J Wrist Surg 2018; 07(04): 298-302
DOI: 10.1055/s-0038-1642615
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Carpal Pronation and Supination Changes in the Unstable Wrist

Frederick W. Werner
1   Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
,
Walter H. Short
1   Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
› Author Affiliations
Funding This study was funded, in part, by the Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York. This study was also funded by National Institute of Arthritis and Musculoskeletal and Skin Diseases grant 1R01 AR050099.
Further Information

Publication History

25 October 2017

17 March 2018

Publication Date:
24 April 2018 (online)

Abstract

Background Little is known about changes in scaphoid and lunate supination and pronation following scapholunate interosseous ligament (SLIL) injury. Information on these changes may help explain why some SLIL reconstructions have failed and help in the development of new techniques.

Purpose To determine if following simulated SLIL injury there was an increase in scaphoid pronation and lunate supination and to determine if concurrently there was an increase in the extensor carpi ulnaris (ECU) force.

Materials and Methods Scaphoid and lunate motion were measured before and after sectioning of the SLIL and two volar ligaments in 22 cadaver wrists, and before and after sectioning of the SLIL and two dorsal ligaments in 15 additional wrists. Each wrist was dynamically moved through wrist flexion/extension, radioulnar deviation, and a dart-throwing motion. Changes in the ECU force were recorded during each wrist motion.

Results Scaphoid pronation and lunate supination significantly increased following ligamentous sectioning during each motion. There were significant differences in the amount of change in lunate motion, but not in scaphoid motion, between the two groups of sectioned ligaments. Greater percentage ECU force was required following ligamentous sectioning to achieve the same wrist motions.

Conclusion Carpal supination/pronation changed with simulated damage to the scapholunate stabilizers. This may be associated with the required increases in the ECU force.

Clinical Relevance In reconstructing the SLIL, one should be aware of the possible need to correct scaphoid pronation and lunate supination that occur following injury. This may be more of a concern when the dorsal stabilizers are injured.

Ethical Approval

As this was a cadaver study, no institutional review board approval was required.


 
  • References

  • 1 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
  • 2 Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 1995; 20 (06) 986-999
  • 3 Salva-Coll G, Lluch-Bergada A, Garcia-Elias M, Espugas-Mimo M, Llusa-Perez M. Kinetics of the wrist in scapholunate advanced collapse. Hand (NY) 2016; 11: 12S-13S
  • 4 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (06) 991-1002
  • 5 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part II. J Hand Surg Am 2005; 30 (01) 24-34
  • 6 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
  • 7 Werner FW, Palmer AK, Somerset JH. , et al. Wrist joint motion simulator. J Orthop Res 1996; 14 (04) 639-646
  • 8 Short WH, Werner FW, Green JK, Weiner MM, Masaoka S. The effect of sectioning the dorsal radiocarpal ligament and insertion of a pressure sensor into the radiocarpal joint on scaphoid and lunate kinematics. J Hand Surg Am 2002; 27 (01) 68-76
  • 9 Werner FW, Short WH, Green JK, Evans PJ, Walker JA. Severity of scapholunate instability is related to joint anatomy and congruency. J Hand Surg Am 2007; 32 (01) 55-60