Evaluating the effectiveness of gloves in reducing the hazards of hand-transmitted vibration

OBJECTIVES

A method of evaluating the effectiveness of gloves in reducing the hazards of hand-transmitted vibration is proposed.

METHOD

The glove isolation effectiveness was calculated from: (a) the measured transmissibility of a glove, (b) the vibration spectrum on the handle of a specific tool (or class of tools), and (c) the frequency weighting indicating the degree to which different frequencies of vibration cause injury. With previously reported tool vibration spectra and glove transmissibilities (from 10-1000 Hz), the method was used to test 10 gloves with 20 different powered tools.

RESULTS

The frequency weighting for hand-transmitted vibration advocated in British standard 6842 (1987) and international standard 5349 (1986) greatly influences the apparent isolation effectiveness of gloves. With the frequency weighting, the gloves had little effect on the transmission of vibration to the hand from most of the tools. Only for two or three tools (those dominated by high frequency vibration) did any glove provide useful attenuation. Without the frequency weighting, some gloves showed useful attenuation of the vibration on most powered tools.

CONCLUSIONS

In view of the uncertain effect of the vibration frequency in the causation of disorders from hand-transmitted vibration, it is provisionally suggested that the wearing of a glove by the user of a particular vibratory tool could be encouraged if the glove reduces the transmission of vibration when it is evaluated without the frequency weighting and does not increase the vibration when it is evaluated with the frequency weighting. A current international standard for the measurement and evaluation of the vibration transmitted by gloves can classify a glove as an antivibration glove when it provides no useful attenuation of vibration, whereas a glove providing useful attenuation of vibration on a specific tool can fail the test.

Acute transient bilateral trigger fingers

A 30-year-old man presented with bilateral, simultaneous, transient triggering of the middle digits which developed acutely after prolonged and sustained use of a garden rotavator. He was asymptomatic in the period before presentation and has remained so 7 years since.

Self-inflicted bite injuries associated with intracerebral haemorrhages

A case of self-inflicted bite injuries of the fingers with an episode of small intracerebral haemorrhages is presented. There were many injuries on the right fingers. The tip of the right forefinger was bitten off, and some small pieces of the finger had been aspirated and swallowed. This unusual case seemed to be an emotional response to pain from cerebral episode.

Hamate fracture with dislocation of the ring and little finger metacarpals

We report a displaced body of hamate fracture in the coronal plane with dislocation of the ring and little metacarpals and interposition of these metacarpals between the two hamate fragments. The diagnosis, radiographic studies and the treatment of this unusual injury are discussed.

Low-velocity gunshot wounds of the proximal phalanx: treatment by early stable fixation

Twenty-eight proximal phalangeal fractures secondary to low-velocity gunshot wounds in 27 patients treated by stable fixation were retrospectively reviewed. Definitive fixation was performed within 1 week of injury. Fractures were stabilized with either a plate, intramedullary spacer, or a combination of both. When necessary, supplemental fixation was achieved with cerclage wires or interfragmentary screws. Twenty fractures with bone loss or comminution were primarily supplemented with iliac crest bone graft. After surgery, the fingers were splinted in 90 degrees of metacarpophalangeal (MP) flexion. An aggressive supervised therapy program was initiated within 24 hours of surgery. The average length of follow-up care was 9 months (range, 3-29 months). Primary union was achieved in all fractures. The average range of motion was 83 degrees for the MP joint and 66 degrees for the proximal interphalangeal joint. The average total active motion (TAM) for the involved digits was 200 degrees (range, 65 degrees-250 degrees). Fractures without intra-articular extension had a significantly better average TAM (213 degrees) than did those with intra-articular extension (169 degrees; p = .05). Primary bone grafting did not adversely effect the final TAM. There were no infections. Early stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.

Snowblower injuries to the hand

We retrospectively reviewed the records of 62 patients who sustained serious hand injuries caused by snowblowers between 1981 and 1990. Frequency of injuries to digits tended to correlate with length (i.e., middle, index, ring, or small finger or thumb). Damage to tendons did not seem to follow any particular pattern. The majority of victims sustained multiple digital involvement. Complete versus partial amputation followed the same length distribution as did injured digits. Most of the injuries occurred to the dominant hand. When patients were further questioned regarding the circumstances and events leading to their injury, a recurring pattern was found. Most patients described a wet, heavy snow having recently fallen. The majority of the patients who were injured by placing their hands into the exit chute admitted that they were aware the machine was running, but thought that they had a greater clearance to the rotating impeller blade.

Isolated subluxation of the extensor pollicis longus tendon. A cause of 'boutonnière' deformity of the thumb

Isolated ulnar subluxation of the extensor pollicis longus (EPL) tendon occurs when there is damage to the radial side of the extensor hood on the dorsum of the metacarpophalangeal joint of the thumb. The thumb collapses into a pseudoboutonnière deformity because the EPL tendon subluxes and comes to lie palmar to the centre of rotation of the metacarpophalangeal joint to act as a flexor instead of an extensor. The extensor pollicis brevis tendon which lies in a deeper plane to the EPL is unaffected. We describe four cases and propose conservative treatment as being effective in recent injuries.

Rupture of the flexor tendons of the little finger in fractures of the hook of the hamate bone. Report of two cases

Two cases of rupture of the flexor tendons of the little finger associated with a fracture of the hook of the hamate bone are presented. The preoperative diagnosis had not been made. Excision of the fractured hook and repair of the tendons by a short graft from the palmaris longus in one case and by the transfer of the superficial flexor of the ring finger in the other case gave a good final result. The authors remark on the rarity of reports of this fracture in the literature, the frequent occurrence of nonunion and the two complications which are exceptional; rupture of the flexor tendons and compression of the deep branch of the ulnar nerve. The fracture is mainly encountered in sports that require the grasping of a handle (tennis, golf, hockey, squash). The diagnosis is often missed at the onset because of not using the correct X-ray positioning: special incidence for the carpal tunnel view and a 3/4 view with the wrist in 45 degrees of supination and forced radial deviation.

Extensor tendon rupture due to Kienböck's disease

Extensor tendon rupture as a complication of Kienbock's disease is rare. We report a case of attritional rupture of the extensor tendon to the index finger by a comminuted dorsal fragment of the lunate after Kienböck's disease in an elderly woman. Excision of the fragment and extensor reconstruction with tendon graft led to a favourable result.

Late results after microvascular reconstruction of severe crush and avulsion injuries of the upper extremity

From 1978 to 1985, a total of 64 patients underwent successful hand and digit replantation/revascularisation for salvage after crush and avulsion trauma to their upper extremities. Forty-seven of them (39 males and 8 females) were followed between 10 and 17 years (mean: 12.6 years). The average age was 33.2 years. In 39 patients, replantations were performed: 37 digits (including seven thumbs), two hands, and three midhands. Eight patients underwent revascularizations in cases of subtotal amputations: two in the midhand, three at the wrist, and three at the lower arm. Concomitant injury to the hand or forearm was a feature of all cases. In 45 percent of the study population, secondary reconstructions were necessary. Outcomes were evaluated using Chen's classification (1981) and showed that 19 percent of the patients were classified grade 1, 49 percent grade II, 28 percent grade III, and 4 percent grade IV. Results demonstrated a greater patient age in the grade III group, and relatively more secondary operations in the grade IV patients.

Sharps injuries involving a sheathed needle

Two dental nurses each sustained a sharps injury while attempting to remove the sheathed needle from a used dental local anaesthetic syringe. The needle had been bent inadvertently during use. Neither of the dental nurses were aware that the needle had perforated the side of the sheath during resheathing. This incident emphasises the need for constant vigilance during the disposal of sharps and for the routine avoidance of direct contact with sheathed or unsheathed needles and other sharps after use.

[Causes for reoperations after osteosyntheses of finger and mid-hand fractures]

31 patients reoperated after osteosynthesis of a metacarpal or a phalangeal fracture were reviewed over a period of three years. The cause of injury was in 18 cases a crush, in six cases a fall, in five cases a saw injury, and in two cases axial trauma. A postoperative plaster splint immobilisation over a period of at least three weeks was carried out in 29 cases. Reoperation was necessary in most of the cases because of a loss of range of motion and a nonunion. The complication rate was independent of the method of fixation, but did depend on the type of injury. Fractures associated with soft tissue injury were more likely to develop complications.

Closed rupture of a finger extensor following the Sauvé-Kapandji procedure: a case report

A case of closed rupture of the ring extensor digitorum tendon following performance of the Sauvé-Kapandji procedure is presented. This complication is not rare following performance of the Darrach procedure. The operative findings indicated that the rupture was caused by an impingement of the tendon between the proximal stump of the ulna and the extensor retinaculum. The patient was successfully treated with shortening of the proximal ulnar stump and tendon transfer.

Influence of local vibration on finger functions of forest workers

We physically examined of forest workers in the northern part of Fukushima District, Japan. The main purpose of this study was to survey the state of finger functions, especially the differences between the functions of right and left fingers of forest workers. This physical examination was conducted in winter. The items of the physical examination were hand grip strength, finger skin temperature, vibration sensation threshold, nail pressure test of the finger. Subjects were classified into A and B groups on the base of the results of the physical examination. A group is normal or slight disorder, and B group is disorder or illness. Hand grip strength was measured five times at five-second intervals. The decrease ratio of the left hand grip strength was greater than that of the right hand grip strength. Although there were significant differences among each finger of A and B groups, there were no big differences in the skin temperatures of the fingers in each group. Vibration sensation threshold was measured for II, III and IV fingers. The vibration sensation threshold of the index finger was the most sensitive and that of IV finger was the least sensitive. The vibration sensation threshold of the right fingers was more sensitive than that of the left fingers. The reaction times of the nail pressure test of the right fingers were generally faster than those of the left fingers. Forestry workers in Japan become elderly. There are big differences among the physical reactions or strengths of elderly people. Standard values for the measuring items for ageing are needed.

Pediatric hand injuries due to exercise bicycles

METHODS

This is a 5-year retrospective review of hand injuries caused by exercise bicycles among 34 children.

RESULTS

Mean age was 3 years and 5 months. Accidents were caused most commonly by impingement of the fingers between the chain and sprocket wheel (77%), but injuries caused by spinning wheel spokes (23%) were generally more severe. Injuries were usually of the avulsion type and ranged in severity from lacerations (43%) to fractures (19%) to amputations (38%). The central digits (87%) were involved more frequently than the border digits (13%). Replantation was possible for 33% of the amputated digits, with 50% of the fingers surviving.

CONCLUSION

The avulsive nature of these injuries should be taken into consideration when attempting replantation. Increased community awareness and equipment safety modifications are needed to eliminate this preventable problem.

[Rehabilitation of hand injured co-workers from the occupational medicine viewpoint (exemplified by a chassis and montage automobile industry]

The majority (about 25%) of work-related accidents involves injuries to the hands and fingers. Depending on type and severity of the injury, it can have profound consequences to an individual's professional future. Due to this basic insight, hand rehabilitation must include vocational rehabilitation.

Anatomical factors predisposing to focal dystonia in the musician's hand--principles, theoretical examples, clinical significance

In this paper, anatomical interconnections between tendons, between tendons and their environment, and anatomical constraints on joint mobility are considered as possible causes of focal dystonia in the hand of the musician. By hypothesis, focal dystonias arise when the constraints on movement resulting from these anatomic limitations impede playing movements with sufficiently low energy expenditure. This hypothesis is modelled for connections between the deep finger flexors. The displacements, forces, stresses, and work per volume in the finger motors in some common piano playing movements are calculated. The results indicate that with mentioned connections, in certain movements the extensor and lumbrical, and in others the lumbrical and interossei are most strained, while the interossei may become the main power source in loaded instrumental movements. Also discussed are compensatory movements. The biomechanical principles of surgical and conservative treatment are summarised.

Association of rattlesnake bite location with severity of clinical manifestations

STUDY OBJECTIVE

To examine an association between bite location in cases of North American crotalid envenomation and the severity of clinical manifestations.

METHODS

We conducted a retrospective review of prospectively collected data for an experimental trial of crotalid antivenom. Our subjects were otherwise healthy individuals with minimal to moderate North American crotalid envenomation. We compared the severity of envenomation for patients with digit bites distal to the proximal interphalangeal joint and bites more proximal using a previously developed and validated snakebite severity score.

RESULTS

Thirteen subjects were classified as having distal bites and 24 as having proximal bites. At baseline (before antivenom administration), the distal group had a mean severity score of 2.9 +/- 1.1, whereas the proximal group had a mean severity score of 5.0 +/- 2.2 (P = .0024). Patients in the proximal group tended to demonstrate a more rapid initial decline in severity score after receiving antivenom than did the distal group.

CONCLUSION

In minimal to moderate North America crotalid envenomation, patients who sustained bites on distal aspects the digits tended to experience less severe clinical manifestations of envenomation. It is possible that an isolated bite to the distal aspect of a finger is an early marker of minimal envenomation.

Flexor tendon ruptures caused by an intraosseous ganglion of the hook of the hamate

A rare case of pathological rupture of the flexor tendons of the small finger caused by an intraosseous ganglion of the hook of the hamate is described.

Complete avulsion of the extensor apparatus of the little finger

We report a case of simultaneous closed avulsions of the terminal extensor insertion and the central slip of the little finger which required operative treatment.

Irreducible dorsal dislocation of the distal interphalangeal joint: case report and literature review

An irreducible dorsal dislocation of the DIP joint is a rare injury. Irreducibility is primarily caused, in closed injuries, by the interposed volar plate, and in open injuries by the dislocated FDP tendon. It is important to recognize the complex nature of this dislocation and to limit attempts at closed reduction. Early surgical exploration, anatomic reduction, and early mobilization are prerequisites to good functional recovery.