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Mitchell T, Hamilton N, Dean B, Rodgers S, Fowler-Davis S, McLean S. A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders. HAND THERAPY 2024; 29:3-20. [PMID: 38425437 PMCID: PMC10901165 DOI: 10.1177/17589983231219595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Introduction Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.
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Affiliation(s)
- Thomas Mitchell
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Nick Hamilton
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Ben Dean
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarah Rodgers
- The Hand Unit, Northern General Hospital, Sheffield, UK
| | | | - Sionnadh McLean
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
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2
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Öztürk T, Burtaç Eren M. Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)? Acta Orthop Belg 2021. [DOI: 10.52628/87.2.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The extensor carpi ulnaris (ECU) tendon is in the sixth extensor compartment of the wrist and is isolated from other tendons by a different sheath. Extensor carpi ulnaris pathologies are characterized by pain locally localized to the wrist ulnar side. Outpatient records and wrist MRI (magnetic resonance imaging) tests were retrospectively scanned between January 2018 and July 2019. By examining the anamnesis and examination notes of the patients in the outpatient clinic records, patients with wrist ulnar side pain, pain or sensitivity on the ulnar styloid and provocation test (synergy) were assigned to the first study group (Group 1).The second study group was composed of patients who underwent wrist MR for the diagnosis or differential diagnosis of a synovial cyst around the wrist, without ulnar side pain (Group 2).While evaluating MR images in the axial plane, the depth and width of the ulnar groove, thickness of the ECU tendon were measured. The position of the ECU tendon relative to the ulnar groove and the forearm rotation during the shooting were recorded.105 cases evaluated, there were 41 cases in the symptomatic subgroup and 64 cases in the asymptomatic subgroup. Among all patients, the mean patient age was 38.05.In the evaluation according to whether cases were symptomatic or not, there was no significant relationship between being symptomatic and the degree of instability and MR withdrawal position.
Our study suggests that ECU instability in MR is not a specific condition, and detection of MR in instability may not be associated with a patient’s symptoms.
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3
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Zhang C, Shen S, Qiu L, Wang L, Zeng X, Zhou Q. Overuse wrist injuries in adolescent platform and springboard divers. Res Sports Med 2021; 31:273-284. [PMID: 34412515 DOI: 10.1080/15438627.2021.1966009] [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: 10/20/2022]
Abstract
To investigate overuse wrist injuries in adolescent divers using magnetic resonance imaging (MRI). The bilateral wrists (76 wrists) of 38 professional divers were examined by MRI; 42 wrists with pain were placed in the symptomatic group, and 34 wrists without pain were placed in the asymptomatic group. Two experienced radiologists assessed the wrist injuries. Chi‑square test was used to compare the difference in injuries between the two groups. Subchondral osteosclerosis was observed in 47.62% of symptomatic wrists and 52.94% of asymptomatic wrists. Distal radial epiphyseal plate injury was detected in 42.86% of symptomatic wrists and 11.76% of asymptomatic wrists. Triangular fibrocartilage complex injury was observed in 19.04% of symptomatic wrists and 8.82% of asymptomatic wrists. Bursae around the wrist were observed in 21.42% of symptomatic wrists and 17.64% of asymptomatic wrists. The incidence of distal radial epiphyseal plate injury was higher in the symptomatic group than in the asymptomatic group (P = 0.007), however, other injuries were not statistically different between the two groups (P > 0.05). This study demonstrated that adolescent divers had various wrist injuries, and distal radial epiphyseal plate injury was more common in the symptomatic wrist; these injuries show no specific clinical symptoms and are easily overlooked.
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Affiliation(s)
- Cici Zhang
- Department of Radiology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Si Shen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lin Qiu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Liqin Wang
- Department of Ultrasound, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Xuwen Zeng
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Quan Zhou
- Department of Radiology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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4
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Solewski B, Lis M, Pękala JR, Brzegowy K, Lauritzen SS, Hołda MK, Walocha JA, Tomaszewski KA, Pękala PA, Koziej M. The persistent median artery and its vascular patterns: A meta-analysis of 10,394 subjects. Clin Anat 2021; 34:1173-1185. [PMID: 34371525 DOI: 10.1002/ca.23770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022]
Abstract
The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.
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Affiliation(s)
- Bernard Solewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Lis
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Brzegowy
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Sigurd S Lauritzen
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Orthopaedics, Scanmed St. Raphael Hospital, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Mateusz Koziej
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Erpala F, Ozturk T. "Snapping" of the extensor carpi ulnaris tendon in asymptomatic population. BMC Musculoskelet Disord 2021; 22:387. [PMID: 33902526 PMCID: PMC8077812 DOI: 10.1186/s12891-021-04271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background Extensor carpi ulnaris tendinopathy (ECU) can be one cause of ulnar side wrist pain and it is more prominent in pronation-supination movements against resistance. In supination, flexion, and ulnar deviation within the ulnar groove, the tendon is tense and becomes predisposed to subluxation or dislocation. Snapping occurs during this dislocation and relocation. As a result of this friction between the tendon sheath and ulnar groove, tendinopathy and pain occur. ECU tendon is an important structure that contributes to the dynamic stability of wrist therefore resulting degeneration contributes disruption of distal radioulnar joint and causes wrist instability. Methods Participants without active wrist complaints who presented to the outpatient clinic between 2019 and 2020 were included. Provocation test was performed and participants with snapping were evaluated with ultrasound to determine subluxation or dislocation. Participants asked to indicate approximately how much time they spent daily on the phone, computer and game console. The distribution of data was evaluated with the Kolmogorov-Smirnov test. Quantitative data that were not normally distributed were evaluated using the Mann-Whitney U test, and Student’s t-test was used for normally distributed data. The Chi-square test was used to compare categorical variables. For all tests, p < 0.05 was considered statistically significant. Results Four hundred and fifteen women and 340 men were included in the study. Fifty of the 755 participants (6.6 %) had snapping. 22 of the 755 participants (2.9 %) had dislocation or subluxation on ultrasound. Three (13.6 %) participants had dislocation and 19 (%86.4) participants had subluxation on ultrasound. All 50 of the participants with snapping had significant repetitive trauma and sports activities. It was determined that 21 of the 22 participants who were found to have subluxation or dislocation by ultrasound had more than two hours of hobby activity and significantly more participants had more than two hours of activity compared to the group without subluxation or dislocation. Conclusions This study with a large number of participants will contribute to the literature in terms of evaluating the contribution of technological devices, such as computers, smartphones, and consoles to chronic wrist pain and the prevalence of ECU snapping in the asymptomatic population. Trial registration Date of Approval; 19.02.2019, Approval Number; 19-KAEK-045.
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Affiliation(s)
- Firat Erpala
- Department of Orthopaedics and Traumatology, Cesme Alpercizgenakat State Hospital, 35930, Izmir, Turkey.
| | - Tahir Ozturk
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University, Tokat, Turkey
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6
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Alpar O. Monitoring and fuzzy warning system for risk prevention of Guyon’s canal syndrome. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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The presentation, diagnosis and management of non-traumatic wrist pain: an evaluation of current practice in secondary care in the UK NHS. Rheumatol Adv Pract 2020; 4:rkaa030. [PMID: 33094215 PMCID: PMC7566494 DOI: 10.1093/rap/rkaa030] [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: 03/26/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives The study aims were to assess the burden of non-traumatic wrist pain in terms of numbers of referrals to secondary care and to characterize how patients present, are diagnosed and are managed in secondary care in the UK National Health Service. Methods Ten consecutive patients presenting with non-traumatic wrist pain were identified retrospectively at each of 16 participating hospitals, and data were extracted for 12 months after the initial referral. Results The 160 patients consisted of 100 females and 60 males with a median age of 49 years, accounting for ∼13% of all new hand/wrist referrals. The dominant wrist was affected in 60% of cases, and the mean symptom duration was 13.3 months. Diagnoses were grouped as follows: OA (31%), tendinopathy (13%), ganglion (14%), ulnar sided pain (17%) and other (25%). The OA group was significantly older than other groups, and other groups contained a predominance of females. The non-surgical interventions, in decreasing frequency of usage, were as follows: CS injections (39%), physiotherapy (32%), splint (31%) and analgesics (12%). Of those who underwent surgery, all patients had previously received non-surgical treatment, but 42% had undergone only one non-surgical intervention. Conclusions Non-traumatic wrist pain represents a significant burden to secondary care both in terms of new patient referrals and in terms of investigation, follow-up and treatment. Those presenting with OA are more likely to be older and male, whereas those presenting with other diagnoses are more likely to be younger and female.
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8
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Ferguson R, Riley ND, Wijendra A, Thurley N, Carr AJ, Bjf D. Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity? BMC Musculoskelet Disord 2019; 20:542. [PMID: 31727033 PMCID: PMC6857228 DOI: 10.1186/s12891-019-2902-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/17/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence and risk factors of wrist pain. METHODS Systematic review. DATA SOURCES The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers. RESULTS In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study). CONCLUSIONS Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population. TRIAL REGISTRATION The review protocol was registered with PROSPERO under the registration number CRD42018090834. LEVEL OF EVIDENCE 1 (Prognostic study).
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Affiliation(s)
- R Ferguson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, Oxford, England
| | - N D Riley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - A Wijendra
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - N Thurley
- Bodleian Health Care Libraries, Cairns Library, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - A J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, Oxford, England
| | - Dean Bjf
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, Oxford, England.
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
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9
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ECU tendon subluxation: A nonspecific MRI finding occurring in all wrist positions irrespective of ulnar-sided symptoms? Eur J Radiol 2019; 116:192-197. [DOI: 10.1016/j.ejrad.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/25/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022]
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10
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Woo EHC, White P, Lai CWK. Effects of electronic device overuse by university students in relation to clinical status and anatomical variations of the median nerve and transverse carpal ligament. Muscle Nerve 2017. [PMID: 28635099 DOI: 10.1002/mus.25697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This study investigates the results of a questionnaire, provocative tests, and ultrasonographic measurements of carpal tunnel morphological parameters in intensive and nonintensive electronic device users. METHODS Forty-eight university students (equal numbers of intensive and nonintensive users, ≥5 h/day and <5 h/day of electronic device usage, respectively) were randomly selected after questionnaire responses were received and evaluated clinically and by ultrasonography. All participants were right-handed. RESULTS Intensive users had significantly more positive results in Phalen's and Durkan's tests and reported more wrist/hand pain compared with nonintensive users (P < 0.05). Intensive users also had significantly larger median nerve cross-sectional areas, flattening ratios, and perimeters as well as greater bowing of the transverse carpal ligament compared with nonintensive users (P < 0.05). DISCUSSION Overuse of electronic devices may adversely affect the median nerve within the carpal tunnel and the transverse carpal ligament, resulting in numbness, tingling, and pain in the hand. Caution may be warranted when using handheld electronic devices. Muscle Nerve 56: 873-880, 2017.
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Affiliation(s)
- Eugenia Hoi Chi Woo
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Room Y934, 9/F, Lee Shau Kee Building, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - Peter White
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Room Y934, 9/F, Lee Shau Kee Building, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - Christopher Wai Keung Lai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Room Y934, 9/F, Lee Shau Kee Building, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
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Singh R, Patel A, Roulohamin N, Turner R. A Classification for Extensor Carpi Ulnaris Groove Morphology as an Aid for Ulnar Sided Wrist Pain. J Hand Surg Asian Pac Vol 2016; 21:246-52. [PMID: 27454641 DOI: 10.1142/s2424835516500260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Distal ulna groove morphology is likely to have a significant role in extensor carpi ulnaris (ECU) tendon stability. The development of a robust anatomical classification system, would be beneficial to further research into ulnar sided wrist pain and would be of use in rationalising treatment regimes. METHODS Cadaveric specimens as well as MRI scans of patients with non-specific wrist pain were analysed independently by 3 orthopaedic surgeons twice to test the integrity of the classification system. The following classification system was developed for the distal ulna groove; Flat = L-shaped slope, S slope = S shaped, Reverse C = C-shaped slope. Findings were then subjected to Fleiss Kappa statistical analysis to evaluate how robust the classification system was. RESULTS From the cadaveric arm of the study, 61 patients had their distal ulna groove morphology categorised according to types C, L, and S. For the MRI arm of the study 103 MRI scans were classified. ECU grove subtype C showed 8% dislocation compared to 33% and 47% for the L subtype and S sub type respectively. CONCLUSIONS Our classification system of ECU groove morphology will help identify different components to ulnar sided wrist problems and may help establish guidelines for treatment. This classification system has been validated for both cadaveric specimens and the MRI scans. It showed substantial agreement to almost perfect agreement in the data tested, thus proving good interand intra-observer reliability. It is a useful tool to help in further research into ulnar sided wrist pain and ECU instability, and may help develop further treatment strategies in the future.
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Affiliation(s)
- Rohit Singh
- 1 Robert Jones Agnes Hunt Oswestry Orthopaedic Hospital, Oswestry, UK
| | - Amit Patel
- 2 University Hospital North Staffordshire, UK
| | - Nick Roulohamin
- 1 Robert Jones Agnes Hunt Oswestry Orthopaedic Hospital, Oswestry, UK
| | - Rob Turner
- 3 The Princess Royal Hospital Telford, UK
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12
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ECU tendon "dislocation" in asymptomatic volunteers. Skeletal Radiol 2016; 45:805-12. [PMID: 26980226 DOI: 10.1007/s00256-016-2352-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Assess extensor carpi ulnaris (ECU) tendon position in the ulnar groove, determine the frequency of tendon "dislocation" with the forearm prone, neutral, and supine, and determine if an association exists between ulnar groove morphology and tendon position in asymptomatic volunteers. MATERIALS AND METHODS Axial proton density-weighted MR was performed through the distal radioulnar joint with the forearm prone, neutral, and supine in 38 asymptomatic wrists. The percentage of the tendon located beyond the ulnar-most border of the ulnar groove was recorded. Ulnar groove depth and length was measured and ECU tendon signal was assessed. RESULTS 15.8 % of tendons remained within the groove in all forearm positions. In 76.3 %, the tendon translated medially from prone to supine. The tendon "dislocated" in 0, 10.5, and 39.5 % with the forearm prone, neutral and supine, respectively. In 7.9 % prone, 5.3 % neutral, and 10.5 % supine exams, the tendon was 51-99 % beyond the ulnar border of the ulnar groove. Mean ulnar groove depth and length were 1.6 and 7.7 mm, respectively, with an overall trend towards greater degrees of tendon translation in shorter, shallower ulnar grooves. CONCLUSIONS The ECU tendon shifts in a medial direction when the forearm is supine; however, tendon "dislocation" has not been previously documented in asymptomatic volunteers. The ECU tendon medially translated or frankly dislocated from the ulnar groove in the majority of our asymptomatic volunteers, particularly when the forearm is supine. Overall greater degrees of tendon translation were observed in shorter and shallower ulnar grooves.
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13
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Abstract
BACKGROUND Magnetic resonance imaging (MRI) commonly finds musculoskeletal abnormalities incidental to the reason for ordering the test. The purpose of this study was to determine if the prevalence of extensor carpi ulnaris (ECU) signal changes on MRI varies between patients undergoing upper extremity MRI for assessment of clinically suspected ECU tendinopathy and those undergoing upper extremity MRI for other indications. Our secondary null hypotheses were that the prevalence of ECU signal changes on MRI does not vary based on patient age or sex and that the prevalence of ECU signal changes on MRI does not vary among other indications for MRI. METHODS We searched MRI reports of all patients undergoing MRI of the hand, wrist, or arm at our institution between 2001 and 2014 for signal changes in the ECU. The medical record was reviewed to determine the indication for the MRI and the presence of clinically suspected ECU tendinopathy. RESULTS ECU signal changes (overall prevalence of 13 %) were more common in patients undergoing MRI for a working clinical diagnosis of ECU tendinopathy or ulnar-sided wrist pain compared to patients evaluated for nonspecific pain and other indications. Age was independently associated with ECU signal changes on MRI. MRI signal changes are uncommonly associated with symptomatic tendinopathy (low positive predictive value). CONCLUSIONS ECU signal changes on MRI are common and often asymptomatic.
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Affiliation(s)
- Michael T. Kuntz
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit St, Boston, MA 02114 USA
| | - Stein J. Janssen
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit St, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit St, Boston, MA 02114 USA
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14
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Influence of the long term use of a computer on median, ulnar and radial sensory nerves in the wrist region. Int J Occup Med Environ Health 2014; 27:1026-35. [DOI: 10.2478/s13382-014-0335-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 07/22/2014] [Indexed: 11/20/2022] Open
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15
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Boutin RD, Buonocore MH, Immerman I, Ashwell Z, Sonico GJ, Szabo RM, Chaudhari AJ. Real-time magnetic resonance imaging (MRI) during active wrist motion--initial observations. PLoS One 2013; 8:e84004. [PMID: 24391865 PMCID: PMC3877133 DOI: 10.1371/journal.pone.0084004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/11/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Non-invasive imaging techniques such as magnetic resonance imaging (MRI) provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist--occurring during joint motion--is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability. METHODS A 3-Tesla "active-MRI" protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, "clenched-fist", and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ) congruity, extensor carpi ulnaris (ECU) tendon translation, the scapholunate (SL) interval, and the SL, radiolunate (RL) and capitolunate (CL) angles from the resulting images. RESULTS The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished. CONCLUSION This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo.
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Affiliation(s)
- Robert D. Boutin
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Michael H. Buonocore
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California, United States of America
- University of California Davis Imaging Research Center, Sacramento, California, United States of America
| | - Igor Immerman
- Department of Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Zachary Ashwell
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Gerald J. Sonico
- Department of Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Robert M. Szabo
- Department of Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Abhijit J. Chaudhari
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California, United States of America
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