Ulnar-sided perilunate instability: An anatomic and biomechanic study

Viegas, Steven F.; Patterson, Rita M.; Peterson, Pamela D.; Pogue, David J.; Jenkins, David K.; Sweo, Timothy D.; Hokanson, Jim

doi:10.1016/0363-5023(90)90107-3

Cited by 199 publications

(62 citation statements)

References 27 publications

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“…Previous studies on wrist biomechanics focused on kinematic changes of carpal disorders (16,23,25,31,32). Our present study is one of the first to determine changes in the biomechanical parameters of wrist motors under pathologic conditions.…”

Section: Discussionmentioning

confidence: 88%

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Tang

Ryu

Han

et al. 1997

Journal Orthopaedic Research

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Loss of integrity of the scaphoid may change the motion center of the entire carpus, and deformities from scaphoid fractures may alter the location of motor tendons of the wrist, thus altering their biomechanics. The goal of this study was to clarify biomechanical changes in these tendons following loss of scaphoid integrity. Excursions and moment arms of the principal flexor and extensor tendons of the wrist were investigated in seven cadaveric upper extremities in intact wrists after simulation of scaphoid waist fracture and after removal of the proximal scaphoid. Excursions of the flexor carpi radialis and ulnaris, extensor carpi radialis longus and brevis, and extensor carpi ulnaris tendons were measured with rotary potentiometers during wrist flexion-extension and radioulnar deviation. Simultaneously, wrist joint angulation was recorded. Moment arms of the tendons were derived from tendon excursions and joint motion. After scaphoid fracture, the moment arms of the flexor carpi radialis and extensor carpi ulnaris tendons increased significantly during wrist flexion-extension, whereas the moment arms of the extensor carpi radialis longus and brevis tendons decreased significantly. After proximal scaphoid excision, the moment arms of the extensor carpi radialis longus and brevis tendons again decreased significantly during wrist flexion-extension. The moment arms of the flexor carpi radialis and extensor carpi radialis brevis tendons increased significantly during radioulnar deviation, whereas those of the wrist motors on the ulnar side decreased. These findings indicate the importance of the integrity of the scaphoid in maintaining normal biomechanics of motor tendons of the wrist. An increase in the moment arm of the radial wrist flexor along with a decrease in moment arms of the radial extensors constitutes as etiology for persistent angulation of the scaphoid and the humpback deformity. In addition, disturbing the biomechanics of the wrist motor tendons predisposes the carpal joints to abnormal loading, potentially contributing to the development of carpal joint degeneration.

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Section: Discussionmentioning

confidence: 88%

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Tang

Ryu

Han

et al. 1997

Journal Orthopaedic Research

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“…Ulnarside wrist pain and weakness are the most common symptoms of patients with LTq instability [ 43 ]. As stated for SLD, there is a spectrum of clinical presentations involving varying degrees of LTq joint disruption, ranging from a partial tear of its proximal membrane to complete dissociation with static carpal collapse [ 42 ]. In the latter stage, the carpus usually collapses into a static VISI, and the wrist presents with a forklike appearance, with the ulnar column sagging palmarly, relative to the prominent distal ulna.…”

Section: Lunotriquetral Dissociationmentioning

confidence: 98%

Chronic Carpal Instability

García-Elias

2014

Disorders of the Hand

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“…Fractures of radius or scaphoid can be associated. The infrequent hyperpronation injuries can cause instability patterns on the ulnar side [29]. Furthermore, posttraumatic sequela, like an abnormal articular tilt of a malunioned distal radius fracture, may consequently result in an instable wrist.…”

Section: Pathogenesismentioning

confidence: 99%

Carpal instability

et al. 2006

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This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads ("dyskinetics") or suffers from abnormal motion of its bones during movement ("dyskinematics"). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being "occult" for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the hand surgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.

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Ulnar-sided perilunate instability: An anatomic and biomechanic study

Cited by 199 publications

References 27 publications

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Chronic Carpal Instability

Carpal instability

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