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Retrospective cross-sectional case series.Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ.In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint.Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values.The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29 with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative).The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.

Study Design This was a clinical trial of prospective cohort. Introduction Wrist pain in gymnasts is a global phenomenon. Compression forces acting on wrists while performing gymnastics is a predisposing factor in the development of wrist pain and consequential injury of the distal radial physis in skeletally immature gymnasts. One approach to mitigate these forces is wrist bracing; however, studies on the efficacy of wrist braces to reduce wrist pain experienced by gymnasts are limited. Purpose of the Study The purpose of this study was to investigate the efficacy of an innovative design of a wrist brace to decrease gymnasts' wrist pain while performing gymnastics. Methods A wrist brace was designed and trialled over 3 weeks by 48 male gymnasts (aged 8-22 years, levels 4-7) with wrist pain. Wrist pain was recorded on a visual analog scale of 1 to 10 before and after trial. Data analysis was performed using SPSS-22 (IBM Inc). Paired t-tests were performed to compare variables before and after trial, with effect size analyses used to quantify the relative magnitude of any differences. Results Paired t-tests indicated the gymnasts reported significantly reduced pain (P = .002; 53.5%) while wearing the braces for training on the pommel, floor, and parallel bars. The overall large effect size value was practically significant (d = 0.902). Discussion For any wrist brace to be effective, it needs to be implemented when the gymnast experiences wrist pain before an injury occurs. This would minimize the development of pain-provoked adaptive movement patterns that perpetuate dysfunction. Conclusions The brace with the volar gel pad is recommended to be worn as an adjunct to current strategies in management of gymnasts' wrist pain or as an injury prevention device in skeletally immature gymnasts.

Carpal instability secondary to scapholunate (SL) ligament tears can lead to a significant disability of the wrist. Different surgical procedures have been proposed to treat SL instability. A variety of dorsal capsulodesis techniques tethering the scaphoid have been used in patients with SL dissociation. We report a novel technique of modified dorsal intercarpal ligament (DICL) capsulodesis for the treatment of SL dissociation. The surgical indication for this procedure is complete SL ligament tear with a reducible carpal malalignment and no secondary osteoarthritis. This procedure is indicated when the remnant of torn ligament in the dorsal SL interosseous space is available for repair. First, carpal malalignment is corrected and the scaphoid and the lunate are temporarily fixed with a transosseous screw or Kirschner wires. Using a dorsal approach, the DICL is then exposed, which originates from the triquetrum and attaches to the scaphoid, trapezium, and trapezoid. The distal and proximal borders of the ligament are identified and elevated without detaching the attachment sites. The DICL is transferred proximally to reinforce the dorsal SL interosseous ligament. The wrist joint is immobilized for 3 weeks postoperatively, and dart-throwing motion is permitted until temporary SL fixation is removed at 2 to 3 months after surgery. A wrist brace is recommended until 3 to 6 months after the first surgery depending on the patient's occupation and sports activity.

Prosthetic arms can significantly increase the upper limb function of individuals with upper limb loss, however despite the development of various multi-DoF prosthetic arms the rate of prosthesis abandonment is still high. One of the major challenges is to design a multi-DoF controller that has high precision, robustness, and intuitiveness for daily use. The present study demonstrates a novel framework for developing a controller leveraging machine learning algorithms and movement synergies to implement natural control of a 2-DoF prosthetic wrist for activities of daily living (ADL). The data was collected during ADL tasks of ten individuals with a wrist brace emulating the absence of wrist function. Using this data, the neural network classifies the movement and then random forest regression computes the desired velocity of the prosthetic wrist. The models were trained/tested with ADLs where their robustness was tested using cross-validation and holdout data sets. The proposed framework demonstrated high accuracy (F-1 score of 99% for the classifier and Pearson’s correlation of 0.98 for the regression). Additionally, the interpretable nature of random forest regression was used to verify the targeted movement synergies. The present work provides a novel and effective framework to develop an intuitive control for multi-DoF prosthetic devices.

Simulators are often used in prosthesis research to evaluate new devices or characterize aspects of prosthesis use, so as to recruit participants without amputations. Simulators, in general, must locate the prosthesis somewhere other than where the intact biological limb exists. In this study, we compared two configurations of simulators for hand prostheses to determine which leads to more natural elbow and shoulder kinematics, and in turn, which is the more valid simulator. One configuration located the prosthesis in-line with the forearm, beyond the biological hand; the other located it beside the hand. We measured the kinematics of 12 non-amputee participants during three clinical tests of hand-arm dexterity, which were completed 1) using each simulator configuration with a body-powered Hosmer 5X hand prosthesis and 2) using the biological hand with a wrist brace. The beside-the-hand configuration resulted in kinematics that were more similar to those measured with the biological hand, particularly during the Box and Blocks Test, which involved navigating the prosthesis around obstacles. Therefore, we concluded that simulators with the beside-the-hand configuration are likely to better emulate the use of hand prostheses for activities involving a wide variety of arm movement. We suggest using this configuration in general, except when arm movement is of secondary importance and when this configuration would be obstructive, visually or otherwise.

Wrist disability caused by a series of diseases or injuries hinders the patient’s capability to perform activities of daily living (ADL). Rehabilitation devices for the wrist motor function have gained popularity among clinics and researchers due to the convenience of self-rehabilitation. The inherent compliance of soft robots enabled safe human-robot interaction and light-weight characteristics, providing new possibilities to develop wearable devices. Compared with the conventional apparatus, soft robotic wearable rehabilitation devices showed advantages in flexibility, cost, and comfort. In this work, a compact and low-profile soft robotic wrist brace was proposed by directly integrating eight soft origami-patterned actuators on the commercially available wrist brace. The linear motion of the actuators was defined by their origami pattern. The extensions of the actuators were constrained by the brace fabrics, deriving the motions of the wrist joint, i.e., extension/flexion, ulnar/radial deviation. The soft actuators were made of ethylene-vinyl acetate by blow molding, achieving mass-production capability, low cost, and high repeatability. The design and fabrication of the soft robotic wrist brace are presented in this work. The experiments on the range of motion, output force, wearing position adaptivity, and performance under disturbance have been carried out with results analyzed. The modular soft actuator approach of design and fabrication of the soft robotic wrist brace has a wide application potential in wearable devices.

Regarding high-sensitivity human wrist joint motion monitoring in exercise rehabilitation, we develop a pair of novel wearable and sensitivity-enhanced plastic optical fiber (POF) strain sensors consisting of an etched grating fiber and a side-polished fiber stitched into a polyamide wrist brace. The two flexible and surface-treated fibers are, respectively, featured with an etched periodic gratings with a pitch of 6 mm and a depth of 0.5 mm and a D-shaped side-polished zone of ~300 &micro, m depth and ~30 mm length, which, correspondingly, show the sensitivities of around 0.0176/&deg, and 0.0167/&deg, in a normalized bending angle by far larger than a conventional commercial POF, because it achieves a more sensitive strain-induced evanescent field interaction with the side-machined fibers. Moreover, in terms of the sensor response to bending deformation in the range of &minus, 40&deg, ~+40&deg, the former exhibits a better sensitivity in lower angle change, while the latter is superior as the bending angle increases, thereby arranging the two modified POFs separately at the side and back of the human wrist, in order to decouple the wrist joint behaviors induced by typical flexion-extension or abduction-adduction movements. Then, the circular and pentagonal wrist motion trajectory patterns are investigated, to demonstrate the maximum average single-axis motion error of 2.94&deg, via the transformation of spatial angle to plane coordinate for the fabricated couple of POF sensors, which is lower than a recognized standard of 5&deg, thus suggesting the great potential in wearable exercise rehabilitation of human joints in the field of medical treatment and healing.

Background: The aim of the study is to investigate current management strategies for lateral epicondylitis by fellowship-trained upper extremity surgeons. Methods: A 17-question survey of treatment approaches and outcomes related to lateral epicondylitis was sent to 3354 surgeons using the American Society for Surgery of the Hand and American Shoulder and Elbow Surgeons member databases. Results: Six hundred twelve upper extremity surgeons completed the survey. The 6 most frequently prescribed nonoperative treatments for lateral epicondylitis were home exercise program/stretching (81%), nonsteroidal anti-inflammatory drugs (75%), steroid injection (71%), counterforce bracing (68%), formal physical therapy (65%), and wrist brace (47%). Less commonly performed nonoperative treatment measures included platelet-rich plasma injection (16%), Tenex procedure (6%), and iontophoresis (2%). Conclusions: There is a lack of consensus in the literature for the management of lateral epicondylitis, which is reflected by individual variation in clinical treatment among the experts. Future prospective randomized control studies are needed to establish evidence-based practice standards for this common diagnosis.

Background Tree planters are at a high risk for wrist injury due to awkward postures and high wrist loads experienced during each planting cycle, specifically at shovel-ground impact. Wrist joint stiffness provides a measure that integrates postural and loading information. Objective The purpose of this study was to evaluate wrist joint stiffness requirements at the instant of shovel-ground impact during tree planting and determine if a wrist brace could alter muscular contributions to wrist joint stiffness. Method Planters simulated tree planting with and without wearing a brace on their planting arm. Surface electromyography (sEMG) from six forearm muscles and wrist kinematics were collected and used to calculate muscular contributions to joint rotational stiffness about the wrist. Results Wrist joint stiffness increased with brace use, an unanticipated and negative consequence of wearing a brace. As a potential benefit, planters achieved a more neutrally oriented wrist angle about the flexion/extension axis, although a less neutral wrist angle about the ulnar/radial axis was observed. Muscle activity did not change between conditions. Conclusion The joint stiffness analysis, combining kinematic and sEMG information in a biologically relevant manner, revealed clear limitations with the interface between the brace grip and shovel handle that jeopardized the prophylactic benefits of the current brace design. This limitation was not as evident when considering kinematics and sEMG data independently. Application A neuromechanical model (joint rotational stiffness) enhanced our ability to evaluate the brace design relative to kinematic and sEMG parameter-based metrics alone.

We report the case of a 19-year old man who presented to our institution with a history of pain of one week in the ulnar side of the left wrist and continuous pressing sensation in the palm. According to patient, there was no history of acute hand trauma. The conventional roentgenograms did not show the fracture and computerized tomographic (CT) scanning demonstrated a complete fracture of the hook of the hamate. The patient was given a surgical intervention and the hamate bone was reduced through a palmar skin incision. After surgery, the operated hand was immobilized in a wrist brace and the patient was put on a rehabilitation protocol. At the last follow-up, the patient was able to return to normal living activities without any symptoms. We reviewed the latest articles of the past 18 years and compared the research studies related to the diagnosis and treatment of the hamate hook fracture. Our conclusion is that CT scan is the most effective diagnostic tool for detecting the hamate hook fracture. Three-dimensionally (3D) reconstructed images based of CT could provide more accurate and insight illustration for better evaluation in surgical planning.

Botulinum toxin type A (BTX-A) injections improve muscle tone and range of motion (ROM) among stroke patients with upper limb spasticity. However, the efficacy of BTX-A injections for improving active function is unclear. We aimed to determine whether BTX-A injections with electrical stimulation (ES) of hand muscles could improve active hand function (AHF) among chronic stroke patients. Our open-label, pilot study included 15 chronic stroke patients. Two weeks after BTX-A injections into the finger and/or wrist flexors, ES of finger extensors was performed while wearing a wrist brace for 4 weeks (5 days per week, 30-min sessions). Various outcomes were assessed at baseline, immediately before BTX-A injections, and 2 and 6 weeks after BTX-A injections. After the intervention, we noted significant improvements in Box and Block test results, Action Research Arm Test results, the number of repeated finger flexions/extensions, which reflect AHF, and flexor spasticity. Moreover, significant improvements in active ROM of wrist extension values were accompanied by marginally significant changes in Medical Research Council wrist extensor and active ROM of wrist flexion values. In conclusion, BTX-A injections into the finger and/or wrist flexors followed by ES of finger extensors improve AHF among chronic stroke patients.

We demonstrate two flexible, sensitivity-enhanced plastic optical fiber (PDF) strain sensors embedded in a polyamide wrist brace for human wrist joint movement monitoring. The two sensors are, respectively, featured with a D-shaped side-polished zone of ~40 µm depth and ~30 mm length and etched periodic gratings with a pitch of 3 mm, which correspondingly exhibit around 46.8 and 17.8 times in normalized bending sensitivity by far larger than conventional commercial POF due to more sensitive strain-induced evanescent field interaction with the side-machined fiber. In terms of different detection sensitivity to bending angles, the two modified sensors are separately arranged at the back and side of the wrist and then enable to decouple wrist joint behaviors induced by flexion-extension and abduction-adduction motions. The application therefore shows a great potential for the developed sensors in wearable exercise rehabilitation of human joints.

This paper presents a motor driven wrist brace that can adjust its stiffness by changing its mesoscale geometry. The design involves a plate structure that folds from a flexible flat shape to a stiff corrugated shape by means of a motor driven tendon. The structure is built using a laminate of rigid and flexible layers, with embedded flexural hinges that allow it to fold. The paper proposes a simplified analytical model to predict stiffness, and physical three-point bending tests indicate that the brace can increase its stiffness up to fifty times by folding.

Previous studies have showed the efficacy of removable brace treatment for distal radius buckle fractures in children, whereas others have independently suggested that these injuries do not require additional radiographic imaging. However, no study has sought to collectively determine whether treating pediatric distal radius buckle fractures with a removable brace and no follow-up visit or imaging after the initial visit is a safe and satisfactory protocol.In total, 42 consecutive patients with a distal forearm buckle fracture seen by a single fellowship trained pediatric orthopaedic surgeon were eligible to participate. Two patients refused participation, yielding 40 patients treated with a standard protocol of immobilization with a removable wrist brace for a prescribed period of time with no additional imaging or clinical follow-up. Two staggered telephone surveys were then conducted. The first survey was conducted within 1 week of the designated brace-removal date to determine the exact date the brace was discontinued. The second survey was conducted 5 to10 months postinjury to determine patient outcomes and parent satisfaction.In total, 100% of patients were reached for the initial survey and 90% (36/40) of patients were reached for the secondary survey. There were no complications, including refracture or residual pain, following treatment. In total, 100% of parents felt their child had returned to full and normal function and all said they would choose to have the same treatment again. In total, 67% of parents would have had to take time off from work and 77% of children would have missed school if they had hypothetically been required to attend a follow-up appointment.Treatment of pediatric distal forearm buckle fractures with a removable wrist brace and no follow-up visit or radiographs results in both excellent patient outcomes and parental satisfaction.Level IV-case series.

Background Trigger wrist is a rare condition first described by Marti in 1960, and various causes have been reported. The condition mostly occurs with finger flexion and extension, and rarely with flexion and extension of the wrist itself. Avascular necrosis of the capitate is also a rare condition, first described by Jönsson in 1942. While some reports of this condition have been published, little is known about its etiology. Therefore, no established treatment exists. We report a case of trigger wrist caused by avascular necrosis of the capitate. Case presentation A 16-year-old right-handed male who was a high school handball player was referred to our department from a nearby hospital 5 months after the onset of pain in the dorsal aspect of the right wrist, with an unknown cause. At the previous hospital, imaging findings led to a diagnosis of avascular necrosis of the capitate, and conservative treatment with a wrist brace did not improve the pain. At the initial visit to our department, the patient was noted to have a painful trigger wrist that was brought on by wrist flexion and extension. Preoperative imaging findings led to a diagnosis of trigger wrist caused by capitolunate instability secondary to avascular necrosis of the capitate. We performed a partial excision of the proximal capitate with tendon ball interposition. Two years after surgery, the patient’s clinical outcome was favorable, with no recurrence of wrist pain or triggering. Conclusions Both trigger wrist and avascular necrosis of the capitate are rare disorders. When a patient presents with painful triggering at the wrist, surgeons must bear in mind that avascular necrosis of the capitate may result in this phenomenon. We recommend partial excision of the proximal capitate with tendon ball interposition for the treatment of this lesion.

The term ‘orthosis’ applies to an external device which is worn to aid function and mobility, reduce pain and accommodate deformities. This includes several types of devices from a simple wrist brace to highly complex bespoke devices such as a knee-ankle-foot orthosis. The aim of this article is to provide an overview of the role of orthotists, to discuss the important use of orthotics immediately following a stroke and to raise awareness of orthotic services, which will improve both the quality outcomes and service to the patient.

The paper presents the development of a new device for measuring continuous pulse pressure waveforms (PPW) from the radial artery via applanation tonometry. The development focuses on improved accuracy, open and affordable design using off-the-shelf components, and greater user control in setting operational and calibration parameters to address user variability. The device design parameters are optimized through a tissue device interaction study based on a computational model. The design incorporates modular components and includes a sensor module for arterial flattening and pressure pick-up, a differential screw mechanism and a related algorithm for controlled stepwise motion and data collection during flattening, and a brace for wrist-flexion adjustment. Maximum pulse amplitude (PA) was used as an indicator of the optimum level of arterial flattening for recording the PPW. The PPW was observed to distort due to changes in parameters like gel-head placement, hold-down pressure (HDP), and wrist extension. The pressure waveforms collected using the device were validated using limited data against established products and showed good correlation within ±1.96 standard deviation of the mean difference in a Bland–Altman plot. This paper thus details the development of a simple and validated mechanical design to measure PPW using arterial tonometry.

This research sought to design and validate a wrist brace able to track kinematic data to quantify occupational risk factors related to repetitive strain injuries such as carpal tunnel syndrome. The wrist brace had rotary encoders positioned over flexion/extension and radial/ulnar deviation joint rotation centres. Thirteen subjects performed activities of daily living while wearing the brace and kinematic data were also collected with VICON motion capture. Range of motion, mean angle, peak and mean velocity, and mean acceleration were compared for each task. There were no significant differences between the brace and VICON measurements in both axial directions. Both collection methods could differentiate between tasks based on the data collected (p

Background Load cells are often used in rehabilitation robotics to monitor human–robot interaction. While load cells are accurate and suitable for the stationary end-point robots used in rehabilitation hospitals, their cost and inability to conform to the shape of the body hinder their application in developing affordable and wearable robotic orthoses for assisting individuals in the activities of daily living. This exploratory work investigates the possibility of using an alternative technology, namely compliant polymeric air cushions, to measure interaction forces between the user and a wearable rigid structure. Methods A polymeric air cushion was designed, analyzed using a finite element model (FEM), and tested using a bench-top characterization system. The cushions underwent repeatability testing, and signal delay testing from a step response while increasing the length of the cushion’s tubes. Subsequently, a 3D printed wrist brace prototype was integrated with six polymeric air cushions and tested in static conditions where a volunteer exerted isometric pronation/supination torque and forces in vertical and horizontal directions. The load measured by integrating data recorded by the six sensors was compared with force data measured by a high quality load cell and torque sensor. Results The FEM and experimental data comparison was within the error bounds of the external differential pressure sensor used to monitor the pressure inside the cushion. The ratio obtained experimentally between the pressure inside the pressure cushion and the 8 N applied load deviated by only 1.28% from the FEM. A drift smaller than 1% was observed over 10 cycles. The rise times of the cushion under an 8 N step response for a 0.46, 1.03, and 2.02 m length tube was 0.45, 0.39, and 0.37 s. Tests with the wrist brace showed a moderate root mean square error (RMSE) between the force estimated by the pressure cushions and the external load cells. Specifically, the RMSE was 13 mNm, 500 mN, and 1.24 N for forearm pronation/supination torque, vertical force, and horizontal force, respectively. Conclusions The use of compliant pressure cushions was shown to be promising for monitoring interaction forces between the forearm and a rigid brace. This work lays the foundation for the future design of an array of pressure cushions for robotic orthoses. Future research should also investigate the compatibility of these polymeric cushions for data acquisition during functional magnetic resonance imaging in shielded rooms.

Purpose.To evaluate outcomes of wide resection and reconstruction of the distal radius with non-vascularised autogenous fibular grafts for giant cell tumour (GCT) of bone.Methods.Medical records of 7 men and 5 women aged 22 to 47 (mean, 31) years who underwent wide resection of the distal radius and reconstruction with non-vascularised autogenous fibular grafts for GCT of bone were reviewed. The mean length of the resected radius was 9 (range, 7–11) cm. The ipsilateral proximal fibula with a small portion of attached ligament was harvested. The articular surface of the graft was fixed to the scapholunate articular surface by Kirschner wires, and the ligament of the fibular head was sutured to the carpal ligaments. The graft was fixed to the proximal radius with a small dynamic compression plate. Iliac cancellous bone graft was added. Pain, instability, and functional status were assessed. Wrist joint movements were measured using a goniometer. The grip strength was measured. The operated and contralateral sides were compared.Results.The mean follow-up was 24 (range, 20–27) months. All patients achieved radiological union after a mean of 16 (range, 14–20) weeks. The mean active range of movement in the operated wrists was 32° dorsiflexion, 38° palmar flexion, 15° radial deviations, 12° ulnar deviations, 50° supination, and 60° pronation. Compared with the contralateral wrists, the operated wrists regained 60% of the function, with satisfactory grip strength, and normal finger and thumb movements and hand sensation. No patient had recurrence after 2 years. Two patients had minor dorsal subluxation, which was resolved with a wrist brace. Three patients had superficial infection, which was resolved with intravenous antibiotics and dressings. Two patients had peroneal nerve palsy, which recovered completely in 12 weeks.Conclusion.Non-vascularised fibular grafts for reconstruction of the distal radius after resection of a GCT of bone achieved good cosmetic and functional outcomes.

Introduction/Background Three-dimensional (3D) printer technology can produce the personalized brace with low cost and less time. 3D printing data files are also advantageous for production of individualized products at no extra cost, even when different designs are used in consecutive production runs. In addition, because the 3D printer is controlled by a computer, it can make objects in various forms and is easy to use, as compared to other manufacturing techniques. The purpose of this study was to develop a personalized wrist brace using a 3D scanner and 3D printer for patients with wrist pain caused by overuse syndrome, and to evaluate the improvement of pain relief, work performance, and daily life satisfaction after wearing the brace. Material and method Twenty patients with wrist pain were randomly assigned to control and experimental groups. The control group wore the cock-up splint and the experimental group wore 3D printed wrist brace for one week. Patient Rated Wrist Evaluation (PRWE), Jebsen Hand Function Test (JHFT), and Orthotics and Prosthetics User Survey (OPUS) were checked before and one week after the application. Results The PRWE showed significant pain relief in both groups. Two items of the 28 OPUS questions, ‘Put toothpaste on brush and brush teeth’ and ‘Dial a touch tone phone’, showed high satisfaction scores, with statistically significant difference in the experimental group (P = 0.036 and 0.004). Conclusion 3D printed wrist brace was superior to the cock-up splint in some items of the OPUS. Wrist pain was reduced in the group wearing the 3D printed wrist brace as well as the group wearing the cock-up splint, so 3D printed wrist brace could possibly play the same role as the cock-up splint.

In this paper, the wrist braces for the wrist fracture patients are developed. Geometry of the patient’s wrist surface anatomy was digitalized and recorded by an optical 3D scanner. An expert software was developed to generate the brace model, on which several holes are distributed to increase the air permeability. Finally, the brace is fabricated by commercial FDM 3D printer. For ensuring the strength of the wrist brace, the tensile test and impact test were conducted to measure the elastic modulus, yielding strength and fracture strength. A finite element model was established to investigate the stresses and deformations when the wrist brace is subjected to a static load. The mechanical properties measured in the tensile tests are as input parameters in the model. The static analysis showed that, for four considered movements of the wrist, the maximum von-Mises stress is less than the yielding strength. An impact analysis was also conducted to simulate brace impacted by a moving rigid ball with a mass of 0.3768[Formula: see text]kg. The results showed that the deformation at the impact point remains in the elastic range when the impact speed is 3[Formula: see text]m/s. The finite element calculations give us rules to design the number of holes and the thickness of the brace.

Rationale Carpal tunnel syndrome (CTS) is the most common peripheral nerve neuropathy resulting from compression of the median nerve as it traverses the carpal tunnel. The pathophysiology of this condition is multifactorial, and majority of cases of CTS are idiopathic. We report cases of CTS caused by synovial osteochondromatosis (SOC), which has rarely been reported. Patient concerns A 45-year-old female was admitted to the clinic due to right hand tingling sensation for 4 months. On physical examination, the patient's symptoms and signs corresponded to the median nerve entrapment at wrist. However, there is mild swelling and tenderness around the second metacarpal bone. Pain was aggravated during wrist and finger flexion. Diagnoses An electrodiagnostic study revealed CTS. She was advised to begin splinting the hand using a wrist brace and to undergo physiotherapy. After 2 weeks, the tingling sensation decreased slightly. However mild swelling and tenderness around the second metacarpal bone did not improve. Ultrasonography showed multiple echogenic foci. Magnetic resonance imaging (MRI) revealed a nodule at the proximal metacarpal level with synovial thickening, enhancement, and a calcified shadow close to the flexor tendon. After confirming the presence of an osseous nodule with synovial thickening, the patient underwent surgery INTERVENTIONS:: Carpal tunnel release and mass excision with synovectomy of the adjacent structures were performed. Histologically, the lesion was compatible with a diagnosis of SOC. Outcome The symptoms have improved. Lessons CTS due to SOC on finger flexor tendon is rare but should be considered for possible etiology. Appropriate clinical examination, plain radiography, ultrasonography, and MRI will help physicians to diagnose this condition. In this paper, we report the successful diagnosis and treatment of CTS caused by SOC within the finger flexor tendon.

RATIONALE In competitive athletes, the upper extremity is subject to tremendous torsional forces with axial loading due to repetitive weight bearing. Approximately 25% of injuries in sports are related to the hand or wrist. Skeletal deformity on the wrist physis is common in athletes due to repetitive loading and presents at early ages between 6 and 13 years. Additionally, it is more common in female than in male athletes. PATIENT CONCERNS An 11-year-old girl who was a climber complained of pain on her left wrist without direct trauma. She had participated in climbing exercise for several years and had no medical history. Thorough radiological evaluation, we diagnosed physeal injury of the left radius. After healing of the physeal injury of the radius, she complained of pain on fourth finger of right hand and radiographs revealed physeal injury of the right fourth finger. DIAGNOSIS Radiographs revealed physeal injury of the left radius. Magnetic resonance imaging revealed epiphyseal widening of the radial aspect of the wrist and bone marrow signal increase on T2-weighted imaging. Likewise, radiographs showed physeal injury of the right fourth finger INTERVENTIONS:: No surgery was performed and we applied wrist brace and finger splint for conservative treatment. OUTCOMES The patient's pain was immediately relieved. The patient had no complications or recurrence of symptoms and was undergoing regular check-ups every 6 months. LESSONS During climbing exercise, repeated high pressure causes damage of the hand and wrist joints in young patients. Chronic pain in this group must be carefully evaluated, and radiographs should be obtained for diagnosis and early treatment. Conservative treatment of these injuries has good results, and avoiding intensive power training avoids the risk of this injury.

Background Bizarre parosteal osteochondromatous proliferation (BPOP), first described by Nora et al. in 1983 and therefore termed “Nora’s lesion”, is a rare lesion that occurs in the short bones of the hands and feet and eventually presents as a parosteal mass. Reports of BPOP in the long bones are very rare. A benign disease, BPOP does not become malignant, although a high rate of recurrence following surgical resection is reported. Because of its atypical imaging findings and histopathological appearance, a BPOP might be misdiagnosed as a malignant tumor such as an osteochondroma with malignant transformation, a parosteal osteosarcoma, or a periosteal osteosarcoma. Case presentation A 58-year-old woman complained of left ulnar wrist pain at the time of her initial presentation. Plain x-rays showed ectopic calcifications in and around the distal radioulnar joint, which supported the diagnosis of subacute arthritis with hydroxyapatite crystal deposition. She was initially given a wrist brace and directed to follow-up, but her persistent pain required the administration of corticosteroid injections into the distal radioulnar joint. Increasing ulnar wrist joint pain and limited forearm pronation and wrist flexion necessitated computed tomography and contrast-enhanced magnetic resonance imaging. BPOP was diagnosed based on the preoperative imaging studies, and a resection of the lesion was performed along with the decortication of the underlying the cortical bone to reduce recurrence rates. The diagnosis of BPOP was confirmed by pathologic examination. Two years after surgery, the patient has no subsequent pain complaints and an improved range of motion. Conclusions BPOP affecting the distal end of the ulna is exceedingly rare. Because BPOP was diagnosed primarily based upon preoperative imaging findings in our patient, decortication of the underlying cortical bone was performed to reduce recurrence rates. Further careful follow-up in these patients is essential, despite the non-recurrence of the lesion.

BackgroundWrist pain from repetitive dorsiflexion and compression during pommel horse exercises is common among male gymnasts.PurposeTo determine the biomechanical effects of a prophylactic wrist brace on the wrist and ulnocarpal joints during mechanical loading in a cadaveric model.HypothesisThe lateral wedge of the palmar pad of the brace will compensate for positive ulnar variance, distributing contact forces more evenly across the radioulnar carpal joint.Study DesignControlled laboratory study.MethodsSix male and six female fixed cadaveric forearm-wrist specimens were subjected to a 32.13-kg compressive load applied through the long axis of the pronated forearm with a dorsiflexed wrist in contact with a support surface. Wrist joint dorsiflexion angle and ulnocarpal joint intraarticular peak pressure were assessed under three brace conditions: Ezy ProBrace with and without palmar pad and a nonbraced control.ResultsWrist joint dorsiflexion angle was significantly reduced by the Ezy ProBrace with and without the palmar pad. However, ulnocarpal joint intraarticular peak pressure was reduced only by the brace with pad.ConclusionPrevention of pathologic wrist changes requires intervention in pressure attenuation, which was achieved with the Ezy ProBrace with palmar pad.Clinical RelevanceThis brace may decrease the cumulative effects of repetitive stress of pommel horse exercise training.

The Mouse Brace is a convenient device that is capable of replacing the existing optical mouse. It consists of a wrist brace that houses the mouse circuitry. The Mouse Brace is a sensor based device that consists of an accelerometer and two flex sensors. The Mouse Brace is also an excellent solution to the Carpal Tunnel Syndrome that may be induced due to excessive computer usage.

Immobilization of the wrist joint with a splint is an established approach for ulnar-sided pain due to ulnocarpal abutment syndrome. However, patients have a tendency to stop wearing the splints because of its inconvenience and there have been no reports based on splint therapy.We investigated the usefulness of a newly designed custom-made aluminum splint for ulnar-sided wrist pain.This was a cohort study of the aluminum splint therapy for the patients who had been primarily treated with a conventional splint but ceased to use it because of the inconvenience in activities of daily living.The subjects included 10 female patients (mean age = 44.2 years). The outcome was assessed using the visual analogue scale score for pain, the disabilities of the arm, shoulder and hand score, range of motion of the wrist, and the grip strength. The mean follow-up period after wearing the aluminum splint was 8.8 months.All parameters, including the visual analogue scale pain and disabilities of the arm, shoulder and hand scores, improved significantly (p0.05) following use of the aluminum splint relative to the pretreatment scores. Seven patients continued to use the aluminum splint, and three of the seven had complete remission from related pain.Constant use of the aluminum splint during the study period was associated with improvement in the ulnar-sided wrist pain scores, which reconfirmed that increased adherence to splint use in daily activities is an important intentional behavioral strategy.Although the custom splint is effective for alleviation of wrist pain in ulnocarpal abutment syndrome, continuity of splint use is a key element of conservative treatment. This study showed that a splint that patients were willing to wear in their daily life was a useful device for alleviation of pain.

Thermoplastic wrist orthoses have been used for some time for serial correction before surgery for radial dysplasia to realign the hand on the forearm bone. However, problems have been experienced with pressure areas, especially at the distal and proximal radial edges. Inserting padding with such a small orthosis (if made for a baby) distorts the fit. A neoprene brace has been developed that can be applied to an infant as young as 3 weeks old. Thermoplastic ulnar and radial reinforcers are used to maintain the correction. The method of construction and positioning are described. The reinforcers can be serially adjusted to achieve a neutral position at the wrist. In babies, passive correction may be easier to obtain, but in older children with soft-tissue shortening, acceptable realignment can be achieved serially and maintained until surgery is appropriate. Using neoprene avoids serious pressure problems. Neoprene is durable, washable, and accepted by this client group and their parents. It has been demonstrated that correcting the alignment of the hand improves hand function, especially in bilateral activities, and allows the child to swim and play in water while wearing it, thus enhancing the quality of life.

Reduction of pain and gain of functionality in symptomatic osteoarthritis of the first carpometacarpal joint.Idiopathic, rheumatic, or posttraumatic osteoarthritis of the first carpometacarpal joint. RELATIVE CONTRAINDICATIONS: Poor general condition, poor condition of the hand's soft tissue/skin, chronic regional pain syndrome, current or recent infections of the hand, heavy manual labor (decision on a by-case basis).Supine position, hand pronated or slightly tilted. Upper arm tourniquet (Esmarch's method). Loupe magnification. Incision over the first extensor compartment. Exposure and incision of the thumb's basal joint. Resection of the trapezium. Exposure of the abductor pollicis longus (APL) tendon. Longitudinal split of the tendon harvesting the distally based ulnar part of the tendon. The split APL tendon is wrapped around the flexor carpi radialis (FCR) muscle tendon, suturing it to the tendon and back to itself. The rest of the split APL tendon is placed into the gap between the scaphoid and the first metacarpal bone, which is followed by wound closure.Plaster cast (thumb abduction splint) for 4 weeks. Stable commercially available wrist brace for at least 2 more weeks.There were no significant differences between the FCR arthroplasty (Epping's method) and the APL arthroplasty (Wulle's technique) regarding pain (visual analog scale), disability/usability (DASH score), or range of motion. Patients who had undergone APL arthroplasty showed significantly better grip and pinch strength. Furthermore, the operating time was significantly shorter and scars were significantly smaller in APL arthroplasty.

Carpal Tunnel Syndrome (CTS) is the most common disorder of neural involvement and the purpose of this study was to determine the impact of Stretching and Massage Therapy on Pain and Function of Females suffering Carpal Tunnel Syndrome. This Randomised Clinical Trial was implemented on 30 females (age: 32 + 4, height: 165 + 8, and weight: 62 + 6) who divided into 3 groups of 10 persons. First group received 20 session of massage therapy while the second had 20 session of stretching exercises and the third group just used the wrist brace. Standard Visual Analogue Scale for Pain (VAS Pain), Boston questionnaire have been used. Descriptive statistics were used for stratifying data and Shapiro test, independent T-test and U Mann Whitney test were used for analysis of data by SPPS version 18. Based on U Mann Whitney test, the effect of massage therapy on pain reduction in CTS is significant (p = 0.5). It has also has shown that massage therapy is effective on severity of symptoms of CTS and improvement of wrist and hand function (p = 0.022), but it doesn’t have any significant impact on paresthesia (p = 0.281), range of motion (p = 0.655), grip force (p = 0.427), and pinch force (p = 0.145) of CTS patients. Independent T-test between stretching group and wrist brace group showed that stretching had a significant effect on pain (p = 0.017), function (p = 0.011), and severity of signs and symptoms of CTS (p = 0.024), but it didn’t have any meaningful impact on paresthesia (p = 0.176), range of motion (p = 0.0537), grip force (p = 0.0587), and pinch force (p = 0.481) of patients. It has been concluded that stretching and massage could be used for treatment of Carpal Tunnel Syndrome.

Objective: We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. Materials and Methods: Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After confirming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasiblity and procedure-related immediate and delayed complications were evaluated. Results: The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. Conclusion: Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced neurointerventionalists, it seems that additional training for perfoming transradial cerebral angiography is not needed.

Injuries of the wrist are common among snowboarders and in-line skaters. Wrist protectors have been developed to protect against injury. Some studies support the use of such wrist protection, but others emphasize the fact that wrist protectors may transfer the injury to other locations in the forearm. We conducted a prospective, randomized, clinical study of 5029 snowboarders, 2515 in a braced group and 2514 in a control group. The primary endpoint was fracture or sprain of the wrist with loss of range of motion and pain of at least a 3-day duration. Concomitant injuries were also recorded. Eight wrist injuries occurred in the braced group and 29 occurred in the control group. This was a significant difference. Beginners (first 5 days on a snowboard) and snowboarders with rented equipment were more prone to injury than others. No injuries could be related to the use of the wrist brace. We conclude that wrist braces are effective in protecting snowboarders against wrist injury. Beginners are a high-risk group.

The purpose of this study was to compare the dynamic impact response of braced and unbraced cadaveric wrists using a commercially available wrist guard. Twelve arms were harvested from six cadavers. Each pair of forearms, one with and one without a brace, were impacted using a modified guillotine-type drop fixture placed over a force platform. Using a piece-wise linear regression analysis, we identified four phases of dynamic loading in the vertical force profile before fracture. These phases included an initial linear loading phase starting at impact, followed by a nonlinear phase, a second rapid linear loading phase, and a final nonlinear loading phase to failure. Three transition points were identified that defined the boundaries of the linear loading phases. Vertical force and impulse were significantly higher (P 0.01) at each transition point and at failure in all braced specimens compared with unbraced specimens. However, the most noticeable differences were found during the initial two loading phases. Time to each transition point and to failure was not significantly different (P 0.27) between the braced and unbraced wrists. The results of this study differ from those obtained under more quasistatic loading conditions. Dynamic impact testing suggests that wrist guards may have a prophylactic effect during low-energy dynamic impact situations.

We compared patterns of bony and ligamentous injury with distal radial fractures in braced and unbraced wrists using 20 paired fresh cadaveric upper extremi ties. A commercially available wrist brace was placed on one wrist in each pair. Specimens were then placed in a fast-loading gravity-driven device and subjected to loads averaging 16 kg from an average height of 78 cm. Postfracture radiographs were obtained, the spec imens were dissected, and fracture patterns and liga mentous integrity were assessed. The following frac ture types were produced: distal radial fractures (eight unbraced, seven braced) and intraarticular (seven un braced, four braced). Radiographically, seven un braced wrists demonstrated carpal bone fracture and one braced wrist demonstrated carpal fractures. Eight unbraced and three braced wrists sustained carpal intrinsic ligament injuries, four unbraced and one braced wrists demonstrated extrinsic ligament injuries. More capsular tears occurred in the unbraced group ( N = 8) than in the braced group ( N = 1). This model demonstrated a difference in the patterns of injury in unbraced and braced wrists subjected to the same mechanical conditions, which suggests that use of a wrist brace may alter patterns of wrist injury.

Skeletal abnormalities are known to be a characteristic feature of the trisomy 8 syndrome, and radiological malformations are often more characteristic than the clinical features. We report a mentally retarded male known to have mosaic trisomy 8 syndrome who presented with radial deviation of his right wrist. Radiographs showed an open ulna epiphysis with a closed radial epiphysis. Surgery was postponed until an older age as his ulna epiphysis had not yet closed, but clinical correction was achieved with a wrist brace. This is the first report of radial deviation of the wrist in a patient with mosaic trisomy 8

Orthoses that are used to stabilize, protect, and support the wrist during functional activities often interfere with normal movement and, therefore, with hand function. This study compared the manual dexterity and grip strength of 20 female subjects while using a free hand and while wearing each of four wrist extensor orthoses: a Futuro prefabricated wrist brace (No. 33), a volar thumbhole orthosis, a volar orthosis with a radial connector bar, and a dorsal orthosis with distal transverse arch support. Of these orthoses, the Futuro prefabricated wrist brace afforded the best overall dexterity, although it was significantly slower (p < .05) than the other orthoses in a writing subtest. Of the custom-made orthoses, the volar style with radial connector bar afforded the best overall dexterity. All of the orthoses significantly (p < .01) reduced grip strength. The Futuro prefabricated wrist brace afforded the strongest grip strength of the four orthoses studied, and the volar thumbhole orthosis permitted the strongest grip among the custom-made orthotic styles.

A method and apparatus for determining the mean arterial blood pressure (MAP) of a subject during tonometric conditions. In one embodiment, the apparatus comprises one or more pressure and ultrasound transducers placed over the radial artery of a human subject's wrist, the latter transmitting and receiving acoustic energy so as to permit the measurement of blood velocity during periods of variable compression of the artery. During compression, the ultrasound velocity waveforms are recorded and processed using time-frequency analysis. The time at which the mean time-frequency distribution is maximal corresponds to the time at which the transmural pressure equals zero, and the mean pressure read by the transducer equals the mean pressure within the artery. In another aspect of the invention, the ultrasound transducer is used to position the transducer over the artery such that the accuracy of the measurement is maximized. In yet another aspect of the invention, a wrist brace useful for measuring blood pressure using the aforementioned apparatus is disclosed.

Introduction Psychogenic movement disorders in childhood have been little researched. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed. Case presentation A 13-year-old Caucasian girl with tremor in both wrists, severe enough to prevent her from attending school, was sent to our hospital. After a complete neurological and psychiatric examination, in-patient child-psychotherapeutic treatment was started, with careful consideration given to both chronic and acute stress factors which constitute her performance and exam anxiety in school as well as the girl's parents' conflicted relationship. With the aid of a customized wrist brace our patient was able to go to school and write despite the presence of a marked tremor, which in turn reduced her avoidance behavior and exam anxiety. By the end of her in-patient treatment, the tremor was still noticeable, but markedly reduced in severity (reduction 80%). Two weeks after she was discharged from hospital, the tremor had completely disappeared. Conclusion After careful clinical diagnostics, this kind of dissociative disorder should be treated appropriately with age-adapted cognitive-behavioral therapy to achieve positive and lasting benefits.

Wrist braces have been used in the industry with the notion that they would restrict the range of motion of the wrist to an extent that it would decrease the risk of CTS during forceful repetitive tasks and enhance productivity. The purpose of this study was to evaluate the effects of the functional wrist brace, wrist angle, and fatigue on maximal grasp strength. Fourteen male and sixteen female college students participated in the study utilizing a soft brace, a hard brace, and no brace in three different static wrist positions (45° flexion, neutral, and 45° extension) prior to and after fatigue to determine the effect on maximal grasp strength measured by a computerized wrist dynamometer. The results of the ANOVA indicated that grasp strength was significantly greater when the wrist was in the flexion position followed by neutral, then wrist extension. However, brace type and fatigue states did not produce statistically significantly different grasp strengths overall. Therefore, the position a grasping task is performed at should be evaluated keeping in mind that the neutral and flexion positions allow for the greatest maximal grasp force with or without a wrist brace. Wrist braces are not recommended as a preventative or protective device during forceful repetitive tasks but the effects of their usage on maximal grasp strength must be evaluated with special consideration of the post-fatigue state.

I have devised a splint which we use at our clinic for fractures of the phalanges with bowing or displacement and which I believe is of great value in industrial work. The splint consists of a leather wrist support made of firm leather, with a wire (modified copy of the banjo splint) over it. The wire is attached to the wrist brace by a slide-rod and thumbscrew which is easily adjustable. By means of this slide-rod and thumbscrew it is possible to make the necessary traction on a finger or fingers and to maintain that traction or to increase or decrease it from visit to visit as one desires without a change of bandage and a great deal of manipulation. Should the thumb be among the injured members, a full circular wire (such as the banjo splint) may be used, the ends of the wire going through the slide-rods and