In-vivo three-dimensional carpal bone kinematics during flexion–extension and radio–ulnar deviation of the wrist: Dynamic motion versus step-wise static wrist positions

An in-vivo approach to the measurement of three-dimensional motion patterns of carpal bones in the wrist may have future diagnostic applications, particularly for ligament injuries of the wrist. Static methods to measure carpal kinematics in-vivo only provide an approximation of the true kinematics of the carpal bones. This study is aimed at finding the difference between dynamically and statically acquired carpal kinematics.For eight healthy subjects, static and a dynamic measurements of the carpal kinematics were performed for a flexion–extension and a radio–ulnar deviation movement. Dynamic scans were acquired by using a four-dimensional X-ray imaging system during an imposed cyclic motion. To assess static kinematics of the wrists, three-dimensional rotational X-ray scans were acquired during step-wise flexion–extension and radio–ulnar deviation. The helical axis rotations and the rotation components. i.e. flexion–extension, radio–ulnar deviation and pro–supination were the primary parameters. Linear mixed model statistical analysis was used to determine the significance of the difference between the dynamically and statically acquired rotations of the carpal bones.Small and in most cases negligible differences were observed between the dynamic motion and the step-wise static motion of the carpal bones. The conclusion is that in the case of individuals without any pathology of the wrist, carpal kinematics can be studied either dynamically or statically. Further research is required to investigate the dynamic in-vivo carpal kinematics in patients with dynamic wrist problems.     

The effect of tendon loading on in-vitro carpal kinematics of the wrist joint

Measurements of in-vitro carpal kinematics of the wrist provide valuable biomechanical data. Tendon loading is often applied during cadaver experiments to simulate natural stabilizing joint compression in the wrist joint. The purpose of this study was to investigate the effect of tendon loading on carpal kinematics in-vitro.A cyclic movement was imposed on 7 cadaveric forearms while the carpal kinematics were acquired by a 4-dimensional rotational X-ray imaging system. The extensor- and flexor tendons were loaded with constant force springs of 50 N, respectively. The measurements were repeated without a load on the tendons. The effect of loading on the kinematics was tested statistically by using a linear mixed model.During flexion and extension, the proximal carpal bones were more extended with tendon loading. The lunate was on the average 2.0° (p=0.012) more extended. With tendon loading the distal carpal bones were more ulnary deviated at each angle of wrist motion. The capitate was on the average 2.4° (p=0.004) more ulnary deviated.During radioulnar deviation, the proximal carpal bones were more radially deviated with the lunate 0.7° more into radial deviation with tendon loading (p<0.001). Conversely, the bones of distal row were more flexed and supinated with the capitate 1.5° more into flexion (p=0.025) and 1.0° more into supination (p=0.011).In conclusion, the application of a constant load onto the flexor and extensor tendons in cadaver experiments has a small but statistically significant effect on the carpal kinematics during flexion–extension and radioulnar deviation.     

Carpal bone kinematics and ligament lengthening studied for the full range of joint movement

Present data on carpal kinematics and carpal ligament behaviour are limited to flexion and deviation movements of the hand. These motions do not represent all the wrist-joint motions which are important for the activities of daily living. The goal of this project was to obtain insight into carpal kinematics and carpal ligament behaviour during motions of the hand covering the full range of motion of the wrist joint.

The carpals and the ligaments of four wrist-joint specimens were provided with radiopaque markers. These joints were subjected to Röntgenstereophotogrammetric experimentation in a large number of hand positions to determine carpal positions and ligament lengths. The movements of the carpal bones were described by means of finite helical axes (FHA).

It was found that the movements of the carpals in the distal row closely resemble those of the hand. Conversely, the motions of the carpals of the proximal row appeared not to be directly proportional to the hand motions and exhibited clear out-of-plane movements. Furthermore, it could be shown that movements of the hand into the ulnodorsal quadrant of the full range of hand motion corresponds to larger helical rotations and translations for most of the carpals than when the hand was moved into any other quadrant. The maximal ligament length changes determined did not exceed the length changes reported for pure flexion and pure deviation movements of the hand.     

Functional morphology of the lemuriform wrist joints and the relationship between wrist morphology and positional behavior in arboreal primates

A comparative study of carpal joint structure and function in six Malagasy lemuriforms was undertaken to test predicted morphoclines in carpal joint morphology between pronograde and orthograde arboreal primates. Patterns of movement at the wrist during locomotion were observed and described for the lemuriform species Lemur fulvus and Propithecus verreauxi. Lemur fulvus, which assumes a pronograde posture during locomotion, extends and pronates the wrist during the support phase of quadrupedal walking and running stride cycles. Furthermore, the forearm of this species exhibits some transverse movement across the proximal wrist joint during the support phase. In contrast, the indriid Propithecus maintains the hand and wrist in a flexed and partially supinated position during vertical clinging and suspensory postures. Habitual quadrupedal and vertical postures in Malagasy primates are in turn related to very different patterns of carpal joint morphology and articular mechanics. Those lemurs which are predominantly pronograde share a series of structural features related to stabilizing the antebrachiocarpal joint during extension and mediolateral deviation and the midcarpal joint during pronation: an intraarticular labrum is present on the inner portion of the radiocarpal ligament, the radiocarpal articular surface is quite flat dorsoventrally, the capitate-trapezoid embrasure is expanded dorsally, and development of the radial and ulnar styloids is more pronounced. The wrists of Propithecus, Avahi, and Lepilemur (vertical clingers) differ from those of quadrupedal lemuriforms in possessing a suite of morphological features related to stabilizing the wrist during antebrachiocarpal flexion and midcarpal supination: the radiocarpal articular surface is deeply curved and tilted anteriorly, the dorsal radiocarpal ligament is very broad, thick, and fibrous, the hamate's triquetral facet is directed proximodistally, and the capitate-trapezoid embrasure is dorsally constricted and expanded palmarly. These observed contrasts in carpal form and function are used to define further the morphological features related to orthograde posture in several lineages of arboreal primates. © 1996 Wiley-Liss, Inc.     

In vivo motion of the scaphotrapezio-trapezoidal (STT) joint

It has previously been shown that the articulation of the scaphotrapezio-trapezoidal (STT) joint can be modeled such that the trapezoid and trapezium are tightly linked and move together on a single path relative to the scaphoid during all directions of wrist motion. The simplicity of such a model is fascinating, but it leaves unanswered why two distinct carpal bones would have a mutually articulating surface if there were no motion between them, and how such a simplistic model of STT joint motion translates into the more complex global carpal motion. We performed an in vivo analysis of the trapezoids and trapeziums of 10 subjects (20 wrists) using a markerless bone registration technique. In particular, we analyzed the centroid spacing, centroid displacements, kinematics, and postures of the trapezoid and trapezium relative to the scaphoid. We found that, on a gross level, the in vivo STT motion was consistent with that reported in vitro. In addition, we found that the magnitude of trapezoid and trapezium motion was dependent upon the direction of wrist motion. However, we also found that when small rotations and displacements are considered there were small but statistically significant relative motions between the trapezoid and trapezium (0.4 mm in maximum flexion, 0.3 mm in radial deviation and at least 10 degrees in flexion extension and ulnar deviation) as well as slight off-path rotations. The results of this study indicate that the STT joint should be considered a mobile joint with motions more complex than previously appreciated.     

New wrist bones of the Malagasy giant subfossil lemurs

Recently discovered wrist bones of the Malagasy subfossil lemurs Babakotia radofilai, Palaeopropithecus ingens, Mesopropithecus dolichobrachion, and Megaladapis madagascariensis shed new light on the postcranial morphologies and positional behaviors that characterized these extinct primates. Wrist bones of P. ingens resemble those of certain modern hominoids in having a relatively enlarged ulnar head and dorsally extended articular surface on the hamate, features related to a large range of rotation at the inferior radioulnar and midcarpal joints. The scaphoid of P. ingens is also similar to that of the extant tree sloth Choloepus in having an elongate, palmarly directed tubercle forming a deep radial margin of the carpal tunnel for the passage of large digital flexors. In contrast, wrist remains of Megaladapis edwardsi and M. madagascariensis exhibit traits observed in the hands of extant pronograde, arboreal primates; these include a dorsopalmarly expanded pisiform and well-developed "spiral" facet on the hamate. Moreover, Megaladapis spp. and Mesopropithecus dolichobrachion possess bony tubercles (e.g., scaphoid tubercle and hamate hamulus) forming the carpal tunnel that are relatively similar in length to those of modern pronograde lemurs. Babakotia and Mesopropithecus differ from Megaladapis in exhibiting features of the midcarpal joint related to frequent supination and radioulnar deviation of the hand characteristic of animals that use vertical and quadrumanous climbing in their foraging behaviors. Comparative analysis of subfossil lemur wrist morphology complements and expands upon prior inferences based on other regions of the postcranial skeleton, and suggests a considerable degree of locomotor and postural heterogeneity among these recently extinct primates.     

Simulation of extension,radial and ulnar deviation of the wrist with a rigid body spring model

A novel computational model of the wrist that predicts carpal bone motion was developed in order to investigate the complex kinematics of the human wrist.This rigid body spring model (RBSM) of the wrist was built using surface models of the eight carpal bones, the bases of the five metacarpal bones, and the distal parts of the ulna and radius, all obtained from computed tomography (CT) scans of a cadaver upper limb. Elastic contact conditions between the rigid bodies modeled the influence of the cartilage layers, and ligamentous structures were constructed using nonlinear, tension-only spring elements. Motion of the wrist was simulated by applying forces to the tendons of the five main wrist muscles modeled.Three wrist motions were simulated: extension, ulnar deviation and radial deviation. The model was tested and tuned by comparing the simulated displacement and orientation of the carpal bones with previously obtained CT-scans of the same cadaver arm in deviated (45°ulnar and 15°radial), and extended (57°) wrist positions. Simulation results for the scaphoid, lunate, capitate, hamate and triquetrum are presented here and provide credible prediction of carpal bone movement. These are the first reported results of such a model. They indicate promise that this model will assist in future wrist kinematics investigations. However, further optimization and validation are required to define and guarantee the validity of results.     

Optimization of compressive loading parameters to mimic in vivo cervical spine kinematics in vitro

The human cervical spine supports substantial compressive load in vivo. However, the traditional in vitro testing methods rarely include compressive loads, especially in investigations of multi-segment cervical spine constructs. Previously, a systematic comparison was performed between the standard pure moment with no compressive loading and published compressive loading techniques (follower load – FL, axial load – AL, and combined load – CL). The systematic comparison was structured a priori using a statistical design of experiments and the desirability function approach, which was chosen based on the goal of determining the optimal compressive loading parameters necessary to mimic the segmental contribution patterns exhibited in vivo. The optimized set of compressive loading parameters resulted in in vitro segmental rotations that were within one standard deviation and 10% of average percent error of the in vivo mean throughout the entire motion path. As hypothesized, the values for the optimized independent variables of FL and AL varied dynamically throughout the motion path. FL was not necessary at the extremes of the flexion–extension (FE) motion path but peaked through the neutral position, whereas, a large negative value of AL was necessary in extension and increased linearly to a large positive value in flexion. Although further validation is required, the long-term goal is to develop a “physiologic” in vitro testing method, which will be valuable for evaluating adjacent segment effect following spinal fusion surgery, disc arthroplasty instrumentation testing and design, as well as mechanobiology experiments where correct kinematics and arthrokinematics are critical.     

Locomotor adaptations reflected in the wrist joints of early tertiary primates (adapiformes)

The positional behaviors inferred for early Tertiary adapiform primates have been the subject of considerable debate. Adapiform wrist morphology is analyzed here within the context of extant morphoclines in carpal joint shape in order to reconstruct adapiform positional behavior. Extant vertical clingers, slow climbers, and arboreal quadrupeds differ significantly from one another in length of the m. flexor carpi ulnaris lever arm, shape of the midcarpal joint articular surface, and size and divergence of the pollical carpometacarpal articulation. These morphological differences are functionally related to differential requirements for wrist flexion, midcarpal mobility and stability, and pollical grasping, respectively. Adapis, Notharctus, and Smilodectes share with living arboreal quadrupeds a tall pisiform body, a mediolaterally flat midcarpal joint surface, and a relatively unexpanded thumb joint. Functionally, these features are related to flexing the wrist from extended positions during palmigrade, quadrupedal locomotion, increasing midcarpal joint stability during quadrupedal, weight-bearing postures, and grasping arboreal supports of predominantly horizontal and oblique orientation. The Messel adapiform (genus indet.) shares certain features of the midcarpal and pollical carpometacarpal articulations with extant vertical clingers, suggesting that this taxon used vertical substrates more frequently than other adapiforms. © 1996 Wiley-Liss, Inc.     

Development and validation of a computed tomography-based methodology to measure carpal kinematics

Motion of the wrist bones is complicated and difficult to measure. Noninvasive measurement of carpal kinematics using medical images has become popular This technique is difficult and most investigators employ custom software. The objective of this paper is to describe a validated methodology for measuring carpal kinematics from computed tomography (CT) scans using commercial software. Four cadaveric wrists were CT imaged in neutral, full flexion, and full extension. A registration block was attached to the distal radius and used to align the data sets from each position. From the CT data, triangulated surface models of the radius, lunate, and capitate bones were generated using commercial software. The surface models from each wrist position were read into engineering design software that was used to calculate the centroid (position) and principal mass moments of inertia (orientation) of (1) the capitate and lunate relative to the fixed radius and (2) the capitate relative to the lunate. These data were used to calculate the helical axis kinematics for the motions from neutral to extension and neutral to flexion. The kinematics were plotted in three dimensions using a data visualization software package. The accuracy of the method was quantified in a separate set of experiments in which an isolated capitate bone was subjected to two different known rotation/translation motions for ten trials each. For comparison to in vivo techniques, the error in distal radius surface matching was determined using the block technique as a gold standard. The motion that the lunate and capitate underwent was half that of the overall wrist flexion-extension range of motion. Individually, the capitate relative to the lunate and the lunate relative to the radius generally flexed or extended about 30 deg, while the entire wrist (capitate relative to radius) typically flexed or extended about 60 deg. Helical axis translations were small, ranging from 0.6 mm to 1.8 mm across all motions. The accuracy of the method was found to be within 1.4 mm and 0.5 deg (95% confidence intervals). The mean error in distal radius surface matching was 2.4 mm and 1.2 deg compared to the use of a registration block. Carpal kinematics measured using the described methodology were accurate, reproducible, and similar to findings of previous investigators. The use of commercially available software should broaden the access of researchers interested in measuring carpal kinematics using medical imaging.     

In vivo kinematic behavior of the radio-capitate joint during wrist flexion-extension and radio-ulnar deviation.

The capitate is often considered the "keystone" of the carpus, not simply because of its central and prominent position in the wrist, but also because of its mechanical interactions with neighboring bones. The purpose of this study was to determine in vivo three-dimensional capitate kinematics. Twenty uninjured wrists were investigated using a recently developed, non-invasive markerless bone registration (MBR) technique. Surface contours of the capitate, third metacarpal and radius were extracted from computed tomography images of seven wrist positions and the three-dimensional motions of the capitate and third metacarpal were calculated with respect to the radius in wrist flexion-extension and radio-ulnar deviation. We found that in vivo capitate motion does not simply occur about a single pivot point like a universal joint, as demonstrated by non-intersecting rotation axes for different capitate motions. The distance between flexion and ulnar deviation axes was 3.9+/-2.0 mm, and the distance between extension and ulnar deviation axes was 3.9+/-1.4 mm. Furthermore, capitate axes for males tended to be located more distally than axes for females. However, we believe that this result is related to subject size and not to gender. We also found that there is minimal relative motion between the capitate and third metacarpal during these in vivo wrist motions. These findings demonstrate the complexity of capitate kinematics, as well as the different mechanisms through which wrist flexion, extension, radial deviation and ulnar deviation occur.     

A digital database of wrist bone anatomy and carpal kinematics

The skeletal wrist consists of eight small, intricately shaped carpal bones. The motion of these bones is complex, occurs in three dimensions, and remains incompletely defined. Our previous efforts have been focused on determining the in vivo three-dimensional (3-D) kinematics of the normal and abnormal carpus. In so doing we have developed an extensive database of carpal bone anatomy and kinematics from a large number of healthy subjects. The purpose of this paper is to describe that database and to make it available to other researchers. CT volume images of both wrists from 30 healthy volunteers (15 males and 15 females) were acquired in multiple wrist positions throughout the normal range of wrist motion. The outer cortical surfaces of the carpal bones, radius and ulna, and proximal metacarpals were segmented and the 3-D motion of each bone was calculated for each wrist position. The database was constructed to include high-resolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone. The database does not include soft tissues of the wrist. While there are numerous digital anatomical databases, this one is unique in that it includes a large number of subjects and it contains in vivo kinematic data as well as the bony anatomy.     

In vivo estimation of the short-range stiffness of cross-bridges from joint rotation

Short-range stiffness (SRS) is a mechanical property of muscles that is characterized by a disproportionally high stiffness within a short length range during both lengthening and shortening movements. SRS is attributed to the cross-bridges and is beneficial for stabilizing a joint during, e.g., postural conditions. Thus far, SRS has been estimated mainly on isolated mammalian muscles. In this study we presented a method to estimate SRS in vivo in the human wrist joint.SRS was estimated at joint level in the angular domain (N m/rad) for both flexion and extension rotations of the human wrist in nine healthy subjects. Wrist rotations of 0.15 rad at 3 rad/s were imposed at eight levels of voluntary contraction ranging from 0 to 2.1 N m by means of a single axis manipulator.Flexion and extension SRS of the wrist joint was estimated consistently and accurately using a dynamic nonlinear model that was fitted onto the recorded wrist torque. SRS increased monotonically with torque in a way consistent with previous studies on isolated muscles.It is concluded that in vivo measurement of joint SRS represents the population of coupled cross-bridges in wrist flexor and extensor muscles. In its current form, the presented technique can be used for clinical applications in many neurological and muscular diseases where altered joint torque and (dissociated) joint stiffness are important clinical parameters.     

Comparison of three local frame definitions for the kinematic analysis of the fingers and the wrist

Because the hand is a complex poly-articular limb, numerous methods have been proposed to investigate its kinematics therefore complicating the comparison between studies and the methodological choices. With the objective of overcoming such issues, the present study compared the effect of three local frame definitions on local axis orientations and joint angles of the fingers and the wrist. Three local frames were implemented for each segment. The “Reference” frames were aligned with global axes during a static neutral posture. The “Landmark” frames were computed using palpated bony landmarks. The “Functional” frames included a flexion–extension axis estimated during functional movements. These definitions were compared with regard to the deviations between obtained local segment axes and the evolution of joint (Cardan) angles during two test motions. Each definition resulted in specific local frame orientations with deviations of 15° in average for a given local axis. Interestingly, these deviations produced only slight differences (below 7°) regarding flexion–extension Cardan angles indicating that there is no preferred method when only interested in finger flexion–extension movements. In this case, the Reference method was the easiest to implement, but did not provide physiological results for the thumb. Using the Functional frames reduced the kinematic cross-talk on the secondary and tertiary Cardan angles by up to 20° indicating that the Functional definition is useful when investigating complex three-dimensional movements. Globally, the Landmark definition provides valuable results and, contrary to the other definitions, is applicable for finger deformities or compromised joint rotations.     

Experimental investigation of the scaphoid strain during wrist motion

The scaphoid is the most frequently fractured of the carpal bones [Taleisnik, J., The Wrist, Churchill Livingstone, New York (1985)]. This project was undertaken to qualitatively evaluate the strain in the scaphoid during wrist motion using a newly developed strain gage method. Strain gage resettes were mounted within the scaphoid and the range of motion of the hand was monitored using a custom designed electrogoniometer and data acquisition system. Ten specimens were utilized for this study. Results indicated that supination/pronation (S/P) of the forearm did not affect the strain in the scaphoid. A map of the strain in the waist of the scaphoid, as a function of flexion/extension (F/E) and radial/ulnar deviation (R/U), was generated. The contour plot of scaphoid strain vs range of motion (ROM) shows a valley where strains are low. Minimum scaphoid strain was found near neutral F/E and 15° of ulnar deviation.     

Palmar shelf arthroplasty, the next generation: distraction/interposition for rheumatoid arthritis of the wrist

Rheumatoid arthritis affects approximately 1 percent of the adult population. Bilateral symmetric involvement of the wrist occurs in 85 percent of these patients, with recurrent flares and relentless progression. Anatomic changes consist of radiocarpal, intercarpal, and radioulnar subluxation and joint destruction. For advanced disease, both wrist arthrodesis and arthroplasty have been recommended. Arthrodesis has been successful for pain relief at the expense of motion. Implant arthroplasty has been unreliable, with failure rates of 25 to 50 percent at 2 to 9 years. Palmar shelf arthroplasty was introduced in 1970 as a resectional fibrous arthroplasty. The results were good but the series was small. Subsequent reports of this procedure have been inconsistent. In 1990, I initiated and have since followed a series of patients treated with the palmar shelf arthroplasty. To the basic procedure, I added joint distraction by external fixator, collagen/bone wax interposition, scapholunate stabilization, and increased immobilization time. Fourteen consecutive patients were enrolled in this study. Each carried a diagnosis of rheumatoid or psoriatic arthritis of the wrist. There were 11 women and 3 men. Age ranged from 28 to 56 years. Follow-up ranged from 2 to 7 years (average 4.2). The patients were interviewed, examined, and x-rayed. A questionnaire using an analog scale as well as the Hospital for Special Surgery scoring system was completed to assess the clinical outcome of the wrist postoperatively compared with its preoperative status and with the contralateral wrist. No patient has requested or required a revision procedure. All patients experienced improvement with both pain and function; no wrist spontaneously fused. Patient satisfaction was high. Patients with ipsilateral arthroplasty and contralateral arthrodesis preferred the arthroplasty. Hospital for Special Surgery score increased from 53 to 91 out of 100 points (p < 0.001). Range of motion averaged 50 degrees flexion, 30 degrees extension. Palmar shelf arthroplasty remains a viable option for severe rheumatoid disease of the wrist. Ideally, the procedure is performed on the dominant wrist of a patient with bilateral wrist involvement in the setting of inflammatory arthritis.     

A musculoskeletal model to estimate the relative changes in wrist strength due to interacting wrist and forearm postures

Wrist rotations about one wrist axis (e.g. flexion/extension) can affect the strength about another wrist axis (e.g. radial/ulnar deviation). This study used a musculoskeletal model of the distal upper extremity, and an optimization approach, to quantify the interaction effects of wrist flexion/extension (FE), radial/ulnar deviation (RUD) and forearm pronation/supination (PS) on wrist strength. Regression equations were developed to predict the relative changes in strength from the neutral posture, so that the changes in strength, due to complex and interacting wrist and forearm rotation postures, can be incorporated within future ergonomics assessments of wrist strength.     

Accuracy of biplane videoradiography for quantifying dynamic wrist kinematics

Accurately assessing the dynamic kinematics of the skeletal wrist could advance our understanding of the normal and pathological wrist. Biplane videoradiography (BVR) has allowed investigators to study dynamic activities in the knee, hip, and shoulder joint; however, currently, BVR has not been utilized for the wrist joint because of the challenges associated with imaging multiple overlapping bones. Therefore, our aim was to develop a BVR procedure and to quantify its accuracy for evaluation of wrist kinematics. BVR was performed on six cadaveric forearms for one neutral static and six dynamic tasks, including flexion-extension, radial-ulnar deviation, circumduction, pronation, supination, and hammering. Optical motion capture (OMC) served as the gold standard for assessing accuracy. We propose a feedforward tracking methodology, which uses a combined model of metacarpals (second and third) for initialization of the third metacarpal (MC3). BVR-calculated kinematic parameters were found to be consistent with the OMC-calculated parameters, and the BVR/OMC agreement had submillimeter and sub-degree biases in tracking individual bones as well as the overall joint’s rotation and translation. All dynamic tasks (except pronation task) showed a limit of agreement within 1.5° for overall rotation, and within 1.3 mm for overall translations. Pronation task had a 2.1° and 1.4 mm limit of agreement for rotation and translation measurement. The poorest precision was achieved in calculating the pronation-supination angle, and radial-ulnar and volar-dorsal translational components, although they were sub-degree and submillimeter. The methodology described herein may assist those interested in examining the complexities of skeletal wrist function during dynamic tasks.