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International Orthopaedics Oct 2020Flexor tendon adhesion to tissues is one of the most frequent complications reported after flexor tendon repair. The human amniotic membrane (HAM) was used to wrap the...
PURPOSE
Flexor tendon adhesion to tissues is one of the most frequent complications reported after flexor tendon repair. The human amniotic membrane (HAM) was used to wrap the tendon repair site to decrease fibrotic response and tendon adhesion.
METHODS
A total of 19 patients with flexor tendon injuries were subjected to surgical repair. The repair site was wrapped with human amniotic membrane (HAM) in nine cases. The remaining ten cases served as controls as no HAM wrap was used. The clinical outcome was assessed by pain, range of motion, and pinch strength. The healing of repair was evaluated with high-frequency ultrasound; the biologic response was assessed with two inflammatory mediators, i.e., interleukin-6 and TGF-beta-1.
RESULTS
HAM wrap cases recorded less pain, higher total active range of motion, and better tendon glide on ultrasonography at follow-up (6-18 months). The levels of serum inflammatory biologic markers decreased in majority of HAM cases whereas they increased in controls at two to six weeks post-operatively. No infection/immune rejection phenomenon was seen in HAM wrap cases.
CONCLUSIONS
HAM wrap around the tendon repair site resulted in quicker function and qualitatively better tendon healing on ultrasound, with a decrease of the biologic response.
Topics: Amnion; Humans; Range of Motion, Articular; Tendon Injuries; Tendons; Tissue Adhesions
PubMed: 32748027
DOI: 10.1007/s00264-020-04752-1 -
Journal of Physical Therapy Science Aug 2022[Purpose] Intensive training can at least partially improve finger movement dysfunction observed after stroke or any neurodegenerative disease. Wearable equipment can...
[Purpose] Intensive training can at least partially improve finger movement dysfunction observed after stroke or any neurodegenerative disease. Wearable equipment can significantly improve patients' quality of life. However, long-term use of conventional training gloves containing metal can injure joints. In this study, we investigated the safety and efficacy of a novel, metal-free, wearable strength-building device. [Participants and Methods] We enrolled 20 healthy participants in whom we measured grip and pinch strength before and while the equipment was worn. Additionally, we investigated the adverse effects and discomfort experienced while participants wore the equipment. [Results] The grip strength was reduced by approximately 20% while participants wore the equipment. We did not observe any serious adverse events. [Conclusion] The knitting equipment described in this study resists movements associated with gripping the hand and acts on all fingers, and may be useful for rehabilitation to improve finger function during routine activities.
PubMed: 35937625
DOI: 10.1589/jpts.34.602 -
The Journal of Hand Surgery Jan 2023Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar...
PURPOSE
Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after repair with suture anchors (SA), suture tape (ST) anchor augmentation, or reconstruction with palmaris longus graft (PL).
METHODS
Thumbs and, if present, the PL tendon were harvested from 15 fresh-frozen cadavers. Each thumb specimen was secured into a servohydraulic biomechanical testing frame to evaluate native radiographic MCP joint angles at 0° flexion when loaded with 0, 5, and 13 N of radial force. Subsequently, a single hand surgeon (S.M.K.) performed complete transection and UCL repair via 1 of 3 methods: SA (n = 5), ST (n = 5), or reconstruction with PL (n = 5). Following repair, MCP joint angles were radiographically evaluated. Specimens that did not fail during joint angle testing were transferred to a separate testing frame for load-to-failure testing. Angle measurements and mean load-to-failure were compared between the groups, and angulation was also compared with each group's native control.
RESULTS
Both ST and SA groups demonstrated comparable stiffness to their native controls, whereas the PL group was significantly more lax. The ST repair was significantly stiffer than the other constructs. ST also required higher forces to reach failure compared to both SA and PL. No difference was found between SA and PL groups.
CONCLUSIONS
Although both ST and SA constructs recapitulate native joint stiffness, repair with ST demonstrated the greatest biomechanical strength in stiffness and load-to-failure.
CLINICAL RELEVANCE
For complete, acute tears of the thumb UCL, ST may be superior for maintaining MCP joint stability and strength over SA and PL.
Topics: Humans; Collateral Ligament, Ulnar; Thumb; Tendons; Muscle, Skeletal; Suture Anchors; Cadaver; Biomechanical Phenomena; Collateral Ligaments
PubMed: 34823921
DOI: 10.1016/j.jhsa.2021.09.028 -
Frontiers in Neurology 2023Over the years, endoscopic carpal tunnel release (ECTR) has gained significant interest as an alternative to surgery. However, no consensus has been reached on the...
BACKGROUND
Over the years, endoscopic carpal tunnel release (ECTR) has gained significant interest as an alternative to surgery. However, no consensus has been reached on the necessity of postoperative wrist immobilization. This study aims to compare the outcomes of wrist immobilization for a period of 2 weeks to immediate wrist mobilization after ECTR.
METHODS
A total of 24 patients with idiopathic carpal tunnel syndrome undergoing dual-portal ECTR from May 2020 to Feb 2022 were enrolled and randomly divided into two groups postoperatively. In one group, patients wore a wrist splint for 2 weeks. In another group, wrist mobilization was allowed immediately after surgery. The two-point discrimination test (2PD test); the Semmes-Weinstein monofilament test (SWM test); the occurrence of pillar pain, digital and wrist range of motion (ROM); grip and pinch strength; the visual analog score (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ) score; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and complications were evaluated at 2 weeks and 1, 2, 3, and 6 months after the surgery.
RESULTS
All 24 subjects finished this study with no dropouts. During the early follow-up, patients with wrist immobilization demonstrated lower VAS scores, lower occurrence of pillar pain, and higher grip and pinch strength compared with the immediate mobilization group. No significant difference was obtained between these two groups in terms of the 2PD test, the SWM test, digital and wrist ROM, BCTQ, and the DASH score. In total, two patients without splints reported transient scar discomfort. No one complained of neurapraxia, injury of the flexor tendon, median nerve, and major artery. At the final follow-up, no significant difference was found in any parameters between both groups. The local scar discomfort mentioned above disappeared and left no serious sequela.
CONCLUSION
Wrist immobilization during the early postoperative period demonstrated significant pain alleviation along with stronger grip and pinch strength. However, wrist immobilization yielded no obvious superiority regarding clinical outcomes at the final follow-up.
PubMed: 37181552
DOI: 10.3389/fneur.2023.1081440 -
Turkish Journal of Physical Medicine... Mar 2021In this study, we aimed to investigate the availability of the Timed Up and Go (TUG) test in daily practice instead of the Tampa Scale for Kinesiophobia (TSK) test for...
OBJECTIVES
In this study, we aimed to investigate the availability of the Timed Up and Go (TUG) test in daily practice instead of the Tampa Scale for Kinesiophobia (TSK) test for the evaluation of fear of movement and to assess the functionality of the upper extremity in postmastectomy lymphedema patients.
PATIENTS AND METHODS
Between March 2018 and July 2018, a total of 30 female patients (mean age 53.8±12.3 years; range, 35 to 80 years) with postmastectomy lymphedema were included in this study. The severity of lymphedema of the patients was measured circumferentially at 5-cm intervals. All patients were evaluated for upper extremity functionality using the Timed Functional Arm and Shoulder Test, hand grip strength using a hand dynamometer, and pinch strength using a pinchmeter. The TSK test was used for the evaluation of fear of movement and TUG test was used for the evaluation of functional status of lower extremity.
RESULTS
There was a significant difference in functionality between the affected and unaffected side of upper extremity (p<0.05). According to the TSK results, all patients described themselves as kinesiophobic, and advanced fear of movement was found in 66.67% of the patients. However, according to the TUG scores, lower extremity functionality of all patients was normal.
CONCLUSION
Our study results showed that, independently of the severity of lymphedema, fear of movement was seen in every patient and functionality of upper extremity decreased on the affected side. On the other hand, the TUG test may not be useful to asses fear of movement in daily practice regarding to functional scores of these patients.
PubMed: 33948544
DOI: 10.5606/tftrd.2021.4616 -
Plastic and Reconstructive Surgery Sep 2023In this study, we wanted to compare the pyrocarbon disc interposition arthroplasty (PDI) with trapeziectomy plus ligament reconstruction tendon interposition (LRTI)....
Stronger pinch strength at long-term follow-up after pyrocarbon disc interposition arthroplasty compared to trapeziectomy with ligament reconstruction and tendon interposition for CMC-1 osteoarthritis.
BACKGROUND/INTRODUCTION
In this study, we wanted to compare the pyrocarbon disc interposition arthroplasty (PDI) with trapeziectomy plus ligament reconstruction tendon interposition (LRTI). Primarily, we tested whether PDI resulted in a higher pinch strength. Secondarily, we compared the grip strength, range of motion (ROM), patient reported outcomes, satisfaction and complications.
METHODS
Due to scarcity of preoperative hand measurements, we performed a descriptional cross-sectional cohort study of patients operated between 2006 and 2014, with a minimum of 5 years of follow-up. Patients were treated with PDI or LRTI. We determined key pinch strength as primary outcome, followed by tip- and tripod pinch, grip strength, palmar abduction and opposition; the Michigan Hand Outcome Questionnaire (MHQ), Patient Reported hand and Wrist evaluation (PRWHE), satisfaction and complications. Propensity score matching was used to match both study groups on demographic variables. A ratio of 2:1 was used resulting in inclusion of 62 (of 154) PDI and 31 (of 31) LRTI thumbs.
RESULTS
The PDI-group patients showed stronger key and tip pinch strength than the LRTI group (p=0.027 and p=0.036 respectively). Tripod pinch, grip strength and ROM were equal for both groups. MHQ and PRWHE were comparable, with higher satisfaction for the PDI group. Eight PDI patients were converted to LRTI due to pain.
CONCLUSION/DISCUSSION
This study confirmed our hypothesis that key and tip pinch strength is stronger after PDI compared to LRTI for CMC-1 joint osteoarthritis. Both techniques have comparable outcomes considering patient reported outcome (MHQ and PRWHE), ROM and complications.
PubMed: 37678813
DOI: 10.1097/PRS.0000000000011038 -
Journal of Wrist Surgery Jun 2021Scaphoid excision and partial wrist fusion is used for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist arthritis. The...
Scaphoid excision and partial wrist fusion is used for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist arthritis. The purpose of this study was to report midterm functional and radiographic outcomes in a series of patients who underwent bicolumnar fusion of the lunocapitate and triquetrohamate joints using retrograde headless screws. Twenty-three consecutive patients (25 wrists) underwent surgery with this technique from January 2014 to May 2017 with a minimum follow-up of 1 year. Assessment consisted of range of motion, grip, and pinch strength. Patient-reported outcome measures included disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores. Fusion rates and the radiolunate joint were evaluated radiographically. The relationship between wrist range of motion and midcarpal fusion angle (neutral position vs. extended capitolunate fusion angle > 20 degrees) was analyzed. Average follow-up was 18 months. Mean wrist extension was 41 degrees, flexion 36 degrees, and radial-ulnar deviation arc was 43 degrees. Grip strength was 39 kg and pinch 9 kg. Residual pain for activities of daily living was 1.6 (visual analog scale). The mean DASH and PRWE scores were 19 ± 16 and 28 ± 18, respectively. Patients with an extended capitolunate fusion angle trended toward more wrist extension but this did not reach statistical significance ( = 0.17). With retrograde headless compression screws, the proximal articular surface of the lunate is not violated, preserving the residual load-bearing articulation. Patients maintained a functional flexion-extension arc of motion with grip-pinch strength close to normal. Capitolunate fusion angle greater than 20 degrees may provide more wrist extension but further studies are needed to demonstrate this. This is a Level IV study.
PubMed: 34109062
DOI: 10.1055/s-0040-1721853 -
Frontiers in Bioengineering and... 2023Scaphoid and lunate fractures have a relatively high incidence rate. Traditional carpectomy and carpal arthrodesis in the treatment of carpal osteonecrosis will lead to...
Scaphoid and lunate fractures have a relatively high incidence rate. Traditional carpectomy and carpal arthrodesis in the treatment of carpal osteonecrosis will lead to many complications. Three-dimensional (3D) printed tantalum has good biocompatibility and can be designed to match the patient's personalized anatomical carpal structure. This study aims to investigate carpal function and prosthesis-related conditions after carpal bone replacement using 3D printed tantalum prostheses. From July 2020 to January 2022 at our center, seven patients with osteonecrosis of the carpus received carpal bone replacement using 3D printed tantalum prosthesis. The Disability of the Arm, Shoulder and Hand (DASH) score and patient satisfaction, as well as the Mayo Wrist Scores (Cooney method, modified Green, and O'Brien wrist score), were used to evaluate the preoperative and postoperative wrist function of patients. The Visual Analog Scale (VAS) pain scores were also recorded before and after surgery. The angles of flexion, dorsiflexion, ulnar deviation, and radial deviation were measured using an arthrometer. The grip strength and pinch strength of the operated hand after carpal bone replacement and the contralateral healthy carpus were measured using a dynamometer. Radiographs were taken to confirm the condition and complications of the tantalum prosthesis. All seven patients were followed for 19.6 ± 2.7 months. At the last follow-up, the grip strength of the operated wrist joint after carpal bone replacement was 33.4 ± 2.3 kg, the pinch strength was 8.9 ± 0.7 kg, the flexion was 54.6° ± 0.8°, the dorsiflexion was 54.7° ± 1.7°, the ulnar deviation was 34.6° ± 1.9°, and the radial deviation was 25.9° ± 0.8°, all of which showed no statistically significant difference with the contralateral healthy carpus ( > 0.05). There were significant differences in the VAS, DASH, and MAYO scores between the preoperative and the last follow-up ( < 0.01). Patients had reduced postoperative pain and improved wrist function and range of motion (ROM), and the tantalum prostheses were stable. The 3D printed tantalum brings us new hope, not only for hip or knee replacement, but also for joint replacement of other complex anatomical structures, and patients with other irregular bone defects such as bone tumors and deformity, which could realize personalized treatment and precise medicine.
PubMed: 37965053
DOI: 10.3389/fbioe.2023.1234052 -
The Journal of Hand Surgery May 2022Pyrocarbon implant hemiarthroplasty is a treatment option for select patients with trapeziometacarpal joint arthritis. The long-term revision rates after implant...
PURPOSE
Pyrocarbon implant hemiarthroplasty is a treatment option for select patients with trapeziometacarpal joint arthritis. The long-term revision rates after implant arthroplasty can be as high as 30%. Revision to trapeziectomy has been described for patients who require implant removal; however, few studies have assessed outcomes in patients in this subgroup.
METHODS
This was a retrospective review of patients who underwent the conversion of a pyrocarbon carpometacarpal implant to trapeziectomy and suspensionplasty from 2003 to 2019. Patients who met the criteria were then compared with a matched cohort who underwent primary trapeziectomy and suspensionplasty. Patients were matched based on the revision procedure, age, and duration of follow-up. Data regarding demographic information, range of motion, grip and pinch strengths, and the need for subsequent procedures were collected.
RESULTS
Twenty-five patients underwent the removal of their pyrocarbon carpometacarpal implant. The patients underwent revision to Thompson suspensionplasty (n = 14), the Weilby procedure (n = 5), ligament reconstruction tendon interposition (n = 2), or a suture-based suspension procedure (n = 4). The age, sex, and preoperative range of motion and strength measures were similar between the 2 groups. All the patients complained of moderate-to-severe pain prior to surgery, which improved in both groups after surgery. Patients who underwent the removal of a pyrocarbon arthroplasty implant lost 6.4° of palmar abduction after surgery. The postoperative grip, opposition strength, apposition pinch strength, and radial and palmar abduction were similar between the 2 groups.
CONCLUSIONS
The removal of a pyrocarbon carpometacarpal implant using subsequent trapeziectomy successfully relieves pain in patients in whom pyrocarbon arthroplasty has failed. After revision, patients may lose abduction motion but have similar strength compared with those who undergo primary trapeziectomy.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic III.
Topics: Arthroplasty; Carbon; Carpometacarpal Joints; Humans; Osteoarthritis; Pain; Range of Motion, Articular; Thumb; Trapezium Bone
PubMed: 35248427
DOI: 10.1016/j.jhsa.2022.01.004 -
Hand (New York, N.Y.) Jan 2023Advanced thumb carpometacarpal (CMC) joint arthritis is widely treated with trapeziectomy. To obviate the need for autologous tissue, maintain thumb length, and reduce...
BACKGROUND
Advanced thumb carpometacarpal (CMC) joint arthritis is widely treated with trapeziectomy. To obviate the need for autologous tissue, maintain thumb length, and reduce the risk of scaphoid impingement, the senior author developed an interposition arthroplasty technique using meniscal allograft. We hypothesize that the use of meniscus improves outcomes and subsequent functionality compared with trapeziectomy alone.
METHODS
Twenty-three patients with Eaton stage III-IV CMC osteoarthritis underwent arthroplasty with meniscal allograft, and 7 patients underwent trapeziectomy alone. Preoperative Disabilities of the Arm, Shoulder, and Hand (DASH), pain, grip and pinch strength, and range of motion scores were compared with postoperative scores at 6 weeks, 6 months, and 1 year.
RESULTS
The study group consisted of 17 women and 6 men, and the control group consisted of 5 women and 2 men. The mean age was similar at 61.4 (48-72) years and 65.7 (56-78) years for the study and control groups, respectively. The DASH scores dropped by 61.8% in the study group compared with 38.8% in the control group (<0.01), whereas pain decreased 86.0% and 69.8%, respectively ( < .01). Strength and range of motion improvement was similar between the groups. Subsidence of the joint space was 1% in the study group compared with 18.4% in the control group. There were no surgical complications in either group.
CONCLUSIONS
Joint resurfacing with meniscal allograft represents a viable joint salvage option in severe cases of CMC arthritis. Early results suggest that, compared with trapeziectomy alone, the approach results in greater reduction in subjective pain and disability scores, similar improvement in strength measures and range of motion, and less subsidence.
Topics: Male; Humans; Female; Middle Aged; Aged; Trapezium Bone; Arthroplasty; Osteoarthritis; Meniscus; Allografts
PubMed: 33789510
DOI: 10.1177/1558944721999730