Musculoskeletal balance of the human wrist elucidated using intraoperative laser diffraction.

This review describes a series of experiments in which sarcomere length was measured in human wrist muscles to understand their design. Sarcomere length measurements were combined with studies on cadaveric extremities to generate biomechanical models of human wrist function and to provide insights into the mechanism by which wrist strength balance is achieved. Intraoperative measurements of the human extensor carpi radialis brevis (ECRB) muscle during wrist joint rotation reveal that this muscle appears to be designed to operate on the descending limb of its length-tension curve and generates maximum tension with the wrist fully extended. Interestingly, the synergistic extensor carpi radialis longus (ECRL) also operates on its descending limb but over a much narrower sarcomere length range. This is due to the longer fibers and smaller wrist extension moment arm of the ECRL compared to the ECRB. Sarcomere lengths measured from wrist flexors are shorter compared to the extensors. Using a combination of intrapoperative measurements on the flexor carpi ulnaris (FCU) and mechanical measurements of wrist muscles, joints and tendons, the general design of the prime wrist movers emerges: both muscle groups generate maximum force with the wrist fully extended. As the wrist flexes, force decreases due to extensor lengthening along the descending limb of their length-tension curve and flexor shortening along the ascending limb of their length-tension curve. The net result is a nearly constant ratio of flexor to extensor torque over the wrist range of motion and a wrist that is most stable in full extension. These experiments demonstrate the elegant match between muscle, tendon and joints acting at the wrist. Overall, the wrist torque motors appear to be designed for balance and control rather than maximum torque generating capacity.