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Midcarpal instability

Saman Modaresi, Madhan S Kallem, Phil Lee, Terence E McIff, E Bruce Toby, Kenneth J Fischer
BACKGROUND: Scapholunate ligament injury is a commonly occurring carpal ligament injury. Pathology associated with scapholunate ligament injury depends on several factors such as the time after injury, type of injury (instability) and the development of osteoarthritis. The aim of this study was to investigate and compare contact mechanics in the lunocapitate and scaphocapitate joints in the normal, injured (scapholunate dissociation) and repaired (postoperative) wrist. METHODS: Four human subjects with scapholunate ligament dissociation participated in this study...
August 2017: Clinical Biomechanics
Victoria M Deans, Zafar Naqui, Lindsay T S W Muir
BACKGROUND: The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical interventions specific to STT OA. METHODS: Medline and Embase libraries were searched using a pre-defined search strategy in October 2014. All study designs and languages were included and evaluated by two reviewers (VMD and LM) against the inclusion/exclusion criteria. The study eligibility criteria included papers discussing surgical treatment of STT OA, and the review was conducted using the PRISMA guidelines...
March 2017: Journal of Hand Surgery Asian-Pacific Volume
María Francisca Vázquez-Alonso, Alberto Viñas-Silva
Scapholunate advance collapse (SLAC) and Scaphoid nonunion advance collapse (SNAC), are the two most common patterns of postraumatic wrist arthritis. SLAC wrist develops after attenuation, either traumatically or atraumatically, of the scapholunate ligament. Atraumatic causes of SLAC wrist include calcium pyrophosphate dehydrate deposition disease, reumathoid arthritis, neuropathic diseases, and b2-microglobulin asociated amyloid deposition diseases. On the other hand, SNAC wrist develops following a scahpoid fracture that has progressed to a nonunion...
2016: Revista Médica del Instituto Mexicano del Seguro Social
Gregory I Bain, Simon B M MacLean, Wing-Lim Tse, Pak-Cheong Ho, David M Lichtman
The assessment and management of Kienböck Disease (KD) has always been a conundrum. The Lichtman classification has traditionally been used to guide treatment based on imaging. Arthroscopy provides a direct visualization of the articular surface, allows probing of the surfaces, and enables minimally invasive techniques to be performed. The Lichtman-Bain classification is a new classification that takes into account the osseous, vascular, and cartilage aspects of the lunate and the secondary effects on the wrist...
November 2016: Journal of Wrist Surgery
Kevin D Han, Jaehon M Kim, Michael V DeFazio, Ricardo J Bello, Ryan D Katz, Brent G Parks, Kenneth R Means
PURPOSE: A high incidence of nonunion and relatively poor outcomes with prior fixation techniques has precluded scapholunate (SL) arthrodesis as a standard treatment for SL instability. Our purpose was to determine the impact on range of motion (ROM) of simulated SL arthrodesis via headless screw fixation. METHODS: We performed baseline wrist ROM for 10 cadaveric wrists using a standardized mounting-and-weights system. Extension, flexion, radial deviation, ulnar deviation, dart-thrower's extension, and dart-thrower's flexion were assessed...
September 2016: Journal of Hand Surgery
Mireia Esplugas, Marc Garcia-Elias, Alex Lluch, Manuel Llusá Pérez
This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency...
April 2016: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Sanglim Lee, Jae-Ha Yu, Suk Ha Jeon
Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment...
June 2016: Clinics in Orthopedic Surgery
J Brunet, G Bacle, E Marteau, F Gadea, J Laulan
Secondary osteoarthritis due to a scapholunate malalignment is well known, but is debatable in cases of lunotriquetral malalignment. It has been shown that lunotriquetral malalignment can lead to midcarpal osteoarthritis. The hypothesis of this retrospective study was that a relationship exists between the presence of midcarpal osteoarthritis and the presence of lunotriquetral malalignment. All patients with midcarpal osteoarthritis, isolated or predominant, treated between 1981 and 2013 were reviewed. Intracarpal angles were measured and the relative position of the carpal bones was analyzed by two examiners...
February 2016: Hand Surgery and Rehabilitation
D G Hargreaves
Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies...
January 2016: Journal of Hand Surgery, European Volume
T R Lindau
Carpal instability is predominantly caused by trauma and presents as a painful wrist with signs and symptoms of weakness, clicking, clunking and a sense of giving way. Wrist arthroscopy is widely regarded as the 'gold standard' in diagnosing and understanding carpal instability. This article is based on an extensive literature search to evaluate the evidence behind the use of wrist arthroscopy in the assessment and management of these patients. There is convincing evidence supporting the role of arthroscopy in diagnosis and assessment of factors involved in the development of carpal instability, but weak evidence for the effectiveness of arthroscopic techniques in the actual treatment of this condition...
January 2016: Journal of Hand Surgery, European Volume
C Harwood, L Turner
Midcarpal instability is a complex condition that can present in various forms, from mild pain to debilitating subluxation. Once diagnosed, treatment guidelines for hand therapy are limited by the scarcity of high-level evidence. Evidence does exist for use of proprioceptive awareness and neuromuscular rehabilitation for instability of the knee, shoulder and ankle joint, but studies of similar programmes for the wrist joint have not been published. The purpose of this review is to examine the evidence supporting current concepts in the non-operative management of midcarpal instability, and to provide recommendations for the management of this condition with hand therapy...
January 2016: Journal of Hand Surgery, European Volume
Robert J van Kampen, Christopher O Bayne, Steven L Moran, Richard A Berger
Purpose In an attempt to restore natural carpal kinematics more closely, bone-ligament-bone (BLB) grafts have been described for treating scapholunate (SL) injury. In this article we report the long-term results of capitohamate BLB autograft for the treatment of SL dissociation. Methods The medical records of patients treated with capitohamate BLB grafts for SL dissociation were retrospectively reviewed. Twenty-three patients were available for evaluation. Patients were sent a Disabilities of the Arm, Shoulder, and Hand (DASH) and a Patient-Rated Wrist Evaluation (PRWE) questionnaire and returned for exam...
November 2015: Journal of Wrist Surgery
Eric E J Raven, Michel P J van den Bekerom, Annechien Beumer, C Niek van Dijk
BACKGROUND: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in rheumatoid arthritis RA). METHODS: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment options. Results. In the search 108 articles were found, of these 12 studies were included for this review...
2015: Open Orthopaedics Journal
Lolade Giwa, Kate Spacey, Greg Packer
Background Intra-articular distal radius fractures can have many complications, including radiocarpal osteoarthritis and distal radioulnar joint (DRUJ) dysfunction leading to pain and restricted wrist function. Case Description We describe the case of a 38-year-old patient who sustained a left distal radius intra-articular fracture, which was treated with volar plating. She developed pain from the radiocarpal joint as a result of intra-articular malunion and was listed for total wrist fusion. On the day of surgery this was converted to a Darrach procedure for minor DRUJ symptoms...
August 2015: Journal of Wrist Surgery
Timothy Niacaris, Bryan W Ming, David M Lichtman
Midcarpal instability has been well described as a clinical entity but the pathokinematics and pathologic anatomy continue to be poorly understood. This article presents a comprehensive review of the existing knowledge and literature-based evidence for the diagnosis and management of the various entities comprising midcarpal instability. It discusses the limitations of the current understanding of midcarpal instability and proposes new directions for furthering knowledge of the causes and treatment of midcarpal instability and wrist pathomechanics in general...
August 2015: Hand Clinics
Anne Gray, Philippe Cuénod, Michaël Y Papaloïzos
PURPOSE: To assess midterm outcomes of our bone-ligament-bone (BLB) grafts for chronic scapholunate (SL) instability and better define criteria for their use. METHODS: We conducted a retrospective review of 26 patients treated with BLB grafts and dorsal capsulodesis between 1997 and 2009. Twenty-four patients were reviewed. Mean follow-up was 8.2 years. Two patients had dynamic lesions, 7 had SL dissociation, 14 had a dorsal intercalated segment instability lesion, and 1 had SL advanced collapse stage 1...
August 2015: Journal of Hand Surgery
Federica Braidotti, Andrea Atzei, Tracy Fairplay
The Authors describe a novel hinged orthosis that permits selective midcarpal mobilization along the plane of the dart throwing motion. This orthotic device can be used to assist rehabilitation protocols aimed to limit radiocarpal joint mobility and scapho-lunate ligament overload and to accelerate wrist functional recovery after ligamentous injuries around the proximal carpal row. - VictoriaW. Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor.
July 2015: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Steve K Lee, Zina Model, Healthy Desai, Patricia Hsu, Nader Paksima, Gurpreet Dhaliwal
PURPOSE: To determine whether specific anatomic lesions of the scapholunate supporting structures are associated with the grades of scapholunate instability according to the Geissler classification. METHODS: Six fresh frozen cadaveric limbs underwent serial arthroscopic sectioning of the scapholunate supporting ligaments. To simulate a progressive scapholunate injury based on the current literature, sectioning occurred as follows: volar scapholunate interosseous ligament (SLIL), membranous SLIL, dorsal SLIL, radioscaphocapitate, long radiolunate, dorsal radiocarpal, dorsal intercarpal, and scaphotrapeziotrapezoid ligaments...
June 2015: Journal of Hand Surgery
Marco J P F Ritt, Peter J M de Groot
Extensor carpi radialis brevis (ECRB) transfer to the hamate bone is a novel procedure that offers a new surgical treatment option for select patients with midcarpal instability (MCI) who do not respond to conservative treatment. We present our early experience with this procedure. In total, 12 patients (13 wrists) were reviewed with a follow-up duration ranging from 1 to 6 years. Complications and changes in active range of motion (AROM) were noted. Patient related outcome was measured using the Patient Rated Wrist/Hand Evaluation (PRWHE) questionnaire, amongst others...
February 2015: Journal of Wrist Surgery
Tahseen Chaudhry, Mohammed Shahid, Feiran Wu, Anuj Mishra, Subodh Deshmukh
PURPOSE: To report the results of a technique of soft tissue stabilization for palmar midcarpal instability using a palmaris longus graft. METHODS: In patients' symptomatic wrists with palmar midcarpal instability that had failed conservative management, we used a dorsal approach and stabilized the hamate and triquetrum by reconstructing the dorsal triquetrohamate ligament. The palmaris longus tendon graft was fixed with bone anchors. Seven wrists in 6 patients were available for follow-up at a mean of 28 months (range, 17-37 mo)...
January 2015: Journal of Hand Surgery
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