To assess the influence of external pressure on the os pisiforme on carpal movements in patients with midcarpal instability
ID
Source
Brief title
Condition
- Tendon, ligament and cartilage disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The X-ray videos will be analysed using the AMC protocol. We will quantify the
pressure needed to cancel the sudden carpal movements of the proximal row
('catch-up-clunk') in ulnar and radial deviation.
Secondary outcome
n.v.t.
Background summary
The wrist is a complex joint composed of eight carpalia which are mutually
linked by ligaments. In a normal situation the ligaments keep the carpalia in a
correct position during the movements of the hand. However, in case of loose
ligaments it is possible that the carpalia move suddenly to their new position,
instead of moving fluently.
This phenomenon is known as: *midcarpal instability*. It causes pain, a sense
of blockade and sometimes a clearly audible, dull click (*catch-up-clunk*).
Currently there is no good treatment available, therefore numerous patients are
strongly limited in their daily activities for a long period, such as hobby*s,
sports and work.
Lichtman et al. describes that external dorsally directed pressure on the os
pisiforme may normalise the aberrant movements of the carpalia, which would
lead to a decrease in wrist disturbances. This theory has never been
objectified. If the external pressure on the os pisiforme has actual effect on
the carpal movements, what we expect, it will be a basis to develop a dynamic
splint. This could be a new, founded therapy for midcarpal instability, which
we will evaluate in follow-up studies.
Study objective
To assess the influence of external pressure on the os pisiforme on carpal
movements in patients with midcarpal instability
Study design
In this pilot-study we will asses under videofluoroscopy the difference of
carpal movements in a group of persons without and with carpal instability
under the influence of an external exerted pressure on the pisiform bone.
We have developed an X-ray translucent instrument which gives an uniformly
distributed external pressure on the os pisiforme in every position of the
hand. The forearm will be fixed on the instrument using belts. A lever
connected to the skin with a small silicon cup will give an external dorsally
directed pressure on the os pisiforme. This pressure will not be unpleasant for
the patients. We will observe the effect of the dorsally directed pressure on
the carpal movements with X-ray videos (videofluoroscopy) and describe our
results in an article.
Intervention
Every patient cq. healthy person will go three times through the cycle of
ulnair to radial deviation. Everytime we will make an X-ray video. The patient
moves his hand himself. We will repeat this process with three different
external pressures on the os pisiforme.
Study burden and risks
The duration of this videofluoroscopy examination will not exceed half an hour.
The pressure on the os pisiforme will be that low that it will not be
unpleasant or riskful, probably it will relieve the pain of the patients with
midcarpal instability. The load of radiation is a category I (<0,1 mSV) of the
ICRP62: trivial risk.
Meibergdreef 9
1100 DE Amsterdam
Nederland
Meibergdreef 9
1100 DE Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
midcarpal instability
Exclusion criteria
pregnancy, children (<18yrs), radiologic employees, participation in a scientific examination with radiologic exposure within the last 12 months.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
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In other registers
| Register | ID |
|---|---|
| CCMO | NL19785.018.07 |