Download PDF
J Wrist Surg 2013; 02(02): 136-140
DOI: 10.1055/s-0033-1341960
Special Focus: The Schapholunate Ligament Complex
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Scapholunate Instability: Proprioception and Neuromuscular Control

Guillem Salva-Coll
1   Department of Hand and Microsurgery, Son Llàtzer Hospital, Ibacma Institute, Palma de Mallorca, Spain
,
Marc Garcia-Elias
2   Institut Kaplan, Barcelona, Spain
3   Department of Anatomy, University of Barcelona, Barcelona, Spain
,
Elisabet Hagert
4   Karolinska Institutet, Stockholm, Sweden
5   Department of Clinical Science and Education, Hand and Foot Surgery Center, Stockholm, Sweden
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2013 (online)

   Permissions and Reprints

Abstract

From a kinetic point of view, the wrist is considered stable when it is capable of resisting load without suffering injury. Several prerequisites are necessary for the wrist to be kinetically stable: bone morphology, normal articulating surfaces, ligaments, the sensorimotor system, the muscles crossing the wrist, and all nerves connecting to ligaments and muscles. Failure of any one of these factors may result in carpal instability. The terms “scapholunate (SL) dissociation” and “SL instability” refer to one of the most frequent types of wrist instability, resulting from rupture or attenuation of the SL supporting ligaments. From a radiologic point of view, SL instability may be dynamic or static. Unlike static instabilities, which tend to be painful and dysfunctional, a good proportion of dynamic SL instabilities remain asymptomatic and stable for prolonged periods of time. Such a lack of symptoms suggests that a ligament rupture, in itself, is not enough for a joint to become unstable. Certainly, the process of achieving stability is multifactorial and involves normal joint surfaces, ligaments, muscles, and a complex network of neural connections linking all these elements. In this article, we will review the neuromuscular stabilization of the SL joint and the proprioceptive mechanisms that contribute to the dynamic carpal stabilization.

Keywords

instability - muscular control - proprioception - scapholunate - wrist

Note

The work was performed in the laboratory of biomechanics in the Department of Anatomy, University of Barcelona, Barcelona, Spain and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.


 

  • References

  • 1 The Anatomy and Biomechanics Committee of the International Federation of Societies for Surgery of the Hand. Definition of carpal instability. J Hand Surg Am 1999; 24 (4) 866-867
    CrossrefPubMedGoogle Scholar
  • 2 Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train 2002; 37 (1) 71-79
    PubMedGoogle Scholar
  • 3 Riemann BL, Lephart SM. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability. J Athl Train 2002; 37 (1) 80-84
    PubMedGoogle Scholar
  • 4 Garcia-Elias M. Carpal instability. In: Wolfe S, Hotchkiss R, Pederson W, Kozin S, , eds. Green's Operative Hand Surgery, 6th ed. New York, NY: Churchill Livingstone; 2011: 465-521
    CrossrefGoogle Scholar
  • 5 Picha BM, Konstantakos EK, Gordon DA. Incidence of bilateral scapholunate dissociation in symptomatic and asymptomatic wrists. J Hand Surg Am 2012; 37 (6) 1130-1135
    CrossrefPubMedGoogle Scholar
  • 6 Garcia-Elias M. Kinetic analysis of carpal stability during grip. Hand Clin 1997; 13 (1) 151-158
    PubMedGoogle Scholar
  • 7 Lichtman DM, Wroten ES. Understanding midcarpal instability. J Hand Surg Am 2006; 31 (3) 491-498
    CrossrefPubMedGoogle Scholar
  • 8 Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin 1997; 13 (1) 63-82
    PubMedGoogle Scholar
  • 9 Hagert E, Forsgren S, Ljung BO. Differences in the presence of mechanoreceptors and nerve structures between wrist ligaments may imply differential roles in wrist stabilization. J Orthop Res 2005; 23 (4) 757-763
    CrossrefPubMedGoogle Scholar
  • 10 Hagert E, Garcia-Elias M, Forsgren S, Ljung BO. Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition. J Hand Surg Am 2007; 32 (1) 30-36
    CrossrefPubMedGoogle Scholar
  • 11 Mataliotakis G, Doukas M, Kostas I, Lykissas M, Batistatou A, Beris A. Sensory innervation of the subregions of the scapholunate interosseous ligament in relation to their structural composition. J Hand Surg Am 2009; 34 (8) 1413-1421
    CrossrefPubMedGoogle Scholar
  • 12 Hagert E. Wrist Ligaments—Innervation Patterns and Ligamento-Muscular Reflexes [dissertation]. Stockholm, Sweden: Dept of Clinical Science and Education, Section of Hand Surgery, Karolinska Institutet; 2008
    Google Scholar
  • 13 Krogsgaard MR, Dyhre-Poulsen P, Fischer-Rasmussen T. Cruciate ligament reflexes. J Electromyogr Kinesiol 2002; 12 (3) 177-182
    CrossrefPubMedGoogle Scholar
  • 14 Konradsen L, Ravn JB, Sørensen AI. Proprioception at the ankle: the effect of anaesthetic blockade of ligament receptors. J Bone Joint Surg Br 1993; 75 (3) 433-436
    PubMedGoogle Scholar
  • 15 Diederichsen LP, Nørregaard J, Krogsgaard M, Fischer-Rasmussen T, Dyhre-Poulsen P. Reflexes in the shoulder muscles elicited from the human coracoacromial ligament. J Orthop Res 2004; 22 (5) 976-983
    CrossrefPubMedGoogle Scholar
  • 16 Hagert E, Persson JK, Werner M, Ljung BO. Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. J Hand Surg Am 2009; 34 (4) 642-651
    CrossrefPubMedGoogle Scholar
  • 17 Lephart SM, Riemann BL, Fu FH. Introduction to the sensorimotor system. In: Lephart SM, Fu FH, , eds. Proprioception and Neuromuscular Control in Joint Stability. Champaign, IL: Human Kinetics; 2000: xvii-xxiv
    Google Scholar
  • 18 Sjölander P, Johansson H, Djupsjöbacka M. Spinal and supraspinal effects of activity in ligament afferents. J Electromyogr Kinesiol 2002; 12 (3) 167-176
    CrossrefPubMedGoogle Scholar
  • 19 Vekris MD, Mataliotakis GI, Beris AE. The scapholunate interosseous ligament afferent proprioceptive pathway: a human in vivo experimental study. J Hand Surg Am 2011; 36 (1) 37-46
    PubMedGoogle Scholar
  • 20 Hagert E, Persson JK. Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes. J Hand Surg Am 2010; 35 (7) 1059-1066
    CrossrefPubMedGoogle Scholar
  • 21 Gay A, Harbst K, Hansen DK, Laskowski ER, Berger RA, Kaufman KR. Effect of partial wrist denervation on wrist kinesthesia: wrist denervation does not impair proprioception. J Hand Surg Am 2011; 36 (11) 1774-1779
    CrossrefPubMedGoogle Scholar
  • 22 Patterson RW, Van Niel M, Shimko P, Pace C, Seitz Jr WH. Proprioception of the wrist following posterior interosseous sensory neurectomy. J Hand Surg Am 2010; 35 (1) 52-56
    PubMedGoogle Scholar
  • 23 Salva-Coll G, Garcia-Elias M, Leon-Lopez MT, Llusá-Perez M, Rodríguez-Baeza A. Effects of forearm muscles on carpal stability. J Hand Surg Eur Vol 2011; 36 (7) 553-559
    PubMedGoogle Scholar
  • 24 Salvà-Coll G, Garcia-Elias M, Llusá-Pérez M, Rodríguez-Baeza A. The role of the flexor carpi radialis muscle in scapholunate instability. J Hand Surg Am 2011; 36 (1) 31-36
    PubMedGoogle Scholar
  • 25 Salva-Coll G, Garcia-Elias M, Leon-Lopez MM, Llusá-Perez M, Rodríguez-Baeza A. Role of the extensor carpi ulnaris and its sheath on dynamic carpal stability. J Hand Surg Eur Vol 2012; 37 (6) 544-548
    CrossrefPubMedGoogle Scholar
  • 26 Jantea CL, An KN, Linscheid RL, Coonney WP. The role of the scapho-trapezial-trapezoidal ligament complex on scaphoid kinematics. In: Schuind F, An KN, Cooney III WP, Garcia-Elias M, , eds. Advances in the Biomechanics of the Hand and Wrist. New York, NY: Plenum Press; 1994: 345-361
    CrossrefGoogle Scholar
  • 27 Kobayashi M, Garcia-Elias M, Nagy L , et al. Axial loading induces rotation of the proximal carpal row bones around unique screw-displacement axes. J Biomech 1997; 30 (11–12) 1165-1167
    CrossrefPubMedGoogle Scholar
  • 28 O'Connor BL, Brandt KD. Neurogenic factors in the etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am 1993; 19 (3) 581-605
    PubMedGoogle Scholar
  • 29 O'Connor BL, Vilensky JA. Peripheral and central nervous system mechanisms of joint protection. Am J Orthop 2003; 32 (7) 330-336
    PubMedGoogle Scholar
  • 30 Hagert E, Ferreres A, Garcia-Elias M. Nerve-sparing dorsal and volar approaches to the radiocarpal joint. J Hand Surg Am 2010; 35 (7) 1070-1074
    CrossrefPubMedGoogle Scholar
  • 31 Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther 2010; 23 (1) 2-16 , quiz 17
    CrossrefPubMedGoogle Scholar