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Research Papers

Subject-Specific Carpal Ligament Elongation in Extreme Positions, Grip, and the Dart Thrower's Motion

[+] Author and Article Information
Michael J. Rainbow

Department of Mechanical
and Materials Engineering,
Human Mobility Research Centre,
Queen's University,
130 Stuart Street,
Kingston, ON K7L 3N6, Canada
e-mail: michael.rainbow@queensu.ca

Robin N. Kamal

Department of Orthopaedic Surgery,
Stanford University,
450 Broadway Street, Pavilion C,
Redwood City, CA 94063
e-mail: rnkamal@stanford.edu

Douglas C. Moore

Department of Orthopaedics,
The Warren Alpert Medical School of Brown University,
Rhode Island Hospital,
1 Hoppin Street,
CORO West,
Suite 404,
Providence, RI 02903
e-mail: douglas_moore@brown.edu

Edward Akelman

Department of Orthopaedics,
The Warren Alpert Medical School of Brown University,
Rhode Island Hospital,
2 Dudley Street, Suite 200
Providence, RI 02905
e-mail: edward_akelman@brown.edu

Scott W. Wolfe

The Hospital for Special Surgery,
Weill Medical College, Cornell University,
East River Professional Building,
4th Floor,
523 East 72nd Street,
New York, NY 10021
e-mail: wolfes@hss.edu

Joseph J. Crisco

Department of Orthopaedics,
The Warren Alpert Medical School of Brown University,
Rhode Island Hospital,
1 Hoppin Street,
CORO West,
Suite 404,
Providence, RI 02903
e-mail: joseph_crisco@brown.edu

1Corresponding author.

Manuscript received May 28, 2014; final manuscript received August 25, 2015; published online September 30, 2015. Assoc. Editor: Zong-Ming Li.

J Biomech Eng 137(11), 111006 (Sep 30, 2015) (10 pages) Paper No: BIO-14-1231; doi: 10.1115/1.4031580 History: Received May 28, 2014; Revised August 25, 2015; Accepted August 26, 2015

This study examined whether the radiocarpal and dorsal capsular ligaments limit end-range wrist motion or remain strained during midrange wrist motion. Fibers of these ligaments were modeled in the wrists of 12 subjects over multiple wrist positions that reflect high demand tasks and the dart thrower's motion. We found that many of the volar and dorsal ligaments were within 5% of their maximum length throughout the range of wrist motion. Our finding of wrist ligament recruitment during midrange and end-range wrist motion helps to explain the complex but remarkably similar intersubject patterns of carpal motion.

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Figures

Grahic Jump Location
Fig. 1

Ligament fibers modeled for a representative subject's right wrist. On the volar side (left panel), the RSC was modeled with a distal (dRSC) and proximal (pRSC) fiber. The LRL was also modeled with a distal (dLRL) and proximal (pLRL) fiber. The SRL ligament was modeled with a radial fiber (rSRL), a central fiber (cSRL), and an ulnar fiber (uSRL). On the dorsal side of the wrist (right panel), the DRC ligament was modeled with a distal (dDRC) and proximal (pDRC) fiber and the DIC ligament was modeled with a distal (dDIC) and proximal (pDIC) fiber.

Grahic Jump Location
Fig. 2

Ligament fibers of a representative subject's right wrist in each TASK position. The color of each ligament fiber correlates to its length as a function of the maximum length or RP value, averaged across all subjects. Blue fibers represent RP values below 90%, green fibers represent RP values greater than or equal to 90% and less than 95%, and the RP value of red fibers is 95% or higher. Unloaded grip and unloaded extension are not shown because they were similar to loaded grip and loaded extension, respectively; therefore, the images are representative of both loading conditions.

Grahic Jump Location
Fig. 3

Ligament fibers of a representative subject's right wrist moving through the DTM. The color of each ligament fiber correlates to its length as a function of the maximum length or RP value, averaged across all subjects. Blue fibers represent RP values below 90%, green fibers represent RP values greater than or equal to 90% and less than 95%, and the RP value of red fibers is 95% or higher. From left to right, the wrist moves from radial-extension in the first hammering position (H1) toward ulnar flexion in the final hammering position (H5).

Grahic Jump Location
Fig. 4

Elongation of the RSC ligament. The dashed lines represent RP values of 90% and 95%. (U) and (L) denote unloaded and loaded conditions, respectively. Top: RP values of the distal (a) and proximal (b) fibers of the RSC for all subjects within the TASK group. Bottom: elongation of the distal (c) and proximal (d) fibers of the RSC during the DTM. Each line represents a subject's elongation pattern. The symbol of each line is consistent across all figures. The solid black line represents a regression line that was fit to elongation as a function of DTM across all subjects. The R2 value of the regression line is included in the figure followed by an indication of whether the slope was significantly different than zero (* = significant: p < 0.05, NS = not significant). The RSC was elongated maximally during extreme extension. During the DTM, fibers of the dRSC also approached their maximum lengths as the wrist rotated from the neutral (0 deg) toward ulnar flexion.

Grahic Jump Location
Fig. 5

Elongation of the LRL. The RP value (left y-axis) is the percentage of εmax (right y-axis). Top: elongation of the distal (a) and proximal (b) fibers of the LRL for all subjects within the TASK group. Bottom: elongation of the distal (c) and proximal (d) fibers of the LRL during the DTM. With the exception of loaded distraction and extreme flexion, the LRL was elongated within 95% of its maximum length throughout the entire range of motion.

Grahic Jump Location
Fig. 6

Elongation of the SRL ligament. The RP value (left y-axis) is the percentage of εmax (right y-axis). Top: elongation of the radial (a), central (b), and ulnar (c) fibers of the SRL for all subjects within the TASK group. Bottom: elongation of the radial (d), central (e), and ulnar (f) fibers of the SRL during the DTM. With the exception of loaded distraction and extreme flexion, the LRL was elongated within 95% of its maximum length throughout the entire range of motion.

Grahic Jump Location
Fig. 7

Elongation of the DRC ligament. The RP value (left y-axis) is the percentage of εmax (right y-axis). Top: elongation of the distal (a) and proximal (b) fibers of the DRC for all subjects within the TASK group. Bottom: elongation of the distal (c) and proximal (d) fibers of the DRC during the DTM. The DRC was elongated within 95% of its maximum length during grip, extreme flexion, and unloaded distraction. The DRC decreased as the wrist moved along the DTM.

Grahic Jump Location
Fig. 8

Elongation of the DIC. The RP value (left y-axis) is the percentage of εmax (right y-axis). Top: elongation of the distal (a) and proximal (b) fibers of the DIC for all subjects within the TASK group. Bottom: elongation of the distal (c) and proximal (d) fibers of the DIC during the DTM. With the exception of unloaded distraction, the DIC was elongated within 94% throughout the range of motion.

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