Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Lalone, Emily A

2nd Supervisor

Walton, David M



The defining symptom, and often the major reason for seeking medical treatment associated with most clinical disorders of the hand and wrist, is pain. However, pain mechanisms following MSK trauma are complex, multifactorial, and remain largely unknown.As such, this thesis sought to understand pain mechanisms in hand and wrist MSK pathologies, using imaging-based biomarkers and gold-standard pain evaluation techniques. Chapter 2 presents an exploratory analysis on the interacting influences of sex on multi-modal pain evaluation techniques that tap different pain domains. Our results highlight the importance of multiple pain measures when creating sex-specific intervention strategies, as the accuracy of predicting ones’ clinical pain evaluation scores did not show true difference greater than chance. Chapter 3 explores the use of imaging-based biomarkers, namely subchondral volumetric bone mineral density (vBMD) and static joint contact area (JCA), to differentiate between two study cohorts. On average, our healthy cohort had a higher vBMD for all measured depths from the subchondral surface of the distal radius. Chapter 4 presents the relationship between subchondral vBMD and kinematic JCA throughout a range of motion in a healthy cohort of adults to understand the impact of joint contact on subchondral bone. In deep regions of subchondral bone, a higher vBMD was significantly correlated to a larger JCA, most notably during wrist extension. Lastly, Chapter 5 explores the preliminary association between structural and clinical disease progression, using pain evaluation measures and our imaging-based biomarkers, in a cohort of thumb carpometacarpal osteoarthritis (CMC OA) patients. Our preliminary results demonstrated that structural severity was significantly associated with a higher pain score and pain presentation was heterogeneous.

Summary for Lay Audience

The defining symptom, and often the major reason for seeking medical treatment associated with most clinical disorders of the hand and wrist, is pain. However, pain following hand and wrist musculoskeletal (MSK) trauma is likely due to several factors and remains largely unknown. The focus of this thesis is to explore underlying causes of pain associated with hand and wrist MSK trauma using imaging techniques and standard pain evaluation measures. The first project in this thesis was designed to explore the relationships between different forms of pain evaluation measures and how the sex of the participant may impact this relationship. We did this by comparing the results obtained from the pain measures between males and females, to determine whether there were consistencies (or differences) in the responses. Our results demonstrated the importance of using multiple pain measures to capture different aspects of the persons’ pain experience. We also demonstrated that males and females likely respond to pain measures differently, and it is important to acknowledge this in studies moving forward. The second project in this thesis was designed to explore our imaging techniques in obtaining objective measures (biomarkers) to better understand pain. Specifically, we looked at bone density and the contact between bones as potential pain contributors. Bone density is thought to be a contributor to pain because of its rich blood and nerve supply. The contact between bones influences bone density, and as such we wanted to explore these two markers to differentiate between a healthy group of people and a group of people who have experienced some form of hand or wrist trauma. On average, the healthy group had an overall higher bone density than the hand or wrist trauma group. This finding encouraged us to explore this association further. The third project investigated the connection between bone density and joint movement in healthy adults, finding that a larger contact area between bones was linked to higher bone density, particularly during certain movements. The final project explored the connection between structural changes to the joint and pain in patients with thumb osteoarthritis. The initial findings from this project suggest that more severe structural changes to the thumb joint (such as a more progressed state of thumb osteoarthritis), were associated with more pain. Using the pain measures introduced in the first project, the results also demonstrated that pain symptoms varied among patients with thumb osteoarthritis. With all this information, we may be able to tailor treatment strategies aimed at minimizing pain following hand and wrist trauma.