DASH Questionnaire Research Articles

Results of tendon transfers for stabilization of wrist joints for patients with rheumatoid arthritis

Objectives. The high incidence of damage to small joints of the hand in rheumatoid arthritis (RA), leading to persistent disability, is an important problem in rheumatoidology. A common operation for arthrodesis of the wrist joint to correct emerging deformities is traumatic and limits the function of the hand. In recent years, at the V.A. Nasonova Research Institute of Rheumatology, it has been replaced by new soft tissue joint-saving operations, which allow maintaining good hand function and preventing the development of severe deformities in the future. Target. Comparison of the results of performing soft tissue stabilizing operations on transposition of the tendons of the long radial and ulnar extensor carpi and arthrodesis of the wrist joint in patients with RA. Methods. The study included 69 patients operated on at the V.A. Nasonova Federal State Budgetary Institution NIIR in the period from 2018 to 2023. 24 patients underwent transposition of the long radial and ulnar extensor carpi (transposition ECU + ECRL - extensor carpi ulnaris and extensor carpi radialis longus) with subsequent tenodesis. The control group consisted of 45 patients who underwent arthrodesis of the wrist joint. The DASH questionnaire was used to assess functional status before and after surgery. To assess quality of life - EQ-5D index, pain - VAS, disease activity was assessed using the DAS28 index. The average follow-up period for patients after surgery was 6 months. Results. The functional status of patients after surgery, assessed by the DASH scale, was significantly better in the group of patients who underwent transposition of the tendons of the long radial and extensor carpi ulnaris 39.41±10.17 compared to the control group of wrist arthrodesis 46.4±15.8 (p0.05). Conclusions: ECU+ECRL tendon transpositions are an effective method for stabilizing the wrist joints and correcting hand deformities, but they have a number of limitations, the most important of which is the degree of damage to the wrist joints and the severity of the deformities.

Clinical Outcomes of Scapular versus Fibular free flaps in Head and Neck Reconstructions: A Retrospective Study of 120 patients".

The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes. Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular- and fibular-reconstructed patients, respectively. A total of 120 patients were recruited: 86 mandibular reconstructions (26 scapulas, 60 fibulas) and 34 maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects (p=0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure and non-unions (p=0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor site outcomes (p=0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula (p=0.64), and by re-suturing the detached muscles to the remaining scapula. (p=0.35). The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling non-osteotomized and chimeric reconstructions without compromising surgical outcomes or quality of life.

Postmastectomy Breast Reconstruction in the Irradiated Patient: a 12-year follow-up of DIEP and Latissimus Dorsi Flap Outcome

The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who had undergone postmastectomy breast reconstruction with DIEP and Latissimus dorsi (LD)-flaps with implant.The follow-up involved 67% of the patients in the original cohort (17 DIEP, 13 LD). Patients´ related outcome measurements (PROMS) were measured using BREAST-Q, SF-36, a satisfaction form, and DASH questionnaire. Aesthetics were evaluated by a board of independent plastic surgeons.The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. BREAST-Q and satisfaction questionnaire showed no group difference. SF-36 showed no group difference but significantly higher values in both groups than the general population with regard to physical role limitations (p=0-034 and p=0.004, respectively). DASH showed minimal shoulder function impact in the LD group.Aesthetic evaluations revealed a discrepancy between patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0-012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural ageing process of autologous reconstruction. This underscores the importance of long-term follow-up studies.

Construct validity of the hand10 questionnaire in patients with hand osteoarthritis

BackgroundThe Hand10 questionnaire is a short, easy-to-understand, visual questionnaire developed for the functional assessment of upper extremity disorders. It consists of visuals of each item as well as facial expressions that reflect the degree of difficulty during the function. It has been stated that the Hand10 questionnaire is suitable for application in the elderly population due to its stated features. ObjectiveThis study aimed to evaluate the validity of the Hand10 questionnaire in hand osteoarthritis, the prevalence of which increases with age. MethodsPatients filled the Hand10, Disabilities of the Arm, Shoulder, and Hand (DASH), and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) questionnaires, once. Validity of Hand10 was determined with DASH and AUSCAN questionnaires using Pearson Correlation Coefficient analysis. ResultsSixty patients were enrolled in the study. The Hand10 score of the patients was 45.15±25.81; DASH score was 76.31±26.37, and AUSCAN score was 32.75±15.58. The analysis revealed that Hand10 scores showed a positive correlation with DASH scores at a “very good” level (r=0.71; p<0.001; 95% confidence interval (CI) [0.55, 0.82]) and AUSCAN scores at an ”excellent” level (r=0.76; p<0.001; 95% CI [0.63, 0.85]). ConclusionThe Hand10 questionnaire is a valid tool in patients with hand OA. This questionnaire, which consists of ten items and includes pictures that have a positive effect on repeatability, is very practical in evaluating hand function in upper extremity disorders, especially in older age individuals.

Prevalence of thoracic outlet syndrome among patients visiting physical therapy outpatient department of public sector Tertiary Care Hospitals, Peshawar

The indications and symptoms in the upper extremity brought on by compression of the brachial plexus, subclavian vein, and/or subclavian artery at the thoracic outlet were originally referred to as thoracic outlet syndrome (TOS). The symptoms of neurogenic thoracic outlet syndrome (NTOS) are caused by compression of the brachial plexus roots as they travel through the thoracic outlet. The most typical symptom of thoracic outlet syndrome is neurogenic thoracic outlet syndrome (NTOS). The brachial plexus is compressed and irritated, which causes its symptoms.A cross-sectional study was conducted from March 2023 to June 2023 among patients visiting Physical therapy outpatient department of public sector tertiary care hospitals Peshawar. The DASH questionnaire was distributed to all patients according to inclusion criteria from different hospitals to collect data on the prevalence of thoracic outlet syndrome.The study found that the prevalence of thoracic outlet syndrome was higher in female. The prevalence was higher among female housewives (77.77%) compared to male (63%). Risk factors associated with this pain included improper posture in same position while working, long work durations, repetitive tasks, and restricted neck movements.

Assessment of Lateral Epicondylitis in Butchers in Islamabad

Background: Lateral epicondylitis, or tennis elbow, is a common overuse injury affecting the extensor muscles of the forearm, particularly in professions requiring repetitive manual tasks, such as butchery.Objective: To assess the prevalence of lateral epicondylitis among butchers in Islamabad and its association with occupational risk factors.Methods: A correlational study was conducted between February and July 2022, involving 205 butchers selected through convenience sampling. Participants with at least one year of work experience were included, while those with pre-existing injuries or diabetes were excluded. Data were collected using the Pain Rating Scale, DASH questionnaire, and Cozen’s test. Descriptive and inferential statistics were performed using SPSS version 25, with a significance level of 0.05.Results: The prevalence of lateral epicondylitis was 23.41% (n=48). Butchers working more than 9 hours daily had a significantly higher prevalence (p=0.001). Mild to moderate pain was reported by 26.3% to 21.5% of participants, particularly in the arm and shoulder.Conclusion: The study found a high prevalence of lateral epicondylitis among butchers, linked to prolonged working hours and repetitive tasks. Ergonomic interventions and work modifications are recommended to reduce risk.

A multi-modal evaluation of experimental pain and psychological function in women with carpometacarpal osteoarthritis

ObjectiveThumb carpometacarpal osteoarthritis (CMC1 OA) is a prevalent and debilitating condition that lacks effective treatments. Understanding the multidimensional pain experience across CMC1 OA disease stages is crucial to improving treatment outcomes. This study examined how radiographic CMC1 OA severity is associated with physical, psychological, and somatosensory function. MethodThirty-one women with early-stage (Eaton-Littler 1–2) or end-stage (Eaton-Littler 3–4) radiographic CMC1 OA completed validated questionnaires to assess pain, disability, and psychological function. Additionally, experimental pain was measured in each participant using quantitative sensory testing (QST) (mechanical, pressure, vibratory, thermal) at seven body sites (thenar, hypothenar, brachioradialis bi-laterally; quadriceps on affected side). Cohort differences (early-vs. end-stage) across all variables were analyzed using a multivariable modeling approach that included fixed effects and interactions; notably, age was controlled as a confounder. ResultsEnd-stage CMC1 OA participants had higher scores in the pain (p ​= ​0.01) and function (p ​= ​0.02) portions of the AUSCAN assessment, self-reported disability of the DASH questionnaire (p ​= ​0.04), and painDETECT scores (p ​= ​0.03), indicating greater pain and disability compared to early-stage participants. Additionally, end-stage CMC1 OA participants demonstrated reduced vibratory detection and heat pain thresholds at multiple body sites (p's ​< ​0.05), with significant interactions observed across the mechanical and cold stimuli. ConclusionFindings revealed women with end-stage CMC1 OA exhibited increased neuropathic pain characteristics and somatosensory loss compared to those with early-stage CMC1 OA. These results underscore the importance of addressing both peripheral and centralized pain mechanisms and the need for multimodal approaches in the treatment of CMC1 OA.

Suprascapular nerve blocks with 5mL × 10mL in the treatment of primary adhesive capsulitis: pilot study of clinical trial.

To assess whether 5mL would not be less effective than 10mL when performing a suprascapular nerve block, regarding shoulder function and quality of life in primary adhesive capsulitis. This is a pilot study of a randomized, controlled, double-blind clinical trial conducted at a single center. Patients with AC characterized by constant pain and restricted movements in anterior elevation, 0°/90° external rotation, and internal rotation were selected. Two groups were randomly selected. In group I, a dose of 10mL of bupivacaine was applied, while in group II, only 5mL, in four weekly blocks. Sealed and sequentially numbered envelopes were used. The SF-36 and DASH questionnaires were applied in five moments. The t-Student test was used to compare the means, with a probability of rejecting null hypothesis of 5%. There were 17 participants with primary AC, seven in group I and 10 in group II. The average age was 54.30 and 50.43years in the 5mL and 10mL groups, respectively. There were no differences when the means were compared by DASH: T0 (p = 0.074); T2 (p = 0.285); T4 (p = 0.333); T8 (p = 0.392), and T12 (p = 0.453). As for the SF-36, there were sparse differences in T2 in the domains of vitality (p = 0.006) and social aspects (p = 0.036) in favor of group I, and in the general health status domain in T8, in favor of group II (p = 0.033). The volume of 5mL is not less effective than 10mL when performing SSNB in the treatment of primary adhesive capsulitis.

Long-term outcomes after capitate fractures: a median 16-year follow-up.

The long-term effects of a capitate fracture are unknown. The aim of this study was to assess both clinical and radiological long-term outcomes after a capitate fracture. From a cohort of 526 consecutive patients with post traumatic radial sided wrist pain, 23 were identified diagnosed with a capitate fracture. 16 of these (11 males and 5 females) with a median age at injury of 17.5 years (range 11-27 years) were eligible for a follow-up after a median of 16 years (range 8 to 17 years). In this study patients were examined using conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) at the time of injury and with CT at the follow-up. At follow-up radiological signs of osteoarthritis were graded in four stages and clinical outcome was evaluated by measuring range of wrist motion and grip and pinch strength. The subjective outcome was assessed using DASH and PRWE questionnaires. Five patients had isolated capitate fractures and 11 had concomitant fractures, 10 of which had a simultaneous scaphoid fracture. 14 patients had been treated non-surgically in a cast and two patients were treated surgically. None of the fractures were visible on conventional radiographs at the time of injury. At follow-up all fractures had healed without signs of avascular necrosis. In one patient, CT examination revealed osteoarthritis between the capitate and lunate. This did not cause clinical symptoms. Functional impairments and pain scores were low: median DASH score 0, median PRWE 3 and median VAS pain score 0. We found no impairment in range of motion or grip and pinch strength. At a median of 16-year follow-up, patients with a capitate fracture report normal self-assessed hand function as well as good wrist motion and strength. The risk of development of posttraumatic arthritis in the joints around the capitate is low.

PREVALENCE OF THORACIC OUTLET SYNDROME IN WORKERS AND PLAYERS OF FAISALABAD

Background of the Study: A neurovascular compression that causes pain and tingling sensation in arms either unilateral or bilateral and aggravates with overhead activities is termed as thoracic outlet syndrome. Symptoms includes discomfort, pain, heaviness and thoracic nerve impingement. It is a form of group of disorders that affects bony, muscular and even fibrous structures. If left untreated TOS can result in devastating functional and structural abnormalities. Methodology: It was a cross sectional observational study. A sample of 195 players and workers was taken from public sector organizations of Faisalabad. Inclusion criteria consisted of participants with 20 years of age or older. Gender was specified to be male only. Players who were actively participating in any sports were included. Laboring staff that were involved in overhead activities were included. Convenience sampling technique was used. Subjects with previously diagnosed traumatic injury and surgery were excluded. Adson maneuver and DASH questionnaire was utilized as data collection procedure. Results: Data was analyzed using SPSS version 21. Independent t test was applied to record prevalence of thoracic outlet syndrome. P-value 0.0001 demonstrates statistically significant prevalence in players and workers. An overall of 59% prevalence was recorded in both workers and players. Conclusions: It is concluded that thoracic outlet syndrome is highly prevalent in both workers and players. Comparison between both populations demonstrates slightly high prevalence in players by 51.8%, as those for workers to be 48.2. It is frequent within age groups of 20-30 in players and 30-50 years in workers.

Functional outcome Measure of Programme for Scalular Stabilisation Exercise in Rehabilitation of Frozen Shoulder : An Experimental Study

Background: The signs and symptoms of adhesive capsulitis, another name for frozen shoulder, include shoulder joint stiffness and pain. Conventional rehabilitation methods concentrate on enhancing shoulder range of motion and minimizing discomfort. It has been suggested that by enhancing scapular kinematics and muscle activation patterns, scapular stabilization workouts can improve functional outcomes. Objective: This study aims to evaluate the functional outcomes of a scapular stabilization exercise program in individuals receiving rehabilitation for frozen shoulder. Methods: Forty people who had been diagnosed with frozen shoulder participated in a randomized controlled trial. One of two groups the scapular stability exercise Group A or the standard rehabilitation Group B was assigned at random to each participant. The eight-week intervention consisted of five thirty minute sessions, held five times a week. For eight weeks, Group A supplemented their traditional range of motion exercises with scapular stabilization exercises. Sessions lasted thirty minutes, consisted of ten repetitions each, and were conducted five days a week. Group B carried on with just traditional workouts. Functional outcomes were assessed using the Numerical Pain Rating Scale NPRS Goniometry for range of motion tests, and the Disability Associated with the Arm, Shoulder, and Hand DASH questionnaire at the beginning of the experiment. Follow up assessments were carried out after the eight week intervention phase. Results and Conclusion: When compared to the control group, the scapular stabilization group showed better results in terms of reduced discomfort and increased mobility. This implies that adding scapular stabilization exercises to the adhesive capsulitis treatment regimen could result in improved therapeutic outcomes. Larger sample sizes and longer follow up times are required for future study in order to confirm these results and improve adhesive capsulitis patient’s treatment plans.

Transcultural adaptation and validation of the DASH questionnaire in Mexican healthy volunteers and patients with neurogenic disorders of the upper extremity

The Disability of the Arm, Shoulder and Hand (DASH) questionnaire assesses the impact of upper extremity disorders on quality of life. However, its use in the Mexican population has not been formally validated. To conduct a cultural adaptation and validation of the DASH questionnaire to evaluate the perspective of patients with neurogenic disorders of the upper extremity regarding the impact on their quality of life. We performed an adaptation of the Spanish version of the DASH questionnaire to the Mexican vocabulary and applied it to 478 volunteers. Ceiling effect, floor effect, item-total correlation, descriptive statistics of items and total score, internal consistency, precision, cross-sectional and longitudinal validity were estimated by comparing healthy controls and affected individuals with different disability levels. Our DASH questionnaire version was equivalent to those previously approved and showed homogeneity of the items with respect to the total value of the questionnaire (Cronbach's alpha > 0.96). In addition, it showed an accuracy of 7.25 points and the crosssectional and longitudinal validity was documented with significant differences between groups and subgroups with distinct disability levels. The DASH questionnaire can be used with a high level of confidence in the Mexican population.

Factors Associated with Upper Extremity Functionality After Mini-Open Release Surgery for Treatment of Carpal Tunnel Syndrome

Aim: The objective of this study was to investigate the correlation between upper extremity functionality, pain intensity, muscle strength, and symptom severity among patients diagnosed with carpal tunnel syndrome (CTS) who underwent mini-open release surgery. Material and Method: This retrospective study entailed the review of medical records of 70 patients diagnosed with CTS who underwent mini-open release surgery between January 2021 and January 2023. Data were collected from preoperative assessments and routine follow-up evaluations conducted at 3 months post-surgery. Upper extremity functionality was assessed utilizing the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, pain severity was determined using the Visual Analog Scale (VAS), muscle strength was evaluated through hand grip strength, and disease severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ). Results: A statistically significant improvement was observed in DASH questionnaire scores, VAS scores, hand grip strength, and BCTQ scores at the 3-month follow-up compared to preoperative values (p

Assessment of Pain Severity and Grip Strength as the Most Accurate Predictors of the Outcome of Treatment of Distal Radial Fractures.

Distal radial fractures are common injuries, accounting for approximately 25% of fractures in the paediatric population and up to 18% of all fractures in the elderly age group. Assessment of treatment outcomes of these fractures includes objective measurements of wrist joint range of motion and grip strength as well as subjective parameters such as the intensity of perceived pain, hand function and quality of life. The recent years have ushered in a trend towards using several outcome measures for a more comprehensive evaluation of the results of the treatment. The objective of this study was to investigate whether the assessment of pain severity and grip strength is sufficiently accurate for correct assessment of the outcome of the treatment of distal radial fractures. One hundred and two patients, 79 women (77%) and 23 men (23%), at a mean age of 54 years with distal radial fractures were treated operatively. Treatment outcomes were assessed at 3 and 6 months by measurements of intensity of pain (according to a numerical rating scale, NRS), grip strength (with a dynamometer) and hand function with the DASH questionnaire. The results of these measurements were compared in order to investigate the strength of the possible correlation between variables. An analysis of the correlation between the variables of interest at 3 and 6 months' assessment showed statistically significant correlations (Spearman rank test, R=0,26-0,41; p&lt;0,01). The NRS correlated negatively with grip strength (less pain - greater strength) and positively with DASH scores (less pain - better hand function). The correlation between grip strength and the DASH was the strongest (Spearman rank test R=0,61; p&lt;0,001, showing that greater power of the hand indicated better function, whereas weaker grip indicated worse function. 1. The severity of pain and the degree of weakness of the hand show (independently of each other) a very good correlation with the comprehensive assessment of hand function using the DASH questionnaire. 2. It follows that pain severity and hand weakness are sufficient to reliably assess the outcome of the treatment of a distal radius fracture.

455 Distal Nerve Transfers in Treatment of Peripheral Nerve Lesions

INTRODUCTION: Distal nerve transfers can be used in treating patients with irreparable high nerve lesions, aiming to regain hand function. The indications for these transfers include upper (C5-C6) and lower (C8-T1) brachial plexus palsy, isolated proximal extensive radial, median, or ulnar nerve lesion, or isolated axillary or musculocutaneous nerve lesion. METHODS: The selected cases (n = 5) included lower brachial plexus injury (n = 2), and isolated radial (n = 1), ulnar (n = 1), and median (n = 1) nerve injuries. The MRC grading was used to examine postoperative muscle strength. The DASH and PNSQoL questionnaires were used to assess the postoperative quality of life. RESULTS: The useful functional recovery (MRC = 4-5) was achieved in all presented cases. The DASH and PNSQoL scores indicated a satisfying quality of life in terms of the absence of postoperative disability. CONCLUSIONS: Distal nerve transfers are a valuable technique for treatment of the patients with irreparable proximal nerve lesions. This technique reduces the path necessary for the regenerative nerve fibers to pass, provides direct nerve coaptation without additional suture line, and facilitates faster and better recovery, with the final outcome as an increase in the patients’ quality of life.

Wrist Radiographic Indices and Patients’ Performance Following Three Surgical Methods for Management of Distal Radius Fractures: A Randomized Single-Blind Controlled Trial

Background. Distal radius fracture has been reported as the most common type of extremity fractures in adults. No treatment method has been introduced definitely for this type of fracture, especially for maintaining hand function in the best state.&#x0D; The aim of this study — to assess the functional and radiological outcomes following three surgical methods, including external fixation, K-wire and external fixation with pinning.&#x0D; Methods. This parallel-designed randomized controlled trial was conducted on adult patients with intra-articular fracture of distal radius. The participants were allocated in three research groups with block random sampling, and were matched for their age and gender. Primary outcome was radiographic parameters, including radial inclination, radial height, ulnar variance and dorsal/palmar tilt. Secondary outcome was the patient’s performance examined with DASH and PRWE questionnaires. All participants were followed 6, 12 and 24 weeks after the surgery for evaluation of these outcomes.&#x0D; Results. Totally, 78 patients, including 42 male and 36 female with mean age of 46.94±11.05 years completed the research protocol. Although the four radiologic primary endpoints were in the normal clinical range after the intervention, a significant statistical difference was observed between the three groups (р0.001). Also, both DASH and PRWE score showed a significant decrease after the therapeutic interventions (р0.001).&#x0D; Conclusion. The statistically significant difference in the research outcomes of the external fixation with pinning can show that this treatment method theoretically preserves the anatomical condition better than the other two methods, and probably has better functional effects on short-term and intermediate-term results following the surgery.

Analysis of the effectiveness of the developed system of physical therapy for patients with rheumatoid arthritis in terms of daily activity, health status and quality of life

Purpose. The purpose of the article is to analyze the effectiveness of the developed system of physical therapy for patients with rheumatoid arthritis based on the results of indicators of daily activity, health status and quality of life. Material &amp; Methods. 188 patients with rheumatoid arthritis were examined, including 156 women (83%) and 32 men (17%), with an average age of 44,9±7,6 years. The patients were randomly divided into a control group (n=92) and a study group (n=96). Patients in the main group were trained according to the proposed system of physical therapy, which was developed in accordance with the domains of the ICF, taking into account factors affecting the level of functional impairment, health status and quality of life (categories at the level of activity and participation). In the dynamics, a comparative assessment of functional limitations in the daily activity of the upper extremities was performed using the DASH questionnaire, health status assessment using the Stanford Health Interview, and quality of life using the EuroQol-5D-5L questionnaire. Results. In patients with rheumatoid arthritis, the initial examination revealed impaired performance of daily activities, in particular, activities requiring hand strength according to the DASH questionnaire, low self-assessment of health according to the Stanford Health Assessment Questionnaire, and significant deterioration in quality of life (EQ-5D-5L) due to the negative impact of existing functional impairments of the upper extremities. After the rehabilitation intervention, patients in both groups showed statistically significant improvement in all studied indicators: facilitation of performing household activities in everyday life, increased self-assessment of health, and improved quality of life compared to baseline data (p &lt; 0.05). However, patients in the main group showed a significantly better result than patients in the control group, which indicates the effectiveness of the proposed rehabilitation measures (p&lt;0.05). Conclusion. Significantly better differences between patients of the main and control groups were found according to the results of the studied indicators, which clearly demonstrates and confirms the effectiveness of the proposed system of physical therapy in contrast to the standard rehabilitation system.

Transforming Rehabilitation for Scapular Dyskinesia: The role of Modified Robbery Exercises in enhancing Muscle Function, reducing Disability, and improving Quality of Life

Background: Scapular dyskinesia affects shoulder function, with significant implications for individuals, especially athletes. Rehabilitation approaches, including modified robbery exercises, aim to address this by improving scapular kinematics and muscle function. This study evaluates the effectiveness of modified robbery exercises supplemented with electromyography (EMG) biofeedback on muscle activation patterns and functional outcomes in individuals with scapular dyskinesia. Methods: A randomized controlled trial was conducted with 40 participants (20 in the control group receiving modified robbery exercises and ergonomic training, and 20 in the experimental group receiving modified robbery exercises with EMG biofeedback). Both interventions lasted 6 weeks, with sessions three times per week. Outcome measures included pain levels (Visual Analog Scale), muscle activation (EMG), functional disability (DASH questionnaire), and health-related quality of life (EQ-5D index and VAS). Independent samples t-tests were used to compare baseline and post-intervention differences between groups. Results: Post-intervention, the experimental group demonstrated significantly greater improvements in muscle activation for the Serratus Anterior, Upper Trapezius, and Lower Trapezius (p&lt;0.001 for SA), indicating the benefit of EMG biofeedback. Both groups experienced pain reduction and functional improvements; however, the experimental group showed a more pronounced decrease in DASH scores (p=0.002) and a notable improvement in EQ-5D Index scores (p=0.008), pointing to enhanced functional outcomes and quality of life. Conclusions: Modified robbery exercises with EMG biofeedback are more effective than traditional exercises alone in improving muscle activation, reducing functional disability, and enhancing the quality of life in individuals with scapular dyskinesia. This study supports the integration of EMG biofeedback into rehabilitation programs for scapular dyskinesia, offering a promising approach for clinicians aiming to optimize recovery outcomes.

Rhizarthrosis: Resection Arthroplasty versus Resection Suspension Arthroplasty - Still the Gold Standard?

Rhizarthrosis is one of the most common arthritic changes in the hand, which has led to the development of a large number of surgical methods in recent years. In addition to the traditional resection arthroplasty with tendon suspension or interposition, if needed, thumb saddle joint prostheses are being used more and more frequently. However, these are not an option for all patients such as those with severe osteoporosis, severe nickel allergy, insufficient height of the trapezium or STT osteoarthritis. This study examined whether the traditional surgical methods continue to have their "right to exist" or whether they will be replaced by prostheses. In a retrospective study with prospective data collection, 48 hands of 45 patients diagnosed with rhizarthrosis in stages II and III according to Eaton and Littler were clinically examined 2.5 years after resection arthroplasty/resection-suspension-interposition arthroplasty using flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strips in the years 2015-2018. The postoperative outcome was assessed using mobility, grip strength, two-point discrimination, postoperative satisfaction with regard to pain and resilience, as well as the DASH and MHQ questionnaires. There were no significant differences in surgery duration, inability to work, time to full weight-bearing, pain, satisfaction, grip strength and mobility. Regardless of the surgical method used, patients achieved an almost free range of motion in the thumb and wrist as well as age-appropriate hand strength. Pain at rest was rare; 48% were pain-free during exercise. The DASH questionnaire scored 20.2, 13.9 and 22.1 points and the MHQ scored 76.3, 79.3 and 79.4 points. Hence, the traditional surgical techniques showed good postoperative results with high patient satisfaction. "Newer procedures" such as endoprosthesis offer promising results in terms of faster regeneration times. However, this is offset by a longer surgery time and higher material costs, which means that resection arthroplasty represents a long-established procedure with a low potential for complications and a lower revision rate and should continue to be used, especially if there are relative contraindications to an endoprosthesis.

Neuropathic pain of the superficial branch of the radial nerve — Factors influencing surgical outcome and patient satisfaction

BackgroundDue to its partially superficial course, the superficial branch of the radial nerve is vulnerable to injury by trauma or surgery, potentially leading to painful neuroma. Surgical treatment is difficult. Among other factors, smoking and duration of pain before revision surgery have been suggested as risk factors for persistent pain after surgical revision, without concrete evidence. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in SBRN neuropathic pain in our department. MethodsAll 51 patients receiving revision surgery of the superficial branch of the radial nerve for neuropathic pain from 2010 to 2020 were contacted; 19 agreed to return for assessment. A medical chart review was performed to collect patient-, pain- and treatment-specific factors. Outcomes were recorded. In an outpatient consultation, clinical follow-up was performed and patients filled out the DASH, MHQ and painDETECT questionnaires. ResultsAfter revision surgery, all patients experienced persistent pain. On multivariate logistic regression evaluating the risk of persistent pain, only smoking emerged as an independent risk factor. Age, gender, dominant side, location, time between trigger and surgery or diagnosis did not emerge as risk factors. No predictor for successful return to work could be identified. ConclusionsTreatment of painful neuroma of the superficial branch of the radial nerve is a challenge. Patients with neuropathic pain should be coached toward smoking cessation before neuroma surgery. Surgery can show benefit even after long symptom duration. No correlations between study clinical variables or test results and return to work could be identified, suggesting that other factors play a role in return to work.