Altered Ulnar Variance With Full-Body Weight-bearing During Handstands With Upper Extremity Weight-bearing CT

Joseph A Buckwalter V; Noah M Scigliano; Ignacio Garcia Fleury; Nicole A D Watson; Kevin N Dibbern; Natalie A Glass; Jessica E Goetz

doi:10.1016/j.jhsa.2023.09.010

Altered Ulnar Variance With Full-Body Weight-bearing During Handstands With Upper Extremity Weight-bearing CT

J Hand Surg Am. 2023 Nov 10:S0363-5023(23)00502-6. doi: 10.1016/j.jhsa.2023.09.010. Online ahead of print.

Authors

Joseph A Buckwalter V¹, Noah M Scigliano², Ignacio Garcia Fleury², Nicole A D Watson², Kevin N Dibbern², Natalie A Glass², Jessica E Goetz²

Affiliations

¹ Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA. Electronic address: joseph-v-buckwalter@uiowa.edu.
² Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA.

PMID: 37952145
DOI: 10.1016/j.jhsa.2023.09.010

Abstract

Purpose: Ulnar variance (UV) is a radiographic measurement relating the articular surface heights of the distal radius and ulna. Abnormal UV increases the risk for wrist pathology; however, it only provides a static measurement of an inherently dynamic bony relationship that changes with wrist position and loading. The purpose of this study was to investigate how full-body weight-bearing affects UV using weight-bearing computed tomography (WBCT).

Methods: Ten gymnasts completed two 45-second scans inside a WBCT machine while performing a handstand on a flat platform (H) and parallettes (P). A non-weight-bearing CT scan was collected to match clinical practice (N). Differences in UV between weight-bearing conditions were evaluated separately for dominant and nondominant sides, and then, UV was compared between weight-bearing conditions on pooled dominant/nondominant data.

Results: Pooled analyses comparing weight-bearing conditions revealed a significant increase in UV for H versus N (0.58 mm) and P versus N (1.00 mm), but no significant change in UV for H versus P (0.43 mm). Significant differences in UV were detected for H versus N, P versus N, and H versus P for dominant and nondominant extremities. The change from N to H was significantly greater in the dominant versus nondominant side, but greater in the nondominant side from N to P.

Conclusions: Ulnar variance changed with the application of load and position of the wrist. Differences in UV were found between dominant and nondominant extremities.

Clinical relevance: Upper extremity loading patterns are affected by hand dominance as defined by a cartwheel and suggest skeletal consequences from repetitive load on a dominantly used wrist. Although statistically significant, subtle changes detected in this investigational study do not necessarily bear clinical significance. Future WBCT research can lead to improved diagnostic measures for wrist pathologies affected by active loading and rotational wrist behavior.

Keywords: Gymnastics; Handstand; Ulnar variance; Weight-bearing CT; Wrist.