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Salva-Coll G, Lluch A, Esplugas M, Carreño A, Scott-Tennent A, Larrea-Zabalo M, Garcia-Elias M. Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception. J Hand Ther 2024; 37:273-281. [PMID: 37852909 DOI: 10.1016/j.jht.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability. PURPOSE To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities. STUDY DESIGN We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability. METHODS The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading. RESULTS The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid. CONCLUSIONS Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability.
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Affiliation(s)
- Guillem Salva-Coll
- Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ibacma Institute, Balearic Institute for Hand and Wrist Surgery, Palma de Mallorca, Spain.
| | - Alex Lluch
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Mireia Esplugas
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
| | - Ana Carreño
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Hand and Elbow Surgery, Hospital Clinic, Barcelona, Spain
| | - Ana Scott-Tennent
- Hospital Universitari Arnau de Vilanova, Lleida, Spain; Hospital Universitari Santa Maria, Lleida, Spain
| | - Maria Larrea-Zabalo
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Mutua Universal Delfos, Barcelona, Spain
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
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Hagert E, Rein S. Wrist proprioception-An update on scientific insights and clinical implications in rehabilitation of the wrist. J Hand Ther 2024; 37:257-268. [PMID: 37866985 DOI: 10.1016/j.jht.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
The field of wrist proprioception, as it relates to rehabilitation and surgery, has gone through a period of intense growth in the past decade. From being primarily focused on the function of the joint and ligaments in patients with wrist trauma or after wrist surgery, the understanding is now that of a greater complexity in treating not just the wrist but the hand and arm as a whole. Proprioception is derived from the Latin words "proprius" - belonging to (oneself) and "-ception" to sense. In other words, how to sense ourselves. To have a complete sense of self, multiple sensory afferents originating from joints, ligaments, muscles, tendons, nerves, skin, vision, and hearing work together to orchestrate a balanced integration of sensorimotor functions, with the true goal to perceive and adapt to the physical world around us. In this update on wrist proprioception, we review current developments in the understanding of proprioception, with an implication for our everyday work as hand therapists and hand surgeons. Each contributing sense-joint, ligaments, muscles, skin, and brain-will be reviewed, and the clinical relevance will be discussed. An updated wrist rehabilitation protocol is proposed where the therapist is guided to rehabilitate a patient after wrist trauma and/or surgery in 4 stages: (1) basic hand and wrist rehabilitation with a focus on reducing edema, pain, and scar formation; (2) proprioception awareness to improve the sense of joint motion and position; (3) conscious neuromuscular rehabilitation where isometric exercises of muscles that are beneficial for a particular injury are promoted, whereas others that are potentially harmful are avoided; and (4) unconscious neuromuscular rehabilitation with training of the reflex and joint protective senses.
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Affiliation(s)
- Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar; Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden.
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Esplugas M, Lluch A, Salva-Coll G, Fernandez-Noguera N, Puig de la Bellacasa I, Llusa-Perez M, Garcia-Elias M. Influence of forearm rotation on the kinetic stabilizing efficiency of the muscles that control the scapholunate joint. Clinical application in proprioceptive and neuromuscular rehabilitation programs. J Hand Ther 2024; 37:282-292. [PMID: 37852910 DOI: 10.1016/j.jht.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND This study focuses on the relationship between forearm muscles, carpal ligaments, and their impact on scapholunate joint stability across varying forearm rotations. This is crucial for optimizing pre and postoperative rehabilitation strategies for scapholunate joint dysfunction. PURPOSE Our study aims to understand the kinetic influence of forearm muscles on scapholunate joint instability. We emphasize the significance of forearm rotation to enhance treatment efficacy. STUDY DESIGN We conducted an experimental study to understand how forearm muscles contribute to the stability of the scapholunate joint during different degrees of forearm rotation and we focused on the joint effect of muscle groups rather than individual muscles for treatment protocols. RESULTS Our findings shed light on the conservative treatment of dynamic scapholunate instability and the postoperative rehabilitation of scapholunate ligament repair. We found that the effect of forearm muscles significantly contributes to preserve stability in the scapholunate joint across various forearm rotational positions. These insights have practical implications for hand therapists, offering innovative strategies to enhance clinical practice. CONCLUSIONS This research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability and provides a valuable perspective in line with current rehabilitation principles.
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Affiliation(s)
- Mireia Esplugas
- Hand and Upper Extremity Surgery, Kaplan Hand Institute, Barcelona, Spain.
| | - Alex Lluch
- Hand and Upper Extremity Surgery, Kaplan Hand Institute, Barcelona, Spain; Department of Hand and Upper Extremity Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Guillem Salva-Coll
- Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ibacma Institute, Balearic Institute for Hand and Wrist Surgery, Palma de Mallorca, Spain
| | - Nuria Fernandez-Noguera
- Department of Hand and Upper Extremity Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | | | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Kaplan Hand Institute, Barcelona, Spain; IFSSH; Fernando Fonseca Foundation, Terrassa, Spain
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Pedrini FA, Innocenti M, Hassan K, Levin LS. Surgical Feasibility Study on Cadaver for Vascularized Wrist Joint Transplantation. J Hand Surg Am 2024; 49:212-221. [PMID: 38069954 DOI: 10.1016/j.jhsa.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024]
Abstract
PURPOSE Despite modern advancements in the treatment of late stages of wrist joint degeneration, few reliable options exist for patients requiring motion-preserving reconstruction of their radiocarpal and midcarpal joints. Vascularized composite allotransplantation (VCA) could be considered an option for wrist reconstruction in the future. The goal of this study was to describe the relevant anatomy and design a potential surgical technique for wrist VCA. METHODS Anatomic studies were performed on 17 human upper extremities. The arterial system of each cadaver was injected with latex dye or radiographic contrast. After injecting a contrast medium visible on a computerized tomography (CT) scan, the initial three specimens were examined using microCT. This confirmed joint vascular patency and allowed for the dissection of the other specimens that were injected with latex for the study of joint vascularization and the design of the wrist VCA. We then outlined a donor and recipient surgical technique for transplant based on recipient CT scans. Customized cutting guides were designed for the transplant procedure. After the procedure, we performed angiography of the VCA to determine the vascularity of the transplant. RESULTS Using a combined volar and dorsal approach, we were able to perform a complete wrist VCA procedure. After the completed transplant procedure, angiographic imaging of the specimens demonstrated that the flap dissection and transplantation preserved the nutrient endosteal supply to the distal end of the radius and ulna, as well as to the carpal bones and the metacarpal bases. CONCLUSIONS The dissection of the donor, recipient, and the entire vascularized joint transplant procedure served to illustrate the anatomical feasibility of the cadaveric surgical technique. This establishes an anatomic basis for the possibility of future human clinical applications. CLINICAL RELEVANCE This study helps investigate the anatomical feasibility of a wrist VCA.
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Affiliation(s)
- Francesca Alice Pedrini
- McKay Orthopaedic Research Laboratory, Levin Laboratory, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; IRCCS Istituto Ortopedico Rizzoli, IV Clinica Ortoplastica, Bologna, Italy.
| | - Marco Innocenti
- IRCCS Istituto Ortopedico Rizzoli, IV Clinica Ortoplastica, Bologna, Italy; Università di Bologna, Bologna, Italy
| | - Kareem Hassan
- Department of Orthopaedic Surgery, Department of Surgery, Division of Plastic Surgery, Penn Medicine University City, Philadelphia, PA
| | - Lawrence Scott Levin
- Department of Orthopaedic Surgery, Department of Surgery, Division of Plastic Surgery, Penn Medicine University City, Philadelphia, PA
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Rust AR, Jain SA. The Relationship Between the Wrist Flexion Creases and the Volar Radiocarpal Joint: A Cadaveric Study. Hand (N Y) 2023:15589447231217760. [PMID: 38142433 DOI: 10.1177/15589447231217760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Surgical approaches to the volar radiocarpal joint have historically entailed wide exposure, possibly contributing to poor wound healing and wrist denervation. To avoid wound complications and wrist denervation, minimally invasive and percutaneous approaches to the volar radiocarpal joint have been proposed. To help guide these minimally invasive or percutaneous approaches to the joint, we sought to characterize the relationship between the volar wrist flexion creases and the volar radiocarpal joint. We propose that the wrist flexion creases will be a reliable method for localizing the joint. METHODS Ten cadaveric upper-extremity specimens consisting of fingertip to mid forearm were obtained. Measurements from the proximal and distal wrist flexion creases were taken via fluoroscopy and gross dissection. RESULTS The wrist flexion creases were located distal to the volar radiocarpal joint in all specimens. The volar radiocarpal joint was located 7 and 16 mm proximal to the proximal and distal wrist flexion creases, respectively. The radiographic anatomy correlated well with the underlying deep anatomy. CONCLUSIONS The wrist flexion creases can serve as a reliable superficial landmark for the identification of the volar radiocarpal joint. These landmarks aid clinicians in performing or interpreting a physical examination or in performing minimally invasive or percutaneous approaches to the volar radiocarpal joint.
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Affiliation(s)
- Andrew R Rust
- The Ohio State University College of Medicine, Columbus, USA
| | - Sonu A Jain
- The Ohio State University Wexner Medical Center, Columbus, USA
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Kaempf de Oliveira R, Brunelli JP, Aita M, Delgado PJ. 360-degree Arthroscopic Management of Scaphoid Pseudarthrosis: Description of Technique and Indications. Tech Hand Up Extrem Surg 2023; 27:230-238. [PMID: 37529866 DOI: 10.1097/bth.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Nonunion remains one of the main complications of scaphoid fractures, with no consensus being reached as to the best surgical technique for scaphoid pseudoarthrosis. Thus, different types of procedures for bone stability and biological stimulus for consolidation have been described. The use of arthroscopy for scaphoid pseudoarthrosis has advantages as it allows for treating associated injuries, preserving wrist proprioception by minimizing damage to the joint capsule and ligaments and not deteriorating the already fragile scaphoid vasculature, leading to a quick recovery. Arthroscopy was initially indicated for stable scaphoid pseudoarthroses, being used in all patterns of this condition, including unstable ones and those with flexion collapse. However, most scientific articles describe the use of arthroscopy only through the dorsal portals, creating technical difficulty in complete debridement of the site of pseudarthrosis and in placing bone graft. This study describes the 360-degree technique, which standardizes arthroscopy in scaphoid pseudoarthrosis treatment, allowing, with the use of dorsal, volar, and radial portals, direct approach to the entire circumference of the nonunion site, facilitating the debridement of the injury site, the correction of the scaphoid deformity, and the placement of a graft directly on the site of the defect, mainly in its volar region after correction of the flexion deformity. The 360-degree technique aims to help and standardize the arthroscopic procedure for scaphoid pseudarthrosis, creating a routine with defined surgery stages. Additional portals allow complete access to the entire nonunion site and better positioning of the bone graft under direct view.
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Affiliation(s)
| | - João Pedro Brunelli
- Hand Surgeon at Hospital Santa Casa de Misericórdia of Porto Alegre, Porto Alegre, Brazil
| | - Márcio Aita
- Hand Surgeon at Faculdade de Medicina do ABC, Santo André, Brazil
| | - Pedro J Delgado
- Coordinating Physician of the Hand Surgery Unit, Hospital Universitário Madrid Monteprincipe, Universidade CEU San Pablo, Boadilla del Monte, Madrid, Spain
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Miles O, Tham S, Morrison W, Ek E, Palmer J, McCombe D. Immunohistochemical Investigation of Mechanoreceptors Within the Injured Scapholunate Ligament. J Hand Surg Am 2023:S0363-5023(23)00546-4. [PMID: 38043032 DOI: 10.1016/j.jhsa.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE Scapholunate ligaments (SLLs) play a well-established role in maintaining carpal alignment and kinematics, and are innervated with sensory mechanoreceptors located within the ligaments. They are involved in the afferent arc of dynamic wrist stability. The aim of this study was to describe the changes in these mechanoreceptor populations in injured SLLs. METHODS Injured SLLs were collected from human wrists at the time of SLL reconstruction or limited wrist fusion, where the ligament remnants would otherwise be discarded. These specimens were formalin-fixed and paraffin-embedded for immunohistochemical analysis to identify mechanoreceptors, which were then classified by type and location within the ligament. RESULTS A total of 15 ligaments were collected, with the interval from injury ranging from 39 days-20 years. Eleven ligaments were collected less than one year after injury, and four ligaments were collected two years or more after injury. A total of 66 mechanoreceptors were identified, with 50 mechanoreceptors identified in nine of the 11 specimens collected less than one year after injury. In this group, 54% of the mechanoreceptors resided in the volar subunit, 20% in the dorsal subunit, and 26% in the proximal subunit. Two of the four specimens collected two years or later after injury contained mechanoreceptors, all of which were located in the dorsal subunit. Increasing time from injury demonstrated a decline in mechanoreceptor numbers within the volar subunit. CONCLUSIONS Mechanoreceptors were consistently located in the SLL, particularly in the volar subunit of specimens collected less than one year after injury. CLINICAL RELEVANCE Ligament reconstruction techniques aim to primarily reconstitute the biomechanical function of the disrupted SLL; however, re-establishing the afferent proprioceptive capacity of the SLL may be a secondary objective. This suggests the need to consider the reconstruction of its volar subunit particularly in those managed within one year of injury.
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Affiliation(s)
- Oliver Miles
- Plastic, Reconstructive and Hand Surgery Unit, St. Vincent's Hospital Melbourne, Fitzroy, Australia; O'Brien Institute, St. Vincent's Institute of Medical Research, Fitzroy, Australia.
| | - Stephen Tham
- Plastic, Reconstructive and Hand Surgery Unit, St. Vincent's Hospital Melbourne, Fitzroy, Australia; O'Brien Institute, St. Vincent's Institute of Medical Research, Fitzroy, Australia; Victorian Hand Surgery Associates. St Vincent's Hospital, Fitzroy, Australia
| | - Wayne Morrison
- O'Brien Institute, St. Vincent's Institute of Medical Research, Fitzroy, Australia; University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, Australia
| | - Eugene Ek
- Mebourne Orthopaedic Group, Windsor, VIC, Australia
| | - Jason Palmer
- O'Brien Institute, St. Vincent's Institute of Medical Research, Fitzroy, Australia
| | - David McCombe
- O'Brien Institute, St. Vincent's Institute of Medical Research, Fitzroy, Australia; Victorian Hand Surgery Associates. St Vincent's Hospital, Fitzroy, Australia; University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, Australia
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Tomlinson JCL, Zwirner J, Oorschot DE, Morawski M, Ondruschka B, Zhang M, Hammer N. Microstructural analysis on the innervation of the anterior, medial, and lateral human hip capsule: Preliminary evidence on its neuromechanical contribution. Osteoarthritis Cartilage 2023; 31:1469-1480. [PMID: 37574111 DOI: 10.1016/j.joca.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Capsular repair aims to minimize damage to the hip joint capsular complex (HJCC) and subsequent dislocation risk following total hip arthroplasty (THA). Numerous explanations for its success have been advocated, including neuromuscular feedback loops originating from within the intact HJCC. This research investigates the hypothesis that the HJCC contributes to hip joint stability by analyzing HJCC innervation. METHOD Twenty-nine samples from the anterior, medial, and lateral aspects of the midportion HJCC of 29 individuals were investigated stereologically and immunohistochemically to identify encapsulated mechanoreceptors according to a modified Freeman and Wyke classification, totaling 11,745 sections. Consecutive slices were observed to determine the nerve course within the HJCC. RESULTS Few encapsulated mechanoreceptors were found in the HJCC subregions and overlying tissues across the cohort studied. Of regions studied, no significant regional differences in the density of mechanoreceptors were found. No significant difference in mechanoreceptor density was found between sides (left, 10.2×10-4/mm3, 4.0×10-4 - 19.0×10-4/mm3; right 12.9×10-4/mm3, 5.0×10-4 - 22.0×10-4/mm3; mean, 95% confidence intervals) sexes (female 10.4×10-4/mm3, 4.0×10-4 - 18.0×10-4/mm3; male 11.6×10-4/mm3, 5.0×10-4 - 20.0×10-4/mm3; mean, 95% confidence intervals), nor in correlation with age demographics. Myelinated nerves coursed consistently within the HJCC in various orientations. CONCLUSION Sparse mechanoreceptor density suggests that the HJCC contributes to a limited extent to hip joint stabilization. HJCC nerve terminals may potentially contribute to neuromuscular feedback loops with associated muscles to mediate joint stability in tandem with the active and passive components of the joint.
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Affiliation(s)
- Joanna C L Tomlinson
- School of Anatomy, University of Bristol, Bristol, United Kingdom; Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand.
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Oral Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Dorothy E Oorschot
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Markus Morawski
- Paul Flechsig Institute for Brain Research, Medical Faculty, University of Leipzig, Leipzig, Saxony, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ming Zhang
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Styria, Austria; Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology (Fraunhofer IWU), Dresden, Saxony, Germany; Department of Orthopaedic and Trauma Surgery, University of Leipzig, Germany
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Meklef RA, Siemers F, Rein S. Development of a 3D-immunofluorescence analysis for sensory nerve endings in human ligaments. J Neurosci Methods 2022; 382:109724. [PMID: 36207004 DOI: 10.1016/j.jneumeth.2022.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The analysis of ligamentous mechanoreceptors is difficult due to a high amount of unclassifiable mechanoreceptors, which result from incomplete visualization through limited microscopic techniques. NEW METHOD The method was developed using dorsal intercarpal ligaments and dorsal regions of the scapholunate interosseous ligament from human cadaver wrists. Consecutive 70 µm thick cryosections were stained with immunofluorescence markers for protein S100B, neurotrophin receptor p75 (p75), protein gene product 9.5 (PGP 9.5) and 4',6-diamidino-2-phenylindole (DAPI). 3D images of sensory nerve endings were obtained using a confocal laser scanning microscope. Experimental point spread functions (PSF) were used to deconvolve images. Sensory nerve endings were localised in each section plane and classified according to Freeman and Wyke. Finally, confocal data was visualized as 3D-images. RESULTS The method produced excellent image quality, revealing detailed three-dimensional structures. The created 3D-model of sensory nerve endings could be analyzed in all three dimensions, augmenting visualization of the form and immunoreactive pattern of sensory nerve endings. Deconvolution with experimentally measured PSFs aided in enhancing image quality. COMPARISON WITH EXISTING METHODS Using a triple immunofluorescent staining method allows to visualize the structure of sensory nerve endings more precisely than techniques with serial analysis of different monostaining of neural markers. Imaging in three dimensions enhances morphologic details, which are limited in 2D-microscopy. CONCLUSION 3D-triple immunofluorescence produces high quality visualization of mechanoreceptors, thereby improving their analysis. As an elaborate technique, it is ideal for defined research questions concerning the microstructure of sensory nerve endings.
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Affiliation(s)
- Rami Al Meklef
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Germany
| | - Frank Siemers
- Martin-Luther-University Halle-Wittenberg, Germany; Department of Plastic and Hand Surgery with Burn Unit, Trauma Center Bergmannstrost, 06112 Halle, Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Germany.
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Oh J, Mahnan A, Xu J, Block HJ, Konczak J. Typical Development of Finger Position Sense From Late Childhood to Adolescence. J Mot Behav 2022; 55:102-110. [PMID: 36257920 DOI: 10.1080/00222895.2022.2134287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Finger position sense is a proprioceptive modality highly important for fine motor control. Its developmental time course is largely unknown. This cross-sectional study examined its typical development in 138 children (8-17 years) and a group of 14 healthy young adults using a fast and novel psychophysical test that yielded objective measures of position sense acuity. Participants placed their hands underneath a computer tablet and judged the perceived position of their unseen index finger relative to two visible areas displayed on a tablet following a two-forced-choice paradigm. Responses were fitted to a psychometric acuity function from which the difference between the point-of-subjective-equality and the veridical finger position (ΔPSE) was derived as a measure of position sense bias, and the uncertainty area (UA) as a measure of precision. The main results are: First, children under 12 exhibited a significantly greater UA than adults while adolescent children (13-17 years) exhibited no significant differences when compared to adults. Second, no significant age-related differences in ΔPSE were found across the age range of 8-17 years. This implies that the typical development of finger position sense from late childhood to adulthood is characterized as an age-dependent increase in proprioceptive precision and not as a decrease in bias.
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Affiliation(s)
- Jinseok Oh
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Arash Mahnan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.,Reality Labs Health and Safety UXR, Meta, Redmond, WA, USA
| | - Jiapeng Xu
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Hannah J Block
- Sensorimotor Neurophysiology Laboratory, School of Public Health, Indiana University Bloomington, IN, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.,Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA
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Mania S, Boudabbous S, Delattre BMA, Lamy C, Beaulieu JY. Anatomical and radiological description of ligament insertions on the radial aspect of the scaphoid bone. HAND SURGERY & REHABILITATION 2022; 41:445-451. [PMID: 35660467 DOI: 10.1016/j.hansur.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Anatomical studies on the radial side of the scaphoid mention inter-ligamentous connections, but without detailed description of their relations to one another. The purpose of this study was to provide an anatomical and radiological description of the ligamentous structure on the radial side of the scaphoid. High-field 3-Tesla 3D MRI scans of 7 cadaveric formaldehyde-fixed wrists were performed to assess the presence and location of each ligament. Dissection was performed in 10 wrists under microscopy on the radial side to assess the dimensions, anatomical variations and angles between ligaments in various wrist positions during in intracarpal pronation/supination, flexion/extension and ulnar/radial deviation. This study confirmed that the same ligament configuration was found on MRI and on dissection. The scaphotrapezial ligament, dorsal intercarpal ligament and radial collateral ligament fibers merge along the dorsal ridge of the scaphoid. The fibers of the radial collateral and radioscaphocapitate ligaments could be distinguished in only 4/10 specimens. Wrist position changes from intracarpal pronation to supination produced major changes in angle between the scaphotrapezial and dorsal intercarpal ligaments, while other position changes affected this angle only slightly. 3D MRI sequences allow these structures to be systematically analyzed in case of scapholunate instability. Further studies should be conducted to assess the biomechanical properties of these ligaments and the clinical consequences of isolated injury in this region.
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Affiliation(s)
- S Mania
- Unit of Anatomy, Faculty of Medicine of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland.
| | - S Boudabbous
- Division of Radiology, Diagnosis Department, Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1205 Geneva, Switzerland
| | - B M A Delattre
- Division of Radiology, Diagnosis Department, Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1205 Geneva, Switzerland
| | - C Lamy
- Unit of Anatomy, Faculty of Medicine of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland
| | - J-Y Beaulieu
- Unit of Anatomy, Faculty of Medicine of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; Unit of Hand and Peripheral Nerve Surgery, Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1205 Geneva, Switzerland
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12
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Chiri W, MacLean SBM, Clarnette J, Eardley-Harris N, White J, Bain GI. Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures. J Wrist Surg 2022; 11:238-249. [PMID: 35837591 PMCID: PMC9276061 DOI: 10.1055/s-0042-1748674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/08/2022] [Indexed: 10/17/2022]
Abstract
Background Volar ulnar corner fractures are a subset of distal radius fractures that can have disastrous complications if not appreciated, recognized, and appropriately managed. The volar ulnar corner of the distal radius is the "critical corner" between the radial calcar, distal ulna, and carpus and is responsible for maintaining stability while transferring force from the carpus. Description Force transmitted from the carpus to the radial diaphysis is via the radial calcar. A breach in this area of thickened cortex may result in the collapse of the critical corner. The watershed ridge (line) is clinically important in these injuries and must be appreciated during planning and fixation. Fractures distal to the watershed ridge create an added level of complexity and associated injuries must be managed. An osteoligamentous unit comprises bone-ligament-bone construct. Volar ulnar corner fractures represent a spectrum of osteoligamentous injuries each with their own associated injuries and management techniques. The force from the initial volar ulnar corner fracture can propagate along the volar rim resulting in an occult volar ligament injury, which is a larger zone of injury than appreciated on radiographs and computerized tomography scan. These lesions are often underestimated at the time of fixation, and for this reason, we refer to them as sleeper lesions. Unfortunately, they may become unmasked once the wrist is mobilized or loaded. Conclusions Management requires careful planning due to a relatively high rate of complications after fixation. A systematic approach to plate positioning, utilizing several fixation techniques beyond the standard volar rim plate, and utilizing fluoroscopy and/or arthroscopy is the key strategy to assist with management. In this article, we take a different view of the volar ulnar corner anatomy, applied anatomy of the region, associated injuries, and management options.
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Affiliation(s)
- Wael Chiri
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
| | - Simon BM MacLean
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand
| | - Jock Clarnette
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
| | - Nathan Eardley-Harris
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
| | - John White
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
| | - Gregory I. Bain
- Division of Upper Limb and Research, Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia
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13
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Oh WT, Park HJ, Koh IH, Choi YR. Outcomes of Arthroscopic Scaphoid Excision and Lunocapitate Fusion for Advanced Traumatic Arthritis of the Wrist. Clin Orthop Surg 2022; 15:308-317. [PMID: 37008977 PMCID: PMC10060770 DOI: 10.4055/cios22066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/02/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Arthroscopic lunocapitate (LC) fusion can be an alternative surgical treatment for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) of the wrist. We retrospectively reviewed patients who had arthroscopic LC fusion to estimate clinical and radiological outcomes. Methods From January 2013 to February 2017, all patients with SLAC (stage II or III) or SNAC (stage II or III) wrists, who underwent arthroscopic LC fusion with scaphoidectomy and were followed up for a minimum of 2 years, were enrolled in this retrospective study. Clinical outcomes included visual analog scale (VAS) pain, grip strength, active range of wrist motion, Mayo wrist score (MWS), and the Disabilities of Arm, Shoulder and Hand (DASH) score. Radiologic outcomes included bony union, carpal height ratio, joint space height ratio, and loosening of screws. We also performed group analysis between patients with 1 and 2 headless compression screws to fix the LC interval. Results Eleven patients were assessed for 32.6 ± 8.0 months. Union was achieved in 10 patients (union rate, 90.9%). There was improvmenet in mean VAS pain score (from 7.9 ± 1.0 to 1.6 ± 0.7, p = 0.003) and grip strength (from 67.5% ± 11.4% to 81.8% ± 8.0%, p = 0.003) postoperatively. The mean MWS and DASH score were 40.9 ± 13.8 and 38.3 ± 8.2, respectively, preoperatively and improved to 75.5 ± 8.2 and 11.3 ± 4.1, respectively, postoperatively (p < 0.001 for all). Radiolucent screw loosening occurred in 3 patients (27.3%), including 1 nonunion patient and 1 patient who underwent screw removal due to the screw migration encroaching the lunate fossa of radius. In group analysis, only the frequency of radiolucent loosening was higher in 1 screw (3 of 4) than 2 screw fixation (0 of 7) (p = 0.024). Conclusions Arthroscopic scaphoid excision and LC fusion for patients with advanced SLAC or SNAC of the wrist was effective and safe only in cases fixed with 2 headless compression screws. We recommend arthroscopic LC fusion using 2 screws rather than 1 to decrease radiolucent loosening, which might affect complications such as nonunion, delayed union, or screw migration.
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Affiliation(s)
- Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Heon-Jung Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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14
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Lindsay TA, Myers HR, Tham S. Ligamentization and Remnant Integration: Review and Analysis of Current Evidence and Implications for Scapholunate Reconstruction. J Wrist Surg 2021; 10:476-483. [PMID: 34877079 PMCID: PMC8635821 DOI: 10.1055/s-0040-1716863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the "ligamentization" of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices. Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization. Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria. Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time. Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery. Level of Evidence This is a level I/II, review study.
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Affiliation(s)
- Tim A.J. Lindsay
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Harley R. Myers
- Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Stephen Tham
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
- St. Vincent's Hand Surgery Unit, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincents Hospital, Fitzroy, Victoria, Australia
- Hand Unit, Dandenong Hospital, Dandenong, Victoria, Australia
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15
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Eraktas İ, Ayhan C, Hayran M, Soylu AR. Alterations in forearm muscle activation patterns after scapholunate interosseous ligament injury: A dynamic electromyography study. J Hand Ther 2021; 34:384-395. [PMID: 32620427 DOI: 10.1016/j.jht.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case control. PURPOSE OF THE STUDY This study aimed to investigate the alterations seen in the activation patterns of the forearm muscles and to demonstrate the associated functional outcomes, in patients with scapholunate interosseous ligament (SLIL) injury. METHODS The study involved 15 patients with SLIL injury (instability group) and 11 healthy participants (control group). Both groups were evaluated with regard to their pain, grip strength, and upper extremity functional level (disabilities of the arm, shoulder and hand and patient-rated wrist evaluation questionnaires), and they also underwent a dynamic electromyography analysis of their forearm muscle activity. The activation patterns of the extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), flexor carpi ulnaris, and flexor carpi radialis muscles during wrist extension and flexion were recorded by means of surface electromyography. RESULTS In the instability group, the pain severity was higher and the functional level was worse than in the control group (P < .05). Furthermore, during wrist extension, the ECR activity was lower and the ECU activity was higher in the instability group than in the control group (P < .05). CONCLUSION Dynamic stabilization of the wrist, flexor carpi ulnaris, and flexor carpi radialis muscles have been shown to play an active role with ECU and ECR. Increased ECU and decreased ECR activation may pose a potential risk in terms of enhancing the scapholunate gap. We, therefore, propose that appropriate preventive neuromuscular exercise strategies implemented as part of a physiotherapy program for patients with SLIL lesions might increase the contribution of the dynamic stability effect of the relevant muscles.
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Affiliation(s)
- İrem Eraktas
- Bolu Physical Therapy and Rehabilitation Hospital, Bolu, Turkey
| | - Cigdem Ayhan
- Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Mutlu Hayran
- School of Medicine, Department of Preventive Oncology, Hacettepe University, Ankara, Turkey
| | - Abdullah Ruhi Soylu
- School of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey
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16
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Lötters FJB, Schreuders TAR, Videler AJ. SMoC-Wrist: a sensorimotor control-based exercise program for patients with chronic wrist pain. J Hand Ther 2021; 33:607-615. [PMID: 30905496 DOI: 10.1016/j.jht.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/09/2018] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN This is a narrative review. INTRODUCTION Chronic wrist pain is a common disorder that can lead to considerable disability in performing activities in daily living and at work. Patients with nonspecific chronic wrist pain are regularly referred to a physiotherapist/hand therapist. Immobilization, avoiding excessive wrist load, steroid injections, and various physical therapy methods predominantly focus on the pain itself. However, these methods often do not result in a satisfactory long-term pain relief. PURPOSE OF THE STUDY In this article, we will describe the principles behind and content of a sensorimotor control-based exercise program as introduced by Videler et al., modified and substantiated by current insights into sensorimotor control training and wrist kinetics. METHODS Both structure and content of the modified exercise program (SMoC-wrist) are substantiated by recent scientific literature. RESULTS A clear 4-level exercise model based on sensorimotor principles is presented, that is, proprioceptive level, conscious static/isometric level, conscious dynamic level, and unconscious dynamic level. The content of each level and the transition toward the next level are described in detail. DISCUSSION Besides the substantiation of the exercise program, possible outcome measures for joint position sense and kinesthesia of the wrist are discussed. CONCLUSION We modified and substantiated a widely used exercise program for patients with nonspecific chronic wrist pain based on recent insights into sensorimotor control principles and wrist kinematics. The presented exercise program (SMoC-wrist) is not primarily focused on reducing pain but on functional reeducation and strengthening of the neuromusculoskeletal system on the basis of sensorimotor control principles.
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Affiliation(s)
| | - Ton A R Schreuders
- Hand and Wrist Rehabilitation, Goes, The Netherlands; Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - Annemieke J Videler
- Hand and Wrist Rehabilitation, Goes, The Netherlands; Hand & Wrist Center Amsterdam/4hands, Amsterdam, The Netherlands
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17
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Rigoni M, Raggi M, Speri L. A New "Denervation" Technique for Painful Arthritic Wrist. J Wrist Surg 2021; 10:359-366. [PMID: 34381642 PMCID: PMC8328562 DOI: 10.1055/s-0040-1720966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 10/22/2022]
Abstract
Wrist denervation is, by the way, one of the most performed and long-lasting surgical technique for wrist arthritis. Despite many progresses in upper extremity joint arthroplasty, wrist arthritis remains difficult to treat specially in young patients and heavy manual workers. The aim of this technical article is to describe a new outpatient's procedure in which applying pulsed radio frequency on nerve structure of the wrist could achieve similar clinical results of a wrist denervation without surgical incision.
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Affiliation(s)
- Massimo Rigoni
- Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Massimiliano Raggi
- Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Luca Speri
- Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
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18
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Bonczar T, Bonczar M, Pękala JR, Mann MR, Walocha JA. Innervation of the wrist joint: Literature review and clinical implications. Clin Anat 2021; 34:1081-1086. [PMID: 33905132 DOI: 10.1002/ca.23734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 11/11/2022]
Abstract
The aim of this study was to review the literature on the innervation of the wrist with an emphasis on pathological and therapeutic aspects. The nerves involved in wrist innervation and their mechanoreceptor endings are described. The literature over the past 30 years includes several topics that are still subjects of discussion and debate and require further research.
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Affiliation(s)
- Tomasz Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Mitchell R Mann
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
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19
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Albanese GA, Holmes MWR, Marini F, Morasso P, Zenzeri J. Wrist Position Sense in Two Dimensions: Between-Hand Symmetry and Anisotropic Accuracy Across the Space. Front Hum Neurosci 2021; 15:662768. [PMID: 33967724 PMCID: PMC8100524 DOI: 10.3389/fnhum.2021.662768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/29/2021] [Indexed: 02/01/2023] Open
Abstract
A deep investigation of proprioceptive processes is necessary to understand the relationship between sensory afferent inputs and motor outcomes. In this work, we investigate whether and how perception of wrist position is influenced by the direction along which the movement occurs. Most previous studies have tested Joint Position Sense (JPS) through 1 degree of freedom (DoF) wrist movements, such as flexion/extension (FE) or radial/ulnar deviation (RUD). However, the wrist joint has 3-DoF and many activities of daily living produce combined movements, requiring at least 2-DoF wrist coordination. For this reason, in this study, target positions involved movement directions that combined wrist flexion or extension with radial or ulnar deviation. The chosen task was a robot-aided Joint Position Matching (JPM), in which blindfolded participants actively reproduced a previously passively assumed target joint configuration. The JPM performance of 20 healthy participants was quantified through measures of accuracy and precision, in terms of both perceived target direction and distance along each direction of movement. Twelve different directions of movement were selected and both hands tested. The left and right hand led to comparable results, both target extents and directions were differently perceived according to the target direction on the FE/RUD space. Moreover, during 2-DoF combined movements, subjects' perception of directions was impaired when compared to 1-DoF target movements. In summary, our results showed that human perception of wrist position on the FE/RUD space is symmetric between hands but not isotropic among movement directions.
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Affiliation(s)
- Giulia A Albanese
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy.,Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Michael W R Holmes
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - Pietro Morasso
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Jacopo Zenzeri
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
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20
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Rebmann D, Mayr HO, Schmal H, Hernandez Latorre S, Bernstein A. Immunohistochemical analysis of sensory corpuscles in human transplants of the anterior cruciate ligament. J Orthop Surg Res 2020; 15:270. [PMID: 32680550 PMCID: PMC7368668 DOI: 10.1186/s13018-020-01785-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/06/2020] [Indexed: 11/12/2022] Open
Abstract
Background Sensory nerve endings in ligaments play an important role for the proprioceptive function. Clinical trials show that the sense of body position does not fully recover in the knee joint after reconstructive surgery of the ruptured anterior cruciate ligament. The aim of this study is to identify sensory corpuscles in autogenous and allogenous transplants of the ligament and to compare their quantity between the used allografts and autografts. Methods Thirty-three patients were included in this study. Three patellar tendon allografts, 14 patellar tendon autografts and 12 semitendinosus autografts were harvested during revision surgery after traumatic rerupture of the graft. The control consisted of 4 healthy anterior cruciate ligaments after fresh rupture. After haematoxylin staining, immunohistochemical analysis was performed using antibodies against S100, p75 and PGP9.5. Microscopical examination was carried out, and the number of mechanoreceptors was counted. Statistical analysis was performed using the Mann-Whitney U test. Results Two types of mechanoreceptors were identified in each graft: Ruffini corpuscles and free nerve endings. The number of Ruffini corpuscles per square centimeter was the highest in the control. Comparing the grafts, the highest number of receptors could be detected in the semitendinosus autograft. The amount of free nerve endings was higher in the semitendinosus and patellar tendon autografts than in the control; the allografts showed the lowest number of receptors. With increasing time after reconstruction, the number of both types of receptors showed a decrease in the semitendinosus graft, whereas it increased in the patellar tendon graft and allograft. The number of mechanoreceptors in the semitendinosus and patellar tendon graft decreased over time after graft-failure, whereas it increased slightly in the allograft. Conclusion This study was the first to identify mechanoreceptors in human transplants of the anterior cruciate ligament. The partial increase in the number of receptors over time after reconstruction could indicate a reinnervation of the grafts.
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Affiliation(s)
- D Rebmann
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - H O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.,Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Strasse 51, 81547, Munich, Germany
| | - H Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - S Hernandez Latorre
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - A Bernstein
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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21
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Nagano H, Takenouchi H, Cao N, Konyo M, Tadokoro S. Tactile feedback system of high-frequency vibration signals for supporting delicate teleoperation of construction robots. Adv Robot 2020. [DOI: 10.1080/01691864.2020.1769725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hikaru Nagano
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Hideto Takenouchi
- Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Nan Cao
- Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Masashi Konyo
- Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Satoshi Tadokoro
- Graduate School of Information Sciences, Tohoku University, Sendai, Japan
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22
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Rein S, Winter J, Kremer T, Siemers F, Range U, Euchner N. Evaluation of proprioception in denervated and healthy wrist joints. J Hand Surg Eur Vol 2020; 45:408-413. [PMID: 31930922 DOI: 10.1177/1753193419897192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We recruited 25 patients after complete wrist denervation and 60 healthy adults to investigate conscious and unconscious proprioception of the wrist. Ipsi- and contralateral joint-position sense, force sense, and wrist reflexes were measured. The latter were triggered by a trapdoor, recording electromyographic signals from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles. No significant differences were found for joint position sense, force sense, and wrist reflexes between both groups, except for reflex time of the flexor carpi ulnaris after denervation of the left wrist as compared with the left flexor carpi ulnaris in controls or in right operated wrists. At a mean follow-up of 32 months (range 8 to 133), we found no proprioceptive deficit of the conscious proprioceptive qualities of joint position sense, force sense, and the unconscious proprioceptive neuromuscular control of wrist reflex time for most muscles after complete wrist denervation. We conclude from this study that complete wrist denervation does not affect the proprioceptive senses of joint position, force sense, and reflex time of the wrist.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| | - Jochen Winter
- Department of Plastic, Aesthetic and Hand Surgery, Hospital Dessau, Dessau-Roßlau, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ursula Range
- Institute of Medical Informatics and Biometry, Medical Faculty of Technical University Dresden, Dresden, Germany
| | - Nane Euchner
- Department of General, Visceral and Vascular Surgery, Hospital Vivantes Spandau, Berlin, Germany
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23
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Abstract
During the protective phase of treatment, therapy for hand and wrist injuries in athletes is similar to the plan of care provided to all patients. The nuances in the care provided to athletes become apparent during the transition to the postprotective phase of rehabilitation when the focus has shifted to return to play. Therapy following a sports injury should address the individual needs of the athletes in their everyday lives as well as the specificity of their training and sports-specific activities. The factors that influence return to play are discussed.
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Affiliation(s)
- Jane M Fedorczyk
- Center for Hand and Upper Limb Health and Performance, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 600, Philadelphia, PA 19107, USA.
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24
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Rein S, Esplugas M, Garcia-Elias M, Magin TM, Randau TM, Siemers F, Philipps HM. Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm. J Anat 2019; 236:906-915. [PMID: 31863467 DOI: 10.1111/joa.13138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/20/2019] [Indexed: 12/22/2022] Open
Abstract
The human interosseous membrane (IOM) is a fundamental stabilizer during forearm rotation. To investigate the dynamic aspects of forearm stability, we analyzed sensory nerve endings in the IOM. The distal oblique bundle (DOB), the distal accessory band (DAB), the central band (CB), the proximal accessory band (PAB), the dorsal oblique accessory cord (DOAC) and the proximal oblique cord (POC) were dissected from 11 human cadaver forearms. Sensory nerve endings were analyzed at two levels per specimen as total cell amount/mm2 after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4',6-diamidino-2-phenylindole on an Apotome microscope, according to Freeman and Wyke's classification. Sensory nerve endings were significantly more commonly found to be equally distributed throughout the structures, rather than being epifascicular, interstitial, or close to the insertion into bone (P ≤ 0.001, respectively). Free nerve endings were the predominant mechanoreceptor in all six structures, with highest density in the DOB, followed by the POC (P ≤ 0.0001, respectively). The DOB had the highest density of Pacini corpuscles. The DOAC and CB had the lowest amounts of sensory innervation. The high density of sensory corpuscles in the DOB, PAB and POC indicate that proprioceptive control of the compressive and directional muscular forces acting on the distal and proximal radioulnar joints is monitored by the DOB, PAB and POC, respectively, due to their closed proximity to both joints, whereas the central parts of the IOM act as structures of passive restraint.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| | | | | | - Thomas M Magin
- Division of Cell and Developmental Biology, Institute of Biology, University of Leipzig, Leipzig, Germany
| | - Thomas M Randau
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hubertus M Philipps
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
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Marini F, Gordon-Murer C, Sera M, Tanha T, Licudo F, Zenzeri J, Hughes CM. Age-related Declines in Sensorimotor Proficiency are Specific to the Tested Motor Skill Component. IEEE Int Conf Rehabil Robot 2019; 2019:654-659. [PMID: 31374705 DOI: 10.1109/icorr.2019.8779560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study utilized a 3-degree of freedom robotic device (Wristbot) to examine wrist proprioception and eye-hand coordination in a cross-sectional sample of sixty-three young adults (19-29 years), 20 older young adults (30-49), and 17 older adults (50 years and older). Results indicated differences in the emergence of age-related declines in sensorimotor functioning depending on the tested motor skill component. While young adults exhibited smaller matching error and lower variability compared to older young adults and older adults on the proprioception task, we observed lower times-on-target and higher Linearity indices for participants older than 50 years of age compared to both young adults and older young adults. The present results provide necessary quantitative information on sensorimotor function in adulthood, and have implications for the early diagnosis and effective management of sensorimotor dysfunction in clinical settings using a commercially available robotic device.
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Bordachar D. Lateral epicondylalgia: A primary nervous system disorder. Med Hypotheses 2019; 123:101-109. [PMID: 30696578 DOI: 10.1016/j.mehy.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 01/05/2023]
Abstract
Lateral epicondylalgia (LE) is the most common chronic painful condition affecting the elbow in the general population. Although major advances have been accomplished in recent years in the understanding of LE, the underlying physiopathology is still a reason for debate. Differences in clinical presentation and evolution of the symptoms among patients, suggest the need for revisiting the current knowledge about subjacent mechanisms that attempt to explain pain and functional loss. Previous models have suggested that the condition is mainly a degenerative tendinopathy, associated with changes in pain pathways and the motor system. The hypothesis of this work is that LE is the clinical manifestation of a primary nervous system disorder, characterized by an abnormal increase in neuronal activity and a subsequent loss of homeostasis, which secondarily affects the musculoskeletal tissues of the elbow-forearm-hand complex. A new model for LE is presented, supported by an in-deep analysis of basic sciences, epidemiological and clinical studies.
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Affiliation(s)
- Diego Bordachar
- Instituto Universitario del Gran Rosario (IUGR), Centro Universitario de Asistencia, Docencia e Investigación (CUADI), Unidad de Investigación Musculoesquelética (UIM), Argentina.
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Pilbeam C, Hood-Moore V. Test–retest reliability of wrist joint position sense in healthy adults in a clinical setting. HAND THERAPY 2018. [DOI: 10.1177/1758998318770227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction Proprioceptive assessments of the wrist inform clinical decision making. In wrist rehabilitation, joint position sense has emerged as one way of assessing conscious proprioception with varying methods and minimal psychometric analysis reported. The purpose of this study was to standardise the wrist joint position sense test method for clinical use and to determine its test–retest reliability in a healthy population. Methods Four wrist positions (20° and 45° flexion, 20° and 45° extension) were measured twice in a random order, by a single rater, using a universal goniometer on the same day. The absolute error in degrees between each position and reposition was calculated. For relative reliability analysis, the intraclass correlation coefficient (3,1) was calculated. For absolute reliability the standard error of the measurement was calculated and Bland–Altman plots visually inspected. Results Fifty-five healthy volunteers (mean age 31.1 SD±10.25 years) were assessed. The mean absolute error, summarised for all positions for test and retest, was 3.98°. The intraclass correlation coefficients were poor to fair (0.07–0.47), and standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were fairly narrow, and the Bland–Altman plots showed random distribution of errors for each position, therefore the measurement error was clinically acceptable. Conclusions The active wrist joint position sense test using goniometry demonstrated poor to fair test–retest reliability and acceptable measurement error in healthy volunteers. The wrist joint position sense angle of 20° flexion was the most reliable.
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Affiliation(s)
- Chloë Pilbeam
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
- Rheumatology Department, Royal Derby Hospital, Derby, UK
| | - Victoria Hood-Moore
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
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Ferreres A. First Commentary on "Partial Wrist Denervation: The Evidence Behind a Small Fix for Big Problems". J Hand Surg Am 2018; 43:278-280. [PMID: 29502580 DOI: 10.1016/j.jhsa.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/14/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Angel Ferreres
- Department of Hand and Upper Extremity Surgery, Institute Kaplan, Barcelona, Spain
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Ayhan C, Tanrıkulu S, Leblebicioglu G. Scapholunate interosseous ligament dysfunction as a source of elbow pain syndromes: Possible mechanisms and implications for hand surgeons and therapists. Med Hypotheses 2018; 110:125-131. [PMID: 29317055 DOI: 10.1016/j.mehy.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/02/2017] [Accepted: 12/03/2017] [Indexed: 12/01/2022]
Abstract
Elbow pain syndromes are common upper extremity musculoskeletal disorders, and they are usually associated with repetitive occupational exposure. Ligaments are often one of the sources of musculoskeletal disorders because of their mechanical and neurological properties. The wrist ligaments are some of the ligaments most vulnerable to occupational exposure. Since most occupational tasks require wrist extension for handling tools and loading, the scapholunate interosseous ligament (SLIL) bears greater strain during loading, which results in creep deformation and hysteresis. Ligamentous creep may result in diminished ability to detect signal changes during joint movements, which impairs neuromuscular control established by ligamentomuscular reflex arcs elicited from mechanoreceptors in the ligaments. Changes in muscle activation patterns of forearm muscles due to diminished ligamentomuscular reflexes may initiate a positive feedback loop, leading to musculoskeletal pain syndromes. The relationship between elbow pain syndromes and SLIL injury will be presented through two hypotheses and relevant pain mechanisms: 1. Repetitive tasks may cause creep deformation of the SLIL, which then impairs ligamentomuscular reflexes, leading to elbow pain disorders. 2. Lateral epicondylalgia may increase the risk of SLIL injury through the compensation of the lower extensor carpi radialis muscle activity by higher extensor carpi ulnaris muscle activity, which may alter carpal kinematics, leading to SLIL degeneration over time. The differential diagnosis is usually complicated in musculoskeletal pain disorders. The failure of treatment methods is one of the issues of concern for many researchers. A key element in developing treatment strategies is to understand the source of the disorder and the nature of the injury. We proposed that the differential diagnosis include SLIL injuries when describing elbow pain syndromes, particularly, lateral epicondylalgia.
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Affiliation(s)
- Cigdem Ayhan
- Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
| | - Seval Tanrıkulu
- Koc University, Faculty of Medicine, Orthopedics and Traumatology Department, Hand Surgery Unit, İstanbul, Turkey
| | - Gursel Leblebicioglu
- Hacettepe University, Faculty of Medicine, Orthopaedics and Traumatology Department, Hand Surgery Unit, Ankara, Turkey
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30
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Tseng YT, Tsai CL, Chen FC, Konczak J. Position Sense Dysfunction Affects Proximal and Distal Arm Joints in Children with Developmental Coordination Disorder. J Mot Behav 2017; 51:49-58. [DOI: 10.1080/00222895.2017.1415200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yu-Ting Tseng
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Chia-Liang Tsai
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Tainan City, Taiwan
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung City, Taiwan
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
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Carvalho VB, Ferreira CHV, Hoshino AR, Bernardo VA, Ruggiero GM, Aita MA. Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft. Rev Bras Ortop 2017; 52:676-684. [PMID: 29234651 PMCID: PMC5720838 DOI: 10.1016/j.rboe.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives To measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. Methods From January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. Results The follow-up time was 12 months (3-17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1-6). DASH was 6.50/100 (1-30). The time to work return work was 4.42 months (2-17). As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities.The preoperative SL gap was 4.29 mm (2-7); in the postoperative period, it was 1.79 mm (1-4). The DISI deformity was present in ten patients with SL angle > 70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. Conclusion The new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.
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Affiliation(s)
| | | | | | - Viviane Alves Bernardo
- Faculdade de Medicina do ABC, Serviço de Ortopedia e Traumatologia, Santo André, SP, Brazil
| | | | - Márcio Aurélio Aita
- Faculdade de Medicina do ABC, Serviço de Ortopedia e Traumatologia, Santo André, SP, Brazil
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Carvalho VB, Ferreira CHV, Hoshino AR, Bernardo VA, Ruggiero GM, Aita MA. Capsulodese dorsal associada à reconstrução assistida por artroscopia do ligamento escafossemilunar com enxerto do tendão do músculo palmar longo. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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El papel de la propiocepción y el control neuromuscular en las inestabilidades del carpo. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2017. [DOI: 10.1016/j.ricma.2015.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
La congruencia articular, la integridad ligamentaria y la compresión de las superficies articulares ocasionada por la contracción muscular se han considerado históricamente los tres pilares básicos para la estabilidad del carpo. En los últimos años se ha propuesto un nuevo factor para explicar los mecanismos de estabilización carpiana, la propiocepción y el control neuromuscular. La propiocepción en la muñeca se origina en órganos sensoriales localizados en los ligamentos y cápsulas articulares (los mecanorreceptores). La estimulación de los mismos inicia un reflejo involuntario que provoca una respuesta muscular selectiva dirigida a proteger la zona de la muñeca donde se ha originado la señal aferente. En este trabajo de revisión se pretende dar a conocer el concepto de propiocepción y control neuromuscular, el papel que tienen en la estabilidad del carpo y las posibles aplicaciones en la práctica clínica.
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Abstract
Recent laboratory research has disclosed that carpal ligaments exhibit different kinetic behaviors depending on the direction and point of application of the forces being applied to the wrist. The so-called helical antipronation ligaments are mostly active when the wrist is axially loaded, whereas the helical antisupination ligaments constrain supination torques to the distal row. This novel way of interpreting the function of the carpal ligaments may help in developing better strategies to treat carpal instabilities.
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Affiliation(s)
- Marc Garcia-Elias
- Hand & Upper Limb Surgery, Institut Kaplan, Passeig de la Bonanova, 9, 2on 2a, Barcelona 08022, Spain; Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Carrer de Villarroel 170, Barcelona 08036, Spain.
| | - Inma Puig de la Bellacasa
- Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Carrer de Villarroel 170, Barcelona 08036, Spain; Hand and Upper Extremity Surgery, Mútua de Terrassa Hospital Universitari, Plaça del Doctor Robert, 5, Terrassa 08221, Spain
| | - Corinne Schouten
- Department of Plastic and Reconstructive, Hand, and Aesthetic Surgery, Catharina Hospital Eindhoven, Vondelstraat 75H, Nijmegen 6512BD, The Netherlands
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35
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Arthroscopic reconstruction for unstable scaphoid non-union. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Skalec A, Egerbacher M. The deep fascia and retinacula of the equine forelimb - structure and innervation. J Anat 2017; 231:405-416. [PMID: 28585281 DOI: 10.1111/joa.12643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 12/31/2022] Open
Abstract
Recent advances in human fascia research have shed new light on the role of the fascial network in movement perception and coordination, transmission of muscle force, and integrative function in body biomechanics. Evolutionary adaptations of equine musculoskeletal apparatus that assure effective terrestrial locomotion are employed in equestrianism, resulting in the wide variety of movements in performing horses, from sophisticated dressage to jumping and high-speed racing. The high importance of horse motion efficiency in the present-day equine industry indicates the significance of scientific knowledge of the structure and physiology of equine fasciae. In this study, we investigated the structure and innervation of the deep fascia of the equine forelimb by means of anatomical dissection, histology and immunohistochemistry. Macroscopically, the deep fascia appears as a dense, glossy and whitish lamina of connective tissue continuous with its fibrous reinforcements represented by extensor and flexor retinacula. According to the results of our histological examination, the general structure of the equine forelimb fascia corresponds to the characteristics of the human deep fasciae of the limbs. Although we did find specific features in all sample types, the general composition of all examined fascial tissues follows roughly the same scheme. It is composed of dense, closely packed collagen fibers organized in layers of thick fibrous bundles with sparse elastic fibers. This compact tissue is covered from both internal and external sides by loosely woven laminae of areolar connective tissue where elastic fibers are mixed with collagen. Numerous blood vessels running within the loose connective tissue contribute to the formation of regular vascular network throughout the compact layer of the deep fascia and retinacula. We found nerve fibers of different calibers in all samples analyzed. The fibers are numerous in the areolar connective tissue and near the blood vessels but scarce in the compact layers of collagen. We did not observe any Ruffini, Pacini or Golgi-Mazzoni corpuscles. In conclusion, the multilayered composition of compact bundles of collagen, sparse elastic fibers in the deep fascia and continuous transition into retinacula probably facilitate resistance to gravitational forces and volume changes during muscle contraction as well as transmission of muscle force during movement. However, further research focused on innervation is needed to clarify whether the deep fascia of the equine forelimb plays a role in proprioception and movement coordination.
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Affiliation(s)
- Aleksandra Skalec
- Department of Animal Physiology and Biostructure, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Monika Egerbacher
- Institute of Anatomy, Histology and Embryology, University of Veterinary Medicine, Vienna, Austria
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37
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Arthroscopic reconstruction for unstable scaphoid non-union. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:216-223. [PMID: 28473231 DOI: 10.1016/j.recot.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the results of arthroscopic reconstruction for the treatment of unstable scaphoid non-union with cancellous bone autograft. METHODS 13 patients were treated with a mean age of 26 (18-45) years. The average time from injury until surgery was 14 (6-48) months. Preoperative and postoperative clinical and radiological parameters were evaluated. Mean follow-up was 16.8 (12-36) months. RESULTS Consolidation was achieved in all cases at 7 (4-10 weeks), no patient had complications or reoperations. Range of motion, pain, functional assessment (DASH questionnaire) and radiological measurements improved compared to preoperative measurements. The average range of flexion improved: flexion 71.9° (55°-80°) to 81.7° (55°-90°), extension 66.3° (30°-80°) to 84.4° (70° -90°), ulnar deviation 21.5 (10°-25°) to 25.5° (20°-45°) and radial deviation 11.9° (5°-25°) to 13.3° (10th-20th). Pain (VAS 0-10) improved from 6.8 (4-10) to 0.7 (0-3). DASH functional scale improved from 36 (12-78) to 8 (0-10). The Scapho-Lunate Angle improved from 67.7° (62°-88°) to 47° (32°-55°), and the Radio-Lunate Angle improved from 30.8° (10° -45°) to 4(0°-10°). CONCLUSION Treatment of unstable scaphoid non-union with cancellous bone graft assisted by arthroscopy presents good clinical results with a short period of consolidation and recovery.
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Hincapie OL, Elkins JS, Vasquez-Welsh L. Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability. J Hand Ther 2017; 29:183-90. [PMID: 27264903 DOI: 10.1016/j.jht.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Previously published studies demonstrate the importance of the sensory innervation of the carpal ligaments and the implication for the sensorimotor control of the wrist. In addition, this case considers key rehabilitation concepts to include the dart-throwing motion and the stabilizing effect of the forearm muscles. PURPOSE OF THE STUDY To describe the rehabilitation program for a patient with chronic wrist pain, diagnosed with a partial tear of the dorsal intercarpal ligament and a sprain of the scapholunate ligament of the right wrist. METHODS The patient participated in a staged treatment plan over a 3-month period (20 sessions), which began with a focus on proprioceptive awareness and joint position sense retraining. The treatment progressed to strengthening of specific muscles to enhance stability of the wrist joint. The patient completed the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation on initial evaluation, re-evaluation at ninth session, and discharge at 20th session. RESULTS Raw scores in the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation improved from 33 and 61.5 on initial evaluation to 18 and 17.5 on discharge, respectively. CONCLUSIONS Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. The effectiveness of proprioceptive retraining needs to be evaluated in a well-designed randomized controlled trial recruiting this patient population. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Olga L Hincapie
- NYU Langone Medical Center, Center for Musculoskeletal Care, Hand Therapy Service, New York, NY, USA.
| | - Jeananne S Elkins
- Northeastern University, College of Professional Studies, Boston, MA, USA
| | - Laura Vasquez-Welsh
- NYU Langone Medical Center, Center for Musculoskeletal Care, Hand Therapy Service, New York, NY, USA
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Karagiannopoulos C, Michlovitz S. Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. J Hand Ther 2017; 29:154-65. [PMID: 26774958 DOI: 10.1016/j.jht.2015.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/03/2015] [Indexed: 02/09/2023]
Abstract
UNLABELLED This clinical review discusses the organization, neuroanatomy, assessment, clinical relevance, and rehabilitation of sensorimotor (SM) control impairment after wrist trauma. The wrist SM control system encompasses complex SM pathways that control normal wrist active range of motion and mediate wrist joint neuromuscular stability for maintaining joint function. Among various known assessment methods of wrist SM control impairment, the active wrist joint position sense test is determined to be a clinically meaningful and responsive measure for wrist SM control impairment after wrist fracture. Wrist trauma may involve significant soft tissue injury (ie, skin, ligament, muscle), which could disrupt the generation and transmission of adequate proprioceptive input from wrist mechanoreceptors, thus leading to significant joint SM impairment. Various clinical examples of wrist trauma (eg, distal radius fracture, scapholunate joint injury) along with known prognostic factors (eg, pain) that may influence wrist SM control impairment recovery are discussed to illustrate this point. This article proposes promising rehabilitation strategies toward restoring wrist joint conscious and unconscious SM control impairments, integrating current research evidence with clinical practice. These strategies require more rigorous evaluation in clinical trials. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Susan Michlovitz
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Esplugas M, Garcia-Elias M, Lluch A, Llusá Pérez M. Role of muscles in the stabilization of ligament-deficient wrists. J Hand Ther 2017; 29:166-74. [PMID: 27264901 DOI: 10.1016/j.jht.2016.03.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 02/03/2023]
Abstract
This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency. MC pronator muscles, by contrast, would be beneficial in stabilizing wrists with ulnar-sided ligament deficiencies owing to their ability to tighten the triquetrum-distal row ligaments. Should these laboratory findings be validated by additional clinical research, proprioceptive reeducation of selected muscles could become an important tool for the treatment of dynamic carpal instabilities.
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Affiliation(s)
- Mireia Esplugas
- Hand Unit, Orthopaedics Department, Clínica Activamutua Tarragona, Tarragona, Spain; Wrist Biomechanics Study Group, Anatomy Department, University of Barcelona, Barcelona, Spain.
| | - Marc Garcia-Elias
- Wrist Biomechanics Study Group, Anatomy Department, University of Barcelona, Barcelona, Spain; Institut Kaplan, Passeig de la Bonanova, Barcelona, Spain
| | - Alex Lluch
- Wrist Biomechanics Study Group, Anatomy Department, University of Barcelona, Barcelona, Spain; Institut Kaplan, Passeig de la Bonanova, Barcelona, Spain; Hand Unit, Orthopedics Department, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Llusá Pérez
- Wrist Biomechanics Study Group, Anatomy Department, University of Barcelona, Barcelona, Spain
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41
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Marini F, Squeri V, Morasso P, Campus C, Konczak J, Masia L. Robot-aided developmental assessment of wrist proprioception in children. J Neuroeng Rehabil 2017; 14:3. [PMID: 28069028 PMCID: PMC5223571 DOI: 10.1186/s12984-016-0215-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several neurodevelopmental disorders and brain injuries in children have been associated with proprioceptive dysfunction that will negatively affect their movement. Unfortunately, there is lack of reliable and objective clinical examination protocols and our current knowledge of how proprioception evolves in typically developing children is still sparse. METHODS Using a robotic exoskeleton, we investigated proprioceptive acuity of the wrist in a group of 49 typically developing healthy children (8-15 years), and a group of 40 young adults. Without vision participants performed an ipsilateral wrist joint position matching task that required them to reproduce (match) a previously experienced target position. All three joint degrees-of-freedom of the wrist/hand complex were assessed. Accuracy and precision were evaluated as a measure of proprioceptive acuity. The cross-sectional data indicating the time course of development of acuity were then fitted by four models in order to determine which function best describes developmental changes in proprioception across age. RESULTS First, the robot-aided assessment proved to be an easy to administer method for objectively measuring proprioceptive acuity in both children and adult populations. Second, proprioceptive acuity continued to develop throughout middle childhood and early adolescence, improving by more than 50% with respect to the youngest group. Adult levels of performance were reached approximately by the age of 12 years. An inverse-root function best described the development of proprioceptive acuity across the age groups. Third, wrist/forearm proprioception is anisotropic across the three DoFs with the Abduction/Adduction exhibiting a higher level of acuity than those of Flexion/extension and Pronation/Supination. This anisotropy did not change across development. CONCLUSIONS Proprioceptive development for the wrist continues well into early adolescence. Our normative data obtained trough this novel robot-aided assessment method provide a basis against which proprioceptive function of pediatric population can be compared. This may aid the design of more effective sensorimotor intervention programs.
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Affiliation(s)
- Francesca Marini
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
| | - Valentina Squeri
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
| | - Pietro Morasso
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
| | - Claudio Campus
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, USA, 1900 University Ave S E, Minneapolis, 24105, USA
| | - Lorenzo Masia
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore, Singapore, 639798.
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Marini F, Squeri V, Morasso P, Konczak J, Masia L. Robot-Aided Mapping of Wrist Proprioceptive Acuity across a 3D Workspace. PLoS One 2016; 11:e0161155. [PMID: 27536882 PMCID: PMC4990409 DOI: 10.1371/journal.pone.0161155] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Proprioceptive signals from peripheral mechanoreceptors form the basis for bodily perception and are known to be essential for motor control. However we still have an incomplete understanding of how proprioception differs between joints, whether it differs among the various degrees-of-freedom (DoFs) within a particular joint, and how such differences affect motor control and learning. We here introduce a robot-aided method to objectively measure proprioceptive function: specifically, we systematically mapped wrist proprioceptive acuity across the three DoFs of the wrist/hand complex with the aim to characterize the wrist position sense. Thirty healthy young adults performed an ipsilateral active joint position matching task with their dominant wrist using a haptic robotic exoskeleton. Our results indicate that the active wrist position sense acuity is anisotropic across the joint, with the abduction/adduction DoF having the highest acuity (the error of acuity for flexion/extension is 4.64 ± 0.24°; abduction/adduction: 3.68 ± 0.32°; supination/pronation: 5.15 ± 0.37°) and they also revealed that proprioceptive acuity decreases for smaller joint displacements. We believe this knowledge is imperative in a clinical scenario when assessing proprioceptive deficits and for understanding how such sensory deficits relate to observable motor impairments.
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Affiliation(s)
- Francesca Marini
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Valentina Squeri
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Pietro Morasso
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lorenzo Masia
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
- * E-mail:
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Pirolo JM, Le W, Yao J. Effect of Electrothermal Treatment on Nerve Tissue Within the Triangular Fibrocartilage Complex, Scapholunate, and Lunotriquetral Interosseous Ligaments. Arthroscopy 2016; 32:773-8. [PMID: 26947354 DOI: 10.1016/j.arthro.2015.11.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/31/2015] [Accepted: 11/20/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of thermal treatment on neural tissue in the triangular fibrocartilage complex (TFCC), scapholunate interosseous ligament (SLIL), and lunotriquetral interosseous ligament (LTIL). METHODS The intact TFCC, SLIL, and LTIL were harvested from cadaveric specimens and treated with a radiofrequency probe as would be performed intraoperatively. Slides were stained using a triple-stain technique for neurotrophin receptor p75, pan-neuronal marker protein gene product 9.5 (PGP 9.5), and 4',6-diamidino-2-phenylindole for neural identification. Five TFCC, 5 SLIL, and 4 LTIL specimens were imaged with fluorescence microscopy. Imaging software was used to measure fluorescence signals and compare thermally treated areas with adjacent untreated areas. A paired t test was used to compare treated versus untreated areas. P < .05 was considered significant. RESULTS For the TFCC, a mean of 94.9% ± 2.7% of PGP 9.5-positive neural tissue was ablated within a mean area of 11.7 ± 2.5 mm(2) (P = .02). For the SLIL treated from the radiocarpal surface, 97.4% ± 1.0% was ablated to a mean depth of 2.4 ± 0.3 mm from the surface and a mean horizontal spread of 3.4 ± 0.5 mm (P = .01). For the LTIL, 96.0% ± 1.5% was ablated to a mean depth of 1.7 ± 0.7 mm and a mean horizontal spread of 2.6 ± 1.0 mm (P = .02). Differences in the presence of neural tissue between treated areas and adjacent untreated areas were statistically significant for all specimens. CONCLUSIONS Our study confirms elimination of neuronal markers after thermal treatment of the TFCC, SLIL, and LTIL in cadaveric specimens. This effect penetrates below the surface to innervated collagen tissue that is left structurally intact after treatment. CLINICAL RELEVANCE Electrothermal treatment as commonly performed to treat symptomatic SLIL, LTIL, and TFCC tears eliminates neuronal tissue in treated areas and may function to relieve pain through a denervation effect.
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Affiliation(s)
- Joseph M Pirolo
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Wei Le
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, California, U.S.A..
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Hagert E, Lluch A, Rein S. The role of proprioception and neuromuscular stability in carpal instabilities. J Hand Surg Eur Vol 2016; 41:94-101. [PMID: 26115684 DOI: 10.1177/1753193415590390] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/12/2015] [Indexed: 02/03/2023]
Abstract
Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.
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Affiliation(s)
- E Hagert
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden Hand & Foot Surgery Center, Stockholm, Sweden
| | - A Lluch
- Institut Kaplan, Barcelona, Spain Department of Orthopaedic Surgery, Vall d'Hebron Hospital, Barcelona, Spain
| | - S Rein
- Department of Orthopaedic and Trauma Surgery, University Hospital 'Carl Gustav Carus', Dresden, Germany Department of Hand and Plastic Surgery, Burn Unit, Berufsgenos-senschaftliche Klinik Bergmannstrost, Halle (Saale), Germany
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Abstract
The purpose of this paper is to describe a mini dorsal approach to the triangular fibrocartilage complex (TFCC). We describe a mini incision approach which aims to preserve the structure and proprioception of the primary and secondary stabilisers of the wrist joint. This approach requires less dissection and provides adequate exposure to the distal aspect of the TFCC and allows visualisation of the distal radial ulna joint (DRUJ) with complete TFCC lesions.
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Ludwig CA, Mobargha N, Okogbaa J, Hagert E, Ladd AL. Altered Innervation Pattern in Ligaments of Patients with Basal Thumb Arthritis. J Wrist Surg 2015; 4:284-291. [PMID: 26649261 PMCID: PMC4626232 DOI: 10.1055/s-0035-1564982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose The population of mechanoreceptors in patients with osteoarthritis (OA) lacks detailed characterization. In this study, we examined the distribution and type of mechanoreceptors of two principal ligaments in surgical subjects with OA of the first carpometacarpal joint (CMC1). Methods We harvested two ligaments from the CMC1 of eleven subjects undergoing complete trapeziectomy and suspension arthroplasty: the anterior oblique (AOL) and dorsal radial ligament (DRL). Ligaments were divided into proximal and distal portions, paraffin-sectioned, and analyzed using immunoflourescent triple staining microscopy. We performed statistical analyses using the Wilcoxon Rank Sum test and ANOVA with post-hoc Bonferroni and Tamhane adjustments. Results The most prevalent nerve endings in the AOL and DRL of subjects with OA were unclassifiable mechanoreceptors, which do not currently fit into a defined morphological scheme. These were found in 11/11 (100%) DRLs and 7/11 (63.6%) AOLs. No significant difference existed with respect to location within the ligament (proximal versus distal) of mechanoreceptors in OA subjects. Conclusion The distribution and type of mechanoreceptors in cadavers with no to mild OA differ from those in surgical patients with OA. Where Ruffini endings predominate in cadavers with no to mild OA, unclassifiable corpuscles predominate in surgical patients with OA. These findings suggest an alteration of the mechanoreceptor population and distribution that accompanies the development of OA. Clinical Relevance Identification of a unique type and distribution of mechanoreceptors in the CMC1 of symptomatic subjects provides preliminary evidence of altered proprioception in OA.
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Affiliation(s)
- Cassie A. Ludwig
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University, Palo Alto, California
| | - Nathalie Mobargha
- Department of Hand and Plastic Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Janet Okogbaa
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University, Palo Alto, California
| | - Elisabet Hagert
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
- Hand and Foot Surgery Center, Stockholm, Sweden
| | - Amy L. Ladd
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University, Palo Alto, California
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Abstract
The scapholunate ligament is both a key ligament in the stability of the carpus and one of the most frequently injured. Thorough understanding of the anatomy, biomechanics, and pathophysiology of the wrist is important in treating injuries to the scapholunate ligament. The presentation of scapholunate instability often includes a vague injury history and pain with grip, wrist extension, and sport or labor. Identified injuries are classified based on dynamic and static radiographic findings, chronicity, and the presence or absence of arthrosis. Surgical options for the treatment of low- and high-grade injuries include both open and arthroscopic procedures and can be broadly classified into four categories: limited arthroscopic procedures, primary ligament repair, reconstructive procedures, and salvage procedures. No strong evidence currently supports any one treatment. Decision making is largely based on expert opinion and surgeon experience. Prognosis is often guarded, and patient expectations should be tempered.
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Cappello L, Elangovan N, Contu S, Khosravani S, Konczak J, Masia L. Robot-aided assessment of wrist proprioception. Front Hum Neurosci 2015; 9:198. [PMID: 25926785 PMCID: PMC4396514 DOI: 10.3389/fnhum.2015.00198] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Impaired proprioception severely affects the control of gross and fine motor function. However, clinical assessment of proprioceptive deficits and its impact on motor function has been difficult to elucidate. Recent advances in haptic robotic interfaces designed for sensorimotor rehabilitation enabled the use of such devices for the assessment of proprioceptive function. PURPOSE This study evaluated the feasibility of a wrist robot system to determine proprioceptive discrimination thresholds for two different DoFs of the wrist. Specifically, we sought to accomplish three aims: first, to establish data validity; second, to show that the system is sensitive to detect small differences in acuity; third, to establish test-retest reliability over repeated testing. METHODOLOGY Eleven healthy adult subjects experienced two passive wrist movements and had to verbally indicate which movement had the larger amplitude. Based on a subject's response data, a psychometric function was fitted and the wrist acuity threshold was established at the 75% correct response level. A subset of five subjects repeated the experimentation three times (T1, T2, and T3) to determine the test-retest reliability. RESULTS Mean threshold for wrist flexion was 2.15°± 0.43° and 1.52°± 0.36° for abduction. Encoder resolutions were 0.0075°(flexion-extension) and 0.0032°(abduction-adduction). Motor resolutions were 0.2°(flexion-extension) and 0.3°(abduction-adduction). Reliability coefficients were r T2-T1 = 0.986 and r T3-T2 = 0.971. CONCLUSION We currently lack established norm data on the proprioceptive acuity of the wrist to establish direct validity. However, the magnitude of our reported thresholds is physiological, plausible, and well in line with available threshold data obtained at the elbow joint. Moreover, system has high resolution and is sensitive enough to detect small differences in acuity. Finally, the system produces reliable data over repeated testing.
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Affiliation(s)
- Leonardo Cappello
- Department of Robotics Brain and Cognitive Sciences, Istituto Italiano di Tecnologia , Genova , Italy
| | - Naveen Elangovan
- School of Kinesiology, University of Minnesota , Minneapolis, MN , USA
| | - Sara Contu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University , Singapore , Singapore
| | - Sanaz Khosravani
- School of Kinesiology, University of Minnesota , Minneapolis, MN , USA
| | - Jürgen Konczak
- School of Kinesiology, University of Minnesota , Minneapolis, MN , USA
| | - Lorenzo Masia
- School of Mechanical and Aerospace Engineering, Nanyang Technological University , Singapore , Singapore
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International Federation of Societies for Surgery of the Hand 2013 Committee's report on wrist dart-throwing motion. J Hand Surg Am 2014; 39:1433-9. [PMID: 24888529 DOI: 10.1016/j.jhsa.2014.02.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/15/2014] [Accepted: 02/25/2014] [Indexed: 02/02/2023]
Abstract
This report updates information on wrist dart-throwing (DT) motion, based on the most recent research published on the kinematics, kinetics, and clinical applications of DT motion. A wide range of DT planes exists. "Pure" DT motion is done along an oblique plane that intercepts the coronal and sagittal planes at the zero position, and occurs almost exclusively at the midcarpal joint with near zero scaphoid and lunate motion. "Functional" DT motion such as a hammering is done along an oblique plane that is almost parallel to the pure DT plane, but that has an offset toward the dorsal side. Functional DT rotation has greater scaphoid and lunate motion compared with pure DT motion. Midcarpal arthrodesis adversely affects DT motion compared with radiocarpal arthrodesis. During a DT motion, the mean and peak tendon forces of the flexor carpi ulnaris and the extensor carpi radialis longus were the greatest among wrist motors. By performing a task along the plane of DT motion, the scapholunate (SL) joint was stable and SL ligament elongation was minimal in healthy subjects. However, a more recent study of patients with SL dissociation revealed that DT exercises applied tensile forces on the SL ligament and induced an SL gap.
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Colditz JC. Dynamic loading posture of the thumb: the Colditz Tear Test. J Hand Ther 2014; 26:360-2; quiz 362. [PMID: 24139832 DOI: 10.1016/j.jht.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/10/2013] [Indexed: 02/03/2023]
Abstract
The movement patterns one sees when loads placed on a joint are incrementally increased provides valuable insight as to how a joint functions during different everyday activities. This author describes a simple, yet effective method of assessing the thumb carpometacarpal joint as load demands increase. It may be used as an evaluative tool or as an adjunct to treatment.
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