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PubMed1997

Comparison between estimates of hand volume and hand strengths with sex and age with and without anthropometric data in healthy working people.

Edema and hand strength measurements are useful for the recovery assessment of patients with a hand lesion. This work determined and compared estimates of hand volume, grip strengths (measured with a Jamar and a Collins dynamometer), and pinch strength (with a Jamar pinch gauge) in terms of sex and age with or without anthropometric indices in healthy working people. The sample included 100 subjects from within the staffs of two rehabilitation centres. For both grip strengths, multiple linear regression models including body height, weight, and arm muscle area were very good (multiple correlation coefficient R of about 0.84) and clearly better than those obtained with sex and age only. For pinch strength, the best estimate was obtained with sex and arm muscle area (R of 0.76); for hand volume, the model with sex, body height, and weight provided the best result (R of 0.93). These findings suggested that anthropometric indices easy to measure must be taken into account to estimate hand volume and hand strengths.

Adult↗
PubMed1985

Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb.

Arthrosis of the trapeziometacarpal joint of the thumb is a predictable sequelae of ligament laxity. A new technique of tendon interposition arthroplasty with ligament reconstruction using the flexor carpi radialis tendon for a painful arthritic trapeziometacarpal joint of the thumb is described. Twenty-one patients had 25 operative procedures; 14 were women and seven were men. All of the patients presented with intractable pain, crepitus, and varying degrees of laxity of the basal joint. Pinch strength was diminished. Follow-up averaged 37 1/2 months. After surgery, 91.7% of patients had good to excellent results, and 56% were completely pain free. Range of motion and grip and pinch strengths were equal on the operated and unoperated sides.

Adult↗
PubMed2001

Effects of aging on hand function.

OBJECTIVES: The purpose of this study was to quantify age-induced changes in handgrip and finger-pinch strength, ability to maintain a steady submaximal finger pinch force and pinch posture, speed in relocating small objects with finger grip, and ability to discriminate two identical mechanical stimuli applied to the finger tip. DESIGN: A cross-sectional study. SETTINGS: Greater Cleveland area of Ohio. PARTICIPANTS: Healthy, independent, young (n = 27, range 20-35 years) and older (n = 28, range 65-79 years) subjects. MEASUREMENTS: Handgrip strength, maximum pinch force (MPF), ability to maintain a steady pinch force at three relative force levels (5%, 10%, and 20% MPF) and three absolute force levels (2.5 Newtons (N), 4 N, and 8 N), ability to maintain a precision pinch posture, speed in relocating pegs from a nearby location onto the pegboard, and the shortest distance for discriminating two stimuli were measured in both young and older groups. RESULTS: Compared with young subjects, the older group's handgrip force was 30% weaker (P < .001), MPF was 26% lower (P < .05), and ability to maintain steady submaximal pinch force and a precision pinch posture was significantly less (P < .05). The time taken to relocate the pegs and the distance needed to discriminate two identical stimuli increased significantly with age (P < .01). The decrease in the ability to maintain steady submaximal pinch force was more pronounced in women than men. CONCLUSION: Aging has a degenerative effect on hand function, including declines in hand and finger strength and ability to control submaximal pinch force and maintain a steady precision pinch posture, manual speed, and hand sensation.

Adult↗
PubMed1999

Severity of hand osteoarthritis and its association with upper extremity impairment in a population of disabled older women: the Women's Health and Aging Study.

Most severity indices of osteoarthritis (OA) include measures of physical function which render them unsuitable for assessing the impact of OA on disability. Data from 1002 moderate to severely disabled community-dwelling women > or = 65 years were used to develop hand OA severity indices which are independent of functional status. Baseline exams and strength tests were conducted by trained nurse examiners. Each distal and proximal interphalangeal joint, and first carpometacarpal joint (20 joints in all) was scored for the presence of a) bony enlargement or deformity, and b) pain on motion or tenderness on palpation. Severity indices were then created: Deformity index (DEF) = sum of joints with bony changes (0-20); Pain/Tenderness index (PT) = sum of joints with pain or tenderness (0-20); and Combined Deformity/Pain index = sum of DEF and PT (0-40). These indices were then validated against grip and pinch strength. All three indices showed a significant trend for weaker grip strength as severity index scores increased. When the 25th, 50th and 75th percentiles were used to divide each severity index into levels of involvement, a threshold effect was observed with significantly poorer grip strength performance above the 75th percentile for each index. Similar results were seen for pinch strength. In conclusion, these hand OA severity indices, based on examination findings alone, help distinguish disease status, and may provide a valuable research tool for investigating the role of hand OA in impairment and disability.

Aged↗
PubMed2006

Validity, factor structure, and clinical relevance of the AUSCAN Osteoarthritis Hand Index.

OBJECTIVE: The Australian/Canadian (AUSCAN) Osteoarthritis Hand Index is a self-report assessment of pain, stiffness, and function in patients with hand osteoarthritis (OA). Small studies have confirmed the reliability, construct validity, and responsiveness of this measure, but the factor structure has not been examined. In this study, we examined the clinimetric properties and clinical relevance of the AUSCAN index in a large sample of patients with familial hand OA. METHODS: The study group comprised 700 patients (80% female, mean age 69 years) who were part of a study on the genetics of generalized OA. All patients had radiographic hand OA bilaterally. The analyses examined internal consistency, factor structure, and relationships of the subscales to grip and pinch strength and a single-item pain measure. RESULTS: Internal consistency was high for the total AUSCAN index and the subscales (Cronbach's alpha = 0.93-0.96). The AUSCAN function subscale had the strongest correlation with grip and pinch strength, and the pain subscale had the strongest correlation with the single-item pain measure, thus supporting the construct validity of these subscales. Factor analysis showed that all pain and function items clearly loaded on the subscale they were intended to measure. Each 1-unit increase in the AUSCAN function subscale was associated with a clinically relevant decrease in hand strength. CONCLUSION: The results of this study strongly confirm the clinimetric properties of the AUSCAN index, including the validity of specific subscales. Results indicate that the AUSCAN index can measure meaningful changes in pain, stiffness, and function.

Aged↗
PubMed1988

Roping injuries in the hand: mechanism of injury and functional results.

Twenty-two patients with roping injuries to 38 digits, including 19 patients injured while team roping, are discussed. Ten digits in nine patients were successfully revascularized or replanted. Seven digits in three patients failed after initial success. One patient is included in both categories. The failure rate is 41 percent for all 17 digits. Average follow-up is 18 months. The dominant hand was injured in 83 percent of team roping injuries; the thumb is the most commonly injured digit. Average interphalangeal motion for thumb replants is zero; for revascularizations, it is 47 degrees. There was 43 percent return of pinch strength for thumb replants compared to 83 percent return for a single thumb revascularization. The most common mechanism of injury was catching the roping thumb in the "thumb up" position during dallying. There are good motion and pinch strength with thumb revascularizations provided tendons and the interphalangeal joint are intact. Reconstruction of the flexor pollicis longus in the replanted thumb gave poor results. Primary tenodesis or arthrodesis is recommended.

Adolescent↗
PubMed1998

First metacarpal osteotomy for trapeziometacarpal osteoarthritis.

We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and pinch strength, with restoration of thumb abduction. Metacarpal osteotomy was equally successful in relieving symptoms of those with early (grade 2) and moderate (grade 3) degenerative changes. This simple procedure provides lasting pain relief, corrects adduction contracture and restores grip and pinch strength, giving good results with few complications.

Adult↗
PubMed2005

Functional outcome after fracture of both bones of the forearm.

Our aim was to correlate the health status with objective and radiological outcomes in patients treated by open reduction and internal fixation for fractures of both bones of the forearm. We assessed 23 patients (24 fractures) subjectively, objectively and radiologically at a mean of 34 months (11 to 72). Subjective assessment used the disability of the arm, shoulder and hand (DASH) and musculoskeletal functional attachment (MFA) questionnaires. The range of movement of the forearm and wrist, grip and pinch strength were measured objectively and standardised radiographs were evaluated. In general, patients reported good overall function based on the DASH (mean 12; range 0 to 42) and MFA (mean 19; range 0 to 51) scores. However, pronation and grip and pinch strength were significantly decreased (p < 0.005). These deficiencies correlated with poorer subjective outcomes. Operative stabilisation of fractures of the radius and ulna led to a reliably acceptable functional outcome. However, despite these generally satisfactory results, the outcome scores worsened with reduction in the range of movement of the forearm and wrist.

Adult↗
PubMed2006

A comparison of two limited open techniques for carpal tunnel release.

Review of the literature shows the effectiveness of limited open carpal tunnel release to be comparable to that of endoscopic carpal tunnel release in respect of recovery of grip strength, time of return to work and complication rate. A randomised, controlled study was designed to compare the effectiveness of a single versus a double limited open technique of carpal tunnel release. Sixty-five patients (73 hands) with a mean age of 48 years were operated on, 40 hands by the single incision and 33 by the double incision method. Grip and pinch strengths, digital sensibility (Filament and 2PD tests) and Levine scores were evaluated throughout 12 months of follow-up. We found that the single incision method offers better results in respect of grip and pinch strengths: less weakness at 1 month after surgery and a faster improvement relative to pre-operative values which is statistically significant. This, however, did not translate directly into Levine functional and symptom scores which, at each assessment, did not differ significantly between the two methods.

Adult↗
PubMed2003

[Anchovy dacron arthroplasty in the treatment of basal osteoarthritis of the thumb: long term results].

INTRODUCTION: Fifteen patients were treated for arthritis of the base of the thumb by trapieziumectomy and anchovy interposition using Dacron[symbol: see text]. The results are described. METHODS: The 15 patients were between 42- and 68-years-old at the time of operation. The mean postoperative follow-up was 3 years. Pain, pinch strength, opposition, opening of the first web space and height of the space formerly occupied by the trapezium were clinically and radiologically evaluated. RESULTS: Pain had completely disappeared in more than 80% of the patients. The mean post-surgical opposition was 8.9/10 (Kapandji score). The pinch strength and first web-space opening were improved, whereas the height of the trapezium site was always reduced by 25%. The only complication was one case of reflex sympathetic dystrophy: no case of foreign body reaction was reported. Eleven of the 15 patients were satisfied with the operation, and noted better thumb function in everyday life. DISCUSSION: The treatment of arthritis of the base of the thumb by means of trapieziumectomy and anchovy interposition is effective with respect to pain in all the studies previously published, whatever the technique used. Mobility is preserved, contrary to arthrodesis, and grip strength remains compatible with the patient's daily life. The choice of a synthetic anchovy such as Dacron[symbol: see text] allows a quicker operation and better than the ones involving sacrifice of a tendon at the wrist. Anchovy interposition remains the preferred alternative among other procedures in the treatment of basal osteoarthritis of the thumb.

Adult↗
PubMed1999

Proximal interphalangeal joint silicone arthroplasty for posttraumatic arthritis.

The long-term results of 16 silicone implant arthroplasties following severe destruction of the proximal interphalangeal joint and surrounding soft tissue in 14 patients were evaluated. Two implants were revised (1 arthrodesis and 1 amputation) and are not included in the results. On a visual analog scale of 0 to 100, the subjective evaluation relating to the quality of function and the ability to perform activities of daily living scored 73 on average (range, 0-100; median, 75). The range of active motion compared with the opposite side ranged from 0% to 100% (average, 47%; median, 56%). The lateral deviation, either radial or ulnar, averaged 4 degrees (range, 0 degrees to 9 degrees; median, 4 degrees). Rotational deformity, either radial or ulnar, averaged 8 (range, 0 degrees to 32 degrees; median, 4 degrees). Pinch strength of the operated finger on average was 75% of the opposite nonoperated finger (range, 14% to 164%; median, 70%). Possible statistical correlation between objective and subjective results was evaluated. Subjectively, most patients were satisfied because they were pain free. Objectively, notable rotational deformity, alignment deviation, and loss of pinch strength and range of motion were observed, but these did not correlate well with the subjective assessment. Silicone implant arthroplasty for posttraumatic arthrosis should be used for those cases in which associated adhesions may be corrected by simple tenolysis, allowing for active range of motion shortly following arthroplasty. Even in these cases, the objective results of silicone arthroplasty may not be as good as its subjective outcome.

Adolescent↗
PubMedDate not supplied

A five-year followup of hand function and activities of daily living in systemic sclerosis (scleroderma).

The purpose of this study was to identify hand factors that change over a five-year period that may be risk factors for the development of functional disability in persons with systemic sclerosis (scleroderma). Sixty individuals with scleroderma were administered assessments of grip and pinch strength, joint range of motion, and pain, and were observed for the presence of digital ulcers, digital scars, calcium deposits, puffy fingers, and tendon friction rubs. Matched-pairs chi square analyses and Fisher's exact tests were performed to compare variables at year 1 and five years later. Grip and pinch strength increased as did joint motion except for the wrist and thumb carpometacarpal joint. There were also significant increases in the presence of scars, friction rubs, calcium deposits, and puffy fingers. Regression analysis was done to determine which variables predicted functional ability. Only puffy fingers predicted functional disability. In conclusion, hand impairment persisted over time while functional ability decreased.

Activities of Daily Living↗
PubMed1987

Functional assessment of bilateral wrist arthrodeses.

We studied the functional results of 18 wrist arthrodeses in nine patients with rheumatoid arthritis. Objective evaluation included radiographic assessment, goniometer assessment of the upper extremity (UE), range of motion (ROM), grip and pinch strength, and the Jebsen-Taylor function test. Subjective evaluation consisted of a questionnaire that compared the upper extremity function of various activities of daily living preoperatively and postoperatively. The mean total range of motion for all patients was below normal on the dominant and nondominant sides, as was the average grip and pinch strength. Results of the Jebsen-Taylor test, compared with results of normal persons, were normal 38% of the time and abnormal 62% of the time. Subjective evaluation revealed postoperative improvement of the hand function in seven patients, whereas the function in two patients remained the same. Bilateral wrist arthrodeses does not seem to adversely affect function of the upper extremity in spite of abnormal grip strength and upper extremity range of motion.

Activities of Daily Living↗
PubMed1992

Direct end-to-end repair of flexor pollicis longus tendon lacerations.

Between 1976 and 1986, 38 consecutive acute isolated flexor pollicis longus lacerations were repaired. This study excluded all replanted or mutilated digits and all lacerations with associated fracture. Average follow-up was 26 months. Tendon rehabilitation was standardized. Range of motion and pinch strength were measured postoperatively. Seventy-four percent (28/38) of the flexor pollicis longus injuries occurred in zone II. Neurovascular injury occurred in 82% of the lacerations, and this correlated with the zone of tendon injury. In 21% of the patients (8/38) both digital nerves and arteries were transected. Postoperative thumb interphalangeal motion averaged 35 degrees and key pinch strength was 81% that of the uninjured thumb. One rupture occurred in a child. Laceration of the flexor pollicis longus is likely to involve damage to neurovascular structures, and repair may be necessary. Direct end-to-end repairs within the pulley system do at least as well as delayed tendon reconstruction and do not require additional procedures.

Adolescent↗
PubMed2001

[Experiences with Eaton-Littler reconstruction for therapy of ligament instability of the thumb saddle joint].

UNLABELLED: Painful instability of the thumb carpometacarpal joint is a rare diagnosis. Between October 1995 and August 1999, eight operations of ligament reconstruction for unstable thumb carpometacarpal joints were performed. We report on the follow-up of these patients which took place at an average time of 12.27 months (range 5 through 36 months) after the operation. Painful hypermobility of the non-arthrotic thumb carpometacarpal joint was the indication for performing the operation in all cases. By this operation, the joint capsule is reinforced in two planes: the existing palmar ligament of the carpometacarpal joint is reinforced while it provides ligament support for the radial aspect of the joint that is otherwise membranous. In our study, we compared the pinch strength, the overall strength of the hand, the motion of the thumb, and radiographic findings for the amount of subluxation before and after performing the operation. In addition, each result was investigated with the DASH-questionnaire (DASH = Disability of Arm--Shoulder--Hand). The results were good or excellent in six cases, satisfactory in one case, and poor in one case. Pinch strength increased from a preoperative average of 19.6 N to 34.3 N and the vigor increased from 84.8 N to 113.1 N. Subluxation on the radiographs could be reduced from an average of 6.0 mm to 3.5 mm. All operated patients were investigated using the DASH-questionnaire. Herein the average score was 22.92 on a scale whereby 0 reflects minimum and 100 maximum disability. CONCLUSIONS: Our experience with the Eaton-Littler procedure for stabilisation of the hypermobile painful thumb carpometacarpal joint were mostly positive. The objective results as well as the results of the evaluation of the DASH-questionnaire could confirm this impression.

Adolescent↗
PubMed2006

Immediate partial great toe transfer for the reconstruction of composite defects of the distal thumb.

BACKGROUND: Thumb defects distal to the interphalangeal joint do not cause any disability; therefore, any consideration to reconstruct the thumb is governed by the lifestyle and cultural background of the patient. This study presents the excellent results achieved by immediate partial great toe-to-hand transfer to reconstruct acute composite defects of the distal thumb. METHODS: Fifty-three patients with amputation or crush injury of the distal thumb who underwent partial great toe-to-hand transfer at the authors' institute over an 11-year period were reviewed. Based on the amputation level of the distal thumb, the authors classified the injuries into three groups. Operative techniques used were osteo-onychocutaneous flap with partial or whole toenail from the great toe and partial great toe transfer with arthrodesis of the interphalangeal joint. Overall results were evaluated in terms of success rate, incidence of emergency reexploration, and number and type of secondary operation. Static two-point discrimination, range of motion, pinch strength, and subjective satisfaction were also evaluated. RESULTS: The success rate of immediate partial great toe-to-hand transfer was 100 percent. The incidence of inflammation and the reexploration rate were not significantly different from those in previously reported articles. In 35 cases where postoperative follow-up was possible, static two-point discrimination, total active range of motion, and pinch strength were generally excellent and the majority of the patients were satisfied with the final outcome. CONCLUSION: Immediate reconstruction with partial great toe transfer is an excellent option for reconstruction of composite defects of the distal thumb, not only for aesthetic reasons but also for functional purposes.

Adolescent↗
PubMed2003

Effect of beta(2)-microglobulin adsorption column on dialysis-related amyloidosis.

BACKGROUND: beta2-microglobulin (beta2-m) is considered a major pathogenic factor in dialysis-related amyloidosis (DRA), often seen in long-term dialysis patients. No effective therapy for this severely debilitating disease is currently available. Lixelle, an adsorption column, has been developed for the elimination of beta2-m; the efficacy of this column has been evaluated in this study. METHODS: Seventeen hemodialysis patients with DRA were first treated with high-flux dialysis for a minimum of 1 year. This was followed by 1-year treatment with Lixelle column connected in series to the high-flux dialyzer. Treatments were used three times a week for both phases of this study. During the study period, beta2-m, pinch strength, motor terminal latency, and activities of daily living were evaluated. RESULTS: After 1-year treatment with high-flux dialysis the beta2-m level remained unchanged; however, after 1-year treatment with the addition of the Lixelle column, beta2-m level decreased significantly from 34.5 +/- 8.4 mg/L to 28.8 +/- 7.3 mg/L (P < 0.05). After 1 year of Lixelle column use, the pinch strength increased from 6.8 +/- 4.7 pounds to 9.1 +/- 5.5 pounds (P < 0.01), and the median motor terminal latency was significantly reduced from 5.1 +/- 1.0 mseconds to 4.5 +/- 1.1 mseconds. A significant improvement was also observed in the activities of daily living score of the upper extremities. CONCLUSION: These results suggest that the addition of Lixelle to the high-flux dialyzer is associated with a significant clinical improvement in DRA patients.

Adsorption↗
PubMed1989

Effects of unilateral brain damage on contralateral and ipsilateral upper extremity function in hemiplegia.

This article describes the long-term effects of unilateral penetrating hemispheric lesions on contralateral and ipsilateral upper extremity motor performance and functional outcome. Activities-of-daily-living skill and gross motor performance contralateral to the lesions were compared among 32 left-sided and 19 right-sided hemiplegic subjects using analysis of variance and chi-square techniques. Ipsilateral to the damaged hemisphere, fine motor tasks of simple visual motor reaction time, grip and pinch strength, finger tapping, and Purdue Pegboard performance were tested. Analysis of covariance compared each ipsilateral task to performance in the corresponding hand of 70 matched controls. Results indicate similar long-term functional ADL outcome in right and left hemisphere-damaged subjects, despite more severe contralateral functional motor deficits following lesions of the left hemisphere. Right hemisphere lesions led to ipsilateral decrements in reaction time, and lesions of either hemisphere diminished grip or pinch strength, finger tapping, and pegboard performance ipsilaterally. These results demonstrate that unilateral brain damage involving the motor areas of either hemisphere has detrimental effects on ipsilateral upper extremity motor function. Findings are discussed and related to the concept that the left hemisphere is specialized or has greater neuronal representation for bilateral motor processes. Physical therapists involved in the treatment of patients with hemiplegia should be aware that motor functions of the ipsilateral, nonparetic upper extremity may also be affected adversely by unilateral brain lesions.

Activities of Daily Living↗