Associations between pinch strength, cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis

BACKGROUND AND AIMS

Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD.

METHODS

Data were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan-Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association.

RESULTS

During a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan-Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64-0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77-1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10-1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased.

CONCLUSIONS

PS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD.

Are there any benefits for post-operative splinting after carpal tunnel release? A systematic review and meta-analysis

BACKGROUND

There is a controversy on the effectiveness of post-operating splinting in patients with carpal tunnel release (CTR) surgery. This study aimed to systematically evaluate various outcomes regarding the effectiveness of post-operating splinting in CTR surgery.

METHODS

Multiple databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, were searched for terms related to carpal tunnel syndrome. A total of eight studies involving 596 patients were included in this meta-analysis. The quality of studies was evaluated, and their risk of bias was calculated using the methodological index for non-randomized studies (MINORS) and Cochrane's collaboration tool for assessing the risk of bias in randomized controlled trials. Data including the visual analogue scale (VAS), pinch strength, grip strength, two-point discrimination, symptom severity score (SSS), and functional status scale (FSS) were extracted.

RESULTS

Our analysis showed no significant differences between the splinted and non-splinted groups based on the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. The calculated values of the standardized mean difference (SMD) or the weighted mean difference (WMD) and a 95% confidence interval (CI) for different variables were as follows: VAS [SMD = 0.004, 95% CI (-0.214, 0.222)], pinch strength [WMD = 1.061, 95% CI (-0.559, 2.681)], grip strength [SMD = 0.178, 95% CI (-0.014, 0.369)], SSS [WMD = 0.026, 95% CI (- 0.191, 0.242)], FSS [SMD = 0.089, 95% CI (-0.092, 0.269)], and the two-point discrimination [SMD = 0.557, 95% CI (-0.140, 1.253)].

CONCLUSIONS

Our findings revealed no statistically significant differences between the splinted and non-splinted groups in terms of the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. These results indicate that there is no substantial evidence supporting a significant advantage of post-operative splinting after CTR.

Effects of weights applied to the apex of a bag-valve-mask and pinch strength on tidal volume: a prospective simulation study

A bag-valve-mask (BVM) is a first aid tool that can easily and quickly provide positive-pressure ventilation in patients with breathing difficulties. The most important aspect of BVM bagging is how closely the mask adheres to the patient's face when the E-C technique is used. In particular, the greater the adhesion force at the apex of the mask, the greater the tidal volume. The purpose of this study was to investigate the effect of various weights applied to the mask's apex and the pinch strength needed to perform the E-C technique, on tidal volume. In this prospective simulation study, quasi-experimental and equivalent time-series designs were used. A total of 72 undergraduate paramedic student from three universities were recruited using convenience sampling. The tidal volumes according to the weights (0 g, 100 g, 200 g, 300 g) applied to the apical area of the mask, handgrip strength, and pinch strength (tip pinch strength, key pinch strength, and tripod pinch strength) were measured. A linear mixed model analysis was performed. Linear mixed model analyses showed that tidal volume was significantly higher at 200 g (B = 43.38, p = 0.022) and 300 g (B = 38.74, p = 0.017) than at 0 g. Tripod pinch strength (B = 12.88, p = 0.007) had a significant effect on mask adhesion for effective BVM ventilation. Adding weight to the apical area of the mask can help maintain the E-C technique and enable effective ventilation. Future studies are required to develop specific strategies to improve the ventilation skills, which can be an important first-aid activity.

Isolated A1 pulley release surgery for trigger finger leads to significant increase in tip-to-tip pinch strength

BACKGROUND

Even in the first application of patients with early complaints of trigger finger, pinch strength of the hand may be affected. Therefore, it is difficult to assess the change of strength as a result of treatment in this problem. In this study, we aimed to evaluate the change of strength taking into account both measured and expected pinch strengths before and after A1 pulley release surgery.

METHODS

Thirty fingers (9 thumbs, 12 middle, 8 ring and 1 index fingers) of 26 patients (17 women, 9 men) who underwent A1 pulley release were included into this study. The mean age of the patients was 53 (16-71). Tip-to-tip finger pinch strengths were measured pre-operatively and at 3 months postoperatively. The expected strengths were calculated using the values obtained from the healthy side and taking into account the dominance effect. In the analysis, pre-operative and postoperative measured strength/expected strength ratios were compared.

RESULTS

The mean of measured pinch strength/expected pinch strength ratio was 0.91 ± 0.3 pre-operatively and 1.14 ± 0.3 postoperatively (p < 0.05).

CONCLUSION

With the calculation method used in this study, it was found that there was a significant increase in the tip-to-tip pinch strength after surgical A1 pulley release for the trigger finger.

LEVEL OF EVIDENCE

III (Retrospective cohort study).

Metacarpophalangeal joint angle of the thumb during maximal pinch strength: a study of healthy volunteers

Mean metacarpophalangeal joint angles of the thumb during maximal pinch were 9° greater in men than in women. More flexion was not associated with more force during key pinch, but a moderate association was found for palmar pinch, especially in men.

Are the sensorimotor control capabilities of the hands the factors influencing hand function in people with schizophrenia?

BACKGROUND

Previous works reported people with schizophrenia experienced inferior hand functions which influence their daily participation and work efficiency. Sensorimotor capability is one of indispensable elements acting in a well-executed feed-forward and feedback control loop to contribute to hand performances. However, rare studies investigated contribution of sensorimotor ability to hand functions for people with schizophrenia. This study aimed to explore hand function in people with schizophrenia based on the perspective of the sensorimotor control capabilities of the hands.

METHODS

Twenty-seven people at the chronic stage of schizophrenia were enrolled. The following assessment tools were used: the Purdue Pegboard Test (PPT) and the VALPAR Component Work Sample-8 (VCWS 8) system for hand function; the Self-Reported Graphic version of the Personal and Social Performance (SRG-PSP) scale for functionality; and the Semmes-Weinstein Monofilaments (SWM), the pinch-holding-up-activity (PHUA) test and the Manual Tactile Test (MTT) for the sensory and sensorimotor parameters. The Clinical Global Impression-Severity (CGI-S) scale and the Extrapyramidal Symptom Rating Scale (ESRS) were used to grade the severity of the illness and the side-effects of the drugs. Spearman's rank correlation coefficient was used to analyze associations among hand function, functionality, and sensorimotor capabilities. A multiple linear regression analysis was used to identify the determinants of hand function.

RESULTS

The results indicated that both hand function and sensorimotor capability were worse in people with schizophrenia than in healthy people, with the exception of the sensory threshold measured with the SWM. Moreover, the sensorimotor abilities of the hands were associated with hand function. The results of the regression analysis showed that the MTT measure of stereognosis was a determinant of the PPT measure of the dominant hand function and of the performance on the VCWS 8, and that the ESRS and the MTT measure of barognosis were determinants of the performance on the assembly task of the PPT.

CONCLUSIONS

The findings suggested that sensorimotor capabilities, especially stereognosis and barognosis, are crucial determinants of hand function in people with schizophrenia. The results also revealed that the side effects of drugs and the duration of the illness directly affect hand function.

CLINICAL TRAIL REGISTRATION

ClinicalTrials.gov , identifier NCT04941677, 28/06/2021.

Pain, function, and radiographic disease in trapeziometacarpal osteoarthritis

INTRODUCTION

Trapeziometacarpal joint osteoarthritis (OA) produces significant functional impairment due to pain and loss of strength in both power and precision grips, but few studies have related radiographic scores to functional and pain-based measures.

PURPOSE

To investigate the association between markers of radiographic disease and outcomes for symptomatic and functional disease.

STUDY DESIGN

This study in an exploratory analysis of baseline data from the first 100 participants in a clinical trial evaluating the efficacy of combined conservative therapies for base of thumb OA (COMBO).

METHODS

Functional Index for Hand Osteoarthritis (FIHOA) scores and Visual Analogue Scale (VAS) scores for pain were recorded for the index hand. Bilateral isometric grip and tip-pinch strength measurements were taken, as well as posteroanterior and Eaton stress-view hand radiographs. Generalized estimating equations (GEEs), univariate, and multivariate analyses were used according to whether the data were bilateral or unilateral.

RESULTS

A total of 79 females and 21 males were included, with a median Kellgren-Lawrence (KL) grade of 3 in the index hand. Higher KL and Eaton grades were associated with lower grip strength in the GEE analysis (B-coefficients of -1.25 and -1.16, and P-values of .002 and .010, respectively). Higher KL grade was also associated with poorer function and higher pain levels in the multivariable analysis (B-coefficients of 1.029 and 3.681, and P-values of .021 and .047, respectively). Lower radial subluxation ratios were associated with lower grip strength in the GEE analysis, and higher pain scores in the multivariable analysis (B-coefficients of 2.06 and -42.1, and P-values of .006 and .031, respectively). Greater pain scores were also associated with poorer function (B-coefficient 0.082, P-value .001).

CONCLUSION

More advanced radiographic trapeziometacarpal OA severity is associated with lower grip strength and poorer self-reported functional outcomes. Lower subluxation ratios were associated with higher pain scores and lower grip strength.

Normative data for the Baseline® 5 position hydraulic pinch meter and the relationship between lateral pinch strength and pinch span

INTRODUCTION

The Baseline® 5 position hydraulic pinch meter allows pinch strength assessment at five different pinch spans. The present study used this newly developed meter to assess where pinch span force is the greatest as previous literature is conflicting.

PURPOSE OF THE STUDY

The primary aim of the study was development of normative data using health subjects, whereas the secondary aims were to evaluate meter inter-rater reliability and to identify in which pinch span the greatest force was produced.

STUDY DESIGN

This is a clinical measurement, cross-sectional study.

METHODS

Ten occupational therapy student raters examined inter-rater reliability by calculating an average intraclass correlation. Recruitment of normative data subjects occurred across various locations in West Michigan to include a diverse population and followed testing procedures recommended by the American Society of Hand Therapists. Data were stratified by age categories and sex to develop normative standards. Data were analyzed using a one-way repeated measures ANOVA and a three-way mixed ANOVA.

RESULTS

Normative data were calculated from a sample of 605 subjects (292 males and 313 females). One-way ANOVA demonstrated a significant difference at the five different spans, noting a small effect size. Also noted were a nonsignificant three-way interaction between age category, pinch spans, and sex using both the right and left hands, along with a significant two-way interaction between spans and sex bilaterally.

DISCUSSION

The meter showed an excellent inter-rater reliability with an intraclass correlation = .98 and indicated the pinch span that produced the greatest amount of force was not consistent with previous literature.

Upper limb manual dexterity, strength and blood flow after walking with backpack load

This study aimed to characterize the effects of walking with backpack load on upper limb function. Fifteen males participated in 3 conditions: no load, 40% body weight loaded backpack (BP) and loaded backpack with simulated rifle (BRC). Pinch strength, grip strength, sensory threshold, blood flow volume, and a manual dexterity test were assessed before and after a 45-min walking trial. Pinch strength in the BP condition was significantly different than the control (p < 0.05). Grooved pegboard times were faster after a seated recovery (p = 0.026) than immediately after walking with load. Blood flow was significantly decreased to <53% of baseline (p ≤ 0.001) in BP and BRC immediately after donning the backpack. No significant changes in grip strength or sensory threshold were measured among conditions or time points. In conclusion, pinch strength, manual dexterity and blood flow were affected by backpack carriage, but other upper limb measures remained unaffected.

Three-Jaw Chuck Pinch Strength and its Correlation with Hand Depth in Electronics Technicians

The three jaw chuck pinch is a variety of pinch technique where thumb opposes both middle and index fingers. Pinch strength is generally influenced by the health status and level of physical activity of a person. The present study was conducted to measure the correlation of three-jaw chuck pinch strength with hand depth in electronics technicians working in Dhaka Metropolitan City. The data obtained from the study may be used as a base line for other professions as well as for research in our country. This cross sectional, analytical study was carried out in the department of Anatomy, Dhaka Medical College, Dhaka, Bangladesh from July 2015 to June 2016 on 100 adults male electronics technicians and 100 adult sedentary workers. Electronics technicians were considered as case group and sedentary workers were considered as control group. Case group was further subdivided according to their working experiences. Study subjects were selected by convenient purposive sampling technique. Hand depth was measured by digital slide calipers and pinch gauge was used to measure the three-jaw chuck pinch strength. The mean three-jaw chuck pinch strength was significantly higher (p<0.05) in case group than in the control group. Significant difference were also observed between case group and control group in the mean hand depth (p<0.05). Mean hand depth was greater in case group than that of control group. Three-jaw chuck pinch strength showed significant positive correlation with hand depth in case group. Case group was further subdivided according to their working experiences, the mean three-jaw chuck pinch strength and hand depth was significantly higher (p<0.05) in more working experience group than in less working experience group. Three-jaw chuck pinch strength showed significant positive correlation with hand depth.

Anthropometric scaling of musculoskeletal models of the hand captures age-dependent differences in lateral pinch force

Musculoskeletal models and computer simulations enable non-invasive study of muscle function and contact forces. Hand models are useful for understanding the complexities of hand strength, precision movement, and the dexterity required during daily activities. Yet, generic models fail to accurately represent the entire scope of the population, while subject-specific models are labor-intensive to create. The objective of this study was to assess the efficacy of scaled generic models to represent the broad spectrum of strength profiles across the lifespan. We examined one hundred lateral pinch simulations using a generic model of the wrist and thumb anthropometrically scaled to represent the full range of heights reported for four ages across childhood, puberty, older adolescence, and adulthood. We evaluated maximum lateral pinch force produced, muscle control strategies, and the effect of linearly scaling the maximum isometric force. Our simulations demonstrated three main concepts. First, anthropometric scaling could capture age-dependent differences in pinch strength. Second, a generic muscle control strategy is not representative of all populations. Lastly, simulations do not employ optimal fiber length to complete a lateral pinch task. These results demonstrate the potential of anthropometrically-scaled models to study hand strength across the lifespan, while also highlighting that muscle control strategies may adapt as we age. The results also provide insight to the force-length relationship of thumb muscles during lateral pinch. We conclude that anthropometric scaling can accurately represent age characteristics of the population, but subject-specific models are still necessary to represent individuals.

Time heals all wounds - Outcomes of deep palmar wrist injuries may improve long after reinnervation

Despite the clinical importance of deep wrist injuries (DWIs), data on the timeframe of possible improvements in hand function are scarce. We tested the hypotheses that a) the length of follow-up is positively correlated with the outcome, and b) this correlation is tempered by nerve involvement. All patients admitted to the Clinic of Plastic Surgery with an acute DWI between 2008 and 2016 were contacted for a follow-up examination including two-point discrimination, range of motion, grip, and pinch strength, as well as DASH and MMWS questionnaires and employment status. Possible confounders such as age, handedness, and intentionality of the injury (accidental or suicidal) were assessed and controlled for statistically. Fifty-three patients were reviewed (74% male and 26% female, 86% right-handed, 70% accidental injuries, mean age at injury 42.0 ± 17.1 years), an average of 4.3 ± 2.9 years after their injury. In patients with a nerve injury, length of follow-up had significant effects on two-point discrimination, grip and pinch strength, self-reported symptom severity and impairment. Contrary to conventional knowledge, the clinical outcome of DWIs may improve beyond 3 years when there is nerve involvement. This important prognostic finding has far-reaching implications for both clinicians (e.g., asked to give their medical opinion) and patients (e.g., considering re-training after a DWI).

Differences between anthropometric and bioimpedance measurements of muscle mass in the arm and hand grip and pinch strength in patients with chronic kidney disease

BACKGROUND & AIMS

Chronic kidney disease (CKD) patients are at increased risk of sarcopenic muscle wasting, with increased mortality risk. Simple screening tests are required to detect sarcopenia to allow for interventional therapies. We wished to compare anthropometric and multifrequency bioimpedance (MFBIA) measurements of arm composition and muscle strength.

METHODS

We measured segmental MFBIA, mid arm upper circumference (MUAC) and triceps skin fold thickness (TSF), hand grip strength (HGS) and pinch strength (PS) in CKD patients attending out-patient review.

RESULTS

We reviewed 146 patients; 94 male (64.4%), 93 (63.7%) diabetic, mean age 70.5 ± 15 years, weight 77.6 ± 17.1 kg, with a mean HGS of 25.2 ± 10.4, and PS 5.0 ± 1.9 kg. HGS and PS were correlated (r = 0.63, p < 0.001). Male patients had greater HGS and PS (28.3 ± 10.1 vs 19.7 ± 7.0 kg; and 5.3 ± 2.0 vs 4.3 ± 1.1 kg, p < 0.05) with greater arm muscle (3.2 ± 0.7 vs 2.4 ± 0.7 kg, p < 0.05) and less arm fat (1.8 ± 1.3 vs 2.9 ± 1.8 kg, p < 0.05), whereas there was no difference in anthropometric measurements of mid upper arm muscle or fat area. Whereas both HGS and PS correlated positively with MFBIA arm lean mass (r = 0.55, r = 0.37, p < 0.001) and negatively for arm fat mass (r = -0.4, p < 0.001, r = -0.32, p = 0.001) respectively, there were no correlations with anthropometric derived estimates of upper arm muscle or fat.

CONCLUSIONS

In CKD patients, segmental MFBIA measurements of the arm, but not those derived from anthropometric measurements demonstrate gender differences and correlate with arm muscle strength, whereas there were no such correlations with anthropometric estimates of upper arm muscle or fat.

Refined Sphenopalatine Ganglion Stimulator Placement and Intensity Setting to Augment Blood Flow and Neurologic Function

Background and Purpose- Two large, randomized trials indicated that sphenopalatine ganglion (SPG) stimulation improves final disability outcome in acute anterior circulation patients with ischemic stroke with confirmed cortical involvement. This study evaluated 2 refinements in SPG stimulation treatment technique: (1) SPG electrode placement with real-time optical tracking guidance; and (2) stimulation intensity comfortable tolerance level selection using non-noxious facial physiological markers. Methods- This study was a single, active arm trial at 4 centers, enrolling patients with anterior circulation ischemic stroke, National Institutes of Health Stroke Scale 1 to 6 including arm weakness subitem score ≥1, not receiving recanalization therapies, and within 24 hours of onset. Stimulation level was set based on ipsilateral facial tingling sensation or lacrimation. SPG stimulation effects were assessed by measuring volumetric blood flow in the ipsilateral common carotid artery by ultrasound and grasp and pinch strength in the affected hand before and during stimulation, and by change in National Institutes of Health Stroke Scale from day 1 to 7. Results- Among 50 enrolled patients, age was median 66 years (interquartile range, 60-74), 44% were female, National Institutes of Health Stroke Scale median was 5 (interquartile range, 4-5), and median onset-to-screening time was 18 hours (interquartile range, 9-20). Median implantation skin-to-skin time was 4 minutes (interquartile range, 3-7), and all 50 implants were placed correctly. Comfortable tolerance level was found based on physiological biomarkers in 96% of patients, including 86% in the optimal, low-medium intensity range. SPG stimulation significantly increased common carotid artery peak systolic and end-diastolic blood flow (44%, P<0.0001; and 52%, P<0.0001) and improved pinch strength (42%, P<0.0001) and grasp strength (26%, P<0.0001). Degree of National Institutes of Health Stroke Scale recovery by day 7 was greater than in matched historic controls, median 75% versus 50%, P=0.0003. Conclusions- SPG stimulator placement with real-time optical tracking guidance was fast and accurate, and selection of stimulation intensity levels based on non-noxious facial tingling and lacrimation was feasible in nearly all patients. SPG stimulation led to cervico-cranial blood flow augmentation and improved hand motor function. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03551093.

Does the educational level of women influence hand grip and pinch strength in carpal tunnel syndrome?

BACKGROUND

Grip and pinch strength are relevant functional variables for various activities of daily life and are related to the quality of life of patients with carpal tunnel syndrome (CTS).

OBJECTIVE

The main aim was to analyze the relationship between grip and pinch strength and the educational level in women with CTS.

STUDY DESIGN

Cross-sectional study.

METHODS

Thirty-one female patients with CTS awaiting surgery were assigned to the low education group if they only had primary education level (completed or not) and the high education group for those having higher education level. The assessments included: grip strength, pinch strength, Visual Analogue Scale, Quick DASH Questionnaire, Pain Catastrophizing Scale and the Tampa scale of kinesiophobia.

RESULTS

A statistically significant difference was obtained for grip strength (p = 0.027), pinch strength (p = 0.002) and catastrophizing (p = 0.038) between the two groups. No significant differences were observed for the other variables studied (p < 0.05). Grip strength was not related to individual factors: type of work, age, body mass index.

CONCLUSION

CTS patients with a low educational level exhibited reduced grip and pinch strength and more catastrophic thinking. Future studies should investigate the mechanisms involved in the loss of strength in patients with lower educational levels.

Coconut crabs

Mark Laidre introduces the coconut crab (Birgus latro), the world's largest terrestrial invertebrate.

The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome: A meta-analysis of randomized controlled trials

BACKGROUND

Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments.

METHODS

The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared.

RESULTS

Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86-7.65]; P = .01) and pinch strength (MD, 1.37 [0.24-2.51]; P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,-8.80 [-9.21 to -8.39]; P < .01) and reduced operative time (standardized mean difference [SMD], -1.68 [-3.24 to-0.12]; P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38-0.96, P = .03).

CONCLUSIONS

Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.

Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Repair with Mini Soft Suture Anchor (JuggerKnot™)

PURPOSE OF THE STUDY We aimed to investigate the functional outcomes and complications of a new approach, the primary UCL repair using JuggerKnot™ Soft Anchor-1.0 mm Mini (Zimmer-Biomet). MATERIAL AND METHODS This study included a total of 12 patients with acute UCL injury who were operated with primary repair with JuggerKnot™ Soft Anchor-1.0 mm Mini between January 2012 and September 2016. All patients were operated on using the same surgical technique. The thumb pinch and grip strengths, articular range of motion, and Glickel functional score were recorded for all patients. The pinch grip strength and articular range of motion were compared with the intact side. Early and late postoperative complications were recorded. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The grip strength and the pinch strength were 94.3% and 92.27%, respectively, of the contralateral side. Articular range of motion attained the same level as the contralatereal side in all patients at the final visit, and no patient suffered from any complication. The patients returned to work at a mean of 5.45 weeks, and the Glickel score was good in 1 patient and excellent in the remainder 11 patients. CONCLUSIONS Surgical repair using the JuggerKnot™ Soft Anchor-1.0 mm is an effective alternative treatment method for acute total ulnar collateral ligament (UCL) rupture. Key words:ulnar collateral ligament, acute total injury, thumb, soft suture anchor, JuggerKnot™.

Grip and pinch strength: Reference values for children and adolescents from India

PURPOSE

The purpose of the study was to provide reference values for grip and pinch strength for healthy children and adolescents in India.

METHODS

Grip and pinch strength were recorded for 900 participants stratified into 5 chronological age groups (5-6, 7-9, 10-12, 13-15 and 16-18 years). Grip strength was measured using a Jamar Dynamometer and pinch strength using a Martin vigorimeter.

RESULTS

The difference in grip and pinch strength between age groups was significant (p< 0.001 respectively). A linear rise in grip strength was noted from age groups of 5-6 years to 16-18 years. Moderate to strong positive association was observed between grip and pinch strength and upper extremity anthropometric characteristics (i.e., palmar width, hand span, hand length, arm length, forearm length, and upper limb length) from age groups of 5-6 years to 16-18 years. Boys demonstrated greater grip and pinch strength compared to girls in all age groups (p< 0.001). No difference was observed between the dominant and non-dominant hand in all age groups.

CONCLUSIONS

Findings from the present study provide reference values for grip strength, tip to tip, key and tripod pinch for healthy Indian children and adolescents from 5-18 years of age, which will be useful to guide rehabilitation outcomes in routine clinical practice.

Decline in functional status after intensive care unit discharge is associated with ICU readmission: a prospective cohort study

OBJECTIVES

To compare the functional status at intensive care unit (ICU) discharge of patients who were later readmitted to the ICU and patients discharged home and to verify whether a decline in functional status is associated with ICU readmission.

DESIGN

Prospective cohort study.

SETTING

ICU at a tertiary teaching hospital.

PARTICIPANTS

Patients admitted to the ICU, ≥18 years old, submitted to invasive mechanical ventilation (IMV), and discharged to the ward.

INTERVENTIONS

Functional assessment at ICU discharge. Discharge Group (DG) (patients discharged home) and Readmission Group (RG) (patients who returned to the ICU) were compared with Mann-Whitney and Chi-square or Exact Fisher tests. Multiple logistic regression verified association.

MAIN OUTCOME MEASURES

Barthel Index, key pinch strength, clinical and demographic data.

RESULTS

Patients in the readmission group presented lower Barthel Index [Median 40 (IQR 20-75) vs 60 (33-83), P=0.033], greater relative variation (pre and post ICU) of the Barthel Index (P=0.04), lower key pinch strength [3.4 (1.8-4.5) vs 4.5 (2.7-6.8)kg·f, P=0.006] and higher APACHE II [18 (12-22) vs 15 (11-20), P=0.027]. Multiple regression found that the relative variation of the Barthel Index was independently associated with ICU readmission (P<0.001), as well as higher APACHE II (P=0.020), shorter IMV duration (P<0.001) and ICU admission without clear diagnosis (P=0.020). The Hosmer-Lemeshow test indicated good adjustment of the model (P=0.99).

CONCLUSION

Readmitted patients presented poorer functional status and lower pinch strength. Relative variation of the Barthel Index was associated with ICU readmission despite other factors, as was higher APACHE II, shorter IMV duration and admission without clear diagnosis.

TRIAL REGISTRATION NUMBER

Not applicable.

Distal medial tibial locking plate for fixation of extraarticular distal humeral fractures; an alternative choice for fixation

OBJECTIVE

The aim of this study was to describe an alternative fixation method for distal humeral extra-articular fractures through posterior approach using distal tibia anatomic locking plate; and to evaluate the patient's functional outcome and union condition.

METHODS

Eighteen patients (11 men and 7 women; average age of 37.0 ± 17.3 years (range: 18-73 years)) with a distal humeral extra-articular fracture who were treated with distal tibial medial locking plate were included into the study. The mean follow up time was 36.2 ± 16.7 (12-57) months. Functional results were evaluated with perception of pain, range of joint motion, grasp and pinch strengths.

RESULTS

Union was achieved in 17 of 18 patients. Only one patient had non-union due to infection and underwent debridement. The mean time for union was 7.8 ± 5.9 months (2-20). Patient perception of pain was X = 1.88 ± 2.50 and X = 4.55 ± 2.68, respectively, at rest and activity. The active ranges of joint motion were adequate for functional use. General functional state of affected extremity (DASH-T) was perfect (X = 27.14 ± 25.66), the performance of elbow joint was good (X = 84.44 ± 11.57). There were no differences in the comparison of grasp and pinch grip of patients with uninvolved extremity (p > 0.05).

CONCLUSIONS

In distal humeral extra-articular fractures, use of distal medial tibia plate has advantages such as providing high rates for union, low rates for complication, and early return to work with early rehabilitation, therefore it may be considered a fixation choice that can be used for distal humeral extra-articular fractures.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Long-term Outcomes of Partial Trapeziectomy With Capsular Interposition Arthroplasty for Osteoarthritis of the Thumb Basal Joint

The purpose of this study was to describe long-term outcomes of partial trapeziectomy with capsular interposition (PTCI) arthroplasty for patients with osteoarthritis of the basal joint of the thumb. A total of 27 patients (20 women, 7 men; 32 thumbs) with a mean age of 61 years (range, 47-74 years) agreed to return for follow-up and were included in the study. Mean postoperative follow-up was 64.3 months (range, 28-112 months). Evaluation included tests for grip and pinch strength; range of motion of the metacarpophalangeal joint; measurement of the first web space; completion of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; visual analog scale (VAS) measurements; and radiographic examination of the hand. A paired, 2-tailed t test was used to determine statistical significance (P<.05) of pre- and postoperative values. Postoperative values for grip strength were significantly increased from preoperative values. No significant loss of pinch strength was noted. Excessive hyperextension of the metacarpophalangeal joint did not occur, and the first web space was maintained. The mean DASH questionnaire and VAS scores were 5.06 (range, 0-26.5) and 0.32, respectively. Use of PTCI arthroplasty resulted in minimal loss in thumb height (7%) and significantly reduced thumb metacarpal subluxation (13%). There were no reported complications. The low DASH questionnaire and VAS scores compare well with other studies and indicate good functional outcomes. In treating thumb basal joint osteoarthritis, use of PTCI arthroplasty may result in improved thumb stability and grip strength, minimal subsidence of the thumb metacarpal, and reduced joint subluxation. [Orthopedics. 2018; 41(2):e228-e233.].

Force illusions and drifts observed during muscle vibration

We explored predictions of a scheme that views position and force perception as a result of measuring proprioceptive signals within a reference frame set by ongoing efferent process. In particular, this hypothesis predicts force illusions caused by muscle vibration and mediated via changes in both afferent and efferent components of kinesthesia. Healthy subjects performed accurate steady force production tasks by pressing with the four fingers of one hand (the task hand) on individual force sensors with and without visual feedback. At various times during the trials, subjects matched the perceived force using the other hand. High-frequency vibration was applied to one or both of the forearms (over the hand and finger extensors). Without visual feedback, subjects showed a drop in the task hand force, which was significantly smaller under the vibration of that forearm. Force production by the matching hand was consistently higher than that of the task hand. Vibrating one of the forearms affected the matching hand in a manner consistent with the perception of higher magnitude of force produced by the vibrated hand. The findings were consistent between the dominant and nondominant hands. The effects of vibration on both force drift and force mismatching suggest that vibration led to shifts in both signals from proprioceptors and the efferent component of perception, the referent coordinate and/or coactivation command. The observations fit the hypothesis on combined perception of kinematic-kinetic variables with little specificity of different groups of peripheral receptors that all contribute to perception of forces and coordinates. NEW & NOTEWORTHY We show that vibration of hand/finger extensors produces consistent errors in finger force perception. Without visual feedback, finger force drifted to lower values without a drift in the matching force produced by the other hand; hand extensor vibration led to smaller finger force drift. The findings fit the scheme with combined perception of kinematic-kinetic variables and suggest that vibration leads to consistent shifts of the referent coordinate and, possibly, of coactivation command to the effector.

Trapeziumectomy And Mini Tightrope Stabilization Of The First Metacarpal For Thumb Carpometacarpal Osteoarthritis : A Prospective Case Series

Our purpose was to investigate the short-term results of trapeziumectomy and stabilization of the first metacarpal by using the TightRope© device, at a maximum follow-up of 1 year post-op. This is a novel method in treating first carpometacarpal joint osteoarthritis and an alternative to the variety of other methods that have been previously reported. We recruited 21 patients and assessed them at regular intervals, comparing pre-operative and postoperative variables. We recorded all complications during the study period. There was a statistically significant improvement in pain, hand grip and tip pinch power and functional outcome scores. Patients were very satisfied at 12 months after surgery. No significant change in thumb opposition was noted. There was subsidence of the first metacarpal at 1 year after surgery. Despite the existence of a significant number of alternative procedures, we feel that the procedure described in this paper has promising short-term results and is safe.

Flexor Pollicis Longus Tendon Rupture After Volar Wrist Plating : Reconstruction With Palmaris Longus Interposition Graft

Rupture of the flexor pollicis longus tendon is a rare complication after volar plating of distal radius fractures. Several surgical treatment options have been proposed but postoperative results are not well documented. The authors retrospectively studied the clinical outcome of 4 patients after flexor pollicis longus tendon reconstruction with a palmaris longus interposition graft. Minimal follow-up was 12 months. Mean active interphalangeal joint flexion (44°) and thumb opposition (Kapandji 8/10) were significantly reduced compared to the opposite side. Mean power grip (32 kg) and key pinch strength (8kg) of the operated hand were comparable to the contralateral hand. The mean Visual Analogue Scale for pain was 2.5/10. The mean DASH score was 14 points. Although flexion and opposition of the thumb did not return to normal after surgery, patients reported excellent functional results.

Trapeziectomy With Ligament Reconstruction and Tendon Interposition Versus a Trapeziometacarpal Prosthesis for the Treatment of Thumb Basal Joint Osteoarthritis

Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study. Patients were assigned to LRTI (LRTI group) or total joint replacement (Arpe group) and were followed for a mean of 4.8 years. The LRTI group included 34 patients and the Arpe group included 31. Clinical outcome variables were determined preoperatively and every 6 months postoperatively. Pain relief and functional improvement were similar between groups. Pinch strength and range of motion were superior in the Arpe group. Metacarpophalangeal hyperextension appeared to be prevented in the Arpe group but increased over the follow-up period in the LRTI group. However, the complication rate was higher in the Arpe group. Arthroplasty with the Arpe prosthesis can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complications rate. [Orthopedics. 2017; 40(4):e681-e686.].

Assessment from Functional Perspectives: Using Sensorimotor Control in the Hand as an Outcome Indicator in the Surgical Treatment of Carpal Tunnel Syndrome

To investigate whether sensorimotor control of the hand could be an outcome indicator after carpal tunnel release (CTR), this work examined changes in the results of patients’ manual tactile test (MTT), pinch-holding-up activity (PHUA), two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) tests. Participants included 30 predominantly sensory neuropathy CTS patients, as confirmed by a nerve conduction study. The MTT, precision pinch performance in PHUA and traditional sensibility (2PD and SWM) tests were used to examine different aspects of sensory status at the time-points of two weeks before operation and one month post-operation, with a single-blind design. The results showed significant improvements in the sensory function as detected by the 2PD and SWM tests (p<0.001) and sensorimotor function as detected by the MTT (p<0.001) and PHUA test (p<0.05) for patients receiving CTR. The responsiveness of the SWM, MTT and PHUA tests (effect size>0.5, p<0.01) are better than that of two-point discrimination test (effect size<0.5, p<0.001). However, pinch strength saw a decline compared to baseline with a moderate effect sizes (effect size = 0.7, p<0.001). This cohort study found that the MTT and PHUA test can both meet all the statistical criteria with regard to assessing treatment outcomes for patients with CTS. In addition, the results of this work provide clinicians with the information that the sensorimotor functions of the hands, as assessed by MTT and PHUA, are responsive to clinical changes due to CTR.

A systematic review of diagnostic performance of quantitative tests to assess musculoskeletal disorders in hand-arm vibration syndrome

The purpose was to systematically review the published reports for the clinical utility of quantitative objective tests commonly used for diagnosing musculoskeletal disorders in hand-arm vibration syndrome (HAVS). Two reviewers independently conducted a computerized literature search in PubMed and Scopus using predefined criteria, and relevant papers were identified. The articles were screened in several stages and considered for final inclusion. Quality of the selected papers was evaluated by a modified QUADAS tool. Relevant data were extracted as necessary. For this review, only 4 relevant studies could be identified for detailed examination. Grip strength, pinch strength, and Purdue pegboard tests were commonly used with their reported sensitivity and specificity ranging between 1.7 to 65.7% and 65.2 to 100%, 1.7 to 40% and 94 to 100%, and 44.8 to 85% and 78 to 95%, respectively. A considerable difference across the studies was observed with respect to patient and control populations, diagnostic performance and cut-off values of different tests. Overall, currently available English-language limited literature do not provide enough evidence in favour of the application of grip strength and pinch strength tests for diagnosing musculoskeletal injuries in HAVS; Purdue pegboard test seems to have some diagnostic value in evaluating impaired dexterity in HAVS.

Impacts of elevated glycaemic haemoglobin and disease duration on the sensorimotor control of hands in diabetes patients

BACKGROUND

To understand the impacts of disease chronicity and hyperglycaemia on sensorimotor control of hands of diabetic patients, this study investigated the differences in hand sensation, strength and motor control by applying the pinch-holding-up activity test for patients with diabetes mellitus (DM) with different levels of glycaemic control and disease chronicity.

METHODS

One hundred and fifty-nine patients with clinically defined DM were included. Semmes-Weinstein monofilament, static two-point discrimination and moving two-point discrimination, maximal pinch strength precision pinch performance tests and nerve conduction studies (NCS) of the subjects were carried out. Forty-seven (29.6%) patients were in the HbA(1c) < 7% category, and 112 (70.4%) patients were in the >7% group. There were 87 (54.7%) patients with the disease duration <10 years, and 72 (45.3%) patients with disease duration ≧10 years.

RESULTS

The severity of hyperglycaemia significantly impacts the results for Semmes-Weinstein monofilament, precision pinch force control, sensory and motor NCS tests (p < 0.05). In addition, the chronicity of disease influences the motor control of precision pinch performance and the amplitude of motor NCS (p < 0.05) for the diabetes patients.

CONCLUSIONS

The evidence suggests that disease chronicity and hyperglycaemia have impacts on sensorimotor control in the hands of DM patients. In addition, the efficiency of prehensile forces of hand-to-object interactions in the pinch-holding-up activity test could be significant for identifying hand function, as well as pathologic changes in median nerve function, for patients with DM.

Age-related differences in the availability of visual feedback during bimanual pinch

PURPOSE

Previous research has indicated that older adults have significantly lower accuracy in terms of force control than young adults. In addition, accuracy of force control is known to decrease in the absence of visual feedback. However, whether the effect of visual feedback on fine motor control is similar for young adults and older adults is not clear. The purpose of this study, therefore, was to examine the effect of visual feedback on bimanual pinch force control in older adults.

METHODS

Thirty-one undergraduate students (age 19.7 ± 0.9 years) and 31 older adults (age 65.1 ± 8.1 years) participated in this study. After measuring finger-pinch maximal voluntary force (MVF), the participants were asked to maintain 10% MVF as steadily as possible in two different conditions: with visual feedback (visual feedback condition; VF condition) and without visual feedback (no visual feedback condition; NVF condition).

RESULTS

We found that older adults had significantly greater targeting error and force variability than young adults in the VF condition, but not in the NVF condition. In addition, older participants exhibited a significantly greater sum of power for the 0-4 and 4-8 Hz frequency bin than young adults (p < 0.05) in the VF condition, although there was no significant difference in the NVF condition.

CONCLUSIONS

These results suggest that older adults do not use visual information as effectively as younger adults to reduce force control error.

Towards a comprehensive Functional Capacity Evaluation for hand function

The aim of this study was to develop a more efficient (i.e. shortened) protocol for hand function capacity evaluation and to test the agreement of the protocol compared to the original protocol. 643 Healthy subjects performed tests for hand function. Agreement between two shortened protocols was compared with an existing protocol. The original protocol was performed once and the proposed shortened protocol differed in the number of trials which were reduced by statistical elimination. Agreement was determined with Intraclass Correlation Coefficients (ICC) and Limits of Agreement (LoA). Excellent ICCs (≥0.91) were observed in all proposed protocols except for the one trial purdue pegboard test protocol. For all tests of hand function, shorter protocols are valid to determine hand function. For Tip Pinch Strength testing, Palmar Pinch Strength testing and the Purdue Pegboard test, a two-trial protocol is recommended, because the LoA were considerable, which could affect decision-making with regards to hand capacity. For the Hand Grip strength test, the Key Pinch Strength test and the Complete Minnesota Dexterity Test, a one-trial protocol is recommended, because the LoA were acceptable. It was concluded that for healthy subjects, this shorter protocol is a reliable measure. Further testing of the short form hand FCE protocols should be completed on patients with disabling conditions prior to widespread use of these protocols among clinical samples.

How the impact of median neuropathy on sensorimotor control capability of hands for diabetes: an achievable assessment from functional perspectives

To comprehend the sensorimotor control ability in diabetic hands, this study investigated the sensation, motor function and precision pinch performances derived from a pinch-holding-up activity (PHUA) test of the hands of diabetic patients and healthy subjects. The precision, sensitivity and specificity of the PHUA test in the measurements of diabetic patients were also analyzed. We hypothesized that the diabetic hands would have impacts on the sensorimotor functions of the hand performances under functionally quantitative measurements. One hundred and fifty-nine patients with clinically defined diabetes mellitus (DM) and 95 age- and gender-matched healthy controls were included. Semmes-Weinstein monofilament (SWM), static and moving two-point discrimination (S2PD and M2PD), maximal pinch strength and precision pinch performance tests were conducted to evaluate the sensation, motor and sensorimotor status of the recruited hands. The results showed that there were significant differences (all p<0.05) in SWM, S2PD, M2PD and maximum pinch strength between the DM and control groups. A higher force ratio in the DM patients than in the controls (p<0.001) revealed a poor ability of pinch force adjustment in the DM patients. The percentage of maximal pinch strength was also significantly different (p<0.001) between the DM and control groups. The sensitivity, specificity and area under the receiver operating characteristic curve were 0.85, 0.51, and 0.724, respectively, for the PHUA test. Statistically significant degradations in sensory and motor functions and sensorimotor control ability were observed in the hands of the diabetic patients. The PHUA test could be feasibly used as a clinical tool to determine the sensorimotor function of the hands of diabetic patients from a functional perspective.

Carpal tunnel release in patients with diabetes: a 5-year follow-up with matched controls

PURPOSE

To compare clinical outcomes 5 years after carpal tunnel release among patients with and without diabetes.

METHODS

In a prospective consecutive series, 35 patients with diabetes (median age, 54 y; 15 type 1 and 20 type 2 diabetes) with carpal tunnel syndrome were age- and sex-matched with 31 control patients without diabetes (median age, 51 y) with idiopathic carpal tunnel syndrome. Exclusion criteria were other nerve entrapment, cervical radiculopathy, inflammatory joint disease, thyroid disorder, previous wrist fracture, and long-term exposure to vibrating tools. Participants were examined independently at baseline, 1 year, and 5 years after surgery for sensory function (Semmes-Weinstein), motor function (abductor pollicis brevis muscle strength and grip strength), cold intolerance, and completion of the Boston Carpal Tunnel Questionnaire symptom severity and functional status score.

RESULTS

Five years after surgery, the overall attendance rate for clinical examinations and completion of the Boston Carpal Tunnel Questionnaire were 86% and 95%, respectively. Between 1 and 5 years after surgery, there was a tendency toward a decrease in sensory function but an increase in motor function, with no statistically significant difference between groups. Cold intolerance demonstrated long-term significant improvement for patients with diabetes. The improvement in symptom severity and functional status score, as well as the large effect size, were maintained at 5 years in both patient groups.

CONCLUSIONS

Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. Furthermore, improvement in cold intolerance in patients with diabetes suggests the potential for the long-term regeneration of small nerve fibers.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic I.

The extensor pollicis longus-loop-knot (ELK) procedure for dynamic balance of the paralyzed thumb interphalangeal joint

Hyperflexion of the thumb interphalangeal (IP) joint interferes significantly with pinching between the thumb and the index finger in a paralyzed hand. The extensor pollicis longus-loop-knot (ELK) procedure was used successfully in 7 tetraplegic patients to balance the IP joint between strong restored flexor function and lacking or weak antagonism of the thumb extensors. A V-shaped incision was made over the extensor hood at the level of the IP joint, the extensor pollicis longus (EPL) tendon was elevated, a loop was formed, secured by sutures, and then turned proximally onto the EPL tendon itself and fixed on both sides. The operation reliably limited the maximum range of IP flexion at 20 to 30 degrees from neutral. Postoperative problems did not occur. The ELK procedure is easy and quick and secures the optimal setting of IP flexion with limited flexibility, which is advantageous compared with rigid bony arthrodesis. It also avoids certain disadvantages of the commonly used flexor pollicis longus split tenodesis and is therefore a valuable alternative for the correction of Froment's sign due to intrinsic or extrinsic paralysis of the thumb.

Feasibility of a novel functional sensibility test as an assisted examination for determining precision pinch performance in patients with carpal tunnel syndrome

To understand the feasibility of a novel functional sensibility test for determining precision pinch performance in patients with carpal tunnel syndrome, this study investigates the validity, sensitivity and specificity of functional sensibility derived from a pinch-holding-up activity (PHUA) test. Participants include 70 clinically defined carpal tunnel syndrome (CTS) patients with 119 involved hands and 70 age- and gender-matched controls. To examine the discriminating ability of the functional sensibility test, the differences in the ability of pinch force adjustments to the inertial load of handling object between CTS and control subjects are analyzed. The results of functional sensibility are correlated with the severity of CTS to establish concurrent validity. The receiver operating characteristic (ROC) curve is constructed to demonstrate the accuracy of the proposed test. The functional sensibility score significantly discriminates the patients and control groups (respectively, 12.94±1.72 vs. 11.51±1.15N in peak pinch force (FP_Peak), p<0.001; 2.92±0.41 vs. 2.52±0.24 in force ratio, p<0.001) and is moderately correlated (r = 0.42–0.54, p<0.001) with the results of traditional sensibility tests (touch-pressure threshold and two-point discrimination test). In addition, there is a statistical difference in the results of functional sensibility (p<0.001) among the subgroups of CTS severity based on electrophysiological study. The sensitivity and specificity are 0.79 and 0.76, respectively, for the functional sensibility test. The areas under the ROC curve are 0.85 and 0.80 for the force ratio and FP_Peak, respectively. In conclusion, the functional sensibility test could be feasibly used as a clinical tool for determining both the sensibility and precision pinch performance of hands for the patients with CTS.

[The efficacy and safety of limited incision technique in carpal tunnel release]

OBJECTIVES

This study aims to determine the safety and symptomatic and functional efficacy of median nerve decompression with 3 cm limited incision in carpal tunnel syndrome surgery.

PATIENTS AND METHODS

Carpal tunnel release with a 3 cm limited palmar incision was performed on 91 hands in 83 patients. Patients were evaluated with Boston Carpal Tunnel Questionnaire, grip strength and pinch strength measurements, Semmes-Weinstein Monofilament test and two-point discrimination tests preoperatively, and at postoperative 3rd and 6th months. The pre- and postoperative mean values for these assessment criteria were statistically analyzed by paired samples t-test. The symptoms, physical findings, electroneuromyography carpal tunnel syndrome severity scores of the patients were evaluated using descriptive statistical analyses.

RESULTS

At postoperative evaluation, there was a statistically significant increase in Boston Carpal Tunnel Questionnaire scores, grip and pinch strengths, and sensory tests results of the patients when compared with preoperative values. No complications other than pillar pain were encountered.

CONCLUSION

Carpal tunnel release with a 3 cm limited incision technique appears to be effective when compared with classical open, endoscopic and mini incision techniques. The rate of complications is lower than that of these techniques. In conclusion, a 3 cm limited incision is both effective and safe in carpal tunnel release.

[Pinch assessing in bio mechanical analysis: methodological and applicative aspects dealt by using the new P force Met portable instrument]

BACKGROUND AND OBJECTIVES

Definition and significance of term pinch and related force exerted are still open outside the ergonomic field of interest too. The lack of consent appears relevant in upper limb biomechanical risk assessment. Aim of this study is to focus methodological aspects and applications of pinch, analyzing four actions by a new portable instrument able to measure strain exertion during pinch action.

METHODS

A portable apparatus named P-forceMet, produced by OT bioelettronics, Turin (Italy) had been used. It measures the force generated by voluntary muscle contraction both in maximal condition (MCV) and in specific working conditions (Spontaneous Force, SF). We examined four groups of 27 subjects exerting forces of different entity required in 4 technical actions: tightening bolts, writing with a pen, use a brush to spread sealer, wiring cables. The workers were asked to exert the MCV and value was registered to be compared with force simulated on the instruments taking into account the specific experienced action. Data from force analysis by Borg scale and data about upper limb disorders had also collected, as well as the results of risk assessment by checklist OCRA application.

RESULTS

Comparing MCV and SF we demonstrated different levels of measured forces: from 2-3% when using the pen to write to 8-12% for cabling and brushing activities to 31% for manual tightening. These results were in good agreement with evaluations by Borg scale, while risk assessment by check list OCRA were discordant (sealing and cable wiring were sometimes at level of mild to medium risk mainly due to posture evaluation of pinch). Workers engaged in writing, sealing and cabling did not suggest disorders to wrist-hand.

CONCLUSIONS

Actions with pinch are numerous in working activities and if defined "at risk" only because they require posture of opposition of the first two fingers, we could not classify correctly to the real bio mechanical overload. This study carried out using an instruments able to measure the force exerted during pinch operations demonstrates that the force (and then of possible strain) is diferent in the four activities. It confirms the importance of critical evaluation of different hazards and of their interaction in causing the functional or organic disorder. In our case a remarkable difference of force was demonstrated by instrument p-force in actions involving the same hazard related to posture. Further investigation appears to be necessary to eliminate the residual subjective component of this force measurement method due to the necessity of simulating the force requested by specific action.

Handgrip prediction models for children, adults and the elderly

This paper describes the development of a set of multiple linear regression equations for predicting maximal voluntary static handgrip strength of males and females, 5-89 years of age, in each hand. Equations are presented for predicting handgrip strength of the left and right hands from: (i) overall body descriptive variables alone--age, sex, body weight and stature, (ii) overall descriptive variables plus pinch strength variables, and (iii) pinch strength variables alone. A data set on 182 persons living in the United States was used for this study. Two-thirds of the observations were used to develop the models and the rest for validating them. Models were found with 3-5 variables, R2 ranging from 0.80-0.87, and root mean square error from 4.7-5.8 kg. Among the most common predictor variables that appeared in the models were: stature, age, sex, and the stronger pinches (chuck, lateral and pulp-2). Model validation indicated a greater tendency to over-predict left hand strength but no directional tendency for right hand strength. Also prediction accuracy (mean absolute percentage error) ranged from 14.9-21.0%, with about equal magnitudes in the two hands. The regression model coefficients were refined by recombining the data set of 182 observations and performing the appropriate regressions analysis.

Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumb--minimum 5-year follow-up evaluation

PURPOSE

The present study evaluated prospectively the functional and radiological results of a consecutive series of 7 patients who had bone-periosteum-bone (BPB) grafts harvested from the iliac crest for treatment of chronic ulnar instability of the metacarpophalangeal (MCP) joint of the thumb after a minimum of 60 months.

METHODS

Seven thumbs from 7 patients were entered into a prospective study for surgical treatment of chronic finger joint instability. Treatment consisted of reconstruction of the ulnar collateral ligament of the MCP joint of the thumb by a BPB graft harvested from the iliac crest. Stability, range of motion, pinch grip, and radiographs were evaluated at least 60 months after surgery.

RESULTS

All 7 patients had full active range of motion of the treated thumb at the final follow-up evaluation (average, 75 months after surgery). All patients had equal stability and normal pinch grip when comparing with the untreated thumb. The mean time off work was 3 months for 6 patients who were injured at work. At final follow-up evaluation, radiographs showed all grafts incorporated without implant complications, no osteoarthritis changes were noted, and stress radiographs showed that all patients had normal stability in the treated thumb when compared with the untreated thumb.

CONCLUSIONS

Chronic ulnar instability of the MCP joint of the thumb reconstructed with BPB graft harvested from the iliac crest is an effective and safe method to allow restoration and maintenance of a stable, pain-free thumb. The results of the current study support the long-term durability of this method.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Variability of precision pinch movements caused by carpal tunnel syndrome

PURPOSE

Carpal tunnel syndrome (CTS) impairs the performance of fine motor tasks of the hand, leading to clumsiness. Precision pinch by the thumb and index finger is a frequent task that requires the fine control of each digit as well as the coordination of the 2 digits. The purpose of this study was to examine the performance of precision pinch movements impaired by CTS.

METHODS

Sixteen CTS subjects and 16 gender- and age-matched control subjects were instructed to repetitively perform the precision pinch movement with the thumb and index finger. A marker-based motion analysis method was used to obtain the kinematic data of the thumb and index finger during the precision pinch movements. Pinch performance was quantified by the variability of tip positions, joint angles, and tip distance at the pinch closures in the repeated movements.

RESULTS

The CTS subjects performed the precision pinch movements less consistently compared with performance of the control subjects. The inconsistency was demonstrated by the increased variability of the tip positions of the 2 digits and the joint angles of the index finger. However, the variability of thumb joint angles was not significantly different between the 2 groups. The tip-to-tip distance, an indicator of thumb and index finger coordination, was relatively reproducible for both groups. Still, the CTS subjects showed a 50% greater variability of the tip distance compared with that of the control subjects.

CONCLUSIONS

Carpal tunnel syndrome impairs the performance of precision pinch movement as indicated by the increased variability. The results correlate with the observed clumsiness or lack of dexterity for patients with CTS.

Voluntary muscle testing and dynamometry in diagnosis of motor impairment in leprosy: a comparative study within the INFIR Cohort Study

AIM

To evaluate hand muscle weakness detected through dynamometry as an indicator for change in motor nerve function detected by Voluntary Muscle Testing (VMT) of ulnar and median nerves.

DESIGN

The research was carried out as part of the INFIR Cohort Study among 303 subjects newly diagnosed with MB leprosy in two centres in UP state, northern India.

METHODS

To assess grip strength, key pinch and pulp-to-pulp pinch we adapted the cuffs of adult and neonatal sphygmomanometers. The testing was carried out at diagnosis and at each visit during a 2-year follow-up.

RESULTS

303 subjects with newly diagnosed MB leprosy were included in the study. We found statistically significant differences in grip strength, key pinch and pulp-to-pulp pinch between groups defined by ulnar VMT grades at time of diagnosis. There was also a statistically significant difference in hand grip between groups defined by median VMT at diagnosis. In each case, strength tended to reduce with increasing motor involvement. We explored reduction in grip strength, key pinch or pulp-to-pulp pinch as indicators of change in ulnar VMT during follow-up. A 25% reduction over two visits was the most effective indicator. Changes were also associated with marginal changes in motor and sensory nerve function, most commonly associated with Type I reactions.

CONCLUSION

Dynamometry is recommended as an additional method that may be used to monitor changes in nerve function in leprosy, particularly in subjects with early motor impairment of the ulnar nerve.

Identification of key pinch forces required to complete functional tasks

Reconstructive hand surgeries restore key pinch to individuals with pinch force deficits caused by tetraplegia. Data that define the magnitudes of force necessary to complete functional key pinch tasks are limited. This study aims to establish target pinch forces for completing selected tasks that represent a range of useful functional activities. A robot arm instrumented with a force sensor completed the tasks and simultaneously measured the forces applied to the task objects. Lateral pinch force requirements were calculated from these measured object forces. Pinch force requirements ranged from 1.4 N to push a button on a remote to 31.4 N to insert a plug into an outlet. Of the tasks studied, 9 of 12 required less than 10.5 N. These pinch force requirements, when compared to pinch forces produced by 14 individuals with spinal cord injuries (with and without surgical reconstruction of pinch), accurately predicted success or failure in 81% of subject trials. The prediction errors indicate a need to measure other factors such as pinch opening, force location, force direction, and proximal joint control.

Late reconstruction for ulnar nerve palsy

Long term paralysis of the ulnar nerve is associated with an array of specific deficits and deformities. The numerous options for reconstruction are reviewed, as well as the specific patient considerations in selecting a strategy. An approach to late reconstruction for late ulnar nerve palsy is presented based upon the authors' experience and the available literature.

Assessment of thumb metacarpophalangeal joint arthrodesis using a single longitudinal K-wire

PURPOSE

To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire.

METHODS

We performed a retrospective review of 27 patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. Outcomes were assessed using self-reported measures (Patient-Rated Wrist/Hand Evaluation; AUSCAN Osteoarthritis Hand Index; Disabilities of the Arm, Shoulder and Hand questionnaire; Short Form-36 General Health questionnaire), measured physical impairments (range of motion, strength, manual dexterity), and radiographic review.

RESULTS

Patient-rated outcome scores indicated mild pain, difficulty with specific and usual tasks, and minimal concern with hand appearance. Most physical impairment measures were not significantly different from the side not surgically treated, and patient satisfaction was high. There was a slight decrease in tripod pinch strength, manual dexterity, interphalangeal joint flexion, handspan, and thumb opposition compared with the contralateral side. The overall complication rate was 11% (3 complications). Twenty-five patients (89%) were able to return to their previous occupations. There were no radiographic malunions or nonunions. Radiographic evidence of degenerative changes was present in 20% of patients at the carpometacarpal joint and 30% of patients at the interphalangeal joint.

CONCLUSIONS

Our technique of performing a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire is effective, with high overall patient satisfaction and a relatively low complication rate, despite small losses of strength, manual dexterity, and motion.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Traitement des dysplasies trapéziennes symptomatiques instables par ostéotomie d'addition–soustraction et ligamentoplastie

INTRODUCTION

Trapezometacarpal instability with trapezial dysplasia is an incapacitating condition long before radiological changes appear. Most of the patients are young and demanding. Treatment is often conservative. Surgical treatment options are relatively classic, starting with a ligamentoplasty of the base of the first metacarpal or a tenotomy of the transarticular accessory slip of the abductor pollicis longus. Other options such as arthrodesis and arthroplasty have not been so successful in this situation.

METHOD

The idea arose to combine two techniques described previously. In 1973 Wilson published his technique of abduction osteotomy of the first metacarpal as a treatment for basal osteoarthritis of the thumb. In 2002, Kapandji and Heim published their opening wedge osteotomy of the trapezium in order to correct the slope of a dysplastic trapezium. The combination of both of these techniques avoids closing of the first web by utilising the abduction osteotomy of the first metacarpal. Moreover, the opening wedge osteotomy corrects the dysplastic lateral rim of the trapezium by correcting its slope.

RESULTS

We have been performing this technique since 2001 and 2005 in six patients. The preliminary results are encouraging, 5 of them were able to resume their work. A fair result was achieved in a young patient.

DISCUSSION

The described technique is relatively easy and has the advantage of preserving the trapezometacarpal joint. In addition, it leaves the door open for other techniques if it eventually should fail in the long term.

Pinch Forces and Instrument Tip Forces During Periodontal Scaling

BACKGROUND

The prevalence of upper-extremity musculoskeletal disorders, such as tendinitis, is elevated among dental practitioners. An important risk factor for these disorders is forceful pinching; however, the pinch forces and instrument forces during scaling are unknown.

METHODS

Six dentists and six senior-year dental students were recruited to use an instrumented periodontal scaler to perform their usual dental scaling work on patients. Thumb pinch force was measured by a pressure sensor, whereas the forces developed at the instrument tip were measured by a six-axis load cell.

RESULTS

Dental students applied greater mean peak pinch force (35.7 +/- 3.8 N) compared to dentists (24.5 +/- 4.1 N) (P = 0.001). On the other hand, the peak forces generated at the instrument tip, which were directly related to the productivity of the dental scaling task, were higher among the dentists. The application of pinch force by dentists was related to the required scaling forces, whereas students applied excessive pinch force to the tools.

CONCLUSIONS

Increased experience in periodontal scaling leads to the application of less pinch force to accomplish scaling. Nonetheless, the applied peak pinch forces in both groups are high and may pose a risk for the development of musculoskeletal disorders of the distal upper extremity.

Validation of the ABILHAND questionnaire as a measure of manual ability in patients with rheumatoid arthritis

OBJECTIVE

Hand and upper limb involvement is common in patients with rheumatoid arthritis (RA). However, its impact on manual activities of daily life has not been fully evaluated. A measure of manual ability was developed, through the Rasch measurement model, by adapting and validating the ABILHAND questionnaire, which measures the patient's perceived difficulty in performing everyday manual activities.

METHODS

112 patients with RA were evaluated. The following tests were performed: the ABILHAND questionnaire, the Health Assessment Questionnaire (HAQ), the Jamar grip and key pinch strength tests, the Box and Block dexterity test and the Purdue pegboard dexterity test. In total, 35 patients were reassessed to determine the test-retest reliability of the ABILHAND, and 6 patients were studied before and after therapy with tumour necrosis factor (TNF) blockers to address sensitivity to change.

RESULTS

The Rasch refinement of the ABILHAND led to a selection of 27 items rated on a 3-point scale. The resulting ability scale was targeted to the ability of the patients. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Grip and key pinch strength and manual and digital dexterity on both hands were significantly, though moderately, correlated with the ABILHAND measures. Manual ability was also significantly related to the number of affected hands, disease duration, tender and swollen joint counts on upper limbs, disease activity and the HAQ. Sensitivity to change was demonstrated in patients treated with TNF blockers, commensurate with their clinical improvement.

CONCLUSION

The ABILHAND questionnaire is a clinically valid person-centred measure of manual ability that could be useful in longitudinal RA studies.

Prevalence and risk factors of work-related musculoskeletal disorders in massage practitioners

INTRODUCTION

Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors.

METHODS

We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression.

RESULTS

Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95% CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height.

CONCLUSION

WMSDs were prevalent among massage practitioners.