The Sensitivity of the Scapholunate Interval and Bony Landmarks to Wrist Rotation on Posteroanterior Radiographs.

BACKGROUND: The objective of this study was to examine the effect of wrist rotation on the scapholunate interval in the posteroanterior radiograph and to identify radiographic landmarks on the posteroanterior projection that can be used to assess position. METHODS: Eleven healthy cadaveric wrists were radiographed in the neutral position and subsequently were rotated and imaged from 30° pronation to 30° supination in 10° intervals. At each interval, the scapholunate interval was measured as well as the following landmarks: (1) the visible perimeter of the base of the hook of the hamate; (2) the radial-ulnar distribution of the dorsal nonarticular surface of the distal third metacarpal head; (3) the radial-ulnar distribution of the pisiform about the longitudinal axis of the ulna; and (4) the overlap of the pisiform and triquetrum. RESULTS: The scapholunate interval was largest in the neutral position and linearly decreased by 34% for every 10° of pronation and decreased nonlinearly by 86% after the first 10° of supination. The appearance of the distal third metacarpal head was shown to be sensitive to both pronation and supination. The perimeter of the hook of the hamate and the distribution of the pisiform compared to the ulna were both shown to be sensitive to supination, whereas overlap of the pisiform and triquetrum was not shown to be sensitive to either direction of rotation. CONCLUSIONS: Our results highlight the significant effect of rotation on radiographic landmarks at the wrist, indicating that 10° of supination can drastically alter the developed radiograph.

Three-dimensional ultrasound to investigate synovitis in first carpometacarpal osteoarthritis: A feasibility study.

BACKGROUND: Synovitis is one of the defining characteristics of osteoarthritis (OA) in the carpometacarpal (CMC1) joint of the thumb. Quantitative characterization of synovial volume is important for furthering our understanding of CMC1 OA disease progression, treatment response, and monitoring strategies. In previous studies, three-dimensional ultrasound (3-D US) has demonstrated the feasibility of being a point-of-care system for monitoring knee OA. However, 3-D US has not been tested on the smaller joints of the hand, which presents unique physiological and imaging challenges. PURPOSE: To develop and validate a novel application of 3-D US to monitor soft-tissue characteristics of OA in a CMC1 OA patient population compared to the current gold standard, magnetic resonance imaging (MRI). METHODS: A motorized submerged transducer moving assembly was designed for this device specifically for imaging the joints of the hands and wrist. The device used a linear 3-D scanning approach, where a 14L5 2-D transducer was translated over the region of interest. Two imaging phantoms were used to test the linear and volumetric measurement accuracy of the 3-D US device. To evaluate the accuracy of the reconstructed 3-D US geometry, a multilayer monofilament string-grid phantom (10 mm square grid) was scanned. To validate the volumetric measurement capabilities of the system, a simulated synovial tissue phantom with an embedded synovial effusion was fabricated and imaged. Ten CMC1 OA patients were imaged by our 3-D US and a 3.0 T MRI system to compare synovial volumes. The synovial volumes were manually segmented by two raters on the 2D slices of the 3D US reconstruction and MR images, to assess the accuracy and precision of the device for determining synovial tissue volumes. The Standard Error of Measurement and Minimal Detectable Change was used to assess the precision and sensitivity of the volume measurements. Paired sample t-tests were used to assess statistical significance. Additionally, rater reliability was assessed using Intra-Class Correlation (ICC) coefficients. RESULTS: The largest percent difference observed between the known physical volume of synovial extrusion in the phantom and the volume measured by our 3D US was 1.1% (p-value = 0.03). The mean volume difference between the 3-D US and the gold standard MRI was 1.78% (p-value = 0.48). The 3-D US synovial tissue volume measurements had a Standard Error Measurement (SEm ) of 11.21 mm3 and a Minimal Detectible Change (MDC) of 31.06 mm3 , while the MRI synovial tissue volume measurements had an SEM of 16.82 mm3 and an MDC of 46.63 mm3 . Excellent inter- and intra-rater reliability (ICCs = 0.94-0.99) observed across all imaging modalities and raters. CONCLUSION: Our results indicate the feasibility of applying 3-D US technology to provide accurate and precise CMC1 synovial tissue volume measurements, similar to MRI volume measurements. Lower MDC and SEm values for 3-D US volume measurements indicate that it is a precise measurement tool to assess synovial volume and that it is sensitive to variation between volume segmentations. The application of this imaging technique to monitor OA pathogenesis and treatment response over time at the patient's bedside should be thoroughly investigated in future studies.

Use it or lose it: The relationship between two image-based biomarkers in better understanding osteoarthritis progression in the wrist.

Bone tissue is influenced by its mechanical environment and adapts in response to its mechanical load. This is supported by studies analyzing bone adaptation in the knee and hip. Changes to the bone have also been found to precede cartilage degeneration in diseases such as osteoarthritis (OA). Our objective was to demonstrate the relationship between joint contact and bone density in the wrists of healthy adults. Static CT scans with a calibration phantom were taken to obtain measures of bone mineral density (vBMD) in 3 normalized depths; 0 - 2.5, 2.5 - 5, and 5 - 7.5 mm. Participants underwent a four-dimensional CT scan (4DCT) while performing maximum wrist extension to maximum wrist flexion. 3D bone models of the distal radius, scaphoid, and lunate were made, and analyzed vBMD and joint contact area (JCA) in the radiolunate (RL) and radioscaphoid (RS) joints separately. Correlation coefficients were calculated where vBMD was the dependent variable, and kinematic JCA throughout every 10 degrees of motion were the independent variables. Statistically significant independent variables associated with vBMD were assessed using a regression model and were entered in steps; (1) significant correlations, (2) sex, and (3) age.An increase in vBMD was significantly, positively associated with an increase in JCa. Notably, in the deeper regions (5 - 7.5 mm) of the radius that is primarily composed of trabecular bone. Sex contributed to the variance in vBMD, while age did not. Subchondral bone changes are influenced by wrist position, demonstrating that the wrist serves to bear load similar to the knee and hip.

A systematic review of the psychometric properties of pressure pain detection threshold in evaluating mechanical pain threshold in people with hand or wrist injuries.

PURPOSE: The aim of this study was to conduct a systematic review of the psychometric properties of Pressure Pain Detection Threshold (PPDT) measures in people with hand or wrist injuries. STUDY DESIGN AND METHODS: MEDLINE, Embase, and CINAHL databases were searched to identify eligible studies evaluating psychometric properties of PPDT in samples composed of at least 50% of people with hand or wrist injury. The Consensus-based Standards for the Measurement of Health Instruments' risk of bias checklist was used to critically appraise the included studies, and qualitative synthesis was performed by pooling the results of all studies that presented the same measurement property using Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: From 415 studies, 11 relevant studies were identified. Of the 11 studies, four hand or wrist injuries were represented; carpal tunnel syndrome, distal radius fractures, osteoarthritis, and complex regional pain syndrome. Intra-rater reliability was considered sufficient (intraclass correlation coefficient 0.64-0.94), with small reported standard error of the mean values (5.3-39.2 kPa). Results of validity and responsiveness could not be synthesized due to heterogeneity. Risk of bias for reliability and measurement error was assessed as very good or adequate, whereas validity and responsiveness were doubtful or inadequate. Overall quality of evidence was low or very low for all measurement properties. CONCLUSIONS: Inconsistent results and low quality evidence provide little confidence in the overall measurement properties of PPDT in a hand or wrist injury population. No criterion standard for pain further highlights complexities around pain measurement such that the results obtained from PPDT measures in clinical practice cannot be compared to a gold standard measure.

A Kinematic Analysis of Wrist and Carpal Function Using Four-Dimensional Computed Tomography Technology: A Dynamic Perspective.

PURPOSE: An emerging imaging modality, four-dimensional computed tomography, can provide dynamic evaluation of carpal motion, which allows for a better understanding of how the carpals work together to achieve range of motion. The objective of this work was to examine kinematic motion of the carpus through a flexion/extension arc of motion using four-dimensional computed tomography. METHODS: A convenience sample of 20 uninjured participants underwent a four-dimensional computed tomography scanning protocol through a complete arc of flexion/extension motion. Kinematic changes in motion were quantified using helical axes motion data for each carpal. Rotation angles were compared between bones to identify differences in kinematic motion between bones. RESULTS: The bones within the proximal carpal row, the lunate, scaphoid, and triquetrum, rotate significantly to differing magnitudes at the ends of motion (40° of flexion and 40° of extension). The scaphoid rotates to the highest magnitude, followed by the triquetrum, and lastly, the lunate. The distal carpal row bones rotate to similar magnitudes throughout the entire range of motion. CONCLUSIONS: This work describes the kinematics of the carpals throughout dynamic in vivo flexion and extension. CLINICAL RELEVANCE: This study adds to an understanding of wrist mechanics and the possible clinical implications of pathological deviation from baseline kinematics.

How does computed tomography inform our understanding of shoulder kinematics? A structured review.

The objective of this structured review was to review how computed tomography (CT) scanning has been used to measure the kinematics of the shoulder. A literature search was conducted using Evidence-based Medicine Reviews (Embase) and PubMed. In total, 29 articles were included in the data extraction process. Forty percent of the studies evaluated healthy participants' shoulder kinematics. The glenohumeral joint was the most studied, followed by the scapulothoracic, acromioclavicular, and sternoclavicular joints. Three-dimensional computed tomography (3DCT) and 3DCT with biplane fluoroscopy are the two primary imaging techniques that have been used to measure shoulder joints' motion under different conditions. Finally, many discrepancies in the reporting of the examined motions were found. Different authors used different perspectives and planes to report similar motions, which results in confusion and misunderstanding of the actual examined motion. The use of 3DCT has been widely used in the examination of shoulder kinematics in a variety of populations with varying methods employed. Future work is needed to extend these methodologies to include more diverse populations, to examine the shoulder complex as a whole, and to standardize their reporting of motion examined to make study to study comparisons possible.

Are people good prognosticators of their own pain? An exploration of the relationship between sex-specific pain beliefs and clinical pain evaluation.

BACKGROUND: Under-explored to date are the interacting influences of patient sex on multi-modal evaluation techniques that tap different domains of the pain experience. OBJECTIVES: The primary aim of Study 1 was to explore the accuracy of sex-specific personal pain beliefs in relation to quantitative pain indicators within sexes, and the secondary objective was to compare the accuracy of sex-specific personal pain beliefs in relation to quantitative pain indicators between sexes. The primary objective of Study 2 was to explore the accuracy of sex-specific personal pain beliefs and self-rated pain severity within sexes, and the secondary objective was to compare sex-specific personal pain beliefs and pain severity ratings between sexes. METHODS: A cross-sectional analysis on two datasets was performed (Study 1, n = 50; Study 2, n = 111). For both studies, independent samples t-tests were used to identify differences in clinical pain evaluations based on sex-specific pain beliefs. Receiver Operating Characteristic (ROC) curves were used to compare the predictive accuracy of males and females clinical pain evaluations based on their ability to handle pain. RESULTS: There were no statistically significant differences in clinical pain evaluations based on self-rated pain beliefs in either study. In Study 2, males were descriptively more accurate predictors of their clinical pain evaluations than were females, though none of the between sex comparisons were statistically significant. CONCLUSION: This work highlights the importance of considering all available clinical pain evaluations as one technique is unlikely to represent the patients pain experience.

The Utility of Quantitative Computed Tomography to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People With Pain Following Wrist Trauma.

The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n = 5 post-trauma; n = 5 healthy) underwent bilateral computed tomography scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral volumetric bone mineral density (vBMD) was studied at three depths from the subchondral surface (0-2.5, 2.5-5, 5-7.5 mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bones, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.

Comparison of finger kinematics between patients with hand osteoarthritis and healthy participants with and without joint protection programs.

STUDY DESIGN: This is a cross-sectional, clinical observational study. BACKGROUND: Finger range of motion (ROM) and functional performance are critical in many daily activities. Hand osteoarthritis (H-OA) is a prevalent disease that impairs both variables. Little quantitative research has been performed on finger kinematics during activities of daily living (ADLs) across health status and method of performance (with or without joint protection programs). PURPOSE: The purpose of this research is to examine the effects of H-OA and method of performance on ROM in the thumb, index, and middle digits (flexion/extension and abduction/adduction) during ADLs. METHODS: This study was conducted using 10 healthy participants (mean age: 28 years) and nine participants with H-OA (mean age: 72 years). All participants performed baseline ROM movements followed by 9 activities of daily living. These activities involved prehension type grasps and were performed with and without the recommended joint protection procedures specific to each task. Thumb IP and MCP, index distal interphalengeal (DIP) and proximal interphalengeal (PIP), and middle DIP and PIP joints were continuously recorded using an electromagnetic tracking system for ROM analysis. RESULTS: Participants with H-OA had a statistically significant decrease in ROM when comparing values measured in the healthy cohort during active ROM (25° decrease) and ADL ROM (25° decrease) in the flex/ext direction. Similarly, following joint protection instruction, a statistically significant decrease in ROM was found during tasks in the flex/ext direction (healthy participant decrease in ROM: 17°, H-OA decrease in ROM:10°) CONCLUSIONS: This study demonstrated that people with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with the controls, and that with instruction on joint protection techniques, participants made significant changes in the amount of movement used to perform tasks, which supports a proof of principle of joint protection.

A method for measuring in vivo finger kinematics using electromagnetic tracking.

Accurate in vivo measurement of finger joint kinematics is important for evaluation of treatment methods, implant designs, and for the development and validation of computer models of the hand. The main objective of this project was to develop a standardized finger kinematic measurement system employing electromagnetic (EM) tracking to measure in vivo finger motion pathways. A landmark digitization protocol was developed and used in vivo, in a biomechanical study using EM trackers secured to the finger segments. In vivo results for finger flexion/extension showed no significant differences between EM and goniometer results, 5°±3°; p = 0.735.

Four-Dimensional Computed Tomography to measure distal radial-ulnar and radio-carpal joint congruency following distal radius fractures.

Four-dimensional computed tomography (4DCT) allows for the assessment of the wrist contact mechanics and kinematics during motion. The purpose of this study was to employ 4DCT to measure the differences in joint surface area (JSA) (3D joint space) at the radioscaphoid, radiolunate, and distal radioulnar joints between a cohort of participants with a distal radius fracture (DRF) and an age-matched cohort of healthy participants. Our results indicated that following a DRF, there was a 20% decrease in JSA at the DRUJ when compared to the healthy (control) cohort. This study demonstrated the use of a non-invasive tool to examine wrist contact mechanics.

The Effect of Malunited Scaphoid Fractures on Joint Congruency.

PURPOSE: Although the consequences of scaphoid nonunion have been well-established, the implications of malunions are not well-known. To date, malunions have mainly been studied with 2-dimensional imaging. The objective of this study was to employ 3-dimensional computed tomography (CT) imaging and inter-bone distance mapping to determine the implications of a scaphoid malunion on 3-dimensional joint surface area (JSA) (a measure of joint contact area) at an average of 7 ± 2 years (range, 4-12 years) after fracture. METHODS: In 14 subjects with previous unilateral, malunited scaphoid fractures, we measured the 3-dimensional JSA using reconstructed CT bone models of the carpus. The JSA was compared within each individual, comparing images of the wrist collected at the time of fracture (baseline) and 7 years later (follow-up CT scans). RESULTS: There was a significant increase in the measured JSA (reduced joint space) at the scaphotrapezial (23% increase) and scaphocapitate (13% increase) joints when the baseline and follow-up scans of the wrist were compared. An increased JSA indicates that the 2 opposing surfaces are closer in contact and have a reduced joint spacing reflective of degenerative changes. However, participants in this study showed no radiographic signs of degenerative changes in the wrists at midterm follow-up. CONCLUSIONS: An increase in JSA was found in patients with a malunited scaphoid in the scaphotrapezial and scaphocapitate joints of the wrist an average of 7 years after injury, but these joint changes were not evident in measured radiographic signs of arthritis. CLINICAL RELEVANCE: As early as 4 years after injury, the 3-dimensional JSA is significantly increased at the scaphocapitate and scaphotrapezial joints. Future work is needed to determine the implication of this increased in 3-dimensional JSA on the underlying subchondral bone, and to observe these patients for longer to determine whether degenerative changes develop.

Evaluation of Four-Dimensional Computed Tomography as a Technique for Quantifying Carpal Motion.

Delayed diagnosis of dynamic carpal instability often occurs because early changes in bone alignment and movement are difficult to detect and manifest mainly during a dynamic/functional task. Current diagnostic tools are only able to examine the carpal bones under static or sequential-static conditions. Four-dimensional (three dimensions + time) computed tomography (4DCT) enables quantification of carpal mechanics through 3D volume sequences of the wrist in motion. A comprehensive understanding of carpal mechanics is needed to define normal function and structure and provide targets for treatment of carpal injuries. In this study, measurements of scaphoid translation and joint congruency were taken by creating models from the CT scans of the carpals in extreme frames of motion, registering those models to the neutral position, transforming the models into a local coordinate system, and using software to calculate the joint surface areas (JSA). Results indicated that the centroid of the scaphoid translated 6.4 ± 1.3 mm and extended from extreme radial to extreme ulnar deviation. Results are consistent with the literature. An additional study was performed to measure the responsiveness of the 4DCT technique presented. Bone models from each frame of motion for radio ulnar deviation (RUD) and flexion extension (FE) were created and distinct differences between their JSA were measured qualitatively and quantitatively. The results show that there was statistically significantly different JSA within carpal joints between RUD and FE. These studies provide the first step in developing the methodology when using 4DCT scanning to measure subtle abnormalities in the wrist.

Barriers, facilitators, preferences and expectations of joint protection programmes for patients with hand arthritis: a cross-sectional survey.

OBJECTIVES: The objective of this survey was to investigate the barriers, facilitators, expectations and patient preferences regarding joint protection (JP) programmes in people with hand arthritis. DESIGN: Cross-sectional survey. SETTING: Tertiary clinic. PARTICIPANTS: Patients with hand arthritis: osteoarthritis, rheumatoid arthritis, psoriatic arthritis and other forms of arthritis. PRIMARY AND SECONDARY OUTCOME MEASURES: This study used a survey among people with hand arthritis. Descriptive statistics and percentages were reported for all the data about the barriers, facilitators and preferences around JP. RESULTS: A total of 192 patients consented to participate. Most of the patients (82%) were unaware of JP. Factors that may act as barriers to participation and were regarded as 'a very big concern' were: cost of the programme (44%), time of offering the programme (39%), work commitments (36%) and having a centre/clinic close to the house (28%). Factors that may act as facilitators and rated as 'extremely helpful' were: research that shows that JP works (26%) and having the centre/clinic close to the house (25%). An online format for JP was the most preferred option (54%). Half (46%) preferred a timeframe of 1 hour, three times per week and 44% preferred a 2-hour programme, for three times per week. CONCLUSIONS: Awareness of the potential benefits of JP, and prior experience with JP programme were very low. Common potentially modifiable patient-reported barriers to participate in future JP interventions, included: cost, work commitments, distance from home to clinic and times that the intervention were provided. These barriers might be addressed with free and accessible forms of delivery of JP, which may lead to better uptake and participation in JP programmes.

Joint Protection Programmes for People with Osteoarthritis and Rheumatoid Arthritis of the Hand: An Overview of Systematic Reviews.

Purpose: Joint protection has been introduced as a self-management strategy for people with rheumatoid arthritis (RA) and osteoarthritis (OA) of the hand. The purpose of this study was to conduct an overview of systematic reviews (SRs) and critically appraise the evidence to establish the current effectiveness of joint protection for people with hand RA and OA. Method: A comprehensive search was conducted of six databases from January 2008 to May 2018. SRs that evaluated the effectiveness of joint protection for people with hand arthritis were eligible for inclusion. The A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 checklist was used to assess the methodological quality of each SR. Results: Nine SRs were included: two were rated as high quality, and seven were rated as low quality. Seven of the nine did not take into account risk of bias when interpreting or discussing their findings, six did not assess publication bias, and five did not register their protocol. The high-quality reviews found no clinically important benefit of joint protection for pain, hand function, and grip strength levels. The low-quality reviews reported improvements in function, pain, grip strength, fatigue, depression, self-efficacy, joint protection behaviours, and disease symptoms in people with RA. Conclusions: High-quality evidence from high-quality reviews found a lack of any clinically important benefit of joint protection programmes for pain, hand function, and grip strength outcomes, whereas low-quality evidence from low-quality reviews found improvements in these outcomes.

Objectif : la protection articulaire est présentée comme une stratégie d'autogestion pour les personnes atteintes d'arthrite rhumatoïde (AR) et d'arthrose de la main. La présente étude visait à survoler les analyses systématiques (AS) et à procéder à une évaluation critique des données probantes afin d'établir l'efficacité actuelle de la protection articulaire pour les personnes ayant une AR et une arthrose de la main. Méthodologie : les chercheurs ont procédé à une recherche exhaustive de six basses de données entre janvier 2008 et mai 2018. Ils ont extrait les AS qui évaluaient l'efficacité de la protection articulaire des personnes atteintes d'arthrite de la main. Ils ont ensuite utilisé la liste AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) pour évaluer la qualité méthodologique de chaque AS. Résultats : neuf AS ont été incluses : deux ont été classées comme de haute qualité et sept, de faible qualité. Sept des neuf ne tenaient pas compte du risque de biais au moment d'interpréter ou de présenter les résultats, six n'ont pas évalué les biais de publication et cinq n'ont pas enregistré leur protocole. Les analyses de qualité n'ont constaté aucun avantage d'importance clinique à la protection articulaire pour atténuer la douleur et préserver la fonction de la main et la force de préhension. Les analyses de basse qualité rendaient compte d'améliorations à la fonction, à la douleur, à la force de préhension, à la fatigue, à la dépression, à l'autoefficacité, aux comportements de protection articulaire et aux symptômes de maladie chez les personnes ayant une AR. Conclusions : selon les données de qualité d'analyses de qualité, les programmes de protection articulaire n'apportaient pas d'avantages importants sur le plan clinique en matière de douleur, de fonction de la main et de force de préhension, mais les données de faible qualité provenant d'analyses de faible qualité constataient des améliorations à l'égard de tous ces résultats.

The Effect of Distal Radius Fractures on 3-Dimensional Joint Congruency.

PURPOSE: Whereas the goal of distal radius fracture treatment is anatomical restoration, controversy exists as to whether it is the severity of the disruption of joint alignment at the time of fracture or residual malalignment after healing that determines outcome. The objective of this study was to compare joint contact mechanics bilaterally a minimum of 3 years following a distal radius fracture. Our hypothesis was that 3-dimensional joint space would be reduced in individuals following wrist fracture and that these changes in joint load lead to the development of degenerative arthritis. To test the hypothesis, an interbone spacing algorithm was used to determine whether 3-dimensional joint space and contact mechanics were altered in the distal radioulnar (DRUJ) and radiocarpal joints following a wrist fracture. METHODS: In 16 subjects with previous unilateral wrist fractures, 3-dimensional interbone distance (joint space), a measure of joint congruency and 3-dimensional alignment, was quantified from reconstructed computed tomography bone models of the distal radius, ulna, scaphoid, and lunate. RESULTS: At an average of 8 years following fracture, joint interbone spacing area was reduced in the radiolunate joint of the injured wrist in comparison with the uninjured wrist. The joint interbone spacing area was decreased in the DRUJ and radioscaphoid joint of the injured wrist compared with the uninjured wrist but this difference was not statistically significant. CONCLUSIONS: This study demonstrates the use of a noninvasive tool that can be used to examine joint loading and suggests that further investigation into the association between altered joint loading and the development of posttraumatic arthritis is needed, especially in the radiocarpal joints. CLINICAL RELEVANCE: This paper provides a noninvasive image-based framework that can be used to examine joint contact area over time and provides preliminary data examining the effect of a distal radius fracture on the joint congruency of the DRUJ and radiocarpal joints.

The development of a novel grip motion analysis technique using the Dartfish movement analysis software to evaluate hand movements during activities of daily living.

Individuals with hand osteoarthritis (OA) have impairments in grip strength and range of motion (ROM). Obtaining quantitative joint angle measures of the hand is difficult. Without a complete understanding of the kinematics of the hand, the assessment of hand OA when performing activities of daily living (ADL) and recreational activities is not fully understood. The objectives of this study were to establish a simple measurement technique (Grip Configuration Model) describing an individual's grip ROM using the Dartfish Movement Analysis Software, and compare the joint angle measures during maximum flexion/extension and five ADL in people with/without hand OA. Forty participants (20 without hand OA, 20 with hand OA) thumb CMC and MCP, and index MCP and PIP joint angles were evaluated for each activity using the Dartfish Software and Grip Configuration Model. Significant limitations of 17.2% (p < 0.001) and 12.7% (p = 0.01) were seen in the group with hand OA for maximum flexion/extension, respectively. The spray bottle task demonstrated a significant difference of 14.7% (p = 0.001) between the two test groups. Measurements using the Dartfish Software were compared against a manual goniometer and electromagnetic tracking system. This study demonstrated the weakened ROM in individuals with hand OA is translated to ADL and how the Grip Configuration Model simplifies the evaluation of how people grasp objects.

Evaluation of the content validity index of the Australian/Canadian osteoarthritis hand index, the patient-rated wrist/hand evaluation and the thumb disability exam in people with hand arthritis.

BACKGROUND: The Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist/Hand Evaluation (PRWHE) and the Thumb Disability Exam (TDX) are patient-reported outcome measures (PROM) designed to assess pain and hand function in patients with hand arthritis, hand pain and disability, or thumb pathology respectively. This study evaluated the content validity of AUSCAN, PRWHE and TDX in people with hand arthritis. METHODS: This study enrolled participants with hand arthritis to rate the items of all 3 PROM in terms of relevance and clarity. The Content Validity Index (CVI) was computed for each item in each scale (I-CVI) as well as for the overall scale (S-CVI). Kappa was used to determine the inter-rater agreement among the raters. RESULTS: Overall, 64 individuals with hand arthritis (27% with OA, 67% with rheumatoid arthritis and 6% with psoriatic arthritis) participated in the study. The I-CVI for all items and all scales were very high (I-CVI > 0.76) and the modified Kappa agreement among the raters demonstrated excellent agreement (k > 0.76). The S-CVI for all PROMs was very high for relevance (AUSCAN = 0.92, 95% CI 0.90 to 0.94; PRWHE = 0.85, 95% CI 0.82 to 0.88 and TDX = 0.87, 95% CI 0.85 to 0.89) and for clarity (AUSCAN = 0.99, 95% CI 0.98 to 1.00; PRWHE = 0.95, 95% CI 0.93 to 0.97 and TDX = 0.91, 95% CI 0.89 to 0.94), respectively. CONCLUSIONS: This study demonstrated very high content validity indices for the AUSCAN, PRWHE and TDX; with strong consensus across raters. This augments prior studies demonstrating appropriate statistical measurement properties, to provide confidence that all three measures assess important patient concepts of pain and disability.

Evaluation of individual finger forces during activities of daily living in healthy individuals and those with hand arthritis.

INTRODUCTION: Measuring finger forces during activities of daily living and how these forces change for individuals with pathologies such as arthritis is valuable to our understanding of hand function. PURPOSE OF THE STUDY: The purpose of this study was to determine the forces of individual fingers during the performance of daily activities in healthy participants and determine the envelope of these applied forces. METHODS: This is a cross-sectional study investigating twenty-five healthy participants (12 female: 22-65 years old and 13 male: 20-53 years old) and participants with osteoarthritis (12 female: 52-79 years old and 9 male: 64-79 years old) examined at one time point. The force sensors were calibrated for each individual using a load cell to provide force output in Newtons. Each participant performed 19 activities of daily living two times. Force was plotted over time for each task, and the maximum force in each finger during that task was evaluated. RESULTS: The range of applied forces was 1.4 ± 0.6 N to 34.8 ± 1.6 N for healthy participants and 2.3 ± 1.0 N to 30.7 ± 3.7 N for those with osteoarthritis. DISCUSSION: Sensors allowed for real-time monitoring of finger forces during tasks of daily life. This provides the opportunity to isolate hand grips based on finger recruitment and provide information about the magnitude of forces during the activity. CONCLUSION: Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions.

Analysis of Three-Dimensional Anatomical Variance and Fit of the Distal Radius to Current Volar Locking Plate Designs.

Purpose: Distal radius fractures are the most common upper-extremity fracture and are increasingly being treated surgically with precontoured volar locking plates. It is not currently known whether existing implant designs are anatomically accurate and whether this has clinical implications. The objective of this study was to determine whether anatomic alignment of the distal radius corresponds accurately to modern volar locking plate designs, including any sex-linked differences in morphology of the distal radius. It was hypothesized that the 2 plates examined would show differences in watershed line (WSL) overlap and that female specimens would have a larger overlap compared with males owing to a decrease in plate-WSL border distances. Methods: We used 3-dimensional models of 20 cadaver arms (10 female: mean age, 88.7 ± 4.6 years [range, 82-97 years]; and 10 male: mean age, 86 ± 3.6 years [range, 81-91 years]) to create 3-dimensional computed tomography models of the distal radius. Virtual models of 2 common volar plates were created and were used to place the plate virtually onto the distal radii. Outcome measures included the volar cortical angle of the bone and plate, the definition of the WSL subsequently followed by quantitative distance and overlap measures, and percent contact between the plate and the distal radius. Results: Both sexes showed an decrease (approximately 7°) in average volar cortical angle measure from medial to lateral columns that was statistically significantly smaller on the lateral column (males: 38°; females: 29°) compared with the medial column (males: 45°; females: 36°). Watershed line overlap ranged from 0% to 34.8% with statistically significant differences between sexes. Average border distance for females was 2.7 mm, compared with 3.8 mm for males. Maximum percent contact of 22.0% was observed at a 0.3-mm threshold. Conclusions: Distal radius fractures are common in elderly female patients, yet clinically available plates have important differences in WSL overlap between sexes, and with minimal contact. Female specimens had more WSL overlap than did males. This indicates the need for volar locking plates to be redesigned to factor in anatomical features of individual patients with a particular focus on sex differences. Clinical relevance: New plate designs should focus on providing smaller head sizes that are more accurately tailored to the natural contours of the volar distal radius. It is recommended that future studies incorporate expertise from multiple surgeons to diversify and further understand plate placement strategies.