Grip Strength Scores Research Articles

Effectiveness of dry needling combined with eccentric strength training in lateral epicondylalgia with trigger points

IntroductionLateral epicondylalgia (LE) is commonly presented with myofascial trigger points (MTrPs) among adults. Dry needling (DN) is used less frequently as a first-line treatment in LE with trigger points, and the short and long-term effectiveness of DN in these populations were not studied. Hence, this study compared the effectiveness of DN with conventional physiotherapy in the population of LE with myofascial trigger points.MethodsFor four weeks, the experimental group (<i>n</i> = 19) received DN with weekly one session, and the control group (<i>n</i> = 19) received therapeutic ultrasound combined with deep friction massage for 2 sessions per week at the active sites of active MTrPs. Both groups performed two eccentric exercises sessions from the 5th to the 6th week. Handgrip, pain and disability scores of patient rated tennis elbow evaluation (PRTEE) at baseline, 4th week, 6th week, and follow-up of 12th week were analysed.ResultsHandgrip strength, pain, and disability scores were significantly improved for the experimental group at 4th week (SMD of 1.21 kg in handgrip, 12.26 in PRTEE scores) and 6th week (SMD of 1.58 kg in handgrip, 10.15 in PRTEE scores) compared to the control group. However, no significant group differences (p > 0.05) after 12th week either grip strength (SMD = 0.84) or PRTEE scores (SMD = 3.74) were obtained.ConclusionsDry needling with exercise produced greater short-term improvements in grip strength and disability compared to the control group. However, no significant difference in outcomes was found between groups over a 12-week follow-up period.

Effect of mixed protein supplementation on golf performance and muscle function: a randomized, double-blind, placebo-controlled study.

As a relatively novel approach to enhancing skeletal muscle health, mixed protein supplementation has shown similar responses to whey protein. However, no previous studies have examined its impact on golf swing performance. This study aimed to examine the effect of mixed protein supplementation on the swing performance and muscle strength of casual golfers. Sixty participants with a handicap of less than 20 were recruited and randomly assigned to a double-blind, placebo-controlled study design. The participants were divided into two groups: a mixed protein group (MG, n = 30), and a placebo control group (CG, n = 30). They were instructed to ingest either a supplement containing casein calcium, whey protein, and isolated pea protein, or a placebo, once daily for 8 weeks. Pre- and posttests consisted of anthropometric measurements, muscle strength (isokinetic knee and trunk strength, and handgrip strength), 2-minute push-ups, balance, and golf swing performance using a driver and 7-iron. After the 8-week supplementation period, ANCOVA, using baseline values as covariates, revealed significant differences for driver distance (p = .004) and driver ball speed (p < .001). MG significantly increased driver distance by 5.17 ± 12.8 m (p = .046), driver ball speed by 1.36 ± 2.87 m/s (p = .021). Additionally, significantly improvements were observed in hand grip strength (+2.12 ± 3.47 kg, p = .004), two-minute push-ups (+4.89 ± 8.14 reps, p = .004), and balance score (-0.37 ± 0.69 min, p = .009). No significant differences were observed in body composition parameters (p > .05). The intake of a mixed protein containing both animal and plant proteins had positive effects on golf performance and muscle function. Therefore, mixed proteins may represent a safe and effective approach to enhancing skeletal muscle health in golf players.

Treatment Options for Coronal Plane Fractures of the Lunate in Kienböck Disease.

The treatment for Kienböck disease varies widely based on the status of the lunate. To date, there is no consensus regarding the optimal treatment for patients with coronal plane fractures of the lunate, or Lichtman Stage IIIC. Therefore, the purpose of this study was to assess whether coronal plane fractures of the lunate in Kienböck disease healed after surgical intervention, and to determine the outcomes after surgical fixation of the lunate compared with treatment with salvage procedures. A retrospective review of 36 patients with Lichtman IIIC Kienböck disease was conducted. Patients were classified into lunate reconstruction (vascularized bone graft [VBG] or non-VBG) or salvage procedures (proximal row carpectomy [PRC] or limited fusion). Preoperative and postoperative visual analog scale (VAS) pain, range of motion, grip strength, and Mayo Wrist Score (MWS) were analyzed. Radiographs and computed tomographic scans were reviewed for Lichtman stage, fracture location, union, modified carpal height ratio, Stahl index, and radioscaphoid angle. Thirteen patients underwent lunate reconstruction, 13 underwent limited fusion, and 10 underwent PRC. The overall union rate was 45% after lunate reconstruction, with average time to union of 7 months. There were no differences in union rates between VBG and non-VBG. All 3 groups experienced improvement in their postoperative grip strength and MWS. There were no statistically significant differences in preoperative to postoperative changes in clinical outcome measures between the 3 cohorts; however, when we compared lunate reconstruction with all patients who underwent salvage procedures (limited carpal fusion and PRC), we noted the latter had improved functional outcomes (P = .019). Four patients (31%) in the reconstruction cohort and 2 patients (8%) in the limited carpal fusion group required reoperation at latest follow-up. Union rate of coronal plane fractures in Kienböck disease remains variable. While the proportion of patients requiring reoperation was higher in the reconstruction group, all groups of patients experienced improvement in their clinical outcomes, without a significant difference between cohorts.

The The relationship between injury severity, grip strength and functionality in traumatic hand injuries

Purpose: This study aimed to investigate the relationship between injury severity and functionality in traumatic hand injuries.Methods: Forty-four patients with traumatic injuries to the hand were included. Patients who were grouped as minor, moderate, and severe-major by Modified Hand Injury Severity Score (mHISS) score, were evaluated with grip strength, lateral grip strength, and Sollerman Hand Function Test (SHFT) at the 4th and 12th weeks. Among the functional scales, The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Patient-Rated Hand and Wrist Evaluation (PRWHE), Health Assessment Questionnaire (HAQ) were used.Results: According to the patients’ total mHISS score, 27.2% were classified as having minor injuries, 43.1% as having moderate injuries, and 29.4% as having serious-major injuries. The first 4 weeks of the rehabilitation period showed a statistically significant increase in both grip strength and SHFT scores. Furthermore, grip strength and SHFT scores were significantly lower across all mHISS groups, with greater reductions observed in the group with more severe injuries. A significant positive correlation was observed between the total mHISS score and PRWHE, DASH, and HAQ scores in all follow-ups. As the severity score increased, functionality worsened.Conclusion: Assessing the severity of injury and functionality in these patients allows for effective management of treatment and rehabilitation, ultimately improving their functional status and general health.

Arthroscopic scaphocapitate fusion without bone graft; clinical and radiological outcomes.

Scaphocapitate fusion (SCF) is an important surgical option for carpal pathologies, which are difficult to manage as Kienböck's disease. With the advantages of arthroscopy combined with percutaneous fixation techniques, arthroscopic scaphocapitate fusion can have the best outcome for the patient from a functional perspective. This study aims to evaluate the clinical, radiological, and functional results of arthroscopic SCF. The study included thirty patients with stage IIIB and IIIC Kienböck's disease. The articular surfaces were prepared using arthroscopic burr then fixed by Herbert screw. The mean follows up period was about 29months. SCF was achieved in approximately seven weeks. There was a statistically significant difference in pre- and post-operative grip strength and Mayo wrist score. According to our study findings, arthroscopic SCF may be performed with significant improvements and satisfactory clinical and functional results in patients with stage IIIB and IIIC Kienböck's disease.

Acute Effects of Squat and Ballistic Jump Exercises on Judo-Specific Performance, Handgrip Strength, and Perceived Exertion in Young Male Judokas

This study aimed to examine the acute effects of squat and ballistic jump exercises during warm-ups on judo-specific performance in young male judokas. Using a randomized crossover design, 10 sub-junior male judokas (age: 12.9 ± 0.7 years) completed three conditions: a controlled warm-up with only judo-specific exercises and two experimental warm-ups including either a three-repetition maximum (RM) back squat (with ~90% 1RM load) or ballistic jumps (squat jumps, scissor jumps, and double-leg bounds) in addition to judo-specific warm-ups. Following each warm-up condition, participants performed the Special Judo Fitness Test (SJFT), with heart rate measured immediately and one minute post-test. Handgrip strength and ratings of perceived exertion (RPE) were recorded after the SJFT. Both squat and ballistic jump exercises significantly improved judo-specific performance compared to the control condition, with large effect sizes (ESs). The number of throws in set 2 (p = 0.001, ηp2 = 0.65, large ES), total throws (p &lt; 0.001, ηp2 = 0.70, large ES), and the SJFT index (p &lt; 0.001, ηp2= 0.65, large ES) all showed significant improvements. Regarding the throw in set 2, significant improvements were observed after both squat (p = 0.003, Hedge’s g = 1.78, large ES) and ballistic jump exercises (p = 0.010, Hedge’s g = 1.44, large ES) compared to the control condition. Similarly, total throws were significantly higher in the squat (p = 0.003, Hedge’s g = 1.51, large ES) and ballistic jump (p &lt; 0.001, Hedge’s g = 1.37, large ES) conditions compared to the control condition. Furthermore, the SJFT index showed notable improvements following squat (p = 0.010, Hedge’s g = 0.80, moderate ES) and ballistic jump (p &lt; 0.001, Hedge’s g = 0.90, moderate ES) conditions compared to control conditions. However, squat exercises led to a significant reduction in right-hand grip strength (p &lt; 0.001, ηp2 = 0.58, large ES) [p = 0.008, Hedge’s g = 0.19, trivial ES for squat vs. control; p = 0.014, Hedge’s g = 0.23, small ES for squat vs. ballistic jump], with no differences observed in left-hand grip strength or RPE scores (p &gt; 0.05). In conclusion, the integration of squat and ballistic jump exercises into warm-up protocols has been shown to significantly improve judo-specific performance in young male judokas without eliciting an increase in RPE values. However, careful consideration should be given when incorporating squat exercises, as they may lead to localized handgrip fatigue (reduced grip strength due to muscle exhaustion), which could affect performance in grip-dependent techniques.

Strength and dexterity of less affected hand of children with unilateral cerebral palsy: a comparison study with normal peers.

A key aspect of hand function is dexterity, which is described as fine voluntary movements used to manipulate small objects during a specific task. The contralateral hand in children with unilateral cerebral palsy (U-CP); is commonly referred to as a "good" and "unimpaired" hand, while others have noted that it has subtle limitations. Therefore, this study aimed to assess and compare between the strength and dexterity of less-affected hand of children with U-CP and the dominant hand of normal peers. A sample of 120 volunteer children from both sexes and age ranged from 6 to 10 years participated in this study. Out of the 120 children, sixty were normal typically developing (TD) and sixty children with U-CP. Assessment of fine motor dexterity and grip and pinch strength were carried out by the Functional dexterity test (FDT) and Pneumatic squeeze Blub Dynamometer respectively. The results showed that there was a significant lower in pinch and grip strength (p < 0.01) and significant higher FDT scores of children with U-CP compared with that of TD children (p = 0.001). Moreover, there was a significant higher functional levels in TD children compared with that of children with U-CP (p < 0.001) with no significant difference between groups in penalty distribution (p > 0.05). Children with U-CP underperformed with their less-affected hand than the dominant hand of TD age matched peers. Future researches on bilateral hand function may be used to determine the best rehabilitation interventions.

Relationship between exercise habits and social isolation in older patients with predialysis CKD: a cross-sectional study

BackgroundMaintaining exercise habits in older patients with predialysis chronic kidney disease (CKD) is important to prevent conversion to renal replacement therapy and improve prognosis. This study identified factors influencing exercise habits in older patients with predialysis CKD.MethodsThis cross-sectional study included 113 patients aged ≥ 65 years with stages 3–5 predialysis CKD who were admitted for CKD education purposes. Exercise habits were assessed using the transtheoretical model. Social isolation was assessed using the Lubben Social Network Scale (LSNS-6). Furthermore, the short physical performance battery (SPPB) and grip strength, exercise self-efficacy (SE), hemoglobin, and estimated glomerular filtration rate of the participants were assessed.ResultsAmong the 55 patients who maintained exercise habits, 20 (57.1%) were at CKD stage 3, 19 (43.2%) were at CKD stage 4, and 16 (47.1%) were at CKD stage 5. The LSNS-6, SPPB, grip strength, and exercise SE scores significantly differed between the with exercise habits group and without exercise habits group (p < 0.05). The multivariate logistic regression analysis results indicated that the LSNS-6 (OR:1.10; 95%CI:1.022–1.210) and exercise SE (OR:1.10; 95%CI:1.009–1.199) were significantly associated with exercise habits (p < 0.05). Conversely, no significant associations were found between exercise habits and SPPB, grip strength, renal function, or anemia.ConclusionsSocial isolation and SE may be an important factor influencing exercise habits in older patients with predialysis CKD.

Integrated care for older people improved intrinsic capacity in elderly patients: a case control study

ObjectivesObserve the effect of integrated care for older people on intrinsic capacity in elderly patients.MethodsSixty elderly patients from department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between June 2021 and December 2021 were selected and divided into control group and intervention group with 30 patients in each group using random sampling method. Two groups implement routine care, and the intervention group implement integrated care by a “hospital-community-family” multidisciplinary team. After 12 weeks of intervention, the differences in frailty, cognition, depression scores, comprehension social support scores, and World Quality of Life Scale scores were compared between the two groups.ResultsBefore intervention, there was no significant difference in the grip strength, step speed, frailty scores, cognition, depression scores, social support and quality of survival between the control group and the intervention group. After intervention, grip strength and depression scores improved both in the control group and the intervention group, but there was no difference between the two groups. Cognitive scores, comprehension social support and quality of survival scores improved only in the intervention group, while only the cognitive ability showed significant differences between the intervention group and the control group after 12 weeks of intervention (P<0.05).ConclusionsIntegrated care for older people intervention can help to improve the intrinsic capacity of the patients, especially cognitive abilities.

What Is the Optimal Method of Fixation for Scaphoid Nonunion Relative to the Location of the Lesion?

Scaphoid nonunion is a typical complication of scaphoid fractures, with the nonunion rate varying by the location of the scaphoid. The current widely used method for treating scaphoid nonunion, which is challenging for surgeons, is the headless compression screw (HCS). Various surgical approaches, such as the scaphoid plate, have been proposed to address the problem of screw fixation; however, no consensus exists regarding the optimal treatment method. This study focused on analyzing appropriate treatment methods based on the anatomical location of the scaphoid nonunion. Ninety-seven patients with scaphoid nonunion were treated between 2008 and 2023. All patients underwent treatment using 1 HCS or scaphoid volar locking plate with nonvascularized bone graft from the distal radius depending on the scaphoid's location. The scaphoid angle and bone union were confirmed using radiological examinations. The clinical evaluations included range of motion, pain, grip strength, and functional wrist scores. Fifty-seven patients were included in the final analysis. In the screw group, 26 patients (26/42 [62%]) obtained a bone union, and all 15 patients (15/15 [100%]) in the plate group obtained a union ( P = 0.005). In the waist group, 16 patients with screw (16/25 [64%]) and 8 using a plate (8/8 [100%]) showed bony healing. In the proximal group, 3 patients with HCS (3/9 [33%]) and 4 using plate (4/4 [100%]) showed bone union. In the distal group, 7 patients with a screw (7/8 [87%]) and 3 with the plate (3/3 [100%]) showed bone union. Significant differences were found in the waist ( P = 0.047) and proximal groups ( P = 0.026), but not in the distal group ( P = 0.521). All groups showed improved radiological angles associated with the scaphoid and better clinical outcomes postoperatively. Plate fixation was overall superior to screw fixation for scaphoid nonunion, especially in the waist and proximal poles, providing better union rates and stability. For the distal group, both methods are effective, with the choice depending on the surgeon's expertise and patient factors. The results highlight the importance of the lesion's anatomical location in selecting the appropriate fixation method.

Prevalence and factors associated with sarcopenia among urban and rural Indian adults in middle age: A cross-sectional study from Western India.

Sarcopenia is the age-related loss of muscle mass and function. India has 8.6% of the global elderly (>60 years) population, and this is expected to increase to 20% by 2050. Around 70% of Indians live in rural areas where lifestyle factors like diet and physical activity differ from urban areas. Understanding age, sex and location-specific sarcopenia prevalence in India is crucial. Thus, our aim was to assess the prevalence and determinants of sarcopenia in urban and rural community-dwelling men and women aged 40 years and older, representing the next generation of older Indian adults. This cross-sectional study included 745 adults (400 women) from urban and rural areas near Pune, Western India. Assessments included socio-demography, diet by-24-hr recall, physical activity, anthropometry (height, weight), muscle mass measurement by dual-energy X-ray absorptiometry, muscle strength (hand grip) & muscle function by Short Physical Performance Battery (SPPB). Sarcopenia was defined by Asian Working Group on Sarcopenia-2019 guidelines Mean age of participants was 53±7.6yrs. Overall prevalence of sarcopenia was 10% and of severe sarcopenia was 4.2%. Sarcopenia prevalence was higher in rural (14.8%) than urban (6.8%) participants and in men (12.5%) than women (8%, all p<0.05). Muscle mass, grip strength and SPPB score were all higher in urban than rural participants (p<0.05). Older age, rural residence, inadequate protein intake, and lower socio-economic status were independently associated with sarcopenia. In this middle-aged group, sarcopenia prevalence was similar to that observed in older Western populations, over 100% higher among rural than urban participants, and higher amongst men than women. Age, location, protein intake and socioeconomic status were factors associated with sarcopenia. Given this rapidly increasing population of older adults in India there is an urgent need to plan strategies for early sarcopenia diagnosis and management, especially in rural populations.

The Prevalence of Sarcopenia and its Impact on Function In Older Adults In a Rehabilitation Unit

Abstract Background Sarcopenia is the leading cause of declining physical functioning and is a significant component of frailty, sharing similar characteristics. It is prevalent among older adults undergoing rehabilitation and is a negative predictor of functional recovery. Methods A retrospective cohort study was undertaken in a Rehabilitation Unit from January to March 2024. Variables included age, gender, mBarthel Index (mBI), Clinical Frailty Scale (CFS), hand grip strength and Timed Up and Go (TUG). The European Working Group on Sarcopenia for Older People criteria was utilised to interpret hand grip strength and TUG scores. Results Sixty-four patients, 33 (52%) male and 31 (48%) female were included. The mean age was 78 years (SD = 8.13). Fifty-five (86%) had their grip strength assessed, of which 20 (36%) had probable sarcopenia. Nineteen patients (95%) with probable sarcopenia had a TUG completed with a mean of 59.88 (SD = 28.86) seconds. In the non-sarcopenia group, 33 (94%) had a TUG assessment with a mean of 53.21 (SD = 39.82) seconds. The median CFS was 6 (IQR: 6, 6.5) in the probable sarcopenia group and also 6 (IQR: 5, 7) in the non-sarcopenia group. The median mBI of those with probable sarcopenia was 10 (IQR: 7, 14) compared to 12 (IQR: 8, 14) in the non-sarcopenia group. The probable sarcopenia group was significantly older (mean: 81.7, SD = 7.92) than the non-sarcopenia group (mean: 75.8, SD = 8.05), (P = 0.011). There was no significant difference in the median length of stay (LOS) between the probable sarcopenia group: 29 days (IQR: 24.5, 42.5), and the non-sarcopenia group: 28 days (IQR: 18, 49), (P = 0.51). There was no difference in rate of home discharge between the probable sarcopenia group (80%) and the non-sarcopenia group (82.8%), (P = 1.00). Conclusion Sarcopenia is often overlooked in clinical practice, however, it is reversible with multi-component targeted interventions such as nutritional care and resistance training.

Long-Term Effects and Impressions of Minimal Footwear in Older Adults

Introduction: Foot pathologies can lead to difficulty walking and falls in older adults. Intrinsic foot muscles contribute to the structural support and alignment of the foot and provide somatosensory input from the ground. Minimally cushioned footwear may naturally strengthen intrinsic foot muscles and enhance sensory input to the foot; however, these effects are largely unknown in older adults. Further, there is little evidence regarding the prescription of minimal footwear and the perceptions of this footwear by older adults. Methods: Twenty-four adults age ≥65 volunteered to use minimal footwear for prescribed times during daily activities for 16 weeks. The cross-sectional area (CSA) of 5 intrinsic foot muscles was measured using ultrasound imaging at baseline, 8 weeks, and 16 weeks. Semi-structured interviews were recorded regarding participants’ impressions of the footwear, the progressive wear schedule, the footwear’s effects on orthopedic-related pain, balance, and foot awareness/sensation. Results: Across the cohort, there was no significant difference in CSA of the 5 muscles after 16 weeks of minimal footwear use. Thirteen participants had clinically meaningful increased CSA of the abductor hallucis muscle (Abh). These positive responders had no significant differences in age, grip strength, foot structure, or fall risk scores compared to participants with little to no CSA change. Interview results indicated a generally positive experience with minimal footwear for 68.1% of the cohort. A large percentage of the cohort reported no difficulty with the progressive wear schedule (77.2%), no aggravation of preexisting conditions and no new pain (77.2%), improved balance (63.6%), and improved foot awareness/sensation (72.7%) with minimal footwear use. The progressive wear schedule was perceived as inconvenient by some in the first few weeks (22.8%), but resulted in mild to no adverse effects when followed as prescribed. Conclusion: Sixteen weeks of progressive minimal footwear use in older adults did not lead to changes in intrinsic foot muscle CSA; however, half of the cohort had clinically meaningful increased CSA in the Abh muscle. It is unclear what individual qualities were associated with this positive response. Older adults reported generally positive experiences with minimal footwear with self-reported improvements in balance and foot awareness/sensation. The wear schedule may have been too conservative or not long enough to produce foot muscle hypertrophy, but subjective reports suggest beneficial neuromuscular adaptations and sensory changes occurred. Future research may need a greater length of time and larger samples to further determine the effects of long-term minimal footwear use in older adults.

Fall Trajectories in Older Men: Trajectories of Change by Age and Predictors for Future Fall Risk.

Very little is known about specific trajectories or patterns of falls over time. Using the well-characterized cohort of the Osteoporotic Fractures in Men Study (MrOS), we classified individuals by fall trajectories across age and identified predictors of group assignment based on characteristics at baseline. Using an analysis sample of 5 976 MrOS participants and 15 years of follow-up data on incident falls, we used group-based trajectory models (PROC TRAJ in SAS) to identify trajectories of change. We assessed the association of baseline characteristics with group assignment using 1-way analysis of variance and chi-square tests. Multivariable logistic regression was used to analyze the outcome of the high-risk fall trajectory groups compared to the low-risk groups. Changes in rates of falls were relatively constant or increasing with 5 distinct groups identified. Mean posterior probabilities for all 5 trajectories were similar and consistently above 0.8 indicating a reasonable model fit. Among the 5 fall trajectory groups, 2 were deemed high risk, those with steeply increasing fall risk and persistently high fall risk. Factors associated with fall risk included body mass index, use of central nervous agents, prior history of diabetes and Parkinson's disease, back pain, grip strength, and physical and mental health scores. Two distinct groups of high fall risk individuals were identified among 5 trajectory groups, those with steeply increasing fall risk and persistently high fall risk. Statistically significant characteristics for group assignment suggest that future fall risk of older men may be predictable at baseline.

Regional differences in frailty among older adults with type 2 diabetes: a multicenter cross-sectional study in Japan

BackgroundSocial environment may broadly impact multifaceted frailty; however, how environmental differences influence frailty in older adults with diabetes remains unclear. This study aimed to investigate regional differences in frailty in urban and rural areas among older adults with diabetes.MethodsThis cross-sectional study was conducted as part of the frailty prevention program for older adults with diabetes study. Older adults aged 60–80 years who could independently perform basic activities of daily living (ADLs) were enrolled sequentially. Trained nurses obtained patient background, complications, body weight, body composition, blood tests, grip strength, frailty assessment, and self-care score results. Regional differences in frailty were evaluated using logistic and multiple linear regression analyses.ResultsThis study included 417 participants (269 urban and 148 rural). The prevalence of robustness was significantly lower in rural areas than in urban areas (29.7% vs. 43.9%, p = 0.018). Living in rural areas was associated with frailty (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.38–4.71) and pre-frailty (OR 2.10, 95%CI 1.30–3.41). Lower instrumental ADL (B 0.28, standard error [SE] 0.073) and social ADL (B 0.265, SE 0.097) were characteristics of rural residents.ConclusionsRegional differences in frailty were observed. Older adults with diabetes living in rural areas have a higher risk of frailty owing to a decline in instrumental and social ADLs. Social environment assessment and intervention programs that include communication strategies to enable care and social participation across environments are crucial to the effective and early prevention of frailty.

COMPARISON OF LIGAMENT Z-PLASTY AND CONVENTIONAL SURGERY FOR THE TREATMENT OF CARPAL TUNNEL SYNDROME. A RANDOMIZED CLINICAL TRIAL.

Conventional surgery performed to treat carpal tunnel syndrome (CTS) is associated with complications such as pillar pain or loss of strength. This study aimed to compare the incidence of pillar pain between two techniques at the 3-week and 6-month follow-up and to determine any differences in the recovery of grip strength (GS), pinch strength (PS), and Boston Carpal Tunnel Questionnaire (BCTQ) scores. This randomized clinical trial comprised 109 patients of which 55 underwent ligament Z-plasty and 54 underwent conventional surgery (longitudinal section of the transverse carpal ligament without posterior closure). The GS, PS, presence of pillar pain, and BCTQ scores were assessed preoperatively and after 3 weeks and 6 months. The incidence of pillar pain after 3 weeks was lower in patients undergoing Z-plasty than in those undergoing conventional surgery (25.5% vs. 44.4%, p = 0.04). Moreover, the absolute change in the PS after 3 weeks (p = 0.01) and GS after 6 months (p = 0.05) and the absolute and relative changes in the PS after 6 months (p = 0.008 and p = 0.01, respectively) were significantly higher in the Z-plasty group than in the conventional surgery group. Z-plasty is a valid surgical procedure for treating CTS. It is associated with a lower incidence of pillar pain and better recovery of postoperative strength compared to the conventional surgical technique, with both techniques showing similar results in CTS recovery.

Autonomic Nervous System and Sarcopenia in Elderly Patients: Insights from Long-Term Heart Rate Variability Monitoring in a Hospital Setting.

Emerging evidence suggests a link between muscle health and the autonomic nervous system, but research is scarce. This study examines the connection between long-term heart rate variability (HRV) measured autonomic function and sarcopenia in the elderly, focusing on muscle mass and strength. This retrospective cross-sectional study comprised 132 elderly hospitalized patients. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, involving reduced muscle mass and strength. HRV was assessed using standard deviation of NN intervals (SDNN), with values below 100 milliseconds indicating reduced HRV. Multivariate logistic regression and Pearson's correlation analyses were conducted to explore the associations between sarcopenia, muscle metrics, and HRV parameters. Among elderly hospitalized patients, 45.45% had reduced HRV, with sarcopenia patients showing a fivefold higher risk (OR: 5.042; p = 0.034). Grip strength and SARC-CalF scores were independent factors associated with reduced HRV. Moderate correlations were noted between grip strength and HRV indices, particularly with SDNN (r = 0.393, p = 0.001) and the triangular index (r = 0.385, p < 0.001), while a weaker correlation was found with very low frequency power (VLF) (r = 0.283, p = 0.006). No significant correlations were identified between HRV and muscle mass. Regression analyses revealed significant independent associations between HRV parameters and the decline in muscle strength and the onset of sarcopenia. Reduced HRV is closely linked to sarcopenia and diminished muscle strength in the elderly, with the triangular index and SDNN as key indicators, highlighting HRV's potential in muscle health assessment.

Efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to assess the efficacy of mirror neuron system-based therapy for managing pain and improving motor and upper limb function in patients with upper limb orthopedic conditions. Systematic bibliographical searches of the PubMed, SCOPUS, and CENTRAL registries and databases up to September 2023 were conducted to find randomized controlled trials (RCTs) assessing the efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions. Two reviewers assessed the RCTs using a Cochrane risk-of-bias tool and extracted data from studies with similar outcome measures in the domains of pain, motor function, or functional score, which were pooled into meta-analyses. The review included 13 studies to compare the efficacy of mirror neuron system-based therapy with that of conventional rehabilitation programs. The therapy reduced pain intensity (mean difference [MD] 2.04, 95% confidence interval [CI] 1.46-2.63) and kinesiophobia (MD 8.43, 95% CI 6.98 to 9.88), and increased grip strength (MD 1.86, 95% CI 0.28-3.45). The therapy also improved upper limb functional outcomes as assessed by the 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score (MD 13.52, 95% CI 10.63-16.41). However, the outcomes as assessed by the 11-item QuickDASH questionnaire and the Shoulder Pain and Disability Index (SPADI) were not superior to conventional rehabilitation. Mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions may reduce pain intensity and kinesophobia, and improve grip strength and DASH scores compared with conventional rehabilitation programs. However, this interpretation is limited by the heterogeneity and various quality of the RCTs included in our meta-analysis.

Cervical spinal cord morphometrics in degenerative cervical myelopathy: quantification using semi-automated normalized technique and correlation with neurological dysfunctions

Degenerative cervical myelopathy (DCM) is characterized by spinal cord atrophy. Accurate estimation of spinal cord atrophy is key to the understanding of neurological diseases, including DCM. However, its clinical application is hampered by difficulties in its precise and consistent estimation due to significant variability in spinal cord morphometry along the cervical spine, both within and between individuals. To characterize morphometrics of the compressed spinal cord in DCM patients. We employed our semiautomated analysis framework that incorporates the Spinal Cord Toolbox (SCT) and a normalization approach to effectively address the challenges posed by cord compression in these patients. Additionally, we examined the clinical relevance of these morphometric measures to enhance our understanding of DCM pathophysiology. Prospective study. This study investigated 36 DCM patients and 31 healthy controls (HCs). Clinical scores including 9-hole peg test for hand dexterity, hand grip strength, balance, gait speed, modified Japanese Orthopaedic Association (mJOA) score, and imaging-based spinal cord morphometrics. Using the generic spine acquisition protocol and our semiautomated analysis pipeline, spinal cord morphometrics, including cross-sectional area (CSA), anterior-posterior (AP) and transverse (RL) diameters, eccentricity, and solidity, were estimated from sagittal T2w magnetic resonance imaging (MRI) images using the Spinal Cord Toolbox (SCT). Normalized metrics were extracted from the C1 to C7 vertebral levels and compared between DCM patients and HC. Morphometric data at regions of maximum spinal cord compression (MSCC) were correlated with the clinical scores. A subset of participants underwent follow-up scans at 6 months to monitor longitudinal changes in spinal cord atrophy. Spinal cord morphometric data were normalized against the healthy population morphometry (PAM50 database) and extracted for all participants. DCM patients showed a notable reduction in CSA, AP, and RL diameter across all vertebral levels compared to HC. MSCC metrics correlated significantly with clinical scores like dexterity, grip strength, and mJOA scores. Longitudinal analysis indicated a decrease in CSA and worsening clinical scores in DCM patients. Our processing pipeline offers a reliable method for assessing spinal cord compression in DCM patients. Normalized spinal cord morphometrics, particularly the CSA could have potential for monitoring DCM disease severity and progression, guiding treatment decisions. Furthermore, to our knowledge our study is the first to apply the generic spinal cord acquisition protocol, ensuring consistent imaging across different MRI scanners and settings. Coupled with our semiautomated analysis pipeline, this protocol is key for the detailed morphometric characterization of compressed spinal cords in patients with DCM, a disease that is both complex and heterogenous. This study was funded by the National Institute of Neurological Disorders and Stroke (NINDS) (K23:NS091430) and (R01: NS129852-01A1).

Three-corner arthrodesis for scapholunate and scaphoid nonunion advanced collapsed wrists: outcomes at long term follow-ups

ObjectivesThis study aimed to assess clinical, functional and radiological outcomes after three-corner arthrodesis in patients suffering from symptomatic scapholunate or scaphoid non-union advanced collapsed wrists. We hypothesised that three-corner arthrodesis provided satisfactory clinical and radiological results in the long term. Material and methodsThis was a retrospective study of 13 patients (14 wrists) who underwent a three-corner arthrodesis between March 2004 and January 2019 with a mean follow-up of 6,7 years. Clinical assessment consisted of wrist motion, grip strength, pain and functional scores (Quick-DASH, PRWE, MWS). All complications and surgical revisions were investigated. Radiographic assessment searched for union, evaluated carpal height and ulnar translation, lunate tilt and occurrence of radio-lunate arthritis. ResultsAt the last follow-up Quick-DASH and PRWE scores were 24,87(± 17.2) and 47.4 (± 26.9) respectively and were significantly improved. Wrist motion was 35°, 32°, 10° et 24° of flexion, extension, radial and ulnar deviation respectively. Union was obtained for 13 (92,9%) wrists. The mean radiolunate angle was 11° (-17°-34°). Three patients needed reintervention, which 2 consisted of total wrist arthrodesis due to persisting pain. Mild signs of radio-lunate arthritis were found in three patients. ConclusionThree-corner arthrodesis seemed to provide satisfactory long-term functional outcomes. The union rate was high and even patients with signs of radio-lunate arthritis still had improved outcomes at the last follow-up. It could be a part of surgical options in wrists with radio- and midcarpal arthritis, among other procedures.