Normative data on wrist function

Bilateral ST-coalition with thumb hypoplasia and scaphoid synchondrosis

Carpal coalitions are rare wrist anomalies and are most often diagnosed incidentally. Due to their infrequent occurrence, there is a lack of treatment guidelines in the literature. We present a case study of a 13-year-old boy who presented with symptomatic synchondrosis in both scaphoids along with a bilateral osseous coalition between the scaphoid and trapezium bones in combination with bilateral thumb hypoplasia. We initiated a 10-week immobilization of the wrist, followed by gradual increasing weight-bearing. The patient showed significant symptom relieve after immobilization, further supporting the conservative treatment. In conclusion, a definitive treatment recommendation cannot be made. For young patients, we suggest initiating conservative treatment as the first option. A precise analysis of the pathology and wrist kinematics is mandatory to recommend further therapy especially if operative interventions might be considered.

Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis

BACKGROUND

Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists.

OBJECTIVE

The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE.

METHODS

Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors.

RESULTS

Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups.

CONCLUSIONS

For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.

High Rate of Union of Scaphoid Pseudoarthrosis Treated With Arthroscopic Olecranon Bone Graft Using Antegrade Percutaneous Headless Compression Screw

PURPOSE

To assess the healing rate of scaphoid pseudoarthrosis treated with wrist arthroscopy, olecranon bone graft, and anterograde screw fixation, as well as evaluate complications and clinical and radiologic outcomes.

METHODS

All patients with scaphoid nonunion were selected between January 2017 and December 2022. Inclusion criteria were patients between 18 and 60 years of age, a diagnosis of scaphoid pseudoarthrosis, complete clinical patient-reported outcomes, radiographic measurements, and at least a 1-year follow-up. Scaphoid pseudoarthrosis was treated arthroscopically with olecranon bone graft and anterograde screw fixation. Clinical assessment was performed through visual analog scale (VAS) for pain, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, wrist range of motion using a standard goniometer, and grip strength in kilograms with a Jamar hydraulic hand dynamometer. Clinical relevance was measured with the minimal clinically important difference (MCID) for VAS and QuickDASH. Scapholunate angle was measured. Union was assessed on a computed tomography scan.

RESULTS

Seventeen patients were included with a mean follow-up of 17.2 months. The mean age was 30.1 years, and the average time from injury to arthroscopic surgery was 11.1 months. At latest follow-up, there was an improvement in VAS pain score and QuickDASH score. Range of motion and grip strength increased at last follow-up. MCID threshold for the VAS and QuickDASH score was reached by 100% and 94.1%, respectively. Union was achieved in 16 patients (94.1%) after a median of 16 weeks (interquartile range, 16-20).

CONCLUSIONS

Arthroscopic treatment of scaphoid pseudoarthrosis with olecranon bone graft and antegrade percutaneous headless compression screw allows a high grade of union and improves pain and function at short-term follow-up.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Forearm rotation improves after corrective osteotomy in patients with symptomatic distal radius malunion

Objectives

Distal radius malunion can result in pain and functional complaints. One of the functional problems that can affect daily life is impaired forearm rotation. The primary aim of this study was to investigate the effect of corrective osteotomy for distal radius malunion on forearm rotation at 12 months after surgery. We secondarily studied the effect on grip strength, radiological measurements, and patient-reported outcome measurements (PROMs).

Patients and methods

This cohort study analysed prospectively collected data of adult patients with symptomatic distal radius malunion. All patients underwent corrective osteotomy for malunion and were followed for 1 year. We measured forearm rotation (pronation and supination) and grip strength and analysed radiographs. PROMs consisted of the Patient-Rated Hand/Wrist Evaluation (PRWHE) questionnaire, Visual Analogue Scale for pain, and satisfaction with hand function.

Results

Preoperative total forearm rotation was 112° (SD: 34°), of which supination of 49° (SD: 25°) was more impaired than pronation of 63° (SD: 17°). Twelve months after surgery, an unpaired Student's t-test showed a significant improvement of total forearm rotation to 142° (SD: 17°) (p < 0.05). Pronation improved to 72° (SD: 10°), and supination to 69° (SD: 13°) (p < 0.05). Grip strength, PROMs, as well as inclination and volar tilt on radiographs improved significantly during the first year after surgery (p < 0.05).

Conclusion

In patients with reduced forearm rotation due to distal radius malunion, corrective osteotomy is an effective treatment that significantly improves forearm rotation. In addition, this intervention improves grip strength, the PRWHE-score, pain, and satisfaction with hand function.

Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study

We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.Level of evidence: II.

Comparison of Intramedullary Screw Fixation, Plating, and K-Wires for Metacarpal Fracture Fixation: A Meta-Analysis

BACKGROUND

Metacarpal fractures are common injuries with multiple options for fixation. Our purpose was to compare outcomes in metacarpal fractures treated with intramedullary screw fixation (IMF), Kirschner wires (K-wires), or plating.

METHODS

A systematic literature review using the MEDLINE database was performed for studies investigating metacarpal fractures treated with IMF, plating, or K-wires. We identified 34 studies (9 IMF, 8 plating, 17 K-wires). A meta-analysis using both mixed and fixed effects models was performed. Outcome measures included mean Disabilities of the Arm, Shoulder, and Hand (DASH) scores, total active motion (TAM), grip strength, time to radiographic healing, and rates of infection and reoperation.

RESULTS

Patients with IMF had significantly lower DASH scores (0.6 [95% confidence interval [CI], 0.2-1.0]) compared with K-wires (7.4 [4.8-9.9]) and plating (9.8 [5.3-14.3]). Intramedullary screw fixation also had significantly lower rates of reoperation (4%, [2%-7%]), compared with K-wires (11% [7%-16%]) and plating (11% [0.07-0.17]). Grip strength was significantly higher in IMF (104.4% [97.0-111.8]) compared with K-wires (88.5%, [88.3-88.7]) and plating (90.3%, [85.4-95.2]). Mean odds ratio time was similar between IMF (21.0 minutes [10.4-31.6]) and K-wires (20.8 minutes [14.0-27.6]), but both were shorter compared with plating (52.6 minutes [33.1-72.1]). There were no statistically significant differences in time to radiographic healing, TAM, or rates of reoperation or infection.

CONCLUSIONS

This meta-analysis compared the outcomes of metacarpal fixation with IMF, K-wires, or plating. Intramedullary screw fixation provided statistically significant lower DASH scores, higher grip strength, and lower rates of reoperation, suggesting that it is a comparable method of fixation to K-wires and plating for metacarpal fractures.

Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures: A Prospective Cohort Study

OBJECTIVES

To identify patient-related factors and fracture characteristics influencing the functional outcomes of nonoperatively treated radial head fractures and to determine function at 1 year.

DESIGN

Prospective cohort study.

SETTING

Academic Level 1 trauma center.

PATIENTS/PARTICIPANTS

Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016.

INTERVENTION

Nonoperative treatment of isolated radial head fractures.

OUTCOME MEASUREMENTS

Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and range of motion at 1.5-3-6-12 months.

RESULTS

One hundred fourteen patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3], and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with, respectively, 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups ( P < 0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1 year ( P < 0.05).

CONCLUSIONS

Although most nonoperatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1 year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow for interventions that may optimize function.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Wrist motion is distinct between touch screen and manual or digital devices

BACKGROUND

Restricted motion during touch screen device use may contribute to wrist overuse injuries. Wrist radioulnar deviation and extension while using touch screen devices and digital or manual counterparts in male and female medical professional dominant and non-dominant hands were quantified to test the hypothesis that mobile touch screen device use reduces wrist motion.

METHODS

An active motion detection system was used to record wrist motion of 12 participants while: tablet swiping and turning book pages; raising a cell and traditional phone to the ear; texting and typing; and entering numbers on a cell phone and manual calculator. Medial and lateral wrist surface range of motion (ROM) and minimum and maximum wrist radial-ulnar deviation and flexion-extension were quantified.

RESULTS

Device, sex and handedness effects were determined (P<0.05). Maximum medial radial deviation and ROM were greater using a cell versus traditional phone. Maximum medial radial deviation was higher in the nondominant wrist during backward tablet swiping and while backward page turning versus tablet swiping. Maximum and minimum medial extension angles and ROM were greater while typing versus texting. Female nondominant hand maximum lateral extension and ROM were greater for typing versus texting and maximum medial extension and lateral extension ROM greater during manual versus cell phone calculator use with handedness combined. Maximum lateral extension and ROM were greater in females versus males using manual calculators.

CONCLUSIONS

Sex and handedness should instruct touch screen, digital and manual device design and use for optimal performance and injury prevention.

Residual dorsal displacement following surgery in distal radial fractures: A cause for trouble?

PURPOSE

Distal radius fractures have great impact on activities of daily living of affected patients. Repeatedly, a non-anatomic restoration of the volar tilt can be observed in a minimum of 20% in postoperative X-ray control examinations. Hence, the question arises whether the achieved reduction is functionally acceptable, or whether a further attempt should be made to improve the surgical outcome.

METHODS

The data presented here originate from a prospective analysis including three therapy studies on surgical treatment options for fractures of the distal radius between 2004 and 2011. For this study, the participants were divided into two groups: The first group represents the cases with non-anatomical restoration of the volar tilt with - 5° to 5°. The second group contains patients with an anatomical volar tilt between 6° and 15°.

RESULTS

A total of 624 patients were screened according to the inclusion criteria. Radiological evaluation showed consolidation of all fractures. The mean volar tilt as measured in standard x-rays of the wrist was 0° and 8°, respectively. The range of wrist motion in relation of the healthy opposite side was comparable in all directions (for example comparison group 1: Ext/Flex 94/94%; group 2: Ext/Flex 93/93%). Functional assessment of postoperative midterm results employing the Castaing and Gartland & Werley scores 2.3 years after surgery did not reveal significant differences between both groups.

CONCLUSION

According to the available data, a volar tilt in the range of - 5° to 5° can be tolerated intraoperatively without any risk of loss of function regarding the patient's manual abilities.

Reconstruction of the Fourth Metacarpal Using a Chimeric Medial Femoral Condyle Vascularized Osteochondral Cutaneous Graft: Case Report

BACKGROUND

The medial femoral condyle has become a matter of great interest, thanks to the possibility of harvesting versatile chimeric flaps for reconstruction of metacarpal defects with minimal donor site morbidity. This case stands out because of the complete reconstruction of the metacarpal head, harvesting with a skin paddle for tension-free closure and monitoring, and the use of external fixation for better predictability of the reconstruction and early postoperative mobilization.

CASE PRESENTATION

We report the case of a 20-year-old male patient who presented with an aneurysmal bone cyst involving the fourth metacarpal bone. The patient underwent resection en bloc of the metaphysis and distal epiphysis of the fourth metacarpal bone, and the bone defect was reconstructed using a 3.4-cm vascularized osteochondral cutaneous graft from the medial femoral condyle.

RESULTS

At 1-year follow-up, the patient showed no impairment in hand range of motion and had a Disabilities of Arm, Shoulder and Hand score inferior to that of the male healthy population. Almost 5 years after the procedure, the radiographic examination did not reveal signs of arthrosis. This case report shows that the medial femoral condyle is an excellent and versatile source of vascularized osteochondral grafts for reconstruction of metacarpal defects.

Combined Treatment of Trapeziometacarpal Joint Arthritis and Scapholunate Advanced Collapse Wrist

PURPOSE

The combined treatment of trapeziometacarpal joint arthritis and scapholunate advanced collapse (SLAC) wrist presents unique challenges. The consequences of the loss of radial column support caused by scaphoidectomy and trapeziectomy are not well known. The purpose of this study was to evaluate the outcomes of the simultaneous and staged treatment of trapeziometacarpal joint arthritis and SLAC wrist.

METHODS

A retrospective review of patients who underwent surgery for both trapeziometacarpal joint arthritis and SLAC wrist was performed. The wrist and thumb range of motion; grip and pinch strength; pain; quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; and radiographs were analyzed.

RESULTS

Twenty-four patients who underwent both trapeziectomy and 1 of 3 procedures for SLAC wrist (4-corner fusion [n = 10]), proximal row carpectomy [n = 9], and total wrist arthroplasty [n = 5]) in a single stage (n = 10) or in 2 stages (n = 14) were included. The median age was 63 years. The median follow-up period was 35 months. Twelve (50%) patients underwent complete scaphoidectomy, and 12 (50%) patients underwent partial scaphoidectomy. All 3 procedures resulted in an improvement in pain at rest, pain during activity, and quick Disabilities of the Arm, Shoulder and Hand scores. The final range of motion, grip and pinch strength, and complication rates were consistent with those reported in the literature for isolated procedures.

CONCLUSIONS

Trapeziometacarpal joint arthritis and SLAC wrist may be treated either simultaneously or in stages.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Comparison of Wrist Motion and Grip Strength between Normal Caucasian, Southern Chinese and Japanese Populations

Background: Differences in structure and function of the hand and wrist between distinct populations affect our approach to treatment, expectations and functional outcomes. The aim of this study is to compare wrist motion and grip strength in Caucasian, Chinese and Japanese populations. Methods: A total of 424 normal wrists were evaluated that included 99 Japanese, 139 Caucasian and 186 Southern Chinese. Demographic information collected included age, gender, hand dominance and occupation. Evaluation included measurement of active motion and grip strength. Motion was measured using a goniometer. Grip strength was evaluated using a JAMAR dynamometer. Demographic information and evaluation was compared among the three cohorts using statistical tests. Multivariate mixed-effect model was further used to assess the racial impact on each evaluation controlling for demographic factors as well as two-hand measurements of everyone. Results: There was no difference in global wrist motion between the cohorts. We did find significant differences between the cohorts in all discrete measurements. Conclusions: Differences in wrist motion and grip strength between normal Japanese, Chinese and Caucasian populations may be due to bony structure rather than soft tissue properties. Knowledge of these disparities can provide references for personalised wrist examination, diagnosis, treatment and comparison of outcomes between different cohorts. Level of Evidence: Level III (Diagnostic).

Grip strength in healthy Israeli adults: Comparison to internationally reported normative data

BACKGROUND: Grip strength is frequently used in research and clinical work and is commonly compared to normative data in clinical settings. To enable accurate interpretation of grip strength values, normative reference values should be close to the demographic, occupational, cultural and geographic characteristics of the individual tested. OBJECTIVE: Investigate the effects of gender, age, work-group and hand dominance on grip strength for the Israeli population, and to compare the grip strength to two normative studies from the United States. METHODS: A cross sectional study. The grip strength of 637 healthy adults was measured using a Jamar dynamometer. The effects for age, gender, hand dominance, and work strain were investigated. Israeli sample results were compared to US norms. RESULTS: Within the Israeli sample, a significant age effect was found for both men and women. This effect was most apparent among the 70+ age groups, in which grip strength was weaker than all the other groups. Males were significantly stronger than females, in both hands, and the dominant hand was significantly stronger, regardless of gender. Results also demonstrated a medium to large effect for type of work on grip strength portraying high manual strain workers to have stronger grip strength. Overall, the grip strength in the Israeli sample was weaker than both US samples. CONCLUSION: Clinicians should be cautious when comparing grip strength to published norms from a different culture/geographical region. The amount of manual strain invested in various occupational roles should be considered in the assessment and intervention process.

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes

PURPOSE

To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of nonunion.

METHODS

Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed.

RESULTS

Twenty-two patients were included. The average follow-up period was 32.5 months. The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001). The minimal clinically important difference threshold for the DASH score was reached by 100% of patients. At final follow-up, all patients had united scaphoid with no complications. The average time to union was 15.3 weeks. Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic nonunion (> 1 year) (17.75 kg vs 12.25 kg, P = .032), between grade IV nonunion and grade V nonunion (14.86 kg vs 10.43 kg, P = .035), and between grade V nonunion and grade VI nonunion (10.43 kg vs 15.63 kg, P = .013). Patients with grade VI nonunion achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV nonunion (11.4 weeks, P = .014).

CONCLUSIONS

Arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of nonunion.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Four-dimensional CT analysis of carpal kinematics: An explorative study on the effect of sex and hand-dominance

Wrist pathology is often diagnosed by using the contralateral wrist as a comparison of baseline motion and strength. However, recent range of motion studies suggest that females have different carpal motion patterns compared to males and that the dominant carpal bones have different motion patterns. The purpose of this study is to evaluate the effect of sex and hand dominance on in vivo kinematics of the scaphoid, lunate and capitate using four-dimensional computed tomography (4D-CT) analysis in healthy uninjured volunteers. In this prospective study, both wrist of 20 uninjured Caucasian volunteers (11 men and 9 women) were assessed using 4D-CT during active flexion-extension and radial-ulnar deviation. A linear mixed model was used to compare the carpal motion patterns. Sex had no influence on carpal kinematics. Hand-dominance in males did have a significant effect on carpal kinematics. During flexion-extension of the male wrist, more radial-ulnar deviation of the lunate, scaphoid and capitate of the non-dominant hand was seen. During radial-ulnar deviation of the male wrist, radial-ulnar deviation and pro-supination of the lunate was more in the dominant hand. This study provides a better understanding of carpal kinematics and the effect of sex and hand-dominance on the scaphoid, lunate and capitate in uninjured wrists.

Long-term outcome after arthroscopic debridement of Palmer type 2C central degenerative lesions of the triangular fibrocartilage complex

PURPOSE

The purpose of this study was to report long-term objective and patient-reported outcome after arthroscopic debridement of central degenerative triangular fibrocartilage complex (TFCC) lesions.

METHODS

A total of 17 patients with central degenerative TFCC (Palmer type 2C) lesions and ulnar positive variance who were treated by arthroscopic debridement were retrospectively reviewed. Mean follow-up was 8.8 years. Assessment facilitating the Modified Mayo Wrist score (MMWS), the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH score), recording of pain level and of patient satisfaction, and radiological examination were done.

RESULTS

Patients reached a pain level of 1.7 VAS, MMW score of 92, and DASH score of 22. No significant differences could be detected between the operated and the contralateral extremity regarding range of motion and grip strength for all patients. No perioperative complications occurred.

CONCLUSION

Arthroscopic debridement of central degenerative TFCC lesions is safe, reliable, and efficacious even for ulnar positive variance.

LEVEL OF EVIDENCE

Therapeutic IV.

Predictors for Clinical Outcomes Related to Upper Extremity Musculoskeletal Disorders in a Healthy Working Population

A wide range of endpoints and methods of analysis can be observed in occupational health studies in the context of work-related musculoskeletal disorders (WMSDs). Comparison of study results is therefore difficult. We investigated the association between different clinical endpoints and the presence of upper extremity WMSDs in a healthy working population. Furthermore, the influence of socio-demographic, work-related, and individual predictors on different endpoints was examined. Two self-administered questionnaires were distributed to 70 workers and employees. In addition, a standardized physical examination and an industry test were performed in this cross-sectional study. Correlations between WMSDs and clinical endpoints were analyzed with the Spearman method and prediction ellipses. Multiple regression models were used to study the strength of associations with a pre-defined set of potential influencing factors. The prevalence of WMSDs was 56% (39/70). Disabilities of Arm, Shoulder, and Hand (DASH) score/pain under strain showed the strongest correlations with WMSDs. When analyzing the correlation between WMSDs and pre-selected predictors, none of the predictors could be identified as a risk factor. The DASH score remains a close candidate for best surrogate endpoint for WMSDs detection. Standardized analysis methods could improve the methodological quality of future occupational health studies.

The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores in 961 Japanese volunteers

INTRODUCTION

Patient-reported outcomes recently have been used to assess treatment outcomes. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) is a particularly convenient and useful tools. However, data on the normative values of Japanese population are lacking, so the present study was conducted to gather this information.

METHODS

We assessed 1098 volunteers over 18 years of age (363 men and 735 women, average 50 years old) who had not received upper limb treatment in a medical facility. These participants included our institution's staff, their family members, and the participants in the group meetings held by institution's staff. Their occupations were also examined. We divided occupations into nonmanual and manual labor. These factors of the participants were then analyzed to clarify which (if any) influenced the QuickDASH.

RESULTS

Valid answers were obtained from 961 subjects (87.5%). The median score was 2 (mean: 4.8) in the overall population, 0 (mean: 2.6) in men, and 2.5 (mean: 6.0) in women. The scores increased with age and were higher in women than in men. There were no significant differences by manual labor. Female sex and older age were identified as factors that influenced the QuickDASH score in the multiple regression analysis. There were high correlations among QuickDASH, work and sports/music scores.

CONCLUSIONS

The present study provided QuickDASH scores for Japanese volunteers who had not received upper limb treatment in a medical facility. The scores were associated with older age and female sex. This study helps us to know the degree of potential upper limb impairment in the general population, and will help in populational strategies as primary and secondary preventive medicine for upper limb-related diseases.

Flexion-extension strength of the index-thumb system in Italian population. A cross-sectional study to gather normative data

STUDY DESIGN

Cross-sectional study.

INTRODUCTION

Flexion (Palmar Pinch, PP-MVC and Tip Pinch, TP-MVC) and extension (E-MVC) maximal voluntary contraction (MVC) of the index-thumb system offers a quick way to estimate the level of hands' impairment in several musculoskeletal and neurologic conditions.

PURPOSE OF THE STUDY

This study established normative data of PP-MVC, TP-MVC, E-MVC in the Italian population and evaluated their correlation with hand dominance, anthropometric factors, dexterity and workload level.

METHODS

In our study, 303 healthy people (150F, 153M) were recruited. Participants performed PP-MVC, TP-MVC and E-MVC tests per hand, conducted by using a pinch-gauge. T-test was used to analyze MVC means between sexes and between hands. One-way ANOVA was conducted to compare MVC means in male and female samples stratified by age (18-29, 30-44, 45-59, 60-74, +75). Spearman's correlation analysis was performed to determine anthropometric variables, dexterity and workload level effects on MVCs.

RESULTS

Medium-to-large effect sizes of age were shown in the majority of tasks. The 30 to 44 years and then +75 years age groups showed the highest and the lowest values, respectively, for both sex and both hands. Men were meanly 50% stronger, and the dominant hand showed higher values (6-10%). MVC-tests correlated moderately with weight and height weakly with dexterity and workload level.

CONCLUSIONS

After 30 to 44 years, hand strength declines in line with the normal process of aging that also entails muscle fibers and the reduction of daily activities in older adults. In relative terms, E-MVC showed the highest strength loss in the over 75 seconds. The difference between sexes was higher in E-MVC than in flexion MVCs. E-MVC seems to depend more on musculoskeletal architecture that differs from women to men, according to the highest correlation between E-MVC and anthropometric variables. Only high workload levels impacted hand strength. In heaviest occupations, no PP-MVCs differences were observed between hands.

Percutaneous fixation of acute scaphoid waist fractures: Long-term patient-reported functional outcomes and satisfaction at a mean of 11 years following surgery

The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range 17-62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. LEVEL OF EVIDENCE: Therapeutic level III (Retrospective Cohort Study).

Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis

BACKGROUND

Proximal radial nerve lesions located between the brachial plexus and its division into the superficial and deep branches are rare but severe injuries. The majority of these lesions occur in association with humerus fractures, directly during trauma or later during osteosynthesis for fracture treatment. Diagnostics and surgical interventions are often delayed. The best type of surgical treatment and the outcome to be expected often is uncertain.

METHODS

Twelve patients with proximal radial nerve lesions due to trauma or prior surgery were included in this study and underwent neurolysis (n = 6) and sural nerve graft interposition (n = 6). Retrospective analysis of the collected patient data was performed and the postoperative course was systematically evaluated. The Disabilities of the Arm, Shoulder, and Hand (DASH) and the LSUHS (Louisiana State University Health Sciences) scores were used to determine regeneration after surgery. Comparison between the patients' and calculated normative DASH scores was performed.

RESULTS

All patients had a traumatically or iatrogenically induced proximal radial nerve lesion and underwent secondary treatments. The average time from radial nerve lesion occurrence to surgical intervention was approximately four months (1.5-10 months). Eight patients (66.67%) had a humeral fracture. During follow up, no statistically significant difference between the calculated normative and the patients' DASH scores was observed. The LSUHS scores were at least satisfactory.

CONCLUSIONS

Neurolysis or sural nerve graft interposition performed within a specific period of time are the primary treatment options for radial nerve lesions. They should be performed depending on the lesion type. Regeneration to a satisfactory degree was observed in all patients, and the majority achieved full recovery of sensory and motor functions. This was the first study to highlight the efficiency of neurolysis and sural nerve graft interposition as secondary treatment interventions, especially for radial nerve lesions.

Pain, function, and patient satisfaction after arthroscopic treatment of elbow in a retrospective series with minimum of 5-year follow-up

BACKGROUND

The clinical indications for elbow arthroscopic procedures have expanded through last decades. The aim of the study was to assess the functional results and patient satisfaction after arthroscopic treatment of various elbow conditions after a minimum 5-year follow-up.

METHODS

We conducted a retrospective study of a consecutive patient cohort who had undergone unilateral elbow arthroscopy between 2008 and 2010. The main outcomes were Disabilities of the Arm, Shoulder and Hand (DASH) score and a specific patient-reported outcome measure questionnaire after a minimum 5-year follow-up.

RESULTS

In total, there were 93 patients in the cohort with different diagnoses. Majority of patients were suffering from elbow osteoarthrosis. After the average follow-up of 72 months (range 60-96 months), the response rate was 67%. Eighty two percent of patients were satisfied with the pain relief and locking of the elbow was relieved in 70% of patients. Elbow range of motion (ROM) improved in 80% of the 55 patients who had a limited ROM before the operation. The overall patient satisfaction after elbow arthroscopic treatment was good. There were no differences in median DASH score between patients with or without post-traumatic condition, but the median DASH score for patients who had severe (grade 3) osteoarthrosis before the operation was significantly worse. There were no major complications reported in this cohort.

CONCLUSIONS

Arthroscopic treatment of various elbow conditions was associated with good patient satisfaction and reduced symptoms without major complications. Level of Evidence: Level IV, therapeutic case series.

Is Repetitive Workload a Risk Factor for Upper Extremity Musculoskeletal Disorders in Surgical Device Mechanics? A Cross-Sectional Analysis

To assess the prevalence of upper extremity work-related musculoskeletal disorders (WMSDs) among surgical device mechanics compared to a control group, a total of 70 employees were included and assigned to three occupational groups (grinders, packers, and control). Personal factors, work exposure, manual skill, and complaints were assessed by two self-administered questionnaires and an industry test. WMSDs were diagnosed in a standardised clinical examination. The two-one-sided t-tests (TOST) procedure was used to test the clinical equivalence of the respective grinding and packaging groups vs. the control group in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score. Thirty-nine study participants (56%) experienced at least one WMSD at the elbow, forearm, and/or wrist, mainly with signs of epicondylitis and nerve entrapment at the medial elbow. The risk of grinders developing upper extremity WMSD was about 2.5-times higher and packers had an 8.6-fold higher risk of a clinically relevant DASH > 29 compared to the control group. However, these differences were not statistically significant. The groups were also proven to be clinically equivalent in terms of DASH score. Surgical device mechanics do not seem to have worse DASH values or be at higher risk of upper limb WMSDs compared to a control group. This is the first study to analyse and compare different workplaces in this industry that are also common in other industries.

Functional outcomes after salvage procedures for the destroyed wrist: an overview

The most widely used procedures for salvaging a destroyed wrist are four-corner arthrodesis, radiocarpal arthrodesis, proximal row carpectomy, total wrist arthrodesis, and total wrist replacement or resurfacing. The purpose of this article is to give an overview of the functional results obtained with the various salvage procedures and of the common methods for assessing the surgical outcomes. The outcomes are assessed by clinical measurements and scoring methods, but the actual functional status and well-being of the patients should be presented together with patient-reported outcomes. No salvage procedure can restore entirely full wrist function. Understanding indications, risks, and the outcomes of these procedures would favour a better decision for surgery and help choose the proper treatment from among the surgical options discussed with patients.

Variation of Grip Strength and Wrist Range of Motion with Forearm Rotation in Healthy Young Volunteers Aged 23 to 30

Background Grip strength and wrist range of motion (ROM) are important metrics used to evaluate hand rehabilitation and outcomes of wrist interventions. Published normative data on these metrics do not recognize the contribution of forearm rotation. This study aims to identify and quantify variations in grip strength and wrist ROM with forearm rotation in healthy young individuals. Materials and Methods Wrist ROM and grip strength were measured in 30 healthy volunteers aged 23 to 30. Participant demographics, grip strength, and wrist ROM (wrist flexion and extension, ulnar and radial deviation) at three forearm positions (full supination, neutral, and full pronation) were measured using a digital dynamometer and standard goniometers. Data analysis was conducted using a one-way repeated measure ANOVA. Forearm position values were compared using post hoc analysis. Results Grip strength in males was greatest in neutral position (males: nondominant 51.4 kg, dominant 56.1 kg) followed by supination (males: nondominant 46.6 kg, dominant 51.7 kg) and weakest in pronation (males: nondominant 40.1 kg, dominant 42.9 kg). Grip strength in females was similar between supination (nondominant: 26.1 kg, dominant: 28.5 kg) and neutral (nondominant: 27.4 kg, dominant: 29.1 kg) positions, but both were greater than in pronation (nondominant: 22.3 kg, dominant: 24.1 kg). Wrist flexion in males was significantly reduced in supination compared with neutral and pronated positions (nondominant: supination 63.1°, neutral 72.6°, pronation 73.3°; dominant: supination 62.4°, neutral 70.2°, pronation 70.3°), whereas not significant wrist flexion in females was also weaker in supination (supination 74.4°, neutral 79.9°). Wrist extension in males was greater in pronation (supination 64.6°, pronation 69.5°) whereas females showed no significant difference in any of the forearm positions. Ulnar deviation in males did not differ with forearm position, but females demonstrated greater ulnar deviation in supination on the nondominant hand (supination 44.6°, pronation 33.2°). Whereas there was no difference in radial deviation with forearm position in females, it was markedly greater in pronation versus supination on both sides in males (nondominant: supination 16.3°, pronation 24.6°; dominant: supination 15.4°, pronation 23.9°). Conclusion This study characterizes variations in grip strength and wrist ROM in three forearm positions in healthy young individuals. All measurements differed with forearm rotation and were not influenced by hand dominance. These results suggest that wrist ROM and grip strength should be evaluated in different positions of forearm rotation, rather than a fixed position. This has functional implications particularly in patients involved with specialized activities such as sports, instrument-playing, or work-related activities.

Utility of the iPhone 4 Gyroscope Application in the Measurement of Wrist Motion

BACKGROUND

Measurement of wrist range of motion (ROM) is important to all aspects of treatment and rehabilitation of upper extremity conditions. Recently, gyroscopes have been used to measure ROM and may be more precise than manual evaluations. The purpose of this study was to evaluate the use of the iPhone gyroscope application and compare it with use of a goniometer, specifically evaluating its accuracy and ease of use.

METHODS

A cross-sectional study evaluated adult Caucasian participants, with no evidence of wrist pathology. Wrist ROM measurements in 306 wrists using the 2 methods were compared. Demographic information was collected including age, sex, and occupation. Analysis included mixed models and Bland-Altman plots.

RESULTS

Wrist motion was similar between the 2 methods. Technical difficulties were encountered with gyroscope use. Age was an independent predictor of ROM.

CONCLUSIONS

Correct measurement of ROM is critical to guide, compare, and evaluate treatment and rehabilitation of the upper extremity. Inaccurate measurements could mislead the surgeon and harm patient adherence with therapy or surgeon instruction. An application used by the patient could improve adherence but needs to be reliable and easy to use. Evaluation is necessary before utilization of such an application. This study supports revision of the application on the iPhone to improve ease of use.

Asymptomatic reference values for the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation - electronic data collection and its clinical implications

The purpose of this study was to establish normal asymptomatic population values for the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation in healthy, asymptomatic individuals of different age, gender, ethnicity, handedness and nationality, using electronic data collection. Two-hundred and ninety-two Australian and 293 Canadian citizens with no active wrist pain, injury or pathology in their dominant hand, were evaluated. Participants completed an electronically administered questionnaire and were assessed clinically. There was no statistically significant association between both wrist scores and nationality. There was a statistically significant association between both wrist scores and age, demonstrating that as age increased, normal wrist function declined. This study has established an electronic, asymptomatic control group for future studies using these scores. When using the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation, the control group can be sourced from a pre-established control group within a database, without necessarily being sourced from the same country of origin. Level of evidence: II.

Forearm Torque and Lifting Strength: Normative Data

PURPOSE

To establish reference values for new methods designed to quantitatively measure forearm torque and lifting strength and to compare these values with grip strength.

METHODS

A total of 499 volunteers, 262 males and 237 females, aged 15 to 85 (mean, 44) years, were tested for lifting strength and forearm torque with the Kern and Baseline dynamometers. These individuals were also tested for grip strength with a Jamar dynamometer. Standardized procedures were used and information about sex, height, weight, hand dominance, and whether their work involved high or low manual strain was collected.

RESULTS

Men had approximately 70% higher forearm torque and lifting strength compared with females. Male subjects aged 26 to 35 years and female subjects aged 36 to 45 years showed highest strength values. In patients with dominant right side, 61% to 78% had a higher or equal strength on this side in the different tests performed. In patients with dominant left side, the corresponding proportions varied between 41% and 65%. There was a high correlation between grip strength and forearm torque and lifting strength. Sex, body height, body weight, and age showed a significant correlation to the strength measurements. In a multiple regression model sex, age (entered as linear and squared) could explain 51% to 63% of the total variances of forearm torque strength and 30% to 36% of lifting strength.

CONCLUSIONS

Reference values for lifting strength and forearm torque to be used in clinical practice were acquired. Grip strength has a high correlation to forearm torque and lifting strength. Sex, age, and height can be used to predict forearm torque and lifting strength. Prediction equations using these variables were generated.

CLINICAL RELEVANCE

Normative data of forearm torque and lifting strength might improve the quality of assessment of wrist and forearm disorders as well as their treatments.

Corticocancellous bone graft vs cancellous bone graft for the management of unstable scaphoid nonunion

INTRODUCTION

This study was undertaken to determine whether corticocancellous bone grafting and cancellous bone grafting differ in terms of bone union rate, restoration of scaphoid anatomy, and wrist function when unstable scaphoid nonunions are concomitantly treated by screw fixation.

MATERIALS AND METHODS

This is retrospective cohort study. In Group A (17 patients), unstable scaphoid nonunion was treated with corticocancellous graft harvested from the iliac crest and headless compression screw using volar approach. In Group B (18 patients), unstable scaphoid nonunion was treated with cancellous graft harvested from the distal radius or iliac crest and headless compression screw using volar approach Mean time to union was measured using CT image. Scaphoid deformity was also measured using lateral intrascaphoid angle and height to length ratio using CT images. Wrist functional status was assessed by measuring grip strength, wrist range of motion, and DASH score at 1 year postoperatively.

RESULTS

Mean time to union was significantly greater in Group A (15 weeks vs. 11 weeks). No significant intergroup difference was observed for lateral intrascaphoid angle and height to length ratio after treatment of scaphoid nonunion. No significant intergroup difference was observed for grip strength, wrist range of motion, or DASH scores at 1 year postoperatively.

CONCLUSIONS

Cancellous bone grafting was found to lead to earlier bone union than corticocancellous bone grafting and to similar restorations of scaphoid deformity and wrist function when scaphoid nonunion was treated by headless compression screw fixation and bone grafting.

LEVEL OF EVIDENCE

Prognostic, III.

Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

Background  The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose  To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods  A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67-78; SD 4.6). Mean follow-up time was 48.2 months (34-59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results  There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30-40 degrees), extension of 30 degrees (range: 20-42 degrees), radial deviation of 18 degrees (range: 10-30 degrees), and ulnar deviation of 15 degrees (range: 0-25 degrees). The mean key pinch was 4.2 kg (range: 0.5-10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0-19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion  RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence  Level IV, therapeutic study.

[Grip strength measurement : Significance and boundaries]

BACKGROUND

Grip strength measurement is a widely used method for clinical as well as scientific purposes. In hand surgery, it is an essential component in the diagnosis of disease, treatment sequences and assessment. In epidemiological studies, it is a good predictor of healthy ageing or disease progression.

PROBLEM

Measurement results and their interpretation can be influenced by many factors. The historical development of dynamometry, measurement technology and the standard values in various population groups are presented. Comparisons with standard values should only be made using current tables because the grip strength has changed in recent decades. Assessment of the voluntarily submaximal grip strength remains problematic. Proposals are made for how to assess grip strength during the evaluation.

Natural history and factors associated with ulnar-sided wrist pain in distal radial fractures treated by plate fixation

We documented longitudinal changes in the incidence of ulnar-sided wrist pain after distal radial fractures treated by plate fixation and identified factors associated with ulnar-sided wrist pain. A total of 140 patients were enrolled in this study. Radiographs were taken 3 months after operation, and were used to measure radial inclination, anterior angulation and ulnar variance, and to identify the presence of an ulnar styloid fracture. Clinical assessments at the same time included grip strengths, ranges of wrist motion and the patient-rated wrist evaluation questionnaire. The presence of ulnar-sided wrist pain was noted at each follow-up visit. The incidence of ulnar-sided wrist pain decreased significantly with time after surgery (22 patients at 3 months, 11 patients at 6 months and three patients at 12 months). The mean age, sex, the presence of an ulnar styloid fracture and the classification of the distal radial fracture were not factors that were associated with a higher incidence of ulnar-sided wrist pain, but there was an association between higher patient-rated wrist evaluation scores and the presence of ulnar-sided wrist pain.

LEVEL OF EVIDENCE

Prognosis, Level IV.

Assessing the Reliability of Ultrasound Imaging to Examine Radial Nerve Excursion

Ultrasound imaging allows cost effective in vivo analysis for quantifying peripheral nerve excursion. This study used ultrasound imaging to quantify longitudinal radial nerve excursion during various active and passive wrist movements in healthy participants. Frame-by-frame cross-correlation software allowed calculation of nerve excursion from video sequences. The reliability of ultrasound measurement of longitudinal radial nerve excursion was moderate to high (intraclass correlation coefficient range = 0.63-0.86, standard error of measurement 0.19-0.48). Radial nerve excursion ranged from 0.41 to 4.03 mm induced by wrist flexion and 0.28 to 2.91 mm induced by wrist ulnar deviation. No significant difference was seen in radial nerve excursion during either wrist movement (p > 0.05). Wrist movements performed in forearm supination produced larger overall nerve excursion (1.41 ± 0.32 mm) compared with those performed in forearm pronation (1.06 ± 0.31 mm) (p < 0.01). Real-time ultrasound is a reliable, cost-effective, in vivo method for analysis of radial nerve excursion.

Determinants of Grip Strength in Tunisian Nurses: A Bicentric Study

Background

Grip muscle force has always been used to assess functional limitations in elderly. Its use as a tool to assess work capacity has never been described in the literature.

Objective

To describe the patent determinants of grip strength and the usefulness of its measurement in assessing workability index in the healthcare sector.

Methods

This is a cross-sectional study conducted in a sample of 293 healthcare workers representative of 1181 based on a comprehensive questionnaire about socio-professional characteristics and on an 8-item work capacity evaluation (WAI). Besides, Body mass index was measured and muscle strength was assessed by JAMAR hydraulic dynamometer.

Results

Handgrip Strength was stronger in male nurses (p < 0.001), with low perceived physical load (p = 0.0001) and working on a night shift (p = 0.001). It decreased with a greater duration of household work (p < 0.0001) and increased with a greater BMI (p = 0.015) and a better workability index (p < 0.0001). After removal of all the variables that were not independently associated with the muscle strength force, factors accounting for 52.6% of the variance in nurses handgrip strength were gender (p < 0.001), workability index (p < 0.001), duration of household work (p = 0.021), BMI (p = 0.002), perceived physical load (p < 0.001) and work schedule (p = 0.002).

Conclusion

Grip Strength Test is a useful tool to assess strength and functional capacity at work in healthcare workers. Further longitudinal studies are required to confirm this hypothesis.

Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures

BACKGROUND

Severe angulation or shortening can be a surgical indication for fifth metacarpal neck fracture. In a previous meta-analysis, antegrade intramedullary pinning was shown to produce better hand function outcomes than percutaneous transverse pinning or miniplate fixation for treatment of fifth metacarpal neck fractures. However, the outcomes of retrograde intramedullary pinning, to our knowledge, have not been compared with those of antegrade intramedullary pinning.

QUESTIONS/PURPOSES

We asked whether the clinical and radiographic outcomes of antegrade intramedullary pinning are different from those of percutaneous retrograde intramedullary pinning for treating patients with displaced fifth metacarpal neck fractures.

METHODS

Forty-six patients with displaced fifth metacarpal neck fractures with an apex dorsal angulation greater than 30° were enrolled in our prospective study. Subjects were treated randomly by antegrade intramedullary pinning (antegrade group) or by percutaneous retrograde intramedullary pinning (retrograde group). Clinical evaluations, which included active ROM of the fifth metacarpophalangeal joint, VAS for pain, grip strength, and DASH score, were performed at 3 months and 6 months postoperatively. Radiographic evaluations of apex dorsal angulation and axial shortening were performed preoperatively and 6 months postoperatively.

RESULTS

Patients in the antegrade group achieved better outcomes than patients in the retrograde group for all clinical parameters at 3 months postoperatively (ROM: antegrade median 80° [range, 57°-90°] versus retrograde 69° [range, 45°-90°], difference of medians 11°, p < 0.001; VAS: antegrade median of 2 [range, 0-5] versus retrograde 4 [range, 0-7], difference of medians 2, p < 0.001; grip strength: antegrade median 81% [range, 60%-100%] versus retrograde 71% [range, 49%-98%], differences of medians 10%, p < 0.001; DASH: antegrade median 4.3 [range, 0-15.8] versus retrograde 10.3 [range, 0-28.4], difference of medians 6, p < 0.001), but these differences, with the numbers available, were not observed at 6 months postoperatively for any clinical parameters (ROM: antegrade median 88° [range, 81°-90°] versus retrograde 87° [range, 80°-90°], difference of medians 1°, p = 0.35; VAS: antegrade median 1 [range, 0-2] versus retrograde 1[range, 0-3], difference of medians 0, p = 0.67; grip strength: antegrade median 93% [range, 78%-104%] versus retrograde 91% [range, 76%-101%], difference of medians 2%, p = 0.41; DASH: antegrade median 3 [range, 0-12.5] versus retrograde of 4.3 [range, 0-15.8], difference of medians 1.3, p = 0.48). At 6 months postoperatively, there also were no differences, with the numbers available, in radiographic parameters between the antegrade and retrograde fixation groups. Residual angulation was not different (antegrade median: 7° [range, 2°-11°], retrograde: 9° [range, 3°-13°], difference of medians 2°, p = 0.56). Shortening between the two groups also was not different (antegrade median: 1 mm [range, 0 mm-2 mm], retrograde median: 1 mm [range, 0 mm-2 mm], difference of medians 0, p = 0.78).

CONCLUSION

Our study findings suggest antegrade intramedullary pinning has some clinical advantages during the early recovery period over percutaneous retrograde intramedullary pinning for treatment of displaced fifth metacarpal neck fractures, but the advantages are not evident at 6 months postoperatively. In addition, our study showed no differences in radiographic outcomes between antegrade and retrograde techniques. For patients who require an early return of hand function, such as athletes, antegrade intramedullary pinning can be recommended. Otherwise, treatment could be decided according to the surgeon's preference and patient status, and based on consideration of the need for an accessory procedure for pin removal after antegrade intramedullary pinning.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Timed Sollerman hand function test for analysis of hand function in normal volunteers

This study describes the development and application of the timed Sollerman hand function test in normal volunteers and the effect of age, gender, dominance and handedness on hand function. A total of 100 volunteers (50 men and 50 women) aged between 20 to 70 years were asked to complete the Sollerman hand function test. We measured the time taken to complete the 20 tasks using seven grips. Volunteers completed the tasks a mean of 20 seconds quicker with the dominant than with the nondominant hand. Individuals who are strongly right-handed showed a pronounced difference taking less time with the dominant hand. Women took less time to complete all tasks in age groups 30 to 40 years, than women in age groups 20 to 30 years and beyond 40 years using the dominant hand. Men also showed worsening performance with age. The centile curves of the total time taken to complete all 20 Sollerman tasks between the ages of 20 to 70 years will allow investigators to adjust their findings for age before attributing observed differences to disease or its treatment.

Functionality after arthroscopic debridement of central triangular fibrocartilage tears with central perforations

PURPOSE

To investigate functional and subjective outcome parameters after arthroscopic debridement of central articular disc lesions (Palmer type 2C) and to correlate these findings with ulna length.

METHODS

Fifty patients (15 men; 35 women; mean age, 47 y) with Palmer type 2C lesions underwent arthroscopic debridement. Nine of these patients (3 men; 6 women; mean static ulnar variance, 2.4 mm; SD, 0.5 mm) later underwent ulnar shortening osteotomy because of persistent pain and had a mean follow-up of 36 months. Mean follow-up was 38 months for patients with debridement only (mean static ulnar variance, 0.5 mm; SD, 1.2 mm). Examination parameters included range of motion, grip and pinch strengths, pain (visual analog scale), and functional outcome scores (Modified Mayo Wrist score [MMWS] and Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire).

RESULTS

Patients who had debridement only reached a DASH questionnaire score of 18 and an MMWS of 89 with significant pain reduction from 7.6 to 2.0 on the visual analog scale. Patients with additional ulnar shortening reached a DASH questionnaire score of 18 and an MMWS of 88, with significant pain reduction from 7.4 to 2.5. Neither surgical treatment compromised grip and pinch strength in comparison with the contralateral side. We identified 1.8 mm or more of positive ulnar variance as an indication for early ulnar shortening in the case of persistent ulnar-sided wrist pain after arthroscopic debridement.

CONCLUSIONS

Arthroscopic debridement was a sufficient and reliable treatment option for the majority of patients with Palmer type 2C lesions. Because reliable predictors of the necessity for ulnar shortening are lacking, we recommend arthroscopic debridement as a first-line treatment for all triangular fibrocartilage 2C lesions, and, in the presence of persistent ulnar-sided wrist pain, ulnar shortening osteotomy after an interval of 6 months. Ulnar shortening proved to be sufficient and safe for these patients. Patients with persistent ulnar-sided wrist pain after debridement who had preoperative static positive ulnar variance of 1.8 mm or more may be treated by ulnar shortening earlier in order to spare them prolonged symptoms.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Sex differences in task distribution and task exposures among Danish house painters: an observational study combining questionnaire data with biomechanical measurements

Objectives

Sex differences in occupational biomechanical exposures may be part of the explanation why musculoskeletal complaints and disorders tend to be more common among women than among men. We aimed to determine possible sex differences in task distribution and task-specific postures and movements of the upper extremities among Danish house painters, and to establish sex-specific task exposure matrices.

Methods

To obtain task distributions, we sent out a questionnaire to all members of the Painters' Union in Denmark (N = 9364), of whom 53% responded. Respondents reported their task distributions in a typical week. To obtain task exposures, postures and movements were measured in 25 male and 25 female house painters for one whole working day per person. We used goniometers on the wrists, and inclinometers on the forehead and the upper arms. Participants filled in a logbook allowing task-specific exposures to be identified. Percentiles and % time with non-neutral postures were used to characterise postures. Velocity, range of motion, repetitiveness, and variation were used as measures of movement. Cochran-Mantel-Haenszel statistics and unpaired double-sided t-tests with post-hoc Bonferroni correction were used to evaluate sex differences.

Results

Statistically significant (p<0.05) sex differences were revealed in task proportions, but the proportions differed by less than 4%. For task exposures, no statistically significant sex differences were found.

Conclusions

Only minor sex differences were found in task distribution and task exposures regarding postures and movements among Danish house painters. Sex-specific task exposure matrices were established.

Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint

INTRODUCTION

The dorsal capsular imbrication of the distal radioulnar joint (DRUJ) which was performed because of posttraumatic dorsal instability showed promising functional results after the first postoperative years. Therefore, we hypothesized that patients after capsular imbrication are characterized by good subjective and functional outcome measurements after a midterm period.

MATERIALS AND METHODS

Eleven patients (range 21-50 years of age; median 35 years of age) were examined after capsular imbrication of the DRUJ because of posttraumatic instability with a mean follow-up time of 72 months (range 46-114 months; median 66 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and functional outcome scores (modified Mayo wrist score (MMWS); Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)).

RESULTS

A mean DASH score of 6.7 (range 0-22.5) and mean MMWS of 91.8 (range 75-100) were measured. Grip strength reached 96.7 % of the contralateral hand. Range of motion reached at least 93.1 % of the contralateral hand. Eight of 11 patients regarded functional outcome and pain reduction as excellent. Six of 11 patients did not recognize a diagnosed instability of DRUJ as such. Ulnar-sided wrist pain was the apparent symptom in these cases.

CONCLUSIONS

Capsular imbrication of the DRUJ is a reliable and sufficient treatment option in case of posttraumatic dorsal instability. Since DRUJ instability is seldom recognized by the patients as such, a standardised diagnostic algorithm is mandatory to guarantee reliability and efficacy for identifying DRUJ instability.

The effect of brachioradialis release during distal radius fracture fixation on elbow flexion strength and wrist function

PURPOSE

To identify whether brachioradialis (BR) release during volar plate fixation for a distal radius fracture affects elbow flexion strength and wrist function.

METHODS

A total of 42 consecutive patients who were treated by open reduction volar plate fixation for unstable distal radius fractures were enrolled in this study. The BR was not released in 20 of 42 patients (BR preserved group) and was released in 22 patients (BR released group). The primary outcome variable was isokinetic strength and endurance testing of elbow flexion measured by the Cybex isokinetic system 3 months after surgery. Measured at the same time, secondary outcome variables were grip strength, a visual analog scale score for wrist pain, Disabilities of the Arm, Shoulder, and Hand score, and radiographic parameters. We used Mann-Whitney U tests to compare these variables between groups.

RESULTS

Neither elbow flexion strength and endurance nor any of the secondary outcome variables differed significantly between groups.

CONCLUSIONS

Release of the BR during a volar approach for a distal radius fracture did not adversely affect elbow flexion strength and wrist function.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic III.

The physical function intensive care test: implementation in survivors of critical illness

BACKGROUND

Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population.

OBJECTIVE

The purpose of this study was to determine the responsiveness and predictive capabilities of the PFIT-s in patients in the United States admitted to the ICU who required mechanical ventilation (MV) for 4 days or longer.

METHODS

This nested study within a randomized trial administered the PFIT-s, Medical Research Council (MRC) sum score, and grip strength test at ICU recruitment and then weekly until hospital discharge, including at ICU discharge. Spearman rho was used to determine validity. The effect size index was used to calculate measurement responsiveness for the PFIT-s. The receiver operating characteristic curve was used in predicting participants' ability to perform functional components of the PFIT-s.

RESULTS

From August 2009 to July 2012, 51 patients were recruited from 4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s scores were highly correlated to MRC sum scores (rho=.923) and grip strength (rho=.763) (P<.0005). Using baseline test with ICU discharge (26 pairs), test responsiveness was large (1.14). At ICU discharge, an MRC sum score cut-point of 41.5 predicted participants' ability to perform the standing components of the PFIT-s.

LIMITATIONS

The small sample size was a limitation. However, the findings are consistent with those in a larger sample from Australia.

CONCLUSIONS

The PFIT-s is a feasible and valid measure of function for individuals who require MV for 4 days or longer and who are alert, able to follow commands, and have sufficient strength to participate.

Quality assessment in hand surgery

Measuring quality assessment in hand surgery remains an underexplored area. However, measuring quality is becoming increasingly transparent and important. Patients now have direct access to hospital and physician metrics and large payers have linked financial incentives to quality metrics. It is critical for hand surgeons to understand the essential elements of quality and its assessment. This article reviews several areas of hand surgery quality assessments including safety, outcomes, satisfaction, and cost.

What is the minimum clinically important difference in grip strength?

BACKGROUND

Grip strength reflects functional status of the upper extremity and has been used in many of the clinical studies regarding upper extremity disease or fracture. However, the smallest difference in grip strength that a patient would notice as an improvement resulting from treatment (defined as the minimum clinically important difference [MCID]), to our knowledge has not been determined.

QUESTIONS/PURPOSES

We asked (1) how 1-year postsurgery grip strength compares with preinjury values; (2) if grip strength correlated with patient's ratings; (3) what the MCID is in the grip strength; and (4) if these values are equivalent to or greater than what can be explained by measurement errors in patients treated for distal radius fracture.

METHODS

Fifty patients treated by volar locking plate fixation for a distal radius fracture constituted the study cohort. Grip strengths were measured 1 year after surgery on the injured and uninjured sides using a dynamometer. Grip strengths before injury were estimated using the grip strengths of the uninjured side with consideration of hand dominance. Patients were asked to rate their subjective level of grip strength weakness at 1 year postoperatively. Receiver operator characteristic curve analysis was used to determine MCIDs. Minimal detectable change in grip strength, which is a statistical estimate of the smallest change between two measurement points expected by measurement error or chance alone, also was determined using the formula 1.65 × √2 × standard error of measurement.

RESULTS

One year after surgery, grip strength (23 kg; 95% CI, 20-27) was less compared with calculated preinjury values (28 kg; 95% CI, 25-31; p < 0.001). Patients' rating of grip strength and measured grip strength changes correlated well (p = 0.56). MCIDs were 6.5 kg for grip strength and 19.5% for percentage grip strength. The MCID was not less than the minimum detectable change for grip strength (also 6.5 kg).

CONCLUSIONS

The MCID of the grip strength was a decrease of 6.5 kg (19.5%). We believe the MCID of grip strength is useful for evaluating effectiveness of new treatments and for determining appropriate sample size in clinical trials of distal radius fractures.

LEVEL OF EVIDENCE

Level III diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

Functionality of middle-aged women after resection-interposition arthroplasty of the trapeziometacarpal joint in comparison to a healthy control group

INTRODUCTION

Trapeziometacarpal joint osteoarthritis is a very common degenerative joint disease which affects especially women between their fifth and sixth decade of life. To determine the final pinch, grip and functional outcome after trapeziometacarpal arthroplasty and to compare to non-arthritic controls, we hypothesized that patients after the former surgery are expected to have lower grip and pinch strength and a higher DASH score.

MATERIALS AND METHODS

44 women (range 50-65 years of age; median 57 years of age) were examined after resection-interposition arthroplasty because of trapeziometacarpal joint osteoarthritis Eaton-Littler stage 3 and 4 with a minimum follow-up time of 12 months (range 12-99 months; median 47 months) using DASH questionnaire and grip and pinch strength evaluation. The control group consisted of 107 healthy age-matched controls (range 50-64 years of age; median 54 years of age). Differences between both groups were statistically analysed using analysis of covariance.

RESULTS

A significant loss of pinch strength and a significant higher DASH score were detected for the patient group in comparison to the controls, whereas grip strength did not differ significantly.

CONCLUSIONS

A loss of pinch strength in conjunction with a higher DASH score was detected. The expected loss of pinch strength in conjunction with a reduced physical functionality should be discussed preoperatively with the patient to meet the expectations and to offer the best suitable treatment option.

Comparative study of the closed reduction percutaneous cannulated screw fixation and open reduction palmar locking plate fixation in the treatment of AO type A2 distal radius fractures

INTRODUCTION

The present study was designed to demonstrate the efficacy of standard 4.0 mm cannulated screw fixation by comparing it with palmar locking plate fixation in the treatment of acute, unstable, simple extra-articular distal radius fractures.

MATERIALS AND METHODS

We prospectively collected and retrospectively analyzed outcomes data for 65 patients aged between 18 and 60 with AO type A2 fractures treated with closed reduction, percutaneous cannulated screw fixation (CRPCS n = 34) or open reduction palmar locking plate fixation (ORPLP n = 31). Range of motion, grip strength, Gartland-Werley and QuickDASH scores were compared at 2 months after surgery, and final follow-up (mean 32 months, range 12-90). Deterioration in radiographic parameters were measured and compared. Operative time and return to preinjury activity were evaluated.

RESULTS

Parameters did not differ significantly between the groups at either time point with respect to grip strength or range of motion, except pronation and supination; they were better in the CRPCS group (p = 0.005 and 0.025, respectively) at 2 month follow-up. The Gartland-Werley and QuickDASH scores obtained at final follow-up were similar for each group and lacked statistical significance. Group comparison for the deterioration of radiologic parameters showed no significant difference. CRPCS group had significantly shorter operative time (p = 0.001) and there was no significant differences between the groups regarding the return to preinjury activity (p = 0.129).

CONCLUSIONS

CRPCS group was found to be as successful as ORPLP group and it may be suitable in the case of young, active individuals with AO type A2 distal radius fractures.

Predicting grip strength and key pinch using anthropometric data, DASH questionnaire and wrist range of motion

PURPOSE

The objective of this study was to examine the influence of anthropometric data, occupational manual strain, DASH (disability of arm, shoulder and hand) score and range of motion (ROM) on grip strength and key pinch. An additional goal was to develop models that enable the prediction of hand strength using the aforementioned parameters.

METHODS

Normative data generated from a healthy working population (n = 750) served as basis for the statistical analysis. Prediction models for hand strength were developed using multivariate regression analysis.

RESULTS

Gender, body weight and height, BMI and extension ROM correlate positively, age and DASH score, however, correlate negatively with grip strength and key pinch. Occupational manual strain has no influence on hand strength. The predictive power of the developed models was 68.4 % for grip strength and 57.1 % for key pinch.

CONCLUSIONS

The developed models enable the prediction of hand strength using easily obtainable data points. The models will have application in clinical practice, physiological studies, medical evidence and rehab decisions.