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PubMed1997

Ligament reconstruction basal joint arthroplasty without tendon interposition.

The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed.

Activities of Daily Living↗
PubMed2006

Treatment of unstable distal radial fractures with the volar locking plating system.

BACKGROUND: The best treatment for an inadequately reduced fracture of the distal part of the radius is not well established. We collected prospective outcomes data for patients undergoing open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. METHODS: Over a two-year period, 161 patients underwent open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. Patients were enrolled in the present study three months after the fracture on the basis of strict entry criteria and were evaluated three, six, and twelve months after surgery. Outcome measures included radiographic parameters, grip strength, lateral pinch strength, the Jebsen-Taylor test, wrist range of motion, and the Michigan Hand Outcomes Questionnaire. RESULTS: Eighty-seven patients with a distal radial fracture were enrolled. The mean age at the time of enrollment was 48.9 years. Forty percent (thirty-five) of the eighty-seven fractures were classified as AO type A, 9% (eight) were classified as type B, and 51% (forty-four) were classified as type C. Radiographic assessment showed that the plating system maintained anatomic reduction at the follow-up periods. At the time of the twelve-month follow-up, the mean grip strength on the injured side was worse than that on the contralateral side (18 compared with 21 kg; p<0.01), the mean pinch strength on the injured side was not significantly different from that on the contralateral side (8.7 compared with 8.9 kg; p=0.27), and the mean flexion of the wrist on the injured side was 86% of that on the contralateral side. All Michigan Hand Outcomes Questionnaire domains approached normal scores at six months, with small continued improvement to one year. CONCLUSIONS: The volar locking plating system appears to provide effective fixation when used for the treatment of initially inadequately reduced distal radial fractures.

Adolescent↗
PubMedDate not supplied

Results following trapeziometacarpal arthroplasty of the thumb.

A retrospective follow-up study was performed on patients with degenerative joint disease (DJD) who underwent trapeziometacarpal arthroplasty of the thumb with 3-week immobilization and without the use of K-wire fixation. Pre- and post-operative pain, activities of daily living (ADLs), grip strength, and pinch strength were compared. Data were collected on 25 hands in 23 patients, 7 hands with full trapezium resections and 18 with hemi-trapezium resections. The median age was 60 years, with a range of 39 to 73 years, and the median follow-up period was 1 year 11 months, with a range of 3 months to 11 years. Grip and pinch strength were measured pre- and postoperatively. Pain was assessed on a visual analog scale (VAS), and ADLs were assessed by means of a 15-item survey. Both pain and ADLs were evaluated postoperatively with recall of preoperative status. Following surgery, all thumbs were immobilized in a static splint for 3 weeks and then allowed progressive use. Median improvements in hemi-trapezium resections included grip, 22.5 lb; pinch, 4.7 lb; and ADLs, 33%. Pain was reduced a median of 7.0 cm on the VAS. Median improvements in full trapezium resection included grip, 29.5 lb; pinch, 0 lb; ADLs, 60%; and pain reduction, 8 cm on the VAS. This follow-up study suggests that satisfactory results can be achieved in pain reduction, strength, and ADLs with an immobilization period of only 3 weeks and without the use of K-wires following carpometacarpal (CMC) arthroplasty.

Activities of Daily Living↗
PubMed2005

Treatment of recalcitrant lateral epicondylitis with suture anchor repair.

BACKGROUND: Chronic lateral epicondylitis has been treated with various surgical procedures with varying and often less-than-satisfactory outcomes. HYPOTHESIS: The use of suture anchor repair of the extensor carpi radialis brevis to the lateral epicondyle in the treatment of chronic lateral epicondylitis will result in a more anatomical repair, with resultant improvements in strength, pain, and return to previous sport. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 20 patients (22 elbows) were treated surgically and were observed for a minimum of 2 years. All patients had debridement of the degenerative tissue, followed by repair of the extensor carpi radialis brevis to the lateral epicondyle with a suture anchor. The average time to follow-up was 4.2 years (range, 2.2-9.5 years). All patients completed a Disabilities of the Arm, Shoulder, and Hand questionnaire to assess residual disability, and 16 patients underwent a physical examination. The objective evaluation included the assessment of range of motion, grip strength, and pinch strength. Pain was assessed preoperatively and postoperatively using a visual analog pain scale. Patients were also questioned with regard to a return to their previous level of activities. RESULTS: The grip and pinch strengths achieved for the operative extremity were 110% and 106%, respectively, of the nonoperative limb. The 16 patients who underwent a physical examination had achieved full range of motion, with 15 (94%) returning to their previous level of activity at an average time of 4.1 months. The mean preoperative pain score was 8.1 (range, 4.0-10.0), whereas the mean postoperative pain score was 0.41 (range, 0-1.5), indicating significant pain relief (P < .001). The Disabilities of the Arm, Shoulder, and Hand scores demonstrated only mild residual disability (mean, 6.6) at follow-up. CONCLUSION: The use of a suture anchor to repair the extensor carpi radialis brevis to the epicondyle after debridement was a satisfactory procedure for recalcitrant lateral epicondylitis with regard to strength, return to previous activities, and pain relief.

Adult↗
PubMed1995

Early mobilization following carpal tunnel release. A prospective randomized study.

A prospective randomized study was undertaken of 50 consecutive patients undergoing surgery for idiopathic carpal tunnel syndrome to determine the value of splintage of the wrist following open carpal tunnel release. Patients were randomized to either be splinted for 2 weeks following surgery or to begin range-of-motion exercises on the first post-operative day. Subjects were evaluated at 2 weeks, 1 month, 3 months, and 6 months after surgery by motor and sensory testing, physical examination, and a questionnaire. Variables assessed included date of return to activities of daily living, dates of return to work at light duty and at full duty, pain level, grip strength, key pinch strength, and occurrence of complications. Patients who were splinted had significant delays in return to activities of daily living, return to work at light and full duty, and in recovery of grip and key pinch strength. Patients with splinted wrists experienced increased pain and scar tenderness in the first month after surgery; otherwise there was no difference between the groups in the incidence of complications. We conclude that splinting the wrist following open release of the flexor retinaculum is largely detrimental, although it may have a role in preventing the rare but significant complications of bowstringing of the tendons or entrapment of the median nerve in scar tissue. We recommend a home physiotherapy programme in which the wrist and fingers are exercised separately to avoid simultaneous finger and wrist flexion, which is the position most prone to cause bowstringing.

Activities of Daily Living↗
PubMed2002

Effect of grip span on lateral pinch grip strength.

Repetitive, high-force pinch grip exertions are common in many occupational activities. The goal of the current study was to quantify the relationship between lateral pinch grip span (distance between thumb and index finger) and lateral pinch grip strength. An experiment was conducted in which 40 participants performed maximal lateral pinch grip exertions at 11 levels of grip span distances (0, 10%, ... 100% of maximum functional lateral pinch grip span distance). The results show a significant effect of lateral pinch grip span, with strength at the maximum functional lateral pinch grip span 40% higher than that found at the smallest lateral pinch grip span considered. Between these two endpoints, strength increased monotonically with increasing pinch grip span. The application of these results in pinch grip design criteria for both high-force and long-duration exertions is discussed. Potential applications of this research include the design of hand tools and controls for which significant force is applied by the user.

Adult↗
PubMed1995

Functional results of dynamic splinting after transmetacarpal, wrist, and distal forearm replantation.

The results of replantation at the wrist and distal forearm are reported to be better than at the metacarpal level, in part because the latter involve direct injury to the intrinsic muscles. This study evaluates a new post-operative protocol for replantation at the metacarpal, wrist and distal forearm levels. 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 4 to 12 weeks, an anticlaw splint alternated with the outrigger splint. After 12 weeks, a dynamic wrist extension orthosis was added to the anti-claw splint. 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993. For distal forearm replantation, TAM of fingers averaged 216 degrees, grip strength 42 lb, and pinch strength 7.2 lb with 75% good or excellent results. For wrist replantations, TAM of fingers averaged 243 degrees, grip strength 37 lb and pinch strength 10.6 lb with 100% good or excellent results. For transmetacarpal replantations, TAM of fingers averaged 189 degrees, grip strength 37 lb and pinch strength 5.6 lb, with 75% good and excellent results. Early protected mobilization, as described here, preserves tendon gliding, muscle strength and excursion. Our results support this protocol for wrist and distal forearm replantation and especially for transmetacarpal replantation, the results of which tend to be poor according to the medical literature.

Adult↗
PubMed2004

Ligament reconstruction with trapezium retention arthroplasty for carpometacarpal arthritis.

PURPOSE: The purpose of this study is to provide a qualitative and quantitative assessment of results in a consecutive series of patients with carpometacarpal arthritis using a trapezium-retaining interposition arthroplasty. METHODS: Between 1999 and 2002, 16 patients with basal joint arthritis were treated with a trapezium-retaining interposition arthroplasty. Fourteen of these patients were evaluated at a mean follow-up time of 20 months (minimum, 12 months) and were compared based on clinical outcome, presurgical and postsurgical x-ray evaluation, and range of motion, grip-strength, and pinch-strength values. RESULTS: Average trapezial height values as quantified by the trapezial space to proximal phalanx ratio were very similar before and after surgery. Average grip-strength values improved significantly. Although average pinch-strength and average range of motion values improved neither of these comparison values were significant. Thirteen of the 14 patients (93%) were satisfied with their results as quantified by postsurgical Disabilities of the Arm, Shoulder, and Hand questionnaires. CONCLUSIONS: Ligament reconstruction with trapezium retention arthroplasty of the basal joint not only successfully maintains trapezial height but also yields patient satisfaction rates comparable to those achieved with other forms of basal joint arthroplasty.

Adult↗
PubMed2007

Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation.

PURPOSE: Although hematoma and distraction arthroplasty has been found to be successful in the treatment of thumb basal joint arthritis in the short term, questions about its efficacy in the long term have been raised. The goal of the present study was to evaluate the results of this procedure in patients at least 6.5 years after surgery. METHODS: Twenty-two thumbs from 22 patients from a single surgeon's practice were entered into a prospective single-arm study for surgical treatment of basal thumb arthritis. Treatment consisted of piecemeal excision of the entire trapezium and 5 weeks of K-wire immobilization of the thumb metacarpal in opposition and slight distraction. No ligament reconstruction or tendon interposition was used. Motion, strength, standardized dexterity tests, stress radiographs, and outcome questionnaires including the Arthritis Impact Measurement Scales 2 were evaluated before surgery and at 6, 24, and at least 79 months after surgery. RESULTS: At 6 months after surgery, 17 of 22 patients reported complete pain relief, and at the most recent follow-up evaluation (average, 88 months after surgery) 18 patients were entirely pain free. Range-of-motion evaluation at the most recent follow-up evaluation showed 21 of 22 thumbs adducted fully into the plane of the palm, and 21 of 22 opposed to the small finger metacarpal head. Comparisons between preoperative and the recent postoperative strength measurements showed an average of 21% increase in grip strength and tip pinch strength, and an 11% increase in key pinch strength over preoperative values. Although the radiographically determined scaphoid-thumb metacarpal distance decreased with time from surgery, no correlation with strength or functional outcome measurements was found. The Arthritis Impact Measurement Scales 2 data showed postoperative improvement in the hand and finger function and arthritis pain scales. CONCLUSIONS: After trapezial excision, K-wire immobilization in a slightly overcorrected position without formal interposition or ligament reconstruction allows for restoration and maintenance of a stable, pain-free thumb that has comparable strength and motion with published reports of more complicated interventions over comparable time periods. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Aged↗
PubMedDate not supplied

The relationship between hand strength and the forces used to access containers by well elderly persons.

OBJECTIVE: This study extended previous work of Rice, Leonard, and Carter [AJOT, 52(8), 621-626] and examined the relationship between grip and pinch strengths and the forces produced while accessing common household containers in healthy, elderly persons. METHOD: Forty-two women and 9 men 60 years of age and older were assigned randomly to one of four order groups in a counterbalanced, repeated-measures design. Grip strength was measured via a dynamometer and pinch strength via a pinch meter. The forces required to access six common household containers were measured with force sensing resistors applied to each container. Data analysis included Pearson product-moment correlations between the dependent variables of grip and pinch strength and force produced on the containers. Analyses of variance were used to determine differences by gender on the dependent measures and order of presentation of containers. RESULTS: A fair relationship (r = .31 to .44) was found between grip and pinch strength and the ability to open three containers. Little or no relationship was found between grip and pinch strength and the ability to open the remaining three containers (r = -.03 to .25). Significant gender differences existed on overall strength and the force used to access two of the six containers. No order effects were found. CONCLUSIONS: Strong relationships did not exist between the grip and pinch strength and the amount of force the elderly participants used to open the containers, which is similar to what Rice et al. found for younger persons. The participants appeared to use a greater proportion of their available strength when accessing the containers than did their younger counterparts previously studied. Further research is needed to determine at what level of weakness one would expect to see performance deficits in common daily occupations.

Activities of Daily Living↗
PubMed2002

Grip strength: effect of hand dominance.

AIM OF THE STUDY: Reliable and valid evaluation of hand strength is important for determining the effectivity of treatment strategies and it is accepted that grip and pinch strength provide an objective index for the functional integrity of upper extremity. This study was designed to evaluate the grip and pinch strength differences between sides for the right and left handed population. METHODS: The study included 128 right and 21 left hand dominant volunteers. Grip strength of the participants were measured by using a Jamar dynamometer. Pulp pinch strength measurements were performed by manual pinchmeter. RESULTS: When the study group was totally evaluated, a statistically significant difference was found between the grip and pinch strengths of dominant and nondominant hands in favour of the dominant hand. For further information we grouped 149 participants as right and left handed and investigated the number of subjects with stronger nondominant hand for each group. The percentage of stronger nondominant hand grip was 10.93% and 33.33% for right and left handed groups respectively. The results were less significant for pinch strength with 28.12% and 28.57% for right and left handed subjects respectively. CONCLUSION: We concluded that the dominant hand is significantly stronger in right handed subjects but no such significant difference between sides could be documented for left handed people.

Adult↗
PubMed2002

The effect of flexible magnets on hand muscle strength: a randomized, double-blind study.

The purpose of this study was to determine the effect of a flexible magnet on hand grip and thumb-forefinger pinch strength. Flexible magnet use has become popular in sports medicine and rehabilitation for a number of reasons, including augmenting muscle force output. Thirty-five university students (18 men and 17 women) volunteered for this study. Each subject was tested for grip strength (grip dynamometer) and thumb-forefinger pinch strength (pinch gauge) under 3 different treatment conditions: baseline (no magnet), sham magnet (placebo), and flexible magnet (700-G intensity). The order of treatments was randomly assigned, and all data collection followed a double-blind format. For grip strength measurements, magnet placement was over the bellies of the flexor digitorum profundus and flexor digitorum superficialis, and for pinch strength measurements, it was over the bellies of the flexor pollicis brevis and opponens pollicis. Three trials for each strength measurement for each of the 3 conditions were performed. Magnets (700 G or sham) were placed on the appropriate areas of the skin 3 minutes before the first test trial, with each subsequent test trial separated by 1 minute. Comparison among the 3 treatment conditions was analyzed using a 1-way analysis of variance (ANOVA) with repeated measures. ANOVA revealed no statistically significant (p > 0.05) mean differences for strength among any of the 3 treatments (baseline, 700-G magnet, or sham magnet) for either hand grip or thumb-forefinger pinch within each sex subgroup or for the combined group. The findings indicate that flexible magnets with a field strength of 700 G do not increase muscle strength.

Adult↗
PubMed1998

First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb.

Trapeziectomy, ligament reconstruction and tendon interposition arthroplasty is one of the most commonly performed procedures to address pain and instability due to osteoarthritis at the basal joint of the thumb. To determine the effect of stress on first metacarpal subsidence, 15 ligament reconstruction and tendon interposition basal joint arthroplasties were evaluated after a mean follow-up of 32 months. Radiographs were obtained of the arthroplasty at rest and then with maximal effort key pinch stress, which is known to subject the first carpometacarpal joint to considerable axial compression stress. Compared with the preoperative x-rays, the first metacarpal had subsided 21% of the arthroplasty space at rest. Under stress, the first metacarpal was found to subside another 10.5% in height. No subluxation of the metacarpal base could be detected. Key pinch strength improved 17% from the preoperative strength. Tip-to-tip pinch strength improved 17% from the preoperative measurement. Grip strength improved 17% from the preoperative measurement. Grip strength was 9% greater than the preoperative grip strength. There was no statistical association between the amount of first metacarpal subsidence and follow-up key pinch, tip pinch, or grip strength. With axial compressive loading of the arthroplasty, such as in lateral pinch, there is some further proximal migration of the first metacarpal, but this is minimal and does not correlate with functional outcome.

Adult↗
PubMed1992

One-stage key pinch and release with thumb carpal-metacarpal fusion in tetraplegia.

One-stage key pinch and release with carpal-metacarpal fusion, extensor pollicis longus tenodesis, and motor transfer to flexor pollicis longus were analyzed for functional results in tetraplegic patients. Eighteen patients (21 hands)--all with International Classification OCu:4 hand function or worse--were studied. Average follow-up was 42 months. All patients experienced significant increase in functional ability and thought the surgery was highly beneficial. Average pinch strength was 3.3 kg, whereas it had been nonmeasurable preoperatively. Both activities of daily living and pinch strength correlated with tetraplegic functional level. The patients with higher preoperative functional level had better postoperative activities of daily living scores and pinch strength. Sixteen hands had solid fusions, and patients with fibrous nonunions showed no decrease in pinch strength, pain, or functional limitations when compared with the patients who had solid fusions. Six hands showed degenerative changes at one or more adjacent joints, but this was not related to results.

Adolescent↗
PubMed2006

Study of hand function in a group of shoe factory workers engaged in repetitive work.

BACKGROUND: Work related hand and wrist musculoskeletal disorders are well known. The contributing factors could be repetitive movements, forceful work and awkward posture. It is not known how these movements affect grip or pinch strength and other functional aspects of the hand. AIMS: To study a group of shoe factory workers doing repetitive thumb and wrist movements for prevalence of musculoskeletal disorders and consequence on grip and pinch strength, two-point discrimination and perceived disability. METHODS: 39 shoe factory workers who put straps into 900 to 1000 pairs of rubber sandals per day and 29 hospital clerks as a control group were evaluated for musculoskeletal disorders, grip and pinch strength, two-point discrimination and perceived disability (by questionnaire). Proportions were compared by chi squared or Fisher Exact test and quantitative outcome by t-test or multiple linear regressions. RESULTS: Common musculoskeletal diseases of thumb/wrist were absent among shoe factory workers as in the clerks. Increased two-point discrimination over thumb (p=0.01, right; p=0.02, left) and a clear trend for reduced pinch strength between thumb and index finger (p=0.06, right; p=0.07, left) were noted compared to clerks after adjusting for years on the job. Perceived disabilities included pain and localised dermal thickening over the thumb. DISCUSSION: No case of carpal tunnel syndrome or hand/wrist tendinitis was detected among workers doing highly repetitive thumb/wrist movement. Pinch strength decreased and two-point discrimination was adversely affected while grip strength remained unaffected. The main perceived disabilities of pain and skin changes over the thumb adversely affected their day-to-day life.

Adult↗
PubMed1993

Effect of flavor enhancement of foods for the elderly on nutritional status: food intake, biochemical indices, and anthropometric measures.

The irreversible declines in taste and smell acuity that occur in many elderly persons can contribute to inadequate food intake and nutrition that are prevalent among the aged. Although chemosensory deficits cannot be reversed, previous studies have shown that the addition of intense flavors to foods can compensate for perceptual losses and improve food palatability and acceptance. In this study, the effect of sustained (3 week) flavor enhancement of typical institutional foods on the diet, health, and well being of 39 elderly (average age 84.6 SE 0.81 years) retirement-home residents was evaluated. For 3 weeks subjects ate an institutional diet (unenhanced). During another 3-week period, the same subjects ate identical foods to which intense flavors were added (enhanced). The 39 subjects were tested in two groups. For group 1 the unenhanced food period preceded the enhanced food period. For group 2, the order was reversed. Food intake was measured every weekday throughout the study, and the nutritional composition of the diet was analyzed. Biochemical measures of health status were obtained at the beginning of the study (baseline) and following both the unenhanced and enhanced periods. These measures included somatomedin-C/insulin-like growth factor I, transferrin, total T- and B-lymphocytes, and routine blood chemistries. Weight, height, midarm circumference, and triceps skinfold thickness were also measured. Handgrip strength and pinch strength were measured in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Trapeziectomy and intermetacarpal ligament reconstruction with the extensor carpi radialis longus for osteoarthritis of the trapeziometacarpal joint: surgical technique and long-term results.

PURPOSE: To report the long-term results of excision of the trapezium and intermetacarpal ligament reconstruction with the extensor carpi radialis longus for thumb trapeziometacarpal osteoarthritis. METHODS: Fourteen women and 5 men were retrospectively reviewed after an average of 9 years of follow-up evaluation. Trapeziectomy was performed and the extensor carpi radialis longus was harvested by a dorsoradial approach to reconstruct the intermetacarpal ligament. All patients wore a below-elbow cast for 6 weeks. Each patient had objective and subjective assessments. Thumb shortening was measured in follow-up radiographs. RESULTS: At the final follow-up evaluation, 16 (84%) patients were free of pain and 17 patients (89%) were satisfied with the results. Grip, key strength, and pinch strength improved compared with preoperative values. The trapezium space lost 14% of its height compared with preoperative values. Thumb motion improved, and there were no cases of instability. CONCLUSIONS: Resection-arthroplasty of the trapezium with intermetacarpal ligament reconstruction with the extensor carpi radialis longus is an effective procedure that permits motion restoration and pain relief in the trapeziometacarpal joint in the long term without affecting thumb stability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Aged↗
PubMed2003

Functional outcomes following surgical repair of wrist extensor tendons.

The long term results following the repair of open injuries to extensors carpi radialis longus and brevis and extensor carpi ulnaris have not previously been reported. A retrospective case note review was performed and patients were called back for assessment following surgical repair. Grip strength and pinch strength were reduced by 9.9% (p=0.017) and 11.5% (p=0.049). Wrist movement was also reduced. This demonstrates that the division of these tendons should not be regarded as trivial as they may have long-term adverse effects on wrist function. Information gained from this study may be beneficial in patient education at the time of injury and may provide useful information when preparing medico legal reports.

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