A novel method to replicate the kinematics of the carpus using a six degree-of-freedom robot

Understanding the kinematics of the carpus is essential to the understanding and treatment of wrist pathologies. However, many of the previous techniques presented are limited by non-functional motion or the interpolation of points from static images at different postures. We present a method that has the capability of replicating the kinematics of the wrist during activities of daily living using a unique mechanical testing system. To quantify the kinematics of the carpal bones, we used bone pin-mounted markers and optical motion capture methods. In this paper, we present a hammering motion as an example of an activity of daily living. However, the method can be applied to a wide variety of movements. Our method showed good accuracy (1.0–2.6°) of in vivo movement reproduction in our ex vivo model. Most carpal motion during wrist flexion–extension occurs at the radiocarpal level while in ulnar deviation the motion is more equally shared between radiocarpal and midcarpal joints, and in radial deviation the motion happens mainly at the midcarpal joint. For all rotations, there was more rotation of the midcarpal row relative to the lunate than relative to the scaphoid or triquetrum. For the functional motion studied (hammering), there was more midcarpal motion in wrist extension compared to pure wrist extension while radioulnar deviation patterns were similar to those observed in pure wrist radioulnar deviation. Finally, it was found that for the amplitudes studied the amount of carpal rotations was proportional to global wrist rotations.     

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.     

Clinical anatomy of the m. flexor carpi radialis tendon sheath

At the transitional zone from the forearm to the hand the insertion tendon of the m.flexor carpi radialis (FCR) glides on a fibrous and fatty cushion, which is connected dorsally with the joint capsule of the radiocarpal articulation. The tendon distally crosses the palmar side of the scaphoid tubercle and enters the dorsally curved rim of the trapezoid tubercle. At the level of the wrist joint the narrow tendon sheath begins, which extends to the insertion at the metacarpus. Immediately after entering the gliding tunnel the tendon branches off radially as a rule with an accessory fibre strand 8 mm in width to the scaphoid, trapezium and the joint capsule between these two bones. The insertion tendon regularly is attached to the palmar and radial surfaces of the second and third metacarpal bones. The wall of the osteofibrous gliding tunnel can be prominent following trauma, inflammation or arthrosis deformans in the trapezio-scaphoideal joint and may irritate the tendon (tendovaginosis stenosans). Against resistance forces pain will occur in the wrist joint during palmar flexion. The typical point of tenderness is situated at the entering of the tendon in the thenar region. Operative decompression will be effective by opening the radial wall of the tendon sheath from the carpal tunnel.     

A 3D quantitative comparison of trapezium and trapezoid relative articular and nonarticular surface areas in modern humans and great apes

The structure and functions of the modern human hand are critical components of what distinguishes Homo sapiens from the great apes (Gorilla, Pan, and Pongo). In this study, attention is focused on the trapezium and trapezoid, the two most lateral bones of the distal carpal row, in the four extant hominid genera, representing the first time they have been quantified and analyzed together as a morphological-functional complex. Our objective is to quantify the relative articular and nonarticular surface areas of these two bones and to test whether modern humans exhibit significant shape differences from the great apes, as predicted by previous qualitative analyses and the functional demands of differing manipulative and locomotor strategies. Modern humans were predicted to show larger relative first metacarpal and scaphoid surfaces on the trapezium because of the regular recruitment of the thumb during manipulative behaviors; alternatively, great apes were predicted to show larger relative second metacarpal and scaphoid surfaces on the trapezoid because of the functional demands on the hands during locomotor behaviors. Modern humans were also expected to exhibit larger relative mutual joint surfaces between the trapezoid and adjacent carpals than do the great apes because of assumed transverse loads generated by the functional demands of the modern human power grip. Using 3D bone models acquired through laser digitizing, the relative articular and nonarticular areas on each bone are quantified and compared. Multivariate analyses of these data clearly distinguish modern humans from the great apes. In total, the observed differences between modern humans and the great apes support morphological predictions based on the fact that this region of the human wrist is no longer involved in weight-bearing during locomotor behavior and is instead recruited solely for manipulative behaviors. The results provide the beginnings of a 3D comparative standard against which further extant and fossil primate wrist bones can be compared within the contexts of manipulative and locomotor behaviors.     

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.     

Kinematic accuracy of three surface registration methods in a three-dimensional wrist bone study

The use of registration techniques to determine motion transformations noninvasively has become more widespread with the increased availability of the necessary software. In this study, three surface registration techniques were used to generate carpal bone kinematic results from a single cadaveric wrist specimen. Surface contours were extracted from specimen computed tomography volume images of the forearm, carpal, and metacarpal bones in four arbitrary positions. Kinematic results from each of three registration techniques were compared with results derived from multiple spherical markers fixed to the specimen. Kinematic accuracy was found to depend on the registration method and bone size and shape. In general, rotation errors of the capitate and scaphoid were less than 0.5 deg for all three techniques. Rotation errors for the other bones were generally less than 2 deg, although error for the trapezoid was greater than 2 deg in one technique. Translation errors of the bones were generally less than 1 mm, although errors of the trapezoid and trapezium were greater than 1 mm for two techniques. Tradeoffs existed in each registration method between image processing time and overall kinematic accuracy. Markerless bone registration (MBR) can provide accurate measurements of carpal kinematics and can be used to study the noninvasive, three-dimensional in vivo kinematics of the wrist and other skeletal joints.     

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.     

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.     

Kinetic chain of overarm throwing in terms of joint rotations revealed by induced acceleration analysis

This study investigated how baseball players generate large angular velocity at each joint by coordinating the joint torque and velocity-dependent torque during overarm throwing. Using a four-segment model (i.e., trunk, upper arm, forearm, and hand) that has 13 degrees of freedom, we conducted the induced acceleration analysis to determine the accelerations induced by these torques by multiplying the inverse of the system inertia matrix to the torque vectors. We found that the proximal joint motions (i.e., trunk forward motion, trunk leftward rotation, and shoulder internal rotation) were mainly accelerated by the joint torques at their own joints, whereas the distal joint motions (i.e., elbow extension and wrist flexion) were mainly accelerated by the velocity-dependent torques. We further examined which segment motion is the source of the velocity-dependent torque acting on the elbow and wrist accelerations. The results showed that the angular velocities of the trunk and upper arm produced the velocity-dependent torque for initial elbow extension acceleration. As a result, the elbow joint angular velocity increased, and concurrently, the forearm angular velocity relative to the ground also increased. The forearm angular velocity subsequently accelerated the elbow extension and wrist flexion. It also accelerated the shoulder internal rotation during the short period around the ball-release time. These results indicate that baseball players accelerate the distal elbow and wrist joint rotations by utilizing the velocity-dependent torque that is originally produced by the proximal trunk and shoulder joint torques in the early phase.     

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.     

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.     

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.     

Measurement of the screw-home motion of the knee is sensitive to errors in axis alignment

Measurements of joint angles during motion analysis are subject to error caused by kinematic crosstalk, that is, one joint rotation (e. g., flexion) being interpreted as another (e.g., abduction). Kinematic crosstalk results from the chosen joint coordinate system being misaligned with the axes about which rotations are assumed to occur. The aim of this paper is to demonstrate that measurement of the so-called "screw-home" motion of the human knee, in which axial rotation and extension are coupled, is especially prone to errors due to crosstalk. The motions of two different two-segment mechanical linkages were examined to study the effects of crosstalk. The segments of the first linkage (NSH) were connected by a revolute joint, but the second linkage (SH) incorporated gearing that caused 15 degrees of screw-home rotation to occur with 90 degrees knee flexion. It was found that rotating the flexion axis (inducing crosstalk) could make linkage NSH appear to exhibit a screw-home motion and that a different rotation of the flexion axis could make linkage SH apparently exhibit pure flexion. These findings suggest that the measurement of screw-home rotation may be strongly influenced by errors in the location of the flexion axis. The magnitudes of these displacements of the flexion axis were consistent with the inter-observer variability seen when five experienced observers defined the flexion axis by palpating the medial and lateral femoral epicondyles. Care should be taken when interpreting small internal-external rotations and abduction-adduction angles to ensure that they are not the products of kinematic crosstalk.     

Axial loading induces rotation of the proximal carpal row bones around unique screw-displacement axes

The changes in carpal bone alignment secondary to the aplication of an axial compressive load through the major wrist motor tendons while the wrist is kept in neutral position (isometric loading) have been investigated on 13 fresh cadaver specimens using a biplanar radiographic method of kinematic analysis. The scaphoid, lunate and triquetrum rotate an average of 5.1, 4.2 and 3.8°, respectively, around different ‘screw displacement axes’, all implying flexion, radial deviation and supination. Based on these findings, a new interpretation of the mechanism by which the wrist remains stable under physiologic loads is provided.     

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.     

Determination of the number of degrees of freedom of the trapeziometacarpal joint–An in vitro study

ObjectiveMost of the studies about trapeziometacarpal joint assume that it exhibits only two independent degrees of freedom, but the experimental or theoretical support for considering a two-degrees of freedom model is not always clear.Materials and methodsTherefore, an in vitro kinematic study has been designed to demonstrate, from experimental data, that only two of the trapeziometacarpal degrees of freedom (i.e., flexion/extension and adduction/abduction) are non-null and independent. Several movements of maximal amplitude in flexion, abduction and circumduction have been realized and the relative position and orientation of the segment coordinate system embedded on the first metacarpal with respect to that embedded on the trapezium have been collected using electromagnetic sensors. The trapeziometacarpal rotations have been described using a joint coordinate system and the joint displacements have been evaluated on the axes of this coordinate system.ResultsThe root mean square (RMS) values of the joint displacement components have been found small enough to assume that the trapeziometacarpal joint has no translation degrees of freedom. A paraboloid coupling equation has been found between the internal/external rotation angle and the two other, flexion/extension and adduction/abduction, angles.ConclusionThus, this study demonstrates that the trapeziometacarpal joint has only two independent rotational degrees of freedom, and further, the described methodology could also be used to determine the coupling laws between degrees of freedom of various joints.     

A joint coordinate system proposal for the study of the trapeziometacarpal joint kinematics

The International Society of Biomechanics (ISB) has recommended a standardisation for the motion reporting of almost all human joints. This study proposes an adaptation for the trapeziometacarpal joint.

The definition of the segment coordinate system of both trapezium and first metacarpal is based on functional anatomy. The definition of the joint coordinate system (JCS) is guided by the two degrees of freedom of the joint, i.e. flexion–extension about a trapezium axis and abduction–adduction about a first metacarpal axis. The rotations obtained using three methods are compared on the same data: the fixed axes sequence proposed by Cooney et al., the mobile axes sequence proposed by the ISB and our alternative mobile axes sequence. The rotation amplitudes show a difference of 9° in flexion–extension, 2° in abduction–adduction and 13° in internal–external rotation.

This study emphasizes the importance of adapting the JCS to the functional anatomy of each particular joint.     

Direct measurement of intervertebral disc maximum shear strain in six degrees of freedom: motions that place disc tissue at risk of injury

Human intervertebral disc specimens were tested to determine the regions of largest maximum shear strain (MSS) experienced by disc tissues in each of three principal displacements and three rotations, and to identify the physiological rotations and displacements that may place the disc at greatest risk for large tissue strains and injury. Tearing of disc annulus may be initiated by large interlamellar shear strains. Nine human lumbar discs were tagged with radiographic markers on the endplates, disc periphery and with a grid of wires in the mid-transverse plane and subjected to each of the six principal displacements and rotations. Stereo-radiographs were taken in each position and digitized for reconstruction of the three-dimensional position of each marker. Maximum tissue shear strains were calculated from relative marker displacements and normalized by the input displacement or rotation. Lateral shear, compression, and lateral bending were the motions that produced the mean (95% confidence interval) largest mean MSS of 9.6 (0.7)%/mm, 9.0 (0.5)%/mm, and 5.8 (1.6)%/ degrees , respectively, and which occurred in the posterior, posterolateral and lateral peripheral regions of the disc. After taking into account the reported maximum physiological range of motion for each degree of freedom, motions producing the highest physiological MSS were lateral bending (57.8 (16.2)%) and flexion (38.3 (3.3)%), followed by lateral shear (14.4 (1.1)%) and compression (12.6 (0.7)%).