-use manual to create fluid formulations that will meet project-specific needs while protecting the environment and the life of the well. Fink creates a concise and comprehensive reference that enables the engineer to logically select and use the appropriate chemicals on any hydraulic fracturing job. The first book devoted entirely to hydraulic fracturing chemicals, Fink eliminates the guesswork so the engineer can select the best chemicals needed on the job while providing the best protection for the well, workers and environment. Pinpoints the specific compounds used in any given fracturing operation Provides a systematic approach to class...
Herzberg, G; Merlini, L; Burnier, M
The authors report their experience with hemi-arthroplasty in irreparable fresh distal radius fracture in independent elderly patients as first-line treatment (12 fractures in 11 women; mean age, 74 years) or in second line after clinically disabling primary failure (4 fractures in 4 women; mean age, 78 years). In the 12 primary surgeries, at a mean 32 months' follow-up, there were no complications requiring implant ablation; mean pain score was 1/10, flexion-extension 62°, Lyon Wrist score 75%, and Patient-Related Wrist Evaluation (PRWE) 22 points. In 2 of the 4 secondary surgeries, at a mean 24 months' follow-up, there were no complications requiring implant ablation; mean pain score was 2.5/10, flexion-extension 62°, Lyon Wrist score 58%, and PRWE 50 points: i.e., slightly poorer results than in primary surgery. Salvage of complex fracture in independent elderly patients by hemi-arthroplasty, whether primary or secondary to failure, seems to be a considerable progress, to be confirmed in larger series. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Glickel, Steven Z; Catalano, Louis W; Raia, Frank J; Barron, O Alton; Grabow, Ryan; Chia, Benjamin
The purpose of this study was to review the long-term outcomes of patients with distal radius fractures treated with closed reduction and percutaneous pinning. We retrospectively reviewed 54 patients with 55 AO type A2, A3, C1, or C2 distal radius fractures treated with closed reduction and percutaneous pinning. The average age of the patients was 57 years. All patients returned for follow-up examination at an average of 59 months, with a minimum of 22 months. Measurements included active range of motion, grip strength, pain assessment, Disabilities of the Arm, Shoulder, and Hand scores, and final radiographic assessment. The paired t-test was used to determine significant differences. All fractures healed within 6 weeks. Active range of motion and grip strength of the injured wrist were statistically equal to those of the uninjured wrist for each of the parameters except wrist flexion and forearm supination. However, the difference in wrist flexion was 5 degrees and the difference in supination was 4 degrees , both of which are of little clinical importance. Eighty-five percent of patients were pain free. Radiographic parameters comparing the immediate postoperative view with the views taken at final follow-up showed no significant differences. One patient required reoperation for loss of reduction after a fall in the preoperative period, and 3 others had minor complications. Patients treated with closed reduction and percutaneous pinning for distal radius fractures had excellent range of motion, normal Disabilities of the Arm, Shoulder, and Hand scores, and no significant differences in the radiographic parameters between fracture fixation and fracture healing. Complications were few. Pinning is an efficacious, low-cost treatment option for 2- and 3-part distal radius fractures with excellent long-term results. Therapeutic IV.
Kox, Laura S.; Kuijer, P. Paul F. M.; Opperman, Jip; Kerkhoffs, Gino M. M. J.; Maas, Mario; Frings-Dresen, Monique H. W.
This study's objective was to collect items from experienced sports physicians, relating to the presence and severity of overuse wrist injuries in young athletes, for developing a measurement instrument for signals of overuse wrist injury. Seven Dutch elite sports physicians involved in guidance and
J.J. Nikken (Jeroen)
textabstractIn this thesis we study the application of MRI in acute trauma of wrist, knee, and ankle, evaluating its potentials, its effects, and its costs. Our aim was to use MRI in all patients with acute trauma of wrist, knee, and ankle, without increasing the overall costs to society,
Boninger, M L; Cooper, R A; Robertson, R N; Rudy, T E
To describe motion, forces, and moments occurring at the wrist in anatomic terms during wheelchair propulsion; to obtain variables that characterize wrist function during propulsion and are statistically stable; and to determine how these variables change with speed. Case series. Biomechanics laboratory. Convenience sample of Paralympic athletes (n = 6) who use manual wheelchairs for mobility and have unimpaired arm function. Subjects propelled a standard wheelchair on a dynamometer at 1.3m/sec and 2.2m/sec. Biomechanical data were obtained using a force and moment sensing pushrim and a motion analysis system. Maximum angles, forces, and moments in a local, wrist coordinate system. Each variable was evaluated for stability using Cronbach's alpha. Measures found to be stable (infinity > .8) at each speed were then compared to look for differences associated with speed. The following measures were stable at both speeds: maximum wrist flexion, ulnar deviation, and radial deviation angles, peak moments acting to cause wrist flexion, extension, and ulnar deviation, peak shear forces acting between the radial and ulnar styloids, and peak axial force acting at the wrist. Of these measures, the following measures differed (p wrist biomechanics during wheelchair propulsion and varied with speed. Ultimately these parameters may provide insight into the cause and prevention of wrist injuries in manual wheelchair users.
Agiovlasitis, Stamatis; Motl, Robert W.; Foley, John T.; Fernhall, Bo
This study examined the relationship between energy expenditure and wrist accelerometer output during walking in persons with and without Down syndrome (DS). Energy expenditure in metabolic equivalent units (METs) and activity-count rate were respectively measured with portable spirometry and a uniaxial wrist accelerometer in 17 persons with DS…
Obdeijn, M. C.; Alewijnse, J. V.; Mathoulin, C.; Liverneaux, P.; Tuijthof, G. J. M.; Schijven, M. P.
The objective of this study was to develop and validate a computer-based module for wrist arthroscopy to which a group of experts could consent. The need for such a module was assessed with members of the European Wrist Arthroscopy Society (EWAS). The computer-based module was developed through
van Vugt, RM; van Jaarsveld, CHM; Hofman, DM; Helders, PJM; Bijlsma, JWJ
Objective, To identify different patterns of disease manifestation and changes in the rate of progression of rheumatoid arthritis (RA) in the wrist.Methods. Forty wrists, with normal baseline radiographs, of 20 patients with RA were evaluated by means of a retrospective radiographic review for a
Holmes, Michael W R; Tat, Jimmy; Keir, Peter J
The purpose of this study was to investigate how gripping modulates forearm muscle co-contraction prior to and during sudden wrist perturbations. Ten males performed a sub-maximal gripping task (no grip, 5% and 10% of maximum) while a perturbation forced wrist flexion or extension. Wrist joint angles and activity from 11 muscles were used to determine forearm co-contraction and muscle contributions to wrist joint stiffness. Co-contraction increased in all pairs as grip force increased (from no grip to 10% grip), corresponding to a 36% increase in overall wrist joint stiffness. Inclusion of individual muscle contributions to wrist joint stiffness enhanced the understanding of forearm co-contraction. The extensor carpi radialis longus (ECRL) and brevis had the largest stiffness contributions (34.5 ± 1.3% and 20.5 ± 2.3%, respectively), yet muscle pairs including ECRL produced the lowest co-contraction. The muscles contributing most to wrist stiffness were consistent across conditions (ECRL for extensors; Flexor Digitorum Superficialis for flexors), suggesting enhanced contributions rather than muscular redistribution. This work provides investigation of the neuromuscular response to wrist perturbations and gripping demands by considering both co-contraction and muscle contributions to joint stiffness. Individual muscle stiffness contributions can be used to enhance the understanding of forearm muscle control during complex tasks.
Matthews, Doris B.; Quinn, Jimmy L.
While evidence exists that a person's peripheral temperature responds to his state of arousal or stress, it also responds to other environmental factors. Wrist temperature has been found to vary with ambient temperature, and to increase during the school day. Before wrist temperature can be established as a valid measure of anxiety, stress, or…
Matthews, Doris B.; Casteel, Jim Frank
Research supports skin temperature changes (increases) as indicators of stress reduction or relaxation. To study the utility of skin temperature at the wrist as a measure of relaxation, 226 seventh grade students recorded their wrist temperatures before and after a 15-minute relaxation training exercise each morning for 29 weeks. Teachers checked…
Iida, Akio; Omokawa, Shohei; Moritomo, Hisao; Omori, Shinsuke; Kataoka, Toshiyuki; Aoki, Mitsuhiro; Wada, Takuro; Fujimiya, Mineko; Tanaka, Yasuhito
We investigated distal radioulnar joint (DRUJ) stability in different wrist positions and examined the relative contribution of each ligamentous component of the triangular fibrocartilage complex (TFCC) to DRUJ stability. We used nine fresh-frozen cadavers. The humerus and ulna were fixed at 90° elbow flexion. The radiocarpal unit was translated relative to the ulna in dorsopalmar directions with the wrist in five positions. Displacement of the unit was measured by an electromagnetic tracking device. Magnitudes of displacement were compared between different wrist positions in various sectioning stages: ulnocarpal ligament (UCL) sectioning, radioulnar ligaments (RUL) sectioning, and extensor carpi ulnaris (ECU) floor sectioning. Wrist position and sectioning stage significantly influenced the displacement. In intact wrists, the displacement in wrist extension was significantly lower than that in neutral. However, after UCL sectioning, there were no longer any significant differences. After RUL sectioning, the displacement in radial deviation was significantly lower than that in neutral. Following ECU floor sectioning, there were no longer any significant differences. Thus, in intact wrists, DRUJ stability in wrist extension is likely due to tightening of the UCL. After complete RUL sectioning, DRUJ is stabilized in radial deviation due to tightening of the ECU floor. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Veehof, M.M.; Taal, Erik; Willems, Marjanne J.; van de Laar, Mart A F J
Objective: To gain insight into the determinants of the use of wrist working splints among patients with rheumatoid arthritis (RA). - Methods: A qualitative descriptive study was performed among 18 patients with RA who recently received a fabric wrist working splint because of pain due to arthritis
Kitamura, Takashi; Murase, Tsuyoshi; Hashimoto, Jun; Tomita, Tetsuya; Arimitsu, Sayuri; Yoshikawa, Hideki; Sugamoto, Kazuomi
When planning therapy for rheumatoid arthritis (RA) in the wrist joint, knowing the pattern of joint destruction is important. There were a few studies using the Larsen and modified Larsen method to evaluate RA wrist joint destruction. However, these methods are inadequate for thoroughly assessing the severity of joint destruction because joint bone erosion and joint space narrowing could not be evaluated individually in these methods. To clarify the pattern of RA wrist joint destruction in the different zones of the wrist, we conducted a large-scale radiographic study. We modified the van der Heijde/Sharp method to assess radiographic images. Subjects were 191 RA patients (22 men and 169 women; mean age 57.0 years) who were examined at our center between 2001 and 2003 and underwent plain X-ray of both wrist joints (n = 382). Using X-ray images of the wrist joint, classification was performed based on the severity of wrist joint surface bone erosion and joint space narrowing at different zones, and the results were statistically analyzed. The results showed that joint space narrowing in the midcarpal joint (MCJ) advanced faster than in the radiocarpal joint (RCJ). Conversely, bone erosion in the RCJ advanced faster than in the MCJ. In X-ray diagnosis of RA wrist joint disorders, knowing the pattern of destruction is useful for assessing the presence or absence of early joint destruction and in planning therapy.
Farooq, Deen; Jahanian, Omid; Slavens, Brooke A; Hsiao-Wecksler, Elizabeth T
Lofstrand, or forearm, crutches are a common assistive mobility device for those with functional impairments. However, repeated loading of the wrist and palmar region and continual hyperextension of the wrist during Lofstrand crutch usage may cause wrist strain, pain, and secondary injuries such as carpal tunnel syndrome. In order to reduce risk of injury, a novel wrist orthosis was developed with the intent of improving wrist posture and reducing/redirecting palmar loads from the carpal tunnel region to the adductor pollicis area. Dominant-hand palmar loads and wrist extension angles of 10 healthy, able-bodied subjects were measured during swing-through Lofstrand crutch-assisted gait to demonstrate the orthosis effectiveness. Each subject performed 10 trials each with and without the orthosis. An enhanced understanding of the effects of the wrist orthosis on kinematics and palmar loading was gained through this study. Results indicated a significant decrease in maximum palmar force, contact area, and wrist extension when using the orthosis. Palmar loads were observed to be redirected toward the adductor pollicis when using an orthosis during Lofstrand crutch-assisted gait. Ultimately, this device was effective in redistributing palmar loads with the potential to reduce pain and risk of carpal tunnel syndrome in long-term Lofstrand crutch users.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity... ``Wrist Conditions Disability Benefits Questionnaire, VA Form 21-0960M-16.'' On June 18, 2013 (78 FR 36643...
Mulders, Marjolein A. M.; Walenkamp, Monique M. J.; Dubois, Bente F. H.; Slaar, Annelie; Goslings, J. Carel; Schep, Niels W. L.
Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these
M.A.M. Mulders (Marjolein A. M.); M.M.J. Walenkamp (Monique); B.F.H. Dubois (Bente F. H.); A. Slaar (Annelie); J.C. Goslings (Carel); N.W.L. Schep (Niels)
textabstractBackground: Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. Objective: The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children
Kox, Laura S; Kuijer, P Paul F M; Opperman, Jip; Kerkhoffs, Gino M M J; Maas, Mario; Frings-Dresen, Monique H W
This study's objective was to collect items from experienced sports physicians, relating to the presence and severity of overuse wrist injuries in young athletes, for developing a measurement instrument for signals of overuse wrist injury. Seven Dutch elite sports physicians involved in guidance and treatment of young athletes in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) participated in a focus group. They discussed signals and limitations related to overuse wrist injuries in young athletes. Data were coded and categorised into signals and limitations with subcategories, using an inductive approach. Of the resulting 61 signals and limitations in nineteen (sub)categories, 20 were considered important, forming a comprehensive item set for identifying overuse wrist injury in young athletes. Signals such as pain, "click", crepitations, swelling and limited range of motion were marked useful for early identification of overuse wrist injury. Limitations in movement and performance were considered indicative of severe overuse injury but less relevant for initial injury identification. The focus group provided 17 important signals and 3 important limitations indicative of overuse wrist injury. These provide the basis for a valid measurement instrument for identifying overuse wrist injury in young athletes, with equal emphasis on pain and on other symptoms.
Foumani, M.; Blankevoort, L.; Stekelenburg, C.; Strackee, S. D.; Carelsen, B.; Jonges, R.; Streekstra, G. J.
Measurements of in-vitro carpal kinematics of the wrist provide valuable biomechanical data. Tendon loading is often applied during cadaver experiments to simulate natural stabilizing joint compression in the wrist joint. The purpose of this study was to investigate the effect of tendon loading on
Dacho, Andreas; Grundel, Johanna; Holle, Gisbert; Germann, Günter; Sauerbier, Michael
Outcome evaluation of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist). Scaphoid nonunion or scapholunate ligament instability results in carpal collapse and subsequent arthrosis. These conditions, termed SLAC-wrist and SNAC-wrist, are the most common patterns of arthrosis in the wrist. The purpose of this retrospective study was the evaluation of functional outcomes following midcarpal arthrodesis and of patients' satisfaction with these outcomes. Forty-nine patients were reexamined at a mean follow-up time of 47 months. Active range of motion (AROM) was verified with a goniometer; grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) for stress and under resting conditions. Patients' upper-extremity functioning was captured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Radiographic evaluation of bony consolidation was verified by conventional x-ray. Postoperative AROM was 56% and grip strength was 76% compared with the contralateral side. The DASH score was 29 points. Pain relief was 34% at rest and 31% after stress. Forty-five patients demonstrated bony consolidation in x-ray control. Six patients (12%) further required a total arthrodesis of the wrist because of pain or absence of bony consolidation. Our data demonstrate that midcarpal arthrodesis is a reliable procedure for treating SLAC- and SNAC-wrists in stages II and III and, furthermore, one which preserves some range of motion. Total wrist fusion should only be used in exceptional circumstances.
Diong, Teik Wei; Haflah, Nor Hazla Mohamed; Kassim, Abdul Yazid Mohd; Habshi, Sharifah Majedah Idrus Al; Shukur, Mohd Hassan
The use of volar locking plate in distal radius fracture can lead to extensor tendon rupture due to dorsal screw penetration. The aim of our study was to investigate the occurrence of dorsal and intra-articular screw penetration using CT scan after volar distal radius osteosynthesis for distal radius fractures. Thirty patients who underwent distal volar locking plate for distal radius fracture were included in a retrospective study. In all 30 patients no dorsal and intra-articular screw penetration were detected on standard AP and lateral views of a plain radiograph. CT scan of the operated wrist was performed to determine the number of intra-articular and dorsal screw penetrations. Clinical examination was performed to determine the wrist functions in comparison to the normal wrist. Nineteen wrists were noted to have screw penetration either dorsally or intraarticularly. The highest incidence is in the 2nd extensor compartment where 13 screws had penetrated with a mean of 2.46 mm. Six screws penetrated into the distal radial ulnar joint and five screws into the wrist joint with a mean of 2.83 mm and 2.6 mm, respectively. However, there was no incidence of tendon irritation or rupture. This study demonstrated a high incidence of dorsal and intra-articular screw penetration detected by CT scan which was not apparent in plain radiograph. We recommend that surgeons adhere to the principle of only near cortex fixation and downsizing the locking screw length by 2 mm.
Marklin, R W; Simoneau, G G; Monroe, J F
A study was conducted on 90 experienced office workers to determine how commercially available alternative computer keyboards affected wrist and forearm posture. The alternative keyboards tested had the QWERTY layout of keys and were of three designs: split fixed angle, split adjustable angle, and vertically inclined (tilted or tented). When set up correctly, commercially available split keyboards reduced mean ulnar deviation of the right and left wrists from 12 degrees to within 5 degrees of a neutral position compared with a conventional keyboard. The finding that split keyboards place the wrist closer to a neutral posture in the radial/ulnar plane substantially reduces one occupational risk factor of work-related musculoskeletal disorders (WMSDs): ulnar deviation of the wrist. Applications of this research include commercially available computer keyboard designs that typists can use and ergonomists can recommend to their clients in order to minimize wrist ulnar deviation from typing.
Gitto, Salvatore; Draghi, Ferdinando
Sonography allows for rapid, cost-effective, noninvasive, and dynamic evaluation of soft tissue structures, thus representing a valuable tool for ruling out musculoskeletal disorders of the wrist. Because of the complexity of the wrist joint, sonographic training and familiarity with normal and variant anatomy are needed to avoid misdiagnosis and improper treatment. The aim of this article is to enlighten readers about the structures representing normal findings or common variants during sonographic evaluations of the wrist. The main text reviews the pertinent gross anatomy and procedures that are recommended to assess the soft tissue structures of the wrist, with particular emphasis given to tendons, nerves, and ligaments. Detailed explanations of the scanning techniques and sonographic appearance of the wrist structures are provided in the figure legends. © 2016 by the American Institute of Ultrasound in Medicine.
Ushiba, J; Masakado, Y; Komune, Y; Muraoka, Y; Chino, N; Tomita, Y
We evaluated the effect of prolonged wrist extension on H reflex in the flexor carpi radialis (FCR) muscle and tendon jerk (T) reflex in the biceps brachii (BB) muscle of 17 chronic hemiplegic patients. H reflex of the FCR and T reflex of the BB were assessed every 5 minutes within 20 minutes during prolonged wrist extension and post-20 minutes after the extension. As a result, H reflex in the FCR was reduced by passive wrist stretch in 82% of the spastic limbs. The effect was larger in the higher spastic group. In 45% of the spastic limbs, T reflex in the BB also was reduced by passive wrist stretch. The inhibitory effects had a tendency to strengthen in accordance with the grade of muscle tone. We considered from these results, prolonged wrist extension generated inhibitory projections via probably group II afferents of the FCR in the homonym and in the transjoint in spastic limbs.
Crisco, Joseph J.; Heard, Wendell M.R.; Rich, Ryan R.; Paller, David J.; Wolfe, Scott W.
Background: The complex motions of the wrist are described in terms of four anatomical directions that are accomplished through the multiple articulations of the carpus. With minimal tendinous insertions, the carpus is primarily a passive structure. This emphasizes the importance of its mechanical properties, which few studies have examined to date. The purpose of the present study was to determine the mechanical properties of the wrist in twenty-four different directions of wrist motion. Methods: The moment-rotation mechanical behavior of six fresh-frozen cadaver wrists was determined in four directions: flexion, extension, ulnar deviation, and radial deviation. Twenty other directions that were a combination of these anatomical directions were also studied. A custom-designed jig was interfaced with a standard materials testing system to apply unconstrained moments. Moments of ±2 Nm were applied, and the moment-rotation data were recorded and analyzed to determine the neutral zone, range of motion, and stiffness values as well as the orientation of the envelope of these values. Results: The envelope of wrist range-of-motion values was ellipsoidal in shape and was oriented obliquely (p wrist range of motion was a mean of 111.5° ± 10.2°, in the direction of ulnar flexion, 30° from pure flexion. The largest stiffness (mean, 0.4 Nm/deg) was in the direction of radial flexion, while the smallest stiffness (mean, 0.15 Nm/deg) was in the direction of ulnar flexion. Conclusions: The mechanical axes of the wrist are oriented obliquely to the anatomical axes. The primary mechanical direction is one of radial extension and ulnar flexion, a direction along a path of the dart thrower's wrist motion. Clinical Relevance: Understanding the mechanical function of the wrist can aid clinical treatment decisions, arthroplasty, and implant designs. The findings of this study provide new evidence that the mechanical axes of the wrist are not collinear with the anatomical axes
Grigor'eva, M A; Anushkina, E S
The objective of the present study was to develop the regression models for the reconstruction of the human body length from the wrist size taking into consideration the availability of the results of the measurements of the palm fragments or the wrist undergoing muscular contracture. The study included 106 Caucasoid subjects (41 men and 65 women) at the age varying from 18 to 76 years. The following parameters were measured: body length, wrist length, the length of the fingers and phalanges on the back of the hand, palmar length and width, ulnar edge size of the palm. It was shown that the selected longitudinal dimensions of the palm and fingers can be used to estimate the body length as accurately as from the wrist length. The high prognostic value of ulnar edge size of the palm was documented which allows this characteristic to be used in the cases of partial palm destruction or in the wrist with pronounced flexion contracture of the fingers. The most exact equations are those derived from the combination of the results of the measurement of the fingers and the ulnar edge size of the palm. Less accurate equations are based on the palmar dimensions alone and on the total wrist size with the exception of the equation for the wrist length with regard to the subject's sex. The gender information needs to be taken into account if the wrist is preserved to the extent that only the length of the palm and of the IV and V fingers can be measured or if the wrist is sufficiently long and wide (short and wide) and the gender is supposed to be masculine. In contrast, this information should be disregarded if the wrist is long and narrow (short and narrow) and the gender is supposedly feminine.
Kox, Laura S.; Kuijer, P. Paul F. M.; Kerkhoffs, Gino M. M. J.; Maas, Mario; Frings-Dresen, Monique H. W.
Overuse wrist injuries can cause long-term symptoms in young athletes performing wrist-loading sports. Information on the prevalence, incidence and associated risk factors is required. We aimed to review the prevalence and incidence of overuse wrist injuries in young athletes and to identify
Platon, Alexandra; Poletti, Pierre-Alexandre; Van Aaken, Jan; Fusetti, Cesare; Della Santa, Dominique; Beaulieu, Jean-Yves; Becker, Christoph D
To evaluate ultrasonography (US) performed by an emergency radiologist in patients with clinical suspicion of scaphoid fracture and normal radiographs. Sixty-two consecutive adult patients admitted to our emergency department with clinical suspicion of scaphoid fracture and normal radiographs underwent US examination of the scaphoid prior to wrist computed tomography (CT), within 3 days following wrist trauma. US examination was performed by a board-certified emergency radiologist, non-specialized in musculoskeletal imaging, using the linear probe (5-13 MHz) of the standard sonographic equipment of the emergency department. The radiologist evaluate for the presence of a cortical interruption of the scaphoid along with a radio-carpal or scapho-trapezium-trapezoid effusion. A CT of the wrist (reference standard) was performed in every patient, immediately after ultrasonography. Fractures were classified into two groups according to their potential for complication: group 1 (high potential, proximal or waist), group 2 (low-potential, distal or tubercle). A scaphoid fracture was demonstrated by CT in 13 (21%) patients: eight (62%) of them belonged to group 1 (three in the proximal pole, five in the waist), five (38%) to group 2 (three in the distal part, two in the tubercle). US was 92% sensitive (12/13) in demonstrating a scaphoid fracture. It was 100% sensitive (8/8) in demonstrating a fracture with a high potential of complication (group 1). Our data show that, in emergency settings, US can be used for the triage to CT in patients with clinical suspicion of scaphoid fracture and normal radiographs.
Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.
A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular
Flores, Diana Castillo; Laurendeau, Simon; Teasdale, Normand; Simoneau, Martin
Wrist movement-related injuries account for a large number of repetitive motion injuries. Remarkably little, if any, empirical data exist to quantify the impact of neuromuscular disorders affecting the wrist or to validate the effectiveness of rehabilitation training programs on wrist functions. The aim of this project was to develop a biomechanical model for quantifying wrist and forearm kinetics during unconstrained movements, to assess its reliability and to determine its sensitivity. Twenty healthy subjects with no history of upper arm and wrist pain volunteered for the experiment. To evaluate the reliability of the data, we quantified their forearm and wrist kinetics on two different days (minimum and maximum number of days between experimental sessions were 1 and 4 days respectively). To measure forearm and wrist kinetics, an apparatus was built to offer rotational inertia during forearm and wrist movements. An inertial measurement unit was located near the top of the device measuring its angular position along the frontal and sagittal planes. We used a mathematical model to infer forearm and wrist torque. Thereafter, we calculated the product of torque and angular velocity to determine forearm and wrist power. Results revealed that for 75% of the power and torque measurements the ICC was greater than 0.75 (range: 0.77 - 0.83). Torque and power measurements for adduction movements, however, were less reliable (i.e., ICC of 0.60 and 0.47, respectively) across testing sessions. The biomechanical model was robust to small measurement errors, and the power peaks between the first and second testing session were not different indicating that there was no systematic bias (i.e., motor performance improvement) between testing sessions. The biomechanical model can be used to assess the effectiveness of rehabilitation programs, document the progression of athletes or conduct research-oriented testing of maximum forearm and wrist kinetic capacities. Nonetheless
Ong, Terence; Sahota, Opinder; Tan, Wei; Marshall, Lindsey
This study examines the relationship between high BMI, a diagnosis of osteoporosis and low trauma fractures. This is a cross sectional analysis using data collected from the Nottingham Fracture Liaison Service. A total of 4288 participants with a low trauma fracture from 1 January 2007 to 31 August 2012 were analysed. Logistic regression adjusted for potential confounders was used investigate osteoporosis and BMI. Fracture types were compared between those who were obese and non-obese. A total of 30% (1285) were obese. Prevalence of osteoporosis was 13.4%, 24.9%, and 40.4% in the obese, overweight and normal category respectively. Being obese has an odds ratio of 0.23 (95% CI 0.19-0.28, pfracture types, obese patients when compared with the non-obese category, were more likely to fracture their ankle (OR 1.48, pfracture their wrist (OR 0.65, p70years), obesity no longer influenced ankle or wrist fractures but there is an increased risk of upper arm fractures (OR 1.46, p=0.005). Higher BMD in obesity is not protective against fractures as there are a significant number of fractures in this group which may be due to body habitus, mechanism of injury and the effect of adiposity on bone. A low trauma osteoporotic fracture will need to be redefined in light of these findings. Copyright © 2013 Elsevier Inc. All rights reserved.
Dhesi, J K; Allain, T J; Mangoni, A A; Jackson, S H D
Fractures are common in elderly subjects, disabling and occasionally fatal. Their incidence increases exponentially with age, with the commonest affected sites being the wrist, vertebrae, hip and humerus. Of these, hip fractures are the most relevant in terms of morbidity and financial cost. The increase in fracture rate with age is believed to result predominantly from age-related increases in the incidence of osteoporosis and falls. This article reviews the evidence for the use of vitamin D and bisphosphonates for the prevention of bone fractures and osteoporosis in elderly patients.
Choe, Hyonmin; Sakano, Hiroaki; Takigami, Hidetake; Inaba, Yutaka; Matsuo, Kosuke; Saito, Tomoyuki
Pyoderma gangrenosum (PG) is a rare, noninfectious, neurotrophic dermatosis. We observed a case of PG mimicking cutaneous and osteoarticular infections that presented with a prolonged ulcer on the forearm, severe wrist pain, anemia, substantial local and systemic inflammation as evaluated by serum laboratory data, and carpal osteolysis. Although PG rarely damages joints, the ulcer extended to the joint and destroyed the osteochondral tissues. Advanced ulcerative colitis, which is a most common comorbidity of PG, proved to be an underlying disease. Antibiotic and surgical treatment did not heal the ulcer, which was successfully treated with corticosteroids. This intractable ulcer is often misdiagnosed. Hence when a patient presents with an enlarged, painful, unusual skin lesion, PG should always be considered. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Erwin, Andrew; Pezent, Evan; Bradley, Joshua; O'Malley, Marcia K
The improvement of movement smoothness over the course of therapy is one of the positive outcomes observed during robotic rehabilitation. Although movements are generally robust to disturbances, certain perturbations might disrupt an individual's ability to produce these smooth movements. In this paper, we explore how a rehabilitation robot's inherent dynamics impact movement smoothness during pointing tasks. Able-bodied participants made wrist pointing movements under four different operating conditions. Despite the relative transparency of the device, inherent dynamic characteristics negatively impacted movement smoothness. Active compensation for Coulomb friction effects failed to mitigate the degradation in smoothness. Assessment of movements that involved coupled motions of the robot's joints reduced the bias seen in single degree of freedom movements. When using robotic devices for assessment of movement quality, the impact of the inherent dynamics must be considered.
Full Text Available In the condition of the insufficient number of PT, the novel wearable rehabilitation devices using a soft pneumatic actuator for the elderly are actively proposed and developed. In the previous study, a wearable wrist rehabilitation device based on a flexible robot arm using three flexible pneumatic cylinders was proposed and tested. In this study, the improvement of the device is carried out so as to use it without limitation of attitude of patient’s arm. The attitude control of the improved device based on the analytical model is also carried out. As a result, it is confirmed that the device can give the motion to patients with any attitude of their arm according to the desired position.
Schousboe, John T; Vo, Tien; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E
Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other
Scalcione, Luke R; Gimber, Lana H; Ho, Annette M; Johnston, Stephen S; Sheppard, Joseph E; Taljanovic, Mihra S
The objectives of this article are to discuss the imaging of carpal dislocations and fracture-dislocations and to review the ligamentous anatomy of the wrist, mechanisms of injury, and routine management of these injuries. Perilunate dislocations, perilunate fracture-dislocations (PLFDs), and lunate dislocations are high-energy wrist injuries that can and should be recognized on radio-graphs. These injuries are a result of important sequential osseous and ligamentous injuries or failures. Prompt and accurate radiographic diagnosis aids in the management of patients with perilunate dislocations, PLFDs, and lunate dislocations while assisting orthopedic surgeons with subsequent surgical planning. CT may better show the extent of the injury and help in treatment planning particularly in cases of delayed treatment or chronic perilunate dislocation. A CT examination with coronal, sagittal, and 3D reformatted images is ordered at our institution in cases in which the extent of the carpal injuries is poorly shown on radiographic examination.
Harvey, Lara; Mitchell, Rebecca; Brodaty, Henry; Draper, Brian; Close, Jacqueline
To explore the impact of dementia on the trends in fall-related fracture and non-fracture injuries for older people. Individuals aged ≥65years who were admitted to a NSW hospital for at least an over-night stay for a fall-related injury from 2003 to 2012 were identified. Age-standardised hospitalisation rates, length of stay, access to in-hospital rehabilitation, 30-day and 1-year mortality were examined. Annual percentage change (PAC) over time was calculated using negative binomial regression. Of the 228,628 fall-related injury hospitalisations, 20.6% were for people with dementia. People with dementia were more likely to be admitted with a hip fracture, and less likely to be admitted with a fracture of the forearm/wrist, and received less in-hospital rehabilitation than people without dementia. Fall-related hip-fracture rates for people with dementia decreased by 4.2% (95%CI -5.6 to -2.7, pdementia (PAC-0.2%; 95%CI -0.8 to 0.5, p=0.643). Rates for other fractures decreased by 1.2% (95%CI -1.9 to -0.5, pdementia, while rates increased by 2.2% (95%CI 1.9-2.5, pdementia. By contrast, non-fracture injuries including traumatic brain injury increased significantly for both people with and without dementia. Rates of fall-related fracture and non-fracture hospitalisations for people with dementia remain higher than for those without dementia. However, fall-related fracture hospitalisation rates have decreased for people with dementia, while there has not been a corresponding decrease in people without dementia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Choung, Sung-Dae; Kwon, Oh-Yun; Park, Kyue-Nam; Kim, Si-Hyun; Cynn, Heon-Seock
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 wrist extension ROM and decrease wrist pain in patients with dorsal wrist pain during weight bearing through the hand. Copyright © 2013 Elsevier Ltd. All rights reserved.
Meluzinová, P; Kopp, L; Dráč, P; Edelmann, K; Obruba, P
The aim of the study was to describe the indication criteria and operative technique and to present the first conclusions of a prospective study dealing with an assessment of functional and radiographic findings in patients with concurrent fractures of the distal ulna and distal radius; the former was treated by osteosynthesis using an LCP Distal Ulna Plate (De Puy Synthes, USA) and the latter by plate osteosynthesis. Between August 2013 and September 2014, 18 patients (3 men and 15 women; average age, 58 years; range, 25-74 years) with a fracture of the distal ulna and a concurrent distal radius fracture were treated by plate osteosynthesis. The indications for surgery included displaced ulnar styloid base fractures in 10 patients, displaced comminuted fractures of the ulnar head in seven patients and a subcapital fracture of the ulna in one patient. The average follow-up was 9 months, with 13 (72%) patients being followed up for 6 months at least. The outcome of surgery was evaluated on the basis of X-ray views and multiplanar reconstruction of CT scans. Functional results were based on measuring the range of motion at wrist and forearm and hand grip strength and on the scores obtained from the Mayo Wrist Score System and Quick DASH Questionnaire. The average values for wrist and forearm range of motion were as follows: 68° in flexion (60-80°), 71° in extension (40- 90°), 87° in pronation (70-90°), 81° in supination (50-90°). This corresponded to a 92% (74-100%) range of motion at the contralateral wrist and forearm. The average hand grip strength measured with a dynamometer was 80.6% (53-100%) of the gripping force exerted by the unaffected extremity. Post-operative X-ray and CT findings showed good reduction of both distal radius and distal ulna fractures as well as good fragment retention by means of LCP implants. During follow-up complete bone union and full stability of the radioulnar joint were achieved in all patients. The functional outcome of
Sotereanos, Dean G; Darlis, Nickolaos A; Kokkalis, Zinon T; Zanaros, George; Altman, Gregory T; Miller, Mark Carl
Radiofrequency (RF) probes used in wrist arthroscopy may raise joint fluid temperature, increasing the risk of capsular and ligamentous damage. The purposes of the current study were to measure joint fluid temperature during wrist arthroscopy with the use of RF probes, and to determine whether using an outlet portal will reduce the maximum temperature. We performed wrist arthroscopy on 8 cadaveric arms. Ablation and coagulation cycles using RF probe were performed at documented locations within the joint. This was done for 60-second intervals on both the radial and ulnar side of the wrist, to mimic clinical practice. We used 4 fiberoptic phosphorescent probes to measure temperature (radial, ulnar, inflow-tube, and outflow-tube probes) and measured joint fluid temperature with and without outflow. There was a significant difference between wrists with and without outflow when examining maximum ablation temperatures (p wrist arthroscopy, the use of an outlet portal reduces the joint fluid temperature. Without an outlet portal, maximum temperatures can exceed desirable levels when using ablation; such temperatures have the potential to damage adjacent tissues. It is useful to maintain adequate outflow when using the radiofrequency probes during wrist arthroscopy.
Lee, Ryan K L; Griffith, James F; Tang, W K; Ng, Alex W H; Yeung, David K W
To compare the effect of traction during non-arthrographic and arthrographic MR examination of the wrist with regard to joint space width, joint fluid dispersion and cartilage surface visibility. Prospective 3-T MRI study of 100 wrists in 96 patients. The first 50 wrists underwent MR arthrography first without traction and then with traction. The following 50 wrists underwent standard MR first without traction and then with traction. On these examinations, two radiologists independently measured (i) joint space width, semi-quantitatively graded (ii) joint fluid dispersion between opposing cartilage surfaces and (iii) articular cartilage surface visibility. The three parameters were compared between the two groups. Traction led to an increase in joint space width at nearly all joints in all patients (p wrist although the effect was not as great as that seen with MR arthography or MR arthrography with traction. Advances in knowledge: This is the first study to show the beneficial effect of traction during standard non-arthrography MRI of the wrist and compare the effect of traction between non-arthrographic and arthrographic MRI of the wrist.
Middleton, Kane Jytte; Alderson, Jacqueline Anne; Elliott, Bruce Clifford; Mills, Peter Michael
This modelling study sought to describe the relationships between elbow joint kinematics and wrist joint linear velocity in cricket fast bowlers, and to assess the sensitivity of wrist velocity to systematic manipulations of empirical joint kinematic profiles. A 12-camera Vicon motion analysis system operating at 250 Hz recorded the bowling actions of 12 high performance fast bowlers. Empirical elbow joint kinematic data were entered into a cricket bowling specific "Forward Kinematic Model" and then subsequently underwent fixed angle, angular offset and angle amplification manipulations. A combination of 20° flexion and 20° abduction at the elbow was shown to maximise wrist velocity within the experimental limits. An increased elbow flexion offset manipulation elicited an increase in wrist velocity. Amplification of elbow joint flexion-extension angular displacement indicated that, contrary to previous research, elbow extension range of motion and angular velocity at the time of ball release were negatively related to wrist velocity. Some relationships between manipulated joint angular waveforms and wrist velocity were non-linear, supporting the use of a model that accounts for the non-linear relationships between execution and outcome variables in assessing the relationships between elbow joint kinematics and wrist joint velocity in cricket fast bowlers.
Jonsson, P; Johnson, P W
Studies have shown that wrist goniometers are prone to measurement errors, particularly due to crosstalk. This study compared two wrist goniometer systems: a commonly used biaxial, single transducer (System A) and a biaxial, two-transducer (System B). Wrist angles, range of movement and crosstalk results were compared. With the wrist in 90 degrees of pronation, eight subjects were placed in 20 different wrist postures between -40 degrees and 40 degrees of flexion/extension and between -10 degrees and 20 degrees of deviation. Relative to System B, System A had larger measurement errors and was more prone to crosstalk. There may be two sources of crosstalk: (1) intrinsic crosstalk associated with the design, application and twisting of the goniometer transducer when on the wrist, and (2) extrinsic crosstalk associated with the anatomy and complex movement of the wrist joint. It appears that the majority of the radial/ulnar crosstalk measured with System A was intrinsic crosstalk due to the twisting of the goniometer transducer.
Bulthaup, S; Cipriani, D J; Thomas, J J
This study examined the effect of commonly used long and short styles of commercially produced wrist extension orthoses on the activity of the proximal muscles of the shoulder and elbow and on wrist flexor and extensor muscle activity. While 17 women between 22 and 40 years of age (M = 26.6) performed a specified movement wearing each of the two styles of orthosis and without an orthosis, their motor unit recruitment of five proximal joint muscle groups, wrist extensors, and wrist flexors was measured by surface electromyography. Motor unit recruitment was significantly greater in both orthosis conditions for four of five proximal muscles and for wrist flexors. There were no significant differences between the short and long orthosis conditions for proximal muscle groups. Wearing a wrist extension orthosis appears to place additional stress on the proximal joint musculature beyond that found without splint use. The study has implications for the prescription of wrist extension orthoses, especially for patients whose proximal joints are already compromised.
Heckmann, A; Lahoda, L U; Alkandari, Q; Vogt, P M; Knobloch, K
Power lifting injuries most often involve shoulder injuries with an injury rate of 0.57 to 0.71/1000 hours of power lifting. Wrist injuries are less common in power lifters with 0.05/1000 hours exposure vs. 0.23/1000 h in elite weight lifting men. Often, two contributing factors causing wrist injuries are encountered: a) loss of balance causing the barbell to drift back behind the head of the power lifter, which hyperextends the wrist and b) the maximal weight. We report on an elite power lifting athlete preparing for the World Masters Bench press championships suffering two months of persisting pain during bench press exercise and rest in the snuff-box area following a loss of balance of the bar-bell during bench press with 280 kg load. Following prolonged presentation 2 months after the initial injury with training in the meantime, CT-scan was performed revealing a C-type scaphoid fracture. Surgery was performed as Herbert screw fixation and bone grafting according to the technique of Matti-Russe, followed by an immobilisation of twelve weeks with a plaster. We recommended ending the athletes' power lifting career, however he further exercised with the plaster with consecutive re-operation 3months later and 2nd Matti-Russe and Herbert screw re-do. One year later he became national champion with 240 kg bench pressing. Given the limited scaphoid blood supply and the high complication rate especially among C-type scaphoid fractures, a surgical procedure with bone grafting, Herbert screw fixation and sufficient plaster immobilisation is advocated in scaphoid fractures in elite athletes.
Valdes, Kristin; Naughton, Nancy; Michlovitz, Susan
The primary purpose of this systematic review is to determine the effectiveness of a home program or a structured therapy program for patients following distal radius fracture. A search was performed using terms wrist fracture, supervised therapy, occupational therapy, physical therapy, splint, orthosis, distal radius fracture, exercise, and home program. Studies that met the inclusion criteria were evaluated for research quality using The Structured Effectiveness for Quality Evaluation of Study (SEQES). Five of the seven trials found no difference between outcomes for their subjects that had uncomplicated distal radius fractures. The population that has complications following distal radius fractures was not represented in the studies reviewed. The available evidence from randomized controlled trials is insufficient to support a home program or therapist supervised clinic-based program as a superior method of treatment for adults following a distal radius fracture without complications or the presence of comorbidities. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Roberts, Darren; Power, Dominic Michael
This paper presents a rare case of trans-scaphoid perilunate fracture dislocation with concurrent scaphoid non-union of the left wrist following a motorcycle accident. Emergent CT identified scaphoid non-union advanced collapse and an acute scaphoidectomy, four-corner fusion, denervation and radiocarpal ligament repair was performed. 2015 BMJ Publishing Group Ltd.
Jørgensen, Henrik L; Kusk, Philip; Madsen, Bente Elmfelt
The purpose of this study is to investigate the association of serum osteoprotegerin (OPG) and the A163G polymorphism in the OPG promoter with peripheral measures of bone mass and with odds ratios for wrist and hip fracture in a case-control study of postmenopausal Danish women. The study included...
Parkar, A A H; Marya, S; Auplish, S
A triplane fracture is so named because of the three planes traversed by the fracture line. These are physeal fractures that result from injury during the final phase of maturation and cessation of growth. This fracture pattern typically involves the distal tibia. We present a rare case of a triplane fracture involving the distal radius.
Lee, Su-Ya; Chieh, Hsiao-Feng; Lin, Chien-Ju; Jou, I-Ming; Kuo, Li-Chieh; Su, Fong-Chin
The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP), radial deviation (RD), and ulnar deviation (UD). The root mean square (RMS) of the electromyographic signal in the extensor digitorum communis (EDC), normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS) had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.
Full Text Available The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP, radial deviation (RD, and ulnar deviation (UD. The root mean square (RMS of the electromyographic signal in the extensor digitorum communis (EDC, normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.
Löw, Steffen; Spies, Christian K; Unglaub, Frank; van Schoonhoven, Jörg; Prommersberger, Karl-Josef; Mühldorfer-Fodor, Marion
Background Frequently, patients undergo repeated wrist arthroscopies for single wrist problems. Purpose The purposes of this study were to assess the indications for repeat wrist arthroscopies and to identify potentially preventable procedures. Methods For this retrospective, two-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by the underlying pathologies and the causes that necessitated repeat arthroscopies. Results Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar triangular fibrocartilage complex (TFCC) avulsions, 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic before therapeutic arthroscopy in 49 (37%) wrists: 48 of which for TFCC pathologies, one for a scapholunate (SL) ligament lesion. The uncertainty of diagnosis despite previous arthroscopy necessitated 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a central TFCC lesion, 2 to reevaluate the SL ligament. Inadequate photo or video documentation of the cartilage necessitated arthroscopic reassessment in 16 (12%) wrists. Conclusion In this series, two out of three revision arthroscopies could potentially have been prevented. Inadequate preoperative diagnostics with the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures. Level of Evidence Level IV.
Jennings, John D; Zielinski, Elizabeth; Tosti, Rick; Ilyas, Asif M
Septic arthritis of the wrist can result in permanent damage to the joint, making timely diagnosis crucial to initiate empiric antibiotics and surgical intervention. Although septic arthritis is routinely included in the differential diagnosis of atraumatic wrist pain, the incidence is unknown. Unlike large joints, there is no consensus on cell count values considered pathognomonic for wrist septic arthritis. The goal of this retrospective study was to determine the incidence of wrist septic arthritis and to identify the clinical, serum, and joint fluid values that predict infection. The records of patients who presented to a single urban hospital with a swollen, painful wrist without trauma during a 10-year period were reviewed. For patients who had a joint fluid analysis, the records were examined for history as well as demographic and laboratory data. Joint fluid analysis consisted of cell count, Gram stain, and cultures. Of 892 patients who met the inclusion criteria, 1.5% had wrist septic arthritis. Variables associated with septic arthritis included serum white blood cell count above 11,000/µL, core temperature above 100.4°F within 24 hours of aspiration, history of intravenous drug abuse, and smoking. No joint cell count analysis predicted septic arthritis, although patients with septic wrists had an elevated joint white blood cell count above 97,000/µL. Wrist septic arthritis is uncommon; however, objective factors can help identify patients at risk. Because joint cell count analysis cannot reliably predict a septic wrist, priority for joint aspirations with limited fluid should be given instead to Gram stain, culture, and crystal analysis. [Orthopedics. 2017; 40(3):e526-e531.]. Copyright 2017, SLACK Incorporated.
de Boer, Ingeborg G; Peeters, André J; Ronday, H Karel; Mertens, Bart J A; Breedveld, Ferdinand C; Vliet Vlieland, Theodora P M
To describe the usage of functional wrist orthoses and to identify factors contributing to usage in patients with rheumatoid arthritis (RA). A multicentre, cross-sectional study, including a random selection of patients with RA visiting outpatient clinics. A total of 240/362 eligible patients (66%) completed questionnaires, a semi-structured interview and a clinical assessment. Usage was registered according to eight categories ranging from 'always' to 'never'. Factors potentially associated with usage included demographic variables, the presence of wrist and hand complaints, general disease characteristics, mental and physical functioning, coping strategies and satisfaction with functional wrist orthoses. Logistic regression analyses were used to determine which factors were associated with the usage of wrist splints. One hundred twenty-eight patients (53%) possessed functional wrist orthoses, whereas 74/128 (58%) were actually using them. Patients used them mainly during house keeping and cycling/driving. Main reasons for using the orthoses were relief of pain and joint protection, and main reasons for not using them were no need and problems with ease of use. Factors significantly associated with usage included the presence of wrist and hand complaints, worse physical functioning and greater satisfaction with comfort of the wrist orthoses. About half of patients with RA possessed functional wrist orthoses, with 58% of them actually being used. Apart from local complaints and general functional ability, satisfaction with comfort of the functional wrist orthoses appears to be an important factor for their usage. These results point at the need for additional research regarding modifiable factors associated with compliance, such as comfort and ease of use.
Casiglia, Edoardo; Tikhonoff, Valérie; Albertini, Federica; Palatini, Paolo
The reliability of blood pressure measurement with wrist devices, which has not previously been assessed under real-life circumstances in general population, is dependent on correct positioning of the wrist device at heart level. We determined whether an error was present when blood pressure was self-measured at the wrist in 721 unselected subjects from the general population. After training, blood pressure was measured in the office and self-measured at home with an upper-arm device (the UA-767 Plus) and a wrist device (the UB-542, not provided with a position sensor). The upper-arm-wrist blood pressure difference detected in the office was used as the reference measurement. The discrepancy between office and home differences was the home measurement error. In the office, systolic blood pressure was 2.5% lower at wrist than at arm (P=0.002), whereas at home, systolic and diastolic blood pressures were higher at wrist than at arm (+5.6% and +5.4%, respectively; Phome measurement error of at least ±5 mm Hg and 455 of at least ±10 mm Hg (bad measurers). In multivariable linear regression, a lower cognitive pattern independently determined both the systolic and the diastolic home measurement error and a longer forearm the systolic error only. This was confirmed by logistic regression having bad measurers as dependent variable. The use of wrist devices for home self-measurement, therefore, leads to frequent detection of falsely elevated blood pressure values likely because of a poor memory and rendition of the instructions, leading to the wrong position of the wrist. © 2016 American Heart Association, Inc.
Fukuda, Koji; Fujioka, Hiroyuki; Fujita, Ikuo; Uemoto, Harunobu; Hiranaka, Takafumi; Tsuji, Mitsuo; Kurosaka, Masahiro
We present a rare case of stress fracture of the second metacarpal bone. A 14-year-old girl felt pain on the dorsal aspect of the right wrist without any history of major trauma, when she played a smash during a game of badminton. On the radiographs, periosteal reaction was detected on the ulnar aspect of the base of the second metacarpal bone. She was treated conservatively and she returned to the original activity level.
Gebuhr, Peter Henrik; Hölmich, P; Orsnes, T
In a prospective study, we randomly allocated 39 patients with isolated fractures of the lower two-thirds of the ulnar shaft to treatment either by a prefabricated functional brace or a long-arm cast. Significantly better wrist function and a higher percentage of satisfied patients were found...... in the braced group. Thirteen patients returned to employment while still wearing the brace but only one was able to work in a cast....
Beaubrun, Anne C; Kilpatrick, Ryan D; Freburger, Janet K; Bradbury, Brian D; Wang, Lily; Brookhart, M Alan
Patients with ESRD have a substantially increased risk of bone fractures, but the burden of fractures has not been sufficiently characterized in this population. Here, we analyzed fracture rates and postdischarge outcomes using Medicare data from hemodialysis patients in the United States between 2000 and 2009. We assessed adjusted quarterly fracture rates (inpatient and outpatient) and consequences of postfracture hospitalization for seven categories of fracture location. Pelvis/hip, vertebral, and lower leg fractures were the most prevalent fracture types. Pelvis/hip fractures declined slightly from 29.6 to 20.6 per 1000 patient-years between early 2000 and late 2009, but the incidence rates for all other fracture types remained relatively constant. Median lengths of stay for the primary fracture hospitalization ranged from 5 days (interquartile range [IQR], 3-9 days) for forearm/wrist fractures to 8 days (IQR, 5-12 days) for femur fractures. The proportion of patients discharged from the primary hospitalization to a skilled-nursing facility ranged from 28% (ribs/sternum) to 47% (pelvis/hip). A negative binomial regression model suggested that patients had an adjusted mean of 3.8-5.2 additional hospitalizations during the year after discharge from the index hospitalization, varying by fracture type, comprising a mean of 33-52 inpatient days. Case-mix-adjusted mortality rates after discharge ranged from 0.43 to 0.91 per patient-year and were highest for vertebral, pelvis/hip, and femur fractures. In conclusion, fractures in the dialysis population are common and are associated with a substantially increased risk for death and hospitalization.
Golriz, Batol; Ahmadi Bani, Monireh; Arazpour, Mokhtar; Bahramizadeh, Mahmood; Curran, Sarah; Madani, Seyed Pezhman; Hutchins, Stephen W
Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking. The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome. Quasi experimental design. A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test. Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength (P = 0.675) and pinch strength (P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P = 0.022) and the Disability of the Arm, Shoulder, and Hand score (P = 0.027) between the two types of splints from baseline to 6 weeks. The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function. A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel
Quadlbauer, S; Pezzei, Ch; Jurkowitsch, J; Keuchel, T; Hausner, T; Leixnering, M
Bacterial septic arthritis rarely occurs in the upper extremities. Yet, early diagnosis and treatment is important, as a delay in diagnosis results in pain, impaired hand function, and degenerative joint disease. Radioscapholunate (RSL) arthrodesis is a well-established procedure for treating inflammatory arthritis and osteoarthritis (primary or posttraumatic), primarily to achieve pain relief. The wrist deformity correction offers an alternative option to total wrist arthrodesis. Indications for a RSL arthrodesis are osteoarthritis of the radiolunate and radioscaphoid joint with a concomitant intact midcarpal joint. We present a case study of spontaneous RSL fusion post wrist infection caused by a dog bite.
Colio, Sean W; Smith, Jay; Pourcho, Adam M
Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis. Copyright © 2016 Elsevier Inc. All rights reserved.
Krege, J H; Wan, X
In the Fracture Prevention Trial, the risks of any nonvertebral fracture (relative risk [RR] 0.65, P=0.04) and any fragility nonvertebral fracture (RR 0.47, P=0.02) were significantly reduced in the teriparatide 20 μg/day (teriparatide) versus placebo group. The purpose of this analysis was to examine the efficacy of teriparatide versus placebo on a variety of other nonvertebral fracture outcomes. The Fracture Prevention Trial was a double-blind trial of postmenopausal women with osteoporosis and vertebral fractures randomly assigned to teriparatide (N=541) or placebo (N=544) administered by daily self-injection for a median of 19 months and a median follow-up of 21 months. All patients received calcium and vitamin D supplementation. Reports of nonvertebral fractures were collected from patients at each visit and confirmed by review of a radiograph or written radiology report. Nonvertebral fractures were recorded for the following sites: distal radius/wrist, humerus, rib/clavicle, hip, ankle, distal foot, pelvis, or other. Pathological fractures and fractures of the face, skull, metacarpals, fingers and toes were excluded. Fractures were classified by investigators as fragility or traumatic fractures. The three endpoints considered were six nonvertebral sites (nonvert-6), a set of common nonvertebral fractures described in a Food and Drug Administration Guidance document for the treatment and prevention of postmenopausal osteoporosis (FDA), and a European Union major set (major) of nonvertebral fractures. For teriparatide versus placebo, the point estimates for the RR of nonvert-6 (RR 0.54, P=0.06; fragility RR 0.32, P=0.014), FDA (RR 0.60, P=0.15; fragility RR 0.38, P=0.05), and major (RR 0.52, P=0.02; fragility RR 0.38, P=0.02) nonvertebral fracture endpoints were smaller than for the all nonvertebral fracture endpoint. Lower RRs were observed when the outcomes were limited to fragility fractures, and significant reductions in traumatic nonvertebral fractures
Chalhoub, Didier; Orwoll, Eric S; Cawthon, Peggy M; Ensrud, Kristine E; Boudreau, Robert; Greenspan, Susan; Newman, Anne B; Zmuda, Joseph; Bauer, Douglas; Cummings, Steven; Cauley, Jane A
Although many studies have examined the association between low bone mineral density (BMD) and fracture risk in older men, none have simultaneously studied the relationship between multiple BMD sites and risk of different types of fractures. Using data from the Osteoporotic Fractures in Men study, we evaluated the association between areal BMD (aBMD) by dual-energy X-ray absorptiometry (DXA) and volumetric BMD (vBMD) by quantitative computed tomography (QCT) measurements, and different types of fractures during an average of 9.7years of follow-up. Men answered questionnaires about fractures every 4months (>97% completions). Fractures were confirmed by centralized review of radiographic reports; pathological fractures were excluded. Risk of fractures was assessed at the hip, spine, wrist, shoulder, rib/chest/sternum, ankle/foot/toe, arm, hand/finger, leg, pelvis/coccyx, skull/face and any non-spine fracture. Age and race adjusted Cox proportional-hazards modeling was used to assess the risk of fracture in 3301 older men with both aBMD (at the femoral neck (FN) and lumbar spine) and vBMD (at the trabecular spine and FN, and cortical FN) measurements, with hazard ratios (HRs) expressed per standard deviation (SD) decrease. Lower FN and spine aBMD were associated with an increased risk of fracture at the hip, spine, wrist, shoulder, rib/chest/sternum, arm, and any non-spine fracture (statistically significant HRs per SD decrease ranged from 1.24-3.57). Lower trabecular spine and FN vBMD were associated with increased risk of most fractures with statistically significant HRs ranging between 1.27 and 3.69. There was a statistically significant association between FN cortical vBMD and fracture risk at the hip (HR=1.55) and spine sites (HR=1.26), but no association at other fracture sites. In summary, both lower aBMD and vBMD were associated with increased fracture risk. The stronger associations observed for trabecular vBMD than cortical vBMD may reflect the greater
... this page: //medlineplus.gov/ency/patientinstructions/000552.htm Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...
Adler, Pierre M; Mourzenko, Valeri V
This monograph on fractures, fracture networks, and fractured porous media provides a systematic treatment of their geometrical and transport properties for students and professionals in geophysics, materials science, and Earth sciences.
Correa, Chad; Lahham, Sari
History of present illness: A 77-year-old female presented to her primary care physician (PCP) with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows), so the patient was referred to the emergency department where a computed tomography (CT) scan was ordered. Significant findings:...
History of present illness: A 19-year-old male presented to the ED with right forearm pain after being struck in the forearm by a baseball. The patient then threw the ball and felt a sharp “pop” in his arm. The patient complained of sharp pain, worse with movement. Upon examination, the patient was neurovascularly intact. Significant findings: The X-ray showed an acute comminuted fracture of the distal diaphysis of the radius with disruption of the distal radioulnar joint, consisten...
Full Text Available Abstract Background In the absence of head-to-head trials, indirect comparisons of randomized placebo-controlled trials may provide a viable option to assess relative efficacy. The purpose was to estimate the relative efficacy of reduction of fractures in post-menopausal women, and to assess robustness of the results. Methods A systematic literature review of multiple databases identified randomized placebo-controlled trials with nine drugs for post-menopausal women. Odds ratio and 95% credibility intervals for the rates of hip, non-vertebral, vertebral, and wrist fractures for each drug and between drugs were derived using a Bayesian approach. A drug was ranked as the most efficacious if it had the highest posterior odds ratio, or had the highest effect size. Results 30 studies including 59,209 patients reported fracture rates for nine drugs: alendronate (6 studies, denosumab (1 study, etidronate (8 studies, ibandronate (4 studies, raloxifene (1 study, risedronate (7 studies, strontium (2 study, teriparatide (1 study, and zoledronic acid (1 study. The drugs with the highest probability of reducing non-vertebral fractures was etidronate and teriparatide while the drugs with the highest probability of reducing vertebral, hip or wrist fractures were teriparatide, zoledronic acid and denosumab. The drugs with the largest effect size for vertebral fractures were zoledronic acid, teriparatide and denosumab, while the drugs with the highest effect size for non-vertebral, hip or wrist fractures were alendronate or risedronate. Estimates were consistent between Bayesian and classical approaches. Conclusion Teriparatide, zoledronic acid and denosumab have the highest probabilities of being most efficacious for non-vertebral and vertebral fractures, and having the greatest effect sizes. The estimates from indirect comparisons were robust to differences in methodology.
Gutowski, Christina; Darvish, Kurosh; Liss, Frederic E; Ilyas, Asif M; Jones, Christopher M
The purpose of this study is to investigate the failure sequence of the distal radius during a simulated fall onto an outstretched hand using cadaver forearms and high-speed X ray and video systems. This apparatus records the beginning and propagation of bony failure, ultimately resulting in distal radius or forearm fracture. The effects of 3 different wrist guard designs are investigated using this system. Serving as a proof-of-concept analysis, this study supports this imaging technique to be used in larger studies of orthopedic trauma and protective devices and specifically for distal radius fractures. Copyright © 2015 Elsevier Inc. All rights reserved.
Glajchen, N. [Mount Sinai Hospital, New York, NY (United States). Dept. of Radiology; Schweitzer, M. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology
De Quervain`s stenosing tenosynovitis of the first dorsal extensor component is traditionally diagnosed clinically but may be encountered when performing MRI of the wrist. A retrospective review of wrist MR images was performed in cases where the diagnosis of de Quervain`s synovitis was suggested (n=5). Imaging findings were correlated with clinical findings in four cases and with wrist arthroscopy in one case. Increased thickness of the extensor pollicus brevis and abductor pollicis longus tendons was the most reliable finding on MRI, being present in all cases. Peritendinous edema was also a reliable finding. Surrounding subcutaneous edema and increased intratendinous signal were less reliable findings in confirmed cases of de Quervain`s disease. De Quervain`s tenosynovitis may be encountered when performing MRI of the wrist. Increased tendon thickness and peritendinous edema are the most reliable imaging findings. (orig.)
Rheault, W; Beal, J L; Kubik, K R; Nowak, T A; Shepley, J A
This study was conducted to determine the intertester reliability of a hand-held dynamometer for the wrist flexor and extensor muscles. Using the break test on 20 healthy subjects, three testers obtained two measures of strength for each muscle group. The data were analyzed using the Pearson product-moment correlation coefficients, intraclass correlations, and an analysis of variance (ANOVA) for repeated measures. Our Pearson product-moment correlations ranged from 0.89 to 0.95 for the intertester reliability of the wrist extensors and 0.90 to 0.93 for the wrist flexors, whereas the intraclass coefficients were 0.91 and 0.85, respectively. Although these correlations were high, ANOVA tests revealed that significant differences existed between testers for both the wrist flexion and extension data (p less than .05). From these results we concluded that although the correlations between testers were good, ANOVA tests suggested that there was limited reliability between testers.
Takeda, Hiroyuki; Tsujiuchi, Nobutaka; Koizumi, Takayuki; Kan, Hiroto; Hirano, Masanori; Nakamura, Yoichiro
Recently, various prosthetic arms have been developed, but few are both attractive and functional. Considering human coexistence, prosthetic arms must be both safe and flexible. In this research, we developed a novel prosthetic arm with a five-fingered prosthetic hand using our original pneumatic actuators and a slender tendon-driven wrist using a wire drive and two small motors. Because the prosthetic hand's driving source is comprised of small pneumatic actuators, the prosthetic hand is safe when it makes contact with people; it can also operate flexibly. In addition, the arm has a tendon-driven wrist to expand its motion space and to perform many operations. First, we explain the pneumatic hand's drive mechanism and its tendon-driven wrist. Next, we identify the characteristics of the hand and the wrist and construct a control system for this arm and verify its control performance.
Conclusion: A complete forensic investigation revealed the case was an unusual complex suicide by vehicle assisted ligature strangulation and wrist-cutting. The case was interesting in terms of involving car assisted ligature strangulation.
Sbai, Mohamed Ali; Benzarti, Sofien; Bouzaidi, Khaled; Sbei, Feten; Maalla, Riadh
The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3 months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12 months promoted healing and good outcome. Copyright © 2015 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
Boeckstyns, Michel E H; Merser, Søren
Disabilites of Arm Shoulder and Hand (QuickDASH) and Patient-rated Wrist Evaluation questionnaires in patients with total wrist arthroplasty. METHODS: In a prospective cohort of 102 cases, we evaluated the QuickDASH. Furthermore, in a cross-sectional study and a test-retest on a subgroup of the patients, we......INTRODUCTION: Patient-rated outcome measures are frequently used to assess the results of total wrist arthroplasty, but their psychometric properties have not yet been evaluated in this group of patients. The purpose of our study was to assess the psychometric properties of the Danish Quick...... evaluated the Patient-rated Wrist Evaluation. RESULTS: Internal consistency and reproducibility were very high (Cronbach's alpha 0.96/0.97; Spearman's rho 0.90/ 0.91; intraclass coefficient 0.91/0.92), and there were no floor or ceiling effects. The responsiveness of the QuickDASH was high (standardised...
Perez-Balke, G; Buchholz, B
Commercial wrist splints do not constitute an ergonomic control for stressors associated with carpal tunnel syndrome. The science of ergonomics seeks to change the environment, not the human, in an effort to fit the work requirements to the capabilities of the individual. In contrast, immobilization of the wrist seeks to change the worker while the work environment exposures remain unchanged. Given this caveat, do wrist splints play a preventive role in the work environment with respect to the control of physical stressors that are likely to cause or exacerbate carpal tunnel syndrome? In an effort to provide an answer to this question, this article will provide a short synopsis of carpal tunnel syndrome as it relates to its diagnosis, occurrence in industry, and conservative treatment; a brief review of splinting as conservative treatment and an overview of the effect of wrist immobilization on physical stressors.
Taneja, Atul K; Bredella, Miriam A; Chang, Connie Y; Joseph Simeone, F; Kattapuram, Susan V; Torriani, Martin
The objective of this study was to determine the prevalence of extrinsic wrist ligament injury by magnetic resonance imaging and its association with intrinsic ligament tears. We reviewed conventional magnetic resonance images performed over a 5-year period from adult patients in the setting of wrist trauma. Two musculoskeletal radiologists examined the integrity of wrist ligaments and presence of bone abnormalities. In a cohort of 75 subjects, extrinsic ligament injury was present in 75%, with radiolunotriquetral being most frequently affected (45%). Intrinsic ligament injury was present in 60%. Almost half of subjects had combined intrinsic and extrinsic ligament injury. Bone abnormalities were seen in 69%. The rate of extrinsic injury was higher in subjects with bone injury (P = 0.008). There is high prevalence of extrinsic ligament injury in the setting of wrist trauma, especially in the presence of bone abnormalities, with combined injury of intrinsic and extrinsic ligaments in about half of cases.
Bode, Dyon; Mugge, Winfred; Schouten, Alfred C.; van Rootselaar, Anne-Fleur; Bour, Lo J.; van der Helm, Frans C. T.; Lammertse, Piet
Tremor, characterized by involuntary and rhythmical movements, is the most common movement disorder. Tremor can have peripheral and central oscillatory components which properly assessed may improve diagnostics. A magnetic resonance (MR)-safe haptic wrist manipulator enables simultaneous measurement
Barden, W; Brooks, D; Ayling-Campos, A
Arthritis commonly affects the hand and wrist in children and may contribute to loss of range of motion and force of the muscles surrounding the involved joints. The purpose of this case report is to describe a physical therapy protocol for managing a subluxated wrist in children with arthritis. Measures of range of motion and force of the wrist observed in two patients up to 2 years after the implementation of this protocol are also reported. The initial phase of the physical therapy program focused on realigning the subluxated wrist. Heat was used to manage flexor muscle tightness and increase tissue extensibility. The carpal bones were then realigned manually and supported in position with a cast for a period of 72 hours. Once alignment of the wrist was achieved, the emphasis of physical therapy was placed on increasing range of motion and force at the wrist joint through visits to the physical therapist and an extensive home program. Measurements of passive range of motion and active range of motion using a goniometer, grip forces using a modified sphygmomanometer, and peak torque of the wrist extensors using a dynamometer (measured in one patient) were recorded before and up to 2 years following the implementation of the protocol. There was an increase in wrist extension passive range of motion (35 degrees in both patients) and active range of motion (15 degrees in patient 1 and 25 degrees in patient 2) between the measurements obtained before and 1 to 2 years following the implementation of the protocol.(ABSTRACT TRUNCATED AT 250 WORDS)
Liu, Yuan; Jiang, Li; Yang, Dapeng; Liu, Hong
Human can successfully grasp various objects in different acceptable relative positions between human hand and objects. This grasp functionality can be described as the grasp tolerance of human hand, which is a significant functionality of human grasp. To understand the motor control of human hand completely, an analysis of hand and wrist postural synergies in tolerance grasping of various objects is needed. Ten healthy right-handed subjects were asked to perform the tolerance grasping with right hand using 6 objects of different shapes, sizes and relative positions between human hand and objects. Subjects were wearing CyberGlove attaching motion tracker on right hand, allowing a measurement of the hand and wrist postures. Correlation analysis of joints and inter-joint/inter-finger modules were carried on to explore the coordination between joints or modules. As the correlation between hand and wrist module is not obvious in tolerance grasping, individual analysis of wrist synergies would be more practical. In this case, postural synergies of hand and wrist were then presented separately through principal component analysis (PCA), expressed through the principal component (PC) information transmitted ratio, PC elements distribution and reconstructed angle error of joints. Results on correlation comparison of different module movements can be well explained by the influence factors of the joint movement correlation. Moreover, correlation analysis of joints and modules showed the wrist module had the lowest correlation among all inter-finger and inter-joint modules. Hand and wrist postures were both sufficient to be described by a few principal components. In terms of the PC elements distribution of hand postures, compared with previous investigations, there was a greater proportion of movement in the thumb joints especially the interphalangeal (IP) and opposition rotation (ROT) joint. The research could serve to a complete understanding of hand grasp, and the design
Wang, Yuexiang; Filius, Anika; Zhao, Chunfeng; Passe, Sandra M; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in patients with CTS. The purpose of this study was to evaluate the deformability and mobility of the median nerve in patients with CTS compared to healthy subjects. Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Shape and position of initial and final median nerve were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter, and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. The deformation ratio for circularity was significantly less in patients with CTS compared to healthy subjects during wrist flexion (P < .05). The mean vector of median nerve displacement during wrist flexion was significantly different between patients with CTS and healthy subjects (P < .05). The displacement magnitude of the median nerve was found to be less in patients with CTS compared to healthy subjects during most movements, with the exception of wrist extension with fingers extended. Patients with CTS differ from normal subjects with regard to mobility and deformability of the median nerve. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.
Sikkandar, M F; Sapuan, J; Singh, R; Abdullah, S
A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.
Bacon, G; Olszewski, E
The Sequential Advancing Flexion Retention Attachment (SAFRA) was developed for cervical spinal cord-injured patients with a muscle grade of poor to fair in the wrist extensors. It is used on a standard wrist-driven flexor hinge hand splint with adjustable tenodesis bar. Through the development of the SAFRA, maintained prehension can be obtained without externally powered devices such as CO2 or electrically powered orthoses. The patient's increased functional abilities are discussed and advantages summarized.
Garg, Rohit; Kraszewski, Andrew P; Stoecklein, Holbrook H; Syrkin, Grisha; Hillstrom, Howard J; Backus, Sherry; Lenhoff, Mark L; Wolff, Aviva L; Crisco, Joseph J; Wolfe, Scott W
To quantify the coupled motion of the wrist during selected functional tasks and to determine the effects of constraining this coupled motion using a radial-ulnar deviation blocking splint on performance of these tasks. Ten healthy, right-handed men performed 15 trials during selected functional tasks with and without a splint, blocking radial and ulnar deviation. The following tasks were performed: dart throwing, hammering, basketball free-throw, overhand baseball and football throwing, clubbing, and pouring. Kinematic coupling parameters (coupling, kinematic path length, flexion-extension range of motion, radial-ulnar deviation range of motion, flexion-extension offset, and radial-ulnar deviation offset) and performance were determined for each functional task. A generalized estimation equation model was used to determine whether each kinematic coupling parameter was significantly different across tasks. A repeated-measures generalized estimation equation model was used to test for differences in performance and kinematic coupling parameters between the free and splinted conditions. Wrist motion exhibited linear coupling between flexion-extension and radial-ulnar deviation, demonstrated by R(2) values from 0.70 to 0.99. Average wrist coupling and kinematic path lengths were significantly different among tasks. Coupling means and kinematic path lengths were different between free and splinted conditions across all tasks other than pouring. Performance was different between wrist conditions for dart throwing, hammering, basketball shooting, and pouring. Wrist kinematic coupling parameters are task specific in healthy individuals. Functional performance is decreased when wrist coupling is constrained by an external splint. Surgical procedures that restrict wrist coupling may have a detrimental effect on functional performance as defined in the study. Patients may benefit from surgical reconstructive procedures and wrist rehabilitation protocols designed to restore
Papadopoulos, Amy; Vivaldi, Nicolas; Crump, Cindy; Silvers, Christine Tsien
There is a significant body of literature demonstrating that accelerometers placed at various locations on the body can provide the data necessary to recognize walking. Most of the literature, however, either does not consider accelerometers placed at the wrist, or suggests that the wrist is not the ideal location. The wrist, however, is probably the most socially-acceptable location for a monitoring device. This study evaluates the possibility of using wrist accelerometers to recognize walking in the elderly during everyday life to evaluate the amount of time spent walking and, moreover, potentially recognize changes in stability that might lead to falls. Thirty elderly individuals aged 65 years and older were asked to wear a wrist accelerometer for four hours each while simultaneously being video recorded as they went about their normal daily activities. Accelerometer data were then analyzed using both frequency- and time-domain analyses. Particular attention was given to methods capable of being calculated on the wrist device so that future work will not require streaming large amounts of data from the device to the central server. Frequency based analysis to characterize walking in the test set yielded results of 98% area under the receiver operating characteristic curve (AUC). Using a time-series algorithm limited to features calculable on the wrist device, moreover, achieved an AUC of 90%. A small, socially-acceptable, wrist-based device, therefore, can successfully be used to differentiate walking from other activities of daily living in older adults. These findings may enable improved gait monitoring and efforts in falls prevention.
Angela Daher; Fady Haddad
Radial mononeuropathy most commonly manifesting as wrist drop is generally secondary to penetrating trauma to the radial nerve or compression injuries. It may also involve sensory changes depending on the location of the lesion. However, it has never been described as a sign of an inflammatory process, in particular an autoimmune disease. We describe the case of a 55-year-old man who was admitted for wrist drop with bilateral paraesthesia of the upper extremities. Based on his medical history...
MacDermid Joy C
Full Text Available Abstract Background Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. Methods This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE, The Wrist Outcome Measure (WOM, and the Medical Outcome Survey Short-Form (SF-36 were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. Results Regression analysis showed that the PRWE explained between 13% (one week and 33% (three months of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months and 8% (one year. Wrist impairment scores were less powerful predictors of health status than the PRWE. Conclusion The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.
Brown Jacques P
Full Text Available Abstract Background Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk. Methods Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (, 65–69, 70–74, 75–79, 80+ years, rising from a chair with arms (yes, no, weight (≥ 57kg, maternal history of hip facture (yes, no, prior fracture after age 50 (yes, no, hip T-score (>-1, -1 to >-2.5, ≤-2.5, and current smoking status (yes, no. Multivariable logistic regression analysis was conducted. Results The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93 was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were: low body weight (1.57; 95% CI: 1.04, 2.37, current smoking (1.95; 95% CI: 1.20, 3.18 and age between 75–79 years (1.96; 95% CI: 1.10, 3.51. New wrist fractures were significantly identified by low body weight (1.71, 95% CI: 1.01, 2.90 and prior fracture after 50 years (1.96; 95% CI: 1.19, 3.22. Predictors of new rib fractures include a maternal history of a hip facture (2.89; 95% CI: 1.04, 8.08 and a prior fracture after 50 years (2.16; 95% CI: 1.20, 3.87. Conclusion This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated
Koizumi, Koji; Charles, Ted; de Keyser, Hendrik
Phenolic Molding Compounds continue to exhibit well balanced properties such as heat resistance, chemical resistance, dimensional stability, and creep resistance. They are widely applied in electrical, appliance, small engine, commutator, and automotive applications. As the focus of the automotive industry is weight reduction for greater fuel efficiency, phenolic molding compounds become appealing alternatives to metals. Current market volumes and trends, formulation components and its impact on properties, and a review of common manufacturing methods are presented. Molding processes as well as unique advanced techniques such as high temperature molding, live sprue, and injection/compression technique provide additional benefits in improving the performance characterisitics of phenolic molding compounds. Of special interest are descriptions of some of the latest innovations in automotive components, such as the phenolic intake manifold and valve block for dual clutch transmissions. The chapter also characterizes the most recent developments in new materials, including long glass phenolic molding compounds and carbon fiber reinforced phenolic molding compounds exhibiting a 10-20-fold increase in Charpy impact strength when compared to short fiber filled materials. The role of fatigue testing and fatigue fracture behavior presents some insight into long-term reliability and durability of glass-filled phenolic molding compounds. A section on new technology outlines the important factors to consider in modeling phenolic parts by finite element analysis and flow simulation.
Gitto, Salvatore; Draghi, Anna Guja; Draghi, Ferdinando
Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis. © 2017 by the American Institute of Ultrasound in Medicine.
Khamwong, Peanchai; Paungmali, Aatit; Pirunsan, Ubon; Joseph, Leonard
High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness. This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group. A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage. The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P wrist extensor muscle group.
Williams, Robert L., III
This paper presents three methods to solve the inverse position kinematics position problem of the double universal joint attached to a manipulator: (1) an analytical solution for two specific cases; (2) an approximate closed form solution based on ignoring the wrist offset; and (3) an iterative method which repeats closed form position and orientation calculations until the solution is achieved. Several manipulators are used to demonstrate the solution methods: cartesian, cylindrical, spherical, and an anthropomorphic articulated arm, based on the Flight Telerobotic Servicer (FTS) arm. A singularity analysis is presented for the double universal joint wrist attached to the above manipulator arms. While the double universal joint wrist standing alone is singularity-free in orientation, the singularity analysis indicates the presence of coupled position/orientation singularities of the spherical and articulated manipulators with the wrist. The cartesian and cylindrical manipulators with the double universal joint wrist were found to be singularity-free. The methods of this paper can be implemented in a real-time controller for manipulators with the double universal joint wrist. Such mechanically dextrous systems could be used in telerobotic and industrial applications, but further work is required to avoid the singularities.
Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Cui, Yao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng
[Purpose] The aim of this study was to examine the immediate effects of muscle strength training and neuromuscular joint facilitation distal resistance training on wrist joints by using electromechanical reaction time. [Subjects and Methods] The subjects were 12 healthy young people (24.2 ± 3.1 years, 169.7 ± 6.5 cm, 65.3 ± 12.6 kg). Two kinds of isotonic contraction techniques were applied on the wrist joint: the wrist joint extension muscle strength training and the wrist joint extension pattern of neuromuscular joint facilitation. The electromechanical reaction time, premotor time, and motor time of the left upper limb were measured before and after each intervention session of muscle strength training and neuromuscular joint facilitation. [Results] The neuromuscular joint facilitation group showed significant shortening of the electromechanical reaction time and motor time after the intervention. [Conclusion] These results suggest that the electromechanical reaction time and motor time of the wrist joint can be improved by neuromuscular joint facilitation together with proximal resistance training, which can be used as a new form of exercise for improving the functions of subdominant hand wrist joints.
Pan, Lizhi; Yang, Zhen; Zhang, Dingguo
The wrist joint is a critical part of the human body for movement. Measuring the torque of the wrist with three degrees of freedom (DOFs) is important in some fields, including rehabilitation, biomechanics, ergonomics, and human-machine interfacing. However, the particular structure of the wrist joint makes it difficult to measure the torque in all three directions simultaneously. This work develops a structurally decoupled instrument for measuring and improving the measurement accuracy of 3-DOF wrist torque during isometric contraction. Three single-axis torque sensors were embedded in a customized mechanical structure. The dimensions and components of the instrument were designed based on requirement of manufacturability. A prototype of the instrument was machined, assembled, integrated, and tested. The results show that the structurally decoupled mechanism is feasible for acquiring wrist torque data in three directions either independently or simultaneously. As a case study, we use the device to measure wrist torques concurrently with electromyography signal acquisition in preparation for simultaneous and proportional myoelectric control of prostheses.
Wang, Yuexiang; Filius, Anika; Zhao, Chunfeng; Passe, Sandra M.; Thoreson, Andrew R.; An, Kai-Nan; Amadio, Peter C.
Rationale and Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in CTS patients. The purpose of this study was to evaluate the deformability and mobility of the median nerve in CTS patients compared to healthy subjects. Materials and Methods: Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Initial and final median nerve shape and position were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. Results: The deformation ratio for circularity was significant less in CTS patients compared to healthy subjects during wrist flexion (Pwrist flexion was significantly different between CTS patients and healthy subjects (Pwrist extension with fingers extended. Conclusions: CTS Patients differ from normal subjects with regard to mobility and deformability of the median nerve. PMID:24594417
Pan, Lizhi; Yang, Zhen; Zhang, Dingguo
The wrist joint is a critical part of the human body for movement. Measuring the torque of the wrist with three degrees of freedom (DOFs) is important in some fields, including rehabilitation, biomechanics, ergonomics, and human-machine interfacing. However, the particular structure of the wrist joint makes it difficult to measure the torque in all three directions simultaneously. This work develops a structurally decoupled instrument for measuring and improving the measurement accuracy of 3-DOF wrist torque during isometric contraction. Three single-axis torque sensors were embedded in a customized mechanical structure. The dimensions and components of the instrument were designed based on requirement of manufacturability. A prototype of the instrument was machined, assembled, integrated, and tested. The results show that the structurally decoupled mechanism is feasible for acquiring wrist torque data in three directions either independently or simultaneously. As a case study, we use the device to measure wrist torques concurrently with electromyography signal acquisition in preparation for simultaneous and proportional myoelectric control of prostheses.
Luria, Shai; Apt, Elad; Kandel, Leonid; Bdolah-Abram, Tali; Zinger, Gershon
To examine our hypothesis that the accuracy of visual estimation, while measuring the angles of forearm, wrist and elbow, may vary between the different angles, and that this may depend on the experience of the observer. A slide show comprising of clinical photos and radiographs of different elbow, forearm and wrist angles was presented to 164 attending orthopedic surgeons, orthopedic residents and medical students who made a visual estimation of the different joints' angles. Forearm pronation was found to be estimated most accurately (mean 6.1°) while radiographs of wrist flexion (mean 12°) and photos of wrist extension (mean 16°) were estimated the least accurately. Specialists estimated angles more accurately than residents and both were more accurate than students, regardless of the estimated joint. The accuracy of visual estimation of a joint's angle depends on the specific joint viewed. Experience in the practice of orthopedic surgery (and not only upper extremity surgery) will improve the accuracy of estimation in general. Regarding the elbow, forearm and wrist, the results of our study suggest that a goniometer should be used whenever an accuracy of up to 10° is important, and for measuring wrist flexion and extension.
Sánchez-Margallo, Francisco M; Pérez-Duarte, Francisco J; Sánchez-Margallo, Juan A; Lucas-Hernández, Marcos; Matos-Azevedo, Ana Maria; Díaz-Güemes, Idoia
This study aims to analyze the surgeons' hand spatial configuration during the use of two different instrument handles for laparoscopy, by obtaining information from the data glove CyberGlove®, and establishing existing risk levels for wrist disorders. Fifty surgeons participated in this study and were distributed into three groups (novices, intermediate and experts). Each subject carried out suturing and dissection tasks on a physical simulator, using axial-handled or ring-handled instruments, respectively. Hand and wrist positions were registered by the CyberGlove® and a modified RULA method was applied to establish appropriate risk levels for wrist disorders. We found statistically significant differences in seven of the eleven glove sensors when comparing both tasks. RULA method showed that all subjects, with the exception of the experts using an axial-handled instrument, assume a prejudicial wrist posture during the practice of suturing and dissection tasks on the simulator. Data glove CyberGlove® allows for the distinction between two laparoscopic exercises performed with different instruments. Also, laparoscopic intracorporeal suturing when performed with an axial-handled needle holder entails a more ergonomic posture for the wrist joint. Previous minimally invasive surgical experience is a positive influencing factor on the surgeons' wrist postures during laparoscopy.
Montagnani, Federico; Smit, Gerwin; Controzzi, Marco; Cipriani, Christian; Plettenburg, Dick H
State of art upper limb prostheses lack several degrees of freedom (DoF) and force the individuals to compensate for them by changing the motions of their arms and body. Such movements often yield to articulation injuries, nonetheless these could be prevented by adding DoFs, for instance, an articulated passive wrist. Available stiff or compliant wrists with passive flexion/extension and/or radial/ulnar deviation are sub-optimal solutions. Indeed, stiff wrists induce the individuals wearing them to perform exaggerated compensatory movements during the reaching phase while compliant wrists proved to be unpractical while manipulating heavy objects. Here we present a wrist capable of combining the benefits of stiff and compliant wrists. It is provided with two switchable levels of passive compliance that are automatically selected. The prototype was integrated in a body-powered hydraulic hand prosthesis and actuated using the same hydraulic circuit of the hand. Detailed analysis of the parameters that affect the compliance, the critical load and the performance of the prosthesis are presented.
Zampetti, Simona; Campagna, Giuseppe; Lucantoni, Federica; Marandola, Lidia; D'Onofrio, Luca; Chiesa, Claudio; Pacifico, Lucia; Vania, Andrea; Buzzetti, Raffaella; Leto, Gaetano
Wrist circumference is a clinical marker for insulin-resistance in overweight/obese children and adolescents. Insulin resistance is considered a major determinant of increased vascular resistance and hypertension. The aim of the study was to investigate the association between wrist circumference and systolic (S) and diastolic (D) blood pressure (BP) in a population of overweight/obese children and adolescents. A population of 1133 overweight/obese children and adolescents (n = 1133) were consecutively enrolled. Multivariate regression analyses were used to investigate the influence of independent variables on the variance of BP. The prevalence of hypertension was 21.74% in males and 28.95% in females (p = 0.048). The results showed that SBP was significantly associated with wrist circumference in both genders (p < 0.0001 for both comparisons). We found no association between DBP and wrist circumference in either gender. Wrist circumference accounted for 17% of the total variance of SBP in males and 14% in females. Wrist circumference, a marker of insulin resistance, is associated with increased SBP in overweight/obese children and adolescents, suggesting a role of insulin resistance in the pathogenesis and development of hypertension.
Scheker, L R; Chesher, S P; Netscher, D T; Julliard, K N; O'Neill, W L
The results of replantation at the wrist and distal forearm are reported to be better than at the metacarpal level, in part because the latter involve direct injury to the intrinsic muscles. This study evaluates a new post-operative protocol for replantation at the metacarpal, wrist and distal forearm levels. 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 4 to 12 weeks, an anticlaw splint alternated with the outrigger splint. After 12 weeks, a dynamic wrist extension orthosis was added to the anti-claw splint. 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993. For distal forearm replantation, TAM of fingers averaged 216 degrees, grip strength 42 lb, and pinch strength 7.2 lb with 75% good or excellent results. For wrist replantations, TAM of fingers averaged 243 degrees, grip strength 37 lb and pinch strength 10.6 lb with 100% good or excellent results. For transmetacarpal replantations, TAM of fingers averaged 189 degrees, grip strength 37 lb and pinch strength 5.6 lb, with 75% good and excellent results. Early protected mobilization, as described here, preserves tendon gliding, muscle strength and excursion. Our results support this protocol for wrist and distal forearm replantation and especially for transmetacarpal replantation, the results of which tend to be poor according to the medical literature.
Full Text Available Background: Characterization of tendo-ligamentous pathologies of wrist remains problematic, despite advances in imaging. By using clinical history and imaging appearance, one can determine the diagnosis. USG is used as first imaging modality whereas MRI aids in making a specific diagnosis of few of the lesions. Aims: To investigate the etiological spectrum of tendo-ligamentous pathologies of wrist on USG & MRI with statistical correlation. Patients and methods: 80 patients (male/female = 46/34 with complaint of swelling or pain in wrist were included and underwent USG and MRI of both the wrists. Results: The spectrum included ganglion cysts, vascular malformations, tenosynovitis, tendinopathy, ligament tears and fibrosis. The analysis was done using kappa coefficient and spearman's rho correlation coefficient. The strength of agreement between USG and MRI for the diagnosis of ganglion cysts, vascular malformations, tenosynovitis and tendinopathy was found to be very good. Conclusion: USG provides detailed depiction of superficial structures, is less expensive, and allows dynamic examinations of the wrist. It should be the first choice of investigation for majority of the cystic, tendinous, vascular, and fibrotic pathologies of the wrist. However, less promising results were observed for ligamentous pathologies on USG in our study. Keywords: Tendo-ligamentous pathologies, Ganglion cyst, Tenosynovitis, Ultrasonography, MRI
Li, Guowei; Thabane, Lehana; Papaioannou, Alexandra; Adachi, Jonathan D
A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that
Bruder, Andrea; Taylor, Nicholas F; Dodd, Karen J; Shields, Nora
What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures? Systematic review of controlled trials. Adults following an upper limb fracture. Any exercise therapy program, including trials where exercise was delivered to both groups providing there was an expectation of different amounts of exercise. Body structure and function, and activity limitations. 13 relevant trials involving 781 participants with an upper limb fracture were identified. 12 of the 13 trials included exercise of different duration and administration in both intervention and comparison groups. In support of the role of exercise there is evidence that: exercise and advice compared to no intervention reduce pain and improve upper limb activity in the short term after distal radius fracture; starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity; and physiotherapy that included supervised exercise and home exercise increased wrist movement after distal radius fracture when compared to home exercise alone. There is contrary evidence from two trials one after distal radius fracture and one after proximal humeral fracture that a home exercise program was superior to a supervised plus home exercise program. Only a single meta-analysis was conducted due to clinical heterogeneity and a lack of common outcome measures among the included trials. There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures. Copyright © 2011 Australian Physiotherapy Association. Published by .. All rights reserved.
Zemirline, Ahmed; Agnus, Vincent; Soler, Luc; Mathoulin, Christophe L.; Liverneaux, Philippe A.; Obdeijn, Miryam
Purpose In video surgery, and more specifically in arthroscopy, one of the major problems is positioning the camera and instruments within the anatomic environment. The concept of computer-guided video surgery has already been used in ear, nose, and throat (ENT), gynecology, and even in hip arthroscopy. These systems, however, rely on optical or mechanical sensors, which turn out to be restricting and cumbersome. The aim of our study was to develop and evaluate the accuracy of a navigation system based on electromagnetic sensors in video surgery. Methods We used an electromagnetic localization device (Aurora, Northern Digital Inc., Ontario, Canada) to track the movements in space of both the camera and the instruments. We have developed a dedicated application in the Python language, using the VTK library for the graphic display and the OpenCV library for camera calibration. Results A prototype has been designed and evaluated for wrist arthroscopy. It allows display of the theoretical position of instruments onto the arthroscopic view with useful accuracy. Discussion The augmented reality view represents valuable assistance when surgeons want to position the arthroscope or locate their instruments. It makes the maneuver more intuitive, increases comfort, saves time, and enhances concentration. PMID:24436832
Full Text Available Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis. Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation. Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Conclusions. Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.
Full Text Available Thermal haptics is a potential system output modality for wearable devices that promises to function at the periphery of human attention. When adequately combined with existing attention-governing mechanisms of the human mind, it could be used for interrupting the human agent at a time when the negative influence on the ongoing activity is minimal. In this article we present our self-mitigated interruption concept (essentially a symbiosis of artificial external stimuli tuned to existing human attention management mechanisms and perform a pilot study laying the ground for using a wrist-worn thermohaptic actuator for self-mitigating interruption. We then develope a prototype and perform an insightful pilot study. We frame our empirical thermohaptic experimental work in terms of Peripheral Interaction concepts and show how this new approach to Human-Computer Interaction relates to the Context-Aware-systems-inspired approach “Egocentric Interaction” aimed at supporting the design of envisioned Wearable Personal Assistants intended to, among other things, help human perception and cognition with the management of interruptions.
Full Text Available Proprioception combines information from cutaneous, joint, tendon, and muscle receptors for maintaining a reliable internal body image. However, it is still a matter of debate, in both neurophysiology and psychology, to what extent such body image is modified or distorted by a changing haptic environment. In particular, what is worth investigating is the contribution of external forces on our perception of body and joint configuration. The proprioceptive acuity of fifteen young participants was tested with a Joint Position Matching (JPM task, performed with the dominant wrist under five different external forces, in order to understand to what extent they affect proprioceptive acuity. Results show that accuracy and precision in target matching do not change in a significant manner as a function of the loading condition, suggesting that the multi-sensory integration process is indeed capable of discriminating different sub-modalities of proprioception, namely the joint position sense and the sense of force. Furthermore, results indicate a preference for target undershooting when movements are performed in a viscous or high resistive force field, rather than passive or null fields in which subjects did not show any predominance for under/over estimation of their position.
Rubio-Sastre, Patricia; Gómez-Abellán, Purificación; Martinez-Nicolas, Antonio; Ordovás, José María; Madrid, Juan Antonio; Garaulet, Marta
The adequate time to perform physical activity (PA) to maintain optimal circadian system health has not been defined. We studied the influence of morning and evening PA on circadian rhythmicity in 16 women with wrist temperature (WT). Participants performed controlled PA (45 min continuous-running) during 7 days in the morning (MPA) and evening (EPA) and results were compared with a no-exercise-week (C). EPA was characterized by a lower amplitude (evening: 0.028 ± 0.01 °C versus control: 0.038 ± 0.016 °C; p evening: 0.41 ± 0.47 versus morning: 1.04 ± 0.59); and achrophase delay (evening: 06:35 ± 02:14 h versus morning: 04:51 ± 01:11 h; p evening might not be as beneficial as in the morning.
Zemirline, Ahmed; Agnus, Vincent; Soler, Luc; Mathoulin, Christophe L; Obdeijn, Miryam; Liverneaux, Philippe A
In video surgery, and more specifically in arthroscopy, one of the major problems is positioning the camera and instruments within the anatomic environment. The concept of computer-guided video surgery has already been used in ear, nose, and throat (ENT), gynecology, and even in hip arthroscopy. These systems, however, rely on optical or mechanical sensors, which turn out to be restricting and cumbersome. The aim of our study was to develop and evaluate the accuracy of a navigation system based on electromagnetic sensors in video surgery. We used an electromagnetic localization device (Aurora, Northern Digital Inc., Ontario, Canada) to track the movements in space of both the camera and the instruments. We have developed a dedicated application in the Python language, using the VTK library for the graphic display and the OpenCV library for camera calibration. A prototype has been designed and evaluated for wrist arthroscopy. It allows display of the theoretical position of instruments onto the arthroscopic view with useful accuracy. The augmented reality view represents valuable assistance when surgeons want to position the arthroscope or locate their instruments. It makes the maneuver more intuitive, increases comfort, saves time, and enhances concentration.
Wang, Yuexiang; Zhao, Chunfeng; Passe, Sandra M.; Filius, Anika; Thoreson, Andrew R.; An, Kai-Nan; Amadio, Peter C.
The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. In order to better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, in order to have a baseline for comparison with abnormal movements. Dynamic ultrasound images were obtained in both wrists of 10 asymptomatic volunteers during wrist maximal flexion, extension and ulnar deviation. In order to simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared to that in the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (pwrist flexion with finger extension and wrist ulnar deviation with finger extension (all pwrist flexion with finger extension (2.36±0.79 NU), wrist flexion with finger flexion (2.46±0.84 NU) and wrist ulnar deviation with finger extension (2.86±0.51 NU) were higher than those in finger flexion (0.82±0.33 NU), wrist extension with finger extension (0.77±0.46 NU) and wrist extension with finger flexion (0.81±0.58 NU) (pwrist flexion and ulnar deviation could induce significant transverse displacement and deformation of the median nerve. PMID:24210862
Kim, Seoyoung C; Paik, Julie M; Liu, Jun; Curhan, Gary C; Solomon, Daniel H
Prior studies suggest an association between osteoporosis, systemic inflammation, and pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004-2013), we evaluated the risk of non-vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout-related drug. Non-gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout-related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non-vertebral fracture in gout patients versus non-gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non-vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non-gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2-year follow-up, the incidence rate of non-vertebral fracture per 1,000 person-years was 2.92 in gout and 2.66 in non-gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85-1.12) for non-vertebral fracture and 0.83 (95% CI 0.65-1.07) for hip fracture in gout versus non-gout. Subgroup analysis (n = 15,079) showed no association between baseline sUA and non-vertebral fracture (HR = 1.03, 95% CI 0.93-1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non
Stenager, E; Jensen, K
In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...
A repeated-measures analysis of the effects of soft tissues on wrist range of motion in the extant phylogenetic bracket of dinosaurs: Implications for the functional origins of an automatic wrist folding mechanism in Crocodilia.
Hutson, Joel David; Hutson, Kelda Nadine
A recent study hypothesized that avian-like wrist folding in quadrupedal dinosaurs could have aided their distinctive style of locomotion with semi-pronated and therefore medially facing palms. However, soft tissues that automatically guide avian wrist folding rarely fossilize, and automatic wrist folding of unknown function in extant crocodilians has not been used to test this hypothesis. Therefore, an investigation of the relative contributions of soft tissues to wrist range of motion (ROM) in the extant phylogenetic bracket of dinosaurs, and the quadrupedal function of crocodilian wrist folding, could inform these questions. Here, we repeatedly measured wrist ROM in degrees through fully fleshed, skinned, minus muscles/tendons, minus ligaments, and skeletonized stages in the American alligator Alligator mississippiensis and the ostrich Struthio camelus. The effects of dissection treatment and observer were statistically significant for alligator wrist folding and ostrich wrist flexion, but not ostrich wrist folding. Final skeletonized wrist folding ROM was higher than (ostrich) or equivalent to (alligator) initial fully fleshed ROM, while final ROM was lower than initial ROM for ostrich wrist flexion. These findings suggest that, unlike the hinge/ball and socket-type elbow and shoulder joints in these archosaurs, ROM within gliding/planar diarthrotic joints is more restricted to the extent of articular surfaces. The alligator data indicate that the crocodilian wrist mechanism functions to automatically lock their semi-pronated palms into a rigid column, which supports the hypothesis that this palmar orientation necessitated soft tissue stiffening mechanisms in certain dinosaurs, although ROM-restricted articulations argue against the presence of an extensive automatic mechanism. Anat Rec, 297:1228-1249, 2014. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
Kim, D H; MacKinnon, T
To identify the extent to which transfer learning from deep convolutional neural networks (CNNs), pre-trained on non-medical images, can be used for automated fracture detection on plain radiographs. The top layer of the Inception v3 network was re-trained using lateral wrist radiographs to produce a model for the classification of new studies as either "fracture" or "no fracture". The model was trained on a total of 11,112 images, after an eightfold data augmentation technique, from an initial set of 1,389 radiographs (695 "fracture" and 694 "no fracture"). The training data set was split 80:10:10 into training, validation, and test groups, respectively. An additional 100 wrist radiographs, comprising 50 "fracture" and 50 "no fracture" images, were used for final testing and statistical analysis. The area under the receiver operator characteristic curve (AUC) for this test was 0.954. Setting the diagnostic cut-off at a threshold designed to maximise both sensitivity and specificity resulted in values of 0.9 and 0.88, respectively. The AUC scores for this test were comparable to state-of-the-art providing proof of concept for transfer learning from CNNs in fracture detection on plain radiographs. This was achieved using only a moderate sample size. This technique is largely transferable, and therefore, has many potential applications in medical imaging, which may lead to significant improvements in workflow productivity and in clinical risk reduction. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Orchard, Tonya S; Larson, Joseph C; Alghothani, Nora; Bout-Tabaku, Sharon; Cauley, Jane A; Chen, Zhao; LaCroix, Andrea Z; Wactawski-Wende, Jean; Jackson, Rebecca D
Magnesium is a necessary component of bone, but its relation to osteoporotic fractures is unclear. We examined magnesium intake as a risk factor for osteoporotic fractures and altered bone mineral density (BMD). This prospective cohort study included 73,684 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Total daily magnesium intake was estimated from baseline food-frequency questionnaires plus supplements. Hip fractures were confirmed by a medical record review; other fractures were identified by self-report. A baseline BMD analysis was performed in 4778 participants. Baseline hip BMD was 3% higher (P 422.5 compared with <206.5 mg Mg/d. However, the incidence and RR of hip and total fractures did not differ across quintiles of magnesium. In contrast, risk of lower-arm or wrist fractures increased with higher magnesium intake [multivariate-adjusted HRs of 1.15 (95% CI: 1.01, 1.32) and 1.23 (95% CI: 1.07, 1.42) for quintiles 4 and 5, respectively, compared with quintile 1; P-trend = 0.002]. In addition, women with the highest magnesium intakes were more physically active and at increased risk of falls [HR for quintile 4: 1.11 (95% CI: 1.06, 1.16); HR for quintile 5: 1.15 (95% CI: 1.10, 1.20); P-trend < 0.001]. Lower magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower-arm and wrist fractures that are possibly related to more physical activity and falls.
Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen
Anderson type III fractures with a characteristic fracture pattern that we refer to as "oblique type axis body fracture." Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic "oblique...... was uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion...
Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: firstname.lastname@example.org; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)
Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.
Swenson, David M; Yard, Ellen E; Collins, Christy L; Fields, Sarah K; Comstock, R Dawn
To describe the epidemiology of fractures among US high school athletes participating in 9 popular sports. Descriptive epidemiologic study. Sports injury data for the 2005-2009 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online (RIO). A nationally representative sample of 100 US high schools. Injuries sustained as a function of sport and sex. Fracture injury rates, body site, outcome, surgery, and mechanism. Fractures (n = 568 177 nationally) accounted for 10.1% of all injuries sustained by US high school athletes. The highest rate of fractures was in football (4.61 per 10 000 athlete exposures) and the lowest in volleyball (0.52). Boys were more likely than girls to sustain a fracture in basketball (rate ratio, 1.35,; 95% confidence interval, 1.06-1.72) and soccer (rate ratio, 1.34; 95% confidence interval, 1.05-1.71). Overall, the most frequently fractured body sites were the hand/finger (28.3%), wrist (10.4%), and lower leg (9.3%). Fractures were the most common injury to the nose (76.9%), forearm (56.4%), hand/finger (41.7%), and wrist (41.6%). Most fractures resulted in >3 weeks' time lost (34.3%) or a medical disqualification from participation (24.2%) and were more likely to result in >3 weeks' time lost and medical disqualification than all other injuries combined. Fractures frequently required expensive medical diagnostic imaging examinations such as x-ray, computed tomographic scan, and magnetic resonance imaging. Additionally, 16.1% of fractures required surgical treatment, accounting for 26.9% of all injuries requiring surgery. Illegal activity was noted in 9.3% of all fractures with the highest proportion of fractures related to illegal activity in girls' soccer (27.9%). Fractures are a major concern for US high school athletes. They can severely affect the athlete's ability to continue sports participation and can impose substantial medical costs on the injured athletes' families. Targeted
Compston, Juliet E.; Chapurlat, Roland D.; Pfeilschifter, Johannes; Cooper, Cyrus; Hosmer, David W.; Adachi, Jonathan D.; Anderson, Frederick A.; Díez-Pérez, Adolfo; Greenspan, Susan L.; Netelenbos, J. Coen; Nieves, Jeri W.; Rossini, Maurizio; Watts, Nelson B.; Hooven, Frederick H.; LaCroix, Andrea Z.; March, Lyn; Roux, Christian; Saag, Kenneth G.; Siris, Ethel S.; Silverman, Stuart; Gehlbach, Stephen H.
Context: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. Objective: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles. Design: This was a prospective, observational cohort study. Setting: The study was conducted at primary care practices in 10 countries. Patients: Women aged 55 years or older participated in the study. Intervention: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures. Main Outcome Measure: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. Results: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase. Conclusions: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model. PMID:24423345
Koutserimpas, Christos; Tsironis, Georg; Salasidis, Antonios; Swatoch, Phillipp; Tsironis, Konstantin
Monteggia and Galeazzi fractures account for 1-5% of total forearm fractures. A combined Monteggia and Galeazzi fracture is an extremely rare injury. We present a case of a Gustillo-Henderson type 2 open combined bipolar Monteggia and Galeazzi fracture, as well as fracture of the ulnar coronoid process in a 49-year old male. The patient was treated surgically, with open reduction and internal fixation. At 6 months postoperative, he was diagnosed with pseudarthrosis and underwent surgery with autologous bone grafting from the iliac crest. At the 1-year follow-up, the patient presented an extension deficit of 5° in elbow, a 15° deficit in pronation and 20° deficit in supination of the wrist. The patient continues to work as a painter without significant problems in his everyday routine and he is still regularly engaged in cycling. Additionally we provide a historical background of these injuries.
To investigate application of the bone flap pedicled on the retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B. From October 2007 to October 2011,41 patients with old scaphoid bone fractures of type AO-B were treated by transplantation of the bone flap pedicled on the retrograde branch of radial artery including 26 males and 15 females with an average of (27.3±4.5) years old ranging from 16 to 43 years old. The courses before operation ranged from 6 to 22 months with an average of 11 months. All fractures belonged to the type B of AO classification, that is old wrist fracture of scaphoid bone. All patients' wrist function (pain, function, motion, grip strength) were evaluated by Cooney's modifiedwrist scoring system before and 6 months after operation,and the conditions of bone healing were observed during the follow-up time. Among them, 36 patients were followed up from 4 to 15 months with an average of 8.3 months. The wounds were healed well without other complications as infection appearing. X-rays or CT confirmed that all fractures were healed completely. The Cooney wrist score was improved from preoperative 53.61±13.97 to postoperative 81.81±8.71 (Pfractures,which is scientific and has curative effects, and valuable for clinical application.
Herzberg, Guillaume; Boeckstyns, Michel Ernest Henri; Sorensen, Allan Ibsen
This study reports the current results of an international multicenter study of one last generation total wrist arthroplasty (TWA) ("ReMotion," Small Bone Innovation, Morristown, PA). The two first authors (G.H. and M.B.) built a Web-based prospective database including clinical and radiological...... preoperative and postoperative reports of "ReMotion" TWA at regular intervals. The cases of 7 centers with more than 15 inclusions were considered for this article. A total of 215 wrists were included. In the rheumatoid arthritis (RA; 129 wrists) and nonrheumatoid arthritis (non-RA; 86 wrists) groups......, there were respectively 5 and 6% complications requiring implant revision with a survival rate of 96 and 92%, respectively, at an average follow-up of 4 years. Within the whole series, only one dislocation was observed in one non-RA wrist. A total of 112 wrists (75 rheumatoid and 37 nonrheumatoid) had more...
Mannini, Andrea; Rosenberger, Mary; Haskell, William L; Sabatini, Angelo M; Intille, Stephen S
State-of-the-art methods for recognizing human activity using raw data from body-worn accelerometers have primarily been validated with data collected from adults. This study applies a previously available method for activity classification using wrist or ankle accelerometer to data sets collected from both adults and youth. An algorithm for detecting activity from wrist-worn accelerometers, originally developed using data from 33 adults, is tested on a data set of 20 youth (age, 13 ± 1.3 yr). The algorithm is also extended by adding new features required to improve performance on the youth data set. Subsequent tests on both the adult and youth data were performed using crossed tests (training on one group and testing on the other) and leave-one-subject-out cross-validation. The new feature set improved overall recognition using wrist data by 2.3% for adults and 5.1% for youth. Leave-one-subject-out cross-validation accuracy performance was 87.0% (wrist) and 94.8% (ankle) for adults, and 91.0% (wrist) and 92.4% (ankle) for youth. Merging the two data sets, overall accuracy was 88.5% (wrist) and 91.6% (ankle). Previously available methodological approaches for activity classification in adults can be extended to youth data. Including youth data in the training phase and using features designed to capture information on the activity fragmentation of young participants allows a better fit of the methodological framework to the characteristics of activity in youth, improving its overall performance. The proposed algorithm differentiates ambulation from sedentary activities that involve gesturing in wrist data, such as that being collected in large surveillance studies.
Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S. [Univ. of California, Orange (United States). Dept. of Radiological Sciences
The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0-3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis. Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7 respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb.
Ambike, Satyajit S.; Paclet, Florent; Latash, Mark L.; Zatsiorsky, Vladimir M.
Extrinsic digit muscles contribute to both fingertip forces and wrist movements (FDP and FPL – flexion, EDC - extension). Hence it is expected that finger forces depend on the wrist movement and position. We investigated the relation between grip force and wrist kinematics to examine whether and how the force: (1) scales with wrist flexion-extension (FE) angle; (2) can be predicted from accelerations induced during FE movement. In one experiment subjects naturally held an instrumented handle using a prismatic grasp and performed very slow FE movements. In another experiment, the same movement was performed cyclically at three prescribed frequencies. In quasistatic conditions, the grip force remained constant over the majority of the wrist range of motion. During the cyclic movements, the grip force changed. The changes were described with a linear regression model that represents the thumb and virtual finger (VF = four fingers combined) normal forces as the sum of the effects of the object’s tangential and radial accelerations and an object-weight-dependent constant term. The model explained 99% of the variability in the data. The independence of the grip force from wrist position agrees with the theory that that the thumb and VF forces are controlled with two neural variables that encode referent coordinates for each digit while accounting for changes in the position dependence of muscle forces, rather than a single neural variable like referent aperture. The results of the cyclical movement study extend the principle of superposition (some complex actions can be decomposed into independently controlled elemental actions) for a motor task involving simultaneous grip force exertion and wrist motion with significant length changes of the grip-force producing muscles. PMID:23625077
Erwin, Andrew; O'Malley, Marcia K; Ress, David; Sergi, Fabrizio
We demonstrate the interaction control capabilities of the MR-SoftWrist, a novel MR-compatible robot capable of applying accurate kinesthetic feedback to wrist pointing movements executed during fMRI. The MR-SoftWrist, based on a novel design that combines parallel piezoelectric actuation with compliant force feedback, is capable of delivering 1.5 N [Formula: see text] of torque to the wrist of an interacting subject about the flexion/extension and radial/ulnar deviation axes. The robot workspace, defined by admissible wrist rotation angles, fully includes a circle with a 20 deg radius. Via dynamic characterization, we demonstrate capability for transparent operation with low (10% of maximum torque output) backdrivability torques at nominal speeds. Moreover, we demonstrate a 5.5 Hz stiffness control bandwidth for a 14 dB range of virtual stiffness values, corresponding to 25%-125% of the device's physical reflected stiffness in the nominal configuration. We finally validate the possibility of operation during fMRI via a case study involving one healthy subject. Our validation experiment demonstrates the capability of the device to apply kinesthetic feedback to elicit distinguishable kinetic and neural responses without significant degradation of image quality or task-induced head movements. With this study, we demonstrate the feasibility of MR-compatible devices like the MR-SoftWrist to be used in support of motor control experiments investigating wrist pointing under robot-applied force fields. Such future studies may elucidate fundamental neural mechanisms enabling robot-assisted motor skill learning, which is crucial for robot-aided neurorehabilitation.
Full Text Available Abstract Background Wrist blood pressure (BP devices have physiological limits with regards to accuracy, therefore they were not preferred for home BP monitoring. However some wrist devices have been successfully validated using etablished validation protocols. Therefore this study assessed the reproducibility of wrist home BP measurement with position sensor and automatic data storage. Methods To compare the reproducibility of three different(BP measurement methods: 1 office BP, 2 home BP (Omron wrist device HEM- 637 IT with position sensor, 3 24-hour ambulatory BP(24-h ABPM (ABPM-04, Meditech, Hunconventional sphygmomanometric office BP was measured on study days 1 and 7, 24-h ABPM on study days 7 and 14 and home BP between study days 1 and 7 and between study days 8 and 14 in 69 hypertensive and 28 normotensive subjects. The correlation coeffcient of each BP measurement method with echocardiographic left ventricular mass index was analyzed. The schedule of home readings was performed according to recently published European Society of Hypertension (ESH- guidelines. Results The reproducibility of home BP measurement analyzed by the standard deviation as well as the squared differeces of mean individual differences between the respective BP measurements was significantly higher than the reproducibility of office BP (p Conclusion The short-term reproducibility of home BP measurement with the Omron HEM-637 IT wrist device was superior to the reproducibility of office BP and 24- h ABPM measurement. Furthermore, home BP with the wrist device showed similar correlations to targed organ damage as recently reported for upper arm devices. Although wrist devices have to be used cautious and with defined limitations, the use of validated devices with position sensor according to recently recommended measurement schedules might have the potential to be used for therapy monitoring.
Carter, Timothy I; Pansy, Brian; Wolff, Aviva L; Hillstrom, Howard J; Backus, Sherry I; Lenhoff, Mark; Wolfe, Scott W
Despite the ubiquitous use of manual goniometry in measuring objective outcomes of hand surgery and therapy, there are limited data concerning its accuracy or repeatability for wrist motion. The purpose of this study was to evaluate the accuracy and reliability (both inter- and intra-rater) in measuring wrist flexion and extension using 3 manual goniometric alignment techniques (ulnar, radial, and dorsal-volar) in cadaveric upper extremities, using fluoroscopic verification of posture as a gold standard. In addition, we sought to assess the accuracy and reliability of the dorsal-volar technique for measurement of radioulnar deviation. External fixators were applied to 10 cadaveric wrists with intramedullary cannulated rods in the radius and third metacarpal for gold-standard fluoroscopic verification of posture. Manual goniometric measurements with each technique were captured by 2 raters (a hand surgeon and a hand therapist) for reliability measurements and by a single rater for accuracy. Wrists were positioned at angles of maximum flexion, extension, and radial and ulnar deviation for reliability testing and at preselected angles across the range of motion for accuracy testing. At each position, wrist angle was measured with a 1 degrees increment goniometer, and fluoroscopic angles were measured digitally. Intraclass correlation coefficients and root mean square values were calculated for all combinations, and analysis of variance was used to test differences between techniques. No technique was statistically less accurate than any other (6 degrees to 7 degrees ). Each method was found to have high intra-rater reliability. For measurement of wrist flexion and extension, the dorsal-volar technique demonstrated the greatest inter-rater reliability, as compared to ulnar and radial, respectively. Although each measurement technique demonstrated a similar degree of accuracy and intra-rater reliability, the dorsal-volar technique demonstrates the greatest level of
Crowe, Matthew M; Houdek, Matthew T; Moran, Steven L; Kakar, Sanjeev
To determine the outcomes of surgical management of aneurysmal bone cysts (ABCs) in the hand, wrist, and forearm. The medical records of 11 patients undergoing surgical treatment of ABCs distal to the elbow from 1994 to 2011 with at least 12 months follow-up were reviewed retrospectively. Mean follow-up was 29 months (range, 13-56 months). There were 7 males and 4 females. Four lesions presented in the radius, 3 in the ulna, 2 in the metacarpals, and 2 in the phalanges. Ten patients underwent wide unroofing and intralesional curettage with 9 undergoing associated high-speed burring. Multiple chemical and thermal adjuvants were used. One patient underwent en bloc resection with reconstruction. There was 1 recurrence in a periphyseal lesion in a 2-year-old boy treated with curettage, burring, and adjuvant chemotherapy. Ten patients incorporated the bone graft and healed without further surgery. One patient required revision bone grafting. The diagnosis of ABC should remain in the differential diagnosis for cystic lesions in the upper extremity in pediatric and adult patients. Low recurrence has been obtained predominantly with intralesional curettage and high-speed burring with and without chemical and thermal adjuvant therapy. Appropriate healing has been obtained with both allograft and autograft reconstructions. Periarticular and periphyseal lesions remain challenging and provide the highest chance for incomplete resection and recurrence. Follow-up with plain radiographs did not lead to any delay in diagnosis of recurrence in any case. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Glueck, Dane A; Charoglu, Constantine P; Lawton, Jeffrey N
Open fractures are often classified according to a system described by Gustilo and Anderson. However, this system was applied to open long bone fractures, which may not predict the incidence of infection in open metaphyseal fractures of the upper extremity. Other studies have found that wound contamination and systemic illness were the best predictors of infections in open hand fractures. Our study assessed infection in open distal radius fractures and identifies factors that are associated with these infections. We hypothesize that contamination, rather than absolute wound size, is the best predictor of infection associated with open distal radius fractures. A review by CPT code yielded 42 patients with open distal radius fractures between 1997 and 2002 treated at a level one trauma center. Medical records and radiographic follow-up were reviewed to assess the time to irrigation and debridement, the number of debridements in initial treatment period, the method of operative stabilization, the Gustilo and Anderson type of fracture, the Swanson type of fracture, and description of wound contamination. Forty-two patients were followed up for an average of 15 months (range 4 to 68 months). Twenty-four fractures were classified as Gustilo and Anderson type I, ten were type II, and eight were type III, 30 were Swanson type I, and 12 were Swanson type II. Five of the 42 fractures were considered contaminated. Two were exposed to fecal contamination. The others were contaminated with tar, dirt/grass, and gravel, respectively. Three of 42 (7%) fractures developed infections. All three infected cases received a single irrigation and debridement. Two of five contaminated fractures (40%) developed a polymicrobial infection. Both were exposed to fecal contamination and, therefore, considered Swanson type II fractures. They were classified as Gustilo and Anderson type II and IIIB based solely upon the size of the wound. Both required multiple debridements and eventually wrist
Ma, Deqiong; Jones, Graeme
The effect of physical activity on upper limb fractures was examined in this population-based case control study with 321 age- and gender-matched pairs. Sports participation increased fracture risk in boys and decreased risk in girls. Television viewing had a deleterious dose response association with wrist and forearm fractures while light physical activity was protective. The aim of this population-based case control study was to examine the association between television, computer, and video viewing; types and levels of physical activity; and upper limb fractures in children 9-16 years of age. A total of 321 fracture cases and 321 randomly selected individually matched controls were studied. Television, computer, and video viewing and types and levels of physical activity were determined by interview-administered questionnaire. Bone strength was assessed by DXA and metacarpal morphometry. In general, sports participation increased total upper limb fracture risk in boys and decreased risk in girls. Gender-specific risk estimates were significantly different for total, contact, noncontact, and high-risk sports participation as well as four individual sports (soccer, cricket, surfing, and swimming). In multivariate analysis, time spent television, computer, and video viewing in both sexes was positively associated with wrist and forearm fracture risk (OR 1.6/category, 95% CI: 1.1-2.2), whereas days involved in light physical activity participation decreased fracture risk (OR 0.8/category, 95% CI: 0.7-1.0). Sports participation increased hand (OR 1.5/sport, 95% CI: 1.1-2.0) and upper arm (OR 29.8/sport, 95% CI: 1.7-535) fracture risk in boys only and decreased wrist and forearm fracture risk in girls only (OR 0.5/sport, 95% CI: 0.3-0.9). Adjustment for bone density and metacarpal morphometry did not alter these associations. There is gender discordance with regard to sports participation and fracture risk in children, which may reflect different approaches to sport
Kim, Jin Young; Tae, Suk Kee
To evaluate the clinical and radiological outcomes of distal radius fractures treated by percutaneous fixation using distal radius-ulna pinning and to assess its effectiveness especially for preventing fracture settling. We retrospectively reviewed 18 distal radius fractures (15 AO type A2 and 3 AO type C1). Range of motion and Disabilities of the Arm, Shoulder, and Hand scores were evaluated. We measured radiographic parameters at the final follow-up and compared them with those on immediate postoperative x-rays. All fractures united and average time to initial healing was 6.9 weeks (range, 6-7 wk). Average follow-up was 29 months (range, 26-43 mo). Average wrist flexion and extension were 70° and 65°, respectively. Average forearm supination and pronation were 82° and 83°, respectively. Average pain score was 1.2 and average Disabilities of the Arm, Shoulder, and Hand score was 13. Mean difference of ulnar variance, volar tilt, and radial inclination between immediate and final follow-up x-rays was 0.7 mm, 1°, and less than 1°, respectively. Percutaneous fixation of distal radius fractures using distal radius-ulna pinning had favorable radiologic and functional outcomes and was effective in preventing fracture settling during initial healing in unstable extra-articular fractures and some simple sagittal split intra-articular fractures. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Kruse, Christian; Eiken, P; Vestergaard, P
BACKGROUND: Data from observational studies have suggested that thiazide diuretics protect against fractures. Few studies have investigated time frames from initiation of treatment to fracture occurrence. OBJECTIVE: To evaluate the time to spinal, hip, femur, wrist and upper extremity fracture...... classification system code C03AB) between 1996 and 2011 were matched with nonexposed control subjects by date of birth and gender. Weekly odds ratios (ORs) of fracture occurrence and total incidence rates (IRs) and incidence rate ratios (IRRs) of fracture risk were calculated for the periods before treatment.......42; 1.47], 1.27 [1.24; 1.29] and 1.14 [1.11; 1.18], respectively. Prescription patterns showed several treatment breaks amongst thiazide users. CONCLUSIONS: It appears that thiazides reduce the background risk of fracture that is increased prior to commencing therapy. Long duration and continuity...
Wang, Liwei; Li, Mei; Cao, Yuying; Han, Zhengqi; Wang, Xueju; Atkinson, Elizabeth J; Liu, Hongfang; Amin, Shreyasee
Proton pump inhibitors (PPIs) are widely used to treat gastric acid-related disorders. Concerns have been raised about potential fracture risk, especially at the hip, spine and wrist. However, fracture risk at other bone sites has not been as well studied. We investigated the association between PPIs and specific fracture sites using an aggregated knowledge-enhanced database, the Food and Drug Administration Adverse Event Reporting System Data Mining Set (AERS-DM). Proportional reporting ratio (PRR) was used to detect statistically significant associations (signals) between PPIs and fractures. We analyzed both high level terms (HLT) and preferred terms (PT) for fracture sites, defined by MedDRA (Medical Dictionary for Regulatory Activities). Of PPI users reporting fractures, the mean age was 65.3 years and the female to male ratio was 3.4:1. Results revealed signals at multiple HLT and PT fracture sites, consistent for both sexes. These included fracture sites with predominant trabecular bone, not previously reported as being associated with PPIs, such as 'rib fractures', where signals were detected for overall PPIs as well as for each of 5 generic ingredients (insufficient data for dexlansoprazole). Based on data mining from AERS-DM, PPI use appears to be associated with an increased risk for fractures at multiple sites.
Lill, H; Katthagen, C; Jensen, G; Voigt, C
Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results.
Abzug, Joshua M; Dua, Karan; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O
Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits in the United States for fractures. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which make fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.
Østergaard, Mikkel; Gideon, P; Sørensen, K
MRI-scores of synovial membrane hypertrophy and bone erosions of the RA-wrist are introduced. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) and conventional radiography (CR) of the wrist were performed in 16 patients with rheumatoid arthritis (RA) and 3 healthy controls. A MRI......-score of synovial membrane hypertrophy was obtained by summation of gradings of synovial hypertrophy in 6 regions of the wrist. The score was significantly higher in wrists with than in wrists without clinical signs of active arthritis. The score was 0 in all healthy controls. Each bone of the wrist was assessed...
Lendner, Nuphar; Wells, Erik; Lavi, Idit; Kwok, Yan Yan; Ho, Pak-Cheong; Wollstein, Ronit
Measurement of wrist range of motion (ROM) is important to all aspects of treatment and rehabilitation of upper extremity conditions. Recently, gyroscopes have been used to measure ROM and may be more precise than manual evaluations. The purpose of this study was to evaluate the use of the iPhone gyroscope application and compare it with use of a goniometer, specifically evaluating its accuracy and ease of use. A cross-sectional study evaluated adult Caucasian participants, with no evidence of wrist pathology. Wrist ROM measurements in 306 wrists using the 2 methods were compared. Demographic information was collected including age, sex, and occupation. Analysis included mixed models and Bland-Altman plots. Wrist motion was similar between the 2 methods. Technical difficulties were encountered with gyroscope use. Age was an independent predictor of ROM. Correct measurement of ROM is critical to guide, compare, and evaluate treatment and rehabilitation of the upper extremity. Inaccurate measurements could mislead the surgeon and harm patient adherence with therapy or surgeon instruction. An application used by the patient could improve adherence but needs to be reliable and easy to use. Evaluation is necessary before utilization of such an application. This study supports revision of the application on the iPhone to improve ease of use.
Tobin, Anna L
Intersection syndrome is an inflammatory condition located at the crossing point between the first and second dorsal compartments in the wrist. It is an uncommon presentation but has been recognized as an injury typical of rowers (when it is named oarsman's wrist) and other sports such as racquet sports, baseball, cycling, hockey, golf, ice hockey, skiing, and softball. It has not been previously described in climbers. This report details 2 cases of intersection associated with the use of an ice axe. The first presentation was in a female climber who was using an ice axe for climbing in the Nepal Himalayas and the second was in a male climber using an ice axe for winter climbing training in the Alps. Both climbers presented with wrist pain, swelling, and crepitus over the dorsum of the wrist, about 5 cm proximal to Lister's tubercle. Although well documented in other sporting populations, there seems to be limited reporting of intersection syndrome in the climbing population. It may be worth considering a diagnosis of "ice axe wrist" as a differential in patients who have been using ice axes in climbing or mountaineering. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
Shamsoddini, Alireza; Hollisaz, Mohammad Taghi
Tennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow. This study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow. Thirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively. Among the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001. The taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients.
Sauerbier, M; Kania, N M; Kluge, S; Bickert, B; Germann, G
Although diagnosis and therapeutic options for post-traumatic, idiopathic, and degenerative wrist arthropathies have improved during recent years, total wrist fusion is still frequently regarded as a popular option of treatment. Fourty-one patients underwent wrist arthrodesis between May 1994 and April 1996 using the recently introduced new AO-plate after earlier wrist trauma or Kienböck's disease. Thirty-five patients were examined. The average follow-up time was 15 months. Hand function and active digital range of motion (ADROM) was assessed clinically, grip strength was measured using a Jamar-Dynamometer and the Dexter-Computer-System. Patient's daily activities and general postoperative quality of life were estimated with the new DASH-questionnaire. It can be concluded from our data, that the widely claimed complete pain relief after total wrist fusion does not match reality. Eighty percent of the patients complained about reduction of postoperative quality of life with impaired personal hygiene and functional deficits; however, the majority would undergo the procedure again. Seventy percent of the patients returned to their original occupation. The DASH-questionnaire proved to be a very useful and sensitive tool for evaluating the patient's problems at the upper extremity.