Changes in Scaphoid and Lunate Position and Loading at Two Wrist Pushup Positions

Author(s): Frederick W. Werner*, Emily R. Tucci, Brett T. Daly, Brian J. Harley

Journal Name: Current Rheumatology Reviews

Volume 16 , Issue 3 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Scapholunate interosseous ligament (SLIL) injury following a fall on an outstretched hand may lead to carpal instability and in some cases require long-term rehabilitation following repair. Rehabilitation, especially in athletes, may include pushups, but little is known as to what type of pushup may be safer.

Objective: To determine biomechanical differences between two pushup positions (neutral or extended).

Methods: Six fresh cadaver wrists with pre-existing SLIL damage were uni-axially loaded in neutral and extension in order to simulate two different pushup styles. The motions of the scaphoid and lunate in relation to the radius were measured. The dorsal, proximal, and volar insertion sites of the SLIL were identified and, using the collected kinematic data, gap distances were calculated for each site.

Results: Gap distance between the proximal SLIL insertion points was significantly greater in neutral than in extension. There was a trend that the dorsal and volar SLIL insertion points were also greater in neutral than in extension. After the wrist was extended 90o, the scaphoid extended 70.1o and the lunate extended 28.6o compared to their positions with the wrist in neutral.

Conclusion: The larger gap distances between the scaphoid and lunate in neutral suggest that a neutral style pushup could put higher forces on a wrist with pre-existing SLIL damage and may thus hinder recovery for a person with a repaired SLIL. A pushup in extension, in these injured wrists, may be less detrimental.

Keywords: Scaphoid, lunate, carpal kinematics, scapholunate interosseous ligament, pushup, positions.

[1]
Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31(1): 125-34.
[http://dx.doi.org/10.1016/j.jhsa.2005.10.011] [PMID: 16443117]
[2]
Geissler WB. Arthroscopic management of scapholunate instability. J Wrist Surg 2013; 2(2): 129-35.
[http://dx.doi.org/10.1055/s-0033-1343354] [PMID: 24436805]
[3]
Goldberg SH, Strauch RE, Rosenwasser MP. Scapholunate and lunotriquetral instability in the athlete: Diagnosis and management. Oper Tech Sports Med 2006; 14(2): 18-121.
[http://dx.doi.org/10.1053/j.otsm.2006.04.001]
[4]
Harvey EJ, Berger RA, Osterman AL, Fernandez DL, Weiss AP. Bone-tissue-bone repairs for scapholunate dissociation. J Hand Surg Am 2007; 32(2): 256-64.
[http://dx.doi.org/10.1016/j.jhsa.2006.11.011] [PMID: 17275604]
[5]
Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37(10): 2175-96.
[http://dx.doi.org/10.1016/j.jhsa.2012.07.035] [PMID: 23021178]
[6]
Kuo CE, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2008; 33(6): 998-1013.
[http://dx.doi.org/10.1016/j.jhsa.2008.04.027] [PMID: 18656780]
[7]
Lewis DM, Osterman AL. Scapholunate instability in athletes. Clin Sports Med 2001; 20(1): 131-140 ix..
[http://dx.doi.org/10.1016/S0278-5919(05)70251-9] [PMID: 11227701]
[8]
Lou S, Lin CJ, Chou PH, Chou YL, Su FC. Elbow load during pushup at various forearm rotations. Clin Biomech (Bristol, Avon) 2001; 16(5): 408-14.
[http://dx.doi.org/10.1016/S0268-0033(01)00008-0] [PMID: 11390048]
[9]
Patterson RM, Yazaki N, Andersen CR, Viegas SF. Prediction of ligament length and carpal diastasis during wrist flexion-extension and after simulated scapholunate instability Journal of Hand Surgery - American Volume 2013; 38(3): 509-18.
[http://dx.doi.org/10.1016/j.jhsa.2012.12.001]
[10]
Rohman EM, Agel J, Putnam MD, Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am 2014; 39(10): 2020-6.
[http://dx.doi.org/10.1016/j.jhsa.2014.06.139] [PMID: 25156088]
[11]
Ruby LK, An KN, Linscheid RL, Cooney WP 3rd, Chao EY. The effect of scapholunate ligament section on scapholunate motion Journal of Hand Surgery - American Volume 1987; 12(5 Pt 1): 767-1.
[http://dx.doi.org/10.1016/S0363-5023(87)80065-5]
[12]
Scordino L, Werner FW, Harley BJ. Force in the scapholunate interosseous ligament during 2 simulated pushup positions. J Hand Surg Am 2016; 41(5): 624-9.
[http://dx.doi.org/10.1016/j.jhsa.2016.02.010] [PMID: 27021634]
[13]
Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. Journal of Hand Surgery - American Volume 1995; 20(6): 986-9.
[http://dx.doi.org/10.1016/S0363-5023(05)80147-9]
[14]
Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27(6): 991-1002.
[http://dx.doi.org/10.1053/jhsu.2002.35878] [PMID: 12457349]
[15]
Slade JF III, Milewski MD. Management of carpal instability in athletes. Hand Clin 2009; 25(3): 395-408.
[http://dx.doi.org/10.1016/j.hcl.2009.05.002] [PMID: 19643339]
[16]
Snider MG, Alsaleh KA, Mah JY. Scapholunate interosseus ligament tears in elite gymnasts. Can J Surg 2006; 49(4): 290-1.
[PMID: 16948889]
[17]
Tucci ER. Comparison of neutral versus extended wrist pushup for patients with wrist injury. Syracuse University Undergraduate Honors Program Cap-stone Project 2015.Paper 906.
[18]
Upal MA, Crisco JJ, Moore DC, Sonenblum SE, Wolfe SW. In vivo elongation of the palmar and dorsal scapholunate interosseous ligament. J Hand Surg Am 2006; 9(3): 358-64.
[http://dx.doi.org/10.1016/j.jhsa.2006.06.005]
[19]
Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9(3): 358-65.
[http://dx.doi.org/10.1016/S0363-5023(84)80223-3] [PMID: 6725894]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 3
Year: 2020
Published on: 22 September, 2020
Page: [201 - 205]
Pages: 5
DOI: 10.2174/1573397115666181210170202
Price: $65

Article Metrics

PDF: 18
HTML: 2
EPUB: 1
PRC: 1