Search

Purpose: Ulnar styloid process (USP) fractures are present in 40–65% of all distal radius fractures (DRFs). USP base fractures can be associated with distal radioulnar joint (DRUJ) instability and ulnar sided wrist pain and are treated by conservative management and surgical fixation, without consensus. This systematic review and meta-analysis compares operative to non-operative treatment of concomitant ulnar styloid base fractures in patients with distal radius fractures. Methods: PubMed/Medline/Embase/CENTRAL databases were searched identifying RCTs and comparative observational studies. Effect estimates were extracted and pooled using random effect models to account for heterogeneity across studies. Results were presented as (standardized) mean differences (SMD or MD) or odds ratios (OR) and corresponding 95% confidence intervals (95%CI). Results: Two RCTs (161 patients) and three observational studies (175 patients) were included. Tension band wiring was used for surgically treated USP fractures. Results were comparable across the different study designs and hence pooled across studies. Non-surgically treated patients had better wrist function at 6 months (SMD 0.57, 95%CI 0.30; 0.90, I2 = 0%). After 12 months there was no observed difference (MD 2.31, 95%CI −2.57; 7.19, I2 = 91%). Fewer patients had USP non-unions in the operative group (OR 0.08, 95%CI 0.04; 0.18, I2 = 0%). More patients suffered complications in the operative group (OR 14.3; 95%CI 1.08; 188, I2 = 89%). Conclusion: Routinely fixating USP base fractures as standard of care is not indicated. Surgery may be considered in selective cases (e.g. persistent DRUJ instability during ballottement test after fixation of the radius). [ABSTRACT FROM AUTHOR]

Studies of lifestyle through comprehensive objective and subjective measurements of health outcomes are lacking. An examination of lifestyle factors in middle-aged and older adults in terms of age, gender, and the interaction effect of age and gender from physiological and psychological perspectives are imperative. Recent advances in technology such as actigraphy have facilitated objective measurements. This exploratory study contributes to research on age and gender interactions on circadian rhythm, physical activity, sleep, and psychological variables by employing wrist accelerometers to measure behavioral circadian rhythm objectively and by using questionnaires to assess psychological status subjectively. The data were drawn from 218 participants aged 50 and older from the "Middle-aged and older adults Chinese Health and Actigraphy in Taiwan (MOCHA-T)". The results: (1) older adult group is associated with declined physical activity (MVPA time 79.9 min VS. 107.9 min, p =.002), worse sleep efficiency (78.1% VS. 81.9%, p =.008), and earlier lifestyle (Acrophase 14.19 h VS. 14.69 h, p =.01) comparing to middle-aged group. (2) Women have a more regular lifestyle (Interdaily stability 0.6 VS. 051, p < 0.001), higher physical activity (MVPA time 105.7 min VS. 79.3 min, p =.004), and better sleep efficiency (81.6% VS. 77.8%, p =.011) than men. (3) Significant age-by-gender interactions existed in life satisfaction (p =.025), relative amplitude (p =.016), and total wake time (p =.038). Furthermore, aging was associated with significant increases in life satisfaction among men as well as significant decreases in relative amplitude and reductions in the total wake time among women. In conclusion, aging exerted differential effects on life satisfaction in men as well as relative amplitude and the total wake time in women. This result highlights disparities in lifestyle arising from interconnected social and biological challenges. [ABSTRACT FROM AUTHOR]

Introduction: This study was to evaluate the efficacy of multiple platelet-rich plasma injections in reflex sympathetic dystrophy following distal radius fracture after previous various treatments have failed. Materials and methods: This comparative prospective study was designed for 64 patients of reflex sympathetic dystrophy developed following distal radius fracture, from January 2009 to December 2020 were enrolled in this study. This cohort of patient was given either four multiple subcutaneous platelet-rich plasma injections at weekly interval (n = 32) or two injections in a month with 15 days interval (n = 32). The primary outcome measure assessed with patient rated wrist evaluation questionnaire score. The secondary outcome was a visual analogue scale pain score. The final follow up was at 2 years. p ≤ 0.05 is considered statistically. Results: The patient rated wrist evaluation score for usual and specific activities and EQ-VAS for pain level showed statistically significant greater improvement in group A (42 ± 21%) compared to group B (19 ± 24%), (p = 0.37). Patients also had improvement in wrist movements with no statistically significant differences in both groups. The standard difference in means of all three functional scores was almost similar between both groups A and B (standard difference in means = 0.032; 95% CI 0.236–0.830; p = 0.495), considered clinically meaningful. Conclusion: This study results suggest autologous platelet-rich plasma injections seem to be safe, cost effective, efficacious algorithm treatment for reflex sympathetic dystrophy following distal radius fracture patients where previous treatments have failed. [ABSTRACT FROM AUTHOR]

Purpose: With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. Methods: A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score. Results: Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group. Conclusion: The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. It is clinically presented by nocturnal pain, paresthesia, and weakness in the distribution of the median nerve. However, extra-median symptoms may develop in some patients, particularly those with mild to moderate CTS. This raised the assumption of possible concomitant ulnar nerve entrapment at the wrist, or Guyon's canal syndrome (GCS). The aim of this study is to evaluate functional and structural changes that may take place in the ulnar nerve at the wrist in those patients. Methods: This is a retrospective case–control study that included forty patients with mild to moderate CTS and 40 matched subjects as a control group. Electrophysiological evaluation was done for all the participants in addition to measuring median and ulnar nerves sonographic parameters in the form of median cross-sectional area (m-CSA) at the level of pisiform bone, median flattening ratio (m-FR), median swelling ratio (m-SR), the difference between m-CSA at the inlet of the carpal tunnel and m-CSA at the distal third of the pronator quadratus (Δ m-CSA), as well as the ulnar cross-sectional area (u-CSA) at the same level. Results: The u-CSA was larger in the patients relative to the control (5.23 ± 1.21 mm2 versus 3.28 ± 0.64 mm2). It did not correlate with m-CSA. However, a statistically significant correlation was demonstrated between u-CSA and median motor conduction parameters (P ≤ 0.001). Conclusion: Although patients with mild to moderate idiopathic CTS may have normal electrophysiological parameters of the ulnar nerve, ultrasonographic evaluation is valuable to detect early ulnar nerve structural changes, which appear to be likely due to concomitant distal ulnar nerve entrapment at the Guyon's canal, which may contribute to the development of extra-median symptoms in those patients. [ABSTRACT FROM AUTHOR]

Purpose: Early diagnosis and treatment of scaphoid fractures is critical to achieve union and prevent wrist degenerative arthritis. Plain radiographic measurements can guide the early approach to suspected fractures. Specifically, the ability to predict fracture or fracture stability from plain radiographs may allow the traumatologist to expand initial referral to three-dimensional imaging. We evaluated the ability of four measured angles to predict presence of a scaphoid fracture and stability. Methods: Fifty patients with a scaphoid fracture and 50 patients without fracture were evaluated for the cortical ring sign, scapho-lunate gapping, lateral scapholunate (SL), radio-scaphoid (RS), radio-lunate (RL), and radio-capitate (RC) angles by two-blinded observers. Results: Measurement of an increased SL interval was associated with the presence of a scaphoid fracture as diagnosed on three-dimensional imaging [odds ratio (OR) 3.0, confidence interval (CI) 1.53–5.87, p = < 0.01]. The measured RL angle was associated with fracture displacement (OR 1.13, 95% CI 1.02–1.25, p = 0.02). Conclusions: Scapholunate gapping on plain radiographs in the context of a clinically suspected scaphoid fracture should increase suspicion for a fracture and may prompt earlier 3-dimensional imaging, while the presence of an abnormal radiolunate angle should increase wariness for instability and can be used in preoperative planning. [ABSTRACT FROM AUTHOR]

Purpose: Using palmar plating to treat complex intraarticular distal radius fractures is standard of care. However, fracture fragments can also be managed using a dorsal approach with arthrotomy, which is useful when treating fractures involving the dorsal joint aspect. We compared radiological and clinical outcomes after dorsal plating with or without an intraoperative arthrotomy. Methods: 31 of the 359 patients with a distal radius fracture had an AO Type 2R3 C3 fracture surgically treated using a dorsal approach (01/2015–10/2018). Fractures other than C3 were excluded from this analysis. Group 1 (n = 14) had no arthrotomy, Group 2 (n = 17) underwent intraoperative dorsal mini-arthrotomy. Clinical results were measured by range of motion (ROM), Patient-rated wrist evaluation (PRWE) and Disabilities of arm, shoulder and hand (DASH) scores. Radiological results were evaluated using the AO scoring system. Results: ROM, DASH and PRWE did not differ significantly between groups. Joint surface restoration was insufficient in five patients in Group 1 (p = 0.05). A trend towards better radiological results, although not statistically significant, was noted in Group 2 (p = 0.06). Plate removal was performed in 12 patients due to limited ROM (6 patients in each group). One patient (Group 2) with chronic pain and step off in the joint line underwent corrective osteotomy. Conclusions: We did not detect a difference in patient outcomes using the dorsal longitudinal mini-arthrotomy; however, it may prevent incongruent joint reconstruction since all cases occurred in Group 1. In the absence of intraoperative CT scan, longitudinal mini-arthrotomy may be used to enhance visualization and achieve joint surface reconstruction. [ABSTRACT FROM AUTHOR]

Background: Intramedullary nailing is the most preferred fixation method for diaphyseal radius and ulna fractures in the young age group. The aim of this study was to compare the dorsal and lateral entry points in the context of entry site-related complications, fracture union and functional results. Methods: This retrospective comparative study included pediatric patients who underwent surgery for isolated diaphyseal radius or both bone forearm fractures with intramedullary nailing using Kirschner wire between January 2013 and January 2019. K-wire was introduced from the distal radius through dorsal entry (Group A) in 19 patients and lateral entry (Group B) in 18 patients. The mean follow-up was 37 months. Complications were noted and functional outcomes were evaluated according to the CHOP criteria. Results: All fractures were healed. The functional results were determined to be excellent for 30, fair for 4, and poor for 3 patients. The overall complication rate was 18.9%, including distal radius fracture, mild pain in the wrist, and minor loss in ROM. No statistically significant differences were determined between the groups in respect of functional results and complication rates. Conclusion: Good functional results and similar complication rates can be obtained with both dorsal and lateral entry approaches. Stainless steel K-wire is an inexpensive intramedullary fixation implant option, which provides strong stabilization. Distal radius fracture is a newly reported complication for forearm intramedullary nailing. Leaving the implant out of the skin seems safe with the benefit of avoiding a further surgical intervention to extract the implant. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to investigate the clinical and radiological results of a hemi-hamate autograft arthroplasty method in patients with acute trauma who had a fragmented fracture of the proximal palmar joint surface of the middle phalanx and dorsal PIP subluxation. Methods: A total of 13 fingers from 13 patients who met the criteria were included in the study (11 men and 2 women) and prospectively reviewed. The mean age of the patients was 39.5 years. The mean interval between the injury and surgery was 6.3 days. The active movement of the DIP, PIP, MP and wrist joints was started on postoperative day. Follow-ups were performed at 6 weeks, 3, 6 and 12 months postoperatively. Range of motion for the DIP, PIP and MP joints, DASH and VAS scores, grip strength, two-point discrimination, finger pulp and palmar curve distance were evaluated. Results: All PIP joints were stable against coronal and sagittal stress at the 1st postoperative year and there was no limitation in wrist movements. Two-point discrimination was < 5 mm in all fingers. Union was achieved in all grafts except one. The mean active total PIP range of motion was 82.3°, DIP range of motion was 61.1°, MP joint motion was 87°. The mean DASH score was 7.6, and the mean VAS score was 1.5. The mean grip strength was 33.7 kg, which was 93% of the healthy side. The mean finger pulp and palmar curve distance was 8.6 mm. Conclusions: We believe that HHA is an appropriate alternative in cases of acute dorsal PIP fracture-dislocations with an intact middle phalanx dorsal cortex that is not suitable for primary fixation, with the advantages of obtaining stable joint and satisfactory functional results [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the results of reconstruction of the dorsal and palmar limbs of the scapholunate interosseous ligament in flexible static scapholunate instability using a slip of flexor carpi radialis tendon. Between June 2012 and August 2018, 13 patients with flexible static scapholunate instability underwent with this surgical technique. Mean patient age at surgery was 42 years. Average follow-up was 52, 8 months. The functional outcome postoperative according to Green and O'Brien was excellent in 1, good in 9 and regular in 3 patients. Postoperative disabilities of the arm, shoulder and hand and modified Mayo scores averaged were 9.02 and 80, respectively. At final follow-up, the radiographic findings demonstrated a significant decrease in scapholunate gap from 5 mm to 2, 5 mm and a significant improvement in scapholunate angle from 65° to 50°. Of the 13 patients, 10 were pain free and 3 had mild pain. Given the small number of cases, few conclusions can be drawn. However, results may be regarded as promising for this technique. [ABSTRACT FROM AUTHOR]

This study compared newly licensed drivers with and without autism spectrum disorder (ASD) and experienced drivers. Twenty new drivers (8 with ASD) and 16 experienced drivers completed the Driving Attitude Scale (DAS) and drove a simulator and an instrumented vehicle. Heart rate (HR), galvanic skin response (GSR), wrist movement, eye-gaze and driving performance were monitored. ASD drivers had more negative attitudes toward driving and greater change in HR, GSR and wrist movement. In a driving simulator, drivers with ASD scored lower than NT drivers and were rated less safe. There were fewer differences during on-road driving. Poorer driving and greater anxiousness in the new drivers with ASD indicates the need for a large-scale study of driving performance and apprehension to formulate remediation. [ABSTRACT FROM AUTHOR]

Objective: To describe the normal motion pattern at the midcarpal compartment during active radial-ulnar deviation of the wrist using dynamic MRI, and to determine the observer performance for measurements obtained in asymptomatic volunteers.Methods: Dynamic MRI of 35 wrists in 19 asymptomatic volunteers (age mean 30.4 years, SD 8.6) was performed during active radial-ulnar deviation using a fast gradient-echo pulse sequence with 315 ms temporal resolution (acquisition time, 19 s). Two independent readers measured the transverse translation of the trapezium at the scaphotrapezium joint (STJ) and the capitate-to-triquetrum distance (CTD). Relationships between these measurements and laterality, sex, lunate type, and wrist kinematic pattern were evaluated.Results: At the STJ, the trapezium moved most in radial deviation, with an overall translation of 2.3 mm between ulnar and radial deviation. Mean CTD measurements were the greatest in ulnar deviation and varied 2.4 mm between ulnar and radial deviation. Mean CTD was greater in men than women in the neutral position (p = 0.019), and in wrists with type II lunate morphology during radial and ulnar deviation (p = 0.001, p = 0.014). There were no significant differences in trapezium translation or CTD with wrist laterality and kinematic pattern. Intraobserver and interobserver correlation coefficients were 0.97 and 0.87 for trapezium translation and 0.84 and 0.67 for CTD.Conclusion: This study is the first to demonstrate the performance of dynamic MRI to quantify STJ motion and CTD. Dynamic MRI with a short acquisition time may be used as a tool to supplement static MRI in evaluation of the midcarpal compartment. [ABSTRACT FROM AUTHOR]

Background: Asymmetric vestibular function, decreased plantar sensation, postural control and functional ability have been associated with fall-related wrist fractures. Objective: To investigate whether multi-sensory training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT). Methods: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, age 50–75 years, were randomized to MST or WT. Pre- and post-training measurements: Head Shake Test (HST), Video-Head Impulse Test (vHIT), Semmes–Weinstein Monofilaments (SWF), Biothesiometer (BT), Sensory Organization Test (SOT), 10-m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities-Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). The training period was 12 weeks, with six supervised sessions by a physical therapist and daily home exercises for both groups. Results: There were significant endpoint differences in SOT (p = 0.01) between the two groups, in favor of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p = 0.04), FTSTS (p = 0.04), SWF (p = 0.04) and SOT scores (p = 0.04) than the WT. Conclusions: MST improves postural control among people with a fall-related wrist fracture. The results further suggest that the program is more effective for those with SOT balance scores below age-related norms. [ABSTRACT FROM AUTHOR]

Purpose: Optimal treatment of persistent radial nerve palsy is controversial. However, most authors agree that tendon transfers lead to satisfactory result in majority of patients. Triple tendon transfer using flexor carpi radialis, pronator teres, and palmaris longus is the most preferred tendon transfer. The aim of this study was to evaluate the results of a split flexor carpi ulnaris (FCU) as a single transfer in such patients and compare our results with other transfers from the available literature. Materials and Methods: A total of 25 patients (20 males and 5 females: mean age: 30.9 years) were selected for FCU split transfer in persistent radial nerve palsy injury from April 2014 to May 2015. All patients were followed up with a mean followup of 1 year. Clinical outcomes were assessed using Bincaz score. Results: Using Bincaz score, 68% of our patients had good-to-excellent result, while 32% patients had fair and none had bad results. Wrist extension was comparatively less in high radial nerve palsy as compared to low radial nerve palsy patients, but all patients were functionally independent. Power grip was assessed using a jammer dynamometer. All patients had adequate grip strength and good active extension of the wrist and fingers. Conclusion: Single transfer using split FCU can be a preferred alternative in patients of low radial nerve palsy, it can be considered for high radial nerve patients in whom multiple donors are absent due to the nature of injury, for example, brachial plexus injury. [ABSTRACT FROM AUTHOR]

The scapholunate ligament stabilizes the scaphoid and lunate of the proximal row in the wrist which allows for proper force transmission with the radius and ulna. Damage to this structure degenerates into arthritis and disability. Controversy exists over the best technique to restore function and reduce pain. A three-dimensional computational model of the wrist and hand was used to investigate the biomechanical effects of scapholunate ligament dissociation and its repair. The model replicated 3D bony anatomy, soft tissue structures, and muscle loading. The model predicted the increased instability caused by the injury, consistent with experimental and clinical evidence, and a return of more healthy kinematics with the repair. Changes to load transmission across the radiocarpal joints were noted with the injury, only some of which were mitigated by the repair. As better understanding of the biomechanics of the wrist joint is achieved, this model could prove to be an important tool to further investigate wrist mechanics and inform the effects of treatment options. Graphical abstract 3D computational model of all bones in the wrist/hand permitted simulation of five major motions-wrist flexion/extension, radial/ulnar deviation, and clenched fist. Shown are the array of tensile elements representing ligaments and capsule, as well as muscle force vectors for the desired motions. SL (scapholunate) separation (interval) predicted by the model for one motion compared well to an experimental study showing the instability induced by an injured (cut) SL ligament and returned stability by a clinical repair procedure, MBT (Modified Brunelli technique). [ABSTRACT FROM AUTHOR]

A 45-year-old man was frequently bothered by a weakness of the right hand, and it was difficult for him to do adduction of the thumb for half a year. According to his presentation, the patient held his child by the right upper limb with wrist flexion habitually for a year. Besides, there was an obvious atrophy of the hypothenar eminence. In MRI image, there were two lobulated cyst lesions in the Guyon's canal between the right hook of the hamate bone and the abductor digiti minimi muscle. During the surgery, the two lobulated cysts were in the Guyon's canal, and the ulnar nerve was compressed. Three weeks after the tumor excision, the weakness of the right hand improved dramatically, and the patient could perform adduction of the right thumb to pinch paper easily without flexion of the interphalangeal joint. [ABSTRACT FROM AUTHOR]

Background: Maximum stresses show critical points on an object because failure may start from the area close to maximum stress points. However, there appears no study on maximum loading points of carpal bones.Purpose: To clarify the loading pattern of each carpal bone during wrist movements.Methods: A finite element wrist model was designed using a three-dimensional reconstruction of computed tomographic images from the distal end of radius and ulna to the proximal third of metacarpals. Loading was performed in neutral, 45° of flexion and extension, 5° of radial and 25° of ulnar deviation, and maximum loading points were plotted.Results: In each position except for extension, minimum loads were carried by triquetrum, while minimum loads were carried by capitatum in extension. Maximum loads were carried by trapezium in neutral and ulnar deviation and flexion but by scaphoideum in radial deviation and extension.Conclusion: Studies on maximum loading of each bone are a new approach and may help to improve the knowledge on wrist mechanics. [ABSTRACT FROM AUTHOR]

Purpose: We compared the modulation of force steadiness by different types of electrical nerve stimulation in young (n = 13, 25 ± 4 years) and older (n = 12, 78 ± 5 years) adults.Methods: The protocol involved four types of isometric contractions with the wrist-extensor muscles at 10% of the maximal force. Three of the contractions involved electrical nerve stimulation that comprised two forms of neuromuscular electrical stimulation (NMES) to evoke muscle contractions and a voluntary contraction with superimposed transcutaneous electrical nerve stimulation (TENS) at an intensity less than motor threshold.Results: The coefficient of variation (CV) for force during voluntary wrist extension was less (P = 0.03) for young (1.82 ± 0.43%) than older adults (2.80 ± 1.08%). The CV for force did not differ between age groups during the three types of electrical nerve stimulation but was reduced relative to the value observed during voluntary wrist extension for older adults. In contrast, the CV for force increased during the voluntary contraction with superimposed TENS for young adults but not for older adults. Moreover, there were significant negative correlations in older adults between the CV for force during the voluntary contraction and its decrease with electrical nerve stimulation.Conclusion: Differences in the CV for force between the evoked and voluntary contractions for the two age groups suggest that the variance in common synaptic input to motor neurons during steady voluntary contractions with the wrist extensors is greater for older adults than young adults. [ABSTRACT FROM AUTHOR]

A mobilization hub inserted into an external fixator was developed for the treatment of fractures of the distal epimetaphysis of the radius bone. The hub was designed in a three-dimensional solid-body modeling system. Experimental prototypes were made of ABS plastic by 3D printing. Cadaver experiments showed that with the device carrying the mobilization hub, the range of movements was not statistically significantly different from the range of passive movements in the intact joint. The X-ray-transparent material used for the hub provides unimpeded visualization of the fracture site and wrist joint. Single use of the hub is proposed, as it can be made using inexpensive plastic and 3D printing, while batch production is by pressure casting. [ABSTRACT FROM AUTHOR]

Background: Tears of the triangular fibrocartilage complex (TFCC) can result in instability of the distal radioulnar joint (DRUJ) and ulnar-sided wrist pain. This study evaluates clinical results of arthroscopic transosseous repair for both proximal and distal components of TFCC tear with DRUJ instability. Materials and Methods: Ten patients who underwent both proximal component and distal component of TFCC repair were retrospectively reviewed. The proximal component of TFCC was repaired through arthroscopic one-tunnel transosseous suture technique, and the combined distal component tear was repaired to the ulnar capsule using same transosseous tunnel in all cases. Visual analog scale (VAS) score for pain, wrist range of motion, grip strength, and postoperative complications were evaluated after a mean followup period of 23.5 months, and each patient was rated according to modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) questionnaire. Results: On arthroscopic findings, the hook test confirmed the proximal component of the TFCC tear and visible capsular detachment from TFCC confirmed combined distal component tear in all patients. At final followup, 7 patients had normal stability of DRUJ and 3 patients showed mild laxity compared with the contralateral side. The mean VAS for pain perception decreased from 4.1 to 0.7, and grip strength was increased significantly. The modified Mayo wrist score and Quick DASH score showed significant functional improvement. No surgery-related complications occurred. Conclusions: Arthroscopic one-tunnel transosseous TFCC foveal repair and simulatneous transosseous capsular repair of distal component can be a safe and effective strategy for repair of complete TFCC tear combined with DRUJ instability. [ABSTRACT FROM AUTHOR]

For describing the state of the wrist, either the force or movement of wrist can be measured as the training target in the simultaneous electromyography control. However, the relationship between the force and movement is so complex that only the force or movement is not precise enough to describe its actual situations. In this paper, we propose a novel platform that can acquire three degrees of freedom (DOF) wrist motion/force synchronously with multi-channel electromyography signals in a hemi-constraint way. The self-made wrist force-movement mapping device establishes a stable relationship between the wrist movement and force. Meanwhile, the elicited wrist movement can be directly fed back to the subjects via laser cursor. The information of the cursor can directly reflect the 3-DOF movement of the wrist without any decoupling algorithms. Through this platform, the support vector regression model learned from the training data can well predict the arbitrary combinations of 3-DOF wrist movements. The cross-validation result indicates that the regression accuracy of free 3-DOF movements can reach a similar performance to that of 2-DOF regular movements (in terms of R2, regular movement vs. free movement, p > 0.1). Graphical abstract The hemi-constrained platform used for detecting 3-DOF wrist movements. [ABSTRACT FROM AUTHOR]

In daily life, a person's gait-an important marker for his/her health status-is usually assessed using inertial sensors fixed to lower limbs or trunk. Such sensor locations are not well suited for continuous and long duration measurements. A better location would be the wrist but with the drawback of the presence of perturbative movements independent of walking. The aim of this study was to devise and validate an algorithm able to accurately estimate walking cadence and speed for daily life walking in various environments based on acceleration measured at the wrist. To this end, a cadence likelihood measure was designed, automatically filtering out perturbative movements and amplifying the periodic wrist movement characteristic of walking. Speed was estimated using a piecewise linear model. The algorithm was validated for outdoor walking in various and challenging environments (e.g., trail, uphill, downhill). Cadence and speed were successfully estimated for all conditions. Overall median (interquartile range) relative errors were -0.13% (-1.72 2.04%) for instantaneous cadence and -0.67% (-6.52 6.23%) for instantaneous speed. The performance was comparable to existing algorithms for trunk- or lower limb-fixed sensors. The algorithm's low complexity would also allow a real-time implementation in a watch. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylalgia (LE) refers to pain at the lateral elbow and is associated with sensory and motor impairments that may impact on neuromuscular control and coordination. Objective: This review aimed to systematically identify and analyse the literature related to the comparison of neuromuscular control of forearm muscles between individuals with and without LE. Methods: A comprehensive search of electronic databases and reference lists using keywords relating to neuromuscular control and LE was undertaken. Studies that investigated electromyography (EMG) measures of forearm muscles in individuals with symptoms of LE were included if the study involved comparison with pain-free controls. The Epidemiological Appraisal Instrument was used to assess study quality. Data extracted from each study were used to calculate the standardised mean difference and 95 % confidence intervals to investigate differences between groups. Results: The search revealed a total of 1920 studies, of which seven were included from 44 that underwent detailed review. Due to differences in outcome measures and tasks assessed, meta-analysis was not possible. The seven included studies used 60 different EMG outcomes, of which 16 (27 %) revealed significant differences between groups. Two were properties of motor unit potentials during wrist extension. Four were measures of increased time between recruitment of wrist extensor muscles and onset of grip force. Seven were measures of amplitude of EMG during tennis strokes. Three were measures of motor cortex organisation. Conclusion: Features of neuromuscular control differ between individuals with LE and pain-free controls. This implies potential central nervous system involvement and indicates that rehabilitation may be enhanced by consideration of neuromuscular control in addition to other treatments. [ABSTRACT FROM AUTHOR]

The wrist is disposed to a variety of instability patterns owing to its complex anatomical and biomechanical properties. Various classification schemes have been proposed to describe the different patterns of carpal instability, of which the Mayo classification is the most commonly used. Understanding the concepts and pertinent terminology of this classification scheme is important for the correct interpretation of images and optimal communication with referring physicians. Standard wrist radiographs are the first line of imaging in carpal instability. Additional information may be obtained with the use of stress radiographs and other imaging modalities. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic tool handles causing wrist flexion and extension more than 15° from neutral are considered "at risk" for musculoskeletal strain. Therefore, this study measured the impact of laparoscopic tool handle angles on wrist postures and task performance.Methods: Eight surgeons performed standard and modified Fundamentals of Laparoscopic Surgery (FLS) tasks with laparoscopic tools. Tool A had three adjustable handle angle configurations, i.e., in-line 0° (A0), 30° (A30), and pistol-grip 70° (A70). Tool B was a fixed pistol-grip grasper. Participants performed FLS peg transfer, inverted peg transfer, and inverted circle cut with each tool and handle angle. Inverted tasks were adapted from standard FLS tasks to simulate advanced tasks observed during abdominal wall surgeries, e.g., ventral hernia. Motion tracking, video analysis, and modified NASA-TLX workload questionnaires were used to measure postures, performance (e.g., completion time and errors), and workload.Results: Task performance did not differ between tools. For FLS peg transfer, self-reported physical workload was lower for B than for A70, and mean wrist postures showed significantly higher flexion for in-line than for pistol-grip tools (B and A70). For inverted peg transfer, workload was higher for all configurations. However, less time was spent in at-risk wrist postures for in-line (47 %) than for pistol-grip (93-94 %), and most participants preferred Tool A. For inverted circle cut, workload did not vary across configurations, mean wrist posture was 10° closer to neutral for A0 than B, and median time in at-risk wrist postures was significantly less for A0 (43 %) than for B (87 %).Conclusion: The best ergonomic wrist positions for FLS (floor) tasks are provided by pistol-grip tools and for tasks on the abdominal wall (ventral surface) by in-line handles. Adjustable handle angle laparoscopic tools can reduce ergonomic risks of musculoskeletal strain and allow versatility for tasks alternating between the floor and ceiling positions in a surgical trainer without impacting performance. [ABSTRACT FROM AUTHOR]

Background: Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation.Methods: 21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis.Results: No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications.Conclusion: Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between video length for wrist arthroscopy and interobserver reliability.Materials and Methods: 100 consecutive wrist arthroscopies were documented by long and short videos of the radiocarpal and the midcarpal joints. The long videos were about twice as long as the short videos. They were presented randomly to two independent and blinded examiners. Their diagnoses were compared to the diagnoses made by the surgeon who performed the arthroscopies. Kappa coefficients were calculated.Results: Kappa statistics were inconsistent and did not show that the long video provided an obvious advantage over the short video. The Kappa coefficients of the two examiners for the assessment of the cartilage status were 0.524 and 0.700 for the long videos and 0.465 and 0.639 for the short videos, respectively. The examiners diagnosed twice as many false-positive cartilage lesions on short videos than on long videos. The assessment of ligament lesions was more accurate on long than on short videos.Conclusions: The results confirmed the hypothesis that the reproducibility of diagnoses based on video documents was influenced by the length of the video sequences. Therefore, it may be advisable for video documentation to be done diligently. The video sequence of the radiocarpal joint should last about 60 s, and that of a midcarpal joint should last about 45 s. Videos of difficult joints should last appropriately longer.Level Of Evidence: Diagnostic II. [ABSTRACT FROM AUTHOR]

Purpose: The scapholunate interossous ligament (SLIL) has a critical role in maintaining the proper kinematic relationship between the scaphoid and the lunate. We hypothesize that the length of SLIL changes significantly at wrist full extension and during forearm rotation. The aim of this study was to investigate the length changes of SLIL at wrist full extension and forearm rotation in vivo. Methods: Twelve volunteers were randomly divided to two groups. We obtained computed tomography scans of the wrists at different wrist positions. The three regions of the SLIL were measured and analyzed with computer modeling. Results: The results showed that from the neutral to full extension of the wrist, the length of volar SLIL and volar, middle portions of the proximal SLIL increased significantly. The volar and proximal SLIL increased significantly in maximal forearm pronation. Conclusions: The lengths of the volar and proximal regions of SLIL increase substantially at wrist full extension, but only slightly at maximal forearm pronation. Clinically, wrist full extension may make the SLIL ligament vulnerable to disruption. [ABSTRACT FROM AUTHOR]

The quick release method was used for measurement of Biomechanical parameters in the wrist joints. Wrist joint was previously studied in many researches for its biomechanical characteristics. However, more automation in measurement process has been discussed. In this research, a new test rig with a specified control unit was fabricated. Measurement of parameters in few seconds after the release was considered in the design of the new test rig. Based on reliability tests performed, the fabricated test rig showed firmly reliable measurements for maximum voluntary contraction, and active stiffness. These were true for both cases of left and right wrists during flexion and extension. [ABSTRACT FROM AUTHOR]

The homology of the 'semilunate' carpal, an important structure linking non-avian and avian dinosaurs, has been controversial. Here we describe the morphology of some theropod wrists, demonstrating that the 'semilunate' carpal is not formed by the same carpal elements in all theropods possessing this feature and that the involvement of the lateralmost distal carpal in forming the 'semilunate' carpal of birds is an inheritance from their non-avian theropod ancestors. Optimization of relevant morphological features indicates that these features evolved in an incremental way and the 'semilunate' structure underwent a lateral shift in position during theropod evolution, possibly as a result of selection for foldable wings in birds and their close theropod relatives. We propose that homeotic transformation was involved in the evolution of the 'semilunate' carpal. In combination with developmental data on avian wing digits, this suggests that homeosis played a significant role in theropod hand evolution in general. [ABSTRACT FROM AUTHOR]

Disorders of the flexor carpi radialis tendon (FCRt) are often missed even though they are a relatively frequent cause of volar radial wrist pain. They can manifest as tenosynovitis, tendinopathy, synovial sheath cysts with or without scaphoid-trapezoid-trapezium (STT) joint pathology, and partial or complete rupture. Because FCRt disorders often present with non-specific symptoms and a non-diagnostic clinical examination, imaging is often necessary for accurate evaluation and therapeutic planning. Conventional radiography provides good visualization of the neighboring bones and joints, as well as rare intratendinous calcifications. MRI enables evaluation of the FCRt and adjacent anatomical structures with excellent tissue resolution. In comparison, ultrasound (US) evaluation of the FCRt is less commonly described in the radiology literature, despite its affordability, exquisite soft tissue resolution, and the advantages of quick, dynamic diagnostic imaging. This pictorial essay describes and demonstrates the normal anatomy of the FCRt, its US examination technique and normal US appearance, and US findings of clinically relevant FCRt disorders. [ABSTRACT FROM AUTHOR]

Radial wrist pain is a common clinical complaint. The relatively complex anatomy in this region, combined with the small size of the anatomical structures and occasionally subtle imaging findings, can pose problems when trying to localize the exact cause of pain. To fully comprehend the underlying pathology, one needs a good understanding of both radial-sided wrist anatomy and the relative merits of the different imaging techniques used to assess these structures. In part I of this review, these aspects will be discussed. [ABSTRACT FROM AUTHOR]

Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment. [ABSTRACT FROM AUTHOR]

Pain on the radial side of the wrist is a common clinical presentation. Such wrist pain may provide a diagnostic challenge for radiologists, in view of the small size of the anatomic structures, the occasional subtlety of the imaging findings, the diversity of potential etiologies, as well as the non-infrequent occurrence of incidental asymptomatic findings in this area. This review discusses the imaging findings in both the more common and less common causes of radial-sided wrist pain, concentrating particularly on the detection of early disease and less readily apparent abnormalities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the clinical efficacy of using the proximal fibular graft for partial wrist arthrodesis or arthroplasty after the resection of giant cell tumours of the distal radius. Methods: Between February 2006 and August 2010, 14 patients (seven males, seven females; average age, 35.7 years) with grade II and III giant cell tumours of the distal radius were treated by tumour resection and autologous proximal fibular grafts to reconstruct the wrist in our hospital. Seven patients each were treated by wrist arthroplasty and partial wrist arthrodesis, and were followed up for 2.2-6.8 years (average, 3.9 years). Results: All patients achieved primary healing. No tumour recurrence was observed during follow-up in any of the patients. No statistically significant difference in forearm rotation was observed between patients undergoing the two different treatments. However, wrist flexion-extension activities were significantly better and the wrist grip strengths were significantly worse in the arthroplasty group than in the arthrodesis group. The Musculoskeletal Tumour Society score did not significantly differ between the groups. Conclusions: Overall, joint arthroplasty remains a favourable treatment with regard to the functional outcome for giant cell tumours of the distal radius; however, some of these patients may have a weaker grip strength. In comparison, partial wrist fusion appears to provide a durable and stable wrist with good long-term functional outcome. [ABSTRACT FROM AUTHOR]

An experiment was designed to determine the degree to which reducing movement amplitude (16°, 8°, to 4°) while keeping the relative accuracy requirements (IDs 1.5, 3, 4.5, and 6) and visual feedback display constant by increasing the display gain proportional to the decrease in amplitude (1×, 2×, 4×) influences reciprocal aiming movements of the wrist and arm. Research on smaller amplitude movements is limited and inconclusive, but these types of movement conditions are becoming increasingly more important as microsurgery and micro-mechanical applications increase. Participants were asked to flex/extend their limb/lever in the horizontal plane at the wrist (arm stabilized) or elbow joint (wrist stabilized) in an attempt to move back and forth between two targets as quickly and accurately as possible. The targets and current position of the limb were projected on the screen in front of the participant. Target width was manipulated with amplitude constant (16°, 8° or 4°). Results indicated that the linear relationship between MT and ID, typically observed for Fitts' tasks, was observed. There were moderate decreases in MT as amplitude was decreased but only for high ID movements. ID 6 movements at 4° amplitude, for example, were produced more quickly than at amplitude 16° without sacrificing end-point accuracy. The decrease in movement time was, however, related to increased dwell time and very low peak velocities. [ABSTRACT FROM AUTHOR]

In this paper, we proposed to utilize a novel spatio-spectral filter, common spatio-spectral pattern (CSSP), to improve the classification accuracy in identifying intended motions based on low-density surface electromyography (EMG). Five able-bodied subjects and a transradial amputee participated in an experiment of eight-task wrist and hand motion recognition. Low-density (six channels) surface EMG signals were collected on forearms. Since surface EMG signals are contaminated by large amount of noises from various sources, the performance of the conventional time-domain feature extraction method is limited. The CSSP method is a classification-oriented optimal spatio-spectral filter, which is capable of separating discriminative information from noise and, thus, leads to better classification accuracy. The substantially improved classification accuracy of the CSSP method over the time-domain and other methods is observed in all five able-bodied subjects and verified via the cross-validation. The CSSP method can also achieve better classification accuracy in the amputee, which shows its potential use for functional prosthetic control. [ABSTRACT FROM AUTHOR]

The interhemispheric interactions between homologous wrist extensor and flexor muscles representations in the right and left primary cortex (M1) were studied using a paired-pulse transcranial magnetic stimulation in healthy subjects. The magnitude of interhemispheric inhibition (IHI) was studied in 9 right-handed subjects at short (10 ms, SIHI) and long (40 ms, LIHI) interstimulus intervals between the magnetic conditioning (CS) and test stimulus in the motor dominant to non-dominant cortex and vice versa, while the right or left hand was at rest or performing a unimanual sustained tonic contraction (holding a pen with the hand contralateral to the CS). A bidirectional powerful interhemispheric inhibition could be elicited at the short and long IHI phases (SIHI and LIHI) in wrist extensor and flexor muscles in most of the subjects at rest. SIHI but not LIHI was significantly bidirectionally reduced during unimanual contraction of the hand contralateral to the CS stimulation in comparison with rest. The amount of IHI after the stimulation of the 'non-dominant' right hemisphere was not reduced in comparison with IHI after stimulation of the 'dominant' left hemisphere whatever the active or resting condition. IHI directed to the wrist muscles had a similar level than IHI directed to digit muscles (FDI) at rest. Our data indicate that contralateral wrist muscles activity evokes a global, bidirectional reduction in IHI which was more pronounced for SIHI. These results provide additional evidence that changes in interhemispheric interactions between the M1s are involved in the control of unimanual movements including suppression of unwanted motor activity in the opposite limb during unilateral movements. [ABSTRACT FROM AUTHOR]

Background: MRI is a sensitive tool for the evaluation of synovitis in juvenile idiopathic arthritis (JIA). Objective: The purpose of this study was to introduce a novel MRI-based score for synovitis in children and to examine its inter- and intraobserver variability in a multi-centre study. Materials and methods: Wrist MRI was performed in 76 children with JIA. On postcontrast 3-D spoiled gradient-echo and fat-suppressed T2-weighted spin-echo images, joint recesses were scored for the degree of synovial enhancement, effusion and overall inflammation independently by two paediatric radiologists. Total-enhancement and inflammation-synovitis scores were calculated. Results: Interobserver agreement was poor to moderate for enhancement and inflammation in all recesses, except in the radioulnar and radiocarpal joints. Intraobserver agreement was good to excellent. For enhancement and inflammation scores, mean differences (95 % CI) between observers were −1.18 (−4.79 to 2.42) and −2.11 (−6.06 to 1.83). Intraobserver variability (reader 1) was 0 (−1.65 to 1.65) and 0.02 (−1.39 to 1.44). Conclusion: Intraobserver agreement was good. Except for the radioulnar and radiocarpal joints, interobserver agreement was not acceptable. Therefore, the proposed scoring system requires further refinement. [ABSTRACT FROM AUTHOR]

Problems with accurate chronological age (CA) reporting occur on a more or less regular basis in youth sports. As a result, there is increasing discussion of age verification. Use of 'bone age' or skeletal age (SA) for the purpose of estimating or verifying CA has been used in medicolegal contexts for many years and also in youth sport competitions. This article reviews the concept of SA, and the three most commonly used methods of assessment. Variation in SA within CA groups among male soccer players and female artistic gymnasts is evaluated relative to the use of SA as a tool for verification of CA. Corresponding data for athletes in several other sports are also summarized. Among adolescent males, a significant number of athletes will be identified as older than a CA cutoff because of advanced skeletal maturation when they in fact have a valid CA. SA assessments of soccer players are comparable to MRI assessments of epiphyseal-diaphyseal union of the distal radius in under-17 soccer players. Both protocols indicate a relatively large number of false negatives among youth players aged 15-17 years. Among adolescent females, a significant number of age-eligible artistic gymnasts will be identified as younger than the CA cutoff because of later skeletal maturation when in fact they have a valid CA. There is also the possibility of false positives-identifying gymnasts as younger than the CA cutoff because of late skeletal maturation when they have a valid CA. The risk of false negatives and false positives implies that SA is not a valid indicator of CA. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine force steadiness in three positions of the forearm in young men and women across a variety of force levels. Eight young men and eight young women performed three maximum voluntary contractions (MVCs) in the neutral, supinated, and pronated forearm positions. Viewing a target line on a computer screen, subjects performed submaximal isometric contractions relative to their own MVC at 2.5, 5, 10, 25, 50, and 75% in each of the three forearm positions. Force steadiness was determined as the coefficient of variation (standard deviation around the mean force). A repeated-measures three-way ANOVA was used to assess the differences in force steadiness between sex, position, and force level. Men were stronger than women in all three forearm positions. Overall, men were steadier than women across all force levels and forearm positions. The neutral and supinated positions were equally strong and steady, and the pronated position was the weakest and least steady position. The forearm was most steady between 25 and 75% MVC, and least steady at the lower force levels. When correlations were run between MVC and coefficient of variation at all force levels and all forearm positions, a strong negative relationship was found (r = -0.49). In conclusion, men were stronger, as well as steadier, than women. The neutral and supinated forearm positions were both stronger and steadier than the pronated position. Results suggest that one of the primary factors influencing sex differences in force steadiness is absolute strength. [ABSTRACT FROM AUTHOR]

Using two photomultiplier tubes (PMT), we measured the biophoton emission of the left and right wrists simultaneously. The subjects performed hand-grip exercises with both hands, during the measurements. We found a slow increase of the emission rates during the exercises, rising in average from 51.6 cps (counts per second) to 72.3 cps and an immediate decrease after the ending of the exercises. Simultaneous measurement of the skin temperature near the wrist using a thermocouple showed steady increase of temperature even after the ending of the exercises. Thus we demonstrated manifestly that the biophoton has no correlation with body temperature changes. We proposed a hypothesis to account the increase of the biophoton due to muscular activity. The oxygen used by the respiratory chain is the main source of reactive oxygen species (ROS) and therefore must be one of the biophoton sources. To flesh out this hypothesis we compared our data to heart beat rates and oxygen consumption values measured while doing the same type of exercises. [ABSTRACT FROM AUTHOR]

Chronic alcohol abuse has adverse effects on skeletal muscle, and reduced muscle strength is frequently seen in chronic alcoholics. In this study the acute effects of moderate alcohol intoxication on motor performance was evaluated in 19 non-alcoholic healthy subjects (10 women, 9 men). A randomised double-blinded placebo controlled design was applied to subjects receiving alcohol in juice and pure juice at two separate test periods. Isokinetic and isometric muscle strength and endurance were determined before, during, 24 and 48 h after the ingestion of alcohol in juice and juice (placebo). To detect a reduced activation of the central motor pathways superimposed external electrical stimulations during voluntary contractions were applied. Creatine kinase (CK) was measured to detect any alcohol-induced changes in sarcolemmal integrity. No change was seen in isokinetic as well as in isometric muscle performance during or following the alcohol intoxication as compared to the non-alcoholic condition. Also, no central activation failure was observed. No significant difference in CK increment was observed comparing the alcoholic- and non-alcoholic condition. In conclusion, a single episode of moderate alcohol intoxication (1,4 g/l) does not impair motor performance, and no accelerated exercise-induced muscle damage is seen. [ABSTRACT FROM AUTHOR]

This study compared cardiovascular responses to static extension and flexion exercises at four upper and lower limb joints. Eight males performed a 2 min static contraction at 30% of maximal voluntary torque followed immediately by 2 min post-exercise muscle ischaemia (PEMI) using each of four joints: the wrist, elbow, ankle, and knee. In the PEMI, an occlusion cuff placed around the proximal portion of the exercising muscle was inflated to 250 mmHg immediately before the cessation of exercise. Mean arterial pressure (MAP), heart rate (HR), calf blood flow, and calf vascular conductance (CVC) in the non-exercised calf were measured. There was a significant interaction for direction of movement (extension vs. flexion) and limb (upper vs. lower) in HR and CVC during both exercise and PEMI; extension in the wrist and elbow evoked a greater increase in HR and a greater decrease in CVC than flexion, whereas flexion in the ankle and knee elicited a greater increase in HR and a greater decrease in CVC than extension. These results suggest that the cardiovascular responses to extension and flexion differ between arms and legs, partly arising from the activation of the muscle metaboreflex. [ABSTRACT FROM AUTHOR]

A four-channel impedance measurement system, including a two-channel goniometer, to analyse human arm movement, was constructed. Impedances and joint angles were simultaneously measured for wrist and elbow movements. As the impedance changes resulting from wrist and elbow movements depended heavily on electrode placement, the optimum electrode configurations for those movements were determined by searching for high correlation coefficients, large impedance changes and minimum interferences in ten subjects (age: 29 +/- 6 years). The optimum electrode configurations showed very strong relationships between the wrist joint angle and forearm impedance (correlation coefficient= 0.95 +/- 0.04) and between the elbow joint angle and upper arm impedance (correlation coefficient= -0.97 +/- 0.03). Although the measured impedance changes of the wrist (1.1 +/-1.5 ohms) and elbow (-5.0 +/-2.9 ohms) varied between individuals, the reproducibilities of wrist and elbow impedance changes of five subjects were 5.8 +/- 1.8% and 4.6 +/- 1.4% for the optimum electrode pairs, respectively. It is proposed that this optimum electrode configuration would be useful for future studies involving the accurate measurement of arm movements by the impedance method. [ABSTRACT FROM AUTHOR]

In the present paper the current clinical knowledge about proprioception is given for the shoulder, knee, ankle, elbow and the radiocarpal joint. Proprioceptive capabilities are decreased after joint injuries such as ACL or meniscus tears, shoulder dislocation, ankle sprain and in joints with degenerative joint disease. Some surgical procedures seem to restore the proprioceptive abilities; others do not. Elastic knee bandages or ankle braces increase different proprioceptive factors like ankle reproduction capability or sports-specific abilities. The present information on proprioception will influence our clinical practice in the future. We should choose surgical procedures that not only reconstruct the anatomy, but also the neurophysiologic feed-back mechanism. [ABSTRACT FROM AUTHOR]

Background: The migraine brain seems to undergo cyclic fluctuations of sensory processing. For instance, during the preictal phase, migraineurs experience symptoms and signs of altered pain perception as well as other well-known premonitory CNS-symptoms. In the present study we measured EEG-activation to non-painful motor and sensorimotor tasks in the different phases of the migraine cycle by longitudinal measurements of beta event related desynchronization (beta-ERD). Methods: We recorded electroencephalography (EEG) of 41 migraine patients and 31 healthy controls. Each subject underwent three EEG recordings on three different days with classification of each EEG recording according to the actual migraine phase. During each recording, subjects performed one motor and one sensorimotor task with the flexion-extension movement of the right wrist. Results: Migraine patients had significantly increased beta-ERD and higher baseline beta power at the contralateral C3 electrode overlying the primary sensorimotor cortex in the preictal phase compared to the interictal phase. We found no significant differences in beta-ERD or baseline beta power between interictal migraineurs and controls. Conclusion: Increased preictal baseline beta activity may reflect a decrease in pre-activation in the sensorimotor cortex. Altered pre-activation may lead to changes in thresholds for inhibitory responses and increased beta-ERD response, possibly reflecting a generally increased preictal cortical responsivity in migraine. Cyclic fluctuations in the activity of second- and third-order afferent somatosensory neurons, and their associated cortical and/or thalamic interneurons, may accordingly also be a central part of the migraine pathophysiology. [ABSTRACT FROM AUTHOR]

In this paper, a virtual rehabilitation training system based on electroencephalogram (EMG) feedback is proposed to solve the problem that the existing virtual rehabilitation training methods can not reflect the initiative of patients and lack of individual adaptability. Aiming at the EEG data fusion rehabilitation system based on Virtual Prototyping technology, a motion pattern recognition method based on the feature fusion of EEG and EMG signals is studied to improve the accuracy and flexibility of the rehabilitation training system. The corresponding virtual rehabilitation training scene is designed, and the control and feedback adjustment of the virtual scene are realized by using the above EEG feature analysis method. Finally, the virtual rehabilitation training is realized. The multi-level coupling relationship between EEG and EMG signals under different grip forces was explored by using the synchronous coupling characteristics between EEG and EMG signals, which provided a theoretical basis for further application in clinical rehabilitation evaluation. [ABSTRACT FROM AUTHOR]

In recent years, the total number of physical therapists is increasing in Japan. However, it is not sufficient to nurse of patients requiring long-term care. In order to cope with the shortage of manpower, it is desirable to develop the rehabilitation equipment. This paper describes the development of a wearable wrist rehabilitation training device using the parallel link mechanism. It is possible to train the translational and rotational motion of the wrist joint by the adoption of parallel links. Training of the translational motion of the wrist joint has not been discussed in existing methods. Therefore, compared to existing methods, this method can be expected to reduce the burden on the wrist joint. And it is possible to move about 60% of the wrist joint movable range of motion. This device performs repetitive training to prevent contracture of the wearer’s joints. In experiments, assumed wrist circumduction motion was trained to the six subjects. The correlation coefficient between the target trajectory and the training result was obtained and evaluated whether correct operation was trained. The validity of the proposed method was demonstrated. [ABSTRACT FROM AUTHOR]