Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ibacma Institute, Balearic Institute for Hand and Wrist Surgery, Palma de Mallorca, Spain.
Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona, Spain.
J Hand Ther. 2024 Apr-Jun;37(2):273-281. doi: 10.1016/j.jht.2023.09.011. Epub 2023 Oct 17.
Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability.
To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities.
We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability.
The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading.
The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid.
Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability.
最近的研究兴趣增长探索肌肉的作用、等长收缩、本体感觉和神经肌肉控制在解决动态舟月和月三角不稳定中的作用，标志着对手腕稳定性的理解发生了转变。
全面回顾腕骨韧带解剖结构和腕部生物力学，特别关注本体感觉在动态腕骨稳定性中的作用及其在管理舟月（SL）和月三角（LTq）动态不稳定中的作用。
我们对文献进行了系统搜索，并回顾了在 pubmed 上发表的与腕部生物力学、本体感觉及其对腕部动态稳定性的贡献相关的最相关文献。
该研究基于尸体研究，对腕骨动态稳定的神经肌肉机制进行了全面综述。在肌腱加载前后监测舟骨、三角骨和头状骨的 3D 位置。
伸腕肌（ECU）和屈腕肌（FCR）被确定为近侧腕骨间关节的主要旋前肌。ECU 的旋前作用可能会使舟月韧带紧张，而旋后肌、拇长展肌（APL）、伸腕肌长头（ECRL）和屈腕肌（FCU）则具有保护作用，特别是在舟月韧带功能障碍的情况下。尽管 FCR 是远侧排的旋前肌，但它具有有益的作用，因为它会引起舟骨的旋后。
理解腕骨功能障碍和不稳定取决于理解腕骨解剖结构和正常生物力学。本体感觉，包括关节位置感觉和神经肌肉控制，对稳定性至关重要。生物力学研究为特定腕骨问题提供了针对性的肌肉强化。对于 SL 损伤应加强旋后肌，而对于 ECU 相关的动态 LTq 不稳定，应进行重点强化和本体感觉训练。进一步的研究应该深入研究腕骨韧带、肌肉和本体感觉之间的复杂关系，以提高手腕稳定性。
