Hand Symptoms Research Articles

Changes in hand function and health state utility after cubital tunnel release using the United Kingdom Hand Registry.

This study aimed to analyse and contrast changes in health-related quality of life (HR-QoL) and hand symptoms in the first 6 months after surgical treatment for primary cubital tunnel syndrome. Data originated from the United Kingdom Hand Registry. HR-QoL was assessed using the generic EuroQol five-dimensional assessment tool (EQ-5D-5L) and hand symptoms using the Patient Evaluation Measure (PEM). In total, 281 patients were included in the statistical analysis. Cubital tunnel release resulted in clinically relevant relief of hand symptoms. However, no improvement in HR-QoL was detected by the EQ-5D-5L. As a result, current health economic models, such as those used by the National Institute for Health Care Excellence (NICE) in the UK, might conclude that cubital tunnel release is not cost-effective. This discrepancy requires exploration, and hand-specific preference-based measures might be needed for value-based healthcare in hand surgery.Level of evidence: III.

Variation in Interpretation of Provocative Tests for Carpal Tunnel Syndrome

We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy. We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand). Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution. Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome. Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as underdiagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of pain).

Temporal associations of emotional and social loneliness and psychosocial functioning in emerging adulthood.

Emerging adulthood is an important developmental phase often accompanied by peaks in loneliness, social anxiety, and depression. However, knowledge is lacking on how the relationships between emotional loneliness, social loneliness, social isolation, social anxiety and depression evolve over time. Gaining insight in these temporal relations is crucial for our understanding of how these problems arise and maintain each other across time. Young adults from a university sample (N = 1,357; M = 23.60 years, SD = 6.30) filled out questionnaires on emotional and social loneliness, social isolation, depressive and social anxiety symptoms at three time points within a 3-year period. Random intercept cross-lagged panel models were used to disentangle reciprocal and prospective associations of loneliness subtypes, social isolation, depressive and social anxiety symptoms across time. Results showed that on the within-person level, increases in emotional and social loneliness as well as social isolation predicted higher depression levels on later timepoints. Increases in depressive symptoms also predicted increases in subsequent social loneliness, but not in emotional loneliness. Finally, increases in depressive symptoms predicted increases in social isolation. There were no significant temporal relations between loneliness and social isolation on the one hand and social anxiety symptoms on the other hand. Social distancing imposed by COVID-19 related government restrictions may have impacted the current results. The findings suggest that emotional and social loneliness precede development of depressive symptoms, which in turn precedes development of social loneliness and social isolation, indicating a potential vicious cycle of social loneliness, social isolation and depressive symptoms in emerging adulthood. Social anxiety did not precede nor follow loneliness, depressive symptoms, or social isolation. The current study sheds more light on the temporal order of loneliness and psychopathological symptoms and hereby assists in identifying times where prevention and intervention efforts may be especially helpful to counter development of depression and loneliness.

Symptoms and Risk Factors of Carpal Tunnel Syndrome among Schoolteachers in Al-Ahsa, Saudi Arabia: A Cross-sectional Study.

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel into the wrist. It is the most common peripheral mononeuropathy and accounts for a large proportion of occupational upper extremity disorders. Teaching is an occupation associated with musculoskeletal disorders. This study aimed to investigate the prevalence of CTS symptoms and related risk factors among schoolteachers in Al-Ahsa. A cross-sectional study was conducted on schoolteachers in Al-Ahsa, Saudi Arabia, during 2023. We distributed the Boston Carpal Tunnel Questionnaire to the teachers' groups through social media in the form of an online questionnaire, and we visited schools to encourage participation. Data were analyzed using the Statistical Package for the Social Sciences. P < 0.05 was considered statistically significant. Our study included 619 schoolteachers. The syndrome symptoms were present in 71.1% of individuals, and functional disruption was present in 52.7%. The likelihood of exhibiting the symptoms is increased by being female, not participating in sports, having a chronic illness, writing for more than 4 h, and having symptoms in both hands. We found a comparatively high percentage (71.1%) of the syndrome symptoms among schoolteachers working in Al-Ahsa, Saudi Arabia, which suggests that any signs of CTS in schoolteachers should be evaluated to ensure proper diagnosis and treatment.

Evaluating the effects of digital stromal vascular fraction injections in systemic sclerosis patients: a retrospective study

ObjectiveManaging hand symptoms in patients with systemic sclerosis is difficult, and the current treatments often provide only limited relief of. In 2014 a new treatment for theses patients was proposed for improving hand function, namely the digital injection of adipose tissue derived stem cells.MethodsFrom 2015 to 2017 seven systemic sclerosis patients with an impaired hand function were treated with the aforesaid injections. A medical chart review was performed to collect pre- and postoperative patient specific data.ResultsOur findings indicated no significant improvement in nailfold capillaroscopic measurements or in the healing of preexisting digital ulcers. Additionally, patients reported a slight worsening in hand function after the treatment. However, we observed a decrease in the modified Rodnan skin score, which measures skin thickness Although previous research has verified the safety and feasibility of this treatment, we found no definitive evidence of its effectiveness.ConclusionOur results suggest that the specific conditions under which this treatment could be beneficial need to be identified through randomized controlled trials involving larger groups of patients.Level of Evidence:Level IV, therapeuticstudy.

INVESTIGATING THE PREVALENCE OF CARPAL TUNNEL SYNDROME IN OFFICE WORKERS

The widespread use of advanced technology and gadgets has led to numerous health problems, including wrist pain due to Carpal Tunnel Syndrome (CTS). CTS is a common and costly issue among office workers. Although research indicates that CTS is not inherently related to work, it is a work-related neuropathy resulting from the compression of the median nerve due to repetitive stressful wrist postures, such as hyperextension or hyperflexion. Objective: This study aims to measure the prevalence of Carpal Tunnel Syndrome (CTS) among office workers, considering computer usage and typing as risk factors, and to assess how job demands contribute to CTS at the workplace. Methods: A quantitative research model using a prospective survey design was employed. The study was conducted among office workers from the manufacturing and services industries in Punjab, Pakistan. A convenient sample of 280 office workers participated. Data were collected using the standardized Boston Carpal Tunnel Syndrome Questionnaire to evaluate the impact of CTS on activities of daily living (ADLs) and socioeconomic life. The study duration was six months. Data analysis was performed using SPSS software version 23.0. Results: The study found a comparatively high prevalence of work-related wrist and hand complaints, including clinically proven CTS, among youthful office employees in Pakistan. Regular discomfort while working significantly increased the likelihood of developing CTS. Extended periods of computer use without breaks also heightened the risk of wrist and hand symptoms. Conclusion: There is a significant prevalence of CTS among office workers in Pakistan linked to prolonged computer use and repetitive wrist postures. Effective interventions and ergonomic practices are essential to reduce the incidence and impact of CTS in the workplace.

Handedness in schizophrenia and affective disorders: a large-scale cross-disorder study.

While most people are right-handed, a minority are left-handed or mixed-handed. It has been suggested that mental and developmental disorders are associated with increased prevalence of left-handedness and mixed-handedness. However, substantial heterogeneity exists across disorders, indicating that not all disorders are associated with a considerable shift away from right-handedness. Increased frequencies in left- and mixed-handedness have also been associated with more severe clinical symptoms, indicating that symptom severity rather than diagnosis explains the high prevalence of non-right-handedness in mental disorders. To address this issue, the present study investigated the association between handedness and measures of stress reactivity, depression, mania, anxiety, and positive and negative symptoms in a large sample of 994 healthy controls and 1213 patients with DSM IV affective disorders, schizoaffective disorders, or schizophrenia. A series of complementary analyses revealed lower lateralization and a higher percentage of mixed-handedness in patients with major depression (14.9%) and schizophrenia (24.0%) compared to healthy controls (12%). For patients with schizophrenia, higher symptom severity was associated with an increasing tendency towards left-handedness. No associations were found for patients diagnosed with major depression, bipolar disorder, or schizoaffective disorder. In healthy controls, no association between hand preference and symptoms was evident. Taken together, these findings suggest that both diagnosis and symptom severity are relevant for the shift away from right-handedness in mental disorders like schizophrenia and major depression.

Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care.

Hand osteoarthritis is more common in women, and its risk increases around the time of the menopause. We set out to describe the timing between menopause and the onset of symptomatic hand osteoarthritis (OA), and associations with the use of hormone replacement therapy (HRT) or its discontinuation, describing any identifiable subgroups of women. Retrospective healthcare-records study of sequential women referred to a specialist hand OA clinic, 2007-2015. Confirmation of hand OA diagnosis was by clinican, by accepted criteria. Demographics and clinical variables were from healthcare-records, recorded by standardised proforma. Outcomes of interest were reported age of onset of hand symptoms, reported age at final menstrual period (FMP), time from FMP to reported onset of hand symptoms and time from cessation of HRT to reported onset of hand symptoms. Exposure categories for systemic HRT use were never users, current users, previous users. Analysis of Variance compared groups; linear regression analysed associations of exposure with outcome. 82/92(89%) of eligible women were post-menopausal, mean age at FMP 49.9 years (SD5.4). In these post-menopausal women, median time from FMP to hand symptom onset was 3 years. 48/82 (59%) developed hand symptoms within the defined peri-menopausal period (FMP ± 4 years), whilst some women developed their symptoms before or after (range -25, 30 years). In women who discontinued HRT prior to symptom onset, the median time from HRT cessation to onset of hand symptoms was 6 months. Past HRT users were older at hand symptom onset than women who had not taken HRT [coeff.4.7 years (0.92, 8.39); P = 0.015]. This study adds to evidence associating the menopause/sex hormone deficiency with hand OA symptom onset in a sizeable subgroup of women (but not all). HRT use/cessation appears to influence the timing of onset of hand OA symptoms. It is not possible to interpret from this type of study whether sex hormone deficiency is causative of disease or modulates its symptoms. It is also not possible to judge whether painful hand osteoarthritis in post-menopausal women is a subtype of disease. Further investigation is indicated of sex-specific subtypes and potential for personalised medicine for post-menopausal women with hand osteoarthritis, as a clearly definable high-risk subgroup.

Modified Scoring of the QuickDASH Can Achieve Previously-unattained Interval-level Measurement in Dupuytren Disease and Carpal Tunnel Syndrome

Background: Rasch measurement theory can be used to identify scales within questionnaires and to map responses to more precise continuous scales. The aim of this article was to use RMT to refine the scoring of the QuickDASH in patients with Dupuytren disease and carpal tunnel syndrome (CTS). Methods: Data were collected between 2013 and 2019 from a single center in the UK. Preoperative QuickDASH responses from patients diagnosed with Dupuytren disease and CTS were used. RMT was used to reduce the number of items in the QuickDASH and examine the reliability and validity of each subscale. Results: The preoperative QuickDASH responses of 750 patients with Dupuytren disease and 1916 patients with CTS were used. The median age of participants was 61 years, and 46% were men. Exploratory factor analysis suggested two distinct subscales within the QuickDASH: task items 1–6 and symptom items 9–11. These items were fitted to the Rasch model, and disordered response thresholds were collapsed. In Dupuytren disease, the two worst responses or each item were disordered. After collapsing these options, good Rasch model fit was demonstrated. CTS responses fitted without modification. Item targeting was more appropriate for CTS than Dupuytren disease. Conclusions: This study proposes a modification to the scoring system for the QuickDASH that provides high-quality, continuous, and condition-specific scales for the QuickDASH. The identification of distinct subscales within the QuickDASH can be used to identify distinct improvements in hand function and/or symptoms in previous, current, and future work.

Enhancing Parkinson's Disease Recognition through Multimodal Analysis of Archimedean Spiral Drawings

Parkinson's disease is one of the most common neurodegenerative diseases, which is incurable according to recent clinical knowledge. Evaluating motor symptoms across diverse modalities such as speech, handwriting, and movement composes a conventional diagnostic approach. However, concurrently utilizing multimodal datasets encompassing drawing and acceleration data remains an underexplored f ield. Our investigation involved examining drawing and movement data of 45 Parkinson's disease (PD) patients and 47 healthy individuals (HC). The PD group presented mild symptoms in the right hand. We transformed drawing data into spiral images and used visual representations of motion data, employing pre-trained models for feature extraction and classifiers. While motion representations exhibited superior performance compared to drawing images, a comprehensive evaluation with the Mann-Whitney U test at a significance level of 0.05 revealed no statistically significant difference between the efficacy of movement and drawing data in all classification scenarios. Significant improvements were made by combining the drawing data predictions with the motion data predictions. The key finding of the research is that the recognition of the disease can be improved by connecting (post-model) the two modalities. Furthermore, it can be concluded that with the present approach, neither the drawing nor the movement data produced lower results on average.

Hand Eczema in the Polish Female Population.

This study aims to investigate the prevalence of hand eczema, its association with disinfectant usage during the COVID-19 pandemic, and potential correlations with age and dermatological history on hand symptoms in the Polish female population. A personalized online questionnaire was administered from January to March 2021 to 142 participants, including individuals with hand eczema. The questionnaire addressed demographics, dermatological history, disinfectant usage, and symptoms experienced during the pandemic. The prevalence of hand eczema was higher in younger adults (aged 18-35), with significant exacerbations reported due to increased disinfectant usage. Respondents with a dermatological history were more susceptible to new skin symptoms during the pandemic. The quality of life was substantially impacted, particularly in individuals with hand skin dermatoses. The COVID-19 pandemic had a considerable influence on hand eczema, affecting prevalence, symptoms, and quality of life. Disinfectant usage emerged as a key factor in exacerbating hand skin lesions. Further research is warranted to explore the influence of specific disinfecting agents and improve treatment guidelines for personalized management of hand eczema. Despite limitations in the online survey method, these findings highlight the importance of proactive healthcare support for individuals with hand eczema during challenging times.

Identification of work‐related injuries among Dhokra handicraft artisans influencing sustainable growth of bell metal handicraft industry: An unorganized sector of Chhattisgarh, India

AbstractHandicraft is the backbone of rural economy of countries of South Asia and Southeast Asia. Bell metal handicraft known as “Dhokra craft,” is an important metal handicraft practiced in India. Commercialization of this craft industry has increased working hours but the business model is still cottage‐based. Manual manufacturing for commercial needs has increased incidence of hand injuries among the artisans affecting sustainable growth. The objective of this research is to find the cause of work‐related hand injuries of the artisans of bell metal handicraft industry to provide direction for future research. Occupational risk on hands were identified using Modified Dutch Musculoskeletal Questionnaire. Severity of hand symptoms were assessed by Modified Boston Hand Evaluation Questionnaire. Direct observation and task analysis was further used to understand the risk involved in the job. Use of hand tools and power tools play significant role in the development of hand injuries among the artisans. Hand problems such as amputation, burning marks, loss of sensitivity, and tingling sensation were highly observed among artisans, those with experience &gt;31 years. Experienced artisans undergo more occupational hand injuries, causing absenteeism, job turnover, and job loss. This ultimately affects the sustainable growth of the Dhokra trade community.

Relating movement markers of schizophrenia to self-experience-a mixed-methods study.

Basic self-disorders on the one hand and motor symptoms on the other hand are discussed as endophenotypes of schizophrenia psychopathology. However, the systematic interaction between motor symptoms and the self-experience of patients is rarely studied. In a previous study we defined motor markers of schizophrenia via a data-driven analysis of patients' gait patterns. In this study, we related the movement markers to measures of basic self-disorder obtained with EASE interviews. We substantiated the correlations with a qualitative content analysis of the interviews of a subset of four patients. We related qualitative and quantitative data on an intra- and interpersonal level. Our results suggest an association between the previously defined, theory-independent movement markers and basic self-disorders, specifically in the domain of cognition, self-experience and bodily experiences. While movement marker manifestation was not precisely reflected in the individuals' descriptions of anomalous self- and body experience, we found clear trends of more and more intense descriptions with increasing movement marker scores, when looking at specific experiences, such as hyper reflexivity. These results foster an integrated view of the patient and could stimulate therapeutic approaches aiming at an improvement of self- and body-experience of patients with schizophrenia.

Prevalence of Self-Reported Hand Eczema Signs among Healthcare Workers after the Third Wave of COVID-19 Pandemic: A Survey in a Northern Italy Hospital.

Background: Proper hand hygiene is one of the enhanced preventive measures immediately proposed to avoid the spreading of the severe acute respiratory syndrome coronavirus-2, also known as COVID-19. Objectives: The objective of this study was to estimate the prevalence of self-reported hand eczema signs and symptoms among healthcare workers in a Northern Italy University Hospital after the third wave of the COVID-19 pandemic. Materials and methods: A cross-sectional study was conducted in June 2021. The hospital workers were invited to complete an online questionnaire through a link sent via institutional e-mail to both health personnel and support staff. Results: Eight-hundred and sixty-three subjects completed the questionnaire; 51.1% of them self-reported suffering from at least one hand skin lesion. One-hundred thirty-seven responders declared that they changed their hand hygiene habits, and 88.9% of them carried out these modifications both in occupational and domestic environments. In detail, a change in terms of daily hand washing frequency is reported as follows: before the COVID-19 pandemic, only 27.8% and 10.1% of responders washed their hands 10-20 and 20+ times per day, respectively, while after the pandemic, the percentage increased to 37.8% and 45.8%, respectively. When comparing the health care workers with the administrative staff, we observed a statistically significative difference (p = 0.0001) in the daily hand washing frequency among the two groups, with a higher value in health care personnel. Accordingly, a higher prevalence of hand eczema signs (52.8% versus 45.6%) was detected in the healthcare group. Conclusions: We underline the potential role of the pandemic in the spread of hand eczema as an occupational disease and the need to implement its prevention.

Experiences of cancer survivors with chemotherapy-induced peripheral neuropathy in the Netherlands: symptoms, daily limitations, involvement of healthcare professionals, and social support

PurposeA significant proportion of cancer patients suffer from chemotherapy-induced peripheral neuropathy (CIPN). This descriptive study aimed to examine patients’ experience of CIPN symptoms, daily limitations, involvement of healthcare professionals, and social support.MethodsCross-sectional data have been collected in the Netherlands via a national online questionnaire comprising closed items only (February 2021).ResultsOut of 3752 respondents, 1975 received chemotherapy only (i.e., without targeted therapy) and were therefore included. The majority (71.2%) reported symptoms in both hands and feet (e.g., tingling and loss of sensation or diminished sensation). Participants reported most limitations in household chores, social activities, hobbies, sports, walking, and sleeping and least in family/(taking care of) children, cycling, driving, self-care, eating and drinking, and sexuality and intimacy. Many patients indicated that their healthcare professionals informed them about the possibility of CIPN development before treatment (58.4%), and they paid attention to CIPN during and after treatment (53.1%). However, many patients (43%) reported a lack of information on what to do when CIPN develops. Few participants (22%) visited their general practitioner (GP) for CIPN. In general, patients’ social environments sometimes to always showed empathy to patients.ConclusionsSymptoms of CIPN are frequently reported and can result in various daily limitations. Support from professionals and peers is crucial in managing CIPN, which is sometimes lacking. Appropriate guidance and support should be provided to patients to decrease the impact of CIPN on daily life. Future research should investigate differences in chemotherapeutic agents and the resulting symptoms and consequences.

Learning Hand Kinematics for Parkinson's Disease Assessment Using a Multimodal Sensor Glove.

Hand dysfunctions in Parkinson's disease include rigidity, muscle weakness, and tremor, which can severely affect the patient's daily life. Herein, a multimodal sensor glove is developed for quantifying the severity of Parkinson's disease symptoms in patients' hands while assessing the hands' multifunctionality. Toward signal processing, various algorithms are used to quantify and analyze each signal: Exponentially Weighted Average algorithm and Kalman filter are used to filter out noise, normalization to process bending signals, K-Means Cluster Analysis to classify muscle strength grades, and Back Propagation Neural Network to identify and classify tremor signals with an accuracy of 95.83%. Given the compelling features, the flexibility, muscle strength, and stability assessed by the glove and the clinical observations are proved to be highly consistent with Kappa values of 0.833, 0.867, and 0.937, respectively. The intraclass correlation coefficients obtained by reliability evaluation experiments for the three assessments are greater than 0.9, indicating that the system is reliable. The glove can be applied to assist in formulating targeted rehabilitation treatments and improve hand recovery efficiency.

Surgical Release of Ulnar and Median Nerves in CMT1A: Prevention and Treatment of a Second Hit (P14-8.013)

<h3>Objective:</h3> To evaluate outcomes of carpal tunnel (CT, CTS), cubital tunnel (CuT, CuTS), and Guyon’s Canal (GC, GCS) release in patients with Charcot-Marie-Tooth disease type 1A (CMT1A). <h3>Background:</h3> Peripheral nerves in patients with CMT1A are diffusely enlarged and areas of potential compression at the CT, CuT, and GC can be released to reduce the risk of a “second hit” (nerve injury due to compression) in the setting of their genetic, progressive neuropathy, however there is little data on the efficacy and timing of surgical nerve decompression. <h3>Design/Methods:</h3> Genetically diagnosed and suspected CMT1A patients that reported hand symptoms seen in clinic in 2021–2022 with electrophysiologic data who were evaluated by neurosurgery for surgical decompression for CTS, CuTS, and GCS were reviewed. <h3>Results:</h3> All patients had severe slowing of motor nerve conduction velocities and absent sensory responses on NCS consistent with CMT1A. Electrographic CTS occurred bilaterally in 83%(5/6). Electrographic bilateral GCS and unilateral CuTS were observed in 33%(2/6) of patients. Three patients with sonographic data all demonstrated diffuse enlargement of the ulnar and median nerves at the forearm (mean cross-sectional area, CSA=20 mm2 and 26 mm2). Focal narrowing occurred at the CT in two patients (mean CSA=11.2 mm2 vs 37 mm2 at the forearm). One patient underwent unilateral and one patient underwent bilateral decompression at the CT, CuT, and GC with a follow-up time of 8 months and 2 months. Both patients endorsed significant improvement of gross grip strength in at least one hand and resolution of median sensory abnormalities in territories of released nerves. <h3>Conclusions:</h3> Although altered due to the nature of CMT1A, electrophysiologic and sonographic data provided focal findings in our patients with hand symptoms. Patients who underwent surgical decompression had symptomatic benefits. These releases can reduce the risk of a “second hit” of neurologic injury due to compression. <b>Disclosure:</b> Dr. McKeen has nothing to disclose. Dr. Katyal has nothing to disclose. Dr. Sakamuri has received personal compensation in the range of $0-$499 for serving as a Conference Faculty with AANEM. Dr. Wilson has nothing to disclose. Dr. Greene has received personal compensation in the range of $500-$4,999 for serving as a Advisory Board Member with Dysimmune Diseases Foundation .

E071 Which clinical, ultrasound and OT hand assessments are most useful in predicting hand disability in early rheumatoid arthritis?

Abstract Background/Aims Developing a clear understanding of the features of hand involvement that are associated with future disability will assist in designing future OT clinical intervention studies and will aid in selecting RA patients for intensive hand therapy and early aggressive medical treatment. This study aimed to determine which hand assessments best predicted hand disability in patients with early Rheumatoid arthritis (RA). Methods 63 early RA patients with hand symptoms were identified from Rheumatology clinics in the Belfast Health and Social Care Trust. Assessments were undertaken at baseline and at 1 year. Hand disability outcome was measured using the Sequential Occupational Dexterity Assessment (SODA). Grip Strength (GS), Total Pain Score (PS), Modified Kapandji index (MK), Stanford Health Assessment Questionnaire (HAQ) and Moberg pick up test (MoV) were assessed by trained occupational therapists (OTs); Ultrasound assessments of hand and wrist were undertaken by trained rheumatologists. Summated (Global) hand and wrist Ultrasound activity score (G-UAS), hand and wrist Power Doppler score (G-PD), and ultrasound erosion score were calculated. Hand deformity score (DS), standardised hand X-ray, Das-28, RF and anti-CCP antibody were undertaken at each assessment. Results There was no significant change in the median SODA score after one year. The main static predictor for baseline SODA was HAQ (25% of the variability). DAS28, MK and Grip Average were statistically significant on their own accounting for between 6-10% variability in the model but when all significant explanatory variables were included HAQ was the only significant variable (23%). Regression for year 1 SODA showed that the main static predictor was MK (adjusted R-squared 59%). PS, DAS28 and GS were statistically significant on their own accounting for between 7-23% variability, but when all significant explanatory variables were included, the MK was the only one of significance (58%). Regressing all explanatory variables against SODA resulted in an adjusted R-squared of 61%: MK and G-UAS (although not significant on its own) were the only ones that were significant. When baseline data was used to predict year 1 SODA, HAQ, MK, PS, DAS28 and GS were statistically significant on their own, but when all significant explanatory variables were included only HAQ and MK were significant explaining 57% of the variability. When HAQ was excluded, PS, DAS28 and GS were statistically significant on their own accounting for between 10-19% variability. When all significant explanatory variables were included, MK was the only one that was significant (adjusted R-squared was 50%). Conclusion Amongst the variables assessed, the HAQ showed good overall prediction for SODA as expected. MK was the most reliable time-lag predictor of hand disability at one year in early RA. X-ray, MoV, GS and ultrasound assessments were much less associated but longer follow-up studies would be useful. Disclosure C. Harkness: None. E. Ball: None. S. Wright: None. E. Crone: None. E. Henry: None. L. Foster: None. H. Farmer: None. A. Bell: None.

Diet as a Factor Supporting Lung Cancer Treatment—A Systematic Review

The purpose of this study was to summarize the evidence from epidemiological studies concerning associations between diet and the effectiveness of treatment for lung cancer. For this review, a literature search has been conducted in the EMBASE and PubMed databases, including papers published between 1977 and June 2022. The term "lung cancer" was used in conjunction with "diet". Footnotes from the selected papers were also analyzed. The present study is in line with the recommendations included in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review included studies involving adults, including randomized controlled trials (RCTs) and cohort and observational studies. In total, 863 papers were found, with duplicates excluded. Ultimately, 20 papers were reviewed. The present systematic review indicates that vitamin A, ascorbic acid (vitamin C), vitamin E, selenium, and zinc-as antioxidants-can strengthen the body's antioxidant barrier. Furthermore, preoperative immunonutrition may not only improve perioperative nutritional status following induction chemoradiotherapy in lung cancer surgery patients but also reduce the severity of postoperative complications. Similarly, a protein supply may exert a beneficial effect on human health by increasing average body weight and muscle mass. Omega-3 fatty acid content in the diet and the consumption of their main source, fish, may have some regulatory effect on inflammation in patients with lung cancer treated with chemotherapy and radiotherapy. In addition, n-3 fatty acids inhibit tumor cell proliferation and may reduce the toxicity of chemotherapy. Increased energy and protein intake are strongly associated with improved quality of life, functional outcomes, hand grip strength, symptoms, and performance in patients with lung cancer. The use of a supportive diet should be the standard of care, alongside pharmaceutical therapy, in treatment for patients with lung cancer.

Carpal tunnel syndrome with shoulder symptoms; is it a different entity? A prospective cohort study comparing recovery patterns following decompression

Background: Carpal tunnel syndrome (CTS) may present with atypical proximal symptoms other than hand symptoms.Among proximal symptoms, shoulder symptoms are most distant to the site of compression and leads to a battery of investigations to exclude other pathologies. The recovery patterns of proximal symptoms have not been studied following carpal tunnel decompression. Methods: A prospective cohort study was conducted to compare the recovery patterns between subgroup-A; CTS patients (n=55) with shoulder symptoms, with subgroup-B; patients (n=55) without shoulder symptoms. A pre-tested questionnaire was administered prior and after the surgery and information was gathered on day-7, day-14 and day-21. Results: Of 110 patients, 81.8% were females. The mean age(+SD) of the total population was 49.2(+10.6), that of subgroup-A was 48.7(+10.3), and subgroup-B was 49.7(+11) years. They were predominantly right-handed (82.7%), 73% had their dominant hand affected while 74.5% were affected bilaterally at presentation. All had hand symptoms: numbness in 94.5%, pain in 85.4%, tingling of hand in 66.3% and all-three symptoms in 57.2%. In subgroup-A, pain was the predominant shoulder symptom which appeared before hand symptoms in 34.5%, after in 47.3% and simultaneously in 18.2%. It was aching-type in 91%. The pain radiated proximally (neck and scapula) in 61.8% and to the arm in 81.8%. The recovery rates (RR) of hand symptoms following decompression on day-7 were 41.8% in subgroup-A and 40.0% in subgroup-B. RR of hand symptoms in subgroup-A and subgroup-B on day-14 were 72.7% and 70.9%, while on day-21 were 83.6%and 85.5% respectively. RR of shoulder symptoms in subgroup-A were 38.2% on day-7, 65.4% on day-14, and 78.2% on day-21. Conclusions: Near identical RR of hand and shoulder symptoms were seen between the two subgroups after decompression, which indicates CTS with shoulder symptoms is not a different entity.