Three-dimensional soft tissue analysis of the hand: a novel method to investigate effects of acromegaly

LGBTQ+ Perspective in Hand Surgery: Surgeon and Patient

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals and patients face high levels of discrimination both in the workplace and in the clinic setting, with more than 25% of LGBTQ+ people experiencing discrimination in the workplace due to their sexual orientation. Hand Surgery stands to continue to advance by encouraging the brightest students into the field no matter their background. LGBTQ+ patients also have specific needs within the field of Hand Surgery, where we are uniquely positioned to treat them or guide them by being well versed in the needs of the community.

Evaluating the Impact of Acromegaly on Quality of Life

Acromegaly has a substantial negative impact on quality of life (QoL). This review aims to discuss the impact of acromegaly on QoL from the clinical perspective as well as from the patient perspective. Furthermore, it aims to evaluate the use of patient-reported outcome measures (PROMs) in acromegaly and how PROMs aid decision-making. The recommendations presented in this review are based on recent clinical evidence on the impact of acromegaly on QoL combined with the authors' own clinical experience treating patients with acromegaly. We recommend that a patient-centered approach should be considered in treatment decisions, integrating conventional biochemical outcomes, tumor control, comorbidities, treatment complications, and PROMs, including QoL measures. This more integrated approach seems effective in treating comorbidities and improving patient-reported outcomes and is critical, as many patients do not achieve biochemical or tumor control and comorbidities, impairment in QoL may not remit even when full biochemical control is achieved.

The Glittre Activities of Daily Living Test in patients with acromegaly: Associations with hand function and health-related quality of life

BACKGROUND

Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T).

OBJECTIVES

To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life.

METHODS

The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test.

RESULTS

Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (rs=-0.487, p= 0.002; rs=-0.369, p= 0.026; rs= 0.538, p= 0.0007, respectively).

CONCLUSIONS

Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.

A Review of Hand Feminization and Masculinization Techniques in Gender Affirming Therapy

INTRODUCTION

Anatomical characteristics that are incongruent with an individual's gender identity can cause significant gender dysphoria. Hands exhibit prominent dimorphic sexual features, but despite their visibility, there are limited studies examining gender affirming procedures for the hands. This review is intended to cover the anatomical features that define masculine and feminine hands, the surgical and non-surgical approaches for feminization and masculinization of the hand, and to adapt established aesthetic hand techniques for gender affirming care.

METHODS

The authors performed a comprehensive database search of PubMed, Embase OVID and SCOPUS to identify articles on the characterization of masculine or feminine hands, hand treatments related to gender affirmation, and articles related to techniques for hand masculinization and feminization in the non-transgender population.

RESULTS

From 656 possibly relevant articles, 42 met the inclusion criteria for the current literature search. There is currently no medical literature specifically exploring the surgical or non-surgical options for hand gender affirmation. The available techniques for gender affirming procedures discussed in this paper are appropriated from those more commonly used for hand rejuvenation.

CONCLUSION

There is a dearth of literature addressing the options for transgender individuals seeking gender affirming procedures of the hand. Though established procedures used for hand rejuvenation may be utilized in gender affirming care, further study is required to determine relative salience of various hand features to gender dysphoria in transgender patients of various identities, as well as development of novel techniques to meet these needs.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. .

Evaluating the accuracy of hand models obtained from two 3D scanning techniques

The aim of this study was to identify an efficient approach for 3D imaging of hand. The 3D photographs of hand were taken with Gemini structured-light scanning system (SL scanning) and CT scanning. The 3D photographs, average time of scanning and reconstruction were compared between these two indirect techniques. The reliability, reproducibility and accuracy were evaluated in these two indirect techniques and the direct measurement (DM). Statistical differences in the measurements were assessed by 99% probability, with clinical significance at > 0.5 mm. The Gemini structured-light scanning system established a complete and smooth 3D hand photograph with shorter scanning and reconstruction time. Reproducibility of CT scanning and SL scanning methods was better (P < 0.01, both) than the DM, but did not differ significantly from each other (P = 0.462). Of the 19 (31.58%) measurements obtained, 6 showed significant differences (P < 0.01). Significant differences were observed more often for circumference dimensions (5/9, 55.56%) than for length dimensions (1/10, 10%). Mean absolute error (AE) of the 10 subjects was very low for 3D CT (0.29 ± 0.10 mm) and SL scanning (0.30 ± 0.11 mm). Absolute percentage error (APE) was 4.69 ± 2.33% and 4.88 ± 2.22% for 3D CT and SL scanning, respectively. AE for the PIP circumference between the 3rd finger (0.58 mm) and 4th finger (0.53 mm) scan was > 0.5 mm, indicating significant difference between DM and CT scanning at the level of 99% probability. In this study, the Gemini structured-light scanning system not only successfully established a complete and smooth 3D hand photograph, but also shortened the scanning and reconstruction time. Compared to the DM, measurements obtained using the two indirect techniques did not show any statistically or clinically insignificant difference in the values of the remaining 17 of 19 measurements (89.47%). Therefore, either of the two alternative techniques could be used instead of the direct measurement method.

3D Facial Analysis in Acromegaly: Gender-Specific Features and Clinical Correlations

Objective: Quantitative investigations of facial changes in acromegaly are rare. A new imaging technique, three-dimensional (3D) stereophotography, can accurately quantify whole facial changes. We aimed to measure facial characteristics in acromegaly patients using 3D stereophotography, analyze gender-specific features, and explore clinical influencing factors. Design: Single-center case-control study. Methods: Thirty-nine acromegaly patients and 39 age- and gender-matched healthy subjects were prospectively enrolled. 3D stereophotography was performed, and facial lines and angles were quantified for each subject. Clinical information for each acromegaly patient was acquired. Results: The nose width, length, height and depth were longer; the upper and lower lips were thicker; the face length, face width and gonion-gnathion distances were longer; and the nasofrontal and columella-labial angles were smaller in the acromegaly patients, especially in males, than in the healthy controls, with statistical significance (p < 0.05). No differences were found in the face breadth, columella-labial angle, or nose length, height or depth between the female patient and healthy control groups. The insulin-like growth factor 1 (IGF-1) levels in the acromegaly patients were linearly and positively correlated with the nose width (p = 0.006) and gonion-gnathion distance (p = 0.029) and linearly and negatively correlated with the nasofrontal angle (p = 0.026). Conclusions: The acromegaly patients' facial changes exhibit a unique trend, and the characteristics are not identical between genders. 3D stereophotography is an accurate and reliable tool for investigating facial characteristics. Recognizing the above facial features might be potential to assist in the early diagnosis and timely treatment of acromegaly and aid in predicting the severity of systemic complications.