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Biomechanics of the Hand and Wrist
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Nicholas Saw, Livio Di Mascio, David Evans
The biomechanics of the hand and wrist represent a subject of immense complexity, and a thorough understanding is difficult because of: The series of joints involved, many of which move together to produce composite movements.The muscles that power movement often cross more than one joint and contraction produces functional movement in concert.The role of ligamentous restraints in the wrist and distal radioulnar joint.Carpal and distal radioulnar joint (DRUJ) kinematics not being understood fully.
Musculoskeletal trauma and soft tissue injuries
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Purudappa Prasad, Gleeson Rebello
Galeazzi’s fracture is an uncommon injury in children. Injury to the distal radio-ulnar joint is frequently overlooked and persistent joint subluxation is responsible for poor long-term results. The Galeazzi equivalent injury is represented by physeal separation of the distal ulna, instead of a triangular fibrocartilage tear. Treatment in young children consists of closed reduction and above-elbow casting with the forearm in full supination. Adolescent children with this injury might require open reduction and internal fixation.
Galeazzi Fracture
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
The distal radioulnar joint is stabilised by bony stabilisers and soft tissue stabilisers. The bony component is provided by the articulation of the distal ulna with the sigmoid notch of the distal radius. The soft tissue stabilisers are a collection of ligamentous structures collectively referred to as the triangular fibrocartilaginous complex (TFCC). The individual components are the articular disc or triangular fibrocartilage, meniscal homologue, the ulnolunate and the ulnotriquetral ligaments. The dorsal and volar radioulnar ligaments, the extensor carpi ulnaris sub sheath and the ulnar collateral ligament also stabilise the distal radioulnar joint.
Dorsal dry needling to the pronator quadratus muscle is a safe and valid technique: A cadaveric study
Published in Physiotherapy Theory and Practice, 2023
Albert Pérez-Bellmunt, Carlos López-de-Celis, Jacobo Rodríguez-Sanz, César Hidalgo-García, Joseph M. Donnelly, Simón A Cedeño-Bermúdez, César Fernández-de-las-Peñas
The pronator quadratus (PQ) is a deep flat muscle covering the distal ends of the ulna and radius anteriorly. It originates from the anterior surface of the distal ulna and inserts onto the distal aspect of the anterior surface of the radius proximal to the wrist (Standring, 2016). This muscle is an important pronator of the forearm and also contributes to stability of the distal radio-ulnar joint. Therefore, due to its function, this muscle is susceptible to repetitive overload that may lead to development of myofascial pain. In fact, patients with TrPs in the PQ clinically report difficulty in using scissors for cutting heavy cloth, handling tools while gardening, or using tools that require stability and a forceful grasp. Similarly, injuries in the lower portion of the forearm, e.g., distal radius fracture, could also affect the PQ muscle (Donnelly, 2019). Interestingly, the pain referral pattern from the PQ muscle was not described by Simons, Travell, and Simons (1999). The pain referral pattern from the PQ was described by Hwang, Kang, and Kim (2005) in an experimentally induced pain model. These authors reported that PQ muscle referred pain pattern spreads both proximally and distally along the medial aspect of the forearm mimicking ulnar or median nerve sensory distributions (Hwang, Kang, and Kim, 2005).
Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively
Published in Acta Orthopaedica, 2020
Maria Moloney, Simon Farnebo, Lars Adolfsson
Fractures of the distal ulna may result in incongruence and instability of the distal radioulnar joint (DRUJ), which may result in chronic pain or limited forearm rotation (Kvernmo 2014). Fractures of the distal ulna most often accompany a distal radius fracture and in the majority of cases they affect the ulnar styloid process, while fractures of the ulnar head and/or neck are less common (Ring et al. 2004). Distal radius fractures and concomitant fractures of the distal radius and ulna are commonly caused by a fall from standing height on an outstretched arm with extended wrist. Isolated ulna fractures on the other hand are most often caused by a direct trauma to the ulnar border of the wrist (Richards and Deal 2014). Among patients with a Colles fracture, excluding ulnar styloid fractures, 5.6% have a concomitant fracture of the distal ulna (Biyani et al. 1995). Internal fixation of these fractures is typically difficult (Ring et al. 2004) as the distal fragment in most cases is small, consisting to a large extent of metaphysis and has a 270° articular surface.
Outcome of the Sauvé–Kapandji procedure for distal radioulnar joint disorder with rheumatoid arthritis or osteoarthritis: Results of one-year follow-up
Published in Modern Rheumatology, 2018
Mikinori Ikeda, Akira Kawabata, Keisuke Suzuki, Masahiko Toyama, Takeshi Egi
Distal radioulnar joint (DRUJ) disorders can be broadly classified into those caused by osteoarthritis (OA) and those caused by rheumatoid arthritis (RA). Wrist injury may result in derangement of the DRUJ and lead to deformity and chronic instability, often causing pain and decreased forearm rotation with loss of function [1]. Patients with OA usually have associated degenerative changes, such as sclerosis and osteophyte formation, and adequate bone stock. In patients with RA, the wrist is commonly affected. Involvement of the DRUJ can lead to subluxation or dislocation of the joint, which can cause pain, decreased forearm rotation and rupture of the extensor tendons [2]. On the other hand, patients with RA have reduced bone stock, and usually, the bone quality is low.