Management of dominant upper extremity injuries: a survey of practice patterns

Severe Upper Limb Injuries in U.S. Military Personnel: Incidence, Risk Factor and Outcomes

BACKGROUND

Severe upper limb injuries (SULI) may pose a significant public health challenge for the military; however, SULI has not been previously defined or studied in the US military. Objective: Determine SULI incidence, risk factors, and outcomes.

MATERIALS AND METHODS

Active Component (AC) U.S. military personnel who served during January 1, 2003 to December 31, 2012 who met the case definition for SULI (N = 213,745) and a random sample from the same population without SULI were included. Data from the Defense Medical Surveillance System and Defense Medical Epidemiology Database was used to calculate incidence. Multiple logistic regression and Cox proportional hazards models were used to analyze SULI risk factors and attrition.

RESULTS

SULI incidence was 15/1,000 person-years. Higher SULI risk was observed in men (OR 1.25; 95% CI 1.22-1.27), age 25-29 (OR 1.07; 95% CI 1.05-1.09) compared to age 20-24, E5-E9 (OR 1.14; 95% CI 1.12-1.17) compared to E1-E4, serving in Coast guard (OR 1.62; 95% CI 1.56-1.68) and Air Force (OR 1.17; 95% CI 1.14-1.19) relative to Army and with a deployment history (OR 2.16, 95% CI 2.12-2.19) while SULI risk was lower for blacks (OR 0.91; 95% CI 0.90-0.93) and those in the "other race" category (HR 0.81; 95% CI 0.80-0.84) compared to whites. SULI was associated with 23% increased risk of attrition (HR 1.23; 95% CI 1.22-1.24).

CONCLUSION

The study findings provide preliminary evidence on the incidence, natural history and distribution of SULI in this population. The findings indicate SULI may impact readiness and result in premature military separation.

Unilateral hand training on functional performance in patients with upper extremity trauma

STUDY DESIGN

Case series.

INTRODUCTION

Upper extremity (UE) trauma and subsequent immobilization affects functional performance.

PURPOSE OF THE STUDY

Determine the usefulness and feasibility of unilateral hand training (UHT) on improving functional performance in patients with UE trauma.

METHODS

Nine participants received UHT within 10 days of immobilization. Functional performance, dexterity, grip, and pinch strength were measured at initial and 4-week visits. Qualitative interviews were coded to develop themes.

RESULTS

All Jebsen-Taylor hand function test subtests improved from pretest to post-test. Disabilities of the Arm, Shoulder and Hand scores of all 9 participants improved. Functional performance was more impaired for participants with dominant UE injury. Four themes emerged: participants were forced to alter or avoid most daily activities, had an increased dependency on others, took longer to perform activities, and felt UHT decreased the impact of UE trauma on function.

DISCUSSION

Functional performance was impaired for all participants. Participants believed that UHT was useful and contributed to improved function.

CONCLUSION

This case series tracked a comprehensive intervention based on a holistic activities of daily living framework that considered the nuances of individual complexities of immobilization following hand trauma. Knowledge from this study supports an early intervention like UHT to educate clients on effective strategies to improve immediate activities of daily living functioning and potentially prevent longer term impairments.

Psychosocial reactions to upper extremity limb salvage: A cross-sectional study

STUDY DESIGN

Descriptive cross-sectional survey study.

INTRODUCTION

Limb salvage spares an extremity at risk for amputation after a major traumatic injury. Psychosocial recovery for individuals with lower extremity limb salvage has been discussed in the literature. However, to date, psychosocial reactions for individuals with upper extremity (UE) limb salvage have not been examined.

PURPOSE OF THE STUDY

To determine which factors may influence psychosocial adaptation to UE limb salvage.

METHODS

Participants (n = 30; 28 males) were adults (mean, 30.13; range, 18-61) who sustained an UE limb salvage from a traumatic event. Adaptation was measured using a modified version of the Reactions to Impairment and Disability Inventory.

RESULTS

A linear mixed-effects regression found that worse psychosocial adaptation was associated with having less than a college degree, being less than 6 months post-injury, being older than 23 years, and having more pain. Dominant hand injuries were found to influence poor adaptation on the denial Reactions to Impairment and Disability Inventory subscale only.

DISCUSSION

The results of this study indicate that there is potential for nonadaptive reactions and psychological distress with certain variables in UE limb salvage. Therapists may use these results to anticipate which clients may be at risk for poor psychosocial outcomes.

CONCLUSIONS

This study indicates the need for early consideration to factors that affect psychological prognosis for the UE limb salvage population. However, future research is indicated to better understand the unique psychosocial challenges and needs of these individuals.

LEVEL OF EVIDENCE

4.

The suitcase packing activity: A new evaluation of hand function

STUDY DESIGN

Prospective, repeated-measures study.

INTRODUCTION

Understanding individual hand function can assist therapists with the process of determining relevant treatment approaches and realistic therapeutic outcomes. At this point in time, a composite test that assesses both unilateral and bimanual hand function in relation to a functional activity is not available.

PURPOSE OF THE STUDY

To establish the reliability and validity of the suitcase packing activity (SPA).

METHODS

An expert panel established face and content validity. Eighty healthy, English-speaking volunteers aged between 18 and 45 years were randomly assigned to either 1 or 2 sessions (test-retest reliability). Relative agreement between 2 examiners using an intraclass correlation coefficient (ICC)_3,1 determined interrater reliability. Test-retest reliability was determined by using a repeated-measures analysis of variance and an ICC_3,2. Concurrent validity was evaluated against 2 well-established hand evaluations using separate tests of correlational coefficients.

RESULTS

Face and content validity were established across 4 focus groups. Our results demonstrate good to excellent interrater reliability (ICC_3,1 ≥ 0.93) and good to excellent test-retest reliability (ICC_3,2 ≥ 0.83). SPA scores were moderately correlated with the 2-hand evaluations.

DISCUSSION

Through evaluating hand function during participation in a goal-directed activity (eg, packing a suitcase), the SPA exhibits promise in usefulness as a future viable outcome measure that can be used to assess functional abilities following a hand injury.

CONCLUSION

The SPA is a valid and reliable tool for assessing bimanual and unilateral hand function in healthy subjects.

LEVELS OF EVIDENCE

Diagnostic level II.