Midcarpal Structure Effect on Force Distribution through the Radiocarpal Joint

Abstract

Background Wrist structure is complicated by distinct anatomical patterns. Previous studies defined radiographic wrist types based on lunate and capitate shape within the midcarpal joint. We hypothesized that these disparate structural patterns will transfer forces differently through the wrist.

Objective This study aims to correlate force transferred to the distal radius and ulna with morphological measurements in cadaver arms.

Methods Radiographs from 46 wrists, previously tested for force transfer between the radius and ulna, were examined. The percentage of compressive force through the distal ulna was determined by mounting load cells to the radius and ulna, while 22.2 Newton (N) tensile forces were individually applied to multiple tendons. Each wrist was tested in a neutral flexion–extension and radial-ulnar deviation position.

Results Wrist type and lunate type were associated with percentage of force transfer through the ulna (p = 0.002, p = 0.0003, respectively). Percentage of force transfer was correlated with capitate circumference (p = 0.02, r = 0.34).

Conclusions This study supports distinct force transfer between morphological wrist types.

Clinical Relevance Understanding the mechanical significance of different structural variations in the wrist bones will improve our ability to understand wrist function and the distinctive development of wrist pathology.

Level of Evidence This is a Level II study.

Keywords

force transfer - structure - midcarpal joint - ulnar variance - wrist

• References

• 1 Nakamura K, Patterson RM, Moritomo H, Viegas SF. Type I versus type II lunates: ligament anatomy and presence of arthrosis. J Hand Surg Am 2001; 26 (03) 428-436
• 2 Yazaki N, Burns ST, Morris RP, Andersen CR, Patterson RM, Viegas SF. Variations of capitate morphology in the wrist. J Hand Surg Am 2008; 33 (05) 660-666
• 3 Viegas SF, Patterson RM, Hokanson JA, Davis J. Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg Am 1993; 18 (03) 463-475
• 4 Rhee PC, Jones DB, Moran SL, Shin AY. The effect of lunate morphology in Kienböck disease. J Hand Surg Am 2015; 40 (04) 738-744
• 5 Bain GI, Clitherow HD, Millar S. , et al. The effect of lunate morphology on the 3-dimensional kinematics of the carpus. J Hand Surg Am 2015; 40 (01) 81-9.e1 , e1
• 6 Majima M, Horii E, Matsuki H, Hirata H, Genda E. Load transmission through the wrist in the extended position. J Hand Surg Am 2008; 33 (02) 182-188
• 7 Polovinets O, Wolf A, Wollstein R. Force transmission through the wrist during performance of push-ups on a hyperextended and a neutral wrist. J Hand Ther 2018; 31 (03) 322-330
• 8 Kramer A, Allon R, Wolf A. , et al. Anatomical wrist patterns on plain radiographs. Curr Rheumatol Rev 2019; 15 (02) 168-171
• 9 Chim H, Moran SL. Wrist essentials: the diagnosis and management of scapholunate ligament injuries. Plast Reconstr Surg 2014; 134 (02) 312e-322e
• 10 Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am 1984; 9 (05) 681-682
• 11 Werner FW, Palmer AK, Fortino MD, Short WH. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am 1992; 17 (03) 423-428
• 12 Koh KH, Lee HI, Lim KS, Seo JS, Park MJ. Effect of wrist position on the measurement of carpal indices on the lateral radiograph. J Hand Surg Eur Vol 2013; 38 (05) 530-541
• 13 Hardy DC, Totty WG, Reinus WR, Gilula LA. Posteroanterior wrist radiography: importance of arm positioning. J Hand Surg Am 1987; 12 (04) 504-508
• 14 Mohammed Ali MH. A normal data-base of posteroanterior radiographic measurements of the wrist in healthy Egyptians. Surg Radiol Anat 2009; 31 (09) 665-674
• 15 Wollstein R, Werner FW, Rubenstein R, Nacca CR, Bilonick RA, Gilula LA. Scaphoid translation measurements in normal wrists. Hand Surg 2013; 18 (02) 179-187
• 16 Naran S, Zaulan Y, Shakir S, Gilula LA, Werner FW, Wollstein R. Radiographic assessment of ligamentous injuries in distal radius fractures after open reduction and internal fixation. Eur J Orthop Surg Traumatol 2014; 24 (07) 1151-1154
• 17 Viegas SF. The lunatohamate articulation of the midcarpal joint. Arthroscopy 1990; 6 (01) 5-10
• 18 Farana R, Jandacka D, Uchytil J, Zahradnik D, Irwin G. The influence of hand positions on biomechanical injury risk factors at the wrist joint during the round-off skills in female gymnastics. J Sports Sci 2017; 35 (02) 124-129
• 19 Farana R, Exell T, Strutzenberger G, Irwin G. Technique selection in young female gymnasts: elbow and wrist joint loading during the cartwheel and round-off. Eur J Sport Sci 2018; 18 (03) 423-430
• 20 Rhee PC, Moran SL, Shin AY. Association between lunate morphology and carpal collapse in cases of scapholunate dissociation. J Hand Surg Am 2009; 34 (09) 1633-1639
• 21 Kramer A, Allon R, Werner F, Lavi I, Wolf A, Wollstein R. Distinct wrist patterns founded on measurements in plain radiographs. J Wrist Surg 2018; 7 (05) 366-374
• 22 Kobayashi M, Berger RA, Nagy L. , et al. Normal kinematics of carpal bones: a three-dimensional analysis of carpal bone motion relative to the radius. J Biomech 1997; 30 (08) 787-793
• 23 Kobayashi M, Berger RA, Linscheid RL, An KN. Intercarpal kinematics during wrist motion. Hand Clin 1997; 13 (01) 143-149
• 24 Harley BJ, Pereria ML, Werner FW, Kinney DA, Sutton LG. Force variations in the distal radius and ulna: effect of ulnar variance and forearm motion. J Hand Surg Am 2015; 40 (02) 211-216