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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.

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]

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]

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]

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]

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: 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]

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]

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]

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]

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Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Objectives Methods Results Conclusions Preschooler physical activity (PA) is vital for growth and development. The World Health Organization PA guidelines state preschoolers should achieve ≥ 180 min/day of Total PA (TPA) of which ≥ 60 min is moderate‐to‐vigorous PA (MVPA). A step/day recommendation to match these guidelines may be a more practical metric for caregivers to promote PA. The purpose of our investigation is to improve upon existing step recommendations by creating one for indoor‐based activities, acknowledging where preschoolers spend most of their time, and various cut‐points for PA.In a laboratory study (Aim 1), a validated direct observation protocol was used to quantify preschooler PA intensity while performing indoor activities (n = 35). Actigraph GT3x accelerometers were placed on the waist, wrist, and ankle to measure step count. In a field study (Aim 2), habitual PA of 881 preschoolers (7113 valid days) via waist‐worn accelerometers was used to assess the agreement between created guidelines (Aim 1) and other step recommendations with PA guidelines using Receiver Operating Characteristic and Area Under the Curve (ROC‐AUC).In the laboratory study, calculated indoor step ranges were 6960–7440 (waist), 7200–8640 (wrist), and 7680–9120 (ankle) to align with existing PA guidance. In the field, the higher step guidelines (> 12 000) achieved very limited agreement, due to few preschoolers achieving this metric. The 6000 step/day guidelines had the highest agreement (AUCs: TPA: 0.637; MVPA: 0.751; TPA + MVPA: 0.761) with PA guideline.When preschoolers are indoors, 6000 steps may be the minimum for adequate PA. [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]

Purpose: The implementation of artificial intelligence (AI) in health care is gaining popularity. Many publications describe powerful AI-enabled algorithms. Yet there's only scarce evidence for measurable value in terms of patient outcomes, clinical decision-making or socio-economic impact. Our aim was to investigate the significance of AI in the emergency treatment of wrist trauma patients. Method: Two groups of physicians were confronted with twenty realistic cases of wrist trauma patients and had to find the correct diagnosis and provide a treatment recommendation. One group was assisted by an AI-enabled application which detects and localizes distal radius fractures (DRF) with near-to-perfect precision while the other group had no help. Primary outcome measurement was diagnostic accuracy. Secondary outcome measurements were required time, number of added CT scans and senior consultations, correctness of the treatment, subjective and objective stress levels. Results: The AI-supported group was able to make a diagnosis without support (no additional CT, no senior consultation) in significantly more of the cases than the control group (75% vs. 52%, p = 0.003). The AI-enhanced group detected DRF with superior sensitivity (1.00 vs. 0.96, p = 0.06) and specificity (0.99 vs. 0.93, p = 0.17), used significantly less additional CT scans to reach the correct diagnosis (14% vs. 28%, p = 0.02) and was subjectively significantly less stressed (p = 0.05). Conclusion: The results indicate that physicians can diagnose wrist trauma more accurately and faster when aided by an AI-tool that lessens the need for extra diagnostic procedures. The AI-tool also seems to lower physicians' stress levels while examining cases. We anticipate that these benefits will be amplified in larger studies as skepticism towards the new technology diminishes. [ABSTRACT FROM AUTHOR]

Wrist mobility contributes significantly to the execution of upper limb motor tasks. Despite this, current prosthetic wrists are far less advanced than other artificial joints. Typically, prosthetic wrists offer limited degrees of freedom, if any, which forces users to execute compensatory movements during task performance. This addition increases weight and complexity, two unwelcome factors in upper limb prostheses. This article presents the design of a 3-degree-of-freedom friction-lockable prosthetic wrist actuated by a single motor. The design features adaptable behavior when unlocked, promoting a gentle interaction with the environment, and enables users to adjust the hand configuration during pre-grasping phases. The proposed system was tested, combined with a hand prosthesis, and compared to a commercial rotational wrist during the execution of functional movements. Experiments involved nine able-bodied subjects and one prosthesis user. Participants also performed the experiments with their biological wrist (the intact wrist for the prosthesis user) as a control. Results showed that the lockable wrist was used actively 20% more often than the commercial solution without compromising users' execution time. Interaction tests reveal that compensatory movements are reduced when using the proposed design, resulting in closer resemblance to the control wrist's performance. The average satisfaction and usability scores were significantly higher for the proposed wrist, indicating its potential acceptance. Finally, the system was validated in a set of activities of daily living performed by the prosthesis user. The study contributes to the development of more intuitive and adaptable prostheses that can improve the quality of life of amputees. [ABSTRACT FROM AUTHOR]

Movement intentions of motor impaired individuals can be detected in laboratory settings via electroencephalography Brain–Computer Interfaces (EEG-BCIs) and used for motor rehabilitation and external system control. The real-world BCI use is limited by the costly, time-consuming, obtrusive, and uncomfortable setup of scalp EEG. Ear-EEG offers a faster, more convenient, and more aesthetic setup for recording EEG, but previous work using expensive amplifiers detected motor intentions at chance level. This study investigates the feasibility of a low-cost ear-EEG BCI for the detection of tongue and hand movements for rehabilitation and control purposes. In this study, ten able-bodied participants performed 100 right wrist extensions and 100 tongue-palate movements while three channels of EEG were recorded around the left ear. Offline movement vs. idle activity classification of ear-EEG was performed using temporal and spectral features classified with Random Forest, Support Vector Machine, K-Nearest Neighbours, and Linear Discriminant Analysis in three scenarios: Hand (rehabilitation purpose), hand (control purpose), and tongue (control purpose). The classification accuracies reached 70%, 73%, and 83%, respectively, which was significantly higher than chance level. These results suggest that a low-cost ear-EEG BCI can detect movement intentions for rehabilitation and control purposes. Future studies should include online BCI use with the intended user group in real-life settings. [ABSTRACT FROM AUTHOR]

Featured Application: The serious game could be used for hand rehabilitation, since it is controlled using five hand movements: wrist extension, wrist flexion, ulnar and radial deviations, and fist movements. Moreover, it has two game modes: a non-tailored mode in which the game difficulty is set randomly, and a tailored mode in which the game difficulty is adjusted according to the participants' range of motion, determined during the hand movements. Background: Traditional physical rehabilitation involves participants performing repetitive body movements with the assistance of physiotherapists. Owing to the exercises' monotonous nature and lack of reward, participants may become disinterested and cease their recovery. Games could be used as tools to engage participants in the rehabilitation process. Consequently, participants could perform rehabilitation exercises while playing the game, receiving rewards from the experience. Maintaining the players' engagement requires regularly adjusting the game difficulty. The players' engagement can be measured using questionnaires and biosignals (e.g., electroencephalography signals—EEG). This study aims to determine whether there is a significant difference in players' engagement between two game modes with different game difficulty adjustments: non-tailored and tailored modes. Methods: We implemented two game modes which were controlled using hand movements. The features of the game rewards (position and size) were changed in the game scene; hence, the game difficulty could be modified. The non-tailored mode set the features of rewards in the game scene randomly. Conversely, the tailored mode set the features of rewards in the game scene based on the participants' range of motion using fuzzy logic. Consequently, the game difficulty was adjusted dynamically. Additionally, engagement was computed from 53 healthy participants in both game modes using two EEG sensors: Bitalino Revolution and Unicorn. Specifically, the theta (θ) and alpha (α) bands from the frontal and parietal lobes were computed from the EEG data. A questionnaire was applied to participants after finishing playing both game modes to collect their impressions on the following: their favorite game mode, the game mode that was the easiest to play, the game mode that was the least frustrating to play, the game mode that was the least boring to play, the game mode that was the most entertaining to play, and the game mode that had the fastest game response time. Results: The non-tailored game mode reported the following means of engagement: 6.297 ± 11.274 using the Unicorn sensor, and 3.616 ± 0.771 using the Bitalino sensor. The tailored game mode reported the following means of engagement: 4.408 ± 6.243 using the Unicorn sensor, and 3.619 ± 0.551 using Bitalino. The non-tailored mode reported the highest mean engagement (6.297) when the Unicorn sensor was used to collect EEG signals. Most participants selected the non-tailored game mode as their favorite, and the most entertaining mode, irrespective of the EEG sensor. Conversely, most participants chose the tailored game mode as the easiest, and the least frustrating mode to play, irrespective of the EEG sensor. Conclusions: A Wilcoxon-Signed-Rank test revealed that there was only a significant difference in engagement between game modes when the EEG signal was collected via the Unicorn sensor (p value = 0.04054). Fisher's exact tests showed significant associations between the game modes (non-tailored, tailored) and the following players' variables: ease of play using the Unicorn sensor (p value = 0.009341), and frustration using Unicorn sensor (p value = 0.0466). [ABSTRACT FROM AUTHOR]

Background: Patients with hereditary multiple exostosis (HME) usually present with forearm deformity with or without radial head dislocation. Ulna lengthening has been proposed to address this condition. Exostosis resection plus ulna lengthening has been adopted in our hospital since 2008, and patients with this condition were retrospectively reviewed. Herein, we aimed to investigate the optimal timing and clinical outcomes of this surgical approach. Methods: In all, thirty-five patients (40 forearms), including 22 boys and 13 girls, were enrolled in our study from July 2014 to September 2020. We divided the patients into 4 groups based on the age when they received surgery and the status of the radial head. Pronation and supination of the forearm, flexion and extension of the elbow, wrist ulnar deviation and wrist radial deviation, and radiological parameters including ulnar length (UL), ulnar variance (UV), the percentage of radial bowing (RB/RL), radio articular angle (RAA) and carpal slip (CS), were assessed and recorded. Results: The mean UL was significantly improved after surgery in four Groups (P<0.05). In patients with radial head dislocation, we found significant improvement in forearm, wrist function and elbow flexion (p < 0.05). For the patients with radial head dislocation, the juniors demonstrated better improvement in % RB and RAA (p<0.05, p = 0.003 and 0.031). Conclusion: Exostosis resection and ulna lengthening with unilateral external fixation can effectively improve the function and radiological parameters of forearm deformity in HME children. For patients with radial head dislocation, early surgery can achieve better results. For patients not associated with radial head dislocation, we recommend regular follow-up and surgical treatment after 10 years of age. [ABSTRACT FROM AUTHOR]

Upper limb actions require intersegmental coordination of the scapula, shoulders, elbows, forearms, wrists, and hand muscles. Stroke hemiparesis, presenting as an impairment of an intersegmentally coordinated voluntary movement, is associated with altered integrity of corticospinal tract (CST) transmission from the motor cortex (M1) to muscles. Motor evoked potentials (MEPs) elicited by M1 transcranial magnetic stimulation (TMS) of "at rest" muscles, or as a backup, during muscle contraction have been used to identify CST integrity and predict the outcome after hemiparesis, under the implicit assumption that MEPs present in only one or two muscles are manifest surrogates of CST integrity for other muscles of the upper limbs. This study presents a method for applying TMS during motor tasks that involve proximal and distal muscles. It focuses on evaluating multi-muscle electromyography (EMG) and MEPs across all task-relevant limb segments. Protocols are presented for assessing voluntary motor behavior in individuals with hemiparetic stroke using isometric, unimanual, bimanual, and "REST" conditions that broaden the concept of the degree of CST integrity in order to inform clinical prescription for neurorehabilitation and distinguish its potential as a prognostic tool. Data describing the recordings of multi-muscle transcranial magnetic stimulation induced motor evoked potentials (TMS-MEP) will be presented in a case of subacute hemiparetic stroke to elucidate our perspective. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcomes of arthroscopic inside-out ganglionectomy of dominant dorsal wrist ganglion. Methods: Patients with dominant wrist ganglion cyst treated in our hospital from January 1, 2014 to June 31, 2023 was enrolled in this retrospective analysis. All patients underwent dye-assist arthroscopic inside-out ganglionectomy. After discharge, the patients were followed for a minimum of 6 months. The primary outcomes were to assess patient wrist function using the Patient-Rated Wrist Evaluation (PRWE) and Mayo Modified Wrist Score (MMWS). The secondary outcomes were visual analog score (VAS), wrist active range of motion (ROM), grip strength, recurrence rate and complication. Results: All ganglion were successfully resected after dye staining. Patients were followed for an average of 12.17 months. There were no significant changes between preoperative and postoperative wrist active ROM or grip strength, except for wrist flexion (which showed a slightly greater improvement after surgery, P = 0.049), there were notable improvements in VAS, MMWS, and PRWE postoperatively. Recurrence occurred in 3 patients. No major complications observed during the follow-up period. Conclusion: Dye-assist arthroscopic inside-out ganglionectomy is safe and uncomplicated, worth of clinical promotion. [ABSTRACT FROM AUTHOR]

A meta-analysis including all relevant randomized controlled trials was conducted to compare soft bandage, splint and cast as the treatment of torus fracture. PubMed, Scopus, and Web of Science databases were searched in January 2023. Two comparisons were made: (1) splint versus cast, and (2) bandage versus rigid immobilization (i.e. splint or cast). Main outcomes were pain, clinical healing of the fracture and return to activities. Secondary outcomes were adverse events (skin issues, problems with cast/splint/bandage) and patient/parental satisfaction. Seven studies with 1550 patients were included. Splint was associated with higher pain scores at 3 days compared to cast (Mean difference [MD] 1.00, CI 0.06–1.94) and at 1 week (MD 1.46, CI 0.84–2.08, moderate-certainty evidence), but faster return to activities (at 3 weeks RR 1.77, CI 1.09–2.88, at 4 weeks RR 1.44, CI 1.11–1.82, moderate-certainty evidence). All torus fractures heal clinically within 3–4 weeks (low-certainty evidence). Bandage may lead to slightly higher pain score (MD 0.35, CI 0.04–0.66, moderate-certainty evidence) at first day after treatment compared to rigid immobilization, but no evidence of a difference was found in later time points. In conclusion, soft bandage or removable wrist splint seem to be optimal first-line treatment of distal forearm torus fracture. [ABSTRACT FROM AUTHOR]

The redundancy present within the musculoskeletal system may offer a non-invasive source of signals for movement augmentation, where the set of muscle activations that do not produce force/torque (muscle-to-force null-space) could be controlled simultaneously to the natural limbs. Here, we investigated the viability of extracting movement augmentation control signals from the muscles of the wrist complex. Our study assessed (i) if controlled variation of the muscle activation patterns in the wrist joint's null-space is possible; and (ii) whether force and null-space cursor targets could be reached concurrently. During the null-space target reaching condition, participants used muscle-to-force null-space muscle activation to move their cursor towards a displayed target while minimising the exerted force as visualised through the cursor's size. Initial targets were positioned to require natural co-contraction in the null-space and if participants showed a consistent ability to reach for their current target, they would rotate 5 ∘ incrementally to generate muscle activation patterns further away from their natural co-contraction. In contrast, during the concurrent target reaching condition participants were required to match a target position and size, where their cursor position was instead controlled by their exerted flexion–extension and radial-ulnar deviation, while its size was changed by their natural co-contraction magnitude. The results collected from 10 participants suggest that while there was variation in each participant's co-contraction behaviour, most did not possess the ability to control this variation for muscle-to-force null-space virtual reaching. In contrast, participants did show a direction and target size dependent ability to vary isometric force and co-contraction activity concurrently. Our results indicate the limitations of using the muscle-to-force null-space activity of joints with a low level of redundancy as a possible command signal for movement augmentation. [ABSTRACT FROM AUTHOR]

Step counts can be estimated from wrist-worn accelerometers through the Verisense Step Count Algorithm. No study has assessed agreement between stepping metrics from ActiGraph accelerometers during free-living. Thirty-four participants (age: 22.9 ± 3.4 years) provided 24 h accelerometer data (non-dominant wrist) and waist. Agreement of two Verisense Algorithms (Verisense 1 & 2) for estimating daily steps, moderate-to-vigorous physical activity (MVPA), peak 1-min and 30-min accumulated steps, against the waist and ActiLife step-count Algorithm was assessed. Mean bias ± 95% limits of agreement (LoA) for daily steps was +1255 ± 3780 steps/day (mean absolute percent error (MAPE): 21%) (Verisense 1) and +1357 ± 3434 steps/day (MAPE: 20%) (Verisense 2). For peak 1-min accumulated steps, mean bias and 95% LoA was −17 ± 23 steps/min (MAPE: 17%) (Verisense 1) and −6 ± 5 steps/min (MAPE: 9%) with Verisense 2. For peak 30-min accumulated steps, mean bias and 95% LoA was −12 ± 45 steps/min (MAPE: 25%) (Verisense 1) and −2 ± 38 steps/min (MAPE: 13%) (Verisense 2). For MVPA steps/day, mean bias and 95% LoA was −1450 ± 3194 steps/day (MAPE: 420%) (Verisense 1) and −844 ± 2571 steps/day (MAPE: 211%) (Verisense 2). For MVPA min/day, mean bias and 95% LoA was −13 ± 27 min/day (MAPE: 368%) (Verisense 1) and −8 ± 24 min/day (MAPE: 209%) (Verisense 2). The Verisense 2 algorithm enhanced agreement for stepping intensity metrics but further refinement is needed to enhance agreement for MVPA against the waist. [ABSTRACT FROM AUTHOR]

Objective The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE). Methods Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5–C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, and width) of the common wrist extensor tendon and extensor carpi radialis brevis muscle as well as the thickness of the supinator muscle were assessed. Results Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space on the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123–0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268–0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side. Conclusions This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE. Impact Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE. [ABSTRACT FROM AUTHOR]

Purpose: The distal radioulnar joint (DRUJ) at the wrist facilitates pronation and supination, and both bone structure and soft tissues contribute to its stability. This study analyzed the characteristics of patients with traumatic posterior DRUJ injuries and examined the clinical outcomes of open or arthroscopic treatment methods for these patients. Methods: A retrospective cohort study was conducted on 14 patients with traumatic posterior DRUJ instability, excluding those with associated radius fractures. The study evaluated patient demographics, injury mechanisms, radiologic findings (DRUJ relationship in the coronal plane, sigmoid notch in the axial plane, the presence and location of an accompanying distal ulnar fracture, and ulnar variance in the opposite wrist), and clinical outcomes (visual analog scale, Disability of Arm, Shoulder, and Hand [DASH] score, and range of motion [ROM]). Patients were treated with either open repair or arthroscopic methods, and postoperative results were monitored over an average of 8.8 months. Results: Ten patients had ulnar styloid fractures, with most occurring at the base or more proximally. The sigmoid notch was classified as the flat-face type in nine cases (64.3%) and the ski-slope type in five cases (35.7%). The clinical outcomes were favorable, with no significant differences between the open and arthroscopic groups regarding pain levels, DASH scores, and ROM. Conclusion: Both treatment methods can achieve favorable clinical outcomes in managing traumatic posterior DRUJ instability. [ABSTRACT FROM AUTHOR]

Birds have remarkable flight capabilities due to their adaptive wing morphology. However, studying live birds is time-consuming and laborious, and obtaining information about the complete wingbeat cycle is difficult. To address this issue and provide a complete dataset, we recorded comprehensive motion capture wing trajectory data from five free-flying pigeons (Columba livia). Five key motion parameters are used to quantitatively characterize wing kinematics: flapping, sweeping, twisting, folding and bending. In addition, the forelimb skeleton is mapped using an open-chain three-bar mechanism model. By systematically evaluating the relationship of joint degrees of freedom (DOFs), we configured the model as a 3-DOF shoulder, 1-DOF elbow and 2-DOF wrist. Based on the correlation analysis between wingbeat kinematics and joint movement, we found that the strongly correlated shoulder and wrist roll within the stroke plane cause wing flap and bending. There is also a strong correlation between shoulder, elbow and wrist yaw out of the stroke plane, which causes wing sweep and fold. By simplifying the wing morphing, we developed three flapping wing robots, each with different DOFs inside and outside the stroke plane. This study provides insight into the design of flapping wing robots capable of mimicking the 3D wing motion of pigeons. [ABSTRACT FROM AUTHOR]

Thumb carpometacarpal (CMC) osteoarthritis (OA) is caused by the degeneration of joint surfaces at the base of the thumb. If conservative treatments have failed, surgery may be needed to improve symptoms. Typically, standard clinical tools, such as the pinch gauge, are used to measure thumb force. However, these devices have utilized multiple digits and do not represent forces specifically generated by the thumb. Therefore, different devices are necessary to accurately measure isolated thumb force. The primary objective was to research the effect of thumb force after ligament reconstruction with tendon interposition surgery. To accomplish this, several sub-objectives were implemented: (1) create a testing device to collect isolated thumb forces, (2) collect a normative thumb force data set of males and females to compare the impact of aging and surgery, (3) collect and compare clinical data to see if these data sets matched isolated thumb forces, (4) determine the effect of wrist position on isolated thumb force data in different wrist positions, and (5) collect thumb force in directions that mimic daily activities, a directional force downward (push) and inward (pull). On average, older participants generated statistically larger forces than younger participants. Additionally, only 50% of CMC OA participants showed greater than 5 N of improvement at 6-months post-surgery compared to pre-surgery, but did not reach healthy force levels. When evaluating wrist rotation, OA participants' push and pull decreased by 8 N and 7 N in the horizontal wrist position, and their push and pull increased by 2 N and 5 N in the vertical wrist position. Evaluation and results with standard clinical tools showed different post-surgery trends than isolated force data, which suggested the clinical approach has mixed results and may be under- or over-estimating the recovery process. These data sets allow surgeons and hand therapists to identify changes in isolated thumb force generation to create specialized therapies and treatment options, which is an improvement upon current clinical measurement tools. [ABSTRACT FROM AUTHOR]

Background: Tremor is the most common movement disorder, with significant functional and psychosocial consequences. Oral medications have been disappointing or limited by side effects. Surgical techniques are effective but associated with risks and adverse events. Botulinum toxin (BT) represents a promising avenue but there is still no double-blind evidence of efficacy on upper limb function. A systematic review on the effects of BT in upper-limb tremor was conducted. Methods: A systematic search of the literature was conducted up to July 2023, including the keywords "botulinum toxin" and "tremor". All randomized controlled trials (RCTs) and open-label studies were analyzed. Independent reviewers assessed their methodological quality. Results: There were only eight published RCTs and seven published open-label studies, with relatively small sample sizes. This review suggests that BT is more effective when injections are patient-tailored, with analyses based on clinical judgement or kinematics. Subjective and objective measures frequently improve but transient weakness may occur after injections, especially if wrist or fingers extensors are targeted. A number of studies had methodological limitations. Conclusions: The authors discuss how to optimize tremor assessments and effects of BT injection. Controlled evidence is still lacking but it is suggested that distal "asymmetric" BT injections (targeting flexors/pronators while sparing extensors/supinators) and proximal injections, involving shoulder rotators when indicated, may avoid excessive weakness while optimizing functional benefit. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA), sleep and sedentary time are now recognised as mutually exclusive and exhaustive parts of the 24‐h day—if PA decreases, time spent sleeping, being sedentary or both must increase so that all components equate to 24 h. Recent advances in time‐use epidemiology suggest that we should not consider time‐use domains (PA, sleep and sedentary time) in isolation from each other, but in terms of a composition—the mix of time‐use domains across the 24‐h day. While interrelated daily activities are known to be important in the management of diabetes mellitus, few studies have investigated the interrelated daily activities in people with an active diabetes‐related foot ulcer (DFU) and their impact on important outcomes such as wound severity, blood glucose control and health‐related quality of life (HRQoL). This feasibility study aims to determine the acceptability and practicality of measuring 24‐h use of time data in people with a DFU and its associations on important outcome measures for this population. Methods: Participants wore a wrist‐worn accelerometer for two weeks and completed demographic and HRQoL questionnaires. Outcomes were participant engagement, reported levels of study burden and value and compositional data analysis as a methodological approach for evaluating 24‐h use of time data. Results: Twenty‐six participants reported low levels of study burden and rated the study value highly. The protocol appears feasible in terms of recruitment (81%) and retention rate (86%). On average, participants were relatively sedentary spending 747, 172 and 18 min in sedentary time, light physical activity and moderate‐to‐vigorous activity, respectively. Sleep appeared adequate with participants obtaining an average of 485 min, but quality of sleep was notably poor with average sleep efficiency of 75%. Compositional data analysis was able to quantify the integrated associations of 24‐h use of time with HRQoL. Conclusion: The protocol provides an acceptable method to collect 24‐h use of time data in people with a DFU. Efforts to consider and analyse PA as part of a 24‐h activity composition may provide holistic and realistic understandings of PA in this clinical population. [ABSTRACT FROM AUTHOR]

Step cadence‐based and machine‐learning (ML) methods have been used to classify physical activity (PA) intensity in health‐related research. This study examined the association of intensity‐specific PA duration with all‐cause (ACM) and CVD mortality using the cadence‐based and ML methods in 68 561 UK Biobank participants wearing wrist‐worn accelerometers. The two‐stage‐ML method categorized activity type and then intensity. The one‐level‐cadence‐method (1LC) derived intensity‐specific duration using all detected steps (including standing utilitarian steps) and cadence thresholds of ≥100 steps/min (moderate intensity) and ≥130 steps/min (vigorous intensity). The two‐level‐cadence‐method (2LC) detected ambulatory steps (i.e., walking and running) and then applied the same cadence thresholds. The 2LC exhibited the most pronounced association at the lower end of duration spectrum. For example, the 2LC showed the smallest minimum moderate‐to‐vigorous‐PA (MVPA) duration (amount associated with 50% of optimal risk reduction) with similar corresponding ACM hazard ratio (HR) to other methods (2LC: 2.8 min/day [95% CI: 2.6, 2.8], HR: 0.83 [95% CI: 0.78, 0.88]; 1LC, 11.1[10.8, 11.4], 0.80 [0.76, 0.85]; ML, 14.9 [14.6, 15.2], 0.82 [0.76, 0.87]). The ML elicited the greatest mortality risk reduction. For example, the medians and corresponding HR in VPA‐ACM association: 2LC, 2.0 min/day [95% CI: 2.0, 2.0], HR, 0.69 [95% CI: 0.61, 0.79]; 1LC, 6.9 [6.9, 7.0], 0.68 [0.60, 0.77]; ML, 3.2 [3.2, 3.2], 0.53 [0.44, 0.64]. After standardizing durations, the ML exhibited the most pronounced associations. For example, the standardized minimum durations in MPA‐CVD mortality association were: 2LC, −0.77; 1LC, −0.85; ML, −0.94; with corresponding HR of 0.82 [0.72, 0.92], 0.79 [0.69, 0.90], and 0.77 [0.69, 0.85], respectively. The 2LC exhibited the most pronounced association with all‐cause and CVD mortality at the lower end of the duration spectrum. The ML method provided the most pronounced association with all‐cause and CVD mortality, thus might be appropriate for estimating health benefits of moderate and vigorous intensity PA in observational studies. [ABSTRACT FROM AUTHOR]

Background/Objectives: A pronator quadratus pedicled bone graft (PQPBG) is a distal radius volar vascularized bone graft used not only for avascular necrosis of the lunate but also for scaphoid nonunion. Despite its potency and its possession of a muscular shield, this vascularized graft has a disadvantage in that the potential shortness of the muscular leash may limit the distal transfer of the bone graft. Releasing of the pronator quadratus (PQ) ulnar origin was used to enhance the distal mobility of the graft. We aimed to investigate the effect of a PQ release on the surgical outcomes of scaphoid nonunions that were operated on with the PQPBG technique. Methods: Patients with scaphoid nonunion that were treated with PQPBG from 2009 to 2020 were reviewed. Patient demographic characteristics, surgical notes, physical examinations, and radiological evaluation data were collected. Wrist range of motion, grip strength, modified Mayo wrist score, and Quick-DASH score were used to evaluate the outcomes. The included patients were divided into two groups based on the origin release status of their PQ, i.e., with and without release. Results: This study included 37 patients, 17 of whom underwent a PQ release and 20 of whom did not. The failure rates for the two groups were one and four patients, respectively, and there was no significant difference between them (p = 0.11). The postoperative mean wrist extension in the patients with a PQ release was significantly greater than that in the patients without a release (43.5 ± 6.8 vs. 36.5 ± 7.7, p = 0.0038). Although wrist flexion, ulnar deviation, radial deviation, mean outcome assessment scores, and grip strength were greater in the patients with a PQ release than in those without, no statistically significant intergroup differences were observed (p > 0.05). Conclusions: The PQPBG technique is a viable option for achieving bony union in patients with scaphoid nonunion, but it results in the postoperative restriction of wrist extension. PQ release during a graft transfer may have a favorable effect on both bone union and clinical outcomes. [ABSTRACT FROM AUTHOR]

Musculoskeletal Disorders (MSDs) stand as a prominent cause of injuries in modern agriculture. Scientific research has highlighted a causal link between MSDs and awkward working postures. Several methods for the evaluation of working postures, and related risks, have been developed such as the Rapid Upper Limb Assessment (RULA). Nevertheless, these methods are generally applied with manual measurements on pictures or videos. As a consequence, their applicability could be scarce, and their effectiveness could be limited. The use of wearable sensors to collect kinetic data could facilitate the use of these methods for risk assessment. Nevertheless, the existing system may not be usable in the agricultural and vine sectors because of its cost, robustness and versatility to the various anthropometric characteristics of workers. The aim of this study was to develop a technology capable of collecting accurate data about uncomfortable postures and repetitive movements typical of vine workers. Specific objectives of the project were the development of a low-cost, robust, and wearable device, which could measure data about wrist angles and workers' hand positions during possible viticultural operations. Furthermore, the project was meant to test its use to evaluate incongruous postures and repetitive movements of workers' hand positions during pruning operations in vineyard. The developed sensor had 3-axis accelerometers and a gyroscope, and it could monitor the positions of the hand–wrist–forearm musculoskeletal system when moving. When such a sensor was applied to the study of a real case, such as the pruning of a vines, it permitted the evaluation of a simulated sequence of pruning and the quantification of the levels of risk induced by this type of agricultural activity. [ABSTRACT FROM AUTHOR]