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PubMed1998

Reconstruction of a congenital hypoplastic thumb with use of a free vascularized metatarsophalangeal joint.

Reconstruction of a Blauth type-IIIB hypoplastic thumb with use of a free vascularized metatarsophalangeal joint was performed in four patients (four hands). Several tendon transfers also were performed, either primarily or secondarily, to mobilize the reconstructed thumb. Three patients (three hands) were followed for at least two years after the reconstruction; the results for these three patients were compared with those for four patients (six hands) who had been managed with pollicization of the index finger because of a similar deformity of the thumb. The patients were evaluated with regard to grip strength, key-pinch strength, and the range of motion of the joints of the thumb in the operatively treated and contralateral hands as well as with regard to skill in performing activities of daily living as assessed with use of the Kobe hand-function test. Although the appearance of the thumb was closer to normal in the group that had had the pollicization procedure, total function of the hand and grip strength were greater in the group that had had the transfer procedure. We believe that reconstruction of an unstable hypoplastic (Blauth type-IIIB) thumb with use of a vascularized metatarsophalangeal joint is an acceptable alternative to pollicization of the index finger.

Activities of Daily Living↗

PubMedDate not supplied

A treatment for carpal tunnel syndrome: results of a follow-up study.

OBJECTIVE: This study was a follow-up evaluation of carpal tunnel syndrome (CTS) subjects based on objective and subjective measures utilizing a conservative treatment method. It was hypothesized that the CTS individuals would maintain their improvements over the course of a 6-mo period after treatments. DESIGN: The design used was a case control study in which the improvements of the CTS subjects were compared within themselves and with a matched comparison group. The treatments were performed at a private chiropractic clinic, and the objective and subjective measures were independently taken in an industrial engineering laboratory. All CTS subjects were volunteers from a random sample. Forty-three individuals were evaluated at the pretreatment period and in the 6-mo follow-up. Only 22 subjects returned for reevaluation. The treatment duration was not controlled. RESULTS: The results indicate that CTS subjects had maintained improvements in most of the objective measures and pain and distress ratings over the pretreatment level (p < .05) at 6 mo post-treatment. When compared to a matched comparison group, CTS-treated subjects demonstrated no significant differences (p < .05) in grip strength (for females), pinch strength, forearm pronation and supination forces, assembly task performance and pain and distress scores. CONCLUSION: The results of statistical analyses indicate that CTS subjects can be treated and achieve a significant recovery to within normal comparative levels of non-CTS subjects in most subjective and objective measures.

Adult↗

PubMed1989

Analysis of pinch and grip strength after carpal tunnel release.

This study evaluates the time required for grip and pinch strength to return to preoperative levels after carpal tunnel release. Grip strength was 28% of preoperative level at 3 weeks; 73% by 6 weeks, and returned to the preoperative level by 3 months. At 6 months grip strength was found to increase to 116%. Pinch strength returned sooner being 74% of preoperative level at 3 weeks and 96% by 6 weeks. By 3 months an increase to 108% was seen and at 6 months an increase to 126% of preoperative levels was found. This data should prove useful in predicting when patients may be able to return to their previous level of occupational-related activity.

Adult↗

PubMed2006

Validation of the ABILHAND questionnaire as a measure of manual ability in patients with rheumatoid arthritis.

OBJECTIVE: Hand and upper limb involvement is common in patients with rheumatoid arthritis (RA). However, its impact on manual activities of daily life has not been fully evaluated. A measure of manual ability was developed, through the Rasch measurement model, by adapting and validating the ABILHAND questionnaire, which measures the patient's perceived difficulty in performing everyday manual activities. METHODS: 112 patients with RA were evaluated. The following tests were performed: the ABILHAND questionnaire, the Health Assessment Questionnaire (HAQ), the Jamar grip and key pinch strength tests, the Box and Block dexterity test and the Purdue pegboard dexterity test. In total, 35 patients were reassessed to determine the test-retest reliability of the ABILHAND, and 6 patients were studied before and after therapy with tumour necrosis factor (TNF) blockers to address sensitivity to change. RESULTS: The Rasch refinement of the ABILHAND led to a selection of 27 items rated on a 3-point scale. The resulting ability scale was targeted to the ability of the patients. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Grip and key pinch strength and manual and digital dexterity on both hands were significantly, though moderately, correlated with the ABILHAND measures. Manual ability was also significantly related to the number of affected hands, disease duration, tender and swollen joint counts on upper limbs, disease activity and the HAQ. Sensitivity to change was demonstrated in patients treated with TNF blockers, commensurate with their clinical improvement. CONCLUSION: The ABILHAND questionnaire is a clinically valid person-centred measure of manual ability that could be useful in longitudinal RA studies.

Activities of Daily Living↗

PubMed2006

Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis.

PURPOSE: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women. Many different surgical techniques have been proposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Joint replacement has been an effective treatment of this condition. The purpose of this article is to present the outcome of a total cemented trapeziometacarpal implant in the treatment of more advanced stages of this disease. METHODS: Total joint arthroplasty of the trapeziometacarpal joint was performed on 26 thumbs in 25 patients to treat advanced osteoarthritis (Eaton and Littler stages III and IV) between 1998 and 2003. Indications for surgery after failure of conservative treatment were severe pain, loss of pinch strength, and diminished thumb motion that limited activities of daily living. A trapeziometacarpal joint prosthesis was the implant used in this series. The average follow-up time was 59 months. RESULTS: At the final follow-up evaluation, thumb abduction averaged 60 degrees and thumb opposition to the base of the small finger was present. The average pinch strength was 5.5 kg (85% of nonaffected side). One patient had posttraumatic loosening, which was revised with satisfactory results. Radiographic studies at the final follow-up evaluations did not show signs of atraumatic implant loosening. One patient complained of minimal pain, and the remaining 24 patients were pain free. CONCLUSIONS: In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. We currently recommend this technique for the treatment of stage III and early stage IV osteoarthritis of the CMC joint in older patients with low activity demands. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Aged↗

PubMed1997

Extensor carpi radialis longus tendon arthroplasty in the treatment of primary trapeziometacarpal arthrosis.

A prospective study was conducted to evaluate patient outcomes following trapezial excision and extensor carpi radialis longus tendon arthroplasty in primary trapeziometacarpal arthrosis. Seventeen patients were evaluated both preoperatively and postoperatively at both 12 months and at final follow-up examination at a mean of 39 months (range, 20-56 months). Surgery resulted in complete or significant pain relief and satisfaction with outcome for 16 patients as evaluated at final follow-up examination. Patients with a longer history of thumb pain and more advanced preoperative radiographic changes were more likely to have residual pain after surgery. The mean preoperative activities of daily living (ADL) scores improved significantly. The mean pulp and key pinch strength were 93% and 100%, respectively, of the preoperative values but were significantly lower than the mean pinch strengths recorded in an age-matched control population. Substantial proximal migration of the first metacarpal during maximal pinch was noted in 4 patients who still had some degree of thumb pain with light work. Scaphotrapezoid arthrosis had no correlation to postoperative residual pain.

Activities of Daily Living↗

PubMed1991

The influence of arm position on the pinch grip strength of female dentists in standing and sitting positions.

The objective of this study was to measure and compare hand pinch grip forces in standing and sitting postures for a group of 77 healthy female dentists of 25 to 55 years old. The equipment used consisted of a gripping device with strain gauges, a measuring device and a printer. The results can be described as follows. With respect to absolute values the hand pinch forces are higher when the subject is standing with her arm supported, than when she is sitting. In the standing position the measured forces were maximum when the forearm was at 60 degrees angle towards the frontal position, while in the sitting position the pinch grip forces were maximum with the forearm vertical (90 degrees ) with respect to the frontal position. The above data can be used to design the dentist's working area.

Journal Article↗

PubMed1996

Results of interfascicular nerve grafting for radial nerve lesions.

During the 10 year interval 1979-1989, 20 patients underwent nerve grafting of a radial nerve lesion, 13 high radial and 7 posterior interosseous. Average follow-up was 38 months (range 12 months-10 years). Overall 72% of patients achieved a Highet Scale rating of M3 or better function and 44% M4 or better recovery. Age of the patient and length of the nerve graft did not seem to influence outcome. Time from initial injury to nerve grafting did affect outcome, with 85% of patients grafted within 6 months obtaining M3 or better recovery. No patient grafted 12 months after injury recovered any useful function. Lesions of the posterior interosseous nerve had a consistently superior recovery. Power grip strength in the affected hand of patients averaged 60% of the unaffected hand while key pinch averaged 74%. There was good correlation between the Highet Scale rating of recovery and the ultimate power grip or key pinch strength obtained. Hand dexterity, as assessed by the turning and displacing tests of the Minnesota Rate of Manipulation Test, displayed a wide range of scores in both affected and unaffected hands. Nevertheless, a relative score derived from the results obtained in the displacing test did show correlation with the Highet Scale rating. All patients with M4 or better recovery obtained relative scores for the affected hand that were in the middle of the range of scores considered an average performance for a normal population. Patients who achieved M4 or better nerve recovery following radial nerve grafting also obtained a functional hand as evidenced by the results of grip, key pinch strength, and hand dexterity testing. Lesser degrees of recovery were accompanied by poorer strength and dexterity ratings reflecting inferior function.

Adult↗

PubMed1993

Grip strength following carpal tunnel decompression.

To monitor the effect of open carpal tunnel decompression on grip strength in the hand, a prospective study was made of 25 patients undergoing a total of 31 operations. Hand grip, key pinch and pulp-to-pulp pinch strengths were measured pre-operatively and at regular intervals until 1 year following operation. At that time there was no significant difference in the hand grip and pulp-to-pulp pinch strengths compared to their pre-operative values, but the key pinch in females showed a marginally significant reduction (P = 0.04) compared to the pre-operative value.

Adult↗

PubMed1987

Low-energy helium neon laser treatment of thumb osteoarthritis.

Eighty-one patients with symptomatic osteoarthritis of the thumb took part in a blinded, controlled study to assess the effectiveness of 0.9 mw continuous wave HeNe laser treatment. The subjects were randomly placed in either a control group or a treatment group. In each group the carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints of the most symptomatic thumb were "treated" with 15 sec irradiations at four equally spaced intervals around each joint three times a week for three weeks. The same protocol was used for both groups except that a hidden switch on the laser was placed in the "on" position for the treated group and in the "off" position for the control group. Although the laser-treated group noted slightly lessened tenderness of the treated MCP and IP joints (p less than 0.01 and 0.05, respectively, Wilcoxon signed-rank test), and a small increase in three-finger chuck pinch strength (p less than 0.04, paired t-test), changes in ROM, pain, joint tenderness, grip and pinch strength, activity level, and medication use, did not significantly differ between the groups. Adverse effects were rare (one in each group), minimal, and subjective. We conclude that HeNe laser irradiation at 0.9 mw is safe, but that it is not an effective treatment of osteoarthritis of the thumb.

Clinical Trials as Topic↗

PubMed2001

Endogenous adrenergic control of reflexes evoked by mechanical stimulation of the heel in the decerebrated rabbit.

In decerebrated rabbits, reflexes were evoked in medial gastrocnemius motoneurones by mechanical stimulation of the heel, using four pinch strengths from 183 (innocuous) to 4577 (noxious) mN. The alpha(2)-adrenoceptor antagonist idazoxan (1-156 microg intrathecal (i.th.) significantly increased responses to pinch strengths of 607 mN and above. Subsequent administration of the alpha(1) adrenoceptor selective antagonist prazosin (200 microg i.th.) decreased reflexes to 4577 mN pinches but had no other significant effects. The opioid antagonist (-)-quadazocine (25 microg i.th.) caused no further changes in reflexes. Spinal section at L1 in the presence of this drug combination enhanced gastrocnemius responses to 183 and 607 mN stimuli, had no effect on reflexes to 1866 mN and significantly decreased responses to 4577 mN pinches. These data confirm that reflexes evoked by 'natural' stimulation of heel mechanoreceptors are subject to powerful tonic descending inhibition mediated by alpha(2)-adrenoceptors. For the highest strength stimulus, the results of alpha(2) blockade involved enabling of descending facilitation as well as reduction of descending inhibition.

Adrenergic alpha-Antagonists↗

PubMed1995

Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition.

Twenty-four thumbs of twenty-two patients were evaluated at an average of nine years (range, eight to eleven years) after a ligament reconstruction-tendon interposition arthroplasty for osteoarthrosis at the base of the thumb. The same group had also been examined two and six years postoperatively. The procedure had been performed as a primary operation in twenty-one thumbs and as a revision of a failed implant arthroplasty in three. Twenty-one (95 per cent) of the twenty-two patients had excellent relief of pain and were satisfied with the outcome. The average grip strength increased ten kilograms (p < 0.005), reflecting a 93 per cent improvement compared with the preoperative values. Similarly, the average tip pinch strength steadily improved, with an increase at the most recent examination of nearly one kilogram (p < 0.005) (65 per cent improvement). Improvements in the average key pinch strength, however, were first noted at the six-year follow-up examination and then tapered slightly; the most recent values reflected an average gain of 34 per cent but were not significantly different from the preoperative values. The tip of twenty-two (92 per cent) of the twenty-four thumbs was able to touch the base of the little finger, and the most recent average web angle (40 degrees) was unchanged from the value at the two-year follow-up examination. Stress radiographs showed an average subluxation of the metacarpal base of 11 per cent at nine years compared with 7 and 8 per cent at two and six years, respectively. Similarly, these radiographs demonstrated an average loss of height of the arthroplasty space of 13 per cent at nine years compared with 11 per cent at both of the earlier follow-up examinations. This modest deterioration of radiographic parameters was not predictive of an unsatisfactory outcome. The ligament reconstruction-tendon interposition arthroplasty provided a stable and functional reconstruction of the thumb, resulting in excellent relief of pain and a significant increase in strength for as long as eleven years after the procedure.

Arthroplasty↗

PubMed1987

Hand function after injuries to the collateral ligaments of the metacarpophalangeal joint of the thumb.

An assessment was made of 34 patients who had sustained injuries to collateral ligaments of the metacarpophalangeal joint of the thumb. 23 patients had symptoms in the thumb, when seen at a mean of 38.7 months later, but these were minor in all but one patient. Assessment of pinch strength revealed that 43% of patients had less than 80% of the strength of the opposite side. This was not related to the presence of symptoms or to demonstrable instability of the joint, but the incidence of such weakness was greater when the operation had been delayed by more than three weeks. Pinch strength should be measured in two positions (key pinch and lateral pinch) as there is occasionally a large discrepancy between the two.

Finger Injuries↗

PubMed2005

Relationship of radiographic and clinical variables to pinch and grip strength among individuals with osteoarthritis.

OBJECTIVE: Little is known about how specific radiographic features are related to hand strength in osteoarthritis (OA). This study examined associations of radiographic variables with pinch and grip strength among individuals with radiographic hand OA. METHODS: Participants (n = 700, 80% female, mean age 69 years) were part of a study on the genetics of generalized OA. All had bilateral radiographic hand OA. Linear models were used to examine associations of grip and pinch strength with 1) OA in joint groups (proximal interphalangeal, metacarpophalangeal [MCP], carpometacarpal [CMC]), 2) OA in rays (first through fifth), and 3) summed Kellgren/Lawrence (K/L) grades for severity of OA in all joints. Adjusted models controlled for age, sex, hand pain, chondrocalcinosis, and hand hypermobility. Mixed models accounted for clustering within families. RESULTS: In bivariate analyses, all joint groups, all rays, and total summed K/L grades were significantly negatively associated with grip and pinch strength (P < 0.05). In adjusted models, the only joint group significantly associated with grip strength was the CMCs, and only OA in the MCP joint was significantly associated with pinch strength (P < 0.05). The only ray significantly associated with grip strength (P < 0.05) was ray 1, and no individual rays were significantly associated with pinch strength. A higher summed K/L grade was significantly associated with both lower grip strength and lower pinch strength. CONCLUSION: Among individuals with radiographic hand OA, increasing radiographic severity is associated with reduced grip and pinch strength, even when controlling for self-reported pain. Individuals with radiographic OA in specific locations (CMC joints, MCP joints, and ray 1) may be at particular risk for reduced hand strength.

Aged↗

PubMed1986

Clinical response to regional intravenous guanethidine in patients with rheumatoid arthritis.

A novel therapy for rheumatoid arthritis, regional sympathetic blockade using guanethidine, was investigated in 24 patients with active disease. In a randomized double blind short-term (14 days) study, we evaluated the effect of therapy on subjective responses, change in pain, stiffness, and morning stiffness and no objective responses, change in pinch strength, grip strength, and joint tenderness. Compared to placebo, guanethidine produced a decrease in pain (p less than 0.025) and an increase in pinch strength (less than 0.025) over the 2-week duration of the study. The therapeutic effect of guanethidine may be mediated by an interruption of the proinflammatory effects of the sympathetic nervous system.

Anti-Inflammatory Agents↗

PubMed2002

Long-term results of trapeziometacarpal silicone arthroplasty.

Long-term results of trapeziometacarpal (TMC) joint silicone arthroplasty were evaluated. From 1975 to 1990, 90 TMC joint silicone implants were placed in 85 patients with TMC joint arthritis caused by osteoarthritis and inflammatory arthritis. Sixty-two implants in 58 patients were available for follow-up evaluation averaging 16.4 years (range, 10-25 years) with a 10-year minimum. Patient satisfaction; range of motion; grip, key pinch, and tip pinch strengths; and radiographs were recorded. Eighty-four percent of the thumbs had satisfactory results with good-to-excellent pain relief and function. Grip, key pinch, and tip pinch strengths increased. The number of thumb tips able to touch the palmar base of the small finger increased. Subluxation was apparent in 19% of implants but was not clinically important; however, implant fracture occurred in 6% and required revision. None of the 62 implants had frank silicone synovitis. Silicone arthroplasty seems to be a reliable option for disabling TMC joint arthritis and is associated with a high degree of patient satisfaction.

Adult↗

PubMed1999

Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest.

OBJECTIVE: To quantitate the functional morbidity to the hand and wrist following harvest of a radial forearm fasciocutaneous free flap. DESIGN: Prospective case-control study, with each patient providing his or her internal control, comparing preoperative and postoperative operated to nonoperated forearms. SETTING: Tertiary care hospital in large metropolitan area. PATIENTS: A consecutive sample of 11 patients who underwent a radial forearm free flap reconstruction of the head and neck from April 1997 to May 1998. MAIN OUTCOME MEASURES: Range of motion of the wrist (flexion and extension, ulnar and radial deviation), grip and pinch strength, and sharp and dull sensation in the distribution of the radial, ulnar, and median nerves. RESULTS: Statistically significant differences (P<.05) were measured in wrist flexion, pinch strength, and sharp sensation in the anatomical snuffbox of the operated forearm. No subjective complaints of loss of function were reported by any patient. CONCLUSIONS: Donor-site functional morbidity associated with harvest of the radial forearm fasciocutaneous free flap is measurable. The statistical differences found do not translate into subjective patient complaints of everyday functional morbidity.

Adult↗

PubMed2000

Early recovery after endoscopic vs. short-incision open carpal tunnel release.

Endoscopic carpal tunnel release has been claimed to offer improvement in recovery time and postoperative discomfort over open carpal tunnel release. Short-incision open carpal tunnel release has been claimed to offer recoveries comparable with endoscopic techniques. Patients receiving carpal tunnel surgery were randomized to short-incision open release or single-portal endoscopic release. Preoperative and postoperative evaluation included grip and pinch strength measurements and patient completion of a questionnaire regarding symptoms and function. Thirty-six operated hands completed evaluation, including 22 endoscopic and 14 open releases. Early grip and pinch strength after endoscopic carpal tunnel release were improved significantly over short-incision open release (p < 0.05). Subjective evaluation indicated a trend toward improved symptoms and function with endoscopic over short-incision open carpal tunnel release. Endoscopic carpal tunnel release provides faster recovery of strength than short-incision open carpal tunnel release and improves early postoperative comfort and function to a small degree.

Carpal Tunnel Syndrome↗