Disorders Of Upper Extremity Research Articles

Factors Associated With Met Expectations in Patients With Hand and Upper Extremity Disorders: A Pilot Study

The degree to which patients' expectations are met during an office visit consistently correlates with patients' satisfaction, whereas the relationship between previsit expectations and satisfaction varies. The aim of this pilot study was to preliminarily assess the relationship of psychosocial factors, pain intensity, and magnitude of disability to previsit expectations, met expectations, and satisfaction with medical care in patients with hand and upper extremity conditions in a surgical outpatient clinic. A cohort of 85 outpatients with upper extremity illnesses indicated their previsit expectations (Patients Intention Questionnaire), degree to which these expectations were met (Expectations Met Questionnaire), level of depressive symptoms (Patient Health Questionnaire-2), confidence about the ability to achieve one's goals in spite of pain (Pain Self-Efficacy Questionnaire), pain intensity (Numerical Rating Scale for pain), disability (Disabilities of the Arm Shoulder and Hand, short version; QuickDASH), and satisfaction with the medical visit (Medical Interview Satisfaction Scale). Higher previsit expectations were associated with more depressive symptoms, lower pain self-efficacy, higher pain intensity, and fewer years of education. Patients in the low and moderate met expectations categories had significantly more symptoms of depression, fewer years of education, and more pain compared to those in the high-met expectations category. Fewer years of education and higher pain intensity predicted higher previsit expectations and explained 19% of variance. Psychosocial factors affect both previsit expectations and met expectations during an outpatient visit to a hand surgeon. Met expectations, but not previsit expectations, affect satisfaction. Prognostic, level II.

Physical Risk Factors Associated with the Upper Extremity Musculoskeletal Disorders among Aluminum Manufacturing Workers

This study define prevalence of upper musculoskeletal disorders (UMSDs) and identified physical risk factors associated with upper extremity disorders amongst aluminum factory workers in Saudi Arabia, during the spring of 2015. We administered a survey to 115 production line workers in an aluminum factory. Surveys addressed demographics, work history, job performance, pain and medical history. Three occupational health experts evaluated risk of UMSDs in each department and created an expert scale indicating UMSDs risk. Overall 45.2% of the workers reported at least one type of pain; joint pain was the most common. 39% of non-Saudi reported pain compared to 18% of Saudi. Muscle pain was associated (p ≤ 0.001) with repetitive movement (RR=5.8), lifting (RR=5.75), pushing and pulling (RR=5.17), awkward movement (RR=3.81). Joint pain was associated (p ≤ 0.001) with repetitive motion (RR=7.12), lifting (RR=3.28), pushing and pulling (RR=3.28) and awkward movement (RR=2.64). A logistic regression model including nationality (OR=3.229, CI=1.052, 9.9) (p=0.041), and department indicates that only anodizing (OR=5.286; CI=1.28, 21.77) (p=0.021), was related to muscle pain when using painting unit as a reference.

Confiabilidade e validade de um dispositivo de célula de carga para avaliação da força de preensão palmar

The grip strength is a complex measure influenced by factors such as gender, age, motivation, muscle training, handedness, height, weight, socioeconomic variables, and participation in specific sports or professions. It can be measured by dynamometers or by tension meters such as load cells (strain gauges). Reliability and validity are important psychometric properties, which analyze consistency and applicability of an instruments' measurement. Thus, the aim of this study was to evaluate the test-retest reliability and construct validity of a load cell device in isometric grip force measurements using a sample of asymptomatic subjects and patients with wrist and hand dysfunctions. Standardized methods of the upper limb positioning and randomization of the sample order were used. Statistical analysis of reliability was conducted by the ICC (Intraclass Correlation Coefficient) and the construct validity by Pearson correlation coefficient (r), with p<0.05, 95% CI, using SPSS version 20(r). The sample consisted of 24 healthy volunteers with an average age of 22.25 years old, all college students, and 21 volunteers with upper extremity and hand disorders, from both genders. The test-retest reliability for the asymptomatic group was ICC 0.90 (0.78-0.95) and for the group of patients was 0.94 (0.87-0.97), both considered excellent. The Bland and Altman graphics showed that although the reliability has displayed excellent levels and low standard error values of measurement, some discrepant data were found. Pearson correlation coefficients were high, both for the asymptomatic group (r=0.85), and for the patients group (r=0.83). Conclusion: based on these findings, it is suggested that this load cell is a reliable and valid device for isometric grip strength measurement and its use is suitable for future clinical trials and practice.

Effect of Shoulder External Rotation on EMG Activity of the Scapular Upward Rotators during Arm Elevation

PURPOSE: The purpose of this study was to determine the effect of shoulder external rotation on muscle activities of the scapular upward rotators during arm elevation. METHODS: Nineteen healthy subjects with no medical history of shoulder pain or upper extremity disorders were recruited for this study. Electromyography (EMG) was used to measure the muscle activities of the serratus anterior (SA), upper trapezius (UP), lower trapezius (LT) and infraspinatus (IS) muscles during arm elevation. The EMG activities were recorded while the subjects performed arm elevation with three different arm positions; palm down (PD), neutral position (NP), and palm up (PU). While seated in a chair, the subject was asked to raise the upper extremity in the sagittal plane in random order. Subjects performed arm elevations in three trials at each arm position. The mean EMG activity normalized by the maximal voluntary isometric contraction was analyzed across three arm positions. Repeated measures one-way ANOVA and the post hoc Bonferroni tests were used to determine the differences in muscle activities among the three arm positions. RESULTS: The EMG activities of the SA and IS were significantly greater in the PU condition than in the other conditions during arm elevation. No significant difference was noted between the NP and PD conditions during arm elevation. CONCLUSION: These results suggest that shoulder external rotation (palm up position) can be used to activate the SA. Therefore, we recommend a scapular protraction exercise in the palm up position for strengthening the SA.

The Relationship Between the Bony Morphology of First Metacarpal Base and the Stability of the Thumb Carpometacarpal Joint in a Normal Female Population: Level 1 Evidence

remaining 34 patients form the basis of this study. Five fellowship-trained hand surgeons, blinded to DEXA scores, evaluated the x-rays and classified them as osteoporotic, osteopenic, or normal bone mineral density. The surgeons viewed the images on a standard PACS terminal and were permitted use of the digital manipulation tools to replicate the common clinical scenario. Four weeks after the initial assessment, the X-rays were again randomized and a second assessment was performed. Accuracy relative to DEXA score was tabulated, and interobserver and intraobserver agreement were also calculated. Results: The observers performed a total of 340 assessments. The assessments relative to DEXA scores were correct in 169 of the assessments (49%). Only one x-ray was correctly diagnosed by all physicians over both assessments while two x-rays were never correctly diagnosed. Analysis of the incorrect assessments revealed that observers tended to underestimate or overestimate bone mineral density at an approximately similar rate (49% and 51% respectively). When the observations were inaccurate, reviewers were off two grades (normal vs. osteoporosis and vice versa) in 17% of the evaluations and 1 grade (normal vs. osteopenia, osteopenia vs. osteoporosis and vice versa) in 83% of the evaluations. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) indicating fair agreement. The mean weighted kappa coefficient for intraobserver agreement between the first and second assessment for all five physicians was 0.46 (range 0.19-0.78) indicating moderate agreement. Summary Points: Abnormally low bone mineral density is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy and only fair agreement in diagnosing osteoporosis compared toDEXAusing visual assessments of digital hand andwrist x-rays. Digital hand x-rays have significant limitations as a tool for evaluating bone mineral density.

Functional Measures Developed for Clinical Populations Identified Impairment Among Active Workers with Upper Extremity Disorders.

Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: (1) UE symptoms, (2) UE musculoskeletal disorders (MSD), (3) carpal tunnel syndrome (CTS), and (4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work.

Determining causation of work-related upper extremity disorders.

To determine causation in work-related upper extremity disorders, one must appreciate the philosophical constructs used in establishing causation and have clear definitions of the disorder in question. The preponderance of evidence does not support repetition as a major risk factor for physical injury. Terms such as "repetitive stress," "repetitive strain," and "cumulative trauma" should be abandoned, and we should educate our patients as to the multiple risk factors for upper extremity pain.

Validation of the simplified Chinese (Mainland) version of the Disability of the Arm, Shoulder, and Hand questionnaire (DASH-CHNPLAGH).

BackgroundWe developed a simplified Chinese version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire (shorthand for DASH-CHNPLAGH) by conducting cross-cultural adaptation and evaluating its reliability and validity.MethodsBoth the forward and back translations were performed by language officers and medical professionals from different fields to translate the original DASH version into the DASH-CHNPLAGH version with minimized culture discrepancies. A total of 300 patients with upper extremity disorders were recruited to complete two DASH-CHNPLAGH questionnaires with 3-week test interval time.ResultsThe intraclass coefficient (ICC) and Cronbach’s alpha for the 30-item disability/symptom of the DASH-CHNPLAGH was 0.94 and 0.96, respectively, which were relatively high among that reported in previous literatures. DASH-CHNPLAGH showed a positive correlation with a visual analogue scale (VAS) and a negative correlation with SF-36 items.ConclusionThe simple Chinese version of DASH is a reliable and valid measurement for patients with upper extremity problems.

Estimation of digraph costs for keyboard layout optimization

The main aim of this study was to estimate the digraph costs (interkey-stroke times) based on the digraph (two consecutive keys) tapping rates for the optimization of keyboard layouts considering the touch typing principles. The study also investigated the effects of column, row, hand and period on digraph-tapping rate. For the purpose, a laboratory experiment was performed with seven subjects using a conventional keyboard. Digraph-tapping rates of a total of 241 same hand digraphs were recorded for a duration of 2-min. The interkey-stroke times were calculated as the digraph costs for the same hand digraphs using the estimated mean digraph-tapping rates. The different hand digraph costs were calculated based on the same hand digraph costs and the results of a previous study. The results indicated significant column, row, hand and period effect on the digraph-tapping rate. Using the digraph costs and the digraph frequencies of the considered language in a quadratic assignment problem, an optimal touch typing keyboard layout can be developed to satisfy all but one of Dvorak's touch typing criteria. As an application, an optimal keyboard layout, called Turkish I-layout, is developed for Turkish language. The comparison results between I and existing Turkish F and Q layouts showed that the I-layout is superior both according to the results of the optimization and Dvorak's criteria. Relevance to industryOptimal and ergonomic keyboard layouts improve typing performance and reduce the likelihood of upper extremity disorders. The digraph-tapping rates estimated through this study are essential for the development of such layouts.

Does the Upper-Limb Work Instability Scale Predict Transitions Out of Work Among Injured Workers?

ObjectiveTo investigate the predictive ability of the Upper-Limb Work Instability Scale (UL-WIS) for transitioning out of work among injured workers with chronic, work-related upper extremity disorders (WRUEDs). DesignSecondary analysis of a 12-month cohort study with data collection at baseline and 3-, 6-, and 12-month follow-up. Survey questionnaires were used to collect data on an array of sociodemographic, health-related, and work-related variables. SettingUpper extremity specialty clinics. ParticipantsInjured workers (N=356) with WRUEDs who were working at the time of initial clinic attendance. InterventionsNot applicable. Main Outcome MeasureTransitioning out of work. ResultsMultivariable logistic regression that considered 9 potential confounders revealed baseline UL-WIS (range, 0–17) to be a statistically significant predictor of a subsequent transition out of work (adjusted odds ratio, 1.18; 95% confidence interval [CI], 1.07–1.31; P=.001). An assessment of predictive values across the UL-WIS score range identified cut-scores of <6 (negative predictive value, .81; 95% CI, .62–.94) and >15 (positive predictive value, .80; 95% CI, .52–.96), differentiating the scale into 3 bands representing low, moderate, and high risk of exiting work. ConclusionsThe UL-WIS was shown to be an independent predictor of poor work sustainability among injured workers with chronic WRUEDs; however, when applied as a standalone tool in clinical settings, some limits to its predictive accuracy should also be recognized.

Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study.

Few large epidemiologic studies have used rigorous case criteria, individual-level exposure measurements, and appropriate control for confounders to examine associations between workplace psychosocial and biomechanical factors and carpal tunnel syndrome (CTS). Pooling data from five independent research studies, we assessed associations between prevalent CTS and personal, work psychosocial, and biomechanical factors while adjusting for confounders using multivariable logistic regression. Prevalent CTS was associated with personal factors of older age, obesity, female sex, medical conditions, previous distal upper extremity disorders, workplace measures of peak forceful hand activity, a composite measure of force and repetition (ACGIH Threshold Limit Value for Hand Activity Level), and hand vibration. In this cross-sectional analysis of production and service workers, CTS prevalence was associated with workplace and biomechanical factors. The findings were similar to those from a prospective analysis of the same cohort with differences that may be due to recall bias and other factors.

Conventional Humeral Retroversion Measurements Using Computed Tomography Slices or Ultrasound Images Are Not Correlated With the 3-Dimensional Humeral Retroversion Angle.

Background:Humeral retroversion angles determined by previous techniques are varied and/or biased by morphologic variations of the proximal and distal humerus, and their validity should be revisited. To overcome the limitations of previous studies associated with 2-dimensional (2D) images and the reference axes, a 3-dimensional (3D) measurement of humeral retroversion is required. However, comparisons of 2D imaging methods with the 3D computed tomography (CT) measurement as a reference standard have not been heretofore performed.Purpose:To determine whether the 3D CT humeral retroversion angle in baseball players is correlated with conventional humeral retroversion measurements.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A total of 28 humeri from 14 male baseball players were used for measuring humeral retroversion. Participants underwent CT scans, and geometric bone models were created for measuring the 3D CT humeral retroversion angle. Using CT slices, the 2D CT humeral retroversion angle was also determined. Bicipital forearm angle was assessed using the indirect ultrasound technique. Linear regressions and Bland-Altman plots were used to determine whether there were agreements among 3 variables: the 3D CT retroversion, 2D CT retroversion, and bicipital forearm angles.Results:In linear regression analyses, the 3D humeral retroversion angle was not predicted by the 2D CT retroversion (R = 0.167, R 2 = 0.028, P = .395) or the bicipital forearm angle (R = 0.049, R 2 = 0.002, P = .805). The bias of these 2 methods was 20.9° and –15.3°, respectively. Regression analysis demonstrated that the bicipital forearm angle was a significant predictor of the 2D CT retroversion angle (R = 0.632, R 2 = 0.400, P < .001).Conclusion:The 3D CT humeral retroversion angle was found to be underestimated by the 2D CT retroversion angle and overestimated by the bicipital forearm angle obtained by the indirect ultrasound, although a previously observed relationship between the 2D CT retroversion and bicipital forearm angles was confirmed.Clinical Relevance:Precise measurement of humeral retroversion angle is important because retroversion has been linked to upper extremity disorders, including throwing-related shoulder and elbow disorders in baseball players.

2013–2014 Sterling Bunnell Traveling Fellowship Report

Since 1982, the American Society for Surgery of the Hand has sponsored a young member each year as its Bunnell Traveling Fellow. The Sterling Bunnell Traveling Fellowship enables young hand surgeons to foster national and international relationships that contribute to their pursuit of higher learning and advance the principles of scholarship by improving treatment of hand and upper extremity disorders. As the Sterling Bunnell Traveling Fellow for 2013 to 2014, I studied microvascular osteochondral reconstruction of the upper extremity. The year allowed me to pursue research abroad and participate in novel operations. These experiences have challenged how I approach common osteoarticular problems in hand surgery. Leaders in wrist surgery around the globe helped me reconsider the treatment of osteonecrotic, degenerative, and posttraumatic cartilage loss in radical new ways.

Correlation of Biomechanical Exposure with Cumulative Trauma Disorders of Upper Extremity in Dental Surgeons

Aims and Objectives: The aim of this study was to determine the occupational musculo-skeletal problems in dentists and to investigate the related risk factors. Biomechanical risk exposures measures are available as is various activity limitations. Activity limitation is specific for various cumulative trauma syndromes found in dental occupation. Hence, this study aims at correlating these two parameters. Study population involves private and institutionalized dentists. So study aims to do a comparison in between the groups also. Materials and Methods: 250 dentists working in Navi Mumbai and Mumbai were included in the study. Their mean ages were 30.15 ΁ 5.70 years. The musculo-skeletal system problems, activity, limitations, pain levels, working posture are some of the factors investigated. Results: The biomechanical exposure analyzed (rapid upper limb assessment, occupational repetitive action) showed strong association with various cumulative trauma disorders assessed by (neck disability index, disabilities of arm, shoulder, hand, and carpal tunnel syndrome questionnaire). Conclusion: Musculo-skeletal problems existed due to the occupational working conditions and these problems caused activity limitation with varying degrees. Occupational risk factors in dentists make dentists conscious about this issue and also preventive rehabilitation programs have to be planned.

Effects of two workstation positions for below-knee assembly work on upper extremity muscle activity.

[Purpose] This study was performed to determine which set of below-knee working conditions minimizes upper extremity muscle activity and which of upward- or downward-direction workstations poses the greater risk of upper extremity disorder. [Subjects] The study population consisted of 15 young male workers. [Methods] EMG activities of the right anterior deltoid, biceps brachii, and lower trapezius muscles were measured in two below-knee assembly workstation positions. [Results] The anterior deltoid and biceps brachii muscle activities of Position 1 were significantly higher than those of Position 2. The lower trapezius muscle activity of Position 2 was significantly higher than that of Position 1. [Conclusion] Upward-direction workstations appear to pose a greater risk of upper extremity disorder than downward-direction workstations in below-knee assembly work.

A Threshold Disability Score Corresponds with an Estimated Diagnosis of Clinical Depression in Patients with Upper Extremity Disease

The purpose of this study was to assess whether there is a threshold Disability of Arm, Shoulder and Hand (DASH) score among patients with common hand diagnoses that corresponds with an estimated diagnosis of clinical depression. Two hundred sixty-nine patients with one of five common upper extremity disorders completed a measure of upper extremity-specific disability (QuickDASH or DASH) and a questionnaire assessing depressive symptoms (Patient Health Questionnaire (PHQ) or Center for Epidemiologic Studies Depression scale (CES-D). A receiver operating characteristic (ROC) analysis of the discriminatory value of a threshold DASH score for an estimated diagnosis of clinical depression was assessed. The threshold DASH score with the highest positive predictive value for an estimated diagnosis of clinical depression was selected. In bivariate analysis, the association between demographic factors, disease factors, and an estimated diagnosis of clinical depression was examined. The area under the ROC curve for a threshold DASH value diagnostic of an estimated diagnosis of clinical depression was 0.75, indicating clinical usefulness for a threshold DASH score as a screening test for depression. The highest positive predictive value of 72% occurred at a threshold QuickDASH/DASH score of 55. In bivariate analysis, only diagnosis and years of education were significantly different between patients with and without an estimated diagnosis of clinical depression. A DASH score of 55 or greater in patients with common upper extremity disorders has an acceptable area under the curve and positive predictive value for an estimated diagnosis of clinical depression. Level 3, diagnostic study.

Who is the expert for the evaluation of work ability?

Who is the expert for the evaluation of work ability?

Predicting work-related incidence of lateral and medial epicondylitis using the strain index.

The Strain Index (SI) has been developed to evaluate the risk for developing a distal upper extremity disorder. The objective of this study is to determine if the SI predicts incidence cases of work-related lateral, medial, or any epicondylities (LEPI, MEPI, and EPI). Six hundred seven workers were followed for up to 3.5 years, 70 developed EPI on the dominant side (44 LEPI, 13 MEPI, and 13 both). Survival analyses were conducted adjusting for demographic, psychosocial, and work organizational factors, with the SI as time-dependent variable. High exposure (SI > 5), older age, and self-perceived poor general health were associated with incidence of LEPI and EPI, but not MEPI. There was a significant relationship between higher scores of SI and LEPI, hazard ratio (HR) 2.00 (95% CI 1.04-3.87) for SI 5.1-12, HR 2.12 (95% CI 1.11-4.05) for SI > 12. The SI can effectively identify jobs with increased risk of developing incidence of LEPI.

Differences in the three-dimensional typing forces between short and long travel keyboards

Keyboards with shorter key travel are becoming widespread yet it is unknown whether there are any biomechanical differences in the typing forces when using these keyboards. If one keyboard promotes typing with more force, this may increase the risk for developing an upper extremity disorder. A total of 17 subjects typed on two short travel keyboards (&lt;2.5 mm) and one long travel keyboard (4.0 mm). The magnitude and angle of the typing forces were measured in the x-, y- and z-axes using a thin, three-dimensional force platform. The aim of this study was to determine whether there were differences between the short and long travel keyboards in the magnitude and direction of the typing forces and the keystroke durations. In addition we wanted to determine whether there were typing force differences between key rows, hands, and fingers. Keyboards with shorter key travel resulted in less extreme angles and smaller magnitudes for forces applied in the x and y directions. Shorter travel distances were associated with smaller peak and mean vector sum forces and shorter keystroke durations. Although these results indicate keyboards with shorter key travel affect typing biomechanics, it is uncertain whether the small differences in keystroke durations and applied typing forces are physiologically meaningful and would reduce a computer user’s risk for developing an upper extremity musculoskeletal disorder.

Neck and upper extremity disorders in hospital staff: Associated factors and quality of life impact

Neck and upper extremity disorders in hospital staff: Associated factors and quality of life impact