The role of proprioception and neuromuscular stability in carpal instabilities

Abstract

Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.

Orthotic intervention incorporating the dart-thrower's motion as part of conservative management guidelines for treatment of scapholunate injury

“…Its intended use was to also harness proprioceptive influences using active motion within the DTM plane and exercises that stimulate mechanoreceptors to enhance stability. 26,36 This orthosis was designed as a response to biomechanical studies suggesting that restraining motion to the DTM would offload a deficient SLIL and more readily permit healing and recovery. 2,15,26 The development of a dynamic orthosis that permits movement in a specific plane is in line with established ligament rehabilitation protocols, [15][16][17] including those for the lower limb.…”

Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty

“…In addition, immunohistochemical methods may be further improved; research on other joint ligaments has noted that other immunological markers may be more suitable alone or in combination, such as p75. The use of other immunological markers may increase the detection of FNEs as they may have different binding affinities [74], stain different aspects of the FNEs [75,76] or produce more clearly stained FNEs [77]. In addition, no research has assessed the reliability of immunohistochemical markers in detecting FNEs in the hip capsule, to date.…”

Biomechanik des Handgelenks

“…In der Praxis konnte nun nachgewiesen werden, dass die auf das Handgelenk einwirkenden Kräfte für die Bänder der proximalen Handwurzelreihe viel zu hoch wären und deren Stabilität bei Weitem nicht ausreichend wäre [1]. Die zusätzliche Stabilität wird durch die Muskulatur und die dazugehörigen Sehnen gewährleistet, die über Mechanorezeptoren in den Bändern der Handwurzel gesteuert werden [16,17].…”

“…Das Handgelenk kann also letztendlich nicht allein durch seinen knöchernen und ligamentären Aufbau ausreichend stabilisiert werden, sondern benötigt dazu entscheidend auch die Unterarmmuskulatur [16,17].…”