Hand Dominance Research Articles

The Effect of Upper Extremity Slings (UESs) on Balance in Young Adults.

Upper extremity slings (UESs) are frequently provided for patients with a hand or forearm injury. However, their effect on balance has not been well explored. We sought to characterize the effect of a UES on balance in young adults. Healthy young adult participants with no injuries acting as a proxy for the general young adult patient population using UESs balanced on a BioDex Balance System platform: once while wearing a UES and once without wearing it, to serve as their own control. Participant weight, height, gender, hand dominance, overall stability index, anterior/posterior stability index, and medial/lateral stability index were recorded. Comparisons were analyzed with paired t-tests and linear regression analysis. Results: No significant difference in the three stability index scores were found between UES and no UES usage. Height and weight were found to have positive significant relationships with the overall stability index during UES usage. Conclusions: Our study demonstrates the feasibility of assessing balance discrepancies between the sling and nonsling usage in a broader patient population and suggests that height and weight may impact balance negatively during UES use.

The Minimum Clinically Important Difference for the Patient-Rated Wrist Evaluation in Surgical Fixation of Distal Radius Fractures: Does Hand Dominance Make a Difference?

BackgroundDistal radius fractures (DRFs) are common orthopaedic injuries. They can be treated in many ways, but the volar locking plate (VLP) is more frequent. Currently, there is limited information regarding the minimum clinically important difference (MCID) in surgically treated DRFs. The purpose of this study was to calculate MCID values for the Patient-Reported Wrist Evaluation (PRWE) in the setting of VLP-treated DRFs. MethodsA retrospective review was conducted for patients with isolated, surgically-treated DRFs with a VLP. Exclusions included any concomitant procedure other than a carpal tunnel release, skeletal immaturity, polytrauma, open fracture, or missing PRWE data. MCID was calculated using PRWE, an overall health question, and the anchor-based method. ResultsA total of 131 patients were identified. Approximately 54.2% injured their dominant hand. AO/OTA classification 23C was the most common (n=89, 67.9%). Average baseline, 6-week, and 12-week PRWE were 71.8 ± 19.6, 34.3 ± 20.1, and 21.2 ± 18.0 respectively. This corresponds to an average change from baseline PRWE at 6 weeks and 12 weeks of -37.5 ± 23.4 and -50.6 ± 22.3, respectively.Average MCID values for 6 weeks and 12 weeks were 43.1 ± 18 and 56.0 ± 20.0, respectively (p<0.001). Hand dominance did not correlate with MCID value (rs = 0.084 at six weeks, rs = 0.099 at 12 weeks). MCID value additionally did not correlate with sex, AO/OTA classification, smoking status, ASA score, or BMI. Treatment at a level 1 trauma center and diagnosis of anxiety and/or depression correlated with a higher 6-week MCID value (rs = 0.308 and rs = 0.410, respectively). Increasing age weakly correlated with higher 12-week MCID value (rs = 0.352). ConclusionsThis study demonstrated an MCID calculation using an overall health anchor. MCID value varied with follow-up time and correlated weakly with age, diagnosis of anxiety and/or depression, and treatment facility, but it did not correlate with injury of the dominant hand. Future research should analyze how to apply MCID and identify successful treatment in the setting of DRF care.

Paper 17: Decreased Glenohumeral External Rotation is associated with Elbow Injury in Adolescent Baseball Pitchers

Objectives: To compare bilateral standard glenohumeral range of motion, humeral torsion &amp; humeral torsion-corrected glenohumeral range of motion within and between healthy adolescent baseball pitchers &amp; adolescent baseball pitchers who have an injury to the throwing elbow. Secondarily, to analyze the relationship between humeral torsion angle and glenohumeral rotational motion in adolescent pitchers. Methods: Baseball pitchers aged 13-17 were prospectively enrolled into either a healthy group, if currently pitching in the community without complaint or injured group, if they presented to clinic for an elbow injury related to pitching. Bilateral standard glenohumeral internal &amp; external rotation was measured in degrees using a bubble goniometer with the scapulothoracic joint manually stabilized. Bilateral humeral torsion angles were measured using an Ultrasound &amp; bubble goniometer and were used to calculate humeral torsion-corrected glenohumeral range of motion. Parametric tests were used to compare values within and between groups for both the dominant and non-dominant extremities with significance defined as p&lt;0.05. Pearson’s correlation was used to evaluate the relationship between humeral torsion and standard glenohumeral motion in each group. Results: Twenty-nine healthy and twenty-five injured pitchers were enrolled with no difference in age or hand dominance between groups. The dominant shoulder of both the healthy (Table 2) and injured (Table 3) groups demonstrated a significant increase in humeral retrotorsion with increased standard glenohumeral external rotation &amp; GIRD. However, no difference in humeral torsion-corrected range of motion was present within groups. Injured pitchers displayed less standard &amp; humeral torsion-corrected external rotation of the dominant shoulder as well as less standard external rotation of the non-dominant shoulder compared to the healthy pitchers (Table 4). No difference in internal rotation measurements or humeral torsion was found between groups. A moderate correlation was found between ipsilateral humeral torsion angle and standard glenohumeral external (r=0.49) &amp; internal rotation (r=-0.58) in the dominant shoulder of healthy pitchers (Figure 1) but no correlation (r&lt; 0.3) was found between these measures in the dominant shoulder of injured pitchers. Conclusions: Both healthy &amp; injured adolescent baseball pitchers displayed dominant shoulder GIRD, external rotation gain &amp; retrotorsion of the humerus. In healthy pitchers, dominant glenohumeral motion was correlated to the humeral torsion angle suggesting that the osseous adaptation of humerus significantly contributed to these findings. However, this correlation was not found in the injured pitchers, suggesting that soft tissue factors played a larger role in the development of GIRD &amp; external rotation gain in this group. Additionally, injured pitchers displayed less standard glenohumeral external rotation of both shoulders and less humeral torsion-corrected external rotation of the dominant shoulder compared to healthy pitchers. This suggests a baseline difference in the soft tissue and/or structure of the pitchers’ shoulders between groups. Glenohumeral internal rotation and humeral retrotorsion were not associated with injury status in our study. Clinically, this study suggests that rehabilitation programs including modalities to improve external rotation may be of benefit for adolescent baseball pitchers with elbow injuries &amp; further research on the structural variations of the adolescent pitching shoulder is needed. [Table: see text][Table: see text][Table: see text]

Paper 19: Fatigue of the Dynamic Stabilizers of the Medial Elbow in Baseball Pitchers

Objectives: The flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) are thought to provide dynamic stability to the medial elbow, with a lesser contribution from the pronator teres (PT). The purposes of this study were to: (1) determine whether middle finger (MF) and/or ring finger (RF) flexion strength tests selectively activate the FCU and FDS, and (2) determine if MF or RF fatigue are more sensitive measures of pitching fatigue than grip strength. It was hypothesized that MF and RF flexion strength tests would selectively activate the FCU and FDS and that MF and RF fatigue during a pitching performance would occur earlier and be more pronounced than grip fatigue. Methods: Surface electromyographic (EMG) signals were recorded from the FCU, FDS and PT during hand-held dynamometry testing of MF and RF flexion strength in 10 healthy men (36±12 yr). EMG amplitudes, expressed as percent of maximal voluntary contraction (MVC) based on standard MVC tests for each muscle, were compared between tests and muscles with repeated measures analysis of variance (ANOVA). Field Testing was performed in 18 baseball pitchers (age 17±4 yr) throwing 4 innings of a simulated game (16 pitches per inning plus 5 warm up pitches each inning; 10 fast balls, 4 curve balls, 2 change ups per inning). MF flexion, RF flexion, and grip strength were recorded prior to the game and after each inning. A standard full grip test (FG) and a modified 3 finger grip test (3F) were employed. Fatigue responses for the 4 tests (MF, RF, FG, 3F) were compared between tests with 4x4 (innings by test) repeated measures ANOVA. Additionally, fatigue was classified as marked (&gt;20% loss), moderate (10-20% loss) or minimal (&lt;10% loss). It was estimated that with 18 pitchers there would be 80% power to detect a 10% difference in fatigue between tests (P&lt;0.05). Results: The MF and RF tests activated the FCU (MF 66%, RF 93%) and FDS (MF 74%, RF 61%) more than the PT (MF 35%, RF 23%; muscle effect P=0.008) indicating that both tests targeted the dynamic stabilizers of the medial elbow. In the baseball pitchers MF strength was greater on the dominant versus nondominant hand (7% P=0.039). There was no hand dominance effect for the other three tests (RF P=0.154, FG P=0.790, 3F P=0.897). The fatigue responses differed significantly between tests (P&lt;0.001). After the fourth inning MF fatigue (21%) was greater than RF (7%, P&lt;0.001), FG (5%, P=0.002) and 3F (5%, P&lt;0.001) fatigue. MF fatigue was evident early and was progressive. After the first inning 4 pitchers (22%) had marked MF fatigue and 3 (17%) had moderate MF fatigue. By the end of the fourth inning 10 pitchers (56%) had marked MF fatigue and 6 (33%) had moderate MF fatigue. By contrast, after four innings only 5 pitchers (28%) had marked RF fatigue, and only 3 pitchers (17%) had marked FG or 3F fatigue. Conclusions: The MF flexion test is a valid test of fatigue in the dynamic stabilizers of the medial elbow during a baseball pitching performance. After only 4 innings more than 50% of pitchers had marked MF fatigue and 89% had some evidence of MF fatigue. MF flexion training to improve fatigue resistance is recommended to maintain dynamic stability of the medial elbow during a pitching performance.

Regional assessments of supraspinatus muscle stiffness in normal adults using shear wave elastography

ObjectivesTo provide normal references for regional shear wave elastography assessments of supraspinatus muscle in a population. MethodsShear wave elastography images of supraspinatus muscles were evaluated on 100 shoulders of 50 normal adults in a fixed position with 30° shoulder abduction both at rest and contraction. Shear wave velocity values and activity values of intramuscular tendon, anterior superficial, anterior deep, posterior superficial, posterior deep, and central subregions were measured. The possible differences in hand dominance, sexes, stratified age groups, and internal muscular-component subregions were discussed. ResultsThe results showed that shear wave velocity values at rest and activity values differed significantly among supraspinatus muscular-component subregions. Shear wave velocity values at rest were normally highest in posterior deep and lowest in central subregions, whereas activity values were highest in central subregions. The results also showed evaluation of the intramuscular tendon using shear wave elastography to be practicable. The differences in shear wave velocity values at rest between the dominant and nondominant sides were not significant in each subregion, while the values at rest of the majority of subregions were significantly greater in males than in females. Stratified by age groups of 10 years, the shear wave velocity values at rest of some subregions tended to increase with age, with uncorrelations possibly related to insufficient sample sizes and different intensities of limb activities. ConclusionsThis study suggested that regional assessments of supraspinatus stiffness using shear wave elastography are feasible, with further research supporting that it can provide information on the surgery, training, and rehabilitation of rotator cuff tears.

BEST: BERT Pre-training for Sign Language Recognition with Coupling Tokenization

In this work, we are dedicated to leveraging the BERT pre-training success and modeling the domain-specific statistics to fertilize the sign language recognition~(SLR) model. Considering the dominance of hand and body in sign language expression, we organize them as pose triplet units and feed them into the Transformer backbone in a frame-wise manner. Pre-training is performed via reconstructing the masked triplet unit from the corrupted input sequence, which learns the hierarchical correlation context cues among internal and external triplet units. Notably, different from the highly semantic word token in BERT, the pose unit is a low-level signal originally locating in continuous space, which prevents the direct adoption of the BERT cross entropy objective. To this end, we bridge this semantic gap via coupling tokenization of the triplet unit. It adaptively extracts the discrete pseudo label from the pose triplet unit, which represents the semantic gesture / body state. After pre-training, we fine-tune the pre-trained encoder on the downstream SLR task, jointly with the newly added task-specific layer. Extensive experiments are conducted to validate the effectiveness of our proposed method, achieving new state-of-the-art performance on all four benchmarks with a notable gain.

Endoscopic Versus Open Carpal Tunnel Surgery: Risk Factors and Rates of Revision Surgery

The purpose of our study was to compare the 1-year revision surgery rates and outcomes of open versus endoscopic carpal tunnel release. Our hypothesis was that, compared to open release, endoscopic carpal tunnel release was an independent risk factor for revision surgery within 1-year. This was a retrospective cohort study of 4338 patients undergoing isolated endoscopic or open carpal tunnel release. Demographic data, medical comorbidities, surgical approach, need for revision surgery, hand dominance, history of prior injection, and Patient Reported Outcomes Measurement Information System upper extremity (UE), pain interference (PI) and physical function scores were analyzed. Multivariable analysis was used to identify the risk factors for revision surgery within one year of the index procedure. In total, 3280 patients (76%) underwent open and 1058 (24%) underwent endoscopic carpal tunnel release. Within one year of the index procedure, 45 patients required revision carpal tunnel release. The average time to revision was 143 days. The rate of revision carpal tunnel release in the open group was 0.71% compared to 2.08% in the endoscopic group. Multivariable analysis demonstrated that endoscopic surgery, male sex, cubital tunnel syndrome, tobacco use, and diabetes were associated independently with revision surgery. In this study, we found that endoscopic carpal tunnel release was associated independently with a 2.96 times greater likelihood of requiring revision carpal tunnel release within one year, compared to open carpal tunnel release. Male sex, concurrent cubital tunnel syndrome, tobacco use, and diabetes also were associated independently with greater risk of needing revision carpal tunnel release within one year. Prognostic II.

Eye dominance and minor physical anomalies in schizophrenia: relations between two biological markers of abnormal neurodevelopment

Background To investigate the frequency of left eye dominance and minor physical anomalies (MPAs) in schizophrenia patients and control subjects and determine the interrelations of these two biological markers of neuronal dysontogenesis in schizophrenia. Subjects and methods Three tests for eye dominance were administered as performance tasks, not preference questionnaires. Seven MPAs were examined. The sample consisted of 180 (98 schizophrenia patients and 82 control subjects). Several statistical methods for examining the eye tests separately and together were used to assess the difference in left-eyedness between schizophrenia patients and control subjects. Results Left eye dominance is significantly higher in schizophrenia subjects. Left-eyed subjects are more stigmatized with MPAs. There is a strong positive correlation between left-eyedness and stigmatization with MPAs in schizophrenia patients. Conclusion As hand dominance is under cultural pressure, eye dominance is culturally independent and is useful and reliable indicator of altered hemispheric lateralization. The significant positive correlations between left-eyedness and MPAs and the high concurrence of these biological markers in schizophrenia patients are a potent indicator of underlying aberrant neurodevelopment.

Psychological factors and symptom duration are associated with exercise-based treatment effect in people with hypermobile shoulders: A secondary analysis of a randomised controlled trial

BackgroundShoulder symptoms are common in patients with hypermobility spectrum disorders (HSD), but few studies focus on identifying factors associated with treatment effects. AimTo identify baseline and clinical characteristics associated with a better outcome 16 weeks after starting an exercise-based treatment in patients with HSD and shoulder symptoms. DesignExploratory secondary analysis of data from a randomised controlled trial. MethodSelf-reported treatment outcome was reported as change between baseline and follow-up after 16 weeks of high-load or low-load shoulder strengthening. Multiple linear and logistic regressions were used to investigate associations of patient expectations of treatment effect, self-efficacy, fear of movement, and symptom duration with change in shoulder function, shoulder pain, quality of life, and patient reported health change. All regression models were performed firstly with adjustments for covariates (age, sex, body mass index, hand dominance, treatment group, and baseline score of the outcome variable) and secondly with additional adjustments for exposure variables. ResultsExpectations of complete recovery were associated with an increased odds of perceiving an important improvement in physical symptoms after a 16-week exercise-based treatment program. Higher self-efficacy at baseline seemed to be associated with improved shoulder function, shoulder pain and quality of life. A higher fear of movement seemed to be associated with increased shoulder pain and decreased quality of life. A longer symptom duration was associated with decreased quality of life. ConclusionExpectations of complete recovery, higher self-efficacy, lower fear of movement and shorter symptom duration seem to be important for better treatment outcomes.

Kinematic differences between left- and right-handed cricket fast bowlers during the bowling action.

Despite differences between left- and right-handed athletes in other sports, minimal evidence exists regarding biomechanical similarities and differences between left- and right-handed cricket fast bowlers performing an equivalent task. This study aimed to compare the kinematics between left and right-handed fast bowlers performing an equivalent task (i.e. bowling 'over the wicket' to a batter of the same handedness as the bowler). Full body, three-dimensional kinematic data for six left-handed and 20 right-handed adolescent, male, fast bowlers were collected using the Xsens inertial measurement system. Time-normalised joint and segment angle time histories from back foot contact to follow-through ground contacts were compared between groups via statistical parametric mapping. Whole movement and subphase durations were also compared. Left-handed players displayed significantly more trunk flexion from 49%-56% of the total movement (ball release occurred at 54%; p = 0.037) and had shorter back foot contact durations on average (0.153 vs 0.177 s; p = 0.036) compared to right-handed players. Left- and right-handed bowlers displayed similar sagittal plane kinematics but appeared to use non-sagittal plane movements differently around the time of ball release. The kinematic differences identified in this study can inform future research investigating the effect of hand dominance on bowling performance and injury risk.

Pediatric Hand and Wrist Fractures in Osteogenesis Imperfecta: An Analysis of Incidence, Patient-specific Risk Factors, and Fracture-specific Characteristics.

Children with osteogenesis imperfecta (OI) frequently present with fractures; however, hand and wrist fractures (HWFs), those distal to the radial and ulnar diaphysis, are seldom observed. Yet, HWFs remain among the most common fractures in children with non-OI. The objective of this study was to identify the incidence of OI HWFs. Secondary objectives aimed at identifying patient-specific risk factors for HWFs in OI and comparing clinical courses to non-OI HWFs. A retrospective cohort study was conducted. Database query by ICD-10 codes identified 18 patients with OI HWF, 451 patients with OI without HWFs, and 26,183 patients with non-OI HWF. Power analysis estimated appropriate sample sizes and random sampling was utilized to collect patients. Patient demographics, OI-specific variables, fracture morphology, and fracture clinical courses were recorded. Data were analyzed for patient-specific and fracture-specific factors affecting OI HWF incidence. Of patients with OI, 3.8% (18/469) sustained HWFs. Patients with OI HWF were significantly older than patients with OI without HWFs ( P = 0.002) with no differences in height, weight, ethnicity, sex, or ambulatory status. Compared with non-OI HWFs, patients with OI HWF were significantly shorter ( P < 0.001), weighed less ( P = 0.002), and were less likely to be ambulatory ( P < 0.001). OI HWFs were more commonly on the side of hand dominance ( P < 0.001) with transverse patterns ( P = 0.001). OI HWFs were less frequent in the thumb ( P = 0.048) and trended towards significance in the metacarpals ( P = 0.054). All OI HWFs were treated nonoperatively with similar union rates and refracture rates to non-OI HWFs. Multivariate regression showed that older patient age (odds ratio: 1.079, 95% CI: 1.005,1.159, P = 0.037) and OI type I (odds ratio: 5.535, 95% CI: 1.069, 26.795, P = 0.041) were significant prognosticators for HWFs in patients with OI. OI HWFs are uncommon (3.8%, 18/469) but specific HWF morphologies and locations are more common in patients with OI; however, these are not pathognomonic. Older patients with mild penetrance of type I OI are at the highest risk for HWFs. OI HWFs do well when managed nonoperatively with noninferior clinical courses compared with non-OI HWFs. Level III.

Factors Influencing Surgical Decision Making in Trapeziometacarpal Osteoarthritis

With trapeziometacarpal osteoarthritis (TMC OA), the relationship between disease severity and pretreatment dysfunction, patient expectations, and preferred patient treatment and management remains unclear. This study aimed to assess the association between functional status, pretreatment expectations, and demographic and clinical characteristics of TMC OA patients who decide to undergo operative management. Patients diagnosed with TMC OA (n= 96) were administered the Thumb Arthritis Expectations Survey and the Brief Michigan Hand Questionnaire (bMHQ) during their initial office visit. Demographic data (sex, age, race, education level, marital status, comorbidities, and hand dominance) and clinical characteristics (prior injury, and therapeutic interventions including splinting, steroid injections, therapy, and anti-inflammatory medication) were collected. Multiple logistic regression was used to assess the association between surgical treatment and expectation scores. Our logistic regression model found that lower bMHQ scores, high thumb arthritis expectation survey scores, and prior treatments for TMC OA were associated significantly with the surgical treatment of TMC OA. After controlling for all possible covariates, the odds of having surgery was 3.9 times higher among patients with high expectations (above median) compared to patients with low expectations (adjusted odds ratio [AOR], 3.9; 95% confidence interval [CI], 1.3-11.2). Patients with average function, as measured by bMHQ scores, were 74.5% less likely to elect for surgery than those with the lowest bMHQ (AOR, 0.3; 95% CI, 0.1-0.9). Patients treated previously with steroids were 13 times more likely to elect for surgery than those who were never treated for TMC arthritis (AOR,13.1; 95% CI, 2.2-77.0). Patients with TMC OA who elect to proceed with surgical management have lower bMHQ (greater perceived dysfunction) and higher expectations, and have had prior treatment. Age was not a significant predictor of surgical management of TMC OA. Prognostic IV.

Improvement of Classification Performance in High-Dimension Low-Sample-Size Modeling by Sparse Functional Connectivity States in Subjects with Attention Deficit-Hyperactivity Disorder and Healthy Controls

Background: The precise identification of attention deficit-hyperactivity disorder (ADHD) is one of the challenging clinical processes. Disorganizations in functional neural networks revealed via functional magnetic resonance imaging have recently been contributing. Machine learning approaches, particularly classification methods, have commonly been employed as a framework for diverse data analysis, indicating promising medical diagnosis results. However, as the neuroimaging data are high-dimensional with a low sample size (the current dataset), this study aimed to evaluate the classification performance of the models by considering the specific contribution of the sparsity of data matrices. Methods: This cross-sectional study analyzed the preprocessed data from the 2011 ADHD-200 Global Competition. A total of 768 and 171 data items were considered training and test, respectively. The diagnosis status was used as a response variable. Age, gender, hand dominance, and activity relationship between 116 brain regions derived from inverse covariance matrix and inverse sparse covariance matrix were used as predictive variables. Accordingly, this study compared the performance of three models, namely support vector machine (SVM), distance-weighted discrimination (DWD), and data maximum dispersion classifier (DMDC) for ADHD categorization. Results: The highest value for the total accuracy was reported for the SVM model on the sparse covariance matrix. Moreover, the highest values for the balanced classification rate (BCR) (59%) and sensitivity (64%) were reported for DMDC on the sparse covariance matrix. The best level of specificity (99%) was obtained from DWD using the sparse covariance matrix. The highest levels of the values (i.e., total accuracy and BCR) were achieved through the model fitting on the sparse matrices. Among the six models, the DMDC model on sparse covariance matrix was the most optimal algorithm due to the superiority of the two indices (i.e., accuracy: 60% and BCR: 60%) and the favorable balance between sensitivity and specificity values. Conclusions: Among the current studied three models, DMDC performance, applying the sparse data, remarkably improved the results of classification processes. Based on the present findings, the neuronal connectivity among subcortical structures comprising parts of the basal ganglia and cerebellum provides a distinction between ADHD subjects and healthy controls.

0983 Hand Dominance in Sexsomnia: A Clue to Pathophysiology?

Abstract Introduction Sexsomnia is a variant of confusional arousal, a NREM parasomnia (NREMP), typically consisting of sexual behaviors manifesting upon partial arousal from deep NREM sleep; however, its pathophysiology is not well understood, and literature is limited. We present a series of patients with non-dominant hand sexsomnia behaviors that may reveal important new clues about the neurophysiologic mechanisms of sexsomnias. Report of case(s) Case 1: 22 y/o right-handed (RH) female, no history of NREMP, or snoring. Presenting complaint (PC): 8-year history of sleep masturbatory behavior (MB) including partial awakening from MB with bloody fingers (left hand) during her menstrual period in the setting of delayed sleep phase disorder. Case 2: 30 y/o ambidextrous male with a history of NREMP. PC: MB involving the left hand, observed by bed partner (BP) in the setting of weight gain and apneas. PSG: AHI 17/h and PLMI 23/h. Case 3: 33 y/o RH female with a history of NREMP. PC: left-handed sleep MB observed by BP in the setting of multiple sclerosis with C2-3 and C4 right posterolateral demyelinating lesions on C-spine MRI. Case 4: A 44 y/o RH male with OCD, depression, and no history of NREMP. PC: bilateral MB and dream enactment behaviors observed by BP, in the setting of sertraline. Events resolved upon switching to quetiapine. Case 5: A 59- y/o RH female with multiple system atrophy (MSA) and RBD, no previous NREMP. PC: sleep MB, noted by BP involving the left hand in the setting of worsening dysautonomia. Dream enactment occurred bilaterally. PSG: AHI 34/h, PLMI: 70/h and REM sleep without atonia. Spells improved with melatonin and PAP. Conclusion This case series highlights a pattern of adult sleep MB involving the non-dominant (left) hand in 4/5 cases and the left hand in one ambidextrous patient. There was no evidence of gender predilection. We speculate that sexsomnia originates from central pattern generators in the brainstem and spinal cord, as opposed to the cerebral cortex (which would likely involve the dominant hand). The lack of involvement of cerebral motor control is further substantiated by amnesia for sexsomnia events. Support (if any)

The effect of the preferred hand on drawing movement

The observation that different effectors can execute the same movement suggests functional equivalences driven by limb independent representation of action in the central nervous system. A common invariant motor behavior is the speed and curvature coupling (the 1/3 power law), a low dimensional (abstract) descriptor of movement which is resilient to different sensorimotor contexts. Our purpose is to verify the consistency of such motor equivalence during a drawing task, by testing the effect of manual dominance and movement speed on motor performance. We hypothesize that abstract kinematic variables are not the most resistant to speed or limb effector changes. The results show specific effects of speed and hand side on the drawing task. Movement duration, speed-curvature covariation, and maximum velocity were not significantly affected by hand side, while geometrical features were strongly speed and limb dependent. However, intra-trial analysis performed over the successive drawing movements reveals a significant hand side effect on the variability of movement vigor and velocity-curvature relationship (the 1/3 PL). The identified effects of speed and hand dominance on the kinematic parameters suggest different neural strategies, in a pattern that does not go from the most abstract to the least abstract component, as proposed by the traditional hierarchical organization of the motor plan.

Variation in radial head fracture treatment recommendations in terrible triad injuries is not influenced by viewing two-dimensional computed tomography.

We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

A Better Approach of Assessing Lalerality by Using Combined Foot and Eye Dominance Scale in Mentally Healthy Subjects

Abstract Objective To investigate the reliability (internal consistency) of a Combined Foot and Eye Dominance Scale in healthy subjects. Materials and methods A total of 82 mentally healthy subjects were assessed with a Combined Foot and Eye Dominance Scale. The Foot Dominance Subscale included a modified Chapman &amp; Chapman Foot Dominance scale and a new Complex Tasks scale with four foot tests reflecting more complex tasks. The Eye Dominance Subscale included three eye tests. Scale reliability statistics (item-scale statistics, summary statistics for the items, Cronbach’s alpha), nonparametric Mann-Whitney test and Spearman’s rank correlation coefficient were used. Results Considerable differences were found in the contribution of the single items to the Combined Scale. The means of some items were 37.83 times greater than those of other items (from 0.15 to 5.61), which suggested greater phenogenetic component and consequently greater contribution of these items to the total scale mean. The mean correlation between the items of the Combined Foot and Eye Dominance Scale was strongly positive (0.39), indicating good internal consistency of the scale. Conclusions Eye and foot dominance appear to be a much subtler indicator of altered hemispheric lateralization than hand dominance. The Combined Dominance Scale provides a more adequate tool for objective measuring of leftedness, as a way to assess laterality, since this scale is to a great degree unaffected by socio-cultural impact. The scale would provide comparability of leftedness as an indirect clue of abnormal lateralization in studies of mentally healthy subjects and subjects with neurodevelopmental disorders with presumed abnormal cerebral asymmetry across cultures.

Osteochondral Autograft Transplantation for Proximal Pole Scaphoid Nonunions

Osteochondral autograft transplantation (OAT) is a technique to reconstruct the proximal pole scaphoid nonunion associated with an intact dorsal and volar scapholunate ligament. This study aimed to report the clinical and radiographic outcomes in patients who underwent OAT for this indication. A retrospective review of patients who underwent proximal pole scaphoid nonunion reconstruction with a femoral trochlea OAT was undertaken between 2018 and 2022. Patient demographics, scaphoid nonunion characteristics, surgery details, and clinical and radiographic outcomes were obtained. Eight patients underwent the procedure at an average of 18.2 months from injury. Four patients failed prior attempts at scaphoid union surgery, one of whom failed two prior surgeries. Four had no prior surgery. The average follow-up was 11.8 months. The postoperative wrist flexion-extension arc of motion was 125° or 87% of the contralateral wrist. Grip strength averaged 30.0 kg or 86% of the contralateral side. Adjusted grip strength for hand dominance was 81% of the contralateral side. All OATs healed. Computed tomography scan confirmed the union in 6 patients between 6 and 10 weeks. Two patients whose radiographs demonstrated OAT incorporation at the time of follow-up did not undergo advanced imaging. Osteochondral autograft transplantation is an attractive surgical reconstructive procedure for patients with proximal pole scaphoid nonunions associated with an intact scapholunate ligament. Osteochondral autograft transplantation mitigates the need for vascularized bone grafting, has a rapid time to osseous incorporation, and has a simple postoperative course in which patients can expect early union, near-full range of motion, and grip strength. Therapeutic V.

EVALUATION OF THE EFFECT OF HAND DOMINANCE ON MEDIAN NERVE CROSS-SECTIONAL AREA AMONG HEALTHY ADULT SUBJECTS: A CROSS-SECTIONAL STUDY

Background:This study was designed considering the existing controversies on the normal range of median nerve cross-sectional area (MNCSA) and its association with hand dominance. Methods:In this cross-sectional descriptive study, the upper limbs of 100 healthy subjects (46 men and 54 women) were assessed bilaterally by sonography. MNCSA was measured at the level of the carpal tunnel inlet. Results:Calculated MNCSA values were 9.29 mm2 and 9.54 mm2 for the right and left sides, respectively. No significant difference was observed between the right and left hands. No significant correlation was observed between hand dominance and MNCSA in right-handed or left-handed subjects. Conclusion:Hand dominance does not significantly affect MNCSA at the wrist level, and thus does not affect the diagnosis of carpal tunnel syndrome.

Factors Associated with Change in Diagnosis of Carpal Tunnel Syndrome after Electrodiagnostic Studies.

Background: Hand surgeons sometimes place more weight on clinical findings and may not always consider the results of electrodiagnostic studies (EDX) in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to determine factors associated with a change in diagnosis of CTS after EDX. Methods: This is a retrospective study of all patients with an initial clinical diagnosis of CTS who underwent EDX at our hospital. We identified patients whose diagnosis changed from CTS to non-CTS after EDX and used univariate and multivariate analysis to determine if age, sex, hand dominance, unilateral symptoms, history of diabetes mellitus, rheumatoid arthritis, haemodialysis, cerebral lesion, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items in CTS-6 and a CTS-negative EDX result were associated with a change in diagnosis after EDX. Results: A total of 479 hands with a clinical diagnosis of CTS underwent EDX. The diagnosis was changed to non-CTS in 61 hands (13%) after EDX. Univariate analysis demonstrated that unilateral symptoms, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items and a CTS-negative EDX result were significantly associated with a change in diagnosis. In the multivariate analysis, only the number of examined items was significantly associated with a change in diagnosis. Conclusions: EDX results were particularly valued in hands where the initial diagnosis was uncertain for CTS. In hands with an initial diagnosis of CTS, the performance of sufficient history-taking and physical examination was more valued at the final diagnosis than EDX results or other aspects of the patient's background. The process of confirming a clear initial clinical diagnosis of CTS using EDX may be of little value for decision-making at the final diagnosis. Level of Evidence: Level III (Therapeutic).