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A flexible conducting lossy shield is developed and demonstrated for a reduction in the back radiation of a linearly polarized X-band patch antenna for Wireless Body Area Network (WBAN) applications. The proposed structure comprises a flexible patch antenna backed by a laminated sheet of Expanded Graphite (EG). This flexible sheet is prepared from EG powder pressed uniformly over a thin adhesive tape. The conducting nature of EG is exploited, and the EG sheet is used as a protective shield to prevent back radiation emanating out of the WBAN antenna from propagating toward the human body. The antenna performance is tested over human wrist phantoms experimentally and through full wave simulation studies. The results indicate the marginal variation in the −10 dB impedance bandwidth with a slight increase in the gain and directivity values for a resonant frequency in the range 9.7–10.3 GHz (bending radius variation of 40, 30, and 20 mm and along two bending planes). A measured on-body gain of 6.7 dBi is exhibited by the antenna backed by the EG shield and bent over a 20 mm radius human wrist phantom with an S11 of −19 dB, a −10 dB % bandwidth of 8%, and a directivity of 9.4 dBi. All the other bending configurations exhibit values higher than these. Electric field and Specific Absorption Rate (SAR) studies reveal a reduction in wave penetration by the EG shield antenna inside the wrist phantom with a decrease in the SAR by a maximum of 5%. The measured front-to-back ratio values indicate the lowering of back radiation with a maximum average increase of 76% exhibited by an EG backed antenna. The developed EG shield has an additional advantage of being a standalone structure, which can be integrated with any wearable antenna for a possible reduction in the back radiation. [ABSTRACT FROM AUTHOR]

The severe mismatch between solid bioelectronics and dynamic biological tissues has posed enduring challenges in the biomonitoring community. Here, we developed a reconfigurable liquid cardiac sensor capable of adapting to dynamic biological tissues, facilitating ambulatory cardiac monitoring unhindered by motion artifacts or interference from other biological activities. We employed an ultrahigh-resolution 3D scanning technique to capture tomographic images of the skin on the wrist. Then, we established a theoretical model to gain a deep understanding of the intricate interaction between our reconfigurable sensor and dynamic biological tissues. To properly elucidate the advantages of this sensor, we conducted cardiac monitoring alongside benchmarks such as the electrocardiogram. The liquid cardiac sensor was demonstrated to produce stable signals of high quality (23.1 dB) in ambulatory settings.

Context: Imbalances in upper-extremity soft tissue stiffness may play a role in the development of shoulder and elbow musculoskeletal injuries in tennis players. Ultrasound shear wave elastography provides quantifiable and specific data regarding muscle stiffness. The purpose of this study was to compare tendon and muscle stiffness in healthy tennis players to nontennis players. Design: Cross-sectional study. Methods: The shear wave modulus, measured in kilopascals, was obtained for the dominant pectoralis major, pectoralis minor, and common wrist-extensor tendon using 2-dimensional shear wave elastography ultrasound imaging (GE Logiq S8, L9 linear transducer). Independent t test was run to compare age, body mass index, and the activity index score between both groups. Within-day intrarater reliability was assessed using a within-examiner intraclass correlation coefficients (ICC [3, 1]) with 95% confidence intervals. A multivariate general linear model was run to compare the mean differences between the tennis and nontennis players for each of the soft tissues. Results: Twenty-six individuals (13 tennis players and 13 nontennis players) were recruited. Within-day ICCs were very good (ICC >.78 for the pectoralis musculature) and excellent (ICC >.94 for the common wrist extensor). Common extensor tendon stiffness was significantly higher in tennis players compared to nontennis players (mean difference = 114.8 [61.8], confidence interval, −22.8 to 252.5 kPa for the dominant arm [P =.039]). Mean pectoralis major and minor stiffness differences were not significant (P >.214). Conclusions: Common wrist-extensor stiffness in healthy recreational tennis players is higher than those who do not play tennis. Therefore, clinicians may need to facilitate a greater soft tissue stiffness response with resistance training when rehabilitating recreational tennis players as compared to those not playing tennis. Additional normative data on a larger sample of recreational tennis players should be collected. [ABSTRACT FROM AUTHOR]

Joint absence in people with upper-limb-difference leads to compensatory motions. Such compensation has long been a topic of study, but typically only for a single object/user layout, which is unlikely to spatially generalize. We seek to understand how motion varies over a planar workspace for different target orientations and wrist mobility conditions. We therefore present a study that records arm and torso pose during grasping of 49 equally spaced cylindrical targets. Furthermore, we seek to validate the research practice of using wrist-immobilizing bypass sockets on able-bodied participants to simulate prostheses without wrists. Participants were 2 transradial amputees and 7 able-bodied individuals who conducted the study with and without wrist braces, generating 2450 trajectories. Heat-maps illustrate variation over the workspace in Mean Joint Angle, Range of Joint Motion and Distance Travelled by Body Segment. Results indicate that greater wrist restriction primarily exacerbated shoulder internal rotation and elbow flexion, not the trunk. We observed that bypass sockets do not fully simulate amputee behavior. Furthermore, amputee reaching with their intact limb is different to the reaching motion of normative participants, implying that transradial limb-difference affects both sides of the body. Differences in participant behavior were also observed between horizontal and vertical target orientations.

Purpose: To examine the effectiveness of wrist orthoses in reducing pain in individuals with carpal tunnel syndrome. Materials and methods: The searches were carried out in the CINAHL, Cochrane Library, EMBASE, Regional Portal of the Virtual Health Library, PubMed, Scopus, and Web of Science databases on 18 February 2021, and updated on 16 February 2023. Four independent evaluators performed the steps for inclusion of studies following the recommendations of the PRISMA and methods of the Cochrane Handbook for systematic review. Results: Three randomized clinical trials, two quasi-randomized clinical trials and one cohort study met the inclusion criteria. The visual analogue scale and numeric analog scale were used as a tool to assess pain outcome. The treatment period ranged from 2 weeks to 3 months. The period of use varied between nighttime only, and nighttime plus daytime. Most orthoses promoted a statistically significant reduction in intensity pain at night, at rest or during activities. Only one study carried out follow-up after the end of treatment and showed that pain reduction was maintained up to 6 months after treatment. Conclusions: The findings suggest that the isolated use of orthoses were effective in reducing pain in individuals with carpal tunnel syndrome. IMPLICATIONS FOR REHABILITATION: Orthoses are effective in reducing pain in individuals with carpal tunnel syndrome. Orthoses can be used nighttime or nighttime plus daytime according to the necessity. Prefabricated orthosis may represent lower cost and greater accessibility. Pain reduction can be maintained up to 6 months after the end of treatment. [ABSTRACT FROM AUTHOR]

Wrist and hand biomechanics under full-body load are not fully understood. To identify potential anatomy-related differences in hand loading, 15 former collegiate athletes completed a 45-second handstand on a novel emed® pressure platform system. Center of pressure (CoP) and force distribution across the palmar surface were analysed during the stabilised phase. Maximum force, mean pressure, and contact area were calculated in four palmar anatomic subregions: hypothenar, thenar, metacarpals, and fingers. These values were related to ulnar variance measurements obtained from a participant handstand hold in a weight-bearing computed tomography machine. About 93% of participants shifted their CoP towards their dominant hand (p  <  0.001), and among all participants, the dominant hand applied an average of 8.91% (p  =  0.002) higher maximum force than the nondominant hand. The proportion of total mean force was highest in the hypothenar (47.1%) and thenar regions (36.5%). Every 1.00 mm increase in ulnar variance corresponded to a 2.8% increase in maximum force in the hypothenar region (p = 0.037). This investigation emphasises the role of gymnastics hand dominance on left/right hand weight distribution and the importance of the hypothenar zone in distributing pressure during handstands. It also indicates that force transmission through the wrist to the palm is contingent on radioulnar positioning. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate whether the anticipation of a mechanical perturbation applied to the arm during a reach-to-grasp movement elicits anticipatory adjustments in the reach and grasp components. Additionally, we aimed to evaluate whether anticipatory adjustments in the upper limb might be global or specific to the direction of the perturbation. Methods: Thirteen healthy participants performed reach-to-grasp with perturbations randomly applied to their dominant limb. Participants were presented with three types of trials: unperturbed (control), trials perturbed in a predictable manner (either Up or Down), or perturbed in a partially predictable manner (knowledge about the perturbation but not its specific direction). EMG activity of 16 muscles, as well as the kinematics of wrist, thumb, and index finger, were acquired and analyzed. Results and discussion: When the perturbation was expected, EMG activity of the triceps and pectoralis major muscles significantly increased about 50 – 200 ms before the perturbation onset. Peak acceleration of the reach was significantly higher and occurred earlier relative to control trials. Similar adjustments were observed in the grasp kinematics, reflected as significantly shorter time to peak aperture velocity and acceleration, as well as in increased activity of flexor and extensor digitorum 100–200 ms before perturbation onset. In summary, our data demonstrate that knowledge of an upcoming perturbation of reach during reach-to-grasp action triggers anticipatory adjustments not only in the muscles controlling the reach component, but also in those controlling grasp. Furthermore, our data revealed that the preparatory activations were generalized, rather than direction specific. [ABSTRACT FROM AUTHOR]

In two experiments, we explored whether cross-modal cues can be used to improve foraging for multiple targets in a novel human foraging paradigm. Foraging arrays consisted of a 6 × 6 grid containing outline circles with a small dot on the circumference. Each dot rotated from a random starting location in steps of 30°, either clockwise or counterclockwise, around the circumference. Targets were defined by a synchronized rate of rotation, which varied from trial-to-trial, and there were two distractor sets, one that rotated faster and one that rotated slower than the target rate. In Experiment 1, we compared baseline performance to a condition in which a nonspatial auditory cue was used to indicate the rate of target rotation. While overall foraging speed remained slow in both conditions, suggesting serial scanning of the display, the auditory cue reduced target detection times by a factor of two. In Experiment 2, we replicated the auditory cue advantage, and also showed that a vibrotactile pulse, delivered to the wrist, could be almost as effective. Interestingly, a visual-cue to rotation rate, in which the frame of the display changed polarity in step with target rotation, did not lead to the same foraging advantage. Our results clearly demonstrate that cross-modal cues to synchrony can be used to improve multitarget foraging, provided that synchrony itself is a defining feature of target identity. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the joint, racket, and ball kinematics between the different levels of male tennis players in tennis serve-return at slow and high serve speeds. Thirty male tennis players were divided into an advanced group (n = 15) and an intermediate group (n = 15) based on skill level. The advanced group and intermediate group matched shake hand-grip players performed serve-receive test at the different serve speeds. Kinematic data were collected on the trunk, upper limbs, racket and ball to compare the differences between the advanced and intermediate groups at different serve speeds. At both serve speeds, the AG has faster racket speed and ball speed, and is closer to the baseline placement (p<0.05). It is characterized by a faster trunk turn, greater speed with the shoulder joint forward and outward and greater angle of wrist flexion and extension during the stroke (p<0.05), and greater speed with the forearm inward and internal rotation during the follow-through swing, at the same time, there is a difference in the angle of the racket to the ground between the advanced group and an intermediate group(p<0.05). Elbow internal rotation and abduction angular velocity in the backswing phase, Timing of peak racket resultant velocity and Wrist extension in the stroke phase, and shoulder and elbow joint activities in the follow-through phase were significantly correlated with the ball speed of the return. With faster serve speeds, higher quality serve-receive can be achieved by shortening the duration of the backswing lifting the upper arm and rotating the forearm inward quickly, accelerating the speed of movement of wrist joints at the impact phase, adjusting the speed of shoulder adduction and elbow internal rotation to complete the follow-through swing. These findings help to improve elite players' serve-receive skills at faster serve speed. [ABSTRACT FROM AUTHOR]

Introduction: wrist ligament injuries and triangular fibrocartilage complex (TFCC) lesions are common but often underdiagnosed conditions causing chronic wrist pain. The diagnostic challenge necessitates a combination of clinical examination, imaging studies, and arthroscopy, considered the gold standard. Ligament injuries, particularly scapholunate ligament (SL), and TFCC lesions account for significant wrist instability and ulnar-sided wrist pain, respectively. Material and methods: this retrospective observational study, conducted at Hospital Ángeles Pedregal, Mexico City, aimed to assess the diagnostic accuracy of wrist magnetic resonance imaging (MRI) compared to arthroscopic findings. The sample included patients with clinical suspicion of wrist ligament or TFCC lesions who underwent both wrist MRI and arthroscopy. Clinical examination maneuvers were also evaluated. The study assessed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each diagnostic modality. Results: arthroscopic evaluation, considered the gold standard, revealed a high prevalence of TFCC and scapholunate ligament lesions (96.6% and 96.6%, respectively). Sensitivity for TFCC lesions on MRI was 71.4%, with 100% specificity. For ligament injuries (SL, lunotriquetral, and radioscapholunate), sensitivities ranged from 21.4% to 60.7%, with 100% specificity. Clinical examination showed higher sensitivity (29.2% to 89.3%) but lower specificity (0% to 100%) compared to MRI. Conclusion: wrist MRI remains the non-invasive imaging choice, although discrepancies exist between MRI and arthroscopic findings, emphasizing the need for careful interpretation. Clinical examination enhances sensitivity but lacks specificity. The study highlights the ongoing challenge in achieving optimal diagnostic accuracy for wrist ligament and TFCC lesions, emphasizing the importance of a multimodal diagnostic approach. [ABSTRACT FROM AUTHOR]

Electromyography (EMG) stands out as an accessible and inexpensive method for identifying muscle contractions on the surface and within deeper muscle tissues. Using specialized electronic circuits for amplification and filtering can help develop simple but effective systems for detecting and analyzing these signals. However, EMG devices developed by research teams frequently lack rigorous methodologies for validating the quality of the signals they record compared to those obtained by commercial systems that have undergone extensive testing and regulatory approval for market release. This underscores the critical need for standardized validation techniques to reliably assess the performance of experimental devices relative to established commercial equipment. Hence, this study introduces a methodology for the development and statistical validation of a laboratory EMG circuit compared with a professional device available on the market. The experiment simultaneously recorded the muscle electrical activity of 18 volunteers using two biosignal acquisition devices—a prototype EMG and a commercial system—both applied in parallel at the same recording site. Volunteers performed a series of finger and wrist extension movements to elicit myoelectric activity in these forearm muscles. To achieve this, it was necessary to develop not only the EMG signal conditioning board, but also two additional interface boards: one for enabling parallel recording on both devices and another for synchronizing the devices with the task programmatically controlled in Python that the volunteers were required to perform. The EMG signals generated during these tasks were recorded simultaneously by both devices. Subsequently, 22 feature indices commonly used for classifying muscular activity patterns were calculated from two-second temporal windows of the recordings to extract detailed temporal and spatial characteristics. Finally, the Mean Absolute Percentage Error (MAPE) was computed to compare the indices from the prototype with those from the commercial device, using this method as a validation system to assess the quality of the signals recorded by the prototype relative to the commercial equipment. A concordance of 87.6% was observed between the feature indices calculated from the recordings of both devices, suggesting high effectiveness and reliability of the EMG signals recorded by the prototype compared to the commercial device. These results validate the efficacy of our EMG prototype device and provide a solid foundation for the future evaluation of similar devices, ensuring their reliability, accuracy, and suitability for research or clinical applications. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions This study investigated wrist joint degeneration after curettage and PMMA treatment for giant cell bone tumours (GCBT) at the distal radius.We performed a retrospective single‐centre study, which included 23 patients with GCBT at distal radius treated with curettage and PMMA between 2001 and 2021. The progression of wrist joint degeneration was assessed through radiographic evidence, comparing the postoperative grade with both the preoperative grade and the grade of the contralateral wrist at the latest follow‐up. We also analyzed the influence of age, sex, tumour distance of the joint, subchondral bone involvement, tumour size and body mass index.The study included 23 patients with a mean age of 32.1 ± 13.3 years. The average duration of follow‐up was 96.4 ± 69 months (range, 24–265 months). The mean tumour–cartilage distance was 1.79 ± 2.4 mm (range, 0–10 mm) and the mean BMI was 23.5 ± 3.8 kg/m2. Degeneration of the wrist joint was evident in 16 patients (69.6%) at the final assessment, however, 10 patients (43.4%) were identified as having a progression of joint degeneration secondary to the surgical procedure among the 16 patients with wrist joint degeneration at the final control view. Age, gender, dominance, tumour–cartilage distance, subchondral bone involvement, tumour size, patient height, weight, and BMI were not associated with secondary joint degeneration.Ten of 23 patients developed wrist joint degeneration over an average follow‐up period of 8 years, and no particular factors associated with the degeneration were identified. [ABSTRACT FROM AUTHOR]

Background: Determining the optimal number of dry needling (DN) sessions to satisfactorily treat a stroke patient with spasticity is important from both clinical and economic perspective. Objective: To explore the effects of one versus three sessions of DN on spasticity of the wrist flexors and motor recovery after stroke. Methods: In this single-blind randomized clinical trial, 24 patients were randomly and equally divided into two groups: one group received one session of DN, while the other group received three sessions of DN in one week. Both groups received one minute of DN of the flexor carpi radialis and flexor carpi ulnaris. The outcome measures were the Modified Modified Ashworth Scale (MMAS), passive resistance torque (PRT), wrist active and passive extension range of motion (ROM), and the Brunnstrom Stages of Stroke Recovery (BSSR) measured before, immediately after, and one week after the last DN session. Results: Both groups demonstrated a significant improvement in all outcomes (p <.05). The MMAS scores in both groups meaningfully improved (p <.001). No significant differences were found between the two groups; however, a significant time-by-group interaction was observed for the PRT (p =.02; Cohen's d = 0.23–0.73), wrist active extension ROM (p =.001; Cohen's d = 0.37–0.67), and wrist passive extension ROM (p =.02; Cohen's d = 0.32–1.30). The BSSR significantly improved from 3 to 4 in both groups (p <.001). Conclusion: Administering three sessions of DN can effectively improve spasticity and motor function after stroke. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of concurrent physical and cognitive demands as well as age on indicators of muscle fatigue at the wrist. Background: There are few studies examining risk indicators for musculoskeletal disorders associated with work-related physical and cognitive demands that often occur simultaneously in the workplace. Methods: Twenty-four gender-balanced older and 24 gender-balanced younger (mean age 60 and 23 years) participants performed four 30 min dual tasks. Tasks differed by the muscular load level during force tracking: 5% and 10% of maximum voluntary contraction force (MVC) and concurrent cognitive demands on the working memory: easy and difficult. Muscle fatigue was assessed by MVC decline and changes in surface electromyography (increased root mean square: RMS, decreased median frequency: MF) at the extensor digitorum (ED) and extensor carpi ulnaris (EU). Results: A decline in MVC was found in all participants when tracking was performed at 10% MVC (mean ± SD: 137.9 ± 49.2 – 123.0 ± 45.3 N). Irrespective of age, muscular, or cognitive load, RMS increased (ED 12.3 ± 6.5 – 14.1 ± 7.0% MVE, EU 15.4 ± 7.6 – 16.9 ± 8.6% MVE) and MF decreased (ED 85.4 ± 13.6 – 83.2 ± 12.8 Hz, EU 107.2 ± 17.1 – 104.3 ± 16.7 Hz) in both muscles. However, changes in MF of EU tended to be more pronounced in the older group at higher cognitive and lower muscular load, without reaching statistical significance. Conclusion: Maximum voluntary contraction indicated no interaction between muscle fatigue, cognitive load, or age. However, the tendencies toward altered muscle activity due to an increase in cognitive load and older age suggest muscular adaptations while maintaining tracking performance during the onset of fatigue signs in the sEMG signal. Application: If the tendencies in muscle activity are confirmed by further studies, ergonomic assessments in industrial workplaces should consider cognitive load and age when describing the risk of musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

InterCriteria analysis (ICrA) and two kinds of correlation analyses, Pearson (PCA) and Spearman (SCA), were applied to surface electromyography (sEMG) signals obtained from human arm movements in the horizontal plane. Ten healthy participants performed ten movements, eight of which were cyclic. Each cyclic movement (CM) consisted of flexion and extension phases with equal duration (10 s, 6 s, 2 s, and 1 s) and two 5 s rest poses between them. The CMs were performed with and without an added load of 0.5 kg on the wrists of the participants. The sEMG signals from six different muscles or separate muscle heads (m. deltoideus pars clavicularis, m. deltoideus pars spinata, m. brachialis, m. anconeus, m. biceps brachii, and m. triceps brachii long head) were recorded and used to compare the results of the ICrA, PCA, and SCA. All three methods found identical consonance pairs for the flexion and extension CM phases. Additionally, PCA detected two more consonance pairs in the extension phases. In this investigation, ICrA, PCA, and SCA were proven to be reliable tools when applied separately or in combination for sEMG data. These three methods are appropriate for researching arm movements in the horizontal plane and experimental protocol revision. [ABSTRACT FROM AUTHOR]

Background: Heart rate (HR) is a critical biomarker that provides insights into overall health, stress levels, and the autonomic nervous system. Pulse wave signals contain valuable information about the cardiovascular system and heart status. However, signal acquisition in wearables poses challenges, particularly when using electrical sensors, due to factors like the distance from the heart, body movement, and suboptimal electrode placement. Methods: Electrical bioimpedance (EBI) measurements using bipolar and tetrapolar electrode systems were employed for pulse wave signal acquisition from the wrist in both perpendicular and distal configurations. Signal preprocessing techniques, including baseline removal via Hankel matrix methods, normalization, cross-correlation, and peak detection, were applied to improve signal quality. This study describes the combination of sensor-level signal acquisition and processing for accurate wearable HR estimation. Results: The bipolar system was shown to produce larger Δ Z (t) , while the tetrapolar system demonstrated higher sensitivity. Distal placement of the electrodes yielded greater Δ Z (t) (up to 0.231 Ω) when targeting both wrist arteries. Bandpass filtering resulted in a better signal-to-noise ratio (SNR), achieving 3.6 dB for the best bipolar setup and 4.8 dB for the tetrapolar setup, compared to 2.6 and 3.3 dB SNR, respectively, with the Savitzky–Golay filter. The custom HR estimation algorithm presented in this paper demonstrated improved accuracy over a reference method, achieving an average error of 1.8 beats per minute for the best bipolar setup, with a mean absolute percentage error (MAPE) of 8%. Conclusions: The analysis supports the feasibility of using bipolar electrode setups on the wrist and highlights the importance of electrode positioning relative to the arteries. The proposed signal processing method, featuring a preprocessing pipeline and HR estimation algorithm, provides a proof-of-concept demonstration for HR estimation from EBI signals acquired at the wrist. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the downsides of surgical treatment of scaphoid fracture nonunion in patients with minor preoperative symptoms. Patients were classified with minor symptoms based on the Patient-Rated Hand/Wrist Evaluation questionnaire. Of the 35 included patients, most patients encountered problems with patient-specific activities; 9% reported worse postoperative functional outcomes, 34% were not satisfied with the treatment and 9% were reoperated. The risk of a worse functional outcome after surgery with the need for further operations and the chance of developing wrist osteoarthritis, along with the possibility of poor patient satisfaction and ongoing daily functional impairment, should be considered during preoperative counselling. Level of evidence: III [ABSTRACT FROM AUTHOR]

BACKGROUND: De Quervain's tenosynovitis is upper-limb disorder, more frequent in women. It is rarely recognized as an occupational disease. OBJECTIVE: In this paper we reported work related de Quervain's tenosynovitis in cow milker. METHODS: Ergonomic risk factors were assessed by utilizing assessment of repetitive tasks (ART) of the upper limbs method. Physical examination and imaging exams were used. RESULTS: We presented a 36-year-old female agricultural worker (workplace cow milker) exposed to work factors (forceful hand/wrist exertions, repetition, extreme postures) for 14 years. She was suffering the pain in the right hand, mainly near the thumb for few years. She was treated conservatively and surgically, however disability was permanent. Clinical examination showed slight edema of the right hand, increased palm's sweating. Patient had reduced range of movements and grip strength. CONCLUSIONS: Report shows that work-related factors were strongly associated with diagnosed de Quervain's tenosynovitis. Hand function plays an essential role in carrying out activities of daily living and this disorder pose a relevant burden of disease. Exposure to biomechanical factors should be an important initial target for the prevention of De Quervain's tenosynovitis in the working population. [ABSTRACT FROM AUTHOR]

Persistent symptoms of lateral epicondylitis prompt patients to seek effective conservative treatment. The study aimed to determine the effects of focused shock wave (FSWT) and ultrasound therapies for lateral epicondylitis. Sixty patients with tennis elbow were randomly divided into three equal groups: A, B, and C. Group A received a total of 3 FSWT sessions, with 7 days between treatments; Group B received ultrasound therapy in 10 sessions over 2 weeks, while patients in Group C were treated with placebo ultrasound. All patients were also given deep friction massage. Before the start of therapy, and at 1, 3, 6, and 12 weeks after its completion, pain intensity and function of the affected upper limb were assessed in all patients. Wrist extensor and flexor strength and grip strength were measured in the affected and unaffected limb. Significant reductions in pain and significant improvements in the function of the affected limb compared to baseline values were observed in all study groups at 6 and 12 weeks after the completion of therapy. Analysis of percentage changes in these variables showed significant differences between Groups A and B in favor of Group A. The strength of wrist extensors and grip strength of the affected limb at 6 and 12 weeks after treatment completion was significantly higher in Groups A and B compared to pre-therapy values. However, there were no statistically significant differences between the groups regarding percentage changes in muscle strength in the affected limb. Pain reduction and function improvement in patients with lateral epicondylitis were significantly greater after FSWT (0.2 mJ/mm2 / 4 Hz / 2000 shocks) than after sonotherapy (3 MHz / 0.5 W/cm2 / 20%). Increases in wrist extensor strength and grip strength of the affected limb were comparable after both therapies. Given the greater therapeutic effect in the subjective evaluation, we recommend a combination therapy of FSWT with deep friction massage. Trial registration The trial was prospectively registered in the ISRCTN registry (no. ISRCTN11907358 registration date 30.07.2020). [ABSTRACT FROM AUTHOR]

Frozen shoulder (FS) is a common shoulder condition accompanied by shoulder pain and a loss of shoulder range of motion (ROM). The typical clinical assessment tools such as questionnaires and ROM measurement are susceptible to subjectivity and individual bias. To provide an objective evaluation for clinical assessment, this study proposes an inertial measurement unit (IMU)-based identification system to automatically identify shoulder tasks whether performed by healthy subjects or FS patients. Two groups of features (time-domain statistical features and kinematic features), seven machine learning (ML) techniques, and two deep learning (DL) models are applied in the proposed identification system. For the experiments, 24 FS patients and 20 healthy subjects were recruited to perform five daily shoulder tasks with two IMUs attached to the arm and the wrist. The results demonstrate that the proposed system using deep learning presented the best identification performance using all features. The convolutional neural network achieved the best identification accuracy of 88.26%, and the multilayer perceptron obtained the best F1 score of 89.23%. Further analysis revealed that the identification performance based on wrist features had a higher accuracy compared to that based on arm features. The system's performance using time-domain statistical features has better discriminability in terms of identifying FS compared to using kinematic features. We demonstrate that the implementation of the IMU-based identification system using ML is feasible for FS assessment in clinical practice. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study investigated factors influencing the prevalence of musculoskeletal disorders (MSDs) resulting from agricultural work, utilizing the 2020 and 2022 occupational disease survey data collected by the Rural Development Administration. The combined data from these years indicated a 6.02% prevalence of MSDs, reflecting a significant class imbalance in the binary response variables. This imbalance could lead to classifiers overlooking rare events, potentially inflating accuracy assessments. Methods: We evaluated five distinct models to compare their performance using both original and synthetic data and assessing the models' performance based on synthetic data generation. In the multivariate logistic model, we focused on the main effects of the covariates as there were no statistically significant second-order interactions. Results: Focusing on the random over-sampling examples (ROSE) method, gender, age, and pesticide use were particularly impactful. The odds of experiencing MSDs were 1.29 times higher for females than males. The odds increased with age: 2.66 times higher for those aged 50–59, 4.60 times higher for those aged 60–69, and 7.16 times higher for those aged 70 or older, compared to those under 50. Pesticide use was associated with 1.26 times higher odds of developing MSDs. Among body part usage variables, all except wrists and knees were significant. Farmers who frequently used their necks, arms, and waist showed 1.27, 1.11, and 1.23 times higher odds of developing MSDs, respectively. Conclusions: The accuracy of the raw method was high, but the ROSE method outperformed it for precision and F1 score, and both methods showed similar AUC. [ABSTRACT FROM AUTHOR]

Wrist function is a top priority for transradial amputees. However, the combined functional, biomechanical, and cognitive impact of using a powered prosthetic wrist is unclear. Here, we quantify task performance, compensatory movements, and cognitive load while three transradial amputees performed a modified Clothespin Relocation Task using two myoelectric prostheses with and without the wrists. The two myoelectric prostheses include a commercial prosthesis with a built-in powered wrist, and a newly developed inexpensive prosthetic wrist for research purposes, called the "Utah wrist", that can be adapted to work with various sockets and prostheses. For these three participants, task failure rate decreased significantly from 66% ± 12% without the wrist to 39% ± 9% with the Utah wrist. Compensatory forward leaning movements also decreased significantly, from 24.2° ± 2.5 without the wrist to 12.6° ± 1.0 with the Utah wrist, and from 23.6° ± 7.6 to 15.3° ± 7.2 with the commercial prosthesis with an integrated wrist. Compensatory leftward bending movements also significantly decreased, from 20.8° ± 8.6 to 12.3° ± 5.3, for the commercial with an integrated wrist. Importantly, simultaneous myoelectric control of either prosthetic wrist had no significant impact on cognitive load, as assessed by the NASA Task Load Index survey and a secondary detection response task. This work suggests that functional prosthetic wrists can improve dexterity and reduce compensation without significantly increasing cognitive effort. These results, and the introduction of a new inexpensive prosthetic wrist for research purposes, can aid future research and development and guide the prescription of upper-limb prostheses. [ABSTRACT FROM AUTHOR]

Tactile stimulation has been shown to increase auditory loudness judgments in listeners. This bias could be utilized to enhance perception for people with deficiencies in auditory intensity perception, such as cochlear implant users. However, several aspects of this enhancement remain uncertain. For instance, does the tactile stimulation need to be applied to the hand or body, or can it be applied to the wrist? Furthermore, can the tactile stimulation both amplify and attenuate the perceived auditory loudness? To address these questions, two loudness-matching experiments were conducted. Participants matched a comparison auditory stimulus with an auditory reference, either with or without spectro-temporally identical tactile stimulation. In the first experiment, fixed-level tactile stimulation was administered to the wrist during the comparison stimulus to assess whether perceived auditory loudness increased. The second experiment replicated the same conditions but introduced tactile stimulation to both the reference and comparison, aiming to investigate the potential decrease in perceived auditory loudness when the two tactile accompaniments were incongruent between the reference and comparison. The results provide evidence supporting the existence of the tactile loudness bias in each experiment and are a step towards wrist-based haptic devices that modulate the auditory dynamic range for a user. [ABSTRACT FROM AUTHOR]

Currently, as an increasing number of people have been addicted to using cellular phones, smartphone tenosynovitis has become common from long-term use of fingers for their operations. Hand exercise while playing video games, which is called exergame, can be a good solution to provide enjoyable daily exercise opportunities for its prevention, particularly, for young people. In this paper, we implemented a simple exergame system with a hand gesture recognition program made in Python using the Mediapipe library. We designed three sets of hand gestures to control the key operations to play the games as different exercises useful for tenosynovitis prevention. For evaluations, we prepared five video games running on a web browser and asked 10 students from Okayama and Hiroshima Universities, Japan, to play them and answer 10 questions in the questionnaire. Their playing results and System Usability Scale (SUS) scores confirmed the usability of the proposal, although we improved one gesture set to reduce its complexity. Moreover, by measuring the angles for maximum wrist movements, we found that the wrist flexibility was improved by playing the games, which verifies the effectiveness of the proposal. [ABSTRACT FROM AUTHOR]

(1) Background: The advancement of technologies has made morphological assessment rapid and reliable. A combination of 3D body scanning (3D-BS) and bioelectrical impedance (BIA) could be essential in monitoring the morphological status of athletes and the general population and their symmetries for coaches, researchers and medical professionals. (2) Methods: The current study presents the use of Inbody-720 BIA and 3D-BS NX-16 for analyzing the asymmetry profile of an athlete in 2 min on a sample of 106 male judo competitors from the following age categories: older boys—U14 (N = 24), younger cadets—U16 (N = 31), cadets—U18 (N = 17), juniors—U21 (N = 19) and seniors (N = 15). Variables observed were arm lean mass, upper arm, elbow, forearm and wrist girth, leg lean mass, thigh length, thigh, knee and calf girth. The paired sample t-test, asymmetry index (AI) and Kruskal–Wallis analysis were used at p ≤ 0.05; (3) Results: Morphological asymmetries were detected in all age categories: seniors—three, U21—four, U18—three, U16—five and U14—four. The most common asymmetrical variable in all categories was the forearm girth, while thigh length, knee girth and upper arm girth presented symmetrical variables in all age categories. AI showed that the size of the asymmetries did not differentiate between the age groups. (4) Conclusions: The current study demonstrated great potential for combining BIA and 3D-BS for rapid asymmetry detection that would allow for monitoring and quick adjustments to the training process in youth to senior age categories. [ABSTRACT FROM AUTHOR]

Purpose: Step count is an intuitive measure of physical activity frequently quantified in health-related studies; however, accurate step counting is difficult in the free-living environment, with error routinely above 20% in wrist-worn devices against camera-annotated ground truth. This study aimed to describe the development and validation of step count derived from a wrist-worn accelerometer and assess its association with cardiovascular and all-cause mortality in a large prospective cohort. Methods: We developed and externally validated a self-supervised machine learning step detection model, trained on an open-source and step-annotated free-living dataset. Thirty-nine individuals will free-living ground-truth annotated step counts were used for model development. An open-source dataset with 30 individuals was used for external validation. Epidemiological analysis was performed using 75,263 UK Biobank participants without prevalent cardiovascular disease (CVD) or cancer. Cox regression was used to test the association of daily step count with fatal CVD and all-cause mortality after adjustment for potential confounders. Results: The algorithm substantially outperformed reference models (free-living mean absolute percent error of 12.5% vs 65%–231%). Our data indicate an inverse dose–response association, where taking 6430–8277 daily steps was associated with 37% (25%–48%) and 28% (20%–35%) lower risk of fatal CVD and all-cause mortality up to 7 yr later, compared with those taking fewer steps each day. Conclusions: We have developed an open and transparent method that markedly improves the measurement of steps in large-scale wrist-worn accelerometer datasets. The application of this method demonstrated expected associations with CVD and all-cause mortality, indicating excellent face validity. This reinforces public health messaging for increasing physical activity and can help lay the groundwork for the inclusion of target step counts in future public health guidelines. [ABSTRACT FROM AUTHOR]

The aim of this study is to determine the maximum loss of median and ulnar nerve substances that can be treated by direct suture in elbow flexion and to quantify this elbow flexion. The other objective is to determine the participation of the wrist position in this direct suture in elbow flexion. We performed an experimental study on 6 ulnar nerve lesions and 6 median nerve lesions. For each defect, a direct tensionless suture was performed with elbow flexion and in three different positions of the wrist (wrist extension, neutral position, and wrist flexion). A 90° elbow flexion allowed direct suturing of defects up to 40 mm in the 3 positions of the wrist. A bowstringing effect (i.e., increase of the perpendicular distance of the nerve from the axis of rotation of the elbow) was noted starting from 25 mm of nerve defect. Wrist extension placed tension on the nerve suture for both nerves. The results of this first anatomical study clarified the conditions for direct suturing of ulnar and median nerve defects in the flexed elbow position and flexed wrist position. This is an approach to consider for limited nerve defects to the elbow or when allograft harvesting is to be avoided. [ABSTRACT FROM AUTHOR]

This study introduces an innovative design for a Variable Stiffness 3 Degrees of Freedom actuated wrist capable of actively and continuously adjusting its overall stiffness by modulating the active length of non-linear elastic elements. This modulation is akin to human muscular cocontraction and is achieved using only four motors. The mechanical configuration employed results in a compact and lightweight device with anthropomorphic characteristics, making it potentially suitable for applications such as prosthetics and humanoid robotics. This design aims to enhance performance in dynamic tasks, improve task adaptability, and ensure safety during interactions with both people and objects. The paper details the first hardware implementation of the proposed design, providing insights into the theoretical model, mechanical and electronic components, as well as the control architecture. System performance is assessed using a motion capture system. The results demonstrate that the prototype offers a broad range of motion ([55, −45]° for flexion/extension, ±48° for radial/ulnar deviation, and ±180° for pronation/supination) while having the capability to triple its stiffness. Furthermore, following proper calibration, the wrist posture can be reconstructed through multivariate linear regression using rotational encoders and the forward kinematic model. This reconstruction achieves an average Root Mean Square Error of 6.6°, with an R2 value of 0.93. [ABSTRACT FROM AUTHOR]

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Gesture recognition using surface electromyography (sEMG) has garnered significant attention due to its potential for intuitive and natural control in wearable human–machine interfaces. However, ensuring robustness remains essential and is currently the primary challenge for practical applications. Methods: This study investigates the impact of limb conditions and analyzes the influence of electrode placement. Both static and dynamic limb conditions were examined using electrodes positioned on the wrist, elbow, and the midpoint between them. Initially, we compared classification performance across various training conditions at these three electrode locations. Subsequently, a feature space analysis was conducted to quantify the effects of limb conditions. Finally, strategies for group training and feature selection were explored to mitigate these effects. Results: The results indicate that with the state-of-the-art method, classification performance at the wrist was comparable to that at the middle position, both of which outperformed the elbow, consistent with the findings from the feature space analysis. In inter-condition classification, training under dynamic limb conditions yielded better results than training under static conditions, especially at the positions covered by dynamic training. Additionally, fast and slow movement speeds produced similar performance outcomes. To mitigate the effects of limb conditions, adding more training conditions reduced classification errors; however, this reduction plateaued after four conditions, resulting in classification errors of 22.72%, 22.65%, and 26.58% for the wrist, middle, and elbow, respectively. Feature selection further improved classification performance, reducing errors to 19.98%, 19.75%, and 27.14% at the respective electrode locations, using three optimal features derived from single-condition training. Conclusions: The study demonstrated that the impact of limb conditions was mitigated when electrodes were placed near the wrist. Dynamic limb condition training, combined with feature optimization, proved to be an effective strategy for reducing this effect. This work contributes to enhancing the robustness of myoelectric-controlled interfaces, thereby advancing the development of wearable intelligent devices. [ABSTRACT FROM AUTHOR]

Shoulder injuries are a common problem in handball. One likely cause of such injuries is excessive throwing. However, it is difficult to measure the number of player throws in large cohort studies using existing methods accurately. Therefore, the purpose of this study is to develop and validate a method for identifying overhead throws using a low-cost inertial measurement unit (IMU) worn on the wrist. In a two-stage approach, we developed a threshold-based automatic identification method for overhead throws in a laboratory study using the IMU. Subsequently, we validated the suggested thresholds in a field setting by comparing throws identified by the threshold-method to throws identified by video recordings of handball practices. The best set of threshold values resulted in a per-player median sensitivity of 100% (range: 84–100%) and a median positive predictive value (PPV) of 96% (range: 86–100%) in the development study. In the validation study, the per-player median sensitivity dropped to 78% sensitivity (range: 52–91%), while the per-player median PPV dropped to 79% (range: 47–90%). The proposed method is a promising method for automatically identifying handball throws in a cheap and feasible way. [ABSTRACT FROM AUTHOR]

Planned actions can be triggered involuntarily by a startling acoustic stimulus (SAS), resulting in very short reaction times (RT). This phenomenon, known as the StartReact effect, is thought to result from the startle-related activation of reticular structures. However, other sensory modalities also can elicit a reflexive startle response. Here, we assessed the effectiveness of an intense startling electric stimulus (SES) in eliciting the StartReact effect as compared to a SAS. We tested SES intensities at 15 and 25 times the perceptual threshold of each participant, as well as SAS intensities of 114 dB and 120 dB. The electrical stimulation electrodes were placed over short head of the biceps brachii on the arm not involved in the task. Intense electric and acoustic stimuli were presented on 20% of the trials in a simple RT paradigm requiring a targeted ballistic wrist extension movement. The proportion of trials showing short latency (≤ 120 ms) startle reflex-related activation in sternocleidomastoid was significantly lower on intense electrical stimulus trials compared to intense acoustic trials, and the startle response onset occurred significantly later on SES trials compared to SAS. However, when a startle reflex was observed, RTs related to the prepared movement were facilitated to a similar extent for both SES and SAS conditions, suggesting that the accelerated response latency associated with the StartReact effect is independent of stimulus type. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to establish the correlation of clinically measured carrying angle with four radiological angles, i.e., Humerus–Elbow–Wrist angle (HEWA), Humero-ulnar angle, Metaphyseal–Diaphyseal angle, and Baumann's angle, and to find out which of the above-mentioned angles co-relates best with the clinically measured carrying angle. Methods: We studied 100 patients in the age group of 2–12 years after Ethics committee approval and informed consent from parents. Clinical angle was measured using goniometer and radiological angles marked on antero-posterior elbow X-ray using a standard method. Collected data were studied using statistical tests to find out correlation. Results: Pearson correlation coefficient for humerus–elbow–wrist angle found to be 0.674 followed by Humero-Ulnar angle (r = 0.417). Regression coefficient for humerus–elbow–wrist angle is 0.635 (p value < 0.001). Conclusion: Humerus–Elbow–Wrist angle correlates better compared to other radiological angles in assessment of varus–valgus angulations of elbow & will not only play a vital role in pre- operative planning of deformity corrections but also in the evaluation & comparison of the post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

The practice of a musical instrument requires fine dexterity, repetitive, fast, and precise movements, as well as important efforts to set the instrument into vibration, while adopting postures often unnatural for the human body. As a result, musicians are often subject to pain and musculoskeletal disorders. In the case of plucked string instruments and especially the concert harp, the plucking force is directly related to the strings' tension. Consequently, the choice of the strings has to be made based on both, the musician feel while playing, and the musculoskeletal consequences. This paper investigates how the string properties and the playing dynamics affect the finger and wrist muscle activity during harp playing. This study first emphasized the noteworthy recruitment of the flexor and extensor muscles (42% and 29% of MVC, respectively). Findings outlined further that the fingering choice, the adopted playing dynamics and the string's material govern the muscular activity level and the playing control. Such results are a first step to better understand how the harp ergonomics may affect the player's integrity and help them decide the most suitable stringing for their practice. [ABSTRACT FROM AUTHOR]

Pain is a challenge in persons with OI and causes much concern in the Osteogenesis Imperfecta (OI) population. We aim to evaluate the usability of the Nordic Musculoskeletal Questionnaire (NMQ) to identify painful sites in adults with OI and to describe the occurrence of musculoskeletal (MSK) pain and its impact on their work and daily activities. This cross-sectional pilot study uses the OI-NMQ to study MSK pain prevalence in nine separate anatomical regions (neck, upper back, lower back, shoulder, elbow, hand/wrist, hip, knee, and ankle/foot) and its impact on regular work and daily activities in adults with OI. The questionnaire was distributed among participants of the 2023 annual meeting of The Danish OI Society. The response rate was 68%, and all participants considered the OI-NMQ helpful in assessing the presence of pain and its consequences. The analysis included 27 adults with OI type I, III, or IV above 18 years. Among all 27 participants, MSK pain was present in 15–56% of the 9 sites within the last 7 days and 33–89% of the nine anatomical regions during the last 12 months. In 7–48% of all the participants, their regular work and daily activities had been affected by the presence of MSK pain. The OI-NMQ was feasible in assessing MSK pain among adults with OI and displayed a high prevalence of MSK pain with a moderate impact on their regular work and daily activities in this OI population. A larger and repeated measurement of MSK pain in adults with OI is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Ballistic shields protect users from a variety of threats, including projectiles. Shield back-face deformation (BFD) is the result of the shield deflecting or absorbing a projectile and deforming toward the user. Back-face deformation can result in localized blunt loading to the upper extremity, where the shield is supported by the user. Two vulnerable locations along the upper extremity were investigated—the wrist and elbow—on eight postmortem human subjects (PMHS) using a pneumatic impacting apparatus for investigating the fracture threshold as a result of behind shield blunt trauma (BSBT). Impacting parameters were established by subjecting an augmented WorldSID anthropomorphic test device (ATD) positioned behind a ballistic shield to ballistic impacts. These data were used to form the impact parameters applied to PMHS, where the wrist most frequently fractured at the distal radius and the elbow most frequently fractured at the radial head. The fracture threshold for the wrist was 5663±1386 N (mean±standard deviation), higher than the elbow at 4765±894 N (though not significantly, p = 0.15). The failure impact velocity for wrist impacts was 17.7±2.1 m/s, while for the elbow, the failure impact velocity was 19.5±0.9 m/s. An approximate 10% risk of fracture threshold was identified on the modified WorldSID ATD (no flesh analogue included) to inform future protective standards. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate an artificial intelligence (AI) system for measuring and detecting signs of carpal instability on conventional radiographs. Materials and methods: Two case-control datasets of hand and wrist radiographs were retrospectively acquired at three hospitals (hospitals A, B, and C). Dataset 1 (2178 radiographs from 1993 patients, hospitals A and B, 2018–2019) was used for developing an AI system for measuring scapholunate (SL) joint distances, SL and capitolunate (CL) angles, and carpal arc interruptions. Dataset 2 (481 radiographs from 217 patients, hospital C, 2017–2021) was used for testing, and with a subsample (174 radiographs from 87 patients), an observer study was conducted to compare its performance to five clinicians. Evaluation metrics included mean absolute error (MAE), sensitivity, and specificity. Results: Dataset 2 included 258 SL distances, 189 SL angles, 191 CL angles, and 217 carpal arc labels obtained from 217 patients (mean age, 51 years ± 23 [standard deviation]; 133 women). The MAE in measuring SL distances, SL angles, and CL angles was respectively 0.65 mm (95%CI: 0.59, 0.72), 7.9 degrees (95%CI: 7.0, 8.9), and 5.9 degrees (95%CI: 5.2, 6.6). The sensitivity and specificity for detecting arc interruptions were 83% (95%CI: 74, 91) and 64% (95%CI: 56, 71). The measurements were largely comparable to those of the clinicians, while arc interruption detections were more accurate than those of most clinicians. Conclusion: This study demonstrates that a newly developed automated AI system accurately measures and detects signs of carpal instability on conventional radiographs. Clinical relevance statement: This system has the potential to improve detections of carpal arc interruptions and could be a promising tool for supporting clinicians in detecting carpal instability. Key Points: Artificial intelligence can accurately measure and detect signs of carpal instability on conventional radiographs. It measures scapholunate distances, scapholunate and capitolunate angles, and detects carpal arc interruptions. The measurement accuracy was largely comparable to five clinicians with different specialties, and the arc interruption detections were more accurate than most clinicians. All measurements and detections are explainable, and a new heat map technique was developed for visualizing the degree and location of carpal arc interruptions in the image. [ABSTRACT FROM AUTHOR]

Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. Key findings: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions. [ABSTRACT FROM AUTHOR]

Ulnar-sided wrist pain remains a commonly encountered diagnostic challenge, and its successful management requires a comprehensive understanding of the multiple conditions that can present with this symptom. Midcarpal impaction syndromes in the form of Hamato-lunate and Triquetro-hamate impingement have both previously been reported as rare potential causes of ulnar-sided wrist pain. Despite this, they remain poorly recognized and incompletely understood. This article reviews existing literature that describes the diagnosis and management of these clinical entities. [ABSTRACT FROM AUTHOR]

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Recently, the electronic skin (E‐skin) based on triboelectric nanogenerators (TENGs) has exhibited enormous potential in smart sports. However, TENGs device installed on human body usually faces challenges in complex mechanical environments. Here, we proposed a flexible TPU/MXene/carbon conductive electrode and combined with PDMS to prepare triboelectric nanogenerator (PT‐TENG) to harvest mechanical energy. Moreover, to demonstrate the application of PT‐TENG in smart sports, we can use it to monitor the posture changes of human joints during Tai Chi exercise and heart rate. The transfer charge (Qsc) of PT‐TENG can arrive at 104.65 nC, which is superior to the output performance produced by using traditional metal aluminum foil to prepare TENG device. The PT‐TENG can obtain the maximum output power of 132.34 μW under the working frequency 2 Hz. The experimental results show that PT‐TENG installed on the fingers, wrists, and knees of the human body can effectively perceive the bending angle of joints, which is very meaningful for evaluating the posture of movements in Tai Chi training. This research provide an effective path to promote the application of the self‐powered E‐skin based on TENG device on the smart sport field. [ABSTRACT FROM AUTHOR]

Background: While living in a socially disadvantaged neighborhood is linked with numerous health outcomes, its effect on patient-reported outcome scores and diagnostic measures in carpal tunnel syndrome (CTS) is not fully understood. This study examines the effect of neighborhood socioeconomic deprivation on CTS severity as measured by the Boston Carpal Tunnel Questionnaire (BCTQ), 6-item Carpal Tunnel Symptoms Scale (CTS-6), and diagnostic testing modalities. Methods: This was a retrospective analysis of patients who presented to the hand clinic at a single hospital system with symptoms consistent with CTS. Ultrasound cross-sectional area (CSA) of the median nerve, CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ, and the Area Deprivation Index (ADI) national rank percentile were collected. Patients were grouped into 4 quartiles based on their ADI national percentile. Analyses of variance (ANOVAs) were conducted to test for statistical differences between the 4 quartiles based on the average values of median nerve CSA, CTS-6, SSS, and FSS score. The bottom quartile was compared with the upper 75% of the sample (26th-100th percentile) and to the upper quartile via Student t test. Statistical significance was set at P <.05. Results: Analyses of variance revealed no statistically significant differences between the 4 quartiles for either median nerve CSA, CTS-6, SSS, or FSS. When comparing the bottom quartile with the upper 75% of the sample and the upper quartile, no significant statistical differences were identified. Conclusions: No relationships were found between social deprivation (ADI) and patient-reported outcomes, CTS-6 scores, or median nerve CSA. [ABSTRACT FROM AUTHOR]

Background: Traumatic hand and wrist amputations are rare but debilitating injuries. Surgical replantation of the hand provides a unique alternative to revision surgery but requires appropriate access to necessary medical resources. This study aims to understand the national practice of replantation of traumatic hand amputation and to determine whether disparities exist in accessing surgical treatment. Methods: International Classification of Diseases, 10th Revision codes for replantation and revision amputation surgeries were used to gather data from the National Inpatient Sample from 2016 to 2019. Summary statistics were calculated on demographic, hospital, and outcome variables, with subanalysis performed for effect on replantation and revision rates. Results: Seventy-two patients were identified. The average patient was 35 years old with a strong male predominance (90%). The racial distribution of the cohort roughly mirrored the demographic proportions of race in the US population. Fifteen (21%) patients underwent replantation. This rate was similar between sexes, races, and income brackets. Hand replantation was primarily performed at large bed size (87%), private not-for-profit (73%), and urban teaching hospitals (94%). The most common insurance status for these patients was private, followed by Medicaid, Medicare, and self-pay. Forty-seven patients underwent revision amputation (65%) with no association between demographic characteristics. The patients remained hospitalized for significantly longer periods (P =.0188) and paid significantly more (P =.0014) if replanted. The patients were most frequently discharged home (65%), followed by skilled nursing facilities (18%). Conclusion: This study describes the current state of hand amputation management and finds no evidence of sociodemographic factors influencing the surgical care provided. [ABSTRACT FROM AUTHOR]

Background: Dorsal spanning plate fixation can be used to treat comminuted distal radius fractures not amenable to volar plating. However, there is a relative paucity of outcomes data; so, the aim of this retrospective study was to investigate outcomes and complications after dorsal spanning plate fixation for distal radius fractures. Methods: Distal radius fractures treated with dorsal spanning plate fixation at a level-1 trauma center were retrospectively identified via Current Procedural Terminology coding and chart review from 2014 to 2019. Patient demographics, fracture pattern characteristics, fixation techniques, and clinical outcomes were all obtained via chart review using the electronic medical record. Results: In all, 43 dorsal plates were identified out of 369 operatively treated distal radius fractures (12%). Of these, 84% were AO type C, 28% were open fractures, and 86% resulted from falls. At the time of dorsal plating, 28% had an additional procedure. One patient had a major complication after surgery, requiring unplanned surgery for a radius nonunion. Average final follow-up occurred 9 weeks after dorsal plate removal, with mean range of motion at the wrist measuring: 36° flexion, 48° extension, 75° pronation, and 63° supination. Finger flexion was also measured, using either tip of finger to palm distance or total active motion, depending on the available data. These were measured at an average of 1.2 cm and 194°, respectively. Conclusions: Dorsal spanning plate fixation provides a safe and effective method for treating complex distal radius fractures. In our series, patients had good functional outcomes with few complications. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the characteristics of concomitant distal radius and scaphoid fractures and determine outcome differences of operative and nonoperative management. Methods: A retrospective search of a level-1 trauma center's database over a 15-year period (2007-2022) for concomitant distal radius and scaphoid fractures in adult patients was completed. In all, 31 cases were reviewed for mechanism of injury, method of fracture management, distal radius fracture AO Foundation/Orthopaedic Trauma Association classification, scaphoid fracture classification, time to radiographic scaphoid union, time to motion, and other demographics. A multivariate statistical analysis was completed comparing outcomes in operative versus conservative management of the scaphoid fracture in these patients. Outcomes were defined as time to radiographic union and time to motion. Results: In all, 22 cases of operative fixation of the scaphoid and 9 cases of nonoperative management of the scaphoid were reviewed. One case of nonunion was identified in the operative group. Operative management of scaphoid fractures resulted in a statistically significant reduction in time to motion (2-week reduction) and time to radiographic union (8-week reduction). Conclusions: This study demonstrates that operative management of scaphoid fractures in the setting of a concomitant distal radius fracture reduces the time to radiographic union and time to clinical motion. This suggests that operative management is ideal in patients who are good candidates for surgery and desire earlier return of motion. However, conservative management should be considered, as nonoperative care showed no statistical difference regarding union rates of scaphoid or distal radius fractures. [ABSTRACT FROM AUTHOR]

Local vibration (LV) mainly stimulates primary afferents (Ia) and can induce a tonic vibration reflex (TVR) and an illusion of movement. This study aimed to evaluate the effect of these two phenomena on maximal voluntary isometric contraction (MVIC) capacity. LV (80 Hz) was applied to the wrist flexor muscles in two randomized experiments for 6 min. LV conditions were adjusted to promote either TVR (visual focus on the vibrated wrist) or ILLUSION [hand hidden, visual focus on electromyographic activity of the flexor carpi radialis muscle (FCR)]. Mechanical and electromyographic (EMG) responses of the FCR and extensor carpi radialis muscles were recorded during MVIC in flexion and extension and during electrically evoked contractions at supramaximal intensity. Measurements were performed before (10 min and just before) and after (0 and 30 min) LV protocol. An increase in FCR EMG was observed during LV in the TVR condition (+340%) compared with the illusion condition (P = 0.003). In contrast, the movement illusion was greater in the ILLUSION condition (assessed through subjective scales) (P = 0.004). MVIC was reduced in flexion only after the TVR condition (≈ − 7 % , all P < 0.034). Moreover, the decrease in force was correlated with the amount of TVR recorded on the FCR muscle (r = −0.64, P = 0.005). Although potentiated doublets of each muscle did not evolve differently between conditions, a decrease was observed between the first and the last measure. In conclusion, when conducting research to assess maximal strength, it is necessary to have better control and reporting of the phenomena induced during LV. NEW & NOTEWORTHY: The maximal force production of the vibrated muscle is reduced after 6 min of LV only in TVR condition. Furthermore, the amount of TVR is negatively correlated with this force decrease. When measuring the effects of LV on maximal force production, it is important to control and report any phenomena induced during vibration, such as TVR or movement illusion, which can be achieved by recording EMG activity of vibrated muscle and quantifying illusion. [ABSTRACT FROM AUTHOR]

The triangular fibrocartilaginous complex is made of multiple components, of which the palmar and dorsal radioulnar ligaments play an important role in distal radioulnar joint stability. The ulnar wrist ligaments may be injured during forearm and wrist trauma. There are several aspects of triangular fibrocartilaginous complex management that are still open to debate. The aim of the present study was to review the current concepts and discuss emerging trends to better elucidate and treat this important ligament complex. Level of evidence: V [ABSTRACT FROM AUTHOR]

We investigated outcomes of clinic-based hand therapy combined with a home-based exercise programme after anterior plating for distal radial fractures. A total of 102 patients were randomly assigned to one of three groups: a home-based exercise programme alone; a home-based exercise programme combined with four hand therapy sessions in the clinic; and a home-based exercise programme with seven sessions in the clinic. Mean Patient-Rated Wrist Evaluation scores at 6 weeks were significantly better for the group of patients with seven sessions in the clinic than in those with only home exercises (12 vs. 30), but the difference was no longer significant at 12 weeks. Grip strength was significantly better at 6 and 12 weeks. Combined home- and clinic-based hand therapy may facilitate an earlier return of function after anterior plating for distal radius fractures. Level of evidence: II [ABSTRACT FROM AUTHOR]

Background: Ehlers-Danlos syndrome (EDS) is a hereditary disease characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Hypermobile EDS (hEDS is the more frequent subtype. Joint surgery may benefit certain patients after failure of medical treatments, but there is no consensus on the optimal surgical management of patients with hEDS. The aims of this retrospective study were to chart the surgical management of patients with hEDS, to determine the role of arthroscopy and to evaluate the functional results of joint surgery, including the reintervention rates. Results: A total of 69 patients with non-vascular EDS were evaluated (60 female; 87%). Mean (SD) age at first surgery was 25.6 ± 11.1 years. Among the 69 patients, first surgeries were carried out on the knee (n = 50; 39.4%), ankle (n = 28; 22.0%), shoulder (n = 22; 17.3%), wrist (n = 18; 14.2%) and elbow (n = 9; 7.1%). One-fifth of all first operations (20.8%) were carried out by arthroscopy, most often on the knee (36% of knee surgery cases). At the time of primary surgery, the surgeon was alerted to the diagnosis or suspicion of hEDS in only 33.9% of patients. The rate of reoperations (2 to ≥ 5) was 35.7% (10/28) for the ankle, 40.9% (9/22) for the shoulder, 44.4% (4/9) for the elbow, 50% (9/18) for the wrist and 60% (30/50) for the knee. Local or regional anaesthesia was badly tolerated or ineffective in 27.8%, 36.4% and 66.6% of operations on the wrist, shoulder and elbow, respectively. Overall, the majority of patients (> 70%) were satisfied or very satisfied with their surgery, particularly on the non-dominant side. The lowest satisfaction rate was for shoulder surgery on the dominant side (58.3% dissatisfied). Conclusions: Surgery for joint instability has a greater chance of success when it is carried out in patients with a known diagnosis of EDS before surgery. The majority of patients were satisfied with their surgery and, with the exception of the knee, there was a low rate of reoperations (≤ 50%). Arthroscopic procedures have an important role to play in these patients, particularly when surgery is performed on the knee. [ABSTRACT FROM AUTHOR]