-
Annals of Plastic Surgery Jun 2024Whether endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) has superior outcomes remains a controversial topic. Therefore, we sought to... (Meta-Analysis)
Meta-Analysis Comparative Study Review
INTRODUCTION
Whether endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) has superior outcomes remains a controversial topic. Therefore, we sought to perform an umbrella review and meta-analysis to compare ECTR and OCTR with regards to (1) postoperative functional ability, (2) operative outcomes, and (3) time to return to work.
METHODS
A PubMed, Scopus, and Cochrane database search was conducted for all meta-analyses comparing ECTR and OCTR performed between 2000 and 2022 in accordance to PRISMA and Joanna Briggs Institute guidance for umbrella reviews. The primary outcomes were as follows: (1) functional ability-symptoms severity, postoperative grip strength, postoperative pinch strength, 2-point discrimination, and pain; (2) operative outcomes-operation time, total complications, nerve injury, and scar-related complication; and (3) time to return to work. Quality was assessed using the Assessment of Multiple Systematic Reviews. Pooled analysis was performed to compare several clinical outcome measures between groups, depending on the availability of data using Review Manager Version 5.2.11.
RESULTS
A total of 9 meta-analyses were included, 5 were of high quality and 4 were moderate quality. For functional ability, ECTR was associated with better pinch strength after 3 months (0.70, 95% confidence interval [CI] = 0.00, 1.40, P = 0.05) and 6 months (0.77, 95% CI = 0.14, 1.40, P = 0.02, I2 = 84%). For return to work, OCTR was associated with longer return to work compared with ECTR (-10.89, 95% CI = -15.14, -6.64, P < 0.00001, I2= 83%). There were no significant differences between OCTR and ECTR in the hand function, symptom severity, grip strength, pain, operation time, and total complications.
CONCLUSIONS
In an umbrella review and meta-analysis of ECTR versus OCTR, ECTR was associated with a higher pinch strength, and a shorter time to return to work. Differences in major complications, such as nerve injury, were unclear due to statistical inconsistency and bias.
Topics: Humans; Carpal Tunnel Syndrome; Endoscopy; Return to Work; Recovery of Function; Treatment Outcome; Decompression, Surgical
PubMed: 38768022
DOI: 10.1097/SAP.0000000000004005 -
Medical Science Monitor : International... May 2024BACKGROUND Scaphoid nonunion (SN) is a challenging condition in wrist pathology, often resulting in severe consequences if left untreated. Surgical intervention,...
Treatment of AVN-Induced Proximal Pole Scaphoid Nonunion Using a Fifth and Fourth Extensor Compartmental Artery as a Vascularized Pedicle Bone Graft: A Retrospective Case Series.
BACKGROUND Scaphoid nonunion (SN) is a challenging condition in wrist pathology, often resulting in severe consequences if left untreated. Surgical intervention, particularly using vascularized bone grafts (VBGs), is a promising but uncertain approach. The 4+5 extensor compartment artery (ECA) pedicled graft, less commonly used for SN, has potential benefits due to its vascular supply and accessibility to the scaphoid. This study aimed to evaluate the effectiveness of the 4+5 ECA pedicled graft combined with headless compression screw fixation in treating avascular necrosis (AVN)-induced proximal pole SN. Radiological results, functional outcomes, and complications related to this method were assessed. MATERIAL AND METHODS This was a retrospective analysis of 19 proximal pole SN cases with AVN treated using the 4+5 ECA-VBG technique from 2016 to 2022. Patients underwent preoperative evaluation and postoperative follow-up for at least 1 year. Data on surgery, demographics, radiological assessments, and functional outcomes were recorded and analyzed statistically. RESULTS All patients achieved radiographic union within 8.5 weeks postoperatively, with revascularization of proximal pole necrosis. Significant improvements in functional outcomes were observed, including pain reduction, increased wrist range of motion, improved grip and pinch strength, and enhanced wrist scores. No major complications were reported. CONCLUSIONS The 4+5 ECA-VBG technique, with headless compression screw fixation, showed high success rates in treating AVN-induced proximal pole SN. This method offers comprehensive restoration of wrist function and minimal complications, making it a viable option for SN management, especially in AVN cases. Further research is needed to confirm these results and establish standardized protocols for SN treatment.
Topics: Humans; Scaphoid Bone; Male; Retrospective Studies; Female; Adult; Fractures, Ununited; Osteonecrosis; Bone Transplantation; Fracture Fixation, Internal; Treatment Outcome; Middle Aged; Range of Motion, Articular; Young Adult; Adolescent; Bone Screws; Arteries
PubMed: 38762751
DOI: 10.12659/MSM.944553 -
Medicine May 2024This study aimed to investigate changes in hand sensation (finger tactile threshold and two-point discrimination) and function in patients with malignant lymphoma,... (Observational Study)
Observational Study
This study aimed to investigate changes in hand sensation (finger tactile threshold and two-point discrimination) and function in patients with malignant lymphoma, particularly during the early stages of chemotherapy with vincristine. Eighteen patients with malignant lymphoma were enrolled in this study. Data on the Common Terminology Criteria for Adverse Events Version 4.0, the visual analog scale for hand numbness, the Semmes Weinstein monofilament test, static and moving two-point discrimination (2PD), grip strength, pinch strength, and the Purdue Pegboard test were collected at 3 time points: before the start of chemotherapy (T0), after the first cycle of chemotherapy (T1), and after the second cycle of chemotherapy (T2). No significant changes were observed in Semmes Weinstein monofilament test at T0, T1, or T2 in either hand. However, the static 2PD was significantly worse for the right ring, little, and left middle fingers, whereas the moving 2PD was significantly worse for the right ring, left index, middle, and ring fingers. Furthermore, the visual analog scale scores for hand numbness and left-hand grip strength worsened significantly. Right-hand grip strength, pinch strength of both hands, and Purdue Pegboard test showed no significant deterioration. Chemotherapy with vincristine may affect hand sensation and function in patients with malignant lymphoma by exacerbating finger 2PD and hand numbness. Additionally, during the early stages of vincristine chemotherapy, it is important to monitor for a decrease in grip strength specifically in the left hand.
Topics: Humans; Vincristine; Male; Female; Hand Strength; Middle Aged; Lymphoma; Hand; Aged; Adult; Antineoplastic Agents, Phytogenic; Hypesthesia
PubMed: 38758870
DOI: 10.1097/MD.0000000000038207 -
PloS One 2024Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains... (Comparative Study)
Comparative Study
Three-dimensional motion analysis of pre- and postoperative thumb movement in trapeziometacarpal joint osteoarthritis-Comparison of arthrodesis and trapeziectomy with suspensionplasty.
Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.
Topics: Humans; Osteoarthritis; Female; Thumb; Male; Middle Aged; Arthrodesis; Range of Motion, Articular; Aged; Trapezium Bone; Biomechanical Phenomena; Carpometacarpal Joints; Movement; Adult; Postoperative Period
PubMed: 38753715
DOI: 10.1371/journal.pone.0302898 -
PloS One 2024African elephants have a wide range of abilities using their trunk. As a muscular hydrostat, and thanks to the two finger-like processes at its tip, this proboscis can...
African elephants have a wide range of abilities using their trunk. As a muscular hydrostat, and thanks to the two finger-like processes at its tip, this proboscis can both precisely grasp and exert considerable force by wrapping. Yet few studies have attempted to quantify its distal grasping force. Thus, using a device equipped with force sensors and an automatic reward system, the trunk tip pinch force has been quantified in five captive female African savanna elephants. Results showed that the maximum pinch force of the trunk was 86.4 N, which may suggest that this part of the trunk is mainly dedicated to precision grasping. We also highlighted for the first time a difference in force between the two fingers of the trunk, with the dorsal finger predominantly stronger than the ventral finger. Finally, we showed that the position of the trunk, particularly the torsion, influences its force and distribution between the two trunk fingers. All these results are discussed in the light of the trunk's anatomy, and open up new avenues for evolutionary reflection and soft robot grippers.
Topics: Animals; Elephants; Female; Torso; Fingers; Hand Strength; Biomechanical Phenomena
PubMed: 38743734
DOI: 10.1371/journal.pone.0301529 -
The Journal of Hand Surgery... Jun 2024Wrist arthroplasty is increasingly offered to patients with symptomatic wrist arthritis as an alternative to wrist arthrodesis. The purpose of this study was to present...
Wrist arthroplasty is increasingly offered to patients with symptomatic wrist arthritis as an alternative to wrist arthrodesis. The purpose of this study was to present our outcomes with the ReMotion™ wrist arthroplasty in a consecutive series of patients with wrist arthritis from non-inflammatory conditions. Thirteen (eight women, nine dominant wrists) patients, 68 (44-85) years of age with advanced radiocarpal arthritis due to SLAC/SNAC (11) and Kienbock disease (2) had a ReMotion™ (Stryker, Michigan, USA) wrist arthroplasty implanted, and were prospectively followed for 7 (4-9) years. The outcome measures included patient-rated wrist and hand evaluation (PRWHE) score, disabilities of the arm, shoulder and hand questionnaire (QuickDASH) score, visual analogue pain score (0-10) on the radial and ulnar aspect of the wrist at rest (VASrR/VASuR) and activity (VASrA/VASuA), active wrist range of motion (AROM) including flexion, extension, ulnar and radial deviation, pronation and supination and grip and key-pinch strength measured preoperatively and at yearly follow-ups by independent hand therapists. Six patients had ten re-operations during the follow-up including four revisions to a new arthroplasty. Four were considered loose at follow-up. A significant reduction in PRWHE (63 to 12), radial pain at activity (6 to 1) and increased pronation (85° v 90°) was observed. We found a high complication and reoperation rate, two out of 13 had no complications or reoperations. The ReMotion™ arthroplasty should be used with caution in non-inflammatory wrist patients and the patients followed closely. A high reoperation and revision rate can be expected, and surgeons familiar with revision arthroplasty procedures should perform the surgery. Level II (Therapeutic).
Topics: Humans; Female; Aged; Wrist Joint; Middle Aged; Male; Aged, 80 and over; Joint Prosthesis; Adult; Range of Motion, Articular; Arthroplasty, Replacement; Prospective Studies; Treatment Outcome; Arthritis; Disability Evaluation; Hand Strength; Pain Measurement; Prosthesis Design
PubMed: 38726500
DOI: 10.1142/S2424835524500218 -
The Journal of Hand Surgery... Jun 2024Untreated or insufficiently treated collateral ligament injuries of the thumb metacarpophalangeal (MP) joint can lead to instability or even osteoarthritis. Arthrodesis...
Untreated or insufficiently treated collateral ligament injuries of the thumb metacarpophalangeal (MP) joint can lead to instability or even osteoarthritis. Arthrodesis is one of the treatment options available for the treatment of the sequelae of collateral ligament injuries. The objective of our study was to evaluate the radiological, clinical and functional outcomes of MP joint arthrodesis performed for sequelae of collateral ligament injuries. We conducted a retrospective, single-centre study and reviewed the files of patients who had a thumb MP joint arthrodesis following a collateral ligament injury between 2011 and 2019. We collected patient's demographic data and the results of the radiological and clinical examinations. Eighteen patients were included in the study. The average age was of 53.6 years and the time between injury to arthrodesis averaged 7 years. Four patients (22%) had nonunion. In the remaining 14 patients with solid union at an average of 72 months follow-up, the visual analogue pain score at rest was 0.14, the thumb opposition was 82%, grip strength 85%, tip pinch 92% and key pinch 79% of the contralateral side. The clinical and functional results of patients with a successful arthrodesis are satisfactory with restoration of good grip and pinch strength. Despite a lack of thumb MP joint flexion, stability allowed force transmission and may be preferred for manual workers. Level IV (Therapeutic).
Topics: Humans; Metacarpophalangeal Joint; Arthrodesis; Male; Middle Aged; Female; Retrospective Studies; Thumb; Collateral Ligaments; Adult; Follow-Up Studies; Aged; Hand Strength; Treatment Outcome
PubMed: 38726488
DOI: 10.1142/S242483552450019X -
Cureus Apr 2024Background and aim Low-level laser therapy (LLLT) is considered a promising non-invasive treatment option for osteoarthritis (OA). The current study aimed to evaluate...
Background and aim Low-level laser therapy (LLLT) is considered a promising non-invasive treatment option for osteoarthritis (OA). The current study aimed to evaluate the effectiveness of LLLT on patients with OA of the first carpometacarpal joint (CMC1) of the thumb. Methods An open-level, prospective, randomized controlled trial was conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, for one year. Initially, 120 patients were approached for the study. Among them, 112 eligible patients were randomly divided into two groups: the intervention group received LLLT in addition to conservative treatment, while the control group received conservative treatment alone for four weeks. Pain and functional capability (motor) improvement were assessed on a weekly follow-up basis by using various parameters such as the visual analogue scale (VAS), Ritchie articular index (tenderness scale), grip strength, key pinch strength, Dreiser functional index, and CMC1 palmer abduction. Eventually, 90 patients completed the follow-ups and were included in the analysis. Results The majority of patients diagnosed with CMC1 joint OA were in their fifties. At baseline, patients of both intervention and control groups were indifferent in terms of demography, pain intensity, motor responses, and duration of suffering. After four weeks of treatment, results indicated an overall improvement in both groups. However, the reduction of pain and increase in functional capability were not found statistically significant (p-value: ≥0.5). Conclusion LLLT with conventional treatment was not found significantly more effective enough than conventional treatment alone, but more well-designed clinical trials with larger sample sizes are needed to reach a definitive conclusion.
PubMed: 38725743
DOI: 10.7759/cureus.57883 -
Journal of Neurology May 2024Impaired motor function is a major cause of disability in multiple sclerosis (MS), involving various neuroplasticity processes typically assessed by neuroimaging. This...
INTRODUCTION
Impaired motor function is a major cause of disability in multiple sclerosis (MS), involving various neuroplasticity processes typically assessed by neuroimaging. This study aimed to determine whether navigated transcranial magnetic stimulation (nTMS) could also provide biomarkers of motor cortex plasticity in patients with MS (pwMS).
METHODS
nTMS motor mapping was performed for hand and leg muscles bilaterally. nTMS variables included the amplitude and latency of motor evoked potentials (MEPs), corticospinal excitability measures, and the size of cortical motor maps (CMMs). Clinical assessment included disability (Expanded Disability Status Scale, EDSS), strength (MRC scale, pinch and grip), and dexterity (9-hole Pegboard Test).
RESULTS
nTMS motor mapping was performed in 68 pwMS. PwMS with high disability (EDSS ≥ 3) had enlarged CMMs with less dense distribution of MEPs and various MEP parameter changes compared to pwMS with low disability (EDSS < 3). Patients with progressive MS had also various MEP parameter changes compared to pwMS with relapsing remitting form. MRC score correlated positively with MEP amplitude and negatively with MEP latency, pinch strength correlated negatively with CMM volume and dexterity with MEP latency.
CONCLUSIONS
This is the first study to perform 4-limb cortical motor mapping in pwMS using a dedicated nTMS procedure. By quantifying the cortical surface representation of a given muscle and the variability of MEP within this representation, nTMS can provide new biomarkers of motor function impairment in pwMS. Our study opens perspectives for the use of nTMS as an objective method for assessing pwMS disability in clinical practice.
PubMed: 38709305
DOI: 10.1007/s00415-024-12398-x -
European Review For Medical and... Apr 2024The palmaris longus (PL) contributes to the palmar fascia, wrist flexion, hand muscle balance, and pinch strength. Also, PL is used as a graft source. So, PL's presence...
OBJECTIVE
The palmaris longus (PL) contributes to the palmar fascia, wrist flexion, hand muscle balance, and pinch strength. Also, PL is used as a graft source. So, PL's presence is helpful for joint stability and grafting. On the other hand, joint hypermobility (JH) is associated with many complaints and disorders. Considering the adverse effects of JH and benefit-based evolution, the genesis rather than agenesis of PL can be expected in JH. Herein, it was hypothesized that PL might be together with JH, and individuals with PL may have higher scores of JH than those without.
PATIENTS AND METHODS
Between June 2023 and October 2023, 200 participants (F/M: 1/1) were included in the study. The Schaeffer's test and the Beighton scores were used to assess PL and JH, respectively. The participants were divided into two bilateral groups according to the presence or absence of PL. Then, the groups were compared for demographics and Beighton scores. Subgroup analyses were also done by considering gender.
RESULTS
No significant differences were found between PL (+) and PL (-) groups considering females+males in age (p=0.559), gender (p=0.517), weight (p=0.375), height (p=0.061), work status (p=0.229), Beighton score (p=0.893), and JH (p=1.0). No significant differences were found between PL (+) and PL (-) groups considering females only in age (p=0.871), weight (p=0.189), height (p=0.127), work status (p=0.200), Beighton score (p=0.727), and JH (p=1.0). No significant differences were found between PL (+) and PL (-) groups considering males only in age (p=0.370), weight (p=0.981), height (p=0.400), BMI (p=0.601), work status (p=0.145), Beighton score (p=0.757), and JH (p=1.0).
CONCLUSIONS
According to the results of this study, no relationship was found between PL and JH. However, this is the first study on the topic and has some limitations.
Topics: Humans; Joint Instability; Female; Male; Adult; Middle Aged; Young Adult; Wrist Joint; Range of Motion, Articular; Muscle, Skeletal
PubMed: 38708478
DOI: 10.26355/eurrev_202404_36048