title: Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament.
abstract: OBJECTIVE
  Recent publications on the sensory innervation of wrist ligaments have challenged our understanding of ligaments as mere passive restraints in wrist stability. Mechanoreceptors in ligaments have a role in signaling joint perturbations, in which the afferent information is believed to influence periarticular muscles. The scapholunate interosseous ligament is one of the most richly innervated ligaments in the wrist. The purpose of our study was to investigate the possible existence of a wrist proprioceptive reflex, by which afferent information elicited in the scapholunate interosseous ligament was hypothesized to influence the muscles moving the wrist joint.
  
  
  METHODS
  Nine volunteers (4 women and 5 men; mean age, 26 years; range, 21-28 years) participated in this study. Using ultrasound guidance, a fine-wire electrode was inserted into the dorsal scapholunate interosseous ligament and stimulated with four 1-ms pulses at 200 Hz. Electromyographic activities in extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles were recorded using surface electrodes with the wrist actively positioned in isometric extension, flexion, and radial and ulnar deviation. The average EMGs from 30 consecutive stimulations were rectified and analyzed using the Student's t-test to compare the prestimulus (t(1)) and poststimulus (t(2)) EMG activities.
  
  
  RESULTS
  Statistically significant changes in poststimulus EMG activity (t(1)- t(2)) were observed at various time intervals. Within 20 ms, an excitation was seen in the flexor carpi radialis and flexor carpi ulnaris in extension, radial and ulnar deviation, and in extensor carpi radialis brevis in flexion. Co-contractions between agonist and antagonist muscles were observed, with peaks around 150 ms after stimulus.
  
  
  CONCLUSIONS
  We present evidence of wrist ligamento-muscular reactions. The early-onset reactions may serve in a joint-protective manner, and later co-contractions indicate a supraspinal control of wrist neuromuscular stability. These findings contribute new information to the physiologic functions of the wrist joint, which may further our understanding of dynamic wrist stability and serve as a foundation for future studies on proprioceptive dysfunctions after wrist ligament injuries.
authors.affiliation: Department of Clinical Science and Education, Section of Hand Surgery, Karolinska Institute, Södersjukhuset, Stockholm, Sweden. elisabet.hagert@ki.se
authors.forename: Elisabet
authors.initials: E
authors.lastname: Hagert
authors.forename: Jonas K E
authors.initials: JK
authors.lastname: Persson
authors.forename: Michael
authors.initials: M
authors.lastname: Werner
authors.forename: Björn-Ove
authors.initials: BO
authors.lastname: Ljung
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000502:physiology; D004576:Electromyography; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D008023:Ligaments, Articular / Q000294:innervation*; D012667:Lunate Bone / Q000294:innervation*; D008297:Male; D008465:Mechanoreceptors / Q000502:physiology*; D018482:Muscle, Skeletal / Q000294:innervation; D011434:Proprioception / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology; D012026:Reflex, Stretch / Q000502:physiology*; D021361:Scaphoid Bone / Q000294:innervation*; D014953:Wrist / Q000294:innervation*; D055815:Young Adult