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Journal of Clinical Orthopaedics and... Oct 2021Ethnic differences in upper limb anthropometry have significant variations which can influence surgical outcomes and rehabilitation. We hypothesize that there would be a...
BACKGROUND
Ethnic differences in upper limb anthropometry have significant variations which can influence surgical outcomes and rehabilitation. We hypothesize that there would be a significant difference in the anthropometry based on ethnicity and gender which will reflect on objective measurements.
METHODS
We performed 13 anthropometric measurements of the upper limb, grip and three types of pinch strength in 210 volunteers across seven ethnicities in young adults at our university campus. We compared them statistically based on ethnic and gender differences.
RESULTS
There was a significant correlation noted between grip, palmar and tip to tip pinch strength in 12 of the 13 anthropometric measurements. Key pinch correlated with eight parameters. Mean grip and pinch strength are noted to be more in males and from developed nations across all ethnicities.
CONCLUSIONS
This study shows that there is significant variation between the anthropometric measurements based on gender and ethnicity which correlates with differences in grip and pinch strength.
PubMed: 34367910
DOI: 10.1016/j.jcot.2021.101504 -
Hand (New York, N.Y.) Jan 2022There is poor understanding regarding functional limitation of thumb strength and dexterity following thumb metacarpophalangeal (MCP) and interphalangeal (IP)...
There is poor understanding regarding functional limitation of thumb strength and dexterity following thumb metacarpophalangeal (MCP) and interphalangeal (IP) arthrodesis. The purpose of this investigation was to quantitatively evaluate the functional limitations of MCP and IP joint fusion using an orthosis to simulate fusion. Thirty-two healthy volunteers underwent simulated MCP and IP thumb arthrodesis using custom-molded orthoses. Each volunteer was independently assessed for hand and thumb function using the Jebsen-Taylor Hand Function test, lateral pinch strength, tip pinch strength, and Grooved Pegboard test. Comparisons between the 3 groups in all functional tests were carried out. The mean lateral pinch strength was significantly greater in the unsplinted group (8.3 kg) compared with the MCP- (6.3 kg) and IP-splinted (5.7 kg) groups. Mean tip pinch strength was also significantly higher in the unsplinted group than in MCP- and IP-splinted thumbs (4.6 kg vs 4.1 and 3.9 kg). There was no difference in the Jebsen-Taylor or Grooved Pegboard test between the 3 groups. Our study suggests that with a fused MCP joint the lateral and tip pinch strength will decrease by 24% and 10%, respectively, compared with a healthy nonsplinted thumb. A fused IP joint will decrease lateral and tip pinch by 31% and 16%, respectively. This information does not take into account an arthritic thumb. We found that the Jebsen-Taylor test and Grooved Pegboard test were not affected by simulated thumb MCP and IP fusion.
Topics: Arthrodesis; Humans; Metacarpophalangeal Joint; Splints; Thumb
PubMed: 32100564
DOI: 10.1177/1558944720906495 -
Hand (New York, N.Y.) Jan 2019We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL)... (Comparative Study)
Comparative Study
BACKGROUND
We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis.
METHODS
Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio.
RESULTS
Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups.
CONCLUSIONS
Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.
Topics: Aged; Arthritis; Carpometacarpal Joints; Female; Follow-Up Studies; Hand Strength; Humans; Male; Middle Aged; Orthopedic Fixation Devices; Orthopedic Procedures; Postoperative Care; Range of Motion, Articular; Retrospective Studies; Tendon Transfer; Thumb; Trapezium Bone; Visual Analog Scale
PubMed: 30188195
DOI: 10.1177/1558944718798850 -
JPRAS Open Mar 2024In thumb carpometacarpal (CMC) instability, laxity of the ligaments surrounding the joint leads to pain and weakness in grip and pinch strength, which predisposes the... (Review)
Review
In thumb carpometacarpal (CMC) instability, laxity of the ligaments surrounding the joint leads to pain and weakness in grip and pinch strength, which predisposes the patient to developing CMC joint arthritis. Recent advancements in joint anatomy and kinematics have led to the development of various surgical reconstructive procedures. This systematic review outlines the available ligament reconstruction techniques and their efficacy in treating nontraumatic and nonarthritic CMC instability. Additionally, we aimed to provide evidence which specific ligament reconstruction technique demonstrates the best results. Four databases (Embase, MEDLINE, Web of Science, and Cochrane Central) were searched for studies that reported on surgical techniques and their clinical outcomes in patients with nontraumatic and nonarthritic CMC instability. Twelve studies were analyzed for qualitative review, including nine different surgical ligament reconstruction techniques involving two hundred and thirty thumbs. All but one of the reported techniques improved postoperative pain scores and showed substantial improvement in pinch and grip strength. Complication rates varied between 0% and 25%. The included studies showed that ligament reconstruction effectively alleviated the patients' complaints regarding pain and instability, resulting in overall high patient satisfaction. Nevertheless, drawing definitive conclusions regarding the superiority of any ligament reconstruction technique remains challenging owing to the limited availability of homogeneous data in the current literature.
PubMed: 38323100
DOI: 10.1016/j.jpra.2024.01.001 -
Journal of Wrist Surgery Aug 2022A painful unstable distal radioulnar joint (DRUJ) can seriously compromise hand and wrist function. The semiconstrained prosthesis was developed to restore DRUJ...
A painful unstable distal radioulnar joint (DRUJ) can seriously compromise hand and wrist function. The semiconstrained prosthesis was developed to restore DRUJ function. To date, most outcome reports are coauthored by the designer. Does independent reporting confirm the promising results of the semiconstrained DRUJ prosthesis? Are complication and failure rates acceptable? We evaluated patients with the semiconstrained DRUJ implant and a minimum follow-up of 2 years. We monitored patient satisfaction and function with functionality questionnaires and measured wrist range of motion, grip, and key pinch strength. Statistical analysis was done using descriptive statistics, Pearson correlation coefficients, linear and logistic regression. We included 41 patients with 42 implants. Mean follow-up was 46 months (range: 24-102 months). Eighty percent of wrist had undergone previous surgery. We found a mean pronation of 83 degrees (0-90 degrees), supination of 70 degrees (0-90 degrees), flexion of 42 degrees (0-90 degrees), extension of 49 degrees (0-90 degrees), ulnar deviation of 24 degrees (0-60 degrees), and radial deviation of 14 degrees (0-40 degrees). Grip and key pinch strength were 20.1 (1-50 kg) and 6 kg (1-12 kg), respectively. Average patient-rated wrist and hand evaluation score was 42.7 (0-95), disabilities of the arm, shoulder and hand score was 38 (0-88), and visual analog scale score was 3.6 (0-8). We found a 43% complication rate (mostly minor: ulnar or radial tendinopathy, temporary hypoesthesia) with 24% reoperation and 92% prosthesis survival rate. The linked semiconstrained DRUJ prosthesis has its value in the surgical treatment of DRUJ failure. Currently, most implants are used in secondary surgery and multioperated wrists. More research is required to assess the value of the DRUJ prosthesis as a primary procedure. This is a level IV, therapeutic study.
PubMed: 35971467
DOI: 10.1055/s-0041-1740135 -
Industrial Health 2015The purpose was to systematically review the published reports for the clinical utility of quantitative objective tests commonly used for diagnosing musculoskeletal... (Review)
Review
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.
Topics: Diagnostic Techniques and Procedures; Hand Strength; Hand-Arm Vibration Syndrome; Humans; Motor Skills; Musculoskeletal Diseases; Pinch Strength; Sensitivity and Specificity
PubMed: 26051288
DOI: 10.2486/indhealth.2014-0221 -
Hand Therapy Jun 2022Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this... (Review)
Review
INTRODUCTION
Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this review was to establish whether either intervention reduced pain and improved pinch strength in people with first CMCJ OA in the short term and assess whether one intervention is superior to the other.
METHOD
This was a systematic review and meta-analysis. Seven databases were searched until May 2021. Only RCTs were included. The Cochrane Risk of Bias Tool and the Grade of Recommendations Assessment, Development and Evaluation system were utilised to rate the evidence. Random-effects meta-analysis with subgroup analyses were used.
RESULTS
Eight studies were included with a total of 417 participants. Mobilisation treatments included manual therapy with or without exercise while immobilisation interventions utilised thumb splinting with several different designs. Very low-quality and low-quality evidence showed that mobilisation led to statistically but not clinically significant improvements in pain (standardised mean difference (SMD) = 0.53; 95% confidence interval (CI) = 0.03 to 1; I = 60%; = 0.06) and pinch strength (SMD = 0.35; 95% CI = 0.03 to 0.7; I = 12%; = 0.3) compared to placebo. Very low-quality and low-quality evidence showed no effect on pain and pinch strength compared to a control or no intervention. Subgroup analyses revealed no difference between interventions.
DISCUSSION
Neither mobilisation nor immobilisation alone led to clinically important improvements in pain or pinch strength in the short term in people with symptomatic first CMCJ OA. Neither therapeutic strategy appeared to be superior.
PubMed: 37904729
DOI: 10.1177/17589983221083994 -
Plastic and Reconstructive Surgery.... May 2023Arthroscopic partial trapeziectomy with suture-button suspensionplasty was developed for the surgical treatment of thumb carpometacarpal arthritis. However, the...
UNLABELLED
Arthroscopic partial trapeziectomy with suture-button suspensionplasty was developed for the surgical treatment of thumb carpometacarpal arthritis. However, the relationship between clinical results and radiographic evidence is unclear.
METHODS
The authors retrospectively reviewed 33 consecutive patients who underwent arthroscopic partial trapeziectomy with suture-button suspensionplasty for thumb carpometacarpal arthritis between 2016 and 2021. Clinical and radiographic outcomes were recorded, and the correlations between them were evaluated.
RESULTS
The average patient age at surgery was 69 years. Patient radiologic evidence was Eaton stage Ⅱ in three thumbs, Ⅲ in 25 thumbs, and Ⅳ in five thumbs. The average trapezial space ratio (TSR) was 0.36 immediately after the operation but declined to 0.32 after 6 months. In contrast, the average joint subluxation was reduced to 0.005 immediately after the operation compared with 0.28 before, and was maintained at 0.04 at final follow-up. A statically significant correlation was detected between grip strength and TSR ( = 0.03), and between pinch strength and TSR ( = 0.02). A significant correlation was detected between TSR and trapezium height ( = 0.0215), which remained after partial trapeziectomy. No correlation was detected between rope position and other clinical or radiographic scores.
CONCLUSIONS
Suture-button can have an effect on the medialization of the first metacarpal base. Excessive trapeziectomy can result in functional deficiency of the thumb through metacarpal subsidence, which potentially causes loss of grip and pinch strength.
PubMed: 37180981
DOI: 10.1097/GOX.0000000000004983 -
Frontiers in Surgery 2022There is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious...
BACKGROUND
There is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious metacarpal subsidence, and decreased stability. The aim of this study is to introduce a different technique to restore the function and stability of the first carpal metacarpal joint with minimal trauma, rapid pain relief, reduced complications, and the clinical outcomes in the long-term follow-up was evaluated and statistically analyzed.
METHODS
This was a retrospective study of 10 patients with a mean age of 51.8 years. The surgery consisted of removing partial trapezium through arthroscopy, reconstructing the stability with flexor carpi radialis suspension and tendon interposition. The subjective assessment included visual analog scale (VAS) of pain, quick disabilities of the arm, shoulder, and hand (Quick-DASH) score, and patient satisfaction. The range of motion, grip strength, pinch strength, and radiographic assessment, which can reflect stability of the thumb, were objectively evaluated and statistically analyzed.
RESULTS
Ten patients were monitored at a mean follow-up of 6.8 years. The mean grip strength improved significantly from 16.64 to 22.57 kg after surgery. Pinch strength improved significantly from 3.72 to 5.71 kg on average. The Kapandji score improved significantly from 5.7 to 8.6 on average. 80% (8/10) of the patients were satisfied with this surgery. On objective indicators, the VAS score decreased significantly from 6.4 to 1.3 on average. The mean Quick-DASH score improved significantly from 6.1 to 28.9. Postoperative x-ray showed slight subsidence and dislocation of the first metacarpal in two patients and did not affect the function by measurement.
CONCLUSION
Arthroscopy-assisted partial trapezium resection combined with ligament reconstruction could be a workable and promising surgical technique in patients with thumb CMC OA. It can offer the advantages of minimizing surgical injury by preserving the first carpal metacarpal joint capsule to protect its stability, with a rapid pain relief, function improvement, and satisfactory results in patients' clinical measurements.
PubMed: 36338619
DOI: 10.3389/fsurg.2022.945013 -
PloS One 2018The present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and...
OBJECTIVE
The present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and manual dexterity.
METHODS
Ten male participants completed eight trials involving 30 min of seated rest followed by 30 min of cooling or control of no cooling (CON) (34°C, 58% relative humidity). The cooling methods utilised were: ice cooling vest (CV0), phase change cooling vest melting at 14°C (CV14), evaporative cooling vest (CVEV), arm immersion in 10°C water (AI), portable water-perfused suit (WPS), heliox inhalation (HE) and ice slushy ingestion (SL). Immediately before and after cooling, participants were assessed for fine (Purdue pegboard task) and gross (grip and pinch strength) manual dexterity. Rectal and skin temperature, as well as thermal sensation and comfort, were monitored throughout.
RESULTS
Compared with CON, SL was the only method to reduce rectal temperature (P = 0.012). All externally applied cooling methods reduced skin temperature (P<0.05), though CV0 resulted in the lowest skin temperature versus other cooling methods. Participants felt cooler with CV0, CV14, WPS, AI and SL (P<0.05). AI significantly impaired Purdue pegboard performance (P = 0.001), but did not affect grip or pinch strength (P>0.05).
CONCLUSION
The present study observed that ice ingestion or ice applied to the skin produced the greatest effect on rectal and skin temperature, respectively. AI should not be utilised if workers require subsequent fine manual dexterity. These results will help inform future studies investigating appropriate pre-cooling methods for the occupational worker.
Topics: Adult; Body Temperature; Female; Humans; Ice; Male; Skin Temperature; Thermosensing
PubMed: 29357373
DOI: 10.1371/journal.pone.0191416