Active Wrist Research Articles

Investigating the influence of keyboard inclinations on sitting and standing workstations

Given the growing global computer workforce, concerns exist about the escalation of computer related injury with Carpal tunnel syndrome (CTS) being one of the most reported work-related musculoskeletal disorders (WMSDs) among office workers. The optimal range of keyboard angles for sitting and standing positions based on wrist posture, forearm muscle activities and user preference as well as the keyboard location in relation to user position were analysed. 30 volunteers with an above 40 words per minute typing speed participated in this study. Result show that, although user prefer to use positive keyboard angle, the negatively tilted keyboard is more ergonomically friendly at both sitting and standing workstations, reducing muscle activity and awkward wrist posture while maintaining performance. The findings indicate that negative sloped keyboard might have the possibility to reduce the risk of developing CTS in office workers. Practitioner summary: This study determines the range of optimal slope of keyboard angle in a sit and stand workstation. Our results indicate a trend in the negative slope keyboard as an ergonomically friendly option for the intervention to Carpal tunnel pressure.

Altered Ulnar Variance With Full-Body Weight-bearing During Handstands With Upper Extremity Weight-bearing CT.

Ulnar variance (UV) is a radiographic measurement relating the articular surface heights of the distal radius and ulna. Abnormal UV increases the risk for wrist pathology; however, it only provides a static measurement of an inherently dynamic bony relationship that changes with wrist position and loading. The purpose of this study was to investigate how full-body weight-bearing affects UV using weight-bearing computed tomography (WBCT). Ten gymnasts completed two 45-second scans inside a WBCT machine while performing a handstand on a flat platform (H) and parallettes (P). A non-weight-bearing CT scan was collected to match clinical practice (N). Differences in UV between weight-bearing conditions were evaluated separately for dominant and nondominant sides, and then, UV was compared between weight-bearing conditions on pooled dominant/nondominant data. Pooled analyses comparing weight-bearing conditions revealed a significant increase in UV for H versus N (0.58 mm) and P versus N (1.00 mm), but no significant change in UV for H versus P (0.43 mm). Significant differences in UV were detected for H versus N, P versus N, and H versus P for dominant and nondominant extremities. The change from N to H was significantly greater in the dominant versus nondominant side, but greater in the nondominant side from N to P. Ulnar variance changed with the application of load and position of the wrist. Differences in UV were found between dominant and nondominant extremities. Upper extremity loading patterns are affected by hand dominance as defined by a cartwheel and suggest skeletal consequences from repetitive load on a dominantly used wrist. Although statistically significant, subtle changes detected in this investigational study do not necessarily bear clinical significance. Future WBCT research can lead to improved diagnostic measures for wrist pathologies affected by active loading and rotational wrist behavior.

Prediction of Spasticity through Upper Limb Active Range of Motion in Stroke Survivors: A Generalized Estimating Equation Model.

We aim to study the association between spasticity and active range of motion (ROM) during four repetitive functional tasks such as cone stacking (CS), fast flexion-extension (FFE), fast ball squeezing (FBS), and slow ball squeezing (SBS), and predicted spasticity models. An experimental study with control and stroke groups was conducted in a Medical Center. A total of sixty-four participants, including healthy control (n = 22; average age (years) = 54.68 ± 9.63; male/female = 12/10) and chronic stroke survivors (n = 42; average age = 56.83 ± 11.74; male/female = 32/10) were recruited. We employed a previously developed smart glove device mounted with multiple inertial measurement unit (IMU) sensors on the upper limbs of healthy and chronic stroke individuals. The recorded ROMs were used to predict subjective spasticity through generalized estimating equations (GEE) for the affected side. The models have significant (p ≤ 0.05 *) prediction of spasticity for the elbow, thumb, index, middle, ring, and little fingers. Overall, during SBS and FFE activities, the maximum number of upper limb joints attained the greater average ROMs. For large joints, the elbow during CS and the wrist during FFE have the highest average ROMs, but smaller joints and the wrist have covered the highest average ROMs during FFE, FBS, and SBS activities. Thus, it is concluded that CS can be used for spasticity assessment of the elbow, FFE for the wrist, and SBS, FFE, and FBS activities for the thumb and finger joints in chronic stroke survivors.

La elastosonografía cuantitativa Shear-Wave aplicada a la sinovitis: un estudio preliminar

AimThis study aims to evaluate the utility of shear wave elastography (SWE) in identifying synovitis in patients with a history of arthritis within the diagnosis of a defined rheumatological disease. Materials and methodsWe performed B-mode and SWE (ultrasound) on 58 participants divided into two groups: group 1 included 29 patients with confirmed active wrist and/or hand synovitis; group 2 included 29 healthy volunteers without suspicion of synovitis. In a subset of patients (n = 8), joint counts and disease evaluations were performed during the elastography to study the correlation between clinical and radiological findings. ResultsThe mean maximum kPa value and the average joint kPa value were significantly different between cases and controls: maximum kPa value for cases was 38.14±35.08 kPa, while for controls it was 4.72±5.93 kPa; average joint value for cases was 29.77±26.07 kPa, while for controls it was 4.17±5.22. The most frequent location for joint effusion in both, cases and controls, was the dorsal radiocarpal joint: 41.4% of controls had a mean kPa value of 7.66±5.39 kPa, while 58.6% of cases had a mean kPa value of 40.61±40.76 kPa (p-value 0.004). kPa values correlated with disease activity measurements in the 8 patients clinically evaluated at the moment of the SWE. ConclusionsSWE is a promising technique that may have a role in the diagnosis and assessment of synovial inflammatory activity in arthritis.

Real-time MRI of the moving wrist at 0.55 tesla.

Magnetic resonance imaging (MRI) using 1.5T or 3.0T systems is routinely employed for assessing wrist pathology; however, due to off-resonance artifacts and high power deposition, these high-field systems have drawbacks for real-time (RT) imaging of the moving wrist. Recently, high-performance 0.55T MRI systems have become available. In this proof-of-concept study, we tested the hypothesis that RT-MRI during continuous, active, and uninterrupted wrist motion is feasible with a high-performance 0.55T system at temporal resolutions below 100 ms and that the resulting images provide visualization of tissues commonly interrogated for assessing dynamic wrist instability. Participants were scanned during uninterrupted wrist radial-ulnar deviation and clenched fist maneuvers. Resulting images (nominal temporal resolution of 12.7-164.6 ms per image) were assessed for image quality. Feasibility of static MRI to supplement RT-MRI acquisition was also tested. The RT images with temporal resolutions < 100 ms demonstrated low distortion and image artifacts, and higher reader assessment scores. Static MRI scans showed the ability to assess anatomical structures of interest in the wrist. RT-MRI of the wrist at a high temporal resolution, coupled with static MRI, is feasible with a high-performance 0.55T system, and may enable improved assessment of wrist dynamic dysfunction and instability. Real-time MRI of the moving wrist is feasible with high-performance 0.55T and may improve the evaluation of dynamic dysfunction of the wrist.

97 Handwriting Speed in Juvenile Idiopathic Arthritis Using the Detailed Assessment of Speed of Handwriting

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common cause of arthritis in children. Common symptoms include pain, joint stiffness, joint swelling, fatigue, and decreased physical function. Over 50% of children have hand or wrist involvement and handwriting is the most commonly reported functional limitation in daily activities. To date there has been limited study of the specific limitations of handwriting in children with JIA. Objectives To better understand handwriting limitations in children with JIA, this pilot study aimed to: (a) describe handwriting speed measured by the Detailed Assessment of Speed of Handwriting (DASH), a standardized assessment of handwriting speed; (b) compare the DASH scores with age- and sex-matched normative data; (c) examine the association between DASH scores and active wrist and hand arthritis; and (d) explore associations between DASH scores and grip strength, quality of life, function, and pain. Design/Methods Participants diagnosed with JIA and actively followed by the paediatric rheumatology clinic at a large tertiary care centre underwent physician assessment with active joint count, occupational therapist (OT) assessment including administration of the DASH, and grip strength measurement by a physiotherapist. Participant-reported outcomes included questionnaires on function (Childhood Health Assessment Questionnaire [CHAQ]), pain, and quality of life (QOL). Results A total of 12 participants aged 9-15 years (M = 12.7y) completed the study. The mean DASH score was 35th percentile (SD = 23) for all participants, 58th percentile (SD = 14) with active hand/wrist arthritis, 25th percentile (SD = 19) with history of hand/wrist arthritis, and 24th percentile (SD = 25) with no history of hand/wrist arthritis. Grip strength was low overall (M = 18th percentile, SD = 28), and lower in participants with active hand/wrist arthritis (M = 4th percentile, SD = 5) and history of hand/wrist arthritis (M = 5th percentile, SD = 7). DASH scores were negatively associated with grip strength (r = -.31), and positively associated with QOL (r = .41) and pain (r = .43). There was no relationship between the DASH and the CHAQ. Conclusion Handwriting speed difficulties are common in children with JIA and may not relate to arthritis disease activity, pain, or function. Handwriting speed may be used in the clinic as a screen to identify children who may benefit from a full OT handwriting assessment. In the absence of access to OT, general guidance can be provided to schools to support a child with JIA in the classroom.

Vascularized pronator quadratus pedicled bone grafting versus iliac crest bone grafting in the treatment of scaphoid nonunion: a retrospective study

Background: Vascularized pronator quadratus pedicled bone grafting is a viable procedure for the treatment of scaphoid nonunion. However, its superiority over iliac crest bone grafting is unknown. In this study, we compare the union rate and outcomes of these procedures in the treatment of scaphoid nonunion. Methods: The medical profiles of the patients with scaphoid nonunion that were treated with either pronator quadratus pedicled bone grafting (n=23) or iliac crest bone grafting procedure (n=31) were retrospectively reviewed. Patients with avascular necrosis of the scaphoid and those with the involvement of the proximal pole were excluded. The outcome measures were the union rate and time, active wrist range of motion, pinch, and grip strength. Results: The mean age of the patients was 30±8.1 yr. Bony union was achieved in all patients of the study groups. The mean time to union was 9.1±2.8 wk in the pronator quadratus group and 8.7±3.5 wk in the iliac crest groups (P=0.14). The mean active flexion, extension, radial deviation, ulnar deviation, pinch, and grip strength of the involved wrist averaged 87.3%, 86.2%, 80.2%, 89.1%, 84.3%, and 85.6% of the contralateral wrist in the pronator quadratus group and 85.5%, 87%, 77.8%, 85.1%, 88.8%, and 87.8% of the contralateral wrist in the iliac crest group, respectively. These differences were not statistically significant. Conclusion: Pronator quadratus pedicled bone grafting provides a similar union rate and outcomes compared to the iliac crest bone grafting in the treatment of scaphoid nonunion. Level of Evidence: IV

SEMG-controlled forearm bracelet and serious game-based rehabilitation for training manual dexterity in people with multiple sclerosis: a randomised controlled trial

BackgroundMuscle strength and dexterity impairments are common among patients with multiple sclerosis (MS) producing limitations in activities of daily living related to the upper limb (UL). This study aimed to evaluate the effectiveness of serious games specifically developed for the MYO Armband® capture sensor in improving forearm and wrist mobility, UL muscle strength, dexterity, fatigue, functionality, quality of life, satisfaction, adverse effects and compliance.MethodsA double-blinded (allocation concealment was performed by a blinded investigator and by blinding for assessors) randomised controlled trial was conducted. The sample was randomised into two groups: an experimental group that received treatment based on UL serious games designed by the research team and controlled by the MYO Armband® gesture capture sensor, along with conventional rehabilitation and a control group that received the same conventional rehabilitation for the UL. Both groups received two 60-min sessions per week over an eight-week period. Wrist range of motion (goniometry), grip muscle strength (Jamar® dynamometer), coordination and gross UL dexterity (Box and Block Test), fatigue (Fatigue Severity Scale), functionality (ABILHAND), quality of life (Multiple Sclerosis Impact Scale-29), adverse effects (Simulator Sickness Questionnaire, SSQ), perceived workload (NASA-Task load index), satisfaction (Client Satisfaction Questionnaire-8 (CSQ-8), Satisfaction with Technology Scale, System Usability Scale (SUS) and QUEST 2.0) and compliance (attendance) were assessed in both groups pre-treatment, post-treatment and during a follow-up period of 2 weeks without receiving any treatment.ResultsSignificant differences were observed in the experimental group compared to the control group in the assessment of forearm supination (p = .004) and grip strength (p = .004). Adverse effects were minimal (SSQ: 7/100 points) and perceived workload was low (NASA-Task Load Index: 25/100 points) in the experimental group. The MYO Armband® technology proved to be useful for the participants (SUS: 80.66/100) and the satisfaction scales received high scores (QUEST 2.0: 59.4/70 points; Satisfaction with Technology: 84.36/100 points). There were significant differences between the groups in terms of attendance percentage (p = .029).ConclusionsAn experimental protocol using MYO Armband®-based serious games designed for UL rehabilitation showed improvements in active wrist range of motion and handgrip strength in patients with MS, with high satisfaction, minimal adverse effects and workload and excellent compliance.Trial registration number: This randomised controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908.

Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study

The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion–extension, radial-ulnar deviation and dart-thrower’s motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.

GBAP/L-proline assist of self-healing nanocomposite hydrogels and their applications in antifreeze, high-sensitivity flexible sensors

For novel wearable flexible electronics, the design of hydrogels materials with anti-freezing capability is of great significance to meet the mechanical flexibility and smart sensing at cryogenic temperatures. Herein, glycosyl cross-linking boron acid and ammonium salt of phytic acid (PA) (GBAP) was synthesized based on eco-friendly organic materials, which was successfully wrapped on the surface of graphene oxide (GO) to obtain GO@GBAP. L-proline (L-Pro) as an antifreeze zwitterion and GO@GBAP were implanted in polyvinyl alcohol (PVA) and xanthan gum (XG) three-dimensional network structure. PA with antifreeze property was further introduced as a crosslinking agent, the PVA-XG/GO@GBAP/PA/L-Pro (PGPL) composite hydrogels were successfully prepared. While at −20°C, the PGPL hydrogels had remarkable mechanical strength (0.80 MPa), and they revealed the splendid self-healing efficiency (89.2%) after 4 h of healing. The high-sensitivity flexible sensors based on these PGPL hydrogels exhibited a rapid response time (220.0 ms) and electrical conductivity (detection mean 2.1 S/m at −20°C). Even at −20°C for 24 h, it could still respond to various physical and physiological movements such as swallowing and wrist activities. This nanocomposite hydrogels constructed in this work had expanded their application scope in the field of cryogenic sensing.

Reconstruction of the Irreparable Proximal Scaphoid with Costo-Osteochondral Graft (Rib Graft)

Abstract Background Irreparable proximal pole fractures of the scaphoid remain a real challenge for the treating handsurgeon. Standard salvage options include 4-corner fusion or proximal row carpectomy. These procedures limit the range of motion and have a high rate of conversion to total wrist fusion. The two current biological reconstructive options are the rib graft or the vascularized femoral trochlea osteocartilaginous free flap. In addition, there is the prosthetic semi-replacement arthroplasty using the pyrocarbon adaptive proximal scaphoid implant (APSI). Aims To present our series of patients with non-reconstructable proximal scaphoid nonunion/fracture (not suitable for conventional bone graft reconstruction) who were treated by the rib graft technique. Methods Our case series of 21 patients treated between March 2013 and January 2019 will been presented (median follow-up 29 months). The surgical technique will be described and crucial technical steps explained. The mean age at surgery was 26 years (SD 5.8) and the median time between injury and rib graft surgery was 2 years (IQR 1.7–3.6). The median postoperative follow-up was 29 months (IQR 19.5–42.4). Results All patients returned to their pre-surgical occupation. Significant differences were found in active wrist movements, grip strength, QuickDASH and PRWE pain scores. Union was seen in all 21 patients. The postoperative capitolunate angles were within normal limits. 17/21 patients showed no progessive postoperative osteoarthritic changes, while 4/21 showed slight progression. Progressive ossification of the graft was noted in 14 /21 patients. No donor site complication occurred. One patient failed and underwent excision of the scaphoid and fourcorner fusion 9 months after the rib graft. At the time of revision, the graft was clinically united. We found statistically significant improvements in QuickDASH and PRWE. Conclusions Our results suggest that reconstruction of the irreparable proximal pole scaphoid nonunion with costo-osteochondral graft reconstruction (rib graft) is a reliable and straightforward procedure in this challenging problem.

0275 Deep Learning-based Sleep Detection using Torso Patch Vital Signs Improves Sleep-Wake Detection over Wrist Actigraphy

Abstract Introduction Motion-based wearable sensors, typically on wrist, have long been used for free-living sleep detection and quantification. However, it is hard to differentiate sleep from sedentary awake time by immobility alone. Vital signs, like heart rate and respiration rate, can greatly enhance determination of wake-sleep state, and are easily monitored with newer wearable sensors. Deep learning techniques are particularly adept at learning labeled physiological states. By combining movement plus vital signs in a deep neural network algorithm, improved sleep detection, fragmentation and sleep staging should be possible compared to activity alone. We report on performance of a deep learning sleep detection and REM/NREM algorithm providing 24-hour evaluation with high specificity using data from a torso-wearable patch sensor as compared to polysomnography (PSG). Methods Twenty-six healthy adults (mean age 53.7 years, 81% female) contributed 150 nights of PSG during laboratory visits, during which participants simultaneously wore a multi-day skin-adherent patch with continuous single-lead ECG and 3-axis accelerometer streams, as well as a wrist activity monitor. A pre-trained deep neural network algorithm generated epoch-level Wake/REM/NREM classification (Sleep equals REM plus NREM) using vital signs and movement derived from the patch sensor ECG and accelerometer waveforms and was then compared to expert human staging of PSGs. The wrist actigraphy sleep-wake determinations (Actiware) were also compared to PSG. Results Data includes 900 hours sleeping and 139 hours awake, of which 195 hours of sleep were in REM state. Using patch data, the deep neural net algorithm achieved 92% sensitivity and 85% specificity to detect sleep as compared to PSG; REM was detected with 85% sensitivity and 97% specificity. By comparison, the wrist motion-based algorithm only exhibited 33% specificity and 95% sensitivity, essentially overcalling immobile wake as sleep. Conclusion Sleep evaluation in free-living environments with wearable sensors can be greatly improved over conventional motion-based wrist sensors by leveraging continuous vital signs. Deep learning-trained neural network algorithms are particularly effective for use with such data, as demonstrated with this algorithm. Support (if any) R01 HL140580 and P01 AG011412

Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach.

A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist. We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores. We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture. We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.

Multimodality Imaging Evaluation of a Unilateral Madelung Deformity

A Filipino female teenager with gross deformity of her right wrist, came as an outpatient for radiographic evaluation nonspecific pain and numbness after prolonged repetitive, active wrist movements like writing and clapping, are noted with no history of trauma, infection, or surgical intervention of the aforementioned wrist.

Unstable distal radius fractures fixation with a 2.4 mm volar variable-angle locking plate: radiological and functional assessment

Background: The main objective of this observational study was to evaluate the functional and radiological outcome of variable angle volar plates in intra-articular distal end radius fractures. Methods: Patients with distal end radius fractures (AO type 3C) treated operatively between Jan 2020 and Dec 2020 and then followed up for at least 12 months. A total of 32 patients (11 men and 21 women) with a mean age of 51.9 years were included in the study. The functional outcome was assessed by using modified Mayo wrist score (MMWS), disabilities of the arm, shoulder, and hand (DASH) score, wrist range of motion (ROM) and grip strength relative to the uninjured side and radiological assessment of radial height, volar tilt, and radial inclination. Results: MMWS and DASH scores improved postoperatively over time. Signs of radiographic union started around 12 weeks after surgery. The most common complication observed was finger and wrist stiffness, which was resolved with active wrist and finger movements. Non-union or hardware-related complications/ late complications such as tendon irritation/attrition were not observed with variable angle volar locking plates. Conclusions: Distal end radius fracture fixation with variable angle plate gives favourable radiological and clinical outcomes. These results can be owed to features such as low profile, variable locking, anatomical design and implant biomechanics. The surgeon determined angulation of the distal row of screw fixation may decrease the incidence of joint penetration and improve fixation of radial styloid and lunate facet stability.

CARPEL TUNNEL SYNDROME: AN OCCUPATIONAL DISEASE

Carpal tunnel syndrome (CTS) is a common problem in certain occupations. Many etiological factors have been suggested for CTS which include repetitive, prolonged hand and intensive activities, forceful exertions, awkward or static posture, vibration, temperature extremes and localised mechanical stress. The references were taken from Grays` anatomy and B.D.Chourasiya which we are supplemented by systematic searches on Google and Pubmed with keywords, occupation incidence, carpal tunnel syndrome, repetitive activities, several specic occupations including cutting metal, dealing with meat and sh processing, slaughter house, manufacturing and construction workers, musicians, repetitive industrial work groups, frozen, food factory employees, grocery store workers, footwear factory workers, etc. In summary, this study concludes that certain occupations involving wrist activities increases the risk of carpal tunnel syndrome. It is recommended that prolonged exposure to highly repetitive action of wrist (i.e. exion and extension) movements should be avoided.

E071 Which clinical, ultrasound and OT hand assessments are most useful in predicting hand disability in early rheumatoid arthritis?

Abstract Background/Aims Developing a clear understanding of the features of hand involvement that are associated with future disability will assist in designing future OT clinical intervention studies and will aid in selecting RA patients for intensive hand therapy and early aggressive medical treatment. This study aimed to determine which hand assessments best predicted hand disability in patients with early Rheumatoid arthritis (RA). Methods 63 early RA patients with hand symptoms were identified from Rheumatology clinics in the Belfast Health and Social Care Trust. Assessments were undertaken at baseline and at 1 year. Hand disability outcome was measured using the Sequential Occupational Dexterity Assessment (SODA). Grip Strength (GS), Total Pain Score (PS), Modified Kapandji index (MK), Stanford Health Assessment Questionnaire (HAQ) and Moberg pick up test (MoV) were assessed by trained occupational therapists (OTs); Ultrasound assessments of hand and wrist were undertaken by trained rheumatologists. Summated (Global) hand and wrist Ultrasound activity score (G-UAS), hand and wrist Power Doppler score (G-PD), and ultrasound erosion score were calculated. Hand deformity score (DS), standardised hand X-ray, Das-28, RF and anti-CCP antibody were undertaken at each assessment. Results There was no significant change in the median SODA score after one year. The main static predictor for baseline SODA was HAQ (25% of the variability). DAS28, MK and Grip Average were statistically significant on their own accounting for between 6-10% variability in the model but when all significant explanatory variables were included HAQ was the only significant variable (23%). Regression for year 1 SODA showed that the main static predictor was MK (adjusted R-squared 59%). PS, DAS28 and GS were statistically significant on their own accounting for between 7-23% variability, but when all significant explanatory variables were included, the MK was the only one of significance (58%). Regressing all explanatory variables against SODA resulted in an adjusted R-squared of 61%: MK and G-UAS (although not significant on its own) were the only ones that were significant. When baseline data was used to predict year 1 SODA, HAQ, MK, PS, DAS28 and GS were statistically significant on their own, but when all significant explanatory variables were included only HAQ and MK were significant explaining 57% of the variability. When HAQ was excluded, PS, DAS28 and GS were statistically significant on their own accounting for between 10-19% variability. When all significant explanatory variables were included, MK was the only one that was significant (adjusted R-squared was 50%). Conclusion Amongst the variables assessed, the HAQ showed good overall prediction for SODA as expected. MK was the most reliable time-lag predictor of hand disability at one year in early RA. X-ray, MoV, GS and ultrasound assessments were much less associated but longer follow-up studies would be useful. Disclosure C. Harkness: None. E. Ball: None. S. Wright: None. E. Crone: None. E. Henry: None. L. Foster: None. H. Farmer: None. A. Bell: None.

Inhibitory Effects of Prolonged Focal Muscle Vibration on Maximal Grip Strength and Muscle Activity of Wrist and Extrinsic Finger Flexor Muscles

ObjectiveThe objective of this study was to identify effective stimulus time by quantifying the inhibitory effects of focal muscle vibration (FMV) on maximal grip strength and muscle activities of the wrist and extrinsic finger flexors. MethodsA randomized repeated-measures design was used in this study. A total of 22 healthy volunteers (mean age, 20.9 years) participated. An FMV of 86 Hz was applied to the anterior surface of the distal forearm under the following 3 conditions: no FMV (control), 5-minute FMV, and 10-minute FMV. Maximal grip strength was measured before and after FMV. The muscle activities of the flexor digitorum superficialis, flexor digitorum profundus (FDP), and flexor carpi ulnaris were simultaneously recorded using surface electromyography. Discomfort and complications following FMV were also assessed. ResultsCompared with the control group, a significant decrease in muscle activity was observed in both the flexor digitorum superficialis and flexor carpi ulnaris after 5 and 10 minutes of FMV. In contrast, there was no significant decrease in the maximal grip strength or FDP muscle activity after either FMV condition. The discomfort was significantly higher immediately after both FMV conditions than in the control group, but it decreased 15 minutes after FMV, indicating no significant difference among the 3 conditions. Redness and/or swelling were observed in 13.6% and 36.3% of the participants after 5 and 10 minutes of FMV, respectively. ConclusionFive-minute FMV to the distal forearm could be a useful therapeutic method with few complications. However, the FMV in this area alone was not sufficient to suppress the muscle activity of the FDP located in the deep layer.

Considerations for at-home upper-limb rehabilitation technology following stroke: Perspectives of stroke survivors and therapists.

This study investigated the needs of stroke survivors and therapists, and how they may contrast, for the design of robots for at-home post stroke rehabilitation therapy, in the Ontario, Canada, context. Individual interviews were conducted with stroke survivors (n = 10) and therapists (n = 6). The transcripts were coded using thematic analysis inspired by the WHO International Classification of Functioning, Disability, and Health. Design recommendations, potential features, and barriers were identified from the interviews. Stroke survivors and therapists agreed on many of the needs for at-home robotic rehabilitation; however, stroke survivors had more insights into their home environment, barriers, and needs relating to technology, while therapists had more insights into therapy methodology and patient safety and interaction. Both groups felt a one-size-fits-all approach to rehabilitation robot design is inappropriate. Designs could address a broader range of impairments by incorporating household items and breaking activities down into their component motions. Designs should incorporate hand and wrist supports and activities. Designs should monitor trunk and shoulder motion and consider incorporating group activities. While therapists can provide insight in the early stages of design of rehabilitation technology, stroke survivors' perspectives are crucial to designing for the home environment.

Symptoms, Diagnosis, and Treatments of Stenosing Tenosynovitis

Sports injuries frequently occur to the hand and wrist, and one of the most common illnesses of the hand and wrist is stenosing tenosynovitis. This report concentrated on stenosing tenosynovitis, encompassing hand and wrist anatomy, high-risk groups and activities, diagnosis, conservative treatment, surgery, traditional Chinese treatment, and post-operative precautions. A high prevalence of stenosing tenosynovitis has been linked to specific sports, occupations, lifestyles, genes, illnesses, and females. The most noticeable clinical symptom is a brief blocking of the fingers during flexion, followed by painful snapping during extension. Auxiliary apparatus such as MRI, ultrasound, and goniometer, as well as specific testing for De Quervain tenosynovitis, are the two basic commonly used diagnostic techniques. Conservative treatment, surgery, and traditional Chinese medicine are options for treating stenosing tenosynovitis. Conservative treatment includes orthoses, steroid injections, and NSAIDs. Surgery involves open release and percutaneous procedures, and the major modalities of Chinese medicine are acupuncture and moxibustion, needle knives and massage. After being successfully treated, the prognosis findings could be influenced by lifestyle, psychological changes, environment, and exercise.