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Sample records for ulnar wrist extensor

  1. Diagnostic Performance of the Extensor Carpi Ulnaris (ECU) Synergy Test to Detect Sonographic ECU Abnormalities in Chronic Dorsal Ulnar-Sided Wrist Pain.

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    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo

    2016-01-01

    The extensor carpi ulnaris (ECU) tendon synergy test is a simple and unique diagnostic maneuver for evaluation of chronic dorsal ulnar-sided wrist pain, which applies isolated tension to the ECU without greatly stressing other structures. This study aimed to investigate the diagnostic performance of the ECU synergy test to detect ECU abnormalities on sonography. Forty affected wrists from 39 consecutive patients with chronic dorsal ulnar-sided wrist pain that continued for greater than 1 month were examined with the ECU synergy test and sonography. The sensitivity, specificity, positive predictive value, and negative predictive value of the ECU synergy test to detect ECU abnormalities were evaluated. We compared the results of the ECU synergy test between groups with and without ECU abnormalities and also compared the ages, sexes, and symptomatic durations of the patients between groups with positive and negative ECU synergy test results and between the groups with and without ECU abnormalities. The sensitivity, specificity, positive predictive value, and negative predictive value were 73.7%, 85.7%, 82.4%, and 78.3%, respectively. There was significant difference in the ECU synergy test results between the groups with and without ECU abnormalities (P synergy test could be a useful provocative maneuver to detect ECU abnormalities in patients with chronic dorsal ulnar-sided wrist pain. © 2016 by the American Institute of Ultrasound in Medicine.

  2. Ulnar-sided wrist pain. II. Clinical imaging and treatment

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    Watanabe, Atsuya; Souza, Felipe [Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); Vezeridis, Peter S.; Blazar, Philip [Brigham and Women' s Hospital, Department of Orthopaedic Surgery, Boston, MA (United States); Yoshioka, Hiroshi [Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); University of California-Irvine, Department of Radiological Sciences, Irvine, CA (United States); UC Irvine Medical Center, Department of Radiological Sciences, Orange, CA (United States)

    2010-09-15

    Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed. (orig.)

  3. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis. 888.3810 Section 888.3810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer prosthesis...

  4. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

    International Nuclear Information System (INIS)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Kattapuram, Susan V.; Torriani, Martin

    2014-01-01

    The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P 0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

  5. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

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    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Kattapuram, Susan V.; Torriani, Martin [General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts, Boston, MA (United States)

    2014-06-15

    The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P < 0.0001; R1 and R2 averaged data, P < 0.0001) and ECU tendon subluxation (P = 0.001; P = 0.0001; P < 0.0001). In subjects with ECU tendon subluxation there was also a trend toward a shorter length (P = 0.3; P <0.0001; P = 0.001) and a shallower ECU groove (P = 0.01; P = 0.03; P = 0.01; R1 and R2 averaged data with Bonferroni correction, P = 0.08). ECU groove depth (P = 0.6; P = 0.8; P = 0.9) and groove length (P = 0.1; P = 0.4; P = 0.7) showed no significant correlation with ECU tendon pathology, and length of the ulnar styloid process showed no significant correlation with ECU tendon pathology (P = 0.2; P = 0.3; P = 0.2) or subluxation (P = 0.4; P = 0.5; P = 0.5). Inter-observer agreement (ICC) was >0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

  6. Ulnar-sided wrist pain. Part I: anatomy and physical examination

    International Nuclear Information System (INIS)

    Vezeridis, Peter S.; Blazar, Philip; Yoshioka, Hiroshi; Han, Roger

    2010-01-01

    Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain. (orig.)

  7. Ulnar-sided pain due to extensor carpi ulnaris tendon subluxation: a case report

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    Cift Hakan

    2012-11-01

    Full Text Available Abstract Introduction We present the case of a patient with extensor carpi ulnaris tendon subluxation who was first treated for distal radioulnar joint sprain. Case presentation A 25-year-old Caucasian man was seen at our policlinic one month after he had fallen on his outstretched hand. A diagnosis of extensor carpi ulnaris subluxation was made clinically but we also had the magnetic resonance imaging scan of the patient’s wrist which displayed an increased signal on T2-weighted images consistent with inflammation around the extensor carpi ulnaris tendon. The extensor carpi ulnaris tendon was found to be dislocating during supination and relocating during pronation. The sheath was reconstructed using extensor retinaculum due to attenuation of subsheath. Conclusion There was no recurrent dislocation of the extensor carpi ulnaris tendon of the patient at his last follow up 12 months after the operation.

  8. Investigation Of Wrist Flexor/Extensor Muscle Strength Following Arthroscopic Surgical Treatment Of Lateral Epicondylitis

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    Mustafa Onur SERBEST

    2016-03-01

    Full Text Available Objective: Lateral epicondylitis is a common disease of elbow joint. Repetitive wrist activities and activities that requires strength are risk factors. Wrist extensor muscle strength are decreased in patients with lateral epicondylitis. Materials and Methods: Eight patients with a diagnosis of lateral epicondylitis enrolled to study. Wrist flexor and extensor muscle strength of patients who were completed one year after surgery were measured by isokinetic dynamometer. Results: There were no statistically significant differences between the flexor and extensor muscle strength of the patients (p>0.05. Conclusion: In this study, arthroscopic extensor carpi radialis brevis tendon release in lateral epicondylitis has shown no negative effect on flexor and extensor wrist muscle stregth.

  9. Hyperparathyroidism-related extensor tenosynovitis at the wrist: a general review of the literature.

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    Ichihara, Satoshi; Hidalgo-Diaz, Juan Jose; Prunières, Guillaume; Facca, Sybille; Bodin, Frédéric; Boucher, Stéphanie; Liverneaux, Philippe

    2015-07-01

    Extensor tenosynovitis often occurs accompanying with rheumatoid arthritis, gout, trauma, mycobacterium and dialysis-related amyloidosis. However, there is no recognition of extensor tenosynovitis accompanying with hyperparathyroidism. The purpose of this general review was to describe the clinical condition and to report the results of surgical intervention in the extensor tenosynovitis at the wrist related to hyperparathyroidism. Hyperparathyroidism is thought to be a rare disease in adult. Although renal symptoms are the commonest symptom, musculoskeletal complaints also occur in hyperparathyroidism. From our general review, hyperparathyroidism deserves consideration in the differential diagnosis of extensor tenosynovitis at the wrist.

  10. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain

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    Moraux, A. [Hopital Roger Salengro, Service d' Imagerie Musculo-Squelettique, Centre de Consultation de l' Appareil Locomoteur, CHRU Lille (France); Imagerie Medicale Jacquemars Gielee, Lille (France); Lefebvre, G.; Pansini, V.; Aucourt, J.; Vandenbussche, L.; Cotten, A. [Hopital Roger Salengro, Service d' Imagerie Musculo-Squelettique, Centre de Consultation de l' Appareil Locomoteur, CHRU Lille (France); Demondion, X. [Hopital Roger Salengro, Service d' Imagerie Musculo-Squelettique, Centre de Consultation de l' Appareil Locomoteur, CHRU Lille (France); Pole Recherche Faculte de Medecine de Lille, Laboratoire d' Anatomie, Lille (France)

    2014-06-15

    Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment. (orig.)

  11. Radiologic examination and measurement of the wrist and distal radio-ulnar joint

    International Nuclear Information System (INIS)

    Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.; Sahlgrenska Sjukhuset, Goeteborg; Uppsala Univ.

    1986-01-01

    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. (orig.)

  12. Radiologic examination and measurement of the wrist and distal radio-ulnar joint. New aspects

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    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.

  13. Ulnar nerve lesion at the wrist and sport: A report of 8 cases compared with 45 non-sport cases.

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    Seror, P

    2015-04-01

    Reporting clinical and electrodiagnostic characteristics of sport-related ulnar neuropathies at the wrist. Eight sport-related and 45 non-sport-related cases from 53 ulnar neuropathies at the wrist cases over 14 years. Sport-related ulnar neuropathies at the wrist cases were due to cycling (5 cases), kayaking (2 cases), and big-game fishing (1 case). No patient had sensory complaints in ulnar digits, and all had motor impairment. Conduction across the wrist with recording on the first dorsal interosseous muscle was impaired in all cases, with conduction block in 5. Two cyclists showed bilateral ulnar neuropathies at the wrist. All cases recovered within 2 to 6 months with sport discontinuation. Distal lesions of the deep motor branch were more frequent in sport- than non-sport-related cases. The 8 sport-related ulnar neuropathies at the wrist cases involved the deep motor branch. Conduction study to the first dorsal interosseous muscle across the wrist is the key to electrodiagnostics. Bilateral cases in cyclists does not require wrist imaging. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. The distally-based island ulnar artery perforator flap for wrist defects

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    Karki Durga

    2007-01-01

    Full Text Available Background: Reconstruction of soft tissue defects around the wrist with exposed tendons, joints, nerves and bone represents a challenge to plastic surgeons, and such defects necessitate flap coverage to preserve hand functions and to protect its vital structures. We evaluated the use of a distally-based island ulnar artery perforator flap in patients with volar soft tissue defects around the wrist. Materials and Methods: Between June 2004 and June 2006, seven patients of soft tissue defects on the volar aspect of the wrist underwent distally-based island ulnar artery perforator flap. Out of seven patients, five were male and two patients were female. This flap was used in the reconstruction of the post road traffic accident defects in four patients and post electric burn defects in three patients. Flap was raised on one or two perforators and was rotated to 180°. Results: All flaps survived completely. Donor sites were closed primarily without donor site morbidity. Conclusion: The distally-based island Ulnar artery perforator flap is convenient, reliable, easy to manage and is a single-stage technique for reconstructing soft tissue defects of the volar aspect of the wrist. Early use of this flap allows preservation of vital structures, decreases morbidity and allows for early rehabilitation.

  15. Tuberculosis tenosynovitis of the extensor tendons of the wrist

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    Mrabet, Dalila; Ouenniche, Kmar; Mizouni, Habiba; Ounaies, Mouna; Khémiri, Chékib; Sahli, Héla; Sellami, Slaheddine

    2011-01-01

    Mycobacterial tuberculous tenosynovitis of the extensor tendon sheath is an extremely rare manifestation of extrapulmonary tuberculosis. The diagnosis may be easily delayed because of its non-specific clinical signs. We report a new case of tuberculous tenosynovitis of the extensor without concomitant pulmonary tuberculosis or documented immunodeficiency.

  16. Spontaneous Extensor Tendon Rupture in the Rheumatoid Wrist: Risk Factors and Preventive Role of Extended Tenosynovectomy.

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    Hsueh, Jung-Hua; Liu, Wen-Chung; Yang, Kuo-Chung; Hsu, Kuei-Chang; Lin, Cheng-Ta; Chen, Lee-Wei

    2016-03-01

    Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture. We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion. The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration longer than 8 years, persistent tenosynovitis longer than 1 year duration, and Larsen grade greater than 4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis longer than 6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery. Risk factors of spontaneous extensor tendon rupture included disease duration longer than 8 years, persistent tenosynovitis longer than 1 year, and wrist Larsen grade greater than 4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy

  17. Anatomical variation of radial wrist extensor muscles: a study in cadavers

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    Soubhagya Ranjan Nayak

    2008-01-01

    Full Text Available OBJECTIVE: The tendons of the extensor carpi radialis longus and brevis muscles are quite useful in tendon transfer, such as in correction of finger clawing and restoration of thumb opposition. Knowledge of additional radial wrist extensor muscle bellies with independent tendons is useful in the above-mentioned surgical procedures. METHODS: The skin, subcutaneous tissue, and antebrachial fascia of 48 (24 on the right side and 24 on left side male upper limb forearms were dissected. The following aspects were then analyzed: (a the presence of additional muscle bellies of radial wrist extensors, (b the origin and insertion of the additional muscle, and (c measurements of the muscle bellies and their tendons. RESULTS: Five out of 48 upper limbs (10.41% had additional radial wrist extensors; this occurred in 3 out of 24 left upper limbs (12.5% and 2 out of 24 right upper limbs (8.3%. In one of the right upper limbs, two additional muscles were found. The length and width of each additional muscle belly and its tendon ranged between 2 - 15cm by 0.35 - 6.4cm and 2.8 - 20.8cm by 0.2 0.5cm, respectively. The additional radial wrist extensor tendons in our study basically originated either from the extensor carpi radialis longus or brevis muscles and were inserted at the base of the 2nd or 3rd metacarpal bone. CONCLUSION: The present study will inform surgeons about the different varieties of additional radial wrist extensors and the frequency of their occurrence.

  18. High-resolution MRI of the ulnar and radial collateral ligaments of the wrist.

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    Nozaki, Taiki; Wu, Wei Der; Kaneko, Yasuhito; Rafijah, Gregory; Yang, Lily; Hitt, Dave; Yoshioka, Hiroshi

    2017-12-01

    Background Accurate diagnosis of injuries to the collateral ligaments of the wrist is technically challenging on MRI. Purpose To investigate usefulness of high-resolution two-dimensional (2D) and isotropic three-dimensional (3D) magnetic resonance imaging (MRI) for identifying and classifying the morphology of the ulnar and radial collateral ligaments (UCL and RCL) of the wrist. Material and Methods Thirty-seven participants were evaluated using 3T coronal 2D and isotropic 3D images by two radiologists independently. The UCL was classified into four types: 1a, narrow attachment to the tip of the ulnar styloid (Tip); 1b, broad attachment to the Tip; 2a, narrow attachment to the medial base of the ulnar styloid (Base); and 2b, broad attachment to the Base. The RCL was also classified into four types: 1a, separate radioscaphoid and scaphotrapezial ligaments (RS + ST) with narrow scaphoid attachment; 1b, RS + ST with broad scaphoid attachment; 2a, continuous radio-scapho-trapezial ligaments (RST) with narrow scaphoid attachment; and 2b, RST with broad scaphoid attachment. The inter-observer reliability of these classifications was calculated. Results Type 1a was the most common of both collateral ligaments. Of UCL classifications, 31.4% were revised after additional review of multiplanar reconstruction (MPR) images from isotropic data. The inter-observer reliability of UCL classification was substantial (k = 0.62) without MPR, and almost perfect (k = 0.84) with MPR. The inter-observer reliability of RCL classification was almost perfect (k = 0.89). Anatomic delineation between the two sequences was not statistically different. Conclusion The UCL and RCL were each identified on high-resolution 2D and isotropic 3D MRI equally well. MPR allows accurate identification of the UCL attachment to the ulnar styloid.

  19. Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist.

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    Shin, Seung-Han; Lee, Yong-Suk; Kang, Jin-Woo; Noh, Dong-Young; Jung, Joon-Yong; Chung, Yang-Guk

    2018-03-01

    The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between "the line of humeral long axis projected on the axial plane of the ulna" and "the line passing the center of the ulnar head and the center of the ulnar styloid" was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of "the volar-dorsal diameter of the ulnar head" and "the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid" was calculated (ulnar styloid location ratio). The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated

  20. Radial and ulnar bursae of the wrist: cadaveric investigation of regional anatomy with ultrasonographic-guided tenography and MR imaging

    International Nuclear Information System (INIS)

    Aguiar, R.O.C.; Gasparetto, E.L.; Marchiori, E.; Escuissato, D.L.; Trudell, D.J.; Haghighi, P.; Resnik, D.

    2006-01-01

    To demonstrate the anatomy of the radial and ulnar bursae of the wrist using MR and US images. Ultrasonographic-guided tenography of the tendon sheath of flexor pollicis longus (FPL) and the common tendon sheath of the flexor digitorum of the fifth digit (FD5) of ten cadaveric hands was performed, followed by magnetic resonance imaging and gross anatomic correlation. Patterns of communication were observed between these tendon sheaths and the radial and ulnar bursae of the wrist. The tendon sheath of the FPL communicated with the radial bursa in 100% (10/10) of cases, and the tendon sheath of the FD5 communicated with the ulnar bursa in 80% (8/10). Communication of the radial and ulnar bursae was evident in 100% (10/10), and presented an ''hourglass'' configuration in the longitudinal plane. The ulnar and radial bursae often communicate. The radial bursa communicates with the FPL tendon sheath, and the ulnar bursa may communicate with the FD5 tendon sheath

  1. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm

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    Bao, Hongjing; Wang, Shanshan; Wang, Guangbin; Hasan, Mansoor-ul; Yao, Bin; Wu, Chao; Wu, Lebin [Shandong University, Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, Shandong (China); Yang, Li [Fudan University, Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Shanghai (China); Zhang, Xu [Shandong Chest Hospital, Department of Radiology, Jinan, Shandong (China); Chen, Weibo; Chan, Queenie [Philips Healthcare, Shanghai (China); Chhabra, Avneesh [UT Southwestern Medical Center, Dallas, TX (United States)

    2017-06-15

    To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 ± 0.62 and 3.10 ± 0.83, inter-observer performance was excellent (k = 0.842). DW-MRN is feasible for improved visualisation of extremity nerves and their lesions in the wrist and palm with adequate image quality, thereby providing a supplementary method to conventional MR imaging. (orig.)

  2. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm

    International Nuclear Information System (INIS)

    Bao, Hongjing; Wang, Shanshan; Wang, Guangbin; Hasan, Mansoor-ul; Yao, Bin; Wu, Chao; Wu, Lebin; Yang, Li; Zhang, Xu; Chen, Weibo; Chan, Queenie; Chhabra, Avneesh

    2017-01-01

    To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 ± 0.62 and 3.10 ± 0.83, inter-observer performance was excellent (k = 0.842). DW-MRN is feasible for improved visualisation of extremity nerves and their lesions in the wrist and palm with adequate image quality, thereby providing a supplementary method to conventional MR imaging. (orig.)

  3. Stabilization of the ulnar stump using modified Breen method after the Sauve-Kapandji procedure in rheumatoid wrist

    International Nuclear Information System (INIS)

    Tanino, Yoshihiko; Yabe, Yutaka; Yamauchi, Kenji; Ikegami, Hiroyasu; Ichikawa, Tooru

    2006-01-01

    We report on the utility of the modified Breen method in addition to the Sauve-Kapandji operation for the treatment of instability and pain in the proximal ulnar stump in rheumatoid arthrities (RA) wrist. We treated a total of 15 hands in 12 patients with disturbances due to instability and pain at the proximal ulnar stump. The average follow-up period was 47 months. We evaluated the range of motion, grip strength, radioulnar distance, and the radioulnar distance at the stump using CT during pronation, supination, and neutral positions of the forearm in 11 of the 15 operated hands. We observed that none of the patients showed any signs of pain at the proximal ulnar stump and no scallop sign was observed. In all the cases, the line connecting the center of the radial head to the proximal ulnar stump served as the axis of rotation for the forearm; this was confirmed by the CT images. We concluded that our operative method resulted in stabilization of the proximal ulnar stump and recovery of powerful grip without pain during forearm rotation. (author)

  4. Effect of simultaneous stretching of the wrist and finger extensors for lateral epicondylitis: a gross anatomical study of the tendinous origins of the extensor carpi radialis brevis and extensor digitorum communis.

    Science.gov (United States)

    Shirato, Rikiya; Wada, Takuro; Aoki, Mitsuhiro; Iba, Kousuke; Kanaya, Kohei; Fujimiya, Mineko; Yamashita, Toshihiko

    2015-11-01

    Pulling the wrist into flexion with the elbow in extension and forearm in pronation has been used as the stretching technique of wrist extensors for lateral epicondylitis. Simultaneous stretching of the fingers in addition to the wrist flexion has also been applied. However, the mechanism of this simultaneous stretching has not been clarified. This study is designed to clarify the mechanism underlying this simultaneous stretching technique based on the anatomical features of the origins of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). Thirty-nine arms from formalin-embalmed Japanese human specimens were dissected. The features of the origins of the ECRB and EDC were macroscopically observed, and the locations of each origin on the lateral epicondyle were measured. The ECRB had a long and wide, purely tendinous origin which originated from the anterior slope of the lateral epicondyle. The tendinous origin of the index finger of the EDC (EDC-IF) arose from the posterior aspect of the ECRB tendinous origin, with a coexisting muscular portion observed at the level of the proximal forearm. The middle finger of the EDC (EDC-MF) had a short tendinous origin with an associated muscular portion and originated proximo-laterally to the origin of the ECRB on the lateral epicondyle. In addition, the muscular origin of the EDC-MF arose on the superficial and posterior aspect of the ECRB tendinous origin. In contrast, the ring and little fingers of the EDC originated from the tendinous septum of the extensor digiti minimi and extensor carpi ulnaris, and had no connection with the ECRB tendinous origin. On the basis of our anatomical findings, simultaneous stretching of the wrist extensors by wrist, index and middle fingers flexion could provide stretching force to both the tendinous origins of the ECRB and EDC through the EDC-IF and EDC-MF.

  5. Anomalous bilateral contribution of extensor pollicis longus and muscle fusion of the first compartment of the wrist

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    Rodrigo César Rosa

    2016-04-01

    Full Text Available Knowledge of the anatomical variations of the muscles of the first dorsal compartments of the wrist is clinically relevant to De Quervain's tenosynovitis and to reconstructive surgeries. In the literature, there are many reports of the presence of multiple insertion tendons in the first dorsal compartment of the wrist, but few reports describe occurrences of fusion and muscle contributions. This case report describes an anomalous bilateral contribution of the extensor pollicis longus. This anomalous contribution was found through a slender auxiliary tendon that crossed laterally under the extensor retinaculum, entered the first dorsal compartment of the wrist and merged with the tendon of the extensor pollicis brevis muscle. In the same cadaver in which this contribution was present, there was atypical muscle fusion of the abductor pollicis longus muscle and extensor pollicis brevis muscle. In conclusion, anomalous bilateral contribution of the extensor pollicis longus muscle and atypical muscle fusion, concomitant with a variant insertion pattern, are the highlight of this case report. Furthermore, it is concluded that additional tendons may be effectively used in reconstructive surgeries, but that there is a need for knowledge of the possible numerical and positional variations of these tendons, with a view to making more effective surgical plans.

  6. Comparison of the electrical activity in upper trapezius and wrist extensor muscles during two typewriting conditions

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    João Carlos Comel

    Full Text Available Introduction The proper use of the position of the arm and wrist while typing may reduce muscle overload and prevent musculoskeletal disorders.Objective To evaluate the electromyographic activity of upper trapezius and wrist extensor muscles during two typewriting conditions.Materials and methods : Six healthy females (Xage = 42 years,SD= 10, (Xheight = 1.65m, SD = 0.05 and (Xweight = 71kg, SD = 16 participated in this study. The task was performed with a newly developed arm support and without the support. A perceived exertion scale was used with all subjects. An ANOVA with repeated measures was used to verify differences in perceived exertion and root mean square (RMS.Results There were no statistically significant differences for the RMS between the typewriting tasks. The condition without arm support presented a significantly greater mean velocity and amount of words typed (P= 0.02; P= 0.03 and there was a significant difference in perceived exertion during the condition without arm support (P= 0.03. Electromyographic activity did not present differences.Conclusion The muscle electrical activity was not altered regardless the arm support and occurred the improvement of the perceived exertion after 10 minutes of typing without support. Long-term studies are needed.

  7. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features

    International Nuclear Information System (INIS)

    Parellada, Antoni J.; Gopez, Angela G.; Morrison, William B.; Sweet, Stephanie; Leinberry, Charles F.; Reiter, Sean B.; Kohn, Mark

    2007-01-01

    To present the MRI imaging findings of extensor tenosynovitis at the distal intersection or crossover between the second (extensor carpi radialis longus (ECRL) and brevis (ECRB)) and third (extensor pollicis longus (EPL)) extensor compartment tendons, and the anatomical details that may play a role in the pathogenesis of this condition. The imaging studies and clinical records of five patients (three females and two males, with ages ranging between 22 and 78 years; mean age, 49 years) presenting with pain on the dorsal and radial aspect of the wrist were reviewed by two musculoskeletal radiologists in consensus. Three cases were identified serendipitously during routine clinical reading sessions; a follow-up computerized database search for additional cases reported in the prior two years yielded two additional cases. The overall number of cases screened was 1,031. The diagnosis of tendinopathy affecting the second and third compartment extensor tendons was made on the basis of MRI findings and clinical follow-up, or synovectomy. All patients showed signs of tenosynovitis: in four patients both the tendons of the second and third extensor compartments were affected; the fifth patient showed signs of tenosynovitis of the EPL tendon, and tendinosis of the extensor carpi radialis tendons. Three patients showed tenosynovitis proximal and distal to the point of intersection; and in two of them, a discrete point of constriction was appreciated at the crossover site in relation to the extensor retinaculum. Two patients showed tenosynovitis limited to the segment distal to the point of decussation. Tendinosis tended to follow the presence of tenosynovitis. In one of the patients, subtendinous reactive marrow edema in Lister's tubercle was noted. Distal intersection tenosynovitis may be related to the biomechanical pulley effect exerted by Lister's tubercle on the EPL tendon as it leaves the third compartment and crosses over the extensor carpi radialis tendons, as well as

  8. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Parellada, Antoni J. [DII - Diagnostic Imaging, Inc., Philadelphia, PA (United States); Frankford Hospitals - Torresdale Campus, Department of Radiology, Philadelphia, PA (United States); Gopez, Angela G.; Morrison, William B. [Thomas Jefferson University, Department of Radiology, Philadelphia, PA (United States); Sweet, Stephanie [Thomas Jefferson University, Philadelphia Hand Center, Philadelphia, PA (United States); Leinberry, Charles F. [Thomas Jefferson University, Department of Orthopedic Surgery - Hand Surgery, Philadelphia, PA (United States); Reiter, Sean B.; Kohn, Mark [DII - Diagnostic Imaging, Inc., Philadelphia, PA (United States)

    2007-03-15

    To present the MRI imaging findings of extensor tenosynovitis at the distal intersection or crossover between the second (extensor carpi radialis longus (ECRL) and brevis (ECRB)) and third (extensor pollicis longus (EPL)) extensor compartment tendons, and the anatomical details that may play a role in the pathogenesis of this condition. The imaging studies and clinical records of five patients (three females and two males, with ages ranging between 22 and 78 years; mean age, 49 years) presenting with pain on the dorsal and radial aspect of the wrist were reviewed by two musculoskeletal radiologists in consensus. Three cases were identified serendipitously during routine clinical reading sessions; a follow-up computerized database search for additional cases reported in the prior two years yielded two additional cases. The overall number of cases screened was 1,031. The diagnosis of tendinopathy affecting the second and third compartment extensor tendons was made on the basis of MRI findings and clinical follow-up, or synovectomy. All patients showed signs of tenosynovitis: in four patients both the tendons of the second and third extensor compartments were affected; the fifth patient showed signs of tenosynovitis of the EPL tendon, and tendinosis of the extensor carpi radialis tendons. Three patients showed tenosynovitis proximal and distal to the point of intersection; and in two of them, a discrete point of constriction was appreciated at the crossover site in relation to the extensor retinaculum. Two patients showed tenosynovitis limited to the segment distal to the point of decussation. Tendinosis tended to follow the presence of tenosynovitis. In one of the patients, subtendinous reactive marrow edema in Lister's tubercle was noted. Distal intersection tenosynovitis may be related to the biomechanical pulley effect exerted by Lister's tubercle on the EPL tendon as it leaves the third compartment and crosses over the extensor carpi radialis tendons

  9. Comparing two methods to record maximal voluntary contractions and different electrode positions in recordings of forearm extensor muscle activity: Refining risk assessments for work-related wrist disorders.

    Science.gov (United States)

    Dahlqvist, Camilla; Nordander, Catarina; Granqvist, Lothy; Forsman, Mikael; Hansson, Gert-Åke

    2018-01-01

    Wrist disorders are common in force demanding industrial repetitive work. Visual assessment of force demands have a low reliability, instead surface electromyography (EMG) may be used as part of a risk assessment for work-related wrist disorders. For normalization of EMG recordings, a power grip (hand grip) is often used as maximal voluntary contraction (MVC) of the forearm extensor muscles. However, the test-retest reproducibility is poor and EMG amplitudes exceeding 100% have occasionally been recorded during work. An alternative MVC is resisted wrist extension, which may be more reliable. To compare hand grip and resisted wrist extension MVCs, in terms of amplitude and reproducibility, and to examine the effect of electrode positioning. Twelve subjects participated. EMG from right forearm extensors, from four electrode pairs, was recorded during MVCs, on three separate occasions. The group mean EMG amplitudes for resisted wrist extension were 1.2-1.7 times greater than those for hand grip. Resisted wrist extension showed better reproducibility than hand grip. The results indicate that the use of resisted wrist extension is a more accurate measurement of maximal effort of wrist extensor contractions than using hand grip and should increase the precision in EMG recordings from forearm extensor muscles, which in turn will increase the quality of risk assessments that are based on these.

  10. Variations of anatomy on MRI of the first extensor compartment of the wrist and association with DeQuervain tenosynovitis

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Kheterpal, Arvin B.; Terneria Vicentini, Joao Rafael; Huang, Ambrose J. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

    2017-08-15

    To study anatomical variations on MRI of the first extensor compartment of the wrist in DeQuervain tenosynovitis (DQT). A retrospective search for DQT patients yielded 47 subjects (51 ± 15 years, 36 female, 11 male). The age-matched control group (normal first extensor compartment) was 49 ± 15 years (29 female, 18 male). Two independent readers reviewed: the number of abductor pollicis longus (APL) tendon slips, tendon sheath septations (compartmentalization), and APL and EPB cross-sectional area (CSA) at the radial styloid. A tendon slip was defined as a discrete structure for ≥5 contiguous slices with its own insertion. The distribution of APL tendon slips was different for the DQT and control groups (Reader 1/Reader 2: P = 0.0001 and 0.001). The most common arrangement for both groups was two APL tendon slips. One tendon slip was less common (P = 0.03 and 0.1) and compartmentalization was more common (P = 0.003; < 0.0001) for the DQT group than the control group. There was no difference in tendon slip insertions on one or multiple bones (P = 0.1; 0.7). APL and EPB compartment CSAs were also higher for the DQT group (combined first extensor compartment area: 21.3 ± 7.6 mm{sup 2}; 21.0 ± 7.1) than the control group (17.2 ± 3.8; 17.1 ± 3.9) (P = 0.002; 0.002). We found a statistically significantly increased proportion of supernumerary tendon slips and compartmentalization of the first extensor compartment in patients with DQT and greater CSA of the first extensor compartment at the radial styloid, consistent with previous anatomical, surgical, and ultrasound studies. (orig.)

  11. Complications of wrist arthroscopy.

    Science.gov (United States)

    Ahsan, Zahab S; Yao, Jeffrey

    2012-06-01

    The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Snapping wrist due to multiple accessory tendon of first extensor compartment

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    S. Dhiyaneswaran Subramaniyam

    2018-01-01

    Conclusion: There are various causes for snapping wrist syndrome. Multiple accessory tendon can also cause snapping as shown in this case report. Moreover am presenting this case to highlight the diagnostic failure with non dynamic radiological investigation and to consider multiple accessory tendon as differential diagnosis for snapping wrist syndrome. Also suggest dynamic study could be a better choice of investigation to diagnosis snapping syndrome. First compartment tunnel release with few accessory tendon slip tenotomy gives good result.

  13. Correlation between the elbow flexion and the hand and wrist flexion after neurotization of the fascicles of the ulnar nerve to the motor branch to the biceps

    Directory of Open Access Journals (Sweden)

    Ricardo Boso Escudero

    Full Text Available ABSTRACT OBJECTIVE: Gain in elbow flexion in patients with brachial plexus injury is extremely important. The transfer of a fascicle from the ulnar nerve to the motor branch of the musculocutaneous nerve (Oberlin surgery is a treatment option. However, in some patients, gain in elbow flexion is associated with wrist and finger flexion. This study aimed to assess the frequency of this association and the functional behavior of the limb. METHODS: Case-control study of 18 patients who underwent the Oberlin surgery. Group 1 included patients without disassociation of range of elbow flexion and that of the fingers and wrist; Group 2 included patients in whom this disassociation was present. In the functional evaluation, the Sollerman and DASH tests were used. RESULTS: It was observed that 38.89% of the patients did not present disassociation of elbow flexion with flexion of the wrist and fingers. Despite the existence of a favorable difference in the group with disassociation of the movement, when the Sollerman protocol was applied to the comparison between both groups, this difference was not statistically significant. With the DASH test, however, there was a statistically significant difference in favor of the group of patients who managed to disassociate the movement. CONCLUSION: The association of elbow flexion with flexion of the wrist and fingers, in the group studied, was shown to be a frequent event, which influenced the functional result of the affected limb.

  14. The natural angle between the hand and handle and the effect of handle orientation on wrist radial/ulnar deviation during maximal push exertions.

    Science.gov (United States)

    Young, Justin G; Lin, Jia-Hua; Chang, Chien-Chi; McGorry, Raymond W

    2013-01-01

    The purpose of this experiment was to quantify the natural angle between the hand and a handle, and to investigate three design factors: handle rotation, handle tilt and between-handle width on the natural angle as well as resultant wrist radial/ulnar deviation ('RUD') for pushing tasks. Photographs taken of the right upper limb of 31 participants (14 women and 17 men) performing maximal seated push exertions on different handles were analysed. Natural hand/handle angle and RUD were assessed. It was found that all of the three design factors significantly affected natural handle angle and wrist RUD, but participant gender did not. The natural angle between the hand and the cylindrical handle was 65 ± 7°. Wrist deviation was reduced for handles that were rotated 0° (horizontal) and at the narrow width (31 cm). Handles that were tilted forward 15° reduced radial deviation consistently (12-13°) across handle conditions. Manual materials handling (MMH) tasks involving pushing have been related to increased risk of musculoskeletal injury. This study shows that handle orientation influences hand and wrist posture during pushing, and suggests that the design of push handles on carts and other MMH aids can be improved by adjusting their orientation to fit the natural interface between the hand and handle.

  15. OSTEOID OSTEOMA OF THE HAMATE AS A CAUSE OF COMPRESSION NEUROPATHY OF THE ULNAR NERVE IN GUYON CANAL (CASE REPORT

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    O. M. Semenkin

    2017-01-01

    Full Text Available Osteoid  osteoma of the wrist bones is rare and its diagnostics is complicated. A clinical case of the surgical treatment of the patient with osteoid osteoma is presented. The clinical manifestations included  pain, extensors  tenosynovitis and neuropathy of the ulnar nerve in guyon’s canal. The diagnosis was confirmed by computer tomography, ultrasonography and electromyography. Partial resection of the hamate including pathology area, and mobilization of the ulnar nerve in the wrist enabled authors  to obtain a good functional outcome.

  16. Evaluation and diagnosis of wrist pain: a case-based approach.

    Science.gov (United States)

    Shehab, Ramsey; Mirabelli, Mark H

    2013-04-15

    Patients with wrist pain commonly present with an acute injury or spontaneous onset of pain without a definite traumatic event. A fall onto an outstretched hand can lead to a scaphoid fracture, which is the most commonly fractured carpal bone. Conventional radiography alone can miss up to 30 percent of scaphoid fractures. Specialized views (e.g., posteroanterior in ulnar deviation, pronated oblique) and repeat radiography in 10 to 14 days can improve sensitivity for scaphoid fractures. If a suspected scaphoid fracture cannot be confirmed with plain radiography, a bone scan or magnetic resonance imaging can be used. Subacute or chronic wrist pain usually develops gradually with or without a prior traumatic event. In these cases, the differential diagnosis is wide and includes tendinopathy and nerve entrapment. Overuse of the muscles of the forearm and wrist may lead to tendinopathy. Radial pain involving mostly the first extensor compartment is commonly de Quervain tenosynovitis. The diagnosis is based on history and examination findings of a positive Finkelstein test and a negative grind test. Nerve entrapment at the wrist presents with pain and also with sensory and sometimes motor symptoms. In ulnar neuropathies of the wrist, the typical presentation is wrist discomfort with sensory changes in the fourth and fifth digits. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers), may increase the risk of ulnar neuropathy. Electrodiagnostic tests identify the area of nerve entrapment and the extent of the pathology. Copyright © 2013 American Academy of Family Physicians.

  17. 4-corner arthrodesis and proximal row carpectomy: a biomechanical comparison of wrist motion and tendon forces.

    Science.gov (United States)

    Debottis, Daniel P; Werner, Frederick W; Sutton, Levi G; Harley, Brian J

    2013-05-01

    Controversy exists as to whether a proximal row carpectomy (PRC) is a better procedure than scaphoid excision with 4-corner arthrodesis for preserving motion in the painful posttraumatic arthritic wrist. The purpose of this study was to determine how the kinematics and tendon forces of the wrist are altered after PRC and 4-corner arthrodesis. We tested 6 fresh cadaver forearms for the extremes of wrist motion and then used a wrist simulator to move them through 4 cyclic dynamic wrist motions, during which time we continuously recorded the tendon forces. We repeated the extremes of wrist motion measurements and the dynamic motions after scaphoid excision with 4-corner arthrodesis, and then again after PRC. We analyzed extremes of wrist motion and the peak tendon forces required for each dynamic motion using a repeated measures analysis of variance. Wrist extremes of motion significantly decreased after both the PRC and 4-corner arthrodesis compared with the intact wrist. Wrist flexion decreased on average 13° after 4-corner arthrodesis and 12° after PRC. Extension decreased 20° after 4-corner arthrodesis and 12° after PRC. Four-corner arthrodesis significantly decreased wrist ulnar deviation from the intact wrist. Four-corner arthrodesis allowed more radial deviation but less ulnar deviation than the PRC. The average peak tendon force was significantly greater after 4-corner arthrodesis than after PRC for the extensor carpi ulnaris during wrist flexion-extension, circumduction, and dart throw motions. The peak forces were significantly greater after 4-corner arthrodesis than in the intact wrist for the extensor carpi ulnaris during the dart throw motion and for the flexor carpi ulnaris during the circumduction motion. The peak extensor carpi radialis brevis force after PRC was significantly less than in the intact wrist. The measured wrist extremes of motion decreased after both 4-corner arthrodesis and PRC. Larger peak tendon forces were required to achieve

  18. ESCAPS study protocol: a feasibility randomised controlled trial of 'Early electrical stimulation to the wrist extensors and wrist flexors to prevent the post-stroke complications of pain and contractures in the paretic arm'.

    Science.gov (United States)

    Fletcher-Smith, Joanna C; Walker, Dawn-Marie; Sprigg, Nikola; James, Marilyn; Walker, Marion F; Allatt, Kate; Mehta, Rajnikant; Pandyan, Anand D

    2016-01-04

    Approximately 70% of patients with stroke experience impaired arm function, which is persistent and disabling for an estimated 40%. Loss of function reduces independence in daily activities and impacts on quality of life. Muscles in those who do not recover functional movement in the stroke affected arm are at risk of atrophy and contractures, which can be established as early as 6 weeks following stroke. Pain is also common. This study aims to evaluate the feasibility of a randomised controlled trial to test the efficacy and cost-effectiveness of delivering early intensive electrical stimulation (ES) to prevent post-stroke complications in the paretic upper limb. This is a feasibility randomised controlled trial (n=40) with embedded qualitative studies (patient/carer interviews and therapist focus groups) and feasibility economic evaluation. Patients will be recruited from the Stroke Unit at the Nottingham University Hospitals National Health Service (NHS) Trust within 72 h after stroke. Participants will be randomised to receive usual care or usual care and early ES to the wrist flexors and extensors for 30 min twice a day, 5 days a week for 3 months. The initial treatment(s) will be delivered by an occupational therapist or physiotherapist who will then train the patient and/or their nominated carer to self-manage subsequent treatments. This study has been granted ethical approval by the National Research Ethics Service, East Midlands Nottingham1 Research Ethics Committee (ref: 15/EM/0006). To our knowledge, this is the first study of its kind of the early application (within 72 h post-stroke) of ES to both the wrist extensors and wrist flexors of stroke survivors with upper limb impairment. The results will inform the design of a definitive randomised controlled trial. Dissemination will include 2 peer-reviewed journal publications and presentations at national conferences. ISRCTN1648908; Pre-results. Clinicaltrials.gov ID: NCT02324634. Published by the BMJ

  19. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture.

    Directory of Open Access Journals (Sweden)

    Su-Ya Lee

    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.

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

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    Akio Minami

    2010-01-01

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

  1. Análise eletromiográfica e força do grupo muscular extensor do punho durante isquemia induzida Electromyographic analysis and strength of the wrist extensor muscle group during induced ischemia

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    CCA Bandeira

    2009-02-01

    Full Text Available OBJETIVO: Avaliar o efeito da isquemia induzida sobre os parâmetros do sinal eletromiográfico e a força do grupo muscular extensor do punho (GMEP em mulheres saudáveis. MÉTODOS: Participaram 13 voluntárias, destras, sedentárias, com idade de 23,38±2,32 anos e índice de massa corporal (IMC de 20,68±1,87kg/m². Para determinar a força do GMEP, foram realizadas 3 contrações isométricas voluntárias máximas (CIVM, utilizando-se uma célula de carga por 15 segundos, com intervalos de 2 minutos entre cada contração, sendo todo procedimento repetido por 3 dias não consecutivos. A isquemia foi realizada por 5 minutos, utilizando um esfigmomanômetro posicionado no braço dominante e inflado até a ausência do fluxo sanguíneo, confirmada pelo ultrassom Doppler. Para coleta do sinal eletromiográfico do GMEP, utilizou-se o equipamento EMG1000 (Lynx® com eletrodo de superfície diferencial (Lynx®. Foram coletadas 3 CIVM por 15 segundos, com intervalo de 30 segundos entre elas, nas situações de pré-isquemia; isquemia; pós-isquemia imediata (pós-1 e pós-isquemia tardia (pós-2 - após 10 minutos do início da isquemia. Para análise dos parâmetros do sinal eletromiográfico, root mean square (RMS, e frequência mediana do espectro de potência do sinal foi utilizado o software MATLAB 6.5.1. Para análise estatística, foram utilizados os testes de Friedman e ANOVA two-way. RESULTADOS: A isquemia promoveu redução significativa (pOBJECTIVE: To analyze the effect of induced ischemia on the parameters of electromyographic signals and the strength of the wrist extensor muscle group (WEMG in healthy women. METHODS: Thirteen right-handed sedentary subjects aged 23.38±2.32 years old, with body mass index (BMI of 20.68±1.87kg/m², took part. To determine WEMG strength, three maximal voluntary isometric contractions (MVIC were performed using a load cell for 15 seconds, with 2 minutes intervals between contractions. The entire

  2. Wrist arthroscopy

    Science.gov (United States)

    Wrist surgery; Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release ... You might need wrist arthroscopy if you have one of these problems: Wrist pain . Arthroscopy allows the surgeon to explore what is causing your wrist ...

  3. Ulnar nerve dysfunction

    Science.gov (United States)

    Neuropathy - ulnar nerve; Ulnar nerve palsy; Mononeuropathy; Cubital tunnel syndrome ... Damage to one nerve group, such as the ulnar nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

  4. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S. [Univ. of California, Orange (United States). Dept. of Radiological Sciences

    2006-11-15

    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.

  5. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

    International Nuclear Information System (INIS)

    Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S.

    2006-01-01

    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

  6. Ulnar nerve entrapment in Guyon's canal due to a lipoma.

    Science.gov (United States)

    Ozdemir, O; Calisaneller, T; Gerilmez, A; Gulsen, S; Altinors, N

    2010-09-01

    Guyon's canal syndrome is an ulnar nerve entrapment at the wrist or palm that can cause motor, sensory or combined motor and sensory loss due to various factors . In this report, we presented a 66-year-old man admitted to our clinic with a history of intermittent pain in the left palm and numbness in 4th and 5th finger for two years. His neurological examination revealed a sensory impairment in the right fifth finger. Also, physical examination displayed a subcutaneous mobile soft tissue in ulnar side of the wrist. Electromyographic examination confirmed the diagnosis of type-1 Guyon's canal syndrome. Under axillary blockage, a lipoma compressing the ulnar nerve was excised totally and ulnar nerve was decompressed. The symptoms were improved after the surgery and patient was symptom free on 3rd postoperative week.

  7. Ulnar nerve damage (image)

    Science.gov (United States)

    The ulnar nerve originates from the brachial plexus and travels down arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near the surface of the body where ...

  8. [Arthroscopically assisted transcapsular refixation of the triangular fibrocartilage complex of the wrist].

    Science.gov (United States)

    Pillukat, T; Fuhrmann, R A; Windolf, J; van Schoonhoven, J

    2016-08-01

    Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist. Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability. Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential. Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment. Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months. In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68-152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0-10), pain at rest was 1 ± 1 (range 0-2) and pain during exercise 2 ± 2 (range 0-5); the DASH score averaged 10 ± 14 points (range 0-39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series. Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.

  9. Palm to Finger Ulnar Sensory Nerve Conduction.

    Science.gov (United States)

    Davidowich, Eduardo; Nascimento, Osvaldo J M; Orsini, Marco; Pupe, Camila; Pessoa, Bruno; Bittar, Caroline; Pires, Karina Lebeis; Bruno, Carlos; Coutinho, Bruno Mattos; de Souza, Olivia Gameiro; Ribeiro, Pedro; Velasques, Bruna; Bittencourt, Juliana; Teixeira, Silmar; Bastos, Victor Hugo

    2015-12-29

    Ulnar neuropathy at the wrist (UNW) is rare, and always challenging to localize. To increase the sensitivity and specificity of the diagnosis of UNW many authors advocate the stimulation of the ulnar nerve (UN) in the segment of the wrist and palm. The focus of this paper is to present a modified and simplified technique of sensory nerve conduction (SNC) of the UN in the wrist and palm segments and demonstrate the validity of this technique in the study of five cases of type III UNW. The SNC of UN was performed antidromically with fifth finger ring recording electrodes. The UN was stimulated 14 cm proximal to the active electrode (the standard way) and 7 cm proximal to the active electrode. The normal data from amplitude and conduction velocity (CV) ratios between the palm to finger and wrist to finger segments were obtained. Normal amplitude ratio was 1.4 to 0.76. Normal CV ratio was 0.8 to 1.23.We found evidences of abnormal SNAP amplitude ratio or substantial slowing of UN sensory fibers across the wrist in 5 of the 5 patients with electrophysiological-definite type III UNW.

  10. Palm to finger ulnar sensory nerve conduction

    Directory of Open Access Journals (Sweden)

    Eduardo Davidowich

    2015-12-01

    Full Text Available Ulnar neuropathy at the wrist (UNW is rare, and always challenging to localize. To increase the sensitivity and specificity of the diagnosis of UNW many authors advocate the stimulation of the ulnar nerve (UN in the segment of the wrist and palm. The focus of this paper is to present a modified and simplified technique of sensory nerve conduction (SNC of the UN in the wrist and palm segments and demonstrate the validity of this technique in the study of five cases of type III UNW. The SNC of UN was performed antidromically with fifth finger ring recording electrodes. The UN was stimulated 14 cm proximal to the active electrode (the standard way and 7 cm proximal to the active electrode. The normal data from amplitude and conduction velocity (CV ratios between the palm to finger and wrist to finger segments were obtained. Normal amplitude ratio was 1.4 to 0.76. Normal CV ratio was 0.8 to 1.23.We found evidences of abnormal SNAP amplitude ratio or substantial slowing of UN sensory fibers across the wrist in 5 of the 5 patients with electrophysiological-definite type III UNW.

  11. Longitudinal, lateral and transverse axes of forearm muscles influence the crosstalk in the mechanomyographic signals during isometric wrist postures.

    Science.gov (United States)

    Islam, Md Anamul; Sundaraj, Kenneth; Ahmad, R Badlishah; Sundaraj, Sebastian; Ahamed, Nizam Uddin; Ali, Md Asraf

    2014-01-01

    In mechanomyography (MMG), crosstalk refers to the contamination of the signal from the muscle of interest by the signal from another muscle or muscle group that is in close proximity. The aim of the present study was two-fold: i) to quantify the level of crosstalk in the mechanomyographic (MMG) signals from the longitudinal (Lo), lateral (La) and transverse (Tr) axes of the extensor digitorum (ED), extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) muscles during isometric wrist flexion (WF) and extension (WE), radial (RD) and ulnar (UD) deviations; and ii) to analyze whether the three-directional MMG signals influence the level of crosstalk between the muscle groups during these wrist postures. Twenty, healthy right-handed men (mean ± SD: age = 26.7±3.83 y; height = 174.47±6.3 cm; mass = 72.79±14.36 kg) participated in this study. During each wrist posture, the MMG signals propagated through the axes of the muscles were detected using three separate tri-axial accelerometers. The x-axis, y-axis, and z-axis of the sensor were placed in the Lo, La, and Tr directions with respect to muscle fibers. The peak cross-correlations were used to quantify the proportion of crosstalk between the different muscle groups. The average level of crosstalk in the MMG signals generated by the muscle groups ranged from: 34.28-69.69% for the Lo axis, 27.32-52.55% for the La axis and 11.38-25.55% for the Tr axis for all participants and their wrist postures. The Tr axes between the muscle groups showed significantly smaller crosstalk values for all wrist postures [F (2, 38) = 14-63, pmovement research, especially for the examination of muscle mechanics during various types of the wrist postures.

  12. Transfer of extensor digiti minimi and extensor carpi ulnaris nerve branches to the intrinsic motor nerve branches: A histological study on cadaver.

    Science.gov (United States)

    Namazi, H; Haji Vandi, S

    2017-06-01

    In cases of high ulnar and median nerve palsy, result of nerve repair in term of intrinsic muscle recovery is unsatisfactory. Distal nerve transfer can alleviate the regeneration time and improve the results. Transfer of the extensor digiti minimi (EDM) and extensor carpi ulnaris (ECU) nerve branches to the deep branch of ulnar nerve (DBUN)/recurrent branch of median nerve (RMN) at wrist had been used to restore intrinsic hand function but, incomplete recovery occurred. The axon count at the donor nerve has a strong influence on the final results. This cadaveric study aims to analyses the histology of this nerve transfer to evaluate whether these donor nerves are suitable for this transfer or another donor nerve may be considered. Ten cadaveric upper limbs dissected to identify the location of the EDM, ECU, RMN and DBUN. Surface area, fascicle count, and axon number was determined by histological methods. The mean of axon number in the EDM, ECU, RMN and DBUN branches was 5931, 7355, 30960 and 35426, respectively. In this study, the number of axons in the EDM and ECU branches was 37% (13281/35426) of that in the DBUN. Also, the number of axons in the EDM and ECU branches was 42% (13281/30960) of that in the RMN. The axon count data showed an unfavorable match between the EDM, ECU and DBUN/RMN. Therefore, it is suggested that another donor nerve with higher axon number to be considered. Cadaver study (histological study). Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Different findings in bone scintigraphy between ulnar impaction syndrome and Kienbock's disease

    International Nuclear Information System (INIS)

    Chung, J.K.; Lee, H.Y.; Lee, M.C.; Baik, G.H.

    2002-01-01

    Objectives: There is an ethnic variance on the length of the ulnar and radius. In Caucasian the length of the radius is relatively longer than the ulnar, but in Oriental the length of the ulnar is longer. This difference results in the different ethnic prevalence of ulnar impaction syndrome and Kienbock's disease, avascular necrosis of the lunate. It is important to differentiate ulnar impaction syndrome from Kienbock's disease, because they show similar symptoms but need different treatment and different method of operation. Methods: Seventeen patients with the wrist pain were enrolled in this study (mean age: 45+/-13yrs M:F=12:5). Nine patients were diagnosed as Kienbock's disease and Eight patients were diagnosed as ulnar impaction. Three to four hours after injection of 20mCi of Tc-99m MDP, bone scintigraphy images of the both hands were obtained and analyzed visually. Results: In Kienbock's disease, 8 patients showed increased uptake in the lunate with or without other carpal bones. One patient showed photon defect in the lunate. Otherwise in all patients with ulnar impaction syndrome, increased uptakes were found in the lunate, with or without increase uptake in the triquetrum or the distal ulnar, which are related to triangular fibrocartilage complex. Pin hole scintigraphy and pin hole SPECT demonstrated more precise structure of the wrist. Conclusion: We could differentiate ulnar impaction syndrome from Kienbock's disease in bone scan. We should carefully evaluate bone scintigraphic findings in patients with wrist pain

  14. A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

    Science.gov (United States)

    Song, Hyun Seok

    2011-01-01

    Background This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. Methods The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. Results The modified Mayo wrist score in groups A, B, and C was 74.5 ± 8.9, 73.9 ± 11.6, and 61.3 ± 10.2, respectively (p 0.05). Conclusions Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable. PMID:21909465

  15. Double-compartment wrist arthrography

    International Nuclear Information System (INIS)

    Quinn, S.F.; Pittman, C.; Belsole, R.; Greene, T.L.; Rayhack, J.; Clark, R.A.; King, P.S.

    1987-01-01

    Seventy patients with clinical wrist problems were studied with double-compartment wrist arthrography. Midcarpal and radiocarpal compartment arthrograms were obtained in all patients. Digital subtraction technique was used to subtract out contrast from the first compartmental injection. Digital technique also allowed a dynamic record of each injection, which helped determine sites of intercompartmental communication. Postarthrography exercises recorded on videotape were performed after each injection. There were 34 normal studies. Abnormalities in the other 36 patients included: scapholunate communication (n = 9), lunatotriquetral communication (n = 6), communication with tendon sheaths (n = 4), communication with distal radioulnar compartment (n = 14), abnormal synovium process (n = 9), and communication through the radial or ulnar collateral ligament (n = 3). Double-compartment wrist arthrography may provide additional information for complex problems of the wrist

  16. Wrist and Hand Ultrasound: Reliability of Side-to-Side Comparisons of Very Small (Structures.

    Science.gov (United States)

    Rossi, Federica; Romano, Nicola; Muda, Alessandro; Martinoli, Carlo; Tagliafico, Alberto

    2018-04-24

    In ultrasound (US) examinations of clinically relevant very small structures of the wrist and hand, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intraindividual side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side US evaluations of very small structures of the wrist and hand. Forty-one healthy volunteers were prospectively studied. Small structures of the wrist and hand were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The first annular pulleys of the second finger and the thumb, sagittal band of the third finger, extensor and flexor retinacula, ulnar collateral ligament of the thumb, radial collateral ligament of the second finger, and palmar cutaneous branches of the median and ulnar nerves were considered. To assess intra- and inter-reader agreement, 10 of 41 (24%) examinations were repeated. Nonparametric statistics were used. Data were not normally distributed (P > .001). Intra-reader agreement was κ = 0.674 (95% confidence interval [CI], 0.57-0.78), and inter-reader agreement was κ = 0.935 (95% CI, 0.92-0.95). The mean value ± SD for all of the structures was 0.78 ± 0.44 mm. The overall coefficient of variation was 9.8% ± 0.07%. The intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98). In clinical practice, the healthy contralateral side can be used as a reference during a real-time musculoskeletal US evaluation of small (structures. © 2018 by the American Institute of Ultrasound in Medicine.

  17. Median and ulnar neuropathies in university guitarists.

    Science.gov (United States)

    Kennedy, Rachel H; Hutcherson, Kimberly J; Kain, Jennifer B; Phillips, Alicia L; Halle, John S; Greathouse, David G

    2006-02-01

    Descriptive study. To determine the presence of median and ulnar neuropathies in both upper extremities of university guitarists. Peripheral nerve entrapment syndromes of the upper extremities are well documented in musicians. Guitarists and plucked-string musicians are at risk for entrapment neuropathies in the upper extremities and are prone to mild neurologic deficits. Twenty-four volunteer male and female guitarists (age range, 18-26 years) were recruited from the Belmont University School of Music and the Vanderbilt University Blair School of Music. Individuals were excluded if they were pregnant or had a history of recent upper extremity or neck injury. Subjects completed a history form, were interviewed, and underwent a physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities was obtained by performing motor, sensory, and F-wave (central) nerve conduction studies. Descriptive statistics of the nerve conduction study variables were computed using Microsoft Excel. Six subjects had positive findings on provocative testing of the median and ulnar nerves. Otherwise, these guitarists had normal upper extremity neural and musculoskeletal function based on the history and physical examinations. When comparing the subjects' nerve conduction study values with a chart of normal nerve conduction studies values, 2 subjects had prolonged distal motor latencies (DMLs) of the left median nerve of 4.3 and 4.7 milliseconds (normal, DMLs are compatible with median neuropathy at or distal to the wrist. Otherwise, all electrophysiological variables were within normal limits for motor, sensory, and F-wave (central) values. However, comparison studies of median and ulnar motor latencies in the same hand demonstrated prolonged differences of greater than 1.0 milliseconds that affected the median nerve in 2 additional subjects, and identified contralateral limb involvement in a subject with a prolonged distal latency. The other 20

  18. Assessment of ulnar variance: a radiological investigation in a Dutch population

    Energy Technology Data Exchange (ETDEWEB)

    Schuurman, A.H. [Dept. of Plastic, Reconstructive and Hand Surgery, University Medical Centre, Utrecht (Netherlands); Dept. of Plastic Surgery, University Medical Centre, Utrecht (Netherlands); Maas, M.; Dijkstra, P.F. [Dept. of Radiology, Univ. of Amsterdam (Netherlands); Kauer, J.M.G. [Dept. of Anatomy and Embryology, Univ. of Nijmegen (Netherlands)

    2001-11-01

    Objective: A radiological study was performed to evaluate ulnar variance in 68 Dutch patients using an electronic digitizer compared with Palmer's concentric circle method. Using the digitizer method only, the effect of different wrist positions and grip on ulnar variance was then investigated. Finally the distribution of ulnar variance in the selected patients was investigated also using the digitizer method. Design and patients: All radiographs were performed with the wrist in a standard zero-rotation position (posteroanterior) and in supination (anteroposterior). Palmer's concentric circle method and an electronic digitizer connected to a personal computer were used to measure ulnar variance. The digitizer consists of a Plexiglas plate with an electronically activated grid beneath it. A radiograph is placed on the plate and a cursor activates a point on the grid. Three plots are marked on the radius and one plot on the most distal part of the ulnar head. The digitizer then determines the difference between a radius passing through the radius plots and the ulnar plot. Results and conclusions: Using the concentric circle method we found an ulna plus predominance, but an ulna minus predominance when using the digitizer method. Overall the ulnar variance distribution for Palmer's method was 41.9% ulna plus, 25.7% neutral and 32.4% ulna minus variance, and for the digitizer method was 40.4% ulna plus, 1.5% neutral and 58.1% ulna minus. The percentage ulnar variance greater than 1 mm on standard radiographs increased from 23% to 58% using the digitizer, with maximum grip, clearly demonstrating the (dynamic) effect of grip on ulnar variance. This almost threefold increase was found to be a significant difference. Significant differences were found between ulnar variance when different wrist positions were compared. (orig.)

  19. Analysis of ulnar variance as a risk factor for developing scaphoid nonunion.

    Science.gov (United States)

    Lirola-Palmero, S; Salvà-Coll, G; Terrades-Cladera, F J

    2015-01-01

    Ulnar variance may be a risk factor of developing scaphoid non-union. A review was made of the posteroanterior wrist radiographs of 95 patients who were diagnosed of scaphoid fracture. All fractures with displacement less than 1mm treated conservatively were included. The ulnar variance was measured in all patients. Ulnar variance was measured in standard posteroanterior wrist radiographs of 95 patients. Eighteen patients (19%) developed scaphoid nonunion, with a mean value of ulnar variance of -1.34 (-/+ 0.85) mm (CI -2.25 - 0.41). Seventy seven patients (81%) healed correctly, and the mean value of ulnar variance was -0.04 (-/+ 1.85) mm (CI -0.46 - 0.38). A significant difference was observed in the distribution of ulnar variance (pvariance less than -1mm, and ulnar variance greater than -1mm. It appears that patients with ulnar variance less than -1mm had an OR 4.58 (CI 1.51 to 13.89) with pvariance less than -1mm have a greater risk of developing scaphoid nonunion, OR 4.58 (CI 1.51 to 13.89) with p<.007. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  20. Traumatic Distal Ulnar Artery Thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet A. Karaarslan

    2014-01-01

    Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

  1. Smartphone photography utilized to measure wrist range of motion.

    Science.gov (United States)

    Wagner, Eric R; Conti Mica, Megan; Shin, Alexander Y

    2018-02-01

    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.

  2. Ganglion Cyst Associated with Triangular Fibrocartilage Complex Tear That Caused Ulnar Nerve Compression

    Directory of Open Access Journals (Sweden)

    Ugur Anil Bingol, MD

    2015-03-01

    Full Text Available Summary: Ganglions are the most frequently seen soft-tissue tumors in the hand. Nerve compression due to ganglion cysts at the wrist is rare. We report 2 ganglion cysts arising from triangular fibrocartilage complex, one of which caused ulnar nerve compression proximal to the Guyonʼs canal, leading to ulnar neuropathy. Ganglion cysts seem unimportant, and many surgeons refrain from performing a general hand examination.

  3. MR Imaging and US of the Wrist Tendons.

    Science.gov (United States)

    Plotkin, Benjamin; Sampath, Srihari C; Sampath, Srinath C; Motamedi, Kambiz

    2016-10-01

    The tendons of the wrist are commonly symptomatic. They can be injured, infected, or inflamed. Magnetic resonance imaging and ultrasonography are useful tools for evaluating the wrist. Pathologic conditions of the wrist tendons include de Quervain tenosynovitis, extensor carpi ulnaris tendinopathy, rheumatoid tenosynovitis, infectious synovitis, tendon tears, hydroxyapatite deposition disease, intersection syndrome, tenosynovial giant cell tumor, and fibroma of the tendon sheath. In this article, we review the normal appearance of the wrist tendons, discuss relevant anatomy, and give an overview of common pathologic conditions affecting the wrist tendons. Online supplemental material is available for this article. © RSNA, 2016.

  4. Longitudinal, lateral and transverse axes of forearm muscles influence the crosstalk in the mechanomyographic signals during isometric wrist postures.

    Directory of Open Access Journals (Sweden)

    Md Anamul Islam

    Full Text Available In mechanomyography (MMG, crosstalk refers to the contamination of the signal from the muscle of interest by the signal from another muscle or muscle group that is in close proximity.The aim of the present study was two-fold: i to quantify the level of crosstalk in the mechanomyographic (MMG signals from the longitudinal (Lo, lateral (La and transverse (Tr axes of the extensor digitorum (ED, extensor carpi ulnaris (ECU and flexor carpi ulnaris (FCU muscles during isometric wrist flexion (WF and extension (WE, radial (RD and ulnar (UD deviations; and ii to analyze whether the three-directional MMG signals influence the level of crosstalk between the muscle groups during these wrist postures.Twenty, healthy right-handed men (mean ± SD: age = 26.7±3.83 y; height = 174.47±6.3 cm; mass = 72.79±14.36 kg participated in this study. During each wrist posture, the MMG signals propagated through the axes of the muscles were detected using three separate tri-axial accelerometers. The x-axis, y-axis, and z-axis of the sensor were placed in the Lo, La, and Tr directions with respect to muscle fibers. The peak cross-correlations were used to quantify the proportion of crosstalk between the different muscle groups.The average level of crosstalk in the MMG signals generated by the muscle groups ranged from: 34.28-69.69% for the Lo axis, 27.32-52.55% for the La axis and 11.38-25.55% for the Tr axis for all participants and their wrist postures. The Tr axes between the muscle groups showed significantly smaller crosstalk values for all wrist postures [F (2, 38 = 14-63, p<0.05, η2 = 0.416-0.769].The results may be applied in the field of human movement research, especially for the examination of muscle mechanics during various types of the wrist postures.

  5. Risk factors for hand-wrist disorders in repetitive work

    DEFF Research Database (Denmark)

    Thomsen, J. F.; Mikkelsen, S.; Andersen, JH

    2007-01-01

    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...... (wrist pain and palpation tenderness) were determined in 3123 employees in 19 industrial settings. With the use of questionnaires and video recordings of homogenous work tasks number of wrist movements, hand force requirements and wrist position were analysed as risk factors for hand-wrist disorders......, controlling for potential personal and psychosocial confounders. All participants were re-examined three times during a follow-up period of three years. RESULTS: Force but not repetition and position was related to hand-wrist pain and possible tendonitis in the baseline analyses showing an exposure...

  6. Wrist Pain

    Science.gov (United States)

    ... at a keyboard, take regular breaks. When you type, keep your wrist in a relaxed, neutral position. An ergonomic ... of Nondiscrimination Advertising Mayo Clinic is a not-for-profit organization ...

  7. Wrist arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, S.G. (Dept. of Diagnostic Radiology, University Hospital, Linkoeping (Sweden))

    1993-03-01

    The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congential perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC. (orig.).

  8. A comparison of 3-D computed tomography versus 2-D radiography measurements of ulnar variance and ulnolunate distance during forearm rotation.

    Science.gov (United States)

    Kawanishi, Y; Moritomo, H; Omori, S; Kataoka, T; Murase, T; Sugamoto, K

    2014-06-01

    Positive ulnar variance is associated with ulnar impaction syndrome and ulnar variance is reported to increase with pronation. However, radiographic measurement can be affected markedly by the incident angle of the X-ray beam. We performed three-dimensional (3-D) computed tomography measurements of ulnar variance and ulnolunate distance during forearm rotation and compared these with plain radiographic measurements in 15 healthy wrists. From supination to pronation, ulnar variance increased in all cases on the radiographs; mean ulnar variance increased significantly and mean ulnolunate distance decreased significantly. However on 3-D imaging, ulna variance decreased in 12 cases on moving into pronation and increased in three cases; neither the mean ulnar variance nor mean ulnolunate distance changed significantly. Our results suggest that the forearm position in which ulnar variance increased varies among individuals. This may explain why some patients with ulnar impaction syndrome complain of wrist pain exacerbated by forearm supination. It also suggests that standard radiographic assessments of ulnar variance are unreliable. © The Author(s) 2013.

  9. Not all sagittal band tears come with extensor instability. A case report with radiological and operative correlation

    International Nuclear Information System (INIS)

    Li, Shuo; Jacob, Jubin; Ghasemiesfe, Ahmadreza; Marrinan, Greg B.; Brooks, Jeffrey J.

    2018-01-01

    The sagittal bands are a component of the extensor hood. They serve an important role in stabilizing the extensor tendon by forming a ''check-rein'' to radial-ulnar translation of the tendon over the metacarpal head, and extending the metacarpophalangeal (MCP) joint by virtue of attaching the extensor tendon to the palmar plate. Injury to the sagittal band is thought to cause extensor instability and subluxation to the contralateral side by disruption of this ''check-rein'' function, although recent evidence from cadaver studies suggests that ulnar sagittal band tear may be spared of extensor instability. As a case in point, we encountered a patient with surgically proven ulnar sagittal band tear, who did not have any extensor tendon subluxation or any limitation in motion. Intraoperative findings demonstrated a chronic-appearing ulnar sagittal band tear, indicating that chronic injury with fibrosis may stabilize the central band. Therefore, in patients with metacarpophalangeal pain without central tendon subluxation or limitation of motion, it remains important to raise the concern of sagittal band tear for appropriate treatment. We present the clinical course of this case, with radiological and operative findings, followed by a review of the relevant literature. (orig.)

  10. Not all sagittal band tears come with extensor instability. A case report with radiological and operative correlation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Shuo; Jacob, Jubin; Ghasemiesfe, Ahmadreza; Marrinan, Greg B. [Yale New Haven Health Bridgeport Hospital, Bridgeport, CT (United States); Brooks, Jeffrey J. [Orthopedic Surgery and Sports Medicine Center, New Canaan, CT (United States)

    2018-04-15

    The sagittal bands are a component of the extensor hood. They serve an important role in stabilizing the extensor tendon by forming a ''check-rein'' to radial-ulnar translation of the tendon over the metacarpal head, and extending the metacarpophalangeal (MCP) joint by virtue of attaching the extensor tendon to the palmar plate. Injury to the sagittal band is thought to cause extensor instability and subluxation to the contralateral side by disruption of this ''check-rein'' function, although recent evidence from cadaver studies suggests that ulnar sagittal band tear may be spared of extensor instability. As a case in point, we encountered a patient with surgically proven ulnar sagittal band tear, who did not have any extensor tendon subluxation or any limitation in motion. Intraoperative findings demonstrated a chronic-appearing ulnar sagittal band tear, indicating that chronic injury with fibrosis may stabilize the central band. Therefore, in patients with metacarpophalangeal pain without central tendon subluxation or limitation of motion, it remains important to raise the concern of sagittal band tear for appropriate treatment. We present the clinical course of this case, with radiological and operative findings, followed by a review of the relevant literature. (orig.)

  11. Spontaneous Rupture of the Extensor Pollicis Longus Tendon due to Unusual Etiology

    Directory of Open Access Journals (Sweden)

    Süleyman Taş

    2014-03-01

    Full Text Available Background: The etiology of spontaneous rupture of the extensor pollicis longus tendon includes systemic or local steroid injections, wrist fracture, tenosynovitis, synovitis, rheumatoid arthritis, and repetitive wrist motions. Case Report: We encountered a case of extensor pollicis longus tendon rupture with an unusual etiology, cow milking. In this case, transfer of the extensor indicis proprius tendon was performed successfully. At 1 year after surgery, extension of the thumb was sufficient. Conclusion: It appears that patients with occupations involving repetitive motions are at a high risk of closed tendon ruptures.

  12. Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome.

    Science.gov (United States)

    Araújo, Rogério Gayer Machado de; Kouyoumdjian, João Aris

    2007-09-01

    Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU) in electrodiagnosis of carpal tunnel syndrome (CTS). Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands). Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands). PMU was obtained at the usual temperature, >32 degrees C, and after wrist/hand cooling to PMU and mixed ulnar palmar latency in patients versus controls. We concluded that cooling significantly modifies the PMU. We propose that the latencies of compressed nerve overreact to cooling and that this response could be a useful tool for incipient CTS electrodiagnosis. There was a significant latency overreaction of the ulnar nerve to cooling in CTS patients. We hypothesize that subclinical ulnar nerve compression is associated with CTS.

  13. Wrist Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Fractures Email to a friend * required fields ...

  14. Wrist Sprains

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Sprains Email to a friend * required fields ...

  15. Wrist Arthroscopy

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Arthroscopy Email to a friend * required fields ...

  16. How does ulnar shortening osteotomy influence morphologic changes in the triangular fibrocartilage complex?

    Science.gov (United States)

    Yamanaka, Yoshiaki; Nakamura, Toshiyasu; Sato, Kazuki; Toyama, Yoshiaki

    2014-11-01

    Ulnar shortening osteotomy often is indicated for treatment of injuries to the triangular fibrocartilage complex (TFCC). However, the effect of ulnar shortening osteotomy on the changes in shape of the TFCC is unclear. In our study, quantitative evaluations were performed using MRI to clarify the effect of ulnar shortening on triangular fibrocartilage (TFC) thickness attributable to disc regeneration of the TFC and TFC angle attributable to the suspension effect of ulnar shortening on the TFC. The purposes of this study were (1) to compare preoperative and postoperative TFC thickness and TFC angle on MR images to quantitatively evaluate the effect of ulnar shortening osteotomy on disc regeneration and the suspension effect on the TFC; and (2) to assess whether changes in TFC thickness and TFC angle correlated with the Mayo wrist score. Between 1995 and 2008, 256 patients underwent ulnar shortening osteotomy for TFCC injuries. The minimum followup was 24 months (mean, 51 months; range, 24-210 months). A total of 79 patients (31%) with complete followup including preoperative and postoperative MR images and the Mayo wrist score was included in this retrospective study. Evaluation of the postoperative MR images and the Mayo wrist score were performed at the final followup. The remaining 177 patients did not undergo postoperative MRI, or they had a previous fracture, large tears of the disc proper, or were lost to followup. Two orthopaedists, one of whom performed the surgeries, measured the TFC thickness and the TFC angle on coronal MR images before and after surgery for each patient. Correlations of the percent change in the TFC thickness and the magnitude of TFC angle change with age, sex, postoperative MR images, extent of ulnar shortening, preoperative ulnar variance, and postoperative Mayo wrist score were assessed. Stepwise regression analysis showed a correlation between the percent change in TFC thickness and preoperative ulnar variance (R2=0.21; β=-0.33; 95

  17. Tuberculous Tenosynovitis Presenting as Ganglion of Wrist

    Directory of Open Access Journals (Sweden)

    Shahaji Chavan

    2012-01-01

    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.

  18. MRI features in de Quervain's tenosynovitis of the wrist

    International Nuclear Information System (INIS)

    Glajchen, N.; Schweitzer, M.

    1996-01-01

    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.)

  19. Productive osseous changes about the wrist in rheumatoid arthritis

    International Nuclear Information System (INIS)

    Cantor, R.M.; Braunstein, E.M.

    1987-01-01

    Radiographs of 225 consecutive patients with adult-form rheumatoid arthritis were examined for evidence of productive osseous changes about the wrist. The prevalence of new bone on the ulnar styloid was 10%. This form of new bone is probably due to overlying chronic tenosynovitis. A collar of new bone around the ulnar head is a result of degenerative change in the distal radioulnar joint. In general, productive osseous changes in theumatoid arthritis may represent inflammatory periosteal bone formation, osteophytosis, or contact remodeling. We found no evidence of an association between diffuse idiopathic skeletal hyperostosis and extensive productive osseous changes in patients with rheumatoid arthritis. (orig.)

  20. Productive osseous changes about the wrist in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Cantor, R.M.; Braunstein, E.M.

    1987-07-01

    Radiographs of 225 consecutive patients with adult-form rheumatoid arthritis were examined for evidence of productive osseous changes about the wrist. The prevalence of new bone on the ulnar styloid was 10%. This form of new bone is probably due to overlying chronic tenosynovitis. A collar of new bone around the ulnar head is a result of degenerative change in the distal radioulnar joint. In general, productive osseous changes in theumatoid arthritis may represent inflammatory periosteal bone formation, osteophytosis, or contact remodeling. We found no evidence of an association between diffuse idiopathic skeletal hyperostosis and extensive productive osseous changes in patients with rheumatoid arthritis.

  1. Wpływ prądów TENS średniej częstotliwości na czynność bioelektyczną mięśni prostowników nadgarstka = The influence of mid-frequency TENS currents on bioelectrical activity of the wrist extensor muscles

    Directory of Open Access Journals (Sweden)

    Grzegorz Srokowski

    2015-09-01

    wrist extensor muscle and ulnaris showed a decrease in firing rate of bioelectric muscle under the influence of currents of medium frequency TENS. This study allows for an objective document activity involved in muscle movement during functional activities. 2. Kinesiology EMG allows for quick and effective action possible to verify TENS currents during the rehabilitation procedure, it is an effective therapeutic method.   Key words: electrostimulation, TENS, EMG.

  2. Arthroscopic Wrist Anatomy

    National Research Council Canada - National Science Library

    Taylor, Nathan

    2004-01-01

    .... Arthroscopy of the wrist is now a primary method of evaluating and treating many intra-articular wrist conditions including triangular fibrocartilage complex tears, chondral injuries, distal radius...

  3. Extensor Tendon Injuries

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Extensor Tendon Injuries Email to a friend * required ...

  4. Diagnostic values of bone scintigram for painful disorders of the hand and the wrist

    International Nuclear Information System (INIS)

    Ogura, Kazuhisa; Yamauchi, Yasuo; Kusunose, Koichi; Sugiyama, Masaru; Honjou, Yuji

    1998-01-01

    From April 1993 to April 1997, 43 patients underwent bone scintigraphic examination for various painful conditions in the hand and the wrist joint. Three hours after an intravenous injection of 740 MBq of TC-99m HMDP, wrist scintigram was obtained. Of 18 patients with ulnar wrist pain, 12 patients had positive scan. The accumulation pattern in the five cases of ulnocarpal abutment syndrome showed different patterns. Slight difference of the accumulation between the ulnar head and the ulnar styloid process was well differentiated. Each carpal bone could be well identified, but when two bones were overlapping as in the triquetrum and the pisiform, additional physical findings were helpful. Six patients showed negative scan. The two patients with positive triangular fibrocartilage (TFC) tear but with negative bone scan showed no bony involvement, whereas those with TFC tear and positive scan were the ones having some bony disorders such as ulnocarpal abutment syndrome. Of 25 patients with wrist pain other than ulnar pain, 14 patients had positive scan. The remaining 11 patients who had negative scan included three patients with occult ganglion, two with wrist sprain and six with various disorders. (K.H.)

  5. Diagnostic values of bone scintigram for painful disorders of the hand and the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Ogura, Kazuhisa; Yamauchi, Yasuo; Kusunose, Koichi; Sugiyama, Masaru; Honjou, Yuji [Juntendo Univ., Tokyo (Japan). School of Medicine

    1998-02-01

    From April 1993 to April 1997, 43 patients underwent bone scintigraphic examination for various painful conditions in the hand and the wrist joint. Three hours after an intravenous injection of 740 MBq of TC-99m HMDP, wrist scintigram was obtained. Of 18 patients with ulnar wrist pain, 12 patients had positive scan. The accumulation pattern in the five cases of ulnocarpal abutment syndrome showed different patterns. Slight difference of the accumulation between the ulnar head and the ulnar styloid process was well differentiated. Each carpal bone could be well identified, but when two bones were overlapping as in the triquetrum and the pisiform, additional physical findings were helpful. Six patients showed negative scan. The two patients with positive triangular fibrocartilage (TFC) tear but with negative bone scan showed no bony involvement, whereas those with TFC tear and positive scan were the ones having some bony disorders such as ulnocarpal abutment syndrome. Of 25 patients with wrist pain other than ulnar pain, 14 patients had positive scan. The remaining 11 patients who had negative scan included three patients with occult ganglion, two with wrist sprain and six with various disorders. (K.H.)

  6. Estimation of Thermal Sensation Based on Wrist Skin Temperatures

    Science.gov (United States)

    Sim, Soo Young; Koh, Myung Jun; Joo, Kwang Min; Noh, Seungwoo; Park, Sangyun; Kim, Youn Ho; Park, Kwang Suk

    2016-01-01

    Thermal comfort is an essential environmental factor related to quality of life and work effectiveness. We assessed the feasibility of wrist skin temperature monitoring for estimating subjective thermal sensation. We invented a wrist band that simultaneously monitors skin temperatures from the wrist (i.e., the radial artery and ulnar artery regions, and upper wrist) and the fingertip. Skin temperatures from eight healthy subjects were acquired while thermal sensation varied. To develop a thermal sensation estimation model, the mean skin temperature, temperature gradient, time differential of the temperatures, and average power of frequency band were calculated. A thermal sensation estimation model using temperatures of the fingertip and wrist showed the highest accuracy (mean root mean square error [RMSE]: 1.26 ± 0.31). An estimation model based on the three wrist skin temperatures showed a slightly better result to the model that used a single fingertip skin temperature (mean RMSE: 1.39 ± 0.18). When a personalized thermal sensation estimation model based on three wrist skin temperatures was used, the mean RMSE was 1.06 ± 0.29, and the correlation coefficient was 0.89. Thermal sensation estimation technology based on wrist skin temperatures, and combined with wearable devices may facilitate intelligent control of one’s thermal environment. PMID:27023538

  7. Positioning of the wrist for scaphoid radiography

    International Nuclear Information System (INIS)

    Toth, Ferenc; Sebestyen, Andor; Balint, Lehel; Mester, Sandor; Szabo, Gyorgy; Nyarady, Jozsef; Weninger, Csaba; Angyal, Miklos; Lovasz, Gyorgy

    2007-01-01

    Purpose: The purpose of this cadaver study was to determine the ideal position of the wrist for scaphoid radiography. Materials and methods: Four cadaver wrists were rotated around their longitudinal axis in 15 deg. increments and exposures were taken. Seven postero-anterior images were taken as well. Thus, 18 images of each wrist were available for assessment. Views were determined in which the main anatomic regions of the scaphoid were visualized undistorted. The size and localization of the overlap of other carpal bones were also evaluated. Finally, views with the best visualization of anatomic landmarks were selected. The results of these three investigations were compared to literature data. Results: We consider the following four images the most valuable in the diagnostic imaging of scaphoid bone: (1) Postero-anterior view in ulnar deviation of wrist and fist position of the hand; (2) oblique view in 60 deg. of pronation; (3) oblique view in 60 deg. of supination; (4) lateral view. Conclusion: We concluded that our four views are sufficient for proper radiographic evaluation of the scaphoid

  8. Role of MR imaging in chronic wrist pain

    International Nuclear Information System (INIS)

    Zanetti, Marco; Saupe, Nadja; Nagy, Ladislav

    2007-01-01

    Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienboeck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain. (orig.)

  9. Role of MR imaging in chronic wrist pain

    Energy Technology Data Exchange (ETDEWEB)

    Zanetti, Marco; Saupe, Nadja [University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Nagy, Ladislav [University Hospital Balgrist, Department of Orthopedic Surgery, Zurich (Switzerland)

    2007-04-15

    Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienboeck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain. (orig.)

  10. Decoupling the Wrist: A Cadaveric Experiment Examining Wrist Kinematics Following Midcarpal Fusion and Scaphoid Excision

    Science.gov (United States)

    Nichols, Jennifer A.; Bednar, Michael S.; Havey, Robert M.; Murray, Wendy M.

    2016-01-01

    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 four-corner fusion (4CF) and scaphoid-excision four-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 eight cadaveric specimens using an optimization algorithm, which fit a two-revolute joint model to experimental data. In each specimen, data measuring the motion of the third metacarpal relative to the radius was collected for three 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 (i.e., 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 percent 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. PMID:27705062

  11. Open extensor tendon injuries: an epidemiologic study.

    Science.gov (United States)

    Patillo, Dominic; Rayan, Ghazi M

    2012-01-01

    To report the epidemiology, mechanism, anatomical location, distribution, and severity of open extensor tendon injuries in the digits, hand, and forearm as well as the frequency of associated injuries to surrounding bone and soft tissue. Retrospective chart review was conducted for patients who had operative repair of open digital extensor tendon injuries in all zones within an 11-year period. Data was grouped according to patient characteristics, zone of injury, mechanism of injury, and presence of associated injury. Statistical analysis was used to determine the presence of relevant associations. Eighty-six patients with 125 severed tendons and 105 injured digits were available for chart reviews. Patients were predominantly males (83%) with a mean age of 34.2 years and the dominant extremity was most often injured (60%). The thumb was the most commonly injured (25.7%), followed by middle finger (24.8), whereas small finger was least affected (10.5%). Sharp laceration was the most common mechanism of injury (60%), and most of these occurred at or proximal to the metacarpophalangeal joints. Most saw injuries occurred distal to the metacarpophalangeal joint. Zone V was the most commonly affected in the fingers (27%) while zone VT was the most commonly affected in the thumb (69%). Associated injuries to bone and soft tissue occurred in 46.7% of all injuries with saw and crush/avulsions being predictive of fractures and damage to the underlying joint capsule. The extensor mechanism is anatomically complex, and open injuries to the dorsum of the hand, wrist, and forearm, especially of crushing nature and those inflicted by saws, must be thoroughly evaluated. Associated injuries should be ruled out in order to customize surgical treatment and optimize outcome.

  12. [Treatment of triangular fibrocartilage complex tear under wrist arthroscopy].

    Science.gov (United States)

    Mi, Kun; Liu, Wu; Liu, Pengfei; Feng, Zhibin; Li, Yuwen; Hui, Guisheng

    2011-01-01

    To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC). Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12 cases, and by falling in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main clinical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and lifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 +/- 5.18) degrees at volar flexion, (41.22 +/- 3.83) degrees at dorsal extension, (17.82 +/- 2.48) degrees at radial deviation, (21.35 +/- 4.61) degrees at ulnar deviation, (69.85 +/- 8.36) degrees at pronation, and (70.13 +/- 6.34) degrees at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridement on triangular fibrocartilage disc, ulnolunate ligament, and ulnotriguetrum ligament; and 1 case of ID with trimming plastic operation. All incisions healed by first intention, and no complications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal life and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 +/- 6.21) degrees at volar flexion, (45.37 +/- 4.65) degrees at dorsal extension, (18.95 +/- 3.56) degrees at radial deviation, (26.28 +/- 5.09) degrees at ulnar deviation, (78.87 +/- 7.69) degrees at pronation, and (76.46 +/- 8

  13. Trends in wrist arthroscopy

    NARCIS (Netherlands)

    Obdeijn, Miryam C.; Tuijthof, Gabrielle J. M.; van der Horst, Chantal M. A. M.; Mathoulin, Christophe; Liverneaux, Philippe

    2013-01-01

    Background Wrist arthroscopy plays a role in both the diagnosis and the treatment of wrist pathology. It has evolved in the last three decades. Questions The present status of wrist arthroscopy was investigated by answering the following questions: -What is its current position in the treatment

  14. Ulnar Collateral Ligament Injuries of the Thumb

    Science.gov (United States)

    McKeon, Kathleen E.; Gelberman, Richard H.; Calfee, Ryan P.

    2013-01-01

    Background: The clinical diagnosis of thumb ulnar collateral ligament disruption has been based on joint angulation during valgus stress testing. This report describes a definitive method of distinguishing between complete and partial ulnar collateral ligament injuries by quantifying translation of the proximal phalanx on the metacarpal head during valgus stress testing. Methods: Sixty-two cadaveric thumbs underwent standardized valgus stress testing under fluoroscopy with the ulnar collateral ligament intact, following an isolated release of the proper ulnar collateral ligament, and following a combined release of both the proper and the accessory ulnar collateral ligament (complete ulnar collateral ligament release). Following complete ulnar collateral ligament release, the final thirty-seven thumbs were also analyzed after the application of a valgus force sufficient to cause 45° of valgus angulation at the metacarpophalangeal joint to model more severe soft-tissue injury. Two independent reviewers measured coronal plane joint angulation (in degrees), ulnar joint line gap formation (in millimeters), and radial translation of the proximal phalanx on the metacarpal head (in millimeters) on digital fluoroscopic images that had been randomized. Results: Coronal angulation across the stressed metacarpophalangeal joint progressively increased through the stages of the testing protocol: ulnar collateral ligament intact (average [and standard deviation], 20° ± 8.1°), release of the proper ulnar collateral ligament (average, 23° ± 8.3°), and complete ulnar collateral ligament release (average, 30° ± 8.9°) (p collateral ligament release (5.7 ± 1.5 mm), to that following complete ulnar collateral ligament release (7.2 ± 1.5 mm) (p collateral ligament (1.6 ± 0.8 mm vs. 1.5 ± 0.9 mm in the intact state). There was a significant increase in translation following release of the complete ulnar collateral ligament complex (3.0 ± 0.9 mm; p collateral ligament

  15. A radiographic study of pediatric ulnar anatomy.

    Science.gov (United States)

    Cravino, Mattia; Oni, Julius K; Sala, Debra A; Chu, Alice

    2014-01-01

    The adult ulna has a unique bony architecture that has been described in the literature, but, to the best of our knowledge, the ulnar anatomy in children has not been described. We examined 75 anteroposterior (AP) and 64 lateral radiographs (29 were bilateral) of 50, 0.5- to 11-year-old, healthy children's forearms. On AP radiographs, the total ulnar length, the ulnar proximal angle, the ulnar distal angle, and the distance between each angle from the tip of the triceps insertion; and, on lateral radiographs, the ulnar length and bow deviation were measured. The correlation between age and radiographic measurements, differences based on sex, differences compared with adults' measurements, and interobserver/intraobserver reliability were assessed. Age had a very strong/strong positive correlation with length/distance measurements on both AP and lateral radiographs. Only AP ulnar distal angle was significantly different between sexes (females > males). Compared with the adult ulnar studies, the AP proximal angle in children is significantly smaller and the location of this angle is significantly more distal. Interobserver and intraobserver reliability were very good for length/distance measurements on AP and lateral radiographs. The knowledge of pediatric ulnar anatomy could be helpful in the treatment of forearm deformities due to multiple hereditary exostosis and osteogenesis imperfecta, and in the treatment of ulnar fractures, particularly in Monteggia variants, where restoration of the correct forearm anatomy is essential to obtain good clinical and functional results. Study of diagnostic test, Level II.

  16. An anomalous accessory extensor proprius indicis muscle: A case report

    Directory of Open Access Journals (Sweden)

    Mustafa Kurklu

    2013-12-01

    Full Text Available Variations related to tendon insertion and musculotendinous junction of the extensor proprius indicis muscle are commonly encountered. An anomalous extensor indicis proprius muscle (EIP tendon was detected in a fifty-year-old female cadaver during routine dissection of the right upper extremity. The body of tendon was initiated from the posterior ulna as a one muscle body, then continued as two separate muscle bodies and tendons and finally they were separated into two slips after passing the fourth dorsal compartment. As a radial part, it was divided into two slips at the level of the first metacarpophalangeal joint, and conjugated with the extensor pollicis longus (EPL muscle. Then, as an ulnar part, it was terminated at the radial side of the lateral band of the second metacarpophalangeal joint. Familiarity with the normal anatomy and variations of the tendons may help to prevent confusion and mistakes during tendon repairs, and tendon transfers. [Hand Microsurg 2013; 2(3.000: 122-124

  17. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction.

    Science.gov (United States)

    Hekner, D D; Roeling, T A P; Van Cann, E M

    2016-08-01

    The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were injected with epoxy resin (Araldite) and the perforating arteries were dissected. The number of clinically relevant perforators from the radial and ulnar arteries was not significantly different in the distal forearm. Most perforators were located in the proximal half of the distal one third, making this part probably the safest location for flap harvest. Close to the wrist, i.e. most distally, there were more perforators on the ulnar side than on the radial side. The ulnar artery stained 77% of the skin surface area of the forearm, showing the ulnar forearm free flap to be more suitable than the radial forearm free flap for the restoration of large defects. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Spontaneous atraumatic extensor pollicis longus rupture in the nonrheumatoid population.

    Science.gov (United States)

    Rada, Erin M; Shridharani, Sachin M; Lifchez, Scott D

    2013-01-01

    Extensor pollicis longus (EPL) tendon rupture is a well-described phenomenon in patients with rheumatoid arthritis. Mechanisms of EPL tendon rupture in the nonrheumatoid population have also been described and include traumatic rupture, repetitive motion strain, and steroid injection into the tendon. The operative records for patients undergoing extensor pollicis longus reconstruction by the senior author were reviewed. Patients with a history of trauma to the wrist or inflammatory arthropathy were excluded. We identified 3 patients who presented with spontaneous EPL tendon rupture. These patients reported no risk factors (as listed earlier) or inciting event. All 3 patients had some exposure to local steroids but this exposure was not at the site of subsequent tendon rupture. All patients were operatively repaired and went on to full recovery of EPL function. In patients with sudden loss of extension of the thumb interphalangeal joint, a thorough history of steroid exposure including local steroid exposure remote to the affected EPL tendon may be relevant.

  19. Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability.

    Science.gov (United States)

    Luchetti, R; Atzei, A; Cozzolino, R; Fairplay, T; Badur, N

    2014-10-01

    The aim of this study was to assess the objective and subjective functional outcomes after foveal reattachment of proximal or complete ulnar-sided triangular fibrocartilage complex lesions by two surgical procedures: an open technique or an arthroscopically assisted repair. The study was done prospectively on 49 wrists affected by post-traumatic distal radio-ulnar joint instability. Twenty-four patients were treated with the open technique (Group 1) and 25 by the arthroscopically assisted technique (Group 2). Magnetic resonance imaging demonstrated a clear foveal detachment of the triangular fibrocartilage complex in 67% of the cases. Arthroscopy showed a positive ulnar-sided detachment of the triangular fibrocartilage complex (positive hook test) in all cases. Distal radio-ulnar joint stability was obtained in all but five patients at a mean follow-up of 6 months. Both groups had improvement of all parameters with significant differences in wrist pain scores, Mayo wrist score, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Rated Wrist/Hand Evaluation questionnaire scores. There were no significant post-operative differences between the two groups in the outcome parameters except for the Disability of the Arm Shoulder and Hand questionnaire score, which was significantly better in Group 2 (p < 0.001). © The Author(s) 2013.

  20. Social humanoid robot SARA: development of the wrist mechanism

    Science.gov (United States)

    Penčić, M.; Rackov, M.; Čavić, M.; Kiss, I.; Cioată, V. G.

    2018-01-01

    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.

  1. Bilateral movements increase sustained extensor force in the paretic arm.

    Science.gov (United States)

    Kang, Nyeonju; Cauraugh, James H

    2018-04-01

    Muscle weakness in the extensors poststroke is a common motor impairment. Unfortunately, research is unclear on whether bilateral movements increase extensor force production in the paretic arm. This study investigated sustained force production while stroke individuals maximally extended their wrist and fingers on their paretic arm. Specifically, we determined isometric force production in three conditions: (a) unilateral paretic arm, (b) unilateral nonparetic arm, and (c) bilateral (both arms executing the same movement simultaneously). Seventeen chronic stroke patients produced isometric sustained force by executing wrist and fingers extension in unilateral and bilateral contraction conditions. Mean force, force variability (coefficient of variation), and signal-to-noise ratio were calculated for each contraction condition. Analysis of two-way (Arm × Type of Condition: 2 × 2; Paretic or Nonparetic Arm × Unilateral or Bilateral Conditions) within-subjects ANOVAs revealed that the bilateral condition increased sustained force in the paretic arm, but reduced sustained force in the nonparetic arm. Further, although the paretic arm exhibited more force variability and less signal-to-noise ratio than the nonparetic arm during a unilateral condition, there were no differences when participants simultaneously executed isometric contractions with both arms. Our unique findings indicate that bilateral contractions transiently increased extensor force in the paretic arm. Implications for Rehabilitation Bilateral movements increased isometric wrsit extensor force in paretic arms and redcued force in nonparetic arms versus unilateral movements. Both paretic and nonparetic arms produced similar force variability and signal-to-noise ratio during bilateral movements. Increased sustained force in the paretic arm during the bilateral condition indicates that rehabilitation protocols based on bilateral movements may be beneficial for functional recovery.

  2. Wrist muscle activity of khatrah approach in Mameluke technique using traditional bow archery

    Science.gov (United States)

    Ariffin, Muhammad Shahimi; Rambely, Azmin Sham; Ariff, Noratiqah Mohd

    2018-04-01

    An investigation of khatrah technique in archery was carried out. An electromyography (EMG) experiment was conducted towards six wrist muscles which are flexor carpi radialis, extensor carpi ulnaris and extensor digitorum communis for both arms. The maximum voluntary contraction (MVC) and activity data were recorded. The bow arm produced a higher muscle force compared to draw arm muscles during release phase. However, the muscle forces produced by bow arm had a consistency in term of pattern throughout the phases. In conclusion, the forces generated by the professional archer produced a force benchmark at the wrist joint to alleviate the risk of injury.

  3. Diagnosis and management of intersection syndrome as a cause of overuse wrist pain.

    Science.gov (United States)

    Chatterjee, Robin; Vyas, Jay

    2016-09-28

    Wrist pain due to repetitive motion or overuse is a common presentation in primary care. This case reports the rare condition of intersection syndrome as the cause of the wrist pain in an amateur tennis player. This is a non-infectious, inflammatory process that occurs where tendons in the first extensor compartment intersect the tendons in the second extensor compartment. Suitable history and examination provided the diagnosis, which was confirmed by MRI. Management consisted of early involvement of the multidisciplinary team, patient education, workplace and sporting adaptations, rest, analgesia, reduction of load, protection and immobilisation of the affected joint followed by a period of rehabilitation. 2016 BMJ Publishing Group Ltd.

  4. MRI features in de Quervain`s tenosynovitis of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    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

    1996-01-01

    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.)

  5. Ulnar variance: its relationship to ulnar foveal morphology and forearm kinematics.

    Science.gov (United States)

    Kataoka, Toshiyuki; Moritomo, Hisao; Omokawa, Shohei; Iida, Akio; Murase, Tsuyoshi; Sugamoto, Kazuomi

    2012-04-01

    It is unclear how individual differences in the anatomy of the distal ulna affect kinematics and pathology of the distal radioulnar joint. This study evaluated how ulnar variance relates to ulnar foveal morphology and the pronosupination axis of the forearm. We performed 3-dimensional computed tomography studies in vivo on 28 forearms in maximum supination and pronation to determine the anatomical center of the ulnar distal pole and the forearm pronosupination axis. We calculated the forearm pronosupination axis using a markerless bone registration technique, which determined the pronosupination center as the point where the axis emerges on the distal ulnar surface. We measured the depth of the anatomical center and classified it into 2 types: concave, with a depth of 0.8 mm or more, and flat, with a depth less than 0.8 mm. We examined whether ulnar variance correlated with foveal type and the distance between anatomical and pronosupination centers. A total of 18 cases had a concave-type fovea surrounded by the C-shaped articular facet of the distal pole, and 10 had a flat-type fovea with a flat surface without evident central depression. Ulnar variance of the flat type was 3.5 ± 1.2 mm, which was significantly greater than the 1.2 ± 1.1 mm of the concave type. Ulnar variance positively correlated with distance between the anatomical and pronosupination centers. Flat-type ulnar heads have a significantly greater ulnar variance than concave types. The pronosupination axis passes through the ulnar head more medially and farther from the anatomical center with increasing ulnar variance. This study suggests that ulnar variance is related in part to foveal morphology and pronosupination axis. This information provides a starting point for future studies investigating how foveal morphology relates to distal ulnar problems. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Median and Ulnar Neuropathy Assessment in Parkinson’s Disease regarding Symptom Severity and Asymmetry

    Directory of Open Access Journals (Sweden)

    Nilgul Yardimci

    2016-01-01

    Full Text Available Background. While increasing evidence suggests comorbidity of peripheral neuropathy (PNP and Parkinson’s disease (PD, the pathogenesis of PNP in PD is still a debate. The aim of this article is to search the core PD symptoms such as rigidity and tremor as contributing factors to mononeuropathy development while emphasizing each individual patient’s asymmetric symptom severity. Methods. We studied 62 wrists and 62 elbows of 31 patients (mean age 66.48±10.67 and 64 wrists and 64 elbows of 32 age-gender matched healthy controls (mean age 62.03±10.40, p=0.145. The Hoehn and Yahr disability scale and Unified Parkinson’s Disease Rated Scale were used to determine the severity of the disease. Results. According to electrodiagnostic criteria, we confirmed median neuropathy in 16.12% (bilateral in two-thirds of the patients and ulnar neuropathy in 3.22% of the PD group. While mean age (p=0.003, age at PD onset (p=0.019, and H&Y scores (p=0.016 were significant, tremor and rigidity scores were not. The comparison of the mean indices of electrophysiologic parameters indicated subclinical median and ulnar nerve demyelination both at the wrist and at the elbow in the patient groups where a longer disease duration and mild tremor and rigidity scores are prominent, remarkably. Conclusion. A disease related peripheral neurodegeneration beyond symptom severity occurs in PD.

  7. Education in wrist arthroscopy

    NARCIS (Netherlands)

    Obdeijn, M.C.

    2014-01-01

    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

  8. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration

    Directory of Open Access Journals (Sweden)

    Yu-hui Kou

    2015-01-01

    Full Text Available Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple amplification of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple amplification of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were sutured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction velocity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons.

  9. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration.

    Science.gov (United States)

    Kou, Yu-Hui; Zhang, Pei-Xun; Wang, Yan-Hua; Chen, Bo; Han, Na; Xue, Feng; Zhang, Hong-Bo; Yin, Xiao-Feng; Jiang, Bao-Guo

    2015-01-01

    Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple amplification of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple amplification of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were sutured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction velocity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons.

  10. Mobilização do osso pisiforme no tratamento da neuropraxia do nervo ulnar no canal de Guyon: relato de caso Pisiform bone mobilization for treating ulnar nerve neuropraxia at Guyon's canal: case report

    Directory of Open Access Journals (Sweden)

    Júlio Guilherme Silva

    2009-12-01

    Full Text Available As neuropraxias do nervo ulnar são lesões bastante freqüentes que provocam efeitos deletérios, como diminuição de força muscular e parestesias; geralmente ocorrem no nível do epicôndilo medial e do túnel ulnar (canal de Guyon. São escassos os relatos referentes a técnicas de terapia manual para compressões do nervo ulnar no canal de Guyon. Este trabalho relata o uso da técnica de mobilização do pisiforme na compressão do nervo ulnar no canal de Guyon de um homem que sofreu luxação do punho direito aos 8 anos e, aos 25, queixava-se de um deficit para adução do dedo mínimo, que atrapalhava a realização de algumas atividades de vida diária. O paciente foi submetido a uma única sessão de mobilização articular do pisiforme. Após a aplicação da técnica, o sinal positivo do teste foi eliminado, restabelecendo-se a função de adução do 5o dedo. Embora carecendo de maior fundamentação teórica, pode-se afirmar que a técnica usada, de mobilização articular do osso pisiforme, é eficaz para melhora do quadro de paresia por neuropraxia do nervo ulnar no canal de Guyon.A common ulnar nerve neuropraxia is lesion that may result in muscle strength decrease and/or paresthesia; it usually takes place at medial epicondyle level and the ulnar tunnel (Guyon's canal. Studies on manual therapy techniques for ulnar nerve compression in Guyon's canal are scarce. This paper reports the use of a technique of pisiform bone mobilization for relieving ulnar nerve compression in Guyon's canal, in a man who had suffered a luxation of the right wrist at the age of 8 and, at 25, complained of adduction deficit of the fifth finger that interfered in his daily life activities. He was submitted to one session of pisiform mobilization; after the session, the positive test sign was eliminated, thus restoring the fifth finger function. Though lacking further grounding, it may be said that the technique used, of mobilizing the pisiform bone

  11. Ulnar nerve injury associated with trampoline injuries.

    Science.gov (United States)

    Maclin, Melvin M; Novak, Christine B; Mackinnon, Susan E

    2004-08-01

    This study reports three cases of ulnar neuropathy after trampoline injuries in children. A chart review was performed on children who sustained an ulnar nerve injury from a trampoline accident. In all cases, surgical intervention was required. Injuries included upper-extremity fractures in two cases and an upper-extremity laceration in one case. All cases required surgical exploration with internal neurolysis and ulnar nerve transposition. Nerve grafts were used in two cases and an additional nerve transfer was used in one case. All patients had return of intrinsic hand function and sensation after surgery. Children should be followed for evolution of ulnar nerve neuropathy after upper-extremity injury with consideration for electrical studies and surgical exploration if there is no improvement after 3 months.

  12. Ulnar nerve sonography in leprosy neuropathy.

    Science.gov (United States)

    Wang, Zhu; Liu, Da-Yue; Lei, Yang-Yang; Yang, Zheng; Wang, Wei

    2016-01-01

    A 23-year-old woman presented with a half-year history of right forearm sensory and motor dysfunction. Ultrasound imaging revealed definite thickening of the right ulnar nerve trunk and inner epineurium, along with heterogeneous hypoechogenicity and unclear nerve fiber bundle. Color Doppler exhibited a rich blood supply, which was clearly different from the normal ulnar nerve presentation with a scarce blood supply. The patient subsequently underwent needle aspiration of the right ulnar nerve, and histopathological examination confirmed that granulomatous nodules had formed with a large number of infiltrating lymphocytes and a plurality of epithelioid cells in the fibrous connective tissues, with visible atypical foam cells and proliferous vascularization, consistent with leprosy. Our report will familiarize readers with the characteristic sonographic features of the ulnar nerve in leprosy, particularly because of the decreasing incidence of leprosy in recent years.

  13. Acute hand and wrist injuries in athletes: evaluation and management.

    Science.gov (United States)

    Morgan, W J; Slowman, L S

    2001-01-01

    Acute hand and wrist injuries in the athlete constitute a unique orthopaedic challenge. Because of the particular demands on the athlete (e.g., financial implications, coaching and administration pressures, self-esteem issues), a specialized management approach is often necessary. Common sites of injury include the ulnar collateral ligament of the thumb metacarpophalangeal joint, proximal interphalangeal joint, metacarpals and phalanges, scaphoid, hamate, and distal radius. Treatment of these injuries varies depending on the patient's age, sport, position played, and level of competition, but departures from standard practice as regards surgery, rehabilitation, and return to competition should never compromise care.

  14. Ulnar nerve entrapment by anconeus epitrochlearis ligament.

    LENUS (Irish Health Repository)

    Tiong, William H C

    2012-01-01

    Ulnar nerve entrapment at the elbow is the second most common upper limb entrapment neuropathy other than carpal tunnel syndrome. There have been many causes identified ranging from chronic aging joint changes to inflammatory conditions or systemic disorders. Among them, uncommon anatomical variants accounts for a small number of cases. Here, we report our experience in managing ulnar nerve entrapment caused by a rare vestigial structure, anconeus epitrochlearis ligament, and provide a brief review of the literature of its management.

  15. [Instability of the distal radioulnar joint: Treatment options for ulnar lesions of the triangular fibrocartilage complex].

    Science.gov (United States)

    Spies, C K; Prommersberger, K J; Langer, M; Müller, L P; Hahn, P; Unglaub, F

    2015-08-01

    Injuries of the triangular fibrocartilage complex (TFCC) may be fatal to the distal radioulnar joint (DRUJ). This structure is one of the crucial stabilizers and guarantees unrestricted pronosupination of the forearm. A systematic examination is mandatory to diagnose DRUJ instability reliably. A clinical examination in comparison to the contralateral side is obligatory. Plain radiographs are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral, pronation and supination is necessary to verify DRUJ instability in ambiguous situations. Based on a systematic examination wrist and DRUJ arthroscopy identify lesions clearly. Injuries of the radioulnar ligaments which entail DRUJ instability, should be reconstructed preferably anatomically. Ulnar-sided TFCC lesions may often cause DRUJ instability. Osseous ligament avulsions are mostly treated osteosynthetically. Ligament tears may be refixated using anchor or transosseous sutures. Tendon transplants are necessary for an anatomical reconstruction in cases of irreparable ruptures.

  16. MRI of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dick, Elizabeth A. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)], E-mail: dickelizabeth@hotmail.com; Burnett, Carole; Gedroyc, Wladyslaw M.W. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)

    2008-08-15

    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.

  17. MR imaging of the triangular fibrocartilage of the wrist

    International Nuclear Information System (INIS)

    Golimbu, C.N.; Firooznia, H.; Rafii, M.; Melone, C.; Leber, C.

    1988-01-01

    Magnetic resonance (MR) imaging of the wrist was performed in 25 patients who had pain or localized soft-tissue swelling in the ulnar side of the wrist. T1-weighted coronal images were obtained in all patients. In addition, coronal or axial images with T2-weighted or fast-field-echo sequences were obtained in 16 of these patients. MR imaging demonstrated tears of the triangular fibrocartilage of the wrist in 13 patients. Twelve of these tears were confirmed at surgery. In one patient, the triangular fibrocartilage was found at surgery to be stretched and folded on itself but not torn. This represents the one false-positive MR image in this group of patients. In 12 patients, the symptoms could be explained by a diversity of MR abnormalities, such as aseptic necrosis of carpal bones, subluxation of distal radioulnar joint, and synovitis of the tendon sheaths. MR imaging offers the advantage of investigating the triangular fibrocartilage of the wrist in a noninvasive manner; it may be used as a screening method in patients considered for surgery

  18. Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography

    International Nuclear Information System (INIS)

    Keen, Nayela N.; Chin, Cynthia T.; Saloner, David; Steinbach, Lynne S.; Engstrom, John W.

    2012-01-01

    Early diagnosis of ulnar neuropathy at the elbow is important. Magnetic resonance neurography (MRN) images peripheral nerves. We evaluated the usefulness of elbow MRN in diagnosing ulnar neuropathy at the elbow. The MR neurograms of 21 patients with ulnar neuropathy were reviewed retrospectively. MRN was performed prospectively on 10 normal volunteers. The MR neurograms included axial T1 and axial T2 fat-saturated and/or axial STIR sequences. The sensitivity and specificity of MRN in detecting ulnar neuropathy were determined. The mean ulnar nerve size in the symptomatic and normal groups was 0.12 and 0.06 cm 2 (P 2 , sensitivity was 95% and specificity was 80%. Ulnar nerve size and signal intensity were greater in patients with ulnar neuropathy. MRN is a useful test in evaluating ulnar neuropathy at the elbow. (orig.)

  19. Median and ulnar neuropathies in U.S. Army Medical Command Band members.

    Science.gov (United States)

    Shaffer, Scott W; Koreerat, Nicholas R; Gordon, Lindsay B; Santillo, Douglas R; Moore, Josef H; Greathouse, David G

    2013-12-01

    Musicians have been reported as having a high prevalence of upper-extremity musculoskeletal disorders, including carpal tunnel syndrome. The purpose of this study was to determine the presence of median and ulnar neuropathies in U.S. Army Medical Command (MEDCOM) Band members at Fort Sam Houston, Texas. Thirty-five MEDCOM Band members (30 males, 5 females) volunteered to participate. There were 33 right-handed musicians, and the mean length of time in the MEDCOM Band was 12.2 yrs (range, 1-30 yrs). Subjects completed a history form, were interviewed, and underwent a physical examination of the cervical spine and bilateral upper extremities. Nerve conduction studies of the bilateral median and ulnar nerves were performed. Electrophysiological variables served as the reference standard for median and ulnar neuropathy and included distal sensory latencies, distal motor latencies, amplitudes, conduction velocities, and comparison study latencies. Ten of the 35 subjects (29%) presented with abnormal electrophysiologic values suggestive of an upper extremity mononeuropathy. Nine of the subjects had abnormal median nerve electrophysiologic values at or distal to the wrist; 2 had bilateral abnormal values. One had an abnormal ulnar nerve electrophysiologic assessment at the elbow. Nine of these 10 subjects had clinical examination findings consistent with the electrophysiological findings. The prevalence of mononeuropathies in this sample of band members is similar to that found in previous research involving civilian musicians (20-36%) and far exceeds that reported in the general population. Prospective research investigating screening, examination items, and injury prevention measures in musicians appears to be warranted.

  20. Biomechanical Analysis of All-Inside, Arthroscopic Suture Repair Versus Extensor Retinaculum Capsulorrhaphy for Triangular Fibrocartilage Complex Tears With Instability.

    Science.gov (United States)

    Patel, Amar A; Alhandi, Ali A; Milne, Edward; Dy, Christopher J; Latta, Loren L; Ouellette, E Anne

    2016-03-01

    To assess ulnocarpal joint stability after treatment of a peripheral triangular fibrocartilage complex (TFCC) injury with all-inside arthroscopic suture repair (SR), extensor retinaculum capsulorrhaphy with the Herbert sling (HS), and a combination of both (SR+HS). Twelve fresh-frozen, age-matched, upper-extremity specimens intact from the distal humerus were prepared. Nondestructive mechanical testing was performed to assess native ulnocarpal joint stability and load-displacement curves were recorded. A peripheral, ulnar-sided TFCC injury was created with arthroscopic assistance, and mechanical testing was performed. Each specimen was treated with SR or HS and testing was repeated. The 6 specimens treated with SR were then treated with HS (SR+HS), and testing was repeated. We used paired Student t tests for statistical analysis within cohorts. For all cohorts, there was an average increase in ulnar translation after the creation of a peripheral TFCC injury and an average decrease after repair. Herbert sling decreased translation by 21%, SR decreased translation by 12%, and SR+HS decreased translation by 26%. Suture repair plus HS and HS reduce ulnar translation the most after a peripheral TFCC injury, followed by SR alone. Ulnocarpal joint stability should be assessed clinically in patients with peripheral TFCC injury, and consideration should be made for using extensor capsulorrhaphy in isolation or as an adjunct to SR as a treatment option. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Anomalies of radial and ulnar arteries

    Directory of Open Access Journals (Sweden)

    Rajani Singh

    Full Text Available Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

  2. The effect of wheelchair propulsion style on changes in time spent in extreme wrist orientations after a bout of fatiguing propulsion.

    Science.gov (United States)

    Zukowski, Lisa A; Hass, Chris J; Shechtman, Orit; Christou, Evangelos A; Tillman, Mark D

    2017-10-01

    This study compared how wheelchair propulsion styles affect changes in percentage of time spent in extreme wrist orientations, which have been associated with median nerve injury, after a fatiguing bout of propulsion. Twenty novice, non-disabled adult males learned arcing (ARC) and semicircular (SEMI) propulsion styles and utilised each to perform a wheelchair fatigue protocol. ARC and SEMI did not significantly differ in terms of changes after the fatigue protocol in percentage of time spent in extreme flexion/extension or radial/ulnar deviation at the push phase beginning or end. A pattern was observed, although not significant, of greater increases in percentage of time spent in extreme wrist extension and ulnar deviation during the push phase beginning and ulnar deviation during the push phase end while utilising SEMI relative to ARC. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles. Practitioner Summary: How wheelchair propulsion styles change with fatigue in terms of extreme wrist orientations was examined. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles and point towards the need for future research on individual differences utilising propulsion styles.

  3. Effect of fascicle composition on ulnar to musculocutaneous nerve transfer (Oberlin transfer) in neonatal brachial plexus palsy.

    Science.gov (United States)

    Smith, Brandon W; Chulski, Nicholas J; Little, Ann A; Chang, Kate W C; Yang, Lynda J S

    2018-06-01

    OBJECTIVE Neonatal brachial plexus palsy (NBPP) continues to be a problematic occurrence impacting approximately 1.5 per 1000 live births in the United States, with 10%-40% of these infants experiencing permanent disability. These children lose elbow flexion, and one surgical option for recovering it is the Oberlin transfer. Published data support the use of the ulnar nerve fascicle that innervates the flexor carpi ulnaris as the donor nerve in adults, but no analogous published data exist for infants. This study investigated the association of ulnar nerve fascicle choice with functional elbow flexion outcome in NBPP. METHODS The authors conducted a retrospective study of 13 cases in which infants underwent ulnar to musculocutaneous nerve transfer for NBPP at a single institution. They collected data on patient demographics, clinical characteristics, active range of motion (AROM), and intraoperative neuromonitoring (IONM) (using 4 ulnar nerve index muscles). Standard statistical analysis compared pre- and postoperative motor function improvement between specific fascicle transfer (1-2 muscles for either wrist flexion or hand intrinsics) and nonspecific fascicle transfer (> 2 muscles for wrist flexion and hand intrinsics) groups. RESULTS The patients' average age at initial clinic visit was 2.9 months, and their average age at surgical intervention was 7.4 months. All NBPPs were unilateral; the majority of patients were female (61%), were Caucasian (69%), had right-sided NBPP (61%), and had Narakas grade I or II injuries (54%). IONM recordings for the fascicular dissection revealed a donor fascicle with nonspecific innervation in 6 (46%) infants and specific innervation in the remaining 7 (54%) patients. At 6-month follow-up, the AROM improvement in elbow flexion in adduction was 38° in the specific fascicle transfer group versus 36° in the nonspecific fascicle transfer group, with no statistically significant difference (p = 0.93). CONCLUSIONS Both specific and

  4. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

    Directory of Open Access Journals (Sweden)

    Asem A. Al-Hiari

    2013-05-01

    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  5. Ulnar nerve entrapment complicating radial head excision

    Directory of Open Access Journals (Sweden)

    Kevin Parfait Bienvenu Bouhelo-Pam

    Full Text Available Introduction: Several mechanisms are involved in ischemia or mechanical compression of ulnar nerve at the elbow. Presentation of case: We hereby present the case of a road accident victim, who received a radial head excision for an isolated fracture of the radial head and complicated by onset of cubital tunnel syndrome. This outcome could be the consequence of an iatrogenic valgus of the elbow due to excision of the radial head. Hitherto the surgical treatment of choice it is gradually been abandoned due to development of radial head implant arthroplasty. However, this management option is still being performed in some rural centers with low resources. Discussion: The radial head plays an important role in the stability of the elbow and his iatrogenic deformity can be complicated by cubital tunnel syndrome. Conclusion: An ulnar nerve release was performed with favorable outcome. Keywords: Cubital tunnel syndrome, Peripheral nerve palsy, Radial head excision, Elbow valgus

  6. ULNAR NEURITIS ASSOCIATED WITH GUN STOCK DEFORMITY FOLLOWING SUPRACONDYLAR FRACTURE OF HUMERUS

    Directory of Open Access Journals (Sweden)

    Sunita Morhan

    2014-04-01

    Full Text Available Background: This case report describes a patient who was referred to physiotherapist from a hand surgeon. Among the fractures around the elbow joint, radial head fracture and fracture of distal end of radius are common among adults. The occurrence of Supracondylar fractures are more commonly seen in children when compared to adults. One of the complications of this fracture is malunion resulting in Gun stock deformity. The main Purpose of this case report is to explore, 1. The complication associated with gunstock deformity 2. Chances of iatrogenic nerve injury after manipulation under anesthesia. 3.Long term supervised rehabilitation approach. Case Description: A 40 years old male patient referred to our Physiotherapy department by a hand surgeon. After the initial evaluation, findings revealed limitation in right elbow movement and tingling and numbness sensation in little and half of ring fingers in his right side. This patient underwent ulnar nerve transposition surgery followed by rehabilitation. His physiotherapy session includes electrotherapeutic agents for pain relief, passive mobilization of elbow and strengthening program for his flexors and extensors of elbow for a period of one year. Outcome: The outcome of the long term rehabilitation approach for a patient with ulnar neuropathy secondary to gunstock deformity after ulnar nerve transposition surgery is good. The patients tingling and numbness decreased and the range of elbow movement improved significantly. Discussion: Most common complications of fracture of distal end of humerus include malunion,ischemic contracture and nerve injuries. The relative incidence of iatrogenic nerve injuries associatedwith this fracture has been reported as being 2%-6%. Nerve injuries after Supracondylar humeral fractures occur primarily due to tenting or entrapment of the nerve on the sharp proximal humeral fragment, while iatrogenic injuries occur either during closed manipulation or percutaneous

  7. Evaluating the Ergonomic Benefit of a Wrist Brace on Wrist Posture, Muscle Activity, Rotational Stiffness, and Peak Shovel-Ground Impact Force During a Simulated Tree-Planting Task.

    Science.gov (United States)

    Sheahan, Peter J; Cashaback, Joshua G A; Fischer, Steven L

    2017-09-01

    Background Tree planters are at a high risk for wrist injury due to awkward postures and high wrist loads experienced during each planting cycle, specifically at shovel-ground impact. Wrist joint stiffness provides a measure that integrates postural and loading information. Objective The purpose of this study was to evaluate wrist joint stiffness requirements at the instant of shovel-ground impact during tree planting and determine if a wrist brace could alter muscular contributions to wrist joint stiffness. Method Planters simulated tree planting with and without wearing a brace on their planting arm. Surface electromyography (sEMG) from six forearm muscles and wrist kinematics were collected and used to calculate muscular contributions to joint rotational stiffness about the wrist. Results Wrist joint stiffness increased with brace use, an unanticipated and negative consequence of wearing a brace. As a potential benefit, planters achieved a more neutrally oriented wrist angle about the flexion/extension axis, although a less neutral wrist angle about the ulnar/radial axis was observed. Muscle activity did not change between conditions. Conclusion The joint stiffness analysis, combining kinematic and sEMG information in a biologically relevant manner, revealed clear limitations with the interface between the brace grip and shovel handle that jeopardized the prophylactic benefits of the current brace design. This limitation was not as evident when considering kinematics and sEMG data independently. Application A neuromechanical model (joint rotational stiffness) enhanced our ability to evaluate the brace design relative to kinematic and sEMG parameter-based metrics alone.

  8. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction

    Energy Technology Data Exchange (ETDEWEB)

    Strobel, Klaus [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Kantonsspital Luzern, Roentgeninstitut/Nuklearmedizin, Luzern (Switzerland); Steurer-Dober, Isabelle; Huellner, Martin W.; Sol Perez Lago, Maria del; Veit-Haibach, Patrick; Tornquist, Katharina [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Silva, Angela J. da [Advanced Molecular Imaging, Philips Healthcare, San Jose, CA (United States); Bodmer, Elvira; Wartburg, Urs von; Hug, Urs [Lucerne Cantonal Hospital, Division of Hand and Plastic Surgery, Lucerne (Switzerland)

    2014-03-15

    To evaluate the feasibility and performance of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. This prospective study included 28 wrists of 27 patients evaluated with SPECT/CT arthrography and MR arthrography. Iodine contrast medium and gadolinium were injected into the distal radioulnar and midcarpal joints. Late-phase SPECT/CT was performed 3.5 h after intravenous injection of approximately 650 MBq {sup 99m}Tc-DPD. MR and SPECT/CT images were separately reviewed in relation to bone marrow oedema, radionuclide uptake, and tears in the scapholunate (SL) and lunotriquetral (LT) ligaments and triangular fibrocartilage complex (TFCC), and an overall diagnosis of ulnar impaction. MR, CT and SPECT/CT imaging findings were compared with each other, with the surgical findings in 12 patients and with clinical follow-up. The quality of MR arthrography and SPECT/CT arthrography images was fully diagnostic in 23 of 28 wrists (82 %) and 25 of 28 wrists (89 %), respectively. SPECT/CT arthrography was not diagnostic for ligament lesions due to insufficient intraarticular contrast in one wrist. MR and SPECT/CT images showed concordant findings regarding TFCC lesions in 22 of 27 wrists (81 %), SL ligament in 22 of 27 wrists (81 %) and LT ligament in 23 of 27 wrists (85 %). Bone marrow oedema on MR images and scintigraphic uptake were concordant in 21 of 28 wrists (75 %). MR images showed partial TFCC defects in four patients with normal SPECT/CT images. MR images showed bone marrow oedema in 4 of 28 wrists (14 %) without scintigraphic uptake, and scintigraphic uptake was present without MR bone marrow oedema in three wrists (11 %). Regarding diagnosis of ulnar impaction the concordance rate between CT and SPECT/CT was 100 % and reached 96 % (27 of 28) between MR and SPECT/CT arthrography. The sensitivity and specificity of MR, CT and SPECT/CT arthrography were 93 %, 100 % and 100 %, and 93 %, 93 % and 93

  9. The hand and wrist

    International Nuclear Information System (INIS)

    Wood, M.B.; Berquist, T.H.

    1985-01-01

    Trauma is the most common etiologic factor leading to disability in the hand and wrist. Judicious radiographic evaluation is required for accurate assessment in practically all but the most minor of such injuries. Frequently serial radiographic evaluation is essential for directing the course of treatment and for following the healing process. A meaningful radiographic evaluation requires a comprehensive knowledge of the normal radiographic anatomy, an overview of the spectrum of pathology, and an awareness of the usual mechanisms of injury, appropriate treatment options, and relevant array of complications

  10. Tubercular monoarthritis of wrist

    Directory of Open Access Journals (Sweden)

    Prakash Joshi

    2017-01-01

    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.

  11. Floating fat in the wrist joint and in the tendon sheaths

    Energy Technology Data Exchange (ETDEWEB)

    Le Corroller, Thomas; Zink, Jean-Vincent; Champsaur, Pierre [Hopital Sainte-Marguerite, Radiology Department, Marseille (France); Parratte, Sebastien; Argenson, Jean-Noel [Hopital Sainte-Marguerite, Orthopaedic Surgery Department, Marseille (France)

    2010-09-15

    A traumatic fat effusion in a tendon sheath is an unreported entity. We report on the clinical and imaging features, including radiography and computed tomography (CT), of a fat-density effusion in the wrist joint and tendon sheaths of the extensor pollicis longus, extensor carpi radialis longus, and extensor carpi radialis brevis in a 28-year-old patient after a roller-skating accident. Radiographs showed a fracture of the distal radius and a wrist joint effusion. Preoperative CT examination exhibited two distinct layers resulting in a fat-fluid level pathognomonic of lipohemarthrosis in the radiocarpal joint. In addition, a fat-density effusion was noted in the sheaths of the second and third compartment extensor tendons. The lipohemarthrosis depicted on imaging classically results from the extrusion of fat from bone marrow into the joint space after an intraarticular fracture. Similarly, a traumatic fat effusion in a tendon sheath presents characteristic imaging features that may help to diagnose a potentially overlooked fracture. (orig.)

  12. Floating fat in the wrist joint and in the tendon sheaths

    International Nuclear Information System (INIS)

    Le Corroller, Thomas; Zink, Jean-Vincent; Champsaur, Pierre; Parratte, Sebastien; Argenson, Jean-Noel

    2010-01-01

    A traumatic fat effusion in a tendon sheath is an unreported entity. We report on the clinical and imaging features, including radiography and computed tomography (CT), of a fat-density effusion in the wrist joint and tendon sheaths of the extensor pollicis longus, extensor carpi radialis longus, and extensor carpi radialis brevis in a 28-year-old patient after a roller-skating accident. Radiographs showed a fracture of the distal radius and a wrist joint effusion. Preoperative CT examination exhibited two distinct layers resulting in a fat-fluid level pathognomonic of lipohemarthrosis in the radiocarpal joint. In addition, a fat-density effusion was noted in the sheaths of the second and third compartment extensor tendons. The lipohemarthrosis depicted on imaging classically results from the extrusion of fat from bone marrow into the joint space after an intraarticular fracture. Similarly, a traumatic fat effusion in a tendon sheath presents characteristic imaging features that may help to diagnose a potentially overlooked fracture. (orig.)

  13. At Home Photography-Based Method for Measuring Wrist Range of Motion.

    Science.gov (United States)

    Trehan, Samir K; Rancy, Schneider K; Johnsen, Parker H; Hillstrom, Howard J; Lee, Steve K; Wolfe, Scott W

    2017-11-01

    Purpose  To determine the reliability of wrist range of motion (WROM) measurements based on digital photographs taken by patients at home compared with traditional measurements done in the office with a goniometer. Methods  Sixty-nine postoperative patients were enrolled in this study at least 3 months postoperatively. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by one of the two attending surgeons with a 1-degree resolution goniometer at the last postoperative office visit. Patients were provided an illustrated instruction sheet detailing how to take digital photographic images at home in six wrist positions (active and passive flexion/extension, and radial/ulnar deviation). Wrist position was measured from digital images by both the attending surgeons in a randomized, blinded fashion on two separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient to assess agreement between clinical and photography-based goniometry, as well as intra- and interobserver agreement. Results  Out of 69 enrolled patients, 30 (43%) patients sent digital images. Of the 180 digital photographs, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was "almost perfect" for passive wrist flexion/extension and "substantial" for active wrist flexion/extension and radial/ulnar deviation. Inter- and intraobserver agreement for the attending surgeons was "almost perfect" for all measurements. Discussion  This study validates a photography-based goniometry protocol allowing accurate and reliable WROM measurements without direct physician contact. Passive WROM was more accurately measured from photographs than active WROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients or their families take and submit their own

  14. Vertical force and wrist deviation angle when using a walker to stand up and sit down.

    Science.gov (United States)

    Leung, Cherng-Yee; Yeh, Po-Chan

    2011-08-01

    Research investigating walkers suggests that safety and assistance for the elderly with weak lower limbs were important. However, the relationship between the use of a walker and the upper limbs has received little investigation. Standing up and sitting down are important daily activities. Therefore, the aim of this study was to explore wrist deviation and vertical force among elderly individuals using a walker for assistance to stand up and sit down. In total, 64 elderly volunteers (M age = 80.22, SD = 9.36) were enrolled. Data were obtained from four load cells and a twin-axis wrist goniometer. Wrist deviation and vertical force were examined when participants used a walker with horizontal handles to assist in standing up and sitting down. Significant wrist angle deviation occurred with the use of a walker, with dorsiflexion of the right hand greater than that of the left. Males exerted significantly greater vertical force. In the sitting position, greater ulnar deviation was seen among experienced walker users, whereas during standing, experienced users exhibited greater dorsiflexion. The horizontal handles of most marketed walkers may cause user wrist deviations, suggesting researchers should pursue improvements in walker design.

  15. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    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....

  16. In vivo fluoroscopic kinematography of dynamic radio-ulnar ...

    African Journals Online (AJOL)

    ... canine elbow joint, as part of the physiological kinematic pattern. However, dysplastic elbow joints do not show an increased radio-ulnar translation, and therfore dRUI cannot be considered causative for medial coronoid disease. Keywords: Canine, Elbow dysplasia, Fluoroscopy, Gait analysis, Radio-ulnar incongruence.

  17. Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography

    Energy Technology Data Exchange (ETDEWEB)

    Keen, Nayela N.; Chin, Cynthia T.; Saloner, David; Steinbach, Lynne S. [University of California San Francisco, Dept of Radiology and Biomedical Imaging, San Francisco, CA (United States); Engstrom, John W. [University of California San Francisco, Department of Neurology, San Francisco, CA (United States)

    2012-04-15

    Early diagnosis of ulnar neuropathy at the elbow is important. Magnetic resonance neurography (MRN) images peripheral nerves. We evaluated the usefulness of elbow MRN in diagnosing ulnar neuropathy at the elbow. The MR neurograms of 21 patients with ulnar neuropathy were reviewed retrospectively. MRN was performed prospectively on 10 normal volunteers. The MR neurograms included axial T1 and axial T2 fat-saturated and/or axial STIR sequences. The sensitivity and specificity of MRN in detecting ulnar neuropathy were determined. The mean ulnar nerve size in the symptomatic and normal groups was 0.12 and 0.06 cm{sup 2} (P < 0.001). The mean relative signal intensity in the symptomatic and normal groups was 2.7 and 1.4 (P < 0.01). When using a size of 0.08 cm{sup 2}, sensitivity was 95% and specificity was 80%. Ulnar nerve size and signal intensity were greater in patients with ulnar neuropathy. MRN is a useful test in evaluating ulnar neuropathy at the elbow. (orig.)

  18. New developmental evidence clarifies the evolution of wrist bones in the dinosaur-bird transition.

    Directory of Open Access Journals (Sweden)

    João Francisco Botelho

    2014-09-01

    Full Text Available From early dinosaurs with as many as nine wrist bones, modern birds evolved to develop only four ossifications. Their identity is uncertain, with different labels used in palaeontology and developmental biology. We examined embryos of several species and studied chicken embryos in detail through a new technique allowing whole-mount immunofluorescence of the embryonic cartilaginous skeleton. Beyond previous controversy, we establish that the proximal-anterior ossification develops from a composite radiale+intermedium cartilage, consistent with fusion of radiale and intermedium observed in some theropod dinosaurs. Despite previous claims that the development of the distal-anterior ossification does not support the dinosaur-bird link, we found its embryonic precursor shows two distinct regions of both collagen type II and collagen type IX expression, resembling the composite semilunate bone of bird-like dinosaurs (distal carpal 1+distal carpal 2. The distal-posterior ossification develops from a cartilage referred to as "element x," but its position corresponds to distal carpal 3. The proximal-posterior ossification is perhaps most controversial: It is labelled as the ulnare in palaeontology, but we confirm the embryonic ulnare is lost during development. Re-examination of the fossil evidence reveals the ulnare was actually absent in bird-like dinosaurs. We confirm the proximal-posterior bone is a pisiform in terms of embryonic position and its development as a sesamoid associated to a tendon. However, the pisiform is absent in bird-like dinosaurs, which are known from several articulated specimens. The combined data provide compelling evidence of a remarkable evolutionary reversal: A large, ossified pisiform re-evolved in the lineage leading to birds, after a period in which it was either absent, nonossified, or very small, consistently escaping fossil preservation. The bird wrist provides a modern example of how developmental and paleontological

  19. New developmental evidence clarifies the evolution of wrist bones in the dinosaur-bird transition.

    Science.gov (United States)

    Botelho, João Francisco; Ossa-Fuentes, Luis; Soto-Acuña, Sergio; Smith-Paredes, Daniel; Nuñez-León, Daniel; Salinas-Saavedra, Miguel; Ruiz-Flores, Macarena; Vargas, Alexander O

    2014-09-01

    From early dinosaurs with as many as nine wrist bones, modern birds evolved to develop only four ossifications. Their identity is uncertain, with different labels used in palaeontology and developmental biology. We examined embryos of several species and studied chicken embryos in detail through a new technique allowing whole-mount immunofluorescence of the embryonic cartilaginous skeleton. Beyond previous controversy, we establish that the proximal-anterior ossification develops from a composite radiale+intermedium cartilage, consistent with fusion of radiale and intermedium observed in some theropod dinosaurs. Despite previous claims that the development of the distal-anterior ossification does not support the dinosaur-bird link, we found its embryonic precursor shows two distinct regions of both collagen type II and collagen type IX expression, resembling the composite semilunate bone of bird-like dinosaurs (distal carpal 1+distal carpal 2). The distal-posterior ossification develops from a cartilage referred to as "element x," but its position corresponds to distal carpal 3. The proximal-posterior ossification is perhaps most controversial: It is labelled as the ulnare in palaeontology, but we confirm the embryonic ulnare is lost during development. Re-examination of the fossil evidence reveals the ulnare was actually absent in bird-like dinosaurs. We confirm the proximal-posterior bone is a pisiform in terms of embryonic position and its development as a sesamoid associated to a tendon. However, the pisiform is absent in bird-like dinosaurs, which are known from several articulated specimens. The combined data provide compelling evidence of a remarkable evolutionary reversal: A large, ossified pisiform re-evolved in the lineage leading to birds, after a period in which it was either absent, nonossified, or very small, consistently escaping fossil preservation. The bird wrist provides a modern example of how developmental and paleontological data illuminate

  20. New Developmental Evidence Clarifies the Evolution of Wrist Bones in the Dinosaur–Bird Transition

    Science.gov (United States)

    Botelho, João Francisco; Ossa-Fuentes, Luis; Soto-Acuña, Sergio; Smith-Paredes, Daniel; Nuñez-León, Daniel; Salinas-Saavedra, Miguel; Ruiz-Flores, Macarena; Vargas, Alexander O.

    2014-01-01

    From early dinosaurs with as many as nine wrist bones, modern birds evolved to develop only four ossifications. Their identity is uncertain, with different labels used in palaeontology and developmental biology. We examined embryos of several species and studied chicken embryos in detail through a new technique allowing whole-mount immunofluorescence of the embryonic cartilaginous skeleton. Beyond previous controversy, we establish that the proximal–anterior ossification develops from a composite radiale+intermedium cartilage, consistent with fusion of radiale and intermedium observed in some theropod dinosaurs. Despite previous claims that the development of the distal–anterior ossification does not support the dinosaur–bird link, we found its embryonic precursor shows two distinct regions of both collagen type II and collagen type IX expression, resembling the composite semilunate bone of bird-like dinosaurs (distal carpal 1+distal carpal 2). The distal–posterior ossification develops from a cartilage referred to as “element x,” but its position corresponds to distal carpal 3. The proximal–posterior ossification is perhaps most controversial: It is labelled as the ulnare in palaeontology, but we confirm the embryonic ulnare is lost during development. Re-examination of the fossil evidence reveals the ulnare was actually absent in bird-like dinosaurs. We confirm the proximal–posterior bone is a pisiform in terms of embryonic position and its development as a sesamoid associated to a tendon. However, the pisiform is absent in bird-like dinosaurs, which are known from several articulated specimens. The combined data provide compelling evidence of a remarkable evolutionary reversal: A large, ossified pisiform re-evolved in the lineage leading to birds, after a period in which it was either absent, nonossified, or very small, consistently escaping fossil preservation. The bird wrist provides a modern example of how developmental and paleontological

  1. Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay

    International Nuclear Information System (INIS)

    Stewart, N.R.; Crabbe, J.P.; McQueen, F.M.

    2001-01-01

    This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement. Copyright (2001) Blackwell Science Pty Ltd

  2. Osteosynthesis for symptomatic ulnar styloid nonunion

    International Nuclear Information System (INIS)

    Kajiwara, Ryoji; Kimori, Kenji; Kawagoe, Hiroyuki; Tsuge, Kenya; Ikuta, Yosikazu

    2008-01-01

    We reviewed cases of osteosynthesis for symptomatic ulnar styloid nonunion. Since 1998, 13 cases of ulnar styloid nonunion have been treated by osteosynthesis. The patients were 10 men and 3 women, with a mean age of 27 years (range 11-65). The nonunion site was located in the middle in one case, in the base in 8 cases, and in the epiphyseal region in 4 cases. Osteosynthesis was performed with tension band wiring in all cases, and cancellous bone graft was performed in 12 of 13 cases. Distal radioulnar joint (DRUJ) instability was found by radiograph or CT in four cases; in two of these, osteosynthesis alone did not improve DRUJ instability and additional DRUJ stabilization was performed. One patient whose treatment failed to correct nonunion did not seek further treatment. In another case, an additional surgery was performed 1 week after the initial surgery to correct displacement of the fragment. The mean follow-up period was 15 months (range 8-45 months). According to Hauck's criteria, final pain was evaluated as excellent in nine cases, good in three cases, including the case resulting in nonunion, and fair in one case. (author)

  3. Case report 393: Extraskeletal chondroma of the soft tissue of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Perri, G.; Tripi, D.

    1986-10-01

    An interesting case of extraskeletal intra-articular chondroma is described. The radiological appearance was that of a soft tissue mass of the wrist on the ulnar side, together with osteopenia and erosions of the pisiform and triquetrum bones. No calcification was noted. The most likely diagnosis was pigmented villonodular synovitis; synovial osteochondromatosis was also considered. However, at operation a single cartilaginous intra-articular nodule, firmly attached to the synovium, proved to be an extraskeletal chondroma. The authors offer speculative theories about the origins of such lesions and describe the various radiological and pathological features of a chondroma of soft tissues.

  4. Case report 393: Extraskeletal chondroma of the soft tissue of the wrist

    International Nuclear Information System (INIS)

    Perri, G.; Tripi, D.

    1986-01-01

    An interesting case of extraskeletal intra-articular chondroma is described. The radiological appearance was that of a soft tissue mass of the wrist on the ulnar side, together with osteopenia and erosions of the pisiform and triquetrum bones. No calcification was noted. The most likely diagnosis was pigmented villonodular synovitis; synovial osteochondromatosis was also considered. However, at operation a single cartilaginous intra-articular nodule, firmly attached to the synovium, proved to be an extraskeletal chondroma. The authors offer speculative theories about the origins of such lesions and describe the various radiological and pathological features of a chondroma of soft tissues. (orig.)

  5. Kinesthetic Feedback During 2DOF Wrist Movements via a Novel MR-Compatible Robot.

    Science.gov (United States)

    Erwin, Andrew; O'Malley, Marcia K; Ress, David; Sergi, Fabrizio

    2017-09-01

    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.

  6. An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

    Science.gov (United States)

    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.

  7. Wrist arthrography: a simple method

    Energy Technology Data Exchange (ETDEWEB)

    Berna-Serna, Juan D.; Reus, Manuel; Alonso, Jose [Virgen de la Arrixaca University Hospital, Department of Radiology, El Palmar (Murcia) (Spain); Martinez, Francisco; Domenech-Ratto, Gines [University of Murcia, Department of Human Anatomy, Faculty of Medicine, Murcia (Spain)

    2006-02-01

    A technique of wrist arthrography is presented using an adhesive marker-plate with radiopaque coordinates to identify precisely sites for puncture arthrography of the wrist and to obviate the need for fluoroscopic guidance. Radiocarpal joint arthrography was performed successfully in all 24 cases, 14 in the cadaveric wrists and 10 in the live patients. The arthrographic procedure described in this study is simple, safe, and rapid, and has the advantage of precise localisation of the site for puncture without need for fluoroscopic guidance. (orig.)

  8. Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient.

    Science.gov (United States)

    Kim, ByungSung; Yoon, Hong-Kee; Nho, Jae-Hwi; Park, Kang Hee; Park, Sung-Yong; Yoon, Jun-Hee; Song, Hyun Seok

    2013-11-01

    Our aim was to evaluate the clinical results of patients treated by arthroscopically assisted reconstruction of foveal avulsion injury of the triangular fibrocartilage complex (TFCC) using a suture anchor. We retrospectively reviewed the results of 15 patients (11 men and 4 women; mean age, 30.5 years) who underwent surgical procedures for the treatment of TFCC foveal avulsion at our hospital. The patients were followed up for a mean of 29 months. The patients had TFCC foveal avulsion caused by sprains (n = 8), falls (n = 4), playing baseball (n = 2), and a motor vehicle accident (n = 1). All the patients underwent magnetic resonance imaging. Radiographs obtained to assess ulnar variance (UV), ulnar-dorsal subluxation, and function of the wrist based on grip power; Disabilities of the Arm, Shoulder and Hand score; and Mayo wrist score were examined for all patients both preoperatively and postoperatively. On preoperative magnetic resonance imaging, TFCC foveal avulsion was observed in 13 of 15 cases. The mean UV value based on preoperative simple radiographic findings was 1.7 ± 1.0 mm, and dorsal subluxation at the distal ulna improved from 2.9 ± 3.0 mm to 0.2 ± 0.9 mm (P = .017). In all cases the distal radioulnar joint instability disappeared postoperatively. Grip power (compared with the uninvolved limb) was 79.3% preoperatively and 82.9% postoperatively (P = .086). The Disabilities of the Arm, Shoulder and Hand scores were 28.4 points preoperatively and 16.6 points postoperatively (P = .061). The Mayo wrist scores were excellent in 10 cases, good in 2, and fair in 3, and the mean score improved significantly from 64 points preoperatively to 84 points postoperatively (P = .007). Arthroscopic-assisted suture anchor reattachment of the TFCC in patients with traumatic TFCC foveal avulsion can prevent or reduce distal radioulnar joint instability and reduce pain even in chronic cases with positive UV. Level IV, therapeutic case series. Copyright © 2013

  9. Evaluation of the performance of three tenodesis techniques for the treatment of scapholunate instability: flexion-extension and radial-ulnar deviation.

    Science.gov (United States)

    Alonso-Rasgado, Teresa; Zhang, Qing-Hang; Jimenez-Cruz, David; Bailey, Colin; Pinder, Elizabeth; Mandaleson, Avanthi; Talwalkar, Sumedh

    2017-11-25

    Chronic scapholunate ligament (SL) injuries are difficult to treat and can lead to wrist dysfunction. Whilst several tendon reconstruction techniques have been employed in the management of SL instability, SL gap reappearance after surgery has been reported. Using a finite element model and cadaveric study data, we investigated the performance of the Corella, scapholunate axis (SLAM) and modified Brunelli tenodesis (MBT) techniques. Scapholunate dorsal and volar gap and angle were obtained following virtual surgery undertaken using each of the three reconstruction methods with the wrist positioned in flexion, extension, ulnar deviation and radial deviation, in addition to the ulnar-deviated clenched fist and neutral positions. From the study, it was found that, following simulated scapholunate interosseous ligament rupture, the Corella technique was better able to restore the SL gap and angle close to the intact ligament for all wrist positions investigated, followed by SLAM and MBT. The results suggest that for the tendon reconstruction techniques, the use of multiple junction points between scaphoid and lunate may be of benefit. Graphical abstract The use of multiple junction points between scaphoid and lunate may be of benefit for tendon reconstruction techniques.

  10. Prevalence of ulnar-to-median nerve motor fiber anastomosis (Riché-Cannieu communicating branch) in hand: An electrophysiological study

    Science.gov (United States)

    Ahadi, Tannaz; Raissi, Gholam Reza; Yavari, Masood; Majidi, Lobat

    2016-01-01

    Background: Two main muscles studied in the hand for evaluation of median nerve injuries are opponens pollicis (OP) and abductor pollicis brevis (APB). However, Riché-Cannieu communicating branch (RCCB) may limit the use of these muscles in electrodiagnosis. This condition is confusing in the case of median nerve injuries. This study was conducted to evaluate the prevalence of RCCB. Methods: Twenty-three consecutive cases of complete median nerve injury were studied. Evoked responses via stimulation of median and ulnar nerves in the wrist and recording with needle in the thenar area were studied. Results: Of the patients, 82.6% exhibited RCCB. In 14 (60.8%) cases the OP and in 19(82.6%) cases APB was supplied by the ulnar nerve. Conclusion: RCCB was detected to be 60.8% in OP and 82.6% in APB, so OP is preferable to APB in the study of median nerve. PMID:27390694

  11. Ulnar nerve paralysis after forearm bone fracture

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2016-08-01

    Full Text Available ABSTRACT Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  12. Kinematics of Hooke universal joint robot wrists

    Science.gov (United States)

    Mckinney, William S., Jr.

    1988-01-01

    The singularity problem associated with wrist mechanisms commonly found on industrial manipulators can be alleviated by redesigning the wrist so that it functions as a three-axis gimbal system. This paper discussess the kinematics of gimbal robot wrists made of one and two Hooke universal joints. Derivations of the resolved rate motion control equations for the single and double Hooke universal joint wrists are presented using the three-axis gimbal system as a theoretical wrist model.

  13. Radiologic evaluation of wrist arthrography

    International Nuclear Information System (INIS)

    Park, Yang Hee; Seong, Hyeun Lim; Yang, Jae Beom; Park, Chan Sup; Lee, Sang Seun

    1991-01-01

    Wrist arthrography allows direct visualization of the cartilage and synovial structure not seen in plain film. Arthrography of the wrist is valuable in evaluating patients with persistent wrist pain and limitation of motion after trauma. Wrist arthrography was performed in the evaluation of 30 patients with rheumatoid arthritis (2 cases), ganglions (12 cases), and wrist trauma (16 cases), and contrast media was injected in radiocarpal joint. The arthrographic findings were analyzed, and the results were as follows: In 16 patients with wrist trauma, 12 cases (75%) of compartment communication was seen including communication with distal radioulnar joint (44%), midcarpal joint (69%), and common carpometacarpal joint (63%). Of the total 30 patients, the pisiform-triquetral joint communicated with the radio carpal joint in 9 cases (30%). In 16 patients with trauma, the findings of post-traumatic arthritis included tendon communication (50%), irregular synovium (31%), and rupture of the joint capsule (25%). There was no lymphatic filling. Of 3 scaphoid fracture patients without bony callus formation, fibrous union was verified in one patient and nouncion in 2. O 12 patients with ganglion, communication between the ganglion and radiocarpal joint was seen in 2 cases and no communication in 10 cases

  14. Validity of F-wave minimal latency of median and ulnar nerves for diagnosis and severity assessment of carpal tunnel syndrome in type II diabetes mellitus

    International Nuclear Information System (INIS)

    Hussain, A.; Habib, S.S.; Omar, S.A.; Drees, M.A.

    2011-01-01

    Type II diabetes mellitus is a common problem and is sometimes associated with Carpal Tunnel Syndrome (CTS) due to compression of median nerve at wrist. Electrophysiological tests are frequently used for its diagnosis. In this work, F-wave minimal latency (FWML) difference between median and ulnar nerve and F-ratio is used to facilitate the diagnosis and severity of CTS in type II diabetes mellitus (T2DM). Methods: Thirty control cases were selected who were physically fit for normal electrophysiological values. Thirty-two patients with a long history of type II diabetes mellitus were studied for electro-diagnostic tests. All patients had clinical evidence of CTS. Among all diabetics about 20 cases had poor glycaemic control (HbA1c>7.5). F-wave minimal latency (FWML) were measured in median and ulnar nerves and F-ratio of median nerve were also noted. The mean values in different groups were compared using t-test and p greater or equal to 0.05 was considered significant. Results: In control group, the ulnar FWML was either equal or slightly longer that the median FWML value. In CTS group with type II diabetes mellitus the FWML value of median nerve were significantly longer than FWML of the ulnar nerve. Moreover, in uncontrolled diabetic patients the FWML values was very much longer than controlled group. Similarly the F-ratio of median nerve was significantly low. Conclusion: In addition to the specific criteria for CTS diagnosis, the parameters like FWML difference in median and ulnar nerve with reduced F-ratio of median nerve can be useful in establishing the diagnosis and severity of CTS in type II diabetes mellitus. (author)

  15. The Relative Contribution to Small Finger Abduction of the Ulnar Versus Radial Slip of the EDM: Implications for Tendon Transfers.

    Science.gov (United States)

    Akinleye, Sheriff D; Culbertson, Maya Deza; Cappelleti, Giacomo; Garofolo, Garret; Choueka, Jack

    2017-09-01

    The extensor digiti minimi (EDM) tendon is commonly divided into a radial slip (EDM-R) and an ulnar slip (EDM-U). To our knowledge, the degree to which each EDM slip concomitantly abducts the small finger with active extension has not been formally tested. This study sought to characterize the comparative contributions of finger abduction inherent to each slip of the EDM to observe the sequelae of active small finger extension following transfer of the contralateral slip. Eighteen fresh-frozen cadaveric hands were used in this study. Starting with the hand in resting position, a controlled traction of 10 N was applied to each slip of the EDM tendon. The range of small finger abduction with respect to the fixed ring finger was recorded utilizing infrared reflective markers tracked through the range of motion using a digital video camera. The mean abduction of the small finger when the radial slip of the EDM tendon was tested was 13.33° (95% confidence interval [CI]: 10.10°-16.55°), which was significantly different ( P ≤ .001) than small finger abduction produced by the ulnar slip of the EDM, with a mean of 23.72° (95% CI: 19.40°-28.04°). Given the fact that the ulnar slip of the EDM tendon is shown to be the major contributor of aberrant abduction with active small finger extension, as traction on this slip produces almost twice as much abduction as the radial slip, the EDM-U is the ideal donor graft with respect to tendon transfers of the EDM.

  16. Dynamic extensor brace for lateral epicondylitis.

    NARCIS (Netherlands)

    Faes, M.C.; Akker, B. van den; Lint, J.A. de; Kooloos, J.G.M.; Hopman, M.T.E.

    2006-01-01

    Lateral epicondylitis (tennis elbow) is a common, often disabling ailment. Based on the failure of current therapies, a new dynamic extensor brace has been developed. In this study, the effects of application of this brace for 3 months on the most important and disabling symptoms of patients with

  17. Sonography findings in tears of the extensor pollicis longus tendon and correlation with CT, MRI and surgical findings

    International Nuclear Information System (INIS)

    Ruiz Santiago, Fernando; Garofano Plazas, Pilar; Fernandez, Juan Miguel Tristan

    2008-01-01

    We present our experience in the diagnosis of extensor pollicis longus tendon tears using different imaging methods. In the past 2 years, 12 patients (7 males, 5 females) with extension deficit of distal phalanx of thumb were diagnosed with extensor pollicis longus tendon (EPL) rupture by means of different imaging methods. The ultrasound pattern consisted of a gap between tendon stumps occupied by a continuous (eight cases) or discontinuous (four cases) attenuated hypoechoic string. In nine cases, the tendon ends were identified as a thickened stump-like structure. In the other three cases, tendon stumps were attenuated and mixed with atrophic muscle or wrist subcutaneous fat. All ultrasound findings were confirmed by CT, MR and/or surgical findings

  18. High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy.

    Science.gov (United States)

    Zhan, Hui-Li; Li, Wen-Ting; Bai, Rong-Jie; Wang, Nai-Li; Qian, Zhan-Hua; Ye, Wei; Yin, Yu-Ming

    2017-04-05

    The injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese. Fourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists. Triangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr. High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

  19. Comparison of Early Active Tension and Immobilization Protocols in Rehabilitation of the Hand, Following Zone 5-6 Extensor Tendon Repair

    Directory of Open Access Journals (Sweden)

    Fereidoun Layeghi

    2013-07-01

    Full Text Available Objective: The objective of the study was to assess and compare Early Active Tension and Immobilization Protocols in Rehabilitation of the Hand, Following Zone 5-6 Extensor Tendon Repair. Materials & Methods: From the 21 patients enrolled in a randomized controlled trial study, 18 cases with average age of 32. 43 years completed the protocol. A total of 41 extensor tendons from 27 fingers of the subjects were studied. A surgeon repaired all tendons in zone 5 and/or 6 by an end to end epitenon running technique using prolen 0.3. For rehabilitation, subjects were randomly assigned into two “Immobilization” and “early active tension” group. Edema, metacarpophalangeal flexion, combined flexion and extension of wrist and fingers, total active motion of fingers and metacarpal extensor lag were assessed 6 weeks after surgery. All aforementioned variables and grip strength were reassessed 12 weeks after surgery. Results: Compared to traditional immobilization protocol, early active tension could significantly improve hand edema, metacarpal flexion, combined flexion and extension of wrist and fingers, total active motion of fingers and grip strength (P0.05. Conclusion: Our results demonstrate that in compliant patients, early active tension could be an alternative method for traditional immobilization protocol, after surgical repair of extensor tendon injuries in zone 5 and/or 6.

  20. Injury to ulnar collateral ligament of thumb.

    Science.gov (United States)

    Madan, Simerjit Singh; Pai, Dinker R; Kaur, Avneet; Dixit, Ruchita

    2014-02-01

    Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed by inexperienced health care personnel in emergency departments. It has frequently been described in skiers, but also occurs in other sports such as rugby, soccer, handball, basketball, volleyball and even after a handshake. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Many treatment options exist, surgical treatment being offered depending on various factors, including timing of presentation (acute or chronic), grade (severity of injury), displacement (Stener lesion), location of tear (mid-substance or peripheral), associated or concomitant surrounding tissue injury (bone, volar plate, etc.), and patient-related factors (occupational demands, etc.). This review aims to identify the optimal diagnostic techniques and management options for UCL injury available thus far. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  1. Investigation of radialization and rerouting of the extensor digiti minimi (EDM) in the abduction deformity of the little finger: a cadaver study.

    Science.gov (United States)

    van Aaken, Jan; Zhu, Jin; Fasel, Jean H D; Beaulieu, Jean-Yves

    2011-06-01

    One of several operations to correct abduction deformity of the little finger, (Wartenberg's sign) in ulnar nerve palsy, is a combined procedure that radializes the extensor digiti minimi (EDM) at the level of the fifth metacarpophalangeal (MCP) joint and reroutes it from the fifth to fourth extensor compartment. This cadaveric study was designed to investigate the impact of both elements on adduction. Anatomy of the little finger extensor apparatus was studied in 16 freshly frozen cadaver hands sectioned at mid forearm. We observed little finger motion after different modifications of the EDM. We tested the effect of a rerouting maneuver by pulling on the EDM, as well as radialization of the EDM alone and in combination with rerouting. The EDM was present in all cases. Little finger extensor digitorum communis (EDC(V)) was missing in two cadavers. In no case was adduction created by rerouting the EDM to the fourth compartment. Radialization of the EDM corrected the abduction deformity beyond the axis of abduction/adduction of the fifth MCP joint in 13 cases and only up to it in three cases. In one of the three with limited correction, a rerouting maneuver allowed for further adduction. The key to correct abduction deformity of the little finger is radialization of the EDM, which can be done through a solitary incision at the level of the MCP joint. Rerouting alone does not correct the abduction deformity, and in combination with radialization it does not predictably enhance the correction.

  2. Computational Biomechanics of the Wrist Joint

    CERN Document Server

    Nazri Bajuri, Mohd

    2013-01-01

    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.

  3. X-Ray Exam: Wrist

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español X-Ray Exam: Wrist KidsHealth / For Parents / X-Ray Exam: ... Muscles, and Joints Broken Bones Getting an X-ray (Video) X-Ray (Video) View more Partner Message About Us ...

  4. Wrist Injuries in Elderly Women

    DEFF Research Database (Denmark)

    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...

  5. Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet.

    Science.gov (United States)

    Uzel, A-P; Bulla, A; Laurent-Joye, M; Caix, P

    2011-08-01

    The Henry approach is the classical anterolateral surgical exposure of the volar aspect of the distal radius. This approach does not allow good access to the medial side of the volar distal radius (lunate facet) and the distal radio-ulnar joint, unless it is extended proximally, retracting the tendons and the median nerve medially, which can cause some trauma. The purpose of our study was to investigate the anatomic basis and to outline the advantages of the unusual anteromedial approach, reporting our experience in the treatment of 4 distal radius fractures, with a 90° or 180° twist of the lunate facet, and 10 wrist dissections on cadavers. The average follow-up was 68.8 months (range 18 to 115 months). In our series, this approach did not cause any nerve injuries or any sensory loss of the distal forearm and the palm. All the fractures of the lunate facet and of the radial styloid process healed. One patient with an ulnar styloid process fracture associated showed pseudarthrosis, but with no instability of the distal radio-ulnar joint or pain on the ulnar side. Using the criteria of Green and O'Brien, modified by Cooney, the results were: excellent in two cases, good in one case, and average in another. The evaluation of arthritis according to Knirk and Jupiter's classification showed grade 0 in three cases and grade 3 in one case with osteochondral sclerosis. We showed that the anteromedial approach is reliable and convenient in the case of fractures situated in the antero-medial portion of the radius, for the double objective of reducing the fracture under direct control and checking the congruence of the distal radio-ulnar joint.

  6. Elbow, forearm, wrist, and hand injuries among sport rock climbers.

    Science.gov (United States)

    Holtzhausen, L M; Noakes, T D

    1996-07-01

    Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. Data were extracted directly from the sourced articles. The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport.

  7. HIGH ORIGIN OF SUPERFICIAL ULNAR ARTERY- A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Anjana Jayakumaran Nair

    2017-03-01

    Full Text Available BACKGROUND High origin and superficially placed ulnar artery is a rare anatomical variant that usually arises either in the axilla or arm and runs a superficial course in the forearm, enters the hand and participates in the formation of superficial palmar arch. During routine dissection of cadavers in our department, we observed a unilateral case of high origin and superficial ulnar artery in a human male cadaver. It originated from the brachial artery in the lower third of arm 4 cm above its bifurcation. From its origin, it passed downwards along the medial aspect of forearm, superficial to the flexors, entered hand superficial to the flexor retinaculum and formed superficial palmar arch. The knowledge of existence of a superficial ulnar artery is important during vascular and reconstructive surgery and also in evaluation of angiographic images. Superficial position makes it more vulnerable to trauma and more accessible to cannulation.

  8. Reconstruction of hand contracture by reverse ulnar perforator flap

    Directory of Open Access Journals (Sweden)

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  9. Accuracy and reliability of wrist-cuff devices for self-measurement of blood pressure.

    Science.gov (United States)

    Kikuya, Masahiro; Chonan, Kenichi; Imai, Yutaka; Goto, Eiji; Ishii, Masao

    2002-04-01

    dorsiflexion was significantly lower than that in palmar extension. In some cases, finger plethysmogram did not disappear during maximum inflation of the wrist-cuff (congruent with 250 mmHg), even in palmar extension and especially in palmar flexion, suggesting incomplete obstruction of radial and/or ulnar arteries during inflation. The results suggest that wrist-cuff devices in the present form are inadequate for self-measurement of blood pressure and, thus, are inadequate for general use or clinical and practical use. However, there is much possibility in wrist-cuff device and the accuracy and reliability of wrist-cuff device are warranted by an improvement of technology.

  10. Location and incidence of localized juxta-articular demineralizations and erosions at the wrist in early rheumatoid arthritis

    International Nuclear Information System (INIS)

    Fischer, E.

    1988-01-01

    In early rheumatoid arthritis the location and incidence of localized juxta-articular demineralizations and erosions were investigated at 53 points of the wrist. On the level of the metacarpal bases, the distal and proximal row of the carpal bones more changes are seen in the oblique vd. and the lateral view than in the dv. view. At the distal bones of the forearm more changes are seen at the radius than at the ulnar styloid. The most often changes at all occur at the volar middle third of the triquetrum in the oblique view and at the distal volar articular facet of the scaphoid in the lateral view. Close relations between localized juxta-articular demineralizations and erosions do not exist. If the early bone changes at the wrist in rheumatoid arthritis are to be detected additional oblique and lateral view are prerequisite. (orig.) [de

  11. Cold intolerance following median and ulnar nerve injuries : prognosis and predictors

    NARCIS (Netherlands)

    Ruijs, A.C.J; Jaquet, J-B.; van Riel, W. G.; Daanen, H. A M; Hovius, S.E.R.

    This study describes the predictors for cold intolerance and the relationship to sensory recovery after median and ulnar nerve injuries. The study population consisted of 107 patients 2 to 10 years after median, ulnar or combined median and ulnar nerve injuries. Patients were asked to fill out the

  12. Cold intolerance following median and ulnar nerve injuries : prognosis and predictors

    NARCIS (Netherlands)

    Ruijs, A.C.J.; Jaquet, J.B.; Riel, W.G. van; Daanen, H.A.M.; Hovius, S.E.R.

    2007-01-01

    This study describes the predictors for cold intolerance and the relationship to sensory recovery after median and ulnar nerve injuries. The study population consisted of 107 patients 2 to 10 years after median, ulnar or combined median and ulnar nerve injuries. Patients were asked to fill out the

  13. Dynamic ulnar impaction syndrome in tennis players: report of two cases

    Directory of Open Access Journals (Sweden)

    Edgard de Novaes França Bisneto

    Full Text Available ABSTRACT In this report, two tennis players with symptoms of ulnar impaction syndrome are reviewed. Both players have neutral ulnar variance. These cases represent dynamic ulnar impaction syndrome, when the impact between ulna and carpus occurs during conditions of pronated grip. The literature and the treatment of these two cases are discussed.

  14. The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI

    International Nuclear Information System (INIS)

    Ali, Sayed; Cunningham, Ryan; Mohamed, Feroze; Amin, Mamta; Popoff, Steven N.; Barbe, Mary F.

    2015-01-01

    To determine if magic angle plays a role in apparent central increased signal intensity of the distal extensor carpi ulnaris tendon (ECU) on MRI, to see if histologic findings of tendon degeneration are associated with increased T1 or T2 tendon signal on MR imaging, and to determine the prevalence of the ECU ''pseudolesion''. A standard 3 Tesla protocol was utilized to scan ten cadaveric wrists. A 40 mm length of 10 ECU and four extensor carpi radialis brevis (ECRB) tendons were immersion fixed before microCT scanning. Staining with Alcian blue, Masson's trichrome and Safranin O was performed before light microscopy. Fifty clinical wrist MRIs were also reviewed for the presence of increased T1 and/or T2 signal. Central increased T1 and/or T2 signal was observed in 9 of 10 cadaveric ECU tendons, but not in ECRB tendons. MicroCT and histology showed inter-tendinous matrix between the two distal heads of the ECU. Increased mucoid degeneration correlated with increased MRI signal intensity. The tendon fibers were at a maximum of 8.39 to the longitudinal axis on microCT. Clinical MRIs showed increased T1 signal in 6 %, increased T2 signal in 8 %, increased T1 and T2 signal in 80 %, and 6 % showing no increased signal. Central increased T1 and/or T2 signal in the ECU tendon indicates the presence of normal inter-tendinous ground substance, with increased proteoglycan content (mucoid degeneration) responsible for increased signal intensity. None of the fibers were shown on microCT to approach the magic angle. (orig.)

  15. The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ali, Sayed; Cunningham, Ryan; Mohamed, Feroze [Temple University Hospital, Department of Radiology, Philadelphia, PA (United States); Amin, Mamta; Popoff, Steven N.; Barbe, Mary F. [Temple University School of Medicine, Department of Anatomy, Philadelphia, PA (United States)

    2015-12-15

    To determine if magic angle plays a role in apparent central increased signal intensity of the distal extensor carpi ulnaris tendon (ECU) on MRI, to see if histologic findings of tendon degeneration are associated with increased T1 or T2 tendon signal on MR imaging, and to determine the prevalence of the ECU ''pseudolesion''. A standard 3 Tesla protocol was utilized to scan ten cadaveric wrists. A 40 mm length of 10 ECU and four extensor carpi radialis brevis (ECRB) tendons were immersion fixed before microCT scanning. Staining with Alcian blue, Masson's trichrome and Safranin O was performed before light microscopy. Fifty clinical wrist MRIs were also reviewed for the presence of increased T1 and/or T2 signal. Central increased T1 and/or T2 signal was observed in 9 of 10 cadaveric ECU tendons, but not in ECRB tendons. MicroCT and histology showed inter-tendinous matrix between the two distal heads of the ECU. Increased mucoid degeneration correlated with increased MRI signal intensity. The tendon fibers were at a maximum of 8.39 to the longitudinal axis on microCT. Clinical MRIs showed increased T1 signal in 6 %, increased T2 signal in 8 %, increased T1 and T2 signal in 80 %, and 6 % showing no increased signal. Central increased T1 and/or T2 signal in the ECU tendon indicates the presence of normal inter-tendinous ground substance, with increased proteoglycan content (mucoid degeneration) responsible for increased signal intensity. None of the fibers were shown on microCT to approach the magic angle. (orig.)

  16. Anatomical Basis and Clinical Application of Synovial Flaps in the Wrist and Distal Forearm.

    Science.gov (United States)

    Colen, David L; Yeh, Jiun-Ting; Colen, Lawrence B

    2017-05-01

    Neuropathic symptoms after median nerve repair at the wrist or secondary to refractory carpal tunnel syndrome may become debilitating. These symptoms develop because of perineural adhesions, intraneural fibrosis, and fixation of the nerve to the transverse carpal ligament after surgery, and often require neurolysis. Interposition of vascularized soft tissue over the median nerve at the time of neurolysis prevents recurrence of such adhesions. The synovial flap, fashioned from the synovial lining of the flexor tendon sheath, is an ideal tissue for this purpose. Previous authors have described the surgical technique of the synovial flap, but the anatomical basis and design of the flap have not been previously discussed. Twenty fresh cadaver upper extremities were injected with Microfil to analyze the arterial anatomy, flap dimensions, and arc of rotation of the flexor tendon synovium mobilized as a flap suitable for coverage of the median nerve at the wrist. The authors determined that both radial and ulnar-based flaps are clinically useful for providing coverage in the wrist and distal forearm. This flap was used in 18 patients with complicated median nerve lesions in this region. All patients had an uncomplicated postoperative course. Of 13 patients treated for posttraumatic median nerve neuromas, all but two had significant resolution of symptoms. When used as a vascularized flap, the flexor tendon synovium provides adequate protection of the median nerve. Flap dimensions and vascularity of this tissue make it an ideal local flap option when performing reoperative surgery on the median nerve.

  17. Strength and power of knee extensor muscles

    Directory of Open Access Journals (Sweden)

    Knežević Olivera

    2011-01-01

    Full Text Available In the studies of human neuromuscular function, the function of leg muscles has been most often measured, particularly the function of the knee extensors. Therefore, this review will be focused on knee extensors, methods for assessment of its function, the interdependence of strength and power, relations that describe these two abilities and the influence of various factors on their production (resistance training, stretching, movement tasks, age, etc.. Given that it consists of four separate muscles, the variability of their anatomical characteristics affects their participation in strength and power production, depending on the type of movement and motion that is performed. Since KE is active in a variety of activities it must be able to generate great strength in a large and diverse range of muscle lengths and high shortening velocities, in respect to different patterns of strength production, and thus different generation capacities within the muscle (Blazevich et al., 2006. It has been speculated that KE exerts its Pmax at workloads close to subject's own body weight or lower (Rahmani et al., 2001, which is very close to the maximum dynamic output hypothesis (MDI of Jaric and Markovic (2009. Changes under the influence of resistance training or biological age are variously manifested in muscle's morphological, physiological and neural characteristics, and thus in strength and power. Understanding the issues related to strength and power as abilities of great importance for daily activities, is also important for sports and rehabilitation. Performances improvement in sports in which leg muscles strength and power are crucial, as well as recovery after the injuries, are largely dependent on the research results regarding KE function. Also, the appropriate strength balance between knee flexors and extensors is important for the knee joint stability, so that the presence of imbalance between these two muscle groups might be a risk factor for

  18. Ulnar hammer syndrome: a systematic review of the literature.

    Science.gov (United States)

    Vartija, Larisa; Cheung, Kevin; Kaur, Manraj; Coroneos, Christopher James; Thoma, Achilleas

    2013-11-01

    Ulnar hammer syndrome is an uncommon form of arterial insufficiency. Many treatments have been described, and debate continues about the best option. The goal of this systematic review was to determine whether ulnar hammer syndrome has an occupational association, to identify the most reliable diagnostic test, and to determine the best treatment modality. A comprehensive literature search was conducted using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, and EMBASE. Data from articles meeting inclusion criteria were collected in duplicate. Methodological quality of studies was assessed using the Methodological Index for Nonrandomized Studies scale. Thirty studies were included in the systematic review. No randomized controlled trials were identified. There is low-quality evidence suggestive of an association between exposure to repetitive hand trauma and vibration and ulnar hammer syndrome. Various diagnostic investigations were used, but few were compared, making it difficult to determine the most reliable diagnostic test. Numerous nonoperative and operative treatments were reported. With nonoperative treatment, 12 percent had complete resolution and 70 percent had partial resolution of their symptoms. Of patients treated operatively, 42.5 percent had complete resolution and 42.5 percent had partial resolution of their symptoms. The heterogeneity in study design and outcome measures limits definitive conclusions about occupational association, best diagnostic test, and treatment for ulnar hammer syndrome. However, there is low-quality evidence that suggests that most patients with ulnar hammer syndrome will have partial relief of symptoms with nonoperative treatment, and operative treatment results in complete or partial resolution of symptoms in the majority of cases. Therapeutic, IV.

  19. Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis.

    Science.gov (United States)

    Shim, Jae Woo; Park, Min Jong

    2017-11-01

    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.

  20. Orthogonal views improves localisation in bone scans of wrist

    International Nuclear Information System (INIS)

    Roth, A.L.

    1997-01-01

    Full text: Of all nuclear medicine studies, bone scans are the most fundamental. However, straightforward these may seem, there are always mechanisms that can be implemented which assist in a more precise diagnosis, particularly in areas with an intricate bone structure. An 18-year-old right-handed student presented to her doctor with a one month history of pain over the right distal radio-ulna joint area. Clinically, she had prominence of the right ulna, which suggested that there may have been a previous injury to the wrist. Also, pronation/supination were painful where there was swelling of the extensor carpi ulnaris tendon, as well as some discomfort with clicking in ulna deviation/rotation. The X-rays demonstrated some premature radial epiphysial closure. A bone scan was requested to attempt to localise the main inflammatory focus. The dynamic study was performed in the planar projection with an immediate blood pool for 300k being taken. These demonstrated a vascular blush medially. A medial blood pool image was acquired and it localised the abnormal vascularity as being dorsal. A separate focal area of less intense blood pooling was also noted in the line of the distal ulna. Delayed images showed increased uptake localised to the ulna styloid. Anatomically, the superficial vascular blush correlated with tenosynovitis. Hence, the orthogonal initial and delayed images were definitive in the diagnoses of tenosynovitis of the extensor carpi ulnaris tendon. This clearly complements the information provided by the palmar view. However, it is important to remember that an increased radiation dose to the technologist is incurred as a result of the extra orthogonal view, hence attention to technique is imperative

  1. Orthogonal views improves localisation in bone scans of wrist

    Energy Technology Data Exchange (ETDEWEB)

    Roth, A.L.

    1997-09-01

    Full text: Of all nuclear medicine studies, bone scans are the most fundamental. However, straightforward these may seem, there are always mechanisms that can be implemented which assist in a more precise diagnosis, particularly in areas with an intricate bone structure. An 18-year-old right-handed student presented to her doctor with a one month history of pain over the right distal radio-ulna joint area. Clinically, she had prominence of the right ulna, which suggested that there may have been a previous injury to the wrist. Also, pronation/supination were painful where there was swelling of the extensor carpi ulnaris tendon, as well as some discomfort with clicking in ulna deviation/rotation. The X-rays demonstrated some premature radial epiphysial closure. A bone scan was requested to attempt to localise the main inflammatory focus. The dynamic study was performed in the planar projection with an immediate blood pool for 300k being taken. These demonstrated a vascular blush medially. A medial blood pool image was acquired and it localised the abnormal vascularity as being dorsal. A separate focal area of less intense blood pooling was also noted in the line of the distal ulna. Delayed images showed increased uptake localised to the ulna styloid. Anatomically, the superficial vascular blush correlated with tenosynovitis. Hence, the orthogonal initial and delayed images were definitive in the diagnoses of tenosynovitis of the extensor carpi ulnaris tendon. This clearly complements the information provided by the palmar view. However, it is important to remember that an increased radiation dose to the technologist is incurred as a result of the extra orthogonal view, hence attention to technique is imperative.

  2. Kinematic control of robot with degenerate wrist

    Science.gov (United States)

    Barker, L. K.; Moore, M. C.

    1984-01-01

    Kinematic resolved rate equations allow an operator with visual feedback to dynamically control a robot hand. When the robot wrist is degenerate, the computed joint angle rates exceed operational limits, and unwanted hand movements can result. The generalized matrix inverse solution can also produce unwanted responses. A method is introduced to control the robot hand in the region of the degenerate robot wrist. The method uses a coordinated movement of the first and third joints of the robot wrist to locate the second wrist joint axis for movement of the robot hand in the commanded direction. The method does not entail infinite joint angle rates.

  3. MR imaging of normal extrinsic wrist ligaments using thin slices with clinical and surgical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Shahabpour, M., E-mail: maryam.shahabpour@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); De Maeseneer, M., E-mail: michel.demaeseneer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Pouders, C. [Department of Experimental Anatomy, Vrije Universiteit Brussel (Belgium); Van Overstraeten, L. [Department of Foot and Hand Surgery, Centre Hospitalier Regional de Wallonie Picarde, Tournai (Belgium); Ceuterick, P. [Department of Hand Surgery, Europa Ziekenhuizen, Brussels (Belgium); Fierens, Y. [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Goubau, J. [Department of Orthopaedic Surgery, UZ Brussel, Brussels (Belgium); De Mey, J. [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium)

    2011-02-15

    Eighty-nine MR examinations of the wrist were retrospectively analyzed. MRI results were compared with clinical findings and/or arthroscopy. Thin proton density and T2 weighted sequences and 3D DESS weighted sequences were applied on a 1.5 T scanner. On the palmar side three radiocarpal ligaments are recognized including the radioscaphocapitate, radiolunotriquetral, radioscapholunate, and midcarpal triquetroscaphoidal ligaments. Ulnocarpal ligaments include the ulnolunate ligament and the ulnotriquetral ligament. On the dorsal side three ligaments are recognized: the dorsal radiolunotriquetral, and the midcarpal triquetroscaphoidal and triquetro-trapezoido-trapezial. The collateral ligaments include the radial and ulnar collateral ligament. MR is a valuable technique in the assessment of the extrinsic and midcarpal ligaments. Depiction of the extrinsic ligaments can best be accomplished with coronal 3D DESS sequences and sagittal and transverse proton density and T2 weighted sequences with thin slices.

  4. [Relieving pre-exam anxiety syndrome with wrist-ankle acupuncture: a randomized controlled trial].

    Science.gov (United States)

    Shu, Shi; Li, Tong-ming; Fang, Fan-fu; He, Hou-luo; Zhou, Qing-hui; Gu, Wei; Zhou, Shuang

    2011-06-01

    Pre-exam anxiety syndrome is a common condition occurring in pre-exam students and directly affects their examination performance and physical state. Wrist-ankle acupuncture has significant therapeutic effects in treating mental disorders and may also relieve the symptoms of pre-exam anxiety syndrome. To assess the therapeutic effect of wrist-ankle acupuncture on pre-exam anxiety syndrome. A total of 60 students who met the inclusion criteria of pre-exam anxiety syndrome were enrolled from a university in Shanghai and they were randomly divided into treatment group and control group. There were 30 cases in each group, and no case failed to follow-up. In the treatment group, wrist-ankle acupuncture was adopted to point upper 1 bilaterally (impression between flexor carpi ulnaris tendon and ulnar margin), and there was no requirement for Deqi (arrival of qi). In the control group, sham acupuncture was adopted. The treatment was applied 3 times totally in both groups one week before the exam, once every other day, each time with the needles retained for 30 min. The therapeutic effects were compared between two groups. Before and after 3 treatments, Sarason Test Anxiety Scale (TAS) and Expectation and Treatment Credibility Scale (ETCS) were measured and evaluated. The therapeutic effect experienced by the treatment group was better than that of the control group (PETCS before treatment between the two groups. The scores of TAS after treatment in two groups were higher than those before treatment (PETCS than those in the control group (P<0.05, P<0.01). No adverse reaction was reported. Wrist-ankle acupuncture can relieve the symptoms of pre-exam anxiety syndrome significantly, and this therapy is highly safe.

  5. Hand rest and wrist support are effective in preventing fatigue during prolonged typing.

    Science.gov (United States)

    Callegari, Bianca; de Resende, Marília Maniglia; da Silva Filho, Manoel

    Case series (longitudinal). Only few reports concerning the efficacy of commonly used strategies for preventing upper limb occupational disorders associated with prolonged typing exist. We aimed to investigate whether the duration of typing and the use of 2 strategies (hand rest and wrist support) changes muscle physiological response and therefore the electromyography records. We enrolled 25 volunteers, who were unfamiliar with the task and did not have musculoskeletal disorders. The subjects underwent 3 prolonged typing protocols to investigate the efficacy of the 2 adopted strategies in reducing the trapezius, biceps brachii, and extensor digitorum communis fatigue. Typing for 1 hour induced muscular fatigue (60%-67% of the subjects). The extensor digitorum communis muscle exhibited the highest percentage of fatigue (72%-84%) after 1 and 4 hours of typing (1 hour, P = .04; 4 hours, P = .02). Fatigue levels in this muscle were significantly reduced (24%) with the use of pause typing (4 hours, P = .045), whereas biceps brachii muscle fatigue was reduced (32%) only with the use of wrist supports (P = .02, after 4 hours). Trapezius muscle fatigue was unaffected by the tested occupational strategies (1 hour, P = .62; 4 hours, P = .85). Despite presenting an overall tendency for fatigue detected during the application of the protocols, the assessed muscles exhibited different behavior patterns, depending on both the preventive strategy applied and the muscle mechanical role during the task. Hand rest and wrist support can successfully reduce muscle fatigue in specific upper limb muscles during prolonged typing, leading to a muscle-selective reduction in the occurrence of fatigue and thus provide direct evidence that they may prevent work-related musculoskeletal disorders. N/A. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  6. Ulnar nerve entrapment in a French horn player.

    Science.gov (United States)

    Hoppmann, R A

    1997-10-01

    Nerve entrapment syndromes are frequent among musicians. Because of the demands on the musculoskeletal system and the great agility needed to per-form, musicians often present with vague complaints early in the course of entrapment, which makes the diagnosis a challenge for the clinician. Presented here is such a case of ulnar nerve entrapment at the left elbow of a French horn player. This case points out some of the difficulties in establishing a diagnosis of nerve entrapment in musicians. It also supports the theory that prolonged elbow flexion and repetitive finger movement contribute to the development of ulnar entrapment at the elbow. Although surgery is not required for most of the musculoskeletal problems of musicians, release of an entrapped nerve refractory to conservative therapy may be career-saving for the musician.

  7. Radiological evaluation of the skeleton: traumatology of the distal forearm, wrist, and hand; Radiologische Skelettdiagnostik: Traumatologie des distalen Unterarmes, der Handgelenke und der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Neumann, K. [Universitaetsklinikum Essen (Germany). Zentralinstitut fuer Roentgendiagnostik; Langer, R. [Universitaetsklinikum Essen (Germany). Zentralinstitut fuer Roentgendiagnostik

    1996-07-01

    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.)

  8. MRI of the wrist and hand

    International Nuclear Information System (INIS)

    Reicher, M.A.; Kellerhouse, L.E.

    1990-01-01

    Magnetic resonance imaging (MRI) is becoming the preferred technique for evaluating a wide range of wrist and hand disorders and has a crucial role in planning arthroscopic and nonarthroscopic wrist surgery. This book details the capabilities of MRI for detecting wrist, hand, and finger pathology; provides a complete understanding of examination techniques, imaging protocols, and anatomy; and contains nearly 400 clear, sharp scans and numerous line drawings showing examination techniques, anatomic structures, and pathologic findings. After an introductory review of MR physics, the book describes state- of-the-art MRI techniques and explains the rationale for selecting imaging protocols. A complete MRI examination of a normal wrist is presented, along with a multiplanar atlas of cross-sectional wrist anatomy

  9. Perforator anatomy of the ulnar forearm fasciocutaneous flap.

    Science.gov (United States)

    Mathy, Jon A; Moaveni, Zachary; Tan, Swee T

    2012-08-01

    The ulnar forearm fasciocutaneous flap (UFFF) is a favourable alternative to the radial forearm flap when thin and pliable tissue is required. The precise anatomy of the cutaneous perforators of UFFF has not been previously reported. The position of cutaneous perforators>0.5 mm was recorded while raising 52 consecutive free UFFFs in 51 patients at our Centre. Three (6%) UFFFs in two patients demonstrated direct cutaneous supply through a superficial ulnar artery, a known anatomic variance. There was no cutaneous perforator>0.5 mm in one flap. Among the remaining 48 dissections, an average of 3 (range, 1-6) cutaneous perforators were identified. Ninety-four percent of these forearms demonstrated at least one perforator>0.5 mm within 3 cm, and all had at least one perforator within 6 cm of the midpoint of the forearm. Proximal perforators were more likely to be musculo-cutaneous through the edge of flexor carpi ulnaris or flexor digitorum superficialis, while mid- to distal perforators were septo-cutaneous. UFFF skin paddle designed to overlie an area within 3 cm of the midpoint between the medial epicondyle and the pisiform is most likely to include at least one cutaneous perforator from the ulnar artery, without a need for intra-operative skin island adjustment. This novel anatomic finding and other practical generalisations are discussed to facilitate successful elevation of UFFF. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Nicola Massy-Westropp

    2012-01-01

    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.

  11. Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

    Science.gov (United States)

    Massy-Westropp, Nicola; Simmonds, Stuart; Caragianis, Suzanne; Potter, Andrew

    2012-01-01

    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. PMID:23251809

  12. Design and characterization of the OpenWrist: A robotic wrist exoskeleton for coordinated hand-wrist rehabilitation.

    Science.gov (United States)

    Pezent, Evan; Rose, Chad G; Deshpande, Ashish D; O'Malley, Marcia K

    2017-07-01

    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.

  13. The post-arthro-CT of the wrist: clinical evaluation

    International Nuclear Information System (INIS)

    Scheurecker, G.

    2001-03-01

    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 negative - AS positive/AG positive - AS negative/ AG and AS negative): SLL: 16/8/0/34, LTL: 13/4/8/33, TFC: 28/5/1/24. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 67/100, LTL 76/80, TFC 85/96. PACT versus AS: The following detection rates were observed (PACT and AS positive/PACT negative - AS positive/PACT positive - AS negative/ PACT and AS negative): SLL: 18/6/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM: 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 75/100, LTL 88/80, TFC 94/92, ChM 57/87. AG+PACT versus AS: The following detection rates were observed (AG+PACT and AS positive/AG+PACT negative - AS positive/AG+PACT positive - AS negative/ AG+PACT and AS negative): SLL: 19/5/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity

  14. The post-arthro-CT of the wrist: clinical evaluation

    International Nuclear Information System (INIS)

    Scheurecker, G.

    2001-03-01

    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 negative - AS positive/AG positive - AS negative/ AG and AS negative): SLL: 16/8/0/34, LTL: 13/4/8/33, TFC: 28/5/1/24. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 67/100, LTL 76/80, TFC 85/96. PACT versus AS: the following detection rates were observed (PACT and AS positive/PACT negative - AS positive/PACT positive - AS negative/ PACT and AS negative): SLL: 18/6/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM: 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 75/100, LTL 88/80, TFC 94/92, ChM 57/87. AG+PACT versus AS: the following detection rates were observed (AG+PACT and AS positive/AG+PACT negative - AS positive/AG+PACT positive - AS negative/ AG+PACT and AS negative): SLL: 19/5/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity

  15. Computer use and ulnar neuropathy: results from a case-referent study

    DEFF Research Database (Denmark)

    Andersen, JH; Frost, P.; Fuglsang-Frederiksen, A.

    2012-01-01

    We aimed to evaluate associations between vocational computer use and 1) ulnar neuropathy, and 2) ulnar neuropathy- like symptoms as distinguished by electroneurography. We identified all patients aged 18-65 years, examined at the Department of Neurophysiology on suspicion of ulnar neuropathy, 2001...... was performed by conditional logistic regression.There were a negative association between daily hours of computer use and the two outcomes of interest. Participants who reported their elbow to be in contact with their working table for 2 hours or more during the workday had an elevated risk for ulnar...

  16. Virtual MR arthroscopy of the wrist joint: a new intraarticular perspective

    International Nuclear Information System (INIS)

    Sahin, Guelden; Dogan, Basak Erguvan; Demirtas, Mehmet

    2004-01-01

    The aim of this study is to investigate whether virtual MR arthroscopy could be used to visualize the internal architecture of the radiocarpal compartment of the wrist joint in comparison to surgical arthroscopy. Diluted paramagnetic contrast material was injected into the radiocarpal compartment prior to MR examination in all patients. A fat-suppressed T1-weighted three-dimensional fast spoiled gradient echo sequence was acquired in addition to our standard MR imaging protocol in each patient. Three-dimensional data sets were then transferred to an independent workstation and were postprocessed using navigator software to generate surface rendered virtual MR arthroscopic images. Nineteen patients referred for chronic ulnar-sided wrist pain were evaluated with conventional MR arthrography prospectively. Virtual MR arthroscopic images demonstrating the triangular fibrocartilage complex (TFCC) in an intraarticular perspective were achieved in 12 out of 19 patients. Our preliminary investigation suggests that although it has several limitations, virtual MR arthroscopy shows promise in visualizing the TFCC from an intraarticular perspective. (orig.)

  17. Initial experience with 3D isotropic high-resolution 3 T MR arthrography of the wrist.

    Science.gov (United States)

    Sutherland, John K; Nozaki, Taiki; Kaneko, Yasuhito; J Yu, Hon; Rafijah, Gregory; Hitt, David; Yoshioka, Hiroshi

    2016-01-16

    Our study was performed to evaluate the image quality of 3 T MR wrist arthrograms with attention to ulnar wrist structures, comparing image quality of isotropic 3D proton density fat suppressed turbo spin echo (PDFS TSE) sequence versus standard 2D 3 T sequences as well as comparison with 1.5 T MR arthrograms. Eleven consecutive 3 T MR wrist arthrograms were performed and the following sequences evaluated: 3D isotropic PDFS, repetition time/echo time (TR/TE) 1400/28.3 ms, voxel size 0.35x0.35x0.35 mm, acquisition time 5 min; 2D coronal sequences with slice thickness 2 mm: T1 fat suppressed turbo spin echo (T1FS TSE) (TR/TE 600/20 ms); proton density (PD) TSE (TR/TE 3499/27 ms). A 1.5 T group of 18 studies with standard sequences were evaluated for comparison. All MR imaging followed fluoroscopically guided intra-articular injection of dilute gadolinium contrast. Qualitative assessment related to delineation of anatomic structures between 1.5 T and 3 T MR arthrograms was carried out using Mann-Whitney test and the differences in delineation of anatomic structures among each sequence in 3 T group were analyzed with Wilcoxon signed-rank test. Quantitative assessment of mean relative signal intensity (SI) and relative contrast measurements was performed using Wilcoxon signed-rank test. Mean qualitative scores for 3 T sequences were significantly higher than 1.5 T (p < 0.01), with isotropic 3D PDFS sequence having highest mean qualitative scores (p < 0.05). Quantitative analysis demonstrated no significant difference in relative signal intensity among the 3 T sequences. Significant differences were found in relative contrast between fluid-bone and fluid-fat comparing 3D and 2D PDFS (p < 0.01). 3D isotropic PDFS sequence showed promise in both qualitative and quantitative assessment, suggesting this may be useful for MR wrist arthrograms at 3 T. Primary reasons for diagnostic potential include the ability to make reformations in any

  18. Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

    International Nuclear Information System (INIS)

    Chang, Weiling; Peduto, Anthony J.; Aguiar, Rodrigo O.C.; Trudell, Debra J.; Resnick, Donald L.

    2007-01-01

    To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

  19. Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Weiling [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Sharp-Grossmont Hospital, Department of Radiology, La Mesa, CA (United States); Peduto, Anthony J. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Westmead Hospital and Western Clinical School of Sydney University, Department of Radiology, Sydney (Australia); Aguiar, Rodrigo O.C. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Universidade Federal do Rio de Janeiro, Rio de Janerio (Brazil); Trudell, Debra J.; Resnick, Donald L. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States)

    2007-07-15

    To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

  20. Forward and inverse kinematics of double universal joint robot wrists

    Science.gov (United States)

    Williams, Robert L., II

    1991-01-01

    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.

  1. Indirect MR arthrography of the wrist in the diagnosis of TFCC-lesions

    International Nuclear Information System (INIS)

    Herold, T.; Lenhart, M.; Held, P.; Feuerbach, S.; Link, J.; Babel, M.; Ruf, S.

    2001-01-01

    Purpose: The objective of this prospective study was to assess the value of the indirect MR arthrography (MR-AR) of the wrist in the detection of lesions of the TFCC. Material and methods: Indirect MR-AR was performed in 45 patients (23 f/22 m) with unclear ulnar wrist pain. After i.v. injection of 0.1 mmol/kg Gd-DTPA and after a motion-phase of the wrist (15 minutes) MRI was performed in a coronal plane. We used a STIR-, a fatsaturated (fs) T1-SE and a 3D-DESS sequence. The images were evaluated by two radiologists using a consensus score. The lesions were assigned to the system of Palmer and correlated with arthroscopy. Results: Indirect MR-AR showed in 35 of 45 patients a lesion of the TFCC, but arthroscopy only revealed a defect in 32 cases. This means three false positive but no false negative assessments by MRI. Using this MRI protocol sensitivity and specificity in the detection of TFCC lesions were calculated as 100% and 77%. The accuracy was 93%. Small degenerative changes of the fibres were most common (Palmer type IIA). In trauma patients the ligaments usually showed tears near the insertion at the ulna (Palmer type IB). The sensitivity and specificity was 88% and 95% for evaluation of the scapho-lunate (SL) ligament, the accuracy was 93%. Arthroscopy and MRI did not diagnose any rupture of the lunate-triquetral (LT) ligament. Conclusion: Indirect MR-AR is a non-invasive method with a high sensitivity in the evaluation of the TFCC and associated injuries. Therefore, it is an excellent screening procedure to assess the indication for therapeutic arthroscopy. (orig.) [de

  2. An immunohistochemical study of the triangular fibrocartilage complex of the wrist: regional variations in cartilage phenotype

    Science.gov (United States)

    Milz, S; Sicking, B; Sprecher, C M; Putz, R; Benjamin, M

    2007-01-01

    The triangular fibrocartilage complex (TFCC) transmits load from the wrist to the ulna and stabilizes the distal radioulnar joint. Damage to it is a major cause of wrist pain. Although its basic structure is well established, little is known of its molecular composition. We have analysed the immunohistochemical labelling pattern of the extracellular matrix of the articular disc and the meniscal homologue of the TFCC in nine elderly individuals (age range 69–96 years), using a panel of monoclonal antibodies directed against collagens, glycosaminoglycans, proteoglycans and cartilage oligomeric matrix protein (COMP). Although many of the molecules (types I, III and VI collagen, chondroitin 4 sulphate, dermatan sulphate and keratan sulphate, the oversulphated epitope of chondroitin 6 sulphate, versican and COMP) were found in all parts of the TFCC, aggrecan, link protein and type II collagen were restricted to the articular disc and to entheses. They were thus not a feature of the meniscal homologue. The shift in tissue phenotype within the TFCC, from a fibrocartilaginous articular disc to a more fibrous meniscal homologue, correlates with biomechanical data suggesting that the radial region is stiff and subject to considerable stress concentration. The presence of aggrecan, link protein and type II collagen in the articular disc could explain why the TFCC is destroyed in rheumatoid arthritis, given that it has been suggested that autoimmunity to these antigens results in the destruction of articular cartilage. The differential distribution of aggrecan within the TFCC is likely to be reflected by regional differences in water content and mobility on the radial and ulnar side. This needs to be taken into account in the design of improved MRI protocols for visualizing this ulnocarpal complex of the wrist. PMID:17532798

  3. Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome Influência do resfriamento nos parâmetros de condução nervosa mista do mediano e ulnar na síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Rogério Gayer Machado de Araújo

    2007-09-01

    Full Text Available Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU in electrodiagnosis of carpal tunnel syndrome (CTS. Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands. Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands. PMU was obtained at the usual temperature, >32°C, and after wrist/hand cooling to Temperatura é uma variável comum e importante que modifica os parâmetros de condução nervosa na prática eletrodiagnóstica. Neste trabalho nós estudamos o efeito do esfriamento na diferença de latências palmares entre o nervo mediano e ulnar (PMU, segmento palma-pulso, utilizada rotineiramente para o eletrodiagnóstico da síndrome do túnel do carpo (STC. Foram estudados 22 controles (19 mulheres, média de idade 42,1 anos, 44 mãos e 25 pacientes (25 mulheres, média de idade 46,6 anos, 34 mãos com diagnóstico de STC leve. PMU foi obtida em temperatura usual (>32°C, e após resfriamento de mão/pulso em água com gelo (<27°C. Após o resfriamento houve aumento significativo na PMU e na latência mista palmar do nervo ulnar nos pacientes quando comparados aos controles. Nós concluímos que o resfriamento modifica significativamente a PMU e propomos que as latências obtidas em nervos submetidos à compressão reagem de maneira mais acentuada ao frio e isso poderia ser uma arma útil para o eletrodiagnóstico da STC incipiente. Da mesma forma, houve reação mais acentuada ao frio no estudo da latência mista palmar do nervo ulnar nos pacientes mas não nos controles, que poderia levantar a hipótese de compressão subclínica do nervo ulnar.

  4. Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management

    International Nuclear Information System (INIS)

    Romaniuk, C.S.; Butt, W.P.; Coral, A.

    1995-01-01

    Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral post-traumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18-55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown. (orig.)

  5. Customizing Extensor Reconstruction in Vascularized Toe Joint Transfers to Finger Proximal Interphalangeal Joints: A Strategic Approach for Correcting Extensor Lag.

    Science.gov (United States)

    Loh, Charles Yuen Yung; Hsu, Chung-Chen; Lin, Cheng-Hung; Chen, Shih-Heng; Lien, Shwu-Huei; Lin, Chih-Hung; Wei, Fu-Chan; Lin, Yu-Te

    2017-04-01

    Vascularized toe proximal interphalangeal joint transfer allows the restoration of damaged joints. However, extensor lag and poor arc of motion have been reported. The authors present their outcomes of treatment according to a novel reconstructive algorithm that addresses extensor lag and allows for consistent results postoperatively. Vascularized toe joint transfers were performed in a consecutive series of 26 digits in 25 patients. The average age was 30.5 years, with 14 right and 12 left hands. Reconstructed digits included eight index, 10 middle, and eight ring fingers. Simultaneous extensor reconstructions were performed and eight were centralization of lateral bands, five were direct extensor digitorum longus-to-extensor digitorum communis repairs, and 13 were central slip reconstructions. The average length of follow-up was 16.7 months. The average extension lag was 17.9 degrees. The arc of motion was 57.7 degrees (81.7 percent functional use of pretransfer toe proximal interphalangeal joint arc of motion). There was no significant difference in the reconstructed proximal interphalangeal joint arc of motion for the handedness (p = 0.23), recipient digits (p = 0.37), or surgical experience in vascularized toe joint transfer (p = 0.25). The outcomes of different techniques of extensor mechanism reconstruction were similar in terms of extensor lag, arc of motion, and reconstructed finger arc of motion compared with the pretransfer toe proximal interphalangeal joint arc of motion. With this treatment algorithm, consistent outcomes can be produced with minimal extensor lag and maximum use of potential toe proximal interphalangeal joint arc of motion. Therapeutic, IV.

  6. Intermuscular interaction via myofascial force transmission: Effects of tibialis anterior and extensor digitorum longus length on force transmission from rat extensor digitorum longus muscle

    NARCIS (Netherlands)

    Maas, Huub; Baan, Guus C.; Huijing, P.A.J.B.M.

    2001-01-01

    Force transmission in rat anterior crural compartment, containing tibialis anterior (TA), extensor hallucis longus (EHL) and extensor digitorum longus (EDL) muscles, was investigated. These muscles together with the muscles of the peroneal compartment were excited maximally. Force was measured at

  7. Impact of ancestry and body size on sonographic ulnar nerve dimensions

    International Nuclear Information System (INIS)

    Childs, Jessie T.; Phillips, Maureen; Thoirs, Kerry A.

    2012-01-01

    Introduction: The purpose of this study was to investigate the impact that geographic ancestry and body size have on ultrasonographic measurements of the ulnar nerve size measured at the elbow. Materials and methods: We performed anthropometric measurements of body size and ultrasonographic measurements of the ulnar nerve at the elbow on 13 Vietnamese and 24 European participants. Regression analysis was used to determine the effect of body size and geographic ancestry on ulnar nerve size. Results: BMI had the greatest impact on ulnar nerve size. The short axis diameter was least resilient, and the long axis diameter was the most resilient to the effects of body size and geographic ancestry. Discussion: The long axis diameter has an apparent immunity to the influences of overall body size, arm size, or geographic ancestry and has the most potential as a sensitive discriminator between normal nerves and nerves affected by ulnar neuropathy at the elbow.

  8. Evaluation of wrist arthroscopy outcomes in patients with chronic wrist pain

    Directory of Open Access Journals (Sweden)

    Reza Shahryar Kamrani

    2015-01-01

    Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.

  9. Ulnar artery: The Ulysses ultimate resort for coronary procedures

    Directory of Open Access Journals (Sweden)

    George Hahalis, MD, PhD

    2016-07-01

    Full Text Available Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA. Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

  10. Ulnar artery: The Ulysses ultimate resort for coronary procedures.

    Science.gov (United States)

    Hahalis, George; Deftereos, Spyridon; Bertrand, Olivier F

    2016-08-20

    Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  11. [Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon].

    Science.gov (United States)

    Loos, A; Kalb, K; Van Schoonhoven, J; Landsleitner Dagger, B

    2003-12-01

    Rupture of the extensor pollicis longus-tendon (EPL) is a frequent complication after distal radius fractures. Other traumatic and non-traumatic reasons for this tendon lesion are known, including a theory about a disorder in the blood supply to the tendon itself. We examined 40 patients after reconstruction of the EPL-tendon in a mean follow-up time of 30 months. All patients were clinically examined and a DASH questionnaire was answered by all patients. The method to reconstruct the EPL-tendon was the transposition of the extensor indicis-tendon. After the operations the thumb was put in a splint for four weeks in a "hitch-hiker's-position". 31 ruptures of the tendon (77.5 %) were a result of trauma. In 20 of them (50 %) a distal radius fracture had occurred. Clinical examination included measurements of the movement of the thumb- and index-finger joints, the grip strength and the maximal span of the hand. Significant differences were not found. The isolated extension of the index finger was possible in all patients. But it was reduced in ten cases which represent 25 %. Our results were evaluated by the Geldmacher score to evaluate the reconstruction of the EPL-tendon. 20 % excellent, 65 % good, 12.5 % fair and 2.5 % poor results were reached. The Geldmacher score was used critically. We suggest its modification for the evaluation of thumb abduction. The DASH score reached a functional value of ten points which represents a very good result. In conclusion the extensor indicis-transposition is a safe method to reconstruct the EPL-tendon. Its substantial advantage is taking a healthy muscle as the motor, thereby avoiding the risk of using a degenerated muscle in late tendon reconstruction. A powerful extension of the index finger will be maintained by physical education. Generally, the loss of the extension of the index finger is negligible. It does not disturb the patients. But it has to be discussed with the patient before the operation.

  12. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad.

    Science.gov (United States)

    Loosemore, Michael; Lightfoot, Joseph; Gatt, Ian; Hayton, Mike; Beardsley, Chris

    2017-03-01

    Background: The purpose of this investigation was to explore prospectively the nature and duration of hand and wrist injuries in training and competition in the Great Britain (GB) amateur boxing squad between 2005 and 2012. Methods: Longitudinal prospective injury surveillance of the GB boxing squad was performed from 2005 to 2012. The location, region affected, description, and the duration of each injury were recorded by the team doctor and team physiotherapist. We recorded whether the injury occurred during competition or training and also whether it was a new or a recurrent injury. The injury rate during competition was calculated as the number of injuries per 1000 hours. Results: Finger carpometacarpal instability and finger metacarpophalangeal joint extensor hood and capsule sprain also known as "boxer's knuckle" injuries were significantly more common than other injury diagnoses. The number of injuries during training or competition was similar, which is remarkable given the far greater number of training hours than competition hours performed. Injury rate for hand and wrist injuries in competition was 347 injuries per 1000 hours, while the estimated injury rate in training was <0.5 injuries per 1000 hours. Conclusion: Carpometacarpal instability and boxer's knuckle were more common than any other kind of hand and wrist injury in this cohort of elite amateur boxers. The rate of hand and wrist injuries was higher in competition than in training. Our study highlights the importance of hand and wrist injury prevention in the competition environment.

  13. Measurement of fatigue in knee flexor and extensor muscles.

    Science.gov (United States)

    Kawabata, Y; Senda, M; Oka, T; Yagata, Y; Takahara, Y; Nagashima, H; Inoue, H

    2000-04-01

    In order to examine fatigue of the knee flexor and extensor muscles and to investigate the characteristics of muscular fatigue in different sports, a Cybex machine was used to measure muscle fatigue and recovery during isokinetic knee flexion and extension. Eighteen baseball players, 12 soccer players and 13 marathon runners were studied. Each subject was tested in the sitting position and made to perform 50 consecutive right knee bends and stretches at maximum strength. This was done 3 times with an interval of 10 min between each series. The peak torque to body weight ratio and the fatigue rate were determined in each case. In all subjects, the peak torque to body weight ratio was higher for extensors than flexors. Over the 3 trials, the fatigue rate of extensors showed little change, while that of flexors had a tendency to increase. In each subject, knee extensors showed a high fatigue rate but a quick recovery, while knee flexors showed a low fatigue rate but a slow recovery. As the marathon runners had the smallest fatigue rates for both flexors and extensors, we concluded that marathon runners had more stamina than baseball players and soccer players.

  14. Three-dimensional display of peripheral nerves in the wrist region based on MR diffusion tensor imaging and maximum intensity projection post-processing

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Wen Quan, E-mail: dingwenquan1982@163.com [Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu (China); Zhou, Xue Jun, E-mail: zxj0925101@sina.com [Department of Radiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu (China); Tang, Jin Bo, E-mail: jinbotang@yahoo.com [Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu (China); Gu, Jian Hui, E-mail: gujianhuint@163.com [Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu (China); Jin, Dong Sheng, E-mail: jindongshengnj@aliyun.com [Department of Radiology, Jiangsu Province Official Hospital, Nanjing, Jiangsu (China)

    2015-06-15

    Highlights: • 3D displays of peripheral nerves can be achieved by 2 MIP post-processing methods. • The median nerves’ FA and ADC values can be accurately measured by using DTI6 data. • Adopting 6-direction DTI scan and MIP can evaluate peripheral nerves efficiently. - Abstract: Objectives: To achieve 3-dimensional (3D) display of peripheral nerves in the wrist region by using maximum intensity projection (MIP) post-processing methods to reconstruct raw images acquired by a diffusion tensor imaging (DTI) scan, and to explore its clinical applications. Methods: We performed DTI scans in 6 (DTI6) and 25 (DTI25) diffusion directions on 20 wrists of 10 healthy young volunteers, 6 wrists of 5 patients with carpal tunnel syndrome, 6 wrists of 6 patients with nerve lacerations, and one patient with neurofibroma. The MIP post-processing methods employed 2 types of DTI raw images: (1) single-direction and (2) T{sub 2}-weighted trace. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the median and ulnar nerves were measured at multiple testing sites. Two radiologists used custom evaluation scales to assess the 3D nerve imaging quality independently. Results: In both DTI6 and DTI25, nerves in the wrist region could be displayed clearly by the 2 MIP post-processing methods. The FA and ADC values were not significantly different between DTI6 and DTI25, except for the FA values of the ulnar nerves at the level of pisiform bone (p = 0.03). As to the imaging quality of each MIP post-processing method, there were no significant differences between DTI6 and DTI25 (p > 0.05). The imaging quality of single-direction MIP post-processing was better than that from T{sub 2}-weighted traces (p < 0.05) because of the higher nerve signal intensity. Conclusions: Three-dimensional displays of peripheral nerves in the wrist region can be achieved by MIP post-processing for single-direction images and T{sub 2}-weighted trace images for both DTI6 and DTI25

  15. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    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......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...

  16. Use of wrist albedo neutron dosimeters

    International Nuclear Information System (INIS)

    Hankins, D.E.

    1983-01-01

    We are developing a wrist dosimeter that can be used to measure the exposure at the wrist to x-rays, gamma rays, beta-particles, thermal neutrons and fast neutrons. It consists of a modified Hankins Type albedo neutron dosimeter and also contains three pieces of CR-39 plastic. ABS plastic in the form of an elongated hemisphere provides the beta and low energy x-ray shielding necessary to meet the requirement of depth dose measurements at 1 cm. The dosimeter has a beta window located in the side of the hemisphere oriented towards an object being held in the hands. A TLD 600 is positioned under the 1 cm thick ABS plastic and is used to measure the thermal neutron dose. At present we are using Velcro straps to hold the dosimeter on the inside of the wrist. 9 figures

  17. ARTHROSCOPIC FOR TREATMENT OF WRIST PATHOLOGIES

    Directory of Open Access Journals (Sweden)

    I. O. Golubev

    2018-01-01

    Full Text Available Diagnostics and treatment of wrist joint pathologies still remain one the key problems in hand traumatology and orthopaedics. Extremal sports availability as well as new options for recreation transportation means only sustains the statistics of such injuries. On the other hand, the technological improvements allowed to develop precise optics for surgeries on small joints. Possibilities of minimally invasive closer visualization at magnification substantially changed not only the approach to treatment of wrist joint pathology but also allowed to describe types of lesions unknown earlier. The authors describe basic principles of wrist joint arthroscopy and features of its application in various injuries: scaphoid fractures, intraarticular fractures of distal radius metaepiphysis, triangular fibrocartilage complex injuries.

  18. MR Imaging of Patients with Lateral Epicondylitis of the Elbow: Is the Common Extensor Tendon an Isolated Lesion?

    Science.gov (United States)

    Li, Feng; Wang, Ren-Fa

    2013-01-01

    Objective To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at plateral ulnar collateral ligament (LUCL). Conclusion Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL. PMID:24244512

  19. MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor tendon an isolated lesion?

    Directory of Open Access Journals (Sweden)

    Liang Qi

    Full Text Available OBJECTIVE: To investigate whether an injury of the common extensor tendon (CET is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI. METHODS: Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1 the injury degree of CET; (2 associated injuries in the elbow joint. Spearman's rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. RESULTS: Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe. Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01 was found in injuries of CET and lateral ulnar collateral ligament (LUCL. CONCLUSION: Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL.

  20. Dynamic neural network models of the premotoneuronal circuitry controlling wrist movements in primates.

    Science.gov (United States)

    Maier, M A; Shupe, L E; Fetz, E E

    2005-10-01

    Dynamic recurrent neural networks were derived to simulate neuronal populations generating bidirectional wrist movements in the monkey. The models incorporate anatomical connections of cortical and rubral neurons, muscle afferents, segmental interneurons and motoneurons; they also incorporate the response profiles of four populations of neurons observed in behaving monkeys. The networks were derived by gradient descent algorithms to generate the eight characteristic patterns of motor unit activations observed during alternating flexion-extension wrist movements. The resulting model generated the appropriate input-output transforms and developed connection strengths resembling those in physiological pathways. We found that this network could be further trained to simulate additional tasks, such as experimentally observed reflex responses to limb perturbations that stretched or shortened the active muscles, and scaling of response amplitudes in proportion to inputs. In the final comprehensive network, motor units are driven by the combined activity of cortical, rubral, spinal and afferent units during step tracking and perturbations. The model displayed many emergent properties corresponding to physiological characteristics. The resulting neural network provides a working model of premotoneuronal circuitry and elucidates the neural mechanisms controlling motoneuron activity. It also predicts several features to be experimentally tested, for example the consequences of eliminating inhibitory connections in cortex and red nucleus. It also reveals that co-contraction can be achieved by simultaneous activation of the flexor and extensor circuits without invoking features specific to co-contraction.

  1. [False traumatic aneurysm of the ulnar artery in a teenager].

    Science.gov (United States)

    Nour, M; Talha, H; El Idrissi, R; Lahraoui, Y; Ouazzani, L; Oubejja, H; Erraji, M; Zerhouni, H; Ettayebi, F

    2014-12-01

    Most aneurysms of hand arteries are traumatic. It is a generally rare unrecognized pathology. Complications are serious (embolism and thromboses of interdigital arteries). Two main causes can be recalled: acute trauma, with development of a false aneurysm; repeated microtrauma (hand hammer syndrome), with occurrence of an arterial dysplasic aneurysm. The diagnosis is based on the presence of a pulsatile mass, with finger dysesthesia, unilateral Raynaud's phenomenon. It is confirmed by duplex Doppler. Arteriography is necessary but can be replaced by an angio-MR. We report a case of false traumatic aneurysm of the ulnar artery in a teenager. This case illustrates this rare condition and opens discussion on therapeutic options. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. Ultrasound guided synovial biopsy of the wrist

    NARCIS (Netherlands)

    van Vugt, R. M.; van Dalen, A.; Bijlsma, J. W.

    1997-01-01

    Seven patients (4 female and 3 male, mean age 46) with arthritis of the wrist (n = 7) without known etiology were evaluated. High-definition ultrasound equipment was used for localization of synovial hypertrophy, suitable for ultrasound guided biopsy without risk. A 18-gauge diameter Tru-cut biopsy

  3. PERIMENOPAUSAL WRIST FRACTURE - AN OPPORTUNITY FOR ...

    African Journals Online (AJOL)

    Review of Medscheme's administrative databases to study ... management of a wrist fracture between 1995 and 1998, and ... reviewed dual-energy ... from three general practices in the UK. ... and Torgerson6 estimated the total cost of treating osteoporotic .... us adults from fHANES Ill. / Bone Miner Res 1997; U, 1761-1768.

  4. Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist?

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume; Sørensen, Allan Ibsen

    2013-01-01

    -generation total wrist arthroplasty was used as a salvage procedure for wrists with severe arthritis due to traumatic causes. The data were prospectively recorded in a web-based registry. Seven centers participated. Thirty-five cases had a minimum follow-up time of 2 years. Average follow-up was 39 (24-96) months...... procedure and gives results that are comparable to those obtained in rheumatoid cases. Level IV Case series....

  5. Elbow flexor and extensor muscle weakness in lateral epicondylalgia.

    Science.gov (United States)

    Coombes, Brooke K; Bisset, Leanne; Vicenzino, Bill

    2012-05-01

    To evaluate whether deficits of elbow flexor and extensor muscle strength exist in lateral epicondylalgia (LE) in comparison with a healthy control population. Cross-sectional study. 150 participants with unilateral LE were compared with 54 healthy control participants. Maximal isometric elbow flexion and extension strength were measured bilaterally using a purpose-built standing frame such that gripping was avoided. The authors found significant side differences in elbow extensor (-6.54 N, 95% CI -11.43 to -1.65, p=0.008, standardised mean difference (SMD) -0.45) and flexor muscle strength (-11.26 N, 95% CI -19.59 to -2.94, p=0.009, SMD -0.46) between LE and control groups. Within the LE group, only elbow extensor muscle strength deficits between sides was significant (affected-unaffected: -2.94 N, 95% CI -5.44 to -0.44). Small significant deficits of elbow extensor and flexor muscle strength exist in the affected arm of unilateral LE in comparison with healthy controls. Notably, comparing elbow strength between the affected and unaffected sides in unilateral epicondylalgia is likely to underestimate these deficits. Trial Registration Australian New Zealand Clinical Trials Register ACTRN12609000051246.

  6. Donor-site morbidity of the radial forearm free flap versus the ulnar forearm free flap.

    Science.gov (United States)

    Hekner, Dominique D; Abbink, Jan H; van Es, Robert J; Rosenberg, Antoine; Koole, Ronald; Van Cann, Ellen M

    2013-08-01

    Donor-site morbidity following harvest of the radial forearm free flap was compared with that following harvest of the ulnar forearm free flap. Twenty-eight radial forearm and 27 ulnar forearm flaps were harvested in 55 patients with head and neck defects. Pressure perception was measured with Semmes-Weinstein monofilaments. Cold perception was tested with chloroethyl. Donor-site healing was evaluated. Patients were interviewed about grip and pinch strength and donor-site appearance. In the radial forearm free flap group, pressure perception and cold perception were reduced in the donor hand, whereas in the ulnar group, no differences were observed between the donor and unoperated hands. In the radial forearm group, 15 percent of patients experienced reduced strength in the donor hand, whereas in the ulnar forearm group, none of the patients reported reduced strength in the donor hand. In the radial forearm group, 14 percent had partial or complete loss of the skin graft, whereas in the ulnar forearm group, 4 percent had partial loss of the skin graft. In the radial forearm group, 18 percent of patients were dissatisfied with the appearance of the donor site, and no complaints were reported in the ulnar forearm group. The authors' study shows less donor site-morbidity following harvest of the ulnar forearm free flap than following harvest of the radial forearm free flap. These results emphasize that the ulnar forearm free flap should be considered as an alternative for the radial forearm free flap for reconstruction of soft-tissue defects. Therapeutic, III.

  7. Prolonged phone-call posture causes changes of ulnar motor nerve conduction across elbow.

    Science.gov (United States)

    Padua, Luca; Coraci, Daniele; Erra, Carmen; Doneddu, Pietro Emiliano; Granata, Giuseppe; Rossini, Paolo Maria

    2016-08-01

    Postures and work-hobby activities may play a role in the origin and progression of ulnar neuropathy at the elbow (UNE), whose occurrence appears to be increasing. The time spent on mobile-phone has increased in the last decades leading to an increased time spent with flexed elbow (prolonged-phone-posture, PPP). We aimed to assess the effect of PPP both in patients with symptoms of UNE and in symptom-free subjects. Patients with pure sensory symptoms of UNE and negative neurophysiological tests (MIN-UNE) and symptom-free subjects were enrolled. We evaluated ulnar motor nerve conduction velocity across elbow at baseline and after 6, 9, 12, 15, and 18min of PPP in both groups. Fifty-six symptom-free subjects and fifty-eight patients were enrolled. Globally 186 ulnar nerves from 114 subjects were studied. Conduction velocity of ulnar nerve across the elbow significantly changed over PPP time in patients with MIN-UNE, showing a different evolution between the two groups. PPP causes a modification of ulnar nerve functionality in patients with MIN-UNE. PPP may cause transient stress of ulnar nerve at elbow. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  8. The superficial ulnar artery: development and clinical significance Artéria ulnar superficial: desenvolvimento e relevância clínica

    Directory of Open Access Journals (Sweden)

    Srinivasulu Reddy

    2007-09-01

    Full Text Available The principal arteries of the upper limb show a wide range of variation that is of considerable interest to orthopedic surgeons, plastic surgeons, radiologists and anatomists. We present here a case of superficial ulnar artery found during the routine dissection of right upper limb of a 50-year-old male cadaver. The superficial ulnar artery originated from the brachial artery, crossed the median nerve anteriorly and ran lateral to this nerve and the brachial artery. The superficial ulnar artery in the arm gave rise to a narrow muscular branch to the biceps brachii. At the elbow level the artery ran superficial to the bicipital aponeurosis where it was crossed by the median cubital vein. It then ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. At the palm, it formed the superficial and deep palmar arches together with the branches of the radial artery. The presence of a superficial ulnar artery is clinically important when raising forearm flaps in reconstructive surgery. The embryology and clinical significance of the variation are discussed.As principais artérias do membro superior apresentam uma ampla variação, que é relativamente importante a cirurgiões ortopédicos e plásticos, radiologistas e anatomistas.Apresentamosumcaso de artéria ulnar superficial encontrada durante dissecção de rotina de membro superior direito de um cadáver masculino de 50 anos de idade.Aartéria ulnar superficial originava-se da artéria braquial, cruzava o nervo mediano anteriormente e percorria lateralmente esse nervo e a artéria braquial. A artéria ulnar superficial no braço deu origem a um ramo muscular estreito do músculo bíceps braquial. Ao nível do cotovelo, a artéria percorria superficialmente a aponeurose bicipital, onde era cruzada pela veia cubital mediana. Percorria, então, em sentido descendente e medialmente superficial aos músculos flexores do antebraço, e então descendia para

  9. Amsterdam wrist rules: A clinical decision aid

    Directory of Open Access Journals (Sweden)

    Bentohami Abdelali

    2011-10-01

    Full Text Available Abstract Background Acute trauma of the wrist is one of the most frequent reasons for visiting the Emergency Department. These patients are routinely referred for radiological examination. Most X-rays however, do not reveal any fractures. A clinical decision rule determining the need for X-rays in patients with acute wrist trauma may help to percolate and select patients with fractures. Methods/Design This study will be a multi-center observational diagnostic study in which the data will be collected cross-sectionally. The study population will consist of all consecutive adult patients (≥18 years presenting with acute wrist trauma at the Emergency Department in the participating hospitals. This research comprises two components: one study will be conducted to determine which clinical parameters are predictive for the presence of a distal radius fracture in adult patients presenting to the Emergency Department following acute wrist trauma. These clinical parameters are defined by trauma-mechanism, physical examination, and functional testing. This data will be collected in two of the three participating hospitals and will be assessed by using logistic regression modelling to estimate the regression coefficients after which a reduced model will be created by means of a log likelihood ratio test. The accuracy of the model will be estimated by a goodness of fit test and an ROC curve. The final model will be validated internally through bootstrapping and by shrinking it, an adjusted model will be generated. In the second component of this study, the developed prediction model will be validated in a new dataset consisting of a population of patients from the third hospital. If necessary, the model will be calibrated using the data from the validation study. Discussion Wrist trauma is frequently encountered at the Emergency Department. However, to this date, no decision rule regarding this type of trauma has been created. Ideally, radiographs are

  10. The prevalence of median neuropathy at wrist in systemic sclerosis patients at Srinagarind Hospital

    Directory of Open Access Journals (Sweden)

    Thanaporn Nimitbancha

    2015-01-01

    Full Text Available Objectives: To determine the prevalence and factor related with median neuropathy at wrist (MNW in systemic sclerosis patients. Study Design: Cross-sectional study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: Systemic sclerosis patients who attended the Scleroderma Clinic, Srinagarind Hospital. Materials and Methods: Seventyfive systemic sclerosis patients were prospectively evaluated by questionnaire, physical examination, and electrodiagnostic study. The questionnaire consisted of the symptoms, duration, and type of systemic sclerosis. The physical examination revealed skin score of systemic sclerosis, pinprick sensation of median nerve distribution of both hands, and weakness of both abductor pollicis brevis muscles. The provocative test which were Tinel′s sign and Phalen′s maneuver were also examined. Moreover, electrodiagnostic study of the bilateral median and ulnar nerves was conducted. Results: The prevalence of MNW in systemic sclerosis patients was 44% - percentage of mild, moderate, and severe were 28%, 9.3%, and 6.7%, respectively. The prevalence of asymptomatic MNW was 88%. There were no association between the presence of MNW and related factors of systemic sclerosis. Conclusions: MNW is one of the most common entrapment neuropathies in systemic sclerosis patients. Systemic sclerosis patients should be screened for early signs of MNW.

  11. Magnetic resonance arthrography in chronic wrist pain

    International Nuclear Information System (INIS)

    Valeri, G.; Ferrara, C.; Carloni, S.

    1999-01-01

    The purpose of this paper is to investigate the clinical role of Magnetic Resonance Arthrography (MRA) of the wrist in subjects with chronic pain. Thirty-five patients complaining of wrist pain for more than 6 months were submitted to MRI an MRA. All patients received and intra-articular injection of 2-10 mL of a 10 mmol saline solution of Gd-DPTA. The overall diagnostic accuracy rates of MRI and MRA were 40% and 81% respectively, with sensitivity and specificity of 63% and 39% (MRI) and of 82% and 79% (MRA). The conclusion is that compared with MRI, MRA can be considered a useful tool for the visualization of interosseus carpal ligaments and of the triangular fibrocartilage complex. MRA also helps detect injuries in these structures [it

  12. Architectures for wrist-worn energy harvesting

    Science.gov (United States)

    Rantz, R.; Halim, M. A.; Xue, T.; Zhang, Q.; Gu, L.; Yang, K.; Roundy, S.

    2018-04-01

    This paper reports the simulation-based analysis of six dynamical structures with respect to their wrist-worn vibration energy harvesting capability. This work approaches the problem of maximizing energy harvesting potential at the wrist by considering multiple mechanical substructures; rotational and linear motion-based architectures are examined. Mathematical models are developed and experimentally corroborated. An optimization routine is applied to the proposed architectures to maximize average power output and allow for comparison. The addition of a linear spring element to the structures has the potential to improve power output; for example, in the case of rotational structures, a 211% improvement in power output was estimated under real walking excitation. The analysis concludes that a sprung rotational harvester architecture outperforms a sprung linear architecture by 66% when real walking data is used as input to the simulations.

  13. Etiology and mechanisms of ulnar and median forearm nerve injuries

    Directory of Open Access Journals (Sweden)

    Puzović Vladimir

    2015-01-01

    Full Text Available Bacgraund/Aim. Most often injuries of brachial plexus and its branches disable the injured from using their arms and/or hands. The aim of this study was to investigate the etiology and mechanisms of median and ulnar forearm nerves injuries. Methods. This retrospective cohort study included 99 patients surgically treated in the Clinic of Neurosurgery, Clinical Center of Serbia, from January 1st, 2000 to December 31st, 2010. All data are obtained from the patients' histories. Results. The majority of the injured patients were male, 81 (81.8%, while only 18 (18.2% were females, both mainly with nerve injuries of the distal forearm - 75 (75.6%. Two injury mechanisms were present, transection in 85 patients and traction and contusion in 14 of the patients. The most frequent etiological factor of nerve injuries was cutting, in 61 of the patients. Nerve injuries are often associated with other injuries. In the studied patients there were 22 vascular injuries, 33 muscle and tendon injuries and 20 bone fractures. Conclusion. The majority of those patients with peripheral nerve injuries are represented in the working age population, which is a major socioeconomic problem. In our study 66 out of 99 patients were between 17 and 40 years old, in the most productive age. The fact that the majority of patients had nerve injuries of the distal forearm and that they are operated within the first 6 months after injury, promises them good functional prognosis.

  14. Atraumatic Main-En-Griffe due to Ulnar Nerve Leprosy

    International Nuclear Information System (INIS)

    Aswani, Yashant; Saifi, Shenaz

    2016-01-01

    Leprosy is the most common form of treatable peripheral neuropathy. However, in spite of effective chemotherapeutic agents, neuropathy and associated deformities are seldom ameliorated to a significant extent. This necessitates early diagnosis and treatment. Clinical examination of peripheral nerves is highly subjective and inaccurate. Electrophysiological studies are painful and expensive. Ultrasonography circumvents these demerits and has emerged as the preferred modality for probing peripheral nerves. We describe a 23-year-old male who presented with weakness and clawing of the medial digits of the right hand (main-en-griffe) and a few skin lesions since eighteen months. The right ulnar nerve was thickened and exquisitely tender on palpation. Ultrasonography revealed an extensive enlargement of the nerve with presence of intraneural color Doppler signals suggestive of acute neuritis. Skin biopsy was consistent with borderline tuberculoid leprosy with type 1 lepra reaction. The patient was started on WHO multidrug therapy for paucibacillary leprosy along with antiinflammatory drugs. Persistence of vascular signals at two months’ follow-up has led to continuation of the steroid therapy. The patient is compliant with the treatment and is on monthly follow-up. In this manuscript, we review multitudinous roles of ultrasonography in examination of peripheral nerves in leprosy. Ultrasonography besides diagnosing enlargement of nerves in leprosy and acute neuritis due to lepra reactions, guides the duration of anti-inflammatory therapy in lepra reactions. Further, it is relatively inexpensive, non-invasive and easily available. All these features make ultrasonography a preferred modality for examination of peripheral nerves

  15. Tubercular tenosynovitis of extensor tendons of foot--a rare ...

    African Journals Online (AJOL)

    Tuberculosis of soft tissues as a result of spread from adjacent bone or joint is a well recognized entity. However isolated tuberculous pyomyositis, bursitis and tenosynovitis are rare, constituting about 1% of skeletal tuberculosis. Tubercular tenosynovitis commonly involves tendon sheaths of wrist and hand. Cases of ...

  16. Wrist loading patterns during pommel horse exercises.

    Science.gov (United States)

    Markolf, K L; Shapiro, M S; Mandelbaum, B R; Teurlings, L

    1990-01-01

    Gymnastics is a sport which involves substantial periods of upper extremity support as well as frequent impacts to the wrist. Not surprisingly, wrist pain is a common finding in gymnasts. Of all events, the pommel horse is the most painful. In order to study the forces of wrist impact, a standard pommel horse was instrumented with a specially designed load cell to record the resultant force of the hand on the pommel during a series of basic skills performed by a group of seventeen elite male gymnasts. The highest mean peak forces were recorded during the front scissors and flair exercises (1.5 BW) with peaks of up to 2.0 BW for some gymnasts. The mean peak force for hip circles at the center or end of the horse was 1.1 BW. The mean overall loading rate (initial contact to first loading peak) ranged from 5.2 BWs-1 (hip circles) to 10.6 BW s-1 (flairs). However, many recordings displayed localized initial loading spikes which occurred during 'hard' landings on the pommel. When front scissors were performed in an aggressive manner, the initial loading spikes averaged 1.0 BW in magnitude (maximum 1.8 BW) with an average rise time of 8.2 ms; calculated localized loading rates averaged 129 BW s-1 (maximum 219 BW s-1). These loading parameters are comparable to those encountered at heel strike during running. These impact forces and loading rates are remarkably high for an upper extremity joint not normally exposed to weight-bearing loads, and may contribute to the pathogenesis of wrist injuries in gymnastics.

  17. ELBOW AND WRIST INJURIES IN SPORTS

    Science.gov (United States)

    Marmor, Leonard; Bechtol, Charles O.

    1960-01-01

    Any disabling injury of the elbow or wrist should be studied roentgenographically for evidence of fracture which may not be otherwise evident but which may cause permanent disability unless the joint is immobilized for healing. “Tennis elbow” may be treated with physical therapy and analgesic injection but may require splinting or tendon stripping. Elbow sprain can occur in the growing epiphysis but is rare in adults. A jarring fall on the hand may cause fracture or dislocation at the elbow. Full extension of the joint should be restored gradually by active exercise rather than passive or forcible stretching. Fracture at the head of the radius may cause joint hemorrhage with severe pain which can be relieved by aspiration. A displacing fracture at the head of the radius requires removal of the head to prevent arthritic changes. Myositis ossificans contraindicates operation until after it has cleared. Healing of wrist fractures may be facilitated by exercise of the shoulder and elbow while the wrist is still in a cast. Fractures of the navicular bone are difficult to detect even roentgenographically and splinting may have to be done on clinical evidence alone. PMID:14421374

  18. Compressed sensing approach for wrist vein biometrics.

    Science.gov (United States)

    Lantsov, Aleksey; Ryabko, Maxim; Shchekin, Aleksey

    2018-04-01

    The work describes features of the compressed sensing (CS) approach utilized for development of a wearable system for wrist vein recognition with single-pixel detection; we consider this system useful for biometrics authentication purposes. The CS approach implies use of a spatial light modulation (SLM) which, in our case, can be performed differently-with a liquid crystal display or diffusely scattering medium. We show that compressed sensing combined with above-mentioned means of SLM allows us to avoid using an optical system-a limiting factor for wearable devices. The trade-off between the 2 different SLM approaches regarding issues of practical implementation of CS approach for wrist vein recognition purposes is discussed. A possible solution of a misalignment problem-a typical issue for imaging systems based upon 2D arrays of photodiodes-is also proposed. Proposed design of the wearable device for wrist vein recognition is based upon single-pixel detection. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Quantification of hand function by power grip and pinch strength force measurements in ulnar nerve lesion simulated by ulnar nerve block.

    Science.gov (United States)

    Wachter, Nikolaus Johannes; Mentzel, Martin; Krischak, Gert D; Gülke, Joachim

    2017-06-24

    In the assessment of hand and upper limb function, grip strength is of the major importance. The measurement by dynamometers has been established. In this study, the effect of a simulated ulnar nerve lesion on different grip force measurements was evaluated. In 25 healthy volunteers, grip force measurement was done by the JAMAR dynamometer (Fabrication Enterprises Inc, Irvington, NY) for power grip and by a pinch strength dynamometer for tip pinch strength, tripod grip, and key pinch strength. A within-subject research design was used in this prospective study. Each subject served as the control by preinjection measurements of grip and pinch strength. Subsequent measurements after ulnar nerve block were used to examine within-subject change. In power grip, there was a significant reduction of maximum grip force of 26.9% with ulnar nerve block compared with grip force without block (P force could be confirmed. However, the assessment of other dimensions of hand strength as tip pinch, tripod pinch and key pinch had more relevance in demonstrating hand strength changes resulting from an distal ulnar nerve lesion. The measurement of tip pinch, tripod grip and key pinch can improve the follow-up in hand rehabilitation. II. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  20. The potential complications of open carpal tunnel release surgery to the ulnar neurovascular bundle and its branches: A cadaveric study.

    Science.gov (United States)

    Boughton, O; Adds, P J; Jayasinghe, J A P

    2010-07-01

    This study investigated the ulnar artery and the ulnar nerve and its branches in the palm to assess how frequently they may be at risk of damage during open carpal tunnel release surgery. Twenty-one formalin-embalmed cadaveric hands were dissected, and the proximity of the ulnar neurovascular bundle to two different lines of incision, the 3rd and 4th interdigital web space axis and the ring finger axis, was assessed and compared. It was found that an incision in the latter (ring finger) axis put the ulnar artery at risk in 12 of 21 specimens, whereas an incision in the former axis (3rd/4th interdigital web space) put the ulnar artery at risk in only two specimens. In 15 hands at least one structure (the ulnar artery or a branch of the ulnar nerve) was at risk in the ring finger axis compared to only seven hands in the axis of the 3rd/4th interdigital web space. We conclude that the ulnar artery and branches of the ulnar nerve are at increased risk of damage with an incision in the axis of the ring finger. The importance of using a blunt dissection technique under direct vision during surgery to identify and preserve these structures and median nerve branches is emphasized. (c) 2010 Wiley-Liss, Inc.

  1. Multiple Tophaceous Gout of Hand with Extensor Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Haruki Tobimatsu

    2017-01-01

    Full Text Available A 45-year-old man presented with painless subcutaneous masses bilaterally on his hands and loss of motion or contracture of the fingers. Initially, drug therapy to reduce the serum uric acid was administered and was expected to reduce the tophi. However, during observation at the clinic, spontaneous rupture of an extensor tendon occurred, and surgical repair of the tendon and resection of the masses were performed. Surgical exploration of the right hand showed hypertrophic white-colored crystal deposits that both surrounded and invaded the extensor digitorum communis of the index finger, which was ruptured. Histopathologic examination of the specimen demonstrated findings consistent with gouty tophi. Tophaceous gout can induce a rupture of tendons during clinical observation, and surgical resection of the tophi might be needed to prevent ruptures.

  2. Clinical and X-ray investigations on congenital radio-ulnar synostosis

    International Nuclear Information System (INIS)

    Heisel, A.

    1982-01-01

    Out of 13 patients with cogenital radio-ulnar synostosis, 10 could be subjected to clinical and X-ray examination and chromosome analysis. In all the family histories the radio-ulnar synostosis was an isolated event. In no case was definite heredity of the same malformation confirmed. In most cases the radio-ulnar synostosis was an isolated malformation. 7 patients were of female, 6 of male sex. In 5 cases the synostosis was bi-lateral, in 8 cases it was unilateral without preference of either side of the body. In 2 out of 10 patients subjected to chromosome analysis gonosomal aneuploidy was found. More often than hitherto supposed, radio-ulnar synostosis seems to be associated with lower forms of polysomia of the x-chromosomes. 15 out of 18 synostoses belonged to type II, 3 to type I. The different types represent merely differring degrees of manifestation of the same deformity occurring bilaterally in one person. All patients with radio-ulnar synostosis exhibited a high degree of functional tolerance to the malformation. The development in child age and the educational and professional record were hardly impaired. (orig./MG) [de

  3. Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve.

    Science.gov (United States)

    Won, Hyung-Sun; Liu, Hong-Fu; Kim, Jun-Ho; Kwak, Dai-Soon; Chung, In-Hyuk; Kim, In-Beom

    2016-12-01

    The aim of this study was to clarify the morphological characteristics of the intermuscular aponeurosis between the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS; IMAS), and that between the FCU and flexor digitorum profundus (FDP; IMAP), and their topographic relationships with the ulnar nerve. Fifty limbs of 38 adult cadavers were studied. The IMAS extended along the deep surface of the FCU adjoining the FDS, having the appearance of a ladder, giving off "steps" that decreased in width from superficial to deep around the middle of the forearm. Its proximal part divided into two bands connected by a thin membrane, and was attached to the medial epicondyle and the tubercle (the most medial prominent part of the coronoid process of the ulna), respectively. The IMAP extended deep between the FCU and FDP from the antebrachial fascia, and its distal end was located on the posterior border of the FCU. The IMAP became broader toward its proximal part, and its proximal end was attached anterior and posterior to the tubercle and the olecranon, respectively. The ulnar nerve passed posterior to the medial epicondyle and then medial to the tubercle, and was crossed by the deep border of the IMAS at 58.3 ± 14.1 mm below the medial epicondyle. The deep border of the IMAS and aberrant tendinous structure passing across the ulnar nerve, or the parts of the IMAS and IMAP passing posterior to the ulnar nerve are potential causes of ulnar nerve compression.

  4. Ulnar neuropathy and medial elbow pain in women's fastpitch softball pitchers: a report of 6 cases.

    Science.gov (United States)

    Smith, Adam M; Butler, Thomas H; Dolan, Michael S

    2017-12-01

    Elite-level women's fastpitch softball players place substantial biomechanical strains on the elbow that can result in medial elbow pain and ulnar neuropathic symptoms. There is scant literature reporting the expected outcomes of the treatment of these injuries. This study examined the results of treatment in a series of these patients. We identified 6 female softball pitchers (4 high school and 2 collegiate) with medial elbow pain and ulnar neuropathic symptoms. Trials of conservative care failed in all 6, and they underwent surgical treatment with subcutaneous ulnar nerve transposition. These patients were subsequently monitored postoperatively to determine outcome. All 6 female pitchers had early resolution of elbow pain and neuropathic symptoms after surgical treatment. Long-term follow-up demonstrated that 1 patient quit playing softball because of other injuries but no longer reported elbow pain or paresthesias. One player was able to return to pitching at the high school level but had recurrent forearm pain and neuritis 1 year later while playing a different sport and subsequently stopped playing competitive sports. Four patients continued to play at the collegiate level without further symptoms. Medial elbow pain in women's softball pitchers caused by ulnar neuropathy can be treated effectively with subcutaneous ulnar nerve transposition if nonsurgical options fail. Further study is necessary to examine the role of overuse, proper training techniques, and whether pitching limits may be necessary to avoid these injuries. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.

    Science.gov (United States)

    Atzei, A; Luchetti, R; Garagnani, L

    2017-05-01

    The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. II.

  6. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

    Science.gov (United States)

    Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

    2016-11-01

    Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association

  7. A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures.

    Science.gov (United States)

    Malhotra, Shweta; Rosewilliam, Sheeba; Hermens, Hermie; Roffe, Christine; Jones, Peter; Pandyan, Anand David

    2013-07-01

    To investigate effects of surface neuromuscular electrical stimulation applied early after stroke to the wrist and finger extensor muscles on upper limb pain, spasticity and contractures in patients with no functional arm movement. Secondary analysis from a Phase II, randomized, controlled, single-blind study. An acute hospital stroke unit. Patients with no useful arm function within six weeks of a first stroke. Patients were randomized to treatment (30-minute sessions of surface neuromuscular stimulation to wrist and finger extensors and 45 minutes of physiotherapy) or control (45 minutes of physiotherapy) groups. All patients had access to routine care. Treatment was given for six weeks from recruitment. Ninety patients (49% male, median age 74 years (range 32-98), median time since stroke onset three weeks (range one to six weeks)) were included. Treatment compliance was variable (mean 28%). The treatment prevented the development of pain (mean difference in rate of change 0.4 units/week, 95% confidence interval (CI) 0.09 to 0.6). Treatment may have prevented a deterioration in contractures (quantified by measuring passive range of movement) in severely disabled patients (mean rate of deterioration -0.5 deg/week; 95% CI -0.9 to -0.06). There were no significant changes in stiffness and spasticity. Surface neuromuscular electrical stimulation reduces pain in stroke patients with a non-functional arm. There was some evidence that treatment with electrical stimulation was beneficial in reducing contractures. Treatment had no effect on spasticity.

  8. Prosthesis of the wrist-joint

    Energy Technology Data Exchange (ETDEWEB)

    Feldmeier, C.

    1983-02-25

    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.

  9. Prosthesis of the wrist-joint

    International Nuclear Information System (INIS)

    Feldmeier, C.

    1983-01-01

    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. (orig.) [de

  10. Periprosthetic osteolysis after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume

    2014-01-01

    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...... of this study was to analyze the prevalence, location, and natural history of PPO following a TWA and to determine whether this was associated with prosthetic loosening. Patients and Methods We analyzed 44 consecutive cases in which a RE-MOTION TWA (Small Bone Innovations Inc., Morrisville, PA, USA) had been...

  11. Wrist-worn pervasive gaze interaction

    DEFF Research Database (Denmark)

    Hansen, John Paulin; Lund, Haakon; Biermann, Florian

    2016-01-01

    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....

  12. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction

    NARCIS (Netherlands)

    Hekner, D.D.; Roeling, TAP; van Cann, EM

    The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were

  13. The Elbow-EpiTrainer: a method of delivering graded resistance to the extensor carpi radialis brevis. Effectiveness of a prototype device in a healthy population.

    Science.gov (United States)

    Navsaria, Rishi; Ryder, Dionne M; Lewis, Jeremy S; Alexander, Caroline M

    2015-03-01

    Tennis elbow or lateral epicondylopathy (LE) is experienced as the lateral elbow has a reported prevalence of 1.3%, with symptoms lasting up to 18 months. LE is most commonly attributed to tendinopathy involving the extensor carpi radialis brevis (ECRB) tendon. The aim of tendinopathy management is to alleviate symptoms and restore function that initially involves relative rest followed by progressive therapeutic exercise. To assess the effectiveness of two prototype exercises using commonly available clinical equipment to progressively increase resistance and activity of the ECRB. Eighteen healthy participants undertook two exercise progressions. Surface electromyography was used to record ECRB activity during the two progressions, involving eccentric exercises of the wrist extensors and elbow pronation exercises using a prototype device. The two progressions were assessed for their linearity of progression using repeated ANOVA and linear regression analysis. Five participants repeated the study to assess reliability. The exercise progressions led to an increase in ECRB electromyographic (EMG) activity (p0.7) between the first and second tests for five participants. Manipulation of resistance and leverage with the prototype exercises was effective in creating significant increases of ECRB normalised EMG activity in a linear manner that may, with future research, become useful to clinicians treating LE. In addition, between trial reliability for the device to generate a consistent load was acceptable. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Reversed Palmaris Longus Muscle Causing Volar Forearm Pain and Ulnar Nerve Paresthesia.

    Science.gov (United States)

    Bhashyam, Abhiram R; Harper, Carl M; Iorio, Matthew L

    2017-04-01

    A case of volar forearm pain associated with ulnar nerve paresthesia caused by a reversed palmaris longus muscle is described. The patient, an otherwise healthy 46-year-old male laborer, presented after a previous unsuccessful forearm fasciotomy for complaints of exercise exacerbated pain affecting the volar forearm associated with paresthesia in the ulnar nerve distribution. A second decompressive fasciotomy was performed revealing an anomalous "reversed" palmaris longus, with the muscle belly located distally. Resection of the anomalous muscle was performed with full relief of pain and sensory symptoms. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Neck extensor muscle weakness (Dropped head syndrome) following radiotherapy

    International Nuclear Information System (INIS)

    Bhatia, S.; Miller, R.C.; Lachance, D.L.

    2006-01-01

    Background. Dropped head syndrome is an unusual condition in which the head cannot be held upright in its normal anatomic position secondary to pronounced, isolated, neck extensor muscle weakness. Case report. A case of dropped head syndrome in a female with a history of radiotherapy for Hodgkin's lymphoma and a clinical history consistent with multiple sclerosis is presented, and potential etiologies are discussed. Conclusions. Muscular atrophy and lower motor neuron injury secondary to isolated anterior horn cell injury from radiotherapy emerge as the most likely etiology. (author)

  16. Polish Adaptation of Wrist Evaluation Questionnaires.

    Science.gov (United States)

    Czarnecki, Piotr; Wawrzyniak-Bielęda, Anna; Romanowski, Leszek

    2015-01-01

    Questionnaires evaluating hand and wrist function are a very useful tool allowing for objective and systematic recording of symptoms reported by the patients. Most questionnaires generally accepted in clinical practice are available in English and need to be appropriately adapted in translation and undergo subsequent validation before they can be used in another culture and language. The process of translation of the questionnaires was based on the generally accepted guidelines of the International Quality of Life Assessment Project (IQOLA). First, the questionnaires were translated from English into Polish by two independent translators. Then, a joint version of the translation was prepared collectively and translated back into English. Each stage was followed by a written report. The translated questionnaires were then evaluated by a group of patients. We selected 31 patients with wrist problems and asked them to complete the PRWE, Mayo, Michigan and DASH questionnaires twice at intervals of 3-10 days. The results were submitted for statistical analysis. We found a statistically significant (pquestionnaires. A comparison of the PRWE and Mayo questionnaires with the DASH questionnaire also showed a statistically significant correlation (pquestionnaires was successful and that the questionnaires may be used in clinical practice.

  17. Wrist stability after experimental traumatic triangular fibrocartilage complex lesions

    DEFF Research Database (Denmark)

    Munk, Bo; Jensen, Steen Lund; Olsen, Bo Sanderhoff

    2005-01-01

    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....

  18. Common extensor origin release in recalcitrant lateral epicondylitis - role justified?

    Directory of Open Access Journals (Sweden)

    Mukundan Cibu

    2010-05-01

    Full Text Available Abstract The aim of our study was to analyse the efficacy of operative management in recalcitrant lateral epicondylitis of elbow. Forty patients included in this study were referred by general practitioners with a diagnosis of tennis elbow to the orthopaedic department at a district general hospital over a five year period. All had two or more steroid injections at the tender spot, without permanent relief of pain. All subsequently underwent simple fasciotomy of the extensor origin. Of forty patients thirty five had improvement in pain and function, two had persistent symptoms and three did not perceive any improvement. Twenty five had excellent, ten had well, two had fair and three had poor outcomes (recurrent problem; pain at rest and night. Two patients underwent revision surgery. Majority of the patients had improvement in pain and function following operative treatment. In this study, an extensor fasciotomy was demonstrated to be an effective treatment for refractory chronic lateral epicondylitis; however, further studies are warranted.

  19. Intraoperative extracorporeal autogenous irradiated tendon grafts for functional limb salvage surgery of soft tissue sarcomas of the wrist and hand.

    Science.gov (United States)

    Omori, Shinsuke; Hamada, Kenichiro; Outani, Hidetatsu; Oshima, Kazuya; Joyama, Susumu; Tomita, Yasuhiko; Naka, Norifumi; Araki, Nobuhito; Yoshikawa, Hideki

    2015-05-12

    In patients with soft tissue sarcoma of the wrist and hand, limb salvage operation is extremely challenging for surgeons in attempting a complete tumor resection with negative surgical margins. In this study, we report four patients with soft tissue sarcoma of the wrist and hand treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts. The patients were all male, and the mean age at the time of surgery was 45 years. Histological diagnoses included clear cell sarcoma in two patients, synovial sarcoma in one, and angiosarcoma in one. All four patients had high grade tumors, wherein three had American Joint Committee on Cancer (AJCC) stage III disease and one with AJCC stage IV disease. The tumors were resected en bloc with involved tendons. The tendons were isolated from the resected tissues, irradiated ex vivo, and re-implanted into the host tendons. In one patient, the bone was resected additionally because of tumor invasion to the bone. Hand function was evaluated using Musculoskeletal Tumor Society (MSTS) rating system. Of the four patients, three died of distant metastatic disease. The remaining patient lives and remains disease-free. The mean follow-up period was 33 months. One patient had local recurrence outside the irradiated graft at 20 months after surgery. The functional rating was 22. Lower scores were seen in patients with reconstruction of flexor tendons than extensor tendons. Limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts is an acceptable method in selected patients with soft tissue sarcoma of the wrist and hand.

  20. INDEX FINGER POSITION AND FORCE OF THE HUMAN FIRST DORSAL INTEROSSEUS AND ITS ULNAR NERVE ANTAGONIST

    NARCIS (Netherlands)

    ZIJDEWIND, Inge; KERNELL, D

    In normal subjects, maximum voluntary contraction (MVC) and electrical ulnar nerve stimulation (UNS; 30-Hz bursts of 0.33 s) were systematically compared with regard to the forces generated in different directions (abduction/adduction and flexion) and at different degrees of index finger abduction.

  1. Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy?

    Science.gov (United States)

    Leis, A Arturo; Smith, Benn E; Kosiorek, Heidi E; Omejec, Gregor; Podnar, Simon

    2017-08-01

    Recurrent complete ulnar nerve dislocation has been perceived as a risk factor for development of ulnar neuropathy at the elbow (UNE). However, the role of dislocation in the pathogenesis of UNE remains uncertain. We studied 133 patients with complete ulnar nerve dislocation to determine whether this condition is a risk factor for UNE. In all, the nerve was palpated as it rolled over the medial epicondyle during elbow flexion. Of 56 elbows with unilateral dislocation, UNE localized contralaterally in 17 elbows (30.4%) and ipsilaterally in 10 elbows (17.9%). Of 154 elbows with bilateral dislocation, 26 had UNE (16.9%). Complete dislocation decreased the odds of having UNE by 44% (odds ratio = 0.475; P =  0.028), and was associated with less severe UNE (P = 0.045). UNE occurs less frequently and is less severe on the side of complete dislocation. Complete dislocation may have a protective effect on the ulnar nerve. Muscle Nerve 56: 242-246, 2017. © 2016 Wiley Periodicals, Inc.

  2. MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy

    DEFF Research Database (Denmark)

    Haakma, Wieke; Jongbloed, Bas A.; Froeling, Martijn

    2017-01-01

    Objectives To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves. Methods We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls...

  3. Reliability, reference values and predictor variables of the ulnar sensory nerve in disease free adults.

    Science.gov (United States)

    Ruediger, T M; Allison, S C; Moore, J M; Wainner, R S

    2014-09-01

    The purposes of this descriptive and exploratory study were to examine electrophysiological measures of ulnar sensory nerve function in disease free adults to determine reliability, determine reference values computed with appropriate statistical methods, and examine predictive ability of anthropometric variables. Antidromic sensory nerve conduction studies of the ulnar nerve using surface electrodes were performed on 100 volunteers. Reference values were computed from optimally transformed data. Reliability was computed from 30 subjects. Multiple linear regression models were constructed from four predictor variables. Reliability was greater than 0.85 for all paired measures. Responses were elicited in all subjects; reference values for sensory nerve action potential (SNAP) amplitude from above elbow stimulation are 3.3 μV and decrement across-elbow less than 46%. No single predictor variable accounted for more than 15% of the variance in the response. Electrophysiologic measures of the ulnar sensory nerve are reliable. Absent SNAP responses are inconsistent with disease free individuals. Reference values recommended in this report are based on appropriate transformations of non-normally distributed data. No strong statistical model of prediction could be derived from the limited set of predictor variables. Reliability analyses combined with relatively low level of measurement error suggest that ulnar sensory reference values may be used with confidence. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. A study on operative findings and pathogenic factors in ulnar neuropathy at the elbow.

    Science.gov (United States)

    Kojima, T; Kurihara, K; Nagano, T

    1979-01-01

    A study was made of operative findings obtained in 44 cases of ulnar nerve neuropathy at the elbow in an attempt to help elucidate the pathogenetic factors for the condition. Distinction must be made between Lig. epitrochleo-anconeum or a ligament-like thickening at the same site and the tendinous arch of M. flexor carpi ulnaris. These 2 sites constitute the entrapment points for the condition. A thick tendinous arch, Lig. epitrochleo-anconeum of M. anconeus epitrochlearis deters the ulnar nerve from being mobile, thereby contributing to the development of neuropathy with trauma acting as a precipitating factor. Dislocation of the ulnar nerve cannot be considered a factor of major etiologic significance. An important part is played by the tendinous arch in the pathogenesis of neuropathy, regardless of whether it is in association with ganglion, osteochondromatosis or osteoarthritis. In surgery for ulnar neuropathy decompression of the nerve is of primary necessity. Division of the tendinous arch is mandatory. Medial epicondylectomy may be added as required.

  5. MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study

    International Nuclear Information System (INIS)

    Breitenseher, Julia B.; Berzaczy, Dominik; Nemec, Stefan F.; Weber, Michael; Prayer, Daniela; Kasprian, Gregor; Kranz, Gottfried; Sycha, Thomas; Hold, Alina

    2015-01-01

    MR neurography, diffusion tensor imaging (DTI) and tractography at 3 Tesla were evaluated for the assessment of patients with ulnar neuropathy at the elbow (UNE). Axial T2-weighted and single-shot DTI sequences (16 gradient encoding directions) were acquired, covering the cubital tunnel of 46 patients with clinically and electrodiagnostically confirmed UNE and 20 healthy controls. Cross-sectional area (CSA) was measured at the retrocondylar sulcus and FA and ADC values on each section along the ulnar nerve. Three-dimensional nerve tractography and T2-weighted neurography results were independently assessed by two raters. Patients showed a significant reduction of ulnar nerve FA values at the retrocondylar sulcus (p = 0.002) and the deep flexor fascia (p = 0.005). At tractography, a complete or partial discontinuity of the ulnar nerve was found in 26/40 (65 %) of patients. Assessment of T2 neurography was most sensitive in detecting UNE (sensitivity, 91 %; specificity, 79 %), followed by tractography (88 %/69 %). CSA and FA measurements were less effective in detecting UNE. T2-weighted neurography remains the most sensitive MR technique in the imaging evaluation of clinically manifest UNE. DTI-based neurography at 3 Tesla supports the MR imaging assessment of UNE patients by adding quantitative and 3D imaging data. (orig.)

  6. MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, Julia B.; Berzaczy, Dominik; Nemec, Stefan F.; Weber, Michael; Prayer, Daniela; Kasprian, Gregor [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Kranz, Gottfried; Sycha, Thomas [Medical University of Vienna, Department of Neurology, Vienna (Austria); Hold, Alina [Medical University of Vienna, Department of Plastic and Reconstructive Surgery, Vienna (Austria)

    2015-07-15

    MR neurography, diffusion tensor imaging (DTI) and tractography at 3 Tesla were evaluated for the assessment of patients with ulnar neuropathy at the elbow (UNE). Axial T2-weighted and single-shot DTI sequences (16 gradient encoding directions) were acquired, covering the cubital tunnel of 46 patients with clinically and electrodiagnostically confirmed UNE and 20 healthy controls. Cross-sectional area (CSA) was measured at the retrocondylar sulcus and FA and ADC values on each section along the ulnar nerve. Three-dimensional nerve tractography and T2-weighted neurography results were independently assessed by two raters. Patients showed a significant reduction of ulnar nerve FA values at the retrocondylar sulcus (p = 0.002) and the deep flexor fascia (p = 0.005). At tractography, a complete or partial discontinuity of the ulnar nerve was found in 26/40 (65 %) of patients. Assessment of T2 neurography was most sensitive in detecting UNE (sensitivity, 91 %; specificity, 79 %), followed by tractography (88 %/69 %). CSA and FA measurements were less effective in detecting UNE. T2-weighted neurography remains the most sensitive MR technique in the imaging evaluation of clinically manifest UNE. DTI-based neurography at 3 Tesla supports the MR imaging assessment of UNE patients by adding quantitative and 3D imaging data. (orig.)

  7. Incorporation of tritium from wrist watches

    International Nuclear Information System (INIS)

    Schoenhofer, F.; Pock, K.

    1995-01-01

    Watches are consumer products and are subject to the regulations that control food and consumer products. Elevated concentrations of tritium were found in the urine of persons who wore wrist watches with luminous dials and plastic cases. High emission of tritium from these watches were observed. In an experiment, a volunteer wore a watch with high emissions and the build-up of the tritium concentration in urine was monitored, as well as the decline after removing the watch. Possible pathways for the incorporation and its mechanism are considered. In spite of the relatively high activity concentrations observed, the dose is negligible. On the other hand, the principle 'ALARA' can be achieved without any costs by simply choosing other types of watches. (author). 12 refs., 2 figs., 2 tabs

  8. Unusual Wrist Tremor: Unilateral Isometric Tremor?

    Directory of Open Access Journals (Sweden)

    Theresa A. Zesiewicz

    2014-01-01

    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.

  9. Ganglion cysts in the paediatric wrist: magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer; Bartlett, Murray [Royal Children' s Hospital, Medical Imaging Department, Melbourne, VIC (Australia)

    2013-12-15

    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.)

  10. Extensor Tendon Instability Due to Sagittal Band Injury in a Martial Arts Athlete: A Case Report.

    Science.gov (United States)

    Kochevar, Andrew; Rayan, Ghazi

    2017-03-01

    A Taekwondo participant sustained a hand injury from punching an opponent that resulted in painful instability of the ring finger extensor digitorum communis tendon due to sagittal band damage. His symptoms resolved after reconstructive surgery on the sagittal band (SB) with stabilization of the extensor tendon over the metacarpophalangeal joint.

  11. ''Dropped-head'' syndrome due to isolated myositis of neck extensor muscles: MRI findings

    International Nuclear Information System (INIS)

    Gaeta, Michele; Mazziotti, Silvio; Blandino, Alfredo; Toscano, Antonio; Rodolico, Carmelo; Mazzeo, Anna

    2006-01-01

    MRI findings of a patient with dropped-head syndrome due to focal myositis of the neck extensor muscles are presented. MRI showed oedematous changes and marked enhancement of the neck extensor muscles. After therapy MRI demonstrated disappearance of the abnormal findings. (orig.)

  12. Extensor Mechanism Disruption after Total Knee Arthroplasty: A Case Series and Review of Literature.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-02-04

    Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare but devastating complication. These patients may require revision of the implants, but even then, it may not be possible to restore the normal function of the knee after the disruption. The patterns of extensor mechanism disruption can broadly be classified into three types: suprapatellar (quadriceps tendon rupture), transpatellar (patellar fracture), or infrapatellar (patellar tendon rupture). Infrapatellar tendon ruptures are the worst injuries, as they carry maximum morbidity and are challenging to manage. The disruption of the extensor mechanism may occur either intra-operatively or in the immediate postoperative period due to an injury. The treatment of extensor mechanism complications after TKA may include either nonsurgical management or surgical intervention in the form of primary repair or reconstruction with autogenous, allogeneic, or synthetic substitutes. We have provided an algorithm for the management of extensor mechanism disruption after TKA.

  13. Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations.

    Science.gov (United States)

    Dezfuli, Bobby; Taljanovic, Mihra S; Melville, David M; Krupinski, Elizabeth A; Sheppard, Joseph E

    2016-02-01

    Lacerations to the extensor mechanism are usually diagnosed clinically. Ultrasound (US) has been a growing diagnostic tool for tendon injuries since the 1990s. To date, there has been no publication establishing the accuracy and reliability of US in the evaluation of extensor mechanism lacerations in the hand. The purpose of this study is to determine the accuracy of US to detect extensor tendon injuries in the hand. Sixteen fingers and 4 thumbs in 4 fresh-frozen and thawed cadaveric hands were used. Sixty-eight 0.5-cm transverse skin lacerations were created. Twenty-seven extensor tendons were sharply transected. The remaining skin lacerations were used as sham dissection controls. One US technologist and one fellowship-trained musculoskeletal radiologist performed real-time dynamic US studies in and out of water bath. A second fellowship trained musculoskeletal radiologist subsequently reviewed the static US images. Dynamic and static US interpretation accuracy was assessed using dissection as "truth." All 27 extensor tendon lacerations and controls were identified correctly with dynamic imaging as either injury models that had a transected extensor tendon or sham controls with intact extensor tendons (sensitivity = 100%, specificity = 100%, positive predictive value = 1.0; all significantly greater than chance). Static imaging had a sensitivity of 85%, specificity of 89%, and accuracy of 88% (all significantly greater than chance). The results of the dynamic real time versus static US imaging were clearly different but did not reach statistical significance. Diagnostic US is a very accurate noninvasive study that can identify extensor mechanism injuries. Clinically suspected cases of acute extensor tendon injury scanned by high-frequency US can aid and/or confirm the diagnosis, with dynamic imaging providing added value compared to static. Ultrasonography, to aid in the diagnosis of extensor mechanism lacerations, can be successfully used in a reliable and

  14. Hyperstaticity for ergonomie design of a wrist exoskeleton.

    Science.gov (United States)

    Esmaeili, Mohammad; Jarrassé, Nathanaël; Dailey, Wayne; Burdet, Etienne; Campolo, Domenico

    2013-06-01

    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.

  15. Hand and wrist arthritis of Behcet disease: Imaging features

    International Nuclear Information System (INIS)

    Sugawara, Shunsuke; Ehara, Shigeru; Hitachi, Shin; Sugimoto, Hideharu

    2010-01-01

    Background: Reports on arthritis in Behcet disease are relatively scarce, and imaging features vary. Purpose: To document the various imaging features of articular disorders of the hand and wrist in Behcet disease. Material and Methods: Four patients, four women aged 26 to 65 years, fulfilling the diagnostic criteria of Behcet disease, with imaging findings of hand and wrist arthritis, were seen in two institutions. Radiography and magnetic resonance (MR) imaging were studied to elucidate the pattern and distribution. Results: Both non-erosive arthritis and erosive arthritis of different features were noted: one with non-erosive synovitis of the wrist, one with wrist synovitis with minimal erosion, and two with erosive arthritis of the distal interphalangeal joint. Conclusion: Imaging manifestations of arthritis of Behcet disease vary, and may be similar to other seronegative arthritides

  16. Golf Injuries to the Hand, Wrist, or Elbow

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Golf Injuries to the Hand, Wrist or Elbow Email ... enjoyment of the game injury free. Types of Golf Injuries Golf injuries can include tendonitis, sprains or ...

  17. Treatment of wrist deformities in children with arthrogryposis multiplex congenita

    Directory of Open Access Journals (Sweden)

    Evgeniya A Kochenova

    2016-03-01

    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.

  18. Kinematics and Dynamics of an Asymmetrical Parallel Robotic Wrist

    DEFF Research Database (Denmark)

    Wu, Guanglei

    2014-01-01

    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...

  19. Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy.

    Science.gov (United States)

    Paulos, Renata; Leclercq, Caroline

    2015-11-01

    Precise knowledge of motor nerve branches is critical to plan selective neurectomies for the treatment of spastic limbs. Our objective is to describe the muscular branching pattern of the ulnar nerve in the forearm and suggest an ideal surgical approach for selective neurectomy of the flexor carpi ulnaris. The ulnar nerve was dissected under loop magnification in 20 upper limbs of fresh frozen cadavers and its branches to the flexor carpi ulnaris muscle (FCU) and to the flexor digitorum profundus muscle (FDP) were quantified. We measured their diameter, length and distance between their origin and the medial epicondyle. The point where the ulnar artery joined the nerve was observed. The position in which the ulnar nerve gave off each branch was noted (ulnar, posterior or radial) and the Martin-Gruber connection, when present, had its origin observed and its diameter measured. The ulnar nerve gave off two to five muscular branches, among which, one to four to the FCU and one or two to the FDP. In all cases, the first branch was to the FCU. It arose on average 1.4 cm distal to the epicondyle, but in four specimens it arose above or at the level of the medial epicondyle (2.0 cm above in one case, 1.5 cm above in two cases, and at the level of the medial epicondyle in one). The first branch to the FDP arose on average 5.0 cm distal to the medial epicondyle. All the branches to FDP but one arose from the radial aspect of the ulnar nerve. A Martin-Gruber connection was present in nine cases. All motor branches arose in the proximal half of the forearm and the ulnar nerve did not give off branches distal to the point where it was joined by the ulnar artery. The number of motor branches of the ulnar nerve to the FCU varies from 2 to 4. An ideal approach for selective neurectomy of the FCU should start 4 cm above the medial epicondyle, and extend distally to 50% of the length of the forearm or just to the point where the ulnar artery joins the nerve.

  20. Arthroscopic Resection of Wrist Ganglion Arising from the Lunotriquetral Joint

    OpenAIRE

    Mak, Michael C. K.; Ho, Pak-cheong; Tse, W. L.; Wong, Clara W. Y.

    2013-01-01

    The dorsal wrist ganglion is the most common wrist mass, and previous studies have shown that it arises from the scapholunate interval in the vast majority of cases. Treatment has traditionally been open excision, and more recently arthroscopic resection has been established as an effective and less invasive treatment method. However, application of this technique to ganglia in atypical locations has not been reported, where open excision is the usual practice. This report describes two cases...

  1. Differentiating C8–T1 Radiculopathy from Ulnar Neuropathy: A Survey of 24 Spine Surgeons

    Science.gov (United States)

    Stoker, Geoffrey E.; Kim, Han Jo; Riew, K. Daniel

    2013-01-01

    Study Design Questionnaire. Objective To evaluate the ability of spine surgeons to distinguish C8–T1 radiculopathies from ulnar neuropathy. Methods Twenty-four self-rated “experienced” cervical spine surgeons completed a questionnaire with the following items. (1) If the ulnar nerve is cut at the elbow, which of the following would be numb: ulnar forearm, small and ring fingers; only the ulnar forearm; only the small and ring fingers; or none of the above? (2) Which of the following muscles are weak with C8–T1 radiculopathies but intact with ulnar neuropathy at the elbow: flexor digiti minimi brevis, flexor pollicis brevis, abductor digiti minimi, abductor pollicis brevis, adductor pollicis, opponens digiti minimi, opponens pollicis, medial lumbricals, lateral lumbricals, dorsal interossei, palmar interossei? Results Fifteen of 24 surgeons (63%) correctly answered the first question—that severing the ulnar nerve results in numbness of the fifth and fourth fingers. None correctly identified all four nonulnar, C8–T1-innervated options in the second question without naming additional muscles. Conclusion The ulnar nerve provides sensation to the fourth and fifth fingers and medial border of the hand. The medial antebrachial cutaneous nerve provides sensation to the medial forearm. The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve. By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8–T1 radiculopathies. Although all participants considered themselves to be experienced cervical spine surgeons, this study reveals inadequate knowledge regarding the clinical manifestations of C8–T1 radiculopathies and cubital tunnel syndrome. PMID:24494175

  2. A digital database of wrist bone anatomy and carpal kinematics.

    Science.gov (United States)

    Moore, Douglas C; Crisco, Joseph J; Trafton, Theodore G; Leventhal, Evan L

    2007-01-01

    The skeletal wrist consists of eight small, intricately shaped carpal bones. The motion of these bones is complex, occurs in three dimensions, and remains incompletely defined. Our previous efforts have been focused on determining the in vivo three-dimensional (3-D) kinematics of the normal and abnormal carpus. In so doing we have developed an extensive database of carpal bone anatomy and kinematics from a large number of healthy subjects. The purpose of this paper is to describe that database and to make it available to other researchers. CT volume images of both wrists from 30 healthy volunteers (15 males and 15 females) were acquired in multiple wrist positions throughout the normal range of wrist motion. The outer cortical surfaces of the carpal bones, radius and ulna, and proximal metacarpals were segmented and the 3-D motion of each bone was calculated for each wrist position. The database was constructed to include high-resolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone. The database does not include soft tissues of the wrist. While there are numerous digital anatomical databases, this one is unique in that it includes a large number of subjects and it contains in vivo kinematic data as well as the bony anatomy.

  3. Intra-articular Entrapment of Medial Epicondyle Fracture Fragment in Elbow Joint Dislocation Causing Ulnar Neuropraxia: A Case Report

    Directory of Open Access Journals (Sweden)

    Syed J

    2017-03-01

    Full Text Available Traumatic elbow dislocations in children are rare but most of them are complex dislocations, and in such dislocations, medial humerus epicondyle fractureis the most common associated injury. Fracture incarceration in the elbow joint occurs in 5-18% of medial humerus epicondyle fractures but ulnar neuropraxia is very rare. Open reduction internal fixation is indicated in medial humerus epicondyle fracture with fracture incarceration, ulnar neuropraxia, marked instability or open fracture. Operative treatment options include fragment excision and sutures, closed or open reduction and Kirschner wire fixation, open reduction and suture fixation, open reduction and smooth pin fixation, and open reduction and screw fixation. However, ulnar nerve transposition is debatable as good outcome had been reported with and without nerve transposition. We report a case of a 13-year old boy, who presented with right elbow dislocation and intra-articular entrapment of medial humerus epicondyle fracture fragment, complicated with sensory ulnar neuropraxia, following a fall onto his right outstretched hand in a motor vehicle accident. The elbow joint was reduced using close manipulative reduction but the fracture fragment remained entrapped post-reduction. The patient then underwent open reduction and screw fixation of the medial humerus epicondyle fracture without ulnar nerve transposition. He had good functional outcome six weeks after surgical intervention, with complete recovery of ulnar neuropraxia six months later. Currently, he is doing well at school and is active with his sporting activity.

  4. Treatment of humeroulnar subluxation with a dynamic proximal ulnar osteotomy: a review of 13 cases

    International Nuclear Information System (INIS)

    Gilson, S.D.; Piermattei, D.L.; Schwarz, P.D.

    1989-01-01

    Humeroulnar subluxation was treated surgically in 13 dogs with 18 affected elbows using a proximal osteotomy of the ulna that allowed the ulna to elongate dynamically. Distal humeroulnar subluxation was secondary to premature closure of the distal ulnar physis in 16 elbows. One distal subluxation was secondary to a radioulnar synostosis, and one proximal subluxation developed after premature closure of the distal radial physis. The mean follow-up time was 22 months. Twenty-eight percent of the elbows were judged to have excellent results, 22% good results, 50% fair results, and none was judged to have a poor outcome. The presenting lameness grade and the severity of preoperative and postoperative humeroulnar subluxation had significant correlations with the prognosis. Associated orthopedic abnormalities and complications of concurrent surgical procedures affected the outcome in several dogs. Overall, the dynamic proximal ulnar osteotomy was a simple and effective technique for the treatment of uncomplicated humeroulnar subluxation

  5. Analysis of the Papal Benediction Sign: The ulnar neuropathy of St. Peter.

    Science.gov (United States)

    Futterman, Bennett

    2015-09-01

    The origin of the Papal Benediction Sign has been a source of controversy for many generations of medical students. The question has been whether the Papal Benediction Sign posture is the result of an injury to the median nerve or to the ulnar nerve. The increasingly popular use of online "chat rooms" and the vast quantities of information available on the internet has led to an increasing level of confusion. Looking in major anatomy texts, anatomy and board review books as well as numerous internet sites the answer remains unresolved. Through the analysis of functional anatomy of the hand, cultural and religious practices of the early centuries of the Common Era and church art a clear answer emerges. It will become apparent that this hand posture results from an ulnar neuropathy. Copyright © 2015 Wiley Periodicals, Inc.

  6. A randomized single blind crossover trial comparing leather and commercial wrist splints for treating chronic wrist pain in adults

    Science.gov (United States)

    Thiele, Jill; Nimmo, Rachel; Rowell, Wendy; Quinn, Stephen; Jones, Graeme

    2009-01-01

    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 leather splint compared to the commercially available splint. Conclusion Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction. PMID:19843345

  7. The influence of fat infiltration of back extensor muscles on osteoporotic vertebral fractures.

    Science.gov (United States)

    So, Kwang-Young; Kim, Dae-Hee; Choi, Dong-Hyuk; Kim, Choong-Young; Kim, Jeong-Seok; Choi, Yong-Soo

    2013-12-01

    Retrospective study. To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%±14.5% and 64.2%±9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

  8. Rupture of the ulnar collateral ligament of the thumb ? a review

    OpenAIRE

    Mahajan, Mandhkani; Rhemrev, Steven J

    2013-01-01

    Skier?s thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier?s thumb. This article provides a review of the relevant anatomy, the correct method of physical examination and the options for additional imaging a...

  9. Sonography of injury of the ulnar collateral ligament of the elbow - initial experience

    International Nuclear Information System (INIS)

    Miller, Theodore T.; Adler, Ronald S.; Friedman, Lawrence

    2004-01-01

    The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. Eight non-professional male baseball pitchers, ages 13-35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months. In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment. Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology. (orig.)

  10. The "hierarchical" Scratch Collapse Test for identifying multilevel ulnar nerve compression.

    Science.gov (United States)

    Davidge, Kristen M; Gontre, Gil; Tang, David; Boyd, Kirsty U; Yee, Andrew; Damiano, Marci S; Mackinnon, Susan E

    2015-09-01

    The Scratch Collapse Test (SCT) is used to assist in the clinical evaluation of patients with ulnar nerve compression. The purpose of this study is to introduce the hierarchical SCT as a physical examination tool for identifying multilevel nerve compression in patients with cubital tunnel syndrome. A prospective cohort study (2010-2011) was conducted of patients referred with primary cubital tunnel syndrome. Five ulnar nerve compression sites were evaluated with the SCT. Each site generating a positive SCT was sequentially "frozen out" with a topical anesthetic to allow determination of both primary and secondary ulnar nerve entrapment points. The order or "hierarchy" of compression sites was recorded. Twenty-five patients (mean age 49.6 ± 12.3 years; 64 % female) were eligible for inclusion. The primary entrapment point was identified as Osborne's band in 80 % and the cubital tunnel retinaculum in 20 % of patients. Secondary entrapment points were also identified in the following order in all patients: (1) volar antebrachial fascia, (2) Guyon's canal, and (3) arcade of Struthers. The SCT is useful in localizing the site of primary compression of the ulnar nerve in patients with cubital tunnel syndrome. It is also sensitive enough to detect secondary compression points when primary sites are sequentially frozen out with a topical anesthetic, termed the hierarchical SCT. The findings of the hierarchical SCT are in keeping with the double crush hypothesis described by Upton and McComas in 1973 and the hypothesis of multilevel nerve compression proposed by Mackinnon and Novak in 1994.

  11. Lipomatous macrodystrophy of the ulnar nerve: Role of magnetic resonance in the diagnosis

    International Nuclear Information System (INIS)

    Capelastegui, A.; Astigarraga, E.; Galan, V.

    1996-01-01

    Lipomatous macrodystrophy is a rare cause of macrodactyly that can be included among the bening adipose tissue tumors of the peripheral nerves. We present a case involving ulnar nerve, which is an unusual location since most of the reported cases correspond to median nerve. the magnetic resonance (MR) images are analyzed, and their role in the characterization and definition of the extension of these lesions is assessed. 4 refs

  12. Luxation of the elbow complicated by proximal radio-ulnar translocation

    International Nuclear Information System (INIS)

    Ekloef, O.; Nybonde, T.; Karlsson, G.; St. Goeran's Children's Hospital, Stockholm

    1990-01-01

    Luxation of the elbow complicated by proximal radio-ulnar translocation is a rare entity. The clue to diagosis is the reversed position of the bones of the proxomal forearm. In the a.p. projection the radial head articulates with the trochlea and the ulna with the capitellum. This unexpected anatomic relationship is easily overlooked. Delayed reduction may result in permanent impairment of elbow motility. Our experience with three recent cases is presented. (orig.)

  13. Luxation of the elbow complicated by proximal radio-ulnar translocation

    Energy Technology Data Exchange (ETDEWEB)

    Ekloef, O.; Nybonde, T.; Karlsson, G. (St. Goeran' s Children' s Hospital, Stockholm (Sweden). Dept. of Radiology St. Goeran' s Children' s Hospital, Stockholm (Sweden). Dept. of Surgery)

    1990-03-01

    Luxation of the elbow complicated by proximal radio-ulnar translocation is a rare entity. The clue to diagosis is the reversed position of the bones of the proxomal forearm. In the a.p. projection the radial head articulates with the trochlea and the ulna with the capitellum. This unexpected anatomic relationship is easily overlooked. Delayed reduction may result in permanent impairment of elbow motility. Our experience with three recent cases is presented. (orig.).

  14. Transfixation pinning and casting of radial-ulnar fractures in calves: A review of three cases

    OpenAIRE

    St-Jean, Guy; Debowes, Richard M.

    1992-01-01

    We reviewed the medical records of three calves with radial-ulnar fractures which were reduced and stabilized by transfixation pinning and casting. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material was placed from proximal to distal radius and served as an external frame to maintain pin position and fracture reduction.

  15. The effect of distal ulnar implant stem material and length on bone strains.

    Science.gov (United States)

    Austman, Rebecca L; Beaton, Brendon J B; Quenneville, Cheryl E; King, Graham J W; Gordon, Karen D; Dunning, Cynthia E

    2007-01-01

    Implant design parameters can greatly affect load transfer from the implant stem to the bone. We have investigated the effect of length or material of distal ulnar implant stems on the surrounding bone strains. Eight cadaveric ulnas were instrumented with 12 strain gauges and secured in a customized jig. Strain data were collected while loads (5-30 N) were applied to the medial surface of the native ulnar head. The native ulnar head was removed, and a stainless steel implant with an 8-cm-long finely threaded stem was cemented into the canal. After the cement had cured, the 8-cm stem was removed, leaving a threaded cement mantle in the canal that could accept shorter threaded stems of interest. The loading protocol was then repeated for stainless steel stems that were 7, 5, and 3 cm in length, as well as for a 5-cm-long titanium alloy (TiAl(6)V(4)) stem. Other stainless steel stem lengths between 3 and 7 cm were tested at intervals of 0.5 cm, with only a 20 N load applied. No stem length tested matched the native strains at all gauge locations. No significant differences were found between any stem length and the native bone at the 5th and 6th strain gauge positions. Strains were consistently closer to the native bone strains with the titanium stem than the stainless steel stem for each gauge pair that was positioned on the bone overlying the stem. The 3-cm stem results were closer to the native strains than the 7-cm stem for all loads at gauges locations that were on top of the stem. The results from this study suggest that the optimal stem characteristics for distal ulnar implants from a load transfer point of view are possessed by shorter (approximately 3 to 4 cm) titanium stems.

  16. Transfixation pinning and casting of radial-ulnar fractures in calves: A review of three cases.

    Science.gov (United States)

    St-Jean, G; Debowes, R M

    1992-04-01

    We reviewed the medical records of three calves with radial-ulnar fractures which were reduced and stabilized by transfixation pinning and casting. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material was placed from proximal to distal radius and served as an external frame to maintain pin position and fracture reduction.At the time of injury, the calves ranged in age from one day to two months and weighed from 37-102 kg. Two fractures were comminuted and one was transverse. All fractures were closed. After surgery, all calves could walk within 24 hours. Radiographic and clinical evidence of fracture healing was present five to seven weeks (mean 6) after surgery. At that time, the pins and cast material were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation five to nine months later.Advantages of transfixation pinning and casting in management of radial-ulnar fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, preservation of joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators. We concluded that transfixation pinning is a useful means of stabilizing radial-ulnar fractures in pediatric bovine patients.

  17. Use of locking compression plates in ulnar fractures of 18 horses.

    Science.gov (United States)

    Jacobs, Carrie C; Levine, David G; Richardson, Dean W

    2017-02-01

    To describe the outcome, clinical findings, and complications associated with the use of the locking compression plate (LCP) for various types of ulnar fractures in horses. Retrospective case series. Client owned horses (n = 18). Medical records, radiographs, and follow-up for horses having an ulnar fracture repaired using at least 1 LCP were reviewed. Fifteen of 18 horses had fractures of the ulna only, and 3 horses had fractures of the ulna and proximal radius. All 18 horses were discharged from the hospital. Complications occurred in 5 horses; incisional infection (n = 4, 22%), implant-associated infection (n = 2, 11%), and colic (n = 1, 6%). Follow-up was available for all horses at a range of 13-120 months and 15 horses (83%) were sound for their intended purpose and 3 horses (17%) were euthanatized. One horse was euthanatized for complications associated with original injury and surgery. The LCP is a viable method of internal fixation for various types of ulnar fractures, with most horses in this series returning to soundness. © 2017 The American College of Veterinary Surgeons.

  18. [Preliminary investigation of treatment of ulnar nerve defect by end-to-side neurorrhaphy].

    Science.gov (United States)

    Luo, Y; Wang, T; Fang, H

    1997-11-01

    In the repair of the defect of peripheral nerve, it was necessary to find an operative method with excellent therapeutic effect but simple technique. Based on the experimental study, one case of old injury of the ulnar nerve was treated by end-to-side neurorraphy with the intact median nerve. In this case the nerve defect was over 3 cm and unable to be sutured directly. The patient was followed up for fourteen months after the operation. The recovery of the sensation and the myodynamia was evaluated. The results showed that: the sensation and the motor function innervated by ulnar nerve were recovered. The function of the hand was almost recovered to be normal. It was proved that the end-to-side neurorraphy between the distal stump with the intact median nerve to repair the defect of the ulnar nerve was a new operative procedure for nerve repair. Clinically it had good effect with little operative difficulty. This would give a bright prospect to repair of peripheral nerve defect in the future.

  19. Wrist ultrasound analysis of patients with early rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    J.A. Mendonça

    2011-01-01

    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.

  20. Machine learning for activity recognition: hip versus wrist data

    International Nuclear Information System (INIS)

    Trost, Stewart G; Zheng, Yonglei; Wong, Weng-Keen

    2014-01-01

    Problem addressed: 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. Methodology: 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). Results: 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. (paper)

  1. Sensory impairments and wrist fractures: A case-control study

    Directory of Open Access Journals (Sweden)

    Bergthora Baldursdottir

    2017-12-01

    Full Text Available Objectives: To investigate vestibular function, foot sensation, postural control and functional abilities, and to evaluate whether these variables are associated with fall-related wrist fracture. Methods: A case-control study was conducted with 98 subjects, age range 50–75 years, who had sustained a fall-related wrist fracture. Forty-eight sex-, age- and physical activity-matched individuals, with no previous history of wrist fracture, served as controls. Measurements included: head-shake test (HST, tuning fork, biothesiometer, Semmes-Weinstein monofilaments (MF, Sensory Organization Test (SOT, Five-Times-Sit-to-Stand Test (FTSTS, 10-m walk test (10MWT, Activities-specific Balance Confidence (ABC, and the Dizziness Handicap Inventory (DHI scales. Logistic regression models were used to determine associations of variables with a fall-related wrist fracture. Results: Vestibular asymmetry was apparent in 82% of wrist fracture subjects and 63% of controls (p = 0.012. Plantar pressure sensation (p <0.001, SOT composite scores (p < 0.001, 10MWT (p <0.001, FTSTS (p <0.001, ABC (p <0.001 and DHI (p <0.005 were significantly poorer among cases than controls. A positive HST (odds ratio (OR 5.424; p = 0.008 and monofilament sensation (OR 3.886; p = 0.014 showed the strongest associations with having a fall-related wrist fracture. Conclusion: Asymmetrical vestibular function and reduced plantar pressure sensation are associated with fall-related wrist fractures among the ageing population. These factors are potential targets for future interventions.

  2. Education in wrist arthroscopy: past, present and future.

    Science.gov (United States)

    Obdeijn, M C; Bavinck, N; Mathoulin, C; van der Horst, C M A M; Schijven, M P; Tuijthof, G J M

    2015-05-01

    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 following research question: Could the current way of teaching wrist arthroscopy skills be supported using new educational media, such as e-learning and simulator training? The literature was searched for available methods of teaching endoscopic skills. Articles were assessed on the evidence of validity. In addition, a survey was sent to all members of the European Wrist Arthroscopy Society (EWAS) to find out whether hand surgeons express a need to embrace modern educational tools such as e-learning or simulators for training of wrist arthroscopy skills. This study shows that the current way of teaching wrist arthroscopy skills can be supported using new educational media, such as e-learning and simulator training. Literature indicates that e-learning can be a valuable tool for teaching basic knowledge of arthroscopy and supports the hypothesis that the use of virtual reality and simulators in training enhances operative skills in surgical trainees. This survey indicates that 55 out of 65 respondents feel that an e-learning program would be a valuable asset and 62 out of the 65 respondents are positive on the additional value of wrist arthroscopy simulator in training. Study results support the need and relevance to strengthen current training of wrist arthroscopy using e-learning and simulator training. V.

  3. Morphology and morphometry of the ulnar head of the pronator teres muscle in relation to median nerve compression at the proximal forearm.

    Science.gov (United States)

    Gurses, I A; Altinel, L; Gayretli, O; Akgul, T; Uzun, I; Dikici, F

    2016-12-01

    The pronator syndrome is a rare compression neuropathy of the median nerve. Ulnar head of the pronator teres muscle may cause compression at proximal forearm. Detailed morphologic and morphometric studies on the anatomy of the ulnar head of pronator teres is scarce. We dissected 112 forearms of fresh cadavers. We evaluated the morphology and morphometry of the ulnar head of pronator teres muscle. The average ulnar head width was 16.3±8.2mm. The median nerve passed anterior to the ulnar head at a distance of 50.4±10.7mm from the interepicondylar line. We classified the morphology of the ulnar head into 5 types. In type 1, the ulnar head was fibromuscular in 60 forearms (53.6%). In type 2, it was muscular in 23 forearms (20.5%). In type 3, it was just a fibrotic band in 18 forearms (16.1%). In type 4, it was absent in 9 forearms (8%). In type 5, the ulnar head had two arches in 2 forearms (1.8%). In 80 forearms (71.5%: types 1, 3, and 5), the ulnar head was either fibromuscular or a fibrotic band. Although the pronator syndrome is a rare compression syndrome, the ulnar head of pronator teres is reported as the major cause of entrapment in the majority of the cases. The location of the compression of the median nerve in relation to the ulnar head of pronator teres muscle and the morphology of the ulnar head is important for open or minimally-invasive surgical treatment. Sectional study. Basic science study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures

    DEFF Research Database (Denmark)

    Valentin, Gitte Hoff; Pedersen, Louise Nymann; Maribo, Thomas

    2014-01-01

    .Study design:Experimental follow-up.Methods:The women used the active spinal orthosis for 3 months. Outcomes were changes in isometric back extensor strength, changes in back pain and changes in physical functioning.Results:A total of 13 women were included in the trial. Wearing the orthosis during a 3-month......Background:Vertebral fractures are the most common clinical manifestations of osteoporosis. Vertebral fractures and reduced back extensor strength can result in hyperkyphosis. Hyperkyphosis is associated with diminished daily functioning and an increased risk of falling. Improvements in back...... extensor strength can result in decreased kyphosis and thus a decreased risk of falls and fractures.Objectives:The aim was to examine the effects of an active spinal orthosis - Spinomed III - on back extensor strength, back pain and physical functioning in women with osteoporotic vertebral fractures...

  5. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis

    DEFF Research Database (Denmark)

    Oiestad, B E; Juhl, C B; Eitzen, I

    2015-01-01

    The objective of this study was to perform a systematic review and meta-analysis on the association between knee extensor muscle weakness and the risk of developing knee osteoarthritis. A systematic review and meta-analysis was conducted with literature searches in Medline, SPORTDiscus, EMBASE......, CINAHL, and AMED. Eligible studies had to include participants with no radiographic or symptomatic knee osteoarthritis at baseline; have a follow-up time of a minimum of 2 years, and include a measure of knee extensor muscle strength. Hierarchies for extracting data on knee osteoarthritis and knee...... extensor muscle strength were defined prior to data extraction. Meta-analysis was applied on the basis of the odds ratios (ORs) of developing symptomatic knee osteoarthritis or radiographic knee osteoarthritis in subjects with knee extensor muscle weakness. ORs for knee osteoarthritis and 95% confidence...

  6. Tenossinovite e sinovite do primeiro compartimento extensor do punho: o que o ultrassonografista precisa saber

    Directory of Open Access Journals (Sweden)

    Carlos Frederico Arend

    2012-08-01

    Full Text Available A tenossinovite do primeiro compartimento extensor é uma enfermidade frequente, cercada por mitos. O objetivo deste artigo é revisar cientificamente alguns dos aspectos mais pertinentes ao ultrassonografista sobre sua terminologia, fisiopatogenia, diagnóstico e acompanhamento.

  7. Identified ankle extensor and flexor motoneurons display different firing profiles in the neonatal rat

    DEFF Research Database (Denmark)

    Cotel, Florence; Antri, Myriam; Barthe, Jean-Yves

    2009-01-01

    population of flexor motoneurons solely exhibited the type II profile, characterized by a frequency-current (F-I) relationship with a clockwise hysteresis. In contrast, in addition to this type II profile, the other three profiles of repetitive firing (type I, III and IV) were observed in extensor...... postnatal development, a significant part of the population of extensor motoneurons, but not flexors, are able to produce self-sustained discharges known to involve the activation of persistent inward currents....

  8. MDCT arthrography of the wrist: Diagnostic accuracy and indications

    International Nuclear Information System (INIS)

    De Filippo, Massimo; Pogliacomi, Francesco; Bertellini, Annalisa; Araoz, Philip A.; Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna; Corradi, Maurizio; Costantino, Cosimo; Zompatori, Maurizio

    2010-01-01

    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.

  9. MDCT arthrography of the wrist: Diagnostic accuracy and indications

    Energy Technology Data Exchange (ETDEWEB)

    De Filippo, Massimo [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy)], E-mail: massimo.defilippo@unipr.it; 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)

    2010-04-15

    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.

  10. Rate of Torque Development and Feedforward Control of the Hip and Knee Extensors: Gender Differences.

    Science.gov (United States)

    Stearns-Reider, Kristen M; Powers, Christopher M

    2017-10-06

    The purpose of this study was to determine whether women demonstrate decreased rate of torque development (RTD) of the hip and knee extensors and altered onset timing of the vastus lateralis and gluteus maximus during a drop-jump task when compared with men. On average, women demonstrated significantly lower normalized RTD of the hip extensors (women: 11.6 ± 1.3 MVT.s -1 , men: 13.1 ± 0.9 MVT.s -1 ; p ≤ .01); however, there was no significant difference in knee extensor RTD. Women also demonstrated significantly earlier activation of their vastus lateralis (women: 206.0 ± 130.6 ms, men: 80.9 ± 69.6 ms; p ≤ .01) and gluteus maximus (women: 85.7 ± 58.6 ms, men: 54.5 ± 35.4 ms; p = .02). In both men and women, there was a significant negative correlation between the hip extensor RTD and the vastus lateralis electromyographic onset time (men: r = -.386, p = .046; women: r = -.531, p = .008). The study findings suggest that women may utilize a feedforward control strategy in which they activate their knee extensors earlier than men to compensate for deficits in hip extensor RTD. The impaired capacity to rapidly stabilize the hip and knee joints during dynamic maneuvers may contribute to the increased risk of anterior cruciate ligament injury observed in women.

  11. Clinical Significance of Presence of Extensor Indicis Brevis Manus – A Case Report

    Directory of Open Access Journals (Sweden)

    N Esakkiammal

    2017-11-01

    Full Text Available Anatomical variations of additional muscles and tendons are commonly encountered in extensor aspect of forearm and hand during surgeries and dissections. There are reports on different kinds of variations like, extra tendons, additional bellies, and abnormal attachments of the muscle. Surgeons should have the knowledge about these variations for muscle or tendon grafting and also to plan surgeries. While dissecting the extensor compartment forearm and dorsum of hand of an elderly female cadaver, an anomalous muscle belly was noticed on dorsum of hand bilaterally alongwith the main tendon of extensor indicis muscle. This additional belly of extensor indicis muscle was called Extensor Indicis Brevis Manus (EIBM. This muscle originated from the dorsal carpal ligament and joined the main tendon of extensor indicis muscle in both the hands. Awareness of existence of this kind of variation is important for clinicians and surgeons for a correct diagnosis and eventual surgery in patients presenting with a cyst on the dorsum of hand, to avoid accidental mishaps.

  12. Nonparetic Knee Extensor Strength Is the Determinant of Exercise Capacity of Community-Dwelling Stroke Survivors

    Directory of Open Access Journals (Sweden)

    Wei-Te Wang

    2014-01-01

    Full Text Available Objective. To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. Design. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects’ exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. Results. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO2 peak was 1.21±0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Conclusions. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.

  13. Nonparetic knee extensor strength is the determinant of exercise capacity of community-dwelling stroke survivors.

    Science.gov (United States)

    Wang, Wei-Te; Huang, Ling-Tzu; Chou, Ya-Hui; Wei, Ta-Sen; Lin, Chung-Che

    2014-01-01

    To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects' exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO₂ peak) was 1.21 ± 0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.

  14. Function and structure of the deep cervical extensor muscles in patients with neck pain.

    Science.gov (United States)

    Schomacher, Jochen; Falla, Deborah

    2013-10-01

    The deep cervical extensors are anatomically able to control segmental movements of the cervical spine in concert with the deep cervical flexors. Several investigations have confirmed changes in cervical flexor muscle control in patients with neck pain and as a result, effective evidence-based therapeutic exercises have been developed to address such dysfunctions. However, knowledge on how the deep extensor muscles behave in patients with neck pain disorders is scare. Structural changes such as higher concentration of fat within the muscle, variable cross-sectional area and higher proportions of type II fibres have been observed in the deep cervical extensors of patients with neck pain compared to healthy controls. These findings suggest that the behaviour of the deep extensors may be altered in patients with neck pain. Consistent with this hypothesis, a recent series of studies confirm that patients display reduced activation of the deep cervical extensors as well as less defined activation patterns. This article provides an overview of the various different structural and functional changes in the deep neck extensor muscles documented in patients with neck pain. Relevant recommendations for the management of muscle dysfunction in patients with neck pain are presented. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Clinical value of MRI on wrists with arthritis

    International Nuclear Information System (INIS)

    Ma Qiang; Ma Daqing; He Wen; Le Erhu; Ma Xinfa; Wang Jun; Zuo Zhaoyong

    2006-01-01

    Objective: To study the appearances of various kinds of arthritis on MRI, and to assess and evaluate the role of MRI on diagnosing various kinds of arthritis. Methods: One hundred and fifty-one patients with medical history of wrist pain entered the study. T 1 -weighted spin echo, STIR (short time inversion recovery) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were examined in the coronal planes. MRl, plain wrist radiographs, clinical data including swollen joint and patient global assessment (AIMS), and laboratory, examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score (HAQ). According to 1987 American Rheumatism Association (ARA) revised criteria, in 151 patients, 80 patients were diagnosed as rheumatoid arthritis, 29 patients as undifferentiated spondyloarthropathy, 20 patients as seronegative spondyloarthropathy, and 22 as other kinds of connective tissue diseases. Results: All 80 patients diagnosed with rheumatoid arthritis had bilateral pannus. Among 29 patients diagnosed with undifferentiated spondyloanthropathy, 3 cases had bilateral pannus, 24 had lateral pannus. Among 20 patients diagnosed with seronegative spondyloanthropathy, 4 cases had bilateral pannus, 15 had lateral pannus. Among 22 patients diagnosed with other kinds of connective tissue disease, 21 had lateral pannus. Bilateral pannus on bilateral wrists occured in 87 patients. There were not significant difference in the unilateral pannus among patients with various arthritis (χ 2 =6.157; P>0.05). But there were significant difference in the bilateral pannus among patients with various arthritis (χ 2 =126.882, P 2 =94.192, P 2 =70.354, P 2 =96.174, P<0.001). Conclusion: MRI can show the pathologic changes of wrists with various kinds of arthritis. MRI plays an important role in the differential diagnosis of various kinds of arthritis

  16. Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy.

    Science.gov (United States)

    Aye, Thanda; Thein, Soe; Hlaing, Thaingi

    2016-01-01

    [Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy.

  17. Imaging of radial wrist pain. I. Imaging modalities and anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ryan Ka Lok; Griffith, James F.; Ng, Alex Wing Hung [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, Shatin (China); Wong, Clara Wing Yee [The Chinese University of Hong Kong, Department of Orthopedics and Traumatology, Shatin (China)

    2014-06-15

    Radial wrist pain is a common clinical complaint. The relatively complex anatomy in this region, combined with the small size of the anatomical structures and occasionally subtle imaging findings, can pose problems when trying to localize the exact cause of pain. To fully comprehend the underlying pathology, one needs a good understanding of both radial-sided wrist anatomy and the relative merits of the different imaging techniques used to assess these structures. In part I of this review, these aspects will be discussed. (orig.)

  18. Arthrography in lesions of triangular fibrocartilage of the wrist

    International Nuclear Information System (INIS)

    Rau, W.S.; Seifert, J.

    1982-01-01

    Arthography of the wrist is a safe method to demonstrate lesions of the triangular fibrocartilage. Indications are posttraumatic pain and restriction of movement of the wrist. Lesions of the triangular fibrocartilage are caused by a distal fracture of the radius with shortening, sudden drop on the overextended hand and work with rock drills. The extent of injury is quite different: small fissures and splits, detachment of the discus from the lower end of the ulna, fragmentation and destruction of the fibrocartilage. Problems of therapy, however, are greater than problems of diagnosis: actually there is no generally adopted surgical method for the treatment of discus lections. (orig./MG)

  19. Arthrography in lesions of triangular fibrocartilage of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Rau, W.S.; Seifert, J.

    1982-05-01

    Arthography of the wrist is a safe method to demonstrate lesions of the triangular fibrocartilage. Indications are posttraumatic pain and restriction of movement of the wrist. Lesions of the triangular fibrocartilage are caused by a distal fracture of the radius with shortening, sudden drop on the overextended hand and work with rock drills. The extent of injury is quite different: small fissures and splits, detachment of the discus from the lower end of the ulna, fragmentation and destruction of the fibrocartilage. Problems of therapy, however, are greater than problems of diagnosis: actually there is no generally adopted surgical method for the treatment of discus lesions.

  20. Hand and Wrist Injuries in Boxing and the Martial Arts.

    Science.gov (United States)

    Drury, Benjamin Todd; Lehman, Thomas P; Rayan, Ghazi

    2017-02-01

    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 © 2016 Elsevier Inc. All rights reserved.

  1. Radiographic findings in wrists and hands of patients with leprosy

    International Nuclear Information System (INIS)

    Carreto, A.; Montero, F.; Garcia Frasquet, A.; Carpintero, P.

    1998-01-01

    Leprosy, like other neuropathic disorders, can involve the skeleton, affecting both bone and joints, especially those segments that have to withstand weight. To asses the osteoarticular involvement of the wrist and hand in 58 patients with leprosy. The radiographic images of wrist and hand of 58 patients with Hansen's disease were reviewed. The entire spectrum of specific and nonspecific bone lesions described in the literature is presented. Despite the fact that the upper limbs do not have to withstand the weight that the feet and ankles do, radiographic images show that gripping and other common motions can also produce lesions compatible with those of neuropathic arthropathy. (Author) 20 refs

  2. Sonographic measurements of the ulnar nerve at the elbow with different degrees of elbow flexion.

    Science.gov (United States)

    Patel, Prutha; Norbury, John W; Fang, Xiangming

    2014-05-01

    To determine whether there were differences in the cross-sectional area (CSA) and the flattening ratio of the normative ulnar nerve as it passes between the medial epicondyle and the olecranon at 30° of elbow flexion versus 90° of elbow flexion. Bilateral upper extremities of normal healthy adult volunteers were evaluated with ultrasound. The CSA and the flattening ratio of the ulnar nerve at the elbow as it passes between the medial epicondyle and the olecranon were measured, with the elbow flexed at 30° and at 90°, by 2 operators with varying ultrasound scanning experience by using ellipse and direct tracing methods. The results from the 2 different angles of elbow flexion were compared for each individual operator. Finally, intraclass correlations for absolute agreement and consistency between the 2 raters were calculated. An outpatient clinic room at a regional rehabilitation center. Twenty-five normal healthy adult volunteers. The mean CSA and the mean flattening ratio of the ulnar nerve at 30° of elbow flexion and at 90° of elbow flexion. First, for the ellipse method, the mean CSA of the ulnar nerve at 90° (9.93 mm(2)) was slightly larger than at 30° (9.77 mm(2)) for rater 1. However, for rater 2, the mean CSA of the ulnar nerve at 90° (6.80 mm(2)) was slightly smaller than at 30° (7.08 mm(2)). This was found to be statistically insignificant when using a matched pairs t test and the Wilcoxon signed-rank test, with a significance level of .05. Similarly, the difference between the right side and the left side was not statistically significant. The intraclass correlations for absolute agreement between the 2 raters were not very high due to different measurement locations, but the intraclass correlations for consistency were high. Second, for the direct tracing method, the mean CSA at 90° (7.26 mm(2)) was slightly lower than at 30° (7.48 mm(2)). This was found to be statistically nonsignificant when using the matched pairs t test and the

  3. 78 FR 68905 - Agency Information Collection (Wrist Conditions Disability Benefits Questionnaire) Under OMB Review

    Science.gov (United States)

    2013-11-15

    ... Number: 2900-NEW (Wrist Conditions Disability Benefits Questionnaire). Type of Review: New data... Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits Administration...- NEW (Wrist Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER...

  4. Validation of the IOF quality of life questionnaire for patients with wrist fracture

    NARCIS (Netherlands)

    Lips, P.T.A.M.; Jameson, K.; Bianchi, M.L.; Goemaere, S.; Boonen, S.; Reeve, J.; Stepan, J.; Johnell, O.; van Schoor, N.M.; Dennison, E.; Kanis, J.A.; Cooper, C.

    2010-01-01

    Introduction: Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a

  5. Interfascicular suture with nerve autografts for median, ulnar and radial nerve lesions.

    Science.gov (United States)

    Pluchino, F; Luccarelli, G

    1981-05-01

    Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.

  6. Radiocephalic Fistula Complicated by Distal Ischemia: Treatment by Ulnar Artery Dilatation

    International Nuclear Information System (INIS)

    Raynaud, Alain; Novelli, Luigi; Rovani, Xavier; Carreres, Thierry; Bourquelot, Pierre; Hermelin, Alain; Angel, C.; Beyssen, B.

    2010-01-01

    Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. However, its frequency is increasing with the rise in numbers of elderly and diabetic patients. This complication, which is more common for proximal than for distal accesses, can be very severe and may cause loss of hand function, damage to fingers, and even amputation of fingers or the hand. Its treatment is difficult and often leads to access loss. We report here a case of severe hand ischemia related to a radiocephalic fistula successfully treated by ulnar artery dilatation.

  7. Severe Ulnar Nerve Injury After Bee Venom Acupuncture at a Traditional Korean Medicine Clinic: A Case Report.

    Science.gov (United States)

    Park, Joon Sang; Park, Yoon Ghil; Jang, Chul Hoon; Cho, Yoo Na; Park, Jung Hyun

    2017-06-01

    This case report describes a severe nerve injury to the right ulnar nerve, caused by bee venom acupuncture. A 52-year-old right-handed man received bee venom acupuncture on the medial side of his right elbow and forearm, at a Traditional Korean Medicine (TKM) clinic. Immediately after acupuncture, the patient experienced pain and swelling on the right elbow. There was further development of weakness of the right little finger, and sensory changes on the ulnar dermatome of the right hand. The patient visited our clinic 7 days after acupuncture. Electrodiagnostic studies 2 weeks after the acupuncture showed ulnar nerve damage. The patient underwent steroid pulse and rehabilitation treatments. However, his condition did not improve completely, even 4 months after acupuncture.

  8. Meta-Analysis: Association Between Wrist Posture and Carpal Tunnel Syndrome Among Workers

    Directory of Open Access Journals (Sweden)

    Doohee You

    2014-03-01

    Conclusion: We found evidence that prolonged exposure to non-neutral wrist postures is associated with a twofold increased risk for CTS compared with low hours of exposure to non-neutral wrist postures. Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

  9. Synovial Chondrosarcoma in the Hand and Wrist: A Case Report

    International Nuclear Information System (INIS)

    An, Yeong Yi; Kim, Jee Young; Kang, Seok Jin; Kang, Yong Koo; Baik, Jun Hyun

    2010-01-01

    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

  10. Synovial Chondrosarcoma in the Hand and Wrist: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2010-01-15

    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.

  11. Stiffness of the ligaments of the human wrist joint

    NARCIS (Netherlands)

    Savelberg, H.H.C.M.; Kooloos, J.G.M.; Huiskes, H.W.J.; Kauer, J.M.G.

    1992-01-01

    The stiffnesses of the superficial ligaments of 14 human cadaver wrist joints have been determined. In these experiments the tested, fresh-frozen carpal joints are divided into a number of bone-ligament-bone complexes, which are loaded in a tensile testing machine at a rate of 66% of the ligaments'

  12. Education in wrist arthroscopy: past, present and future

    NARCIS (Netherlands)

    Obdeijn, M. C.; Bavinck, N.; Mathoulin, C.; van der Horst, C. M. A. M.; Schijven, M. P.; Tuijthof, G. J. M.

    2015-01-01

    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

  13. TOPOGRAFÍA INTRANEURAL DE LA RAMA PROFUNDA DEL NERVIO ULNAR EN EL ANTEBRAZO DISTAL: ESTUDIO CADAVÉRICO. Intraneural topography of the deep branch of the ulnar nerve in the distal forearm: cadaveric study.

    Directory of Open Access Journals (Sweden)

    Joaquín García Pisón

    2016-07-01

    Full Text Available Objetivo: estudiar la topografía intraneural de la rama profunda del nervio ulnar (RPNU en el antebrazo distal en vistas a su identificación mediante disección intraneural mínima durante la transferencia del nervio del pronador cuadrado (NPC a la RPNU. Materiales y métodos: En 15 antebrazos cadavéricos se fijó el paquete vasculonervioso ulnar a los planos musculares profundos cada un centímetro tomando como referencia el hueso pisiforme. Se disecó en sentido proximal la RPNU bajo microscopio quirúrgico (Olympus OME, 4-20x y se registró su posición intraneural en base a una división en cuadrantes. Se midió la distancia desde el origen de la rama cutánea dorsal (RCD del nervio ulnar al pisiforme y se registró su relación intraneural con la RPNU. Resultados: La RPNU se individualizó hasta 69mm (41-94 proximal al hueso pisiforme, ubicándose en el cuadrante posteromedial del nervio ulnar en el 78% (67-87, el 93% (92-93 y el 100% de los casos entre los 0-2, 3-6 y 7-9 centímetros, respectivamente. La distancia pisiforme-RCD fue de 63mm (52-83. En 11 miembros la disección de la RPNU se extendió proximalmente al origen de la RCD, ubicándose siempre entre esta última y la rama superficial del nervio ulnar. Conclusiones: La topografía intraneural de la RPNU en el sitio óptimo para su sección en vistas a su anastomosis con el NPC es predecible en la mayoría de los casos, lo que confirma la viabilidad de su identificación precisa mediante disección intraneural mínima.  Objective: to assess the intraneural anatomy of the deep branch of the ulnar nerve (DBUN in the distal forearm in reference to its identification by means of minimal intraneural dissection during pronator quadratus nerve to DBUN transfers. Materials and methods: In 15 cadaveric forearms the ulnar neurovascular bundle was identified and attached to the subjacent muscles every one centimeter. Pisiform bone was used as reference. Intraneural proximal dissection of

  14. The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting.

    Science.gov (United States)

    Hu, Boyi; Ning, Xiaopeng

    2015-01-01

    Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

  15. Isometric elbow extensors strength in supine- and prone-lying positions.

    Science.gov (United States)

    Abdelzaher, Ibrahim E; Ababneh, Anas F; Alzyoud, Jehad M

    2013-01-01

    The purpose of this study was to compare isometric strength of elbow extensors measured in supine- and prone-lying positions at elbow flexion angles of 45 and 90 degrees. Twenty-two male subjects under single-blind procedures participated in the study. Each subject participated in both supine-lying and prone-lying measuring protocols. Calibrated cable tensiometer was used to measure isometric strength of the right elbow extensors and a biofeedback electromyography was used to assure no substitution movements from shoulder girdle muscles. The mean values of isometric strength of elbow extensors measured from supine-lying position at elbow flexion angles of 45 and 90 degrees were 11.1  ±  4.2 kg and 13.1  ±  4.6 kg, while those measured from prone-lying position were 9.9  ±  3.6 kg and 12  ±  4.2 kg, respectively. There is statistical significant difference between the isometric strength of elbow extensors measured from supine-lying position at elbow flexion angles of 45 and 90 degrees compared to that measured from prone-lying position (p  isometric strength of elbow extensors since supine-lying starting position is better than prone-lying starting position.

  16. Completed Ulnar Shaft Stress Fracture in a Fast-Pitch Softball Pitcher.

    Science.gov (United States)

    Wiltfong, Roger E; Carruthers, Katherine H; Popp, James E

    2017-03-01

    Stress fractures of the upper extremity have been previously described in the literature, yet reports of isolated injury to the ulna diaphysis or olecranon are rare. The authors describe a case involving an 18-year-old fast-pitch softball pitcher. She presented with a long history of elbow and forearm pain, which was exacerbated during a long weekend of pitching. Her initial physician diagnosed her as having forearm tendinitis. She was treated with nonsurgical means including rest, anti-inflammatory medications, therapy, and kinesiology taping. She resumed pitching when allowed and subsequently had an acute event immediately ceasing pitching. She presented to an urgent care clinic that evening and was diagnosed as having a complete ulnar shaft fracture subsequently needing surgical management. This case illustrates the need for a high degree of suspicion for ulnar stress fractures in fast-pitch soft-ball pitchers with an insidious onset of unilateral forearm pain. Through early identification and intervention, physicians may be able to reduce the risk of injury progression and possibly eliminate the need for surgical management. [Orthopedics. 2017; 40(2):e360-e362.]. Copyright 2016, SLACK Incorporated.

  17. Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Wei Huang

    2015-01-01

    Full Text Available Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28% had grade IIA neuropathy, 20 (31% had grade IIB, and 27 (42% had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%, good in 16 (25%, fair in 7 (11%, and poor in 4 (6%, with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

  18. Hypothenar Hammer Syndrome Caused by Recreational Sports Activities and Muscle Anomaly in the Wrist

    International Nuclear Information System (INIS)

    Kreitner, Karl-Friedrich; Dueber, Christoph; Mueller, Lars-Peter; Degreif, Juergen

    1996-01-01

    A 34-year-old man with digital ischemia is reported. Angiography revealed thromboembolic occlusions of the proper digital arteries of the index, middle, and ring fingers and a tortuous ulnar artery in Guyon's canal. Though hypothenar hammer syndrome was suspected, there was no relevant occupational history. Magnetic resonance imaging and magnetic resonance angiography demonstrated an anomalous muscular sling around the ulnar artery immediately adjacent to the hook of the hamate. The ulnar artery showed mural thrombi in its tortuous segment. These findings were confirmed during operative exploration. After thrombectomy and embolectomy the involved segment of the ulnar artery was replaced by an autologous vein graft. Postoperatively there was complete resolution of the symptoms. Only during convalescence did it become clear that the patient was a passionate golfer

  19. Fracture of the proximal tibia after revision total knee arthroplasty with an extensor mechanism allograft.

    Science.gov (United States)

    Klein, Gregg R; Levine, Harlan B; Sporer, Scott M; Hartzband, Mark A

    2013-02-01

    Extensor mechanism reconstruction with an extensor mechanism allograft (EMA) remains one of the most reliable methods for treating the extensor mechanism deficient total knee arthroplasty. We report 3 patients who were treated with an EMA who sustained a proximal tibial shaft fracture. In all 3 cases, a short tibial component was present that ended close to the level of the distal extent of the bone block. When performing an EMA, it is important to recognize that the tibial bone block creates a stress riser and revision to a long-stemmed tibial component should be strongly considered to bypass this point to minimize the risk of fracture. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Knee extensor muscle strength in middle-aged and older individuals undergoing arthroscopic partial meniscectomy

    DEFF Research Database (Denmark)

    Hall, Michelle; Juhl, Carsten B; Lund, Hans

    2015-01-01

    OBJECTIVE: People with meniscal tears are at high risk to develop or progress knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is often reported in these individuals. The purpose of this systematic review and meta-analysis was to investigate knee...... for a meniscal tear and used either a healthy control group or the contralateral leg to compare knee extensor muscle strength were included. Methodological quality was assessed using guidelines from the Centre for Reviews and Dissemination. RESULTS: Eleven studies, including predominately males were included (n...... and knee extensor muscle weakness are risk factors for osteoarthritis these results highlight the clinical importance of addressing muscle weakness in these individuals. This article is protected by copyright. All rights reserved....

  1. Knee extensor strength and risk of structural, symptomatic and functional decline in knee osteoarthritis

    DEFF Research Database (Denmark)

    Culvenor, Adam G; Ruhdorfer, Anja; Juhl, Carsten

    2017-01-01

    OBJECTIVE: To perform a systematic review and meta-analysis on the association between knee extensor strength and the risk of structural, symptomatic, or functional deterioration in individuals with or at risk of knee osteoarthritis (KOA). METHODS: We systematically identified and methodologically...... appraised all longitudinal studies (≥1-year follow-up) reporting an association between knee extensor strength and structural (tibiofemoral, patellofemoral), symptomatic (self-reported, knee replacement), or functional (subjective, objective) decline in individuals with or at risk of radiographic......-analysis revealed that lower knee extensor strength was associated with an increased risk of symptomatic (WOMAC-Pain: odds ratio [OR] 1.35, 95% confidence interval [CI] 1.10, 1.67) and functional decline (WOMAC-Function: OR 1.38, 95%CI 1.00, 1.89; chair-stand task: OR 1.03, 95%CI 1.03, 1.04), but not increased risk...

  2. Trigger wrist and carpal tunnel syndrome caused by hand intramuscular intrasynovial angiofibrolipoma: A rare case report

    Directory of Open Access Journals (Sweden)

    Turan C Dulgeroglu

    2016-08-01

    Full Text Available Trigger wrist is a clinical entity characterized by triggering or the crackling of the wrist. Here, a case is reported of intrasynovial angiofibrolipoma that caused trigger wrist and carpal tunnel syndrome. This is the only case report where trigger wrist and carpal tunnel syndrome caused by the intrasynovial angiofibrolipoma were developed simultaneously. it is believed that that adhesive tenosynovitis developing in the tendons may have contributed to the triggering and carpal tunnel syndrome in the wrist as a result of inflammation occuring as a consequence of intrasynovial angiofibrolipoma. [Hand Microsurg 2016; 5(2.000: 107-109

  3. Validity and test-retest reliability of a novel simple back extensor muscle strength test.

    Science.gov (United States)

    Harding, Amy T; Weeks, Benjamin Kurt; Horan, Sean A; Little, Andrew; Watson, Steven L; Beck, Belinda Ruth

    2017-01-01

    To develop and determine convergent validity and reliability of a simple and inexpensive clinical test to quantify back extensor muscle strength. Two testing sessions were conducted, 7 days apart. Each session involved three trials of standing maximal isometric back extensor muscle strength using both the novel test and isokinetic dynamometry. Lumbar spine bone mineral density was examined by dual-energy X-ray absorptiometry. Validation was examined with Pearson correlations ( r ). Test-retest reliability was examined with intraclass correlation coefficients and limits of agreement. Pearson correlations and intraclass correlation coefficients are presented with corresponding 95% confidence intervals. Linear regression was used to examine the ability of peak back extensor muscle strength to predict indices of lumbar spine bone mineral density and strength. A total of 52 healthy adults (26 men, 26 women) aged 46.4 ± 20.4 years were recruited from the community. A strong positive relationship was observed between peak back extensor strength from hand-held and isokinetic dynamometry ( r  = 0.824, p  strength test, short- and long-term reliability was excellent (intraclass correlation coefficient = 0.983 (95% confidence interval, 0.971-0.990), p  strength measures with the novel back extensor strength protocol were -6.63 to 7.70 kg, with a mean bias of +0.71 kg. Back extensor strength predicted 11% of variance in lumbar spine bone mineral density ( p  strength ( p  strength is quick, relatively inexpensive, and reliable; demonstrates initial convergent validity in a healthy population; and is associated with bone mass at a clinically important site.

  4. Degree of thoracic kyphosis and peak torque of trunk flexors and extensors among healthy women.

    Science.gov (United States)

    Granito, Renata Neves; Aveiro, Mariana Chaves; Rennó, Ana Claudia Muniz; Oishi, Jorge; Driusso, Patricia

    2014-01-01

    The aim of this study was to analyze the effects of aging on the degree of thoracic kyphosis and peak torque of the trunk flexor and extensor muscles among women without a densitometric diagnosis of osteoporosis. Thirty women were selected to make up three groups: young women (n = 10; 24.60 ± 2.27 years of age); adults (n = 10; 43.50 ± 2.88); and elderly women (n = 10; 62.40 ± 2.67). Bone mineral density (BMD), degree of thoracic kyphosis and peak torque of the trunk flexors and extensors were evaluated. Differences between the groups were evaluated using the Kruskal-Wallis ANOVA and Mann-Whitney U tests. Pearson's correlation coefficient was used to assess correlations between the variables. The significance level was taken to be 5% (p ≤ 0.05). The elderly group presented a greater degree of thoracic kyphosis (p = 0.009) and lower peak torque of the trunk flexors and extensors than the young group. The adult group presented lower peak torque of the trunk than the young group. A negative correlation was observed between age and peak torque of the trunk flexors and extensors (p ≤ 0.001), and a positive correlation between age and the degree of thoracic kyphosis (r = 0.58; p ≤ 0.001). The elderly group presented higher values for the eccentric/concentric ratio of the peak torque for flexors (p = 0.03) and extensors (p = 0.02). This study suggests that physiological aging may be associated with a greater degree of thoracic kyphosis and lower muscle strength of the trunk flexors and extensors. Moreover, the elderly women showed a relative capacity for preservation of eccentric strength.

  5. Degree of thoracic kyphosis and peak torque of trunk flexors and extensors among healthy women,

    Directory of Open Access Journals (Sweden)

    Renata Neves Granito

    2014-06-01

    Full Text Available OBJECTIVE: The aim of this study was to analyze the effects of aging on the degree of thoracic kyphosis and peak torque of the trunk flexor and extensor muscles among women without a densitometric diagnosis of osteoporosis.METHODS: Thirty women were selected to make up three groups: young women (n = 10; 24.60 ± 2.27 years of age; adults (n = 10; 43.50 ± 2.88; and elderly women (n= 10; 62.40 ± 2.67. Bone mineral density (BMD, degree of thoracic kyphosis and peak torque of the trunk flexors and extensors were evaluated. Differences between the groups were evaluated using the Kruskal-Wallis ANOVA and Mann-Whitney U tests. Pearson's correlation coefficient was used to assess correlations between the variables. The significance level was taken to be 5% (p < 0.05.RESULTS: The elderly group presented a greater degree of thoracic kyphosis (p = 0.009 and lower peak torque of the trunk flexors and extensors than the young group. The adult group presented lower peak torque of the trunk than the young group. A negative correlation was observed between age and peak torque of the trunk flexors and extensors (p < 0.001, and a positive correlation between age and the degree of thoracic kyphosis (r = 0.58; p < 0.001. The elderly group presented higher values for the eccentric/concentric ratio of the peak torque for flexors (p = 0.03 and extensors (p = 0.02.CONCLUSION: This study suggests that physiological aging may be associated with a greater degree of thoracic kyphosis and lower muscle strength of the trunk flexors and extensors. Moreover, the elderly women showed a relative capacity for preservation of eccentric strength.

  6. Associations of knee extensor strength and standing balance with physical function in knee osteoarthritis.

    Science.gov (United States)

    Pua, Yong-Hao; Liang, Zhiqi; Ong, Peck-Hoon; Bryant, Adam L; Lo, Ngai-Nung; Clark, Ross A

    2011-12-01

    Knee extensor strength is an important correlate of physical function in patients with knee osteoarthritis; however, it remains unclear whether standing balance is also a correlate. The purpose of this study was to evaluate the cross-sectional associations of knee extensor strength, standing balance, and their interaction with physical function. One hundred four older adults with end-stage knee osteoarthritis awaiting a total knee replacement (mean ± SD age 67 ± 8 years) participated. Isometric knee extensor strength was measured using an isokinetic dynamometer. Standing balance performance was measured by the center of pressure displacement during quiet standing on a balance board. Physical function was measured by the self-report Short Form 36 (SF-36) questionnaire and by the 10-meter fast-pace gait speed test. After adjustment for demographic and knee pain variables, we detected significant knee strength by standing balance interaction terms for both SF-36 physical function and fast-pace gait speed. Interrogation of the interaction revealed that standing balance in the anteroposterior plane was positively related to physical function among patients with lower knee extensor strength. Conversely, among patients with higher knee extensor strength, the standing balance-physical function associations were, or tended to be, negative. These findings suggest that although standing balance was related to physical function in patients with knee osteoarthritis, this relationship was complex and dependent on knee extensor strength level. These results are of importance in developing intervention strategies and refining theoretical models, but they call for further study. Copyright © 2011 by the American College of Rheumatology.

  7. Enhanced spinal excitation from ankle flexors to knee extensors during walking in stroke patients

    DEFF Research Database (Denmark)

    Achache, V.; Mazevet, D.; Iglesias, C.

    2010-01-01

    : The spinal, presumed group II, excitation from ankle dorsiflexors to knee extensors is particularly enhanced during post-stroke walking probably due to plastic adaptations in the descending control. SIGNIFICANCE: This adaptation may help to stabilize the knee in early stance when the patients have recover......OBJECTIVES: It is still unclear to what an extent altered reflex activity contributes to gait deficit following stroke. Spinal group I and group II excitations from ankle dorsiflexors to knee extensors were investigated during post-stroke walking. METHODS: Electrical stimulation was applied...... ankle dorsiflexor functions....

  8. Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion.

    Science.gov (United States)

    Palomo López, P; Becerro de Bengoa Vallejo, R; López López, D; Prados Frutos, J C; Alfonso Murillo González, J; Losa Iglesias, M E

    2015-10-01

    The purpose of this study was to delineate the relationship of the terminal extensor hallucis longus tendon insertion to the proximal limit of the nail matrix of the great toe. Fifty fresh-frozen human cadaver great toes with no evidence of trauma (average age, 62.5 years; 29 males and 21 females) were used for this study. Under 25X magnification, the proximal limit of the nail matrix and the terminal bony insertion of the extensor hallucis longus tendons were identified. The distance from the terminal tendon insertion to the nail matrix was ascertained using precision calipers, an optical microscope, and autocad(®) software for windows. Twenty-five great toes were placed in a neutral formalin solution and further analysed by histological longitudinal-sections. The specimens were stained with haematoxylin and eosin and examined microscopically to determine the presence of the extensor hallucis longus tendon along the dorsal aspect of the distal phalanx of each great toe. The main result we found in great toes was that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx in all, 100%, specimens. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of the distal phalanx as is the case for fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. We have found that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of distal phalanx as is the case in fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. Our anatomic study demonstrates that the proximal limit of the matrix and nail bed of the human great toe are dorsal and

  9. Meta-analysis: association between wrist posture and carpal tunnel syndrome among workers.

    Science.gov (United States)

    You, Doohee; Smith, Allan H; Rempel, David

    2014-03-01

    Carpal tunnel syndrome (CTS) is a common work-related peripheral neuropathy. In addition to grip force and repetitive hand exertions, wrist posture (hyperextension and hyperflexion) may be a risk factor for CTS among workers. However, findings of studies evaluating the relationship between wrist posture and CTS are inconsistent. The purpose of this paper was to conduct a meta-analysis of existing studies to evaluate the evidence of the relationship between wrist posture at work and risk of CTS. PubMed and Google Scholar were searched to identify relevant studies published between 1980 and 2012. The following search terms were used: "work related", "carpal tunnel syndrome", "wrist posture", and "epidemiology". The studies defined wrist posture as the deviation of the wrist in extension or flexion from a neutral wrist posture. Relative risk (RR) of individual studies for postural risk was pooled to evaluate the overall risk of wrist posture on CTS. Nine studies met the inclusion criteria. All were cross-sectional or case-control designs and relied on self-report or observer's estimates for wrist posture assessment. The pooled RR of work-related CTS increased with increasing hours of exposure to wrist deviation or extension/flexion [RR = 2.01; 95% confidence interval (CI): 1.646-2.43; p Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

  10. Clarification of Eponymous Anatomical Terminology: Structures Named After Dr Geoffrey V. Osborne That Compress the Ulnar Nerve at the Elbow.

    Science.gov (United States)

    Wali, Arvin R; Gabel, Brandon; Mitwalli, Madhawi; Tubbs, R Shane; Brown, Justin M

    2017-05-01

    In 1957, Dr Geoffrey Osborne described a structure between the medial epicondyle and the olecranon that placed excessive pressure on the ulnar nerve. Three terms associated with such structures have emerged: Osborne's band, Osborne's ligament, and Osborne's fascia. As anatomical language moves away from eponymous terminology for descriptive, consistent nomenclature, we find discrepancies in the use of anatomic terms. This review clarifies the definitions of the above 3 terms. We conducted an extensive electronic search via PubMed and Google Scholar to identify key anatomical and surgical texts that describe ulnar nerve compression at the elbow. We searched the following terms separately and in combination: "Osborne's band," "Osborne's ligament," and "Osborne's fascia." A total of 36 papers were included from 1957 to 2016. Osborne's band, Osborne's ligament, and Osborne's fascia were found to inconsistently describe the etiology of ulnar neuritis, referring either to the connective tissue between the 2 heads of the flexor carpi ulnaris muscle as described by Dr Osborne or to the anatomically distinct fibrous tissue between the olecranon process of the ulna and the medial epicondyle of the humerus. The use of eponymous terms to describe ulnar pathology of the elbow remains common, and although these terms allude to the rich history of surgical anatomy, these nonspecific descriptions lead to inconsistencies. As Osborne's band, Osborne's ligament, and Osborne's fascia are not used consistently across the literature, this research demonstrates the need for improved terminology to provide reliable interpretation of these terms among surgeons.

  11. Handlebar palsy--a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking.

    Science.gov (United States)

    Capitani, Daniel; Beer, Serafin

    2002-10-01

    We describe 3 patients who developed a severe palsy of the intrinsic ulnar supplied hand muscles after bicycle riding. Clinically and electrophysiologically all showed an isolated lesion of the deep terminal motor branch of the ulnar nerve leaving the hypothenar muscle and the distal sensory branch intact. This type of lesion at the canal of Guyon is quite unusual, caused in the majority of cases by chronic external pressure over the ulnar palm. In earlier reports describing this lesion in bicycle riders, most patients experienced this lesion after a long distance ride. Due to the change of riding position and shape of handlebars (horn handle) in recent years, however, even a single bicycle ride may be sufficient to cause a lesion of this ulnar branch. Especially in downhill riding, a large part of the body weight is supported by the hand on the corner of the handlebar leading to a high load at Guyon's canal. As no sensory fibres are affected, the patients are not aware of the ongoing nerve compression until a severe lesion develops. Individual adaptation of the handlebar and riding position seems to be crucial for prevention of this type of nerve lesion.

  12. Effect of therapeutic ultrasound intensity on subcutaneous tissue temperature and ulnar nerve conduction velocity.

    Science.gov (United States)

    Kramer, J F

    1985-02-01

    Twenty subjects completed 5 min. periods of sonation, at each of six US intensities, over the ulnar nerve in the proximal forearm. All posttreatment NCV's differed significantly from the respective pretreatment velocities. The immediate posttreatment NCV associated with placebo US was significantly (p less than 0.01) less than that observed immediately pretreatment (2.81 m/s), while the five clinical US intensities produced significantly increased immediate posttreatment velocities: 0.5 w/cm2 (2.23 m/s) at (p less than 0.05), and 1.0 w/cm2 (2.78 m/s), 1.5 w/cm2 (3.15 m/s), 2.0 w/cm2 (4.47 m/s) and 2.5 w/cm2 (2.97 m/s) at (p less than 0.01). The posttreatment velocities associated with the five clinical intensities were all significantly greater (p less than 0.01) than that associated with placebo US. Subcutaneous tissue temperatures were directly related to the intensity of US. Not until US intensity had reached 1.5 w/cm2 did the heating effect of US negate the cooling effect of the US transmission gel, to produce significantly increased subcutaneous tissue temperatures after 5 min. sonation. The decreased ulnar motor NCV's associated with placebo US are attributed to the cooling effect of the US transmission gel. The increased ulnar motor NCV's associated with the clinical intensities of US are attributed to the deep heating effect of US. The breakdown of this linear relationship at 2.5 w/cm2 intensity suggests that at this point heating on the nerve and/or the mechanical effects of US were of sufficient magnitude so as to limit the increase in conduction velocity. Sonation over an area of approximately 4.5 times the soundhead for 5 min., along the proximal forearm, at clinical intensities did not have a bipositive effect on motor NCV.

  13. ''Dropped-head'' syndrome due to isolated myositis of neck extensor muscles: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Gaeta, Michele; Mazziotti, Silvio; Blandino, Alfredo [University of Messina, Department of Radiological Sciences, Messina (Italy); Toscano, Antonio; Rodolico, Carmelo; Mazzeo, Anna [University of Messina, Department of Neurosciences, Psychiatry and Anaesthesiology, Messina (Italy)

    2006-02-15

    MRI findings of a patient with dropped-head syndrome due to focal myositis of the neck extensor muscles are presented. MRI showed oedematous changes and marked enhancement of the neck extensor muscles. After therapy MRI demonstrated disappearance of the abnormal findings. (orig.)

  14. Low-level activity of the trunk extensor muscles causes electromyographic manifestations of fatigue in absence of decreased oxygenation

    NARCIS (Netherlands)

    Dieën, J.H. van; Westebring van der; Putten, E.P.; Kingma, I.; Looze, M.P. de

    2009-01-01

    This study was designed to determine whether trunk extensor fatigue occurs during low-level activity and whether this is associated with a drop in muscle tissue oxygenation. Electromyography (EMG) feedback was used to impose constant activity in a part of the trunk extensor muscles. We hypothesized

  15. Relationship between the Ulnar Nerve and the Branches of the Radial Nerve to the Medial Head of the Triceps Brachii Muscle.

    Science.gov (United States)

    Sh, Cho; Ih, Chung; Uy, Lee

    2018-05-17

    One branch of the radial nerve to the medial head of the triceps brachii muscle (MHN) has been described as accompanying or joining the ulnar nerve. Mostly two MHN branches have been reported, with some reports of one; however, the topographical anatomy is not well documented. We dissected 52 upper limbs from adult cadavers and found one, two, and three MHN branches in 9.6%, 80.8%, and 9.6% of cases, respectively. The MHN accompanying the ulnar nerve was always the superior MHN. The relationship between the ulnar nerve and the MHN was classified into four types according to whether the MHN was enveloped along with the ulnar nerve in the connective tissue sheath and whether it was in contact with the ulnar nerve. It contacted the ulnar nerve in 75.0% of cases and accompanied it over a mean distance of 73.6 mm (range 36-116 mm). In all cases in which the connective tissue sheath enveloped the branch of the MHN and the ulnar nerve, removing the sheath confirmed that the MHN branch originated from the radial nerve. The detailed findings and anatomical measurements of the MHN in this study will help in identifying its branches during surgical procedures. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

  16. Monosynaptic Ia projections from intrinsic hand muscles to forearm motoneurones in humans.

    Science.gov (United States)

    Marchand-Pauvert, V; Nicolas, G; Pierrot-Deseilligny, E

    2000-05-15

    Heteronymous Ia excitatory projections from intrinsic hand muscles to human forearm motoneurones (MNs) were investigated. Changes in firing probability of single motor units (MUs) in the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), extensor carpi radialis (ECR), extensor carpi ulnaris (ECU) and extensor digitorum communis (EDC) were studied after electrical stimuli were applied to the median and ulnar nerve at wrist level and to the corresponding homonymous nerve at elbow level. Homonymous facilitation, occurring at the same latency as the H reflex, and therefore attributed to monosynaptic Ia EPSPs, was found in all the sampled units. In many MUs an early facilitation was also evoked by heteronymous low-threshold afferents from intrinsic hand muscles. The low threshold (between 0.5 and 0.6 times motor threshold (MT)) and the inability of a pure cutaneous stimulation to reproduce this effect indicate that it is due to stimulation of group I muscle afferents. Evidence for a similar central delay (monosynaptic) in heteronymous as in homonymous pathways was accepted when the difference in latencies of the homonymous and heteronymous peaks did not differ from the estimated supplementary afferent conduction time from wrist to elbow level by more than 0.5 ms (conduction velocity in the fastest Ia afferents between wrist and elbow levels being equal to 69 m s-1). A statistically significant heteronymous monosynaptic Ia excitation from intrinsic hand muscles supplied by both median and ulnar nerves was found in MUs belonging to all forearm motor nuclei tested (although not in ECU MUs after ulnar stimulation). It was, however, more often found in flexors than in extensors, in wrist than in finger muscles and in muscles operating in the radial than in the ulnar side. It is argued that the connections of Ia afferents from intrinsic hand muscles to forearm MNs, which are stronger and more widely distributed than in the cat

  17. Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings.

    Science.gov (United States)

    Payne, Russell; Baccon, Jennifer; Dossett, John; Scollard, David; Byler, Debra; Patel, Akshal; Harbaugh, Kimberly

    2015-11-01

    Hansen's disease, or leprosy, is a chronic infectious disease with many manifestations. Though still a major health concern and leading cause of peripheral neuropathy in the developing world, it is rare in the United States, with only about 150 cases reported each year. Nevertheless, it is imperative that neurosurgeons consider it in the differential diagnosis of neuropathy. The causative organism is Mycobacterium leprae, which infects and damages Schwann cells in the peripheral nervous system, leading first to sensory and then to motor deficits. A rare presentation of Hansen's disease is pure neuritic leprosy. It is characterized by nerve involvement without the characteristic cutaneous stigmata. The authors of this report describe a case of pure neuritic leprosy presenting as ulnar nerve neuropathy with corresponding radiographic, electrodiagnostic, and histopathological data. This 11-year-old, otherwise healthy male presented with progressive right-hand weakness and numbness with no cutaneous abnormalities. Physical examination and electrodiagnostic testing revealed findings consistent with a severe ulnar neuropathy at the elbow. Magnetic resonance imaging revealed diffuse thickening and enhancement of the ulnar nerve and narrowing at the cubital tunnel. The patient underwent ulnar nerve decompression with biopsy. Pathology revealed acid-fast organisms within the nerve, which was pathognomonic for Hansen's disease. He was started on antibiotic therapy, and on follow-up he had improved strength and sensation in the ulnar nerve distribution. Pure neuritic leprosy, though rare in the United States, should be considered in the differential diagnosis of those presenting with peripheral neuropathy and a history of travel to leprosy-endemic areas. The long incubation period of M. leprae, the ability of leprosy to mimic other conditions, and the low sensitivity of serological tests make clinical, electrodiagnostic, and radiographic evaluation necessary for diagnosis

  18. Wear particles and osteolysis in patients with total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula

    2014-01-01

    PURPOSE: To determine whether the amount of polyethylene debris in the interphase tissue between prosthesis and bone in patients with total wrist arthroplasty correlated with the degree of periprosthetic osteolysis (PPO); and to investigate the occurrence of metal particles in the periprosthetic...... 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......-up. Serial annual radiographs were performed prospectively for the evaluation of PPO. We collected blood samples for white blood cell count, C-reactive protein, and metallic ion level. RESULTS: A radiolucent zone of greater than 2 mm was observed juxta-articular to the radial component in 4 patients...

  19. High-resolution MR imaging of wrist cartilage

    International Nuclear Information System (INIS)

    Rominger, M.B.; Bernreuter, W.K.; Listinsky, J.J.; Lee, D.H.; Kenney, P.J.; Colgin, S.L.

    1991-01-01

    This paper reports that cartilage is an important prognostic factor in arthritis. MR imaging can demonstrate both articular cartilage and subchondral bone. Our purpose was to compare various sequences, for wrist cartilage imaging and determine how extensive damage must be before it is detectable with MR imaging. Six cadaver wrists were imaged before and after arthroscopic cartilage injury (coronal and axial T1- and T2-weighted SE sequences, 3-mm sections; SPGR 45 degrees flip angle volume images with fat saturation. 1.2-mm sections; plus T1-weighted coronal images with fat saturation after injury; General Electric Signa, 1.5 T, with transmit-receive extremity coil). Twenty-two defects were created arthroscopically. Five normal volunteers were imaged for comparison. The greatest contrast among bone, cartilage, and synovial fluid was achieved with T1-weighted fat-suppressed SE image and SPGR. Gradient-recalled volume sequences generated very thin sections but were susceptible to artifact

  20. Wrist arthrography: The value of the three compartment injection technique

    Energy Technology Data Exchange (ETDEWEB)

    Levinsohn, E.M.; Coren, A.B.; Palmer, A.K.; Zinberg, E.

    1987-10-01

    Arthrography of the wrist was performed on 50 consecutive patients with obscure post-traumatic wrist pain by injecting contrast separately into the radiocarpal joint, midcarpal compartment, and distal radioulnar joint. When distal radioulnar joint and midcarpal compartment injections were added to the standard radiocarpal injection, many significant unsuspected abnormalities were identified. Of the 25 triangular fibrocartilage complex abnormalities identified, six (24%) were found only with the distal radioulnar joint injection. Of the 29 abnormal communications between the midcarpal compartment and the radiocarpal joint, ten (35%) were found only with the midcarpal injection. Similarly, five of 29 (17%) of the abnormal radiocarpal-midcarpal communications would have been missed if a midcarpal injection alone had been performed. These findings indicate that separate injections into the radiocarpal joint, midcarpal compartment, and distal radioulnar joint are needed to identify a large number of abnormalities not seen with injections into one compartment alone.

  1. Pose Tracking Algorithm of an Endoscopic Surgery Robot Wrist

    International Nuclear Information System (INIS)

    Wang, L; Yin, H L; Meng, Q

    2006-01-01

    In recent two decades, more and more research on the endoscopic surgery has been carried out [2]. Most of the work focuses on the development of the robot in the field of robotics and the navigation of the surgery tools based on computer graphics. But the tracking and locating of the EndoWrist is also a very important aspect. This paper deals with the the tracking algorithm of the EndoWrist's pose (position and orientation). The linear tracking of the position is handled by the Kalman Filter. The quaternion-based nonlinear orientation tracking is implemented with the Extended Kalman Filter. The most innovative point of this paper is the parameterization of the motion model of the Extended Kalman Filter

  2. Pose Tracking Algorithm of an Endoscopic Surgery Robot Wrist

    Energy Technology Data Exchange (ETDEWEB)

    Wang, L [Chinese-German Institute of Automatic Control Engineering, Tongji University (China); Yin, H L [Chinese-German Institute of Automatic Control Engineering, Tongji University (China); Meng, Q [Shanghai University of Electric Power (China)

    2006-10-15

    In recent two decades, more and more research on the endoscopic surgery has been carried out [2]. Most of the work focuses on the development of the robot in the field of robotics and the navigation of the surgery tools based on computer graphics. But the tracking and locating of the EndoWrist is also a very important aspect. This paper deals with the the tracking algorithm of the EndoWrist's pose (position and orientation). The linear tracking of the position is handled by the Kalman Filter. The quaternion-based nonlinear orientation tracking is implemented with the Extended Kalman Filter. The most innovative point of this paper is the parameterization of the motion model of the Extended Kalman Filter.

  3. Early-onset dropped head syndrome after radiotherapy for head and neck cancer: dose constraints for neck extensor muscles

    International Nuclear Information System (INIS)

    Inaba, Koji; Nakamura, Satoshi; Okamoto, Hiroyuki; Kashihara, Tairo; Kobayashi, Kazuma; Harada, Ken; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Murakami, Naoya; Ito, Yoshinori; Igaki, Hiroshi; Uno, Takashi; Itami, Jun

    2016-01-01

    Dropped head syndrome (DHS) is a famous but unusual late complication of multimodality treatment for head and neck carcinoma. We reported this early-onset complication and analyzed the dose to the neck extensor muscles. We examined the records of three patients with DHS after radiotherapy. The doses to the neck extensor muscles were compared between three patients with DHS and nine patients without DHS. The mean dose to the neck extensor muscles of the three patients with DHS were 58.5 Gy, 42.3 Gy and 60.9 Gy, while the dose was <50 Gy in all nine patients in the control group. The onset of this syndrome was 5 months, 6 months and 15 months. The early-onset DHS may have something to do with dose to the neck extensor muscles. The proposed dose to the neck extensor muscles might be <46 Gy (or at least <50 Gy)

  4. The variation of the strength of neck extensor muscles and semispinalis capitis muscle size with head and neck position.

    Science.gov (United States)

    Rezasoltani, A; Nasiri, R; Faizei, A M; Zaafari, G; Mirshahvelayati, A S; Bakhshidarabad, L

    2013-04-01

    Semispinalis capitis muscle (SECM) is a massive and long cervico-thoracic muscle which functions as a main head and neck extensor muscle. The aim of this study was to detect the effect of head and neck positions on the strength of neck extensor muscles and size of SECM in healthy subjects. Thirty healthy women students voluntarily participated in this study. An ultrasonography apparatus (Hitachi EUB 525) and a system of tension-meter were used to scan the right SECM at the level of third cervical spine and to measure the strength of neck extensor muscles at three head and neck positions. Neck extensor muscles were stronger in neutral than flexion or than extension positions while the size of SECM was larger in extension than neutral or than flexion position. The force generation capacity of the main neck extensor muscle was lower at two head and neck flexion and extension positions than neutral position. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Dynamic Causal Modeling of the Cortical Responses to Wrist Perturbations

    Directory of Open Access Journals (Sweden)

    Yuan Yang

    2017-09-01

    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.

  6. Intersection Syndrome: The Subtle Squeak of an Overused Wrist.

    Science.gov (United States)

    Skinner, Thomas M

    2017-01-01

    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.

  7. Magnetic resonance imaging of the wrist: Diagnostic performance statistics

    International Nuclear Information System (INIS)

    Hobby, Jonathan L.; Tom, Brian D.M.; Bearcroft, Philip W.P.; Dixon, Adrian K.

    2001-01-01

    AIM: To review the published diagnostic performance statistics for magnetic resonance imaging (MRI) of the wrist for tears of the triangular fibrocartilage complex, the intrinsic carpal ligaments, and for osteonecrosis of the carpal bones. MATERIALS AND METHODS: We used Medline and Embase to search the English language literature. Studies evaluating the diagnostic performance of MRI of the wrist in living patients with surgical confirmation of MR findings were identified. RESULTS: We identified 11 studies reporting the diagnostic performance of MRI for tears of the triangular fibrocartilage complex for a total of 410 patients, six studies for the scapho-lunate ligament (159 patients), six studies for the luno-triquetral ligament (142 patients) and four studies (56 patients) for osteonecrosis of the carpal bones. CONCLUSIONS: Magnetic resonance imaging is an accurate means of diagnosing tears of the triangular fibrocartilage and carpal osteonecrosis. Although MRI is highly specific for tears of the intrinsic carpal ligaments, its sensitivity is low. The diagnostic performance of MRI in the wrist is improved by using high-resolution T2* weighted 3D gradient echo sequences. Using current imaging techniques without intra-articular contrast medium, magnetic resonance imaging cannot reliably exclude tears of the intrinsic carpal ligaments. Hobby, J.L. (2001)

  8. Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes.

    Science.gov (United States)

    Clark, Nicholas J; Desai, Vishal S; Dines, Joshua D; Morrey, Mark E; Camp, Christopher L

    2018-03-01

    This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

  9. In vivo electrophysiological measurement of the rat ulnar nerve with axonal excitability testing

    DEFF Research Database (Denmark)

    Wild, Brandon M.; Morris, Renée; Moldovan, Mihai

    2018-01-01

    Electrophysiology enables the objective assessment of peripheral nerve function in vivo. Traditional nerve conduction measures such as amplitude and latency detect chronic axon loss and demyelination, respectively. Axonal excitability techniques "by threshold tracking" expand upon these measures...... by providing information regarding the activity of ion channels, pumps and exchangers that relate to acute function and may precede degenerative events. As such, the use of axonal excitability in animal models of neurological disorders may provide a useful in vivo measure to assess novel therapeutic...... interventions. Here we describe an experimental setup for multiple measures of motor axonal excitability techniques in the rat ulnar nerve. The animals are anesthetized with isoflurane and carefully monitored to ensure constant and adequate depth of anesthesia. Body temperature, respiration rate, heart rate...

  10. Recovery from distal ulnar motor conduction block injury: serial EMG studies.

    Science.gov (United States)

    Montoya, Liliana; Felice, Kevin J

    2002-07-01

    Acute conduction block injuries often result from nerve compression or trauma. The temporal pattern of clinical, electrophysiologic, and histopathologic changes following these injuries has been extensively studied in experimental animal models but not in humans. Our recent evaluation of a young man with an injury to the deep motor branch of the ulnar nerve following nerve compression from weightlifting exercises provided the opportunity to follow the course and recovery of a severe conduction block injury with sequential nerve conduction studies. The conduction block slowly and completely resolved, as did the clinical deficit, over a 14-week period. The reduction in conduction block occurred at a linear rate of -6.1% per week. Copyright 2002 Wiley Periodicals, Inc.

  11. Ulnar nerve injury due to lateral traction device during shoulder arthroscopy: Was it avoidable?

    Directory of Open Access Journals (Sweden)

    Vivek Pandey

    2017-01-01

    Full Text Available Most of the nerve injuries reported during shoulder arthroscopy in a beach chair, or lateral position is related to inappropriate patient positioning or excess traction. The lateral decubitus position is more vulnerable for traction-related neuropraxia. The present case serves as an important lesson from an avoidable situation of “having a one track mind” of the surgical team during the arthroscopic repair of shoulder instability performed in the lateral decubitus position. The operating surgeon must supervise the appropriate positioning of the patient on operation table and adequate padding of vulnerable bony points before beginning of shoulder arthroscopy to prevent any position-related nerve injuries. This is probably the first case to illustrate an unusual cause of ulnar nerve compression particularly related to the use of an additional traction device in the arthroscopic repair of shoulder instability performed in lateral decubitus position, which has not been previously defined.

  12. Pseudarthrosis of radial shaft with dislocation of heads of radial and ulnar bones (case report

    Directory of Open Access Journals (Sweden)

    M. E. Puseva

    2013-01-01

    Full Text Available The authors presented a rare clinical case - the injury of forearm complicated by the formation of the pseudarthrosis of the radial shaft in combination with old dislocation of heads the radius and ulna. The differentiated approach to the choice of surgical tactics was proposed, which consists of several consistent stages: taking free autotransplant from the crest of iliac bone, resection of pseudarthrosis of radius with replacement of the bone defect by the graft for restoration of anatomic length, conducting combined strained osteosynthesis and elimination of dislocation of a head of radial and ulnar bones by transosseous osteosynthesis. The chosen treatment strategy allowed to restore the anatomy and function of the upper extremity.

  13. Acute Compressive Ulnar Neuropathy in a Patient of Dengue Fever: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Anil K Mehtani

    2013-04-01

    Full Text Available Introduction: Dengue haemorrhagic fever is known for its haemorrhagic and neurologic complications. Neurologic complications are caused by three mechanism namely neurotropism, systemic complications causing encephalopathy and postinfectious immune-mediated mechanisms. However acute compressive neuropathy due to haemorrhage is not frequent and we could find no literature describing this Case Report: We report a case of acute compressive ulnar neuropathy due to peri neural hematoma, following an attempt at intravenous cannulation in the cubital fossa in a patient of dengue haemorrhagic fever with thrombocytopenia. Immediate fasciotomy and removal of haematoma was performed to relieve the symptoms. Conclusion: Compression neuropathies can be seen in dengue hemorrhagic fever and removal of compressing hematoma relieves symptoms. Keywords: Dengue haemmorrhagic fever; coagulopathy; peri neural haematoma.

  14. The predictive value of the extensor grip test for the effectiveness of bracing for tennis elbow

    NARCIS (Netherlands)

    Struijs, Peter A. A.; Assendelft, Willem J. J.; Kerkhoffs, Gino M. M. J.; Souer, Sebastiaan; van Dijk, C. Niek

    2005-01-01

    Background: Tennis elbow is a common complaint. Several treatment strategies, such as corticosteroid injections and physical therapy and braces, have been described. Hypothesis: The extensor grip test has predictive value in assessing the effectiveness of bracing in tennis elbow. Study Design:

  15. Recovery Kinetics of Knee Flexor and Extensor Strength after a Football Match

    Science.gov (United States)

    Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C.; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K.; Douroudos, Ioannis I.; Margonis, Konstantinos; Gioftsidou, Asimenia; Fouris, Andreas D.; Jamurtas, Athanasios Z.; Koutedakis, Yiannis; Fatouros, Ioannis G.

    2015-01-01

    We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12h, 36h and 60h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12h, 36h and 60h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (Pfootball-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical conditioning level. PMID:26043222

  16. Surgical and anatomical studies on De Quervain's tenosynovitis syndrome: Variations in the first extensor compartment

    Directory of Open Access Journals (Sweden)

    Paulo Randal Pires J and uacute;nior

    2016-08-01

    Clinical relevance: As septation of the first extensor compartment and multiple APL tendons appears to represent risk factors for the development of DQT, prior knowledge of the frequency of such anomalies may assist surgeons in pre-operative evaluation and perioperative procedures. [Hand Microsurg 2016; 5(2.000: 50-55

  17. Interval training by normobaric hypoxia accelerates the reinnervation of musculus extensor digitorum longus in mice

    DEFF Research Database (Denmark)

    Vardya, Irina; (Vard'ya); Mospanova, Svetlana V.

    2000-01-01

    Dokl Biol Sci. 2000 Mar-Apr;371:112-4. Interval training by normobaric hypoxia accelerates the reinnervation of musculus extensor digitorum longus in mice. Vard'ya IV , Mospanova SV , Portnov VV , Balezina OP , Koshelev VB . Department of Human and Animal Physiology, Faculty of Biology, Moscow St...... State University, Russia. PMID: 10833635 [PubMed - indexed for MEDLINE] Udgivelsesdato: 2000...

  18. Ultrasonographic Characteristics of the Common Extensor Tendon of the Elbow in Asymptomatic Individuals

    DEFF Research Database (Denmark)

    Krogh, Thøger P; Fredberg, Ulrich; Ammitzbøl, Christian

    2017-01-01

    BACKGROUND: Ultrasonography (US) of the common extensor tendon (CET) of the elbow is often part of the assessment of patients with lateral epicondylitis. This US assessment is currently based on general tendinopathy references and not well-defined US entities. PURPOSE: To describe CET thickness...

  19. A Short Submaximal test to determine the fatigue threshold of knee extensors in young men

    NARCIS (Netherlands)

    de Ruiter, C.J.; Hamacher, P.; Wolfs, B.G.A.

    Purpose Recently, a fatigue threshold obtained during submaximal repetitive isometric knee extensor contractions was related to VO 2max measured during cycling and to exercise endurance. However, test duration is quite long (20-30 min in young people) to be of practical and possibly clinical use.

  20. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    International Nuclear Information System (INIS)

    Tehranzadeh, Jamshid; Ashikyan, Oganes; Anavim, Arash; Shin, John

    2008-01-01

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The ''rheumatoid'' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of

  1. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, Jamshid [University of California, Department of Radiological Sciences, Irvine (United States); University of California Medical Center, Department of Radiological Sciences R-140, Orange, CA (United States); Ashikyan, Oganes; Anavim, Arash; Shin, John [University of California, Department of Radiological Sciences, Irvine (United States)

    2008-05-15

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The 'rheumatoid' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with

  2. MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Haakma, Wieke [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Aarhus University, Department of Forensic Medicine and Comparative Medicine Lab, Aarhus (Denmark); Jongbloed, Bas A.; Goedee, H.S.; Berg, Leonard H. van den; Pol, W.L. van der [University Medical Center Utrecht, Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, Utrecht (Netherlands); Froeling, Martijn; Bos, Clemens; Hendrikse, Jeroen [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Leemans, Alexander [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2017-05-15

    To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves. We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls (HCs). Patients underwent MRI (in a prone position) and nerve conduction studies. DTI and fat-suppressed T2-weighted scans of the forearms were performed on a 3.0T MRI scanner. Fibre tractography of the median and ulnar nerves was performed to extract diffusion parameters: fractional anisotropy (FA), mean (MD), axial (AD) and radial (RD) diffusivity. Cross-sectional areas (CSA) were measured on T2-weighted scans. Forty-five out of 60 arms were included in the analysis. AD was significantly lower in MMN patients (2.20 ± 0.12 x 10{sup -3} mm{sup 2}/s) compared to ALS patients (2.31 ± 0.17 x 10{sup -3} mm{sup 2}/s; p < 0.05) and HCs (2.31± 0.17 x 10{sup -3} mm{sup 2}/s; p < 0.05). Segmental analysis showed significant restriction of AD, RD and MD (p < 0.005) in the proximal third of the nerves. CSA was significantly larger in MMN patients compared to ALS patients and HCs (p < 0.01). Thickening of nerves is compatible with changes in the myelin sheath structure, whereas lowered AD values suggest axonal dysfunction. These findings suggest that myelin and axons are diffusely involved in MMN pathogenesis. (orig.)

  3. Evaluation of cranial tibial and extensor carpi radialis reflexes before and after anesthetic block in cats.

    Science.gov (United States)

    Tudury, Eduardo Alberto; de Figueiredo, Marcella Luiz; Fernandes, Thaiza Helena Tavares; Araújo, Bruno Martins; Bonelli, Marília de Albuquerque; Diogo, Camila Cardoso; Silva, Amanda Camilo; Santos, Cássia Regina Oliveira; Rocha, Nadyne Lorrayne Farias Cardoso

    2017-02-01

    Objectives This study aimed to test the extensor carpi radialis and cranial tibial reflexes in cats before and after anesthetic block of the brachial and lumbosacral plexus, respectively, to determine whether they depend on a myotatic reflex arc. Methods Fifty-five cats with a normal neurologic examination that were referred for elective gonadectomy were divided into group 1 (29 cats) for testing the extensor carpi radialis reflex, and group 2 (26 cats) for testing the cranial tibial reflex. In group 1, the extensor carpi radialis reflex was tested after anesthetic induction and 15 mins after brachial plexus block with lidocaine. In group 2, the cranial tibial, withdrawal and patellar reflexes were elicited in 52 hindlimbs and retested 15 mins after epidural anesthesia. Results In group 1, before the anesthetic block, 55.17% of the cats had a decreased and 44.83% had a normal extensor carpi radialis reflex. After the block, 68.96% showed a decreased and 27.59% a normal reflex. No cat had an increased or absent reflex before anesthetic block. In group 2, prior to the anesthetic block, 15.38% of the cats had a decreased cranial tibial reflex and 84.62% had a normal response, whereas after the block it was decreased in 26.92% and normal in 73.08% of the cats. None of the cats had an increased or absent reflex. Regarding the presence of both reflexes before and after anesthetic block, there was no significant difference at 1% ( P = 0.013). Conclusions and relevance The extensor carpi radialis and cranial tibial reflexes in cats are not strictly myotatic reflexes, as they are independent of the reflex arc, and may be idiomuscular responses. Therefore, they are not reliable for neurologic examination in this species.

  4. Ulnar Artery Compression: A Feasible and Effective Approach to Prevent the Radial Artery Occlusion after Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Jun Tian

    2015-01-01

    Full Text Available Background: Radial artery (RA occlusion (RAO is not rare in patients undergoing coronary intervention by transradial approach (TRCI. Predictors of and prevention from RAO have not been systematically studied. This study aimed to analyze the risk factors of the weakness of RA pulsation (RAP and its predictive value for RAO after TRCI, and simultaneously to describe a feasible and effective approach to maintain RA patency. Methods: Between June 2006 and March 2010, all patients who underwent TRCI were classified according to the weakness of RAP after removing compression bandage with confirmation by Doppler ultrasound for the first 30 consecutive patients. Among a total of 2658 patients studied, 187 (7% patients having a weaker RAP were prospectively monitored. At 1 h after bandage removal, the ulnar artery in puncture side of all patients was blocked with manual compression to favor brachial and collateral artery blood flow through the RA until a good RAP was restored. The primary analysis was the occurrence of RAO. Results: Doppler ultrasound demonstrated the significant reduction of both systolic velocity (61.24 ± 3.95 cm/s vs. 72.31 ± 3.57 cm/s and diastolic velocity (1.83 ± 0.32 cm/s vs. 17.77 ± 3.97 cm/s in RA at access side as compared to the contralateral RA (all P < 0.001, but these velocities in ipsilateral ulnar artery (81.2 ± 2.16 cm/s and 13.1 ± 2.86 cm/s, respectively increased profoundly. The average time of ulnar artery compression was 4.1 ± 1.2 h (ranged 2.5-6.5 h. There were two patients experienced persistent RAO with a success rate of 98.9% and RAO in 0.075% of patients after ulnar artery compression was applied. The pulsation of the ulnar artery after compression was removed had not been influenced by the compression. Conclusions: After intervention using TRCI approach, the presence of a weaker RAP is an indicator of imminent RAO. The continuing compression of ipsilateral ulnar artery is an effective approach to

  5. Current role of multidetector computed tomography in imaging of wrist injuries.

    Science.gov (United States)

    Syed, Mohd Arif; Raj, Vimal; Jeyapalan, Kanagaratnam

    2013-01-01

    Imaging of the wrist is challenging to both radiologists and orthopedic surgeons. This is primarily because of the complex anatomy/functionality of the wrist and also the fact that many frequent injuries are sustained to the hands. On going developments in multidetector computed tomography (MDCT) technology with its "state of the art" postprocessing capabilities have revolutionized this field. Apart from routine imaging of wrist trauma, it is now possible to assess intrinsic ligaments with MDCT arthrography, thereby avoiding invasive diagnostic arthroscopies. Postoperative wrist imaging can be a diagnostic challenge, and MDCT can be helpful in assessment of these cases because volume acquisition and excellent postprocessing abilities help to evaluate these wrists in any desired plane and thinner slices. This article pictorially reviews the current clinical role of MDCT imaging of wrist in our practice. It also describes arthrography technique and scanning parameters used at our center. Copyright © 2013 Mosby, Inc. All rights reserved.

  6. Myostatin dysfunction impairs force generation in extensor digitorum longus muscle and increases exercise-induced protein efflux from extensor digitorum longus and soleus muscles.

    Science.gov (United States)

    Baltusnikas, Juozas; Kilikevicius, Audrius; Venckunas, Tomas; Fokin, Andrej; Bünger, Lutz; Lionikas, Arimantas; Ratkevicius, Aivaras

    2015-08-01

    Myostatin dysfunction promotes muscle hypertrophy, which can complicate assessment of muscle properties. We examined force generating capacity and creatine kinase (CK) efflux from skeletal muscles of young mice before they reach adult body and muscle size. Isolated soleus (SOL) and extensor digitorum longus (EDL) muscles of Berlin high (BEH) mice with dysfunctional myostatin, i.e., homozygous for inactivating myostatin mutation, and with a wild-type myostatin (BEH+/+) were studied. The muscles of BEH mice showed faster (P myostatin dysfunction leads to impairment in muscle force generating capacity in EDL and increases susceptibility of SOL and EDL to protein loss after exercise.

  7. The Diagnostic Utility of Midcarpal Anesthetic Injection in the Evaluation of Chronic Wrist Pain

    OpenAIRE

    Bell, S. Josh; Hofmeister, Eric P.; Moran, Steven L.; Shin, Alexander Y.

    2007-01-01

    The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip strength were compared to the presence of intracarpal pathology as confirmed by wrist arthros...

  8. Seasonal variation in isokinetic strength of knee flexors and extensors in soccer players

    Directory of Open Access Journals (Sweden)

    Michal Lehnert

    2015-06-01

    Full Text Available BACKGROUND: Muscle strength is an important factor in soccer from the performance and health perspective. There is a lack of knowledge about changes in muscle strength of the knee flexors and extensors and their ratios during annual training cycle. OBJECTIVES: The aim of this study was to evaluate the seasonal variability of the observed parameters of isokinetic strength of the knee flexors and extensors in soccer players, U19, from the performance and health perspective. METHODS: The strength of the knee flexors and extensors was measured in players U19 category (n = 9; the average age 18.5 ±0.4 years on the isokinetic dynamometer IsoMed 2000 in angular velocity 60° × s-1. Measurement was performed in concentric/concentric and excentric/excentric mode of muscle action at the beginning of the winter preparatory period, at the end of the preparatory period and at the end of the spring competitive period. Monitored parameters were absolute peak torque (PT, conventional H/Q ratio (H/QCON, functional H/Q ratio (H/QFUN and functional H/Q ratio in range 10-30° of knee flexion (H/QFUN_10-30. RESULTS: Significant change in PT (p < .05 was noted only in cases of the knee extensors of the nondominant leg in the concentric mode. The evaluation of imbalance of the knee flexors and extensors by H/QCON and H/QFUN ratios did not show any significant changes, but there was found a significant decrease of the H/QFUN_10-30 ratio in the dominant leg between measurements at the beginning and at the end of the winter preparatory period. CONCLUSIONS: The results of the current study indicate that throughout the monitored periods of the annual training cycle desirable changes in knee flexors and extensors strength did not occur. The values suggest the disruption of the dynamic stabilization of the knee joint and increase in injury risk. Different dynamics of the three observed ratios confirmed that they provide different information about the physical fitness of

  9. Immediate effects of different treatments for the wrist joints of subdominant hands, using electromechanical reaction time

    OpenAIRE

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Cui, Yao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

    2016-01-01

    [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 pa...

  10. A rare localization of tuberculosis of the wrist: The scapholunate joint

    Directory of Open Access Journals (Sweden)

    Mohamed Ali Sbai

    2015-01-01

    Full Text Available 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.

  11. A study comparing MRI with clinical examinations on wrists with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Wang Jun; Niu Jinliang; Xie Weina; Song Zhizhen; Zheng Jie; Ma Qiang

    2004-01-01

    Objective: To study the appearances of rheumatoid arthritis (RA) on MRI, and compare MRI with clinical examinations on wrists with RA. Methods: Fifty patients, fulfilled 1987 American Rheumatism Association (ARA) revised criteria, and 10 age-matched healthy controls entered the study. T 1 -weighted spin echo, short time inversion recovery (STIR) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were performed in the coronal planes. MRl, plain wrist radiographs, clinical date, including swollen joint, patient global assessment (AIMS), and laboratory examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score. Results: In 50 patients, all had pannus on MRI of wrists, 38 patients had enhanced signal intensity for pannus, 21 patients had bone marrow edema, 37 patients had joint effusion, and 37 patients had bone erosions. There were significant difference in the ESR, HAQ, AIMS as well as swollen joint count between patients with bone marrow edema and patients without bone marrow edema (P 2 =5.06, P=0.025; χ 2 =5.59, P=0.018). Number of patients with MRI erosion of wrists was associated with the number of patients without MRI bone marrow edema of wrists (χ 2 =5.11, P=0.024). Conclusion: MRI can find the appearances of wrists with RA. Comparing MRI with clinical examinations on wrists with RA, authors can assess and evaluate the role of MRI on RA

  12. [Theoretical origin and clinical application of wrist-ankle acupuncture therapy].

    Science.gov (United States)

    Wang, Qiong; Zhou, Qinghui

    2017-05-12

    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.

  13. Paralisia do nervo ulnar na lepra sem alterações cutâneas: biópsia do ramo superficial do nervo ulnar na mão

    Directory of Open Access Journals (Sweden)

    FREITAS MARCOS R. G. DE

    1998-01-01

    Full Text Available A lepra constitui causa frequente de acometimento de nervos periféricos, em nosso meio. O sistema nervoso periférico é acometido por vezes sem que haja alterações cutâneas: é a chamada forma neurítica pura. Nessa variante, o nervo mais afetado é o ulnar. Nos casos de acometimento isolado de nervos periféricos somente a feitura de biópsia de nervo conduzirá ao diagnóstico. Assim, resolvemos realizar biópsia do ramo sensitivo superficial do nervo ulnar na mão em 17 pacientes com paresia ou paralisia desse nervo e espessamento do mesmo na altura do cotovelo. Os principais achados foram: redução do número de fibras mielínicas em 14 casos, infiltrado inflamatório em 13, fibrose em 12, desmielinização e remielinização em 9, presença de granuloma em 6 e visualização do Mycobacterium leprae em 5. Concluímos que a biópsia do ramo sensitivo superficial do nervo ulnar na mão é um bom meio diagnóstico de lepra em pacientes com acometimento desse nervo

  14. CT-based three-dimensional kinematic comparison of dart-throwing motion between wrists with malunited distal radius and contralateral normal wrists

    International Nuclear Information System (INIS)

    Lee, S.; Kim, Y.S.; Park, C.S.; Kim, K.G.; Lee, Y.H.; Gong, H.S.; Lee, H.J.; Baek, G.H.

    2014-01-01

    Aim: To compare motion of the capitate, scaphoid, and lunate in wrists with a malunited distal radius and contralateral normal wrists during dart-throwing motion (DTM) by three-dimensional kinematic studies using computed tomography (CT) images. Materials and methods: CT was performed simultaneously on both wrists in six patients with a unilateral distal radius malunion at three stepwise positions simulating DTM. Using volume registration technique, the kinematic variables of helical axis motion of the capitate, scaphoid, and lunate were calculated and compared between both wrists. The helical motion of the capitate was also evaluated in a scaphoid- and lunate-based coordinate system. Results: Among the average rotation and translation of the scaphoid, lunate, and capitate during DTM, only the average rotation of the capitate was significantly different between the uninjured (88.9°) and the injured (70°) wrist (p = 0.0075). Rotation of the capitate relative to the scaphoid (26.3° versus 37.8°, p = 0.029) or lunate (39.2° versus 59.3°, p = 0.028) was smaller in the malunited wrist. The centres of helical axis motion of the three carpal bones were located more dorsally and radially in the injured wrist. Conclusions: The present study showed that decreased DTM in wrists with a distal radius malunion resulted from decreased midcarpal motion. The present study of the capitate, scaphoid, and lunate in wrists with distal radius malunion might be the first to present a 3D kinematic analysis of the effect of distal radius malunion on the carpal bones

  15. Hypothenar hammer syndrome: long-term follow-up after ulnar artery reconstruction with the lateral circumflex femoral artery.

    Science.gov (United States)

    de Niet, A; Van Uchelen, J H

    2017-06-01

    In symptomatic patients with hypothenar hammer syndrome, the occluded part of the ulnar artery can be reconstructed with an autologous graft. Venous grafts are used frequently, but they are known for their low patency rate. Arterial grafts show better patency rates than venous grafts in coronary bypass surgery. We performed 11 ulnar artery reconstructions with the descending branch of the lateral circumflex femoral artery and compared these with previously performed venous reconstructions. All patients with an arterial graft reconstruction had a patent graft at a mean follow-up of 63 months. In addition, nine out of 11 patients reported improvement in their symptoms. The patency rate of venous reconstructions in hypothenar hammer syndrome is significantly lower. Arterial grafting for hypothenar hammer syndrome has superior patency compared with venous grafting; we recommend it as the surgical treatment of choice for symptomatic hypothenar hammer syndrome. 4.

  16. Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players.

    Science.gov (United States)

    Saper, Michael; Shung, Joseph; Pearce, Stephanie; Bompadre, Viviana; Andrews, James R

    2018-04-01

    The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied. The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up. Case series; Level of evidence, 4. We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire. The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were "excellent" in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of

  17. Enthesopathy of the Extensor Carpi Radialis Brevis Origin: Effective Communication Strategies.

    Science.gov (United States)

    Drake, Matthew L; Ring, David C

    2016-06-01

    Enthesopathy of the extensor carpi radialis brevis origin, generally known as tennis elbow, is a common condition arising in middle-aged persons. The diagnosis is typically clear based on the patient interview and physical examination alone; therefore, imaging and other diagnostic tests are usually unnecessary. The natural history of the disorder is spontaneous resolution, but it can last for >1 year. The patient's attitude and circumstances, including stress, distress, and ineffective coping strategies, determine the intensity of the pain and the magnitude of the disability. Despite the best efforts of medical science, no treatments, invasive or noninvasive, have been proven to alter the natural history of the condition. Given the lack of disease-modifying treatments for enthesopathy of the extensor carpi radialis brevis origin, orthopaedic surgeons can benefit from learning effective communication strategies to help convey accurate information that is hopeful and enabling.

  18. Muscle protein degradation and amino acid metabolism during prolonged knee-extensor exercise in humans

    DEFF Research Database (Denmark)

    Van Hall, Gerrit; Saltin, B; Wagenmakers, A J

    1999-01-01

    to a substantial increase in net muscle protein degradation, and that a lowering of the starting muscle glycogen content leads to a further increase. The carbon atoms of the branched-chain amino acids (BCAA), glutamate, aspartate and asparagine, liberated by protein degradation, and the BCAA and glutamate......The aim of this study was to investigate whether prolonged one-leg knee-extensor exercise enhances net protein degradation in muscle with a normal or low glycogen content. Net amino acid production, as a measure of net protein degradation, was estimated from leg exchange and from changes...... in the concentrations of amino acids that are not metabolized in skeletal muscle. Experiments were performed at rest and during one-leg knee-extensor exercise in six subjects having one leg with a normal glycogen content and the other with a low glycogen content. Exercise was performed for 90 min at a workload of 60...

  19. Isokinetic Evaluation of the Hip Flexor and Extensor Muscles: A Systematic Review.

    Science.gov (United States)

    Zapparoli, Fabricio Yuri; Riberto, Marcelo

    2017-11-01

    Isokinetic dynamometry testing is a safe and reliable method accepted as the "gold standard" in the evaluation of muscle strength in the open kinetic chain. Isokinetic hip examinations face problems in the standardization of the position of the equipment axis, in the individual being examined, and in the adjustment of the lever arm and in stabilization strategies for the patients during the tests. Identification of the methodologic procedures with best reproducibility is also needed. To review the literature to evaluate the parameters used for the isokinetic evaluation of the hip flexor and extensor muscles and its reproducibility. This is a systematic literature review of the Cochrane, LILACS, PEDro, PubMed, and SciELO databases. The inclusion criteria were articles on the evaluation of hip flexor and/or extensor muscular strength with an isokinetic dynamometer and articles that analyzed the ICC or Pearson's reproducibility. The information extracted was positioning of the patient; positioning of the dynamometer axis; positioning of the lever arm; angular speed; sample size, pathology; type of contraction; and ICC and Pearson's results. 204 articles were found, from which 14 were selected that evaluated hip flexor and extensor muscles, involving 550 individuals who were submitted to an isokinetic hip evaluation. Five articles obtained the best result in reproducibility and had their methodology analyzed. To obtain better reproducibility of the isokinetic evaluation of the hip flexor and extensor muscles, the following recommendations must be followed: the individual must be positioned in the supine position and the dynamometer axis must be aligned with the greater trochanter of the femur. The positioning of the lever arm must be in the most distal region of the thigh possible. The angular speed used to analyze torque peak and muscle work was 60°/s, and to evaluate the muscle power it was 180°/s, with concentric and eccentric contractions being analyzed.

  20. Sex Comparison of Knee Extensor Size, Strength and Fatigue Adaptation to Sprint Interval Training.

    Science.gov (United States)

    Bagley, Liam; Al-Shanti, Nasser; Bradburn, Steven; Baig, Osamah; Slevin, Mark; McPhee, Jamie S

    2018-03-12

    Regular sprint interval training (SIT) improves whole-body aerobic capacity and muscle oxidative potential, but very little is known about knee extensor anabolic or fatigue resistance adaptations, or whether effects are similar for males and females. The purpose of this study was to compare sex-related differences in knee extensor size, torque-velocity relationship and fatigability adaptations to 12 weeks SIT. Sixteen males and fifteen females (mean (SEM) age: 41 (±2.5) yrs) completed measurements of total body composition assessed by DXA, quadriceps muscle cross-sectional area (CSAQ) assessed by MRI, the knee extensor torque-velocity relationship (covering 0 - 240°·sec) and fatigue resistance, which was measured as the decline in torque from the first to the last of 60 repeated concentric knee extensions performed at 180°·sec. SIT consisted of 4 x 20 second sprints on a cycle ergometer set at an initial power output of 175% of power at VO2max, three times per week for 12 weeks. CSAQ increased by 5% (p=0.023) and fatigue resistance improved 4.8% (p=0.048), with no sex differences in these adaptations (sex comparisons: p=0.140 and p=0.282, respectively). Knee extensor isometric and concentric torque was unaffected by SIT in both males and females (p>0.05 for all velocities). 12 weeks SIT, totalling 4 minutes very intense cycling per week, significantly increased fatigue resistance and CSAQ similarly in males and females, but did not significantly increase torque in males or females. These results suggest that SIT is a time-effective training modality for males and females to increase leg muscle size and fatigue resistance.

  1. Volume estimation of extensor muscles of the lower leg based on MR imaging

    International Nuclear Information System (INIS)

    Lund, Hans; Christensen, Line; Savnik, Anette; Danneskiold-Samsoee, Bente; Bliddal, Henning; Boesen, Jens

    2002-01-01

    Magnetic resonance imaging can be used to measure the muscle volume of a given muscle or muscle group. The purpose of this study was to determine both the intra- and inter-observer variation of the manually outlined volume of the extensor muscles (tibialis anterior, extensor digitorum longus and extensor hallucis longus), to estimate the minimum number of slices needed for these calculations and to compare estimates of volume based on an assumed conic shape of the muscles with that of an assumed cylindrical shape, the calculation in both cases based on the Cavalieri principle. Eleven young and healthy subjects (4 women and 7 men, age range 24-40 years) participated. Magnetic resonance imaging of the left leg was obtained on a 1.5-T MR system using a knee coil (receive only). A total of 50 consecutive slices were obtained beginning 10 cm below the caput fibula sin. and proceeding distally with a slice thickness of 1.5 mm without gap. The intra-class correlation coefficient (ICC) was used to calculate the relative reliability (interval from 0 to 1.0). A high reliability for both intra- and inter-reliability was observed (ICC 0.98 and 1.0). The difference was only 0.004% between calculations based on measurement of all 50 slices with respect to 8 slices equally distributed along the muscle group. No difference was found between the two different volumetric assumptions in the Cavalieri principle. The manually outlining of extensor muscles volumes was reliable and only 8 slices of the calf were needed. No difference was seen between the two used mathematical calculations. (orig.)

  2. [Fall risk assessment and knee extensor muscle activity in elderly people].

    Science.gov (United States)

    Oya, Yukiko; Nakamura, Masumi; Tabata, Emi; Morizono, Ryo; Mori, Sachiko; Kimuro, Yukari; Horikawa, Etsuo

    2008-05-01

    The purpose of this study was to analyze relationships between the history of falls, tripping, sway, and knee extensor muscle strengths as a tool for fall risk assessment in elderly people. We examined effective fall prevention measures. We investigated 102 elderly volunteers in the community. The subjects were classified according to history of falls, tripping, sway and 5 performance tests conducted to assess fall risk including Timed up-and-go test (TUG), Functional Reach test (FR), Hand grip and Reaction time (RT). In addition, the time serial data of the knee extensor muscle strength were acquired using a hand-held dynamometer. In comparison to the non-faller group, the faller group showed a significantly higher incident rate of tripping and sway. A frequency analysis using the Maximum Entropy Method revealed that the fallers group showed lower peak frequency (p=0.025). Also, the slope of the logarithmical spectrum was less steep in the fallers group (p=0.035). Also results from analysis of the peak force latency from the beginning of measurement to 50%, 80%, and 100% muscle strength, also showed that the faller group took more time for maximal voluntary contraction. The frequency analysis of the time series date of peak force latency of knee extensor muscle strength revealed that the muscle activity differs in faller compared to non-fallers. This study suggested that knee extensor muscle isometric performance could possibly be used as a new tool for fall risk assessment. We concluded that exercises to raise maximal muscle strength and muscle response speed are useful for the prevention of falls.

  3. Intervention randomized controlled trials involving wrist and shoulder arthroscopy: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Although arthroscopy of upper extremity joints was initially a diagnostic tool, it is increasingly used for therapeutic interventions. Randomized controlled trials (RCTs) are considered the gold standard for assessing treatment efficacy. We aimed to review the literature for intervention RCTs involving wrist and shoulder arthroscopy. Methods We performed a systematic review for RCTs in which at least one arm was an intervention performed through wrist arthroscopy or shoulder arthroscopy. PubMed and Cochrane Library databases were searched up to December 2012. Two researchers reviewed each article and recorded the condition treated, randomization method, number of randomized participants, time of randomization, outcomes measures, blinding, and description of dropouts and withdrawals. We used the modified Jadad scale that considers the randomization method, blinding, and dropouts/withdrawals; score 0 (lowest quality) to 5 (highest quality). The scores for the wrist and shoulder RCTs were compared with the Mann–Whitney test. Results The first references to both wrist and shoulder arthroscopy appeared in the late 1970s. The search found 4 wrist arthroscopy intervention RCTs (Kienböck’s disease, dorsal wrist ganglia, volar wrist ganglia, and distal radius fracture; first 3 compared arthroscopic with open surgery). The median number of participants was 45. The search found 50 shoulder arthroscopy intervention RCTs (rotator cuff tears 22, instability 14, impingement 9, and other conditions 5). Of these, 31 compared different arthroscopic treatments, 12 compared arthroscopic with open treatment, and 7 compared arthroscopic with nonoperative treatment. The median number of participants was 60. The median modified Jadad score for the wrist RCTs was 0.5 (range 0–1) and for the shoulder RCTs 3.0 (range 0–5) (p = 0.012). Conclusion Despite the increasing use of wrist arthroscopy in the treatment of various wrist disorders the efficacy of arthroscopically

  4. Trigger wrist caused by avascular necrosis of the capitate: a case report.

    Science.gov (United States)

    Matsui, Yuichiro; Kawamura, Daisuke; Kida, Hiroaki; Hatanaka, Kanako C; Iwasaki, Norimasa

    2018-03-27

    Trigger wrist is a rare condition first described by Marti in 1960, and various causes have been reported. The condition mostly occurs with finger flexion and extension, and rarely with flexion and extension of the wrist itself. Avascular necrosis of the capitate is also a rare condition, first described by Jönsson in 1942. While some reports of this condition have been published, little is known about its etiology. Therefore, no established treatment exists. We report a case of trigger wrist caused by avascular necrosis of the capitate. A 16-year-old right-handed male who was a high school handball player was referred to our department from a nearby hospital 5 months after the onset of pain in the dorsal aspect of the right wrist, with an unknown cause. At the previous hospital, imaging findings led to a diagnosis of avascular necrosis of the capitate, and conservative treatment with a wrist brace did not improve the pain. At the initial visit to our department, the patient was noted to have a painful trigger wrist that was brought on by wrist flexion and extension. Preoperative imaging findings led to a diagnosis of trigger wrist caused by capitolunate instability secondary to avascular necrosis of the capitate. We performed a partial excision of the proximal capitate with tendon ball interposition. Two years after surgery, the patient's clinical outcome was favorable, with no recurrence of wrist pain or triggering. Both trigger wrist and avascular necrosis of the capitate are rare disorders. When a patient presents with painful triggering at the wrist, surgeons must bear in mind that avascular necrosis of the capitate may result in this phenomenon. We recommend partial excision of the proximal capitate with tendon ball interposition for the treatment of this lesion.

  5. Lumbar extensor muscle force control is associated with disability in people with chronic low back pain.

    Science.gov (United States)

    Pranata, Adrian; Perraton, Luke; El-Ansary, Doa; Clark, Ross; Fortin, Karine; Dettmann, Tim; Brandham, Robert; Bryant, Adam

    2017-07-01

    The ability to control lumbar extensor force output is necessary for daily activities. However, it is unknown whether this ability is impaired in chronic low back pain patients. Similarly, it is unknown whether lumbar extensor force control is related to the disability levels of chronic low back pain patients. Thirty-three chronic low back pain and 20 healthy people performed lumbar extension force-matching task where they increased and decreased their force output to match a variable target force within 20%-50% maximal voluntary isometric contraction. Force control was quantified as the root-mean-square-error between participants' force output and target force across the entire, during the increasing and decreasing portions of the force curve. Within- and between-group differences in force-matching error and the relationship between back pain group's force-matching results and their Oswestry Disability Index scores were assessed using ANCOVA and linear regression respectively. Back pain group demonstrated more overall force-matching error (mean difference=1.60 [0.78, 2.43], Pback pain group demonstrated more force-matching error while increasing than decreasing force output (mean difference=1.74, Pback pain group (R 2 =0.19, P=0.006). Lumbar extensor muscle force control is compromised in chronic low back pain patients. Force-matching error predicts disability, confirming the validity of our force control protocol for chronic low back pain patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. A New Myohaptic Instrument to Assess Wrist Motion Dynamically

    Directory of Open Access Journals (Sweden)

    Mario Manto

    2010-04-01

    Full Text Available The pathophysiological assessment of joint properties and voluntary motion in neurological patients remains a challenge. This is typically the case in cerebellar patients, who exhibit dysmetric movements due to the dysfunction of cerebellar circuitry. Several tools have been developed, but so far most of these tools have remained confined to laboratories, with a lack of standardization. We report on a new device which combines the use of electromyographic (EMG sensors with haptic technology for the dynamic investigation of wrist properties. The instrument is composed of a drivetrain, a haptic controller and a signal acquisition unit. Angular accuracy is 0.00611 rad, nominal torque is 6 N·m, maximal rotation velocity is 34.907 rad/sec, with a range of motion of –1.0472 to +1.0472 rad. The inertia of the motor and handgrip is 0.004 kg·m². This is the first standardized myohaptic instrument allowing the dynamic characterization of wrist properties, including under the condition of artificial damping. We show that cerebellar patients are unable to adapt EMG activities when faced with an increase in damping while performing fast reversal movements. The instrument allows the extraction of an electrophysiological signature of a cerebellar deficit.

  7. A new myohaptic instrument to assess wrist motion dynamically.

    Science.gov (United States)

    Manto, Mario; Van Den Braber, Niels; Grimaldi, Giuliana; Lammertse, Piet

    2010-01-01

    The pathophysiological assessment of joint properties and voluntary motion in neurological patients remains a challenge. This is typically the case in cerebellar patients, who exhibit dysmetric movements due to the dysfunction of cerebellar circuitry. Several tools have been developed, but so far most of these tools have remained confined to laboratories, with a lack of standardization. We report on a new device which combines the use of electromyographic (EMG) sensors with haptic technology for the dynamic investigation of wrist properties. The instrument is composed of a drivetrain, a haptic controller and a signal acquisition unit. Angular accuracy is 0.00611 rad, nominal torque is 6 N·m, maximal rotation velocity is 34.907 rad/sec, with a range of motion of -1.0472 to +1.0472 rad. The inertia of the motor and handgrip is 0.004 kg·m2. This is the first standardized myohaptic instrument allowing the dynamic characterization of wrist properties, including under the condition of artificial damping. We show that cerebellar patients are unable to adapt EMG activities when faced with an increase in damping while performing fast reversal movements. The instrument allows the extraction of an electrophysiological signature of a cerebellar deficit.

  8. Omitting histopathology in wrist ganglions. A risky proposition

    Science.gov (United States)

    Zubairi, Akbar J.; Kumar, Santosh; Mohib, Yasir; Rashid, Rizwan H.; Noordin, Shahryar

    2016-01-01

    Objectives: To identify incidence and utility of histopathology in wrist ganglions. Methods: A retrospective study of 112 patients operated for wrist swellings between January 2009 and March 2014 at Aga Khan University Hospital, Karachi, Pakistan, was conducted. Medical records were reviewed for demographics, history, location and associated symptoms, provisional diagnosis and operative details. Histopathology reports were reviewed to confirm the final diagnosis. Results: One hundred and twelve patients were included in the study (34 males and 78 females) with a mean age of 28 ± 12 years. Ninety-five percent of ganglia were dorsally located and 85% were solitary in nature. Histopathology reports confirmed 107 as ganglion cysts, whereas 3 had giant cell tumor of tendon sheath and 2 were reported to be tuberculous tenosynovitis. Conclusion: Although most of the time, the clinical diagnosis conforms to the final diagnosis, the possibility of an alternate diagnosis cannot be ignored (4% in this study). We suggest routine histopathological analysis so that such diagnoses are not missed. PMID:27464871

  9. Estimating anatomical wrist joint motion with a robotic exoskeleton.

    Science.gov (United States)

    Rose, Chad G; Kann, Claudia K; Deshpande, Ashish D; O'Malley, Marcia K

    2017-07-01

    Robotic exoskeletons can provide the high intensity, long duration targeted therapeutic interventions required for regaining motor function lost as a result of neurological injury. Quantitative measurements by exoskeletons have been proposed as measures of rehabilitative outcomes. Exoskeletons, in contrast to end effector designs, have the potential to provide a direct mapping between human and robot joints. This mapping rests on the assumption that anatomical axes and robot axes are aligned well, and that movement within the exoskeleton is negligible. These assumptions hold well for simple one degree-of-freedom joints, but may not be valid for multi-articular joints with unique musculoskeletal properties such as the wrist. This paper presents an experiment comparing robot joint kinematic measurements from an exoskeleton to anatomical joint angles measured with a motion capture system. Joint-space position measurements and task-space smoothness metrics were compared between the two measurement modalities. The experimental results quantify the error between joint-level position measurements, and show that exoskeleton kinematic measurements preserve smoothness characteristics found in anatomical measures of wrist movements.

  10. Wrist ligament injuries: value of post-arthrography computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Theumann, N.; Schnyder, P.; Meuli, R. [Dept. of Diagnostic and Interventional Radiology, University Hospital, CHUV, Lausanne (Switzerland); Favarger, N. [Clinique Longeraie, Lausanne (Switzerland)

    2001-02-01

    Objective: To evaluate the use of post-arthrography high-resolution computed tomography in wrist ligament injuries.Design and patients: Thirty-six consecutive patients who had a history and clinical findings suggestive of ligamentous injuries of the wrist were prospectively studied. The findings of three-compartment arthrography and post-arthrography computed tomography (arthro-CT) were compared with those of arthroscopy. The evaluation concentrates on the detection and precise localization of ligament lesions in the triangular fibrocartilage (TFC), the scapholunate ligament (SLL) and the lunotriquetral ligament (LTL).Results: For TFC, SLL and LTL lesions, standard arthrography responded with a sensitivity and specificity of 85% and 100%, 85% and 100%, 80% and 100% respectively, while arthro-CT showed a sensitivity and specificity of 85% and 100%, 100% and 100%, 80% and 100% respectively. The precise localization of the lesions was possible only with arthro-CT.Conclusion: The sensitivity and specificity of standard arthrography and arthro-CT are similar, although the latter shows the site of tears or perforation with greater precision, while conventional arthrography demonstrates them indirectly. This precision is essential and may have clinical implications for the success of treatment procedures. (orig.)

  11. Wrist ultrasonography of ossification centers during the adolescent growth spurt

    International Nuclear Information System (INIS)

    Nessi, Renato; Zaffaroni, Roberto; Lazzerini, Francesco; Garattini, Giovanna; Bazzini, Elena

    1997-01-01

    High-resolution ultrasound (US) of the hand and wrist was compared with radiography in 26 patients (mean age: 11.4 years) to be submitted to orthodontic therapy. US scans were targeted on the ossification centers critical for the growth spurt, namely the pisiform and abductor sesamoid bones of the metacarpophalaneal joint of the thumb and the cartilage of the distal phalanx of the third finger. All images were retrospectively reviewed on a double-blind basis by two independent observers who gave a conspicuity score to each structure of interest. All the scores were submitted to statistical analysis with the Wilcoxon test. US images clearly demonstrated the initial appearance of the ossification centers of the pisiform and sesamoid bones. These structures appeared as hyperechoic spots causing marked acoustic shadowing. The persistence of the phalangeal cartilage was depicted as a thin rim interrupting the hyperechoic cortical profile of the bone. Us results were statistically equivalent to radiographic findings in the pisiform. A statistically significant difference between the two techniques was found in the third finger cartilage because its profile was poorly depicted on some US images. To conclude, wrist US is proposed as a simple and valuable radiation-free support examination for the follow-up of skeletal maturation in adolescents to be submitted to orthodontic therapy

  12. Are fatigue-related EMG-parameters correlated to trunk extensor muscles fatigue induced by the Sörensen test?

    OpenAIRE

    Demoulin Christophe; George, Florian; Matheve, Thomas; Jidovtseff, Boris; Vanderthommen, Marc

    2016-01-01

    The Sorensen test has been extensively studied and is a rapid, simple, and reproducible evaluation of the trunk extensor muscles [1]. It is often considered as a fatigue test because fatigue-related electromyographic (EMG) parameters change throughout the test [2]; however, only recently it has been confirmed that this test induces a decrease of trunk extensor force during a maximal voluntary contraction (MVC) [3], which best characterises muscle fatigue. The main aim of this stud...

  13. Impact of Fat Infiltration in Cervical Extensor Muscles on Cervical Lordosis and Neck Pain: A Cross-Sectional Study.

    Science.gov (United States)

    Kim, Choong-Young; Lee, Sang-Min; Lim, Seong-An; Choi, Yong-Soo

    2018-06-01

    Weakness of cervical extensor muscles causes loss of cervical lordosis, which could also cause neck pain. The aim of this study was to investigate the impact of fat infiltration in cervical extensor muscles on cervical lordosis and neck pain. Fifty-six patients who suffered from neck pain were included in this study. Fat infiltration in cervical extensor muscles was measured at each level of C2-3 and C6-7 using axial magnetic resonance imaging. The visual analogue scale (VAS), 12-Item Short Form Health Survey (SF-12), and Neck Disability Index (NDI) were used for clinical assessment. The mean fat infiltration was 206.3 mm 2 (20.3%) at C2-3 and 240.6 mm 2 (19.5%) at C6-7. Fat infiltration in cervical extensor muscles was associated with high VAS scores at both levels ( p = 0.047 at C2-3; p = 0.009 at C6-7). At C2-3, there was a negative correlation between fat infiltration of the cervical extensor muscles and cervical lordosis (r = -0.216; p = 0.020). At C6-7, fat infiltration in the cervical extensor muscles was closely related to NDI ( p = 0.003) and SF-12 ( p > 0.05). However, there was no significant correlation between cervical lordosis and clinical outcomes (VAS, p = 0.112; NDI, p = 0.087; and SF-12, p > 0.05). These results suggest that fat infiltration in the upper cervical extensor muscles has relevance to the loss of cervical lordosis, whereas fat infiltration in the lower cervical extensor muscles is associated with cervical functional disability.

  14. TBX3 regulates splicing in vivo: a novel molecular mechanism for Ulnar-mammary syndrome.

    Directory of Open Access Journals (Sweden)

    Pavan Kumar P

    2014-03-01

    Full Text Available TBX3 is a member of the T-box family of transcription factors with critical roles in development, oncogenesis, cell fate, and tissue homeostasis. TBX3 mutations in humans cause complex congenital malformations and Ulnar-mammary syndrome. Previous investigations into TBX3 function focused on its activity as a transcriptional repressor. We used an unbiased proteomic approach to identify TBX3 interacting proteins in vivo and discovered that TBX3 interacts with multiple mRNA splicing factors and RNA metabolic proteins. We discovered that TBX3 regulates alternative splicing in vivo and can promote or inhibit splicing depending on context and transcript. TBX3 associates with alternatively spliced mRNAs and binds RNA directly. TBX3 binds RNAs containing TBX binding motifs, and these motifs are required for regulation of splicing. Our study reveals that TBX3 mutations seen in humans with UMS disrupt its splicing regulatory function. The pleiotropic effects of TBX3 mutations in humans and mice likely result from disrupting at least two molecular functions of this protein: transcriptional regulation and pre-mRNA splicing.

  15. TBX3 regulates splicing in vivo: a novel molecular mechanism for Ulnar-mammary syndrome.

    Science.gov (United States)

    Kumar P, Pavan; Franklin, Sarah; Emechebe, Uchenna; Hu, Hao; Moore, Barry; Lehman, Chris; Yandell, Mark; Moon, Anne M

    2014-03-01

    TBX3 is a member of the T-box family of transcription factors with critical roles in development, oncogenesis, cell fate, and tissue homeostasis. TBX3 mutations in humans cause complex congenital malformations and Ulnar-mammary syndrome. Previous investigations into TBX3 function focused on its activity as a transcriptional repressor. We used an unbiased proteomic approach to identify TBX3 interacting proteins in vivo and discovered that TBX3 interacts with multiple mRNA splicing factors and RNA metabolic proteins. We discovered that TBX3 regulates alternative splicing in vivo and can promote or inhibit splicing depending on context and transcript. TBX3 associates with alternatively spliced mRNAs and binds RNA directly. TBX3 binds RNAs containing TBX binding motifs, and these motifs are required for regulation of splicing. Our study reveals that TBX3 mutations seen in humans with UMS disrupt its splicing regulatory function. The pleiotropic effects of TBX3 mutations in humans and mice likely result from disrupting at least two molecular functions of this protein: transcriptional regulation and pre-mRNA splicing.

  16. A rare variant of the ulnar artery with important clinical implications: a case report

    Directory of Open Access Journals (Sweden)

    Casal Diogo

    2012-11-01

    Full Text Available Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

  17. MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow

    International Nuclear Information System (INIS)

    Nakanishi, Katsunuki; Masatomi, Takashi; Ochi, Takahiro; Ishida, Takeshi; Hori, Shinichi; Ikezoe, Junpei; Nakamura, Hironobu

    1996-01-01

    Objective. The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI and MR arthrography. Design. Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. Results. The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. Conclusion. MR arthrography provided additional information for evaluating the degree of UCL injury. (orig.). With 5 figs., 1 tab

  18. Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

    2017-02-01

    Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

  19. The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.

    Science.gov (United States)

    Keller, Robert A; Steffes, Matthew J; Zhuo, David; Bey, Michael J; Moutzouros, Vasilios

    2014-11-01

    Medial ulnar collateral ligament (MUCL) reconstruction is commonly performed on Major League Baseball (MLB) pitchers. Previous studies have reported that most pitchers return to presurgical statistical performance levels after MUCL reconstruction. Pitching performance data--specifically, earned run average (ERA), walks and hits per inning pitched (WHIP), winning percentage, and innings pitched--were acquired for 168 MLB pitchers who had undergone MUCL reconstruction. These data were averaged over the 3 years before surgery and the 3 years after surgery and also acquired from 178 age-matched, uninjured MLB pitchers. Of the pitchers who had MUCL reconstruction surgery, 87% returned to MLB pitching. However, compared with presurgical data, pitching performance declined in terms of ERA (P = .001), WHIP (P = .011), and innings pitched (P = .026). Pitching performance also declined in the season before the surgery compared with previous years (ERA, P = .014; WHIP, P = .036; innings pitched, P risk factor for requiring surgery. In addition, there is an increased risk of MUCL reconstruction for pitchers who enter the major leagues at a younger age. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. MR imaging in chronic rupture of the ulnar collateral ligament of the thumb

    International Nuclear Information System (INIS)

    Lohman, M.; Kivisaari, A.; Kivisaari, L.; Vasenius, J.

    2000-01-01

    MR imaging has been shown as the best radiologic method for verifying and classifying acute ulnar collateral ligament (UCL) ruptures of the thumb. Our aim was to analyse the usefulness of MR also in old ruptures and to establish the most useful sequences. Ten patients with an old UCL rupture of the thumb were preoperatively imaged using 1.5 T MR. Three radiologists blinded to the findings separately analysed the MR images of these patients and of 10 age-and sex-matched voluntary controls. MR findings of the patients were compared with those of surgery. The consensus diagnosis of an UCL rupture was accurate in all 10 patients. All controls were classified as having no UCL rupture. In 5 of the 7 patients with a surgically defined Stener or non-Stener lesion, the consensus diagnosis was the same as the operative diagnosis. Due to excessive scarring it was not possible to verify any Stener lesion intra-operatively in 3 patients. The most informative MR sequence was T2 TSE in the coronal plane, the second most informative was T1 SE with fat suppression in the coronal plane. An old UCL rupture is well verified by MR but typing of the lesion as either a Stener or non-Stener type is not always possible

  1. Four cases of variations in the forearm extensor musculature in a study of hundred limbs and review of literature

    Directory of Open Access Journals (Sweden)

    Rao Mohandas

    2006-01-01

    Full Text Available All surgeons must bear in mind the existence of muscular variations when performing common tendon transfers. Presence of additional bellies and tendons of existing muscles or presence of additional muscles in unusual locations might misguide a surgeon, during surgery and also during diagnosis. In the present paper we are reporting four cases of variations encountered during the study of extensor muscles of the forearm in 100 limbs. In Case 1, additional bellies of extensor carpi radialis longus and extensor carpi radialis brevis and multiple tendons of insertion of abductor pollicis longus were observed in a single limb. In Case 2, an additional belly of the abductor pollicis longus was observed. In Case 3, a short muscle on the dorsum of the hand going to the index finger [extensor indicis brevis (EIB] was found in addition to the normal extensor indicis (EI. It was also observed that some of the most superficial fleshy fibers of EIB were getting inserted into the tendon of EI. In Case 4, a rare incidence of extensor digiti medii proprius was observed. Further, the related literature is reviewed and the clinical and surgical importance of these muscular variations in diagnosis and proper planning of treatment is discussed.

  2. Clinical, Radiologic, and Legal Significance of "Extensor Response" in Posttraumatic Coma.

    Science.gov (United States)

    Firsching, Raimund; Woischneck, Dieter; Langejürgen, Alexander; Parreidt, Andreas; Bondar, Imre; Skalej, Martin; Röhl, Friedrich; Voellger, Benjamin

    2015-11-01

    The timely detection of neurologic deterioration can be critical for the survival of a neurosurgical patient following head injury. Because little reliable evidence is available on the prognostic value of the clinical sign "extensor response" in comatose posttraumatic patients, we investigated the correlation of this clinical sign with outcome and with early radiologic findings from magnetic resonance imaging (MRI). This retrospective analysis of prospectively obtained data included 157 patients who had remained in a coma for a minimum of 24 hours after traumatic brain injury. All patients received a 1.5-T MRI within 10 days (median: 2 days) of the injury. The correlations between clinical findings 12 and 24 hours after the injury-in particular, extensor response and pupillary function, MRI findings, and outcome after 1 year-were investigated. Statistical analysis included contingency tables, Fisher exact test, odds ratios (ORs) with confidence intervals (CIs), and weighted κ values. There were 48 patients with extensor response within the first 24 hours after the injury. Patients with extensor response (World Federation of Neurosurgical Societies coma grade III) statistically were significantly more likely to harbor MRI lesions in the brainstem when compared with patients in a coma who had no further deficiencies (coma grade I; p = 0.0004 by Fisher exact test, OR 10.8 with 95% CI, 2.7-42.5) and patients with unilateral loss of pupil function (coma grade II; p = 0.0187, OR 2.8 with 95% CI, 1.2-6.5). The correlation of brainstem lesions as found by MRI and outcome according to the Glasgow Outcome Scale after 1 year was also highly significant (p ≤ 0.016). The correlation of extensor response and loss of pupil function with an unfavorable outcome and with brainstem lesions revealed by MRI is highly significant. Their sudden onset may be associated with the sudden onset of brainstem dysfunction and should therefore be regarded as one of the most

  3. Comparability and feasibility of wrist- and hip-worn accelerometers in free-living adolescents.

    Science.gov (United States)

    Scott, Joseph J; Rowlands, Alex V; Cliff, Dylan P; Morgan, Philip J; Plotnikoff, Ronald C; Lubans, David R

    2017-12-01

    To determine the comparability and feasibility of wrist- and hip-worn accelerometers among free-living adolescents. 89 adolescents (age=13-14years old) from eight secondary schools in New South Wales (NSW), Australia wore wrist-worn GENEActiv and hip-worn ActiGraph (GT3X+) accelerometers simultaneously for seven days and completed an accelerometry behavior questionnaire. Bivariate correlations between the wrist- and hip-worn out-put were used to determine concurrent validity. Paired samples t-test were used to compare minutes per day in moderate-to-vigorous physical activity (MVPA). Group means and paired sample t-tests were used to analyze participants' perceptions of the wrist- and hip-worn monitoring protocols to assist with determining the feasibility. Wrist-worn accelerometry compared favorably with the hip-worn in average activity (r=0.88, phip-worn accelerometer (n=152, 24.4%). Participants reported they liked to wear the device on the wrist (phip (phip-worn accelerometer out-put among adolescents in free-living conditions. Adolescent compliance was significantly higher with wrist placement, with participants reporting that it was more comfortable and less embarrassing to wear on the wrist. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  4. Fine motor assessment in chronic wrist pain: the role of adapted motor control

    NARCIS (Netherlands)

    Smeulders, M. J.; Kreulen, M.; Bos, K. E.

    2001-01-01

    To show whether a difference in fine motor control exists between patients with chronic, undiagnosed wrist pain (CUWP) and healthy controls. Furthermore, a method to assess fine motor function of the wrist is evaluated. A case-control study. The Academic Medical Center in Amsterdam, the Netherlands.

  5. The current role of high-resolution ultrasonography of the hand and wrist in rheumatic diseases

    NARCIS (Netherlands)

    van Vugt, R. M.; van Dalen, A.; Bijlsma, J. W.

    1998-01-01

    To assess the current role of ultrasound in the diagnosis and treatment of pathological changes in the wrist and hand. 39 patients (14 male and 25 female, mean age 35 yrs.) with ill-defined pain and/or swelling of the wrist or hand were examined using a high-definition ultrasound (US) instrument. 18

  6. The effect of tendon loading on in-vitro carpal kinematics of the wrist joint

    NARCIS (Netherlands)

    Foumani, M.; Blankevoort, L.; Stekelenburg, C.; Strackee, S. D.; Carelsen, B.; Jonges, R.; Streekstra, G. J.

    2010-01-01

    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

  7. Chronic wrist pain: diagnosis and management. Development and use of a new algorithm

    NARCIS (Netherlands)

    van Vugt, R. M.; Bijlsma, J. W.; van Vugt, A. C.

    1999-01-01

    Chronic wrist pain can be difficult to manage and the differential diagnosis is extensive. To provide guidelines for assessment of the painful wrist an algorithm was developed to encourage a structured approach to the diagnosis and management of these patients. A review of the literature on causes

  8. Poor Reliability of Wrist Blood Pressure Self-Measurement at Home: A Population-Based Study.

    Science.gov (United States)

    Casiglia, Edoardo; Tikhonoff, Valérie; Albertini, Federica; Palatini, Paolo

    2016-10-01

    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; Pblood 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.

  9. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

  10. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...

  11. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...

  12. A Study of Repeated Wrist Temperature of Sixth, Seventh, and Eighth Graders.

    Science.gov (United States)

    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…

  13. Acute Effects of Hand Elevation and Wrist Position on Mean Arterial Pressure and Pulse Rate Measured in the Hand

    National Research Council Canada - National Science Library

    Shibley, Lee

    2000-01-01

    Musculoskeletal disorders (MSD) to the wrist and hand are common among workers, and are associated with working conditions that use forceful, repetitive and extreme wrist joint postures that including end range flexion...

  14. A feasibility study on age-related factors of wrist pulse using principal component analysis.

    Science.gov (United States)

    Jang-Han Bae; Young Ju Jeon; Sanghun Lee; Jaeuk U Kim

    2016-08-01

    Various analysis methods for examining wrist pulse characteristics are needed for accurate pulse diagnosis. In this feasibility study, principal component analysis (PCA) was performed to observe age-related factors of wrist pulse from various analysis parameters. Forty subjects in the age group of 20s and 40s were participated, and their wrist pulse signal and respiration signal were acquired with the pulse tonometric device. After pre-processing of the signals, twenty analysis parameters which have been regarded as values reflecting pulse characteristics were calculated and PCA was performed. As a results, we could reduce complex parameters to lower dimension and age-related factors of wrist pulse were observed by combining-new analysis parameter derived from PCA. These results demonstrate that PCA can be useful tool for analyzing wrist pulse signal.

  15. How repeated 15-minute assertiveness training sessions reduce wrist cutting in patients with borderline personality disorder.

    Science.gov (United States)

    Hayakawa, Masaya

    2009-01-01

    The aim of this work was to examine a possible treatment for patients with borderline personality disorder who have wrist-cutting syndrome, a condition characterized by repeated, superficial wrist cutting in a non-suicidal fashion. Within the current healthcare system in Japan, the average amount of time a doctor can spend with a psychiatric outpatient is about 8 to 15 minutes. We, therefore, examined whether repeated 15-minute psychotherapy sessions to improve patient assertiveness would be effective for reducing wrist cutting and possibly other forms of self-mutilation. We treated 13 patients diagnosed with borderline personality disorder and wrist-cutting syndrome with assertiveness training during 15-minute, biweekly therapy sessions over a course of one to four years. At the conclusion of psychotherapeutic treatment, 69% of outpatients showed a statistically significant reduction in wrist-cutting behavior.

  16. Different evolutionary pathways underlie the morphology of wrist bones in hominoids.

    Science.gov (United States)

    Kivell, Tracy L; Barros, Anna P; Smaers, Jeroen B

    2013-10-23

    The hominoid wrist has been a focus of numerous morphological analyses that aim to better understand long-standing questions about the evolution of human and hominoid hand use. However, these same analyses also suggest various scenarios of complex and mosaic patterns of morphological evolution within the wrist and potentially multiple instances of homoplasy that would benefit from require formal analysis within a phylogenetic context.We identify morphological features that principally characterize primate - and, in particular, hominoid (apes, including humans) - wrist evolution and reveal the rate, process and evolutionary timing of patterns of morphological change on individual branches of the primate tree of life. Linear morphological variables of five wrist bones - the scaphoid, lunate, triquetrum, capitate and hamate - are analyzed in a diverse sample of extant hominoids (12 species, 332 specimens), Old World (8 species, 43 specimens) and New World (4 species, 26 specimens) monkeys, fossil Miocene apes (8 species, 20 specimens) and Plio-Pleistocene hominins (8 species, 18 specimens). Results reveal a combination of parallel and synapomorphic morphology within haplorrhines, and especially within hominoids, across individual wrist bones. Similar morphology of some wrist bones reflects locomotor behaviour shared between clades (scaphoid, triquetrum and capitate) while others (lunate and hamate) indicate clade-specific synapomorphic morphology. Overall, hominoids show increased variation in wrist bone morphology compared with other primate clades, supporting previous analyses, and demonstrate several occurrences of parallel evolution, particularly between orangutans and hylobatids, and among hominines (extant African apes, humans and fossil hominins). Our analyses indicate that different evolutionary processes can underlie the evolution of a single anatomical unit (the wrist) to produce diversity in functional and morphological adaptations across individual wrist

  17. Tuberculous tenosynovitis of the wrist: MRI findings in three patients

    Energy Technology Data Exchange (ETDEWEB)

    Sueyoshi, E. [Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852 (Japan); Uetani, M. [Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852 (Japan); Hayashi, K. [Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852 (Japan); Kohzaki, S. [Nagasaki Municipal Hospital, Nagasaki (Japan)

    1996-08-01

    We report recent MRI findings in patients with tuberculous tenosynovitis of the wrist. Marked synovial thickening around the flexor tendons and fluid in the tendon sheath were clearly shown on MRI. Post-contrast study was useful in distinguishing the thick tenosynovium from the surrounding structures and fluid in the tendon sheath. The well-enhanced tenosynovium was also seen in the carpal tunnel in all cases. On the basis of these findings, we could easily distinguish tenosynovitis from other soft-tissue-mass lesions, such as tumors or infected ganglia. Tuberculous tenosynovitis is often not diagnosed early, and its differentiation from soft tissue tumors may be clinically difficult. MRI, particularly post-contrast study, is useful for early diagnosis of, and planning treatment for, tuberculous tenosynovitis. (orig.). With 3 figs.

  18. Tuberculous tenosynovitis of the wrist: MRI findings in three patients

    International Nuclear Information System (INIS)

    Sueyoshi, E.; Uetani, M.; Hayashi, K.; Kohzaki, S.

    1996-01-01

    We report recent MRI findings in patients with tuberculous tenosynovitis of the wrist. Marked synovial thickening around the flexor tendons and fluid in the tendon sheath were clearly shown on MRI. Post-contrast study was useful in distinguishing the thick tenosynovium from the surrounding structures and fluid in the tendon sheath. The well-enhanced tenosynovium was also seen in the carpal tunnel in all cases. On the basis of these findings, we could easily distinguish tenosynovitis from other soft-tissue-mass lesions, such as tumors or infected ganglia. Tuberculous tenosynovitis is often not diagnosed early, and its differentiation from soft tissue tumors may be clinically difficult. MRI, particularly post-contrast study, is useful for early diagnosis of, and planning treatment for, tuberculous tenosynovitis. (orig.). With 3 figs

  19. Variants, pitfalls and asymptomatic findings in wrist and hand imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pfirrmann, Christian W.A. [University Hospital Balgrist, Radiology, University of Zurich Switzerland, Forchstrasse 340, CH-8008 Zurich (Switzerland)]. E-mail: christian@pfirrmann.ch; Zanetti, Marco [University Hospital Balgrist, Radiology, University of Zurich Switzerland, Forchstrasse 340, CH-8008 Zurich (Switzerland)

    2005-12-15

    Anatomic variants of the bones, ligaments, tendons and muscles are frequent findings in imaging of the wrist and hand. Many findings especially changes in the triangular fibrocartilage (TFC) and the interosseous ligaments are asymptomatic, their incidence is increasing with age, and they are frequently found bilaterally. Abnormalities such as increased signal within tendons are common in asymptomatic subjects. They may be explained by normal physiology, anatomical variability, MR artifacts or true abnormalities without clinical importance. Although it is not always possible to differentiate variants and artifacts from clinically relevant findings it is important to know their potential etiology and clinical importance and not to over report them as abnormality requiring additional imaging or treatment.

  20. POSSIBLE ENTRAPMENT OF THE ULNAR ARTERY BY THE THIRD HEAD OF PRONATOR TERES MUSCLE. El posible atrapamiento de la arteria ulnar por el tercer fascículo del músculo pronador teres

    Directory of Open Access Journals (Sweden)

    Naveen Kumar

    2016-03-01

    Full Text Available El conocimiento de las variaciones en los alrededores de la fosa cubital es útil para cirujanos ortopédicos, cirujanos plásticos y médicos en general. Observamos las variaciones arteriales y musculares en y alrededor de la fosa cubital. La arteria braquial terminó 2 pulgadas por encima de la base de la fosa cubital. Las arterias radiales y cubitales entraron en la fosa cubital  pasando delante de los tendones de los músculos braquial y bíceps braquial respectivamente. La arteria cubital estaba rodeada por el tercer fascículo del pronador teres, que tuvo su origen en la fascia cubriendo la parte distal del músculo braquial. Este músculo se unió a tendón de pronador teres distalmente y fue suministrado por una rama del nervio mediano. Este músculo podría alterar el flujo sanguíneo en la arteria cubital y puede causar dificultades para el registro de la presión sanguínea. Knowledge of variations at and in the surroundings of cubital fossa is useful for the orthopedic surgeons, plastic surgeons and medical practitioners in general. During routine dissection, we observed arterial and muscular variations in and around the cubital fossa. The brachial artery terminated 2 inches above the base of the cubital fossa. The radial and ulnar arteries entered the cubital fossa by passing in front of the tendons of brachialis and biceps brachii respectively. The ulnar artery was surrounded by the third head of pronator teres which took its origin from the fascia covering the distal part of the brachialis muscle. This muscle joined pronator teres tendon distally and was supplied by a branch of median nerve. This muscle could alter the blood flow in the ulnar artery and may cause difficulties in recording the blood pressure.

  1. POSSIBLE ENTRAPMENT OF THE ULNAR ARTERY BY THE THIRD HEAD OF PRONATOR TERES MUSCLE. EL POSIBLE ATRAPAMIENTO DE LA ARTERIA ULNAR POR EL TERCER FASCÍCULO DEL MÚSCULO PRONADOR TERES

    Directory of Open Access Journals (Sweden)

    Satheesha Nayak B

    2012-11-01

    Full Text Available Knowledge of variations at and in the surroundings of cubital fossa is useful for the orthopedic surgeons, plastic surgeons and medical practitioners in general. During routine dissection, we observed arterial and muscular variations in and around the cubital fossa. The brachial artery terminated 2 inches above the base of the cubital fossa. The radial and ulnar arteries entered the cubital fossa by passing in front of the tendons of brachialis and biceps brachii respectively. The ulnar artery was surrounded by the third head of pronator teres which took its origin from the fascia covering the distal part of the brachialis muscle. This muscle joined pronator teres tendon distally and was supplied by a branch of median nerve. This muscle could alter the blood flow in the ulnar artery and may cause difficulties in recording the blood pressure.El conocimiento de las variaciones en los alrededores de la fosa cubital es útil para cirujanos ortopédicos, cirujanos plásticos y médicos en general. Observamos las variaciones arteriales y musculares en y alrededor de la fosa cubital. La arteria braquial terminó 2 pulgadas por encima de la base de la fosa cubital. Las arterias radiales y cubitales entraron en la fosa cubital pasando delante de los tendones de los músculos braquial y bíceps braquial respectivamente. La arteria cubital estaba rodeada por el tercer fascículo del pronador teres, que tuvo su origen en la fascia cubriendo la parte distal del músculo braquial. Este músculo se unió a tendón de pronador teres distalmente y fue suministrado por una rama del nervio mediano. Este músculo podría alterar el flujo sanguíneo en la arteria cubital y puede causar dificultades para el registro de la presión sanguínea.

  2. Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction?

    Science.gov (United States)

    Osbahr, Daryl C; Dines, Joshua S; Rosenbaum, Andrew J; Nguyen, Joseph T; Altchek, David W

    2012-06-01

    Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play. The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia. We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months). Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient. Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

  3. Reliability and precision of stress sonography of the ulnar collateral ligament.

    Science.gov (United States)

    Bica, David; Armen, Joseph; Kulas, Anthony S; Youngs, Kevin; Womack, Zachary

    2015-03-01

    Musculoskeletal sonography has emerged as an additional diagnostic tool that can be used to assess medial elbow pain and laxity in overhead throwers. It provides a dynamic, rapid, and noninvasive modality in the evaluation of ligamentous structural integrity. Many studies have demonstrated the utility of dynamic sonography for medial elbow and ulnar collateral ligament (UCL) integrity. However, evaluating the reliabilityand precision of these measurements is critical if sonography is ultimately used as a clinical diagnostic tool. The purpose of this study was to evaluate the reliability and precision of stress sonography applied to the medial elbow. We conducted a cross-sectional study during the 2011 baseball off-season. Eighteen National Collegiate Athletic Association Division I pitchers were enrolled, and 36 elbows were studied. Using sonography, the medial elbow was assessed, and measurements of the UCL length and ulnohumeral joint gapping were performed twice under two conditions (unloaded and loaded) and bilaterally. Intraclass correlation coefficients (0.72-0.94) and standard errors of measurements (0.3-0.9 mm) for UCL length and ulnohumeral joint gapping were good to excellent. Mean differences between unloaded and loaded conditions for the dominant arms were 1.3 mm (gapping; P < .001) and 1.4 mm (UCL length; P < .001). Medial elbow stress sonography is a reliable and precise method for detecting changes in ulnohumeral joint gapping and UCL lengthening. Ultimately, this method may provide clinicians valuable information regarding the medial elbow's response to valgus loading and may help guide treatment options. © 2015 by the American Institute of Ultrasound in Medicine.

  4. Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.

    Science.gov (United States)

    Wilson, Alexander T; Pidgeon, Tyler S; Morrell, Nathan T; DaSilva, Manuel F

    2015-11-01

    To determine the frequency of revision elbow ulnar collateral ligament (UCL) reconstruction in professional baseball pitchers. Data were collected on 271 professional baseball pitchers who underwent primary UCL reconstruction. Each player was evaluated retrospectively for occurrence of revision UCL reconstructive surgery to treat failed primary reconstruction. Data on players who underwent revision UCL reconstruction were compiled to determine total surgical revision incidence and revision rate by year. The incidence of early revision was analyzed for trends. Average career length after primary UCL reconstruction was calculated and compared with that of players who underwent revision surgery. Logistic regression analysis was performed to assess risk factors for revision including handedness, pitching role, and age at the time of primary reconstruction. Between 1974 and 2014, the annual incidence of primary UCL reconstructions among professional pitchers increased, while the proportion of cases being revised per year decreased. Of the 271 pitchers included in the study, 40 (15%) required at least 1 revision procedure during their playing career. Three cases required a second UCL revision reconstruction. The average time from primary surgery to revision was 5.2 ± 3.2 years (range, 1-13 years). The average length of career following primary reconstruction for all players was 4.9 ± 4.3 years (range, 0-22 years). The average length of career following revision UCL reconstruction was 2.5 ± 2.4 years (range, 0-8 years). No risk factors for needing revision UCL reconstruction were identified. The incidence of primary UCL reconstructions among professional pitchers is increasing; however, the rate of primary reconstructions requiring revision is decreasing. Explanations for the decreased revision rate may include improved surgical technique and improved rehabilitation protocols. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by

  5. Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury.

    Science.gov (United States)

    Keller, Robert A; Marshall, Nathan E; Guest, John-Michael; Okoroha, Kelechi R; Jung, Edward K; Moutzouros, Vasilios

    2016-04-01

    The number of Major League Baseball (MLB) pitchers requiring ulnar collateral ligament (UCL) reconstructions is increasing. Recent literature has attempted to correlate specific stresses placed on the throwing arm to risk for UCL injury, with limited results. Eighty-three MLB pitchers who underwent primary UCL reconstruction were evaluated. Pitching velocity and percent of pitch type thrown (fastball, curve ball, slider, and change-up) were evaluated 2 years before and after surgery. Data were compared with control pitchers matched for age, position, size, innings pitched, and experience. The evaluation of pitch velocity compared with matched controls found no differences in pre-UCL reconstruction pitch velocities for fastballs (91.5 vs. 91.2 miles per hour [mph], P = .69), curveballs (78.2 vs. 77.9 mph, P = .92), sliders (83.3 vs. 83.5 mph, P = .88), or change-ups (83.9 vs. 83.8 mph, P = .96). When the percentage of pitches thrown was evaluated, UCL reconstructed pitchers pitch significantly more fastballs than controls (46.7% vs. 39.4%, P = .035). This correlated to a 2% increase in risk for UCL injury for every 1% increase in fastballs thrown. Pitching more than 48% fastballs was a significant predictor of UCL injury, because pitchers over this threshold required reconstruction (P = .006). MLB pitchers requiring UCL reconstruction do not pitch at higher velocities than matched controls, and pitch velocity does not appear to be a risk factor for UCL reconstruction. However, MLB pitchers who pitch a high percentage of fastballs may be at increased risk for UCL injury because pitching a higher percent of fastballs appears to be a risk factor for UCL reconstruction. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Khalil, Lafi S; Ahmad, Christopher S; ElAttrache, Neal

    2017-03-01

    With an increasing number of Major League Baseball (MLB) players undergoing ulnar collateral ligament (UCL) reconstruction, there remains limited literature on appropriate post-reconstruction workload management to limit the risk of reinjury. A total of 28 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction were identified and compared with 137 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared 3 years before and after primary reconstruction. Results were then compared between groups. Pitchers who later required revision increased their games pitched by 14.1% after reconstruction whereas the no-revision group pitched 13.6% fewer games than before reconstruction (P < .01). Inning workload was reduced by 9.8% after surgery (89.8 innings after vs 99.6 innings before) for the revision group compared with the no-revision group, which threw 26% fewer innings after surgery (86.3 innings after vs 116.7 innings before) (P = .05). In addition, the revision group pitched 6.6% more pitches after reconstruction, 1138.9 pitches, compared with before reconstruction, 1068.6 pitches. Pitchers who did not require revision, in contrast, pitched 19.6% fewer pitches after reconstruction than before reconstruction (P = .08). This study's findings suggest that MLB pitchers who require revision UCL reconstruction after returning to play following primary UCL reconstruction pitch at or above their pre-primary UCL reconstruction workload whereas control pitchers who do not require revision pitch significantly less, below their pre-primary UCL reconstruction workload. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. The Reliability of Isometer 2 Device in Measuring of Cervical Flexor and Extensor Muscles Strength

    Directory of Open Access Journals (Sweden)

    Asghar Reza Soltan-Zadeh

    2006-07-01

    Full Text Available Objective: The strength of a group of muscles can be measured by muscle strength test, employing a force measuring instrument. In order to monitor the effectiveness of a therapeutic or training programs we need a reliable technique which is also accurate in repeated measurements. The purpose of this study was to examine the reliability of an isometric neck muscle force measurement device.  Materials & Methods: Thirty seven healthy non athlete subjects (18 males and 19 females, aged 18-25 participated in this analytical study. The maximal isometric contractions of the neck extensor and flexor muscles were measured in different times and different days and by two different testers. A new sensitive “load cell” was applied to our previously designed neck muscle force measurement apparatus. Results: The results of the inter-trail, test retest, and inter rater reliability (0.86 < ICC < 0.98 , 2.2< Sw <5.1 N indicated that the neck muscle force measurements were highly repeatable and less variable between measurements. There were no statistically significant differences in neck muscle force measurements, between times, between days and between retsters. Maximum isometric contractions were significantly higher in males than in the females (p < 0.001. Women’s neck muscle strengths were 30.8% and 46.1% of men in cervical extension and cervical flexion. Conclusion: In this study we used a new model (Isometer 2 of our previous apparatus (Isometer. The isometric strength of neck flexor and extensor muscles which was measured by Isometer 2 appeared to be a reliable and useful method for measuring the force of the neck extensor and flexor muscles.

  8. The effect of knee extensor open kinetic chain resistance training in the ACL-injured knee.

    Science.gov (United States)

    Barcellona, Massimo G; Morrissey, Matthew C; Milligan, Peter; Clinton, Melissa; Amis, Andrew A

    2015-11-01

    To investigate the effect of different loads of knee extensor open kinetic chain resistance training on anterior knee laxity and function in the ACL-injured (ACLI) knee. Fifty-eight ACLI subjects were randomised to one of three (12-week duration) training groups. The STAND group trained according to a standardised rehabilitation protocol. Subjects in the LOW and HIGH group trained as did the STAND group but with the addition of seated knee extensor open kinetic chain resistance training at loads of 2 sets of 20 repetition maximum (RM) and 20 sets of 2RM, respectively. Anterior knee laxity and measurements of physical and subjective function were performed at baseline, 6 and 12 weeks. Thirty-six subjects were tested at both baseline and 12 weeks (STAND n = 13, LOW n = 11, HIGH n = 12). The LOW group demonstrated a reduction in 133 N anterior knee laxity between baseline and 12 weeks testing when compared to the HIGH and the STAND groups (p = 0.009). Specifically, the trained-untrained knee laxity decreased an average of approximately 5 mm in the LOW group while remaining the same in the other two groups. Twelve weeks of knee extensor open kinetic chain resistance training at loads of 2 sets of 20RM led to a reduction in anterior knee laxity in the ACLI knee. This reduction in laxity does not appear to offer any significant short-term functional advantages when compared to a standard rehabilitation protocol. These results indicate that knee laxity can be decreased with resistance training of the thigh muscles. Randomised controlled trial, Level II.

  9. Sex differences in neuromuscular function after repeated eccentric contractions of the knee extensor muscles.

    Science.gov (United States)

    Lee, Andrea; Baxter, Jake; Eischer, Claire; Gage, Matt; Hunter, Sandra; Yoon, Tejin

    2017-06-01

    This study examined the mechanisms for force and power reduction during and up to 48 h after maximal eccentric contractions of the knee extensor muscles in young men and women. 13 men (22.8 ± 2.6 years) and 13 women (21.6 ± 2.2 years) performed 150 maximal effort eccentric contractions (5 sets of 30) with the knee extensor muscles at 60° s -1 . Maximal voluntary isometric contractions (MVIC) and maximal voluntary concentric contractions (MVCC) were performed before and after the 150 eccentric contractions. The MVCCs involved a set of two isokinetic contractions at 60° s -1 and sets of isotonic contractions performed at seven different resistance loads (1 N m, 10, 20, 30, 40, 50, and 60% MVIC). Electrical stimulation was used during the MVICs and at rest to determine changes in voluntary activation and contractile properties. At baseline, men were stronger than women (MVIC: 276 ± 48 vs. 133 ± 37 N m) and more powerful (MVCC: 649 ± 77 vs. 346 ± 78 W). At termination of the eccentric contractions, voluntary activation, resting twitch amplitude, and peak power during concentric contractions at the seven loads and at 60° s -1 decreased (P  0.05) with no sex differences. Central mechanisms were primarily responsible for the depressed maximal force production up to 48 h after repeated eccentric contractions of the knee extensors and these mechanisms were similar in men and women.

  10. Deep and shallow forms of the sulcus for extensor carpi ulnaris.

    OpenAIRE

    Nakashima, T; Hojo, T; Furukawa, H

    1993-01-01

    Anatomical variations in the sulcus for the tendon of extensor carpi ulnaris were studied in 240 upper limbs. The sulcus lies between the head and the styloid process on the dorsal surface of the distal end of the ulna. This groove has deep and shallow forms and, rarely, a flat form. The sulcus was classified into 4 grades according to its depth. Grade I, a deep sulcus, was found in 51.3%. Grades II and III are shallow, but the styloid process in grade II is more prominent than in grade III. ...

  11. Effect of wrist cooling on aerobic and anaerobic performance in elite sportsmen.

    Science.gov (United States)

    Krishnan, Anup; Singh, Krishan; Sharma, Deep; Upadhyay, Vivekanand; Singh, Amit

    2018-01-01

    Body cooling has been used to increase sporting performance and enhance recovery. Several studies have reported improvement in exercise capacities using forearm and hand cooling or only hand cooling. Wrist cooling has emerged as a portable light weight solution for precooling prior to sporting activity. The Astrand test for aerobic performance and the Wingate test for anaerobic performance are reliable and accurate tests for performance assessment. This study conducted on elite Indian athletes analyses the effects of wrist precooling on aerobic and anaerobic performance as tested by the Astrand test and the Wingate test before and after wrist precooling. 67 elite sportsmen were administered Wingate and Astrand test under standardised conditions with and without wrist precooling using a wrist cooling device (dhamaSPORT). Paired t -test was applied to study effect on aerobic [VO 2 (ml/min/kg)] and anaerobic performance [peak power (W/kg) and average power (W/kg)] and Cohen's d was used to calculate effect size of wrist precooling. After wrist precooling, significant increase of 0.22 ( p  = 0.014, 95% CI: 0.047, 0.398) in peak power (W/kg) and 0.22 ( p  effective in aerobic performance. Wrist cooling effect size was smaller in VO 2 (Cohen's d  = 0.21), peak power (Cohen's d  = 0.31) and it was larger in average power (Cohen's d  = 0.71). Results show wrist precooling significantly improves anaerobic than aerobic performance of elite sportsmen.

  12. Psychometric properties of two questionnaires in the context of total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Merser, Søren

    2014-01-01

    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...... patients scored significantly higher on the QuickDASH than other patients did. The scores of both questionnaires were very closely related. CONCLUSION: Both questionnaires are valid and equivalent for use in patients with total wrist arthroplasty. FUNDING: This research received no specific grant from any...

  13. MAGNETIC RESONANCE IMAGING FOR TRIQUETROUS FIBROCARTILAGE COMPLEX DAMAGES AT WRIST JOINT INJURIES

    Directory of Open Access Journals (Sweden)

    E. A. Kadubovskaya

    2010-01-01

    Full Text Available A brief review of the literature on normal anatomy and pathological changes of trihedral fibro-cartilage complex of wrist. The authors described in detail a method of wrist MRI, MR-image of normal and damaged articular disk, considered possible variants for his injuries. The results of MRI of wrist in 110 people including 40 patients with suspected damage were analyzed. At present MRI is the only available non-invasive method for diagnosing injuries of intraarticular structures, in particular trihedral fibro-cartilage complex.

  14. [Cinematography, a new diagnostic procedure in evaluation of the injured painful wrist joint].

    Science.gov (United States)

    Werber, K D; Wuttge-Hannig, A; Hannig, C

    1990-01-01

    By the X-ray Cineradiografie we are able to examine and to judge the dynamic of the wrist bones by 50 pictures/sec. in comparison to one another and also depending on their ligaments. We did an investigation of 170 patients with painful wrist. With the method we were able to make up a clear diagnosis and to propose the therapy. I.e.: If consecutive shortening of the radius after distal radius fracture resulting ingruency of the wrist joint is relevant, or a scaphoid pseudarthrosis is fixed elastically, or a scaphoic dissociation is effective. The variations were shown in comparison to normal circumstances.

  15. Electromyographic activity of the trunk extensor muscles: effect of varying hip position and lumbar posture during Roman chair exercise.

    Science.gov (United States)

    Mayer, John M; Verna, Joe L; Manini, Todd M; Mooney, Vert; Graves, James E

    2002-11-01

    To evaluate the effect of hip position and lumbar posture on the surface electromyographic activity of the trunk extensors during Roman chair exercise. Descriptive, repeated measures. University-based musculoskeletal research laboratory. Twelve healthy volunteers (7 men, 5 women; age range, 18-35y) without a history of low back pain were recruited from a university setting. Not applicable. Surface electromyographic activity was recorded from the lumbar extensor, gluteal, and hamstring musculature during dynamic Roman chair exercise. For each muscle group, electromyographic activity (mV/rep) was compared among exercises with internal hip rotation and external hip rotation and among exercises by using a typical lumbar posture (nonbiphasic) and a posture that accentuated lumbar lordosis (biphasic). For the lumbar extensors, electromyographic activity during exercise was 18% greater with internal hip rotation than external hip rotation (Phamstrings, there was no difference in electromyographic activity between internal and external hip rotation or between biphasic and nonbiphasic postures (P >.05). The level of recruitment of the lumbar extensors can be modified during Roman chair exercise by altering hip position and lumbar posture. Clinicians can use these data to develop progressive exercise protocols for the lumbar extensors with a variety of resistance levels without the need for complex equipment. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

  16. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2016-01-15

    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.)

  17. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    International Nuclear Information System (INIS)

    Slaar, Annelie; Maas, Mario; Rijn, Rick R. van; Walenkamp, Monique M.J.; Bentohami, Abdelali; Goslings, J.C.; Steyerberg, Ewout W.; Jager, L.C.; Sosef, Nico L.; Velde, Romuald van; Ultee, Jan M.; Schep, Niels W.L.

    2016-01-01

    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.)

  18. Reliability of contractile properties of the knee extensor muscles in individuals with post-polio syndrome.

    Directory of Open Access Journals (Sweden)

    Eric L Voorn

    Full Text Available To assess the reliability of contractile properties of the knee extensor muscles in 23 individuals with post-polio syndrome (PPS and 18 age-matched healthy individuals.Contractile properties of the knee extensors were assessed from repeated electrically evoked contractions on 2 separate days, with the use of a fixed dynamometer. Reliability was determined for fatigue resistance, rate of torque development (MRTD, and early and late relaxation time (RT50 and RT25, using the intraclass correlation coefficient (ICC and standard error of measurement (SEM, expressed as % of the mean.In both groups, reliability for fatigue resistance was good, with high ICCs (>0.90 and small SEM values (PPS: 7.1%, healthy individuals: 7.0%. Reliability for contractile speed indices varied, with the best values found for RT50 (ICCs>0.82, SEM values <2.8%. We found no systematic differences between test and retest occasions, except for RT50 in healthy subjects (p = 0.016.In PPS and healthy individuals, the reliability of fatigue resistance, as obtained from electrically evoked contractions is high. The reliability of contractile speed is only moderate, except for RT50 in PPS, demonstrating high reliability.This was the first study to examine the reliability of electrically evoked contractile properties in individuals with PPS. Our results demonstrate its potential to study mechanisms underlying muscle fatigue in PPS and to evaluate changes in contractile properties over time in response to interventions or from natural course.

  19. Proximal forearm extensor muscle strain is reduced when driving nails using a shock-controlled hammer.

    Science.gov (United States)

    Buchanan, Kimberly A; Maza, Maria; Pérez-Vázquez, Carlos E; Yen, Thomas Y; Kijowski, Richard; Liu, Fang; Radwin, Robert G

    2016-10-01

    Repetitive hammer use has been associated with strain and musculoskeletal injuries. This study investigated if using a shock-control hammer reduces forearm muscle strain by observing adverse physiological responses (i.e. inflammation and localized edema) after use. Three matched framing hammers were studied, including a wood-handle, steel-handle, and shock-control hammer. Fifty volunteers were randomly assigned to use one of these hammers at a fatiguing pace of one strike every second, to seat 20 nails in a wood beam. Magnetic resonance imaging was used to scan the forearm muscles for inflammation before the task, immediately after hammering, and one to two days after. Electromyogram signals were measured to estimate grip exertions and localized muscle fatigue. High-speed video was used to calculate the energy of nail strikes. While estimated grip force was similar across the three hammers, the shock-control hammer had 40% greater kinetic energy upon impact and markedly less proximal extensor muscle edema than the wood-handle and steel-handle hammers, immediately after use (phandle shock can mitigate strain in proximal forearm extensor muscles. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Reconstruction of long digital extensor tendon by cranial tibial muscle fascia graft in a dog.

    Science.gov (United States)

    Sabiza, Soroush; Khajeh, Ahmad; Naddaf, Hadi

    2016-01-01

    Tendon rupture in dogs is generally the result of a direct trauma. This report described the use of adjacent muscle autogenic fascial graft for reconstruction of distal rupture of long digital extensor tendon in a dog. A two-year-old male mix breed dog, was presented with a non-weight bearing lameness of the right hind limb and a deep rupture of lateral side of right tarsus. History taking revealed that this rupture appeared without any apparent cause, when walking around the farm, three days before. Radiography was done and no fracture was observed. Hyperextension of right tarsal joint compared to left limb was observed. Under general anesthesia, after dissections of the ruptured area, complete rupture of long digital extensor tendon was revealed. Then, we attempted to locate the edge of the tendon, however, the tendon length was shortened approximately 1 cm. Hence, a strip of 1 cm length from fascia of cranial tibial muscle was harvested to fill the defect. The graft was sutured to the two ends of tendon using locking loop pattern. Subcutaneous layers and the skin were sutured routinely. Ehmer sling bandage was applied to prevent weight bearing on the surgical region. Re-examination and phone contact with the owner eight weeks and six months postoperatively revealed a poor lameness and excellent function of the dog, respectively. It could be concluded that the fascia of adjacent muscles can be used as an autogenic graft for reconstruction of some tendon ruptures.

  1. The frondiform ligament and pseudotenosynovitis of the extensor digitorum longus tendon: MRI evaluation with cadaveric correlation

    International Nuclear Information System (INIS)

    Zember, Jonathan; Rosenberg, Zehava; Mba-Jones, Chimere; Bencardino, Jenny; Rossi, Ignacio

    2016-01-01

    Fluid along the frondiform ligament, the sinus tarsi stem of the inferior extensor retinaculum (IER), can approximate the extensor digitorum longus (EDL), at times simulating tenosynovitis. Our purpose, based on MRI and cadaveric studies, was to further evaluate this scantly described phenomenon, to identify associated findings and to alert the radiologists to the potential pitfall of over diagnosing EDL tenosynovitis. Two musculoskeletal radiologists retrospectively reviewed the radiology reports and MRI studies of 258 ankle MRI exams, performed at our institution, for fluid along the frondiform ligament extending toward the EDL. No patient had EDL pathology clinically. MRI was performed in two cadaveric ankles following injection of the sinus tarsi and EDL tendon sheath, under ultrasound guidance. Altogether, 31 MRIs demonstrated fluid extending from the sinus tarsi along the frondiform ligament toward the EDL. In 30 cases (97 %), the fluid partially surrounded the tendon, without tendon sheath distension. Based on the radiology reports, in 11 of the 31 cases (35 %), the fluid was misinterpreted as abnormal. Most common associated findings included ligamentous injury, posterior tibial tendon (PTT) tear, flat-foot, and osteoarthrosis. In the cadavers, fluid extended along the frondiform ligament toward the EDL after sinus tarsi injection; there was no communication between EDL tendon sheath and the sinus tarsi. Fluid within the sinus tarsi can extend along the frondiform ligament and partially surround the EDL, manifesting as pseudotenosynovitis. This phenomenon, often seen with ligamentous tears or PTT dysfunction, should not be misdiagnosed as true pathology of the EDL. (orig.)

  2. Sex comparisons of non-local muscle fatigue in human elbow flexors and knee extensors

    Science.gov (United States)

    Ye, Xin; Beck, Travis W.; Wages, Nathan P.; Carr, Joshua C.

    2018-01-01

    Objectives: To examine non-local muscle fatigue (NLMF) in both contralateral homologous and non-related heterogonous muscles for both sexes. Methods: Ten men and nine women participated in this study. After the familiarization visit, subjects completed four separate randomly sequenced experimental visits, during which the fatiguing interventions (six sets of 30-second maximal isometric contractions) were performed on either their right elbow flexors or knee extensors. Before (Pre-) and after (Post-) the fatiguing interventions, the isometric strength and the corresponding surface electromyographic (EMG) amplitude were measured for the non-exercised left elbow flexors or knee extensors. Results: For the non-exercised elbow flexors, the isometric strength decreased for both sexes (sex combined mean±SE: Pre vs. Post=339.67±18.02 N vs. 314.41±16.37 N; pisometric knee extension strength for men (Pre vs. Post =845.02±66.26 N vs. 817.39±67.64 N; p=0.019), but not for women. Conclusions: The presence of NMLF can be affected by factors such as sex and muscle being tested. Women are less likely to demonstrate NLMF in lower body muscle groups. PMID:29504584

  3. The effects of implant composition on extensor tenosynovitis in a canine distal radius fracture model.

    Science.gov (United States)

    Sinicropi, Stefano M; Su, Brian W; Raia, Frank J; Parisien, May; Strauch, Robert J; Rosenwasser, Melvin P

    2005-03-01

    Dorsal plating of distal radius fractures with titanium plates has resulted in clinically observed tenosynovitis and tendon rupture. The goal of this study was to investigate whether titanium-based implants result in more extensor tendon inflammation than matched stainless-steel implants in a canine fracture model. An osteotomy was created in the distal radius of 18 beagles and fixed with 2.7-mm 4-hole plates composed of commercially pure titanium, titanium alloy (Ti-Al6-V4), or 316L stainless steel. Animals were killed at an average of 4 months. Tendon gliding was assessed by applying a force at the extensor musculotendinous junction and noting gliding. Histologic grading (mild, moderate, severe) was based on cellular hypertrophy, hyperplasia, and leukocytic infiltration. Tendons glided freely in 100% stainless-steel specimens, 75% of titanium alloy, and 43% of commercially pure titanium groups. A severe inflammatory reaction was identified in 60% of the titanium alloy (Ti-A16-V4) group, 57% of the pure titanium group, and 0% of the stainless-steel group. Dorsal plating of the canine radius with commercially pure titanium or titanium alloy implants produced a greater inflammatory peritendinous response than matched stainless-steel implants.

  4. [Obtaining a fermented chickpea extract (Cicer arietinum L.) and its use as a milk extensor].

    Science.gov (United States)

    Morales de León, J; Cassís Nosthas, M L; Cecin Salomón, P

    2000-06-01

    Chickpea (Cicer arietinum L) is cultivated in the North part of México and it is considered a good source of vegetal protein of low cost (20% average), nevertheless, the 80% used for the exportation and only the 20% less was used for animal feeding. The main objective in this study is to obtain a fermented chickpea extract for using in dairy extensor. Chickpea water absorbtion kinetics were carried out in e temperature conditions:while the conditions were established, chickpea was grounded and fermented in different amounts with its natural flora, L. casei, L. plantarum and a mixture culture of both microorganism in logarithmic phase. The results showed that the presence of microorganism of chickpea natural flora interferes during the fermentation, so before the inoculation it was necessary treat the chickpea extract (CE) terminally in a dilution 1:4 during 20 min at 7.7 kg/cm2 of pressure. The use of a mixture culture of 5% of L. casei and 5% L. plantarum inoculated in MRS broth was used to decrease fermentation time. Its addition in logarithmic phase to the sterile chickpea extract increased the lactic acid production and decreased the pH value in 6 h which was less time that one obtained with each of lactobacillus. The fermented extract obtained finally, presented similar sensory characteristics to the ones of dairy products. Therefore, chickpea is a good alternative as a extensor for this kind of products.

  5. Neurotization of the biceps muscle by end-to-side neurorraphy between ulnar and musculocutaneous nerves. A series of five cases.

    Science.gov (United States)

    Franciosi, L F; Modestti, C; Mueller, S F

    1998-01-01

    Three patients with avulsed C5, C6, and C7 roots and two patients with avulsed C5 and C6 roots after trauma of the brachial plexus, were treated by neurotization of the biceps using nerve fibers derived from the ulnar nerve and obtained by end-to-side neurorraphy between the ulnar and musculocutaneous nerves. The age of patients ranged from 19 to 45. The interval between the accident and surgery was 2 to 13 months. Return of biceps contraction was observed 4 to 6 months after surgery. Four patients recovered grade 4 elbow flexion. One 45-year-old patient did not obtain any biceps contraction after 9 months.

  6. What wrist should you wear your actigraphy device on? Analysis of dominant vs. non-dominant wrist actigraphy for measuring sleep in healthy adults

    Directory of Open Access Journals (Sweden)

    Matthew William Driller

    Full Text Available OBJECTIVE: Differences in sleep results due to the placement of actigraphy devices (non-dominant vs. dominant wrist are yet to be determined. METHODS: 65 nights of data from 13 adult participants was collected while participants wore two actigraphy devices, one on each wrist. Sleep indices including total sleep time (TST, total time in bed (TTB, sleep efficiency (SE%, sleep latency (SL, wake after sleep onset (WASO, sleep onset time (SOT and wake time (WT were assessed between the two devices. RESULTS: There were no significant differences between devices for any of the measured sleep variables (p>0.05. SE%, SL and WASO resulted in high correlations between devices (0.89, 0.89 and 0.76, respectively, with all other sleep variables resulting in very high correlations (>0.90 between devices. CONCLUSIONS: Based on our results, it does not seem critical which wrist the actigraphy device is worn on for measuring key sleep variables.

  7. Extrinsic wrist ligaments: prevalence of injury by magnetic resonance imaging and association with intrinsic ligament tears.

    Science.gov (United States)

    Taneja, Atul K; Bredella, Miriam A; Chang, Connie Y; Joseph Simeone, F; Kattapuram, Susan V; Torriani, Martin

    2013-01-01

    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.

  8. Design of a Magnetic Resonance-Safe Haptic Wrist Manipulator for Movement Disorder Diagnostics

    NARCIS (Netherlands)

    Bode, Dyon; Mugge, Winfred; Schouten, Alfred C.; van Rootselaar, Anne-Fleur; Bour, Lo J.; van der Helm, Frans C. T.; Lammertse, Piet

    2017-01-01

    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

  9. COBRA-Bee Carpal-Wrist Gimbal for Astrobee, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — TUI proposes to develop a carpal-wrist gimbal payload for the Astrobee free-flier, called 'COBRA-Bee' to satisfy Astrobee mission needs for a lightweight, integrated...

  10. A complex suicide by vehicle assisted ligature strangulation and wrist-cutting

    Directory of Open Access Journals (Sweden)

    Ramazan Akçan

    2016-12-01

    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.

  11. MR anatomy of the joints: an MR-cadaveric correlative study: part I. wrist

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Heung Sik [Seoul National University College of Medicine, Seoul (Korea, Republic of); Donald Resnick [University of California, San Diego (United States)

    1991-07-15

    To acquire the anatomic information necessary for correct interpretation of MR images of the wrist, transverse, coronal, and sagittal MR images of 3 fresh cadaveric wrists were obtained and, subsequently, sectioned along the MR imaging planes. For the precise correlation of anatomic features depicted with MR and with specimen section, cadaveric wrists were fixed in a rectangular cardboard box using paraffin and frozen after MR imaging. High contrast and spatial resolution enabled delineation of small structures including tendons, nerves, vessels, and ligaments, as well as osseous structures. Transverse images provided the best delineation of the carpal tunnel, tendons, nerves, and vessels. Coronal images permitted optimal visualization of triangular fibrocartilage and lunotriquetral and scapholunate ligaments. We conclude that MR imaging accurately and reliably displays the anatomy of the wrist.

  12. Effect of platelet-rich plasma combined with demineralised bone matrix on bone healing in rabbit ulnar defects.

    Science.gov (United States)

    Galanis, Vasilios; Fiska, Alice; Kapetanakis, Stylianos; Kazakos, Konstantinos; Demetriou, Thespis

    2017-09-01

    This study evaluates the effect of autologous platelet-rich plasma (PRP) combined with xenogeneic demineralised bone matrix (DBM) on bone healing of critical-size ulnar defects (2-2.5 times the ulnar diameter) in New Zealand White rabbits. Critical-size defects were created unilaterally in the ulna of 36 rabbits, while keeping the contralateral limb intact. They were divided into three groups. In Group A, the defect was filled with autologous PRP and in Group B, with autologous PRP combined with DBM; in Group C, the defect remained empty. The rabbits were euthanised 12 weeks postoperatively. Radiological, biomechanical and histological assessments were carried out and statistical analysis of the results was performed. Group B had significantly higher radiological and histological scores than Groups A and C. Defects in Group B showed significant new bone formation, whereas there was minimal or no new bone formation in Groups A and C. Only specimens in Group B showed macroscopic bone union. Biomechanical evaluation of the treated and intact contralateral limbs in Group B showed significant differences. In this study, statistically significant enhancement of bone healing was found in critical-size defects treated with PRP and DBM, as shown by radiological findings, gross assessment, and biomechanical and histopathological results. Defects in the two other groups remained unbridged. Therefore, PRP was effective only when it was used in combination with a bone graft. Copyright: © Singapore Medical Association

  13. Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age.

    Science.gov (United States)

    Turkiewicz, Aleksandra; Timpka, Simon; Thorlund, Jonas Bloch; Ageberg, Eva; Englund, Martin

    2017-10-01

    To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data on isometric knee extensor strength, weight, height, smoking, alcohol consumption, parental education and adult occupation from Swedish registries. We identified participants diagnosed with knee OA or knee injury from 1987 to 2010 through the National Patient Register. We estimated the HR of knee OA using multivariable-adjusted Cox proportional regression model. To assess the influence of adult knee injury and occupation, we performed a formal mediation analysis. The mean (SD) knee extensor strength was 234 (47) Nm, the mean (SD) weight was 66 (9.3) kg. During 24 years (median) of follow-up starting at the age of 35 years, 2049 persons were diagnosed with knee OA. The adjusted HR (95% CI) of incident knee OA was 1.12 (1.06 to 1.18) for each SD of knee extensor strength and 1.18 (1.15 to 1.21) per 5 kg of body weight. Fifteen per cent of the increase in OA risk due to higher knee extensor strength could be attributed to knee injury and adult occupation. Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor for knee OA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. The effects of knee extensor eccentric training on functional tests in healthy subjects Os efeitos do treino isocinético excêntrico dos extensores do joelho nos testes funcionais em sujeitos saudáveis

    Directory of Open Access Journals (Sweden)

    Heleodório H. Santos

    2010-08-01

    Full Text Available BACKGROUND: It is well known that eccentric training increases muscle strength and promotes greater neural activation, and therefore has been used in the recovery of knee extensors. The hypothesis of this study was that there would be a strong correlation between knee extensor torque and functional tests. OBJECTIVES: To investigate the relationship between knee extensor peak torque and functional tests of agility (runs and propulsion (hop for distance after short-term isokinetic eccentric training. METHODS: Twenty healthy and active male undergraduate students (age 22.5±2.1 years; height 1.72±0.10 m; weight 67.8±9.5 kg; body mass index: 22.5±2.0 kg/m², with no abnormalities or history of injury of the limbs, performed an isokinetic assessment of the knee extensors and flexors and also functional tests before and after isokinetic training, which consisted of 3 sets of 10 MVECs at 30º/s, with 3 minutes of rest between sets, twice a week for 6 weeks. RESULTS: The eccentric training increased the extensor peak torque (16, 27 and 17%; PCONTEXTUALIZAÇÃO: Sabe-se que o treino excêntrico aumenta a força muscular, promovendo uma maior ativação neural e, portanto, tem sido usado na recuperação do torque extensor. A hipótese deste estudo foi a de que possa existir uma forte correlação entre o torque extensor do joelho e os testes funcionais. OBJETIVOS: Correlacionar o torque extensor do joelho com os testes funcionais de agilidade (corridas e impulsão (saltos em distância após o treino isocinético excêntrico de curta duração. MÉTODOS: Vinte homens universitários, ativos e saudáveis (22,5±2,1 anos; 1,72±0,10 m; 67,8±9,5 kg; IMC 22,5±2,0 kg/m², sem reportar anormalidades ou história de lesão no membro inferior, realizaram avaliação isocinética do torque extensor e flexor do joelho e testes funcionais antes e depois do treino isocinético que consistiu em três séries de 10 CEVM a 30º/s, com 3 minutos de repouso entre as

  15. Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age

    DEFF Research Database (Denmark)

    Turkiewicz, Aleksandra; Timpka, Simon; Thorlund, Jonas Bloch

    2017-01-01

    be attributed to knee injury and adult occupation. CONCLUSION: Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor......OBJECTIVES: To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. METHODS: We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data...

  16. Effect of Knee Extensor Strength on Incident Radiographic and Symptomatic Knee Osteoarthritis in Individuals with Meniscal Pathology

    DEFF Research Database (Denmark)

    Thorlund, Jonas B; Felson, David T; Segal, Neil A

    2016-01-01

    months. Separate binomial regression analyses with robust standard errors adjusted for age, history of knee surgery, physical activity level and clinic site were conducted for men and women. RESULTS: High knee extensor strength (normalized by allometric scaling) was associated with a reduced risk...... of radiographic knee OA in women (relative risk: 0.52; 95% CI: 0.29 to 0.94) but not in men (0.56; 0.27 to 1.16). High knee extensor strength did not protect against the development of symptomatic knee OA, either in women or in men. CONCLUSION: The results only partly confirm the hypothesis that high knee...

  17. Augmented reality-based navigation system for wrist arthroscopy: feasibility.

    Science.gov (United States)

    Zemirline, Ahmed; Agnus, Vincent; Soler, Luc; Mathoulin, Christophe L; Obdeijn, Miryam; Liverneaux, Philippe A

    2013-11-01

    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.

  18. (Dry) arthroscopic partial wrist arthrodesis: tips and tricks.

    Science.gov (United States)

    del Piñal, F; Tandioy-Delgado, F

    2014-10-01

    One of the options for performing a partial wrist arthrodesis is the arthroscopic technique. As a first advantage arthroscopy allows us to directly assess the state of the articular surface of the carpal bones and define the best surgical option during the salvage operation. Furthermore, it allows performance of the procedure with minimal ligament damage and minimal interference with the blood supply of the carpals. These will (presumably) entail less capsular scarring and more rapid healing. Lastly, there is cosmetic benefit by reducing the amount of external scarring. The procedure has a steep learning curve even for accomplished arthroscopists but can be performed in a competitive manner to the open procedure if the dry technique is used. The aim of this paper is to present the technical details, tricks and tips to make the procedure accessible to all hand specialists with an arthroscopic interest. As it is paramount that the surgeon is acquainted with the "dry" technique, some technical details about it will also be presented. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Solar powered wrist worn acquisition system for continuous photoplethysmogram monitoring.

    Science.gov (United States)

    Dieffenderfer, James P; Beppler, Eric; Novak, Tristan; Whitmire, Eric; Jayakumar, Rochana; Randall, Clive; Qu, Weiguo; Rajagopalan, Ramakrishnan; Bozkurt, Alper

    2014-01-01

    We present a solar-powered, wireless, wrist-worn platform for continuous monitoring of physiological and environmental parameters during the activities of daily life. In this study, we demonstrate the capability to produce photoplethysmogram (PPG) signals using this platform. To adhere to a low power budget for solar-powering, a 574 nm green light source is used where the PPG from the radial artery would be obtained with minimal signal conditioning. The system incorporates two monocrystalline solar cells to charge the onboard 20 mAh lithium polymer battery. Bluetooth Low Energy (BLE) is used to tether the device to a smartphone that makes the phone an access point to a dedicated server for long term continuous storage of data. Two power management schemes have been proposed depending on the availability of solar energy. In low light situations, if the battery is low, the device obtains a 5-second PPG waveform every minute to consume an average power of 0.57 mW. In scenarios where the battery is at a sustainable voltage, the device is set to enter its normal 30 Hz acquisition mode, consuming around 13.7 mW. We also present our efforts towards improving the charge storage capacity of our on-board super-capacitor.

  20. Immediate effects of different treatments for the wrist joints of subdominant hands, using electromechanical reaction time.

    Science.gov (United States)

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Cui, Yao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

    2016-08-01

    [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.

  1. Registration-based Bone Morphometry for Shape Analysis of the Bones of the Human Wrist

    Science.gov (United States)

    Joshi, Anand A.; Leahy, Richard M.; Badawi, Ramsey D.; Chaudhari, Abhijit J.

    2015-01-01

    We present a method that quantifies point-wise changes in surface morphology of the bones of the human wrist. The proposed method, referred to as Registration-based Bone Morphometry (RBM), consists of two steps: an atlas selection step and an atlas warping step. The atlas for individual wrist bones was selected based on the shortest l2 distance to the ensemble of wrist bones from a database of a healthy population of subjects. The selected atlas was then warped to the corresponding bones of individuals in the population using a non-linear registration method based on regularized l2 distance minimization. The displacement field thus calculated showed local differences in bone shape that then were used for the analysis of group differences. Our results indicate that RBM has potential to provide a standardized approach to shape analysis of bones of the human wrist. We demonstrate the performance of RBM for examining group differences in wrist bone shapes based on sex and between those of the right and left wrists in healthy individuals. We also present data to show the application of RBM for tracking bone erosion status in rheumatoid arthritis. PMID:26353369

  2. Tendo-ligamentous pathologies of the wrist joint: Can ultrasonography replace magnetic resonance imaging?

    Directory of Open Access Journals (Sweden)

    Kunwarpal Singh

    2017-09-01

    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

  3. Fortalecimento dos músculos da mão em pacientes submetidos a neurorrafia do ulnar com videogame/Strengthening of hand muscles in patients submitted to neurorrhaphy of ulnar nerve through the videogame

    Directory of Open Access Journals (Sweden)

    Bruno Goto Kimura

    2017-09-01

    Full Text Available O objetivo deste trabalho foi verificar se o fortalecimento muscular com o uso do videogame E-link promove aumento da força para os músculos da mão em pacientes com lesão de nervo ulnar. Resultados: Comparando a média das forças de preensão e pinças antes e após o fortalecimento, houve um aumento de força para todos os movimentos. Na força de preensão palmar houve em média um aumento de 50%, na pinça polpa-lateral houve na média um aumento de 24%, na pinça polpa-trípode a média foi de 8% de ganho de força e na pinça polpa-polpa a média foi de 10% de aumento na força. Discussão: A realidade virtual tem sido utilizada atualmente para modificar as terapias tradicionais com o intuito de aumentar a motivação no tratamento, como forma de entretenimento para o paciente, aumentando assim o seu desempenho na realização dos exercícios. Conclusão: Este estudo demonstrou houve ganho de força de preensão e das pinças, após o programa de fortalecimento com o uso do videogame para os músculos intrínsecos e extrínsecos da mão de pacientes após neurorrafia do nervo ulnar. AbstractThe objective of this study was to verify if muscle strengthening using the E-link videogame promotes increased strength for the hand muscles in patients with ulnar nerve injury. Results: Comparing the average grip and pinch strength before and after strengthening, there was an increase in strength for all movements. In the palmar grip strength there was an increase of 50%, in key pinch there was an increase of 24%, in tripod pinch the average was 8% and tip-to-tip pinch the increase was 10% in strength. Discussion: Virtual reality has been use most frequently to modify traditional therapies in order to improve treatment motivation as a form of entertainment for the patient, thus increasing their performance in performing the exercises. Conclusion: This study demonstrated an increase in grip and pinch strength. After the program of strengthening

  4. Do changes in neuromuscular activation contribute to the knee extensor angle-torque relationship?

    Science.gov (United States)

    Lanza, Marcel B; Balshaw, Thomas G; Folland, Jonathan P

    2017-08-01

    What is the central question of the study? Do changes in neuromuscular activation contribute to the knee extensor angle-torque relationship? What is the main finding and its importance? Both agonist (quadriceps) and antagonist coactivation (hamstrings) differed with knee joint angle during maximal isometric knee extensions and thus both are likely to contribute to the angle-torque relationship. Specifically, two independent measurement techniques showed quadriceps activation to be lower at more extended positions. These effects might influence the capacity for neural changes in response to training and rehabilitation at different knee joint angles. The influence of joint angle on knee extensor neuromuscular activation is unclear, owing in part to the diversity of surface electromyography (sEMG) and/or interpolated twitch technique (ITT) methods used. The aim of the study was to compare neuromuscular activation, using rigorous contemporary sEMG and ITT procedures, during isometric maximal voluntary contractions (iMVCs) of the quadriceps femoris at different knee joint angles and examine whether activation contributes to the angle-torque relationship. Sixteen healthy active men completed two familiarization sessions and two experimental sessions of isometric knee extension and knee flexion contractions. The experimental sessions included the following at each of four joint angles (25, 50, 80 and 106 deg): iMVCs (with and without superimposed evoked doublets); submaximal contractions with superimposed doublets; and evoked twitch and doublet contractions whilst voluntarily passive, and knee flexion iMVC at the same knee joint positions. The absolute quadriceps femoris EMG was normalized to the peak-to-peak amplitude of an evoked maximal M-wave, and the doublet-voluntary torque relationship was used to calculate activation with the ITT. Agonist activation, assessed with both normalized EMG and the ITT, was reduced at the more extended compared with the more flexed

  5. Myofascial force transmission causes interaction between adjacent muscles and connective tissue: Effects of blunt dissection and compartmental fasciotomy on length force characteristics of rat extensor digitorum longus muscle

    NARCIS (Netherlands)

    Huijing, P.A.J.B.M.; Baan, G.C.

    2001-01-01

    Muscles within the anterior tibial compartment (extensor digitorum longus: EDL. tibialis anterior: TA, and extensor hallucis longus muscles: EHL) and within the peroneal compartment were excited simultaneously and maximally. The ankle joint was fixed kept at 90°. For EDL length force characteristics

  6. Effects of a low-intensity strength-training program on knee-extensor strength and functional ability of frail older people

    NARCIS (Netherlands)

    Westhoff, M.H.; Stemmerik, L.; Boshuizen, H.C.

    2000-01-01

    This study's purpose was to investigate whether a 10-week low-intensity strength-training program could improve strength of the knee extensors and functional ability. Participants 65 years and older with low knee-extensor muscle strength were randomized into an exercise (n = 11) and a control group

  7. Neurophysiological localisation of ulnar neuropathy at the elbow: validation of diagnostic criteria developed by a taskforce of the Danish Society of Clinical Neurophysiology

    DEFF Research Database (Denmark)

    Pugdahl, Kirsten; Beniczky, Sándor; Wanscher, Benedikte

    2017-01-01

    OBJECTIVE: This study validates consensus criteria for localisation of ulnar neuropathy at elbow (UNE) developed by a taskforce of the Danish Society of Clinical Neurophysiology and compares them to the existing criteria from the American Association of Neuromuscular and Electrodiagnostic Medicine...

  8. Modulation of recurrent inhibition from knee extensors to ankle motoneurones during human walking

    DEFF Research Database (Denmark)

    Lamy, Jean-Charles; Iglesias, Caroline; Lackmy, Alexandra

    2008-01-01

    The neural control for muscle coordination during human locomotion involves spinal and supraspinal networks, but little is known about the exact mechanisms implicated. The present study focused on modulation of heteronymous recurrent inhibition from knee extensors to ankle motoneurones at different...... times in the gait cycle, when quadriceps (Quad) muscle activity overlaps that in tibialis anterior (TA) and soleus (Sol). The effects of femoral nerve stimulation on ankle motoneurones were investigated during treadmill walking and during tonic co-contraction of Quad and TA/Sol while standing. Recurrent...... inhibition of TA motoneurones depended on the level of background EMG, and was similar during walking and standing for matched background EMG levels. On the other hand, recurrent inhibition in Sol was reduced in early stance, with respect to standing, and enhanced in late stance. Reduced inhibition in Sol...

  9. Surgical Treatment of Traumatic Myositis Ossificans of the Extensor Carpi Radialis Muscle in a Dog.

    Science.gov (United States)

    Morton, Bridget A; Hettlich, Bianca F; Pool, Roy R

    2015-07-01

    To report clinical signs, diagnostic imaging findings, and outcome in a dog with traumatic myositis ossificans of the origin of the extensor carpi radialis muscle. Clinical report. An 8-month-old intact female Irish Setter Dog. After radiographic and computed tomographic evaluation of an osseous proliferation arising from the cranial cortex of the right distal humeral diaphysis, the protruding bone was surgically removed and evaluated by histopathology. Traumatic myositis ossificans was successfully treated with surgical removal of the osseous proliferation resulting in improved postoperative range of motion of the right elbow joint. There was no evidence of lameness or abnormal bone regrowth associated with the surgical site radiographically at follow up. Surgical removal of a traumatic myositis ossificans lesion resulted in full return to function in a young, competitive show dog. © Copyright 2014 by The American College of Veterinary Surgeons.

  10. Isolated Tuberculous Tenosynovitis of the Anterior Tibial and Extensor Digitorum Longus Tendons

    Directory of Open Access Journals (Sweden)

    Berhan Genç

    2013-01-01

    Full Text Available Musculoskeletal system is involved in 1-5% of extrapulmonary cases of tuberculosis. Tuberculous tenosynovitis is a rare form of musculoskeletal tuberculosis. Tuberculosis of the tendon sheath in the hand has been seen in a few cases. Involvement of the tendons of the leg is less common. Diagnosis is not easy as there are no specific clinical symptoms or signs. A 33-year-old male presented with painful swelling in the distal right lower limb that caused restriction of movement. Imaging studies showed inflammation and infection of the extensor digitorium longus and tibialis anterior tendons. Histopathological studies showed a necrotizing granulomatous inflammation in the synovial tissue. A diagnosis of tuberculosis was made and medical treatment was initiated that proved successful. Patient remained infection-free at 26-month follow-up examination.

  11. Chronic triceps insufficiency managed with extensor carpi radialis longus and palmaris longus tendon grafts.

    Science.gov (United States)

    Singh, Dhanpal; Kumar, K Arun; Dinesh, Mc; Raj, Ranju

    2012-03-01

    Chronic triceps insufficiency, causing prolonged disability, occurs due to a missed diagnosis of an acute rupture. We report a 25 year old male with history of a significant fall sustaining multiple injuries. Since then, he had inability in extending his right elbow for which he sought intervention after a year. Diagnosis of triceps rupture was made clinicoradiologically and surgery was planned. Intraoperative findings revealed a deficient triceps with a fleck of avulsed bone from olecranon. Ipsilateral double tendon graft including extensor carpi radialis longus and palmaris longus were anchored to triceps and secured with the olecranon. Six-months follow revealed a complete active extension of elbow and a full function at the donor site.

  12. Catalase-positive microperoxisomes in rat soleus and extensor digitorum longus muscle fiber types

    Science.gov (United States)

    Riley, Danny A.; Bain, James L. W.; Ellis, Stanley

    1988-01-01

    The size, distribution, and content of catalase-reactive microperoxisomes were investigated cytochemically in three types of muscle fibers from the soleus and the extensor digitorum longus (EDL) of male rats. Muscle fibers were classified on the basis of the mitochondrial content and distribution, the Z-band widths, and the size and shape of myofibrils as the slow-twitch oxidative (SO), the fast-twitch oxidative glycolytic (FOG), and the fast-twitch glycolytic (FG) fibers. It was found that both the EDL and soleus SO fibers possessed the largest microperoxisomes. A comparison of microperoxisome number per muscle fiber area or the microperoxisome area per fiber area revealed following ranking, starting from the largest number and the area-ratio values: soleus SO, EDL SO, EDL FOG, and EDL FG.

  13. Electromyographic analysis of the vertebral extensor muscles during the Biering-Sorensen Test

    Directory of Open Access Journals (Sweden)

    Ligia Moreira de Santana

    2014-03-01

    Full Text Available The purpose of the study was to analyze the electromyographic signal of the multifidus, longissimus thoracis and the lumbar iliocostalis muscles during the Biering-Sorensen test in subjects without lower back pain. Twenty volunteers performed the test on three separate occasions. An analysis of variance detected a difference between the three test times (p = 0.0026. For the frequency domain, it was observed that there were differences between the multifidus and the lumbar erectors muscles; longissimus and iliocostalis muscles. However, in the time domain analysis, no difference was observed. As the values of the slope coefficients of median frequencies were higher for the multifidus muscle, compared to the longissimus and lumbar iliocostalis muscles, this may indicate a higher tendency toward muscle fatigue. Therefore, considering the applied methodology, the study of electromyographic signals in the frequency domain should be considered as an instrument to assess fatigue of the spinal extensor muscles in clinical situations.

  14. Variant Branching Pattern of Dorsalis Pedis Artery Accompanied with Anomalous Presence of Extensor Hallucis Brevis Muscle

    Directory of Open Access Journals (Sweden)

    Ashwini Aithal Padur

    2017-10-01

    Full Text Available During routine dissection, we came across multiple variations in the dorsum of the right foot. Dorsalis pedis artery (DPA presented with an unusual branching pattern. The arcuate artery was completely absent, and hence three tarsal branches arose from lateral side of DPA. The first branch continued as first dorsal metatarsal artery, the second branch continued as the second dorsal metatarsal artery, and the third branch continued as third dorsal metatarsal artery which also provided a small twig to the fourth intermetatarsal space as the fourth dorsal metatarsal artery. We also observed the unique presence of extensor hallucis brevis muscle with the origin from the medial part of superior surface of the calcaneus and inserted to proximal phalanx of great toe. Since the DPA was just beneath this muscle, anomalous presence of the muscle may lead to compression of DPA. Awareness regarding such variations is critical for angiographers, vascular surgeons, reconstructive and plastic surgeons.

  15. The Effects of Counterforce Brace Size on the Wrist Range of Motility, Pain, Grip & Wrist Extension Sterngth in Normal Subjects and Patients with Tennis Elbow

    Directory of Open Access Journals (Sweden)

    Ali Asghar Jameh-Bozorgi

    2006-04-01

    Full Text Available Objective: Counter force brace is one of the most usefull treatments for lateral opicondylitis (Tennis elbow because it decreases grip pain and increases the power of grip, power of wrist extension and Wrist Range of Motility. The purpose of this quasi experimental (repeated measurementsstudy was to determine the effect of 3 counterforce brace sizes on the wrist R.O.M, grip and wrist extension strength and pain intensity in two groups of healthy subjects and patients with tennis elbow. Materials & Methods: 18 normal subjects & 18 patients with tennis elbow were selected simple conveniently and were tested with no brace and 3 size of counterforce (1,2 and 3 inches. The R.O.M , strength and pain intensity were measured by jamar goniometry and Nicholas MMT dynamometry & VAS, respectively. Results: 1 With all sizes there was a significant decrease of R.O.M on normal subjects but no significant difference in patients. 2 There was a significant decrease of grip strength with 1-inch brace in normal subjects but a significant increase of grip strength with 2 and 3-inch brace in patiens. 3 All sizes of brace caused significant decrease of extension strength in normal subjects but increase in patients. 4All size caused significant decrease of pain intensity that was more considerable in the case of 2 and 3 inch size. Conclusion: The results shows that the counterforce brace may be considered as an effective treatment for increasing strength and decreasing pain in patients with tennis elbow.

  16. 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.

    Science.gov (United States)

    Hutson, Joel David; Hutson, Kelda Nadine

    2014-07-01

    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.

  17. β-alanine supplementation improves isometric endurance of the knee extensor muscles

    Directory of Open Access Journals (Sweden)

    Sale Craig

    2012-06-01

    Full Text Available Abstract Background We examined the effect of four weeks of β-alanine supplementation on isometric endurance of the knee extensors at 45% maximal voluntary isometric contraction (MVIC. Methods Thirteen males (age 23 ± 6 y; height 1.80 ± 0.05 m; body mass 81.0 ± 10.5 kg, matched for pre-supplementation isometric endurance, were allocated to either a placebo (n = 6 or β-alanine (n = 7; 6.4 g·d-1 over 4 weeks supplementation group. Participants completed an isometric knee extension test (IKET to fatigue, at an intensity of 45% MVIC, before and after supplementation. In addition, two habituation tests were completed in the week prior to the pre-supplementation test and a further practice test was completed in the week prior to the post-supplementation test. MVIC force, IKET hold-time, and impulse generated were recorded. Results IKET hold-time increased by 9.7 ± 9.4 s (13.2% and impulse by 3.7 ± 1.3 kN·s-1 (13.9% following β-alanine supplementation. These changes were significantly greater than those in the placebo group (IKET: t(11 = 2.9, p ≤0.05; impulse: t(11 = 3.1, p ≤ 0.05. There were no significant changes in MVIC force in either group. Conclusion Four weeks of β-alanine supplementation at 6.4 g·d-1 improved endurance capacity of the knee extensors at 45% MVIC, which most likely results from improved pH regulation within the muscle cell as a result of elevated muscle carnosine levels.

  18. Surface EMG characteristics of people with multiple sclerosis during static contractions of the knee extensors.

    Science.gov (United States)

    Scott, Sasha M; Hughes, Adrienne R; Galloway, Stuart D R; Hunter, Angus M

    2011-01-01

    This study was designed to determine whether any alterations existed in surface electromyography (sEMG) in people with multiple sclerosis (MS) during isometric contractions of the knee extensors. Fifteen people with MS and 14 matched controls (mean ± SD age and body mass index 53·7 ± 10·5 versus 54·6 ± 9·6 years and 27·7 ± 6·1 versus 26·5 ± 4, respectively) completed 20%, 40%, 60% and 80% of their maximal voluntary contraction (MVC) of the knee extensors. sEMG was recorded from the vastus lateralis where muscle fibre conduction velocity (MFCV) and sEMG amplitude (RMS) were assessed. Body composition was determined using dual-energy X-ray absorptiometry and physical activity with the use of accelerometry. People with MS showed significantly (P<0·05) faster MFCV during MVC (6·6 ± 2·7 versus 4·7 ± 1·4 m s(-1) ) and all submaximal contractions, while RMS was significantly (P<0·05) less (0·11 ± 0·03 versus 0·24 ± 0·06 mV) in comparison with the controls. MVC along with specific thigh lean mass to torque, rate of force development and mean physical activity were significantly (P<0·01) less in PwMS. People with MS have elevated MFCV alongside reduced RMS during isometric contraction. This elevation in MFCV should be accounted for when interpreting sEMG from people with MS. © 2010 University of Stirling. Clinical physiology and Functional Imaging © 2010 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

  19. Evaluation of a compact portable DEXA unit for wrist densitometry

    Energy Technology Data Exchange (ETDEWEB)

    Mares, T.; Bonovas, G.; Larcos, G. [Westmead Hospital, Sydney, NSW (Australia). Department of Nuclear Medicine

    1998-06-01

    Full text: Recently, a number of manufacturers have introduced compact, portable DEXA units in order to facilitate osteoporosis screening in remote communities and on an in-office basis. The purposes of this study were to evaluate the accuracy and reproducibility of the Norland-Stratec (pDEXA) compared to measurements obtained using a conventional densitometer (Norland XR-36). We recruited 61 adults (3 men, 58 women) with mean age 54 years (range: 19-76) referred for clinical assessment of BMD. Most patients had medications (n=39; 64%) or disorders (n=48;79%) known to interfere with bone mineral metabolism. Subjects underwent bone densitometry of the lumbar spine, (AP; L2-4) femoral neck and distal radius/ulna of the nondominant forearm using the Norland XR-36, with the wrist subsequently re-scanned on pDEXA. Four subjects also underwent 5 scans each on the pDEXA. Mean BMD for the distal radius/ulna was 0.30g/cm2 (range: 0.17 - 0.539/cm2; XR-36) vs 0.319/cm2 (range: 0.18-0.56 g/cm2; pDEXA), r = 0.98 (SEE = 0.07). Mean BMC for the distal radius/ulna was 1.229 (range: 0.67-2.59; XR-36) vs 1.289 (range:0.74-2.69; pDEXA), r = 0.97 (SEE= 0.08). The CV for pDEXA was 0.8% (BMD) and 2.5% (BMC). Thus, we conclude that pDEXA has excellent in-vivo reproducibility, with good correlation of BMD and BMC with standard densitometers

  20. Hand and wrist involvement in systemic sclerosis: US features.

    Science.gov (United States)

    Freire, Véronique; Bazeli, Ramin; Elhai, Muriel; Campagna, Raphaël; Pessis, Éric; Avouac, Jérôme; Allanore, Yannick; Drapé, Jean-Luc; Guérini, Henri

    2013-12-01

    To characterize ultrasonographic (US) features in the hand of patients with systemic sclerosis (SSc) and to evaluate the sensitivity of US in the detection of calcinosis and acroosteolysis. The local ethics committee approved this study, and oral informed consent was obtained. A total of 44 consecutive patients with SSc (34 women; mean age, 56.1 years ± 12.1 [standard deviation]; 10 men; mean age, 45.0 years ± 14.0) and 30 healthy control subjects (20 women; mean age, 46.3 years ± 12.1; 10 men; mean age, 39.6 years ± 10.8) were included between October 2010 and December 2011. Bilateral US, including Doppler assessment of the wrists, hands, and fingers, was performed, and presence of synovitis, tenosynovitis with or without a layered appearance, calcifications, acroosteolysis, and distal vascularization was recorded. Radiography of both hands was performed to assess for acroosteolysis and calcinosis. Frequency of US features, sensitivity of US for calcinosis and acroosteolysis, and respective confidence intervals were calculated. Synovitis was found in 17 patients (39%). Tenosynovitis was found in 12 patients (27%), and it had a layered pattern in 15 (41%) of 37 cases. Calcinosis was found in 17 patients (39%) with US, with a sensitivity of 89%. Acroosteolysis was found in nine (20%) patients with US and in 10 (23%) patients with radiography, with 90% sensitivity for US. Distal vascularization was detected in 26 patients (59%) and 30 control subjects (100%) and was in contact with the acroosteolysis bed in seven (78%) of nine patients with SSc. US can be used to assess features of SSc, including synovitis, tenosynovitis, calcinosis, acroosteolysis, and distal vascularization and is sensitive for calcinosis and acroosteolysis detection. A layered pattern (similar to the appearance of an artichoke heart) of tenosynovitis was seen commonly. Online supplemental material is available for this article. © RSNA, 2013.