Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority. The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed. Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography. Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers. Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated. The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.

A dissertation presented in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2006. / 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). / M

Title: Difference wrist mobility with players racing and recreational tennis Objective: The aim of this work is to measure and compare the range of motion of the wrist in racing and recreational tennis players and both upper limbs (playing, not playing). To compare the values measured 2D electrogoniometry, by sex and game levels. Method: Research probands were divided into two groups, a total of 20 people. In one group, there were ten boys and ten girls aged 14-17 years who play tennis at competitive level and train four to five times a week for at least 4 years. The second group also consisted of 10 boys and 10 girls in the same age range, but tennis is played on a recreational level once maximum twice a week for at least 4 years. It was important that the criteria for selecting probands had several common denominators. These are gender, age, level of game, whether measured by an individual not had any injury, regeneration is not and should not do other activities besides tennis. Wrist probands were tested using an electric goniometer. Were measured in the frontal plane (radial and ulnar reduction) and sagittal plane (dorsal and palmar flexion). These data were measured by sitting electrogoniometry and subsequently were compared and statistically analyzed. Results: Measurements confirmed...

O objetivo neste estudo foi avaliar a possível relação entre os estágios de maturidade óssea avaliados em radiografias de mão e punho e das vértebras cervicais em telerradiografias em norma lateral, em indivíduos com idade média de 13 anos e 6 meses e desvio padrão de 2 anos e 3 meses (variando de 8 anos e 6 meses a 16 anos e 11 meses). A casuística foi composta por 209 conjuntos radiográficos (radiografias de mão e punho e telerradiografias em norma lateral) tomados na mesma data para cada indivíduo . Dois avaliadores, devidamente treinados e calibrados classificaram por estágios de maturidade óssea todas as radiografias, as de mão e punho segundo Helm et al, e a avaliação das vértebras cervicais nas telerradiografias em norma lateral, segundo O’Reilly e Yaniello (1988) e Baccetti, Franchi e McNamara (2002). Considerando a classificacão de Helm et al (1971) como padrão áureo, teste de correlação de Spearman foi aplicado para verificar relação com os dois métodos que avaliam as vértebras cervicais. Os resultados indicam que houve forte correlação entre os métodos de avaliação das vértebras cervicais e de mão e punho (Rs= 0,906 para O’Reilly e Yaniello(1988) e Helm et al. (1971) e Rs= 0,889 para Baccetti, Franchi e McNamara Jr (2002) e Helm et al. (1971), para todos p<0,001). A análise estatística descritiva indicou que houve maior número de ocorrências concordantes na identificação do início e do pico máximo do surto. Com base nesses resultados pode-se concluir que a avaliação da maturidade óssea pelas vértebras cervicais oferece confiabilidade para a identificação do início e pico do surto de crescimento puberal, mas não para a identificação dos estágios na fase descendente, portanto, continuar usando a radiografia de mão e punho ainda se faz imprescindível quando é necessária a identificação de algum potencial de crescimento restante . / The purpose of this study was to evaluate the possible relationship between the stages of skeletal maturation analyzed by means of hand-wrist radiography and cervical vertebrae in lateral cephalograms, from individuals with mean age of 13 years and 6 months, S.D. 2 years and 3 months (ranging from 8 years and 6 months to 16 years and 11 months). The sample was composed by 209 radiography sets (hand-wrist radiography and lateral cephalograms) taken in the same date for each individual. Two investigators, properly trained and calibrated, classified all the hand-wrist radiography relating them to the skeletal maturation according to Helm et al. The cervical vertebrae evaluation was performed in lateral cephalograms by means of the O'Reilly and Yaniello and Baccetti, Franchi and McNamara method. Considering the classification of Helm et al as “gold standard’, Spearman test correlation was applied to verify relationship with the two methods that evaluate the cervical vertebrae. The results indicated that there was strong correlation among the methods of evaluation of the cervical vertebrae and hand-wrist radiography (Rs =0,906 for O'Reilly and Yaniello and Helm et al and Rs = 0,889 for Baccetti et al and Helm et al, for all p <0,001). The descriptive statistical analysis indicated that there was larger number of concordant occurrences in the identification of the onset and maximum peak of the adolescent growth spurt. Based on these results, it can be concluded that the evaluation of the skeletal maturation by means of the cervical vertebrae method can offer reliability only for the identification of the onset and peak of adolescent growth spurt. Thus, is still indispensable to continue using the hand-wrist radiography when it is necessary the identification of some potential remaining growth.

TThis thesis looks at the development of a Hand and Wrist Strength Gauge. The gauge was developed by the author at the Flinders Medical Centre Occupational Therapy Department in 1997. / thesis (MApSc(OccupationalTherapy))--University of South Australia, 2003.

Residual dysfunction after a fracture of the distal radius is most often mild but may give rise to significant impairment especially in the younger active population. The symptoms often manifest around the distal ulna when loading the hand or rotating the forearm. In this region are found articular and soft tissue connections running from the distal ulna to the distal radius as well as to the ulnar side of the carpus. The aims of this thesis were to investigate the effects of distal radius fractures on the structures about the distal ulna and to what extent malunion and ulnar soft tissue lesions affect function. Both patients and cadaver specimens were used in the five different studies. In a retrospective study of 17 malunited distal radius fractures supination impairment improved significantly by correction of the skeletal malunion. This highlights the importance of distal radioulnar joint congruity for forearm rotation in a subset of cases. The pathomechanisms of injury to the triangular fibrocartilage complex (TFCC) were studied. In a cadaveric distal radius fracture model different restraining properties and injury patterns were investigated. Similar patterns of injury were then observed in 20 patients with a displaced distal radius fracture. It was found that a TFCC injury can be expected with dorsal displacement of the distal radius fragment of 32o or more from the anatomically correct position. The distribution of a TFCC injury apparently differs depending on the size of an associated ulnar styloid fracture. In cases of an intact ulnar styloid or a concomitant tip fracture (Type 1) the first stage of injury seems to be extensor carpi ulnaris subsheath separation from the distal ulna and the dorsal radioulnar ligament. Thereafter follows a disruption of the deep insertions into the fovea of the ulna starting from the palmar and extending dorsally and radially. An extensive injury can be detected with a novel non-invasive test called the ‘bald ulnar head test’, which is performed under anaesthesia. Diagnosis of an acute TFCC injury is difficult using non-invasive methods. In a prospective study of 48 patients, CT scanning to detect pathologic subluxation was found to be of little use in both acute and chronic cases, and is therefore not endorsed on this indication. A radioulnar stress test, which in previous studies has correlated well to a deep TFCC injury, was found to be highly reliable but not to correspond with significant disability in self-administered questionnaires of functional outcome two years or more after injury. This indicates that the subset of patients possibly benefiting from acute repair must be identified by other means.

The increasing level of computerization in design and engineering work has led to development of software such as Digital Human Modeling (DHM) Tools. These tools are used to simulate and visualize human work as well as evaluating ergonomic conditions. The ergonomic assessment methods based on observations, such as OWAS and RULA, are used for characterizing static load and are usually integrated in DHM tools. Researchers now aims at developing assessment methods of dynamic work where even time-dependent variables are taken into account. The purpose of this thesis is to develop a concept for quantification of wrist movements in flexion and extension, based on three exposure variables; angular position, angular velocity and repetitiveness. The concept is intended to form the basis for further development of a comprehensive assessment method for wrist movements, adapted for use in DHM tools. Such an approach is necessary because of the large amount of work-related cumulative disorders, reported from industry. The method approach contained a literature review, an establishment of concept content, a collection of motion data using goniometry and computer programming, in order to illustrate the function of the concept. The result proposed a quantification concept for wrist movements in flexion and extension, concerning angular position exposure, angular velocity level exposure and repetitiveness. The concept is based on a combination of modified and established evaluation methods, including suggestions for how to identify fundamental cycles, in order to determine repetitiveness. The presented concept provides a basis for further development of a comprehensive assessment method and highlights deficiencies in the lack of existing definitions concerning exposure threshold values. / Den ökande datoriseringen av konstruktion och produktionsplanering har lett till utveckling av mjukvaror såsom Digital Human Modeling (DHM)-verktyg. Dessa används för att simulera och visualisera människors arbete samt utvärdera ergonomiska förhållanden. De metoder som används för detta bygger på observation av statiska positioner, exempelvis OWAS och RULA, vilka i de flesta fall finns implementerade i DHM-verktygen. Forskare strävar nu efter att utveckla ergonomiska bedömningsmetoder av dynamiskt arbete där även tidsberoende variabler beaktas. Syftet med detta examensarbete är att utveckla ett koncept för kvantifiering av handledsrörelser i flexion och extension, med avseende på handledsposition, vinkelhastighet och repetitivitet. Konceptet ska ligga till grund för vidare utveckling mot en komplett bedömningsmetod av handledsrörelser, anpassade för användning i DHM-verktyg. En sådan är nödvändig på grund av den stora mängd arbetsrelaterade belastningsskor som rapporteras från industrin. Genomförandet bestod av litteraturstudier, beslut om konceptinnehåll, insamling av rörelsedata för handleden med hjälp av en electrogoniometer samt programmering för att illustrera kvantifieringskonceptet i siffror samt för att förenkla implementering i DHM-verktyg. Resultatet visar ett kvantifieringskoncept för handledsrörelser i flexion/extension med avseende på de ovan givna exponeringsvariablerna, samt ett förslag på hur identifikation av fundamentala cykler kan ske. Detta för att ge en uppfattning om graden av repetitivitet. Det presenterade konceptet i denna rapport ger en grund för fortsatt utveckling mot en heltäckande bedömningsmetod, samt belyser svårigheter i definitioner av exponeringsgränsvärden.

Objective: The purposes of this thesis included: i) To explore the annual incidence and time-loss duration of traumatic, work-related injuries of four nature-of-injury (fractures, nerve lacerations, tendon lacerations/disruptions and amputations) and two part-of-body categories (hand and wrist); and ii) To identify the incidence and time-loss duration, and examine explanatory variables that were associated with time-loss duration for subjects with hand fractures. Methodology: Data on incidence, time-loss duration and explanatory variables were reviewed on claims accepted between January – December 2006 at WorkSafe-New Brunswick. Descriptive statistics and non-parametric tests were used to explore incidence and time-loss duration. Using a biopsychosocial framework, explanatory variables associated with time-loss duration were analyzed using Cox Proportional Hazards regression. Results: The incidence for hand and wrist trauma involving fractures, tendon lacerations/disruptions and amputations was low (3%). Incidence was significantly higher for fractures and for injuries to the hand, while time-loss duration was significantly higher for the wrist (p< .05). The incidence rate of hand fractures was low (1.5%) and average time-loss duration was high (92 days). Increased time-loss duration was associated with greater medical aid costs (used as a proxy for injury severity) older age and increased receipt of therapy (Physiotherapy/Occupational Therapy). Conclusions: The annual incidence of specific injuries involving the hand and wrist is challenging to compare to the literature since incidence is presented in many ways. Time-loss duration following hand and wrist injuries is highly variable. Time-loss duration for hand fractures exceeded reports in the literature and predicted values reported in disability duration guidelines. Consideration of the impairment, personal and environmental factors is warranted to provide a framework to the return-to-work process for all stakeholders involved in the care of the hand- and wrist-injured worker.

With continually growing availability of high performance computing resources, the finite element methods (FEM) are becoming increasingly more efficient and practical research tools. In the domain of computational biomechanics, FEMs have been successfully applied in investigation of biomedical problems that include impact and fracture mechanics of bone, load transmission through the joints, feasibility of joint replacements, and many others. The present research study was concerned with the development of a detailed, anatomically accurate, finite element model of the human hand and wrist. As a first step in this direction, we used a publically available database of wrist bone anatomy and carpal kinematics to construct a multi-body statistical shape model (SSM) of the wrist. The resulting model provides an efficient parameterization of anatomical variations of the entire training set and can thus overcome the major shortcoming of conventional biomechanical models associated with limited generalization ability. The main contributions of this work are: 1) A robust method for constructing multi-body SSM of the wrist from surface meshes. 2) A novel technique for resampling closed genus-0 meshes to produce high quality triangulations suitable for finite element simulations. Additionally, all techniques developed in the course of this study could be directly applied to create an equivalent model of the tarsus.

TThis thesis looks at the development of a Hand and Wrist Strength Gauge. The gauge was developed by the author at the Flinders Medical Centre Occupational Therapy Department in 1997. / thesis (MApSc(OccupationalTherapy))--University of South Australia, 2003.