Wrist salvage procedures alter moment arms of the primary wrist muscles

Nichols, Jennifer A.; Bednar, Michael S.; Havey, Robert M.; Murray, Wendy M.

doi:10.1016/j.clinbiomech.2015.03.015

Cited by 12 publications

(14 citation statements)

References 26 publications

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“…Since the application of muscle tension to a moment arm produces joint torque, alterations in forearm position might affect wrist torque. Torque ratios [ 6 ] and moment arm ratios [ 7 ] have previously been used as measures of wrist balance. In addition, the relationship between wrist position and strength/torque [ 8 ] has been examined.…”

Section: Introductionmentioning

confidence: 99%

Measurement of wrist flexion and extension torques in different forearm positions

et al. 2015

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BackgroundForceful activities of the wrist were considered to be a risk factor for the epicondylitis. However, there are still conflicting evidence concerning work-relatedness of epicondylitis. The main problem is that there is little information about which forearm postures are capable of withstanding higher torque loads and the extent of the differences in the torques generated by different forearm postures. The objective of this study was to investigate the differences in wrist flexion and extension torques among different forearm positions in healthy subjects.MethodsTwenty wrists of 10 asymptomatic volunteers were evaluated. The apparatus to measure the wrist torque consisted of a handle with a force sensor and a table to place the forearm in different positions. The direction of the handle can change when measuring different forearm positions. The forearm of the examinee was secured to the table. The participants were asked to exert themselves in maximal isometric contraction for wrist flexion or extension, and to maintain it for 5 s. Each evaluation of the flexion and extension torque was conducted twice. Three forearm positions were evaluated: neutral, pronation, and supination. The intra-class correlation coefficients between first and second measurements were evaluated for the maximum torque. The maximum torques and flexion/extension ratio were compared among the positions. In addition, the agility and endurance for the wrist extension/flexion torques were compared among the positions.ResultsThe intra-class correlation coefficients between first and second measurements were 0.928 and 0.866 for the wrist flexion and extension measurements, respectively. The highest torques for the wrist flexion and extension were observed in the supination and pronation positions, respectively (P < 0.01). There was a higher extension/flexion ratio in the supination position compared to the other positions (P < 0.05). There was a superior agility for the wrist flexion in the supination position compared to the pronation position.ConclusionsThe normal balance of the wrist flexion–extension torques in different forearm positions were characterized. This information might aid the provision of advice regarding the optimal positions for performing specific tasks and could help to elucidate the pathophysiology of epicondylitis.

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Section: Introductionmentioning

confidence: 99%

Measurement of wrist flexion and extension torques in different forearm positions

et al. 2015

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“…For example, the nonimpaired thumb model (excluding the wrist) was validated by replicating cadaveric and in vivo data (see Wohlman and Murray 2013). The endpoint forces simulated with the SE4CF and PRC models have not been evaluated against similar data, despite being based on experimental data (Blankenhorn et al 2007; Nichols et al 2015; Nichols et al 2016; Nichols et al 2017). While many studies summarize clinical outcomes of these surgeries, studies that provide the scope and quantitative detail needed to validate our biomechanicalsimulationsdonotexist.Experimentalvalidationisalsoneededtoinformexpansion of the models to include finger kinematics, which were excluded from this study, as well as extrinsic finger muscles, which we represented as reserve torques.…”

Section: Discussionmentioning

confidence: 99%

“…To test this hypothesis, we leverage available biomechanical data characterizing the wrist surgeries (Blankenhorn et al. 2007; Nichols et al 2015; Nichols et al 2016; Nichols et al 2017) and computational advances in biomechanical simulation of force development at the thumb (Valero-Cuevas et al 2003; Goehler and Murray 2010; Wohlman and Murray 2013) to develop dynamic musculoskeletal simulations of lateral pinch force that integrate the wrist and thumb. We then utilize these simulations to specifically examine how having a nonimpaired versus a surgically-altered wrist influences joint torques, muscle force transmission, and muscle control strategies during lateral pinch.…”

Section: Introductionmentioning

confidence: 99%

Connecting the wrist to the hand: A simulation study exploring changes in thumb-tip endpoint force following wrist surgery

Nichols

Bednar

Wohlman

et al. 2017

Journal of Biomechanics

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The wrist is essential for hand function. Yet, due to the complexity of the wrist and hand, studies often examine their biomechanical features in isolation. This approach is insufficient for understanding links between orthopaedic surgery at the wrist and concomitant functional impairments at the hand. We hypothesize that clinical reports of reduced force production by the hand following wrist surgeries can be explained by the surgically-induced, biomechanical changes to the system, even when those changes are isolated to the wrist. This study develops dynamic simulations of lateral pinch force following two common surgeries for wrist osteoarthritis: scaphoid-excision four-corner fusion (SE4CF) and proximal row carpectomy (PRC). Simulations of lateral pinch force production in the nonimpaired, SE4CF, and PRC conditions were developed by adapting published models of the nonimpaired wrist and thumb. Our simulations and biomechanical analyses demonstrate how the increased torque-generating requirements at the wrist imposed by the orthopaedic surgeries influence force production to such an extent that changes in motor control strategy are required to generate well-directed thumb-tip end-point forces. The novel implications of our work include identifying the need for surgeries that optimize the configuration of wrist axes of rotation, rehabilitation strategies that improve post-operative wrist strength, and scientific evaluation of motor control strategies following surgery. Our simulations of SE4CF and PRC replicate surgically-imposed decreases in pinch strength, and also identify the wrist's torque-generating capacity and the adaptability of muscle coordination patterns as key research areas to improve post-operative hand function.

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“…The moment arm experiment was designed to measure the muscle moment arms of the primary wrist and extrinsic thumb muscles. The data describing the primary wrist muscle moment arms has been previously described [ 47 ]. Briefly, muscle moment arms for the nonimpaired and surgically salvaged wrists were measured in eight unmatched, fresh-frozen cadaver upper extremities (four male, four female; avg.…”

Section: Methodsmentioning

confidence: 99%

“…There are over 500 ICD-9 codes classifying distinct diseases and procedures in the upper limb [ 31 ]. Yet, moment arms have been measured following less than 20 procedures in the shoulder [ 28 , 32 – 38 ], elbow [ 39 ], forearm [ 40 , 41 ], wrist [ 42 – 47 ], and hand [ 48 – 50 ]. The lack of studies measuring moment arms following orthopaedic procedures highlights that performing these experiments is difficult; they require a specific type of research environment that includes scientists skilled at collecting moment arm data as well as surgeons available to properly perform the surgical procedure under investigation.…”

Section: Introductionmentioning

confidence: 99%

Surgical Simulations Based on Limited Quantitative Data: Understanding How Musculoskeletal Models Can Be Used to Predict Moment Arms and Guide Experimental Design

2016

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The utility of biomechanical models and simulations to examine clinical problems is currently limited by the need for extensive amounts of experimental data describing how a given procedure or disease affects the musculoskeletal system. Methods capable of predicting how individual biomechanical parameters are altered by surgery are necessary for the efficient development of surgical simulations. In this study, we evaluate to what extent models based on limited amounts of quantitative data can be used to predict how surgery influences muscle moment arms, a critical parameter that defines how muscle force is transformed into joint torque. We specifically examine proximal row carpectomy and scaphoid-excision four-corner fusion, two common surgeries to treat wrist osteoarthritis. Using models of these surgeries, which are based on limited data and many assumptions, we perform simulations to formulate a hypothesis regarding how these wrist surgeries influence muscle moment arms. Importantly, the hypothesis is based on analysis of only the primary wrist muscles. We then test the simulation-based hypothesis using a cadaveric experiment that measures moment arms of both the primary wrist and extrinsic thumb muscles. The measured moment arms of the primary wrist muscles are used to verify the hypothesis, while those of the extrinsic thumb muscles are used as cross-validation to test whether the hypothesis is generalizable. The moment arms estimated by the models and measured in the cadaveric experiment both indicate that a critical difference between the surgeries is how they alter radial-ulnar deviation versus flexion-extension moment arms at the wrist. Thus, our results demonstrate that models based on limited quantitative data can provide novel insights. This work also highlights that synergistically utilizing simulation and experimental methods can aid the design of experiments and make it possible to test the predictive limits of current computer simulation techniques.

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Wrist salvage procedures alter moment arms of the primary wrist muscles

Cited by 12 publications

References 26 publications

Measurement of wrist flexion and extension torques in different forearm positions

Measurement of wrist flexion and extension torques in different forearm positions

Connecting the wrist to the hand: A simulation study exploring changes in thumb-tip endpoint force following wrist surgery

Surgical Simulations Based on Limited Quantitative Data: Understanding How Musculoskeletal Models Can Be Used to Predict Moment Arms and Guide Experimental Design

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