gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Restoring Functional Motion in the Arthritic Wrist through Circumduction

Meeting Abstract

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  • presenting/speaker Maheen Nadeem - Cleveland Clinic, Cleveland, United States
  • Jeremy Loss - Cleveland Clinic, Cleveland, United States
  • Zong Ming Li - Cleveland Clinic, Cleveland, United States
  • William Seitz - Cleveland Clinic, Cleveland, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-864

doi: 10.3205/19ifssh0204, urn:nbn:de:0183-19ifssh02041

Veröffentlicht: 6. Februar 2020

© 2020 Nadeem et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: We hypothesize that functional wrist motion is lost in the arthritic wrist due to a combination of mechanical incongruity & pain. Restoration of functional motion is achieved through elimination of pain generators and reestablishment of adequate freedom of motion through a three dimensional envelope of motion allowing near-normal circumduction.

Materials Biomechanical studies performed in our laboratory have mapped out 3-D arcs of motion needed to carry out normal ADL tasks. These were compared to patients who underwent motion-sparing reconstructive wrist surgery (4-C-F, PRC, SHARC, TWA) who reported satisfactory wrist function following surgery/rehabilitation. Limitations in any direction were compared to the total circumductive envelope achieved clinically.

Results: Satisfactory ADL mobility parallels reestablishment of movement through a stable, pain-free circumductive arc of motion by means of limited arthrodesis, excision of mechanical obstruction, preservation of congruent healthy articular surfaces, or arthroplasty which restore wrist kinematics to near-normal.

Conclusion: PRC, SHARC, TWA appear to restore central, unimpeded circumduction of roughly 60% of normal which provides adequate 3-D mobility for restoration of functional ADLs. 4-C-F results in a longer lever arm with increased stress at the R-C articulation which offers a more restrictive & less functional circumductive envelope.