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    All active motion wrist joint simulators have been designed to simulate physiologic wrist motion; however, a main difference among them is the orientation of the forearm (horizontal or vertical with respect to gravity). Moreover, the effect of forearm orientation on experimental results has yet to be quantified, but it may be an important variable. Thus, the purpose of this study was to determine the effect of forearm orientation on wrist kinematics and contact mechanics. Eight cadaveric upper limbs were cycled through a flexion-extension motion using an active motion wrist simulator. Motion trials were performed in 3 forearm orientations (gravity-neutral, gravity-flexion, and gravity-extension). A computed tomography-based joint congruency technique was used to examine radiocarpal joint contact and joint contact centroid translation in the 3 tested orientations. At full wrist extension and wrist flexion, radioscaphoid contact area was greatest in the gravity-extension orientation. Radiolunate contact area was similar among all 3 forearm orientations. The radioscaphoid contact centroid was consistent among the 3 tested positions with the wrist in neutral wrist position. In contrast, the radioscaphoid contact centroid translated radially in the gravity-neutral position relative to the gravity-flexion position in extreme extension. There were no differences in radiolunate centroid contact position in the 3 forearm orientations. This study demonstrates that forearm orientation affects contact mechanics and end-range carpal kinematics. Future biomechanical studies should report forearm orientation and discuss the implication of the forearm orientation used on the experimental results. This study provides evidence that the wrist joint is sensitive to forearm positions consistent with activities of daily living and rehabilitation protocols. Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.


    Clare E Padmore, Andrea H W Chan, G Daniel G Langohr, James A Johnson, Nina Suh. The Effect of Forearm Position on Wrist Joint Biomechanics. The Journal of hand surgery. 2021 May;46(5):425.e1-425.e10

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    PMID: 33303325

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