Wrist circumduction reduced by finger constraints

Ulnar Extension Coupling in Functional Wrist Kinematics During Hand Activities of Daily Living

PURPOSE

Wrist circumduction is increasingly used as a functional motion assessment for patients. Thus, increasing our understanding of its relation to the functional motion envelope is valuable. Previous studies have shown that the wrist is preferentially extended during hand activities of daily living (ADLs), with greater ulnar than radial deviation. The purpose of this study was to characterize the functional wrist motions of 22 modern ADLs in healthy subjects. We hypothesized that the subjects would perform ADLs predominantly in ulnar extension.

METHODS

Ten right-handed, healthy subjects performed flexion-extension, radioulnar deviation, maximal circumduction, and 22 modern ADLs. Angular wrist positions were obtained by tracking retroreflective markers on the hand and forearm. Angular motion data were analyzed with a custom program for peak/trough angles in flexion extension and radioulnar deviation, ellipse area of circumduction data, and ellipse area of combined motion data.

RESULTS

The required ranges of motion for ADLs were from 46.6° ± 16.5° of flexion (stirring task) to 63.8° ± 14.2° of extension (combing) in flexion-extension and from 15.6° ± 8.9° of radial deviation (opening a jar) to 32.5° ± 8.3° of ulnar deviation (picking up smartphone) in radioulnar deviation. Ellipse area of combined motion data of the 22 ADLs were, on average, 58.2% ± 14.3% of the ellipse area of maximal circumduction. A motion data quadrantal analysis revealed that 54.9% of all ADL wrist motion occurred in ulnar extension. Among the average wrist positions for 22 ADLs, 16 were located in the ulnar extension quadrant.

CONCLUSIONS

This study revealed a functional wrist motion envelope that was less than 60% of wrist maximal motion capacity on average. Our results also showed that the majority of ADLs are performed in ulnar extension of the wrist.

CLINICAL RELEVANCE

Baseline values for healthy subjects performing 22 wrist ADLs can inform future studies assessing dysfunction, postsurgical changes, and rehabilitation progress.

An in vitro hand simulator for simultaneous control of hand and wrist movements

A human hand is a complex biomechanical system, in which bones, ligaments, and musculotendon units dynamically interact to produce seemingly simple motions. A new physiological hand simulator has been developed, in which electromechanical actuators apply load to the tendons of extrinsic hand and wrist muscles to recreate movements in cadaveric specimens in a biofidelic way. This novel simulator simultaneously and independently controls the movements of the wrist (flexion/extension and radio-ulnar deviation) and flexion/extension of the fingers and thumb. Control of these four degrees of freedom (DOF) is made possible by actuating eleven extrinsic muscles of the hand. The coupled dynamics of the wrist, fingers, and thumb, and the over-actuated nature of the human musculoskeletal system make feedback control of hand movements challenging. Two control algorithms were developed and tested. The optimal controller relies on an optimization algorithm to calculate the required tendon tensions using the collective error in all DOFs, and the action-based controller loads the tendons solely based on their actions on the controlled DOFs (e.g., activating all flexors if a flexing moment is required). Both controllers resulted in hand movements with small errors from the reference trajectories (<3.4); however, the optimal controller achieved this with 16% lower total force. Owing to its simpler structure, the action-based controller was extended to enable feedback control of grip force. This simulator has been shown to be a highly repeatable tool (<0.25 N and <0.2 variations in force and kinematics, respectively) for in vitro analyses of human hand biomechanics.

The SE-AssessWrist for robot-aided assessment of wrist stiffness and range of motion: Development and experimental validation

Introduction

Physical human-robot interaction offers a compelling platform for assessing recovery from neurological injury; however, robots currently used for assessment have typically been designed for the requirements of rehabilitation, not assessment. In this work, we present the design, control, and experimental validation of the SE-AssessWrist, which extends the capabilities of prior robotic devices to include complete wrist range of motion assessment in addition to stiffness evaluation.

Methods

The SE-AssessWrist uses a Bowden cable-based transmission in conjunction with series elastic actuation to increase device range of motion while not sacrificing torque output. Experimental validation of robot-aided wrist range of motion and stiffness assessment was carried out with five able-bodied individuals.

Results

The SE-AssessWrist achieves the desired maximum wrist range of motion, while having sufficient position and zero force control performance for wrist biomechanical assessment. Measurements of two-degree-of-freedom wrist range of motion and stiffness envelopes revealed that the axis of greatest range of motion and least stiffness were oblique to the conventional anatomical axes, and approximately parallel to each other.

Conclusions

Such an assessment could be beneficial in the clinic, where standard clinical measures of recovery after neurological injury are subjective, labor intensive, and graded on an ordinal scale.

The Functional Rotational Workspace of a Human-Robot System can be Influenced by Adjusting the Telemanipulator Handle Orientation

The handle design of telemanipulation master devices has not been extensively studied so far. However, the master device handle is an integral part of the robotic system through which the user interacts with the system. Previous work showed that the size and shape of the functional rotational workspace of the human-robot system and its usability are influenced by the design of the master device handle. Still, in certain situations, e.g., due to user preference, a specific grasp type handle might be desired. Therefore, in this article, we provide a systematic approach on how to assess and adjust the functional rotational workspace of a human-robot system. We investigated the functional rotational workspace with two exemplary grasp type handles and two different mounting orientations for each handle. The results showed that by adapting the handle orientation in the home configuration of the telemanipulator, the functional rotational workspace of the human-robot system can be adjusted systematically to cover more of the mechanical workspace of the master device. Finally, we deduct recommendations on how to choose and adjust a telemanipulator handle.

An Exoneuromusculoskeleton for Self-Help Upper Limb Rehabilitation After Stroke

This article presents a novel electromyography (EMG)-driven exoneuromusculoskeleton that integrates the neuromuscular electrical stimulation (NMES), soft pneumatic muscle, and exoskeleton techniques, for self-help upper limb training after stroke. The developed system can assist the elbow, wrist, and fingers to perform sequential arm reaching and withdrawing tasks under voluntary effort control through EMG, with a lightweight, compact, and low-power requirement design. The pressure/torque transmission properties of the designed musculoskeletons were quantified, and the assistive capability of the developed system was evaluated on patients with chronic stroke (n = 10). The designed musculoskeletons exerted sufficient mechanical torque to support joint extension for stroke survivors. Compared with the limb performance when no assistance was provided, the limb performance (measured as the range of motion in joint extension) significantly improved when mechanical torque and NMES were provided (p < 0.05). A pilot trial was conducted on patients with chronic stroke (n = 15) to investigate the feasibility of using the developed system in self-help training and the rehabilitation effects of the system. All the participants completed the self-help device-assisted training with minimal professional assistance. After a 20-session training, significant improvements were noted in the voluntary motor function and release of muscle spasticity at the elbow, wrist, and fingers, as indicated by the clinical scores (p < 0.05). The EMG parameters (p < 0.05) indicated that the muscular coordination of the entire upper limb improved significantly after training. The results suggested that the developed system can effectively support self-help upper limb rehabilitation after stroke. ClinicalTrials.gov Register Number NCT03752775.

Biomechanical function requirements of the wrist. Circumduction versus flexion/abduction range of motion

The biomechanical function of the wrist is widely assessed by measuring the range of motion (RoM) in two separate orthogonal planes: flexion-extension (FE) and radioulnar deviation (RUD). However, the two motions are coupled. The aim of this study is to compare wrist circumduction with FE and RUD RoM in terms of representativeness of the kinematic requirements for performing activities of daily living (ADL). To this end, the wrist motion of healthy participants was measured while performing maximum RoM in FE and in RUD, circumduction, and thirty-two representative ADL. Active and functional RoM (ARoM and FRoM) were computed in each plane, the evolving circumduction curves were adjusted to ellipses, and intensity maps representing the frequency of the coupling angles in ADL were plotted, both per ADL and globally for both hands. Ellipses representing different percentages of coupling angles in ADL were also plotted. Wrist circumduction fits the coupling angles measured in ADL better than ARoM or FRoM. As a novelty, quantitative data for both circumduction and the coupling angles required in ADL are provided, shedding light on the real biomechanical function requirements of the wrist. Results might be used to quantify mobility reduction and its impact on the performance of ADL, globally and per ADL, to enhance rehabilitation strategies, as well as in clinical decision-making, robotics, and prostheses.

Development and evaluation of RAMP II - a practitioner's tool for assessing musculoskeletal disorder risk factors in industrial manual handling

RAMP II is an observation-based tool developed for assessing a wide range of musculoskeletal disorder risk factors related to industrial manual handling. RAMP II, which is part of the RAMP tool, is based on research studies and expert judgments. The assessment relies mainly on direct or video observations of the work being assessed, but additionally on measured push/pull forces and weights of handled objects, and on perceived workload and discomfort. Over 80 practitioners participated in the development of the tool. According to the evaluations, 73% of the assessment items evaluated had acceptable reliability, and the majority of the potential end-users reported that RAMP II is usable for assessing risks and as a decision base. It is concluded that this study provides support that RAMP II is usable for risk assessment of musculoskeletal disorder risk factors in industrial manual handling. Practitioner summary: RAMP II is an observation-based assessment tool for screening and assessing major musculoskeletal exposures in industrial manual handling jobs. Over 80 practitioners participated in the development of the tool. This study provides support that RAMP II is usable for risk assessment of musculoskeletal disorder risk factors in industrial manual handling. Abbreviations: CTS: carpal tunnel syndrome; HARM: the Hand Arm Risk Assessment method; IMP: intramuscular pressure; κ_w: linearly weighted kappa; LBD: lower back disorders; LBP: lower back pain; MAWL: maximum acceptable weight of lift; MHO: manual handling operations; MSD: musculoskeletal disorder; MNSD: neck-shoulder disorder; NSP: neck-shoulder pain; OCRA: the Occupational Repetitive Action methods; OHS: occupational health and safety; PABAK: prevalence and bias adjusted kappa; p₀: proportion of agreement; RAMP: Risk Assessment and Management tool for manual handling Proactively; ROM: range of motion; RPL: risk and priority level; RSI: the Revised Strain Index; RULA: the Rapid Upper Limb Assessment; SWEA: Swedish Work Environment Authority; UEMSDs: upper-extremity work-related musculoskeletal disorders; WMSD: work-related musculoskeletal disorder; WRMSD: work-related musculoskeletal disorder; workday_8h: eight hours workday.

Influence of Wrist Position on the Metacarpophalangeal Joint Motion of the Index Through Small Finger

BACKGROUND

The metacarpophalangeal joints exhibit range of motion that is influenced by wrist position. Synergistic motion occurs between the wrist and the metacarpophalangeal joints with different static wrist positions affecting joints' motion capability. The aim of this study was to determine how different wrist positions influence the active range of motion of the index through small finger metacarpophalangeal joints.

METHODS

The active range of motion of the index through small finger metacarpophalangeal joints of 31 healthy subjects was measured in flexion/extension and radial/ulnar deviation in 5 different flexion/extension wrist positions, using biaxial electrogoniometers.

RESULTS

There was a difference in range of motion of all fingers depending on the wrist position. The minimum metacarpophalangeal joint range of motion was found in 80° wrist extension, the maximum in neutral wrist position. For the index finger, flexion/extension was 84.7° (±8.6°) to 25.9° (±10.2°) and radial/ulnar deviation was 32.1° (±11.3°) to 22.6° (±12.8°). For the middle finger, flexion/extension was 84.8° (±8.5°) to 25.9° (±10.1°) and radial/ulnar deviation 28.8° (±11.1°) to 22.1° (±8.9). The fourth finger showed a range of motion for flexion/extension of 87.2° (±11.5°) to 22.8° (±11.6°) and radial/ulnar deviation of 8.1° (±5.8°) to 32.3° (±12.4°). The highest range of motion was measured at the fifth finger with flexion/extension of 84.0° (±8.6°) to 32.1°(±16.8°) and radial/ulnar deviation of 15.1° (±12.9°) up to 54.6° (±18.7°).

CONCLUSIONS

The range of motion of the index through small finger metacarpophalangeal joints was significantly influenced by wrist position. The highest metacarpophalangeal joint range of motion of all fingers was conducted in neutral wrist positions. Apart from ergonomic implications, we conclude that metacarpophalangeal joint motion should be assessed under standardized wrist positions.

Motion-plane dependency of the range of dart throw motion and the effects of tendon action due to finger extrinsic muscles during the motion

[Purpose] To clarify the motion-plane dependency of the range of dart throw motion and the effects of tendon action due to long finger flexors and extensors during the motion. [Subjects and Methods] Forty healthy subjects attended the experiment, and the active range of wrist motion in seven motion planes was measured with an originally designed apparatus. [Results] The reliability of the measurement was acceptable. The range of dart throw motion depended on the motion planes, with a maximum at around the motion plane of 45° from the sagittal plane (45° of pronation). The tendon action of long finger muscles was shown in dart throw motion except in 45° of pronation. [Conclusion] Motion-plane dependency of the range of dart throw motion exists in healthy subjects. The absence of tendon action due to finger extrinsic muscles in dart throw motion at 45° might be one of the causes of the advantage of dart throw motion.

Active Ankle Circumduction to Identify Mobility Deficits in Subacute Ankle Sprain Patients

Assessment of ankle mobility is complex and of clinical relevance after an ankle sprain. This study develops and tests a biomechanical model to assess active ankle circumduction and its reliability. The model was then applied to compare individuals' ankle mobility between injured and noninjured ankles after a sprain episode. Twenty patients with subacute unilateral ankle sprain were assessed at 4 weeks and 10 weeks after the injury. They underwent a clinical exam and an ankle circumduction test during which the kinematics were recorded with an optoelectronic device. A biomechanical model was applied to explore ankle kinematics. Reliability of the ankle circumduction tests were good to excellent (ICC of 0.55-0.89). Comparison between noninjured and injured ankles showed a mobility deficit of the injured ankle (dorsiflexion = -27.4%, plantar flexion = -25.9%, eversion = -27.2%, and inversion = -11.6%). The model allows a graphical representation of these deficits in 4 quadrants. Active ankle circumduction movement can be reliably assessed with this model. In addition, the graphical representation allows an easy understanding of the mobility deficits which were present in all 4 quadrants in our cohort of patients with subacute ankle sprain.

Wrist motion analysis in scaphoid nonunion

INTRODUCTION

The motion of human wrist is a complex and multidirectional process. The aim of this study was to develop a reliable and practicable method to measure motion impairment of the wrist in patients who incurred a scaphoid nonunion. A scaphoid nonunion in computed tomography as well as the consent in this study was required.

METHODS

A total of nine patients with unilateral scaphoid nonunion accomplished maximal circumferential wrist movements. The wrist movements were measured with an electrogoniometer (Biometrics Ltd.). To quantify maximal wrist motion we constructed the maximal boundaries of the wrist motion from angular plots in flexion-extension (FE) and radio-ulnar deviation (RUD). We calculated the area of the circumduction envelope, the ranges of motion in FE and RUD and the main axis in wrist motion (dart-throwin-motion). The collected data were reconstructed with a custom-made MatLab program. We compared the impaired with the unimpaired side of each patient and analyzed with student's t test.

RESULTS

A scaphoid nonunion significantly reduced motion ranges in flexion/extension but not in ulnar and radial deviation. The overall mobility as quantified by the area of the circumduction envelope, decreased significantly. The circumduction boundaries of the wrists showed a kidney-shaped configuration with an oblique axis from radial/extension to ulnar/flexion.

CONCLUSION

Our results demonstrate that scaphoid nonunion without pain has motion deficits and may be poorly quantified with conventional manual goniometers.

Functional kinematics of the wrist

The purpose of this article is to review past and present concepts concerning functional kinematics of the healthy and injured wrist. To provide a context for students of the wrist, we describe the progression of techniques for measuring carpal kinematics over the past century and discuss how this has influenced today's understanding of functional kinematics. Next, we provide an overview of recent developments and highlight the clinical relevance of these findings. We use these findings and recent evidence that supports the importance of coupled motion in early rehabilitation of radiocarpal injuries to develop the argument that coupled motion during functional activities is a clinically relevant outcome; therefore, clinicians should develop a framework for its dynamic assessment. This should enable a tailored and individualized approach to the treatment of carpal injuries.

Passive stiffness of coupled wrist and forearm rotations

Coordinated movement requires that the neuromuscular system account and compensate for movement dynamics. One particularly complex aspect of movement dynamics is the interaction that occurs between degrees of freedom (DOF), which may be caused by inertia, damping, and/or stiffness. During wrist rotations, the two DOF of the wrist (flexion-extension and radial-ulnar deviation, FE and RUD) are coupled through interaction torques arising from passive joint stiffness. One important unanswered question is whether the DOF of the forearm (pronation-supination, PS) is coupled to the two DOF of the wrist. Answering this question, and understanding the dynamics of wrist and forearm rotations in general, requires knowledge of the stiffness encountered during rotations involving all three DOF (PS, FE, and RUD). Here we present the first-ever measurement of the passive stiffness encountered during simultaneous wrist and forearm rotations. Using a wrist and forearm robot, we measured coupled wrist and forearm stiffness in 10 subjects and present it as a 3-by-3 stiffness matrix. This measurement of passive wrist and forearm stiffness will enable future studies investigating the dynamics of wrist and forearm rotations, exposing the dynamics for which the neuromuscular system must plan and compensate during movements involving the wrist and forearm.

Assessment of velocity, range, and smoothness of wrist circumduction using flexible electrogoniometry

PURPOSE

To quantify the range, velocity, and smoothness of wrist circumduction, to explore the oblique functional plane of wrist circumduction, and to establish the reproducibility and reliability of these measures.

METHODS

Forty healthy subjects with a mean age of 43 years and without a history of wrist pathology or pain participated in this study. We used a flexible electrogoniometer with a twin-axis sensor to measure the relative angles between the 2 end blocks while the subject performed maximum excursion of flexion-extension, radioulnar deviation, and circumduction of the wrist held in a standardized, fully pronated position. A software package was used to further analyze the characteristics of the circumduction curve or oval such as the mean area (designated as degree-degree or oo) shape, size, rate, smoothness, and orientation.

RESULTS

The mean area of circumduction (4729 [degree-degree]) and circumference (265°) of the circumduction curve indicated the total range of circumduction. The velocity of circumduction (mean 179°/s) and the time (1.6 second) taken to complete 1 cycle of circumduction were similar in both hands. The 4 quadrants for the velocity of circumduction showed that the velocity was faster in the radioulnar deviation quadrants compared with flexion and extension. Quadrant analysis showed the smoothness was greater in the radioulnar deviation quadrants than in the flexion and extension quadrants. The oblique planes of the circumduction curves of all the normal wrists lie in ulnopalmar and radiodorsal direction with a mean angle of 28° to the vertical flexion and extension plane.

CONCLUSIONS

This technique was accurate and reliable in measuring the velocity, range, and smoothness of wrist circumduction.

The mechanical axes of the wrist are oriented obliquely to the anatomical axes

BACKGROUND

the complex motions of the wrist are described in terms of four anatomical directions that are accomplished through the multiple articulations of the carpus. With minimal tendinous insertions, the carpus is primarily a passive structure. This emphasizes the importance of its mechanical properties, which few studies have examined to date. The purpose of the present study was to determine the mechanical properties of the wrist in twenty-four different directions of wrist motion.

METHODS

the moment-rotation mechanical behavior of six fresh-frozen cadaver wrists was determined in four directions: flexion, extension, ulnar deviation, and radial deviation. Twenty other directions that were a combination of these anatomical directions were also studied. A custom-designed jig was interfaced with a standard materials testing system to apply unconstrained moments. Moments of ± 2 Nm were applied, and the moment-rotation data were recorded and analyzed to determine the neutral zone, range of motion, and stiffness values as well as the orientation of the envelope of these values.

RESULTS

the envelope of wrist range-of-motion values was ellipsoidal in shape and was oriented obliquely (p < 0.001) to the direction of pure flexion-extension by a mean (and standard deviation) of 26.6° ± 4.4°. The largest wrist range of motion was a mean of 111.5° ± 10.2°, in the direction of ulnar flexion, 30° from pure flexion. The largest stiffness (mean, 0.4 Nm/deg) was in the direction of radial flexion, while the smallest stiffness (mean, 0.15 Nm/deg) was in the direction of ulnar flexion.

CONCLUSIONS

the mechanical axes of the wrist are oriented obliquely to the anatomical axes. The primary mechanical direction is one of radial extension and ulnar flexion, a direction along a path of the dart thrower's wrist motion.

CLINICAL RELEVANCE

understanding the mechanical function of the wrist can aid clinical treatment decisions, arthroplasty, and implant designs. The findings of this study provide new evidence that the mechanical axes of the wrist are not collinear with the anatomical axes.