Disability Of Arm, Shoulder And Hand Score Research Articles

Prefabricated curvature internal fixation with Kirschner needle for forearm fracture in children

To explore clinical effect of precast curvature internal fixation with Kirschner needle in treating forearm fracture in children. From October 2019 to December 2022,32 children with forearm fractures were treated with precast curvature internal fixation with Kirkler's needles,including 25 males and 7 females,aged from 3 to 15 years old with an average of (8.0±0.5) years old,18 patients on the left side and 14 on the right side,24 patients with double fractures of radial and ulna,3 patients with Monteggia fractures,and 4 patients with Galeazzi fractures,and 1 patient with radial neck fracture of crooked cap. Operation time,intraoperative blood loss,C-arm fluoroscopy,fracture healing time and complications were recorded,and disabilities of arm,shoulder and hand (DASH) scale and Grace-Eversman forearm double fracture evaluation system were used to evaluate clinical efficacy of precast curvature internal fixation with Kirschner's needle for forearm fracture in children. All 32 patients were followed up for 2 to 12 months with an average of (7.16±2.51) months. Intraoperative blood loss was (20.68±5.50) ml,C-arm fluoroscopy was(5.80±2.50),and operation time was (24.34±5.10) min,fracture healing time was (8.82±1.62) weeks. Two patients occurred complications,including postoperative rupture of extensor pollicis longus tendon in 1 patient and obvious displacement of fracture caused by rotation of prefabricated curvature Kirschler needle on bone marrow cavity in 1 patient. DASH scores ranged from 0 to 16 scores with an average of (8.32±1.50) scores. According to Grace-Eversman double fracture evaluation system,28 patients got excellent result,2 good and 2 fair. The treatment of forearm fracture with Kirschner's needle prefabricated curvature internal fixation has advantages of less trauma,less bleeding,good reduction,stable fixation,fast fracture healing and good functional recovery.

Clinical effect of nice knot-assisted minimally invasive titanium elastic nail fixation to treat Robinson 2B midshaft clavicular fracture

BackgroundThe treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures.MethodsA retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded.ResultsThe length of the incision was 2–6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92–100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12–26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm).ConclusionsIntramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures.Trial registrationRetrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People’s Hospital (LW20220021).

Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?

The objective of this study is to retrospectively assess the use of single-plate (SP) and double-plate (DP) fixation in the open reduction and internal fixation of comminuted clavicle fractures, focusing on fracture union and complications. We retrospectively evaluated comminuted diaphyseal clavicle fractures (Arbeitsgemeinschaft für Osteosynthesefragen type 15.B1-3) treated with open reduction and internal fixation and having a minimum 1-year follow-up. Two patient cohorts were identified: DP (utilizing a superiorly located clavicle-specific plate and an anteriorly located tubular plate) and SP (utilizing a superiorly located clavicle-specific plate). These groups were compared in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, Disabilities of Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) scores. The study included 27 SP and 23 DP patients meeting the inclusion criteria. There was no significant difference between the 2 cohorts in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, DASH, and ASES scores at the end of the first year (P = .889, P = 1.00, P = .122, P = 1.00, P = 1.00, P = .493, P = .736, P = .762, P = .937 respectively). However, it was observed that the DP group showed a significantly earlier return to work time and better DASH scores at 3rd and 6th months, whereas the SP group exhibited significantly better ASES scores at 3rd and 6th months (P = .034, P = .016, P = .032, P = .036, P = .021, respectively). No significant difference was observed in terms of union and complications in acute clavicle fractures treated with SP and DP fixation. The DP group demonstrated an earlier return to work and superior early functional scores compared to the SP group. Our findings suggest that a secondary plate can be reliably used, particularly in situations where clavicle fracture fixation is insufficient or in cases of comminuted clavicle fractures.

THE OFFICIAL TRANSLATION OF THE DASH SCORING SYSTEM TO ISIZULU FOR USE IN SOUTH AFRICA

The Disability of Arm Shoulder and Hand (DASH) score questionnaire is a common self-administered tool to assess symptom severity and function in patients with injuries or pathology of the upper limb. However, having such a pertinent tool only in English is limiting in multi-cultural and multilingual populations where English is not always the first language, such as our South African context. IsiZulu is the most widely spoken language in South Africa (approximately 25% of the population). There are certain instances in research, particularly in international studies, where non-English speaking individuals need to be excluded based on translator reliability. This puts our institutions at a disadvantage by not being able to contribute to research.As per the international Institute of Work and Health (IWH), we followed the 5 stage guidelines to achieve the most appropriate linguistic and cultural adapted translation for our setting. (1) Two independent translations from English to isiZulu. (2) A synthesis of the 2 initial translations. (3) Two independent back-translations from the synthesized isiZulu version into English. (4) Expert panel (consisting of university lecturers and official translators) to review all versions and re-create an optimized synthesized version. (5) Pre-testing of the final optimized synthesized version in a pilot study. This rigorous process allowed for a concise and more culturally relevant translation for use in our population. The fourth stage in the process was integral in synthesizing the tool while considering the colloquial and semantic differences and resolving them with appropriate equivalents.The IWH guidelines aids in the cross-cultural adaptation of the DASH score while remaining valid and comparable to the original English version. This is beneficial in multi-national research projects and allows for the standardization of health outcome measures.

Comparison of Functional Outcome of Conservative Management and Operative Treatment for Displaced Mid-Shaft Clavicle Fractures

Objective: To compare functional outcomes of conservative management and operative treatment for Displaced Mid-shaft Clavicle fractures. Study Design: Prospective comparative study. Place and Duration of Study: Department of Orthopaedics Combined Military Hospital, Rawalpindi, Pakistan, from Dec 2020 to Sep 2021. Methodology: In a cohort of 80 patients with displaced midshaft clavicle fractures, 40 patients were managed conservatively with an arm sling, and 40 were managed operatively with an anatomical clavicle plate. All these patients were followed up for three months. The functional efficacy of different treatment options in displaced midshaft clavicle fractures was assessed using a Disability of Arm, Shoulder and Hand (DASH) score. Results: The DASH Score showed Functional outcomes were significantly better (p<0.01) in the Operative-Group at 4 weeks, 2 months and 3 months. At two-month follow-up, the Conservative Group had a DASH score of 21.2±2.1, whereas the Surgical Group had a DASH score of 11.7±1.8. The DASH score at three months follow-up was 5.5±1.3 and 12.5±1.9 for the Operative and Conservative Groups, respectively. Conclusion: Plate fixation improves the functional results for individuals with a displaced mid-shaft clavicle fracture. This study showed that DASH scores are lower in the operative Group. When it comes to non-displaced mid-shaft clavicle fractures, conservative management has always been the best option.

Lidong needling therapy combined with functional exercise in treatment of upper limb lymphedema after breast cancer surgery: a randomized controlled trial

To observe the clinical efficacy of lidong needling therapy (acupuncture technique combined with therapeutic movement of the body) on upper limb lymphedema after breast cancer surgery in combination with functional exercise. A total of 73 patients with postoperative lymphedema of breast cancer in the upper limbs were randomized into an observation group (36 cases) and a control group (37 cases). The routine nursing care and functional exercise were given in the control group, twice a day, for about 10-15 min each time, lasting 8 weeks. On the basis of the treatment as the control group, lidong needling therapy was applied to the acupionts on the affected upper limb, i.e. Jianyu (LI 15), Waiguan (TE 5), Hegu (LI 4) and ashi points (the most obvious swelling sites), as well as to bilateral Yinlingquan (SP 9) and Zusanli (ST 36), etc. The needles were retained for 30 min. While the needles retained, the patients were asked to move the affected shoulder to 90° by the sagittal anteflexion and keep it elevated. Simultaneously, the hand on the affected side was clenched and opened slowly and coordinately. Lidong needling therapy was delivered once every two days, three times weekly for 8 weeks. Before and after treatment, the difference of the circumference between the affected and healthy limbs, the score of visual analogue scale (VAS) for swelling and the score of disability of arm, shoulder and hand (DASH) were compared in the patients of the two groups. The clinical efficacy was evaluated. After 2, 4, 6 and 8 weeks of treatment, except for the circumference of the area 10 cm below the cubitel crease in the control group, the differences in the circumferences of the rest parts between the affected and healthy limbs were reduced in comparison with those before treatment in the two groups (P<0.01, P<0.05). After 6 weeks of treatment, in the observation group, for the circumference at the level of hand between the thumb and the index finger and that of the wrist, the differences between the affected and healthy limbs was smaller compared with those in the control group (P<0.05). After 8 weeks of treatment, except for the areas 5 cm below and above the cubitel crease, the differences of circumferences between the affected and healthy limbs in the observation group were smaller than those in the control group in the rest parts (P<0.01, P<0.05). After 8 weeks of treatment, the swelling VAS scores were reduced when compared with those before treatment in the two groups (P<0.05), and the score in the observation group was lower than that in the control group (P<0.01). After 4 and 8 weeks of treatment, DASH scores were reduced in comparison with those before treatment in the two groups (P<0.01). The total effective rate of the observation group was 83.3% (30/36), which was higher than that of the control group (35.1%, 13/37, P<0.01). Lidong needling therapy combined with the functional exercise obtains the satisfactory clinical effect on the upper limb lymphedema after breast cancer surgery. This treatment effectively relieves swelling and improves the upper limb function.

Comparing the outcomes of tripod technique and locked plate fixation for the treatment of Mason type 3 radial head fractures.

In this study, we aimed to compare functional outcomes and complication rates of tripod technique and locked plate fixation used in Mason type 3 radial head fractures. Between January 2012 and December 2019, a total of 27 patients (16 males, 11 females; median age: 43.2 years; range, 20 to 68 years) with Mason type 3 radial head fractures were retrospectively analyzed. The patients were divided into two groups according to fixation method used. Group 1 consisted of 12 patients who were treated with tripod technique, and Group 2 consisted of 15 patients who were treated with locked plate fixation. Operation time, follow-up period, length of hospital stay, union time, Disabilities of Arm, Shoulder and Hand (DASH) scores, range of motions and complications were recorded. The median time to bone union was 46.7 days in Group 1, which was significantly shorter than Group 2 (p<0.001). The median forearm pronation-supination arc was 123.75° (range, 30° to 180°) in Group 1 and was 94° (range, 45° to 180°) in Group 2. There was no significant difference in the forearm rotation between the groups. The median elbow flexion-extension arc was 99.17° (range, 65° to 130°) in Group 1 and was 80.33° (range, 30° to 130°) in Group 2. No statistically significant difference was found in the flexion-extension and pronation-supination arc degrees. There was no significant difference in the postoperative DASH scores between the groups (p=0.464). Our study results demonstrate that comparable results can be achieved in both techniques regarding functional outcome and range of motion. With a shorter union time and less complication rates, the tripod technique should be considered as the primary treatment method for the comminuted radial head fractures without a metaphyseal defect.

Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis.

The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.

Short- to Mid-term Results of Patient-Specific Polymethylmethacrylate Radial Head Prosthesis in Complex Radial Head Fractures Using 3-Dimensional Mold System.

Background: We used antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement to make a patient-specific radial head prosthesis (RHP) by applying the 3-dimensional (3D) designing technique in patients with Mason types 3 and 4 radial head fractures. The aim of this study is to report the short- to mid-term outcomes of this procedure. Methods: This is a prospective study of all patients who underwent a patient-specific PMMA bone cement RHP at our institute over a 1-year period from May 2017 to June 2018. The outcome measures included range of motion, grip strength, visual analogue scale (VAS) for pain at rest and at activity, disabilities of arm, shoulder and hand (DASH) score and Mayo elbow performance index (MEPI). Radiographs of the elbow ere obtained at final follow-up and any complications were also recorded. Results: Our study included eight patients with a mean follow-up of 18 months (13-20 months). The mean arc of extension-flexion and supination-pronation of the operated side was 86% and 96% of the unaffected side, respectively. Mean grip strength was 86% of the unaffected side. The mean VAS for pain at rest was 0 and during activity was 2 out of 10. The mean DASH score was 8 out of 100 (0-22), showing minimal disability and ability to cope with most living activities. MEPI showed four excellent, three good and one fair result. One patient complained of proximal forearm pain that appeared 1 year after surgery. No patient complained of ulnar nerve symptoms requiring intervention. No RHP was removed during the follow-up. Conclusions: PMMA RHP can be used safely as an alternative to metal prostheses to restore valgus and axial stability of the forearm. The use of 3D printing optimised the design and surgical technique of radial head arthroplasty, and we need further studies to assess the long-term follow-ups. Level of Evidence: Level IV (Therapeutic).

Outcomes of radial head fractures treated with pre-curved metacarpal plate

ObjectiveTo explore the clinical outcomes of MasonII/III radial head fractures without the neck involvement treated with pre-curved metacarpal plates.MethodsNinety cases of Mason typeII/III radial head fractures without the neck involvement were retrospectively collected from the department of orthopaedics of our hospital from September 2015 to May 2021. Group A (n = 44) underwent open reduction and internal fixation with pre-curved metacarpal plate, and Group B (n = 46) were fixed by traditional T-shaped plates. The operation time and the incision length were recorded during the operation. The Mayo Elbow Performance Score (MEPS), Disability of Arm, Shoulder and Hand (DASH) score, visual analogue scale (VAS) for pain, range of motion (ROM) and post-operative complications were evaluated at the last follow-up.ResultsAll the patients were followed up for at least 12 months. There were no significant difference between two groups regarding operation time (54.2 ± 12.1 v.s 51.3 ± 7.2, mins), MEPS (88.9 ± 4.2 v.s 87.8 ± 4.4), DASH score (7.3 ± 4.6 v.s 9.0 ± 4.0), VAS (1.6 ± 0.8 v.s 1.7 ± 0.7), and ROM. However, the incision length was shorter in Group A (5.6 ± 0.5 v.s 6.6 ± 0.5, cm, P < 0.01). The postoperative complication rate was also lower in Group A (1/44 v.s 8/46, P = 0.02).ConclusionMasson II/III radial head fractures without the neck involvement treated with pre-curved metacarpal plates could achieve satisfactory outcomes comparable to traditional T-shaped plates. Moreover, the invasiveness and postoperative complications are less in patients with pre-curved metacarpal plates.Level of evidenceIII, retrospective comparison study.

Trapeziectomy with ligament reconstruction and tendon interposition arthroplasty continuously improves hand functions up to 5-year postoperatively.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty is a reliable surgical procedure for the treatment of thumb carpometacarpal osteoarthritis, which provides good long-term outcomes. However, it remains unclear when the greatest benefit of this procedure can be obtained, and how long these benefits will continue. Therefore, we investigated the middle- to long-term advantages of this procedure by analysing the chronological changes in clinical outcomes by following the same patients from 1year to a median 5years after trapeziectomy with LRTI. Sixteen thumbs that completed consecutive clinical and radiographic evaluations preoperatively, 1year, 2years, 3years, and median 5years (range 4-8years) after trapeziectomy with LRTI were included in this study. We investigated grip strength, pinch strength, range of motion (ROM) of the thumb, a visual analogue scale for pain, Disabilities of Arm, Shoulder and Hand (DASH) score, Hand20 questionnaire score, trapezial space height, and trapezial space ratio at every time point. Hand strength (grip, pulp, and lateral pinch), palmar abduction, DASH score, and Hand20 questionnaire score were improved at 1year postoperatively while the radial abduction showed significant improvement at the final follow-up. Moreover, pulp pinch strength, DASH score, and Hand20 questionnaire score continued to improve significantly from 1year postoperatively to the final follow-up. Conversely, trapezial space height and ratio continuously decreased up to the final follow-up. Trapeziectomy with LRTI consecutively improved the pinch strength, ROM of the thumb, DASH score, and Hand20 questionnaire score up to 5years postoperatively. It also maintained the improvement of the other clinical outcomes up to 5years postoperatively except for radiological findings.

Evaluation of treatment of nonunited middle third scaphoid fractures using threaded Kirschner wires fixation with iliac bone grafting

Abstract Objectives To evaluate the results of iliac bone grafting with threaded Kirschner wires (K-wires) fixation in treating of nonunited middle third scaphoid fractures. Background Scaphoid nonunion is a common complication after scaphoid fractures as it is an intra-articular fracture with high fracture mobility and instability. In addition, the scaphoid is devoid of periosteum along with impaired vascularity. Scaphoid nonunion results in carpal collapse with secondary osteoarthritis. To avoid that, the aim of treatment should be to enhance the biology of fracture through bone grafting and provide adequate stability of the fracture in an anatomic alignment. Patients and methods This study is a prospective case series of 30 patients with nonunited middle third scaphoid fractures admitted to an academically supervised trauma center from June 2018 to June 2020. They were managed by open reduction, refreshment of the scaphoid nonunion site with iliac crest bone grafting, and threaded K-wires fixation in an anatomical alignment. The mean age was 28.58 ± 4.47 years. Postoperative clinical outcomes were evaluated using the Quick disabilities of arm, shoulder and hand (DASH) score, and modified Mayo wrist score. Postoperative radiological union and scaphoid alignment were assessed. The minimum period of follow-up was one year. Results One year postoperatively, the mean modified Mayo wrist score was 81.67 ± 9.39 and the mean Quick DASH score was 25.67 ± 14.97. Radiologically, the union was achieved in 86.7%. The mean union time was 11.92 ± 1.54 weeks. Conclusions Threaded K-wires fixation with iliac bone grafting is an effective method for treating nonunited middle third scaphoid fractures.

Robot-Assisted Retroauricular Anterior Scalenectomy for Neurogenic Thoracic Outlet Syndrome.

This study described the surgical technique of a robot-assisted retroauricular anterior scalenectomy and assessed clinical outcomes and complications for patients with neurogenic thoracic outlet syndrome (nTOS). Between February 2014 and August 2016, 5 patients underwent robot-assisted retroauricular anterior scalenectomy using the da Vinci Xi system for nTOS. For clinical assessment, visual analog scale (VAS) symptom score, pinch and grip strength, and disabilities of arm, shoulder and hand (DASH) score were assessed to compare preoperative and postoperative outcomes. Postoperative complications were also reviewed. The VAS symptom, pinch and grip strength, and DASH scores improved 1 year after the operation. All patients were satisfied with the surgical scars. Temporary postoperative complications, which spontaneously resolved within 3 months, were noticed in 2 patients: one with vocal cord palsy and the other with upper brachial plexus palsy. The robot-assisted retroauricular anterior scalenectomy for patients with nTOS seems feasible and safe, providing satisfactory cosmetic results.

Functional Outcome of Isolated Middle to Distal Third Ulnar Shaft Fracture in Adults with Square Nail Fixation

Introduction: Isolated ulnar shaft are uncommon injuries with most of the fractures occurring following direct trauma. Open reduction and internal fixation with plating is the gold standard treatment but is associated with complications. Treatment with square nail provides rotational stability, is cheaper, safer with minimum complications of plating.&#x0D; Aims: To evaluate the functional outcome of isolated fracture of middle third to distal third ulna treated with square nail.&#x0D; Methods: This prospective observational study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur from September 2018 to August 2022. Patients aged above 18 and below 60 years who had displaced isolated fracture of middle third or distal third of ulna were evaluated for demographic details, union, functional outcome and associated complications. All of the fractures of ulna were treated by square nail and outcomes were evaluated using disability of arm, shoulder and hand (DASH) score and Grace and Eversmann scoring system.&#x0D; Results: In this study of 39 patients with the mean age of 30.84±8.12 years, 56.4% of the patients were in age group 18-30 years, 27 (69.2%) were males and 12 (30.8%) were females. The right limb was fractured in majority, distal third was more commonly involved, physical assault was the most common mode of injury, transverse was the most common fracture pattern. The average time to union was 11.61±2.74 weeks. Most (74.4%) of the patients had good result in DASH score and most (94.9%) had good to excellent result in Grace and Eversmannscoring at final follow-up. The most common complication noted was olecranon bursitis (17.94%) followed by skin irritation (12.82%).&#x0D; Conclusion: Square nail fixation of isolated middle third to distal third ulna is safe procedure with few complications, produces excellent to good results.

Manual therapy improves symptom severity and disability in patients with carpal tunnel syndrome

Aim: The aim of the study was to assess early outcomes of manual therapy in patients with carpal tunnel syndrome. Materials and methods: In this study, patients diagnosed with electrophysiologically confirmed carpal tunnel syndrome received manual therapy. The therapy was used in 41 individuals who received one session in line with IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) standards per week for 5 weeks. Grip strength was assessed using a dynamometer, disability was assessed using the DASH (Disability of Arm, Shoulder and Hand) questionnaire, and the quality of life was assessed using VASEQ5D5L (Visual Analog Scale of the 5-level EQ-5D). Data was collected before the first treatment and one week after the last treatment. Results: We observed significant change in DASH score and quality of life. Grip strength tended to improve, but the effect was statistically significant only in patients over 50 years of age. Symptom severity (Carpal Tunnel 6 score, Douleur Neuropathique 4 score and peripheral cutaneous threshold assessed with Semmes–Weinstein monofilament) improved significantly. There was no significant correlation between changes in DASH score and grip strength. Conclusion: Manual therapy significantly improves quality of life and reduces upper limb disability in patients with carpal tunnel syndrome.

Do Variable Locking Plates Provide Better Functional and Radiological Outcomes in Volar Barton Fractures?

A volar or reverse Barton fracture refers to an intra-articular distal radius fracture that extends out to the volar aspect of the distal radius and there may be subluxation or dislocation in that direction. The overall goal of managing volar Barton fractures is to obtain motion that is pain-free, allow the patient to return to their usual activities, and minimize the risk of development of early-onset arthritis which may cause disability. Though various management options are available, this study deals with the assessment of functional and radiological outcomes of volar Barton fracture fixed with a variable locking plate. A prospective, observational, and hospital-based study was conducted at R. L. Jalappa Hospital and Research Centre, Sri Devaraj Urs Medical College (SDUMC), Tamaka, India, on patients with volar Barton fracture managed with a variable locking plate from the period December 2019 to June 2021. Clinical data were assessed with Disabilities of Arm, Shoulder and Hand (DASH) score, Gartland and Werley demerit criteria, and Sarmiento modification of Lindstrom criteria. Results: Forty subjects with a mean age of 36.43 ± 10.59 years were included in the study. The mean flexion, extension, supination, and pronation were 70.63° ± 3.6°, 74.3° ± 3.64°, 79.83° ± 2.67°, and 76.28° ± 1.99° degrees respectively at the end of six months. Based on Gartland and Werley's outcome, the majority (65%) of the study population was found to have an excellent outcome, 30% had a good outcome and only 5% had a fair outcome. The mean DASH score was 13.98 ± 5.76. According to Sarmiento's modification of Lindstrom criteria, 22 patients had good radiological outcomes, 11 had excellent outcomes and seven hadfair outcomes. The study concludes that fixation of volar Barton fractures with variable locking plates has a better role in immediate stability, maintaining anatomic reduction, and early mobilization. It also provides better functional outcomes and a good anatomical reduction.

When Healing Hands Hurt: Epidemiology of Thoracic Outlet Syndrome Among Physicians

Thoracic outlet syndrome (TOS) is an infrequent condition which results in disability in use of upper extremity. While TOS is often associated with manual labor, industrial workers, and accidents, it has not been reported in a physician (MD) population. Given the investment of time and effort in training to become a MD, the impact of TOS may be devastating. Our objective is to report the presentation and outcome of TOS in MDs. A prospectively surgical database was reviewed for MDs who sought care of disabling TOS between 1997 and 2022. Demographic, clinical, outcome and pathological data were reviewed. Outcomes were assessed based on Somatic Pain Scale (SPS), Quick Disabilities of Arm, Shoulder and Hand (DASH) scores, and Derkash scores. Results were also assessed based on return to employment. A total of 19 MDs were identified, from 1,687 TOS cases. The group included 13 (63%) men, 6 (31%) women, average age 45years (range 27-57). Presentations included 1 (5.3%) arterial TOS (ATOS), 9 (47.4%) venous TOS (VTOS), and 9 (47.4) neurogenic TOS (NTOS). All patients were right-handed, and symptomatic side was dominant hand in 7 (37%) patients. Etiologies included repetitive motion injury, athletic injury, and congenital bony abnormalities. Repetitive motion was associated with 3/9 (33%) NTOS. Significant athletic activities were noted in 12 of 19 (63%) MDs, including 8/9 (89%) VTOS and 4/9 (44%) NTOS. Athletic activities associated with VTOS included triathletes (2), rock climbing (1), long distance swimming (2), and weightlifting (3). Of the 9 NTOS cases, 3 were associated with weightlifting and 1 with skiing. Congenital causes included 1 (5%) abnormal first rib and 1 (5%) cervical rib. Time from symptom onset to consultation varied significantly according to diagnosis: ATOS 6days, VTOS 97days, and NTOS 2,335days (P<0.05). All underwent first rib resection (FRR), and 4 (4) patients required contralateral FRR. Time from surgery to last follow-up averaged 1,005days (range: 37-4,535days). On presentation, 6 patients were work disabled and 13 patients were work restricted. Following surgery, 4 MDs remained work restricted with mild to moderate symptoms. After surgery, standardized outcomes (SPS, Quick DASH, and Derkash score) improved in all metrics. All who were initially disabled returned to work without restriction. Significant non-TOS related comorbidities were present in all who had residual restriction. Return to work was documented in all. Although it has not been reported, MDs are subject to developing TOS. Causes include repetitive motions, athletic injuries, and congenital bony abnormalities. Surgical decompression is beneficial with significant reduction in pain and disability. MDs are highly motivated and insightful; accordingly, they have a very high probability of successful work resumption, with all returning to their medical positions.

Influence of diabetes on response to ultrasound guided hydrodistension treatment of adhesive capsulitis: a retrospective study

BackgroundDiabetes is associated with microvascular and macrovascular complications. Although it is less recognized, diabetes also has an important role in the development of musculoskeletal disorders. Our objective was to evaluate the effect of type 2 diabetes (T2D) on the severity of adhesive capsulitis of the shoulder (AC) and on the efficacy of ultrasound guided hydrodistension treatment.MethodsWe conducted a retrospective longitudinal observational study, of patients with AC who underwent ultrasound guided hydrodistension at our Centre. Severity was measured with DASH (Disabilities of Arm, Shoulder and Hand) score and pain was evaluated with a score between 0 and 10. The association of T2D with baseline characteristics of AC, and with outcomes at 6–12 months was analyzed using linear and logistic regression models.ResultsWe evaluated 120 ultrasound guided hydrodistension treatments of AC, 85 in patients without diabetes and 35 in patients with T2D. Patients with diabetes had a higher prevalence of dyslipidemia, hypertension and higher HbA1c values. The average duration of diabetes was 4.8 years (2.0, 7.9). The baseline characteristics of AC were not significantly different between patients with and without diabetes. Patients with T2D relapsed more frequently and required more reinterventions than patients without diabetes (20.0% vs 4.7%, p = 0.008), had higher post-intervention pain scale values [4.0 (0.0–5.0) vs 0.0 (0.0–5.0), p = 0.022] and higher post-intervention DASH score [0.8 (0.0–1.8) vs 0.0 (0.0–0.8), p = 0.038].ConclusionAlthough baseline characteristics of AC in patients with diabetes were similar to those without diabetes, patients with diabetes had a worse response to treatment, more frequent relapses and a greater need for new interventions.

Evaluation of functional outcome following ORIF of complex proximal humerus fractures with PHILOS plating

Background: Neers 3 and 4 part proximal humerus fractures are often difficult to treat due to the complex nature of the fracture patterns. The aim of this study was to evaluate the functional outcome of these fractures following ORIF (Open reduction and internal fixation) with PHILOS plate. Methods: 30 patients with fractures of the proximal humerus who presented between June 2013 to June 2016 were managed by ORIF with PHILOS plating and were followed up for a period of 3 years. Functional assessment was done using the DASH (Disabilities of arm, shoulder and hand) and Constant and Murley scores. Results: There was a male preponderance seen in our study with the right side being more commonly affected. The mean time to fracture union was 11.9 weeks. The average DASH score at 1 year was 8.9±6.4 and the Constant and Murley score was 64.5±7.2. All patients were satisfied with the functional outcome achieved. Conclusion: PHILOS plating is a good treatment option for complex proximal humerus fractures. It provides multiple divergent screw options for securing purchase in osteoporotic bone and requires less soft tissue stripping and aids in preserving the blood supply to the bone. It provides good union rates and better functional outcomes.

Functional and radiological outcomes of mid-shaft clavicle fracture managed by flexible intramedullary nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Clavicle fracture is a common injury accounting for 2.6-5% of all injuries. The commonest site of fracture is the midshaft. Historically clavicle fractures were managed conservatively with figure-of-eight bandage resulting in higher non-union and symptomatic malunion rates. With the advent of operative fixation of these fractures the ideal surgical technique remains elusive. Flexible intramedullary nailing stands out as a minimally invasive and effective method with excellent outcomes for fixation of these fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was carried out over 18 months. A total of 26 patients met the inclusion criteria and were operated with flexible intramedullary nailing. Regular follow up was done till 14 weeks. At each postoperative visit patients were evaluated for shoulder function using constant score and DASH score. Radiographs were taken at each visit to evaluate for fracture alignment and union.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this prospective study a total of 26 patients with closed midshaft clavicle fracture were managed using flexible intramedullary nail. Average time to radiological union was 7.5 weeks. Average disabilities of arm, shoulder and hand (DASH) score at 14 weeks was 13 and average constant score was 95 suggesting excellent functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Flexible intramedullary nailing is a simple, minimally invasive surgical technique with excellent functional outcomes for management of midshaft clavicle fractures.&lt;/p&gt;