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PubMedDate not supplied

Assessing hand grip endurance with repetitive maximal isometric contractions.

The purpose of this study was to identify a method for measuring hand grip endurance in patients with hand injury as well as in healthy subjects. Twenty hand-injured patients and 60 healthy subjects participated in the study. Each subject performed two sets of maximal repetitive isometric contractions on the Grippit instrument for 180 seconds, with a contraction time of 2.5 seconds and a rest time of 1 second. Reliability data were high for initial grip force and for absolute and relative endurance values at 90 seconds (r range, 0.73 to 0.97, p < 0.001). Relative endurance at 180 seconds, though, showed weaker reproducibility (r = 0.54, p < 0.01). A measuring period of 90 seconds instead of 180 seconds is suggested, because of the results of test-retest reliability. The method allows endurance to be described in relative force values (as a percentage) as well as in absolute force values (Newtons).

Adult↗
PubMed1990

Upper-extremity rehabilitation: conditioning and orthotics for the athlete and performing artist.

Rehabilitation of athletes or musicians with hand injuries begins immediately after injury. Accurate diagnosis of the injury and tissues involved is followed by specific acute and rehabilitative therapies to correct the injury and determine any biomechanical changes that may have occurred. Medication and physical methods aid in decreasing inflammation and pain. Mobility is progressively restored, with the aid of appropriate heating modalities, as soon as signs and symptoms allow. Proprioception and neuromuscular coordination are then retrained. This is followed by balanced muscle strength training. Finally, sport-specific endurance and biomechanical skills are developed. Emotional aspects of the injury may be dealt with by investigating the physical and emotional stresses of the performance, and discussing them with the patient. Some patients may also be helped by psychologic counseling. Orthotics may be used to decrease swelling, decrease pain, and inhibit unwanted motion. Some variations allow for progressive range of motion and strength building. Attention to these details maximizes the chances of successful return to performance in the athlete or performing artist with a hand injury.

Athletic Injuries↗
PubMed1985

Current concepts in the diagnosis and treatment of hand and wrist injuries in sports.

The hand is the most commonly injured part in sport. Fortunately, most injuries are minor and do not interfere with the sport participation, but even these leave residual functional deficits that may increase with time. More severe injuries of the hand are appreciated instantly by the player and health care personnel and generally receive better care. The goal is to maintain the best functioning hands now for the sport and in the future for the life's work of the hand. A program is herein described outlining the care of minor and major sports injuries to the hand that tries to return the injured player quickly to the sport participation while not jeopardizing the future. Because injuries to this most important tool are so frequent, it is recommended that a lecture be given to each sport group prior to the season to describe and raise the awareness of the players regarding hand and finger injury.

Athletic Injuries↗
PubMed1996

Cold-induced vasospasm after finger replantation; abnormal sensory regeneration and sensitisation of cold nociceptors.

Cold-induced vasospasm which may present clinically as "white fingers", after hand injuries has been reported to be as high as 100% after replanted digital amputations. The exact cause of this is obscure and no specific treatment is available. To try to shed light on the cause of post-traumatic cold-induced vasospasm we evaluated replanted digits in seven patients who had had replantations more than 10 years ago. Our results show that cold-induced vasospasm occurred in six out of seven patients. Cold nociceptors were sensitised in patients who had abnormal two point discrimination, all of whom responded to cooling by vasospasm. One patient with normal circulation did not recover cold nociception during cooling. This indicates that secondary Raynaud's syndrome after injuries to the hand may be related to sensitisation of cold nociceptors. Even simple nerve injuries may lead to secondary Raynaud's syndrome.

Adolescent↗
PubMed1997

Case report: sequential vascular connection of free flaps in the upper extremity.

Devastating hand injuries often require multiple microvascular reconstructions. We report a patient in whom two flaps were used for late reconstruction of a devastating hand injury involving devascularization of the right hand, severely comminuted fractures of the hand and forearm, and multiple tendon avulsions. We believe the sequential vascular connection of free flaps offers the best method of reconstruction in this severe case, allowing composite tissue transfer, monitoring of the osseous flap, and optimal positioning of the two free tissue transfers.

Adult↗
PubMed2006

Hospitalized Swedish children with hand and forearm injuries: a retrospective review.

AIM: To analyse incidences and find risk groups in children hospitalized with hand injuries in a national retrospective study. METHODS: All children with a primary hand or forearm injury admitted to Swedish hospitals during 1987-2001 were retrieved from the Swedish Hospital Discharge Register and analysed as to incidence and characteristics. RESULTS: Among 9855 children included, the median age was 7.0 y and two-thirds were boys. The incidence increased in both younger (0-6 y) and older (7-14 y) children. Wounds and fractures almost doubled, while muscle/tendon injuries decreased. In younger children, wounds and burns were the most frequent diagnoses. In older children, fractures and muscle/tendon injuries were common. Sharp objects caused most of the injuries. University hospitals treated almost half of the children. CONCLUSION: The number of children with hand injuries admitted to hospitals in Sweden increased annually. Analyses of causes behind the increase are important to counter this trend.

Adolescent↗
PubMed2004

Distally based dorsal metacarpal flaps: a review of a series of patients treated in a 6-month period.

The management of dorsal digital and hand injuries can pose a difficult problem to the trainee surgeon. Often repair involves using tissue from neighbouring digits. Our experience using local perforator flaps based on the direct cutaneous branch of the dorsal metacarpal arteries shows that these can be dissected and used successfully in the management of complex injuries of the dorsum of the hand and proximal phalanges. The flap has been used in a series of seven patients treated over a 6-month period by plastic surgery trainees with 100% success. This one-stage procedure resulted in good functional and aesthetic outcome and left an acceptable donor scar.

Adult↗
PubMed1991

[The treatment of gunshot wounds of the hand].

During the war in Afghanistan gunshot hand injuries came to 12% of all wounded among Soviet servicemen. At the stages of specialized medical care the vast wounds, crushes or amputations of hand were 49%, hand injuries accompanied by traumata of other anatomical zones were 42%. The gravity, concomitant and multiorgan character of the injuries required that the conservative and active methods of treatment, as well as the expert appreciation of that category of wounded should be developed and improved. Field surgeons frequently performed primary operations accompanied with the elements of the specialized medical care. The experience shows that the local purulent complications during the primary surgical management of wounds performed without elements of specialized medical care were up to 29,5%, and in primary reconstructive operations--12.4%. Osteomyelitis was correspondingly recorded at 11.1% and 3.2% of cases. The efficiency of treatment was growing when microsurgical technique was used.

Afghanistan↗
PubMed1989

Injury pattern aboard the USS Enterprise.

A retrospective analysis of the radiographic records of 1653 sailors aboard the USS Enterprise was performed during the author's recent reserve assignment. For the period 1985 to 1987, 102 radiographically recognizable injuries were discovered in the study group. The high rate (53.9%) of hand injuries aboard ship typifies that of a wage-earning population (age 20 to 50). However, analysis of the fracture pattern in the hand indicates that many of the most frequently encountered hand injuries may be preventable. Since the rates of anterior shoulder dislocation and gamekeeper's thumb may also be increased, initiating the necessary investigation and control measures for these injuries seems warranted.

Arthrography↗
PubMed1996

Proximal interphalangeal joint injuries of the hand. Part I: anatomy and diagnosis.

Injury to the proximal interphalangeal (PIP) joint is one of the most common hand injuries encountered by orthopedic surgeons. The injuries are often misdiagnosed, resulting in delayed treatment and permanent impairment. The different types of PIP-joint fractures and dislocations have been well described, and a variety of therapeutic options have been proposed. Early detection and aggressive rehabilitation are the cornerstones of successful treatment. This is the first of a two-part series reviewing PIP injuries. We describe the anatomy and biomechanics of the PIP joint and review the classification and diagnosis of these injuries.

Biomechanical Phenomena↗
PubMed1985

Meat grinder injuries to the upper extremity.

Three cases of hand injury caused by meat grinders are presented. All 3 injuries involved the dominant hand and resulted in varying degrees of deformity. Two of the 3 patients arrived in the emergency room with the injured hand still firmly wedged in the meat grinder. Although these injuries continue to prove very mutilating, maximum restoration of the injured hand can be accomplished by careful extrication, followed by preservation and reconstruction of all viable tissues. Perioperative antibiotics and wound irrigation with antibiotic solution are recommended. Microsurgical technique can be of value in treating selected patients.

Adolescent↗
PubMed1991

Dupuytren's disease: relation to work and injury.

The present status of adjudication for workers claiming compensation for Dupuytren's disease is inconsistent and, therefore, unfair to both workers and employers. In some Eastern European countries Dupuytren's disease is classified as an industrial disease, whereas in other countries it is considered to have no relation to manual work or hand injury. In jurisdictions that sometimes award compensation, the reasons for acceptance or rejection of a claim vary from case to case and are not necessarily based on our present knowledge of the disease. The purpose of this communication is to highlight the features of Dupuytren's disease that are pertinent to manual work and hand injury and to suggest guidelines that would provide some consistency in the adjudication process. It is hoped that these guidelines would be valuable to the individual surgeon, insurance agencies, and compensation boards.

Dupuytren Contracture↗
PubMed1998

[Self-mutilating hand and finger injuries among physicians suspected of insurance fraud].

27 cases of questionable self-mutilation among physicians (concerning finger and hand injuries) were analyzed retrospectively. The evaluation based on files of the insurance companies, reconstructive examinations and experimental investigations. Three typical cases are described in detail, the "victims" were suspected to have committed a special kind of fraud in order to claim financial compensation from their accident-insurance companies; the contract included special invalidity payments for finger injures (so-called "Gliedertaxe"). Many of these physicians had worked in the surgical field: apart from one 38-year-old female all of them were males, aged between 41 and 66 years. The mutilating instruments were often circular saws, sometimes chain saws and a great variety of other tools, for example hatchet, big scissors and other sharp instruments. By means of forensic-medical expertise and criminalistic investigations the insurance companies were able to demonstrate clearly that the amputation was voluntarily self-inflicted. The forensic-medical argumentation concerning intentional self-mutilation included the so-called execution position of the finger, the injury pattern, the investigations of blood stains and ergonometric aspects.

Adult↗
PubMed2006

Systems of provision and delivery of hand care, and its impact on the community.

Hand injuries are important causes of impairment in the United States. They are one of the top causes for days lost from work and they impose a great economic burden on the country. In less affluent regions of the world, the impact of hand injuries on the population is even more dire, rendering the affected to life-long disability. When one considers that 85% of the world's population lives in low to middle income countries, the global deleterious effect of hand trauma becomes apparent. This paper is a review of pertinent literature available on the provision and delivery of trauma care around the world. While specific reference to hand surgery care is sparse, we will infer trauma management in these countries, synthesised from available literature, to the provision of hand surgery care. We will also examine programs around the world that are implemented at an affordable cost to the respective countries.

Delivery of Health Care↗