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OBJECTIVE: To evaluate the clinical outcomes of arthroscopic inside-out ganglionectomy of dominant dorsal wrist ganglion. METHODS: Patients with dominant wrist ganglion cyst treated in our hospital from January 1, 2014 to June 31, 2023 was enrolled in this retrospective analysis. All patients underwent dye-assist arthroscopic inside-out ganglionectomy. After discharge, the patients were followed for a minimum of 6 months. The primary outcomes were to assess patient wrist function using the Patient-Rated Wrist Evaluation (PRWE) and Mayo Modified Wrist Score (MMWS). The secondary outcomes were visual analog score (VAS), wrist active range of motion (ROM), grip strength, recurrence rate and complication. RESULTS: All ganglion were successfully resected after dye staining. Patients were followed for an average of 12.17 months. There were no significant changes between preoperative and postoperative wrist active ROM or grip strength, except for wrist flexion (which showed a slightly greater improvement after surgery, P = 0.049), there were notable improvements in VAS, MMWS, and PRWE postoperatively. Recurrence occurred in 3 patients. No major complications observed during the follow-up period. CONCLUSION: Dye-assist arthroscopic inside-out ganglionectomy is safe and uncomplicated, worth of clinical promotion.

Asunto(s)

Artroscopía , Ganglión , Ganglionectomía , Humanos , Estudios Retrospectivos , Masculino , Artroscopía/métodos , Artroscopía/efectos adversos , Femenino , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Ganglión/cirugía , Ganglionectomía/métodos , Rango del Movimiento Articular , Colorantes , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/fisiopatología , Adulto Joven , Estudios de Seguimiento , Fuerza de la Mano , Recurrencia

RESUMEN

Surface electromyography (sEMG) offers a novel method in human-machine interactions (HMIs) since it is a distinct physiological electrical signal that conceals human movement intention and muscle information. Unfortunately, the nonlinear and non-smooth features of sEMG signals often make joint angle estimation difficult. This paper proposes a joint angle prediction model for the continuous estimation of wrist motion angle changes based on sEMG signals. The proposed model combines a temporal convolutional network (TCN) with a long short-term memory (LSTM) network, where the TCN can sense local information and mine the deeper information of the sEMG signals, while LSTM, with its excellent temporal memory capability, can make up for the lack of the ability of the TCN to capture the long-term dependence of the sEMG signals, resulting in a better prediction. We validated the proposed method in the publicly available Ninapro DB1 dataset by selecting the first eight subjects and picking three types of wrist-dependent movements: wrist flexion (WF), wrist ulnar deviation (WUD), and wrist extension and closed hand (WECH). Finally, the proposed TCN-LSTM model was compared with the TCN and LSTM models. The proposed TCN-LSTM outperformed the TCN and LSTM models in terms of the root mean square error (RMSE) and average coefficient of determination (R2). The TCN-LSTM model achieved an average RMSE of 0.064, representing a 41% reduction compared to the TCN model and a 52% reduction compared to the LSTM model. The TCN-LSTM also achieved an average R2 of 0.93, indicating an 11% improvement over the TCN model and an 18% improvement over the LSTM model.

Asunto(s)

Electromiografía , Redes Neurales de la Computación , Articulación de la Muñeca , Humanos , Electromiografía/métodos , Articulación de la Muñeca/fisiología , Rango del Movimiento Articular/fisiología , Movimiento/fisiología , Procesamiento de Señales Asistido por Computador , Algoritmos , Adulto , Masculino , Muñeca/fisiología

Asunto(s)

Ultrasonografía , Articulación de la Muñeca , Humanos , Articulación de la Muñeca/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Diagnóstico Diferencial , Traumatismos de la Mano/diagnóstico por imagen

RESUMEN

Although an increase in ulnar variance with power grip is well documented in the medical literature, there is a paucity of information concerning its mechanism. This concept was examined in five healthy individuals using computed tomography of their wrists and elbows. Images were obtained of both joints in the resting position and with maximum power grip. Ulnar variance at the wrist increased an average of 0.64 mm (range: 0.3 to 1.2 mm). While the ulnohumeral joint remained unchanged, the radiocapitellar distance shortened an average of 0.62 mm (range: 0.3 to 1.0 mm; p = 0.03), which correlated directly with the change at the wrist. Our study showed that the increase in ulnar variance with grip was due to proximal shift of the radius and not to any distal migration of the ulna, which may have clinical implications in reconstruction or arthroplasty of the elbow.

Asunto(s)

Articulación del Codo , Fuerza de la Mano , Cúbito , Articulación de la Muñeca , Humanos , Cúbito/diagnóstico por imagen , Fuerza de la Mano/fisiología , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Masculino , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Adulto , Femenino , Tomografía Computarizada por Rayos X , Voluntarios Sanos , Fenómenos Biomecánicos , Adulto Joven , Radio (Anatomía)/diagnóstico por imagen , Valor Predictivo de las Pruebas , Persona de Mediana Edad , Rango del Movimiento Articular/fisiología

RESUMEN

The redundancy present within the musculoskeletal system may offer a non-invasive source of signals for movement augmentation, where the set of muscle activations that do not produce force/torque (muscle-to-force null-space) could be controlled simultaneously to the natural limbs. Here, we investigated the viability of extracting movement augmentation control signals from the muscles of the wrist complex. Our study assessed (i) if controlled variation of the muscle activation patterns in the wrist joint's null-space is possible; and (ii) whether force and null-space cursor targets could be reached concurrently. During the null-space target reaching condition, participants used muscle-to-force null-space muscle activation to move their cursor towards a displayed target while minimising the exerted force as visualised through the cursor's size. Initial targets were positioned to require natural co-contraction in the null-space and if participants showed a consistent ability to reach for their current target, they would rotate 5 ∘ incrementally to generate muscle activation patterns further away from their natural co-contraction. In contrast, during the concurrent target reaching condition participants were required to match a target position and size, where their cursor position was instead controlled by their exerted flexion-extension and radial-ulnar deviation, while its size was changed by their natural co-contraction magnitude. The results collected from 10 participants suggest that while there was variation in each participant's co-contraction behaviour, most did not possess the ability to control this variation for muscle-to-force null-space virtual reaching. In contrast, participants did show a direction and target size dependent ability to vary isometric force and co-contraction activity concurrently. Our results indicate the limitations of using the muscle-to-force null-space activity of joints with a low level of redundancy as a possible command signal for movement augmentation.

Asunto(s)

Contracción Muscular , Músculo Esquelético , Articulación de la Muñeca , Muñeca , Humanos , Músculo Esquelético/fisiología , Masculino , Femenino , Muñeca/fisiología , Adulto , Articulación de la Muñeca/fisiología , Contracción Muscular/fisiología , Electromiografía , Movimiento/fisiología , Adulto Joven , Fenómenos Biomecánicos

RESUMEN

BACKGROUND: Triangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist. METHODS: In this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery. RESULTS: The cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%. CONCLUSION: Arthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries.

Asunto(s)

Artroscopía , Rango del Movimiento Articular , Fibrocartílago Triangular , Humanos , Artroscopía/métodos , Masculino , Femenino , Estudios Retrospectivos , Fibrocartílago Triangular/lesiones , Fibrocartílago Triangular/cirugía , Adulto , Persona de Mediana Edad , Adulto Joven , Traumatismos de la Muñeca/cirugía , Resultado del Tratamiento , Fuerza de la Mano , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/fisiopatología

RESUMEN

When fatigued, the wrist extensors, which are the primary wrist stabilizers, impair distal upper limb motor performance in a surprisingly similar way as when fatiguing the wrist flexors. It is possible that the wrist extensors are so active as antagonists that they develop an equal degree of fatigue during wrist flexion contractions, making it difficult to truly isolate their impact on performance. Thus, the purpose of this study was to examine how wrist flexion/extension forces are impaired following either agonist or antagonist sustained submaximal wrist contractions. 13 male participants attended four laboratory sessions. In these sessions, fatigue was induced via a sustained submaximal isometric contraction of either wrist flexion or extension. These contractions were held for up to 10 min at 20% of the participant's baseline maximal voluntary contraction (MVC) force. Throughout the sustained contraction, intermittent agonist (matching the sustained contraction) or antagonist (opposing the sustained contraction) MVCs were performed. Unsurprisingly, agonist MVC forces decreased significantly more than antagonist (Agonist: 58.5%, Antagonist: 86.5% of MVC, P < 0.001). However, while there were no differences in antagonist wrist extension and flexion MVC decreases (Wrist Flexion: 87.5%, Wrist Extension: 85.5%, P = 0.41), wrist extension MVCs did decrease significantly more than wrist flexion MVCs when forces were expressed relative to the agonist (P = 0.036). These findings partially support the hypothesis that the wrist extensors may be more susceptible to developing fatigue when functioning as antagonists than the wrist flexors. This work will help equip future research into the motor control of the upper limb and the prevention of forearm-related musculoskeletal disorders.

Asunto(s)

Contracción Isométrica , Fatiga Muscular , Músculo Esquelético , Muñeca , Humanos , Masculino , Contracción Isométrica/fisiología , Fatiga Muscular/fisiología , Adulto , Adulto Joven , Muñeca/fisiología , Músculo Esquelético/fisiología , Articulación de la Muñeca/fisiología , Rango del Movimiento Articular/fisiología , Fenómenos Biomecánicos/fisiología , Electromiografía

RESUMEN

INTRODUCTION: The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease. PATIENT CONCERNS: A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand. DIAGNOSES: Left-sided infected wrist arthritis complicating ACTS. INTERVENTIONS: The child received emergency surgery and anti-infective treatment combined with regular rehabilitation. OUTCOMES: During the treatment period, the child's wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited. CONCLUSION: In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.

Asunto(s)

Artritis Infecciosa , Síndrome del Túnel Carpiano , Articulación de la Muñeca , Humanos , Masculino , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Niño , Artritis Infecciosa/complicaciones , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Artritis Infecciosa/diagnóstico , Antibacterianos/uso terapéutico , Enfermedad Aguda

RESUMEN

CASE: We report a case of progressive angular deformity of the left wrist in a 4-year-old girl with a 2-year history of juvenile idiopathic arthritis (JIA)-oligoarthritis subtype (<4 joints affected) with inflammatory extensor tenosynovitis affecting the left wrist, who underwent a left distal radius osteotomy with tricortical allograft for angular correction and functional recovery. Six years postoperatively, the patient demonstrates a near-anatomic left wrist and has recovered full range of motion and function. CONCLUSION: This case demonstrates how rare clinically devastating angular deformities in JIA may safely and effectively be surgically managed to promote normal, long-term, extremity function.

Asunto(s)

Artritis Juvenil , Osteotomía , Radio (Anatomía) , Humanos , Femenino , Artritis Juvenil/complicaciones , Artritis Juvenil/cirugía , Preescolar , Radio (Anatomía)/cirugía , Radio (Anatomía)/anomalías , Radio (Anatomía)/diagnóstico por imagen , Osteotomía/métodos , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/diagnóstico por imagen

RESUMEN

BACKGROUND: Capitate osteonecrosis is a rare condition that mainly presents in young patients with chronic wrist pain. Treatment aims to address pain, arthritic changes, or carpal instability. METHODS: We present the surgical technique and outcomes of using a vascularized pedicled second metacarpal base transferred on the second dorsal metacarpal artery to treat capitate osteonecrosis in a 20-year-old female secretary, former gymnast, and a 25-year-old female student with acute lymphoblastic leukemia. These patients presented with idiopathic chronic wrist pain with MRI showing capitate osteonecrosis with preserved carpal height and intact articular cartilage. RESULTS: After 2 years of follow-up, both patients endorsed pain resolution and demonstrated preservation of wrist motion and grip strength with evidence of capitate healing on plain radiographs. Case 1 demonstrated grip strength 60 lbs., pinch strength 5 lbs., and wrist flexion-extension arc of 70 to 80°. Case 2 had grip strength 31 lbs., pinch strength 9 lbs., and wrist flexion-extension arc of 40 to 30° on the left. CONCLUSION: Vascularized pedicled second metacarpal base transferred on the second dorsal metacarpal artery can be successfully used in the management of capitate osteonecrosis and offers advantages over other vascularized bone grafts for capitate osteonecrosis.

Asunto(s)

Hueso Grande del Carpo , Huesos del Metacarpo , Osteonecrosis , Humanos , Osteonecrosis/cirugía , Osteonecrosis/diagnóstico por imagen , Femenino , Hueso Grande del Carpo/cirugía , Adulto , Huesos del Metacarpo/cirugía , Adulto Joven , Fuerza de la Mano , Articulación de la Muñeca/cirugía , Trasplante Óseo/métodos

RESUMEN

BACKGROUND: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes. PATIENTS AND METHODS: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported. RESULTS: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively. CONCLUSION: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF. LEVEL OF EVIDENCE: level IV evidence.

Asunto(s)

Artrodesis , Hueso Grande del Carpo , Fracturas no Consolidadas , Hueso Semilunar , Hueso Escafoides , Humanos , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Hueso Escafoides/diagnóstico por imagen , Masculino , Artrodesis/métodos , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Hueso Semilunar/cirugía , Hueso Semilunar/lesiones , Hueso Semilunar/diagnóstico por imagen , Hueso Grande del Carpo/cirugía , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Resultado del Tratamiento , Traumatismos de la Muñeca/cirugía , Traumatismos de la Muñeca/diagnóstico por imagen , Rango del Movimiento Articular , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatología , Adulto Joven , Estudios de Seguimiento , Fuerza de la Mano

RESUMEN

OBJECTIVES: To explore the effects of different test positions on quantitative muscle strength of wrist and finger flexor muscle groups and to establish a standardized muscle strength test protocol for each muscle group. METHODS: Forty healthy subjects (12 males and 28 females) were recruited. A portable digital quantitative muscle strength tester, Micro FET2TM, was used to measure the flexor muscle strength of each finger and the wrist joint at the 30° extension, 0° neutral, and 30° flexion, respectively. Palmar abduction strength of the thumb was measured at 30° and 60°, respectively. Ten subjects were randomly selected from the 40 subjects, and the quantitative muscle strength of each muscle group was tested again by the same operator after an interval of 10 to 15 days. RESULTS: Except for the fact that in males, there was no significant difference in flexor muscle strength of thumb and wrist joint between 30° of wrist extension and neutral 0° position, the muscle strength of the other fingers flexion and wrist palmar flexor showed the following characteristics：30° of wrist extension > neutral 0° position > 30° of flexion, and the PAST was 30°>60°; The flexor muscle strength of all the subjects was thumb > index finger > middle finger > ring finger > little finger; All muscle strength values of male were greater than those of female, and the difference was statistically significant (P<0.05); There was no significant difference between the left and right side muscle strength values of all subjects (P>0.05). The reliability of muscle strength values measured at different times in 10 subjects was good. CONCLUSIONS: The quantitative muscle strength of each muscle group of the hand and wrist is affected by the test position, and a standardized and uniformed test position should be adopted in the actual identification. Micro FET2TM has good reliability for hand and wrist quantitative muscle strength testing. The 30° extension of the wrist can be used as the best standardized test position for the flexion muscle strength of each finger and wrist joint. The 30° position can be used as the best standardized test position for PAST.

Asunto(s)

Dedos , Fuerza Muscular , Músculo Esquelético , Articulación de la Muñeca , Humanos , Masculino , Femenino , Dedos/fisiología , Músculo Esquelético/fisiología , Adulto , Fuerza Muscular/fisiología , Adulto Joven , Articulación de la Muñeca/fisiología , Muñeca/fisiología , Fuerza de la Mano/fisiología , Rango del Movimiento Articular/fisiología , Postura/fisiología , Dinamómetro de Fuerza Muscular , Pulgar/fisiología , Articulaciones de los Dedos/fisiología , Reproducibilidad de los Resultados

RESUMEN

Objective: To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods: A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results: All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05). Conclusion: For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.

Asunto(s)

Artroscopía , Fijación Interna de Fracturas , Fracturas del Radio , Rango del Movimiento Articular , Fibrocartílago Triangular , Fracturas del Cúbito , Humanos , Fibrocartílago Triangular/lesiones , Fibrocartílago Triangular/cirugía , Fracturas del Cúbito/cirugía , Fijación Interna de Fracturas/métodos , Estudios Retrospectivos , Artroscopía/métodos , Fracturas del Radio/cirugía , Fuerza de la Mano , Resultado del Tratamiento , Masculino , Femenino , Articulación de la Muñeca/cirugía , Traumatismos de la Muñeca/cirugía , Adulto

RESUMEN

PURPOSE: Exploring the therapeutic effects of Ni-Ti shape memory alloy four-corner arthrodesis concentrator (NT-FCAC) in treating scaphoid nonunion advanced collapse (SNAC) and providing a decade-long follow-up report. MATERIALS AND METHODS: Twenty-six patients with SNAC underwent scaphoidectomy, along with four-corner arthrodesis fusion involving the capitate, lunate, triquetrum, and hamate, using NT-MFCAC. Grip strength was measured using a Jamar dynamometer, while wrist joint mobility was assessed using a goniometer. Preoperative and postoperative assessments were conducted using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire to monitor limb functionality restoration. Pain levels at the wrist joint were evaluated using the visual analog scale (VAS). Postoperative wrist bone fusion status was assessed through anteroposterior and lateral radiographs of the wrist joint. RESULTS: After a 3-month postoperative period, all 26 patients exhibited osseous union at the wrist joint. Over a follow-up spanning 10-15 years, no severe postoperative complications were observed in any patient. Grip strength in the affected side of all patients recovered to 81.96% compared to the healthy side, while wrist joint mobility in the affected side reached over 60% of the healthy side's functionality. VAS scores decreased significantly from 5.85 ± 0.73 preoperatively to 0.19 ± 0.40 at the final follow-up; Quick DASH scores reduced from 69.88 ± 5.12 preoperatively to 6.30 ± 1.25 at final follow-up. Statistically significant differences were noted in VAS and Quick DASH scores for all patients (p < 0.05). However, beyond 60 months postoperatively, subsequent follow-ups did not yield statistically significant differences in VAS and Quick DASH scores for all patients (p > 0.05). CONCLUSIONS: Utilizing NT-FCAC for SNAC treated with four-corner arthrodesis fusion results in a high rate of wrist bone fusion, preserving a significant portion of wrist joint function and exhibiting favorable long-term outcomes. This approach is suitable for treating patients with SNAC requiring four-corner arthrodesis fusion.

Asunto(s)

Artrodesis , Fracturas no Consolidadas , Fuerza de la Mano , Níquel , Hueso Escafoides , Titanio , Humanos , Artrodesis/instrumentación , Masculino , Femenino , Hueso Escafoides/cirugía , Estudios de Seguimiento , Adulto , Persona de Mediana Edad , Fracturas no Consolidadas/cirugía , Rango del Movimiento Articular , Articulación de la Muñeca/cirugía , Adulto Joven , Resultado del Tratamiento , Dimensión del Dolor

RESUMEN

SUMMARY: The distal radioulnar joint (DRUJ) is vital to the stability and function of the wrist and forearm. The osseous morphology is variable and provides little stability. A complex of confluent soft tissues is the primary stabilizer; however, the contribution of each component has yet to be elucidated. It has become increasingly clear that the anatomic fixation of distal radius fractures restores DRUJ stability, obviating the need for additional DRUJ stabilization. This review will describe the anatomy and biomechanics of the DRUJ and discuss injury patterns, treatments, and clinical results.

Asunto(s)

Inestabilidad de la Articulación , Fracturas del Radio , Articulación de la Muñeca , Humanos , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/cirugía , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/cirugía , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Fenómenos Biomecánicos , Fijación Interna de Fracturas/métodos , Radio (Anatomía)/anatomía & histología

RESUMEN

Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.

Asunto(s)

Luxaciones Articulares , Traumatismos de la Muñeca , Humanos , Masculino , Luxaciones Articulares/cirugía , Adulto Joven , Traumatismos de la Muñeca/cirugía , Articulación de la Muñeca

RESUMEN

BACKGROUND: Active wrist joint position sense (JPS) is a feasible method for determining wrist proprioception. However, the normative values and factors affecting wrist JPS are not known. OBJECTIVES: To identify normative values of active wrist JPS in young healthy adults and explore the influence of sex, hand dominance and direction of wrist movement. DESIGN: Cross-sectional study. METHOD: JPS of 100 individuals aged 18-40 years, (male: female = 51:49) were measured at two wrist positions (20° flexion/extension) using the active wrist JPS test. Absolute error (in degrees) was calculated and summarized using descriptive measures. Kruskal-Wallis analysis of variance was performed to determine the differences in JPS error based on sex, dominance and direction of wrist movement. RESULTS: Mean absolute JPS flexion error on the dominant side was 3.47°(SD = 3.91°), and non-dominant side was 3.26°(SD = 3.23°). Mean absolute JPS extension error on the dominant side was 3.35°(SD = 3.43°), and non-dominant side was 4.59°(SD = 4.82°). Compared to males, females had more absolute error for flexion and extension on the dominant side. No significant difference was found in the absolute error between the dominant and non-dominant sides or between flexion and extension. CONCLUSION: These normative values of active JPS in young healthy adults can help clinicians while assessing proprioceptive impairments of the wrist. Differences in JPS errors due to sex were found, but not due to dominance or direction of movement. These findings can guide future research on mechanisms involved in wrist JPS.

Asunto(s)

Propiocepción , Rango del Movimiento Articular , Articulación de la Muñeca , Humanos , Masculino , Femenino , Adulto , Articulación de la Muñeca/fisiología , Estudios Transversales , Propiocepción/fisiología , Adulto Joven , Rango del Movimiento Articular/fisiología , Valores de Referencia , Adolescente , Factores Sexuales , Movimiento/fisiología , Voluntarios Sanos , Lateralidad Funcional/fisiología

RESUMEN

OBJECTIVE: The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius, leading to Madelung deformity. The purpose of this study was to clarify the nature of the Vickers ligament and investigate its pathogenesis in Madelung deformities based on our observation of the Vickers ligament. METHODS: All 22 patients (33 wrists) with Madelung deformities treated surgically between 2018 and 2022 were included. The diagnosis was confirmed radiographically in all patients. The three-dimensional computed tomography (3D-CT) data of 16 patients (19 wrists) were available. Magnetic resonance imaging (MRI) data were available for 9 patients (14 wrists). Wrist arthroscopy was used in 4 patients. The Vickers ligament was resected and submitted for histopathological examination in 8 patients. Radiographic outcomes, 3D-CT, MRI, arthroscopy, surgical findings, and histopathology of the Vickers ligament were evaluated. RESULTS: The 3D-CT revealed that the Vickers ligament originated in the metaphysis and formed a metaphyseal defect at the palmar ulnar radius. In the sequential MR coronal images, the Vickers ligament could be divided into 3 branches, extending to the lunate, triquetrum and ulnar styloid. Arthroscopy and surgical findings revealed that the nature of the Vickers ligament was the stretched palmar ligament of the wrist. The histopathology results revealed ligamentous tissue and fibrocartilaginous metaplasia with a structure similar to that of the triangular fibrocartilage complex (TFCC). CONCLUSIONS: The Vickers ligament is not a separate aberrant ligament. The nature of the Vickers ligament is a combination of the stretched TFCC ligament (palmar radioulnar ligament, ulnotriquetral ligament and ulnolunate ligament) and radiolunate ligament. The possible pathogenesis of Madelung deformity might be focal early epiphyseal closure at the middle part of the sigmoid notch, which leads to focal growth retardation of the radius and pulls palmar ligaments proximally to form the Vickers ligament.

Asunto(s)

Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Adulto , Adolescente , Tomografía Computarizada por Rayos X , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/patología , Articulación de la Muñeca/anomalías , Adulto Joven , Osteocondrodisplasias/diagnóstico por imagen , Osteocondrodisplasias/patología , Artroscopía , Niño , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/patología , Imagenología Tridimensional , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/anomalías , Radio (Anatomía)/patología , Persona de Mediana Edad , Trastornos del Crecimiento

RESUMEN

BACKGROUND: Data in the literature on the results of Kinesio taping (KT) application after cast removal in patients with distal radius fracture (DRF) are quite limited. PURPOSE: It was aimed to evaluate the effectiveness of KT applied immediately after cast removal in addition to the exercise program on edema, functionality, range of motion, and muscle strength in patients with conservatively followed DRF. STUDY DESIGN: Randomized controlled single-blinded clinical study. METHODS: This study was conducted with 64 patients with a diagnosis of DRF. The patients were randomized as Kinesio taping group (KTG) and control group. Both groups received a conventional home exercise program. KT was applied to patients in KTG for 10 days. Circumference and volume measurements were taken at baseline and day 10. Arm, Shoulder, and Hand Questionnaire for Disability, Visual Analog Scale, grip strength, and wrist joint range of motion measurements were taken at baseline, day 5, and day 10. RESULTS: The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the fifth day at the wrist level (<0.001) and 6 cm proximal to the wrist (p = 0.001). The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the 10th day at the wrist level (p < 0.05) and 6 cm proximal to the wrist (p = 0.01). Wrist extension angle (<0.001), wrist flexion angle (p = 0.001), and supination angle (p = 0.001) were higher in KTG on the 10th day. On the 10th day, the grip strength (p < 0.05) was higher in the KTG, while the Visual Analog Scale value (p < 0.01), Arm, Shoulder, and Hand Questionnaire for Disability score (p < 0.01), and the percentage of strength loss in the healthy arm (p < 0.01) were lower in the KTG. CONCLUSIONS: In patients with DRF who were treated conservatively with a cast, the inclusion of Kinesio taping (KT) in the rehabilitation program was found to be effective in reducing edema and pain, as well as improving functionality, strength, and range of motion.

Asunto(s)

Cinta Atlética , Moldes Quirúrgicos , Edema , Fracturas del Radio , Rango del Movimiento Articular , Humanos , Método Simple Ciego , Masculino , Fracturas del Radio/terapia , Fracturas del Radio/rehabilitación , Femenino , Rango del Movimiento Articular/fisiología , Edema/etiología , Persona de Mediana Edad , Fuerza de la Mano/fisiología , Adulto , Articulación de la Muñeca/fisiopatología , Fuerza Muscular/fisiología , Anciano , Terapia por Ejercicio/métodos , Tratamiento Conservador , Fracturas de la Muñeca

RESUMEN

Ulnar-sided wrist pain is a challenging clinical scenario due to multiple overlapping pathologies and involved anatomic structures. Advanced imaging such as magnetic resonance imaging can be used as an effective diagnostic adjunct if interpreted correctly. In this article, clinically relevant structures and radiographic correlates of the ulnar wrist are discussed and a corresponding systematic approach to reviewing magnetic resonance imaging is presented.

Asunto(s)

Artralgia , Imagen por Resonancia Magnética , Articulación de la Muñeca , Humanos , Articulación de la Muñeca/diagnóstico por imagen , Artralgia/diagnóstico por imagen , Artralgia/etiología , Cúbito/diagnóstico por imagen