Disability Arm Shoulder And Hand Research Articles

Occupational tasks associated with shoulder pain and upper extremity disability: a cross-sectional study in the Johnston County Osteoarthritis Project

BackgroundShoulder pain is a leading cause of disability. Occupations requiring high upper extremity demands may put workers at greater risk of shoulder injury and resulting pain. We examined associations of occupation with shoulder pain and upper extremity disability in the Johnston County Osteoarthritis Project.MethodsWork industry and occupational tasks for the longest job held were collected from participants. At follow-up ranging from 4–10 years later, participants were asked about shoulder symptoms (pain, aching, or stiffness occurring most days of 1 month in the last year) and given a 9-item, modified Disabilities Arm Shoulder and Hand (DASH) questionnaire to categorize disability from 0–4 (none-worst). Logistic regression and cumulative logit regression models were used to estimate associations with prevalent shoulder symptoms and with worse disability category, respectively. Models were adjusted for cohort, age, sex, race, education and time to follow-up. Sex- and race-stratified associations were evaluated.ResultsAmong 1560 included participants, mean age was 62 years (standard deviation ± 9 years); 32% were men, and 31% were Black. Compared to the managerial/professional industry, higher odds of both shoulder symptoms and worse upper extremity disability were seen for most industrial groups with physically demanding jobs, particularly the service industry. Work that often or always required lifting/moving > 10 lbs. was associated with higher odds of shoulder symptoms. Work that sometimes or always required heavy work while standing was associated with higher odds of shoulder symptoms, and this association was stronger among men and White workers.ConclusionPhysically demanding occupations were associated with increased occurrence of shoulder pain and disability. Mitigating specific physical work demands may reduce shoulder-related disability.

The Shanghai Elbow Dysfunction Score: Psychometric Properties, Reliability and Validity Study of the Turkish Version.

The Shanghai Elbow Dysfunction Score (SHEDS) is a self-reported assessment of post-traumatic elbow stiffness that measures elbow-related symptoms and elbow motion capacities. This study aimed to (1) translate and cross-culturally adapt the SHEDS into Turkish and (2) investigate the psychometric properties of the Turkish version in patients with post-traumatic elbow stiffness. The psychometric properties of the Turkish version of the SHEDS (SHEDS-T) were tested in 108 patients (72 male; mean age, 43.2 ± 11.2years) with post-traumatic elbow stiffness. Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficients were used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Disabilities Arm, Shoulder and Hand (DASH), the Mayo Elbow Performance Score (MEPS), and the Short Form-12 (PCS-12 and MCS-12). The SHEDS-T showed sufficient internal consistency (Cronbach's α coefficient = 0.83) and test-retest reliability (ICC = .96). The correlation coefficients between the SHEDS-T, the DASH, and the MEPS were .75 and .54, respectively (p < .001). There was a moderate correlation between the SHEDS-T and PCS-12 (r = .65, p = .01) and a weak positive correlation between the SHEDS and the MCS-12 (r = .40, p = .03). The SHEDS-T has sufficient reliability and validity to measure elbow-related symptoms and elbow motion capacities for Turkish-speaking individuals with post-traumatic elbow stiffness.

Comparing hand strength and quality life of locking plate versus intramedullary k wire for transverse midshaft metacarpal fractures.

Aim In the scientific literature there are no papers that clarify which method of surgical fixation in transverse metacarpal fractures has the best functional outcomes. The aim of this study was to compare the hand strength obtained using two different methods in the treatment of these fractures. Methods A total of 52 patients who presented a transverse metacarpal fracture were enrolled. They were divided in two groups: 26 patients treated with K-wire (IMN) and 26 patients treated with plate and screws (PW). The evaluation criteria were: fracture healing time, performed force testing collected ultimate tensile strength and grip, the Disability Arm Shoulder and Hand (DASH) score, and the range of motion of the hand. Results In both groups obtained results were comparable in terms of full hand function, healing and total range of motion and DASH. Results in group K were slightly better than group PW in terms of strength and grip pain within 3 months from osteosynthesis. Conclusion Neither of the two techniques, either in the literature or in biomechanical studies, shows to have superior functional outcomes for fixation of transverse metacarpal fractures. Since the K-wire is cheaper and has no intrinsic complications as compared with plating (such as scar and tendon irritation), fixation with the latter is preferable to the plate in the treatment of these fractures in non-expert hands.

O uso do programa de tratamento Stress Loading no tratamento da síndrome complexa de dor regional de tipo I

Este estudo o objetive de analisar os benefícios da intervenção terapêutica ocupacional a partir da utilização do Programa de Tratamento Stress Loading, junto a duas pessoas acometidas pela Síndrome Complexa de Dor Regional de tipo I (SCDR I). Este caracteriza-se como um estudo de caso, descritivo, comparativo pré e pós tratamento. As intervenções ocorreram nos meses de maio a junho de 2014 e os instrumentos de coleta de dados utilizados foram Disabilities Arm Shoulder and Hand (DASH) e a Escala Visual Analógica (EVA). Participaram deste estudo duas mulheres, com 52 e 59 anos de idade, no momento do estudo ambas estavam afastadas de suas atividades laborais, mantinham acompanhamento fisioterapêutico e terapêutico ocupacional e utilizavam medicamentos antidepressivos e analgésicos. Pode-se observar que ambas as participantes apresentaram melhoras no escore do DASH e a EVA após as intervenções terapêuticas ocupacionais de seis semanas com o Programa de Tratamento Stress Loading.

Plaque palmaire pour fracture distale intra-articulaire du radius : étude prospective comparant sujets jeunes versus âgés

IntroductionTreatment of the distal radius fracture in elderly remains controversial. The objective was to assess the outcomes of volar locking plate for displaced complete intra-articular distal radius fractures in elderly as compared to younger patients. HypothesisThe outcomes in elderly patients would be comparable with those in younger patients with a low rate of complications. Material and methodsNonrandomized prospective comparative study between 70 patients older than 65 years and 46 younger patients with AO type C fractures. The main outcome was Disabilities Arm, Shoulder and Hand (DASH) score. Secondary variables were Patient-Rated Wrist Evaluation (PRWE) score, range of motion, visual analogue scale (VAS) for pain, and grip strength. Radiological measurements were also performed. ResultsThe mean follow-up was 30.9 (range, 24–53) months. There were no significant differences in mean DASH, PRWE, VAS-pain, wrist motion or radiological parameters at final follow-up. Multivariate analysis showed that the functional outcomes were significantly influenced by baseline ulnar positivity greater than 3mm at baseline but not by age. DiscussionThe study hypothesis was confirmed. Surgical treatment with volar locking plate for displaced complete intra-articular fractures of the distal radius in elderly patients represents a safe and effective treatment alternative with similar early complication rate than in younger. Level of EvidenceIII, cohort study.

Arthroscopic Foveal Reattachment of the Triangular Fibro Cartilaginous Complex.

Background Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair, providing a strong bony fixation in the fovea. Materials and Methods Through 3-4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture at its free end. It is then reattached to the fovea with an impacted anchor. Retrospective Study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluation was based on a compared measurement of the grip strength, pain on a visual analogic scale (VAS), different ranges of motion, and distal radioulnar joint (DRUJ) stability. We also used functional scores: Mayo modified wrist score (MMWS), Quick disability arm, shoulder and hand (DASH), and patient-related wrist evaluation (PRWE). The average follow-up was 29.4 months (range 9-42 months). Results On postoperative evaluation, pain was reduced by 5 points (range 1-9) and grip strength averaged 94% of the unaffected side. Range of motion averaged 92% on the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1, and satisfactory for 3 patients. Quick Dash averaged 17.68 (range 0-38.6) compared with preoperative average of 59.48 (range 45-77) with an amelioration of 43 (range 34-57). PRWE averaged 20 (range 1-41.5) compared with preoperative average of 60.3 (range 33.5-76.5) with an amelioration of 41 (range 32-58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Conclusions We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea. Repairs performed with this technique are simple and the results achieved seem to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow-up are required. It however became our first choice of treatment in European Wrist Arthroscopy Society (EWAS) 2 lesions of the TFCC.

Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients

IntroductionTreatment of the distal radius fracture in elderly remains controversial. The objective was to assess the outcomes of volar locking plate for displaced complete intra-articular distal radius fractures in elderly as compared to younger patients. HypothesisThe outcomes in elderly patients would be comparable with those in younger patients with a low rate of complications. Material and methodsNon-randomised prospective comparative study between 70 patients older than 65 years and 46 younger patients with AO type-C fractures. The main outcome was Disabilities Arm, Shoulder and Hand (DASH) score. Secondary variables were Patient-Rated Wrist Evaluation (PRWE) score, range of motion, Visual Analogue Scale (VAS) for pain, and grip strength. Radiological measurements were also performed. ResultsThe mean follow-up was 30.9 (range, 24–53) months. There were no significant differences in mean DASH, PRWE, VAS-pain, wrist motion or radiological parameters at final follow-up. Multivariate analysis showed that the functional outcomes were significantly influenced by baseline ulnar positivity greater than 3mm at baseline but not by age. DiscussionThe study hypothesis was confirmed. Surgical treatment with volar locking plate for displaced complete intra-articular fractures of the distal radius in elderly patients represents a safe and effective treatment alternative with similar early complication rate than in younger. Level of evidenceIII, cohort study.

Réinsertion fovéale du complexe triangulaire fibro-cartilagineux purement arthroscopique. Description technique et résultats préliminaires

Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair providing a strong bony fixation in the fovea. Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluations were based on a compared measurement of the grip strength, pain on a visual analogic scale, of the different ranges of motion and distal radioulnar joint (DRUJ) stability. We also used functional scores : Mayo Modified Wrist Score (MMWS), Quick DASH (Disability Arm, shoulder and Hand) and PRWE. The average follow-up was 29.4 months (range 9 to 42 months). Through 3-4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture on its free end. It is then reattached to the fovea with an impacted anchor. On postoperative evaluation, pain was reduced of 5 points (range 1 to 9), grip strength averaged 94% of the unaffected side. Range of motion averaged 92% of the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1 and satisfactory for 3 patients. Quick Dash averaged 17,68 (range 0 to 38.6) compared to preoperative average of 59.48 (range 45 to 77) with an amelioration of 43 (range 34 to 57). PRWE averaged 20 (range 1 to 41.5) compared to preoperative average of 60.3 (range 33.5 to 76.5) with an amelioration of 41 (range 32 to 58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Repairs performed with this technique are simple and results achieved seems to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow-up are required. We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea, which became our first choice of treatment in EWAS 2 lesions of the TFCC.

Réinsertion fovéale du complexe triangulaire fibrocartilagineux purement arthroscopique. Desciption technique et résultats préliminaires

Introduction Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair providing a strong bony fixation in the fovea. Material and method Operative Techniques: Through 3–4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture on its free end. It is then reattached to the fovea with an impacted anchor. Retrospective study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluations were based on a compared measurement of the grip strength, pain on a visual analogic scale, of the different ranges of motion and distal radioulnar joint (DRUJ) stability. We also used functional scores: Mayo Modified Wrist Score (MMWS), Quick DASH (Disability Arm, shoulder and Hand) and PRWE. The average follow up was 29,4 months (range 9 to 42 months). Results On postoperative evaluation, pain was reduced of 5 points (range 1 to 9), grip strength averaged 94 % of the unaffected side. Range of motion averaged 92 % of the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1 and satisfactory for 3 patients. Quick Dash averaged 17.68 (range 0 to 38.6) compared to preoperative average of 59.48 (range 45 to 77) with an amelioration of 43 (range 34 to 57). PRWE averaged 20 (range 1 to 41.5) compared to preoperative average of 60.3 (range 33.5 to 76.5) with an amelioration of 41 (range 32 to 58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Conclusions We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea. Repairs performed in this fashion are simple and results achieved seems to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow up are required. It however became our first choice of treatment in EWAS 2 lesions of the TFCC.

In-office wide-awake hand surgery versus traditional surgery in the operating room: a comparison of clinical outcomes and healthcare costs at an academic institution

Background: Our study compared clinical outcomes and healthcare costs of A1 pulley release performed wide-awake in an office setting to A1 pulley release performed in an operating room with monitored anesthesia care (MAC) at a United States academic institution. Methods: A retrospective chart review was performed on consecutive patients who underwent single-digit A1 pulley release wide-awake in an office setting or in an ambulatory surgical center with MAC. Clinical outcomes were assessed using the modified Disabilities Arm Shoulder and Hand (DASH) scores and a telephone questionnaire. Hospital financial records were reviewed for all patients and the summation of professional fee, anesthesiology fee, and hospital fee was calculated to determine healthcare cost. Financial comparisons were stratified by insurance carriers. Results: There were 76 patients with complete records: 43 wide-awake, 33 traditional. Both groups had significant improvement in postoperative quick DASH scores. When asked about subsequent surgery, 100% of wide-awake patients and 68% of traditional patients reported they would prefer to be wide-awake. Eighty percent of wide-awake patients said the procedure was less painful or comparable to a procedure at the dentist. Eighty-four percent of wide-awake patients said their experience was better than they expected, compared to 23% of traditional patients. The traditional group had significantly higher total healthcare costs ($2148.62 vs. $607.65), a more than 250% increase in healthcare spending. Professional reimbursement was significantly higher in the wide-awake group ($607.65 vs. $298.83). Conclusions: A1 pulley release performed with patients wide-awake in an office setting led to higher patient satisfaction, decreased healthcare spending and higher physician reimbursement than when performed in an operating room with sedation.

Randomized, Double-Blind, Placebo-Controlled Phase II Clinical Trial on the Use of Uncaria tomentosa (Cat's Claw) for Aromatase Inhibitor-Induced Arthralgia: A Pilot Study

Introduction: Aromatase inhibitors (AI) are widely used in adjuvant breast cancer treatment, and diffuse articular pain secondary to AI use is the most common cause of treatment discontinuation. Uncaria tomentosa (cat’s claw) has antiinflammatory activity and is used to treat arthrosis and arthritis. Patients and Methods: This prospective, single-center, double-blind, randomized, placebo-controlled phase II study analyzed 70 patients with breast cancer undergoing AI therapy with complaints of arthralgia. The patients received 100 mg of the dry extract of Uncaria tomentosa three times daily for 4 weeks. At the beginning and end of the study, patients answered the Brief Pain Inventory (BPI), Disability Arm, Shoulder, and Hand (DASH), Lequesne, SF-36 Quality of Life questionnaires, completed a visual analog scale (VAS) for pain, and underwent laboratory testing. Results: U. tomentosa was not more effective than the placebo. No evidence of grade 3 or 4 toxicity was found. In addition, no significant differences were seen in laboratory results or inflammatory markers between the two study groups. Conclusion: Dry extract of U. tomentosa was safe but ineffective in reducing AI-induced arthralgia compared with the placebo. Furthermore, the plant extract had no detectable anti-inflammatory activity.

Functional recovery after bilateral extended autologous latissimus dorsi breast reconstruction: A prospective observational study

The impact of unilateral extended autologous latissimus dorsi (EALD) flap harvest and axillary surgery on shoulder function has been well described, but the impact of bilateral EALD flap harvest has not been clearly defined nor is it clear whether reconstructions should be synchronous or staged. In this prospective observational study, patients undergoing bilateral EALD breast reconstruction (February 2003-December 2009) completed the disability, arm, shoulder and hand (DASH) questionnaire preoperatively and at five post-operative timepoints. Intensive shoulder physiotherapy was offered to those whose DASH score was >30 at 6 weeks or >20 at 12 weeks post-operatively. Sixty patients underwent bilateral EALD flap breast reconstruction (51 synchronous, 9 metachronous). Patients with pre-existing shoulder pathology (n = 1) and those who failed to return any post-operative DASH questionnaire (n = 10) were excluded from initial DASH analysis. However, these eleven patients were included in a separate analysis as an intention-to-treat analysis. Statistical analysis was performed using non-parametric, Friedman test and multiple comparison model. Forty-nine patients' DASH scores were analysed. DASH score initially increased after surgery and then returned to functionally normal within 3-6 months (median DASH: preoperative = 1 vs 6 weeks post-operation = 26, p=<0.001; vs 3months = 19, p=<0.001; vs 6 months = 13, p=<0.001); thereafter, the scores remained less than 12 (p=<0.001). Median DASH score after synchronous reconstruction was not higher than that after metachronous reconstructions, although the metachronous sample size was small. With appropriate patient selection and intensive physiotherapy, bilateral EALD breast reconstruction does not appear to cause significant long-term impairment of shoulder function, and patients can now be counselled about the likely timecourse of shoulder recovery. There seems no reason to stage bilateral reconstruction to reduce shoulder morbidity.

Anatomic Pyrocarbon Hemiarthroplasty for Thumb Carpometacarpal Osteoarthritis in Patients under 65 Years: Mid Term Results.

To assess the midterm outcome of patients under 65 who underwent anatomic pyrocarbon hemiarthroplasty for thumb carpometacarpal (CMC) osteoarthritis. A prospective analysis was performed of a consecutive series of active patients, less than 65 years of age, with symptomatic osteoarthritis who had undergone a CMC hemiarthroplasty using a stemmed metacarpal based, anatomic pyrolytic carbon resurfacing with an additional one third flexor carpi radialis (FCR) tendon transfer to maintain stability. The Wrightington Hand Score, Disability Arm Shoulder and Hand (DASH) Score, and the Patient Rated Wrist Evaluation Score (PRWE) were utilised. Clinical data was obtained for grip strength, pinch strength, and range of motion. The MEAN age was 57.6 years. MEAN follow up was 6.5 years. All patients had improvement in pain, grip strength and function. There was no significant difference in grip and pinch strengths between the individual's left and right hand. All patients stated that they would undergo the procedure again. There was one revision following a traumatic trapezium fracture. One patient underwent a neurolysis of a superficial radial nerve neuroma associated with an impinging trapezial osteophyte. Active patients, under 65 years of age with Eaton-Littler stage III osteoarthritis of the thumb CMC joint who are treated with anatomic pyrolytic carbon resurfacing hemiarthroplasty and stabilisation may achieve sustained improvement in pain and hand function for up to 6.5 years.

Effects on Upper-Limb Function with Dynamic and Static Orthosis Use for Radial Nerve Injury: A Randomized Trial

The management of radial nerve palsy associated with humerus’s shaft fractures has been discussed for several decades, instead, is the most common nerve complication after humeral shaft fracture. Indeed, radial nerve palsy recovery rate ranges from 70 to 90%, many reports related to the use of dynamic orthosis options are described in the literature. The purpose of this study is to determinate which orthosis or splint is the best option to improve patient’s upper limb function, measured with DASH (Disability arm shoulder and hand) questionnaire when surgical intervention is not indicated. Final sample size consisted of 18 participants (14 men and 4 women) with an average age of 46 who suffered from a radial nerve lesion in the dominant arm after humerus’s shaft fractures were included in the study. Participants were randomized into 2 equal groups (9 patients for the static orthosis or splint group and 9 for the dynamic orthosis/splint group). The variance analysis showed a main effect in time lapse (F (1, 58) = 71, P<0.001) indicating a significant improvement in function. Results were significantly better for the static orthosis/splint group than for the dynamic splint group. Treatment with static orthosis produces further improvement in function compared to the treatment with dynamic orthosis.

Health professionals identify components of the International Classification of Functioning, Disability and Health (ICF) in questionnaires for the upper limb.

BACKGROUND: Several Brazilian studies have addressed the International Classification of Functioning, Disability and Health (ICF), but few have analyzed the knowledge of the health professionals with regards to the ICF.OBJECTIVE: To verify whether the classification of the items in the Brazilian-Portuguese versions of The Shoulder Pain and Disability Index (SPADI) and The Disabilities Arm, Shoulder and Hand (DASH) questionnaires, obtained from health professionals who worked with patients having upper limb injuries, could be related to ICF components as defined by others studies.METHOD: There were 4 participants for the group "professionals with high familiarity of the ICF (PHF)" and 19 for the group of "professionals with some or no familiarity of the ICF (PSNF)". The participants judged whether the items on the two questionnaires belonged to the ICF body function, body structure or activity-participation component, and marked a confidence level for each trial using a numerical scale ranging from zero to 10. The items were classified by the discriminant content validity method using the Student'st-test and the Hochberg correction. The ratings were compared to the literature by the percentage of agreement and Kappa coefficient.RESULTS: The percentage of agreement of the rating from the PSNF and the PHF groups with the literature was equal to or greater than 77%. For the DASH, the agreement of the PSNF and PHF groups with the literature were, respectively, moderate (Kappa=0.46 to 0.48) and substantial (Kappa=0.62 to 0.70).CONCLUSIONS: Health professionals were able to correlate the three components of the ICF for most items on the 2 questionnaires, demonstrating some ease of understanding the ICF components. However, the relation of concept of pain with body function component is not clear for professional and deserves a more attentive approach.

Short-Term Outcome After Arthroscopic Bursectomy Debridement of Rotator Cuff Calcific Tendonopathy With and Without Subacromial Decompression: A Prospective Randomized Controlled Trial

To conduct a prospective randomized controlled trial to assess whether arthroscopic bursectomy and debridement of the calcific deposit, with or without subacromial decompression, influences the functional outcome of patients with calcific tendonitis. During a 4-year period, 80 patients were recruited who presented to the study center with refractory calcific tendonitis of the shoulder. Forty patients were randomized to have a subacromial decompression, and 40 were randomized not to have a subacromial decompression in combination with bursectomy and arthroscopic removal of the calcific deposit. All surgery was performed by one surgeon who was blinded to the functional assessment of the patients. Patient demographics, body mass index (BMI), and length of symptoms were recorded at the time of randomization. Patients were asked to complete a pain visual analog score (VAS), short form (SF-12), disability arm shoulder and hand (DASH), and Constant score (CS) preoperatively and at 1 year postoperatively. There were 21 male and 59 female patients with a mean age of 49 (range, 32 to 75) years. The mean time of follow-up was 13 (range, 12 to 15) months. There were no significant differences in gender, age, BMI, length of symptoms, or preoperative outcome measures assessed between the groups. Overall, for both groups there was a significant improvement in the pain VAS (P < .001), DASH (P < .001), and CS (P < .001) at 1 year compared with preoperative scores. There were no significant differences demonstrated between the groups for improvement in the pain VAS (P = .57), DASH (P = .93), SF-12 physical component score (P = .58), or CS (P = .27) at 1 year. This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. Level I therapeutic study, randomized controlled trial.

Cross-cultural adaptation, reliability, internal consistency and validation of the Hand Function Sort (HFS©) for French speaking patients with upper limb complaints.

Functional evaluation of upper limb is not only based on clinical findings but requires self-administered questionnaires to address patients' perspective. The Hand Function Sort (HFS©) was only validated in English. The aim of this study was the French cross cultural adaptation and validation of the HFS© (HFS-F). 150 patients with various upper limbs impairments were recruited in a rehabilitation center. Translation and cross-cultural adaptation were made according to international guidelines. Construct validity was estimated through correlations with Disabilities Arm Shoulder and Hand (DASH) questionnaire, SF-36 mental component summary (MCS),SF-36 physical component summary (PCS) and pain intensity. Internal consistency was assessed by Cronbach's α and test-retest reliability by intraclass correlation. Cronbach's α was 0.98, test-retest reliability was excellent at 0.921 (95 % CI 0.871-0.971) same as original HFS©. Correlations with DASH were-0.779 (95 % CI -0.847 to -0.685); with SF 36 PCS 0.452 (95 % CI 0.276-0.599); with pain -0.247 (95 % CI -0.429 to -0.041); with SF 36 MCS 0.242 (95 % CI 0.042-0.422). There were no floor or ceiling effects. The HFS-F has the same good psychometric properties as the original HFS© (internal consistency, test retest reliability, convergent validity with DASH, divergent validity with SF-36 MCS, and no floor or ceiling effects). The convergent validity with SF-36 PCS was poor; we found no correlation with pain. The HFS-F could be used with confidence in a population of working patients. Other studies are necessary to study its psychometric properties in other populations.

Dorsally comminuted fractures of the distal end of the radius: osteosynthesis with volar fixed angle locking plates.

Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.

Construct validity of the French version of the PRWE (Patient Rated Wrist Evaluation) with the French version of the DASH (Disabilities Arm Shoulder and Hand) is good to very good in a population of patients with wrist injuries in an inpatient rehabilitation unit

Objective.- The Patient-Rated Wrist Evaluation is a specific questionnaire for the wrist [1]. It consists of 15 questions with a total score of 100. It was recently translated into French [2]. However, its validity has not been tested in this language. The Disabilities Arm Shoulder and Hand (DASH), with well-established psychometric properties, is considered as the reference questionnaire for the evaluation of upper extremities. The objective of this study is to measure the construct validity of the PRWE-F with the DASH-F in patients with wrist pathology.Patients and methods.- Fifty-one patients (40 m, 11 w, mean age 42 years), 25 fractures of the radius and 26 lesions of the carpus.Questionnaires PRWE-F and DASH-F at entry and at discharge (0 to 100). Calculation of the construct validity of the PRWE-F comparing with the DASH-F with Pearson correlation coefficients (r) at entry and at discharge. Level of significance (alpha) was set at 5%.Results.- Correlation DASH/PRWE at entry: r = 0.799 (95% CI 0.671 to 0.881), P < 0.0001. Correlation DASH/PRWE at discharge: r = 0.847 (95% CI: 0.745 to 0.910), P < 0.0001.Discussion.- The construct validity of the two instruments indicates that they measure the same concept. Our correlation between DASH-F and PRWE-F, going from 0.799 to 0.847, are comparable to those published in different languages (0.71 to 0.84) [3,4]. The questionnaires PRWE-F can thus be used in rehabilitation patients presenting with wrist pathologies; it is comparable to the DASH but described by MacDermid [1] to be more specific. Compared to the DASH it has the advantage of consisting of two dimensions. Its construct validity is excellent. This questionnaire should be evaluated in other populations, and it should be compared with hand questionnaires more specific than the DASH.

A modified QuickDASH-9 provides a valid outcome instrument for upper limb function.

BackgroundThe 30-item Disabilities Arm Shoulder and Hand (DASH) questionnaire was introduced to facilitate assessment of upper limb functional limitations. To improve practicality and eliminate item redundancy a modified instrument was needed. The 11-item QuickDASH was developed to fulfil these requirements and translated into several languages. However, prospective investigations of psychometric and practical characteristics are limited. No published study investigated readability or used concurrent validation with a standardized upper limb criterion measure. The validity of the QuickDASH has been questioned as the results for factor structure are conflicting, and the English-language version has not yet had factor structure reported. A shortened 9-item version, the QuickDASH-9, that addresses these issues is proposed.MethodsThis two-stage observational study assessed the psychometric and practical characteristics of the QuickDASH and the extracted QuickDASH-9. The Upper Limb Functional Index (ULFI) was the criterion standard in both stages. Stage 1, calibration, reanalyzed extracted QuickDASH and QuickDASH-9 responses from a previous prospective study, by the authors, of the 30-item DASH (n = 137). Stage 2, prospective validation, investigated the QuickDASH through repeated measures in consecutive upper limb musculoskeletal participants' consulting for physical therapy in Australia (n = 67). The QuickDASH and extracted QuickDASH-9 data from both stages was analyzed and compared for psychometric properties, practical characteristics and factor structure.ResultsThe proposed QuickDASH-9 had a unidimensional structure, high reliability (ICC 2:1, r = 0.92), internal consistency (alpha = 0.93) and responsiveness (ES = 1.05). It correlated highly with both the DASH (r = 0.97), QuickDASH (r = 0.99) and ULFI criterion (r = 0.85). QuickDASH-9 missing responses reduced to 3.5% from 26% in the QuickDASH. Completion and scoring time was 134 ± 56 seconds and required a computational aid. The QuickDASH demonstrated a bidimensional structure making it invalid. The QuickDASH-9 summary performance was measured on the 'Measurement of Outcome Measures' at 88% and on the 'Bot' clinimetric scale at 75%.ConclusionsThe proposed QuickDASH-9 had a unidimensional structure and similar psychometric precision to the full-length DASH with improved practicality and completion time. The QuickDASH was invalid as its bidimensional structure made a single summated score inappropriate. The QuickDASH-9 offers a future direction for ongoing use of the QuickDASH concept.