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Journal of Hand Therapy : Official... Jun 2024Hand function is reduced with aging which can lead to impairments in the performance of daily activities and eventually loss of independence. The ability to perceive the...
BACKGROUND
Hand function is reduced with aging which can lead to impairments in the performance of daily activities and eventually loss of independence. The ability to perceive the forces being applied to an object is an important component of hand control that also declines with age. However, the extent to which force perception can be improved through training remains largely unknown.
PURPOSE
This study evaluated the effectiveness of a home-training program focused on improving force perception in older adults.
STUDY DESIGN
Quasi-experimental - Uncontrolled trial.
METHODS
Eleven independent, healthy adults (mean age: 77.2 ± 6.8 years) participated in a home-based sensorimotor hand training program 6 days/week for 6 weeks. Force perception, the primary outcome variable, was measured as the ability to reproduce a pinch force equal to 25% maximum voluntary contraction in the absence of visual feedback using either the ipsilateral remembered or contralateral concurrent (CC) hand. We also measured hand strength, dexterity, tactile acuity, and cognition before and after training.
RESULTS
After the program was completed, participants showed a 35% reduction in absolute (p < 0.01, confidence interval (CI): [7.3, 33.2], effect sizes (ES): 0.87) and constant (p = 0.05, CI: [0.0, 34.9], ES: 0.79) force matching errors in the CC condition. Improvements in dominant hand dexterity (Purdue pegboard test) (p < 0.05, CI: [0.2, 2.4], ES: 0.60) and tactile sensitivity (JVP thresholds) (p < 0.05, CI: [-1.7, -0.1], ES: 0.94), as well as cognition (Trail Making Test B) (p < 0.05, CI: [-24,1. -1.6], ES: 0.30) were also observed post-training.
CONCLUSIONS
The results suggest that home-hand training can be an effective way to improve force perception among older adults.
PubMed: 38942652
DOI: 10.1016/j.jht.2024.02.002 -
The Journal of Hand Surgery Jun 2024This study aimed to report clinical and patient-reported outcomes collected in a registry after thumb ulnar collateral ligament (UCL) reconstruction with a free tendon...
PURPOSE
This study aimed to report clinical and patient-reported outcomes collected in a registry after thumb ulnar collateral ligament (UCL) reconstruction with a free tendon autograft. Furthermore, the patient-reported outcomes of patients with persistent instability after reconstruction and patients with concomitant metacarpophalangeal joint arthritis diagnosed during surgery were analyzed.
METHODS
Patients undergoing reconstruction with a tendon autograft between December 2011 and February 2021 were included. Michigan Hand Outcomes Questionnaire (MHQ) scores at baseline were compared with those at 3 and 12 months after surgery. Stability was tested at 3 months after surgery. Tip and key pinch strength and metacarpophalangeal joint range of motion were measured at baseline and 12 months after surgery.
RESULTS
We included 31 patients with thumb UCL insufficiency or failed UCL surgery who underwent reconstruction. The MHQ total score improved significantly from 62 at baseline to 75 at 3 months and continued to increase to 84 at 12 months after surgery. The MHQ function and pain scores improved significantly from intake to 3 and 12 months after surgery. Twenty-six of 31 patients (84%) regained postoperative metacarpophalangeal stability. Key pinch strength improved significantly 12 months after surgery from 5.2 kg at baseline to 6.4 kg at 12 months. The MHQ total, pain, and function scores of patients with persistent instability remained similar from baseline to 12 months after surgery. In four patients with metacarpophalangeal arthritis, the MHQ total and pain score improved significantly from baseline to 3 and 12 months after surgery.
CONCLUSIONS
Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. Although the sample size of patients with thumb metacarpophalangeal arthritis diagnosed during surgery was small, they reached adequate patient-reported outcomes at 12 months after surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 38935001
DOI: 10.1016/j.jhsa.2024.05.005 -
The Journal of Hand Surgery Jun 2024Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA...
PURPOSE
Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant.
METHODS
This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared.
RESULTS
Mean follow-up was 134 months (range: 120-158 months). Mean age at the time of surgery was 67 years (range: 53-84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84-93) versus 93% (95% confidence interval: 87-98) over 5 years.
CONCLUSIONS
MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 38935000
DOI: 10.1016/j.jhsa.2024.03.019 -
The Journal of Hand Surgery Jun 2024We performed a randomized controlled trial assessing patient-reported outcome measures following trapeziectomy with ligament reconstruction and tendon interposition...
A Prospective Randomized Pilot Study: One-Year Outcomes of Ligament Reconstruction Tendon Interposition Versus Suture Tape Suspensionplasty for Thumb Carpometacarpal Joint Arthritis.
PURPOSE
We performed a randomized controlled trial assessing patient-reported outcome measures following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) or suture tape suspensionplasty (STS) for treatment of thumb carpometacarpal joint osteoarthritis.
METHODS
Patients undergoing surgery for thumb carpometacarpal joint osteoarthritis were prospectively randomized to LRTI or STS. Outcome measures were collected at 2 weeks, 4 weeks, 3 months, and 1 year and included visual analog scale pain, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, return to work/activity, range of motion, grip/pinch strength, and complications.
RESULTS
Thirty-one patients (32 thumbs) were randomized from 51 patients offered participation over two years. One-year follow-up was 97%. Both groups had a decrease in visual analog scale pain scores at all postoperative time points. The trajectory of postoperative Patient-Reported Outcomes Measurement Information System Upper Extremity scores was similar, and both groups achieved the meaningful clinically important difference for improvement in PROMIS Upper Extremity by three months. Grip strength was substantially increased in both groups at one year. Return to work/activity and surgical complications favored the LRTI group.
CONCLUSIONS
Our study did not suggest any clinically relevant differences in the postoperative patient-reported outcome measures or objective clinical measurements between LRTI and STS, although LRTI patients had a faster return to work/activity and lower complication rates.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prospective randomized clinical trial, level IIB clinical.
PubMed: 38934993
DOI: 10.1016/j.jhsa.2024.04.012 -
Techniques in Hand & Upper Extremity... Jun 2024Thumb carpometacarpal arthritis is common with aging, more common in women than men, and usually occurs after age 40. If a patient fails conservative treatments such as...
Thumb carpometacarpal arthritis is common with aging, more common in women than men, and usually occurs after age 40. If a patient fails conservative treatments such as splinting, medications, and corticosteroid injections, then surgical intervention may be appropriate. Currently, there is no consensus on the best surgical treatment. By limiting metacarpal subsidence, ligament suspensionplasty with suture tape augmentation offers great pain relief, excellent functional outcomes, and limited postoperative immobilization. With this technique, trapeziectomy is first performed. A portion of the abductor pollicis longus tendon is resected and loaded onto the SwiveLock anchor using 4-0 FiberLoop, in addition to suture tape. The prepared graft and tape construct is anchored into the lateral first metacarpal (MC) base and index metacarpal base. After surgery, patients are put in a short arm thumb spica splint, interphalangeal (IP) joints free. Active motion is initiated at the first postoperative visit, usually within 1 week. All patients who had thumb arthritis treated with carpometacarpal suspensionplasty and suture tape augmentation between 2015 and 2022 by a single hand surgeon at our institution were queried. A total of 110 patients were invited to take part in this study, and 61 patients consented and were included in this study. Mean last in-office follow up was at 7.5±4.0 months, which showed significant improvements in pinch strength (P=0.011). A survey taken at a mean 2.8±1.3 years (range: 0.5 to 5.2 y) after surgery reports a postoperative DASH score of 7.3±7.7 (range: 0 to 23.3), and VAS pain score of 0.7±1.1 (range: 0 to 5).
PubMed: 38907603
DOI: 10.1097/BTH.0000000000000489 -
Journal of Hand Surgery Global Online Mar 2024Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis....
PURPOSE
Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years.
METHODS
We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.
RESULTS
The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0-40.9) at the long-term follow-up, compared with 26.2 (range: 4.5-75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement.
CONCLUSIONS
Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 38903836
DOI: 10.1016/j.jhsg.2023.12.002 -
Sensors (Basel, Switzerland) May 2024Previous investigations have shown a positive relationship between baseball pitching velocity and the kinetic chain involved in pitching motion. However, no study has...
BACKGROUND
Previous investigations have shown a positive relationship between baseball pitching velocity and the kinetic chain involved in pitching motion. However, no study has examined the influence of finger characteristics on pitching velocity and rate of spin via a sensor-embedded baseball.
METHODS
Twenty-one pitchers volunteered and were recruited for this study. An experimental baseball embedded with a force sensor and an inertial measurement unit was designed for pitching performance measurement. Finger length and strength were measured as dependent variables. Spin rate and velocity were independent variables. Pearson product-moment correlations (r) and intraclass correlation coefficients (ICCs) determined the relationship between finger characteristics and pitching performance.
RESULTS
Finger length discrepancy, two-point pinch strength, index finger RFD (rate of force development), middle finger impulse, and force discrepancy had significant correlations with spin rate (r = 0.500~0.576, ≤ 0.05). Finger length discrepancy, two-point pinch, three-point pinch strength, index and middle finger RFD, middle finger impulse, and force combination had significant correlations with fastball pitching velocity (r = 0.491~0.584, ≤ 0.05).
CONCLUSIONS
Finger length discrepancy, finger pinch strength, and pitching finger force including maximal force and RFD may be factors that impact fastball spin rate and fastball pitching velocity.
Topics: Baseball; Humans; Fingers; Male; Biomechanical Phenomena; Young Adult; Adult; Athletic Performance
PubMed: 38894314
DOI: 10.3390/s24113523 -
Brain and Behavior Jun 2024The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions in stroke patients.
METHODS
Eighteen stroke patients were included and randomly allocated into two groups. The Tele-CIMT (modified-constraint induced movement therapy-based telerehabilitation) (n = 10) group received m-CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3 weeks at home. Additionally, both the Tele-CIMT group and the control group (CG) (n = 8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3 weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FM-UE), Wolf Motor Function Test (WMFT), 9-Hole Peg Test (9-HPT), grip strengths, pinch strengths, Motor Activity Log-28 (MAL-28), and Functional Independence Measure (FIM).
RESULTS
Significant group-by-time interactions on STREAM, FM-UE, WMFT, grip strength, pinch strengths, MAL-28, and FIM were found to be in favor of the Tele-CIMT group. Additionally, post hoc analyses revealed that the Tele-CIMT group significantly improved in terms of these parameters (p > .05).
CONCLUSION
This is the first randomized controlled trial showing that Tele-CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele-CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics.
Topics: Humans; Stroke Rehabilitation; Male; Female; Upper Extremity; Middle Aged; Telerehabilitation; Aged; Stroke; Exercise Therapy; Recovery of Function; Adult; Treatment Outcome
PubMed: 38873866
DOI: 10.1002/brb3.3569 -
International Journal of Occupational... Jun 2024The hands are the most complex organs of the body for performing various activities. Therefore, it is critical to protect them against dangers. Protective gloves can...
The hands are the most complex organs of the body for performing various activities. Therefore, it is critical to protect them against dangers. Protective gloves can reduce or prevent injuries, but they can downgrade hand performance in various aspects, including tactile sensitivity, strength, grip force and hand dexterity. In this study, eight protective gloves with different designs and materials were made. The study investigated the influence of the number of layers and several characteristics, e.g., mass per square meter, thickness, bending stiffness and compressibility, on the gloved hand performance regarding protection ability, tactile sensitivity, strength capability and manual dexterity. The results indicated that despite the improving effects of increasing layer thickness, weight, bending energy and compressibility on protection ability, the gloves diminish tactile sensitivity, grip and pinch force, and manual dexterity. Therefore, it is necessary to select an optimum design to ensure a satisfactory trade-off between protection and performance.
PubMed: 38872424
DOI: 10.1080/10803548.2024.2357941 -
Clinical & Experimental Optometry Jun 2024Ocular lubricants are the mainstay of dry eye management and are available in a variety of formulations and bottle designs. The squeezability of ocular lubricant bottles...
CLINICAL RELEVANCE
Ocular lubricants are the mainstay of dry eye management and are available in a variety of formulations and bottle designs. The squeezability of ocular lubricant bottles may influence administration and compliance.
BACKGROUND
A key component for managing dry eye disease is the use of ocular lubricants. The different bottle types, each with their unique material strength and dispensing mechanism, may be challenging for patients with limited hand and pinch strength. The aim of this study was to evaluate the force required to expulse a drop from different eye drop containers used in the management of dry eye disease.
METHODS
The force, in newtons (N), required to expulse a drop from different eye drops was evaluated five times using a force gauge, and divided by bottle type, i.e. tubes, unidose, multidose with preservatives, and multidose preservative free (MDPF) bottles.
RESULTS
Sixty ( = 60) bottles were examined with 57 eye lubricants and 3 dry eye medications (cyclosporine (0.5% and 0.9%), and lifitegrast). The average force varied depending on the bottle type (tubes 4.28 ± 1.29 N; unidose 14.24 ± 4.83 N; multidose 16.62 ± 5.21 N; MDPF 26.68 ± 8.32 N, < 0.001). Post-hoc test revealed that MDPF bottles required more force than all other bottle types ( < 0.001), and among those, the ophthalmic squeeze dispenser bottle required significantly more force ( < 0.001). Lifitegrast required more force (17.38 ± 2.13 N) than cyclosporine 0.5% (9.16 ± 0.80 N, < 0.024) and cyclosporine 0.9% (5.68 ± 0.40 N, < 0.001), but was not significantly different from unidose ocular lubricants ( > 0.05).
CONCLUSION
The squeezability of bottles used in dry eye disease management varies with bottle type. Hand and pinch strength should be considered when choosing products for dry eye disease management, as the squeezability of an ophthalmic drop can influence its administration and compliance.
PubMed: 38858843
DOI: 10.1080/08164622.2024.2361781