Design and fabrication of the radial and ulnar wrist articulating control orthoses.

STUDY DESIGN: Case series. INTRODUCTION: Pain and injury at the radial and ulnar aspects of the wrist due to overuse or trauma are commonly treated in hand therapy clinics. PURPOSE OF STUDY: Describe two orthoses that allow targeted rest and recovery of involved anatomical structure(s) while preserving function of surrounding uninvolved structures in patients who have sustained overuse or traumatic injury at the radial or ulnar aspect of the wrist. METHODS: Outline the fabrication of the Ulnar-Wrist Articulating Control Orthosis (U-WACO) and Radial-Wrist Articulating Control Orthosis (R-WACO) as well as presents case examples for each orthosis. RESULTS: The U-WACO and R-WACO designs may improve comfort, compliance, and functional ability to complete daily tasks while allowing targeted rest and recovery of involved anatomical structure(s) at the radial and ulnar aspects of the wrist due to overuse or trauma. CONCLUSION: Dynamic orthoses that allow for movement in one plane while restricting movement in another may overcome the shortcomings of some static orthotic designs.

Partial Wrist Denervation for Idiopathic Dorsal Wrist Pain in an Active Duty Military Population.

PURPOSE: Treating dorsal wrist pain of unknown etiology provides a challenge to the most experienced hand surgeon. Therefore, we conducted a study aimed to determine outcomes of patients undergoing a posterior interosseous nerve (PIN) or anterior/posterior interosseous nerve (AIN/PIN) neurectomy for wrist pain without a known cause, in patients who responded to preoperative injection. METHODS: A retrospective chart review was performed of all active duty patients undergoing isolated PIN or AIN/PIN neurectomy for idiopathic dorsal wrist pain with a documented response to preoperative injection between December 2011 and April 2017. Demographic data, return to duty status, pain scores, and range of motion were among the data collected and reviewed. RESULTS: The initial search yielded 108 patients of whom 13 met inclusion criteria for our study. Overall, only 2 of 13 patients were able to return to full duty without restrictions, 5 went on to medical discharge, and 6 were placed on permanent duty restrictions. No patients within our study were deployed. Patients had improvement in their pain scores from 4.0 to 2.2. Range of motion was similar before and after surgery. CONCLUSIONS: A PIN or AIN/PIN neurectomy resulted in improvement in pain scores in patients, but was not successful in returning the majority of patient to full active duty status without restrictions. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.