Wednesday, October 27, 2010

Correction of Wrist Position may prevent Shoulder Problem

Shoulder pain in tetraplegia is related to many factors. For example, the weakness of rotator cuff muscles may set off an inward rotation of shoulder and over time cause dislocation and inflammatory reaction in the shoulder joint. A compensatory strategy is automatically developed in people with normal forearm muscles. In people with tetraplegia, the ability to adjust position of forearm is limited and the wrist is usually deviating in the direction to the thumb (radially). By correcting this deviation surgically, it now possible to improve the opening of the hand and allowing for a more straight approach during reach out and grasp. In other words, by surgically deviate the hand in the direction of the little finger (ulnarly) the distance between the thumb and index finger can be increased (figure demonstrates shortening of an extensor tendon to normalize wrist position). This position facilitates the hand to come around objects for grasp and reduce the need for the shoulder to compensate for insufficient opening of the hand by outward rotation. As a consequence, in our practice, the surgical positioning of the wrist more ulnarly has proven successful to alleviate pain in the shoulder. This conclusion is reached by the follow-up studies of more than 20 wrist positions corrected surgically.

Posted by Carina Reinholdt and Jan Fridén