Ulnar midcarpal instability—Clinical and laboratory analysis

Lichtman, David M.; Schneider, James R.; Swafford, Albert R.; Mack, Gregory R.

doi:10.1016/s0363-5023(81)80115-3

Cited by 267 publications

(58 citation statements)

References 12 publications

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“…Given that climbers present a stronger imbalance, it is probable that they have more difficulties in controlling and protecting their joints and are, therefore, more exposed to joint instability, joint surface over-use and/or ligament tears (Centomo et al 2008;Stokes and Gardner-Morse 2003). This finding could explain why wrist medio-carpal instability (Garcia-Elias 2008;Lichtman et al 1981;Lichtman and Wroten 2006) is often observed in climbers, although no medical reports have been published recently. This important imbalance may also be implicated in finger pulley ruptures, since the extensor muscle action is also required during the crimp grip technique .…”

Section: Discussionmentioning

confidence: 99%

Estimation of hand and wrist muscle capacities in rock climbers

2014

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imbalance between flexor and extensor capacities which suggests a potential risk of pathologies. Conclusions The practice of climbing not only increased the strength of climbers but also resulted in specific adaptations among hand muscles. The proposed method and the obtained data could be re-used to optimize the training programs as well as the rehabilitation processes following hand pathologies. Muscle imbalance ratio of the j joint (j = MCP or wrist) Keywords AbstractPurpose This study investigated the hand and wrist muscle capacities among expert rock climbers and compared them with those of non-climbers. The objective was to identify the adaptations resulting from several years of climbing practice. Methods Twelve climbers (nine males and three females) and 13 non-climber males participated in this study. Each subject performed a set of maximal voluntary contractions about the wrist and the metacarpo-phalengeal joints during which net joint moments and electromyographic activities were recorded. From this data set, the muscle capacities of the five main muscle groups of the hand (wrist flexors, wrist extensors, finger flexors, finger extensors and intrinsic muscles) were estimated using a biomechanical model. This process consisted in adjusting the physiological crosssectional area (PCSA) and the maximal muscle stress value from an initial generic model. Results Results obtained from the model provided several new pieces of information compared to the analysis of only the net joint moments. Particularly, the capacities of the climbers were 37.1 % higher for finger flexors compared to non-climbers and were similar for finger extensor and for the other muscle groups. Climbers thus presented a greaterCommunicated by Nicolas Place.

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Section: Discussionmentioning

confidence: 99%

Estimation of hand and wrist muscle capacities in rock climbers

2014

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“…This phenomenon can be either static (at rest) or dynamic (with use), and is usually due to ligament tears, fractures, or both [5,11]. Cooney et al proposed a classification based on the compromise of static and dynamic components of the wrist [5].…”

Section: Discussionmentioning

confidence: 99%

The Floating Lunate: Arthroscopic Treatment of Simultaneous Complete Tears of the Scapholunate and Lunotriquetral Ligaments

Badía¹,

Khanchandani²

2008

Hand (New York, N,Y.)

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Carpal instabilities continue to be a controversial topic in hand surgery. Accurate diagnosis of the ligament injuries is usually difficult without an arthroscopic evaluation. Few studies have focused on the diagnosis and proper management of simultaneous scapholunate (SL) and lunotriquetral (LT) ligament tears. This is an uncommon injury that leads to marked disability and chronic wrist pain. This is essentially a "floating lunate" and indicates a severe ligamentous lesion. Thirteen patients (six female and seven male) with complete SL and LT tears and with gross arthroscopic dynamic carpal instability were included in the present study. None of the patients showed radiographic evidence of lunate dislocation. One patient presented acutely and was operated on 3 days after the injury. The average time from the initial injury to the arthroscopy for the other 12 patients was 13.5 months (range 1.5-84 months). All patients underwent arthroscopic debridement of the SL and LT ligaments coupled with percutaneous pinning (two 0.045-in. Kirschner wires) in both joints. At the final follow-up, the average range of motion was 50°o f flexion, 54°of extension, 77°of pronation, 80°of supination, 25°of ulnar deviation, and 15°of radial deviation. The average final grip strength was 67% from the non-affected side. All patients had negative shifting tests at final follow-up. Furthermore, there was no evidence of any static or dynamic instability in all the patients except for one patient who developed a volar intercalated segment instability 8 months after the surgery. At the final followup, ten patients had no pain, one had mild pain, and two experienced moderate pain.

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“…In midcarpal instability the Lichtman test is, in our opinion the most important stress test to perform, both clinically as well as using cineradiography (Lichtman et al 1981(Lichtman et al , 1993. In this test the thumb of the investigator is placed over the distal carpal row.…”

Section: Cineradiographymentioning

confidence: 99%