Can we map the wrist by starting with a theoretical, simplified “spherical cow”? Probably not. What we can do is take observational studies (formalised observation), use them to create models, then test these models in real world. The aim is to create a model that delivers predictable scenarios and outcomes. There have been many important contributors to this research.
I did this talk for a hand therapy group a few months back. It principally references the work of Marc Garcia-Elias as well as my simple understanding of tensegrity structures. Marc’s paper on the spiral anti-pronation tenodesis was published way back in 2012 and sparked a revolution in our understanding of carpal kinematics and instability. He presented his research to the Brisbane hand therapists at our local gathering in 2016. I was lucky enough to be there. Since that time there has been important fine-tuning of this model. Michael Sandow (an Adelaide boy) used 3D CT modelling to identify ligament isometric points. We now recognise the importance of the dorsal and volar scaphotriquetral ligament in cupping the distal carpal row (the dSTL is essentially the deep part of the DICL) and the synergy of certain extrinsic ligaments which help keep the proximal carpal row aligned (Mark Ross, a local boy, was an important contributor). While these developments have an impact on how we currently approach the management of traumatic carpal instability (Garcia-Elias or EWAS grading → treatment recommendations) I don’t believe it alters the overall gist of this talk. This is a complicated enough topic as it is.
Ulnar-side wrist pain with normal, intact ligaments and without arthritis has many possible causes. This talk describes one possible cause.
I didn’t choose the topic and, apart from a couple of observations, the talk contains nothing new or original. It was, to my surprise, well-received.
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