Carpal Tunnel Volume Changes of the Wrist Under Distraction

Cho, M. S.; Means, Kenneth R.; Shrout, J. A.; Segalman, Keith A.

doi:10.1177/1753193408092037

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…A handful of studies have suggested that carpal distraction is associated with negative clinical outcomes 8,9. While some authors have the opinion that distraction can cause neural damage 10,11, at this point causation has not been definitively established. An understanding of the conformational changes in the carpus during distraction in vivo will be useful for the establishment of safe limits for distractive maneuvers used to diagnose wrist ligament injury.…”

Section: Introductionmentioning

confidence: 99%

Conformational Changes in the Carpus During Finger Trap Distraction

Leventhal

Moore²,

Akelman³

et al. 2010

The Journal of Hand Surgery

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Introduction Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and mid-carpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied. The purpose of this study was to measure the 3-D conformational changes of the carpal bones in the normal wrist as a result of a static distractive load. Methods The dominant wrists of 14 healthy volunteers were scanned using computed tomography at rest and during application of 98N of distraction. Load was applied using finger traps and volunteers were encouraged to relax their forearm muscles and to allow distraction of the wrist. The motions of the bones in the wrist were tracked between the unloaded and loaded trial using markerless bone registration. The average displacement vector of each bone was calculated relative to the radius as well as the interbone distances for 20 bone-bone interactions. Joint separation was estimated at the radiocarpal, midcarpal and carpal-metacarpal joints in the direction of loading using the radius, lunate, capitate and 3rd metacarpal. Results With loading, the distance between the radius and 3rd metacarpal increased an average of 3.3±3.1mm in the direction of loading. This separation was primarily located in the axial direction at the radiocarpal (1.0±1.0mm) and midcarpal (2.0±1.7mm) joints. There were minimal changes in the transverse direction within the distal row, although the proximal row narrowed by 0.98±0.7mm. Distraction between the radius and scaphoid (2.5±2.2mm) was 2.4 times greater than between the radius and lunate (1.0±1.0mm). Conclusions Carpal distraction has a significant effect on the conformation of the carpus, especially at the radiocarpal and midcarpal joints. In the normal wrist, external traction causes twice as much distraction at the lunocapitate joint than at the radiolunate joint.

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