Wrist

We studied the e¡ect of stimulus predictability on the alpha and beta changes observed in central regions during stimulus-induced movement paradigms. Six young volunteers were instructed to extend briskly their dominant wrist as soon as possible after hearing a 2000 Hz sound.Two sequences of stimuli were presented to each subject, the ¢rst rhythmic at 1/6 s and the second with random intervals between 5 and13 s. A time-frequency analysis of nonphaselocked activity in the 7^37 Hz range was performed on stimuluscentred EEG sweeps using wavelet ¢lters and Gabor transforms. During the sequence of predictable rhythmic stimuli, stimulus-induced movements were accompanied by a decrease in beta activity that began contralaterally about 1s prior to the stimulus and extended to both sides later on. This decrease was followed by a rebound after the end of the movement. In the alpha band, the decrease observed started just after the sound. During the sequence of non-predictable, random stimuli, stimulus-induced movements were accompanied by a shorter and smaller alpha and beta-ERD, that started after the stimulus.The presence of a pre-stimulus beta ERD only in the rhythmic predictable paradigm suggests that central pre-movement beta ERD may be an indicator of motor preparation, and could be used for objective evaluation of time estimation and motor timing. The minimal di¡erences observed in the alpha changes in both paradigms suggest that alpha-ERD may not be linked to motor preparation.

Motor improvements in chronic stroke recovery accrue from coupled protocols of bilateral movements and active neuromuscular stimulation. This experiment investigated coupled protocols and within-limb transfer between distal and proximal joint combinations. The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints. Twenty-six volunteers completed one of three motor

We prospectively evaluated aesthetic outcomes in a group of randomised patients who underwent elective daycase hand and wrist surgery using either absorbable or non-absorbable sutures. PATIENTS AND METHODS A cohort of 100 adult patients were randomised using sealed envelopes to receive either absorbable or non-absorbable sutures for their wound closure. Clinical review was carried out at 6 weeks. A postal questionnaire was sent to all patients 3 months following surgery comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6-point patient scar assessment tool and the shortened version of the disabilities of the arm, shoulder and hand questionnaire (QuickDASH). RESULTS From the postal questionnaire, 70 responses were received. There was no statistically significant difference between the two groups in terms of VAS, patient scar assessment tool and quick DASH. CONCLUSIONS For elective day-case hand and wrist surgery, either suture material can be used confidently with respect to overall aesthetic appearance in such patients.

We compared a unilateral robot-assisted training protocol (URTP) and a bilateral robot-assisted training protocol (BRTP) to study their differential effects. We recruited 21 patients with stroke who received 90–105 min of therapy 5 days/wk for 4 wk. Participants in the URTP and BRTP groups practiced forearm pronation and supination and wrist flexion and extension in a simultaneous manner with the Bi-Manu-Track. The control group received standard rehabilitation. Clinical measures included the Fugl-Meyer Assessment, the Medical Research Council instrument, grip strength, and the Modified Ashworth Scale to assess motor impairment, muscle power, muscle strength, and spasticity, respectively. The pilot study indicated that the URTP and BRTP might have differential benefits for movement improvement. URTP might be a more compelling approach to improving upper-limb motor impairment, muscle power, and strength at the distal joints than BRTP, whereas BRTP could be an optimal approach to impr...

The aim of this study was to identify cutoff values for body, hand, and wrist measurements in order to correctly identify individuals with increased risk of carpal tunnel syndrome (CTS). Patients and methods This study included 30 patients with clinically diagnosed and electrophysiologically confirmed idiopathic CTS and 30 age-matched and sex-matched healthy volunteers as the control group. Both groups performed sensory and motor conduction studies of the median nerve. Body, hand, and wrist anthropometric measurements were taken including weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, palm length/width, and hand length. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), confidence intervals, cutoff values, sensitivity, and specificity were calculated separately for each measured parameter. Results There were statistically significant differences among the studied participants regarding all measured anthropometric parameters (P<0.001). As a result, all studied patients had squarer wrists and shorter hands than healthy participants. The AUC values for all studied measurements showed high accuracy (AUC<95) except for hip circumference, waist-to-hip ratio, palm length, third digit length, and digit index which showed moderate accuracy. In the studied patients there were positive significant correlations between BMI, wrist depth, wrist ratio, and shape index with an electrophysiological severity grading of CTS of the studied patients; on the other hand, there were negative significant correlations between palm length, hand length, and hand ratio with electrophysiological severity grading of CTS. Conclusion The cutoff values for body, wrist, and hand anthropometric measurements are useful tools to assess the risk factors for CTS.

Downloaded from after the 15th treatment session and on day 45. In the HBO group there was a significant decrease in pain and oedema and a significant increase in the ROM of the wrist. When we compared the two groups, the HBO group had significantly better results with the exception of wrist extension. In conclusion, HBO is an effective and well-tolerated method for decreasing pain and oedema and increasing the ROM in patients with CRPS.

Palmaris longus muscle, although of little functional use to the human upper limb, assumes great importance when used as a donor tendon for transfer or transplant. The variability in the prevalence of palmaris longus agenesis among various ethnic groups has been established, and the surgeon’s awareness of the prevalence in a population or ethnic group is desirable. The prevalence of palmaris longus agenesis has, to the best of the authors’ knowledge, not been reported in Indian patients. Five hundred Indian patients were examined for the presence or absence of palmaris longus tendon, using the conventional test for presence of palmaris longus. The prevalence and pattern of palmaris longus agenesis was analyzed statistically and any difference in prevalence or pattern of palmaris longus agenesis with regard to body side or sex was looked for. All statistical analysis was done using SPSS (version 12). ÷ 2 test was used to analyze the association of agenesis with limb laterality and sex. The prevalence of palmaris longus agenesis was found to be 17.2% (8% bilateral and 9.2% unilateral). The prevalence of agenesis was significantly more common on the left side. Male subjects had a greater likelihood of unilateral agenesis, while female subjects were more likely to have bilateral agenesis. That prevalence of palmaris longus agenesis is race dependent is reaffirmed in the present study. Although the prevalence of palmaris longus agenesis in Indian patients was found to be much higher than the reported average prevalence in an Asian population, this tendon can still be counted on by surgeons treating Indian patients for use as a donor tendon, which will be present in a vast majority of Indian patients.

Background and Purpose-After stroke, many individuals have chronic unilateral motor dysfunction in the upper extremity that severely limits their functional movement control. The purpose of this study was to determine the effect of electromyography-triggered neuromuscular electrical stimulation on the wrist and finger extension muscles in individuals who had a stroke Ն1 year earlier. Methods-Eleven individuals volunteered to participate and were randomly assigned to either the electromyographytriggered neuromuscular stimulation experimental group (7 subjects) or the control group (4 subjects). After completing a pretest involving 5 motor capability tests, the poststroke subjects completed 12 treatment sessions (30 minutes each) according to group assignments. Once the control subjects completed 12 sessions attempting wrist and finger extension without any external assistance and were posttested, they were then given 12 sessions of the rehabilitation treatment.

The palmaris longus muscle (PLM) is described as a weak flexor of the wrist and a tensor of the palmar aponeurosis, but not a thumb abductor. The PLM is believed to aid thumb abduction through its insertion onto the thenar eminence. Two groups, both right hand dominant, were selected from 1,200 sampled participants. The first group comprised of 38 subjects with unilateral presence of the PLM and was used to determine the strength of thumb abduction. The second group comprised of 30 subjects, with bilateral presence of the PLM, and it was used to calculate the effects of hand dominance. A significant number of subjects with bilateral absence of the PLM were observed and undocumented. Using a dynamometer in subjects with unilateral presence of the PLM, the force of thumb abduction was significantly greater on the hand with a PLM than the one without it (P = 0.014), irrespective of hand dominance. In the second sample with bilateral PLM, thumb abduction on the dominant hand was 10% stronger than on the nondominant hand and was similar to the universally accepted average of 10% increase in grip strength of the dominant hand. Thus, 10% was deducted from all the dominant hands, and the force of thumb abduction remained greater on the hand with PLM than the hand without it (P = 0.049). The results of this study demonstrated the PLM to be involved in thumb abduction, and the authors therefore recommend that this action of the muscle be universally accepted by anatomists and hand surgeons. Clin. Anat. 23:431–436, 2010. © 2010 Wiley-Liss, Inc.

Spasticity has been successfully managed with different treatment modalities or combinations. No information is available on the effectiveness or individual contribution of botulinum toxin type A (BTA) combined with physical and occupational therapy and neuromuscular electrical stimulation to treat spastic upper limb. The purpose of this study was to assess the effects of such treatment and to inform sample-size calculations for a randomized controlled trial. BTA was injected into spastic upper limb muscles of 10 children. They received 10 sessions of physical and occupational therapy followed by 10 sessions of neuromuscular electrical stimulation on the wrist extensors (antagonist muscles). Degree of spasticity using the Modified Ashworth scale, active range of motion, and manual function with the Jebsen hand test, were assessed. Meaningful improvement was observed in hand function posttreatment (P = 0.03). Median spasticity showed a reduction trend and median amplitude of wrist range of motion registered an increase; however, neither of these were significant (P > 0.05). There is evidence of a beneficial effect of the combined treatment. Adequate information has been obtained on main outcome-measurement variability for calculating sample size for a subsequent study to quantify the treatment effect precisely.

This one-day workshop will introduce course participants to the Bayley-IIl. It will include an overview of the subtests, a broad look at the changes from BSID II, research design, psychometric properties, and special group studies. The Cognitive Scale, Language Scale, Motor Scale, Social-Emotional, and Adaptive Behaviour Scales will all be discussed. Administration and scoring procedures will be described and interpretative considerations discussed. The workshop is aimed at paediatric therapists, psychologists, paediatricians, and others responsible for assessing child development, who meet the criteria for a CL2 registration code with Harcourt Assessment.

Extracellular (ECW) and intracellular (ICW) volumes were measured using both segmental and wrist-ankle (W-A) bioimpedance spectroscopy (5-1000 kHz) in 15 healthy subjects (7 men, 8 women). In the 1st protocol, the subject, after sitting for 30 min, laid supine for at least 30 min. In the second protocol, the subject, who had been supine for 1 hr, sat up in bed for 10 min and returned to supine position for another hour. Segmental ECW and ICW resistances of legs, arms and trunk were measured by placing four voltage electrodes on wrist, shoulder, top of thigh and ankle and using Hanai's conductivity theory. W-A resistances were found to be very close to the sum of segmental resistances. When switching from sitting to supine (protocol 1), the mean ECW leg resistance increased by 18.2%, that of arm and W-A by 12.4%. Trunk resistance also increased but not significantly by 4.8%. Corresponding increases in ICW resistance were smaller for legs (3.7%) and arm ( 0.7%) but larger for the trunk (21.4%). Total body ECW volumes from segmental measurements were in good agreement with W-A and Watson anthropomorphic correlation. The decrease in total ECW volume (when supine) calculated from segmental resistances was at 0.79 l less than the W-A one (1.12 l). Total ICW volume reductions were 3.4% (segmental) and 3.8% (W-A). Tests of protocol 2 confirmed that resistance and fluid volume values were not affected by a temporary position change.

Atrophic scaphoid non-union and lunate necrosis can be treated with vascularized bone grafting; through a posterior approach as described by Zaidemberg, based on a supraretinacular artery, or through an anterior approach, based on the volar carpal artery, according to Kuhlmann's procedure. The aim of our study was to determine the area covered by each of these two grafts and their respective future applications. Fifteen hands from eight adult human cadavers, free of any scar, were dissected after injection of colored Xuid latex, through dorso-radial approach for Zaidemberg's graft and through volar approach for Kuhlmann's. We observed the morphological parameters of the pedicles and the arc of rotation of each Xap. The volar vascularized graft had a constant origin and it could be transferred to the scaphoid, the lunate and the scapholunate joint. The posterior graft of Zaidemberg was technically more diYcult to harvest because of the anatomical variations. It made it possible to reach the scaphoid, the trapezium and the scaphotrapeziotrapezoid joint line. Both these two vascularized bone grafts represent interesting procedures for treatment of scaphoid non-union or lunate necrosis, or intracarpal bones arthrodesis. They bring various possibilities of bone covering, related to speciWc area of mobilization and are not opposite procedures, but have diVerent targeted indications. One must better deWne the respective places of the vascularized bone grafts, compared with the traditional free (non-vascularized) graft.

This paper analyses the relationship between the thickness of the anterior femoral head cartilage (FHC), as measured by ultrasound, and some anthropometric parameters, such as height, weight, skeletal and chronological age. In addition, it provides standard norms for FHC thickness in a paediatric population. Both hips were examined in 213 consecutive subjects (99 boys and 114 girls), aged 1.9-14 years. Seventy-four subjects underwent hand and wrist X-rays for skeletal maturation: 32 of these were dropped from the study because a discrepancy as high as two standard deviations was found between their skeletal and their chronological age. The thickness of FHC correlated strongly with skeletal and chronological age, standing height and body weight. A side difference of 0.2 mm in FHC was considered to be abnormal. The study population was divided into 13 groups according to chronological age and values of FHC for boys and girls are provided for each group. It is suggested that the magnitude of hyaline FHC is a valuable feature in the evaluation of skeletal maturation in children.

Background: To guarantee equal chances for different age groups, age-related tournaments for male and female players have been established in soccer. However, as registration at birth is not compulsory in some countries, other methods of age determination are needed to prevent participation in the incorrect age group. Objectives: To evaluate the age of soccer players of international U-17 competitions from the degree of fusion of the distal radius and to compare the findings with an age-related normative population. Methods: MRI scans of the wrist of a representative sample of 189 players from four U-17 competitions (FIFA U-17 World Cups 2003 and 2005, and Asian (AFC) U-17 championships 2004 and 2006) were analysed using a previously published grading system.

The aim of the experiment was to identify the control mechanisms involved in a goal-directed task by manipulating the temporal constraints. Subjects were required to catch, with one hand, table tennis balls projected by a ball-projection machine under five temporal conditions (ball speed ranged from 5.7 to 9 m/s, giving rise to flight times of 550-350 ms). By means of three-dimensional kinematics analysis the following results were obtained, which are some spatio-temporal adaptations of the catching movement to the increase of temporal constraints: (1) a decrease in movement time, (2) an increase in the straightness of the trajectory of the wrist, and (3) a shift backwards of the place of ball-hand contact while (4) the grasping time was kept constant. Moreover, as a result of increasing temporal constraints, the acceleration phase of the transportation component was kept constant while the deceleration phase was progressively decreased and nearly suppressed. Further, an increased correlation of the initial direction of the transportation component with the initial direction of the ball path was found. These findings show some spatio-temporal adaptations of the catching movement when the time available is manipulated. They also support the contention of a shift in the control mechanisms involved in one-handed catching facing different temporal constraints.

The purpose of this study was to investigate the utility of peak outward acceleration (POA) measured from an inertial sensor worn at the wrist as an indicator of the critical end point of the bowling action - ball release, a critical element when assessing illegal actions. Twenty-one finger-spin and fast bowlers from nine countries were recruited from the ICC under-19 Cricket World Cup to take part in this research. Bowlers delivered a cross section of their standard deliveries while wearing an inertial sensor placed on their wrists. Ball release was determined by a validated motional analysis ball release (MABR) protocol and compared to the simultaneously collected POA. POA was shown to be highly correlated with MABR (R(2) = 0.98) and a Bland-Altman plot indicated that all 148 trials were within the 3.42 frame (0.014 s) limits of agreement. POA when measured by an inertial sensor worn on the wrist during bowling had a close relationship with an established method of identifying bal...

Purpose Recent publications on the sensory innervation of wrist ligaments have challenged our understanding of ligaments as mere passive restraints in wrist stability. Mechanoreceptors in ligaments have a role in signaling joint perturbations, in which the afferent information is believed to influence periarticular muscles. The scapholunate interosseous ligament is one of the most richly innervated ligaments in the wrist. The purpose of our study was to investigate the possible existence of a wrist proprioceptive reflex, by which afferent information elicited in the scapholunate interosseous ligament was hypothesized to influence the muscles moving the wrist joint.

Work-related overload syndromes are chiefly associated with the upper limbs, where carpal tunnel syndrome (CTS) plays a leading role. This article analyses methods of diagnosing CTS, with special emphasis on those that can be used by physicians in early diagnosis of CTS in workers doing monotonous work. It also discusses occupational (e.g., assembly work, typing, playing instruments, packaging and work associated with the use of a hammer or pruning scissors) and extra-occupational factors (e.g., post-traumatic deformation of bone elements of the carpal tunnel, degenerative and inflammatory changes in tendon sheaths, connective tissue hypertrophy or formation of crystal deposits) leading to CTS; diagnostic methods (subjective symptoms, physical examination and manual provocative tests, vibration perception threshold, electrophysiological examination and imaging methods); and therapeutic and preventive management tools accessible in occupational medicine practice.

Objectives: Variation in swing mechanics between golfers of different skill levels has been previously reported. To investigate if differences in three-dimensional wrist kinematics and the angle of golf club descent between low and high handicap golfers. Design: A descriptive laboratory study was performed with twenty-eight male golfers divided into two groups, low handicap golfers (handicap = 0-5, n = 15) and high handicap golfers (handicap ≥ 10, n = 13). Methods: Bilateral peak three-dimensional wrist mechanics, bilateral wrist mechanics at ball contact (BC), peak angle of descent from the end of the backswing to ball contact, and the angle of descent when the forearm was parallel to the ground (DEC-PAR) were determined using an 8 camera motion capture system. Independent t-tests were completed for each study variable (α = 0.05). Pearson correlation coefficients were determined between golf handicap and each of the study variables. Results: The peak lead arm radial deviation (5.7 degrees, p = 0.008), lead arm radial deviation at ball contact (7.1 degrees, p = 0.001), and DEC-PAR (15.8 degrees, p = 0.002) were significantly greater in the high handicap group. Conclusion: In comparison with golfers with a low handicap, golfers with a high handicap have increased radial deviation during the golf swing and at ball contact.

The present experiment addressed the time course of corticospinal excitability changes following interventional muscle tendon vibration. Using transcranial magnetic stimulation, motor evoked potentials of the £exor carpi radialis and extensor carpi radialis brevis muscle were recorded for a period of 60 min after cessation of vibration (80 Hz, 0.5 mm, 30 min) to the distal wrist £exor tendons. A delayed corticospinal excitability increase in both the vibrated and non-vibrated antagonistic muscle was observed, with lasting levels of facilitation for the latter. No changes were observed following interventional cutaneous vibration. These results underscore a facilitatory in£uence of prolonged Ia-a¡erent activation on corticospinal excitability. Findings are discussed in light of recent advances in promoting motor recovery after brain injury by somatosensory stimulation. NeuroReport14 :1901^1905

Scoping review. Sensorimotor deficits can impair function and may be present in individuals with common upper extremity conditions. To provide clinicians with an understanding of the usefulness of the assessments to evaluate sensorimotor function and the interventions reported in the literature to effect positive change in our patients with sensorimotor deficits affecting the hand and wrist. A systematic search produced seventeen studies involving sensorimotor retraining and assessment of sensorimotor performance for the upper extremity. Sensorimotor interventions and assessments found in the literature vary in regards to their effectiveness in restoring sensorimotor function in subjects with a number of conditions that affect hand and wrist function. There is a potential value of sensorimotor interventions for individuals with specific upper extremity conditions. There is a need for further studies to improve treatment of sensorimotor deficits and understanding of sensorimotor inte...

We combined psychophysical and transcranial magnetic stimulation studies to investigate the dynamics of action anticipation and its underlying neural correlates in professional basketball players. Athletes predicted the success of free shots at a basket earlier and more accurately than did individuals with comparable visual experience (coaches or sports journalists) and novices. Moreover, performance between athletes and the other groups differed before the ball was seen to leave the model's hands, suggesting that athletes predicted the basket shot's fate by reading the body kinematics. Both visuo-motor and visual experts showed a selective increase of motor-evoked potentials during observation of basket shots. However, only athletes showed a time-specific motor activation during observation of erroneous basket throws. Results suggest that achieving excellence in sports may be related to the fine-tuning of specific anticipatory 'resonance' mechanisms that endow elite athletes' brains with the ability to predict others' actions ahead of their realization.

Carpal tunnel syndrome (CTS) is the most common nerve entrapment. Electrodiagnostic (EDX) studies are a valid and reliable means of confirming the diagnosis. This monograph addresses the various EDX techniques used to evaluate the median nerve at the wrist. It also demonstrates the limitations of EDX studies with a focus on the sensitivity and specificity of EDX testing for CTS. The need to use reference values for populations such as diabetics and active workers, where normative values differ from conventional cutoffs used to confirm suspected CTS, is presented. The value of needle electromyography (EMG) is examined. 44: 597-607, 2011 Carpal tunnel syndrome (CTS) is a clinical syn-Abbreviations: AANEM, American Association of Neuromuscular and Electrodiagnostic Medicine; AAOS, American Academy of Orthopedic Surgeons; APB, abductor pollicis brevis; CMAP, compound muscle action potential; CSI, combined summary index; CTS, carpal tunnel syndrome; EDX, electrodiagnostic; EMG, electromyography; inching, median sensory short segment stimulation across the wrist; MGA, Martin-Gruber anastomosis; MMW, median mononeuropathy at the wrist; NAP, nerve action potential; NCS, nerve conduction studies; palmdiff, median-ulnar mixed nerve palm latency difference from palm to wrist; ringdiff, median-ulnar sensory latency difference to the ring finger; SNAP, sensory nerve action potential; thumbdiff, median-radial latency difference to the thumb

Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnarsided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain.

Magnetic resonance imaging is the optimal modality for characterizing the ligaments, tendons, muscles, and neurovascular structures of the wrist and hand. Continued refinement in pulse sequence and coil design permits high-resolution examination of the many small structures and complex anatomy of this region. In this context, frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment. This article discusses the osseous and soft tissue anatomy of the wrist and hand, as well as normal variants.

A torque-driven, 3D computer simulation model of an arm-racquet system was used to investigate the effects of ball impact location and grip tightness on the arm, racquet and ball during one-handed tennis backhand groundstrokes. The stringbed was represented by nine point masses connected to each other and the racquet frame with elastic springs and three torsional spring-dampers between the hand and the racquet were used to represent grip tightness. For each perturbation of nine impact locations and grip tightness, simulations were run for a 50 ms period starting with ball-racquet impact. Simulations showed that during off-centre impacts below the longitudinal axis of the racquet, the wrist was forced to flex up to 161 more with up to six times more wrist extension torque when compared to a centre impact simulation. Perturbing grip tightness had no substantial effect on centre impact simulations. However, for off-centre impacts (below the longitudinal axis of the racquet) a tight grip condition resulted in a substantial decrease in racquet rotation within the hand (less than 21) and an increase of 61 in wrist flexion angle when compared to the equivalent simulation with a normal grip. In addition there was approximately 20% more wrist extension torque when compared with equivalent off-centre impact simulation with a normal grip. Consequently off-centre impacts below the longitudinal axis of the racquet may be a substantial contributing factor for tennis elbow injuries with a tight grip aggravating the effect due to high eccentric wrist extension torques and forced wrist flexion.

This paper illustrates and discusses problems with the implementation and use of ergonomic tools and techniques in the process of cleaning. Cleaning is an occupation with a high risk of developing work-related disorders. One high-strain task where recommended tools and techniques are difficult to apply is cleaning staircases. This study evaluated the muscular activity of cleaners while mopping staircases using two different mop handles and found that an easily adjustable mop handle can decrease a cleaner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s physical load. The results also show that the implementation and contextualization of the mop are of great importance for how a mop is used. A more holistic approach is needed to improve the benefits of good tools and techniques in cleaning work. More research is needed on how workplace organization can be improved to support the implementation of strategies to increase the health of professional cleaners.

Guyons canal syndrome, an ulnar nerve entrapment at the wrist, is a well-recognized entity. The most common causes that involve the ulnar nerve at the wrist are compression from a ganglion, occupational traumatic neuritis, a musculotendinous arch and disease of the ulnar artery. We describe two cases of Guyons canal syndrome and discuss the anatomy, aetiology, clinical features, anatomical classification, diagnostic criteria and treatment. It is emphasized that the knowledge of both the surgical technique and anatomy is very important for a satisfactory surgical result.

Objective-Chronic wrist pain can be difficult to manage and the diVerential diagnosis is extensive. To provide guidelines for assessment of the painful wrist an algorithm was developed to encourage a structured approach to the diagnosis and management of these patients. Methods-A review of the literature on causes of chronic wrist pain was undertaken; history taking, physical examination and imaging studies were evaluated systematically to determine which of the many potential conditions was the cause of the wrist pain. Chronic wrist pain was subdivided into pain of probable intraarticular or extra-articular origin. By means of this classification a clinical algorithm was developed to establish a diagnosis and its clinical usefulness was tested in a prospective study of 84 patients presenting to our outpatient clinic. Results-A definite diagnosis could be established in 59% (49 of 84) of the cases by careful history taking, extensive physical examination, plain radiographs, ultrasound examination and bone scintigraphy. In 19% of the cases (16 of 84) a probable diagnosis was made resulting in a total . Additional imaging studies (arthrography, magnetic resonance imaging and computed tomography) increased the definite diagnoses to 70% (59 of 84). Conclusion-The algorithm proved easy to use and by the use of careful history taking, thorough physical examination and simple imaging techniques (ultrasonography and scintigraphy) a diagnosis was made in 78% of cases. (Ann Rheum Dis 1999;58:665-674) Ann Rheum Dis 1999;58:665-674 Department of Rheumatology and Clinical Immunology, F02.127, University

The wrist pulse signals can be used to analyze a person's health status in that they reflect the pathologic changes of the person's body condition. This paper aims to present a novel time series analysis approach to analyze wrist pulse signals. First, a data normalization procedure is proposed. This procedure selects a reference signal that is 'closest' to a newly obtained signal from an ensemble of signals recorded from the healthy persons. Second, an autoregressive (AR) model is constructed from the selected reference signal. Then, the residual error, which is the difference between the actual measurement for the new signal and the prediction obtained from the AR model established by reference signal, is defined as the diseasesensitive feature. This approach is based on the premise that if the signal is from a patient, the prediction model previously identified using the healthy persons would not be able to reproduce the time series measured from the patients. The applicability of this approach is demonstrated using a wrist pulse signal database collected using a Doppler Ultrasound device. The classification accuracy is over 82% in distinguishing healthy persons from patients with acute appendicitis, and over 90% for other diseases. These results indicate a great promise of the proposed method in telling healthy subjects from patients of specific diseases.

A new triaradiate skin incision is presented as an approach to the wrist. Centred over Lister's tubercle, it consists of one longitudinal proximal and two oblique,: distal rays, making three 120 ° skin flaps. These provide an excellent triangular operating field to the distal radius, the radiocarpal joint and the carpus itself, allowing for most procedures in this region. There have been no complications in 32 patients, and the cosmetic appearance has been excellent in most of them.

The construction of robotic systems that can move the way humans do, with respect to agility, stability and precision, is a necessary prerequisite for the successful integration of robotic systems in human environments. We explain human-centered views on robotics, based on the three basic ingredients (1) actuation; (2) sensing; and (3) control, and formulate detailed examples thereof.