Incidence and causes of tenosynovitis of the wrist extensors in long distance paddle canoeists.
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OBJECTIVES: To investigate the incidence and causes of acute tenosynovitis of the forearm of long distance canoeists. METHOD: A systematic sample of canoeists competing in four canoe marathons were interviewed. The interview included questions about the presence and severity of pain in the forearm and average training distances. Features of the paddles and canoes were determined. RESULTS: An average of 23% of the competitors in each race developed this condition. The incidence was significantly higher in the dominant than the nondominant hand but was unrelated to the type of canoe and the angle of the paddle blades. Canoeists who covered more than 100 km a week for eight weeks preceding the race had a significantly lower incidence of tenosynovitis than those who trained less. Environmental conditions during racing, including fast flowing water, high winds, and choppy waters, and the paddling techniques, especially hyperextension of the wrist during the pushing phase of the stroke, were both related to the incidence of tenosynovitis. CONCLUSION: Tenosynovitis is a common injury in long distance canoeists. The study suggests that development of tenosynovitis is not related to the equipment used, but is probably caused by difficult paddling conditions, in particular uneven surface conditions, which may cause an altered paddling style. However, a number of factors can affect canoeing style. Level of fitness and the ability to balance even a less stable canoe, thereby maintaining optimum paddling style without repeated eccentric loading of the forearm tendons to limit hyperextension of the wrist, would seem to be important. (+info)
The wrist of the formula 1 driver.
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OBJECTIVES: During formula 1 driving, repetitive cumulative trauma may provoke nerve disorders such as nerve compression syndrome as well as osteoligament injuries. A study based on interrogatory and clinical examination of 22 drivers was carried out during the 1998 formula 1 World Championship in order to better define the type and frequency of these lesions. METHODS: The questions investigated nervous symptoms, such as paraesthesia and diminishment of sensitivity, and osteoligamentous symptoms, such as pain, specifying the localisation (ulnar side, dorsal aspect of the wrist, snuff box) and the effect of the wrist position on the intensity of the pain. Clinical examination was carried out bilaterally and symmetrically. RESULTS: Fourteen of the 22 drivers reported symptoms. One suffered cramp in his hands at the end of each race and one described a typical forearm effort compartment syndrome. Six drivers had effort "osteoligamentous" symptoms: three scapholunate pain; one medial hypercompression of the wrist; two sequellae of a distal radius fracture. Seven reported nerve disorders: two effort carpal tunnel syndromes; one typical carpal tunnel syndrome; one effort cubital tunnel syndrome; three paraesthesia in all fingers at the end of a race, without any objective signs. CONCLUSIONS: This appears to be the first report of upper extremity disorders in competition drivers. The use of a wrist pad to reduce the effects of vibration may help to prevent trauma to the wrist in formula 1 drivers. (+info)
Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach.
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We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58 %), scapholunate (85 %) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of < or =1 mm. Pain was significantly related to the size of the step. There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p < 0.01): I (0%), II (0%), III (42%) and IV (100%). We recommend anatomical reduction and acceptance of a step of <1 mm since the size of the step is related to the incidence of pain. (+info)
Kinematics of the wrist. Evidence for two types of movement.
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We enrolled 34 normal volunteers to test the hypothesis that there were two types of movement of the wrist. On lateral radiographs two distinct patterns of movement emerged. Some volunteers showed extensive rotation of the lunate with a mean range of dorsiflexion of 65 degrees, while others had a mean range of 50 degrees. The extensive rotators were associated with a greater excursion of the centre of articulation of the wrist. It is suggested that dynamic external fixation of a fracture of the distal radius carries with it the risk of stretching the ligaments or causing volar displacement at the site of the fracture. (+info)
Influence of clinical information on the detection of wrist fractures in children.
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The purpose of this investigation is to assess the importance of clinical information for the detection of non-displaced wrist fractures in children. Twenty non-displaced fractures of the distal radius in children younger than 15 years of age and twenty age-matched controls were evaluated by five blinded observers before and after giving clinical data, and a receiver operating characteristic (ROC) analysis using a continuous rating scale with a line-marking method was performed. The detection of the fractures was significantly improved with clinical information, and the main reason for this was an increase in true positive fraction. Availability of adequate clinical data should be emphasized for interpreting radiography. (+info)
Use of magnetic resonance imaging to diagnose common wrist disorders.
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Magnetic resonance imaging is being used more frequently to diagnose and plan treatment of wrist disorders. This article reviews the common pathologic lesions of the wrist: avascular necrosis, triangular fibrocartilage complex tears, ligamentous tears, ganglion cysts, carpal tunnel syndrome, and osteoarthritis. The typical magnetic resonance imaging characteristics of these lesions is discussed. (+info)
Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients.
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Stable fixation of fractures of the distal radius can be achieved by using two 2.0 mm titanium plates placed on the radial and intermediate columns angled 50 degrees to 70 degrees apart. We describe our results with this method in a prospective series of 74 fractures (58 severely comminuted) in 73 consecutive patients. Early postoperative mobilisation was possible in all except four wrists. All of the 73 patients, except two with other injuries, returned to work and daily activities with no limitations. The anatomical results were excellent or good in 72 patients and fair in one. Our discussion includes details of important technical considerations based on an analysis of the specific complications which were seen early in the series. (+info)
A systematic review of the content and quality of wrist outcome instruments.
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OBJECTIVE: To assess the content and quality of published wrist outcome instruments using standardized criteria. DESIGN: An analytical study that examined 32 wrist outcome instruments sourced from textbooks, Medline (1951 to present) and Current Contents. MAIN MEASURES: The content of each instrument was classified into four categories: traditional measures (such as range of movement and strength), measures of the ability to perform daily activities, compensatory mechanisms used, and 'other'. Analysis included the frequency of assessment per category and the method of assessment. In addition, each instrument was graded using 13 quality criteria. Three criteria (scientific justification of the content and scoring system used, demographic utility) were considered to be essential. RESULTS: Eighty-two per cent of instruments reviewed for this paper contained traditional measures, of which most were assessed objectively. The ability to perform specific daily activities was assessed in 31% of the instruments whereas compensatory mechanisms were evaluated in only one instrument. These variables were not assessed in a consistent manner. Using the quality scoring system derived for this study, the quality of the instruments was generally poor. Only one instrument fulfilled all of the essential criteria. Only four instruments completely satisfied more than 50% of the criteria. CONCLUSIONS: Most wrist outcome instruments neglected to assess the impact of the disorder on the individual. Outcome was generally not expressed in functional terms or in terms that were relevant to each individual. The majority of the reviewed articles had poor quality. Thus use of these instruments may preclude sensitive evaluation of the efficacy of any intervention. (+info)