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Background: Reliability in measurement of wrist range of motion (ROM) is necessary in clinical examination and evaluation. An infrared position capture device for detection and measurement of hand and finger movements without any physical contact with the device was introduced in 2013. No prior study has evaluated the reliability of this device relative to the measurement of wrist ROM. Objective: To determine the reliability of the infrared position capture device, and to evaluate its agreement with universal standard goniometer for the measurement of wrist ROM. Materials and Methods: A comparison of wrist ROM measurements was performed in 33 healthy subjects at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Candidates with previous wrist injury, wrist surgery, or severe obesity were excluded. Two examiners independently evaluated each participant using both measurement method. The results of both the two measurement methods and the two examiners were compared. Results: Significant interobserver and intraobserver reliability were found in the measurement of wrist angle using the infrared position capture device and universal standard goniometer. Intraclass correlation coefficient (ICC) comparing infrared position capture device and goniometer was, as follows: flexion 0.86, extension 0.92, radial deviation 0.53, and ulnar deviation 0.76 for examiner 1; and, flexion 0.83, extension 0.92, radial deviation 0.69, and ulnar deviation 0.80 for examiner 2 (range: 0.53 to 0.92). Infrared position capture device measurements of wrist angle in all 4 positions were very similar to those of universal standard goniometer. The mean difference between methods for measurement of wrist angle ranged from 0.15 to 3.88 degrees. Conclusion: The infrared position capture device was found to be a reliable tool for measurement of wrist motion. Measurements by infrared position capture device were found to be in agreement with measurements by universal standard goniometer, which is the current standard technique. [ABSTRACT FROM AUTHOR]

Background: Operative fixation has become increasingly more common for treatment of hand fractures. The dorsal cutaneous branch of the ulnar nerve (DCBUN) is a distal sensory branch of the ulnar nerve. Iatrogenic injuries during surgery were reported in previous study. Although many authors have described the DCBUN anatomy at the wrist, our review of the literature did not reveal any reports that define the relationship between DCBUN and the fifth metacarpal bone. Objective: To investigate the anatomical relationship between the DCBUN and the fifth metacarpal bone. Materials and Methods: Thirty-one fresh cadavers were dissected. The number and distribution of DCBUN branches relative to the ulnar styloid and imaginary point of the fifth metacarpal bone were recorded. Results: In 29 specimens, the DCBUN had 2 branches while the rest had 3 branches. The mean distance from the origin of DCBUN to the ulnar-most base of the bone in dorsal view (point A) was 7.41 cm. The mean distance from the DCBUN branching point to point A was 2.83 cm. The most ulnar branch of DCBUN innervated to subcutaneous border along the most ulnar and palmar side of the bone. The mean proportion of the length between point G, where the most radial branch crosses over the most radial side of the bone and the radial-most base of the bone in dorsal view (point B) (GB), and the length of the most radial side of the bone between base (point B) and head (point D) (BD) was 0.15 (range: 0.0 to 0.45). Conclusion: The results of the present study suggest the safe area for making a skin incision to be at the mid-axial ulnar side of the fifth metacarpal bone to prevent ulnar branch injury. A dorsal skin incision over the proximal half of the fifth metacarpal bone may injure the radial branch. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. Standard open carpal tunnel release is the gold standard treatment; however, that procedure can result in scar tenderness and pillar pain. Minimally invasive surgery is less likely to cause these post-surgical complications. The authors invented a newly-designed instrument that facilitates easier placement of the instrument into the carpal tunnel, and that has a more secure holding piece to stabilize the instrument during division of the ligament. Objective: To investigate the efficacy of our newly-designed instrument using the limited skin incision technique in cadaver model, and to identify potential risks of injury to nearby important structures. Materials and Methods: Forty unembalmed cadaveric wrists without history or sign of previous injury or surgery were used for carpal tunnel release procedure using limited longitudinal skin incision at palm. To assess the completeness of transverse carpal ligament release, a proximally-extended skin incision was made to evaluate the released ligament. Median nerve, recurrent motor branch of median nerve, palmar cutaneous branch of median nerve, flexor tendons in carpal tunnel, and superficial palmar arterial arch were dissected to identify evidence of injury. Results: All transverse carpal ligaments of 40 cadaveric wrists were completely released with preservation of fascial coverage between the thenar and hypothenar muscles. All surrounding important structures were identified without evidence of injury. Conclusion: This newly designed instrument for carpal tunnel release demonstrated precision function and efficacy without injury to surrounding structures, and with preservation of fascial coverage above the ligament. Further investigation for application in clinical use is needed to confirm the safety and efficacy of this newly-designed instrument. [ABSTRACT FROM AUTHOR]