Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.
AgebergE. Consequences of a ligament injury on neuromuscular function and relevance to rehabilitation – using the anterior cruciate ligament-injured knee as model. J Electromyogr Kinesiol. 2002, 12: 205–12.
2.
AgebergEPetterssonAFridenT. 15-year follow-up of neuromuscular function in patients with unilateral nonreconstructed anterior cruciate ligament injury initially treated with rehabilitation and activity modification: a longitudinal prospective study. Am J Sports Med. 2007, 35: 2109–17.
3.
AmanJEElangovanNYehILKonczakJ. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci. 2014, 8: 1075.
4.
BergerRA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop. 2001, 383: 32–40.
5.
ChinchalkarSYongSA. An ulnar boost splint for midcarpal instability. J Hand Ther. 2004, 17: 377–9.
6.
EilsERosenbaumD. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exerc. 2001, 33: 1991–8.
FortierSBassetFA. The effects of exercise on limb proprioceptive signals. J Electromyogr Kinesiol. 2012, 22: 795–802.
9.
FreemanMAWykeB. The innervation of the knee joint. An anatomical and histological study in the cat. J Anat. 1967, 101: 505–32.
10.
FukumotoKKojimaTKinoshitaYKodaM. An anatomic study of the innervation of the wrist joint and Wilhelm’s technique for denervation. J Hand Surg Am. 1993, 18: 484–9.
11.
Garcia-EliasM. The non-dissociative clunking wrist: a personal view. J Hand Surg Eur. 2008, 33: 698–711.
12.
HagertE. Wrist ligaments – Innervation patterns and ligamento-muscular reflexes. PhD Thesis, Department of Clinical Science and Education, Section of Hand Surgery, Stockholm, Karolinska Institutet, 2008.
13.
HagertE. Proprioception of the wrist following posterior interosseous sensory neurectomy. J Hand Surg Am. 2010a, 35: 690–1; author reply 691.
14.
HagertE. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther. 2010b, 23: 2–17.
15.
HagertEPerssonJK. Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes. J Hand Surg Am. 2010, 35: 1059–66.
16.
HagertEFerreresAGarcia-EliasM. Nerve-sparing dorsal and volar approaches to the radiocarpal joint. J Hand Surg Am. 2010, 35: 1070–4.
17.
HagertEForsgrenSLjungBO. Differences in the presence of mechanoreceptors and nerve structures between wrist ligaments may imply differential roles in wrist stabilization. J Orthop Res. 2005, 23: 757–63.
18.
HagertEGarcia-EliasMForsgrenSLjungBO. Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition. J Hand Surg Am. 2007, 32: 30–6.
19.
HagertELjungBOForsgrenS. General innervation pattern and sensory corpuscles in the scapholunate interosseous ligament. Cells Tissues Organs. 2004, 177: 47–54.
20.
HagertEPerssonJKWernerMLjungBO. Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. J Hand Surg. 2009, 34A: 642–51.
Leon-LopezMMSalva-CollGGarcia-EliasMLluch-BergadaALlusa-PerezM. Role of the extensor carpi ulnaris in the stabilization of the lunotriquetral joint. An experimental study. J Hand Ther. 2013, 26: 312–7; quiz 7.
23.
LephartSMRiemannBLFuFH. Introduction to the sensorimotor system. In: LephartSMFuFH (Eds.) Proprioception and neuromuscular control in joint stability. Champaign, IL, Human Kinetics, 2000: xvii–xxiv.
LinscheidRLDobynsJHBeaboutJWBryanRS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972, 54: 1612–32.
29.
Lluch BergadaALeon LopezMMLlusa PerezMGarcia-EliasM. Neuromuscular control of the carpus in simulated palmar midcarpal instability. Thesis in progress, Institut Kaplan, Barcelona University, Spain, 2015.
30.
MasonWTHargreavesDG. Arthroscopic thermal capsulorrhaphy for palmar midcarpal instability. J Hand Surg Eur. 2007, 32: 411–6.
31.
MataliotakisGDoukasMKostasILykissasMBatistatouABerisA. Sensory innervation of the subregions of the scapholunate interosseous ligament in relation to their structural composition. J Hand Surg Am. 2009, 34: 1413–21.
32.
O’BrienMT. An innovative orthotic design for midcarpal instability, non-dissociative: mobility with stability. J Hand Ther. 2013, 26: 363–4.
33.
PetrieSCollinsJSolomonowMWinkCChuinardR. Mechanoreceptors in the palmar wrist ligaments. J Bone Joint Surg Br. 1997, 79: 494–6.
34.
ProskeUGandeviaSC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiological reviews. 2012, 92: 1651–97.
35.
RiemannBLLephartSM. The sensorimotor system, Part I: The physiologic basis of functional joint stability. J Athl Train. 2002, 37: 71–9.
36.
RittMJde GrootPJ. A new technique for the treatment of midcarpal instability. J Wrist Surg. 2015, 4: 71–4.
37.
SalvaGGarcia-EliasM. Role of muscles in carpal stability. American Society for Surgery of the Hand/American Society for Hand Therapy Combined Meeting, San Francisco, USA, 2009.
Salva-CollGGarcia-EliasMLeon-LopezMMLlusa-PerezMRodriguez-BaezaA. Role of the extensor carpi ulnaris and its sheath on dynamic carpal stability. J Hand Surg Eur. 2011, 36: 553–9.
40.
Salva-CollGGarcia-EliasMLlusa-PerezMRodriguez-BaezaA. The role of the flexor carpi radialis muscle in scapholunate instability. J Hand Surg Am. 2011b, 36: 31–6.
41.
SherringtonCS. The integrative action of the nervous system. New Haven, CT, Yale University Press, 1906.
42.
ShigemitsuTTobeMMizutaniKMurakamiKIshikawaYSatoF. Innervation of the triangular fibrocartilage complex of the human wrist: quantitative immunohistochemical study. Anatomical Science International/Japanese Association of Anatomists. 2007, 82: 127–32.
43.
SjolanderPJohanssonHDjupsjobackaM. Spinal and supraspinal effects of activity in ligament afferents. J Electromyogr Kinesiol. 2002, 12: 167–76.
44.
SmithTOBaconHJermanEPhysiotherapy and occupational therapy interventions for people with benign joint hypermobility syndrome: a systematic review of clinical trials. Disabil Rehabil. 2014, 36: 797–803.
45.
TakebayashiTYamashitaTMinakiYIshiiS. Mechanosensitive afferent units in the lateral ligament of the ankle. J Bone Joint Surg Br. 1997, 79: 490–3.
46.
TomitaKBergerEJBergerRAKraisarinJAnKN. Distribution of nerve endings in the human dorsal radiocarpal ligament. J Hand Surg Am. 2007, 32: 466–73.
47.
ValdesKNaughtonNAlgarL. Sensorimotor interventions and assessments for the hand and wrist: a scoping review. J Hand Ther. 2014, 27: 272–85; quiz 86.
48.
Van de PolGJKoudstaalMJSchuurmanAHBleysRL. Innervation of the wrist joint and surgical perspectives of denervation. J Hand Surg Am. 2006, 31: 28–34.
49.
VekrisMDMataliotakisGIBerisAE. The scapholunate interosseous ligament afferent proprioceptive pathway: a human in vivo experimental study. J Hand Surg Am. 2011, 36: 37–46.
50.
WinterTBeckHWaltherAZwippHReinS. Influence of a proprioceptive training on functional ankle stability in young speed skaters – a prospective randomised study. J Sports Sci. 2015, 33: 831–40.
