One of the most devastating effects of tetraplegia is the inability to grasp and manipulate everyday objects necessary to living an independent life. Currently surgery is widely accepted as the solution to improve hand functionality. However, surgery becomes difficult when the user has paralysed wrists as is the case with C5 tetraplegia. The aim of this research was to develop a solution which provided controlled wrist flexion and extension which, when combined with surgery, achieves a 'key pinch' grip. This particular grip is critically important for people with C5 tetraplegia as it is used for countless grasping activities, necessary on a day-to-day basis. A systematic design process was used to evolve the solution to provide controlled wrist flexion and extension. Concept brainstorming identified four alternative solutions which were evaluated to find the preferred concept. The chosen solution was called the Self Powered Wrist Extension Orthosis, more commonly referred to as the 'orthosis'. This concept contained a shoulder harness which provided both energy and control to the wrist harness, which in turn changed the wrist position. The orthosis was developed with the use of a mathematical model which theoretically predicted the functional performance by comparing the required force needed to move the wrist harness to the achievable force supplied by the user's shoulders. Using these parameters, the orthosis was optimized using the matlab Nelder-Mead algorithm which adjusted the wrist harness geometries to maximize the functional performance. A prototype was constructed and tested with the help of two participants who when combined, achieved an average of 18.5° of wrist rotation. The theoretical model however predicted an average range of motion of 28.4°. The discrepancy found between the theoretical and experimental result can be contributed to incorrect assumptions in the theoretical model. This included unaccounted friction and inaccurate modeling of the orthosis dynamics. The feedback from potential users of the orthosis was enthusiastic and encouraging especially towards the simplicity, usability and practicality of the design.

Hand-intensive work is closely related to the prevalence of upper body and hand/wrist work-related musculoskeletal disorders (WMSDs) in office work, manufacturing, service industries, as well as the healthcare industry. Some risk factors include vibrations, forceful exertions, heavy manual handling, repetitive motions, and prolonged nonneutral wrist postures. To address the growing WMSD epidemic among various occupational groups, simple-to-use exposure measurements are required. However, common quantitative measurement methods for the hand/wrist, such as electrogoniometry and optical motion capture, are both costly and challenging to use. Small, portable inertial measurement units (IMUs) may therefore be considered as a potentially good, affordable wearable option for measuring hand/wrist posture. However, it is difficult to track the position and orientation of a rigid body due to, among other factors, the IMU sensors' sensitivity to ambient magnetic disturbances. As a result, despite advancements in hardware quality, there is still no widely accepted standard for IMU-based motion capture. This study attempted to address this issue by analysing various orientation algorithms to estimate wrist angle from two IMU sensors and compare them to the electrogoniometer-derived measures, i.e., the gold-standard method in field measurements. Five hand-intensive simulated work tasks, each lasting 4–10 minutes, were completed by six participants. These tasks were chosen to resemble some difficult real-world work conditions closely. The wrist posture of the participants was measured using an electrogoniometer and two IMU sensors that were mounted on top of the electrogoniometer's end blocks. The IMU signal of each sensor was processed using seven different orientation algorithms, and the flexion/extension and radial/ulnar deviation angles between them were extracted and compared to the corresponding electrogoniometer angles. For the best-performing orientation algorithm, which was a first-order complementary filter, the mean cross-correlation coefficient between the two measurements was between 0.41 and 0.90 for the flexion/extension and between 0.19 and 0.53 for the radial/ulnar deviation. The mean absolute error (standard deviation) of the best-performing algorithm for the 10th, 50th, and 90th percentile flexion/extension was 8.38 (8.5), 3.99 (3.4), and 11.93 (10) degrees and for the corresponding percentiles of radial/ulnar deviation it was 9.6 (6.5), 5.5 (4.8), and 10.21 (7.1) degrees.  This result can likely be further improved by applying a better orientation algorithm and reducing measurement artifacts such as sensor vibration. However, this experiment demonstrates the potential of IMU-based wrist angle estimation as a simple measurement tool for occupational risk assessment. / Manuellt fysiskt arbete kan orsaka arbetsrelaterade besvär i rörelseorganen i överkropp och hand/handled inom kontorsarbete, tillverkning, industri samt inom hälso- och sjukvårdssektorn. Vibrationer, kraftfulla ansträngningar, tung manuell hantering, upprepade rörelser och långvariga icke-neutrala handledsställningar är några av riskfaktorerna. För att komma till rätta med de arbetsrelaterade besvären bland olika yrkesgrupper, krävs lättanvända exponeringsmätmetoder, eftersom observationsmetoder har en låg tillförlitlighet och de sedvanliga objektiva kvantitativa mätmetoderna för hand/handled, såsom elektrogoniometri och optiska rörelsemätningar, är både dyra och svåra att använda. Små, bärbara s.k. inertial measurement units (IMUs) är därför ett utmärkt, prisvärt och praktiskt alternativ för att mäta hand-/handledsrörelse. Men att estimera positionen och orienteringen av en kroppsdel med hjälp av IMU-sensorer medför stora utmaningar inte minst på grund av sensorernas känslighet för omgivande magnetiska störningar. Trots framsteg i hårdvarukvalitet, finns det fortfarande ingen allmänt accepterad standardmetod för IMU-baserad rörelsemätning. Syftet med det här projektet var att öka kunskapen i det här området genom att analysera olika orienteringsalgoritmer för att uppskatta den absoluta handledsvinkeln från två IMU-sensorer och sedan jämföra den med motsvarande ifrån den etablerade standardmätmetoden med en elektrogoniometer. Fem simulerade handintensiva arbetsuppgifter, var och en mellan 4–10 minuter, genomfördes av sex deltagare. Dessa uppgifter valdes för att härma några arbetsförhållanden som har rapporterats ge risk för besvär. Deltagarnas handledsställning mättes med hjälp av en elektrogoniometer och två IMU-sensorer som monterades ovanpå elektrogoniometers ändblock. IMU-signalen från varje sensor analyserades med sju olika, tidigare framtagna, orienteringsalgoritmer, vinklarna för flexion/extension samt radial/ulnar deviation beräknades och jämfördes sedan med motsvarande elektrogoniometervinklar. För den bäst presterande algoritmen, en första ordningens komplementfilter, varierade den genomsnittliga korrelationskoefficienten mellan 0,41 och 0,90 för flexion/extension och mellan 0,19 och 0,53 för radial/ulnar deviation. Det genomsnittliga absoluta felet (standardavvikelse), för den bäst presterande algoritmen, för den 10:e, 50:e och 90:e percentilen flexion/extension var 8,38 (8,5), 3,99 (3,4) och 11,93 (10) grader. Motsvarande percentiler av radial/ulnar deviation var 9,6 (6,5), 5,5 (4,8) och 10,21 (7,1) grader. Detta resultat kan sannolikt förbättras ytterligare genom att tillämpa en bättre orienteringsalgoritm och minska mätartefakter från sensorvibrationer. Detta experiment visar dock potentialen för IMU-baserad handledsvinkeluppskattning som ett enkelt mätverktyg vid riskbedömningar inom manuella arbeten.

Upper extremity splinting is a popular treatment method for a range of conditions, such as rheumatoid arthritis. The intent of this treatment approach is multifaceted, but fundamentally, the provision of tools to enable and encourage patients to carry out everyday activities and to improve their quality of life is paramount. However, the aesthetic and functional limitations of wrist immobilisation splints demonstrate various weaknesses in terms of wear duration and frequency. Patient compliance is often compromised due to a number of factors, including the perceived stigma associated with assistive devices. Additive Manufacturing (AM) has proved its worth in a number of applications relating to the design of assistive devices; builds of complex, bespoke fitting geometries make AM an ideal fabrication method for upper extremity splints. However, recent advances in system technology to enable multi-material builds have been limited in this field, and a distinct need for a specialised three-dimensional (3D) Computer Aided Design (CAD) software approach is required to allow therapists to design splints for AM. Furthermore, the intent to keep practising therapists at the forefront of splint prescription is of utmost importance. This research proposes a digitised splinting approach, specifically through development of a 3D CAD software strategy to allow therapists to capture their design intent without compromising creativity. Furthermore, the approach proposes the exploration of AM build capabilities by allowing the integration of more creative features, such as aesthetically pleasing lattice structures for increased skin ventilation. The approach also proposes the integration of multiple materials to replicate and improve upon current splint design and fabrication practises. The approach therefore explores an exciting new paradigm for upper extremity splinting, the driving characteristics of which have not been proposed before as a collective medium. This research describes the feasibility of capturing therapists design intent in a 3D CAD virtual environment, whilst capturing therapists opinions of the approach with suggestions for future research and development. Results concluded that therapists were excited by the proposed transition in AM splinting, but that significant development is required elsewhere to establish a supporting infrastructure in order to make the approach a viable option in future upper extremity splinting.

Objetivos: Avaliar a densidade radiográfica de três ossos do carpo - capitato, escafóide e hamato, em pacientes do sexo masculino e do sexo feminino, com idades entre 7 e 18 anos, por meio de um programa gerenciador de imagens - Adobe Photoshop - 6.0®. Métodos: Leituras das intensidades de cinza de cada imagem selecionada em cada osso e obtenção de um histograma referente aos valores de número de pixels da imagem analisada, valor médio dos tons de cinza, mediana e o desvio padrão da área selecionada na digitalização e tratamento estatístico destes dados. Resultados: As comparações entre médias de densidades dos ossos analisados para o sexo masculino, não apresentou médias estatisticamente diferentes somente para a comparação capitato x hamato, enquanto no sexo feminino as comparações entre ossos se mostraram estatisticamente desiguais; a comparação entre média de densidade de cada osso e idade cronológica apresentou dependência significativa somente para o osso hamato no sexo masculino; a comparação entre as médias de densidade dos ossos para os sexos masculino e feminino, mostrou não existir diferenças estatisticamente significativas entre ambos considerando-se os três ossos analisados. Conclusões: Para o sexo masculino na amostra analisada, houve dependência somente entre a média de densidade dos ossos capitato e hamato, enquanto para o sexo feminino não houve correlação de dependência entre os três ossos analisados; a comparação entre as densidades ósseas e a idade cronológica, indicou que somente o osso hamato apresenta grau de dependência significativo com a faixa etária no sexo masculino, enquanto no sexo feminino nenhum dos ossos apresentou grau de dependência significativo em relação à idade cronológica na amostra analisada; a densidade dos três ossos: hamato, capitato e escafóide, não apresentam diferenças significativas quando comparadas entre sexo masculino e feminino na mesma faixa etária. / Objectives: To evaluate the radiographic density of three carpal bones (hamate, capitate and scaphoid bones) in male and female patients aged 7 to 18 years by means of an image-editing software (Adobe Photoshop - 6.0®). Methods: Readings of gray intensities of each image selected in each bone and drawing of a histogram referring to the values of number of pixels of the analyzed image, mean value of the gray tons, median and standard deviation of the area demarcated in the digitized image and statistical analysis of data. Results: For the male patients, comparisons of the means of densities of the analyzed bones did not show statistically significant difference only for the hamate X capitate pair. For the female patients, comparisons among the bones appeared statistically different; comparison between the density means of each bone and the chronological age showed significant dependence only for the hamate bone in the male patients; comparison among the bone density means for the male and female patients showed no statistically significant difference between genders for the tree types of bone. Conclusions: In the evaluated population, for the male gender, there was dependence only between the density means of the capitate and hamate bones, while for the female gender there was no dependence correlation among the three bone types; comparison between the bone densities and the chronological age showed that only the hamate bone presented a significant degree of dependence with the age group in the male patients, while in the female patients none of the bone presented a significant degree of dependence in relation to the chronological age in the analyzed sample; the densities of the three bones (hamate, capitate and scaphoid bones) did no show statistically significant difference when compared between males and females belonging to the same age group.

Contexte : Le trafic aérien, en constante augmentation au cours de ces dernières décennies, n'est pas sans impact sur l'environnement et la population. En particulier, le bruit émis par les avions constitue une nuisance importante et un problème majeur de santé publique, notamment en termes de perturbations du sommeil. Pour autant, en France surtout, les conséquences de l'exposition au bruit des avions restent insuffisamment évaluées. Objectif : L'objectif de ce travail de thèse est de mieux connaître et de mieux quantifier les effets du bruit des avions sur la qualité du sommeil des riverains des aéroports en France, en distinguant qualité subjective et qualité objective. Méthodes : Pour répondre aux objectifs de cette thèse, nous avons utilisé les données recueillies dans un programme de recherche épidémiologique appelé DEBATS (Discussion sur les Effets du Bruit des Aéronefs Touchant la Santé). L'étude principale, dite « étude longitudinale », a inclus 1244 participants vivant à proximité de trois aéroports français d'importance : Paris-Charles de Gaulle, Lyon-Saint Exupéry et Toulouse-Blagnac. La qualité subjective du sommeil a été évaluée grâce à un questionnaire administré par des enquêteurs au domicile des sujets. Le niveau d'exposition au bruit des avions a été estimé à l'adresse du domicile de chaque participant à partir des cartes de bruit produites par la Direction Générale de l'Aviation Civile. Une étude complémentaire dite « étude sommeil » a permis d'évaluer la qualité objective du sommeil de 112 des 1244 participants à l'étude longitudinale grâce au port d'un actimètre pendant huit jours et d'un Actiheart (enregistreur de la fréquence cardiaque) pendant une nuit. Des mesures acoustiques ont été réalisées pendant ces huit jours en façade et à l'intérieur de la chambre à coucher des participants, afin de caractériser leur exposition au bruit des avions à l'aide d'indicateurs non seulement énergétiques (LAeq, LA90) mais aussi événementiels (nombre d'événements et niveau maximum de bruit de l'évènement ou LAmax). Résultats : L'analyse de « l'étude longitudinale » a permis de montrer une association entre l'exposition au bruit des avions la nuit (Lnight) et la qualité subjective du sommeil caractérisée par un risque de déclarer dormir moins de 6 heures par nuit (OR=1,63 pour 10 dB(A) ; IC 95% : 1,15-2,32) et de se sentir fatigué au réveil (OR=1,23 pour 10 dB(A) ; IC 95% : 1,00-1,54). Nous n'avons pas trouvé de relation significative avec les autres paramètres subjectifs de la qualité du sommeil rapportés par les sujets eux-mêmes, tels que le temps d'endormissement, les éveils nocturnes, la satisfaction du sommeil et la prise de médicaments pour dormir. Nous avons également montré une association entre l'exposition au bruit des avions et les paramètres objectifs de la qualité du sommeil avec une augmentation du temps d'endormissement et de la durée des éveils intra-sommeil, une diminution de l'efficacité du sommeil, mais aussi une augmentation du temps total de sommeil et du temps passé au lit (cette dernière pouvant être interprétée comme un mécanisme d'adaptation à la privation de sommeil). Les indicateurs énergétiques, mais plus encore les indicateurs liés aux événements de bruit, sont significativement associés aux paramètres objectifs de la qualité du sommeil. Par exemple, les événements de bruit d'avions détectés à l'intérieur de la chambre à coucher sont associés à une augmentation de la durée totale des éveils intra-sommeil supérieure à 30 minutes (OR=1,10 pour 10 événements ; IC 95% : 1,03-1,16). Enfin, nous avons observé une augmentation significative de l'amplitude de la fréquence cardiaque pendant un évènement sonore associé au passage d'un avion et le niveau maximum de bruit de cet évènement (LAmax) [etc...] / Background: Air traffic, in constant increase during the last decades, is not without impact on the environment and the population. Aircraft noise in particular represents a serious nuisance and a major issue for public health, particularly in terms of sleep disturbances. However, in France especially, the effects of aircraft noise exposure remain insufficiently evaluated. Objectives: The objective of this PhD is to better know and better quantify the effects of aircraft noise exposure on sleep quality in populations living near airports in France, while distinguishing subjective quality and objective quality. Methods: In order to meet the objectives of the PhD, we used the data collected in an epidemiological research program called DEBATS (Discussion on the Health Effects of Aircraft Noise). The main study, also called the “longitudinal study”, included 1,244 participants living near three French major airports: Paris-Charles de Gaulle, Lyon-Saint-Exupéry and Toulouse-Blagnac. The subjective quality of sleep was assessed using a questionnaire administered by interviewers at the place of residence of the participants. Aircraft noise levels were estimated at each participant's home address using noise maps produced by the French Civil Aviation Authority. A complementary, also called the “sleep study” allowed us to estimate the objective sleep quality of 112 of the 1,244 participants in the longitudinal study. These 112 participants have worn a wrist actigraph for eight nights and an Actiheart (heart rate recorder) for one night. Acoustic measurements were made during these eight days and nights, both inside the participants’ bedrooms and outside (at the exterior façade) in order to characterize their aircraft noise exposure using not only energy indicators (LAeq, LA90) but also events indicators (number of events and maximum level of an noise event or LAmax). Results: The “longitudinaly study” analysis showed an association between aircraft noise exposure during the night (Lnight) and the subjective quality of sleep characterized by a risk of reporting to sleep less than 6 hours per night (OR=1.63 for 10 dB(A); 95% CI: 1.15–2.32) and a risk of feeling tired while awakening in the morning (OR=1.23 for 10 dB(A); 95% CI: 1.00– 1.54). We did not find any significant relationship with the other subjective parameters of sleep quality reported by the subjects themselves, such as time to fall asleep, nocturnal awakenings, sleep satisfaction, and sleep medication intake. We also showed an association between aircraft noise exposure and the objective parameters of sleep quality with an increase in time of sleep onset and duration of wake after sleep onset, and a reduction in sleep efficiency. Aircraft noise exposure also increased total sleep time and time in bed (this could be a matter of behavioral adaption to sleep deprivation). The energy indicators, but more still events indicators, were significantly associated with the objective parameters of sleep quality. For example, aircraft noise events detected inside the bedroom were associated with an increase in total duration of wake after sleep onset greater than 30 minutes (OR=1.10 for 10 events; 95% CI: 1.03-1.16). Finally, we observed a significant increase in amplitude of heart rate during a noise event associated with the passage of an aircraft and the maximum noise level of this event (LAmax). Conclusions: These results, mostly similar to those obtained in the majority of studies in the international literature, confirm that exposure to aircraft noise can decrease both subjective and objective quality of sleep. They also contribute to support the hypothesis that acoustic events indicators could, better than energy indicators more widely used, characterize the effects of aircraft noise on sleep

Fracture of the distal radius is one of the most frequent injuries, and it represents about 20% of all adults taken into emergency rooms. A number of studies suggest various methods to reduce the dislocation and to secure fragments of the distal radius. In this study, the Non-Bridging External Wrist Fixator System (NBX), a pre-market-released product manufactured by NUTEK Inc. was biomechanically assessed by comparing with the Universal Distal Radius System (Volar Plate Fixator: VPF), a market-released product manufactured by Stryker Co. The comparison was performed in several parameters, which were wrist motion, radial tilt angle, radial length, volar tilt angle, stiffness, and failure load. Five pairs of fresh human cadaver arms were used for this study. The wrists were tested to obtain x-ray images for 1 normal and 2 injury conditions (intact, fractured, and fixed), 2 load conditions (gravity only and torque applied), and 4 postural conditions (volar flexion, dorsiflexion, ulnar deviation, and radial deviation). These tests yielded 24 (3×2×4) x-ray images for each wrist, and the images were analyzed to obtain the data for each parameter. Although the results were not statistically significant in some conditions, NBX fixation limited wrist motion more than VPF fixation. This result can be explained not only by the difference in the ability of fixation, but also by the difference in the surgical trauma (NBX is less invasive than VPF). Furthermore, in the measurement of radial tilt angle, radial length, and volar tilt angle, NBX was more effective than VPF to reduce and secure the bone fragments of the distal radius. In destructive test, the NBX is less strong than VPF. However, NBX is strong enough to sustain the expected forces of daily activity.

La muñeca es una articulación compleja con un mecanismo de estabilización muy complicado. Se conocen bien las estructuras anatómicas que aseguran una correcta transmisión de cargas a través de ella de un modo estático, se ignoran, en cambio, muchos de los mecanismos dinámicos neuromusculares que modulan dicha transmisión de forma óptima. La evolución natural de una lesión ligamentosa que ocasiona inestabilidad en el carpo, suele ser una artrosis generalizada e incapacitante para el enfermo. Sin embargo, no son raros los casos en que una lesión ligamentosa no cursa con dolor ni causa una gran incapacidad funcional. En estos casos, se ha postulado la posibilidad de que la acción muscular ha compensado el fallo de función ligamentosa, evitando de esta manera que se produzca una inestabilidad articular. Para valorar la influencia que tienen los músculos periarticulares en la posición y orientación de los huesos del carpo cuando los ligamentos primarios fallan, hemos realizado un estudio con veinte antebrazos de cadáver criopreservados, que previamente no presentaban ninguna lesión ligamentosa ni ósea que pudiera alterar el resultado del estudio. Simulamos la contracción muscular mediante la carga axial de los músculos motores directos de la muñeca (FCR, FCU, APL, ECRL y ECU), de manera proporcional al área de sección fisiológica y actividad electromiográfica de cada músculo, antes y después de crear una inestabilidad escafolunar en diez antebrazos, y una inestabilidad lunopiramidal en otros diez. El movimiento que presentan los huesos del carpo se registra a través de un dispositivo de rastreo en las tres direcciones del espacio, mediante unos sensores colocados en escafoides, piramidal y hueso grande; comparamos situaciones similares de carga muscular, antes y después de cada inestabilidad con el test de Wilcoxon. En los casos con inestabilidad escafolunar, observamos que la acción de los músculos supinadores de la fila distal (ECRL y APL) no altera significativamente el movimiento de los huesos del carpo después de producir la disociación. El FCU, aunque es un supinador tiene un efecto negativo sobre esta articulación, ya que produce rotaciones opuestas en el escafoides y el piramidal aumentando la disociación. La contracción aislada del ECU, produce una pronación de la fila proximal y distal, que desestabiliza al escafoides en los tres planos del espacio, produciendo la típica subluxación rotatoria del escafoides. El FCR, aunque es un pronador de la fila distal y del piramidal, produce una supinación en el escafoides, con lo que provoca un acercamiento dorsal de la pareja piramidal-semilunar al escafoides, relajando la articulación, por lo que su efecto es beneficioso para este tipo de inestabilidad. En cuanto a la inestabilidad lunopiramidal, el efecto de los músculos supinadores de forma aislada (APL, ECRL y FCU) aumenta la flexión del piramidal y produce una supinación de la pareja escafoides-semilunar provocando una incongruencia articular y el típico resalte de esta inestabilidad. En cambio, el efecto aislado del ECU, produce cambios en la movilidad de los huesos del carpo que benefician a la articulación lunopiramidal, manteniéndola reducida. Por lo tanto, podemos concluir que ante una inestabilidad escafolunar dinámica, la fisioterapia de la mano debería basarse en la inhibición del ECU y del FCU y en el entrenamiento propioceptivo del ECRL, APL y FCR; en cambio, cuando existe una inestabilidad lunopiramidal hay que potenciar la contracción isométrica del ECU, e inhibir la acción de los músculos supinadores (APL, ECRL y FCU). Por otra parte, la manera de ferulizar la muñeca sería forzando una supinación intracarpiana y una desviación cubital de la muñeca en los casos con lesión aguda parcial del ligamento escafolunar, y mediante una pronación intracarpiana en los casos con lesión aguda parcial del ligamento lunopiramidal. / Twenty cadaveric forearms were tested using a wrist testing apparatus designed to investigate the mechanisms of muscle stabilization of the wrist. In ten specimens we created a scapholunate ligament disruption, while another ten we did a lunotriquetral dissociation. The specimens were set in a jig allowing the distal row to migrate proximally and rotate around the axis of pronosupination. Five wrist motor tendons (FCR, FCU, ECU, ECRL and APL) were loaded with specific weights. Reactive rotations of the scaphoid, triquetrum and capitate were measured by an electromagnetic motion tracking device before and after sectioning specific carpal ligaments. We compared similar situations of load before and after creating the dissociation with the Wilcoxon test. With scapholunate dissociation the action of supinator muscles (ECRL and APL) do not alter the movement of the carpal bones; the FCU has a negative effect on the scapholunate joint, as it produces opposite rotations between the scaphoid and lunate that increase the instability. Individual loading of ECU induces a pronation of the distal and proximal row, that destabilizes the scaphoid in the three space planes, producing the typical rotary subluxation of the scaphoid. The FCR has a supination effect on the scaphoid while it pronates the triquetrum and the distal row, this keeps the scapholunate joint closed. With the disruption of the lunotriquetral ligaments, individual loading of the supinator muscles (APL, ECRL and FCU), increases significantly the amount of flexion and supination exhibited by the triquetrum, this produces a joint incongruity that determines the presence of the typical lunotriquetral clunking. However, the ECU protects against carpal collapse, keeping the joint reduced. In conclusion, we can suppose that hand therapy in dynamic scapholunar dissociations should aim at proprioceptionally training the ECRL, APL and FCR muscles and an inhibition of ECU and FCU; while in dynamic lunotriquetral dissociations we must emphasize isometric contraction of the ECU and inhibit the action of the supinator muscles. Anyway, splinting of the wrist should be with intracarpal supination and wrist ulnar deviation in case of partial injury of scapholunate ligament, and with intracarpal pronation in case of partial injury of lunotriquetral ligament.

Background - Hand intense occupational activities have been associated with an increase in the incidence of carpal tunnel syndrome (CTS). CTS is characterized by an impairment of median nerve function. To date, a dose-response relationship between wrist activity and median nerve performance has not been documented. Since repetitive hand/wrist activity in the workplace has significant implications, it is important to establish a scientific basis for the aetiology of work-related carpal tunnel syndrome. Methods -- In a laboratory environment, twenty-seven clinically confirmed asymptomatic female subjects performed continuous repetitive wrist motion in the flexion-extension plane during which an angle of 120 degrees was subtended about the neutral wrist position. Four levels of wrist activity, corresponding with 0 (static), 22 (Iow), 38 (medium) and 49 (high) repetitions per minute, were prescribed. Wrist motion was recorded using a state-of-the-art 3D electromagnetic tracking system (HumanTRAC). Mathematical descriptors of wrist kinematics, including cycle time, amplitude, angular velocity and angular acceleration, were calculated. Sensory median nerve response to imposed physical stressors was monitored antidromically and recorded using a clinical electroneurometer every ten minutes throughout the simulated work activities. Near-nerve skin temperature was recorded at three sites along the distal sensory branch of the median nerve every twenty minutes. Results - After adjusting for changes in near-nerve skin temperature, a significant within-subject effect of duration of exposure (time) was detected. Sensory median nerve conduction velocity differed statistically by 2.1 ms-1 between the static and high wrist activity conditions after 120 minutes of exposure, signifying adverse effects on nerve conduction that are uniquely attributable to repetitive hand motion. Wrist activity measures of mean angular acceleration presented a highly significant association with nerve performance, where nerve conduction decreased as wrist activity increased. Using regression analysis, a maximum safe wrist-workload exposure limit of 0.91 repetitions per minute is proposed. Limitations of this result are discussed. A biomechanical model is presented to calculate the effect of physical risk factors on tendon forces at the wrist. This model offers a method by which findings of the study can be employed for workplace exposure surveillance and development of ergonomic workstation design recommendations. Conclusions -- Across the study population of clinically asymptomatic female participants, a change in median nerve performance was observed. This significant effect was evoked due to imposed physical stressors. A dose response relationship between work intensity, exposure time and median nerve conduction velocity was demonstrated. The research explored in this thesis presents a foundation for the future development of a "Dynamic Median Nerve Stress Test". This test would involve the performance of a repetitive motion activity of the wrist during which changes in the function of the median nerve are closely monitored. The Dynamic Median Nerve Stress Test might prove to be valuable both as a provocative clinical test as well as an important research tool.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2006 116 leaves / The aim was to evaluate the prevalence of hand and wrist pain, as well as the relationships between occupational overuse syndromes in the hands and wrists of chiropractors in South Africa as a result of their daily use of manual therapy techniques while at work. There are very few statistics available that disclose the nature and incidence of work related injuries. However those statistics that do exist suggest that hands on patient activities place physical therapists at greater risk of injury in comparison to other health care workers (Lunne et al., 2000). A study conducted by Bork et al.(1996) determined the prevalence of work-related musculoskeletal injuries sustained by physical therapists. Hand pain (29.6%) and back pain (45%) where the leading cause of pain in physical therapists (Bork et al., 1996.) Chiropractic and physiotherapy are both health care professions that specialize in the treatment of disorders pertaining to the neuro-musculo-skeletal system (Hunter, 2004). Physical therapists use manual therapy techniques as part of their daily working activities, so it can be assumed that chiropractors too will have a high prevalence of hand and wrist pain as they utilize similar therapeutic techniques to physical therapists. Cromie et al.(2000) evaluated the prevalence, severity, risks, and responses of disorders in physical therapists. He identified 4 categories of major risk factors commonly associated with workers musculo-skeletal disorders in physical therapists 1. Risk factors related to specific activities. 2. Postural risk factors. 3. Risk factors with regard to work load issues 4. Risk factors in regard of work capacity and health of the participant (Cromie et al., 2000). Physical risk factors found to be associated with neck, shoulder, or hand and wrist disorders in cross sectional studies are heavy lifting, monotonous work, static work postures, vibrations and repetitive jobs, and a high work pace (Alfredsson et al., 1999). Other factors that have been associated with musculoskeletal pain are higher age and female gender (de Zwart et al., 2001; Wahlstedt et al., 2001; Feveile et al., 2002).

Orientadores: Alberto Cliquet Junior, Luis Alberto Magna / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T18:03:51Z (GMT). No. of bitstreams: 1 Ferrigno_IracemaSerratVergotti_D.pdf: 2039256 bytes, checksum: 490b0a3b26f1e38aae5a8c5e2e403a93 (MD5) Previous issue date: 2009 / Resumo: Com o advento da tecnologia de informação tem-se observado o aparecimento de problemas de saúde relacionados ao uso excessivo do computador, especialmente no que se refere às disfunções músculo-esqueléticas da região cervical e do membro superior. O objetivo deste estudo foi examinar o efeito das órteses de punho na atividade eletromiográfica dos músculos extensor ulnar do carpo, flexor superficial dos dedos e fibras superiores do trapézio durante o uso do computador. Vinte três estudantes universitários saudáveis, entre 18 e 26 anos realizaram tarefas padronizadas, randomizadas, de digitação em teclado e com o uso do mouse, quer sem órteses ou com dois tipos de órteses para o punho. Utilizou-se eletromiografia de superfície e considerou-se 100% da contração voluntária máxima como referência para representar a amplitude da atividade eletromiográfica. Observou-se um aumento na atividade miolétrica do trapézio (P<0,05) com o uso de órteses. Nenhuma diferença significativa foi observada no flexor superficial dos dedos ou no extensor ulnar do carpo durante a digitação, com ou sem órteses. No entanto, quando os participantes usaram o mouse, o músculo extensor ulnar do carpo apresentou aumento da sua atividade mioelétrica com as duas órteses e o mesmo padrão foi observado para o músculo flexor superficial dos dedos com o uso da órtese feita sob medida. Concluiu-se que as órteses de punho, nos modelos testados, afetam certas atividades musculares do membro superior em adultos saudáveis durante o uso do computador. / Abstract: With the advent of information technology, health problems related to the excessive use of the computer have appeared, mainly in what it refers to musculoskeletal overuse of the cervical region and upper limbs. The objective this study was to examine the effect of wrist orthoses on the electromyographycal activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work. Twenty-three healthy university students, ranging from 18 to 26 years of age, performed standardized tasks, randomized, such as typing and using the mouse while wearing one of two types of wrist orthoses or without orthosis. Surface electromyography was used considering 100% the maximum voluntary contraction to represent the amplitude of electromyographic activity. A significant increase in the electromyographic activity of the trapezius (P<0.05) was found when either of the orthoses was used. No significant difference was observed in the activities of the flexor digitorum superficialis or extensor carpi ulnaris whether or not orthoses were used in participants who typed. However, upon mouse use, the extensor carpi ulnaris activities was increased with both orthoses, and the same pattern was observed in the flexor digitorum superficialis when the volunteers used the custom-made orthosis. It was concluded that the studied models of wrist orthoses may affect the some muscle activities in the upper limbs of healthy adults when using a computer. / Doutorado / Pesquisa Experimental / Doutor em Cirurgia