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Carpal kinematics after proximal row carpectomy.
J Hand Surg Am. 2007 Jan; 32(1):37-46.JH

Abstract

PURPOSE

Proximal row carpectomy (PRC) is a clinically useful motion-sparing procedure for the treatment of certain degenerative conditions of the wrist. Clinical outcome studies after PRC have shown that wrist flexion-extension averages approximately 60% of that of the contralateral wrist. The purpose of this study was to determine how the kinematics of the wrist are altered after PRC.

METHODS

Eight fresh-frozen cadaver forearms were scanned with computed tomography before and after PRC. Forearms were scanned in 5 different wrist positions (neutral, extension, flexion, radial deviations, and ulnar deviation). Wrists were positioned dynamically and then held statically in a custom fixture through forces applied to the 4 wrist flexor/extensor tendon groups. Three-dimensional computer models of the radius, lunate, and capitate were generated from the computed tomographic images, and the kinematics of the capitate and lunate were calculated relative to the neutral position. For the intact wrist, the motion of the capitate was calculated relative to both the lunate (midcarpal motion) and the radius (overall wrist motion) and the motion of the lunate was calculated relative to the radius (radiocarpal motion). After PRC, only the movement of the capitate relative to the radius was calculated, which represents radiocapitate and overall wrist motion. All motions were plotted in 3 dimensions for purposes of qualitative visualization.

RESULTS

After PRC, the capitate articulated with the lunate fossa of the radius for all positions in all samples. Overall wrist motion decreased 28%, 30%, 40%, and 12% in flexion, extension, radial deviation, and ulnar deviation, respectively. Motion at the radiocarpal joint after PRC, however, was greater compared with motion at the radiocarpal and midcarpal joints of the intact wrist during flexion and extension. This was not the case in radial deviation because of impingement of the trapezoid on the radial styloid. In radial and ulnar deviation, motion of the capitate head changed from predominantly rotational in the intact wrist (midcarpal joint) to a combination of rotation and translation after PRC (radiocarpal joint).

CONCLUSIONS

Removal of the proximal carpal row decreased normal wrist flexion and extension. Although ulnar deviation was preserved, radial deviation was limited by impingement of the trapezoid on the radial styloid. Radiocapitate range of motion after PRC was greater than capitolunate range of motion in the intact wrists. Compared with previously published requirements, wrist range of motion observed after PRC was sufficient for activities of daily living.

Authors+Show Affiliations

Musculoskeletal Imaging and Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17218174

Citation

Blankenhorn, Brad D., et al. "Carpal Kinematics After Proximal Row Carpectomy." The Journal of Hand Surgery, vol. 32, no. 1, 2007, pp. 37-46.
Blankenhorn BD, Pfaeffle HJ, Tang P, et al. Carpal kinematics after proximal row carpectomy. J Hand Surg Am. 2007;32(1):37-46.
Blankenhorn, B. D., Pfaeffle, H. J., Tang, P., Robertson, D., Imbriglia, J., & Goitz, R. J. (2007). Carpal kinematics after proximal row carpectomy. The Journal of Hand Surgery, 32(1), 37-46.
Blankenhorn BD, et al. Carpal Kinematics After Proximal Row Carpectomy. J Hand Surg Am. 2007;32(1):37-46. PubMed PMID: 17218174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carpal kinematics after proximal row carpectomy. AU - Blankenhorn,Brad D, AU - Pfaeffle,H James, AU - Tang,Peter, AU - Robertson,Doug, AU - Imbriglia,Joseph, AU - Goitz,Robert J, PY - 2006/06/15/received PY - 2006/08/30/revised PY - 2006/10/02/accepted PY - 2007/1/16/pubmed PY - 2007/3/16/medline PY - 2007/1/16/entrez SP - 37 EP - 46 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 32 IS - 1 N2 - PURPOSE: Proximal row carpectomy (PRC) is a clinically useful motion-sparing procedure for the treatment of certain degenerative conditions of the wrist. Clinical outcome studies after PRC have shown that wrist flexion-extension averages approximately 60% of that of the contralateral wrist. The purpose of this study was to determine how the kinematics of the wrist are altered after PRC. METHODS: Eight fresh-frozen cadaver forearms were scanned with computed tomography before and after PRC. Forearms were scanned in 5 different wrist positions (neutral, extension, flexion, radial deviations, and ulnar deviation). Wrists were positioned dynamically and then held statically in a custom fixture through forces applied to the 4 wrist flexor/extensor tendon groups. Three-dimensional computer models of the radius, lunate, and capitate were generated from the computed tomographic images, and the kinematics of the capitate and lunate were calculated relative to the neutral position. For the intact wrist, the motion of the capitate was calculated relative to both the lunate (midcarpal motion) and the radius (overall wrist motion) and the motion of the lunate was calculated relative to the radius (radiocarpal motion). After PRC, only the movement of the capitate relative to the radius was calculated, which represents radiocapitate and overall wrist motion. All motions were plotted in 3 dimensions for purposes of qualitative visualization. RESULTS: After PRC, the capitate articulated with the lunate fossa of the radius for all positions in all samples. Overall wrist motion decreased 28%, 30%, 40%, and 12% in flexion, extension, radial deviation, and ulnar deviation, respectively. Motion at the radiocarpal joint after PRC, however, was greater compared with motion at the radiocarpal and midcarpal joints of the intact wrist during flexion and extension. This was not the case in radial deviation because of impingement of the trapezoid on the radial styloid. In radial and ulnar deviation, motion of the capitate head changed from predominantly rotational in the intact wrist (midcarpal joint) to a combination of rotation and translation after PRC (radiocarpal joint). CONCLUSIONS: Removal of the proximal carpal row decreased normal wrist flexion and extension. Although ulnar deviation was preserved, radial deviation was limited by impingement of the trapezoid on the radial styloid. Radiocapitate range of motion after PRC was greater than capitolunate range of motion in the intact wrists. Compared with previously published requirements, wrist range of motion observed after PRC was sufficient for activities of daily living. SN - 0363-5023 UR - https://www.unboundmedicine.com/medline/citation/17218174/Carpal_kinematics_after_proximal_row_carpectomy_ DB - PRIME DP - Unbound Medicine ER -