Hand Questionnaire Research Articles

Office-Based Carpal Tunnel Release With Ultrasound Guidance: 6-month Outcomes From the Multicenter ROBUST Trial

The purpose of this study was to determine the safety and effectiveness of office-based carpal tunnel release with ultrasound guidance (CTR-US). In this prospective multicenter observational study, patients were treated with CTR-US in an office setting. Outcomes were time to resume normal daily activities, time to return to work, Boston Carpal Tunnel Questionnaire Symptom Severity Scale and Functional Status Scale scores, Michigan Hand Questionnaire, Numeric Pain Scale, EuroQoL-5 Dimension 5-Level score, procedure satisfaction, and adverse events over 6 months. A total of 149 participants (226 hands) from seven centers underwent office-based CTR-US. The mean age was 58 years, 52% were women, and 68% were employed. The mean incision length was 5 mm, 52% had simultaneous bilateral procedures, and wide-awake local anesthesia no tourniquet was used in all cases. All procedures were completed as planned, with no conversions to open repair and mean intraoperative pain severity of 1.6 ± 1.5. The median time to resume normal activities was 2 days (interquartile range: 1-4 days) and return to work was 4 days (interquartile range: 1-5 days). Over 6 months, Boston Carpal Tunnel Questionnaire Symptom Severity Scale decreased by a mean of 1.7 points, Boston Carpal Tunnel Questionnaire Functional Status Scale decreased by 1.1 points, Michigan Hand Questionnaire Global score increased by 35 points, Numeric Pain Scale decreased by 3.7 points, and EuroQoL-5 Dimension 5-Level score increased by 0.11 points. At 6 months, 94% reported procedure satisfaction. Unilateral and simultaneous bilateral procedures were similarly effective. There was one (0.4%) adverse event, a nerve contusion treated with neurolysis and nerve wrap where the patient fully regained normal function within 7 weeks. There were no revisions for persistent or recurrent carpal tunnel syndrome symptoms. Office-based CTR-US, performed either unilaterally or as simultaneous bilateral procedures, is well tolerated with a low complication rate and associated with rapid recovery, sustained improvement in symptoms and function, and high procedure satisfaction. Therapeutic III.

The association of ICUC trauma score and quick DASH in a distal radius fracture cohort

BackgroundThis study evaluates the association between ICUC trauma and short-form Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) scores among patients who underwent surgery for distal radius fractures.MethodsThis research gathered patient-reported outcomes (PROs) from patients registered in the ICUC database at a single trauma center. The study involved 76 adult patients who underwent surgical treatment for distal radius fractures before 2023. These patients received a volar locking plate for their distal radius fracture. The research utilized two different PROs to evaluate the patients’ conditions. The ICUC trauma score measures functional impairment and pain through two 5-point scale questions, allowing patients to self-assess these aspects. The Quick DASH, comprising 11 questions, was used to evaluate symptoms and functionality of the upper extremity.ResultsFor patients aged 55.9 ± 15.3 years and 4.6 ± 3.9 years post-op follow-up, the ICUC trauma score was 0.70 ± 0.95, and Quick DASH was 6.07 ± 10.35. A strong correlation between ICUC and Quick DASH was identified (r = 0.71, P < 0.01). The interaction between the ICUC trauma score and age at the surgery to Quick DASH revealed a significant unstandardized partial regression coefficient of 0.19 (95% confidence interval 0.08–0.31; P < 0.01).ConclusionThis study demonstrated a strong correlation between the ICUC trauma score and the Quick DASH among patients, especially the elderly. It was noted that an elevation in the ICUC trauma score is linked to a more marked increase in the Quick DASH score, particularly in older patients. Given its simplicity and efficacy, the ICUC trauma score may be a viable alternative to the Quick DASH for assessing the patient’s clinical outcomes.

Effect of Adding Shoulder Stabilization Exercises to the Rehabilitation of Postoperative Hand Injuries in Young Adult Patients.

Hand injuries are common and could have an impact on all upper limb functions. Engaging shoulder muscle training during the rehabilitation protocol postoperatively could have a significant impact on regaining all upper limb function. The purpose of this study was to assess the effect of adding shoulder stabilization exercise to hand rehabilitation postoperatively. Forty patients were randomly assigned to 2 equal groups. Group A received a standard physical therapy program plus shoulder exercise protocol and group B received only a standard physical therapy protocol for hand rehabilitation. Outcome measures were pain intensity; grip strength; Arabic modified Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; and range of motion (ROM). All outcome measures were assessed before and after treatment. Statistical analysis revealed that both groups, the experimental and control, showed significant improvement in all outcome measures, but experimental group A showed significant improvement than the control group B posttreatment for hand grip strength, ROM, and QuickDASH questioners (P < .001). Adding shoulder stabilizer muscle training to the hand rehabilitation protocol postoperatively has a significant impact on hand function outcomes.

Comparison of the Effects of Stretching and Splinting in Improving the Range of Motion and Functional Status for Prevention of Post-Burn Axillary Contracture

Background: Burn injuries often lead to severe complications, including axillary contractures, which can significantly restrict shoulder movement and impact quality of life. The rehabilitation strategies for managing post-burn axillary contractures, particularly stretching and splinting, have been the subject of much research, given their potential to improve shoulder range of motion and functional status. Objective: This study aims to compare the effects of stretching combined with splinting versus splinting alone on the range of motion and functional status in patients with post-burn axillary contracture, to determine the most effective treatment modality for preventing the development of contractures. Methods: A single-blinded randomized clinical trial was conducted at the Burn and Plastic Surgery Department of Mayo Hospital, Lahore, over six months. Forty patients aged 20-50 years with Type 1 to Type 3 axillary contractures and shoulder abduction ranging from 20 to 100 degrees were enrolled. Participants were randomly assigned to either Group A (stretching plus splinting) or Group B (splinting alone). Outcomes were measured using the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and goniometry for shoulder motion range, before and after the interventions. Statistical analysis was performed using SPSS version 25, with paired and independent T-tests applied for within and between-group comparisons, respectively. Results: The stretching group demonstrated significant improvements in shoulder motion ranges: flexion (91.00 ± 19.97 to 98.75 ± 19.75, p&lt;0.000), extension (34.50 ± 12.13 to 41.85 ± 12.70, p&lt;0.000), abduction (94.50 ± 26.84 to 103.50 ± 25.97, p&lt;0.000), external rotation (34.15 ± 18.79 to 42.85 ± 18.87, p&lt;0.000), and internal rotation (33.95 ± 11.05 to 42.90 ± 11.03, p&lt;0.000). The DASH scores improved from 21.35 ± 3.58 to 31.30 ± 3.48 (p&lt;0.000). Similar improvements were noted in the splinting group but were more pronounced in the stretching group. Between-group analysis revealed significant differences in favor of the stretching group for all measures of shoulder motion and DASH scores. Conclusion: The study concluded that stretching, when combined with splinting, is more effective than splinting alone in improving shoulder range of motion and functional status in patients with post-burn axillary contracture. These findings suggest that incorporating stretching into the rehabilitation protocols for burn survivors could significantly enhance recovery outcomes.

Polyethylene Glycol-Mediated Axonal Fusion Promotes Early Sensory Recovery After Digital Nerve Injury: A Randomized Clinical Trial

Background. Peripheral nerve repair is limited by Wallerian degeneration coupled with the slow and inconsistent rates of nerve regrowth. In more proximal injuries, delayed nerve regeneration can cause debilitating muscle atrophy. Topical application of polyethylene glycol (PEG) during neurorrhaphy facilitates the fusion of severed axonal membranes, immediately restoring action potentials across the coaptation site. In preclinical animal models, PEG-fusion resulted in remarkable early functional recovery. Methods. This is the first randomized clinical trial comparing functional outcomes between PEG-fusion and standard neurorrhaphy. Participants with digital nerve transections were followed up at 2 weeks, 1 month, and 3 months postoperatively. The primary outcome was assessed using the Medical Research Council Classification (MRCC) rating for sensory recovery at each timepoint. Semmes-Weinstein monofilaments and static two-point discrimination determined MRCC ratings. Postoperative quality of life was measured using the Michigan Hand Questionnaire (MHQ). Results. Forty-eight transected digital nerves (25 control, 23 PEG) across twenty-two patients were analyzed. PEG-fused nerves demonstrated significantly higher MRCC scores at 2 weeks (OR 16.95, 95% CI: 1.79 – 160.38, p = 0.008) and 1 month (OR 13.40, 95% CI: 1.64 – 109.77, p = 0.009). Participants in the PEG cohort also had significantly higher average MHQ scores at 2 weeks (Hodge’s g 1.28, 95% CI: 0.23 – 2.30, p = 0.0163) and 1 month (Hodge’s g 1.02, 95% CI: 0.04 – 1.99, p = 0.049). No participants had adverse events related to the study drug. Conclusion. PEG-fusion promotes early sensory recovery and improved patient well-being following peripheral nerve repair of digital nerves.

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm.

Acute and chronic injuries of the interosseus membrane can result in longitudinal instability of the forearm. Reconstruction of the central band of the interosseus membrane can help to restore biomechanical stability. Different methods have been used to reconstruct the central band, including tendon grafts, bone-ligament-bone grafts, and synthetic grafts. This Idea, Development, Exploration, Assessment, and Long-term (IDEAL) phase 1 study aims to review the clinical results of reconstruction using a synthetic braided cross-linked graft secured at either end with an Endobutton to restore the force balance between the bones of the forearm. An independent retrospective review was conducted of a consecutive series of 21 patients with longitudinal instability injuries treated with anatomical central band reconstruction between February 2011 and July 2019. Patients with less than 12 months' follow-up or who were treated acutely were excluded, leaving 18 patients in total. Preoperative clinical and radiological assessments were compared with prospectively gathered data using range of motion and the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) functional outcome score. Of the 18 patients (nine male, nine female) who met the inclusion criteria, the median follow-up was 8.5 years (interquartile range (IQR) 5.6 to 10). Their mean age was 49 years (SD 11). The mean extension improved significantly from 38° (SD 15°) to 24° (SD 9°) (p = 0.027), with a mean flexion-extension arc change from 81° (SD 27°) to 93° (SD 30°) (p = 0.172) but with no forearm rotational improvement (p = 0.233) at latest follow-up. The QuickDASH functional score improved significantly from 80 (SD 14) to 52 (SD 26) following reconstruction (p = 0.031), but generally the level of disability remains high. Radiological assessment showed no progression of proximal migration of the radius, with a stable interbutton distance and ulnar variance from immediate postoperative radiograph to the latest follow-up. Central band interosseus membrane reconstruction using a synthetic braided cross-linked graft can improve patient-rated arm function and range of motion, but significant functional deficits remain in patients with chronic injuries.

Understanding overall shoulder function and health: the value of specific quantitative vs. qualitative shoulder range of motion on patient-reported outcome measures

Hypothesis and BackgroundIt is known that, though widely used, shoulder range of motion (ROM) measurements are not standardized and have a high rate of intra- and interobserver differences. Particularly, the inconsistency in quantitative and qualitative measurements and their relationship to patient-reported outcome measures (PROMs) make shoulder health difficult to determine. MethodsThis was a prospective study of 147 patients who presented with a chief complaint of shoulder pain to the orthopedic sports medicine and shoulder clinic of a single fellowship-trained surgeon. Measured by one examiner, quantitative ROM measurements were taken with a goniometer and qualitative ROM measured by the anatomic level that the patient could reach. The following PROMs were used as well: American Shoulder and Elbow Surgeons Shoulder Score (ASES), Single Assessment Numeric Evaluation (SANE), Shoulder Pain and Disability Index (SPADI), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), 12-Item Short Form Health Survey (SF-12), and Patient-Reported Outcomes Measurement Information System pain interference short form 6a (PROMIS 6a). Statistical analysis was performed with SPSS using Pearson correlation and two-sample t-test. Benjamini-Hochberg correction was used to determine p-value at which statistical significance was reached to correct for multiple comparisons. ResultsQualitative internal rotation (IR), (the hand behind back reach test) and qualitative forward flexion (FF) correlated with all goniometer angle measurements and PROMs (both shoulder and general health scores). These qualitative measures proved to be an appropriate proxy for IR and FF goniometer measurements. Qualitative external rotation (ER) was not a good substitute for quantitative ER measurement. Quantitative ER correlated with all PROMs. As ROM increased when measured by quantitative ER, qualitative IR, and qualitative FF, shoulder and general health PROMs incrementally increased as well. Discussion/ConclusionQualitative IR measurement, the hand-behind-back reach test, is an adequate substitution for IR goniometer angle as well as a strong representation of global shoulder ROM, shoulder health, and general health while factoring in patient age. Qualitative FF measurement is also an appropriate proxy for quantitative FF and represents global shoulder and general health without factoring in age. Quantitative ER via goniometer angle, is a better assessment of the shoulder than qualitative ER and is a representation of overall shoulder and general health. We recommend the use of quantitative ER, qualitative IR, and qualitative FF measurements to best understand a patient’s overall shoulder health and its impact on their overall health.

Cross-cultural adaptation and validation of the Italian version of the Western Ontario Rotator Cuff (WORC) index

The aim of the study was to accomplish translation, cross-cultural adaptation and validation of the Western Ontario Rotator Cuff (WORC) Index questionnaire for its use in Italy. The WORC original version was translated and cross-culturally adapted into Italian. Subsequently, it was administered to a population of 60 patients suffering from rotator cuff disease to evaluate the validity and reliability of the Italian version. The content validity evaluated the correlation between questions and total score of each domain through Pearson’s correlation coefficient. The construct validity was similarly assessed through Pearson’s correlation coefficient by testing the correlation between the Italian WORC and the Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Reliability was assessed using two methods: internal consistency by calculating the Cronbach’s alpha coefficient for each domain; and test–retest by means of the intraclass correlation coefficient (ICC). The translation and cross-cultural adaptation of the Italian version did not reveal any major problems. No significant floor or ceiling effects were found. All the questions were linearly related to the concept expressed by the domain of belonging. Overall correlation with the DASH score was 0.75. Internal consistency was very high overall (α = 0.93) as well as reliability (overall ICC = 0.87). The Italian version of the WORC questionnaire is a valid and reproducible measuring instrument and can be considered a valid tool for the evaluation of the effectiveness of a treatment in terms of quality of life, in Italian patients affected by rotator cuff diseases.Level of evidence Diagnostic study, level II.

Modified Chinese disabilities of arm, shoulder and hand tool: Validity and reliability for upper extremity injuries

DesignClinimetric evaluation study. IntroductionThe Chinese Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has necessitated the development of a revised version to the specific needs of individuals with upper extremity injuries with the progress of times and lifestyle changes. Purpose of the studyThis research aimed to evaluate the reliability and validity of Modified Chinese Disability of Arm, Shoulder and Hand (MC-DASH) questionnaire in individuals with upper extremity injuries. MethodsOne hundred and one individuals with upper extremity injuries (UEI) were recruited. The function of upper extremity was measured using the electronic version of MC-DASH, and compared against the Chinese Disability of Arm, Shoulder and Hand. The MC-DASH was reassessed within three days in all individuals. We investigated the internal consistency, test-retest reliability, content validity, criterion validity, and construct validity of MC-DASH. ResultsThe internal consistency was deemed sufficient, as indicated by a Cronbach's alpha of 0.986 and an intraclass correlation coefficient of 0.957. Moreover, the mean total scores of MC-DASH on the first-test and retest were 37.86 and 38.19, respectively (ICC: 0.957, 95 %CI: 0.937–0.971, p < 0.001). Furthermore, the MC-DASH version exhibited satisfactory content validity evidenced by its strong correlation (R= 0.903, p < 0.001) with the Chinese DASH. Three major influencing factors were identified from 37 items. The cumulative variance contribution rate of the MC-DASH questionnaire was 75.76 %, confirming its construct validity. ConclusionThe Modified Chinese Disability of Arm, Shoulder and Hand questionnaire has been shown to be a valid, reliable, and practical tool for use in patients with upper extremity injuries.

Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up

Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years. We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0-40.9) at the long-term follow-up, compared with 26.2 (range: 4.5-75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement. Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis. Therapeutic IV.

Outcomes of Thumb Carpometacarpal Joint Osteoarthritis Treated with Arthroscopic Fusion.

Background The thumb carpometacarpal joint (CMCJ) osteoarthritis is one of the most common pathologies in the hand with controversial treatment options. Description of Technique Describe the use of arthroscopic technique for thumb CMCJ arthrodesis and the clinical outcome. Patients and Methods Cases with Eaton III thumb CMCJ osteoarthritis treated with arthroscopic arthrodesis were reviewed. Patient evaluations include: grip strength, pinch strength, range of motion, Kapandji score, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the visual analog scores for pain. All cases were assessed before the surgery and at 3, 6, 12, and 24 months after surgery. Radiographs were reviewed. Results There were total 16 patients with 18 arthrodesis performed. The average age was 62.2 years with M:F ratio of 2:7. The average follow-up time was 57.2 months. There was improvement of pain score as early as at postop 3 months ( p < 0.001) and continued to improve at 6, 12, and 24 months. There was improvement of grip strength and pinch strength at 12 and 24 months (p < 0.001). The DASH score showed improvement as early as at 3 months ( p = 0.012). There was a reduction of Kapandji score and interphalangeal joint motion at 3 months postop, but these returned to normal at 6 months. There was no major complication. There was one case of nonunion (5.6%). Conclusion Arthroscopic arthrodesis is a feasible treatment option and provides excellent pain relief, restore thumb strength and stability, retain functional thumb mobility, and hence improvement in hand function.

High frequency neuronavigated repetitive transcranial magnetic stimulation in post-stroke shoulder pain: A double-blinded, randomized controlled study

ObjectiveThis study aimed to determine the effect of 5Hz neuronavigated repetitive transcranial magnetic stimulation (rTMS) to the affected primary motor cortex (M1) on pain, the effect of pain on activities of daily living, disability, mood, neurophysiological parameters and passive shoulder joint range of motion in patients with post-stroke shoulder pain. DesignTwenty two patients were randomized into an experimental group (rTMS, n=7) who received daily rTMS 5Hz 1000 pulses, five times/week for three weeks (15 sessions) to the affected M1 and a control group (n=11) who received sham stimulation. Outcome measures were Numeric Rating Scale (NRS), Brief Pain Inventory (BPI), Disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), Hospital Depression Anxiety Scale (HADS), joint range of motion (ROM) measurements, neurophysiological parameters. Selected outcome measures were performed before treatment (T0), after the 5th session (T1) of rTMS treatment, after the 10th session (T2), after the 15th session (T3), and four weeks after the end of the treatment (T4). In the analysis of the outcomes, within-group comparisons were performed by using the Wilcoxon or Friedman test and between-group comparisons were performed by using the Mann-Whitney U test. ResultsThere was no statistically significant difference between and within groups in terms of change- and followup scores in the NRS measurements (p>0.05). BPI scale was found to be lower in rTMS group at T0 and T3 (p= 0.010). Quick-DASH scores at T4 were found to be significantly lower in rTMS group (p= 0.032). However, no difference was found within each group over time (p>0.05) and there was no statistical difference between the groups in terms of change scores (T3-T0 and T4-T0) (p>0.05) for BPI and Quick-DASH. In rTMS group, there was a statistically significant difference in shoulder external rotation at T3 compared to the baseline (T0) (p=0.039). However, the magnitude of external rotation change (T3-T0) with the treatment was comparable in the groups. No statistically significant change occurred in both treatment groups in other range of motion measurements. ConclusionHigh frequency neuronavigated rTMS to the affected M1 did not show any significant beneficial effect on pain, activities of daily living, disability, anxiety and depression, neurophysiological measurements and passive ROM over sham stimulation.

Comparison of Functionality Level, Disability and Quality of Life in Subjects with Peripheral Nerve Repair in the Upper Extremity.

Peripheral nerve damage is a very important factor in patients' quality of life and functionality for various reasons. We aimed to compare the functionality level, disability and quality of life in subjects with peripheral nerve repair in the upper extremity. This cross-sectional study was conducted on patients with nerve injuries in 2019. Among those patients, Eighty-five were selected as the sample. The instruments used in this study included the health-related quality of life standard questionnaire (SF-36), and the disability of the arm, shoulder and hand questionnaire (DASH-38). Data were analyzed by SPSS software version 22 and one-way ANOVA and Kruskal-Wallis statistical tests. Results of the Kruskal-Wallis test showed that the disability score in the groups of patients was not significant. In addition, according to the results of the one-way ANOVA test, the quality of life score was not significant among the patient groups. Considering that peripheral nerve damage has a significant impact on patients' quality of life and functionality, apart from more research on the subject, it is necessary to provide support for patients to improve their quality of life.

Association between Shoulder Dysfunction and Concomitant Neck Disability in Patients with Shoulder Disorders.

This study aimed to investigate the impact of shoulder dysfunction on concomitant neck disability in patients with shoulder disorders. The participants were patients with subacromial impingement syndrome (SIS) and frozen shoulder (FS). Twenty patients with SIS and 21 with FS without cervical radiculopathy were enrolled. The participants were assessed for the 4-week prevalence of neck pain, Neck Disability Index (NDI), shoulder strength and range of motion, a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (quick-DASH), and the Pain Catastrophizing Scale (PCS). The 4-week prevalence of neck pain was 12 out of 20 (60%) in patients with SIS and 13 out of 21 (62%) in patients with FS. The median NDIs were 13 and 12 for SIS and FS, respectively, with no statistically significant difference. About 41% (17/41) of the participants displayed an NDI greater than the cutoff value for disability in daily living. Although shoulder abduction strength correlated with the NDI in patients with SIS, the PCS score correlated with the NDI in patients with FS. Concomitant neck disability is a critical concern for patients with shoulder disorders. The clinical factors related to concomitant neck disability differ between SIS and FS, with specific interventions recommended for each condition.

Trigger finger - Poor outcome of surgery associated with younger age, pain, psoriatic arthritis and atopic disease.

Trigger finger, or stenosing tendovaginitis, is one of the most common causes of hand disability, where a finger or thumb painfully snaps and locks due to a tendon-sheath size mismatch at the A1 pulley. The exact aetiology of trigger finger is unknown, though it is associated with factors like diabetes, rheumatic disease and carpal tunnel syndrome. The main purpose of this prospective study was to explore clinical characteristics and comorbidities in a cohort of 139 patients who underwent surgery for trigger finger and find factors of importance for the outcome 1 year postoperatively. Pain, range of motion, hand function evaluated by the Disabilities of the Arm Shoulder and Hand questionnaire as well as Quinnell grade of triggering were examined preoperatively. Symptom duration, working status, medical history and comorbidities at baseline were also noted. Further, range of motion was evaluated 3 months after surgery, pain and hand function were evaluated 3 and 12 months after surgery. An outcome scale with three levels was defined. The development of any new comorbidities was monitored during an extended postoperative observation period, with a mean duration of 70 months (range: 56-88 months). Poor outcome was strongly associated with younger age (P = 0.0009), a high level of preoperative pain in the operated hand (P = 0.0027), psoriatic arthritis (P = 0.021) and atopic disease (P = 0.028; odds ratio [OR]: 3.87, 95% confidence interval [CI]: 1.15-13.04). A low range of motion preoperatively did not affect the outcome. Carpal tunnel syndrome was the most common comorbidity but did not affect the outcome. A good preoperative range of motion, good hand function and less pain were associated with better outcomes. Younger age, a high level of preoperative pain, psoriatic arthritis and atopic disease were factors associated with a worse outcome of trigger finger surgery. Pain and disability decreased 3 months postoperatively and continued to decrease between 3 and 12 months.

Subtotal palmar fasciectomy with skin Z-plasty results in Dupuytren’s disease : Minimum one year follow-up

Backround Dupuytren's disease is a condition that leads to progressive contractures in the hand, significantly impacting the quality of life. These rigid deformities impair hand functions and have adverse effects on daily life. Various surgical treatment options are available. In this study, our goal is to report the results of patients for whom we performed subtotal palmar fasciectomy and skin Z-plasty. Method A retrospective analysis was conducted on 16 patients who underwent subtotal palmar fasciotomy. The range of motion before and after the operation, along with patient-reported outcome scores using the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QDASH), were compared. Additionally, the time return to work time and any complications were documented. Results The mean preoperative MCP joint flexion contracture degree was 42.8 (range: 30-70 degrees), while the postoperative mean was 2 (range: 0-30 degrees). Similarly, the mean preoperative PIP joint flexion contracture degree was 41 (range: 20-90 degrees), and the postoperative mean was 8 (range: 0-30 degrees). The mean preoperative QDASH score decreased from 44 (range: 32.5-50) to 9.6 postoperatively (range: 7.5-12.5). The average return-to-work time was 42 days. Conclusion Subtotal palmar fasciotomy stands as a surgical alternative with high patient satisfaction in treating Dupuytren's disease. The application of Z-plasty during closure helps to reduce postoperative wound problems by alleviating tension.

Percutaneous Tenotomy for Chronic Tennis Elbow: A Minimally Invasive Technique with Better Outcomes - A Case Series.

Tennis elbow (lateral epicondylitis elbow) is a self-limiting disease of indeterminate pathogenesis. Conservative therapy is the treatment of choice. In chronic tennis elbow with failure of conservative therapy; surgical treatment is a method of choice. Percutaneous tenotomy of extensor origin for patients with chronic tennis elbow is a minimally invasive technique with better long-term outcomes. Ten patients (six males, four females) presented with chronic tennis elbow, who did not respond to conservative treatment/non-surgical intervention for more than 6 months underwent percutaneous tenotomy in an outpatient setting. Two patients were lost to follow-up at 2 months' post-operative. The remaining eight patients were evaluated at a mean follow-up of 3 years and assessed using the numerical rating scale, disabilities of the arm, shoulder and hand questionnaire ,and Oxford elbow score. These scores had a statistically significant difference in baseline to 3-year follow-up values (P < 0.05). No adverse outcomes, recurrence of symptoms, and signs of lateral epicondylitis elbow were noted and none required open surgical release. Percutaneous tenotomy, a minimally invasive technique is an effective and well-tolerated treatment for chronic tennis elbow and gives good pain relief and functional recovery.

Shoulder and Elbow Synergy for Lateral Epicondylalgia Management: A Case Report

Lateral epicondylalgia, commonly known as tennis elbow, is a chronic overuse injury characterised by acute inflammation at the common wrist extensor origin, resulting in pain. Scapular muscle weakness has been linked to lateral epicondylalgia, as weakness or instability in proximal muscles can trigger distal issues. Non-operative interventions, such as activity adjustments, physiotherapy, and various therapeutic methods, have been effective in managing symptoms. This case report demonstrates the effectiveness of scapular muscle strengthening in improving lateral epicondylalgia, along with extensor strengthening. The patient, a 36-yearold male construction manager, underwent a comprehensive course of physical therapy, including scapular muscle strengthening exercises. Comprehensive follow-up using outcome measures such as the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and handheld dynamometer was done. The treatment resulted in improvements in daily function, physical activity, and sports performance, indicating the potential benefits of incorporating scapular muscle strengthening in the management of lateral epicondylalgia. This case emphasizes the need for a tailored approach, suggesting scapular muscle strengthening exercises as a more targeted intervention for lateral epicondylalgia.

Investigation Into the Effects of Intra-Articular Steroid on Post-Traumatic Osteoarthritis in Distal Radius Fractures: A Randomized Controlled Pilot Study

The aim of this prospective, randomized, controlled, double-blinded pilot study was to determine the rates of post-traumatic osteoarthritis and assess joint space width in the presence or absence of a single intra-articular injection of corticosteroid after an acute, intra-articular distal radius fracture (DRF). Forty patients received a single, intra-articular, radiocarpal joint injection of 4 mg of dexamethasone (DEX) (n= 19) or normal saline placebo (n= 21) within 2 weeks of a surgically or nonsurgically treated intra-articular DRF. The primary outcome measure was minimum radiocarpal joint space width (mJSW) on noncontrast computed tomography scans at 2 years postinjection. Secondary outcomes were obtained at 3 months, 6 months, 1 year, and 2 years postinjection and included Disabilities of the Arm, Shoulder, and Hand; Michigan Hand Questionnaire; Patient-Rated Wrist Evaluation; wrist range of motion; and grip strength. At 2-year follow-up, there was no difference in mean mJSW between the DEX group (2.2 mm; standard deviation, 0.6; range, 1.4-3.2) and the placebo group (2.3 mm; standard deviation, 0.7; range, 0.9-3.9). Further, there were no differences in any secondary outcome measures at any postinjection follow-up interval. Radiocarpal joint injection of corticosteroid within 2 weeks of an intra-articular DRF does not appear to affect the development of post-traumatic osteoarthritis within 2 years follow-up in a small pilot cohort. Therapeutic II.

Analysis of Hand Function, Upper Limb Disability, and Its Relationship with Peripheral Vascular Alterations in Raynaud's Phenomenon.

This study aimed to compare vascular involvement, hand functionality, and upper limb disability between Raynaud's phenomenon participants and controls. Also, we analyzed the relationships between vascular impairment, mobility, and strength with disability in this Raynaud population. We conducted a case-control study with fifty-seven participants. We registered sociodemographic and clinical data; vascular variables (temperature, cold test, blood flow, and oxygen saturation); functional variables (pinch strength, range of motion), and disability (Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire) (Q-DASH). Raynaud participants present more disability in all Q-DASH subscales, lower hands' temperature pre and post cold test, decreased blood flow on radial artery, decreased ranges of motions at passive extension of index finger, and active flexion and extension of thumb than the healthy controls. The multivariate regression analysis showed that extension of the index finger, lateral pinch strength, and oxygen saturation were significantly associated with disability in RP, almost the 55% of the total variance on the upper limb, 27% at sports/arts, and 42% at work. Our findings suggest that RP has a disabling effect on the upper extremities and a practice of activities in people who suffer it. Also, disability in Raynaud seems to be more related with hand mobility and strength impairment than vascular injury.