# How Do Wrist Surgical Salvage Procedures Limit Hand Strength?

> **NIH VA I01** · EDWARD HINES JR VA HOSPITAL · 2021 · —

## Abstract

Wrist osteoarthritis has been described as “one of the most common conditions encountered by the
orthopaedic surgeon”. In men older than 60, severe osteoarthritis is more frequently present at the wrist than
the hip. The wrist is a complicated joint that implant technology has failed to effectively replicate. As a result,
surgical salvage procedures are commonly used to treat osteoarthritis at the wrist, unlike at the hip or knee
where joint replacement is the gold standard. The two most common surgical salvage procedures are
scaphoid-excision four-corner fusion (SE4CF) and proximal row carpectomy (PRC). In each procedure, the
arthritic scaphoid bone is removed. In SE4CF, the midcarpal joint (the interface between the remaining bones
in the proximal and distal rows) is fused to prevent carpal collapse in the absence of the scaphoid. In PRC, the
lengths of the carpus and distal upper limb are shortened because the two additional bones (lunate, triquetrum)
that articulate with the forearm are also removed. These drastic geometric and kinematic re-designs
permanently decrease wrist range of motion and grip strength. Loss of grip strength is particularly detrimental;
it limits patient's abilities to perform activities of daily living, such as picking up a saucepan, unscrewing a jar
lid, and opening a door. Why grip strength is lost following surgical salvage procedures is not understood. Our
long-term goal is to develop innovative orthopaedic surgical interventions for wrist osteoarthritis. The objective
of this proposal, the next step toward attainment of that goal, is to determine why grip force is limited following
PRC and SE4CF. Our central hypothesis is that the surgical re-design of the wrist in PRC and SE4CF impose
mechanical differences in muscle function at the wrist joint, and it is these effects that ultimately limit hand
strength post-operatively. Our hypothesis was developed based on our preliminary work, in which we first
characterized biomechanical differences between muscle mechanical capabilities in nonimpaired and
surgically salvaged wrist joints in cadaveric specimens, and then demonstrated the impact of these mechanical
effects on lateral pinch strength using computer simulation. The rationale that underlies the proposed research
is that improving surgical interventions for wrist osteoarthritis first requires understanding how changing the
kinematic and geometric design of the wrist joint influences the hand's ability to generate force. Ultimately, the
research studies proposed here will improve the scientific understanding of how the design of the wrist
influences both wrist and hand function. This knowledge will aid therapists in designing rehabilitation protocols
targeted at specific points of biomechanical weakness and surgeons in developing novel surgical techniques to
reduce biomechanical changes. For example, if muscle adaptations cause wrist extensors to be weaker
following PRC, a tendon transfer to strengthen these muscle...

## Key facts

- **NIH application ID:** 10322969
- **Project number:** 5I01RX001990-05
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** Wendy M Murray
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2016-08-01 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10322969

## Citation

> US National Institutes of Health, RePORTER application 10322969, How Do Wrist Surgical Salvage Procedures Limit Hand Strength? (5I01RX001990-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10322969. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*