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Ten cadaver wrists were examined with CT-Absorptiometry in order to assess bone density in the subchondral bone. In normal wrists the distal radius contained two centroids of bone density, one in the lunate fossa and another in the scaphoid fossa. Pathologically altered wrists showed a shift in bone density towards the scaphoid fossa, with the subchondral bone in the lunate fossa and distal ulna becoming less dense. Bone density patterns in the wrist reflect the long-term force transmission. As bone density alters according to loading conditions, this method can be used to determine force transmission patterns before and after wrist surgery., (Copyright 2002 The British Society for Surgery of the Hand.)

Two cases of effort-related distal median nerve compression in the dominant forearm caused by a reversed palmaris longus muscle are presented. Simple resection of the muscle belly was performed. Carpal tunnel release was done in one case, but in retrospect this was probably not necessary.

Seven wrists in six patients with ulno-carpal abutment syndrome were treated by a subchondral distal ulna resection (wafer procedure). The average follow-up was 36 months. Wrist function was evaluated using a clinical scoring chart. The parameters were pain, range of motion, grip strength and activities. One patient had a poor result, one a fair result and the remaining had good to excellent results. In all cases grip strength showed dramatic improvement. Complications were limited to palpable subcutaneous nylon sutures requiring removal in three patients and extensor carpi ulnaris tendinitis in one.

The metacarpophalangeal joint bears most of the stresses to which the thumb ray is subjected. Instability of this joint results in considerable functional impairment of the hand. Volar instability may be secondary to trauma, rheumatoid arthritis, or adduction spasms in cerebral palsy. The resulting hyperextension causes pain and weakness of pinch (Fig. 1). Various techniques have been described to correct this deformity. We prefer a volar capsulodesis as first described by Filler (1976), in which the whole volar plate is reinserted. Detailed knowledge of the complicated volar anatomy is essential. We have treated eight patients (two bilaterally) with this technique, all with satisfactory results.