Disabilities Of Arm Research Articles

Evaluation of the Treatment Process with Home Exercise Program and Telerehabilitation in Patients with Breast Cancer-Related Lymphedema: A Case-Control Study.

Background: This study aimed to evaluate and compare the effectiveness of telerehabilitation (TR) and home exercise program (HEP) in patients with breast cancer-related lymphedema and the patients' compliance with these treatment processes. Methods and Results: 23 patients were prospectively included in the HEP group and 22 patients in the TR group, who were followed up in the Lymphedema Outpatient Clinic of the Department of Physical Medicine and Rehabilitation of a University Hospital. These patients were randomized. The volume difference between the extremities of the patients was calculated with the truncated cone formula, before and after treatment. The patients' pain, tightness, heaviness, and stiffness symptoms associated with lymphedema were questioned using a numerical scale. The patients' functionality and participation in daily life activities were evaluated with disabilities of arm, shoulder, and hand Quick Questionnaire (Quick-DASH) and the Lymphedema Life Impact Scale (LLIS). Patients' treatment satisfaction and compliance with treatment were questioned using Likert scales. A total of 45 patients were included in the study. The mean age and body mass index were similar between the groups (p ≥ 0.05). In the evaluations performed, no significant differences were observed within groups or between groups in terms of volume difference, quick DASH, pain, tightness, heaviness, stiffness, and LLIS scores (p ≥ 0.05). Patient satisfaction was significantly higher in the TR group (p ≤ 0.001). During treatment follow-up, only one person from the TR group missed the 5th-week checkup (4.5%), whereas five patients from the HEP missed the 5th-week checkup and three missed the 8th-week checkup. Overall, eight patients discontinued treatment (34%). Conclusion: Although there were no significant differences in clinical assessments between TR and HEP groups, patient satisfaction, and treatment adherence were significantly higher in the TR group.

Ulnoradial - metacarpal reconstruction for emergency one-stage procedure in complicated wrist amputation.

Complicated wrist amputation caused by severe trauma poses a real challenge for orthopedic and hand surgeons. This study aimed to evaluate a procedure of ulnoradial-metacarpal reconstruction as a rescue option in this challenging situation. In total, 12 patients with complicated wrist amputation induced by serious injury were selected from 2015 to 2020 and followed up for 1∼6 years at a level 1 trauma center. All patients underwent initial treatment in the Emergency Department followed by transfer to the main operating theater for emergency ulnoradial-metacarpal reconstruction. Patient demographics, surgical techniques, clinical outcomes, and complications were also retrieved from medical records. Functional outcomes were assessed with Disabilities of Arm, Shoulder and Hand score (DASH) and Mayo Wrist Score (MWS). Descriptive statistics were used to calculate, including frequencies for categorial variables and mean values and ranges for continuous variables. The mean age of patients was 49.3 years (ranging from 41 to 61 years), with ten males and two females. The mean time to union was 4.8 months; 11 patients had a complete union. There was one case of nonunion due to bone resorption resulting from inadequate blood supply and smoking. Compared with the contralateral limb, the total active motion of the hand was 25% (ranging from 17 to 38%), and grip strength was 7% (ranging from 0 to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6mm (ranging from 8 to 12mm). All mean outcome scores indicated moderate disability, including disabilities of Arm, Shoulder, and Hand (12; ranging from 4 to 27). Based on Mayo Wrist Score, all patients were loss of wrist function forever. The majority of patients were satisfied with the hand function after recovery. Despite all patients experiencing significant impairments in their overall hand function, ulnoradial-metacarpal fusion presents a viable option for hand replantation in instances where the carpus has been irreparably damaged. Therapeutic IV.

Results of open reduction and internal fixation of proximal humerus fractures using a proximal humeral plating system with smooth pegs.

The aim of this study was to evaluate clinical results and complication rate in patients with proximal humeral fracture treated with Anatomical Locking Plate System (A.L.P.S.) Proximal Humeral Plating System with smooth pegs. Retrospective evaluation of 116 consecutive patients treated with A.L.P.S. Proximal Humeral Plating System. Shoulder function was evaluated by Constant score and disabilities of arm, shoulder and hand (DASH). Furthermore, European Quality of life 5 Dimensions (EQ-5D) and single shoulder value (SSV) were assessed. Fractures were classified according to Neer. Fifty-two patients were included with a mean follow-up of 49 months. Mean Constant score was 62.8. Mean DASH was 17, and the mean EQ-5D was 0.91. According to Neer classification 63% (n = 33) of the fractures were two-part, 31% (n = 16) three-part, and 6% (n = 3) four-part fractures. Peg penetration was registered in 13 cases (25%, n = 52). In total a reoperation rate of 23% (n = 12) and an overall complication rate of 37% (n = 19) were recorded. Open reduction and plate fixation with the A.L.P.S. Proximal Humeral Plating System with smooth pegs provides a stable fixation with good clinical outcome and complication and reoperation rates in line with previous studies with plates using screws in the humeral head.

Comparative Efficacy of Platelet-Rich Plasma, Corticosteroid, Hyaluronic Acid, and Placebo (Saline) Injections in Patients with Lateral Elbow Tendinopathy: A Randomized Controlled Trial.

Background: Lateral elbow tendinopathy is a common condition that significantly alters the function of the upper extremities. In case of first-line treatment failure, different local injections are usually used. Due to the lack of sufficient evidence to support it, we conducted the study to compare the outcomes of different single injections, including Platelet-Rich Plasma (PRP), Corticosteroids (CS), Hyaluronic Acid (HA), and placebo (saline). Methods: Sixty patients with confirmed lateral elbow tendinopathy were enrolled in the study and divided into four groups. Pain intensity (average for the current day, at rest, during provocative tests) measured by Visual Analogue Scale (VAS), pressure pain threshold (PPT), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disability of Arm, Shoulder and Hand (DASH), Subjected Elbow Value (SEV), and strength of selected muscle groups were measured before and during follow-up visits (1, 4, 12, 24, and 52 weeks after treatment). The treatment was considered successful when minimal clinically important difference (MCID) was achieved in primary outcomes (VAS, PRTEE). Results: A significant improvement was achieved in most measurements in all groups. At the final follow-up, MCID for the mean pain reduction measured with VAS and improvement in the PRTEE score were achieved in 52 and 54 patients, respectively. The complete absence of pain was achieved after 1, 4, 12, 24, and 52 weeks in 2, 5, 10, 22, and 40 patients, respectively. The comparison between the groups found a significant difference in pain intensity between CS and other groups one week after injection, between the CS and PRP group in the fourth week, and between PRP and HA in the fourth week (p < 0.05). No other significant differences were found between each group at each follow-up time point. Conclusions: We conclude that each injection treatment provides good long-term clinical outcomes, but not better than placebo. A CS injection might be regarded as a more effective treatment only within the first month post-injection.

Correlation of scapular Dyskinesia and hand grip strength in students with smartphone addiction pursuing a bachelor's degree in healthcare profession education.

Hand grip strength is a critical indicator of upper extremity function, especially important in healthcare professions. Effective upper extremity function relies on proximal stability from the scapula and distal mobility from hand actions. This study aimed to examine the relationship between scapular dyskinesia and hand grip strength in healthcare students with smartphone addiction. A descriptive cross-sectional study was conducted with 63 students with smartphone addiction. Scapular dyskinesia was measured using Lateral Scapular Slide Test (LSST) at neutral, 45 and 90 degrees. Hand grip strength was measured using the Jamar Hydraulic hand dynamometer. The Short version of Smartphone Addiction Scale (SAS-SV) questionnaire assessed the severity of smartphone addiction, while the Disability of Arm, Shoulder and Hand (DASH) questionnaire evaluated the impact on upper extremity function. A negative correlation was found between LSST at 45degrees and hand grip strength. However, no significant correlation was observed between SAS-SV, DASH, and scapular dyskinesia. Findings of the present study report a negative association between scapular dyskinesia at 45 degrees of LSST and hand grip strength. This suggests greater the scapular dyskinesis, lower will be the hand grip strength.

Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of de Quervain Tenosynovitis: A Randomised Control Open Label Equivalence Trial.

Background: De Quervain (DQ) tenosynovitis is a frequent source of wrist pain amongst middle-aged adults. Steroid injections are recommended after conservative methods fail, despite unclear mechanisms. The effectiveness of platelet-rich plasma (PRP) for DQ is not well-studied. To address this gap, we conducted a randomised controlled trial comparing the efficacy of PRP and corticosteroid (CS) injections for treating DQ. Methods: This prospective, randomised and open-label trial was conducted at a tertiary care hospital in India. Adult patients aged 18-60 were randomly assigned to receive either ultrasound-guided triamcinolone acetonide injections or autologous PRP in the first extensor compartment. Outcomes were measured at baseline and at 1, 4 and 12 weeks using the VAS and quick disabilities of arm, shoulder and hand (QuickDASH) questionnaires. Results: Eighty-six age- and sex-matched patients, with an average disease duration of 14 weeks in both groups, were enrolled. Both the CS and PRP groups demonstrated a significant reduction in pain scores and improvement in functions at 1, 4 and 12 weeks. However, between the groups, the degree of improvement in pain was more in CS group at 1 week and similar improvements between the groups at 4 and 12 weeks. Regarding hand function, the CS group exhibited notable at 1 and 4 weeks based on the QuickDASH scale. Yet, by the 12th week, hand function improvements were comparable between both groups. Conclusions: This study suggests that PRP is equivalent to CS in reducing pain in DQ tenosynovitis. Hand function improved more significantly in the CS group at 1 and 4 weeks post-injection. Both PRP and CS are safe and equally effective treatments for DQ. Level of Evidence: Level I (Therapeutic).

Comparison of Recruitment Method on Clinical Outcomes Following Cervical Disc Arthroplasty.

Retrospective cohort. To compare the clinical outcomes of trial versus standard clinical practice (SCP) patients following cervical disc arthroplasty (CDA). CDA is hypothesized to reduce the shear strain and related complications resulting from fusion procedures. CDA has gained significant traction in recent decades. The typical non-trial patient undergoing CDA does not undergo the same level of preoperative scrutiny as those treated in formal clinical trials. Concerns exist about diverging clinical outcomes between these groups. This investigation retrospectively reviews prospectively collected data on one and two-level CDA patients from C3-T1. Patients were recruited into randomized, controlled trials or SCP practice beginning in 2002 or 2018, respectively. One-year minimum follow-up was required. Hybrid constructs and prior cervical spine surgical history have been excluded. Clinical assessments included reoperation history and the patient-reported outcome measures of Visual Analog Scale (VAS) neck, VAS arm, and Neck Disability Index (NDI). Data was collected at the preoperative, postoperative, one-year, two-year, three-year, five-year, and ten-year time points. One hundred and sixty-eight patients underwent CDA at 193 cervical levels, including 104 trial patients and 64 SCP patients. Mean follow-up for the entire cohort was 6.1 years (0.9 - 20.4 years). Eight unique disc designs were utilized. Trial patients had a greater proportion of females and longer follow-up duration (P<0.05). Trial patients had significantly worse preoperative clinical scores with greater improvements at each follow-up time point. SCP patients had significantly higher index-level reoperation rates at five years. Trial patients have lower rates of reoperation and improved clinical performance which could be in part due to more stringent selection criteria. This study is limited by long-term SCP response rates. Additional studies with larger cohorts are needed to improve our understanding of disc implant performance.

Does a Prolonged Sham Theta Burst Stimulation Intervention Regimen Outperform Standard Care in Terms of Functional Recovery and Pain Relief After an Upper Limb Fracture?

In a recent sham-controlled 13-session prolonged continuous theta burst stimulation intervention protocol, recovery from upper limb fracture at both 1 and 3 months was better than anticipated in patients assigned to the sham intervention group. To determine whether potential placebo effect and close patient monitoring affected recovery, the current study aimed to compare clinical outcomes between sham-treated participants who also received standard care with similarly injured patients who only received standard care. Twenty participants with isolated upper limb fractures from the sham group were seen 13 times post-fracture (1 baseline session, 10 treatments, and 2 follow-ups [1 and 3 months]) over 3 months. They completed the self-reported Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the Numerical Rating Scale for pain assessment at 1 and 3 months post-fracture. Two control groups were recruited: 43 participants at 1 month post-fracture and another 40 participants at 3 months post-fracture. These control groups completed the same questionnaires online, without any lab visits. At 1 month, patients from the sham group reported significantly less functional impairments on the DASH (p = .010). At 3 months, significantly more patients from the control group reported functional limitations (72.5% versus sham's 40%, p = .015). Although preliminary, these findings suggest clinically significant beneficial effects of the sham intervention over the standard care groups. This positive sham intervention effect may be attributed to a placebo response that includes the placebo effect associated with sham rTMS, but also the impact of various factors such as the close monitoring of the injury.

Internal brace augmentation in elbow varus posteromedial rotatory instability (VPMRI) allows early rehabilitation and prevents stiffness.

Varus posteromedial rotatory instability (VPMRI) involves anteromedial coronoid fracture (AMCF), lateral ulnar collateral ligament (LUCL), and medial collateral ligament (MCL) injury. There is no general consensus regarding the surgical treatment, but most surgeons recommend internal fixation of the coronoid along with primary ligament repair. This methodology involves postoperative immobilization to allow ligament healing, occasionally associated with stiffness. Augmentation of one/or both collateral ligaments using a non-absorbable suture tape as an internal brace in VPMRI cases was the subject of the presented study. This method allows brace-free initiation of full elbow range of motion while protecting bony and soft tissue healing. 17 patients (13 males and four females) with VPMRI were treated in the center from 2017 to 2021 with internal brace augmentation of collateral ligament along with ORIF (Open reduction & internal fixation)/ reconstruction of the coronoid fragment. All patients were actively mobilized early after surgery. Patients who completed a minimum follow up of 24 months were included in the study. Clinical examination findings at follow-up assessment included ROM (range of motion) recording and instability testing, including special instability tests such as moving valgus stress test, lateral pivot shift test, Posterolateral rotatory drawer test, and gravity-assisted varus stress test. Disabilities of arm, shoulder and hand (DASH) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Visual Analogue Score (VAS), and SEV (Simple Elbow values) were assessed and noted at follow-up. At 43 months of mean follow-up, none of the patients had significant postoperative contracture, and none had any clinically apparent signs of instability or suffered subluxation or re-dislocation. Postoperative radiographs showed complete fracture/graft healing with no signs of subluxation in all patients. The mean range of motion of the patients was 6.20 (1.00-11.30) to 139.10 (136.20-142.00), with a mean Oxford elbow score (OES) of 42.0 (39.9-44.7). The mean DASH (Disability of Arm, Shoulder & Hand) score was 11.4 (6.7-16.1), the mean MEPS (Mayo Elbow Performance Score) was 91.2 (86.3-96.0), the mean Visual Analogue Score (VAS) score was 0.6 (0.1-1.2), and the mean Simple Elbow value (SEV) was 85.4% (81.1-89.8%). Internal brace augmentation with a non-absorbable suture tape in the setting of VPMRI is a safe and helpful adjunct to coronoid repair/reconstruction and primary ligament repair and allows early mobilization and recovery of elbow stability and range of motion.

Clinical results of autologous fat transfer for basal thumb arthritis with a minimum of three years' follow-up.

In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness. Patients diagnosed with stage one to three OA received a single intra-articular autologous fat transplantation. Fat tissue was harvested from the abdomen and injected into the trapeziometacarpal (TMC) joint under radiological guidance, followed by one week of immobilization. Patients with a minimum three-year post-procedure period were assessed for pain level (numerical rating scale), quality of life (Mental Health Quotient (MHQ)), the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH)), and grip and pinch strength, as well as their overall impression of the treatment. Wilcoxon tests compared data from pre-intervention, and at one and three years post-intervention. Out of 136 treated joints, the study involved 87 patients (37 patients were loss to follow-up, and 12 patients (9%) who underwent resection arthroplasty) with a median follow-up of 4.9 years (IQR 5.4 to 5.9). Pain, both at rest and during stress, significantly improved at one year and remained stable through three years. Sex, age, and stage of disease were not associated with postoperative pain levels. Patient-reported outcome measures for QuickDASH and MHQ improved up to at least three years post-treatment. Patients reported high satisfaction and willingness to recommend the procedure. Grip and pinch strength did not significantly change over time. The data show that autologous fat transfer has a longer-lasting effect in two-thirds of re-examined patients. If patients had an initial positive response, the pain-reducing effect lasted for at least three years. Therefore, this minimally invasive approach can offer a valuable treatment alternative for basal thumb OA.

Italian translation, cultural adaptation, and validation of the Action Research Arm Test (ARAT) and the Stroke Upper Limb Capacity Scale (SULCS) for individuals post-stroke.

This study aims to culturally adapt and validate the Stroke Upper Limb Capacity Scale (SULCS) and Action Research Arm Test (ARAT) for use with post-stroke patients in Italy. The original scales were translated and culturally adapted following the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines. We assessed internal consistency and test-retest reliability, while concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Disability Arm Shoulder and Hand (DASH). A total of 56 participants were recruited for the study. The Italian versions of the scales demonstrated excellent stability and reliability both within and between raters. The Cronbach's alpha coefficients were 0.904 for SULCS and 0.998 for ARAT, indicating strong internal consistency among items. The interclass correlation coefficients were 0.998 (95% C.I.: 0.993-0.990) for inter-rater reliability and 0.987 (95% C.I.: 0.984-0.995) for intra-rater reliability for SULCS, and 0.998 (95% C.I.: 0.999-0.996) for inter-rater reliability and 0.992 (95% C.I.: 0.998-0.987) for intra-rater reliability for ARAT. Both scales exhibit robust validity and reliability, making them valuable tools for clinical assessment and functional evaluation of upper limb capacity in post-stroke patients. We recommend the integration of the ARAT and SULCS into initial patient assessments and ongoing monitoring to enhance rehabilitation outcomes.

Additive effect of glenohumeral joint hydrodilatation applied in addition to suprascapular nerve blockage in patients with adhesive capsulitis

BackgroundWe aimed to investigate the efficacy of shoulder hydrodilatation (HD) applied in addition to suprascapular nerve blockage (SSNB) on severity of pain, shoulder joint range of motion (ROM), functional status, handgrip (HG) strength in patients with adhesive capsulitis (AC).MethodsForty-eight patients who were diagnosed with AC based on physical examination findings included in the study. The patients were randomized into two groups as combination of SSNB + HD and SSNB alone. Injections were performed under ultrasonography guidance.Shoulder ROM angles were measured with a goniometer. Pain intensity was evaluated with visual analog scale. Functional status was evaluated with Quick Disability of Arm, Shoulder, and Hand (QDASH). HG strength was measured by a Jamar dynometer. After the injection, a home-based exercise program was given to all patients. Patients were evaluated at baseline, 1st and 3rd month.ResultsAbduction and external rotation ROM angles were statistically significantly limited in SSNB group, at baseline (p = 0.020, p = 0.018, respectively). In terms of other parameters, both groups were similar at baseline (p > 0.05). At comparison of baseline-1st month, a significant improvement was observed in VAS score, abduction and flexion ROM and QDASH score, in both groups (p < 0.05), however, there was no statistically significant difference between the groups. There is a statistically significant decrease in VAS score in both groups, at all times, but, no significant difference between the groups. At the comparison of baseline-3rd month measurements, it was observed that all of the parameters significantly improved in both groups, and there was no statistically significant difference between the groups except for abduction and external rotation ROM (p > 0.05). Abduction ROM and external rotation ROM were significantly higher in the SSNB group than SSNB + HD group at 3rd month.ConclusionsBoth SSNB + HD and SSNB alone provide significant improvement clinically especially in shoulder pain. HD added to SSNB does not seem to provide any additional benefit. SSNB is an effective treatment option for up to 3 months in patients with AC, mainly in abduction and external rotation limitation.

Outcomes of coronoid-first repair through an anterior approach in patients with terrible triad injury of the elbow: a prospective study with a minimum 2-year follow-up

BackgroundIn the treatment of terrible triad injury of the elbow (TTIE), the indication and the appropriate approach and sequence for coronoid process (CP) fixation remain debatable. No gold standard protocol has been established for CP fixation. In this study, we evaluated the midterm outcomes of coronoid-first repair through an anterior approach in patients with unstable TTIE.Materials and methodsThis prospective observational study included patients with TTIE who exhibited posterior or posterolateral subluxation/dislocation during examination under anesthesia (EUA) at our institute between January 2019 and December 2021. All patients underwent coronoid-first repair through an anterior approach, regardless of fragment size. After CP fixation, radial head fixation/replacement and lateral ulnar collateral ligament repair were performed through the lateral Kocher approach. Radiographic and functional (Mayo Elbow Performance Score [MEPS] and Disabilities of Arm, Shoulder, and Hand score [DASH]) assessments were performed 3, 6, 12, and 24 months after surgery. Complications such as recurrent subluxation/dislocation, synostosis, heterotopic ossification, traumatic arthritis, and stiffness were examined at the follow-up visits.ResultsThe analysis included 27 patients. The mean follow-up duration was 29.9 (range 24–44) months. At the 3-, 6-, 12-, and 24-month follow-up, the mean flexion–extension arcs were 88.7° ± 14.7°, 107.9° ± 11.9°, 128.3° ± 15.5°, and 130.9° ± 15.3°; the mean supination–pronation arcs were 143.7° ± 9.9°, 160.4° ± 7.6°, 165.0° ± 6.0°, and 167.9° ± 4.9°; the mean DASH scores were 18.7 ± 5.7, 4.5 ± 6.1, 2.7 ± 6.5, and 2.0 ± 6.8; and the mean MEPS were 79.1 ± 10.3, 90.2 ± 8.3, 94.8 ± 6.6, and 95.9 ± 5.7, respectively. At the 24-month follow-up, 26 patients had excellent and 1 patient had good results according to MEPS. Only one patient had a complication: they exhibited stiffness and did not have a 30–130° flexion–extension arc at 24 months postoperatively.ConclusionsThe EUA findings, rather than fragment size alone, may be a good indicator of whether the CP needs to be repaired. Midterm follow-up results implied that coronoid-first repair through an anterior approach yields satisfactory functional outcomes with minimal complications.Level of evidence: Therapeutic level II.

Surgical Treatment and Outcomes of Trans-Ulnar Basal Coronoid Fracture-Dislocations

Trans-ulnar fracture-dislocations of the elbow are complex injuries that can be difficult to classify and treat. Trans-ulnar basal coronoid injuries, in which the coronoid is not attached to either the olecranon or the metaphysis, present substantial challenges to achieve anatomic reduction and stable internal fixation. The purpose of this study was to analyze the outcome of surgical treatment of trans-ulnar basal coronoid fracture-dislocations. Between 2002 and 2019, 32 consecutive trans-ulnar basal coronoid fracture-dislocations underwent open reduction and internal fixation (ORIF) at our institution. Four elbows were lost to follow-up within the first 6 months after surgery and were excluded. Among the 28 elbows remaining, there were 13 females and 15 males with a mean age of 56 (range 28-78) years at the time of injury. The mean clinical and radiographic follow-up times were 37 months and 29 months, respectively. Radiographs were reviewed to determine rates of union, Hastings and Graham heterotopic ossification (HO) grade, and Broberg and Morrey arthritis grade. Union occurred in 25 elbows. Union could not be determined for 1 elbow at most recent follow-up and the remaining 2 elbows developed nonunion of the coronoid. Complications occurred in 10 elbows (36%): deep infection (4), ulnar neuropathy (2), elbow contracture (2), and nonunion (2). There were reoperations in 11 elbows (39%): irrigation and débridement with hardware removal (4), hardware removal (2), ulnar nerve transposition (2), contracture release with HO removal (2), and revision ORIF with iliac crest autograft (1). At most recent follow-up, the mean flexion-extension arc was 106° (range 10-150°), and the mean pronation-supination arc was 137° (range 0-170°). The mean Quick Disabilities of Arm, Shoulder, and Hand score was 11 (range 0-39) points with a mean Single Assessment Numeric Evaluation-Elbow score of 81 (range 55-100) points. At final radiographic follow-up, 16 elbows (57%) had HO (8 class I and 8 class II), and 20 elbows (71%) had arthritis (8 grade 1, 6 grade 2, and 6 grade 3). Trans-ulnar basal coronoid fracture dislocations are severe injuries associated with high rates of reoperation, heterotopic ossification, and post-traumatic arthritis. However, the majority of elbows achieve union, a functional range of motion, and reasonable patient reported outcome measures. Over the study period, surgeons were more likely to utilize multiple deep approaches and separate fixation of the coronoid (either with lag screws or anteromedial plates) to ensure anatomic reduction.

Effect of scapular and shoulder strengthening exercises on prevention of upper limb lymphedema – a pilot study

Background. The most frequent type of cancer among women is breast cancer. According to the report published by Indian Council for Medical Research (ICMR, 2019), there are 1.5 lakh new instances of breast cancer nationwide and around 70,000 people in India die from breast cancer each year. Secondary lymphedema (SL) following breast cancer surgery can occur due to the removal of lymph nodes during breast cancer surgery. Objective. This pilot study was done with the objectives to improve the strength of scapular and shoulder muscles, increase the shoulder range of motion, prevent the development of upper limb lymphedema, to reduce shoulder pain and disability and to improve the quality of life among women who underwent breast cancer surgery. Methodology. Ten patients with a mean age of 49.9 ± 8.6 and mean Body mass index (BMI) of 28.4 ± 3.9 were included according to the inclusion and exclusion criteria. They were randomized into interventional group (Group A n = 5) and conventional group (Group B n = 5). The interventional group performed the routine exercises prescribed along with the scapular and shoulder muscle strengthening exercises, while the conventional group performed only the routine exercises for 12 weeks. Result. The mean change score values of the outcome variables of both the groups were analyzed using Independent ‘t’ test. Discussion. Arm circumference measurement, shoulder pain, disability and quality of life measures showed significant difference between groups at p &lt; 0.05. Shoulder range of motion, muscle strength and arm volumetry did not show much difference between groups indicating the need for long term continuation of the exercises to produce improvement in those parameters. Conclusion. Long term effect of strengthening exercises will have an effect on improvement of shoulder range of motion, arm volume and muscle strength among the women following breast cancer surgery. Strengthening exercises should be recommended as a part of breast cancer rehabilitation protocol to prevent secondary lymphedema and other postsurgical complications.

Wrist Stabilising Exercise Versus Hand Orthotic Intervention for Persons with Hypermobility – A Randomised Clinical Trial

Objective To investigate the effectiveness of wrist stabilisation exercises compared to conventional intervention, whether it reduces pain and/or paraesthesia in the hand, as well as how the interventions affected activity ability, health-related quality of life and effects on hand function and grip strength in people with Hypermobility Diagnosis. Design A randomised controlled trial. Setting: Units of Occupational therapy in Primary Care, Kalmar County Council, Sweden Participants: The study included 169 participants’ data randomised to the Exercise group (n = 83) or the Control group (n = 86). The samples consisted of adults in diagnosed Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome with symptoms of pain and/or paraesthesia in the hands in the last three years. Interventions: The Exercise group trained according to structured progressive exercises and weights programme. The Control group used the hand orthosis during selected activities. Both groups performed randomised intervention for 12 weeks. Main measures: The primary outcome was the Disabilities of Arm, Shoulder, and Hand questionnaire. Secondary outcomes were the Grip Ability Test, the Jamar dynamometer and the EuroQol EQ-5D. Results There were 116 subjects who completed the intervention. There were no statistically significant difference between the wrist stabilisation exercise and the conventional intervention in terms of activity ability, health-related quality of life, hand function, grip strength, pain or paraesthesia in people with Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome. Conclusion There is no statistically significant difference between the Exercise group and the Control group regarding activity ability after 12 weeks intervention period.

Relationship Between Pain, Muscle Strength, Function, and Quality of Life in Overhead Players With Chronic Internal Shoulder Impingement

Background and Objectives: This study aims to determine the relationship between pain, muscle strength, function, and quality of life (QoL) in overhead players with chronic shoulder internal impingement syndrome. Methods: Forty-seven overhead players consisting of 15 men, 32 and women (mean age 32.45±7.2) with chronic shoulder internal impingement were enrolled. The pain was measured by a visual analogue scale (VAS). Disabilities of the arm, shoulder, and hand (DASH) and shoulder pain and disability index (SPADI) questionnaires were used to measure pain and function, and a short form (SF)-36 questionnaire to measure QoL. Muscle strengths were evaluated in both hands with a hand-held dynamometer and players were asked to hold the maximal voluntary isometric contraction (MVIC) in the middle range for 3 s and rest for 30 s between each test and each contraction was repeated three times on both affected and healthy side and the average of contractions was considered for each side. Results: The study showed a significant relationship between pain, the strength of shoulder muscle groups (-0.354), function (-0.935), and QoL (-0.861) in overhead throwers with chronic shoulder internal impingement syndrome and the strength of internal rotators of the affected shoulder decreased more than others. (P&lt;0.05) Conclusions: This correlational study showed a significant relationship between pain and strength of shoulder muscles and function and QoL in overhead throwers with this syndrome.

Effectiveness of high-intensity laser therapy on pain in tendinopathy

Introduction: High-intensity laser therapies (HILT) have gained significant attention in therapeutic pain treat-ment. The aim of this systematic review was to determine the effectiveness of HILT therapies in the management of different types of tendinopathy-related pain, and the long-term benefits associated with treatment process.Methodology: A systematic literature review of prospective randomized controlled trials from electronic data-bases: Google Scholar, Pub Med, Embase, Science Direct, and ProQuest, using relevant key words, was per-formed. Randomized trials that included HILT, patients with tendinopathy, pain management, and at least one single clinically pertinent attribute were selected. Standard PRISMA protocols were followed when completing the assessment.Results: The physical, demographic, and theoretical insights from various studies suggest that HILT is a highly promising approach for managing pain in patients with tendinopathy. The most common body parts for treating tendinopathy using this method were the shoulder, elbow, ankle, and knee. Various attributes and parameters, such as Hand function evaluated by Quick Disabilities of Arm, Shoulder and Hand Questionnaire (QDASH) and Hand-grip Strength; pain assessed by the visual analogue score (VAS) during rest or activity, 36-item short-form health survey (SF-36) for physical and mental health, and the shoulder pain and Disability Index (SPADI) for shoulder and elbow assessment, were frequently significant across studies.Conclusion: HILT could be recommended as a treatment of choice for reducing pain and improving function in patients with tendinopathy, with potential benefits when combined with other physical therapy treatments. Further studies are needed to clarify optimal treatment protocols and long- term outcomes.

Ulnar Nerve Management in Complex Elbow Dislocations: A Retrospective Monocentric Study.

The ulnar nerve's unique anatomy makes it vulnerable to complex elbow dislocations. Depending on the nature of the injury, the clinical treatment and outcomes related to the nerve may vary. Unfortunately, the current literature provides limited and fragmented information on managing the ulnar nerve and the incidence of neuropathy in complex elbow dislocations. This study aimed to determine the occurrence of ulnar nerve pain and its relationship with transposition. A retrospective evaluation was conducted on a consecutive series of 44 patients who underwent surgery for complex elbow dislocations. The average follow-up period was 29 months. Patients were categorized based on their condition (trans-olecranon fracture-dislocation, Terrible Triad, Monteggia-like lesions, and injuries not falling into the previous categories). The study assessed whether the ulnar nerve was released from the cubital tunnel and underwent transposition. Additionally, the study examined the number of patients experiencing ulnar pain in the postoperative period and its duration over time. All patients were also evaluated using the Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder, and Hand (DASH) score, and Oxford Elbow Score (OES). Patients who underwent simultaneous ulnar nerve transposition surgery with complex elbow dislocation showed a higher incidence of neuropathy. In these patients, the symptoms were less severe but lasted longer. MEPS, DASH, and OES did not show statistically significant differences between the two groups; however, they were slightly better for the group without ulnar nerve transposition. Surgeons should refrain from routinely transposing the ulnar nerve in complex elbow dislocations. However, further studies involving larger populations are necessary.

Protocol for a prospective randomized trial of surgical versus conservative management for unstable fractures of the distal radius in patients aged 65 years and older.

The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups. A prospectively registered (ISRCTN95922938) randomized parallel group trial will be conducted. Elderly patients meeting the inclusion criteria with a dorsally displaced distal radius facture will be randomized (1:1 ratio) to either conservative management (cast without further manipulation) or surgery. Patients will be assessed at six, 12, 26 weeks, and 52 weeks post intervention. The primary outcome measure and endpoint will be the Patient-Rated Wrist Evaluation (PRWE) at 52 weeks. In addition, the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH), EuroQol five-dimension questionnaire, pain score (visual analogue scale 1 to 10), complications, grip strength (dynamometer), range of motion (goniometer), and radiological assessments will be undertaken. A cost-utility analysis will be performed to assess the cost-effectiveness of surgery. We aim to recruit 89 subjects per arm (total sample size 178). The results of this study will help guide treatment of dorsally displaced distal radial fractures in the elderly and assess whether surgery offers functional benefit to patients. This is an important finding, as the number of elderly distal radial fractures is estimated to increase in the future due to the ageing population. Evidence-based management strategies are therefore required to ensure the best outcome for the patient and to optimize the use of increasingly scarce healthcare resources.