Interphalangeal Joint Range Of Motion Research Articles

Novel figure-of-eight reconstruction with free tendon graft for unrepairable collateral ligament of the thumb metacarpophalangeal joint

ObjectivesThis study aimed to report surgical technique and clinical outcomes for a novel figure-of-eight collateral ligament reconstruction technique using palmaris longus autograft for chronic irreparable collateral ligament injury of the thumb metacarpophalangeal joint. Material and methodsThe Jobe elbow collateral ligament reconstruction method was adapted for thumb metacarpophalangeal joint collateral ligament reconstruction. Sixteen reconstructions (7 ulnar collateral ligament, 9 radial collateral ligament) using palmaris longus autograft were reviewed retrospectively. Surgery was performed at a mean 12 months post-injury. All 16 patients were followed up for more than 1 year. Metacarpophalangeal joint radial and ulnar deviation, metacarpophalangeal and interphalangeal joint range of motion, key pinch and grip strength, Glickel functional grade and QuickDASH score were evaluated. ResultsPreoperative radial or ulnar deviation improved from 19.3° to 5.3° postoperatively. Metacarpophalangeal range of motion improved from 31.5° to 46.6°, and interphalangeal range of motion from 48.4° to 65.6°. Preoperative key pinch and grip strength were respectively 49% and 81% of contralateral values and improved to 82% and 87%. On Glickel grade, 9 cases were excellent and 7 good. ConclusionThe novel Jobe-like figure-of-eight reconstruction technique using palmaris longus graft was useful for reconstructing irreparable thumb metacarpophalangeal joint instability without an incision on the opposite side or an additional implant. Level of evidenceTherapeutic study, level IV.

Hemi-hamate arthroplasty outcomes: a single-centre experience.

This retrospective observational study evaluated outcomes after hemi-hamate arthroplasty. A palmar cortical step caused by the osteochondral graft was associated with reduced proximal interphalangeal joint range of motion compared to a flush palmar cortex at early follow-up (62° vs. 83°; p = 0.006).

Single-Portal Antegrade Endoscopic Trigger Finger Release: Cadaveric and Clinical Outcomes.

This study aimed to examine the relationship between anatomical surface landmarks in fresh frozen cadavers as related to in vivo endoscopic trigger finger release (ETFR) and present clinical outcomes after a single-portal antegrade ETFR technique. Endoscopic trigger finger release was performed on 40 cadaveric digits. Each digit was dissected and the following measurements were recorded: distance from palmar digital crease and A1 pulley, length of the A1 pulley, percentage of A1 pulley released, and injury to vulnerable anatomy. A retrospective chart review was performed on 48 patients (62 digits) treated with ETFR. Outcome measures included grip and pinch strength, range of motion, Disability of Arm, Shoulder, and Hand (DASH) questionnaires, and Visual Analog Scale (VAS) pain scores. Release of the A1 pulley was achieved in 33 of the 40 cadaveric digits (83%) with an A2 pulley laceration rate of 25%. No flexor tendon or neurovascular injuries occurred. Gross grasp, lateral pinch, 3-jaw chuck, and precision pinch strength had 85%, 90%, 82%, and 90% recovery, respectively. At the final follow-up, average metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint range of motion were within the normal limits. Mean VAS scores decreased from 5.7 preoperatively to 1.0 postoperatively and mean DASH score at the final follow-up was 4.8. With the use of anatomical surface landmarks, ETFR may be performed in an efficient and reproducible manner. Patients treated with ETFR had low complication rates, good functional recovery, and improved pain at short-term follow-up. Further study of long-term outcomes and cost-effectiveness of ETFR is warranted.

Early Surgical Results of Pediatric Unicondylar Phalangeal Fractures

Conventional teaching dictates that timely diagnosis and expeditious treatment of unicondylar phalangeal fractures are essential to restore articular congruity, which allows for optimal range of motion and function. The objective of this study was to compare the radiographic and clinical results of surgical treatment of acute and chronic unicondylar phalanx fractures in pediatric patients. Thirty-four patients with unicondylar phalangeal fractures underwent surgical intervention at a pediatric tertiary care center from 2004 to 2016. A fracture was defined as acute if an interval of 4 weeks or less had elapsed between the date of injury and date of surgery and chronic if an interval of more than 4 weeks had elapsed between the date of injury and date of surgery. Preoperative and postoperative radiographs were assessed. The joint alignment was determined by measuring the angle between the longitudinal axis of the phalanx and a line tangential to the articular condyles on anteroposterior radiographs. There were 24 patients (71%) with acute and 10 (29%) with chronic fractures. An oblique volar fracture pattern was most common in both the groups. The average joint alignment obtained from the anteroposterior radiographs at presentation was 6° in the acute group and 12° in the chronic group. The surgical procedures performed included closed reduction and percutaneous pinning, open reduction and internal fixation, osteoclasis or osteotomy and fixation, and corrective advancement osteotomy. The posttreatment alignment was within 3° of neutral in 21 patients (88%) with acute injury and 8 (80%) with chronic injury. The average interphalangeal joint range of motion at the final clinic visit was 1°-92° in the acute group and 4°-85° in the chronic group. One patient with chronic injury developed avascular necrosis after treatment with corrective osteotomy. The patterns and characteristics of unicondylar phalanx fractures are similar between pediatric patients and adults. The radiographic alignment and digital motion are improved with surgical reduction and fixation, regardless of chronicity. Therapeutic IV.

Complications and Clinical Outcomes Following Zone I Flexor Tendon Repair Using All-Inside Suture Fixation

The purpose of this study was to evaluate complications and outcomes of an all-inside repair technique for flexor digitorum profundus (FDP) avulsions. A retrospective review of a single institution database identified all FDP avulsions that were repaired using an all-inside technique by a single surgeon. In this method, 2 Keith needles are drilled from the volar to dorsal aspect, exiting proximal to the nail matrix and within the extensor tendon. Nonabsorbable sutures were placed in the flexor tendon and passed through the bone tunnels, tying dorsally over the distal phalanx. The demographics characteristics, injury characteristics, the surgical procedure, postoperative complications, and outcomes were reviewed. Seventeen patients were included in the study. The average age was 40 years (range, 21-68 years), and 2 patients were women. Seventeen fingers were included: 14 ring fingers, 1 index finger, and 2 little fingers. Six patients had an associated distal phalanx fracture and one had an associated distal interphalangeal joint dislocation. The average time between injury and surgery was 9 days (range, 2-18 days). Four patients had complications: 3 with erythema related to infection, which appeared to be a reaction to the suture prompting removal, and 1 with a subungual mass related to the suture at removal. One patient had persistent pain. Postoperative range of motion, assessed using the Strickland criteria, was excellent or good in 5 (33%) of 15 patients, but this was predominantly due to motion at the proximal joints as overall DIP motion was limited. Patients had a mean distal interphalangeal joint range of motion of 24° (range, 0° to 55°). In our series, repair of FDP avulsions via all-inside suture fixation is associated with limited distal interphalangeal joint motion and an incidence of infection (24%) at final follow-up. Therapeutic V.

The Evaluation of a Flexor Digitorum Profundus-to-Volar Plate Zone I Repair Versus Button Repair: An In vitro Biomechanics Study

The purpose of the study was to evaluate joint kinematics and tendon work of flexion (WOF) following a flexor digitorum profundus (FDP)-to-volar plate (VP) repair technique relative to a pullout button for zone I flexor tendon injuries. Fourteen digits were tested using an invitro active finger motion simulator under 3 repaired conditions following a simulated zone I avulsion: button, FDP-VP, and "no slack" FDP-VP (corrected for additional VP length). Outcome metrics included active joint range of motion (ROM), fingertip strength, FDP and flexor digitorum superficialis tensile loads, and WOF. The button and FDP-VP techniques restored WOF to the intact condition for FDP and flexor digitorum superficialis. All repairs restored distal interphalangeal joint ROM and kinematics to the intact condition. Similarly, all repairs restored WOF; however, the "no slack" FDP-VP significantly increased WOF by 10% to 12% over the simple FDP-VP repair. The button technique had similar fingertip strength to the intact condition, whereas the FDP-VP repairs significantly reduced peak fingertip strength from intact, albeit only 1-2 N compared with the button repair. In this invitro cadaveric model, the button and FDP-VP techniques restored WOF and ROM to within intact levels, with no difference between these repairs in all measured outcome metrics. Based on its initial strength and its equal biomechanical performance compared with the button repair, the FDP-VP technique may be a viable option for treating FDP avulsions.

Conservative versus Surgical Treatment in Management of Closed Mallet Finger:A Systematic Review and MetaAnalysis

Abstract Background Several methods of treatment have been mentioned in management of closed mallet finger injury, as conservative methods using stack splint,dorsal aluminum splint or custom thermoplastic splint, or surgical procedures as direct pinning method, extention block technique or hook plate fixation, there is no consensus for the best method of treatment. Objectives to review and meta-analyze the outcomes of conservative versus surgical treatment in management of closed mallet finger injury and statistically compare between their results of pain, extensor lag, range of motion of distal inter-phalangeal joint. Materials and Methods The review will be restricted to randomized controlled trials (RCTs), clinical trials, and comparative studies, either prospective or retrospective, which studied the outcome of conservative versus surgical treatment in management of closed mallet finger, articles published in English. PRISMA flow chart 950 articles were found using search keywords. By filtration and screening of the title and exclusion of unrelated articles, 150 articles were found. By applications of all inclusion and exclusion criteria, only 55 articles which met all inclusion criteria, 50 studies were systematically reviewed, and 5 randomized controlled trials were fit to undergo a meta-analysis, after conducting meta-analysis we found that P value for pain svore based on visual analogue score (VAS) was 1, extensor lag P value < 0.001, and range of motion P value <0.001. Conclusion No significant differences was found between the conservative and the surgical groups regarding the pain score, distal inter-phalangeal joint extensor lag, and distal inter-phalangeal joint range of motion in treatment of closed mallet finger.

Investigating the effects of flexor tendon shortening on active range of motion after finger tendon repair.

Evaluation of surgical effects is often done using simple cadaver experimentation. This study uses a robotic testbed to estimate the best-case clinical outcomes of flexor tendon shortening during repair surgery on cadaver hands. Nine fresh-frozen cadaver subjects were connected to an extrinsic index finger robotic muscle testbed and measurement system. The flexor digitorum profundus tendons were severed and surgically repaired at different shortening levels. The index finger's extrinsic tendons were robotically actuated using Hill-type muscle models to emulate the muscle force-length relationships. Extensor muscles were then activated to estimate the active range of motion (ROM) of the all-finger joints after surgery. The effects of metacarpophalangeal (MCP) joint extension limits and extensor muscle activation were also investigated. The resulting interphalangeal joint ROM was clinically graded. Active ROM of the finger decreases as tendon shortening increases ( ), like passive ROM. This results in a clinical reduction of functionality grade from excellent to good at 10 mm of shortening. Blocking MCP joint ROM and extensor activation also showed significant effects on recovered ROM ( and 0.86). Significant two-way interactions were also observed between shortening and MCP joint blocking ( ) and between shortening and extensor activation ( ). Results support clinical recommendations of limiting shortening to 10 mm. While this article provides additional experimental evidence for current surgical recommendations, it also validates a new robotic-cadaver methodology for predicting active hand recovery in terms of clinical measurements.

Measurement of finger joint motion after flexor tendon repair: smartphone photography compared with traditional goniometry.

The purpose of our study was to determine whether smartphone photography is as reliable and valid as clinical goniometry for measuring interphalangeal joint range of motion. We conducted a retrospective review of 37 fingers in 33 patients after flexor tendon repair. The measurements on photographs taken with a smartphone by a surgeon were compared with manual measurements with goniometry by the same surgeon. Pearson coefficients and interclass correlation coefficients were all above 0.85, and Bland-Altman analysis demonstrated that at least 35 of 37 measurements were within the 95% confidence interval in all variables. According to the Tang criteria, the total number of excellent and good results were equivalent according to both methods. There was high interobserver reliability between measurements by surgeons and a therapist. We conclude that if the pictures are properly taken, the measurement of the angles in the smartphone pictures are as reliable as measuring the angles with goniometry and that grading of the results according to the two methods gives identical results.

Use of Thermoplastic Rings Following Venting of Flexor Tendon Pulleys: A Biomechanical Analysis

Normal digital flexion relies on flexor tendon pulleys to convert linear muscular force to angular digital motion. However, there is a growing trend to vent them partially during flexor tendon repair. The objective of this study was to examine the effects of a thermoplastic ring, acting as an external pulley, on flexor tendon biomechanics and finger range of motion (ROM) after pulley venting. We tested 15 cadaveric digits using an invitro active finger motion simulator. We measured loads induced by flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) as well as joint ROM with sequential sectioning of the A2, A3, and A4 pulleys compared with an intact pulley condition. At each stage, external thermoplastic pulley rings were applied snugly over the proximal and middle phalanges to recreate A2 and A4 function, respectively. After complete venting of the A2, A3, and A4 pulleys, proximal interphalangeal joint ROM significantly decreased by 13.4° ± 2.7° and distal interphalangeal joint ROM decreased by 15.8° ± 2.1°. Application of external rings over the proximal and middle phalanx resulted in a residual ROM decrease of 8.3° ± 1.9° at the proximal interphalangeal joint and 7.9° ± 2.1° at the distal interphalangeal joint, nearly restoring ROM. Similarly, complete pulley venting resulted in reduced FDS load by 37% and FDP load by 50% compared with intact pulleys. After application of external rings, loads were restored almost to normal, with a 9% reduction for FDS load and 9% reduction for FDP load compared with intact pulleys. The application of thermoplastic rings acting as external pulleys is an effective, noninvasive, and reproducible approach to restore flexor tendon biomechanics and digit ROM after pulley venting. Thermoplastic rings may be a useful therapeutic adjunct in restoring joint ROM and flexor tendon loads after surgical venting of the pulleys.

Comparison of Innervated Digital Artery Perforator Flap Versus Homodigital Reverse Flow Flap Techniques for Fingertip Reconstruction

The aim of this study was to investigate and compare outcomes of 2 different flap techniques for fingertip reconstruction: innervated digital artery perforator (IDAP) flap and homodigital reverse-flow flap. Medical records of 33 patients who underwent fingertip reconstruction either with an IDAP flap (15 patients) or with a homodigital reverse-flow flap (18 patients), between 2014 and 2016, were evaluated retrospectively. In both study groups, full-thickness skin grafts harvested from the proximal/volar side of the forearm were used to cover the flap donor site. Flap survival, venous congestion, cold intolerance, static 2-point discrimination, flap size, duration of surgery, time to return to work, proximal and distal interphalangeal joint range of motion, Disability of the Arm, Shoulder, and Hand questionnaire scores, and follow-up time were evaluated. All the major outcomes, including flap survival, cold intolerance, static 2-point discrimination, flap size, time to return to work, range of motion values for proximal and distal interphalangeal joints, Disability of the Arm, Shoulder, and Hand questionnaire scores, and follow-up time, were similar between the 2 flap methods. Mean duration of surgery was shorter in the IDAP flap group. Marginal flap necrosis occurred in 1 IDAP flap, and there was complete survival of the remainder of the flap after debridement. Temporary venous congestion was seen in 3 IDAP flaps, all of which resolved with nonsurgical measures. Similar success rates and satisfactory outcomes were achieved with IDAP flap and reverse-flow flap techniques used for fingertip reconstruction. Therapeutic IV.

Comparison of Homodigital Dorsolateral Flap and Cross-Finger Flap for the Reconstruction of Pulp Defects

The homodigital dorsolateral flap (HDF) was described to treat various types of pulp and fingertip defects. The aim of this study was to analyze the intermediate-term function after fingertip reconstruction with HDF and compare these results with the cross-finger flap. We analyzed a retrospective cohort of 25 patients. The HDF group consisted of 16 patients (18 fingertip defects) with a mean age of 44 years (range, 16-63 y). The cross-finger flap group consisted of 9 patients (10 fingertip defects) with a mean age of 33 years (range, 16-47 y). The average follow-up time was 12 months (range, 6-36 mo). Patients with homodigital reconstruction demonstrated better sensibility in terms of mean static 2-point discrimination. Two-point discrimination was also better when the flap was advanced compared with when the flap was rotated. Mean distal interphalangeal joint range of motion for the HDF group was significantly better compared with the cross-finger flap group. Proximal interphalangeal joint range of motion was significantly better in the HDF group. The HDF for reconstruction of pulp defects is a reliable option for 1-stage reconstruction. Related complications are minimal, and the intermediate-term functional results are better compared with cross-finger flaps. Therapeutic IV.

Multiple Recurrences in Aggressive Forms of Dupuytren’s Disease—Can Patients Benefit from Repeated Selective Fasciectomy?

Background:In Dupuytren’s disease (DD), limited fasciectomy is the mainstay of surgical therapy in patients at risk of contractures and disease recurrences. New minimally invasive treatments such as injection of collagenase clostridium histolyticum have evolved as a common tool for the preliminary treatment of Dupuytren’s contractures. However, recurrences and their therapy remain controversial. In this study, we evaluate the benefit of repeated limited fasciectomy in patients with aggressive forms of the disease and multiple recurrences of contractures.Methods:We evaluated the outcome of 16 patients undergoing limited fasciectomy 3 or more times on a single hand.Results:Postoperatively, 10 of 13 (76.9%) patients were satisfied with the clinical result after the last operation; 10 of 12 (83.3%) patients would choose to have their surgery repeated, if so needed. The mean improvement of proximal interphalangeal joint range of motion was 59.2 degrees (SD 26.8) and 86.2% (SD 19.9). There were no severe complications after treatment within the observed time period.Conclusions:Our findings demonstrate that patients with recurrence of contractures after multiple previous treatments in aggressive forms of DD can benefit from surgical intervention. In conclusion, repeated limited fasciectomy remains indicated in patients after previous surgeries with DD.

Effects of a Modified Hand Compression Bandage for Treatment of Post-Burn Hand Edemas.

ObjectiveTo evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema.MethodsPatients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment.ResultsAs a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p<0.05) and time×group (reciprocal action) effect (p<0.05). The results of grasp power, Jebsen hand function test, and each proximal interphalangeal joint ROM, show significant differences in accordance with the time effect (p<0.05), however, there was no reciprocal action effect (p>0.05).ConclusionThe modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.

Treatment of fracture subluxations of the proximal interphalangeal joint using a ligamentotaxis device: a multidisciplinary approach.

Complex fracture subluxations of the proximal interphalangeal joint are often difficult to treat and their outcome variable. A number of methods for treatment of these injuries have been described. We have used a ligamentotaxis device (Ligamentotaxor, Arex, Palaiseau Cedex, France) since 2008. We performed 28 operations in 28 patients with complex proximal interphalangeal joint injuries over a 3-year period. Patients followed a standardized postoperative rehabilitation regime, including fixator adjustment as necessary. The mean age was 33 years (range 18-67). The mean time to surgery was 7 days. At final follow-up (mean 22 months, range 6-52) the mean proximal interphalangeal joint range of motion was 85° (range 60°-110°). The mean QuickDASH functional outcome score was 4.8 (range 0-36.4). Our results compare favourably with other devices reported in the literature.

The hemi-hamate autograft arthroplasty in proximal interphalangeal joint reconstruction: a systematic review

Palmar lip injuries of the proximal interphalangeal joint with dorsal fracture-dislocation are difficult to treat and often require major reconstruction. A systematic review was performed and yielded 177 articles. Thirteen articles on hemi-hamate autograft were included in full-text analysis. Results of 71 cases were summarized. Mean follow-up was 36 months and mean proximal interphalangeal joint range of motion was 77°. Overall complication rate was around 35%. Up to 50% of the patients showed radiographic signs of osteoarthritis. However, few of those patients complained about pain or impaired finger motion. Based on this systematic analysis and review, hemi-hamate autograft can be considered reliable for the reconstruction of acute and chronic proximal interphalangeal joint fracture-dislocations with joint involvement >50%, but longer-term follow-up studies are required to evaluate its outcome, especially regarding the rate of osteoarthritis.

Stability of Acute Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint: A Biomechanical Study

We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects). Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred. No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67° (range, 10° to 90°) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14° (range, 4° to 40°). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1mm in the 80% group. Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability. Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations.

The outcomes of zone 1 flexor tendon injuries treated using micro bone suture anchors

This article evaluates the outcome of 42 consecutive zone 1 flexor tendon injuries treated by using micro bone anchors during the period 2003-2008. Patients were rehabilitated using the modified Belfast Regime. The range of motion at the distal interphalangeal joint was assessed using Moiemen's classification. A total of 56% of patients achieved excellent or good results for range of motion at the distal interphalangeal joint and 23% had a poor outcome. The mean distal interphalangeal joint and proximal interphalangeal joint range of motion were 48° and 96°, respectively. A total of 94% of patients returned back to work by 12 weeks. One patient sustained a tendon rupture and one developed osteomyelitis. The mean QuickDASH score was 13.5 and 81% of patients were satisfied with their outcomes. This is the largest clinical study on the use of bone anchors for zone 1 tendon injuries. Our study demonstrated a low rate of complications and outcomes that compare favourably with other published techniques.

Target-focused Exercise Regime: A Motivational Strategy to Improve Patient's Adherence to Treatment of a Stiff Thumb Interphalangeal Joint

As hand therapists, we are often creative in altering and individualizing orthoses to meet specific patient needs. To assist patients in regaining desired thumb interphalangeal joint range of motion, these authors added a target component to a standard short opponens orthosis. This target component allowed patients to visualize the range of motion goal, thus subjectively resulting in better patient compliance and range of motion.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor As hand therapists, we are often creative in altering and individualizing orthoses to meet specific patient needs. To assist patients in regaining desired thumb interphalangeal joint range of motion, these authors added a target component to a standard short opponens orthosis. This target component allowed patients to visualize the range of motion goal, thus subjectively resulting in better patient compliance and range of motion.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor JHT Read for CreditQuiz: Article #234Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.#1.The target component was placed towarda.radial deviationb.ulnar deviationc.flexiond.extension#2.The desired weekly progression was established as an increase of approximatelya.10°–15°b.15°–20°c.20°–25°d.5°–10°#3.The authors present their work as aa.single case studyb.random clinical trials designc.series of cases with definitive diagnosesd.clinic wide experiential report#4.Though the reader cannot be sure, one can presume that goals and gains were expressed as increases ina.composite flexionb.lag reductionc.AROMd.PROM#5.The authors took into account the severity of the stiffness by using the Modified Weeks Test before setting goalsa.Trueb.the descriptive paper does not sayWhen submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit. Quiz: Article #234Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.#1.The target component was placed towarda.radial deviationb.ulnar deviationc.flexiond.extension#2.The desired weekly progression was established as an increase of approximatelya.10°–15°b.15°–20°c.20°–25°d.5°–10°#3.The authors present their work as aa.single case studyb.random clinical trials designc.series of cases with definitive diagnosesd.clinic wide experiential report#4.Though the reader cannot be sure, one can presume that goals and gains were expressed as increases ina.composite flexionb.lag reductionc.AROMd.PROM#5.The authors took into account the severity of the stiffness by using the Modified Weeks Test before setting goalsa.Trueb.the descriptive paper does not sayWhen submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit. Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.#1.The target component was placed towarda.radial deviationb.ulnar deviationc.flexiond.extension#2.The desired weekly progression was established as an increase of approximatelya.10°–15°b.15°–20°c.20°–25°d.5°–10°#3.The authors present their work as aa.single case studyb.random clinical trials designc.series of cases with definitive diagnosesd.clinic wide experiential report#4.Though the reader cannot be sure, one can presume that goals and gains were expressed as increases ina.composite flexionb.lag reductionc.AROMd.PROM#5.The authors took into account the severity of the stiffness by using the Modified Weeks Test before setting goalsa.Trueb.the descriptive paper does not say When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.

Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion

This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). Dorsiflexion of the hallux interphalangeal joint was measured in 60 normal feet and in 60 feet with hallux limitus to find correlations with first metatarsophalangeal joint dorsiflexion with the Spearman correlation coefficient and a simple linear regression equation. In addition, movement of the hallux interphalangeal joint was compared between normal and hallux limitus feet with the Mann-Whitney U test. Significant differences were found between the groups in mean ± SD interphalangeal joint dorsiflexion (control group: 1.17° ± 2.50° ; hallux limitus group: 10.65° ± 8.24° ; P < .001). A significant inverse correlation was found between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion (ρ = -0.766, P < .001), and the regression equation from which predictions could be made is the following: hallux interphalangeal joint dorsiflexion = 27.17 - 0.381 × first metatarsophalangeal joint dorsiflexion. Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet. There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.