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The redundancy present within the musculoskeletal system may offer a non-invasive source of signals for movement augmentation, where the set of muscle activations that do not produce force/torque (muscle-to-force null-space) could be controlled simultaneously to the natural limbs. Here, we investigated the viability of extracting movement augmentation control signals from the muscles of the wrist complex. Our study assessed (i) if controlled variation of the muscle activation patterns in the wrist joint's null-space is possible; and (ii) whether force and null-space cursor targets could be reached concurrently. During the null-space target reaching condition, participants used muscle-to-force null-space muscle activation to move their cursor towards a displayed target while minimising the exerted force as visualised through the cursor's size. Initial targets were positioned to require natural co-contraction in the null-space and if participants showed a consistent ability to reach for their current target, they would rotate 5 ∘ incrementally to generate muscle activation patterns further away from their natural co-contraction. In contrast, during the concurrent target reaching condition participants were required to match a target position and size, where their cursor position was instead controlled by their exerted flexion–extension and radial-ulnar deviation, while its size was changed by their natural co-contraction magnitude. The results collected from 10 participants suggest that while there was variation in each participant's co-contraction behaviour, most did not possess the ability to control this variation for muscle-to-force null-space virtual reaching. In contrast, participants did show a direction and target size dependent ability to vary isometric force and co-contraction activity concurrently. Our results indicate the limitations of using the muscle-to-force null-space activity of joints with a low level of redundancy as a possible command signal for movement augmentation. [ABSTRACT FROM AUTHOR]

Background: The accuracy of decoding fine motor imagery (MI) tasks remains relatively low due to the dense distribution of active areas in the cerebral cortex. Methods: To enhance the decoding of unilateral fine MI activity in the brain, a weight-optimized EEGNet model is introduced that recognizes six types of MI for the right upper limb, namely elbow flexion/extension, wrist pronation/supination and hand opening/grasping. The model is trained with augmented electroencephalography (EEG) data to learn deep features for MI classification. To address the sensitivity issue of the initial model weights to classification performance, a genetic algorithm (GA) is employed to determine the convolution kernel parameters for each layer of the EEGNet network, followed by optimization of the network weights through backpropagation. Results: The algorithm's performance on the three joint classification is validated through experiment, achieving an average accuracy of 87.97%. The binary classification recognition rates for elbow joint, wrist joint, and hand joint are respectively 93.92%, 90.2%, and 94.64%. Thus, the product of the two-step accuracy value is obtained as the overall capability to distinguish the six types of MI, reaching an average accuracy of 81.74%. Compared to commonly used neural networks and traditional algorithms, the proposed method outperforms and significantly reduces the average error of different subjects. Conclusions: Overall, this algorithm effectively addresses the sensitivity of network parameters to initial weights, enhances algorithm robustness and improves the overall performance of MI task classification. Moreover, the method is applicable to other EEG classification tasks; for example, emotion and object recognition. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the clinical effect of an intra-articular and local infiltration injection of a compound analgesic mixture of ropivacaine and compound betamethasone on the repair of the triangular fibrocartilage complex under wrist arthroscopy. This prospective, double-blind, randomized study involved 20 patients with Atzei type 2 or 3 injuries of the triangular fibrocartilage complex who underwent repair under wrist arthroscopy. Patients were divided into two groups (n = 10) according to the systematic random sampling method. The test group was injected with a "cocktail" mixture for pain relief. The control group was injected with normal saline. The visual analog scale (VAS) pain score, pinch force, wrist joint mobility, wrist joint function score (PRWE score), occurrence of adverse reactions and dosage of analgesic drugs were evaluated before and after the operation in the two groups. The resting pain of the patients in the test group was less severe than that of the control group at 12 h, 24 h and 48 h after the operation (P < 0.05), and the pinch force of the patients in the test group was significantly greater than that of the control group at 1 d, 2 d and 3 d after the operation (P < 0.01). The amount of postoperative analgesics used in the test group was significantly lower than that in the control group (P < 0.01), and the patient satisfaction rate in the test group was higher than that in the control group (P < 0.05). There were no postoperative adverse effects in either group. An intra-articular and local infiltration injection of a "cocktail" analgesic mixture in the repair of triangular fibrocartilage complex under wrist arthroscopy can provide good pain control in the early postoperative period and reduce the amount of postoperative analgesic drugs administered, thus improving clinical safety. Level II; Randomized Controlled Trial; Treatment Study. [ABSTRACT FROM AUTHOR]

Background: Triangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist. Methods: In this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery. Results: The cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%. Conclusion: Arthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries. [ABSTRACT FROM AUTHOR]

Giant cell tumor of bone (GCTB) represents an intermediate, locally aggressive tumor, with a peak of incidence in the third decade of life with female predominance (2:1). The distal radius is the third most common localization and especially challenging in the treatment is saving the wrist joint function. In this report, we present a case of a 32-year-old patient diagnosed with a giant cell tumor of the distal radius, primarily treated with curettage of the bone. Due to aggressive tumor recurrence, considering local control of the tumor, we decided to perform a resection of the distal radius and reconstruction with an autologous proximal vascular fibular graft. We performed a SPECT/CT scan to confirm the functionality of the graft. We find this procedure a safe technique for local control of tumor recurrence and an ideal substitute for a limb salvage procedure. [ABSTRACT FROM AUTHOR]

Background: ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°‐unrestricted movement of the wrist joint, as in robotic surgery. Objective: The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. Methods: A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. Results: The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. Conclusions: Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy. Synopsis: Myomectomy as performed with an ArtiSential instrument enabling free, 360°‐unrestricted movement of the wrist joint seems to be feasible and safe. [ABSTRACT FROM AUTHOR]

Background: Factors such as age and joint structure affect normal wrist motion. The midcarpal joint participates in flexion/extension, radial-ulnar/deviation (RUD), and since lunate/wrist type-2 is likely more stable than a lunate/wrist type-1, we suggest that midcarpal joint structure will affect wrist motion. Our purpose was to compare wrist motion in Caucasian and Japanese populations and to associate motion with midcarpal joint morphology. We hypothesised that radiographic structure would correlate with wrist motion. Methods: A total of 164 patients with normal wrist radiographs were included. Clinical measurements included wrist extension, flexion and RUD. Radiographic measurements included the radiocarpal joint: ulnar variance, radial height, radial inclination, volar inclination and carpal joint measurements: lunate type, capitate circumference and each of its joints contact measured and calculated as a proportion of capitate circumference. Results: The groups differed in wrist motion and in multiple radiographic measurements. When the two populations were analysed together, there were no significant associations between midcarpal joint type and wrist motion. The radiocarpal joint: ulnar variance was correlated with extension and radial deviation. Radial height was directly related to flexion, and both radial height and radial inclination were directly correlated with ulnar deviation. The intracarpal measurements: The main measurement affecting motion was the contact between the capitate and the scaphoid (as a proportion of capitate circumference) with lesser correlations of the contact of the capitate with the trapezoid and hamate. The most significant measurement associated with a lunate type-2 was scaphoid contact with the capitate p = 0.01. Logistic regression demonstrated that the measurements most associated with wrist motion were scaphoid contact with the capitate/capitate circumference and hamate contact with the capitate/capitate. Conclusions: This study supports discrepancies in wrist motion amongst different racial cohorts, and a relationship between bone/joint structure in the wrist and wrist motion. This can help treat wrist pathology. Level of Evidence: Level III (Diagnostic) [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the features of the clinical picture of the disease in patients with ACPA–negative and ACPA-positive variants of rheumatoid arthritis. Materials and methods. : The study included patients with a reliable diagnosis of rheumatoid arthritis (RA) according to the criteria of ACR/EULAR 2010. Depending on the ACPA values, two groups of patients were recruited: ACPA-positive and ACPA-negative, comparable in gender, age, duration of the disease, and therapy. The nature of the onset and course of the disease and the activity of RA were evaluated (according to the DAS28, SDAI, CDAI indices). Results and discussion. : The study involved 79 patients with ACPA-negative variant of RA and 79 ACPA-positive patients. The age of patients (Me [IR] (in years)) with the ACPA(–) variant was 52 [39; 62]; with the ACPA(+) variant, 54 [42; 62]; the duration of the disease (in months) was 59 [23; 122] and 48 [17; 84], respectively. In ACPA(+) patients, a higher disease activity was determined (by the indices DAS 28crp, DAS28esr, SDAI, CDAI), higher values of C-reactive protein and erythrocyte sedimentation rate, and a greater number of painful and swollen joints (p < 0.05). According to the localization of the involved joints, arthritis of the proximal interphalangeal, metacarpal, wrist and shoulder joints was more often determined in ACPA(+) patients. Systemic manifestations of RA at the time of examination and in the anamnesis were statistically significantly more common in ACPA(+) (32.9%) than in ACPA(–) (17.7%) patients. Of the systemic manifestations, rheumatoid nodules were more common in ACPA(+) patients, whereas a tendency to a higher frequency of neuropathy, sclerites, and episcleritis was revealed in ACPA(–) patients. Conclusions:. In patients with ACPA(–) subtype, clinical signs of joint damage and the inflammatory component are less pronounced compared to ACPA(+). However, the mixed picture of manifestation, the less "bright" course of the disease, the absence of characteristic immunological biomarkers necessitate long-term and careful monitoring of this group of patients. At the same time, the subjective severity of the disease and dysfunction due to ankylosing joints do not differ from the ACPA(+) variant of RA. [ABSTRACT FROM AUTHOR]

Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position. [ABSTRACT FROM AUTHOR]

Background: The Sauvé–Kapandji (S-K) method is a surgical procedure performed for chronic deformities of the distal radial ulnar joint (DRUJ). Changes to the joint contact surface from pre- to postoperatively under physiological in vivo conditions have not yet been determined for this useful treatment. The aim of the present study was therefore to compare the articular contact area of the wrist joint between before and after the S-K method for DRUJ disorders. Methods: The SK method was performed for 15 patients with DRUJ osteoarthritis and ulnar impaction syndrome. We calculated the Mayo Wrist Score as the patient's clinical findings and created 3-dimensional bone models of cases in which the S-K method was performed and calculated the contact area and shift in the center of the contact area using customized software. Results: The Mean modified Mayo Wrist Score improved significantly from 60.3 preoperatively to 80.3 postoperatively (P < 0.01). Scaphoid contact area to the radius increased significantly from 112.6 ± 37.0 mm2 preoperatively to 127.5 ± 27.8 mm2 postoperatively (P = 0.03). Lunate contact area to radius-ulna was 121.3 ± 43.3 mm2 preoperatively and 112.5 ± 37.6 mm2 postoperatively, but this decrease was not significant (P = 0.38). Contact area ratio of scaphoid to lunate increased significantly from 1.01 ± 0.4 preoperatively to 1.20 ± 0.3 postoperatively (P = 0.02). Postoperative translations of the center of the scaphoid and lunate contact areas were decomposed into ulnar and proximal directions. Ulnar and proximal translation distances of the scaphoid contact area were 0.8 ± 1.7 mm and 0.4 ± 0.6 mm, respectively, and those of the lunate contact area were 1.1 ± 1.7 mm and 0.4 ± 1.1 mm, respectively. This study revealed changes in wrist contact area and center of the contact area before and after the S-K method. Conclusion: These results may accurately indicate changes in wrist joint contact area from pre- to postoperatively using the S-K method for patients with DRUJ disorder. Evaluation of changes in contact area due to bone surface modeling of the wrist joint using 3DCT images may be useful in considering surgical methods. [ABSTRACT FROM AUTHOR]

Introduction: The wrist joint is a complex anatomical structure, and various radiographic parameters are utilized to assess its normal alignment and orientation. Among these parameters are carpal height ratio (CHR) and ulnar variance (UV). Previous literature has indicated that factors such as age and gender may influence these parameters; However, there is a lack of studies investigating these differences specifically in the Middle East or Jordan. Additionally, no prior research has explored the relationship between UV and CHR. Therefore, the objective of this study is to investigate these critical radiological parameters and their associations. Methodology: A cross-sectional study design was employed, wherein a total of 385 normal wrist X-rays were reviewed, and CHR and UV were measured. Intra-observer and inter-observer reliability assessments were conducted to ensure the consistency and accuracy of measurements. Additionally, the association between UV and CHR was measured and plotted for further analysis. Results: In our study, the mean CHR was 0.5 (range: 0.4 to 1.5), and the mean UV was − 0.3 mm (range: -5.8 mm to 4.1 mm). We found a significant negative correlation between CHR and age (p < 0.05). No significant gender differences were observed in UV and CHR. Additionally, a weak positive correlation was found between UV and CHR (Pearson correlation coefficient = 0.13, p = 0.01; adjusted R2 = 0.014, p = 0.02). Conclusion: Age correlated significantly with a decline in carpal height ratio. Additionally, ulnar variance had a week positive yet significant correlation with carpal height ratio. Level of evidence: Cross-sectional study, Level III. [ABSTRACT FROM AUTHOR]

The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. Purpose: The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. Patients and methods: In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. Results: The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. Conclusion: In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Level of evidence IV: Retrospective case series study. [ABSTRACT FROM AUTHOR]

This article presents a case study on the treatment of a complete extensor tendon rupture in a patient with rheumatoid arthritis. The patient, a 73-year-old woman, experienced a rupture of all extensor tendons in her fingers. The authors performed a surgical procedure involving tendon transfer and tenodesis to restore finger extension. The patient showed positive results in finger range of motion after six months. This case study suggests that this treatment option may be suitable for patients with complete extensor rupture and thumb joint deformity, as long as wrist range of motion is normal. [Extracted from the article]

Background: To evaluate radiological and functional outcome of malunited distal radial fractures treated with iliac crest bone graft and Volar plating with or without K- wires. Materials and Methods: This is a prospective study conducted on twenty adult patients with distal radial fractures treated at Department of Orthopaedics, Rangaraya Medical College, Kakinada between September 2021 to August 2023. Results: The study included twenty cases of malunited distal radius fractures in adults treated with osteotomy, ipsilateral tri cortical iliac crest bone grafting, and volar Ellis plating over a 12- to 18-month period. Right side (dominant wrist) was involved in 12 (60%) patients and the left side involved in 8(40%) patients. In the present study 13 (65%) patients had union within 2-3 months and 7(35%) patients had union in 3-4monthsThere were no cases of delayed union or non –union. Mean preop DASH score – Mean postop DASH score>25 Excellent Mean preop DASH score–Mean postop DASH score16-25 good Mean preop DASH score–Mean postop DASH score 6-15 fair Mean preop DASH score–Mean postop DASH score≤5 poor. Osteotomy, ipsilateraliliac crest bone grafting and volar Ellis plating demonstrates good reproducible outcomes with minimal risk in appropriately selected cases of Malunion. This technique can provide adequate restoration of normal anatomy and soft tissue and vascular preservation, in addition to minimal patient morbidity, which may facilitatea more rapid return to function. Conclusion: We can conclude that osteotomy, tricortical iliac crest bone grafting, and volar Ellis plating are a simple, reliable, and effective method for restoring normal distal radius radiological parameters, particularly in young adults. Functional end results have a direct relationship with anatomical end results, especially in young adults, though good functional results can be obtained even when anatomical results are poor in elderly people due to innate mobility of the wrist joint. [ABSTRACT FROM AUTHOR]

Radial nerve palsies present a challenging clinical scenario, often leading to substantial functional impairment. This study focuses on evaluating the outcomes of tendon transfer surgeries in patients with post-traumatic radial nerve injuries. The radial nerve, vital for upper limb movements, faces various etiologies, such as trauma, compression, or idiopathy. Patients with radial nerve palsy encounter difficulties in daily activities, emphasizing the need for effective management strategies. The research introduces a novel evaluation protocol, aiming to comprehensively assess tendon transfer outcomes. This protocol incorporates functional movements of wrist and finger joints, encompassing both objective and subjective parameters. The retrospective study includes eleven patients treated between 2010 and 2022, with a minimum follow-up of one year post-surgery. Tendon transfers demonstrated positive results. The evaluation protocol covers a wide range of parameters, including wrist and finger mobility, thumb function, grip strength, and patient satisfaction. The results indicate successful restoration of motor function, with an average grip strength of 70% compared to the healthy arm. The proposed evaluation protocol facilitates standardized and reproducible assessment, minimizing subjective errors in clinical evaluations. Despite the study's limitations, such as a relatively small sample size, the findings underscore the effectiveness of tendon transfers in treating radial nerve palsies. The introduced evaluation scheme provides a comprehensive and reproducible approach to assess outcomes, contributing to the global standardization of tendon transfer assessments in radial nerve injuries. [ABSTRACT FROM AUTHOR]

Intra-articular lipomas are infrequently reported, with most reported cases occurring in the knee joint. A case of intra-articular lipoma in the small joints of the hand, specifically in the pisotriquetral joint, has been documented for the first time. A 24-year-old male visited the emergency department after a road traffic accident with a painful and swollen wrist. Radiographic examination revealed fractures of the distal radius and triquetrum. A subsequent wrist computed tomography scan identified an intra-articular lipoma within the pisotriquetral joint, further confirmed by ultrasonography. This article underscores the importance of recognizing that, though exceedingly rare, intra-articular lipomas should be considered in the differential diagnosis of soft-tissue tumors affecting the hand and wrist. [ABSTRACT FROM AUTHOR]

This article addresses products from leading foreign manufacturers of upper limb prostheses with bioelectric control. These were analyzed and compared in terms of the following parameters: method of control, numbers of degrees of freedom and microdrives, method of adduction and abduction of the thumb, type of the wrist joint, use of feedback, and number and types of grip. The study results identified common key parameters characteristic of devices in demand in the current prosthetics and orthopedic equipment market. [ABSTRACT FROM AUTHOR]

Background and Objectives: Non-specific chronic wrist pain is wrist pain that occurs without a specific cause, such as trauma, and may limit the range of motion of the joints of the wrist and hand, affecting muscle strength, grip strength, and function. This study aimed to determine the effects of grip-strengthening exercises combined with wrist stability training on pain and function in patients with non-specific chronic wrist pain. Materials and Methods: The subjects of the study were 31 patients with wrist pain. To determine the effect of grip-strengthening exercises combined with wrist stability training, 15 participants participated in grip-strengthening exercises combined with wrist stability training and 16 control subjects participated. The experimental group participated in wrist-stability training. Grip-strengthening exercises combined with wrist stability training were performed for 20 min/day twice a week for 4 weeks, and relaxation massage and conservative physical therapy were performed for 20 min/day twice a week for 4 weeks. The control group received relaxation massage and conservative physical therapy for 40 min/day twice a week for 4 weeks. A visual pain scale was used to evaluate the degree of pain before and after treatment, and a patient-rated wrist evaluation was used to evaluate wrist function. Results: The results showed that the visual score significantly decreased in the time effect before and after the intervention in both groups (p < 0.001), patient-rated wrist evaluation significantly decreased (p < 0.001), and grip strength and muscle strength significantly increased (p < 0.001). The results of this study showed that grip-strengthening exercises combined with wrist stability training were effective in improving pain, function, grip strength, and muscle strength in patients with non-specific chronic wrist pain. Conclusions: Grip-strengthening exercises combined with wrist stability training can be used as an effective intervention method to improve pain, function, grip strength, and muscle strength, emphasizing the need for wrist exercise interventions in patients with non-specific chronic wrist pain in the future. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Magnetic resonance imaging (MRI) using 1.5T or 3.0T systems is routinely employed for assessing wrist pathology; however, due to off-resonance artifacts and high power deposition, these high-field systems have drawbacks for real-time (RT) imaging of the moving wrist. Recently, high-performance 0.55T MRI systems have become available. In this proof-of-concept study, we tested the hypothesis that RT-MRI during continuous, active, and uninterrupted wrist motion is feasible with a high-performance 0.55T system at temporal resolutions below 100 ms and that the resulting images provide visualization of tissues commonly interrogated for assessing dynamic wrist instability. METHODS: Participants were scanned during uninterrupted wrist radial-ulnar deviation and clenched fist maneuvers. Resulting images (nominal temporal resolution of 12.7-164.6 ms per image) were assessed for image quality. Feasibility of static MRI to supplement RT-MRI acquisition was also tested. RESULTS: The RT images with temporal resolutions < 100 ms demonstrated low distortion and image artifacts, and higher reader assessment scores. Static MRI scans showed the ability to assess anatomical structures of interest in the wrist. CONCLUSION: RT-MRI of the wrist at a high temporal resolution, coupled with static MRI, is feasible with a high-performance 0.55T system, and may enable improved assessment of wrist dynamic dysfunction and instability. ADVANCES IN KNOWLEDGE: Real-time MRI of the moving wrist is feasible with high-performance 0.55T and may improve the evaluation of dynamic dysfunction of the wrist.

Abstract Introduction The wrist joint is a complex anatomical structure, and various radiographic parameters are utilized to assess its normal alignment and orientation. Among these parameters are carpal height ratio (CHR) and ulnar variance (UV). Previous literature has indicated that factors such as age and gender may influence these parameters; However, there is a lack of studies investigating these differences specifically in the Middle East or Jordan. Additionally, no prior research has explored the relationship between UV and CHR. Therefore, the objective of this study is to investigate these critical radiological parameters and their associations. Methodology A cross-sectional study design was employed, wherein a total of 385 normal wrist X-rays were reviewed, and CHR and UV were measured. Intra-observer and inter-observer reliability assessments were conducted to ensure the consistency and accuracy of measurements. Additionally, the association between UV and CHR was measured and plotted for further analysis. Results In our study, the mean CHR was 0.5 (range: 0.4 to 1.5), and the mean UV was − 0.3 mm (range: -5.8 mm to 4.1 mm). We found a significant negative correlation between CHR and age (p

Purpose: The accuracy of heart rate measured with a wrist photoplethysmography monitor can be influenced by the tightening of the wristband, movement of arms, or kinetics of the signal (eg, steady-state exercise vs on- and off-transients). To test these hypotheses, photoplethysmographic and electrocardiographic (ECG) signals were compared. Methods: Thirty participants (50% female) randomly performed two 13′ sequences (3′ rest, 5′ submaximal-intensity exercise, and 5′ passive recovery) on a motorized treadmill and a bicycle ergometer. Heart rate was measured concomitantly with a 10-lead ECG, a chest-strap monitor, and 2 wrist photoplethysmography monitors (Polar Unite) with different tightening (free vs imposed at the maximum tolerable). Results: The level of association (r) and coefficient of variation (CV; ie, the error of measurement) of the Polar Unite versus the 10-lead ECG is affected by the tightness of the wristband (normal vs high; r =.83 and.96, CV = 16.1 and 8.1% for the treadmill, respectively; r =.71 and.97, CV = 20.3% and 6.2% for the bicycle, respectively) by the phase of the signal (transition vs steady state; r =.90 and.97, CV = 9.0% and 7.6% for the treadmill, respectively; r =.93 and.99, CV = 7.5% and 3.1% for the bicycle, respectively) and movement of arms (treadmill vs bicycle; r =.90 and.93, CV = 9.0% and 7.5% during the transition phase, respectively; r =.97 and.99, CV = 7.6% and 3.1% during the steady-state phase, respectively). Conclusion: The accuracy of heart rate measured with a wrist photoplethysmography monitor is affected by the tightness of the wristband and the phase of the signal. A high tightening is required when high accuracy is expected. [ABSTRACT FROM AUTHOR]

Background: Joint access is essential for arthrocentesis, or joint aspiration of fluids. Joint treatments that are not performed properly can result in avoidable patient issues such as damage to the muscles, tendons, and blood vessels surrounding the joint. The use of ultrasound has become the gold standard for this procedure and proven to be a support in the skill learning process. However, success with this equipment, particularly in small joints like the wrist, depends on a clinician's capacity to recognize the crucial landmarks that guide these procedures. Prior to executing on a real patient, task trainers have proven to be an effective way for doctors to practice and prepare for procedures. However, shortcomings of current solutions include high purchase costs, incompatibility with ultrasound imaging, and low reusability. In addition, since this is a procedure that is not performed frequently, there may not be space or resources available in healthcare facilities to accommodate one at the point of care. This study aimed to close the existing gap by developing a DIY ultrasound compatible task trainer for wrist joint access training. Results: We developed a novel ultrasound compatible wrist joint model that can be made from sustainable materials and reusable parts, thus reducing the costs for acquisition and environmental impact. Our model, which was produced utilizing small-batch production methods, is made up of 3D-printed bones enclosed in an ultrasound-compatible gelatin mixture. It can be easily remade after each practice session, removing needle tracks that are visible under ultrasound for conventional phantoms. The ultrasonic properties of this model were tested through pixel brightness analysis and visual inspection of simulated anatomical structures. Conclusion: Our results report the advantages and limitations of the proposed model regarding production, practice, and ultrasound compatibility. While future work entails the transfer to patients of the same skill, this reusable and replicable model has proven, when presented to experts, to be successful in representing the physical characteristics and ultrasound profile of significant anatomical structures. This novel DIY product could be an effective alternative to teach procedures in the context of resource-restrained clinical simulation centers. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. Methods: A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) –score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. Results: Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. Conclusion: Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist. [ABSTRACT FROM AUTHOR]

Rubber band constriction syndrome has been described in the literature, although there are very few case reports. Non-healing recurrent tenosynovitis and synovitis of the wrist joint demonstrating a circular rubber band on imaging has not been described before. Imaging studies showed retained circular band deep to the extensor tendons, embedded within the joint capsule. Surgical removal of the band by open incision led to a dramatic improvement in the outcome of the patient. Level of evidence V. [ABSTRACT FROM AUTHOR]

Purpose: Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II–III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint. Materials and Methods: Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius. Results: A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain. No statistically significant differences were observed between 3 and 4CF in all parameters compared. Conclusions: The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome. Level of Evidence: Level III, Retrospective comparative study. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate if a difference in synovial amikacin concentrations exists in the radiocarpal joint (RCJ) following different durations of instillation of an IV regional limb perfusion (IVRLP) perfusate. ANIMALS 7 healthy horses. METHODS Horses received 2 IVRLPs with 2 g amikacin diluted to 60 mL with 0.9% NaCl via the cephalic vein in a crossover study design with a wash-out period between procedures. Instillation of the perfusate was administered over a 1-minute (technique 1) and 5-minute (technique 5) period. Concentrations of amikacin within the RCJ were measured at time (T) 5, 10, 15, 20, 25, and 30 minutes after instillation of the perfusate. Systemic concentrations of amikacin were measured at T0, 5, 10, 15, 20, 25, 29 minutes, and 1 minute after tourniquet removal (T31). Amikacin concentrations were determined by fluorescence polarization immunoassay. RESULTS The median maximum concentration (CMAX) of amikacin within the RCJ for technique 1 was 338.4 µg/mL (range, 60 to 4,925 µg/mL), while the median CMAX for technique 5 was higher at 694.8 µg/mL (range, 169.2 to 3,410 µg/mL; P = .398). There was a higher amikacin blood concentration over time for technique 1 compared to technique 5 (P = .004). CLINICAL RELEVANCE Administration of perfusate at different rates did not significantly affect synovial concentration of amikacin within the RCJ when performing IVRLP. However, increased systemic leakage was noted when the perfusate was administered over 1 minute, which might affect synovial concentrations in a larger group of horses. [ABSTRACT FROM AUTHOR]

Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by a deficiency of glycosaminoglycan (GAG) catalytic enzymes, resulting in an accumulation of unprocessed or partly degraded GAGs in different tissues, including bones and joints. Notably, skeletal and joint abnormalities may be the first complaint that prompts patients to seek medical attention, especially in the milder forms of the disease. To our knowledge, there are no prior imaging reports that have documented capsuloligamentous thickening in patients with MPS on MRI. In this study, we present four cases of patients with clinically and genetically confirmed diagnosis of type II MPS, encompassing seven MRI examination of different joints, including cervical spine, hip, wrist, knee, and shoulder. All of the patients were male, aged between 14 and 35 years, and exhibited varying degrees of joint stiffness in the clinical examination and carpal tunnel syndrome in cases of the wrist joint was affected. None of the patients had a history of surgical procedures on the affected joint, other metabolic or deposit diseases, or sports activity practice. The MRI revealed significant capsuloligamentous and retinaculum thickening, up to eight times greater than the normal capsular thickness reported in the literature. [ABSTRACT FROM AUTHOR]

Introduction: The scapholunate interosseous ligament is pivotal for wrist stability, and its impairment can result in instability and joint degeneration. This study explores the application of real-time MRI for dynamic assessment of the scapholunate joint during wrist motion with the objective of determining its diagnostic value in efficacy in contrast to static imaging modalities. Materials and Methods: Ten healthy participants underwent real-time MRI scans during wrist ab/adduction and fist-clenching maneuvers. Measurements were obtained at proximal, medial, and distal landmarks on both dynamic and static images with statistical analyses conducted to evaluate the reliability of measurements at each landmark and the concordance between dynamic measurements and established static images. Additionally, inter- and intraobserver variabilities were evaluated. Results: Measurements of the medial landmarks demonstrated the closest agreement with static images and exhibited the least scatter. Distal landmark measurements showed a similar level of agreement but with increased scatter. Proximal landmark measurements displayed substantial deviation, which was accompanied by an even greater degree of scatter. Although no significant differences were observed between the ab/adduction and fist-clenching maneuvers, both inter- and intraobserver variabilities were significant across all measurements. Conclusions: This study highlights the potential of real-time MRI in the dynamic assessment of the scapholunate joint particularly at the medial landmark. Despite promising results, challenges such as measurement variability need to be addressed. Standardization and integration with advanced image processing methods could significantly enhance the accuracy and reliability of real-time MRI, paving the way for its clinical implementation in dynamic wrist imaging studies. [ABSTRACT FROM AUTHOR]

This paper focuses on the online control of a class of nonlinear dynamical systems, specifically robotic manipulators. Solutions utilizing Proportional–Integral–Derivative (PID) control schemes are employed to control the joints of robotic manipulators. However, the existing control strategies utilize fixed gains, which do not fully account for the inherent nonlinearity of the dynamical structure or the dynamics of reference-tracking error. Additionally, the individual joint's dynamic performance is optimized independently from the performance of other joints. This work introduces an adaptive integral Reinforcement Learning algorithm to control a four-DoF robotic arm in real time. This is done using a model-free Value Iteration process implemented in a continuous-time mode. The solution does not assume any knowledge of the dynamics of the robot arm and does not require any initial admissible control strategy to proceed with the adaptive learning solution. The self-learning algorithm provides adaptable strategies to control the turntable, forearm, bicep, and wrist joints of the robotic arm. The performance of the adaptive learning solution is compared with those of Proportional–Integral–Derivative and high-order model-free adaptive control schemes to highlight its effectiveness. [ABSTRACT FROM AUTHOR]

Training costs for operators of robotic arms in forestry and construction are high. A systematic analysis of skill development can help to make training more efficient. This research focuses on motor skill development by investigating the bimanual control of a four-DoF robotic arm. The two-time scale power law of learning was used to identify difficulties in control learning. Ten participants acquired the control of the robotic arm in a simulator over ten sessions within seven weeks. Eight movement targets were presented in each of six blocks per session, comprising 432 robotic arm movements. The results suggest that learning varies for each joystick axis, with control of the elbow joint showing the highest learning gain. The base and shoulder joints showed similar learning gains. The wrist joint showed mixed results in terms of use or disuse. Performance increased with retention, suggesting that a longer period of consolidation aided skill acquisition. Practitioner summary: A shortage of skilled operators, costly, and extensive training of heavy machine operators in robotic arm control requires to revisit control skill learning. This study showed that focus of training ought to be shifted to specific joints and training requires to emphasise longer resting periods between training sessions. [ABSTRACT FROM AUTHOR]

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Carpal boss is a bony protrusion on the dorsal aspect of wrist quadrangular joint. The exact cause and prevalence are not well understood. Most of the patients are asymptomatic, although some experience pain, bony prominence, restricted mobility, and joint instability in sever neglected cases. We are presenting a case of a 24-year-old male had chronic dorsal wrist pain with bony prominence appearance underwent surgical excision of a carpal boss lesion in concomitant with soft tissue ganglion cyst over the carpal boss after failed conservative management, resulting in significant symptom improvement and restored range of motion. Carpal boss lesion is a common condition that can be undiagnosed due to asymptomatic presentation or the presence of overlying soft tissue pathology as ganglion cyst. Although conservative treatment is helpful in some patients, most symptomatic carpal boss lesion patients eventually need surgical excision. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Giant cell tumor of bone (GCT) is a rare neoplasm which often presents as a lytic lesion in the epiphyseal region of long bones and which are usually accompanied by pain, swelling, and restricted movement. Giant cell tumor of bone (GCT) is a rare neoplasm that affects individuals in their third and fourth decades of life. Clinically, it often presents as a lytic lesion in the epiphyseal region of bones, notably the distal femur and proximal tibia. Radiologically, GCT appears as a distinct lytic lesion in the epiphyseal region. Histopathologically, GCTs are composed of mononuclear cells, macrophages, and multinuclear giant cells, indicative of osteoclastogenic stromal tumors. A 37‐year‐old man presented with left wrist pain, swelling, and restricted movement persisting for a year, worsening over the last 7 months. Radiographic assessments revealed a distal radius bone mass involving the radiocarpal joint. Biopsy confirmed a GCT with extension into peripheral muscle. PET/CT scan showed localized pathology without metastasis. Histopathologically, GCT exhibited multinucleated giant cells, spindle cells, and aneurysmal bone cyst‐like regions with coagulation necrosis. Surgical resection involved en‐bloc removal and reconstruction with a non‐vascularized radius bone graft. Postoperatively, the patient showed no complications at the one‐year follow‐up, suggesting successful intervention. [ABSTRACT FROM AUTHOR]

This article examines the radiological changes in the hands and feet of leprosy patients with disabilities and deformities. The study, conducted in India, involved 50 leprosy patients and found that non-specific bone changes were more common than specific ones. These changes were more prevalent in females and were associated with lepromatous leprosy. The study emphasizes the importance of comprehensive diagnostic evaluations in managing leprosy and contributes to our understanding of its radiological manifestations. [Extracted from the article]

Impaired upper limb movements are a key feature in dyskinetic cerebral palsy (CP). However, information on how specific movement patterns relate to manual ability, performance and underlying movement disorders is lacking. Insight in these associations may contribute to targeted upper limb management in dyskinetic CP. This study aimed to explore associations between deviant upper limb movement patterns and (1) manual ability, (2) severity of dystonia/choreoathetosis, and (3) movement time/trajectory deviation during reaching and grasping. Participants underwent three-dimensional upper limb analysis during reaching forwards (RF), reaching sideways (RS) and reach-and-grasp vertical (RGV) as well as clinical assessment. Canonical correlation and regression analysis with statistical parametric mapping were used to explore associations between clinical/performance parameters and movement patterns (mean and variability). Thirty individuals with dyskinetic CP participated (mean age 16±5 y; 20 girls). Lower manual ability was related to higher variability in wrist flexion/extension during RF and RS early in the reaching cycle (p < 0.05). Higher dystonia severity was associated with higher mean wrist flexion (40–82 % of the reaching cycle; p = 0.004) and higher variability in wrist flexion/extension (31–75 %; p < 0.001) and deviation (2–14 %; p = 0.007/60–73 %; p = 0.006) during RF. Choreoathetosis severity was associated with higher elbow pro/supination variability (12–19 %; p = 0.009) during RGV. Trajectory deviation was associated with wrist and elbow movement variability (p < 0.05). Current novel analysis of upper limb movement patterns and respective timings allows to detect joint angles and periods in the movement cycle wherein associations with clinical parameters occur. These associations are not present at each joint level, nor during the full movement cycle. This knowledge should be considered for individualized treatment strategies. • Statistical parametric mapping provides insight in the relation of kinematics and clinical parameters. • Higher movement variability around the wrist joint was associated with lower manual ability. • Higher dystonia severity related to higher wrist flexion in the second part of the reaching cycle. • Higher choreoathetosis severity related to higher movement variability at the elbow. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Various conditions, including traffic accidents, sports injuries, and neurological disorders, can impair human wrist movements, underscoring the importance of effective rehabilitation methods. Robotic devices play a crucial role in this regard, particularly in wrist rehabilitation, given the complexity of the human wrist joint, which encompasses three degrees of freedom: flexion/extension, pronation/supination, and radial/ulnar deviation. This paper provides a comprehensive review of wrist rehabilitation devices, employing a methodological approach based on primary articles sourced from PubMed, ScienceDirect, Scopus, and IEEE, using the keywords "wrist rehabilitation robot" from 2007 onwards. The findings highlight a diverse array of wrist rehabilitation devices, systematically organized in a tabular format for enhanced comprehension. Serving as a valuable resource for researchers, this paper enables comparative analyses of robotic wrist rehabilitation devices across various attributes, offering insights into future advancements. Particularly noteworthy is the integration of serious games with simplified wrist rehabilitation devices, signaling a promising avenue for enhancing rehabilitation outcomes. These insights lay the groundwork for the development of new robotic wrist rehabilitation devices or to make improvements to existing prototypes incorporating a forward-looking approach to improve rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Upper limb functionality is essential to perform activities of daily living. It is critical to investigate neurorehabilitation therapies in order to improve upper limb functionality in post-stroke patients. This paper presents a soft-robotic bilateral system to provide rehabilitation therapy for hand and wrist joints. A sensorized glove that tracks finger and wrist joint movements is worn on the healthy limb, which guides the movement of the paretic limb. The input of sensors from the healthy limb is provided to the soft robotic exoskeleton attached to the paretic limb to mimic the motion. A proportional derivative flow-based control algorithm is used to perform bilateral therapy. To test the feasibility of the developed system, two different applications are performed experimentally: (1) Wrist exercise with a dumbbell, and (2) Object pick-and-place task. The initial tests of the developed system verified its capability to perform bilateral therapy. [ABSTRACT FROM AUTHOR]

Scapholunate complex injuries are the most frequent lesions associated with distal radius fractures and the treatment algorithm according to the stage of the instability remains controversial. However, there is an admitted consensus around the necessary treatment of the associated high-grade instabilities. They occur frequently in young patients after high energy trauma, and not treated, they can lead to chronic wrist pain and eventually to scapholunate advanced collapse. The routine use of the arthroscopy provides an accurate intraoperative staging of the lesions and allows a tailored treatment depending on the severity of the scapholunate instability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Scaphoid fractures are common wrist fractures. The percutaneous screw is used to treat scaphoid fractures. The closed reduction of the fracture site, the precise placement of the hollow compression screw in the scaphoid axis and the compression fixation of the fracture site can promote fracture healing and achieve the better function of the wrist. OBJECTIVE: To evaluate the efficacy of percutaneous hollow compression screw fixation of scaphoid fractures using a novel Kirschner wire guide. METHODS: Between January 2015 and December 2020, clinical data from 15 patients with scaphoid fractures selected at the Department of Hand Surgery, Third Hospital of Hebei Medical University were retrospectively analyzed. All patients underwent percutaneous hollow compression screw fixation by a novel Kirschner wire guide. Fracture healing time, operation time, number of intraoperative fluoroscopies, time to return to work and complications were collected. According to the modified Mayo wrist scoring system, the functional outcomes of wrists were assessed 12 months after surgery. Wrist flexion, extension, ulnar deviation, radial deviation and grip strength were measured. RESULTS AND CONCLUSION: All patients were followed up for 12 months. The compression screw was located in the axial position of the scaphoid by routine immediate postoperative radiographs. All scaphoid fractures united at an average of 10.0 weeks. The average operation time was 55.7 minutes. The number of intraoperative fluoroscopies was 10.9. The average time to return to work was 10.3 weeks. The results of wrist joint function were excellent in 9 cases, good in 5 cases, and average in 1 case, with an excellent and good rate of 93.3%. No significant differences in wrist flexion, extension, ulnar deviation, radial deviation and grip strength were found between the affected and healthy sides (P > 0.05). None of the patients had wound infection, malunion, screw displacement, or screw breakage. These findings indicate that the application of a novel guide can shorten the operation time, reduce the number of intraoperative fluoroscopies, improve the accuracy of screw insertion, and shorten the time to return to work. The function of the wrist was satisfactory after the operation. The novel Kirschner wire guide made percutaneous hollow compression screw fixation easier for scaphoid fractures. [ABSTRACT FROM AUTHOR]

The wing is one of the most important parts of a bird's locomotor system and is the inspiration origination for bionic wing design. During wing motions, the wing shape is closely related to the rotation angles of wing bones. Therefore, the research on the law of bone movement in the process of wing movement can be good guidance for the design of the bionic morphing wing. In this paper, the skeletal posture of the peregrine falcon wing during the extension/flexion is studied to obtain critical data on skeletal posture. Since an elbow joint and a wrist joint rotate correlatively to drive a wing to flex/extend, the wing skeleton is simplified as a four-bar mechanism in this paper. The degree of reproduction of wing skeleton postures was quantitatively analyzed using the four-bar mechanism model, and the bionic wing skeleton was designed. It is found that the wing motions have been reproduced with high precision. [ABSTRACT FROM AUTHOR]

The aim was to compare the differences in kinematics of elbow and wrist and shock transmission of the upper extremity in wheelchair tennis players and able-bodied players (in standing and sitting position) during backhand strokes. Fifteen wheelchair tennis and 15 able-bodied tennis players enrolled. Electromagnetic system and trial-axial accelerometers were used to measure the difference in the kinematic parameters of the upper extremity and the impact vibration transferred across the wrist joint. The results indicated that wheelchair players demonstrated unique elbow and wrist kinematics, especially shorter total swing time, greater elbow flexion at preparation, lower wrist extension acceleration before impact, and smaller racket vibration at impact. Comparing to able-bodied players in standing, wheelchair players and players in sitting demonstrated significantly greater elbow joint flexion/extension angle, angular velocity, angular acceleration during extension, and wrist joint flexion angle. Wheelchair players also differ significantly with the players in sitting regarding elbow joint angular velocity and acceleration, and wrist joint flexion velocity. These adaptations and adjustments can be attributed to the missing lower extremity function and deficient trunk kinetic chain. The differences between wheelchair tennis players and able-bodied players in sitting could represent the progress as the wheelchair players moving from novices to experts. [ABSTRACT FROM AUTHOR]

Climbing is a fast-growing sport, with one of the most common injuries being a rupture of the finger flexor tendon pulley. The strain on pulleys increases as finger joints flex. However, to our knowledge, no study has conducted a kinematic analysis of climbers' fingers. Thus, this study aimed to examine finger kinematics during typical climbing tasks. Eleven elite climbers performed a sequence of four climbing moves, which were recorded by an optical motion capture system. Participants used crimp, half-crimp, and open-hand grips for three trials each, with the fourth condition involving campusing using any grip except crimp. Mean proximal interphalangeal joint (PIP) flexion during the holding phase was 87° (SD 12°), 70° (14°) and 39° (27°) for the crimp, half-crimp and open-hand grip, respectively. Hence, inter-individual PIP flexion ranges overlap between different gripping conditions. Two different movement patterns emerged in the open-hand grip, possibly influenced by the use of the little finger, leading to varying degrees of flexion in the middle and ring fingers. Avoiding little finger usage in the open-hand grip may reduce load during pulley rupture rehabilitation. The implications of PIP joint angle variability on individual pulley injury risk or prevention warrant further investigation. Motion capture proved effective for understanding finger kinematics during climbing and could guide future studies on pulley injury risk factors. [ABSTRACT FROM AUTHOR]

Background: The most common types of wrist dislocation are trans-scaphoid lunate dislocation (TLD) and trans-scaphoid perilunate dislocation, in which the lunate and proximal scaphoid are dislocated through the midcarpal joint. There is another rare type of dislocation in which the proximal carpi are dislocated through the radiocarpal joint. The purpose of this study is to examine the clinical features of this type of dislocation. Methods: Six cases of the proximal carpal fracture dislocation via the radiocarpal joint were retrospectively reviewed. All patients underwent open reduction and internal fixation with the ligament reconstruction. A Mayo wrist score was assigned to each patient based on the assessment of pain, functional status, range of motion and grip strength at the last follow-up. Clinical subjective evaluation of function and pain was assessed using the patient-rated wrist evaluation (PRWE) method. Results: All patients were male and injured with a median age of 33.5 years. The median follow-up period was 10 months. There were three types of dislocations: Scaphoid fracture dislocation, TLD and scaphoid-lunate dislocation. All patients had satisfactory results with an average PRWE of 7.2 ± 4.7. The preoperative VAS was 6.7 ± 1.0 and the postoperative VAS was 0.7 ± 0.7 (p < 0.01). Postoperative grip strength accounted for 89.2% ± 9.8% of the contralateral side; the Mayo wrist score averaged 90.0 ± 6.5, with four patients obtaining excellent and two good results. Conclusions: Fracture dislocation of the proximal carpal bones through the radiocarpal joint is an independent type of wrist dislocation that tends to occur in young men with high-energy impact. The wrist is most often injured in a pronation hyperextension position. If treatment is timely and appropriate, the prognosis is quite good. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

This article presents a case study of a patient with systemic lupus erythematosus (SLE) who developed rice body formation in the wrist. Rice body formation is a non-specific inflammatory process characterized by small, rice-like structures in the joints. The understanding of this phenomenon is limited to individual case reports, and there is a lack of accurate data on its prevalence and impact. The case study aims to contribute to the understanding of rice body formation in autoimmune diseases and provide insights for rheumatologists. The article discusses the diagnosis, treatment, and follow-up of the patient, as well as the relationship between rice body formation and SLE. Further research is needed in this area. [Extracted from the article]

Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability. To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities. We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability. The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading. The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid. Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability. • Forearm muscles are categorized as carpal pronators or supinators based on their effect during traction in neutral rotation. • The carpal pronator muscles are the extensor carpi ulnaris and the flexor carpi radialis. • The carpal supinator muscles are the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris. • Scapholunate dysfunction may benefit from strengthening and proprioceptive training of the supinator muscles and flexor carpi radialis. • Lunotriquetral dysfuntions may benefit from strengthening and proprioceptive training of the extensor carpi ulnaris. [ABSTRACT FROM AUTHOR]

Sensorimotor impairment following distal radius fracture (DRF) has been associated with a significant decline in function. Joint position sense (JPS) testing is a meaningful and responsive way to assess sensorimotor impairment for individuals who have sustained a DRF; however, there are factors that may influence the results of JPS testing, including kinesiophobia and pain intensity. This study aimed to evaluate the influence kinesiophobia may have on wrist JPS testing and if pain intensity impacts kinesiophobia and JPS in individuals with a DRF. This was a cross-sectional study. Participants referred from two medical centers with a diagnosis of DRF treated with at least 3 weeks of immobilization were enrolled in the study. Data were collected at 1 week and 6 weeks postimmobilization period. Demographics were summarized with descriptive statistics, and linear relationships between kinesiophobia, pain intensity, and wrist JPS were examined using Pearson correlation coefficient. Forty-eight participants were included in this study (mean age 42.9 years). Significant positive correlations were found between the Tampa Scale for Kinesiophobia (TSK) and Numeric Rating Scale (NRS; r = 0.951, p < 0.001), TSK and JPS error (r = 0.942, p < 0.001), as well as NRS and JPS error (r = 0.898, p < 0.001). These correlations indicate that higher levels of kinesiophobia are associated with increased pain intensity and greater JPS error. T -tests reveal no significant difference between male and female for the TSK, NRS, or JPS scores. There is an association for individuals with high levels of kinesiophobia and both greater pain and errors with JPS testing. • Information on the relevance of the relationship between kinesiophobia, pain intensity, and wrist JPS testing error following a DRF is lacking. • An evaluation of psychological factors is relevant and clinically meaningful for clinicians when assessing and treating individuals with DRF. • High levels of kinesiophobia are associated with greater pain intensity and JPS error for individuals who sustained a DRF. [ABSTRACT FROM AUTHOR]

Although the use of KT has increased considerably in the clinical practice in the last years, there is limited evidence about the effects of its application in proprioception. The aim of this study was to determine the effect of KT on joint position sense and force sense on the wrist of healthy subjects. Fifty-four subjects were analyzed in a randomized, crossover, single-blind study design. To determine the force sense, the subjects had to reach 50% of their maximum grip force. Wrist joint position sense was assessed during active repositioning tests at the target angles of 30° flexion and extension of wrist. A digital dynamometer was used to determine the sense of force and a digital goniometer was used to determine the joint position sense. Subjects were evaluated with KT (I- strip on ventral aspect of forearms from origin to insertion) and placebo (an inelastic tape was applied following the same procedure as KT). No significant differences have been found in the force sense, neither in the comparisons between control and interventions (p =0.286), nor between pre and post-intervention (p =0.111). For wrist joint position sense, a statistically significant effect (p < 0.05) was found at 30º of extension between the control and experimental group in favor of the control group. The application of KT did not produce changes in FS and only caused a significant improvement in JPS in extension (30º). The results appear to indicate that the application of KT to improve proprioception in healthy subjects should be reconsidered. • Kinesio tape applied on forearm did not improve force sense in healthy subjects. • Kinesio tape did not improve wrist joint position sense in healthy subjects. • The effect of Kinesio tape may be time-dependent. [ABSTRACT FROM AUTHOR]

Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established. This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based. This was a quasi-experimental cross-sectional study. Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation. A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t -tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function. CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH. • CWH is very prevalent in young adults, and it can be diagnosed via specific criteria. • CWH prevails among females with atraumatic midcarpal or intercarpal laxities, and BJHS. • CWH adversely affects wrist proprioception, wrist strength, grip-force, and function. [ABSTRACT FROM AUTHOR]