Muscular control of scapholunate instability. An experimental study

León-López, M.M.; García-Elias, Marc; Salvà-Coll, Guillem; Llusá-Pérez, Manuel; Lluch-Bergadà, Alex

doi:10.1016/j.recote.2014.01.006

Cited by 6 publications

(14 citation statements)

References 20 publications

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“…In recent years, several cadaveric studies have reviewed the effect of muscle activation on carpal kinematics in stable and unstable wrists. [18][19][20][21] Current research suggests that tendon loading should be concentrated on FCR, ECRL and APL muscles. 21,22 In SLIL complex injured wrists, isolated isometric contraction of the ECRL and APL can create a supination moment on the scaphoid.…”

Section: Kinematics Of the Carpals: Normal And Abnormalmentioning

confidence: 99%

“…With this knowledge, focussed isometric strengthening of APL, ECRL and FCR should be an aim of rehabilitation. 21 Rehabilitation should avoid recruiting scaphoid pronating muscles (ECU) and Flexor Carpi Ulnaris (FCU) due to the Chronic SLIL disruption with cartilage loss tendency (of FCU) to force the maximum cubital inclination of the scaphoid, as these may increase the SL gap. 21 Proprioceptive rehabilitation, including joint position sense, kinaesthesia, conscious and unconscious neuromuscular control exercises are considered to help restore wrist stability.…”

Section: Kinematics Of the Carpals: Normal And Abnormalmentioning

confidence: 99%

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Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

et al. 2017

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Introduction: Scapholunate instability is commonly caused by a fall on an outstretched hand resulting in structural pathology and pain. In recent years, dynamic stability mechanisms have been described that may aid in the non-operative management of this patient group. Limited evidence exists regarding the clinical application of stability mechanisms for scapholunate instability, and there is a void of reproducible structured exercise regimes. Method: A service evaluation was conducted over 16 months to assess patient outcomes following an evidence-based treatment protocol in the conservative management of stage one scapholunate instability. Pain-free grip, maximal grip, grip strength ratio, Euro-Qol five dimensions questionnaire (EQ-5D), Visual Analogue Scale (VAS) and Quick Disability of Arm, Shoulder and Hand questionnaire (Quick-DASH) scores were compared between baseline and final follow-up. Results: Six consecutive patients (seven wrists) were included with five patients (six wrists) completing treatment. Mean grip strength ratio improved by 45%, mean VAS improved by 5.5 points, mean Quick-DASH improved by 33.96% and EQ-5D improved by 0.187 quality-adjusted life years. Where established, all outcomes exceeded minimal clinically important difference values. Discussion: The Birmingham Wrist Instability Programme can yield clinically important results for patients with stage one scapholunate instability in the short term based on a small service evaluation. The findings support the need for further research to evaluate the rehabilitation programme in a larger group of patients over the longer term.

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Section: Kinematics Of the Carpals: Normal And Abnormalmentioning

confidence: 99%

Section: Kinematics Of the Carpals: Normal And Abnormalmentioning

confidence: 99%

Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

et al. 2017

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“…The repartition of traumas was as follows: sport accident in nine cases (60%), road traffic accident in three cases (20%), and accident at work in three cases (20%). The average time between trauma and surgery was 9 months (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Dominant side was involved in 11 patients (73%).…”

Section: Study Outlinementioning

confidence: 99%

“…A strict immobilization of the wrist using removable splint was prescribed for 21 days. Soft physiotherapy aimed at muscular reinforcement insisting on radial muscles, insisting on the flexor carpi radialis (FCR) and extensor carpi radialis longus (ECRL), 15,16 was performed after the immobilization phase. Return to sports was authorized 3 months after surgery.…”

Section: Postoperative Protocolmentioning

confidence: 99%

“…9,30 Specific strengthening program for the radial muscles, FCR and ECRL, is also recommended, regarding their actions on dynamic stabilization of the SL complex. 15,16,30 Van Overstraeten and Camus 32 and Messina et al 9 consider that the genesis of SL instability would then be an association of one lesion of the interosseous SL ligament and at least one extrinsic ligament, they insist of preoperative testing of each. 32,33 According to Short et al, the development of intracarpal instability following a section of the interosseous SL ligament is secondary to the deficiency of the extrinsic stabilizers.…”

Section: Two Types Of Stabilizers Compose the Scapholunate Complexmentioning

confidence: 99%

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Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year

et al. 2018

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We retrospectively evaluated the results of all arthroscopic dorsal scapholunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro-computed tomography scan after failed medical treatment. Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal intercalated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification. The mean follow-up period was 20.2 months (range, 12-41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB ( = 8) or EWAS IIIC ( = 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion-extension increased from 92.9 degrees preoperatively to 126.2 degrees postoperatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion-extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted. Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure. This is a level IV, case series.

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Current Concepts in Scapholunate Instability Without Arthritic Changes

Amarasooriya

Jerome²,

Tourret

2023

JOIO

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Scapholunate instability (SLI) is the most common carpal instability described. SLI leads to a degenerative arthritic pattern known as scapholunate advanced collapse (SLAC). Diagnosis of SLI can be challenging in pre-dynamic and dynamic stages. CT arthrogram, MR arthrogram and dynamic fluoroscopy are helpful in diagnosis while arthroscopy remains the gold standard. SLI is a multi-ligament injury, which involves not only the scapholunate interosseous ligament (SLIL) but also the extrinsic carpal ligaments. Hence, it is better described as an injury compromising the ‘dorsal scapholunate(dSLL) complex’. A repair can be attempted for acute SLI presenting within 6 weeks of injury. Reconstruction is the mainstay of treatment for chronic SLI without degenerative changes. Multiple repair techniques have been described which include capsulodesis and tenodesis procedures. The clinical outcomes of the techniques have improved over the years. However, a common problem of all these techniques is the lack of long-term data on the outcomes and deteriorating radiological parameters over time. SLI staging is an important factor to be considered in choosing the reconstruction techniques for a better outcome. Currently, there is a trend towards more biological and less invasive techniques. Regardless of the technique, it is important to preserve the nerve supply of the dorsal capsuloligamentous structures of the wrist. Arthroscopic techniques being minimally invasive have the advantage of less collateral damage to the capsuloligamentous structures. Rehabilitation involves a team approach where a protected dart thrower’s motion is allowed after a period of immobilization. Strengthening SL-friendly muscles and inhibiting SL-unfriendly muscles is a key principle in rehabilitation.

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Muscular control of scapholunate instability. An experimental study

Cited by 6 publications

References 20 publications

Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year

Current Concepts in Scapholunate Instability Without Arthritic Changes

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