Radial-sided wrist pain differentials: presentation, pathoanatomy, diagnosis, and management / Dolor radial de muñeca: diferencias en la presentación, anatomía patológica, diagnóstico y tratamiento

Abstract Patients with radial-sided wrist pain can be challenging to diagnose and treat. Various physicians, including emergency physicians, primary care physicians, and orthopedic or plastic surgeons can be involved in the initial and subsequent evaluation. We delve into the differential diagnosis of radial-sided wrist pain including osteoarticular, ligament, tendon, nerve, and other pathologies. We review the physical exam findings, diagnostic studies, and treatment options for each pathology based on recent and updated literature.

Resumen Los casos de pacientes que presentan dolor radial de muñeca pueden ser de difícil diagnóstico y tratamiento. Varias especialidades médicas, incluidas emergentólogos, médicos de atención primaria, cirujanos ortopédicos o cirujanos plásticos, pueden estar involucrados desde el inicio de la patología y subsecuente evaluación. Pro fundizamos aquí en el diagnóstico diferencial del dolor radial de muñeca incluyendo las debidas a patologías osteoarticulares, ligamentosas, tendinopatías y neuropatías, entre otras. Esta revisión incluye examen físico, estudios diagnósticos, y opciones terapéuticas para cada condición con base en la literatura reciente y actualizada.

Association between wrist pain and awkward postures among workers in 10 key industries / 环境与职业医学

Background Prolonged awkward postures during occupational activities can lead to excessive musculoskeletal load on the wrist of workers and symptoms such as wrist pain or discomfort. Objective To survey the prevalence of wrist pain among workers in 10 key industries and analyze its correlation with wrist working postures. Methods By using stratified cluster sampling method, workers from 10 key industries, such as footwear manufacturing industry, shipbuilding manufacturing industry, and automobile manufacturing industry, were selected from seven regions in North China, East China, Central China, South China, Southwest China, Northwest China, and Northeast China. The demographic information, wrist working postures, pain in wrist of the workers were collected through a cross-sectional survey. Pearson χ2 test was used to compare prevalence by selected factors, trend χ2 test for between group comparison, and unconditional logistic regression models for the association of wrist working postures with wrist pain. Results There were 64052 workers enrolled in this survey, and 56286 provided valid questionnaires (the effective rate was 87.8%). According to the survey, the prevalence of wrist pain was 23.3% (13112/56286), and the industries with higher prevalences were footwear manufacturing (27.1%, 1927/7106), automobile manufacturing (24.9%, 5378/21560), and shipbuilding and related equipment manufacturing (24.4%, 850/3488) industries. Finger pinching (OR=2.09, 95%CI: 1.95-2.24), frequent wrist bending (OR=2.03, 95%CI: 1.92-2.15), fixed wrist bending (OR=1.77, 95%CI: 1.69-1.85), wrist on hard edge (OR=1.34, 95%CI: 1.28-1.40), and arms over shoulders (OR=1.11, 95%CI: 1.05-1.17) increased the risk of reporting wrist pain. Conclusion Awkward postures are related to wrist pain among workers in selected 10 key industries. The related factors are wrist on hard edge, frequent wrist bending, finger pinching, fixed wrist bending, and arms over shoulders.

Clinical analysis of distal radius core decompression for chronic wrist pain / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Effectiveness of an educative ergonomic plan in reducing musculo-skeletal disorders among dental practitioners / Efetividade de um plano ergonômico educativo na redução de distúrbios osteormusculares entre dentistas

Objective: Work related musculo skeletal disorders (WMSD) are very common among dental practitioners who use precise hand-wrist motions and prolonged static postures. The aim of this study was to develop an educative ergonomic plan and test its effectiveness in reducing symptoms of musculo-skeletal disorders among dental practitioners. Material and Methods: This study was conducted on a random sample of 50 dental practitioners of both genders (25 male, 25 female) practising for more than 4 years in urban Bengaluru, India and showing symptoms of neck pain, back pain or wrist pain. In the first round of the questionnaire data was collected from all 50 dentists. Next an educative ergonomic plan was developed which included simple exercises and recommendations in the form of do's and don'ts. The study population were asked to follow the guidelines given and perform the exercises given in the poster daily for a period of 3 months. Then, the questions were again asked. The differences in responses during the first stage and second stage were analyzed. Results: The use of the ergonomic plan led to a statistically significant improvement in certain ergonomic practises such as practise of changing their positions during clinical practice, keeping shoulders and arm at correct level while working and keeping instruments within hand reach. There was a statistically significant reduction in pain levels after the use of the ergonomic plan. Conclusion: The ergonomic plan in the form of recommendations and exercises were an effective tool in improving ergonomic practises and reducing the symptoms of musculoskeletal disorders among dental practitioners. (AU)

Objetivo: Distúrbios osteomusculares relacionados ao trabalho (DORT) são muito comuns entre os dentistas que usam movimentos precisos de mão e punho e posturas estáticas prolongadas. O objetivo deste estudo foi desenvolver um plano ergonômico educativo e testar sua eficácia na redução de sintomas de distúrbios osteomusculares em dentistas. Material e Métodos: Este estudo foi realizado em uma amostra aleatória de 50 dentistas de ambos os sexos (25 homens, 25 mulheres) trabalhando há mais de 4 anos na área urbana de Bengaluru, Índia e apresentando sintomas de dor no pescoço, dor nas costas ou dor no punho. Na primeira etapa do questionário foram coletados dados de todos os 50 dentistas. Em seguida, foi desenvolvido um plano ergonômico educativo que incluía exercícios simples e recomendações na forma de fazer e não fazer. Os participantes foram solicitados a seguir as orientações dadas e realizar os exercícios indicados no pôster diariamente por um período de 3 meses. Em seguida, as perguntas foram feitas novamente. Foram analisadas as diferenças nas respostas durante a primeira etapa e a segunda etapa. Resultados: A utilização do plano ergonômico levou a uma melhora estatisticamente significativa em algumas práticas ergonômicas, como a prática de mudar de posição durante o atendimento clínico, manter ombros e braços no nível correto durante o trabalho e manter os instrumentos ao alcance das mãos. Houve redução estatisticamente significativa dos níveis de dor após a utilização do plano ergonômico. Conclusão: O plano ergonômico na forma de recomendações e exercícios foi uma ferramenta eficaz na melhoria das práticas ergonômicas e na redução dos sintomas de distúrbios osteomusculares entre os cirurgiões-dentistas. (AU)

Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture / 北京大学学报(医学版)

OBJECTIVE@#To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture.@*METHODS@#In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus.@*RESULTS@#The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group.@*CONCLUSION@#The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

Inestabilidad Radiocubital Distal (IRCD) postraumática sintomatica en paciente pediatrico. Correlación funcional e imaginológica. Serie de Casos / Distal symptomatic postraumatic Radioulnar instability (DSPRI) in childs. Functional and imaginological correlation. Case Series

Introducción Actualmente no se encuentra bien establecida la prevalencia, diagnóstico y manejo de la IRCD postraumática en pacientes pediátricos, siendo escasa la literatura al respecto. el propósito del estudio es establecer objetivamente la sintomatología y la funcionalidad. Materiales & Métodos Presentamos un estudio de serie de casos en el cual se evaluaron 126 pacientes con fractura de antebrazo distal entre febrero y noviembre de 2017 que consultaron en el servicio de urgencias del Hospital Guillermo Grant Benavente, Concepción, Chile. Para la evaluación de los pacientes se utilizó el Quick-DASH, Mayo Wrist Score, Fuerza de prensión comparativa mediante dinamómetro y su correlación imagenológica mediante TAC abreviado de muñeca utilizando 3 métodos para evaluar la congruencia articular. Resultados 11 pacientes (8.7%) evolucionaron con IRCD postraumática sintomática, la mayoría de sexo masculino (83%), con media de edad de 10.4 años (4 a 14 años), 82% de los pacientes diestros, el 45% sufrió fractura de extremidad superior derecha, 92% de los pacientes tuvo una caída a nivel siendo 73% de baja energía y todos los pacientes fueron tratados con reducción Ortopédica y yeso braquipalmar con un promedio de 5.5 semanas (2-9 semanas) y un seguimiento total promedio de 10.2 semanas. Discusión la IRCD postraumática en pacientes pediátricos no se debe a una mala reducción de la fractura y un mal eje de alineación sino a una lesión ligamentaria sub-diagnosticada.

Background Currently, the prevalence, diagnosis and management of distal symptomatic post-traumatic radioulnar instability (DSPRI) in pediatric patients is not well established, and the literature on this is scarce. the purpose of the study is to objectively establish the symptoms and functionality. Methods We present a case series study in which 126 patients with a distal forearm fracture were evaluated between February and November 2017, who consulted the emergency department of the Guillermo Grant Benavente Hospital, Concepción, Chile. For the evaluation of the patients, the Quick-DASH, Mayo Wrist Score, comparative grip strength by dynamometer and its imaging correlation by abbreviated CAT scan of the wrist were used using 3 methods to evaluate joint congruence. Results 11 patients (8.7%) evolved with DSPRI, most of them male (83%), with a mean age of 10.4 years (4 to 14 years), 82% of right-handed patients, 45% suffered a fracture of the right upper limb, 92% of the patients had a level drop, 73% being low energy and all the patients were treated with orthopedic reduction and brachypalmar cast with an average of 5.5 weeks (2-9 weeks) and an average total follow-up. 10.2 weeks. Discussion Post-traumatic DSPRI in pediatric patients is not due to poor fracture reduction and poor alignment axis, but to underdiagnosed ligament injury.

Combination Effects of Self-Volar Gliding Using a Strap and Wrist Distraction on Pain and Wrist Extension Range of Motion in Subjects with Dorsal Wrist Pain

PURPOSE: This study examined the effects of self-volar gliding combined with a strap and wrist distraction on pain and the active and passive wrist extension range of motion (ROM) in subjects with dorsal wrist pain during partial weight bearing of the hand.METHODS: Thirty subjects (14 males and 16 females) with dorsal wrist pain during partial weight bearing through the hand participated in this study. The two different self-volar gliding techniques were performed for each group. Self-volar gliding using a strap (SVGS) and SVGS and wrist distraction (SVGSD) were performed five times for one week for each group. The active and passive ROM of wrist extension and the peak pressure pushed by the hand at pain (PPHP) were measured. An independent t-test was used to compare the improvements of these elements between the two different self-volar gliding techniques. The level of statistical significance was at α=0.05.RESULTS: The active and passive ROM of wrist extension and PPHP were greater in both self-volar gliding groups after the one week intervention. On the other hand, these parameters were greater in the SVGSD group than in the SVGS group (p<0.05)CONCLUSION: SVGSD is recommended to improve the active and passive ROM of wrist extension and PPHP in subjects with dorsal wrist pain during partial weight bearing of the hand.

Effects of surgical and nonoperative treatment on wrist function of patients with distal radius fracture / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To study the effects of surgical and nonoperative treatment on wrist function in patients with distal radius fracture.</p><p><b>METHODS</b>In total, 97 patients treated for distal radius fracture in the Department of Orthopedic Trauma at the People's Hospital of Peking University from Jan. 2010 to Jun. 2016 were selected for outpatient follow-up, including manipulative reduction and dorsal splint fixation in 24 cases, bivalve cast fixation in 19 cases and open reduction and internal fixation in 54 cases. Evaluation was based on Sartiento's modification of the Gartland and Werley score. Efficacy was assessed with wrist pain as the focus.</p><p><b>RESULTS</b>The wrist function scores of the surgical group were better than nonoperative groups. There was no significant difference in wrist function scores between the dorsal splint group and the bivalve cast group. The ulnar wrist pain incidence had no significant difference in surgical and nonoperative groups. The displace rate in dorsal splint group was higher than other groups.</p><p><b>CONCLUSION</b>The overall effect of surgical treatment of distal radius fracture is better than nonoperative treatment. The ulnar wrist pain incidence has no significant difference in these groups. Dorsal splint fixation is more prone to displace than bivalve cast fixation.</p>

Double-Bellied Extensor Digitorum Brevis Manus: A Case Report.

Most of the anatomical variations are noted during the cadaveric dissections. A rare variation of the Extensor digitorum brevis manus was observed on the dorsal aspect of the right hand of a 69-year-old male cadaver. This atavistic muscle had two bellies which originated from the dorsal aspect of the lower end of radius and the capsule of the wrist joint respectively. The two bellies fused to form a single tendon which inserted into the ulnar side of the dorsal digital expansion of the middle finger. Posterior interosseous nerve innervated the two bellies. This muscle may be involved in the wrist pain or may be misinterpreted as a ganglion or a nodule upon radiological examination. This muscle may be used for reconstructive purposes.

Surgical Management of Pisiform Bone Deformity Associated with Tendonitis of Flexor Carpi Ulnaris

PURPOSE: This study was performed to investigate the degree of symptom improvement after removal of bone fragment in patients with deformed pisiform bone associated with tendonitis of flexor carpi ulnaris. METHODS: Pisiform bone fragment removal was performed in 12 patients who had failed conservative treatment from January 2008 to December 2011. They were followed up at 2 weeks, 1 month, 2 months, 6 months, and 12 months after surgery. Their symptoms were assessed with Green score. RESULTS: Eleven of 12 patients who underwent bone fragment removal showed symptom improvement. Symptoms worsened in 1 patient due to pain and restricted range of motion caused by postoperative scar. CONCLUSION: The results of this study suggest that removal of bone fragment may be an effective treatment in patients with tendonitis of flexor carpi ulnaris accompanied by pisiform bone deformity whose pain does not improve with conservative management.