Digital Range Of Motion Research Articles

Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion

Objectives:Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting.Methods:A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/)Results:Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed.Conclusions:These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.

Use of Thermoplastic Rings Following Venting of Flexor Tendon Pulleys: A Biomechanical Analysis

Normal digital flexion relies on flexor tendon pulleys to convert linear muscular force to angular digital motion. However, there is a growing trend to vent them partially during flexor tendon repair. The objective of this study was to examine the effects of a thermoplastic ring, acting as an external pulley, on flexor tendon biomechanics and finger range of motion (ROM) after pulley venting. We tested 15 cadaveric digits using an invitro active finger motion simulator. We measured loads induced by flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) as well as joint ROM with sequential sectioning of the A2, A3, and A4 pulleys compared with an intact pulley condition. At each stage, external thermoplastic pulley rings were applied snugly over the proximal and middle phalanges to recreate A2 and A4 function, respectively. After complete venting of the A2, A3, and A4 pulleys, proximal interphalangeal joint ROM significantly decreased by 13.4° ± 2.7° and distal interphalangeal joint ROM decreased by 15.8° ± 2.1°. Application of external rings over the proximal and middle phalanx resulted in a residual ROM decrease of 8.3° ± 1.9° at the proximal interphalangeal joint and 7.9° ± 2.1° at the distal interphalangeal joint, nearly restoring ROM. Similarly, complete pulley venting resulted in reduced FDS load by 37% and FDP load by 50% compared with intact pulleys. After application of external rings, loads were restored almost to normal, with a 9% reduction for FDS load and 9% reduction for FDP load compared with intact pulleys. The application of thermoplastic rings acting as external pulleys is an effective, noninvasive, and reproducible approach to restore flexor tendon biomechanics and digit ROM after pulley venting. Thermoplastic rings may be a useful therapeutic adjunct in restoring joint ROM and flexor tendon loads after surgical venting of the pulleys.

Midterm Clinical and Radiographic Follow-Up of Pyrolytic Carbon PIP Arthroplasty

The use of pyrolytic carbon arthroplasty (PCA) for the proximal interphalangeal (PIP) joint is controversial. The goal of this study was to evaluate the clinical and radiographic midterm outcomes of PIP joint PCA. Patients were contacted after PIP PCA at 6.4 ± 1.9 years (mean ± SD). Evaluation included grip and pinch strength and digital range of motion (ROM). Radiographs and patient reported outcomes surveys were obtained. This study included 29 PIP joint PCA devices implanted in 23 hands among 19 patients. Seven devices underwent subsequent procedures. Three were removed and revised to silicone implants because of 2 dislocations and one implant migration. One underwent revision to a larger distal component. Three required soft tissue surgical revisions in which the implant was retained (one flexor digitorum superficialis tenodesis and 2 capsulectomies). At the time of latest follow-up, there was 86.2% original implant survivorship. The most recent radiographic review of the remaining 26 implants revealed 2 swan neck deformities and 2 implant migrations. Postoperative grip (38.4 ± 16.8 lb) and pinch (13.8 ± 2.7 lb) strength were 92% and 91%, respectively, of nonsurgical grip and pinch strength. Final mean ROM (range) for the metacarpophalangeal joint was 82.1° (60° to 100°) and for the PIP joint was 60.6° (20° to 110°). Mean outcome scores were: visual analog scale, 1.6 (± 2.4), Michigan Hand Questionnaire, 71.6 (± 17.6), and Disabilities of the Arm, Shoulder, and Hand, 24.7 (± 14.5). Midterm follow-up (mean, 6.4 years) for 29 PCA implants in 19 patients revealed a surgical revision rate of 24.1%. Of the 29 implants, 13.8% were removed at a mean of 4.6 years (range, 1.3-7.9 years). Strength, ROM, and pain relief were all satisfactory. Prognostic IV.

Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant.

Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.

Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: Long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands

Study DesignObservational cohort study. IntroductionInvestigating prognostic factors using population-based data may be used to improve functional outcome after flexor tendon injury and repair. Purpose of the StudyThe aim of this study is to investigate the effect of concomitant nerve transection, combined flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendon transection and the age of the patient, on digital range of motion (ROM) more than 1 year after FDP tendon transection and repair in zone I and II. MethodsTwo hundred seventy-three patients with a total of 311 fingers admitted for FDP injury in zone I and II were treated with active extension-passive flexion with rubber bands and followed for at least 1 year. We compared outcome by evaluating digital mobility using Strickland's evaluation system. ResultsAt 12 months 72% of patients aged > 50 had fair or poor ROM compared to 17% of patients aged 0-25 years. At 24 months the results for patients aged > 50 had improved to 33% with fair or poor ROM, whereas no improvement had occurred for patients aged 0-25 (17% with fair or poor ROM). Concomitant nerve transection and FDS tendon transection had no negative effects on digital mobility. DiscussionAge above 50 was significantly associated with impaired digital ROM during the first year after flexor tendon injury and repair but not at 2 years follow-up. Concomitant nerve transection and combined transection of FDP and FDS do not affect digital mobility. ConclusionsOlder patients are likely to have a slower healing process and impaired digital ROM during the first year after surgery.

Kinesiology taping reduces the pain of finger osteoarthritis: a pilot single-blinded two-group parallel randomized trial.

ObjectivesOsteoarthritis (OA) is the most common arthropathy of the hand, and current treatments carry risks of adverse events. Supportive (kinesiology) tape may be analgesic and provide functional improvement, with a low risk of adverse outcomes. We experimented with supportive tape for OA of the proximal interphalangeal joint (PIPJ) of the finger in this pilot randomized trial.MethodsThis two-group parallel randomized trial recruited adults with OA of the PIPJ of the finger. We excluded patients lacking capacity or the ability to safely apply the tape. Participants were randomized to receive kinesiology tape on the dorsum of the finger, blind to grouping. Pain was the primary outcome, which was recorded on a visual analog scale (VAS). Secondary outcomes were hand function and adverse reactions. Bootstrapped between-group analyses are reported.ResultsTen patients were included and randomized and provided complete data. There was no significant difference in pain between the groups (mean difference of 0.4 VAS units [95% confidence interval {CI} –1.6, 0.7], p=0.4). Overall, the application of kinesiology tape reduced reported pain by 6% (mean reduction of 0.6 VAS units [95% CI 0, 1.2], p=0.04). Taping did not affect hand function or digital range of motion. There were difficulties in recruiting individuals owing to the lack of dedicated research staff.ConclusionKinesiology taping may reduce the pain of OA in the finger; however, whether this is a true effect, placebo effect, Hawthorne phenomenon, or due to a statistical error (ie, type 1 error due to underpowering) is unclear. Hence, further trials are required.

Viability of Hand and Wrist Photogoniometry

No goniometric technique is both maximally convenient and completely accurate, although photogoniometry (ie, picture taking to facilitate digital angle measurement) shows promise in this regard. Our purpose was to test the feasibility and reliability of a photogoniometric protocol designed to measure wrist and digit range of motion in general. Two independent observers examined a sample of joints in both normal and abnormal hands according to a photogoniometric protocol. Interrater and intrarater correlation were calculated, and these measurements were compared with measurements made by a third independent examiner with a manual goniometer. The photo-based measurements were reliable within and between observers; however, only a minority of these measurements were in agreement with manually collected values. At present, photogoniometry is not an acceptable alternative to manual goniometry for determining wrist and digit range of motion in general. Joint-specific photogoniometry should be the subject of future study, as should relevant imaging and software technology.

Solitary Myxoid Neurofibroma of the Palm.

Dear sir A 21-year-old femalepresented with a four-month history of a gradually-enlarging mass of her non-dominant left palm. She denied pain at rest, but noted some discomfort when firm pressure was applied to the area. She also noted mild tingling in the middle and ring fingers. The patient had no history of trauma or prior surgery to the area. Past medical history was unremarkable. On physical exam there was a nodular mass palpable at the base of the middle and ring fingers at the level of the distal palmar crease, measuring approximately one x one centimeters (cm). Sensation to light touch and capillary refill were normal throughout. She had full wrist and digital range of motion. An MRI of the left hand demonstrated a homogenous cylindrical mass measuring 1.9 × 0.7 × 0.8 cm, that was hypo- and hyperintense on T1- and T2-weighted imaging, respectively. The patient underwent surgical excision under tourniquet control, with intravenous sedation and local anesthetic. The mass was seen tenting the common sensory nerve to the ring and middle fingers. The nerve was mobilized and neurolysed from the underlying mass, which was subsequently excised from the surrounding soft tissues. After hemostasis of feeder vessels was achieved, the skin was closed. Gross examination of the specimen revealed a pale yellow well-demarcated, elongated mass measuring 2.0 × 0.7 × 0.7 cm. (Fig. 1).

Prosthetic Arthroplasty Versus Arthrodesis for Osteoarthritis and Posttraumatic Arthritis of the Index Finger Proximal Interphalangeal Joint

To compare outcomes of prosthetic arthroplasty versus arthrodesis to treat index finger proximal interphalangeal (PIP) joint arthritis. Patients with osteoarthritis or posttraumatic arthritis of index finger PIP joints were evaluated. Digit range of motion, grip and pinch strength, patient-rated pain and satisfaction scores, Michigan Hand Questionnaire scores, and complications were recorded. A total of 79 finger PIP joints were followed for a median of 67 months overall (72 months for arthroplasty and 8 months for the arthrodesis group). Sixty-five were treated with arthroplasty and 14 with arthrodesis. Patients undergoing arthroplasty experienced no significant postoperative change in PIP joint range of motion whereas all preoperative PIP joint motion was eliminated after arthrodesis. Patients undergoing arthroplasty experienced significant postoperative improvement in opposition pinch. In contrast, patients undergoing arthrodesis experienced significant improvement in both opposition and apposition pinch. There were no differences in pain relief, satisfaction, or Michigan Hand Questionnaire scores between treatment groups. Patients undergoing arthroplasty had a significantly greater mean number of complications per year and mean number of complications in the first year postoperatively. There was a 4.3 times increased risk of complication in patients undergoing arthroplasty versus arthrodesis, and Kaplan-Meier analysis revealed a shorter time to first complication among patients undergoing arthroplasty. The decision for prosthetic arthroplasty versus arthrodesis in the index finger of patients with osteoarthritis or posttraumatic arthritis must be made with patient goals in mind and in light of greater risk of complications associated with arthroplasty.

Outcomes of Opening Wedge Osteotomy to Correct Angular Deformity in Little Finger Clinodactyly

To evaluate the outcomes and complications in a series of children with clinodactyly treated with opening wedge osteotomy of the abnormal phalanx. We performed a retrospective review of all children with clinodactyly treated at our institution with opening wedge osteotomy of the abnormal middle phalanx between 2003 and 2013. Patients with concomitant pathology or prior surgery in the affected finger were excluded. Preoperative and postoperative clinical angle, radiographic angle, digital range of motion, and pain were compared and complications were recorded. We included 13 digits in 9 patients. All had greater than 20° of preoperative clinical angulation (mean, 36°). Mean age at time of surgery was 11 years; mean duration of follow-up was 25 months (range, 12-43 mo). All digits had significant improvement (mean, 32°) in clinical and radiographic angles after surgery. This improvement was maintained at final follow-up in 12 digits. Six patients had pain preoperatively and no patient had pain postoperatively. One digit had a recurrent deformity at final follow-up and 3 digits developed stiffness at the distal interphalangeal joint. Opening wedge osteotomy is an effective treatment for angulation in children with clinodactyly. We counsel families regarding the risk of distal interphalangeal joint stiffness. Therapeutic IV.

Psychometric properties of health-related quality of life instruments in patients undergoing palmar fasciectomy for dupuytren's disease: a prospective study.

The traditional outcome measured following treatment of Dupuytren's Disease (DD) has been digital range of motion; specifically the gain in digital extension. The outcomes research movement in the last three decades however has been advocating the measurement of outcomes from the patient's perspective using Health-Related Quality of Life questionnaires (HRQOL). Although several generic and region-specific HRQOL questionnaires exist, there is no guidance as to which one is the most appropriate for this population. The objective of this study is to evaluate the psychometric properties of three self-reported HRQOL outcome measures in patients with DD. Patients with DD were enrolled from the practices of three plastic surgeons. Test-retest reliability, concurrent validity and responsiveness of three HRQOL questionnaires were compared in a prospective study design. The HRQOL measures included Health Utilities Index Mark 3 (HUI3), Short Form-36 (SF-36), and the Michigan Hand Questionnaire (MHQ). All three measures demonstrated good test-retest reliability (ICC = 0.77-0.85). Concurrent validity was found between the HUI3 pain and dexterity attributes and SF-36 physical summary score. The sensitivity of the MHQ to detect changes in the status of the patient was found to be high (effect size = 1.14) whereas that of the SF-36 was trivial. The HUI3 and the MHQ seem to be reliable and valid tools to assess the HRQOL in patients with Dupuytren's Disease.

Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytren’s Disease

We investigated interrater reliability of motion (ROM) measurement in the finger joints of people with Dupuytren's disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytren's disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was ≤3° for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytren's disease.

Severity of Contracture and Self-reported Disability in Patients with Dupuytren’s Contracture Referred for Surgery

The purpose of the study was to explore the relationship between preoperative flexion contracture (FC) and self-reported disability in patients undergoing surgical release by fasciectomy or dermofasciectomy. The study design used was a prospective observational study: Dupuytren’s disease (DD) is a fibroproliferative disorder of the palmar fascia and may lead to functional deficits requiring surgical intervention. Outcomes are usually reported using digital range of motion although recent studies have also included patient-rated outcome measures with the extensively validated Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire commonly used. One hundred fifty-four patients consecutively enrolled in a prospective randomized trial were assessed before surgery for active range of movement using goniometry and self-reported functioning using DASH questionnaire. The small finger was affected in 69% of patients with a mean FC of 77.8 degrees (standard deviation = 43.5°). The mean DASH score was 16 points (range, 0–62). The correlation between severity of FC in all four fingers and DASH was weak ( r = 0.264, p = 0.001). At individual digital level, the correlation between FC and DASH was weak in the index ( r = 0.26), middle ( r = 0.28), and ring ( r = 0.21) fingers but almost absent in the small finger ( r = 0.07). These results show that the relationship between severity of FC and functional disability measured by the DASH questionnaire appear to be very weak or even absent. Level of evidence: Level III prospective cohort study.

Early excision and skin grafting versus delayed skin grafting in deep hand burns (a randomised clinical controlled trial)

Introduction Early excision and grafting (E&G) of burn wounds has been reported to decrease hospital stay, hospital costs and septic complications, and some purport reduced mortality while decreasing hospital costs. In today's practice, all burn wounds unlikely to achieve spontaneous closure within 3 weeks are excised and grafted. Early studies did not demonstrate dramatic differences in cosmetic or functional results. This is particularly true with burns of the face, hands and feet. In this study, early excision and skin grafting was compared with delayed skin grafting in deep hand burns. Materials and methods From September 2006 to February 2008, 50 patients with hand burns and average burn size less than 30% total body surface area (TBSA) deep second- and third-degree were randomly divided into early E&G group (group I) and delayed grafting group (group II). Gradual and careful limb and digit range of motion was started on about 10th–14th postoperative day. We used a questionnaire based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to evaluate final functional outcome. Further, hypertrophic scar formation, contracture and deformities were followed and managed accordingly. Results The most common site of involvement was the metacarpophalangeal (MCP) joint with frequency of 39% and 40% in groups I and II, respectively. There were no statistically significant differences between both groups regarding deformity severity, scar formation, sensation, major activities and overall satisfaction. Discussion In treating burns of the hand, the primary goal should always be to restore the functionality of the hand. Although early surgery shortens the healing time and lessens the hospital stay, our results did not show any significant difference between these two methods regarding the function, scar formation, daily activity limitation and overall satisfaction.

Acupuncture for Upper-Extremity Rehabilitation in Chronic Stroke: A Randomized Sham-Controlled Study

Wayne PM, Krebs DE, Macklin EA, Schnyer R, Kaptchuk TJ, Parker SW, Scarborough DM, McGibbon CA, Schaechter JD, Stein J, Stason WB. Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study. Objective To compare the effects of traditional Chinese acupuncture with sham acupuncture on upper-extremity (UE) function and quality of life (QOL) in patients with chronic hemiparesis from stroke. Design A prospective, sham-controlled, randomized controlled trial (RCT). Setting Patients recruited through a hospital stroke rehabilitation program. Participants Thirty-three subjects who incurred a stroke 0.8 to 24 years previously and had moderate to severe UE functional impairment. Interventions Active acupuncture tailored to traditional Chinese medicine diagnoses, including electroacupuncture, or sham acupuncture. Up to 20 treatment sessions (mean, 16.9) over a mean of 10.5 weeks. Main Outcome Measures UE motor function, spasticity, grip strength, range of motion (ROM), activities of daily living, QOL, and mood. All outcomes were measured at baseline and after treatment. Results Intention-to-treat (ITT) analyses found no statistically significant differences in outcomes between active and sham acupuncture groups. Analyses of protocol-compliant subjects revealed significant improvement in wrist spasticity ( P<.01) and both wrist ( P<.01) and shoulder ( P<.01) ROM in the active acupuncture group, and improvement trends in UE motor function ( P=.09) and digit ROM ( P=.06). Conclusions Based on ITT analyses, we conclude that acupuncture does not improve UE function or QOL in patients with chronic stroke symptoms. However, gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms. These results must be interpreted cautiously because of small sample sizes and multiple, unadjusted, post hoc comparisons. A larger, more definitive RCT using a similar design is feasible and warranted.

Health Status After Total Wrist Arthrodesis for Posttraumatic Arthritis

Total wrist arthrodesis is regarded as the most predictable way to relieve the pain of posttraumatic wrist arthritis. Wrist arthrodesis also is believed to be compatible with a high level of upper-extremity function. This study evaluated the effect of total wrist arthrodesis on both general and upper-extremity-specific health status in patients treated for posttraumatic wrist arthritis. By using an institutional review board-approved protocol 22 patients were evaluated an average of 6 years after total wrist arthrodesis for posttraumatic arthritis. Upper-extremity-specific and general health status were measured using the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Short-Form 36 (SF-36) instruments, respectively. Patient satisfaction and interest in pursuing a wrist-mobilizing procedure should one become available also were assessed. Objective assessment included grip strength, digit range of motion, and radiographic fusion. Grip strength averaged 79% of the uninvolved wrist. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 25. The average physical component score of the Short-Form 36 was 39 and the average mental component score was 52. Fourteen patients complained of wrist pain, including severe pain in 4 patients. Fifteen patients were satisfied or very satisfied with the result of the fusion, 5 patients were neutral, and 2 patients were mildly dissatisfied. Twenty patients would elect to have a procedure that could make their wrist move again if one were available. Substantial dysfunction was noted on both upper-extremity-specific and general health status measures after total wrist arthrodesis for posttraumatic conditions. Pain was improved but not eliminated.

A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren's contracture

Early postoperative treatment after Dupuytren's fasciectomy traditionally has included the application of mechanical stress to digital extension with splints and exercise. This study examines the effect of mechanical stress, which may compromise nutrient delivery to the tissues, on inflammation, flare, hypertrophic scar, digital range of motion (ROM), and therapy visits. The authors compared functional outcomes in operated digits treated postoperatively with tension applied (TA) and no tension applied (NTA), retrospectively from 1983 to 1993 (TA only) and prospectively from 1993 to 1999 (TA and NTA). The charts of 268 patients who underwent Dupuytren's fasciectomy were reviewed and divided into 2 groups (TA and NTA). Each case was analyzed with respect to age, sex, number of digits operated, postoperative management technique, therapy visits, metacarpophalangeal joint, and proximal interphalangeal joint ROM, degree of flare, and scar. There were significant differences in ROM, scar formation, flare, and treatment time in favor of the NTA technique. The results indicate that postoperative management that prevents applied mechanical tension in the early phases of wound healing decreases complications after this surgery and that no digital motion is lost to extension with the NTA technique. J HAND THER. 2002;15:331-339.

Intrasynovial Flexor Tendon Repair

Rehabilitation methods that generate increased tendon force and motion have been advocated to improve results following intrasynovial flexor tendon repair. However, the effects of rehabilitation force and motion on tendon-healing may be masked by the high stiffness produced by newer suture methods. Our objective was to determine whether the biomechanical properties of tendons repaired by one of two multistrand suture methods were sensitive to an increased level of applied rehabilitation force. Two hundred and fourteen flexor digitorum profundus tendons from 107 adult dogs were transected and repaired. Dogs were assigned to one of four groups based on the rehabilitation method (low force [<5 N] or high force [17 N]) and the repair technique (four-strand or eight-strand core suture) and were killed between five and forty-two days after the procedure. Repair-site structural properties were determined by tensile testing, and digital range of motion was assessed with use of a motion-analysis system. Tensile properties did not differ between the low and high-force rehabilitation groups, regardless of the repair technique (p > 0.05). In contrast, tensile properties were strongly affected by the repair technique, with tendons in the eight-strand group having an approximately 35% increase in ultimate force and rigidity compared with those in the four-strand group (p < 0.05). Ultimate force did not change significantly with time during the first twenty-one days (p > 0.05); there was no evidence of softening in either of the repair or rehabilitation groups. Force increased significantly from twenty-one to forty-two days, while rigidity increased throughout the forty-two-day period (p < 0.05). Increasing the level of force applied during postoperative rehabilitation from 5 to 17 N did not accelerate the time-dependent accrual of stiffness or strength. Suture technique was of primary importance in providing a stiff and strong repair throughout the early healing interval. Our findings suggest that there be a reexamination of the concept that increases in force produced by more vigorous mobilization protocols are beneficial to tendon-healing. While more vigorous rehabilitation may help to improve hand function, we found no evidence that it enhances tissue-healing or strength in the context of a modern suture repair.

Giant cell tumor of the hand: superior results with curettage, cryosurgery, and cementation.

At our institution giant cell tumors arising in all locations are treated with curettage, cryosurgery, and cementation to avoid resection or amputation, increase local tumor control over curettage alone, and avoid the morbidity associated with immobilization. We report the oncologic and functional results of 3 patients with giant cell tumors arising from the tubular bones of the hand who were treated in this manner. At a mean follow-up period of 54 months there were no local recurrences. No patient complained of pain. Digital range of motion and grip strength were within normal limits for all 3 patients. All patients returned to their previous occupational and recreational activities. One instance of minor wound necrosis was successfully treated conservatively. There were no other complications (fractures, infections, neuropraxias, or vascular damage). Curettage, cryosurgery, and cementation performed by experienced surgeons appears to be a safe, effective, and reliable method for treating selected giant cell tumors of the hand.

Effects of Increased In Vivo Excursion on Digital Range of Motion and Tendon Strength following Flexor Tendon Repair

Effects of Increased In Vivo Excursion on Digital Range of Motion and Tendon Strength following Flexor Tendon Repair