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At least 73 records · Page 4Linked to original sources
PubMed1994

Double incision open technique for carpal tunnel release: an alternative to endoscopic release.

I prospectively evaluated the results of 30 consecutive patients with bilateral carpal tunnel release using two techniques. The first release was performed with a standard incision while the opposite hand underwent release by a double incision open technique. Postoperatively, subjective complaints of pain, grip strength, pinch strength, and pillar tenderness were evaluated at 1, 2, 4, 6, and 10 weeks. All patients expressed complete relief of preoperative numbness in both hands. The improvement in pinch and grip strength and lack of pillar tenderness in the hands that underwent the double incision open technique closely matched the reported results of endoscopic carpal tunnel release. There were no complications with either technique.

Adolescent↗
PubMed2003

Results of ray resection and amputation for ring avulsion injuries at the proximal interphalangeal joint.

We investigated the long-term functional results of ray resection (14 cases) and amputation (nine cases) for ring avulsion injuries of ring finger which could not be replanted or underwent failed replantation. The mean follow-up was 37 (range, 24-63) months in the ray resection group and 32 (range, 24-40) months in the amputation group. Grip strength, key pinch strength, chuck pinch strength, hand circumference and palmar volume were decreased in the ray resection group but only grip strength and pulp pinch strength were significantly decreased in the amputation group. These results suggest that ray resection should be avoided in patients with occupations that need strong key and chuck pinch functions.

Adolescent↗
PubMed2003

One-fascicle median nerve transfer to biceps muscle in C5 and C6 root avulsions of brachial plexus injury.

Five male patients with avulsions of the C5 and C6 roots of the brachial plexus underwent transfer of one fascicle of the median nerve to the motor branch of the biceps muscle. The mean period of follow-up was 32 months. The average reinnervation time of the biceps was 3.4 months. Four patients achieved biceps strength of Medical Research Council (MRC) grade 4, and one patient had strength of the biceps of MRC grade 3. The mean period of time from surgery to MRC grade 3 was 9 months. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination, and strength of wrist volar flexion on the affected side were not worse than before the operation in any patient.

Adolescent↗
PubMed1983

Bilateral differences of normal hand strength.

The normal grip strength, pinch strength and key strength was determined by specially designed dynamometers in 30 females and 30 males aged 22-68 years. No significant difference was found between the strength patterns of the dominant and non-dominant hand. It is concluded that in the evaluation of hand strength under pathological conditions, the strength of the other hand should be a useful parameter.

Adult↗
PubMed1994

Dynamic analysis of profundus tendon function.

A method for analysis of hand function is reported through evaluation and characterization of flexor digitorum profundus (FDP) tendon mechanics. A testing platform is used that allows for the dynamic evaluation of intact cadaver hand mechanics under normal and pathologic conditions using simultaneous measurements of tendon load, tendon excursion, grip strength, pinch strength, and joint angle. This study of FDP tendons in normal fresh cadaver hands demonstrates that FDP tendon excursion increases as the number and size of joints flexed increases. Extensor counterweighting 500 g, increases FDP tendon load and work but not excursion requirements, and FDP loads of up to 75 N are required for single finger grip strengths of 4 kg force. These loads do not result in permanent (plastic) deformation of either the tendon or the restraining soft tissues. Detailed descriptions of the platform and the mechanical tests performed are provided.

Adult↗
PubMed2004

A prospective outcomes study of Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand.

PURPOSE: Destruction and dislocation of the metacarpophalangeal (MCP) joints are common occurrences in patients with rheumatoid arthritis (RA). Disruption of the support ligaments around the MCP joints and ulnar deviation of the fingers affect hand function and hamper the ability to perform activities of daily living. A common surgical intervention is the Swanson Metacarpophalangeal Joint Arthroplasty (SMPA), which restores alignment of the fingers. METHODS: We conducted a prospective study with 16 patients to determine outcomes of this procedure. We present our data from the 6-month and 1-year follow-up periods. RESULTS: Functional assessment by grip strength, pinch strength, and Jebsen-Taylor Test did not improve significantly when compared with preoperative values. Subjective assessment by the Michigan Hand Outcomes Questionnaire (MHQ), however, did improve significantly. Large improvements were seen in the function, activities of daily living, aesthetics, and patient satisfaction domains, with preoperative to 1-year postoperative score improvements of 26, 42, 57, and 43 points, respectively, based on a 100-point scale. Ulnar drift significantly decreased 1 year after surgery by an average of 24 degrees and MCP joint range of motion increased, but this change was not significant. CONCLUSIONS: Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. Continued follow-up evaluation of this cohort will determine whether these improvements are maintained in the long term.

Activities of Daily Living↗
PubMed2006

Outcomes using an internal osteotomy and distraction device for corrective osteotomy of distal radius malunions requiring correction in multiple planes.

PURPOSE: Many different methods have been proposed for correction of distal radius malunions; however, precise correction of a severe malunion that requires simultaneous adjustment of displacement, angulation, and rotation in multiple planes is difficult. This prospective study measured radiographic and functional outcomes using an adjustable osteotomy, distraction, and fixation system for distal radius malunions that required correction in multiple planes. METHODS: Five consecutive patients with symptomatic distal radius malunions requiring correction in multiple planes were recruited into this study. All patients had correction of the malunion with an adjustable osteotomy, distraction, and fixation device. Radiographic parameters and objective and subjective functional outcomes were measured before surgery and at 3 months, 6 months, and 1 year after surgery. RESULTS: All radiographic measurements improved after surgery. Grip strength, pinch strength, and the Jebsen-Taylor test showed only marginal improvement. Ulnar deviation of the wrist and forearm pronation-supination improved, but the wrist extension-flexion arc did not. The Michigan Hand Outcomes Questionnaire showed improvement in all domains, and significant improvement was seen in the overall, work, aesthetic, and satisfaction domains. The Michigan Hand Outcomes Questionnaire, however, also indicated a substantial amount of residual impairment in all domains, including activities of daily living and pain. CONCLUSIONS: Corrective osteotomy with the adjustable osteotomy, distraction, and fixation device resulted in improvement in distal radius anatomy and function. However, not all improvements were statistically significant, and anatomy and function did not returned to baseline levels. Despite residual disability, patients noted substantial improvement in subjective outcomes. This system is useful for improving anatomy and function in distal radius malunions that require correction in multiple planes, but patients should be informed that they cannot expect to regain normal anatomy or function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Activities of Daily Living↗
PubMed2003

Endoscopic versus open carpal tunnel release: a randomized trial.

PURPOSE: This study compared the outcomes in patients assigned to either endoscopic carpal tunnel release (ECTR) or traditional open carpal tunnel release (OCTR). METHODS: An unbalanced randomized clinical trial (91 endoscopic, 32 open) was conducted. Short-term and long-term outcomes were evaluated by a blinded assessor. The primary outcome measures were symptom severity measured on a self-report scale and nerve/vascular complications. Secondary outcomes included the McGill pain questionnaire, grip strength, pinch strength, sensory threshold (NK PSSD device, NK Biotechnical Corp, Minneapolis, MN), and time to return to work. RESULTS: Both groups improved on all outcomes. No differences were observed in primary outcomes between the groups at either baseline or follow-up at 1 week, 6 weeks, or 12 weeks after surgery. No significant complications occurred in either group. Grip strength and pain were significantly better at 1 and 6 weeks in the endoscopic group although differences dissipated by 12 weeks. No significant differences occurred in other secondary outcomes. Long-term satisfaction was lower in the endoscopic group, attributable to a 5% rate of re-operation. Lower rates of endoscopic release have occurred at our center once these results were available to surgeons and patients. CONCLUSIONS: No substantive difference in benefit was shown for these 2 methods of carpal tunnel release.

Carpal Tunnel Syndrome↗
PubMed2000

Transfer of a single fascicle from the ulnar nerve to the biceps muscle after avulsions of upper roots of the brachial plexus.

Thirty-six patients with avulsions of upper roots of the brachial plexus underwent transfer of a single fascicle from the ulnar nerve to the proximal motor branch of the biceps muscle to restore elbow flexion. The mean period of follow-up was 22 months. The average reinnervation time for the biceps muscle was 3.3 months. Thirty-four patients achieved biceps strength of Medical Research Council grade 3 or better. The operative results in the patients with C5, C6 avulsions were better than those with C5, C6, C7 avulsions. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination and the strength of flexion of the wrist on the affected side was not worse than before surgery in any patient.

Adult↗
PubMedDate not supplied

Neuromuscular and psychological characteristics in subjects with work-related forearm pain.

There are scant data available on the neuromuscular and psychological characteristics of patients with cumulative trauma disorders. We compared 16 subjects with work-related forearm and hand pain in the dominant upper limb with 9 age-matched control subjects. Pain subjects were divided into two groups based on nerve conduction studies: eight subjects were in the study group for median neuropathy at the wrist (MN, median transcarpal latency >2.3 ms), and eight were in the study group for electrodiagnostically negative pain (EN). Average pain, forearm muscle tenderness, grip strength, pinch strength, and wrist flexor and extensor strength were measured. The Health Status Questionnaire and the Beck Depression Inventory were used to measure health perception and depressive symptoms, respectively. Work satisfaction was determined by a newly devised scale. Statistical analysis was by analysis of variance and planned comparison analysis. The MN and EN groups did not significantly differ on any of the measures except median transcarpal latency. Both pain groups had significantly (P < 0.05) greater average pain, greater extensor muscle tenderness, higher Beck Depression Inventory scores, higher pain rating, and poorer physical functioning on the Health Status Questionnaire than did the normal control group. Grip strength and wrist extension force were diminished in both cumulative trauma groups compared with control subjects; however, only grip strength in the MN group and wrist extension force in the EN group differed significantly (P < 0.05) from control subjects. Only the EN group had significantly less work satisfaction than did the control group. Overall, both pain groups differed from control subjects and shared similar characteristics, with the exception of median neuropathy.

Adult↗
PubMedDate not supplied

A comparison of two methods of assessing disease activity in the joints.

BACKGROUND: Considerable debate has occurred concerning the utility of different methods of obtaining joint counts and their usefulness in predicting outcomes in persons with rheumatoid arthritis. OBJECTIVE: The purpose of this study was to compare two methods of assessing disease activity in the joints (clinician joint count, self-reported joint count), and to compare their relative utility in predicting two methods of assessing outcomes (self-reported ratings of impairment and pain, objective performance index) with and without controlling for negative affectivity. METHOD: Data for this study were obtained during home visits from 185 persons diagnosed with rheumatoid arthritis. Individuals completed a series of self-report measures including the joint count. Trained research assistants completed a 28-joint count and timed participants on a series of measured performance activities (e.g., grip strength, pinch strength, walk time). RESULTS: The self-report joint count was highly correlated with the clinician joint count and also accounted for as much, if not more, variance in the subjective outcome measures than did clinician assessments. Both types of indicators predicted unique variance in the objective performance index. CONCLUSIONS: For most research purposes, measures such as self-report joint counts have sufficient validity to be used in place of more costly clinician assessment of joint counts.

Activities of Daily Living↗
PubMed1992

Upper extremity impairment in workers performing repetitive tasks.

A series of subjective and objective measures were chosen to determine impairment of upper extremity function in 157 workers performing repetitive tasks. Workers were asked to respond to questions regarding their perception of the presence or absence of numbness, pain, weakness, or swelling in their upper extremities. Objective tests consisted of the measurement of grip strength, pinch strength, Semmes-Weinstein monofilament sensory responses, vibrometer responses, neurometer measurement, and the presence or absence of Tinel's or Phalen's signs. These measures were considered collectively to estimate the overall levels of impairment of each individual. Overall findings show that 55 percent of workers examined had impairment scores of 2 or more and 75 percent had scores of 1 or more. Significant differences were found in impairment ratings between job types. Those jobs requiring the highest repetition with the least rest per cycle had the highest impairment ratings. Workers that rotated jobs had impairment scores significantly less (p less than 0.005) than the average of workers performing single-task jobs. We conclude that cumulative trauma disorders are more prevalent than originally believed and that the disorder is best examined from an overall functional impairment perspective.

Adult↗
PubMed1997

Radial forearm flap donor-site complications and morbidity: a prospective study.

One-hundred patients undergoing radial forearm flap reconstruction in the head and neck over a 2-year period were followed prospectively to assess complications and morbidity associated with the radial flap donor site. Eighty-six patients were available follow-up at 3 months and 74 at 1 year (49 fasciocutaneous, 25 composite). Partial loss of the donor-site skin graft occurred in 14 patients (16 percent), with exposure of tendons in 11 patients (13 percent). Delay in healing of the split-thickness skin graft at the donor site occurred in 19 patients (22 percent). Fracture of the radius occurred in 6 of 35 patients with composite flaps (17 percent). Superficial radial nerve sensation was reduced in 24 patients (32 percent) at 1 year. Ten patients (14 percent) reported cold intolerance, and 21 patients (28 percent) complained of poor aesthetic result. Function of the donor arm was restricted in 8 patients (16 percent) in the fasciocutaneous group, in 7 patients (36 percent) in the composite group without fracture, and in all patients who had a fracture of the radius following harvesting of composite flaps. Detailed measurements of forearm circumference, grip strength, pinch strength, and wrist movements showed greater reduction in these parameters in patients reporting restricted function compared with those reporting normal function. It is concluded that there is a low incidence of long-term morbidity associated with fasciocutaneous flaps and a higher incidence with composite flaps. Fracture of the radius results in reduced function in all cases.

Female↗
PubMed1987

Physiological methods used in Japan for the diagnosis of suspected hand-arm vibration syndrome.

In the pathogenesis of hand-arm vibration syndrome, vibration affects the peripheral system, especially the circulatory, nervous, and musculoskeletal systems. Medical questionnaires, physical examinations, and laboratory tests are used to diagnose the hand-arm vibration syndrome. The laboratory tests are satisfactory diagnostic aids for detecting slight disorders of the peripheral circulatory, nervous, and musculoskeletal systems. Peripheral circulatory function tests include skin temperature measured by a thermistor under specific temperature conditions, the nail compression test, and the cold provocation test (10-min immersion in cold water at 5 or 10 degrees C). To assess peripheral nervous function, tests for the pain and vibration senses are included. Peripheral musculoskeletal function tests consist of grip strength, pinch strength and tapping counts. These physiological tests are applied in worker screening twice a year. These tests have been authorized by the Ministry of Labour since 1973. Several criteria for the tests, although not authorized, are widely used. The diagnostic implication of each separate test may be low. Consequently, some laboratory tests should be evaluated, along with medical questionnaires and physical examinations, in the diagnosis of suspected hand-arm vibration syndrome.

Arm↗
PubMed1996

Dynamic radio-ulnar convergence after the Darrach procedure.

We reviewed 23 patients who had had 25 Darrach procedures for traumatic or post-traumatic disorders of the wrist at a mean follow-up of 75.5 months (36 to 121). The mean age at the time of operation was 61.1 years (34 to 82). All patients were reviewed in person. Assessment included a history, a questionnaire on patient satisfaction and a detailed physical examination. Standardised radiographs of both wrists were taken with the patient's hands in a resting position and during maximal grip. Convergence of the distal ulnar stump towards the distal radius during maximal grip (dynamic radio-ulnar convergence) was seen in 14 wrists including five with actual contact (dynamic radio-ulnar impingement), but this produced symptoms in only two cases. The presence of dynamic radio-ulnar convergence did not correlate with grip strength, pinch strength, range of movement or wrist score, but was associated with increased length of excision of the distal ulna. Nineteen of the 23 patients were satisfied with the procedure. Dynamic radio-ulnar convergence is common after the Darrach procedure, but is rarely symptomatic; resection of the distal ulna remains a reliable procedure in the older patient with pain and loss of movement. Excision of the lower end of the ulna should be restricted to the least required to restore full rotation.

Activities of Daily Living↗
PubMed1996

The use of the palmaris brevis flap in recurrent carpal tunnel syndrome.

In failed cases of primary carpal tunnel release, the addition of the highly vascular palmaris brevis turnover flap as an adjunct to internal neurolysis discourages scarring and provides a nutrient bed for axonal regeneration. In fact, the palmaris muscle flap actually may suppress the growth of nerve fibers into the overlying scar. Experimentally, classic neuromas do not form when a severed nerve is placed in an innervated muscle, particularly those with minimal excursion, as is the case with the turned over palmaris cushion. Major advantages of the palmaris turnover muscle are (1) proximity of the muscle to the operative field, obviating the need for a distant graft source; (2) negligible functional motor loss as a result of forfeiting this muscle; (3) no separate scar is created in raising this flap; and (4) adequate padding of the subcutaneous fat is still left at the donor site to protect the ulnar neurovascular bundle. Although postoperative healing and rehabilitation time are relatively lengthened by the more extensive dissection, subjective assessments of pain relief and clinical improvements in grip strength, pinch strength, and sensory parameters justify the use of the palmaris brevis turnover flap in recalcitrant carpal tunnel cases.

Adult↗
PubMed1998

Long-term complications of snake bites to the upper extremity.

The purpose of this study was to determine long-term complications of upper-extremity snake envenomations. The records of 73 patients, who were seen for snake bites were obtained; 46 of these patients had bites to the upper extremity, and 27 had bites to the lower extremity. These patients were graded according to the severity of the bite. The snakes involved were eastern diamondback rattlesnake, coral snake, pigmy rattlesnake, water moccasin, and unknown. Fourteen of the 46 patients receiving upper extremity bites were examined by a hand surgeon and an occupational hand therapist 1 to 3.2 years after their bite. Subjective pain data, range-of-motion, intrinsic, extrinsic, finger-flexion tightness, grip strength, pinch strength and objective sensory data were collected. Four patients had continued pain and tissue atrophy at the bite site. There were no long-term sequelae from a missed compartment syndrome.

Adult↗
PubMed1986

The effect of thumb interphalangeal joint position on strength of key pinch.

Thirty normal male and female subjects participated in a study to determine if the interphalangeal (IP) joint position of the thumb affects the outcome of lateral pinch strength tests. The subjects performed strong lateral pinch for three trials with both the thumb IP joint flexed and extended. The results showed that when flexion of the thumb IP joint was used, female subjects showed an increased strength of 30% for the right side and 28% for the left side compared to when they used extension of the thumb IP joint during lateral pinch. The male subjects showed increased strength of 36% for the right side and 38% for the left side when flexion versus extension of the thumb IP joint was used. IP joint position of the thumb was found to significantly affect the results of lateral pinch strength tests.

Adult↗