Full Fist Research Articles

Visualization of Human Hand Tendon Mechanical Anisotropy in 3D Using High-Frequency Dual-Direction Shear Wave Imaging.

High-resolution ultrasound shear wave elastography has been used to determine the mechanical properties of hand tendons. However, because of fiber orientation, tendons have anisotropic properties; this results in differences of shear wave velocity (SWV) between ultrasound scanning cross sections. Rotating transducers can be used to achieve full-angle scanning. However, this technique is inconvenient to implement in clinical settings. Therefore, in this study, high-frequency ultrasound (HFUS) dual-direction shear wave imaging (DDSWI) based on two external vibrators was used to create both transverse and longitudinal shear waves in the human flexor carpi radialis tendon. SWV maps from two directions were obtained using 40-MHz ultrafast imaging at the same scanning cross section. The anisotropic map was calculated pixel by pixel, and 3D information was obtained using mechanical scanning. A standard phantom experiment was then conducted to verify the performance of the proposed HFUS DDSWI technique. Human studies were also conducted where volunteers assumed three hand postures: relaxed (Rel), full fist (FF), and tabletop (TT). The experimental results indicated that both the transverse and the longitudinal SWVs increased due to tendon flexion. The transverse SWV surpassed the longitudinal SWV in all cases. The average anisotropic ratios for the Rel, FF, and TT hand postures were 1.78, 2.01, and 2.21, respectively. Both the transverse and the longitudinal SWVs were higher at the central region of the tendon than at the surrounding region. In conclusion, the proposed HFUS DDSWI technique is a high-resolution imaging technique capable of characterizing the anisotropic properties of tendons in clinical applications.

A soft pneumatic glove with multiple rehabilitation postures and assisted grasping modes

This article proposes a novel soft pneumatic glove with multiple rehabilitation postures and assisted grasping modes, which is composed of five segmented pneumatic networks (PneuNets) bidirectional bending actuators with a variable height structure. The metacarpophalangeal (MCP) joint chambers and the distal phalangeal (DIP) joint chambers are designed with a trapezoidal side profile, which enhances the reverse bending ability and can effectively expand the range of hand rehabilitation activities. In order to avoid hindering the forward bending, the chambers of the reverse bending module are designed as a triangular prism chamber. Experimental tests were performed and the results show that the soft actuator can produce a bending angle of 261° under an air pressure of 100 kPa, and can produce a fingertip force of 1.59 N under an air pressure of 130 kPa. In the rehabilitation mode, the designed soft rehabilitation gloves can help the hand to form four kinds of rehabilitation postures, namely full fist, straight fist, hook fist and table top. By ventilating different finger joints, and it can also help the fingers to stretch. Under the initial air pressure of 60 kPa, the design of the reverse bending module can increase the fingertip force of reverse bending by 40 %. In the assisted grasping mode, by adjusting the input air pressure, it can help the hand to grasp objects with cylindrical and large plane contour, which is very useful for the rehabilitation of patients with partial loss of hand function. • A novel soft pneumatic glove with multiple rehabilitation postures and assisted grasping modes is proposed. • The soft glove is composed of five PneuNets bidirectional bending actuators with a variable height structure. • The soft actuator can produce a angle of 261° under pressure of 100 kPa, and a force of 1.59 N under pressure of 130 kPa.

Radiographic Evaluation of Carpal Mechanics and the Scapholunate Angle in a Clenched Fist with Dynamic Computed Tomography Imaging

The long-term consequences of injuries to the scapholunate joint can severely limit hand function, and the potential for posttraumatic deformity makes early recognition of these injuries important. The purpose of this study was to evaluate the motion of the scapholunate joint in normal wrists through the radial and ulnar deviation using novel dynamic computed tomography (CT) imaging. Fifteen participants consented to have their uninjured wrists scanned. A protocol was designed to ensure adequate time, yet limited exposure, for volunteers. Participants began with the hand in a relaxed fist position and then proceeded to clench the hand in a full fist and relax. Once relaxed again, the wrist was maximally ulnarly deviated and then maximally radially deviated in a fluid motion. Dynamic CT imaging was captured throughout the range of motion. The scapholunate angle was measured on dynamic wrist images. The mean range of the scapholunate angle that the wrists moved through was 37.2°-45.9°, and the mean midpoint angle was 41.2° ± 0.4°. All wrists had small, measurable differences in the scapholunate angle when moving from the maximum ulnar deviation to the maximal radial deviation. The average maximum angle change through the range is 11.7°, whereas the average minimum angle change was 0.9°. In this study, scapholunate angle calculations using dynamic wrist CT scans were within the range of accepted normal for the angle in uninjured wrists. With the increased focus on dynamic imaging for wrist motion, it may be possible to derive a standardized protocol for mapping the carpal motion that is clinically applicable and reproducible. Diagnostic IV.

Outcomes of Carpal Tunnel Release in Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy/Sudeck Disease Patients.

The clinical features of classic carpal tunnel syndrome are well known. However, some patients who display atypical symptoms and signs of pain and dysesthesias in the hand, worsening of symptoms at night, and above all, inability to make a full fist, respond equally well to carpal tunnel release. This same clinical picture was shared by some patients labeled as having complex regional pain syndrome. Because of the poor outcome of complex regional pain syndrome patients with current regimens, the authors tested the hypothesis that carpal tunnel release could be effective on them. The purpose of this article is to report the outcome of carpal tunnel release in complex regional pain syndrome patients who presented the above signs and symptoms. Fifty-three patients with an average age of 55 years presenting the above cluster of symptoms were operated on. All were unilateral cases, had sustained trauma, and were treated for complex regional pain syndrome before referral for an average of 16 months. All patients underwent carpal tunnel release. At a minimum of 6 months' follow-up, pain dropped 7.5 points on a numerical rating scale of 0 to 10 ( p < 0.001). Disabilities of the Arm, Shoulder and Hand scoring fell from 82 to 17 ( p < 0.001). Six patients had an unsatisfactory result. Some patients with complex regional pain syndrome may respond successfully to a carpal tunnel release operation. Recognition of this possibility is crucial, as the symptoms and signs might lead the clinician away from the proper diagnosis and treatment. Therapeutic, IV.

Contact Force Measurement Approach for Measuring Glove-Skin Interfacial Pressure

Pressure garments for medical had been widely used to enhance the recovery after an operation, for treatment of arthritis, deep vein thrombosis, leg ulcers, varicose veins or hypertrophic scars. This research aims to develop a contact force measuring approach to measure glove-skin interfacial pressure. With the aid of a force measuring sensors system, it is easier to study the efficiency of pressure garments. Besides, occupational therapists can also design a user-friendly pressure garment that is comfortable and easy to donning and doffing, especially for children. Two types of flexible force sensors were used to measure the glove-skin interfacial pressure using two types of pressure therapy gloves. Pressure therapy glove is selected to represent pressure garments. The measuring sensors were placed at three different locations on the dorsal side of the hand, and the glove-skin interfacial pressure was measured in two different postures, which is full fist and tabletop posture. It was found that different postures had led to different interfacial pressure. The glove-skin interfacial pressure was found to be greater during full fist posture compared to tabletop posture. This show that the applied glove-skin interfacial pressure is affected by postures and movement.

Safety of Early Postoperative Range of Motion in Burn Patients With Newly Placed Hand Autografts: A Pilot Study.

Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection. Recent practice at our burn center includes an early range of motion (EROM) following hand grafting to limit unnecessary immobilization. The purpose of this study was to determine whether EROM is safe to perform after hand grafting and if there is any clinical benefit. This retrospective, matched case-control study of adults compared patients who received EROM to subjects who received the standard 3 to 5 days of postoperative immobilization. Patients were evaluated for graft loss and range of motion. Seventy-one patients were included in this study: 37 EROM patients and 34 matched controls. Six patients experienced minor graft loss, three of these were not attributable to EROM. All graft loss was less than 1 cm and none required additional surgery. Significantly more patients who received EROM achieved full-digital flexion by the first outpatient visit (25/27 = 92.6% vs 15/22 = 68.2%; P = .028). Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients' ability to make a full fist at initial outpatient follow-up. Additional prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.

T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts

Abstract Introduction Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence. Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit. Methods In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion. Results Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033). Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes). Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028). Conclusions Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas. Applicability of Research to Practice Clinical change in post-operative management after hand grafting.

MNT-DeepSL: Median nerve tracking from carpal tunnel ultrasound images with deep similarity learning and analysis on continuous wrist motions

Carpal tunnel syndrome (CTS) is a clinical disease that caused by the compression of median nerve within carpal tunnel. Traditional examining for CTS is electrodiagnostic (EDx), but the evaluation of EDx is more expensive and time-consuming. In the present day, ultrasound (US) image is used to clinical examining to make up the lack of nerve electrical inspection. The diagnostic criteria of US image for CTS are also defined in many researches. In this study, we propose a new tracking model with deep similarity learning for median nerve from CTS US images. Six wrist motions are defined in the clinical rehabilitation, and the proposed method can achieve accuracy more than 90 % for median nerve tracking. In the experiment, we discover some wrist motions, such as hook to full fist, the statistical information of median nerve tracking is more significant (P < 0.001). It means that some wrist motions are more easily to diagnose the problem of median nerve, and can be used as a basis for quick examining for CTS.

Comparing Shape Categorization to Circularity Measurement in the Evaluation of Median Nerve Compression Using Sonography.

This study aimed to develop a subjective categorization of nerve shape and to examine the relationship of shape categorizations to measurement of nerve circularity. Wrists were evaluated with sonography in healthy participants. Images of the median nerve were obtained in the transverse plane at the level of pisiform with the fingers resting, gripping, and pinching. Nerves were categorized as ovoid, angular, or irregular, and the cross-sectional area and perimeter were measured to calculate nerve circularity. Across 167 participants, the median nerve shifted from being primarily ovoid at rest to angular shaped when the fingers were in a full fist or pinching. Approximately three-quarters of subjects exhibited a shape change during dynamic movement. Irregular nerves had the lowest circularity values; however, the majority of nerves had similar circularity measures despite having different shapes. Subjective categorization of shape has the potential to be a valid technique for evaluation of the median nerve using sonography, and this evaluation may provide additional information regarding nerve compression that is not fully captured by a circularity measure. Further investigation is needed to determine how these two techniques may be best used individually or together to advance clinical diagnosis, prevention, and rehabilitative interventions.

Repaired Flexor Tendon Excursion with Half a Fist of True Active Movement Versus Full Fist Place and Hold in the Awake Patient.

Supplemental Digital Content is available in the text.

Multilevel critical stenosis with minimal functional deficits: a case of cervical spondylotic myelopathy

We present a case of a previously asymptomatic and highly functional individual whose critical degenerative stenosis was exacerbated by recent trauma (motor vehicle accident), resulting in cervical spondylotic myelopathy. A 57-year-old African-American man with no significant past medical history presented to the Orthopaedic Surgery outpatient clinic with mild neck discomfort, stiffness, and bilateral hand numbness 4 days after being involved in a motor vehicle accident. He ambulated without assistive devices and displayed a tandem gait pattern with normal cadence. He was minimally tender to palpation at the posterior cervical midline and paraspinal musculature with motor and sensory function intact bilaterally. Reflexes were hypoactive at C5, C6, C7, L4, and S1 bilaterally with positive Babinski signs bilaterally. Imaging revealed degenerative changes, spinal stenosis, and cord compression. The patient eventually underwent posterior cervical decompression and fusion from the C3 to the C6 level, with the only reported complication being transient loss of somatosensory evoked potential (SSEP) signals intra-operatively. In the postoperative period, the patient complained of stiffness in his left shoulder, elbow, and hand, as well as left hand palmar numbness and an inability to make a full fist. His complaints were managed with medication and physical therapy. This case report highlights the point that stenosis that occurs slowly over time is often well compensated, and patients are commonly asymptomatic at first glance. Often times, acute events tip patients from being asymptomatic to symptomatic, generally warranting invasive intervention to prevent further insults from causing permanent damage.

Deformation of the median nerve at different finger postures and wrist angles.

BackgroundThe objective of this study was to evaluate the changes of the median nerve cross-sectional area (MNCSA) and diameters of the median nerve at different finger postures and wrist angles.MethodsTwenty-five healthy male participants were recruited in this study. The median nerve at wrist crease was examined at six finger postures, and repeated with the wrist in 30° flexion, neutral (0°), and 30° extension. The six finger postures are relaxed, straight finger, hook, full fist, tabletop, and straight fist.ResultsThe main effects of both finger postures and wrist angles are significant (p < 0.05) on changes of the MNCSA. Different finger tendon gliding postures cause a change in the MNCSA. Furthermore, wrist flexion and extension cause higher deformation of the MNCSA at different finger postures.DiscussionThe median nerve parameters such as MNCSA and diameter were altered by a change in wrist angle and finger posture. The results may help to understand the direct biomechanical stresses on the median nerve by different wrist-finger activities.

Flexor Tendon Repair Postoperative Rehabilitation: The Saint John Protocol.

The Saint John Protocol describes a rehabilitation program of up to half a fist of protected true active finger flexion beginning 3 to 5 days after flexor tendon repair. We no longer use full fist place and hold. We illustrate with film and text the reasons for these changes.

Benefits of the Modified Graded Motor Imagery Protocol in the Treatment of Patients With Complex Regional Pain Syndrome Type I and Type II

Introduction: The abnormal prolongation of pain, dystrophic events, autonomic dysfunction, microvascular abnormality, localized atrophy, and functional impairment constitutes complex regional pain syndrome (CRPS).It could appear after trauma or surgery. New information regarding cortical changes in patients with chronic pain has prompted a reevaluation of the type of treatment. Graded Motor Imagery (GMI) is one of the treatment techniques from the “top-down” paradigm designed to treat chronic pain. The aim of this study was to evaluate the functional results of the occupational therapy treatment in patients with CRPS type I and type II including the Modified GMI Protocol. Methods: Fifteen patients of both sexes with CRPS type I and type II as a complication of various pathologies of the upper extremity were evaluated. They were treated from November 2014 to January 2016. Patients who were diagnosed with CRPS type I or type II by the physician (hand surgeon or rheumatologist) and underwent a minimum of 10 treatment sessions were included. Patients were assessed with goniometry of the wrist and thumb opposition, distance to the distal palmar crease, visual analogue scale (VAS), and Patient-Rated Wrist/Hand Evaluation (PRWHE). GMI consisted of 3 stages: recognition of hand laterality, imagined hand movements, and mirror therapy. The execution time for these was based on the performance of the patient. Together with the Modified GMI Protocol, other activities such as global and functional range of motion of the upper extremity, sensory reeducation, and edema treatment were developed. Results: Active wrist flexion increased to 61% and the extension to 76.6% in comparison with the first evaluation. Six patients did not achieve the complete opposition of the thumb to the base of the fifth metacarpal in an average of 1.3 cm (range, 1-3 cm). Five patients were able to make the active full fist to the distal palmar crease, the remaining patients had an average deficit of 2.20 cm. Pain decreased in an average of 3/10 (range, 0-7) in the VAS. The PRWHE showed that the patients presented an average of 18.13/50 of difficulty in the Function subscale (specific activities and usual activities). Conclusions: The results obtained in this study suggest that the inclusion of the Modified GMI Protocol has significant advantages, decreasing pain, increasing the active mobility of the affected hand, as well as facilitating its performance in daily activities. We have noted that the protocol can be performed by devoting less time to the stages of laterality and imagined movements if the patient has no difficulty in performing them. Nevertheless, it is important to do the 3 steps in order to allow cortical reorganization of the body scheme and the movements of the affected limb.

Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve

In cases of median nerve injury alongside an unsalvageable ulnar nerve, a vascularized ulnar nerve graft to reconstruct the median nerve is a viable option. While restoration of median nerve sensation is consistently reported, recovery of significant motor function is less frequently observed. The authors report a case involving a previously healthy man who sustained upper arm segmental median and ulnar nerve injuries and, after failure of sural nerve grafts, was treated with a pedicled vascularized ulnar nerve graft to restore median nerve function. Long-term follow-up showed near full fist, with 12 kg of grip strength, key pinch with 1.5 kg of strength and protective sensation in the median nerve distribution. The present case demonstrates that pedicled ulnar vascularized nerve grafts can provide significant improvements to median nerve sensory and motor function in a heavily scarred environment.

Decreasing tendon rupture and tenolysis with wide awake surgery

There are 5 main reasons that I never want to repair a flexor tendon in sedated patients ever again. If a patient is wide awake (unsedated) with no tourniquet and only lidocaine with epinephrine is used in the fingers and hand for local anesthesia and hemostasis, 5 major things happen to improve the results: 1) Decrease rupture rate with intraoperative active testing of repair: Injection of only lidocaine with epinephrine wherever incisions will be made in the finger and hand permits comfortable tourniquet-free awake patients cooperate with active full flexion and extension of fingers testing during the surgery. The rupture rate decreases because the repair can be tested with full active flexion and full active extension to make sure that there is no gapping which will lead to rupture. If there is gapping, the repair can be augmented and the gap eliminated by the surgeon before the skin is closed so there will be no rupture. This has decreased the rupture rate by 7% in the largest WALANT flexor tendon repair series to date (Higgins A, Lalonde DH, et al. Avoiding flexor tendon repair rupture with intraoperative total active movement examination. Plast Reconstr Surg 2010;126(3):941.) 2) Knowing there is no gap with a full fist permits half a fist true active movement post op for better results: If the surgeon sees the patient make a full fist and completely extend the fingers with no gapping during the surgery, he will be confident to let the patient start controlled TRUE active movement 3 days after the surgery (not Kleinert rubber bands nor “place and hold”). True active movement means up to half a fist of active flexion and extension. If the patient can make a full fist at surgery, he is not likely to rupture with half a fist after surgery. 3) Decrease tenolysis rate by testing active movement intraoperatively: The awake cooperative pain free patient can make a complete fist to make sure the repair fits through the pulleys before the surgeon closes the skin. If the repair does not fit at the time of surgery, it will not fit later and the surgeon will need to come back and do a tenolysis. The distal half of A2, and the entire A4 pulleys can be vented (divided) without major bowstringing if adjacent cruciate pulleys are maintained. Only the pulleys that need be vented are vented. Active movement during the surgery reveals what needs to be done to decrease the tenolysis rate. 4) Knowing what happens to active movement if superficialis is repaired during surgery: If the active movement seen during surgery is downgraded by repairing superficialis, the superficialis repair can be taken down, and a slip of superficialis can be resected if required to optimize movement. 5) An educated flexor tendon repair patient who has seen his finger during surgery is more likely to be cooperative after surgery: The surgeon (and therapist in our institution) gets a minimum of 90 minutes to educate the patient during surgery about how to get a good result after surgery. Seeing is believing. A patient who has seen the challenges involved in repairing the tendon at surgery has much more of a vested interest and a better understanding of how to cooperate to get a good result.

Finger Movement Function After Ultrasound-Guided Percutaneous Pulley Release for Trigger Finger: Effects of Postoperative Rehabilitation

ObjectiveTo develop and test a postoperative rehabilitation protocol for use by individuals with trigger finger undergoing ultrasound-guided percutaneous pulley release. DesignNonrandomized controlled trial. SettingHospital and local community. ParticipantsIndividuals suffering from trigger finger with joint contracture (N=21) were recruited and grouped into an intervention group (n=9) or a control group (n=12). InterventionsAll the participants underwent the same surgical procedure performed by the same surgeon. A 4-week postoperative rehabilitation program was designed based on the wound healing process. The intervention group received postoperative rehabilitation after the surgery, whereas the control group received no treatment after the surgery. Main Outcome MeasuresThe finger movement functions were quantitatively evaluated before and 1 month after the surgery using a 3-dimensional motion capture system. The fingertip workspace and joint range of motion (ROM) were evaluated while the participant was performing a sequential 5-posture movement, including finger extension, intrinsic plus, straight fist, full fist, and hook fist. ResultsThe intervention group demonstrated significantly more improvements than the control group in the fingertip workspace (49% vs 17%), ROM of the distal interphalangeal (DIP) joint (16% vs 4%), ROM of the proximal interphalangeal (PIP) joint (21% vs 5%), and total active ROM (17% vs 5%). ConclusionsThis pilot study evaluated a postoperative rehabilitation protocol for trigger finger and demonstrated its effects on various finger functions. Participants who underwent the rehabilitation program had significantly more improvements in the fingertip workspace, ROM of the DIP and PIP joints, and total active ROM.

The applicability of four clinical methods to evaluate arm and hand function in all stages of spinal muscular atrophy type II

Aim: To evaluate the ability of four clinical methods to reflect arm and hand function at impairment and activity level and to determine their ability to discriminate among SMA II patients of all ages and in all stages of the disease. Methods: Fifty-two patients with SMA II (age range: 8–73 years) were assessed by means of the Egen Klassifikation 2 (EK2 scale), the Motor Function Measure Scale (MFM D3), the Manual Muscle Test (MMT) and Hand-Held Dynamometry (HHD) in full fist grip and lateral pinch grip. Patients were classified into six levels of upper limb function by means of the Brooke Upper Limb Scale, and the four methods’ ability to differentiate among patients within these levels was calculated. Modified versions of the EK2 scale (EK Upper Limb) and the MFM D3 (MFM D3 Upper Limb) were assessed in the same manner. Results: The patients’ physical abilities were best described by the MMT and EK2 while the “EK Upper Limb”, MFM D3 and MMT were best at discriminating among patients across the range of upper limb function. Quantitative muscle tests as measured by Citec™ HHD were less applicable to weak patients; full fist grip could discriminate among patients at Brooke levels 3–5, and lateral pinch grip among the strongest patients. Conclusion: At the impairment level, MMT is the superior measure of muscle function in very weak patients in whom HHD cannot reflect capacity. At the activity level, the EK 2 represents daily activities whereas the MFM D3 measures motor functions. In differentiating among SMA II patients of all ages and in all stages of the disease, the ability of abbreviated versions of scales targeting upper limb function is superior to unabridged versions of these scales.Implications for RehabilitationEvaluation of upper limb function in spinal muscular atrophy IIEven very weak patients with SMA II have some residual upper limb function that is measurable if the right method is chosen.The Manual muscle test is applicable to all patients with SMA II and is useful to determine possible interventions – such as methods to drive a wheelchair or operate a computer.Abbreviated versions of the EK2 scale and the MFM are useful as methods to evaluate subtle changes in upper limb function resulting from disease progression or interventions.

Composite Flexion Splint for the Stiff Hand

The ability to make a full fist and grasp objects is a necessary motion for many everyday activities. For this reason, therapists continually create and modify splints in an attempt to achieve composite flexion in the hand. In this article, the authors describe their static progressive splinting approach to improve composite flexion in patients with hand stiffness due to trauma.

Ultrasonographic Assessment of Long Finger Tendon Excursion in Zone V During Passive and Active Tendon Gliding Exercises

Cadaver and in vivo studies report variable results for tendon excursion during active and passive hand movements. The purpose of this study was to measure long finger flexor digitorum profundus (FDP) tendon excursion during active and passive movement using high-resolution ultrasound images. The FDP tendon excursion was measured at the wrist level in 10 healthy subjects during full tip-to-palm active and passive flexion of the fingers. Passive movement was performed 2 ways: (1) straight to full fist: passive flexion starting at the metacarpophalangeal joint, followed by proximal interphalangeal and distal interphalangeal joint flexion; and (2) hook to full fist: passive flexion starting at the distal interphalangeal joint, followed by proximal interphalangeal and metacarpophalangeal joint flexion. Tendon excursion was measured using an in-house-developed, frame-to-frame analysis of high-resolution ultrasound images. Median FDP excursion was 24.3 mm, 14.0 mm, and 13.6 mm for active fist, straight to full fist, and hook to full fist movements, respectively. Tendon excursions during active movements was significantly larger than excursions during passive movements (p = .005). The adjusted median tendon excursion was 12.7 mm/100 degrees , 7.5 mm/100 degrees , and 7.4 mm/100 degrees for active fist, straight to full fist, and hook to full fist movements, respectively. Adjusted tendon excursions during active movement were significantly larger than those achieved during passive straight to full fist movement). Adjusted tendon excursions during straight to full fist movements were significantly larger than those achieved during passive hook to full fist movement. Active motion produced 74% and 79% increases in excursions compared to both passive motions in healthy controls. The study results can serve as a reference for evaluating excursions in patients with tendon pathology, including those who have had tendon repair and reconstruction.