Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception

Guillem Salva-Coll; Alex Lluch; Mireia Esplugas; Ana Carreño; Ana Scott-Tennent; Maria Larrea-Zabalo; Marc Garcia-Elias

doi:10.1016/j.jht.2023.09.011

Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception

J Hand Ther. 2023 Oct 17:S0894-1130(23)00138-2. doi: 10.1016/j.jht.2023.09.011. Online ahead of print.

Authors

Guillem Salva-Coll¹, Alex Lluch², Mireia Esplugas³, Ana Carreño⁴, Ana Scott-Tennent⁵, Maria Larrea-Zabalo⁶, Marc Garcia-Elias³

Affiliations

¹ 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. Electronic address: gsalva@ibacma.com.
² Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona, Spain.
³ Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain.
⁴ Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Hand and Elbow Surgery, Hospital Clinic, Barcelona, Spain.
⁵ Hospital Universitari Arnau de Vilanova, Lleida, Spain; Hospital Universitari Santa Maria, Lleida, Spain.
⁶ Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Mutua Universal Delfos, Barcelona, Spain.

PMID: 37852909
DOI: 10.1016/j.jht.2023.09.011

Abstract

Background: 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.

Purpose: 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.

Study design: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Dynamic carpal stability; Lunotriquetral joint muscle control; Scapholunate joint muscle control; Wrist kinematics; Wrist kinetics; Wrist proprioception.