scholarly journals Assessment of Wrist Function After Simulated Total Wrist Arthrodesis

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 464-468 ◽  
Author(s):  
Richard M. Hinds ◽  
Eitan Melamed ◽  
April O’Connell ◽  
Francoise Cherry ◽  
Monica Seu ◽  
...  
Keyword(s):  
Grip Strength ◽  
Functional Limitation ◽  
Test Duration ◽  
Fusion Model ◽  
Optimal Position ◽  
Wrist Arthrodesis ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Wrist Fusion ◽  
Wrist Function

Background: There is poor consensus in the literature regarding associated functional limitation and the preferred wrist position for total wrist arthrodesis. The purpose of the current investigation was twofold: (1) to assess the functional limitations of wrist arthrodesis and (2) to determine the optimal position for wrist arthrodesis using a simulated wrist fusion model. Methods: Twenty healthy volunteers underwent simulated wrist arthrodesis in 6 different positions using custom-molded wrist splints: 15° extension with 0° radio-ulnar deviation, 15° extension with 10° ulnar deviation, 15° extension with 10° radial deviation, 0° extension with 0° radio-ulnar deviation, 0° extension with 10° ulnar deviation, and 0° extension with 10° radial deviation. Each volunteer was independently assessed for wrist function using the Jebsen-Taylor hand function test, grip strength, and satisfaction in the simulated wrist fusion positions. Comparisons between all simulated fusion wrists and the baseline unsplinted wrist as well as among the 6 simulated fusion positions were performed. Results: Turning over a card (5.1 vs 4.3 seconds), picking up small objects (7.1 vs 5.8 seconds), and simulated feeding (8.3 vs 7.1 seconds) as well as total Jebsen-Taylor test duration (41.8 vs 37.9 seconds) was significantly longer in simulated fusion wrists. Both grip strength (55.9 vs 80.7 kg) and satisfaction scores (6.4 vs 9.6) were lower in simulated fusion wrists. Wrists in 0° extension also demonstrated significantly shorter durations in stacking checkers than wrists in 15° extension. Conclusion: Our findings suggest that wrist arthrodesis may only compromise select wrist functions. Among the tested wrist fusion positions, wrists fused in neutral may demonstrate better function than wrist fused in slight extension. However, grip strength and satisfaction seem to be unaffected by wrist fusion position.

scholarly journals Variation of Grip Strength and Wrist Range of Motion with Forearm Rotation in Healthy Young Volunteers Aged 23 to 30

2018 ◽  
Vol 11 (02) ◽  
pp. 088-093 ◽  
Author(s):  
Stacy Fan ◽  
Jeremy Cepek ◽  
Caitlin Symonette ◽  
Douglas Ross ◽  
Shrikant Chinchalkar ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Repeated Measure ◽  
Neutral Position ◽  
Wrist Flexion ◽  
Hand Rehabilitation ◽  
Forearm Rotation ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Significant Difference

Abstract Background Grip strength and wrist range of motion (ROM) are important metrics used to evaluate hand rehabilitation and outcomes of wrist interventions. Published normative data on these metrics do not recognize the contribution of forearm rotation. This study aims to identify and quantify variations in grip strength and wrist ROM with forearm rotation in healthy young individuals. Materials and Methods Wrist ROM and grip strength were measured in 30 healthy volunteers aged 23 to 30. Participant demographics, grip strength, and wrist ROM (wrist flexion and extension, ulnar and radial deviation) at three forearm positions (full supination, neutral, and full pronation) were measured using a digital dynamometer and standard goniometers. Data analysis was conducted using a one-way repeated measure ANOVA. Forearm position values were compared using post hoc analysis. Results Grip strength in males was greatest in neutral position (males: nondominant 51.4 kg, dominant 56.1 kg) followed by supination (males: nondominant 46.6 kg, dominant 51.7 kg) and weakest in pronation (males: nondominant 40.1 kg, dominant 42.9 kg). Grip strength in females was similar between supination (nondominant: 26.1 kg, dominant: 28.5 kg) and neutral (nondominant: 27.4 kg, dominant: 29.1 kg) positions, but both were greater than in pronation (nondominant: 22.3 kg, dominant: 24.1 kg). Wrist flexion in males was significantly reduced in supination compared with neutral and pronated positions (nondominant: supination 63.1°, neutral 72.6°, pronation 73.3°; dominant: supination 62.4°, neutral 70.2°, pronation 70.3°), whereas not significant wrist flexion in females was also weaker in supination (supination 74.4°, neutral 79.9°). Wrist extension in males was greater in pronation (supination 64.6°, pronation 69.5°) whereas females showed no significant difference in any of the forearm positions. Ulnar deviation in males did not differ with forearm position, but females demonstrated greater ulnar deviation in supination on the nondominant hand (supination 44.6°, pronation 33.2°). Whereas there was no difference in radial deviation with forearm position in females, it was markedly greater in pronation versus supination on both sides in males (nondominant: supination 16.3°, pronation 24.6°; dominant: supination 15.4°, pronation 23.9°). Conclusion This study characterizes variations in grip strength and wrist ROM in three forearm positions in healthy young individuals. All measurements differed with forearm rotation and were not influenced by hand dominance. These results suggest that wrist ROM and grip strength should be evaluated in different positions of forearm rotation, rather than a fixed position. This has functional implications particularly in patients involved with specialized activities such as sports, instrument-playing, or work-related activities.

The use of a pyrocarbon capitate resurfacing implant in chronic wrist disorders

2013 ◽  
Vol 39 (6) ◽  
pp. 611-618 ◽  
Author(s):  
A. Marcuzzi ◽  
H. Ozben ◽  
A. Russomando
Keyword(s):  
Surgical Treatment ◽  
Pain Relief ◽  
Grip Strength ◽  
Surgical Procedure ◽  
Good Alternative ◽  
Proximal Row Carpectomy ◽  
Wrist Arthrodesis ◽  
Wrist Function ◽  
Arthritic Changes ◽  
Indication For Surgical Treatment

The present study describes the technique and results of proximal row carpectomy with resection of the head of the capitate and replacement with a pyrocarbon capitate resurfacing implant. The major indication for surgical treatment was arthritic changes on the head of the capitate. Patients were assessed by range of motion, grip strength, pain and functional scoring, and radiographic studies. In most patients, wrist function was improved and pain relief was obtained. This surgical procedure may represent a good alternative to total and partial wrist arthrodesis.

scholarly journals Effect of static wrist position on grip strength

2011 ◽  
Vol 44 (01) ◽  
pp. 055-058 ◽  
Author(s):  
Praveen Bhardwaj ◽  
Saumyakumar S. Nayak ◽  
Asif M. Kiswar ◽  
S. Raja Sabapathy
Keyword(s):  
Grip Strength ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Wrist Arthrodesis ◽  
Left Hand ◽  
Hand Grip ◽  
Ideal Position ◽  
Wrist Fusion ◽  
The Difference ◽  
The Ideal

ABSTRACT Background: Grip strength after wrist arthrodesis is reported to be significantly less than normal. One of the reasons suggested for this decrease in grip strength is that the arthrodesis was performed in a suboptimal position. However, there is no consensus on the ideal position of wrist fusion. There is a paucity of studies evaluating the effect of various fixed positions of the wrist on grip strength and therefore, there is no guide regarding the ideal position of wrist fusion. The authors’ aim was to determine the grip strength in various fixed positions of the wrist and subsequently to find out in which position of wrist fusion the grip strength would be maximal. Materials and Methods: One hundred healthy adults participated in the study. For the purpose of this study, the authors constructed splints to hold the wrist in five different fixed positions: 45, 30 and 15 degrees of wrist extension, neutral and 30 degrees of wrist flexion. The grip strength in all the participants was measured bilaterally, first without a splint and then with each splint sequentially. Results: The average grip strength without the splint was 34.3 kg for right and 32.3 kg for the left hand. Grip strength decreased by 19–25% when the wrist was splinted. The maximum average grip strength with a splint on was recorded at 45 degrees of extension (27.9 kg for right and 26.3 kg for left side). There was a gradual increase in the grip strength with increase in wrist extension but the difference was not statistically significant (P = 0.29). The grip strength was significantly less in flexed position of the wrist (P < 0.001).

Radio-Lunate Arthrodesis for Distal Radial Intraarticular Malunion

1996 ◽  
Vol 21 (1) ◽  
pp. 14-20 ◽  
Author(s):  
P. SAFFAR
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Velocity ◽  
Posterior Approach ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Posterior Subluxation ◽  
The Mean

Eleven cases of symptomatic distal radial intraarticular malunion were treated by radio-lunate arthrodesis from 1983 to 1991. The mean age was 35.3 years. There were 11 men, all manual workers. The mechanism was usually a high velocity injury. The time elapsed since injury was a mean 23 months (2–109 months). The range of motion was, on average, flexion 39°, extension 27°, radial deviation 10° and ulnar deviation 20°. Pain was present on light work and grip strength was 45% of the opposite side. The average step-off was 4.4 mm. The scapho-lunate gap was greater than 3 mm in three cases and 5 mm in one case. An ulnar translation of the carpus greater than 4 mm was present in four cases. Posterior subluxation was significant in three cases. The distal radio-ulnar joint (DRUJ) was totally destroyed in three cases, and incongruent in five. Radio-lunate arthrodesis is performed by a posterior approach. Other procedures were combined, mainly on the DRUJ. The average follow-up was 28.5 months (8–79 months). Healing was achieved in ten out of 11 cases in 45 to 90 days. Pain was absent or moderate after 4 months. The range of motion was 33° in flexion, 39° in extension, 17° in radial deviation and 29° in ulnar deviation. The average post-operative strength was 57% of the opposite side (19 kg/33). Eight patients returned to their previous work and two to lighter work.

scholarly journals Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis

2018 ◽  
Vol 07 (05) ◽  
pp. 424-440 ◽  
Author(s):  
Lorenzo Garagnani ◽  
Sam Gidwani ◽  
Onur Berber
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Quality Data ◽  
Fourth Generation ◽  
Secondary Outcome ◽  
Wrist Arthrodesis ◽  
Wrist Fusion ◽  
End Stage ◽  
Wrist Arthroplasty ◽  
Better Than

Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations in 603 patients, and 1,371 index arthroplasty operations in 1,295 patients. A significant improvement in functional outcome was seen with both interventions. Similar improvements were seen in pain scores, and modest improvements were seen in grip strength. Range of motion following arthroplasty improved to a functional level in two studies. Complication rates were higher after arthroplasty (range: 0.2–9.5%) than those after arthrodesis (range: 0.1–6.1%; p = 0.06). Fourth-generation implants (range 0.1–2.9%) performed better than earlier designs (range: 0.2–8.1%; p = 0.002). Implant revision rates ranged from 3.5 to 52.6%. Fourth-generation prostheses survival rates were 78% at 15 years (Universal 2), 86% at 10 years (Motec), 90% at 9 years (Re-Motion), and 95% at 8 years (Maestro). Conclusion The newer fourth-generation wrist implants appear to be performing better than earlier designs. Both wrist arthrodesis and wrist arthroplasty improve function, pain, and grip strength. The risk of complication following wrist replacements is higher than that after total wrist arthrodesis.

Functional Outcome Following Extensor Synovectomy and Excision of the Distal Ulna in Patients With Rheumatoid Arthritis

2003 ◽  
Vol 28 (6) ◽  
pp. 531-536 ◽  
Author(s):  
A. JAIN ◽  
C. BALL ◽  
J. NANCHAHAL
Keyword(s):  
Rheumatoid Arthritis ◽  
Grip Strength ◽  
Hand Function ◽  
Distal Ulna ◽  
Ulnar Deviation ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
Function Test ◽  
Wrist Function ◽  
Simulated Feeding

We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation ( P = 0.04), supination ( P = 0.03) and wrist extension ( P = 0.02), but a reduction in flexion ( P = 0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength ( P = 0.05) and reduction in wrist pain ( P = < 0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.

Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries

Hand Therapy ◽  
2021 ◽  
pp. 175899832110333
Author(s):  
Zhiqing Chen
Keyword(s):  
Grip Strength ◽  
Outcome Measures ◽  
Rating Scale ◽  
Weight Bearing ◽  
Rehabilitation Program ◽  
Triangular Fibrocartilage Complex ◽  
Effect Sizes ◽  
Pronator Quadratus ◽  
Triangular Fibrocartilage ◽  
Wrist Function

Introduction Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Methods Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the ‘push-off’ test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Results Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen’s D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. Discussion WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.

Pronated Grip View With Wrist Deviation: A Pilot Study on the Effect on Ulnocarpal Relationships

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
Anthony L. Logli ◽  
Beth A. Schueler ◽  
Laurel A. Littrell ◽  
Sanjeev Kakar
Keyword(s):  
Pilot Study ◽  
Surface Area ◽  
Coronal Plane ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Wrist Position ◽  
Standardized Protocol ◽  
Ulnar Impaction ◽  
Lunate Surface ◽  
Adult Volunteers

Background We hypothesize that different positions of the wrist in the coronal plane makes the carpus susceptible to ulnar impaction. Methods We prospectively enrolled 10 adult volunteers and obtained fluoroscopic images of each wrist in 12 different positions using a standardized protocol. Distances from the ulna to the lunate (UL) and ulna to the triquetrum (UT) were digitally measured as was the portion of the lunate surface area that was uncovered (LUR) with wrist deviation. Results A wrist position of Pronation, Neutral Deviation, and Grip (P-ND-G) significantly shortened the ulnocarpal distance when compared to a position of Neutral Rotation, Neutral Deviation, and No Grip (NR-ND-NG). Radial deviation during pronation and gripping (Pronated, Radial Deviation, Gripping [P-RD-G]) resulted in the lowest mean UL distance (1.2 mm). UT distance was minimized by a position of ulnar deviation during a pronated grip (Pronated, Ulnar Deviation, Gripping [P-UD-G]) (3.1 mm). The lunate becomes more uncovered with radial deviation. Conclusion Radial deviation minimizes the UL distance while ulnar deviation minimizes the UT distance during a wrist position of pronation and gripping. Further, there is more proximal lunate surface area uncoverage during all positions of radial deviation compared to ulnar deviation.

Modified Instruments for Wrist Fusion

1986 ◽  
Vol 11 (2) ◽  
pp. 245-249
Author(s):  
J. K. STANLEY ◽  
S. R. GUPTA ◽  
M. G. HULLIN
Keyword(s):  
Surgical Procedures ◽  
Operative Time ◽  
Intramedullary Fixation ◽  
Early Mobilisation ◽  
Wrist Arthrodesis ◽  
Wrist Fusion ◽  
New Instruments

A technique and new instruments for intramedullary fixation of the wrist arthrodesis is described, based on the technique of Clayton, popularised by Nalebuff and Millender. This allows early mobilisation, secure fixation and simplicity of the technique. It also allows other surgical procedures to be performed under the same anaesthetic and tourniquet due to the reduction in operative time.

scholarly journals Ulna Autograft for Wrist Arthrodesis: A Novel Approach in Failed Wrist Arthoplasty

2017 ◽  
Vol 11 (1) ◽  
pp. 768-776 ◽  
Author(s):  
Nastaran Sargazi ◽  
M. Philpott ◽  
A. Malik ◽  
M. Waseem
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Salvage Surgery ◽  
Wrist Arthrodesis ◽  
Novel Approach ◽  
Total Wrist Arthroplasty ◽  
Stage Disease ◽  
Wrist Function ◽  
End Stage ◽  
Wrist Arthroplasty

Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function. Where complications occur with total wrist arthroplasty, salvage surgery with arthrodesis can be considered, however this requires satisfactory bone stock to enable stable fusion of the joint following arthroplasty. We report our experience of Ulna strut allografts in wrist arthrodesis in the management of failed total wrist arthroplasty.

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