Examining the Disabilities of Arm, Shoulder, and Hand (DASH) Outcome Instrument in Extended Reality: X-DASH

The purpose of the present study is to evaluate the results of the treatment of intra-articular fractures with the volar 2.4 mm LCP with regard to loss of reduction, clinical outcome and complications. Patients treated with a volar 2.4 mm LCP following a complex intra-articular distal radius fracture were assessed by clinical and radiological examination of both wrists, the Disability of Arm, Shoulder and Hand (DASH) outcome instrument, Martini score and the pain Visual Analogue Scale score. Forty patients (40 fractures: 5 type C1, 11 type C2, and 24 type C3 according to AO/OTA classification) were followed at a mean 18 months from the injury. Of the initial 40 fractures, 4 fractures required surgical revision (1 because of loss of reduction, 2 due to fracture incongruity as seen on the postoperative computer tomogram and 1 case of screw displacement in the radial shaft). Radiographs in the immediate postoperative period showed a radial inclination of 22.1 degrees, volar tilt of 7.2 degrees, and ulnar deviation of 0.2 mm (means). At follow-up examination, radial inclination was 23.8 degrees, volar tilt was 6.2 degrees and ulnar deviation was 0.9 mm (means). Average final wrist range of motion was significantly (p < 0.05) decreased in comparison to contralateral wrist. Average DASH and Martini scores were 18 and 27, respectively, with no significant differences between C1-, C2- and C3-type fractures. Patients who underwent a surgical revision had poorer Martini score. Complications were an EPL tendon rupture, a tendon irritation and a complex regional pain syndrome in a patient who underwent revision. The treatment of complex intra-articular distal radius fractures with the volar 2.4 mm LCP provides sufficient fixation to prevent clinically significant loss of articular reduction, acceptable patient outcomes and minimal soft tissue complications.

In determining treatment outcomes of the hand, the Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ) and Milliken Activities of Daily Living Scale (MAS) questionnaires are the most commonly used. The aim of this study was to evaluate the relations, strengths and weaknesses of these questionnaires and determine the most appropriate outcome measure for the Turkish population. The study included 74 patients with various types of hand injuries. Patients filled out the DASH-Turkish, MHQ and MAS questionnaires. Grip strength and pain intensity were also assessed. MAS parameters were well-correlated with DASH-Turkish and grip strength (p<0.05). MHQ was correlated with all other outcomes except the left hand part. The DASH, MHQ and MAS questionnaires are culturally compatible with the Turkish population and have revealed a good correlation. These results suggest that these outcome instruments can be used in the assessment of hand and wrist surgery outcomes in the Turkish population.

Are standardized patient self-reporting instruments applicable to the evaluation of ulnar neuropathy at the elbow?

BackgroundThe traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified speciic limitations of the shoulder function in subgroups of patients with these injuries.AimA prospective, multicentre randomised controlled trial (RCT) will be conducted in 21 hospitals in the Netherlands, comparing fracture consolidation and shoulder function after either non-operative treatment with a sling or a plate fixation.Methods/designA total of 350 patients will be included, between 18 and 60 years of age, with a dislocated midshaft clavicular fracture. The primary outcome is the incidence of non-union, which will be determined with standardised X-rays (Antero-Posterior and 30 degrees caudocephalad view). Secondary outcome will be the functional outcome, measured using the Constant Score. Strength of the shoulder muscles will be measured with a handheld dynamometer (MicroFET2). Furthermore, the health-related Quality of Life score (ShortForm-36) and the Disabilities of Arm, Shoulder and Hand (DASH) Outcome Measure will be monitored as subjective parameters. Data on complications, bone union, cosmetic aspects and use of painkillers will be collected with follow-up questionnaires. The follow-up time will be two years. All patients will be monitored at regular intervals over the subsequent twelve months (two and six weeks, three months and one year). After two years an interview by telephone and a written survey will be performed to evaluate the two-year functional and mechanical outcomes. All data will be analysed on an intention-to-treat basis, using univariate and multivariate analyses.DiscussionThis trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two standardised treatment options for dislocated midshaft clavicular fractures. The gathered data may support the development of a clinical guideline for treatment of clavicular fractures.Trial registrationNetherlands National Trial Register NTR2399

Measuring shoulder injury function: Common scales and checklists

The Outcome of Intra-Articular Distal Radius Fractures Treated With Fragment-Specific Fixation

Cultural adaptation of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome: A Turkish version study

BackgroundIn 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA). Hand function was incorporated into evaluations from 2014 onward. The objectives were to examine hand function in our cohort, compare hand function with function in healthy controls and determine the factors associated with impaired function.MethodsFrom February 2014 to June 2015, 139 patients (97.2 % of the cohort) had disease activity scored (28 joints, [DAS28]); the Michigan Hand Outcome Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) were completed, and the tip-, key- and palmar-pinch and grip strengths were measured. Sixty-nine healthy controls underwent the same evaluations. Ninety-nine patients underwent a second evaluation one year after their baseline. Descriptive statistics and linear regression models were used. Patients and controls signed informed consent.ResultsPatients were primarily middle-aged females with a median disease duration of 7 years; 91 patients had DAS28-remission, and 16, 23, and 9 patients had low, moderate and high disease activity, respectively. Controls scored better than did patients with (any) disease activity level; remission patients had similar DASH and key pinch function as did controls with poorer MHQ and both tip and palmar pinch and grip strength. DAS28 was consistently associated with impaired hand function. Among the patients with a one-year re-assessment, changes in DAS28 correlated (rho = 0.34 to 0.63) with changes in hand function (p ≤ 0.01 for all comparisons), but there was no correlation with palmar pinch strength.ConclusionsDisease activity was associated with hand function impairment in RA patients with variable follow-up. MHQ discriminated poorer hand function in remission patients who otherwise had similar DASH scores as the controls did.

Objective: To determine the effect of mirror visual feedback (MVF) on disability, pain, and motor function on patients who underwent hand reconstructive surgery. Design: Randomized, single-blinded controlled trial. Setting: Rehabilitation center. Subjects: A total of 40 patients who were randomly assigned into the intervention group (n = 20) and control group (n = 20) participated in this study. Interventions: The rehabilitation sessions took place twice a week for eight weeks. The control group received traditional rehabilitation for 75 minutes. While the intervention group performed MVF and traditional rehabilitation for 30 and 45 minutes, respectively. Measures: Pain and disability of the hand were assessed with McGill pain questionnaire and Disability of Arm, Shoulder, and Hand (DASH) scores. The range of joint motion was evaluated by Goniometer, and the strength of grip and pinch was evaluated by Dynamometer and Pinch gauge and dexterity evaluated by Minnesota Manual Muscle test. Results: The results indicated that both traditional and MVF methods induced significant decreasing pain (Pain Rate Index: F = 68.48, P = 0.000; Number of Word Count: F = 70.96, P = 0.000), disability (F = 50.08, P = 0.000) and increasing dexterity (placing test: F = 28.73, P = 0.000), and range of motion (F = 33.16, P = 0.000). The results also showed that the positive effect of MVF on pain, disability, dexterity, and range of motion was significantly greater than that of controls (P < 0.05), but there was no significant result in grip and lateral pinch strength between the intervention and control group (P > 0.05). Conclusion: MVF, in conjunction with traditional rehabilitation programs, may lead to greater improvements in pain, disability, placing dexterity, and range of motion. But it seems not to be effective on pinch and grip power and turning dexterity.

Test-retest and Internal Consistency of the Disability of Arm, Shoulder and Hand (DASH) Outcome Measure in Assessing Functional Status among Breast Cancer Survivors with Lymphedema

Results of parallel plate fixation of comminuted intra-articular distal humeral fractures

Background: In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. Purpose: The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Study Design: Case series: Level of evidence, 4. Methods: Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Results: At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition (P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly (P < .01). The MMCPI score improved from “poor” to “excellent.” The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient. Conclusion: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.

Internal Consistency of the Disability of Arm, Shoulder and Hand (DASH) Outcome Measure in Assessing Functional Status Among Breast Cancer Survivors

Purpose: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire is used internationally to assess function and disability. The instrument has been translated into several languages, but no Hebrew version exists. The objective of this study was to evaluate the use of the 12-item WHODAS 2.0 questionnaire among Hebrew speakers with and without hand injuries (HI).Methods: The translated questionnaire was conducted among 155 uninjured subjects (UI) and 77 male workers with HI. Internal consistency was assessed using Cronbach’s alpha. Test–retest reliability was assessed in UI subjects and calculated using the intraclass correlation coefficient (ICCagreement). Validity was evaluated by correlating the 12-item WHODAS 2.0 to the short-form of health survey (SF-12) in UI subjects and comparing the 12-item WHODAS 2.0 scores and the Quick Disability of Arm, Shoulder, and Hand (QDASH) Outcome Measure in the HI group.Results: The Cronbach’s alpha of the WHODAS 2.0 for the entire sample was α = 0.83. The ICCagreement for test–retest reliability was 0.88. A positive significant correlation was found between the 12-item WHODAS 2.0 and the QDASH (rs = 0.53, p < .005).Conclusions: The results support the reliability and validity of this Hebrew translation of the 12-item WHODAS 2.0. IMPLICATIONS FOR REHABILITATIONMeasurement tools that assess activities and participation after HI are an essential part of the rehabilitation process. The 12-item WHODAS 2.0 is a useful tool, since it addresses a broader range of activity and participation domains compared to the DASH and enables better implementation of the ICF model.Since the WHODAS 2.0 does not target a specific disease (as oppose to the DASH), it can be used to compare disabilities caused by different diseases or traumas.The WHODAS 2.0 measures both the function and disability in general populations as well as clinical situations; therefore, the instrument is useful for assessing both health and disability.

Nerve Injury Predicts Functional Outcomes in Pediatric Supracondylar Humerus Fractures: A Prospective Study: Level 2 Evidence