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PubMed1983

Evaluation of sensibility and function with microsurgical free tissue transfer of the great toe to the hand for thumb reconstruction.

Detailed evaluation of sensibility and function on 10 patients was carried out on an average of 42 months after thumb reconstruction by microsurgical free tissue transfer. Sensibility based on modified two-point discrimination and ridge criteria was found to be directly related to the patient's age at time of neurosuture. The plantar aspect of the distal 2 cm of the normal toe showed two-point value averaging 6 mm in 20 normal shoe-wearing adults, compared to values of 12 mm when the toe was tested over the plantar surface of the proximal half of the distal phalanx. Metacarpophalangeal joint motion and interphalangeal joint motion were limited when compared with the opposite normal thumb and unoperated great toe. Grip strength and pinch strength reflected the degree of associated injuries in the hand. Cold intolerance was present in all patients. Patients' subjective assessment of their ability to use their hand as compared to their hand prior to injury was rated at less than 10% preoperatively compared to 52% to 87% postoperatively. None of the patients perceived a problem of social acceptance after the surgery. Postoperative studies of the feet revealed concentration of weight bearing between the second and third metatarsal heads on Harris mat studies and slowing of the forward and medial progression of the center of pressure on gait analysis. Some weakness in push-off and cutting maneuvers in sports activities was reported in half of the patients. None of the patients experienced difficulty when running long distances on level ground. All the patients returned to gainful employment postoperatively.

Adolescent↗
PubMed2000

Primary vascularized distal radius bone graft for nonunion of the scaphoid.

A vascularized bone graft from the dorsoradial aspect of the distal radius was used with internal fixation to treat nonunion of the scaphoid in ten patients who had not received any previous surgical treatment. Five cases were classified as Lichtman type I and five as type II. The average age was 30 years (range, 18-40 years). Associated avascular necrosis was observed in five cases. Postoperatively pain was relieved and union was achieved in all cases. The mean time to union was 6.5 weeks. Range of motion, grip strength and pinch strength were also restored satisfactorily. These results suggest that this vascularized bone graft should be used as the primary procedure in Lichtman type I and II of scaphoid nonunions, regardless of the presence of avascular necrosis of the proximal pole.

Adult↗
PubMed1988

Reconstruction of the thumb with a trimmed-toe transfer technique.

The trimmed-toe transfer is a new modification of the existing great-toe transfer technique for thumb reconstruction. This procedure was devised to circumvent patient concerns regarding overly large reconstructed digits following total great-toe-to-hand transfer. This technique involves reduction of both the bony and soft-tissue elements along the medial aspect of the transferred great toe in order to produce a more normal sized thumb. Follow-up of the initial 20 patients from 1983 to 1986 demonstrates good stability, grip strength, and pinch strength. Although compared with total great-toe transfer a modest reduction in joint motion of trimmed toes has been observed, the overall appearance and usefulness of the reconstructed thumbs have been excellent.

Adolescent↗
PubMed2006

A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity.

BACKGROUND: Scapholunate advanced collapse wrist deformity is a common pattern of degenerative arthrosis of the wrist. This study prospectively evaluated a series of patients who underwent four-corner fusion using a circular plate internal fixation technique. METHODS: Patients with symptomatic stage II scapholunate advanced collapse wrist deformity were treated with scaphoid excision and four-corner fusion using the Spider Limited Wrist Fusion Plate (KMI, San Diego, Calif.). Patients were prospectively evaluated at 6 months and 1 year using a standard study protocol with radiographs, functional tests, and an outcomes questionnaire. Outcomes were compared with those of historical series from the literature. RESULTS: Eleven patients were enrolled and 10 patients completed their 1-year follow-up. Grip strength, lateral pinch strength, and Jebsen-Taylor test scores at 1 year were not significantly different from preoperative values. Mean active range of motion was 87 degrees preoperatively and 74 degrees at 1-year follow-up (p = 0.19). The Michigan Hand Outcomes Questionnaire showed no significant improvement in function, activities of daily living, work, pain, or patient satisfaction. The mean pain scores decreased from 54 preoperatively to 42 1-year postoperatively (p = 0.30), indicating persistent wrist discomfort. Three patients had broken screws: one was asymptomatic, one required 3 months of strict wrist immobilization, and one was reoperated for symptomatic nonunion. CONCLUSIONS: Four-corner fusion using the first-generation Spider plate technique has the advantage of earlier mobility and more patient comfort from absence of protruding Kirschner wires; however, patients continued to have disabling pain, functional limitations, work impairment, and low satisfaction scores postoperatively. Although limited by a small patient sample, this series presents outcomes data that may be useful in counseling patients who are contemplating four-corner fusion using this internal fixation device. Further investigation is necessary to evaluate the biomechanical properties of the Spider plate. The data suggest that better implants should be designed to avoid implant failure, which occurred in three of the 11 patients in this series.

Activities of Daily Living↗
PubMed1991

Abductor pollicis longus tendon arthroplasty for treatment of arthrosis in the first carpometacarpal joint.

A retrospective study of 21 hands in 19 patients was carried out to show the results after excision of the os trapezium for the treatment of arthrosis of the first carpometacarpal joint. A technically easy procedure was used that was based on a tendon plasty using the abductor pollicis longus (APL) tendon. Special attention was paid to the effects of compressive load on the stability of the thumb. The mean follow-up time was 25 months (range 11-38) and all patients achieved good mobility. Pain was reduced in all cases but one. In operated hands grip strength was 84% of estimated normal strength and pinch strength 83%. On radiographs of the hands the mean distance between the base of the metacarpal bone and the scaphoid bone was 4.6 mm, this was reduced by 1.9 mm during compression. When radiographs were taken during a compressive load, two dislocations of the thumb base were found that had otherwise been missed.

Aged↗
PubMed2003

Hand function assessment in patients receiving haemodialysis.

OBJECTIVE: To assess the usefulness of Duruöz's Hand Index (DHI) in patients undergoing haemodialysis. METHODS: Patients receiving haemodialysis for more than 2 months were recruited randomly. Demographic, clinical and functional characteristics of patients were evaluated. Functional assessment was performed with DHI, Hand Functional Index (HFI), Health Assessment Questionnaire (HAQ), Purdue Pegboard, grip strength and 3 kinds of pinch strengths. DHI was correlated (Spearman's) with the other functional parameters in assessing the convergent validity and with non-functional parameters in assessing the divergent validity. RESULTS: Sixty patients with a mean age of 50.05 were recruited. The average duration of haemodialysis was 55.02 months. DHI is significantly correlated with HAQ, HFI, Purdue Pegboard scores, grip strength and 3 types of pinch strengths while no significant correlation was found with non-functional parameters. CONCLUSIONS: DHI is a practical scale which is efficient in assessing accurately the functional disability of the hand in patients receiving haemodialysis.

Adolescent↗
PubMed2003

[Ligament reconstruction for the chronic instability of the traumatic thumb carpometacarpal joint].

OBJECTIVES: We evaluated the results of ligament reconstruction performed for chronic instability of the traumatic thumb carpometacarpal joint. METHODS: Seven male patients with traumatic instability of the thumb carpometacarpal joint underwent ligament reconstruction with the use of the technique described by Eaton and Littler. The mean duration between the traumatic event and the operation was eight months. According to the radiological criteria by Eaton and Littler, five patients had stage I, and two patients had stage II disease. The mean follow-up period was 23 months. The results were assessed according to the criteria by Lane and Eaton. RESULTS: Postoperatively, the patients' grip strength and pinch strength increased by a mean of 40.4% (range 31% to 50%) and 75.4% (range 62% to 100%), respectively. No increases in the extent of arthrosis were observed in the carpometacarpal joint during the follow-up period. None of the patients developed morbidity associated with the functions of the flexor carpi radialis and the wrist. The results were excellent in four, and good in three patients. No complications occurred such as infection or recurrent instability, nor were there any problems related to the skin and Kirschner wires. CONCLUSION: Ligament reconstruction for the carpometacarpal joint of the thumb relieves pain and restores stability while preserving a functional range of motion in patients with chronic instability.

Adult↗
PubMed1995

Thumb reconstruction by micro-vascular techniques.

Sixty-three patients with thumb reconstruction by total or partial toe transfer have been reviewed. Mean age was 25 years. Males (84%) and manual workers (76%) dominated the series. The rate of failure was 3%. Second toe transfer gave a functionally acceptable thumb with 10 mm two point discrimination, 59% of strength in pinching (compared to normal side), 30 degrees of range of flexion but with a flessum deformity (average 27 degrees) and a poor cosmesis score (1.5 on a 5 point scale). Partial toe transfers were useful in amputations at metacarpophalangeal (MP) level and distal to this area. Around MP level, three techniques were available: wrap around, Twisted Two Toes and "bipolar" lengthening. More distally a "custom made" transfer allows to match exactly the defect. All of these techniques save the great toe length. When a pulp was incorporated in the transfer, two point discrimination averaged 9 mm and in the entire series the mean pinch strength was 93% normal and the mean cosmetic score was 3.5 points. Partial toe transfers are preferable in cases with any otherwise normal hand, providing good function and better cosmesis.

Adult↗
PubMed2006

Flexor pollicis brevis adductorplasty: an alternative method in ulnar nerve paralysis.

Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this paper, we discuss the transfer of flexor digitorum brevis muscle to the tendon of adductor pollicis muscle as an alternative method to restore key pinch in ulnar nerve paralysis. The technique was applied to 4 patients with ulnar nerve paralysis. Before clinical application, an anatomic study was carried out in 6 cadaver hands. In cadavers, radial and ulnar arteries were injected with latex and arterial pedicles of flexor pollicis brevis muscle were dissected under 4x magnification. Also, motor branches from the median nerve were shown at the entrance point to the muscle. In surgical practice, the superficial head of the muscle is detached from its insertion and the minor pedicle of the muscle is cut. Muscle is dissected proximally up to two thirds of its length. The dominant pedicle of the muscle originating from superficial palmar arcus is preserved, and the muscle is sutured to the tendon of the adductor pollicis muscle close to its insertion. Patients were evaluated in terms of key pinch strength preoperatively and at the postoperative sixth month using a pinch meter (Chattanooga Group, Inc). Key pinch strengths were recorded and expressed as percentage of the strength of the contralateral uninvolved hand. Mean key pinch strength of our patients was 29.7%. In conclusion, we believe in that flexor pollicis brevis adductorplasty may be an alternative method for restoration of adductor pollicis muscle function in ulnar nerve paralysis.

Adult↗
PubMed1999

[Supra-fascial elevated free forearm flap--indications, surgical technique and follow-up examination of the donor site defect].

From March 1995 to May 1997, 66 free radial forearm flaps were used for orofacial reconstructions. All flaps were elevated following the suprafascial technique. Donor-site closure was performed with split-thickness skin grafts in 54 cases, and with full-thickness skin grafts in 12 patients. Investigations after six months included grip strength, pulp-to-pulp pinch strength, range of motion as compared to preoperative values, aesthetical self-assessment, cold intolerance, and dysesthesias. The latter evaluation could be performed in 42 patients, whereas the complete follow-up protocol included 36 patients. Primary wound healing with immediate complete take of skin grafts was achieved in 93.9%. Grip strength and pulp-to-pulp pinch strength showed no decrease postoperatively. An impairment of range of motion of the wrist was observed in 2.8%. There was no cold intolerance. Aesthetical outcome was rated as good or fair in 97.3%. Slight numbness distally to the donor-site was found in 59.5%. The results of this prospective study show a superiority of suprafascial elevation of the radial foream flap as compared to the classic elevation technique, particularly in a higher rate of primary wound healing, thus avoiding impairment of range of motion and strength of the donor hand.

Adult↗
PubMed2006

Long-term functional and subjective results of thumb replantation.

The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992-1997, were reexamined after 6.5 years (range, 4.2-9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. Range of motion, grip strength, cutaneous sensibility, and upper-extremity functioning using the DASH questionnaire were determined. A correlation analysis with important variables was performed. Average range-of-motion in the metacarpophalangeal joint was 44 degrees (+/-24.2) and in the interphalangeal joint was 12 degrees (+/-8.4). Grip-strength of the injured hand was 70% (+/-31.4) and pinch strength was 68% (+/-28.7) in comparison to the non-injured hand. DASH-scores correlated with grip-strength, pinch-strength, and cutaneous sensation but no correlation was found between DASH and the level of amputation. Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation.

Adolescent↗
PubMed2003

Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures.

PURPOSE: Many surgeons have abandoned the simple trapeziectomy as a surgical treatment option for thumb basal joint arthritis secondary to reports of postoperative weakness. The thumb metacarpal subsiding into the trapezial void has been proposed as the causative factor. The goal of the present study was to evaluate the results of trapeziectomy and postoperative K-wire immobilization of the thumb metacarpal in a distracted position without the use of ligament reconstruction or tendon interposition. METHODS: Twenty-six thumbs in 26 patients from a single surgeon's practice were entered into a prospective single-arm study for surgical treatment of peritrapezial arthritis. Treatment consisted of piecemeal excision of the entire trapezium and 5 weeks of K-wire immobilization of the first metacarpal in slight distraction and opposition. No ligament reconstruction or tendon interposition was used. Motion, strength, stress radiographs, standardized dexterity tests, and outcomes questionnaires including the Arthritis Impact Measurement Scales 2 (AIMS2) were evaluated before surgery and 6 and 24 months after surgery. RESULTS: At 6 months 19 of 26 patients (73%) reported complete relief of pain and at 24 months 92% were entirely pain free. Range of motion evaluation showed 24 of 26 thumbs adducted fully into the plane of the palm and 25 of 26 opposed to the fifth metacarpal head. Comparisons between preoperative and 24-month postoperative strength measurements showed an average 47% increase in grip strength, 33% increase in key pinch strength, and a 23% increase in tip pinch strength over preoperative values. AIMS2 data showed postoperative improvement in "hand and finger function" and "arthritis pain" scales. CONCLUSIONS: After trapezial excision K-wire immobilization in a slightly overcorrected position without tissue interposition or ligament reconstruction restores a stable, pain-free thumb that has superior strength and motion compared with published reports of the more complicated interventions.

Aged↗
PubMed2006

The effects of the diabetes related soft tissue hand lesions and the reduced hand strength on functional disability of hand in type 2 diabetic patients.

OBJECTIVES: The aim of the present study is to examine the effects of diabetes related soft tissue hand lesions such as Dupuytren's disease, trigger finger and limited joint mobility (LJM) and the reduced hand strength on the functional disability of the hand in type 2 diabetic patients. METHODS: Forty-four type 2 diabetic patients and 60 age and sex matched controls were included in the study. Subjects were examined for the presence of Dupuytren's disease, trigger finger and LJM. Grip strength was tested first with Jamar dynamometer followed by pinch strength measurements using by a manual pinchmeter. Electrophysiological studies were performed in both groups. Duruöz Hand Index (DHI) was used to assess the functional hand disability. RESULTS: The mean DHI score of the diabetics was significantly higher than controls (p<0.0001). Dupuytren's disease, trigger finger or LJM was not correlated with DHI in diabetic patients (p>0.05). The grip and pinch strengths were significantly lower in diabetic patients than the non-diabetic controls (p<0.05) and the grip and pinch strengths were negatively correlated with DHI in type 2 diabetic patients (p<0.001). CONCLUSION: Dupuytren's disease, trigger finger and LJM did not cause to functional disability of hand but low hand strength was found to cause functional disability of hand in our type 2 diabetic patients.

Aged↗
PubMedDate not supplied

The impact of hand dominance and ulnar and median nerve impairment on strength and basic daily activities.

The authors sought to determine the impact of hand dominance and its relation to function among ulnar alone and combined ulnar and median nerve lesions in leprosy patients. The study sample consisted of 62 persons affected with leprosy (mean age 36.1 years) who were either suffering from ulnar nerve lesions alone (34 patients) or combined ulnar and median lesions (28 patients). The data from the earlier work of this institution with normal hands in the adjacent rural uninvolved population were taken as controls. Grip, pulp-to-pulp, lateral, and three-jaw-chuck pinch strengths were measured using a hydraulic hand dynamometer and a pinch gauge. Basic daily activities were assessed using the battery developed at Karigiri. Means, standard errors, correlations, and t-tests were used in the analyses. The overall difference between grip and pinch strength measurements in both dominant and nondominant hands was 40% less than those in normal hands if the ulnar nerve alone was involved. If impairment of this nerve was combined with that of the median nerve, the overall difference in strength measurements increased to 51%. The hand strength of the dominant side was statistically significant between single and two nerves for pulp-to-pulp pinch (p = 0.019). No other strength tests produced statistically significantly results related to hand dominance (grip strength, lateral, chuck pinch) with either one or two nerve involvement. To observe differences in basic daily activities, scores were compared to Karigiri norms. The bilateral basic daily activities score was impaired by 45% compared with norms with only ulnar nerve involvement and by 59% with ulnar and median nerve involvement. The different pinch strengths related to basic daily activities was not significantly affected in nondominant hands, whether it was ulnar alone or combined ulnar and median nerve lesions. In this population diagnosed with leprosy, ulnar nerve impairment at the level of the elbow reduced the grip and pinch strengths and performance in basic daily activities by 40% and 45%, respectively. If combined with median nerve lesion at wrist level, the strengths and daily activity losses increased to 50% and 60%, respectively. There is no effect on grip strength either in ulnar or ulnar and median nerve injuries, irrespective of whether dominant or nondominant hands were involved. Different pinch strengths related to basic daily activities were significantly affected only in the dominant hand with involvement of these nerves.

Activities of Daily Living↗
PubMedDate not supplied

Strength measurements of the intrinsic hand muscles: a review of the development and evaluation of the Rotterdam intrinsic hand myometer.

Numerous neurological diseases are accompanied by atrophy of the intrinsic muscles of the hand. Muscle strength testing of these muscles is frequently used for clinical decision making. Traditionally, these strength measurements have focused on manual muscle testing (MMT) or on grip and pinch strength dynamometry. We have developed a hand-held dynamometer, the Rotterdam Intrinsic Hand Myometer (RIHM), to measure this intrinsic muscle strength. The RIHM was designed such that it can measure a wide range of muscle groups, such as the abduction and adduction strength of the little finger and index finger, the opposition, palmar abduction (anteposition) and opposition strength of the thumb, and intrinsic muscles of the fingers combined in the intrinsic plus position. We found that the reliability of RIHM measurements in nerve injury patients was comparable to grip and pinch strength measurements and is appropriate to study the functional recovery of the intrinsic muscles of the hand in isolation. We have applied the RIHM in a recent study on the long-term outcome of muscle strength in patients with ulnar and median nerve injuries and found that while recovery of grip and pinch strength was relatively good, recovery of the ulnar nerve innervated muscles measured with the RIHM was poor. This poor recovery could not be detected with manual muscle strength testing or with grip and pinch dynamometry. We conclude that the RIHM provides an accurate clinical assessment of the muscle strength of the intrinsic hand muscles that adds valuable information to MMT and grip and pinch dynamometry.

Equipment Design↗
PubMed2001

Functional and biomechanical assessment of the normal and rheumatoid hand.

OBJECTIVE: To assess hand function in accordance with its accepted definition and to compare the results of three different assessment techniques. DESIGN: A clinical-type assessment was used together with measurement of pinch grip and three-dimensional biomechanical trials. BACKGROUND: Traditional clinical assessment may not relate to a patient's actual hand function. If hand function is defined as "the ability to use the hand in daily activities" then it is more appropriate to measure the forces available for performing everyday tasks using biomechanical tests. METHODS: Eight female patients with rheumatoid arthritis and eight control subjects were recruited for the study. Volunteers underwent a clinical-type assessment using a six-task activity board. Lateral pinch grip of both hands was measured using a custom-built transducer. Biomechanical trials were conducted using a 6 degree-of-freedom transducer and 6-camera motion analysis. RESULTS: Functional differences between the two subject groups were apparent using all three methods of assessment. Pinch strength correlated well with the biomechanical trial data but results from the clinical-type assessment provided only a weak correlation. CONCLUSIONS: Clinical-type assessments do not give an accurate measure of hand function. Pinch strength measurements can provide a cost-effective alternative to full biomechanical analysis. RELEVANCE: Traditional functional assessment uses measurements of grip or pinch strength and range of motion together with a subjective assessment of activities of daily living. This study demonstrates that pinch strength measurements can provide an accurate measure of hand function. The results from activity-board trials do not reflect hand ability and are of limited use for hand evaluation.

Adult↗
PubMed1982

Silicone spacer or tendon spacer for trapezium resection arthroplasty--comparison of results.

A comparison study was done for 25 consecutive trapeziectomies in 21 women with silicone replacements and 25 consecutive trapeziectomies in 24 women without silicone replacements who were reviewed from 1 to 9 years postoperatively. The patients, who ranged from 35 to 75 years of age, were housewives and clerical workers. All had trapeziometacarpal osteoarthritis. Among the patients with silicone replacement of the trapezium, 90% reported pain relief; mean thumb abduction was 42.5 degrees, pronation was 37.5 degrees, and pinch strength averaged 5 kg. Among the patients without silicone replacement after trapeziectomy, 95% reported pain relief; mean thumb abduction was 46.8 degrees, pronation was 41.4 degrees, and pinch strength averaged 4.6 kg. For those patients with only one hand operated upon, pinch strength in that hand averaged 85% that of the opposite hand in patients with silicone trapezial replacement and 82% for those without silicone trapezial replacement. In this patient population, trapeziectomies with or without silicone replacement as treatment for trapeziometacarpal osteoarthritis appear to give similar results.

Adult↗
PubMed1988

Hand function in patients on maintenance hemodialysis.

The purpose of this study was to assess characteristics of hand function in 30 subjects on maintenance hemodialysis (MHD) with a forearm vascular access. Hand function was evaluated by measuring subjects' grip and pinch strength, range of motion, edema, and sensation and with the Grip Function Test and self-assessment scale. A difference in all hand function test results was found in the extremity with the vascular access compared with the contralateral extremity. Comparison of short-term subjects (on MHD less than two years) with long-term subjects (on MHD greater than two years) revealed significantly lower handgrip strength (p less than .05) and pinch strength (p less than .05) and significantly higher hand volume (edema) (p less than .05) in the long-term group than in the short-term group. We suggest that both the chronicity of renal failure and the presence of a vascular access may contribute to deterioration of hand function. The presence of hand deterioration in patients on MHD identifies a new patient population and a need for early baseline measurement and periodic assessment by physical therapists or hand therapists as renal rehabilitation team members.

Adult↗