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Research Papers

Does Wrist Laxity Influence Three-Dimensional Carpal Bone Motion?

[+] Author and Article Information
Gordon M. Best

Department of Mechanical and Materials
Engineering,
Human Mobility Research Centre,
Queen's University,
130 Stuart Street,
Kingston K7 L 3N6, ON, Canada
e-mail: Gordon.best@queensu.ca

Michelle L. Zec

Department of Surgery,
Human Mobility Research Centre,
Queen's University,
130 Stuart Street,
Kingston K7 L 3N6, ON, Canada
e-mail: m.zec@queensu.ca

David R. Pichora

Department of Mechanical and
Materials Engineering,
Human Mobility Research Centre,
Queen's University,
130 Stuart Street,
Kingston K7 L 3N6, ON, Canada
e-mail: pichorad@hdh.kari.net

Robin N. Kamal

Department of Orthopaedic Surgery,
Robert A. Chase Hand & Upper Limb Center,
Stanford University,
450 Broadway Street,
Redwood City, CA 94063
e-mail: rnkamal@stanford.edu

Michael J. Rainbow

Department of Mechanical and
Materials Engineering,
Human Mobility Research Centre,
Queen's University,
130 Stuart Street,
Kingston K7 L 3N6, ON, Canada
e-mail: michael.rainbow@queensu.ca

Manuscript received April 4, 2017; final manuscript received December 17, 2017; published online February 5, 2018. Assoc. Editor: Zong-Ming Li.

J Biomech Eng 140(4), 041007 (Feb 05, 2018) (9 pages) Paper No: BIO-17-1143; doi: 10.1115/1.4038897 History: Received April 04, 2017; Revised December 17, 2017

Previous two-dimensional (2D) studies have shown that there is a spectrum of carpal mechanics that varies between row-type motion and column-type motion as a function of wrist laxity. More recent three-dimensional (3D) studies have suggested instead that carpal bone motion is consistent across individuals. The purpose of this study was to use 3D methods to determine whether carpal kinematics differ between stiffer wrists and wrists with higher laxity. Wrist laxity was quantified using a goniometer in ten subjects by measuring passive wrist flexion–extension (FE) range of motion (ROM). In vivo kinematics of subjects' scaphoid and lunate with respect to the radius were computed from computed tomography (CT) volume images in wrist radial and ulnar deviation positions. Scaphoid and lunate motion was defined as “column-type” if the bones flexed and extended during wrist radial–ulnar deviation (RUD), and “row-type” if the bones radial–ulnar deviated during wrist RUD. We found that through wrist RUD, the scaphoid primarily flexed and extended, but the scaphoids of subjects with decreased laxity had a larger component of RUD (R2 = 0.48, P < 0.05). We also determined that the posture of the scaphoid in the neutral wrist position predicts wrist radial deviation (RD) ROM (R2 = 0.46, P < 0.05). These results suggest that ligament laxity plays a role in affecting carpal bone motion of the proximal row throughout radial and ulnar deviation motions; however, other factors such as bone position may also affect motion. By developing a better understanding of normal carpal kinematics and how they are affected, this will help physicians provide patient-specific approaches to different wrist pathologies.

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Copyright © 2018 by ASME
Topics: Kinematics , Bone , Rotation
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Figures

Grahic Jump Location
Fig. 4

Three views of the scaphoid (green), lunate (blue), and distal parts of the radius (grey) in 20 deg of RD (dark color) and 20 deg of ulnar deviation (light color). The quaternion averaged helical axes are shown with the variation of the orientation of helical axis illustrated with the cones.

Grahic Jump Location
Fig. 5

Location of the rotation axes for the scaphoid (a) and lunate (b) of each subject relative to the radius for the RD of 20 deg to ulnar deviation of 20 deg motion in the respective carpal inertia coordinate systems. The average location is shown of the rotation axis with the standard deviation in both directions as denoted by the cross. The location of the centroid of the carpal bones is indicated by the green dot. Contours of each individual scaphoid and lunate are also plotted in the same plane as the respective principal axes.

Grahic Jump Location
Fig. 3

Scaphoid flexion angle was approximately the angle between the first principal inertial axis of the scaphoid and the first principal axis of the ACS

Grahic Jump Location
Fig. 2

The volar and radial views of two different wrists with different kinematic behavior. For a row-type wrist (left) through wrist radial and ulnar deviation, the scaphoid and lunate radially and ulnarly deviate relative to the radius, and the motion is primarily in the coronal (frontal) plane of the wrist. For a column-type wrist (right), through wrist radial and ulnar deviation the scaphoid and lunate flex and extend relative to the radius, and the motion is primarily in the sagittal plane of the wrist.

Grahic Jump Location
Fig. 1

Illustrations of the different wrist and thumb positions used to measure wrist laxity. For wrist flexion (a), extension (b), RD (c) and ulnar deviation (d), both active (no applied external force) and passive (applied external force) measurements were taken in degrees. For thumb flexion (f) and extension (e), only passive measurements were taken and the distance from the mid line of the distal thumb phalange was measured to the forearm in millimeters.

Grahic Jump Location
Fig. 6

Using k-means clustering, passive FE was used to group subjects into two distinct groups of low (N = 5) and high (N = 5) wrist laxity. Using a Student's t-test, we found that there was a trend in the difference in direction of the SR rotation axis between the two laxity groups the (P = 0.07). For the LR rotation axis, there was no trend in the difference in direction (P = 0.43). Rotation axis orientation less than 45 deg indicates a column-type wrist.

Grahic Jump Location
Fig. 7

A trend can be seen that shows a negative relationship between wrist passive flexion extension range and the orientation of the SR helical axis (top) relative to the flexion extension axis of the wrist; as passive flexion extension range increases, the SR rotation axis approaches that of the flexion extension axis of the wrist behaving more like a column wrist. This same relationship does not exist with the LR helical axis (bottom). Specific SR and LR helical axes are shown on the right illustrating the difference in angle orientations. For both regressions, one outlier (circled on the graphs) was excluded due to low carpal bone rotations.

Grahic Jump Location
Fig. 8

The scaphoid flexion angle in the neutral posture is related to the range of RD as determined by a regression analysis (R2 = 0.46) (a). This same relationship did not exist with ulnar deviation ROM (R2 = 0.18) (b). The scaphoid flexion angle was found to be independent of absolute wrist posture ((c) and (d)). This suggests that scaphoid initial bone posture may play a role in dictating the RD ROM of the wrist.

Grahic Jump Location
Fig. 9

Graphs of the different wrist laxity measurement relationships. (a) There was a relationship between a subject's active wrist FE ROM and their active wrist RUD ROM. There is also a relationship between active wrist flexion and active wrist extension (b), but no relationship between active RD and ulnar deviation (c). There is a relationship between ulnar deviation and FE (d), and no relationship between active RD and active FE(e).

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