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Glanville J, Bates KT, Brown D, Potts D, Curran J, Fichera S. Evaluation of a cadaveric wrist motion simulator using marker-based X-ray reconstruction of moving morphology. PeerJ 2024; 12:e17179. [PMID: 38803578 PMCID: PMC11129696 DOI: 10.7717/peerj.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/05/2024] [Indexed: 05/29/2024] Open
Abstract
Surgical intervention is a common option for the treatment of wrist joint arthritis and traumatic wrist injury. Whether this surgery is arthrodesis or a motion preserving procedure such as arthroplasty, wrist joint biomechanics are inevitably altered. To evaluate effects of surgery on parameters such as range of motion, efficiency and carpal kinematics, repeatable and controlled motion of cadaveric specimens is required. This study describes the development of a device that enables cadaveric wrist motion to be simulated before and after motion preserving surgery in a highly controlled manner. The simulator achieves joint motion through the application of predetermined displacements to the five major tendons of the wrist, and records tendon forces. A pilot experiment using six wrists aimed to evaluate its accuracy and reproducibility. Biplanar X-ray videoradiography (BPVR) and X-Ray Reconstruction of Moving Morphology (XROMM) were used to measure overall wrist angles before and after total wrist arthroplasty. The simulator was able to produce flexion, extension, radioulnar deviation, dart thrower's motion and circumduction within previously reported functional ranges of motion. Pre- and post-surgical wrist angles did not significantly differ. Intra-specimen motion trials were repeatable; root mean square errors between individual trials and average wrist angle and tendon force profiles were below 1° and 2 N respectively. Inter-specimen variation was higher, likely due to anatomical variation and lack of wrist position feedback. In conclusion, combining repeatable intra-specimen cadaveric motion simulation with BPVR and XROMM can be used to determine potential effects of motion preserving surgeries on wrist range of motion and biomechanics.
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Affiliation(s)
- Joanna Glanville
- School of Engineering, University of Liverpool, Liverpool, Merseyside, United Kingdom
- Department of Musculoskeletal & Ageing Science, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Karl T. Bates
- Department of Musculoskeletal & Ageing Science, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Daniel Brown
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals, Liverpool, Merseyside, United Kingdom
| | - Daniel Potts
- School of Engineering, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - John Curran
- School of Engineering, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Sebastiano Fichera
- School of Engineering, University of Liverpool, Liverpool, Merseyside, United Kingdom
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Chan R, Goursat J, Payen M, Lalevée M, Guelmi K. Proximal row carpectomy versus four-corner arthrodesis: a retrospective comparative study. J Plast Surg Hand Surg 2024; 59:77-82. [PMID: 38769788 DOI: 10.2340/jphs.v59.18338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are frequently performed in wrists with post-traumatic Scaphoid Non- Union Advanced Collapse (SNAC)/Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis. The aim of this study was to compare the clinical outcomes of these two procedures. METHODS This single-center, retrospective cohort study included all patients who had PRC or FCA between January 1st, 2009 and January 1st, 2019 and who were followed up. Follow-up included: mobility (radial deviation, ulnar deviation, flexion, extension), strength (grip test, pinch test), function (QuickDash, patient-rated wrist evaluation [PRWE]), subjective mobility, and global satisfaction scores. RESULTS Among 25 patients included, 11 had PRC and 14 had FCA with a mean follow-up of 69.5 months [12-132]. Radial deviation was 18° versus 14° (p = 0.7), ulnar deviation was 21° versus 22° (p = 0.15), flexion was 39° versus 30° (p = 0.32), extension was 32.5° versus 29.5° (p = 0.09), grip test compared to the controlateral side was 72% versus 62% (p = 0.53), Quick Dash score was 12.5 versus 17.6 (p = 0.84), PRWE was 18.7 versus 17.6 (p = 0.38), subjective mobility was 7.8 versus 7.5 (p = 0.23), and satisfaction score was 8.7 versus 9 (p = 0.76), respectively, in the FCA group and the PRC group. Re-operation rates were 14% patients in the FCA group and 0% in the PRC group. CONCLUSION This study found no significant difference between FCA and PRC on strength, mobility, and function in patients with post-traumatic SLAC or SNAC stage II wrist arthritis. Both FCA and PRC seem to be reliable surgical techniques with good outcomes with more revision in the FCA group.
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Affiliation(s)
- Richard Chan
- Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; Chirurgie de la main et plastique adulte, CHU Charles Nicolle, Rouen, France
| | - Justine Goursat
- Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France
| | - Mathilde Payen
- Chirurgie Orthopédique Pédiatrique, CHU Charles Nicolle, Rouen, France.
| | - Matthieu Lalevée
- Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, Université de Rouen, Mont-Saint-Aignan, France
| | - Kamel Guelmi
- Chirurgie Orthopédique Adulte, GHH Monod, Montivilliers, France
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Karagiannopoulos C. Active wrist joint position sense (AWJPS) test offers variable reliability levels and scores among multiple wrist angles and tester-experience levels. J Hand Ther 2024; 37:234-237. [PMID: 36914494 DOI: 10.1016/j.jht.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/13/2022] [Indexed: 03/16/2023]
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Hones KM, Hao KA, Rakauskas TR, Densley S, Hampton H, Kim J, Wright TW, Chim H. Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis. J Hand Surg Am 2024:S0363-5023(24)00027-3. [PMID: 38416092 DOI: 10.1016/j.jhsa.2024.01.011] [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: 09/18/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. METHODS A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. RESULTS Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. CONCLUSIONS In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL
| | | | | | - Hailey Hampton
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Jongmin Kim
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Harvey Chim
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL.
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Babazadeh-Zavieh SS, Ansari NN, Ghotbi N, Naghdi S, Jafar Haeri SM. Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial. NeuroRehabilitation 2024; 54:399-409. [PMID: 38393926 DOI: 10.3233/nre-230081] [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] [Indexed: 02/25/2024]
Abstract
BACKGROUND The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. OBJECTIVE To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. METHODS Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. RESULTS A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. CONCLUSION The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.
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Affiliation(s)
- Seyedeh Saeideh Babazadeh-Zavieh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Hirata J, Yoshimura M, Inoue K. Effect of wrist orthoses on upper limb function, activities of daily living, and stress response. J Rehabil Assist Technol Eng 2024; 11:20556683241250307. [PMID: 38680617 PMCID: PMC11047247 DOI: 10.1177/20556683241250307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction This study examined the effects on upper limb function, activities of daily living, and stress responses when wearing a wrist orthosis made of padded fiberglass or thermoplastic and provided essential information for selecting an orthosis. Methods Thirty-one healthy adults performed two tests while not wearing a wrist orthosis, wearing a padded fiberglass wrist orthosis, and wearing a thermoplastic wrist orthosis. The Purdue Pegboard Test examined upper limb control. In the second test, the actions indicated by the Hand20 questionnaire were performed while wearing a wrist orthosis. An electrocardiogram was obtained before and after each test to identify any changes in sympathetic nervous system activity. Results The Purdue Pegboard Test scores were significantly higher when not wearing a wrist orthosis than when wearing wrist orthosis, and the Hand20 scores for all question were significantly lower. Thermoplastic wrist orthoses had fewer restrictions for upper limb function compared to padded fiberglass wrist orthoses, however activities of daily living were more limited. The low frequency/high frequency ratio and high frequency measures showed no significant differences. Conclusions Pegboard test scores and the Hand 20 scores suggest that a wrist orthosis causes restriction of upper limb function.
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Affiliation(s)
- Junya Hirata
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Manabu Yoshimura
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Keiko Inoue
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
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De-Rosende-Celeiro I, Fernández-Barreiro JJ. Functional Changes After Occupational Therapy Among Individuals With a Distal Radius Fracture: A Longitudinal Study. Am J Occup Ther 2023; 77:7706205010. [PMID: 37971386 DOI: 10.5014/ajot.2023.050218] [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: 11/19/2023] Open
Abstract
IMPORTANCE Identifying the outcomes of occupational therapy after a distal radius fracture (DRF) is important so that effective strategies can be developed to mitigate the consequences associated with this common fracture. OBJECTIVE To determine whether participation in occupational therapy improved functional status. Secondary objectives were to assess its effects on body functions and to examine the association between changes in outcome measures and occupational therapy-related factors. DESIGN Longitudinal, with consecutive sampling over a 12-mo period. SETTING Outpatient rehabilitation service. PARTICIPANTS Participants were 38 adults with a unilateral DRF (ages 31-75 yr.; 81.6% female). INTERVENTION Multicomponent occupational therapy, including supplemental techniques and activity-based interventions. OUTCOMES AND MEASURES Functional status and body functions were assessed before and after therapy. RESULTS All standardized measures of functional status showed significant improvements, which were large in size. Several body functions improved significantly (pain, sleep, wrist and forearm movements, and grip strength fraction), and effect sizes ranged from medium to large. For several outcome variables, earlier therapy was significantly associated with better results; moreover, the likelihood of achieving better outcomes was significantly higher among participants who attended more sessions. CONCLUSIONS AND RELEVANCE Occupational therapy services have an important role to play after a DRF in terms of returning to daily activities and reducing impairments in body functions. Earlier intervention and attending a higher number of occupational therapy sessions are likely to further improve these outcomes. What This Article Adds: Because the effects of occupational therapy among people with a DRF remain uncertain, we quantified the outcomes of this intervention in an outpatient rehabilitation service, revealing medium to large improvements in the performance of daily activities and in various body functions. Our findings identified two factors associated with better results: early initiation of therapy and a higher number of occupational therapy sessions.
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Affiliation(s)
- Iván De-Rosende-Celeiro
- Iván De-Rosende-Celeiro, PhD, OT, is Assistant Professor and Occupational Therapist, Department of Health Sciences, University of A Coruña, A Coruña, Spain;
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Marcos-Antón S, Jardón-Huete A, Oña-Simbaña ED, Blázquez-Fernández A, Martínez-Rolando L, Cano-de-la-Cuerda R. sEMG-controlled forearm bracelet and serious game-based rehabilitation for training manual dexterity in people with multiple sclerosis: a randomised controlled trial. J Neuroeng Rehabil 2023; 20:110. [PMID: 37598176 PMCID: PMC10440030 DOI: 10.1186/s12984-023-01233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Muscle strength and dexterity impairments are common among patients with multiple sclerosis (MS) producing limitations in activities of daily living related to the upper limb (UL). This study aimed to evaluate the effectiveness of serious games specifically developed for the MYO Armband® capture sensor in improving forearm and wrist mobility, UL muscle strength, dexterity, fatigue, functionality, quality of life, satisfaction, adverse effects and compliance. METHODS A double-blinded (allocation concealment was performed by a blinded investigator and by blinding for assessors) randomised controlled trial was conducted. The sample was randomised into two groups: an experimental group that received treatment based on UL serious games designed by the research team and controlled by the MYO Armband® gesture capture sensor, along with conventional rehabilitation and a control group that received the same conventional rehabilitation for the UL. Both groups received two 60-min sessions per week over an eight-week period. Wrist range of motion (goniometry), grip muscle strength (Jamar® dynamometer), coordination and gross UL dexterity (Box and Block Test), fatigue (Fatigue Severity Scale), functionality (ABILHAND), quality of life (Multiple Sclerosis Impact Scale-29), adverse effects (Simulator Sickness Questionnaire, SSQ), perceived workload (NASA-Task load index), satisfaction (Client Satisfaction Questionnaire-8 (CSQ-8), Satisfaction with Technology Scale, System Usability Scale (SUS) and QUEST 2.0) and compliance (attendance) were assessed in both groups pre-treatment, post-treatment and during a follow-up period of 2 weeks without receiving any treatment. RESULTS Significant differences were observed in the experimental group compared to the control group in the assessment of forearm supination (p = .004) and grip strength (p = .004). Adverse effects were minimal (SSQ: 7/100 points) and perceived workload was low (NASA-Task Load Index: 25/100 points) in the experimental group. The MYO Armband® technology proved to be useful for the participants (SUS: 80.66/100) and the satisfaction scales received high scores (QUEST 2.0: 59.4/70 points; Satisfaction with Technology: 84.36/100 points). There were significant differences between the groups in terms of attendance percentage (p = .029). CONCLUSIONS An experimental protocol using MYO Armband®-based serious games designed for UL rehabilitation showed improvements in active wrist range of motion and handgrip strength in patients with MS, with high satisfaction, minimal adverse effects and workload and excellent compliance. TRIAL REGISTRATION NUMBER This randomised controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908.
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Affiliation(s)
- Selena Marcos-Antón
- Faculty of Health Sciences, International PhD School, Rey Juan Carlos University, 28008, Madrid, Spain.
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain.
- Asociación de Leganés de Esclerosis Múltiple (ALEM), 28915, Leganés, Madrid, Spain.
| | - Alberto Jardón-Huete
- Robotics Lab, Department of Systems Engineering and Automation, University Carlos III of Madrid, 28911, Leganés, Madrid, Spain
| | - Edwin Daniel Oña-Simbaña
- Robotics Lab, Department of Systems Engineering and Automation, University Carlos III of Madrid, 28911, Leganés, Madrid, Spain
| | | | | | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain
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LoGiudice A, Awan H. Wrist Arthritis and Arthrodesis: Preserving Function, Minimizing Problems. Hand Clin 2023; 39:353-365. [PMID: 37453763 DOI: 10.1016/j.hcl.2023.04.001] [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] [Indexed: 07/18/2023]
Abstract
Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient age, comorbidities, occupation, duration of symptoms, and failed treatment modalities. Arthroscopy and denervation are appealing because of shorter recovery time and preservation of motion, but duration of effectiveness varies between patients. Patients who fail these smaller procedures or those with pancarpal arthrosis are treated effectively with total wrist arthrodesis or total wrist arthroplasty in lower-demand patients. This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications.
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Affiliation(s)
- Anthony LoGiudice
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Hisham Awan
- Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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Anderton W, Tew S, Ferguson S, Hernandez J, Charles SK. Movement preferences of the wrist and forearm during activities of daily living. J Hand Ther 2023; 36:580-592. [PMID: 36127238 DOI: 10.1016/j.jht.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND During activities of daily living, the main degrees of freedom of the forearm and wrist-forearm pronation-supination (PS), wrist flexion-extension (FE), and wrist radial-ulnar deviation (RUD)-combine seamlessly to allow the hand to engage with and manipulate objects in our environment. Yet the combined behavior of these three degrees of freedom is relatively unknown. PURPOSE To provide a characterization of natural forearm and wrist kinematics (joint configuration, movement direction, and speed) during activities of daily living. STUDY DESIGN This is a descriptive cross-sectional study. METHODS Ten healthy subjects performed 24 activities of daily living chosen to represent a wide variety of activities, while we measured their PS, FE, and RUD angles using electromagnetic motion capture. The orientation of the forearm and wrist was represented in the three-dimensional "configuration space" spanned by PS, FE, and RUD. From the time course of forearm and wrist orientation in configuration space, we extracted three-dimensional distributions of joint configuration, movement direction, and speed. RESULTS Most joint configurations were focused in a relatively small area: subjects spent roughly 50% of the time in the central 20% of their functional range of motion. Some movement directions were significantly more common than others (p < 0.001); in particular, the direction of the dart-thrower's motion (DTM) was about three times more common than motion perpendicular to it. Most movements were slow: the likelihood of moving at increasing speeds dropped off exponentially. Interestingly, the most common high-speed motion combined the DTM with a twist from pronation to supination. As this motion allows one to pick up an object in front of one's body and bring it to the head, it is essential for self-care. Thus, although many activities of daily living follow the DTM without significant forearm rotation, the greatest importance of the DTM may lie in its combination with forearm rotation. CONCLUSIONS Despite the wide variety of activities, we found evidence of preferred movement behavior, and this behavior showed significant coupling between the wrist and forearm.
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Affiliation(s)
- Will Anderton
- Mechanical Engineering, Brigham Young University, Provo, UT, USA
| | - Scott Tew
- Mechanical Engineering, Brigham Young University, Provo, UT, USA
| | - Spencer Ferguson
- Mechanical Engineering, Brigham Young University, Provo, UT, USA
| | | | - Steven K Charles
- Mechanical Engineering, Brigham Young University, Provo, UT, USA; Neuroscience, Brigham Young University, Provo, UT, USA.
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Collis JM, Mayland EC, Wright-St Clair V, Rashid U, Kayes N, Signal N. An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study. J Hand Ther 2023; 36:593-605. [PMID: 35953335 DOI: 10.1016/j.jht.2022.07.009] [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: 11/08/2021] [Revised: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.
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Affiliation(s)
- Julie M Collis
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand.
| | - Elizabeth C Mayland
- Western Sydney University, School of Health Sciences, Campbelltown, New South Wales, Australia
| | | | - Usman Rashid
- Auckland University of Technology, Health & Rehabilitation Research Institue, Auckland, New Zealand
| | - Nicola Kayes
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
| | - Nada Signal
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
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Khan JS, Mohammadi M, Rasmussen J, Andreasen Struijk LNS. Simulation-based design optimization of a wrist exoskeleton. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082616 DOI: 10.1109/embc40787.2023.10340424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Exoskeletons are widely used in the field of rehabilitation robotics. Upper limb exoskeletons (ULEs) can be very useful for patients with diminished ability to control their limbs in aiding activities of daily living (ADLs). The design of ULEs must account for a human's limitations and ability to work with an exoskeleton. It can typically be achieved by the involvement of vulnerable end-users in each design cycle. On the other hand, simulation-based design methods on a model with human-in-the-loop can limit the design cycles, thereby reducing research time and dependency on end users. This study makes it evident by using a case where the design of an exoskeleton wrist can be optimized with the usage of a torsional spring at the joint, that compensates for the required motor torque. Considering the human-in-the-loop system, the multibody modeling results show that the usage of a torsional spring in the joint can be useful in designing a lightweight and compact exoskeleton joint by downsizing the motor.Clinical Relevance- The proposed methodology of designing an upper-limb exoskeleton has a utility in limiting design cycles and making it both convenient and useful to assist users with severe impairment in ADLs.
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Wu J, Zhu Y, Lin ZY, Lin SH, Zhao SS, Cheng L, Sun BH, Long HT. Post-traumatic distal ulnar bifurcation in children: a case report. BMC Musculoskelet Disord 2023; 24:430. [PMID: 37254081 DOI: 10.1186/s12891-023-06494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Galeazzi fracture dislocation is a compound injury that encompasses fractures of the distal third of the radius and dislocation of the distal radial ulnar joint (DRUJ). Clinically, this condition is rare and often leads to distal ulnar bifurcation. In previous similar reports, patients were effectively managed through surgery. CASE PRESENTATION In this case report, we describe an 11-year-old male child who presented with an ulnar bifida following trauma to the hand, and was treated with manipulation and conservative treatment without surgery. A follow-up performed over the years demonstrated that the patient recovered well, and had normal wrist movements without significant pain, and the patient expressed great satisfaction. CONCLUSIONS Ulnar diaphyseal fracture may occur in children or adolescents due to injuries, and may be accompanied with manipulation and repositioning. Conservative treatment can be applied to avoid the trauma associated with surgery especially in the absence of severe joint mobility impairment with good outcomes.
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Affiliation(s)
- Jia Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zhang-Yuan Lin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Shao-Hai Lin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Shu-Shan Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Liang Cheng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Bu-Hua Sun
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hai-Tao Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China.
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14
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Korkoman AJ, Alrajhi S, AlQahtani AA. Open Trans-Scaphoid Transcapitate Perilunate Fracture-Dislocation: A Case Report. Cureus 2023; 15:e38958. [PMID: 37313096 PMCID: PMC10258656 DOI: 10.7759/cureus.38958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
Perilunate dislocations and fracture-dislocations are considered rare injuries. Perilunate injuries are frequently missed during primary evaluations. We report a case of a 37-year-old male presenting with an open perilunate fracture-dislocation a few days after experiencing trauma. He underwent repeated debridements, and provisional external fixator application followed by a definitive open reduction through a combined dual approach and internal fixation of scaphoid and capitate with headless screws. Aggressive physiotherapy exercises were started eight weeks after definitive fixation. After six years, the patient had a satisfactory outcome with an excellent Mayo wrist score. Perilunate injuries should be considered one of the important differential diagnoses in wrist injuries. Early diagnosis and treatment are of utmost importance to gain optimum outcomes. The best results could be achieved with open reduction and internal fixation through a combined volar and dorsal approach.
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Affiliation(s)
- Abdulrahman J Korkoman
- Orthopedic Surgery, University of Bisha, Bisha, SAU
- Orthopedic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Sara Alrajhi
- Orthopedics, King Fahad Specialist Hospital, Riyadh, SAU
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15
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Reyniers P, van Beek N, De Schrijver F, Goeminne S, Reyniers P. Proximal row carpectomy versus four-corner arthrodesis in the treatment of SLAC and SNAC wrist: meta-analysis and literature review. HAND SURGERY & REHABILITATION 2023; 42:194-202. [PMID: 37031919 DOI: 10.1016/j.hansur.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.
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Affiliation(s)
- P Reyniers
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | - N van Beek
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | | | - S Goeminne
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
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16
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Bezirgan U, Acar E, Yoğun Y, Savran MD, Keskin ÖH, Armangil M. Nascent Malunion of Distal Radius Fractures Treated with Fixed Angled Volar Plates without Using Bone Grafts. Indian J Orthop 2023; 57:533-542. [PMID: 37006733 PMCID: PMC10050669 DOI: 10.1007/s43465-023-00864-z] [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: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Purpose Malunion of the distal radius is a common complication. Using bone grafts is common to restore the bone to an acceptable level. This study aimed to verify if it is necessary to use bone grafts in nascent malunion of distal radius fractures treated with fixed angled volar plates and which radiographic parameters are essential to obtain satisfactory outcomes. Methods This single-centered prospective study included 11 patients who underwent corrective osteotomy of the radius for malunion. Patients with a metaphyseal, extraarticular osteotomy stabilized by a volar fixed angle plate within 3 months after the fracture are included. Patients underwent a standard radiological evaluation at postoperative 1 month, 3 months, 6 months, 1 year, and annually thereafter. Radial inclination, radial height, ulnar variance, and palmar tilt were measured. Wrist ranges of motion are measured throughout follow-up with a goniometer. Grip strength is measured using a Jamar Hand Dynamometer. The function is evaluated via the Gartland-Werley (GW) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The mean age of 11 patients, 9 (81.82%) males, included in the study was 41.45 ± 14.89 years. The mean post-fracture admission time is 39.3 ± 15.1 days. Radial inclination, radial length, and ulnar variance improved significantly after surgery (p = 0.0023, 0.0002, 0.0037). Radial inclination values are within normal limits for all patients at admission. The radial length was in the normal range for 72.73%, the ulnar variance was in the normal range for 72.73%, and palmar tilt was in the normal range for 100% of the patients. Extension 54.55%, flexion 72.73%, radial deviation 81.82%, ulnar deviation 63.64%, pronation 90.91%, and supination 72.73% were achieved after surgery. GW average was 3.09 ± 3.24 DASH score average was 12.24 ± 13.48. The mean grip strength was 29.27 ± 7.21 on the operated side, while it was 34.91 ± 5.32, on the healthy side, with a significant difference (p = 0.0108). Conclusion It is possible to get good results without using bone grafts in corrective osteotomy of distal radius malunions.
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Affiliation(s)
- Uğur Bezirgan
- Faculty of Medicine, Orthopedics and Traumatology Department, Ibn’i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey
| | - Erdinç Acar
- Orthopedics and Traumatology Department, Ankara City Hospital, Hand Surgery Unit, Ankara, Turkey
| | - Yener Yoğun
- Faculty of Medicine, Orthopedics and Traumatology Department, Ibn’i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey
| | - Merve Dursun Savran
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Ömer Halit Keskin
- Orthopedics and Traumatology Department, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Armangil
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Ankara, Turkey
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17
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Hayashi M, Kato H, Komatsu M, Yamazaki H, Uchiyama S, Takahashi J. Changes in the Functional Range of Motion of the Thumb Metacarpophalangeal Joint After Trapeziometacarpal Arthrodesis for Patients With Advanced Trapeziometacarpal Osteoarthritis. J Hand Surg Am 2023; 48:83.e1-83.e8. [PMID: 34772546 DOI: 10.1016/j.jhsa.2021.09.018] [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: 03/02/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Advanced-stage trapeziometacarpal (TMC) osteoarthritis of the thumb often presents with concomitant hyperextension deformity of the metacarpophalangeal (MCP) joint. Although several studies have reported simultaneous procedures to correct this deformity, the indication for these procedures remains controversial. The purpose of this study was to evaluate changes in the range of motion (ROM) of the thumb MCP joint before and after TMC arthrodesis. METHODS We evaluated the functional flexion and extension and functional ROM of the MCP joints during the performance of 10 activities of daily living tasks before and after TMC arthrodesis in 10 thumbs of 9 patients with Eaton stage III TMC osteoarthritis and hyperextension deformity of the MCP joint. RESULTS The mean functional flexion of the MCP joint increased from 26° to 38°, and the mean functional extension of the MCP joint decreased from 16° to 5° of hyperextension. There was no change in the mean total arc of functional ROM of the MCP joint. CONCLUSIONS The MCP joint motion shifted from extension to flexion after TMC arthrodesis, and the total arc of functional ROM of the MCP joint was similar before and after arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masatoshi Komatsu
- Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Okaya City Hospital, Okaya, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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18
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Roberts T, Kocialcowski C, Cowey A. Dorsal bridging plates for the treatment of high and low energy distal radius fractures. J Clin Orthop Trauma 2022; 35:102048. [PMID: 36340961 PMCID: PMC9634010 DOI: 10.1016/j.jcot.2022.102048] [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: 05/03/2022] [Revised: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Distal radius fractures are common and treatment of complex fracture pattens can be challenging. We assessed functional outcomes, radiographic analysis, and complications of 26 distal radius fractures treated with dorsal bridging plate (DBP) at a mean of 14 months post plate removal (6-34 months). Radiographic parameters were measured pre- and post-operatively and patient reported wrist evaluation scores, patient reported wrist range of movement and satisfaction scores. Mean post-operative total PRWE was 26 (range 0-76) and mean wrist mobility 52° flexion (range 10°-85°) and 50° extension (range 10°-85°). Mean post-operative patient satisfaction score was 89% (range 50-100%). Four patients developed complications (one EPL rupture and three developed CRPS). DBP can reliably restore distal radius anatomy and is associated with good functional outcome scores, return of functional range of wrist movement and high levels of patient satisfaction. Level of Evidence III.
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Affiliation(s)
- Tobias Roberts
- Corresponding author. Trauma & Orthopaedic Department, St. George's Hospital, London, SW17 0QT, UK.
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19
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Marin-Pardo O, Donnelly MR, Phanord CS, Wong K, Pan J, Liew SL. Functional and neuromuscular changes induced via a low-cost, muscle-computer interface for telerehabilitation: A feasibility study in chronic stroke. FRONTIERS IN NEUROERGONOMICS 2022; 3:1046695. [PMID: 38235476 PMCID: PMC10790881 DOI: 10.3389/fnrgo.2022.1046695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 01/19/2024]
Abstract
Stroke is a leading cause of adult disability in the United States. High doses of repeated task-specific practice have shown promising results in restoring upper limb function in chronic stroke. However, it is currently challenging to provide such doses in clinical practice. At-home telerehabilitation supervised by a clinician is a potential solution to provide higher-dose interventions. However, telerehabilitation systems developed for repeated task-specific practice typically require a minimum level of active movement. Therefore, severely impaired people necessitate alternative therapeutic approaches. Measurement and feedback of electrical muscle activity via electromyography (EMG) have been previously implemented in the presence of minimal or no volitional movement to improve motor performance in people with stroke. Specifically, muscle neurofeedback training to reduce unintended co-contractions of the impaired hand may be a targeted intervention to improve motor control in severely impaired populations. Here, we present the preliminary results of a low-cost, portable EMG biofeedback system (Tele-REINVENT) for supervised and unsupervised upper limb telerehabilitation after stroke. We aimed to explore the feasibility of providing higher doses of repeated task-specific practice during at-home training. Therefore, we recruited 5 participants (age = 44-73 years) with chronic, severe impairment due to stroke (Fugl-Meyer = 19-40/66). They completed a 6-week home-based training program that reinforced activity of the wrist extensor muscles while avoiding coactivation of flexor muscles via computer games. We used EMG signals to quantify the contribution of two antagonistic muscles and provide biofeedback of individuated activity, defined as a ratio of extensor and flexor activity during movement attempt. Our data suggest that 30 1-h sessions over 6 weeks of at-home training with our Tele-REINVENT system is feasible and may improve individuated muscle activity as well as scores on standard clinical assessments (e.g., Fugl-Meyer Assessment, Action Research Arm Test, active wrist range of motion) for some individuals. Furthermore, tests of neuromuscular control suggest modest changes in the synchronization of electroencephalography (EEG) and EMG signals within the beta band (12-30 Hz). Finally, all participants showed high adherence to the training protocol and reported enjoying using the system. These preliminary results suggest that using low-cost technology for home-based telerehabilitation after severe chronic stroke is feasible and may be effective in improving motor control via feedback of individuated muscle activity.
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Affiliation(s)
- Octavio Marin-Pardo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Miranda Rennie Donnelly
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Coralie S. Phanord
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Kira Wong
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Jessica Pan
- Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, United States
| | - Sook-Lei Liew
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
- Stevens Neuroinformatics Institute, Department of Neurology, University of Southern California, Los Angeles, CA, United States
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20
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Chammas PE, Hadouiri N, Chammas M, Ramos-Pascual S, Stirling P, Nover L, Klouche S. Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis. Orthop Traumatol Surg Res 2022; 108:103373. [PMID: 35940440 DOI: 10.1016/j.otsr.2022.103373] [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: 01/09/2022] [Revised: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC) and scaphoid excision followed by four corner arthrodesis (4CA). Despite satisfactory overall results, the debate continues about which one provides the best results and long-term outcomes, particularly prevention of arthritis progression. Recent comparative studies now provide us with information about mid- and long-term results. The aim of this study was to compare the clinical results, complications, conversion rate to total wrist arthrodesis and progression to osteoarthritis of PRC versus 4CA in the medium and long term. HYPOTHESIS The null hypothesis was that there is no significant difference between PRC and 4CA in the clinical results, complications, conversion to total wrist arthrodesis and arthritis progression. MATERIALS AND METHODS A systematic literature review was carried out by following the PRISMA guidelines. Included were studies comparing 4CA and PRC for the treatment of post-traumatic wrist arthritis secondary to scapholunate dissociation (SLAC) and scaphoid nonunion (SNAC) with a mean follow-up of 5 years. A search was performed of the MEDLINE, EMBASE and Cochrane databases that identified 831 articles. After removing 230 duplicates and excluding 595 articles based on their title and/or abstract, and then adding 1 article manually, 7 articles were included in our analysis. Parameters analyzed were range of motion (ROM), pain, grip strength, functional scores, complications, conversion to total wrist arthrodesis, and arthritis progression. RESULTS In the 7 articles, 1059 wrists - 582 PRC and 477 4CA - were analyzed with follow-up ranging from 5.2 to 18 years. PRC produced significantly better ROM in flexion (weighted mean difference [WMD]=10.0°; p<0.01) and in ulnar deviation (WMD=8.7°; p<0.01) along with significantly lower complication rates (OR=0.3; p<0.01) and reoperation rates (OR=0.1; p<0.01). There was no significant difference in the conversion rate, grip strength, extension, radial deviation, pain, DASH and PRWE scores. The progression of osteoarthritis could not be analyzed due to lack of data. DISCUSSION This meta-analysis was the first to include recently published mid- and long-term studies comparing PRC and 4CA. The main finding is that PRC is superior overall with better ROM and a lower complication rate. Another important finding was the absence of differences in grip strength and the conversion rate to total wrist arthrodesis. Unfortunately, the lack of systematic studies on arthritis progression leaves this question unanswered. Our findings must be interpreted cautiously because it was impossible to stratify the cases by etiology and osteoarthritis stage. LEVEL OF EVIDENCE III; systematic review and meta-analysis.
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Affiliation(s)
- Pierre-Emmanuel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France; Collège des Jeunes Orthopédistes, Rue Boissonade 56, 75014 Paris, France.
| | - Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Boulevard du Maréchal de Lattre de Tassigny 2, 21000 Dijon, France; InterSyndicale Nationale des Internes, Rue du Fer À Moulin 17, 75005 Paris, France
| | - Michel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France
| | | | | | - Luca Nover
- ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland
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21
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Prosthetic and robotic wrists comparing with the intelligently evolved human wrist: A review. ROBOTICA 2022. [DOI: 10.1017/s0263574722000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Both prosthetic and robotic research communities have tended to focus on hand/gripper development. However, the wrist unit could enable higher mobility of the end effector and thus more efficient and dexterous manipulation. The current state of the art in both prosthetic and robotic wrists is reviewed systematically, mainly concerning their kinematic structures and resultant capabilities. Further, by considering the biomechanical advantages of the human wrist, an evaluation including the mobility, stability, output capability, load capacity and flexibility of the current artificial wrists is conducted. With the pentagonal capability radar charts, the major limitations and challenges in the current development of artificial wrists are derived. This paper hence provides some useful insights for better robotic wrist design and development.
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22
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Nobaveh AA, Caasenbrood B. Design Feasibility of an Energy-efficient Wrist Flexion-Extension Exoskeleton using Compliant Beams and Soft Actuators . IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176134 DOI: 10.1109/icorr55369.2022.9896528] [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: 06/16/2023]
Abstract
Passive and active exoskeletons have been used over recent decades. However, regarding many physiological systems, we see that the majority explore both active and passive elements to minimize energy consumption while retaining proper motion control. In light of this, we propose a design that combines compliant mechanisms as passive support for gravity balancing of the hand's weight and soft actuators as active support for wrist flexion-extension. Our approach offers a safe, lightweight solution that intrinsically complements and supports the wrist's degrees of freedom. We hypothesize that the proposed soft wearable device is able to increase the range of motion and reduce muscle fatigue while being energy-conservative by balancing of the passive and active subsystems. In this work, we perform a design feasibility study for such soft wrist exoskeletons, particularly focused on wrist flexion-extension rehabilitation. Through optimization, geometries for the required functionality of the compliant beam and soft actuator are obtained, and their performance as separate subsystems is evaluated by simulations and experiments. Under the appropriate inputs, we show that the system can introduce a controllable bifurcation. Through experiments, we investigate such bi-stability and explore its usefulness for rehabilitative support of wrist flexion-extension. In short, the proposed wearable can offer a viable, energy-efficient alternative to traditional rehabilitation technologies.
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23
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Fu J, Zhang H, Wei K, Shi C, Zong W. Design and Performance Analysis of a Dynamic Magnetic Resonance Imaging-Compatible Device for Triangular Fibrocartilage Complex Injury Diagnosis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9688441. [PMID: 35756094 PMCID: PMC9225906 DOI: 10.1155/2022/9688441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022]
Abstract
Pain and injury of the triangular fibrocartilage complex (TFCC) due to overuse or trauma are commonly diagnosed through static MRI scanning, while TFCC is always involved in radial and ulnar deviation of the wrist. To the best of our knowledge, a dynamic MRI diagnostic method and auxiliary tool have not been applied or fully developed in the literature. As such, this study presents the design and evaluation of a dynamic magnetic resonance imaging (MRI) auxiliary tool for TFCC injury diagnosis. First, 3D scanning and Python are used to measure and fit the radial and ulnar deviation trajectories of healthy participants and patients. 3D printing is then used to manufacture the auxiliary tool for dynamic MRI, and dynamic MRI diagnosis is then conducted to explore the clinical effect. The radial and ulnar deviation trajectory is presented as an asymmetric curve without an obvious circular centre, and the results indicate that the designed auxiliary device meets the requirements of the ulnar and radial movements of the human wrist. According to the MRI contrast test results, the image quality score of patients wearing the auxiliary device is higher than for those without. Such devices could assist clinicians in the diagnosis of TFCC damage, and our method could not only serve as the reference standard for clinical noninvasive diagnosis but also help in understanding the disease and improving the accuracy of TFCC diagnosis.
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Affiliation(s)
- Jiayu Fu
- China University of Mining and Technology, College of Architecture and Design, School of Industrial Design, 1 Daxue Road, Xuzhou, Jiangsu, China
| | - Hui Zhang
- Xuzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Radiology, 169 Zhongshan South Road, Xuzhou, Jiangsu, China
| | - Kaiqi Wei
- China University of Mining and Technology, College of Architecture and Design, School of Industrial Design, 1 Daxue Road, Xuzhou, Jiangsu, China
| | - Chao Shi
- Xuzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Orthopedic, 169 Zhongshan South Road, Xuzhou, Jiangsu, China
| | - Wei Zong
- China University of Mining and Technology, College of Architecture and Design, School of Industrial Design, 1 Daxue Road, Xuzhou, Jiangsu, China
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GARG V, DHAWAN P, VALSANGKAR N, KUMAR A. A Comparison of Arc of Motion, Radiological Parameters of the Wrist and Patient Rated Wrist Evaluation between Adult Transfusion Dependent Thalassemics and Normal Subjects. J Hand Surg Asian Pac Vol 2022; 27:466-472. [DOI: 10.1142/s242483552250045x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Bony deformities and arthropathies have been noticed in thalassemia patients. The aim of this study is to compare the arc of motion and radiological parameters of the wrist and patient rated wrist evaluation (PRWE) between adult transfusion-dependent thalassemics and normal subjects. Methods: An observational cross-sectional study was done in the department of orthopaedics over a period of 2 years where a total of 30 skeletally mature thalassemia major patients (group A) were assessed. The data was then compared with the data of demographically matched 30 healthy adults (group B). Arc of motion of the dominant wrist that included flexion, extension, radial and ulnar deviation, pronation and supination was measured using a handheld goniometer for both groups. Radiographs of the dominant wrist were obtained in both groups and used to determine the radial height, radial articular angle and carpal slip. PRWE was used to assess the function of the wrist. A p-value of <0.05 was considered statistically significant. Results: Clinical abnormalities at the wrist joint were found in 80% of thalassaemia patients. There was a statistically significant increase in ulnar deviation, wrist extension and decrease in wrist flexion in group A compared to group B. Radiological abnormalities were found in 100% of thalassaemia patients. All the radiological parameters were significantly increased in group A compared to group B. There were no differences in PRWE scores between both groups. Conclusion: Clinical and radiological changes of wrist joint occur in skeletally mature thalassaemia major patients due to shortened ulna compared to healthy adults. This may be due to disease itself, bone marrow expansion, osteopenia, drug (chelating agent) or iron toxicity. Understanding the changes at the wrist in patients with thalassemia major is important to increasing the life expectancy of these patients. Level of Evidence: Level IV (Diagnostic)
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Affiliation(s)
- Varun GARG
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Pawan DHAWAN
- Department of Orthopaedics, Max Superspeciality Hospital, Patparganj, New Delhi, India
| | - Nikhil VALSANGKAR
- Department of Orthopaedics, LHMC and Associated SSKH, New Delhi, India
| | - Ajeet KUMAR
- Department of Orthopaedics, LHMC and Associated SSKH, New Delhi, India
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Eschweiler J, Li J, Quack V, Rath B, Baroncini A, Hildebrand F, Migliorini F. Total Wrist Arthroplasty—A Systematic Review of the Outcome, and an Introduction of FreeMove—An Approach to Improve TWA. Life (Basel) 2022; 12:life12030411. [PMID: 35330163 PMCID: PMC8951379 DOI: 10.3390/life12030411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 01/11/2023] Open
Abstract
The Swanson silicone prosthesis was one of the first devices to realize total wrist arthroplasty (TWA). It has been used regularly since the early 1960s. This systematic review of the literature evaluated the status quos of TWA. The present study was conducted according to the PRISMA guidelines. A literature search was made in Medline, PubMed, Google Scholar, and the Cochrane Library databases. The focus of the present study was on implant survivorship and related functional outcomes. Data from 2286 TWA (53 studies) were collected. Fifteen studies were included for the analysis of implant survivorship. Fifteen studies were included for the analysis of pain. Twenty-eight studies were included for the analysis of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Grip strength was tracked in 16 studies. The range of motion (RoM) was evaluated in 46 studies. For supination and pronation, 18 articles were available. Despite some methodological heterogeneities, TWA may be effective and safe in pain reduction and improving function and motion. There is still a range for a future improvement of the procedure.
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Affiliation(s)
- Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
- Correspondence: ; Tel.: +49-(0)-241-8037368
| | - Jianzhang Li
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
| | - Valentin Quack
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
| | - Björn Rath
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, 4710 Wels, Austria;
| | - Alice Baroncini
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany;
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany;
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Abstract
BACKGROUND Numerous surgical reconstructive techniques have been described for chronic scapholunate and lunotriquetral interosseous ligament instability. METHODS The authors retrospectively reviewed 16 consecutive patients who underwent bone-ligament-bone reconstruction for scapholunate or lunotriquetral intraosseous ligament predynamic and dynamic instability at a single tertiary care institution from 2013 to 2019. Clinical and radiographic outcomes, and complications, were recorded. RESULTS Eleven patients had bone-ligament-bone reconstruction for scapholunate ligament injury and five for lunotriquetral instability. Fourteen patients (87.5 percent) underwent diagnostic arthroscopy before bone-ligament-bone reconstruction, with nine of 14 having grade 3 and four of 14 having grade 4 injury. Capitohamate bone-ligament-bone grafts were used in nine patients (56 percent) and the graft was taken from Lister tubercle in seven (44 percent). The average age at surgery was 37 years. The average follow-up was 60.6 weeks. There were no significant differences between preoperative and postoperative radiographic parameters. Median postoperative wrist flexion was 45 degrees, and mean postoperative wrist extension was 53 degrees, which were significantly less than contralateral flexion (85 degrees; p < 0.0001) and extension (78 degrees; p < 0.0001). Thirty-eight percent of patients complained of persistent pain at final follow-up, and two patients (13 percent) underwent salvage procedures, both at approximately 6.5 months after the index reconstruction. CONCLUSION Short-term outcomes of bone-ligament-bone reconstruction for early-stage scapholunate and lunotriquetral ligament injuries reveal many patients with residual postoperative wrist pain and disability, and almost uniform limitations in flexion-extension motion. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Prestia A, Rossi F, Mongardi A, Ros PM, Roch MR, Martina M, Demarchi D. Motion Analysis for Experimental Evaluation of an Event-Driven FES System. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2022; 16:3-14. [PMID: 34932485 DOI: 10.1109/tbcas.2021.3137027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, a system for controlling Functional Electrical Stimulation (FES) has been experimentally evaluated. The peculiarity of the system is to use an event-driven approach to modulate stimulation intensity, instead of the typical feature extraction of surface ElectroMyoGraphic (sEMG) signal. To validate our methodology, the system capability to control FES was tested on a population of 17 subjects, reproducing 6 different movements. Limbs trajectories were acquired using a gold standard motion tracking tool. The implemented segmentation algorithm has been detailed, together with the designed experimental protocol. A motion analysis was performed through a multi-parametric evaluation, including the extraction of features such as the trajectory area and the movement velocity. The obtained results show a median cross-correlation coefficient of 0.910 and a median delay of 800 ms, between each couple of voluntary and stimulated exercise, making our system comparable w.r.t. state-of-the-art works. Furthermore, a 97.39% successful rate on movement replication demonstrates the feasibility of the system for rehabilitation purposes.
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Ulnar Extension Coupling in Functional Wrist Kinematics During Hand Activities of Daily Living. J Hand Surg Am 2022; 47:187.e1-187.e13. [PMID: 34049729 DOI: 10.1016/j.jhsa.2021.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/24/2021] [Accepted: 03/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist circumduction is increasingly used as a functional motion assessment for patients. Thus, increasing our understanding of its relation to the functional motion envelope is valuable. Previous studies have shown that the wrist is preferentially extended during hand activities of daily living (ADLs), with greater ulnar than radial deviation. The purpose of this study was to characterize the functional wrist motions of 22 modern ADLs in healthy subjects. We hypothesized that the subjects would perform ADLs predominantly in ulnar extension. METHODS Ten right-handed, healthy subjects performed flexion-extension, radioulnar deviation, maximal circumduction, and 22 modern ADLs. Angular wrist positions were obtained by tracking retroreflective markers on the hand and forearm. Angular motion data were analyzed with a custom program for peak/trough angles in flexion extension and radioulnar deviation, ellipse area of circumduction data, and ellipse area of combined motion data. RESULTS The required ranges of motion for ADLs were from 46.6° ± 16.5° of flexion (stirring task) to 63.8° ± 14.2° of extension (combing) in flexion-extension and from 15.6° ± 8.9° of radial deviation (opening a jar) to 32.5° ± 8.3° of ulnar deviation (picking up smartphone) in radioulnar deviation. Ellipse area of combined motion data of the 22 ADLs were, on average, 58.2% ± 14.3% of the ellipse area of maximal circumduction. A motion data quadrantal analysis revealed that 54.9% of all ADL wrist motion occurred in ulnar extension. Among the average wrist positions for 22 ADLs, 16 were located in the ulnar extension quadrant. CONCLUSIONS This study revealed a functional wrist motion envelope that was less than 60% of wrist maximal motion capacity on average. Our results also showed that the majority of ADLs are performed in ulnar extension of the wrist. CLINICAL RELEVANCE Baseline values for healthy subjects performing 22 wrist ADLs can inform future studies assessing dysfunction, postsurgical changes, and rehabilitation progress.
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Jamnik AA, Pirkle S, Chacon J, Xiao AX, Wagner ER, Gottschalk MB. The Effect of Immobilization Position on Functional Outcomes and Complications Associated With the Conservative Treatment of Distal Radius Fractures: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:25-31. [PMID: 35415593 PMCID: PMC8991451 DOI: 10.1016/j.jhsg.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose We evaluated the literature on complications associated with different positions used for immobilizing the upper extremity during conservative treatment of distal radius fractures (DRF). Methods A search of PubMed, Embase, and Medline was conducted to identify original research on the effects that upper extremity positioning during the treatment of DRFs has on complication rates. Treatment groups were categorized by wrist positioning in flexion, extension, or neutral, as well as forearm positioning in pronation, supination, or neutral. The primary endpoints examined included the loss of reduction, recasting/refabricating an orthosis, and functional limitations. Results A total of 1,655 articles were identified through an initial database search. Ultimately, 8 studies, with 786 total patients, met the inclusion criteria for this systematic review. A qualitative analysis determined that immobilizing DRFs with the wrist in extension results in better functional and radiographic outcomes with lower rates of complications, such as pain, recasting, and the need for operation. The 2 studies that compared forearm pronation versus supination revealed contradictory results regarding which position was associated with superior outcomes. A meta-analysis comparing the various wrist and forearm positions failed to demonstrate statistically significant differences in the rates of loss of reduction or recasting/refabricating an orthosis between the groups. This analysis was limited by considerable heterogeneity in the data from the different studies. Conclusions Despite the high incidence of DRFs, there is limited research on the optimal position of immobilization for conservative treatment of them. Available evidence suggests that the wrist should be immobilized in extension, as these patients had improved functional and radiographic outcomes. No conclusion can be drawn from the existing literature on ideal forearm position during immobilization. This review also suggests better data reporting practices for studies researching DRFs, so that future meta-analyses can be more comprehensive. Type of study/level of evidence Therapeutic II.
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Affiliation(s)
| | - Sarah Pirkle
- Emory University School of Medicine, Atlanta, GA
| | - Jose Chacon
- School of Medicine, American University of Integrative Sciences, Tucker, GA
| | | | - Eric R. Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, GA
| | - Michael B. Gottschalk
- Department of Orthopedic Surgery, Emory University, Atlanta, GA
- Corresponding author: Michael B. Gottschalk, MD, Department of Orthopedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA 30329.
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Gatt I, Allen T, Wheat J. Quantifying wrist angular excursion on impact for Jab and Hook lead arm shots in boxing. Sports Biomech 2021:1-13. [PMID: 34872457 DOI: 10.1080/14763141.2021.2006296] [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: 04/14/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
The hand region is reported as the most common injury site in boxing, with more observed time loss than any other area in this sport. The amount of wrist motion, specifically flexion, has been described as contributing to these injuries, yet no literature is available to quantify wrist kinematics in boxing. This is the first paper describing wrist motion on impact in boxing. Utilising an electromagnetic tracking system, two types of shots were assessed, Jab (straight arm) and Hook (bent arm), during in-vivo testing procedures with 29 elite boxers. For both shots, flexion and ulnar deviation occurred concurrent on impact, with an M and SD of 9.3 ± 1.9° and 4.7 ± 1.2° respectively for Jab shots, and 5.5 ± 1.1° and 3.3 ± 1.1° respectively for Hook shots, supporting dart throwing motion at the wrist. For both Jab & Hook, wrist motion on impact occurred within >30% and >20% respectively of total available active range of motion, with wrist angles greater in both flexion (t = 9.0, p < 0.001, d = 1.7) and ulnar deviation (t = 8.4, p < 0.001, d = 1.6) for Jab compared to Hook shots. The study provides novel and quantifiable information regarding wrist kinematics during the impact phase of punching and potentially an improved understanding of injury mechanisms in boxing.
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Affiliation(s)
- Ian Gatt
- Physiotherapy Department, English Institute of Sport, Manchester, United Kingdom of Great Britain and Northern Ireland
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Allen
- School of Engineering, Manchester Metropolitan University, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Wheat
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
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Lee J, Kim H, Yang W. Development of Wrist Interface Based on Fully Actuated Coaxial Spherical Parallel Mechanism for Force Interaction. SENSORS 2021; 21:s21238073. [PMID: 34884077 PMCID: PMC8659704 DOI: 10.3390/s21238073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
To develop a wrist robotic exoskeleton-type interface (REI) for force interaction, it should have a suitable range of motion similar to human wrist activities of daily living, large torque output performance, and low moving parts inertia for dynamic motion response to cover the human behavior frequency. In this paper, a wrist REI based on a fully actuated coaxial spherical parallel mechanism (CSPM) is proposed to satisfy the aforementioned features. The fully actuated CSPM-based wrist REI (FC-WREI) has the characteristics of pure rotation similar to the human wrist, high torque output by parallel torque synthesis, and low moving parts inertia due to the base arrangement of the actuators. Due to the mechanical advantages and design optimization, the FC-WREI maximally provides torque as much as 56.49–130.43% of the maximum isometric torque of the human wrist, while providing a consistent range of motion to the human wrist without interference problem. Moreover, it is confirmed that the inertia of the FC-WREI is up to 5.35 times lower than similar devices. These advantages of the FC-WREI mean that the device is applicable to various fields of REIs for force interaction.
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Affiliation(s)
- Jaeyong Lee
- School of Robotics, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea;
| | - Hyungjoo Kim
- Hyundai Motor Company, Crash Safety, Saimdang-ro 17-gil 116 101-1105, Seoul 01897, Korea;
| | - Woosung Yang
- School of Robotics, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea;
- Correspondence: ; Tel.: +82-940-8115
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Aguilera-Godoy A, Antúnez-Riveros MA, Carrasco-Penna G, Núñez-Cortés R. A post-surgical rehabilitation program for women over 60 years old who underwent surgery in trauma and orthopedic hospital after distal radius fracture. J Bodyw Mov Ther 2021; 28:362-368. [PMID: 34776165 DOI: 10.1016/j.jbmt.2021.07.042] [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: 03/07/2021] [Revised: 07/03/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Distal radius fractures (DRFs) are associated with a high economic burden and an impact on quality of life on these patients. Its high prevalence demonstrates the importance of registering functional results, with emphasis on vulnerable population such as elderly females. METHODS Thirty-six patients were admitted to a multimodal rehabilitation program. Exercise progressions combined with manual therapy and electrophysical agents were provided, taking into account bone and soft tissues healing stages, protection of surgical intervention and symptoms of each patient. The primary outcome was the Patient Rated Wrist Evaluation (PRWE) questionnaire. The secondary outcomes were wrist and forearm range of motion (ROM), grip strength and lateral and tripod pinch strength. The paired t-test was used to compare mean PRWE, ROM, and strength between 6 and 12 weeks. RESULTS An improvement of functionality was observed with a decreased of -20.9 (CI 95%: 25.9 to -15.9) points in the PRWE questionnaire (p < 0.001) between 6 and 12 weeks after DRF surgery. In addition, an increase in the ROM of the wrist (p < 0.001), grip strength (p < 0.001), lateral pinch (p < 0.001) and tripod pinch (p < 0.001) were observed between 6 and 12 weeks after surgery. CONCLUSIONS These findings showed a clinically and statistically significant improvement in function, ROM, and strength assessed at weeks 6 and 12 after surgery. However, this study design cannot establish a cause-and-effect relationship. Future randomized controlled clinical trials should investigate the effectivity of similar rehabilitation programs.
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Affiliation(s)
| | | | | | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
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Yang S, Li M, Wang J, Wang T, Liang Z, He B, Xie J, Xu G. A novel wrist rehabilitation exoskeleton using 3D-printed multi-segment mechanism. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4769-4772. [PMID: 34892277 DOI: 10.1109/embc46164.2021.9630996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Wrist rehabilitation exoskeleton can effectively assist wrist recovery from stroke. However, current wrist rehabilitation devices have shortcomings such as heavy weight, uncertain motion trajectory, etc. This paper proposes a wrist rehabilitation robot driven by 3D-printed multi-segment mechanism to realize wrist rehabilitation in three degrees of freedom. We conducted three tests including bearing force, rehabilitation trajectory, range of motion tests. The results prove this exoskeleton can provide enough force and torque, and it can achieve larger range of motion within the same motor displacement, that makes it more compact and lighter in hardware and less expensive in cost. Moreover, its motion trajectory can be controlled and stable, that makes it more applicable for real application in human rehabilitation.Clinical Relevance- Stroke is the leading cause of hemiplegia, and this symptom usually degrades patients' living standard and flexibility. This device can offer patients stable wrist rehabilitation training in three degrees of freedom with compact and lightweight characteristics.
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Long-term outcome after arthroscopic debridement of Palmer type 2C central degenerative lesions of the triangular fibrocartilage complex. Arch Orthop Trauma Surg 2021; 141:1807-1814. [PMID: 33932158 DOI: 10.1007/s00402-021-03918-9] [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: 04/07/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to report long-term objective and patient-reported outcome after arthroscopic debridement of central degenerative triangular fibrocartilage complex (TFCC) lesions. METHODS A total of 17 patients with central degenerative TFCC (Palmer type 2C) lesions and ulnar positive variance who were treated by arthroscopic debridement were retrospectively reviewed. Mean follow-up was 8.8 years. Assessment facilitating the Modified Mayo Wrist score (MMWS), the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH score), recording of pain level and of patient satisfaction, and radiological examination were done. RESULTS Patients reached a pain level of 1.7 VAS, MMW score of 92, and DASH score of 22. No significant differences could be detected between the operated and the contralateral extremity regarding range of motion and grip strength for all patients. No perioperative complications occurred. CONCLUSION Arthroscopic debridement of central degenerative TFCC lesions is safe, reliable, and efficacious even for ulnar positive variance. LEVEL OF EVIDENCE Therapeutic IV.
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d'Almeida MA, Sturbois-Nachef N, Amouyel T, Chantelot C, Saab M. Four-corner fusion: Clinical and radiological outcome after fixation by headless compression screws or dorsal locking plate at minimum 5 years' follow-up. Orthop Traumatol Surg Res 2021; 107:102886. [PMID: 33711508 DOI: 10.1016/j.otsr.2021.102886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Among the various procedures for degenerative carpal lesions, four-corner fusion relieves pain while conserving motion and strength. There are various fixation options, not presently standardised. HYPOTHESIS Internal fixation by screws or dorsal locking plate provides good 5-year clinical results in four-corner fusion. MATERIAL AND METHOD A single-centre retrospective study included 18 four-corner fusions at a minimum 5 years' follow-up: 8 plate and 10 screw fixations. Endpoints comprised pain, wrist range of motion, grip strength, QuickDASH and PRWE scores, and immobilisation time. Radiographic analysis was performed and complications inventoried. RESULTS Pain VAS score fell to 1/10 in both groups. Flexion-extension was 56° with screws and 55° with plates. QuickDASH was 20.5 and 4.6 respectively, and PRWE 11 and 9. Grip strength was 16kg in both groups. The consolidation rate was 85.7% with screws and 57.1% with plates. Eighty percent of patients with screw fixation progressed toward radiolunate osteoarthritis. Four patients required revision surgery: 3 in the screw group and 1 in the plate group. DISCUSSION There was clear clinical and functional improvement in both groups at a minimum 5 years. Consolidation was better with screw fixation, but with risk of radiolunate osteoarthritis. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
| | | | - Thomas Amouyel
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
| | - Christophe Chantelot
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
| | - Marc Saab
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
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The effect of muscle fatigue on wrist joint position sense in healthy adults. J Hand Ther 2021; 33:329-338. [PMID: 30962121 DOI: 10.1016/j.jht.2019.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Pretest and posttest experimental study. INTRODUCTION The effect of muscle fatigue on wrist joint position sense (JPS) has yet to be determined. PURPOSE OF THE STUDY The primary aim was to determine whether muscle fatigue affects wrist JPS in healthy adults. The secondary aims were to compare the effect of muscle fatigue on younger and older adults JPS and determine the association between JPS rate of change and total muscle fatigue (TMF) rates postexercise. METHODS Forty male and female healthy adults were assigned into younger (18-40 years) and older (41-65 years) groups. Preexercise and postexercise testing consisted of active wrist JPS, handgrip, and wrist extensor strength assessments. Muscle fatigue was induced via a calibrated gripper and wrist extension dumbbell exercises. Dependent variables were the JPS rate of change (ie, preexercise and postexercise), TMF rate (ie, grip and wrist extension average strength decline), and Borg Rating of Perceived Exertion scale scores. RESULTS Postexercise wrist JPS test scores were significantly higher than preexercise. Exercises induced statistically significant TMF rates and Borg Rating of Perceived Exertion scores among all participants. No statistically significant age-group differences on JPS rate of change, and TMF rate was found. A statistically significant mild correlation (r = 0.425) existed between JPS rate of change and TMF rates. DISCUSSION Postexercise fatigue significantly impairs wrist JPS in both younger and older adults. On average, an 18% muscle strength decline led to 215% wrist JPS deficit. CONCLUSIONS Significant wrist proprioception deficits persist for ≤5 min following exertional exercises, regardless of age level.
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Lunn K, Hoftiezer Y, Lans J, van der Heijden B, Chen N, Lozano-Calderón SA. Joint-sparing versus nonjoint-sparing reconstruction of the radius following oncologic resection: A systematic review. J Surg Oncol 2021; 124:1523-1535. [PMID: 34432294 DOI: 10.1002/jso.26660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Reconstructions of the distal radius are uncommon procedures. This systematic review compares joints-sparing (JS) versus nonjoint-sparing (NJS) reconstructions following oncologic resection of the distal radius. METHODS A search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Collected outcomes included patient-reported outcome measures (PROMs), range of motion and grip strength, and complication and reoperation rates. RESULTS A total of 52 nonrandomized cohort studies (n = 715) were included. PROMs were comparable between the cohorts, while the range of flexion-extension was greater in JS reconstructions (78.1° vs. 25.6°) and the range of pronation-supination was greater in NJS reconstructions (133.6° vs. 109.8°). Relative grip strength was greater following JS reconstruction (65.0% vs. 56.4%). About one in sixteen of the JS reconstructions were eventually revised to an NJS construct. CONCLUSIONS This systematic review demonstrates that JS reconstructive techniques can offer satisfying results in patients treated for oncologic distal radius defects. However, about 6% of JS reconstructions are eventually revised to a NJS construct. Further investigation is warranted to identify factors that affect or predict these findings, to aid in future in treatment selection and reduce the common need for reoperations following these procedures.
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Affiliation(s)
- Kiera Lunn
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yannick Hoftiezer
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, Netherlands
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, Netherlands.,Department of Plastic Surgery, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Gui XY, Cheng ZH, Shi HF, Chen YX, Xiong J, Wang JF, Qiu XS, Zhang ZT. Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution. J Orthop Surg Res 2021; 16:530. [PMID: 34433474 PMCID: PMC8385909 DOI: 10.1186/s13018-021-02641-w] [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: 05/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. MATERIALS AND METHODS Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors' institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. RESULTS A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month's follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. CONCLUSIONS The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. TRIAL REGISTRATION This study has been registered on the ClinicalTrials.gov.
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Affiliation(s)
- Xue-Yang Gui
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zhao-Hui Cheng
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Hong-Fei Shi
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Yi-Xin Chen
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jun-Fei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Xu-Sheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zi-Tao Zhang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
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Accuracy of a Low-Cost 3D-Printed Wearable Goniometer for Measuring Wrist Motion. SENSORS 2021; 21:s21144799. [PMID: 34300540 PMCID: PMC8309942 DOI: 10.3390/s21144799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
Wrist motion provides an important metric for disease monitoring and occupational risk assessment. The collection of wrist kinematics in occupational or other real-world environments could augment traditional observational or video-analysis based assessment. We have developed a low-cost 3D printed wearable device, capable of being produced on consumer grade desktop 3D printers. Here we present a preliminary validation of the device against a gold standard optical motion capture system. Data were collected from 10 participants performing a static angle matching task while seated at a desk. The wearable device output was significantly correlated with the optical motion capture system yielding a coefficient of determination (R2) of 0.991 and 0.972 for flexion/extension (FE) and radial/ulnar deviation (RUD) respectively (p < 0.0001). Error was similarly low with a root mean squared error of 4.9° (FE) and 3.9° (RUD). Agreement between the two systems was quantified using Bland–Altman analysis, with bias and 95% limits of agreement of 3.1° ± 7.4° and −0.16° ± 7.7° for FE and RUD, respectively. These results compare favourably with current methods for occupational assessment, suggesting strong potential for field implementation.
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Fares AB, Childs BR, Polmear MM, Clark DM, Nesti LJ, Dunn JC. Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review. J Hand Surg Am 2021; 46:627.e1-627.e8. [PMID: 33573844 DOI: 10.1016/j.jhsa.2020.11.026] [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: 08/26/2019] [Revised: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal radius fractures. METHODS A literature search performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 206 articles, 12 of which met inclusion criteria, accounting for 310 patients. Included articles contained the results of DBP for treatment of distal radius fractures with reported outcomes between 1988 and 2018. Data were pooled and analyzed focusing on patient demographics, as well as 3 primary outcomes of complications, range of motion (ROM), and Disabilities of the Arm, Shoulder, and Hand (DASH) and QuickDASH scores. RESULTS Average age was 55 years, median follow-up was 24 months, and the most common use was in comminuted (92%) intra-articular (92%) distal radius fracture caused by fall (58%), or motor vehicle collision or motorcycle collision (27%). A minority of patients had open fractures (16%) and most were cases of polytrauma (65%). Median time from placement to DBP removal was 17 weeks (mean, 119 days). At final follow-up, mean wrist ROM was 45° flexion, 50° extension, 75° pronation, and 73° supination. Mean DASH score was 26.1, and mean QuickDASH score was 19.8. The overall rate for any complication was 13%; the most common was hardware failure (3%) followed by symptomatic malunion or nonunion (3%), and persistent pain after hardware removal (2%). CONCLUSIONS Dorsal bridge plating was found to be used most commonly in intra-articular, comminuted distal radius fractures with overall functional wrist ROM, moderate patient-reported disability, and a 13% complication rate at follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Austin B Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX.
| | - Benjamin R Childs
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Michael M Polmear
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - DesRaj M Clark
- Department of Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Leon J Nesti
- Department of Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
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de Los Reyes-Guzmán A, Lozano-Berrio V, Alvarez-Rodríguez M, López-Dolado E, Ceruelo-Abajo S, Talavera-Díaz F, Gil-Agudo A. RehabHand: Oriented-tasks serious games for upper limb rehabilitation by using Leap Motion Controller and target population in spinal cord injury. NeuroRehabilitation 2021; 48:365-373. [PMID: 33814469 DOI: 10.3233/nre-201598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a growing interest in the use of technology in the field of neurorehabilitation in order to quantify and generate knowledge about sensorimotor disorders after neurological diseases, understanding that the technology has a high potential for its use as therapeutic tools. Taking into account that the rehabilitative process of motor disorders should extend beyond the inpatient condition, it's necessary to involve low-cost technology, in order to have technological solutions that can approach the outpatient period at home. OBJECTIVE to present the virtual applications-based RehabHand prototype for the rehabilitation of manipulative skills of the upper limbs in patients with neurological conditions and to determine the target population with respect to spinal cord injured patients. METHODS Seven virtual reality applications have been designed and developed with a therapeutic sense, manipulated by means of Leap Motion Controller. The target population was determined from a sample of 40 people, healthy and patients, analyzing hand movements and gestures. RESULTS The hand movements and gestures were estimated with a fitting rate between the range 0.607-0.953, determining the target population by cervical levels and upper extremity motor score. CONCLUSIONS Leap Motion is suitable for a determined sample of cervical patients with a rehabilitation purpose.
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Affiliation(s)
- Ana de Los Reyes-Guzmán
- Department of Biomechanics and Technical Aids, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Vicente Lozano-Berrio
- Department of Biomechanics and Technical Aids, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
| | - María Alvarez-Rodríguez
- Department of Biomechanics and Technical Aids, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Elisa López-Dolado
- Department of Rehabilitation, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Silvia Ceruelo-Abajo
- Department of Rehabilitation, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Francisco Talavera-Díaz
- Department of Rehabilitation, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Angel Gil-Agudo
- Department of Rehabilitation, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda, Toledo, Spain
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Cholley-Roulleau M, Dap F, Dautel G, Athlani L. Scaphotrapeziotrapezoid arthrodesis for isolated osteoarthritis: results at a mean 8 years' follow-up. HAND SURGERY & REHABILITATION 2021; 40:602-608. [PMID: 33992817 DOI: 10.1016/j.hansur.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
The aim of this retrospective study was to report medium- to long-term outcome of scaphotrapeziotrapezoid (STT) arthrodesis with staple fixation to treat painful isolated osteoarthritis (OA). Twenty-one consecutive patients (22 wrists) who had undergone STT arthrodesis were retrospectively reviewed by an independent examiner. Clinical and radiological evaluation was performed. At a mean follow-up of 8 years (range 2-20 years), pain levels were significantly decreased, and functional scores were significantly improved. Grip and pinch strength were 86% and 82% of those of the contralateral side. Wrist range of motion in flexion-extension and radial-ulnar deviation was significantly less than on the contralateral side at last follow-up (104° vs. 131° and 38° vs. 55°, respectively). Non-union was found on X-ray in 4 wrists (18%), but in 2 cases showed as partial non-union on CT, with complete scaphotrapezial consolidation; 1 of the 4 wrists required surgical revision. Another patient was re-operated on for symptomatic external staple displacement without non-union. There were 8 cases (36%) of radiographic narrowing of the styloscaphoid joint space; contact between the staple and styloid was found in all 8 cases. Four patients (18%) had narrowing of the scaphocapital joint space; protrusion of the proximal part of the staple into the joint space was noted in all 4 wrists. No differences were found for the radioscaphoid, capitolunate and scapholunate angles before and after surgery. STT arthrodesis with staple fixation to treat isolated STT OA led to a significant reduction in pain, with improved strength and functional scores. To avoid styloid impingement, we recommend systematic styloidectomy. Complete non-union seems to be overestimated on radiographs. Partial non-union with scaphotrapezial union should not be considered as a complication. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- M Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
| | - F Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
| | - G Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
| | - L Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
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Gui XY, Shi HF, Xiong J, Chen YX, Wang JF, Huang J, Qiu XS, Wang YH. A modified intrafocal pinning technique with three-dimensional planning to facilitate volar plating in dorsally comminuted AO/OTA C2 and C3 distal radius fractures. BMC Musculoskelet Disord 2021; 22:379. [PMID: 33892699 PMCID: PMC8066843 DOI: 10.1186/s12891-021-04265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/14/2021] [Indexed: 01/03/2023] Open
Abstract
Backgrounds Theaim of this study was to assess the efficacy of a modified intrafocal pinningtechnique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures. Methods Intotal 35 AO/OTA type C2 and C3 fractures were finally included.The 3D digital model of the fracture was reconstructed based on preoperative computedtomographic (CT) images, with the displacement of the comminuted dorsalfragment and the intra-articular fragment analyzed for preoperative planning. During operation, amodified intrafocal pinning technique was applied percutaneously from thedorsal aspect of the radius to reduce the collapsed intra-articular fragmentfollowing volar plating. Adequate reduction was confirmed in all of patientsconsidering radial height, radial inclination and volar tilt in postoperativeradiographs. Results No significant fracture re-displacement wasobserved in most of the cases during a mean follow-up period of 17.4 months, exceptfor two patients withthe C3 fracture. All of the patients achieved adequate clinicalROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achievedan excellent (n = 21) or good (n = 12) Gartland and Werley wrist score. Conclusions Ourmodified intrafocal pinning technique with 3D planning contributes to a satisfactoryclinical and radiological outcome in dorsally comminuted intra-articular distalradius fractures fixed with a volar locking plate. Trialregistration Notapplicable because the design of the study is retrospective.
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Affiliation(s)
- Xue-Yang Gui
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Hong-Fei Shi
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
| | - Yi-Xin Chen
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jun-Fei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jie Huang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Xu-Sheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Yin-He Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
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Martínez Villén G, Rodríguez Nogué L. Universal 2™ total wrist arthroplasty: A single-surgeon 6.5-year follow-up study of 22 prostheses. HAND SURGERY & REHABILITATION 2021; 40:413-419. [PMID: 33813044 DOI: 10.1016/j.hansur.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022]
Abstract
Total wrist arthroplasty remains controversial, with the few studies undertaken being heterogeneous and having low patient numbers. This prospective study involved 22 Universal 2™ total wrist prostheses implanted by the same surgeon between 2003 and 2017. There were 13 women and nine men with an average age of 56 (42-69.5) years. Indications for total wrist arthroplasty were post-traumatic arthritis, rheumatoid arthritis and Kienböck's disease. The mean follow-up was 6.5 (3-17) years. Two failed implants required total wrist fusion. Postoperative pain, grip strength, QuickDASH, patient-rated wrist evaluation, and Mayo wrist scores improved significantly compared with preoperative scores. The prosthesis preserved equal or slightly greater range of motion than the preoperative range of motion, sufficient to undertake activities of daily living and improve quality of life. Postoperative radiographs 1 month after the surgery and then annually showed signs of bone deterioration in 64% of implants, most osteolysis without loosening, compatible with asymptomatic function. Although a high number of radiographic signs of implant changes were apparent in the midterm, 91% of prostheses are still in place. The long-term survival of this implant is uncertain. LEVEL OF EVIDENCE: Therapeutic IV.
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Affiliation(s)
- G Martínez Villén
- Department of Orthopaedic and Traumatology, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain; Hand and Reconstructive Surgery Unit, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
| | - L Rodríguez Nogué
- Department of Orthopaedic and Traumatology, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
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45
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Reigstad O, Holm-Glad T, Dovland P, Korslund J, Grimsgaard C, Thorkildsen RD, Røkkum M. Progressing arthrosis and a high conversion rate 11 (4-19) years after four corner fusion. J Plast Surg Hand Surg 2021; 55:354-360. [PMID: 33733991 DOI: 10.1080/2000656x.2021.1898970] [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: 10/21/2022]
Abstract
Four corner fusion (4CF) is a limited wrist arthrodesis offered to patients with painful wrists due to scaphoid non-union advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC). A retrospective study of 42 wrists (in 36 patients), operated with 4CF using K-wires and autologous bone graft followed up after 11 (4-19) years was performed, 25 were male and mean age at surgery was 51 (22-71) years. During the follow-up period, 13 wrists were converted to total wrist arthrodesis or wrist arthroplasty, and one is scheduled for conversion (14/42, 33%) due to non-union (3), DISI and progressing arthrosis (7) or progressing arthrosis (4). Non-union was seen in 3/42 (93%) wrists, all were later converted. At the final follow-up, the patients reported residual pain, VAS = 15 and 36 at rest and activity, respectively, and QDASH/PRWHE = 32 and 31, respectively. Active range of motion (AROM) was 38% and grip-strength was 76% compared to the uninjured side. Degenerative changes were seen in 88% on CT scans at follow-up. 4CF renders an acceptable pain reduction and function in the majority of patients, but increased degeneration and a high number of conversions after a longer follow-up time is concerning.
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Affiliation(s)
- Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Preben Dovland
- Department of Orthopedics, Østfold Hospital Trust, Graalum, Norway
| | - Johanne Korslund
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Rasmus D Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Andreasson I, Carlsson G, Kjellby-Wendt G, Karlsson J, Fagevik Olsén M. Daily life one year after corrective osteotomy for malunion of a distal radius fracture an interview study. J Plast Surg Hand Surg 2021; 56:16-22. [PMID: 33726632 DOI: 10.1080/2000656x.2021.1899934] [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] [Indexed: 10/21/2022]
Abstract
The aim of this study was to explore the everyday life experiences of people one year after corrective osteotomy following a symptomatic, malunited, distal radius fracture.Semi-structured interviews were conducted with twenty respondents, median age 65 (22-81) years. The respondents were recruited consecutively. The interviews were subjected to qualitative content analysis. Three authors took part in the analysis.The result is presented as one theme, 'Daily life works again' with five categories: Relief of inconveniences and symptoms, Managing new symptoms and complications, Regaining abilities, Normalised social relationships, Increased wellbeing. The symptoms had declined in severity, some participants regarded themselves as fully restored and used their hand again without hesitation. Others were still bothered by their wrist occasionally and a few had to manage complications. The participants had regained the ability to perform many everyday life activities and reported increased independence and less irritation between spouses, as well as increased wellbeing.One year after a corrective osteotomy following malunion of a distal radius fracture, the patients' experiences represent a continuum. Some are still restricted by their wrist occasionally, the majority experience an increased ease in their performance of activities of daily life and some regard themselves as fully restored. The recovery has a positive impact on social relationships and the patients' wellbeing.
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Affiliation(s)
- Ingrid Andreasson
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Carlsson
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Physiotherapy, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Monika Fagevik Olsén
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Physiotherapy, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chiaradia D, Tiseni L, Xiloyannis M, Solazzi M, Masia L, Frisoli A. An Assistive Soft Wrist Exosuit for Flexion Movements With an Ergonomic Reinforced Glove. Front Robot AI 2021; 7:595862. [PMID: 33537345 PMCID: PMC7848217 DOI: 10.3389/frobt.2020.595862] [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: 08/17/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Soft exosuits are a promising solution for the assistance and augmentation of human motor abilities in the industrial field, where the use of more symbiotic wearable robots can avoid excessive worker fatigue and improve the quality of the work. One of the challenges in the design of soft exosuits is the choice of the right amount of softness to balance load transfer, ergonomics, and weight. This article presents a cable-driven based soft wrist exosuit for flexion assistance with the use of an ergonomic reinforced glove. The flexible and highly compliant three-dimensional (3D)-printed plastic structure that is sewn on the glove allows an optimal force transfer from the remotely located motor to the wrist articulation and to preserve a high level of comfort for the user during assistance. The device is shown to reduce fatigue and the muscular effort required for holding and lifting loads in healthy subjects for weights up to 3 kg.
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Affiliation(s)
- Domenico Chiaradia
- Percro Laboratory, Tecip Institute, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Luca Tiseni
- Percro Laboratory, Tecip Institute, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Michele Xiloyannis
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Switzerland and the Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Massimiliano Solazzi
- Percro Laboratory, Tecip Institute, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Lorenzo Masia
- Institut für Technische Informatik (ZITI), Heidelberg University, Heidelberg, Germany
| | - Antonio Frisoli
- Percro Laboratory, Tecip Institute, Sant'Anna School of Advanced Studies, Pisa, Italy
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Biomechanical function requirements of the wrist. Circumduction versus flexion/abduction range of motion. J Biomech 2020; 110:109975. [PMID: 32827773 DOI: 10.1016/j.jbiomech.2020.109975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
The biomechanical function of the wrist is widely assessed by measuring the range of motion (RoM) in two separate orthogonal planes: flexion-extension (FE) and radioulnar deviation (RUD). However, the two motions are coupled. The aim of this study is to compare wrist circumduction with FE and RUD RoM in terms of representativeness of the kinematic requirements for performing activities of daily living (ADL). To this end, the wrist motion of healthy participants was measured while performing maximum RoM in FE and in RUD, circumduction, and thirty-two representative ADL. Active and functional RoM (ARoM and FRoM) were computed in each plane, the evolving circumduction curves were adjusted to ellipses, and intensity maps representing the frequency of the coupling angles in ADL were plotted, both per ADL and globally for both hands. Ellipses representing different percentages of coupling angles in ADL were also plotted. Wrist circumduction fits the coupling angles measured in ADL better than ARoM or FRoM. As a novelty, quantitative data for both circumduction and the coupling angles required in ADL are provided, shedding light on the real biomechanical function requirements of the wrist. Results might be used to quantify mobility reduction and its impact on the performance of ADL, globally and per ADL, to enhance rehabilitation strategies, as well as in clinical decision-making, robotics, and prostheses.
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Goislard de Monsabert B, Hauraix H, Caumes M, Herbaut A, Berton E, Vigouroux L. Modelling force-length-activation relationships of wrist and finger extensor muscles. Med Biol Eng Comput 2020; 58:2531-2549. [PMID: 32803449 DOI: 10.1007/s11517-020-02239-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022]
Abstract
The wrist and finger extensors play a crucial role in the muscle coordination during grasping tasks. Nevertheless, few data are available regarding their force-generating capacities. The objective of this study was to provide a model of the force-length-activation relationships of the hand extensors using non-invasive methods. The extensor carpi radialis (ECR) and the extensor digitorum communis (EDC) were studied as representative of wrist and finger extensors. Ten participants performed isometric extension force-varying contractions in different postures on an ergometer recording resultant moment. The joint angle, the myotendinous junction displacement and activation were synchronously tracked using motion capture, ultrasound and electromyography. Muscle force was estimated via a musculoskeletal model using the measured joint angle and moment. The force-length-activation relationship was then obtained by fitting a force-length model at different activation levels to the measured data. The obtained relationships agreed with previously reported data regarding muscle architecture, sarcomere length and activation-dependent shift of optimal length. Muscle forces estimated from kinematics and electromyography using the force-length-activation relationships were comparable, below 15% differences, to those estimated from moment via the musculoskeletal model. The obtained quantitative data provides a new insight into the different muscle mechanics of finger and wrist extensors. Graphical abstract By combining in vivo data (kinematics, dynamometry, electromyography, ultrasonography) during isometric force-varying contractions with musculoskeletal modelling, the force-length-activation relationships of both finger and wrist extensors were obtained. The results provided a new insight into the role of hand extensors in the generation and control of hand movements.
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Affiliation(s)
| | - Hugo Hauraix
- Aix-Marseille Univ, CNRS, ISM, Marseille, France
| | | | - Alexis Herbaut
- Department of Movement Sciences, Decathlon SportsLab, Villeneuve d'Ascq, France
| | - Eric Berton
- Aix-Marseille Univ, CNRS, ISM, Marseille, France
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Preliminary Clinical, Radiographic, and Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Lunate Reconstruction in Advanced Kienböck Disease. J Hand Surg Am 2020; 45:774.e1-774.e8. [PMID: 32147088 DOI: 10.1016/j.jhsa.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/21/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to describe the radiographic, functional, and patient-reported outcomes (PROs) of medial femoral trochlea osteochondral free flap reconstruction of the proximal lunate in stage IIIA and IIIB Kienböck disease. METHODS Eighteen adult patients underwent medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease by a single surgeon. Eight of these patients returned for clinical examination, radiographs, and completion of PRO questionnaires. An additional 4 patients completed PRO questionnaires remotely. RESULTS The mean patient age was 28.4 years. The mean radiographic and physical examination follow-up was 1.4 and 2.2 years, respectively. The mean PRO follow-up was 2.1 years. Radiographic measurements (carpal height ratio, radioscaphoid angle) demonstrated that carpal collapse was halted, and carpal alignment was maintained, after surgery. Wrist flexion (38.3°) and extension (37.3°) were unchanged by this operation, and postoperative pinch and grip strength were 90% and 68% of the uninjured side, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 10.8, and the Patient-Rated Wrist Evaluation score was 18.1. Knee Injury and Osteoarthritis Outcomes Score subscales, International Knee Documentation Committee, and Kujala lower extremity PRO scores ranged from 83.1 to 96.8. The Patient-Reported Outcomes Measurement Information System Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior scores reflected good postoperative patient health and function and low pain levels. CONCLUSIONS Following medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease, we observed a cessation of radiocarpal collapse. After surgery, patients demonstrated acceptable levels of function, pain, and wrist range of motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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