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Journal of Biomechanics Mar 2024Hypermobility of the trapeziometacarpal joint is commonly considered to be a potential risk factor for osteoarthritis. Nevertheless, the results remain controversial due...
Hypermobility of the trapeziometacarpal joint is commonly considered to be a potential risk factor for osteoarthritis. Nevertheless, the results remain controversial due to a lack of quantitative validation. The objective of this study was to evaluate the effect of joint laxity on the mechanical loadings of cartilage. A patient-specific finite element model of trapeziometacarpal joint passive stiffness was developed. The joint passive stiffness was modeled by creating linear springs all around the joint. The linear spring stiffness was determined by using an optimization process to fit force-displacement data measured during laxity tests performed on eight healthy volunteers. The estimated passive stiffness parameters were then included in a full thumb finite element simulation of a pinch grip task driven by muscle forces to evaluate the effect on trapeziometacarpal loading. The correlation between stiffness and the loading of cartilage in terms of joint contact pressure and maximum shear strain was analyzed. A significant negative correlation was found between the trapeziometacarpal joint passive stiffness and the contact pressure on trapezium cartilage during the simulated pinch grip task. These results therefore suggest that the hypermobility of the trapeziometacarpal joint could affect the contact pressure on trapezium cartilage and support the existence of an increased risk associated with hypermobility.
Topics: Humans; Thumb; Trapezium Bone; Osteoarthritis; Cartilage, Articular; Hand Strength
PubMed: 38498967
DOI: 10.1016/j.jbiomech.2024.112042 -
The Journal of Hand Surgery, European... May 2024There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates... (Meta-Analysis)
Meta-Analysis
There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.
Topics: Humans; Collateral Ligament, Ulnar; Thumb; Bone Wires; Rupture; Hand Strength; Range of Motion, Articular; Suture Anchors; Treatment Outcome; Ulnar Collateral Ligament Reconstruction
PubMed: 38488512
DOI: 10.1177/17531934241235556 -
Acta Orthopaedica Et Traumatologica... Nov 2023This study aimed to investigate the effects of the accompanying ulnar styloid fracture and 2 different postoperative rehabilitation protocols on the final outcomes...
OBJECTIVE
This study aimed to investigate the effects of the accompanying ulnar styloid fracture and 2 different postoperative rehabilitation protocols on the final outcomes following surgical treatment of distal radius fractures.
METHODS
In this retrospective study, 47 patients (11 male, 35 female; mean age=52.6 years, age range=24-85) who underwent plate fixation for distal radius fractures were divided into 4 groups based on the presence of an ulnar styloid fracture and type of rehabilitation. To evaluate clinical outcomes, wrist range of motion (ROM), grip strength, lateral pinch strength, disabilities of the arm, shoulder, and hand (DASH) questionnaire scores and visual analog scale (VAS) scores were obtained at the final follow-up. The rehabilitation exercises of the patients in groups 1 and 2 were carried out in the physical therapy room by the hand therapist during the postoperative 2 months. Patients in groups 3 and 4 were supplied with videos of the exercises of each phase and instructed to carry out those exercises at home routinely.
RESULTS
Patients who received home rehabilitation programs demonstrated greater grip strength loss. Patients without accompanying ulnar styloid fractures had better DASH and VAS scores. Final wrist ROM and the duration for return to preinjury activity level did not differ among groups.
CONCLUSION
This study has suggested that accompanying ulnar styloid fractures may worsen the functional outcomes after plate fixation of distal radius fractures. Home-based programs may provide patients with adequate overall wrist function with certain drawbacks compared to rehabilitation under direct supervision.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Retrospective Studies; Wrist Fractures; Fracture Fixation, Internal; Wrist Joint; Wrist Injuries; Ulna Fractures; Range of Motion, Articular; Radius Fractures; Bone Plates; Treatment Outcome
PubMed: 38454215
DOI: 10.5152/j.aott.2023.21245 -
Disability and Rehabilitation Mar 2024This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of... (Review)
Review
PURPOSE
This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of pain, hand function, grip or pinch strength.
METHODS
RCTs that used some type of physiotherapeutic intervention compared to a passive or active control group were included. The quality of the evidence was assessed using the GRADE approach and, for the calculation of the meta-analysis, the standardized difference of means (SMD) was used.
RESULTS
Nineteen studies ( = 1477) were included and eight studies ( = 568) underwent meta-analysis. Orthosis intervention was superior to passive control group for pain improvement (SMD = -1.02, = 0.03, very low evidence), grip strength (SMD = 0.45, = 0.02, very low evidence) and pinch strength (SMD = 1.78, = 0.01, very low evidence), but there was no improvement in hand function ( = 0.54). The use of a neoprene orthosis was similar to the use of a thermoplastic orthosis in improving pain ( = 0.38), hand function ( = 0.50), grip strength ( = 0.42) and pinch strength ( = 0.14). The use of short thermoplastic orthosis was also similar to long thermoplastic orthosis in improving pain ( = 0.88) and hand function ( = 0.58).
CONCLUSION
The use of orthoses is superior to no intervention in all outcomes, exception hand function.IMPLICATIONS FOR REHABILITATIONThe use of orthosis is recommended for the treatment of patients with rhizoarthrosisUse of orthosis is better than no intervention in improving pain, grip and pinch strength.The type of orthosis (neoprene or thermoplastic, short or long thermoplastic) does not affect the clinical improvement of the individual to the outcomes of pain, hand physical function, grip and pinch strength.
PubMed: 38450686
DOI: 10.1080/09638288.2024.2325652 -
Journal of Clinical Neuromuscular... Mar 2024Ultrasound studies in inclusion body myositis (IBM) have reported a characteristic pattern of increased echointensity in the flexor digitorum profundus (FDP) with...
OBJECTIVE
Ultrasound studies in inclusion body myositis (IBM) have reported a characteristic pattern of increased echointensity in the flexor digitorum profundus (FDP) with relative sparing of the flexor carpi ulnaris (FCU). We examined the relationship between echointensity of the FDP and FCU muscles and hand strength or patient-reported outcomes (PROs).
METHODS
A total of 15 patients with IBM were recruited. Ultrasound images of the FDP and FCU muscles were obtained by a point-of-care ultrasound and graded using the modified Heckmatt score. Hand grip and neutral pinch strength were measured by dynamometry. PROs were assessed by the IBM Upper Extremity Function Scale.
RESULTS
FDP and/or FCU modified Heckmatt score showed a significant relationship with grip, neutral pinch strength, and PROs.
CONCLUSIONS
Point-of-care ultrasound examination of the forearm may serve as an extension of the neuromuscular examination. The semi-qualitative echointensity rating based on modified Heckmatt score seems to correlate well with the objective strength measurement and PROs.
Topics: Humans; Myositis, Inclusion Body; Hand Strength; Upper Extremity; Hand; Ultrasonography
PubMed: 38441927
DOI: 10.1097/CND.0000000000000463 -
The American Journal of Cardiology Jun 2024Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA)... (Randomized Controlled Trial)
Randomized Controlled Trial
Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA) access in the anatomical snuffbox preserves the RA but safety and potential detrimental effects on hand function are unknown. We aimed to assess hand function and complications after DRA and PRA. In this single-center trial, 300 patients were randomly allocated 1:1 to cardiac catheterization through DRA or PRA. The primary end point of change in hand function from baseline to 1 year was a composite of the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, hand grip test, and thumb-forefinger pinch test. The secondary end points included access feasibility and complications. Of 216 patients with 1-year completed follow-up, 112 were randomly allocated to DRA and 104 to PRA, with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%, p = 0.25). Radial artery occlusion occurred in 1 PRA patient versus 2 in DRA. There was no significant difference in change of hand function, median (interquartile range) hand grip (DRA 0.7 [-3 to 4.5] vs PRA 1.3 [-2 to 4.3] kg, p = 0.57), pinch grip (DRA -0.1 [-1.1 to 1] vs PRA -0.3 [-1 to 0.7] kg, p = 0.66), and Quick DASH (DRA 0 [-6.6 to 2.3] vs PRA 0 [-4.6 to 2.9] points, p = 0.58). The composite of hand function was comparable between PRA and DRA. In conclusion, DRA is a safe strategy for cardiac catheterization, with a low complication rate. Compared with PRA, there is no increased risk of hand dysfunction or radial artery occlusion at 1 year.
Topics: Humans; Radial Artery; Male; Female; Cardiac Catheterization; Middle Aged; Aged; Hand Strength; Follow-Up Studies; Time Factors
PubMed: 38432334
DOI: 10.1016/j.amjcard.2024.02.036 -
Journal of Neuroengineering and... Mar 2024Although clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected.... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of the powerball® system on muscle strength, coordination, fatigue, functionality and quality of life in people with multiple sclerosis. A randomized clinical trial.
INTRODUCTION
Although clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected. Clinical impairment of the UL in patients with MS is very common with muscle strength and hand dexterity as critical factors in maintaining functional activities that are the basis for independence and quality of life in people with MS.
OBJECTIVE
To investigate the effects of a training protocol using the Powerball® system in combination with conventional physiotherapy on muscle strength, coordination, fatigue, functionality, and quality of life in persons with MS over an 8-week period.
MATERIALS AND METHODS
A double-blind randomized controlled trial was conducted. The control group received conventional treatment, while the experimental group received additional UL training using the Powerball® system. Both groups received the same number of sessions and weeks of intervention. The following outcome measures were used: isometric grip and pinch strength, Box and Block Test (BBT), Nine Hole Peg Test (NHPT), Abilhand scale, Fatigue Severity Scale (FSS), Multiple Sclerosis Impact Scale (MSIS-29), and Likert satisfaction questionnaire for the experimental group. All measures were administered at baseline, after the treatment, and during a 3-week follow-up period.
RESULTS
25 patients completed the study (12 in the experimental and 13 in the control group). The experimental group showed significant improvements in coordination and manual dexterity of the more affected UL as measured by the BBT comparing pre- to post-treatment (p = 0.048) and pre-treatment to follow-up (p = 0.001), and on the less affected UP comparing pre-treatment to follow-up (p < 0.001) and post-treatment to follow-up (p = 0.034). The Likert-type satisfaction questionnaire obtained a mean score of 89.10 (± 8.54) out of 100 points.
CONCLUSIONS
Upper limb treatment protocol using the Powerball® system, in combination with conventional physiotherapy for 8 weeks resulted in significant improvements in the intra-group analysis for UL coordination and manual dexterity in favor of the experimental group. The experimental group showed excellent satisfaction to the treatment.
Topics: Humans; Multiple Sclerosis; Quality of Life; Muscle Strength; Upper Extremity; Hand Strength; Fatigue
PubMed: 38431591
DOI: 10.1186/s12984-024-01325-w -
BMC Musculoskeletal Disorders Feb 2024There is a controversy on the effectiveness of post-operating splinting in patients with carpal tunnel release (CTR) surgery. This study aimed to systematically evaluate... (Meta-Analysis)
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.
Topics: Humans; Carpal Tunnel Syndrome; Hand Strength; Pinch Strength; Splints; Pain Measurement
PubMed: 38383364
DOI: 10.1186/s12891-024-07230-6 -
Hand (New York, N.Y.) Feb 2024This article's purpose was to analyze clinical results obtained with thumb carpometacarpal (CMC) arthroscopic hemitrapeziectomy with temporary suspension with a...
BACKGROUND
This article's purpose was to analyze clinical results obtained with thumb carpometacarpal (CMC) arthroscopic hemitrapeziectomy with temporary suspension with a Kirschner wire (K-wire).
METHODS
Seventy thumb CMC arthroscopic hemitrapeziectomies with a mean age of 59 and 18 months of follow-up were performed in our center during a 13-year period. All of them followed the same protocol. Surgical technique is described.
RESULTS
All patients were arthroscopically classified as Badia's III stage. No tendon interposition was used, and a K-wire was temporarily implanted for 5.1 weeks. Mean postsurgical Visual Analogue Scale of 1.6, Kapandji Opposition Score of 8.1, grip strength of 42.2 lbs, lateral pinch of 9.5 lbs, tip-to-tip pinch of 4.2 lbs and tripod pinch of 7.8 lbs were measured. All previous active workers resumed their previous job.
CONCLUSIONS
We conclude that thumb CMC arthroscopic hemitrapeziectomy with temporary suspension with K-wire reaches good results in terms of pain reduction, strength, and functionality, without the necessity of an internal brace which increases risks of a second metacarpal fracture.
PubMed: 38380812
DOI: 10.1177/15589447241231301 -
Text neck is not associated with neck and upper limb disability in young adults who use smartphones.European Spine Journal : Official... Mar 2024The objective of the present study was to correlate neck and upper-limb disabilities with neck flexion in university students who are smartphone users. While handling... (Observational Study)
Observational Study
PURPOSE
The objective of the present study was to correlate neck and upper-limb disabilities with neck flexion in university students who are smartphone users. While handling smartphones, a posture with sustained neck flexion known as "Text Neck" is usually adopted, and some authors related to musculoskeletal symptoms on the neck and the upper limb. However, recent studies state that such an association is questionable.
METHODS
This is an observational study when evaluating 192 university students through questionnaires such as the Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), besides the maximal neck flexion, grip and lateral pinch strength of the participants.
RESULTS
The sociodemographic questionnaire demonstrated that most participants had used the device for 5 to 10 years, for five or more hours per day. The DASH questionnaire scores presented an average of 7.2 points, while the data regarding grip and lateral pinch strength showed averages of 29.5 kgf and 8.8 kgf, respectively. The NDI questionnaire scores presented an average of 10.5. The average range of motion of the maximum neck flexion was 27°.
CONCLUSION
There was no association between neck flexion with the DASH and NDI or the grip and lateral pinch strength after the correlation and binary logistic regression analyses. The results show that the scores of DASH, NDI, hand grip and lateral pinch strength, have no association with the maximum neck flexion.
Topics: Humans; Young Adult; Smartphone; Hand Strength; Upper Extremity; Shoulder; Hand; Disability Evaluation
PubMed: 38369595
DOI: 10.1007/s00586-024-08139-3