Search Results (18)

Background and Clinical Significance: Scapular stress fractures are exceptionally rare in athletes and are notoriously difficult to diagnose due to their subtle presentation and poor sensitivity on initial radiographs. This case report describes the diagnostic challenge of a scapular body stress fracture in an elite boxer who initially presented with wrist pain. Case Presentation: A 19-year-old right-hand-dominant female elite boxer presented with a three-month history of bilateral wrist pain. Initial examination and MRI were consistent with a triangular fibrocartilage complex (TFCC) injury. Despite conservative management, her symptoms persisted, and she subsequently developed mechanical right shoulder pain and a sensation of instability. Physical examination revealed scapular dyskinesis, with a positive push-up test and weakness on punch protraction. Plain radiographs of the scapula were unremarkable. Point-of-care musculoskeletal ultrasound (MSK US) identified a cortical irregularity at the medial scapular border. A subsequent computed tomography (CT) scan obtained at three-month follow-up definitively confirmed a stress fracture at this site. Treatment focused on scapular stabilization via prolotherapy and activity modification, leading to symptomatic resolution and a successful return to sport. Conclusions: This case underscores the importance of evaluating the entire kinetic chain in athletes presenting with focal complaints. It demonstrates the utility of MSK US as an effective initial screening tool for cortical stress fractures and highlights the necessity of CT for definitive confirmation. Clinicians should maintain a high index of suspicion for scapular stress injuries in overhead athletes with unexplained shoulder dysfunction. Full article

Background/Objectives: Scapholunate ligament injuries represent one of the most challenging diagnostic problems in wrist surgery, with conventional radiographs often appearing normal despite significant ligamentous disruption. The optimal stress radiographic views for detecting these injuries remain incompletely defined. To systematically evaluate and compare the diagnostic utility of eight different stress radiographic views in detecting isolated scapholunate ligament disruption using a cadaveric model. Methods: Nine fresh-frozen cadaveric wrists underwent complete scapholunate ligament transection while preserving secondary stabilizers. Eight radiographic positions were evaluated: posteroanterior (PA) neutral, PA wrist extension, PA wrist flexion, PA radial deviation, PA ulnar deviation, anteroposterior (AP) clenched fist, AP neutral, and lateral neutral. Scapholunate gap measurements were obtained using calibrated digital software with 20 mm reference markers. Statistical analysis employed repeated-measures ANOVA with post hoc comparisons. Results: PA wrist extension demonstrated the greatest scapholunate gap widening (2.68 ± 0.84 mm, p = 0.006), followed by AP clenched fist views (2.32 ± 1.07 mm, p = 0.036). PA wrist flexion showed significant gap reduction (0.47 ± 0.44 mm, p < 0.001). Twenty-two percent of specimens demonstrated scapholunate angles exceeding 70° on lateral radiographs. Inter-specimen variability was observed, with gap measurements ranging from 1.2 to 4.8 mm across different positions. Conclusions: PA wrist extension and AP clenched fist views demonstrate superior diagnostic utility for detecting scapholunate ligament injuries compared to neutral radiographs. These stress radiographic techniques offer accessible, cost-effective alternatives to advanced imaging modalities for early detection of scapholunate ligament pathology in clinical practice. Full article

Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the Garcia-Elias classification. Materials and Methods: A retrospective study was performed on ten patients treated with this novel technique. The technique involves a dorsal approach to the wrist through a 5–7 cm incision ulnar to Lister’s tubercle. After exposing the scapholunate joint, reduction is performed using Kirschner wires (K-wires) as joysticks, followed by stabilisation with three K-wires through the scapholunate, scapho-capitate, and radio-lunate joints. Two 2.3 mm suture anchors with double sutures are placed where the reduction K-wires were removed. One pair of sutures connects the anchors and any remaining SLIL tissue, while the second pair create a shoelace-like capsulodesis. Post-operative care includes staged K-wire removal at one and two months, with progressive rehabilitation before returning to weight-bearing activities at six months. Results: All patients improved in pain and function. The technique addresses SLIL injuries by restoring both coronal alignment through ligament repair and sagittal alignment via dorsal capsulodesis. The use of suture anchors and direct repair preserves the native tissue while reinforcing the dorsal capsule–scapholunate septum complex, avoiding the need for tendon grafts or extensive bone tunnelling. Conclusions: This ligament-sparing technique offers several advantages, including absence of donor site morbidity, minimal damage to carpal cartilage and vascularity, and preservation of surgical options should revision be necessary. The procedure effectively addresses both components of scapholunate instability while maintaining a relatively straightforward surgical approach. Full article

Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after surgery. Post-operative MR imaging can reveal potential pathologies but it needs to be assessed whether depicted changes are normal or whether these findings have a clinical significance. Therefore, the purpose of this study was to evaluate postoperative MR imaging and the function of the patients’ wrists in order to assess which postoperative changes are correlated with pain. Patients and Methods: All patients with a TFCC lesion who were treated arthroscopically at our hospital between January 2012 and December 2016 were retrospectively enrolled. Seventeen patients with complete data sets were enrolled. Post-operative MRI examinations needed to be performed within 24 months after arthroscopy. The mean magnet resonance imaging (MRI) follow-up was 22 months. The average clinical follow-up was 27.3 months. Age, gender, pain level, PROM scores (Munich Wrist Questionnaire, MWQ), follow-up interval, and TFCC classification (Palmer) were documented. The patients underwent a clinical examination and MR imaging. Results: Ten patients (59%) had scar tissue at the triangular fibrocartilaginous complex (TFCC) and nine (53%) had an effusion in the ulnar recess. These findings were not necessarily associated with pain, as six patients without pain and four with pain had scar tissue at the TFCC and six patients without pain and three with pain showed an effusion in the ulnar recessus. Bone marrow edema could be found in the lunate of five patients (29%) (three with pain, two without pain) and in the distal radial ulnar joint (DRUJ) of one patient (6%) with pain. However, typical degenerative changes were not necessarily associated with pain. Conclusions: This present study is the first study correlating postoperative MRI findings after arthroscopic assisted TFCC surgery with both pain and function. Bone edema seems to be associated with pain, whereas scarring at the TFCC is visible on MRI but is not necessarily associated with pain. Full article

Background/Objectives: Acute isolated distal radioulnar joint (DRUJ) dislocations are rare and often misdiagnosed during initial evaluation due to subtle clinical presentation, low index of suspicion, and imaging barriers. Prompt diagnosis and treatment are critical to avoid chronic instability, limited wrist mobility, and osteoarthritis. This systematic review evaluates the functional outcomes of conservative and surgical treatment protocols for acute isolated DRUJ dislocations. Methods: A systematic search of PubMed, Scopus, and Mendeley databases (2000–2024) was conducted following PRISMA guidelines. Inclusion criteria involved adult patients with isolated DRUJ dislocations diagnosed and managed within one week of injury. Studies reporting on underage patients, associated fractures, delayed management, and open injuries were excluded. Data on demographics, injury mechanism, diagnostic methods, treatment protocols, and functional outcomes were extracted and analyzed. Results: In total, 22 cases across 20 studies were included. The majority (90.9%) were males, with a mean age of 37.9 years (range: 20–70 years). Falls and sports injuries were the major causes, with volar dislocations predominating (18/22). The misdiagnosis rate was equal to 18%. Most cases were treated conservatively with closed reduction and immobilization for an average of 4.9 weeks. Operative treatment was performed in 6 cases, mainly following failed closed reductions. Functional outcomes were generally favorable, although the same parameters were not consistently studied in all patients. Overall, 82% (14 of 17 patients) achieved a full range of motion; 88% (14 of 16 patients) reported no pain, and all assessed cases had stable DRUJs at follow-up. Conclusions: This review highlights the rarity and diagnostic challenges of this injury. The functional outcomes of both conservative and operative treatment are generally satisfactory. Conservative treatment should be the first-line approach, with surgery reserved for irreducible or unstable cases. Future research using standardized outcome measures is needed to provide guidance for clinicians. Full article

Wearable devices have potential applications in health monitoring and personalized healthcare due to their portability, conformability, and excellent mechanical flexibility. However, their performance is often limited by instability in acidic or basic environments. In this study, a flexible sensor with excellent stability based on a GaN nanoplate was developed through a simple and controllable fabrication process, where the linearity and stability remained at almost 99% of the original performance for 40 days in an air atmosphere. Moreover, perfect stability was also demonstrated in acid–base environments, with pH values ranging from 1 to 13. Based on its excellent stability and piezotronic performance, a flexible device for motion monitoring was developed, capable of detecting motions such as finger, knee, and wrist bending, as well as swallowing. Furthermore, gesture recognition and intelligent fall monitoring were explored based on the bending properties. In addition, an intelligent fall warning system was proposed for the personalized healthcare application of elders by applying machine learning to analyze data collected from typical activities. Our research provides a path for stable and flexible electronics and personalized healthcare applications. Full article

Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity. Full article

Background: Stroke is a leading cause of disability, especially due to an increased fall risk and postural instability. The objective of this study was to analyze the impact of motor impairment in the hemiparetic UE on static balance in standing, in subject with chronic stroke. Methods: Seventy adults with chronic stroke, capable of independent standing and walking, participated in this cross-sectional study. The exclusion criteria included vestibular, cerebellar, or posterior cord lesions. The participants were classified based on their UE impairment using the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). A posturographic evaluation (mCTSIB) was performed in the standing position to analyze the center of pressure (COP) displacement in the mediolateral (ML) and anteroposterior (AP) axes and its mean speed with eyes open (OE) and closed (EC) on stable and unstable surfaces. Results: A strong and significant correlation (r = −0.53; p < 0.001) was observed between the mediolateral (ML) center of pressure (COP) oscillation and the FMA-UE, which was particularly strong with eyes closed [r(EO) = 0.5; r(EC) = 0.54]. The results of the multiple linear regression analysis indicated that the ML oscillation is influenced significantly by the FMA-Motor, and specifically by the sections on UE, wrist, coordination/speed, and sensation. Conclusions: The hemiparetic UE motor capacity is strongly related to the ML COP oscillation during standing in individuals with chronic stroke, with a lower motor capacity associated with a greater instability. Understanding these relationships underpins the interventions to improve balance and reduce falls in people who have had a stroke. Full article

Introduction: The scapholunate interosseous ligament is pivotal for wrist stability, and its impairment can result in instability and joint degeneration. This study explores the application of real-time MRI for dynamic assessment of the scapholunate joint during wrist motion with the objective of determining its diagnostic value in efficacy in contrast to static imaging modalities. Materials and Methods: Ten healthy participants underwent real-time MRI scans during wrist ab/adduction and fist-clenching maneuvers. Measurements were obtained at proximal, medial, and distal landmarks on both dynamic and static images with statistical analyses conducted to evaluate the reliability of measurements at each landmark and the concordance between dynamic measurements and established static images. Additionally, inter- and intraobserver variabilities were evaluated. Results: Measurements of the medial landmarks demonstrated the closest agreement with static images and exhibited the least scatter. Distal landmark measurements showed a similar level of agreement but with increased scatter. Proximal landmark measurements displayed substantial deviation, which was accompanied by an even greater degree of scatter. Although no significant differences were observed between the ab/adduction and fist-clenching maneuvers, both inter- and intraobserver variabilities were significant across all measurements. Conclusions: This study highlights the potential of real-time MRI in the dynamic assessment of the scapholunate joint particularly at the medial landmark. Despite promising results, challenges such as measurement variability need to be addressed. Standardization and integration with advanced image processing methods could significantly enhance the accuracy and reliability of real-time MRI, paving the way for its clinical implementation in dynamic wrist imaging studies. Full article

Background: This study compared clinical outcomes between arthroscopic and open repair of triangular fibrocartilage complex (TFCC) foveal tears in chronic distal radioulnar joint (DRUJ) instability patients. Methods: A total of 79 patients who had gone through foveal repair of TFCC using arthroscopic technique (n = 35) or open technique (n = 44) between 2016 and 2020 were retrospectively analyzed. The visual analog scale (VAS) score for pain, active range of motion (ROM), grip strength, Mayo Modified Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and Patient-Rated Wrist Evaluation (PRWE) score at 2-4-6-12-24 months postoperatively were compared between two groups. Results: Two years after the operation, clinical parameters (VAS, MMWS, DASH, and PRWE), grip strength, and ROM showed significant advancement in the two groups in comparison to their values measured preoperatively (p < 0.001). Nonetheless, we could not identify any statistically significant differences in the above clinical factors between the two groups. The arthroscopic group showed a better flexion–extension arc at 2 months and supination–pronation arc at 2 and 4 months than the open group (p < 0.001). There were no significant differences between the two groups at 2 years postoperatively. Ten patients (12.6%) had recurrent instability (three in the arthroscopic group and seven in the open group, p = 0.499). Similarly, both groups showed no significant difference in the return to work period. Conclusions: Arthroscopic foveal repair of TFCC provided similarly favorable outcomes and early recovery of pain and ROM compared to open repair. Full article

The standard treatment for distal radioulnar joint (DRUJ) instability involves repairing the triangular fibrocartilage complex (TFCC) and immobilizing the joint with a sugar tong slab, but this can cause elbow stiffness. To address this, a modified ulnar gutter slab was designed to enhance elbow mobility during immobilization. A prospective randomized controlled trial was conducted on 23 DRUJ instability patients who underwent arthroscopic TFCC repair. Two post-operative splinting techniques were compared: the modified ulnar gutter slab and the sugar tong slab. The assessment included the Disabilities of Arm, Shoulder, and Hand (DASH) score; elbow, forearm, and wrist range of motion (ROM); post-operative DRUJ stability; and complications. DASH scores at 4 and 6 weeks were not significantly different. However, the modified ulnar gutter slab improved elbow extension range of motion at 4 weeks (extension lag: 20.0 vs. 6.5 in the sugar tong group) (p = 0.011). Post-operative DRUJ stability was comparable between the two groups. Notably, one patient in the sugar tong slab group experienced complex regional pain syndrome (CRPS). The modified ulnar gutter slab offers a post-operative alternative after TFCC repair. It effectively immobilizes forearm and wrist motion while enhancing elbow mobility, potentially reducing post-operative elbow stiffness. Full article

Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed. Full article

The continuous monitoring of arterial blood pressure (BP) is vital for assessing and treating cardiovascular instability in a sick infant. Currently, invasive catheters are inserted into an artery to monitor critically-ill infants. Catheterization requires skill, is time consuming, prone to complications, and often painful. Herein, we report on the feasibility and accuracy of a non-invasive, wearable device that is easy to place and operate and continuously monitors BP without the need for external calibration. The device uses capacitive sensors to acquire pulse waveform measurements from the wrist and/or foot of preterm and term infants. Systolic, diastolic, and mean arterial pressures are inferred from the recorded pulse waveform data using algorithms trained using artificial neural network (ANN) techniques. The sensor-derived, continuous, non-invasive BP data were compared with corresponding invasive arterial line (IAL) data from 81 infants with a wide variety of pathologies to conclude that inferred BP values meet FDA-level accuracy requirements for these critically ill, yet normotensive term and preterm infants. Full article

The purpose of this study was to investigate whether a watch-shaped external wrist band brace improves distal radioulnar joint (DRUJ) stability. Seven fresh cadaveric arms were used. Using a customized testing system, volar and dorsal translation forces were applied to the radius externally while the ulna was fixed. The test was performed with the forearm in neutral, 60° pronated, and 60° supinated positions, once without the brace and once with the brace applied. In each condition, the amount of translation was measured. Then, the triangular fibrocartilage complex (TFCC) was detached from the ulnar styloid process and the fovea ulnaris, and the same tests were performed again. Detachment of the TFCC significantly increased volar and dorsal translations in all forearm rotations compared to the intact condition (p < 0.05), except for the pronated dorsal translation of the radius (p = 0.091). Brace application significantly reduced volar and dorsal translations in all forearm rotations both in intact specimens and in TFCC-detached specimens (p < 0.05), except for pronated volar and dorsal translations in TFCC-detached specimens (p = 0.101 and p = 0.131, respectively). With the brace applied, the TFCC-detached specimens showed no significant difference in volar or dorsal translation in all forearm rotations compared to the intact specimens (p > 0.05). The external wrist band brace improved DRUJ stability in both normal and TFCC-torn wrists and reduced the DRUJ instability caused by TFCC tear to a near-normal level. Full article

While morphologic magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of ligamentous wrist injuries, it is merely static and incapable of diagnosing dynamic wrist instability. Based on real-time MRI and algorithm-based image post-processing in terms of convolutional neural networks (CNNs), this study aims to develop and validate an automatic technique to quantify wrist movement. A total of 56 bilateral wrists (28 healthy volunteers) were imaged during continuous and alternating maximum ulnar and radial abduction. Following CNN-based automatic segmentations of carpal bone contours, scapholunate and lunotriquetral gap widths were quantified based on dedicated algorithms and as a function of wrist position. Automatic segmentations were in excellent agreement with manual reference segmentations performed by two radiologists as indicated by Dice similarity coefficients of 0.96 ± 0.02 and consistent and unskewed Bland–Altman plots. Clinical applicability of the framework was assessed in a patient with diagnosed scapholunate ligament injury. Considerable increases in scapholunate gap widths across the range-of-motion were found. In conclusion, the combination of real-time wrist MRI and the present framework provides a powerful diagnostic tool for dynamic assessment of wrist function and, if confirmed in clinical trials, dynamic carpal instability that may elude static assessment using clinical-standard imaging modalities. Full article