Hand and Wrist Injuries: Common Problems and Solutions

No Evidence for the Superiority of 3 Tesla Magnetic Resonance Imaging Over 1.5 Tesla Magnetic Resonance Imaging for Diagnosing Wrist Ligamentous Lesions: A Systematic Review and Meta-analysis

PURPOSE

To determine the diagnostic accuracy of native magnetic resonance imaging (MRI) regarding different ligamentous lesions of the wrist and to analyze the influence of technical characteristics, such as field strength, application of fat saturation, 3-dimensional sequences, and wrist coils.

METHODS

A systematic search was performed using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases. Studies that were published before February 12, 2024, were included. All studies comparing the diagnostic accuracy of native wrist MRI with that of wrist arthroscopy for suspected ligamentous lesions were included. Results were analyzed by anatomic localization and technical aspects of the MRI. To assess the quality of included studies, we used the revised Quality Assessment of Diagnostic Accuracy Studies tool.

RESULTS

The systematic search revealed 5,181 articles. Thirty-seven studies, reporting 3,893 ligamentous lesions, were eligible for inclusion. The studies displayed heterogeneity in terms of technical conditions, such as field strength, the use of wrist coils, the application of 3-dimensional sequences, and fat saturation. Research methods also varied. Overall sensitivity and specificity were 0.78 (0.66-0.86) and 0.81 (0.70-0.89) for 1.5 Tesla (1.5T) MRI, whereas sensitivity was 0.73 (0.68-0.78) and specificity was 0.90 (0.59-0.98) for 3 Tesla (3T) MRI. There was no significant difference between the 2 subgroups (P = .3807 and P = .4248). Sensitivity was 0.82 (0.75-0.87) for triangular fibrocartilage complex lesions, 0.63 (0.50-0.74) for scapholunate ligament tears, and 0.41 (0.25-0.60) for lunotriquetral ligament lesions. Specificity for triangular fibrocartilage complex lesions was 0.82 (0.73-0.89), for scapholunate ligament tears was 0.86 (0.73-0.93), and for lunotriquetral ligament lesions was 0.93 (0.81-0.98).

CONCLUSIONS

The sensitivity and specificity of MRI are influenced by the anatomic location of the lesion and technical conditions. In terms of diagnostic accuracy, no significant difference was found between 1.5T and 3T MRI.

LEVEL OF EVIDENCE

Level III, systematic review of Level II-III studies.

The treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur contact sport athletes: A scoping review

INTRODUCTION

Amateur and professional participation in sport and physical activity worldwide is increasing in popularity, which in turn is increasing the volume and types of injuries sustained by athletes. Ensuring these injuries are treated appropriately and efficiently is paramount for athletes' recovery and return to sport in a timely and safe manner.

METHODS

A scoping review to map the evidence regarding the treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur athlete from contact sports. A search of seven electronic databases; SPORTdiscus, CINAHL, Medline, Scopus, Web of Science, Embase and Cochrane Library and grey literature was conducted in January 2024. The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Inductive content analysis was used to examine the data and the Critical Appraisal Skills Programme was used to appraise the quality of the included studies.

RESULTS

Eight papers met the inclusion criteria and three themes emerged addressing the return to play/sport, surgical and conservative treatment and the most common/reoccurring injuries sustained from contact sports.

CONCLUSION

Managing hand, wrist, finger, and thumb injuries in athletes requires a varied approach depending on the type of injury, treatment options, and external pressures. While conservative treatment is common and effective, surgical intervention may be necessary in certain cases to improve recovery and facilitate a faster return to sport. Preventive measures in high-risk sports settings could help reduce the incidence of these injuries.

Development of the Biomech-Wrist: A 3-DOF Exoskeleton for Rehabilitation and Training of Human Wrist

This work describes a three-degrees-of-freedom rehabilitation exoskeleton robot for wrist articulation movement: the Biomech-Wrist. The proposed development includes the design requirements based on the biomechanics and anthropometric features of the upper limb, the mechanical design, electronic instrumentation, software design, manufacturing, control algorithm implementation, and the experimental setup to validate the functionality of the system. The design requirements were set to achieve human wrist-like movements: ulnar-radial deviation, flexion-extension, and pronation-supination. Then, the mechanical design considers the human range of motion with proper torques, velocities, and geometry. The manufacturing consists of 3D-printed elements and tubular aluminum sections resulting in lightweight components with modifiable distances. The central aspect of the instrumentation is the actuation system consisting of three brushless motors and a microcontroller for the control implementation. The proposed device was evaluated by considering two control schemes to regulate the trajectory tracking on each joint. The first scheme was the conventional proportional-derivative controller, whereas the second was proposed as a first-order sliding mode. The results show that the Biomech-Wrist exoskeleton can perform trajectory tracking with high precision ( RMSEmax = 0.0556 rad) when implementing the sliding mode controller.

Biophysical Stimulation in Delayed Fracture Healing of Hand Phalanx: A Radiographic Evaluation

Phalangeal fractures are common events among the upper limbs accounting for 10% of all human body fractures. Fracture complete healing process may persevere several months or years. Most phalangeal fractures present favorable union within 3 to 6 weeks. In the literature, biophysical stimulation has yielded favorable outcomes in the treatment of hand fractures. A survey involving hospitals in the US reported the use of biophysical stimulation (72%) in relation to nonhealing fractures at three months after trauma. A noninvasive procedure such as biophysical stimulation may be preferential prior to consideration of invasive procedures. In this retrospective study, we analyzed 80 phalangeal fractures, 43 of which did not show any radiographic sign of healing 30 days after surgery; on radiograms, we calculated radiographic data and the total active motion (TAM) for clinical comparison. All radiographic images were evaluated using Adobe Photoshop CS3 (version 10.0, Adobe Systems Inc., San Jose, CA, USA). We calculated the index of relative bone healing each month after surgery starting from 30 days, which was considered as T1, and followed up for a total of 6 months after stimulation (T6) with better results in stimulated groups. We concluded that prompt administration of biophysical stimulation supports fracture healing and yields an important improvement in the union rate compared with nontreatment. Above all, our patients experienced less injury-related distress between the fracture and repair period, which consequently reduced immobilization time, envisaging an early rehabilitation interval, with a better patient hand outcome.

Posttreatment Imaging of the Wrist and Hand: Update 2022

Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.

COMPUTED TOMOGRAPHY MEDICAL IMAGE ANALYSIS OF BASKETBALL PLAYERS’ BONE GEOMETRY

ABSTRACT Introduction: Basketball sports will effect on the morphology and structure of the hand bones and joints. Objective: The article selected nine professional basketball players (basketball group) and 11 non-basketball players (control group) in the provincial youth team. A 64-row spiral computed tomography scan was used to scan the wrist and three-dimensional reconstruction. The volume of each carpal bone and the computed tomography value (bone density) were measured. Methods: To explore the influence of basketball sports on the hand bones and joints’ morphological structure, the paper analyzes the structural characteristics of the computed tomography images of young male basketball players’ wrist bones. Results: Compared with the carpal bones in the control group, the volume of the right navicular bone and the small polygonal bone, the left-hand navicular bone, the large triangular bone, and the small polygonal bone in the basketball group increased significantly (P<0.05). Conclusions: Basketball can increase the volume of the part of the wrist bones of adolescent male athletes and reduce the bone density; the morphological structure of the non-smashing wrist bones of basketball players has similar changes to that of the spikers. Level of evidence II; Therapeutic studies - investigation of treatment results.

Epidemiology and Long-Term Outcomes of Wrist Sprains in Military Academy Cadets

BACKGROUND

The American Society for Surgery of the Hand advises patients that symptoms after wrist sprains resolve in 6 weeks and that recovery is usually excellent; however, there is scant supporting evidence for this reassurance.

PURPOSE

To describe the epidemiology and report long-term outcomes of wrist sprains.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The US Department of Defense Military Health System Management Analysis and Reporting Tool was queried for wrist sprain International Classification of Diseases, Ninth Revision, codes between 2005 and 2008 among US Military Academy cadets. The electronic medical records were reviewed to obtain demographic information, mechanism of injury, and patient characteristics. A telephone survey was conducted to collect Single Assessment Numeric Evaluation (SANE) score, the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and ability to return to full military duty.

RESULTS

Of the 90 patients identified, 49 patients (50 wrists) met the final inclusion criteria. The mean patient age was 21 years, the majority were male (86%), and most sprains occurred during athletics (65%) and military activities (20%). Most patients (61%) had radiographs taken after index wrist sprain, and few (14%) underwent magnetic resonance imaging (MRI). After a mean follow-up of 10.4 years, most patients (78%) had no further wrist injury. The average SANE and QuickDASH scores were 88 and 7.5, respectively. Two patients (4%) ultimately were treated with surgical repair. Most patients (96%) were on an upper extremity profile, limiting military duty for a median of 14 days. All patients ultimately returned to full military duty.

CONCLUSION

Patients with a wrist sprain diagnosis were followed for an average of 10 years. Although the majority (96%) of patients required a median of 14 days with limited upper extremity function, MRI is rarely indicated in the acute setting and most patients will never have another wrist injury and can expect excellent wrist recovery outcomes.