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Radiology of the Wrist and Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Anil K Bhat, Ashwath M Acharya, Mithun Pai G
In these views, the central beam is directed perpendicular to the film and centred on the waist of the scaphoid. The wrist should be in the true lateral position on both radiographs. The extension and flexion of the wrist(maximum) are recognised by observation of the long axis of the third metacarpal extended dorsally (Figure 16.21) and flexed volar (Figure 16.22), respectively, relative to the long axis of the radius and ulna. These views demonstrate extension and flexion at the radiocarpal and midcarpal joints in normal wrists and can be further used to evaluate carpal instability patterns. In particular, these views can assist in distinguishing between a true instability pattern versus normal variance.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The wrist and hand are a complex region containing many joints that provide flexibility and enable the hand to interact with its environment. This dexterity of the hand is essential because it provides direct interaction with the world around us and the objects in it. The major joint of this region is the radiocarpal (wrist) joint, the primary connection between the forearm and the hand. The bones of the carpal region have a little movement between them, mostly at the midcarpal joint between the proximal and distal rows of carpal bones. The intermetacarpal and carpometacarpal articulations give the palm of the hand its flexibility. The metacarpophalangeal joints – the knuckles – give the digits their independent movements and the interphalangeal joints enable the digits to flex and extend in grasping movements. Injuries of the wrist and hand can be both traumatic and overuse types.
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The midcarpal joint is a joint between the proximal and distal carpals, which contributes to abduction and flexion, and particularly to adduction and extension, of the hand. The carpometacarpal joint between the distal carpals and the metacarpals does not contribute significantly to movements of the digits, except those of the thumb (digit 1), which is much more mobile than the other digits, and to a lesser extent digit 5. It is this thumb joint that allows the palmar surfaces of digits 1 and 5 to meet each other in full opposition (Figure 4.2). This ability is only present in humans, and reflects the crucial role played by thumb movements (for instance, for tool manufacture and use) in the evolutionary history of the human lineage.
Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Carpal tunnel syndrome is a peripheral nerve entrapment syndrome affecting a large portion of the general (Atroshi et al. 1999) and working populations (Dale et al. 2013; Luckhaupt et al. 2013). The most common treatment for carpal tunnel syndrome is to undergo carpal tunnel release surgery, whereby pressure at the median nerve is relieved by transecting the transverse carpal ligament (TCL) (Badger et al. 2008; Rodner and Katarincic 2008). Regarding various patient outcome measurables, surgical treatment shows preferred results, as compared to those for therapeutic options such as splinting (Gerritsen et al. 2002), non-steroidal anti-inflammatory drugs (Jarvik et al. 2009) and steroid injections (Hui et al. 2005). Although surgery is more effective, the invasive nature of the procedure does present the risk of complications, albeit rare (Karl et al. 2016). Such risks are minimal with noninvasive physical therapeutics. These options, which can include splinting (Huisstede et al. 2010) and carpal bone mobilization (Huisstede et al. 2010), often involve force application at or near the radiocarpal or midcarpal joint. These force applications are likely to induce relative motion of the carpal bones.
Reliability and responsiveness of a goniometric device for measuring the range of motion in the dart-throwing motion plane
Published in Physiotherapy Theory and Practice, 2019
Kenji Kasubuchi, Yoshihiro Dohi, Hiroyuki Fujita, Takahiko Fukumoto
The DTM is functionally relevant, being essential for a variety of activities of daily living, ranging from an effective use of tools such as: hammering a nail; to combing one’s hair; pouring from a pitcher; (Palmer, Werner, Murphy, and Glisson, 1985); throwing a ball; drinking from a glass; and twisting the lid of a jar to open or close it (Brigstocke, Hearnden, Holt, and Whatling, 2014). Although the DTM represents a natural functional pattern of wrist movement, the underlying kinematics are complex and have only recently been clarified using three-dimensional motion analysis (Moojen et al., 2002; Moritomo et al., 2003, 2004; Sonenblum, Crisco, Kang, and Akelman, 2004). Specifically, Moritomo et al. (2006) reported a movement at the midcarpal joint from radial extension to ulnar flexion, regardless of global wrist motion. Therefore, DTM is a vital plane of wrist motion and one that needs to be considered in the rehabilitation of hand trauma and general disorders of the hand and wrist. However, to our knowledge, no measurement method is currently available to measure the range of motion (ROM) of the wrist specifically in the DTM plane and yet, such a measure would be required in clinical practice.
Simultaneous non-union of scaphoid and capitate: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Ryunosuke Fukushi, Kohei Kanaya, Kousuke Iba, Toshihiko Yamashita
A transverse incision was made on the dorsal wrist. The capitate was exposed through capsulotomy of the midcarpal joint. After curettage of the capitate non-union, the cancellous bone graft from the iliac crest was performed, and the capitate was fixed with an Acutrak Mini (Acutrak Headless Compression Screw System, Japan Medicalnext Co., Ltd., Tokyo, Japan). A gentle curvilinear dorsoradial incision was used to expose the scaphoid and bone graft donor site. The dorsoradial capsule of the wrist joint was incised, and the non-union was removed from the sclerotic fracture surfaces and from the exposed cancellous bone. The 1,2 ICSRA was visualised on the surface of the retinaculum between the first and second extensor tendon compartments. Both compartments were opened, and a cuboid bone graft was raised on the 1,2 ICSRA. After releasing the tourniquet, circulation of the bone graft was confirmed. The pedicle bone graft was trimmed to fit the defect and was placed in the non-union bed using two K-wires. Postoperatively, the wrist was immobilised with a below-elbow plaster cast for 12 weeks.