title: The role of proprioception and neuromuscular stability in carpal instabilities.
abstract: 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.
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden Hand & Foot Surgery Center, Stockholm, Sweden elisabet.hagert@ki.se.
authors.forename: E
authors.initials: E
authors.lastname: Hagert
authors.affiliation: Institut Kaplan, Barcelona, Spain Department of Orthopaedic Surgery, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lluch
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital 'Carl Gustav Carus', Dresden, Germany Department of Hand and Plastic Surgery, Burn Unit, Berufsgenos-senschaftliche Klinik Bergmannstrost, Halle (Saale), Germany.
authors.forename: S
authors.initials: S
authors.lastname: Rein
mesh_terms: D050824:Carpal Joints / Q000294:innervation* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000628:therapy; D008023:Ligaments, Articular / Q000294:innervation / Q000503:physiopathology / Q000601:surgery; D008465:Mechanoreceptors / Q000502:physiology; D019637:Orthopedic Procedures; D009989:Orthotic Devices; D026741:Physical Therapy Modalities; D011434:Proprioception / Q000502:physiology; D012018:Reflex / Q000502:physiology; D014955:Wrist Joint / Q000294:innervation / Q000502:physiology
keywords: Carpal instability; joint innervation; mechanoreceptors; neuromuscular control; proprioception; wrist