Lateral Pinch Research Articles

Influence of Upper Extremity Muscle Mass on Lateral Pinch Strength

Background: Pinch strength is required for activities of daily living, and any decline in it can cause difficulty with fine motor skills, such as fastening buttons or tying shoelaces. Thus, it is important to prevent the deterioration of pinch strength. Muscle strength is positively related to muscle mass. Conversely, it has been reported that changes in muscle mass and muscle strength do not always correspond and bioelectrical impedance analysis is a relatively easy method to measure muscle mass. But there has been little study of how upper extremity muscle mass using bioelectrical impedance analysis influences pinch strength. In this study, we aimed to investigate the relationship between upper extremity muscle mass and pinch strength. Furthermore, we examined the association between upper extremity fat mass and pinch strength. Methods: This cross-sectional study included 82 healthy young men and women aged 20-22 years (mean age, 21.1 ± 0.7 years). Maximum lateral pinch strength was measured using a digital pinch sensor. Upper extremity muscle mass and fat mass were estimated using bioelectrical impedance analysis. The relationships between pinch strength, upper extremity muscle mass, and upper extremity fat mass were assessed using correlation and multiple regression analyses. Results: Men had a greater pinch strength and upper extremity muscle mass than women (P < 0.05); however, there was no significant difference in upper extremity fat mass (P > 0.05). Pinch strength showed a significantly positive association with upper extremity muscle mass (P < 0.05), but not with upper extremity fat mass (P > 0.05). In multiple regression analysis adjusted for sex, upper extremity muscle mass was found to be a significant explanatory variable for pinch strength (P < 0.05). Conclusion: To prevent the decline in pinch strength, preserving the ability of daily living activities that involve the hands, such as fastening buttons or tying shoelaces, needs to be focused on by improving upper extremity muscle mass using bioelectrical impedance analysis.

Efficacy of Primary Repair in Professional Athletes with Chronic Radial Collateral Ligament Injuries of Thumb Metacarpophalangeal Joint.

Background: Management of grade III injuries of the radial collateral ligament (RCL) of the thumb is controversial. These injuries are often treated with early surgery. However, early surgery may not be practical for the professional athlete. We report on the outcome of delayed primary repair of chronic RCL injuries without the use of tendon grafts or tendon transfers. Methods: Twelve elite professional athletes with 15 soft tissue RCL injuries who underwent delayed surgery (greater than 6 weeks) were included in this study. Athletes were managed with splinting and ongoing play during the sporting season, and underwent surgery at the conclusion of the season. Mean duration from injury to surgery was 5 months. Mean follow-up was 4.2 years after surgery. Patient-report outcome measures including pain, satisfaction rating, and disability of the arm, shoulder and hand (DASH) scores were collected. Examination findings including range of motion, laxity, and grip and pinch strength were also measured. Return-to-play data were collected for all athletes. Results: The RCL was able to be primarily repaired with suture anchors in all cases. All twelve patients were able to return to competitive play at the same pre-injury professional level. Post-operative joint function such as range of motion and laxity were comparable to the unaffected contralateral side, as were grip and lateral pinch strengths. Tip-pinch strength is lower compared to the unaffected side, but is comparable to age and sex-matched reference group. Conclusions: Delayed primary repair of the RCL is a viable option and results in satisfactory long-term outcomes. This option may be more preferable to the professional athlete who wishes to avoid surgery during the sporting season.

Efficacy of Virtual Reality Combined With Real Instrument Training for Patients With Stroke: A Randomized Controlled Trial

ObjectiveTo investigate the efficacy of real instrument training in virtual reality (VR) environment for improving upper-extremity and cognitive function after stroke. DesignSingle-blind, randomized trial. SettingMedical center. ParticipantsEnrolled subjects (N=31) were first-episode stroke, assessed for a period of 6 months after stroke onset; age between 20 and 85 years; patients with unilateral paralysis and a Fugl-Meyer assessment upper-extremity scale score >18. InterventionsBoth groups were trained 30 minutes per day, 3 days a week, for 6 weeks, with the experimental group performing the VR combined real instrument training and the control group performing conventional occupational therapy. Main Outcome MeasuresManual Muscle Test, modified Ashworth scale, Fugl-Meyer upper motor scale, hand grip, Box and Block, 9-Hole Peg Test (9-HPT), Korean Mini-Mental State Examination, and Korean-Montreal Cognitive Assessment. ResultsThe experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and Box and Block Tests. Patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, Box and Block, and 9-HPTs from before to immediately after training. Significantly greater improvements in the tip pinch power immediately after training and spasticity of elbow flexion 4 weeks after training completion were noted in the experimental group. ConclusionsVR combined real instrument training was effective at promoting recovery of patients’ upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke.

Influences of gender, hand dominance, and anthropometric characteristics on different types of pinch strength: A partial least squares (PLS) approach

The relationships of demographic and anthropometric characteristics (17 dimensions related to the hand, wrist, and arm) with four different pinch strengths (lateral pinch, key pinch, three-jaw chuck pinch and tip-to-tip pinch strengths) were evaluated among 196 (96 males and 100 females) young adults aged 19–30 years. For both dominant and non-dominant hands, the lateral pinch was greatest, followed by the key pinch, three-jaw chuck pinch and tip-to-tip pinch strengths. Mean pinch strengths of the dominant and non-dominant hands of females varied between 62%–78% and 61%–73% of those exerted by males, respectively. Strength of the dominant hand was 5.3%–7.5% stronger than of that of the non-dominant hand, with this difference being generally higher in females than in males. Hand length and forearm length showed the strongest correlation with all types of pinch strengths exerted by both the dominant and non-dominant hands. In the partial least squares analysis, 10 out of 17 anthropometric indices including hand length, forearm length, arm length, middle finger width, thumb length, index finger width, thumb width, wrist depth, palm depth and index finger depth had considerable loadings in the extracted component, explaining 37% of the total variance. These findings can fill the gap in the strength data, or used by health professionals and designers in the field.

Percentage difference of hand dimensions and their correlation with hand grip and pinch strength among schoolchildren in Saudi Arabia.

The study aimed to assess the percentage difference of hand dimensions and their correlation with grip and pinch strength among school children in Saudi Arabia. Anthropometric measurements, hand dimensions, grip, and pinch strength measurements were obtained from 200 healthy schoolchildren in both genders aged 6-16 years. A Jamar electronic handgrip dynamometer was used to measure handgrip strength in kg. Pinch dynamometer was used to measure the two-point pinch strength, three-point pinch strength and lateral pinch strength in kg. Hand circumference was measured following hand arch at the maximum palm level. Hand span from the tip of the thumb to the tip of the little finger with the hand opened as broad as possible. Hand length from the tip of the middle finger to the midline of the distal wrist crease. Palm length from the distal wrist crease to the base of the middle finger. The percentage of difference of hand dimensions between both the genders was statistically significant. Both handgrip and pinch strength were significantly correlated with anthropometric measurements and hand dimensions. Body mass index had mild correlation with both handgrip strength and pinch strength (P < 0.05). Age, hand circumference, hand span, hand length and palm length had moderate to strong correlation with both grip and pinch strength (P < 0.01). The current study provides a source of perspective reference values in clinical settings for hand dimensions. The present study showed significant correlations with handgrip and pinch grip strengths among schoolchildren in Saudi Arabia.

The effect of early intervention of mirror visual feedback on pain, disability and motor function following hand reconstructive surgery: a randomized clinical trial

Objective: To determine the effect of mirror visual feedback (MVF) on disability, pain, and motor function on patients who underwent hand reconstructive surgery. Design: Randomized, single-blinded controlled trial. Setting: Rehabilitation center. Subjects: A total of 40 patients who were randomly assigned into the intervention group (n = 20) and control group (n = 20) participated in this study. Interventions: The rehabilitation sessions took place twice a week for eight weeks. The control group received traditional rehabilitation for 75 minutes. While the intervention group performed MVF and traditional rehabilitation for 30 and 45 minutes, respectively. Measures: Pain and disability of the hand were assessed with McGill pain questionnaire and Disability of Arm, Shoulder, and Hand (DASH) scores. The range of joint motion was evaluated by Goniometer, and the strength of grip and pinch was evaluated by Dynamometer and Pinch gauge and dexterity evaluated by Minnesota Manual Muscle test. Results: The results indicated that both traditional and MVF methods induced significant decreasing pain (Pain Rate Index: F = 68.48, P = 0.000; Number of Word Count: F = 70.96, P = 0.000), disability (F = 50.08, P = 0.000) and increasing dexterity (placing test: F = 28.73, P = 0.000), and range of motion (F = 33.16, P = 0.000). The results also showed that the positive effect of MVF on pain, disability, dexterity, and range of motion was significantly greater than that of controls (P < 0.05), but there was no significant result in grip and lateral pinch strength between the intervention and control group (P > 0.05). Conclusion: MVF, in conjunction with traditional rehabilitation programs, may lead to greater improvements in pain, disability, placing dexterity, and range of motion. But it seems not to be effective on pinch and grip power and turning dexterity.

Nykščio riešinio sąnario artrozės gydymas atvirąja sinovektomija su sąnario išvalymu: vėlyvųjų pooperacinių gydymo rezultatų įvertinimas

[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba]&#x0D; Įvadas. Atlikta sisteminė mokslinės literatūros apžvalga parodė, kad gydant nykščio riešinio sąnario osteoartitą nė viena chirurginė metodika nėra reikšmingai pranašesnė. Straipsnyje siekiama įvertinti atvirosios sinovektomijos su sąnario išvalymu („debridementu“) vėlyvuosius pooperacinius gydymo rezultatus ir palyginti juos su kitų, dažnai taikomų metodikų, rezultatais.Metodai. Atlikta retrospektyvinė studija, kurioje įvertinta 19 pacientų (20 nykščių), sergančių II–IV stadijos nykščio riešinio sąnario osteoartritu. Visi pacientai operuoti vieno chirurgo, taikant atvirą sinovektomiją su sąnario išvalymu, kurios metu pašalinta išvešėjusi sinovija, kaulinės išaugos ir laisvieji kūnai.Pagal vidutinį pacientų stebėjimo laiką skiriamos dvi tiriamųjų grupės: iki 4,5 metų (N = 10) ir daugiau negu 4,5 metų (N = 9) po operacijos stebėti pacientai. Įvertintas pokytis skaitinėje skausmo skalėje, pooperacinė plaštakos funkcija (pincetinio ir šoninio gnybio jėga, priešpastatymo amplitudė, QuickDASH klausimyno įvertis), pooperacinė sąnario būklė (dviejų krypčių plaštakos rentgenogramos) ir trukmė iki susigrąžinto darbingumo. Gauti rezultatai lyginti su dažniausiai pasirenkamų gydymo metodų studijų rezultatais.Rezultatai. Nustatyta, kad visiems pacientams po operacijos statistiškai reikšmingai sumažėjo skausmo intensyvumas (kaip ir kitose studijose, kurių duomenys buvo lyginami). Visiško skausmo išnykimo procentas II grupėje reikšmingai nesiskyrė nuo rezultatų, pateikiamų kitose studijose. Reikšmingų skirtumų lyginant QuickDASH įverčius taip pat nenustatyta. Lyginant pincetinio ir šoninio gnybio jėgas, gauti panašūs arba aukštesni įverčiai.Populiariose gydymo metodikose, kurių rezultatai buvo lyginami su atlikto tyrimo duomenimis, minima pagrindinė komplikacija ­– delnakaulio proksimalizacija. Atliktame tyrime, įvertinus tiriamųjų pooperacines rentgenogramas, tokios komplikacijos nenustatyta. Tiriamieji grįžo į kasdienę savo veiklą vidutiniškai per tris mėnesius, o tai reikšmingai skyrėsi nuo kitų gydymo metodikų, kuriose taikoma fiksacija Kiršnerio vielomis ir ilgai trunkanti reabilitacija.Išvados. Atlikto tyrimo rezultatus palyginus su dažniausiai taikomų chirurginių metodikų rezultatais, vertinant plaštakos skausmą ir funkciją pacientų ilgojo stebėjimo laikotarpiu reikšmingų skirtumų nenustatyta. Tiriamiesiems rentgenografiškai diagnozuota palankesnė pooperacinė sąnario būklė, leidžianti pacientui greičiau susigrąžinti darbingumą. Dėl minėtų priežasčių atviroji sinovektomija su sąnario išvalymu galėtų būti pirmo pasirinkimo metodas gydant nykščio riešinio sąnario osteoartritą.

Поєднані ушкодження нервових та сухожилково-м’язових структур на передпліччі, що супроводжуються їх значними дефектами: роль вимушеної транспозиції м’язів у відновленні основних функцій кисті

Мета роботи: оцінити ефективність “вимушених” транспозицій при ушкодженнях сухожилково-м’язових та нервових структур на відновлення основних захватів кисті.&#x0D; Матеріали і методи. Проведено ретроспективний аналіз результатів реконструктивних втручань у 9 пацієнтів (6 чоловіків та 3 жінки) віком від 9 до 70 року (середній вік 36,4 року) із наслідками проксимальних поєднаних ушкоджень довгих нервів та сухожилково-м’язового апарату передньої поверхні передпліччя. Травма сухожилково-м’язового апарату була поєднана із ушкодженням в 4 випадках серединного нерва, в 4 випадках серединного та ліктьового нервів, в одному випадку – серединного нерва та поверхневої гілки променевого нерва. Термін, в який проводились реконструктивні втручання, складав у середньому 5 місяців (від 2 до 11 місяців) після травми. У 6 пацієнтів хірургічна реконструкція нервів полягала у виконанні автологічної пластики, у 2 пацієнтів – невролізу, в одного пацієнта – шва нерва. У 5 випадках “вимушена” транспозиція була виконана з метою відновлення незалежної функції довгого згинача 1 пальця, у 6 випадках – незалежної функції глибоких згиначів 2–3 пальців. Відновлення неврологічних функцій оцінювали за MRC Scale, класифікацією за Seddon, відновленням 4 захватів кисті, власною оцінкою відновлених функцій за Brief Michigan Hand Questionnaire.&#x0D; Результати досліджень та їх обговорення. У всіх 4 пацієнтів із ушкодженням лише серединного нерва відновлення чутливості становило в середньому 3,75 за Seddon. У 4 пацієнтів із ушкодженням серединного та ліктьового нервів відновлення чутливості становило в середньому 3 та 2 за Seddon відповідно. Неефективне відновлення протиставлення першого пальця в 2 пацієнтів скореговано транспозицією за Bunnel. У 4 пацієнтів із ушкодженням серединного та ліктьового нервів ми спостерігали незадовільне відновлення “внутрішніх” м’язів кисті. У 5 пацієнтів «вимушені» транспозиції відновили незалежну функцію довгого згинача 1 пальця, у 6 пацієнтів – незалежну функцію глибоких згиначів 2–3 пальців. У 9 пацієнтів комплексна хірургічна реконструкція відновила функцію поперечного долонного, діагонального долонного та щипкового захватів. У 4 пацієнтів (44 %) не досягнуто відновлення ключового захвату, у зв’язку із незадовільним відновленням “внутрішніх” м’язів кисті (ліктьовий нерв). Середня власна оцінка функції кисті за MBHQ відповідала задовільній у 9 пацієнтів – 70,12 балів в середньому (від 43,75 до 89,6).

Assessment of hand function and disability in fibromyalgia

Fibromyalgia, apotentially debilitating chronic pain syndrome, is achronic disease. We aimed to compare the hand function of fibromyalgia (FM) patients and healthy individuals and to demonstrate the relationship between hand disability and FM. The study was consisted of 40female patients with FM and 30healthy controls. All participants were evaluated for pain threshold measurements, handgrip strength, and pinch strength. Functional states, hand disability, and hand skills and coordination were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) form, the Disability of Arm-Shoulder-Hand (DASH) questionnaire and the Purdue Pegboard Test, respectively. Handgrip strength values, DASH score, lateral pinch strength test, Pegboard placement time, and Pegboard collection time of the patient group were significantly lower than those of the control group (all p < 0.05). Anegative correlation was found between FIQ score and handgrip strength, two-point pinch strength test, three-point pinch strength test, and lateral pinch strength test in patients with moderate FM (all p < 0.05). Furthermore, acorrelation was observed between DASH score and handgrip strength, lateral pinch strength test, Purdue Pegboard placement time, and Purdue Pegboard collection time in patients with moderate FM (all p < 0.05). Our results show that hand function was decreased in patients with FM compared to healthy controls and decreasing hand function was influenced by FIQ score. As aresult, the evaluation of hand function should be taken into consideration in the management of FM.

Hand strength and dexterity in patients with Prader-Willi syndrome: a pilot intervention study.

ObjectiveThe study aim was to examine the hand function (hand strength and dexterity) and intervention effects of training in adults with Prader–Willi syndrome (PWS).MethodsSix adults with PWS (two females; mean age 26.14 years) underwent hand muscle strength and dexterity training for 3 months (2 hours per week). The following hand function tests were performed pre- and post-intervention: (1) hand grip, lateral pinch, and tip pinch hand strength tests, (2) the Box and Block test (BBT) for gross manual dexterity and (3) the Purdue Pegboard test for finger dexterity.ResultsBefore treatment, all subjects showed lower hand grip, lateral pinch, tip pinch strength, and poorer manual/finger dexterity relative to healthy adults. After training, hand function scores improved on many test items, but only the left hand tip pinch and the right hand BBT performance showed significant improvements.ConclusionsAll subjects showed lower hand strength and poorer manual/finger dexterity compared with healthy adults; this should be considered during physical training programs. Owing to limitations in the intervention intensity and possible subject behavioral deficits, further research is needed to clarify the effects of this intervention on hand function in PWS patients.

Outcomes After Revision Amputation or Replantation in FRANCHISE (Finger Replantation and Amputation Callenges in Assessing Impairment, Satisfaction, and Effectiveness) Study

Outcomes After Revision Amputation or Replantation in FRANCHISE (Finger Replantation and Amputation Callenges in Assessing Impairment, Satisfaction, and Effectiveness) Study

The effect of new articulated splint in pinch strength in De Quervain syndrome: A comparative study

For patients with De Quervain syndrome using thumb spica orthosis prescribing in acute stage of syndrome, is restricting. Many patients are dissatisfied with using the static hard design and find it difficult to perform their daily activities. The aim of this study is to compare the effect of modified articulated and conventional static orthoses on pinch power and functional abilities of hand in De Quervain syndrome. In this quasi-experimental study, palmar and lateral pinch strength of the thumb, pain and functional abilities of hand, patient's satisfaction of orthoses, were evaluated after using modified articulated and conventional static orthosis in two groups. Twenty-four women between 18 and 60 years with De Quervain syndrome were randomly allocated in two groups of treatment. The first group used conventional static orthoses and the second one utilized modified articulated design. During the period of treatment, patients were encouraged to do their daily activities just like before. Both orthoses improved palmar and lateral pinch strength of the thumb, pain level and functional abilities. In comparison of mentioned variables, there was no significant difference between two groups regarding to pain recovery and abilities improvement ( P > 0.05). However, the satisfaction level of the patients who had used the articulated orthosis was higher ( P < 0.05). It seems, adding a joint to the static thumb spica leads to patient's relief and consequently to their satisfaction. This study shows that static and modified articulated thumb spica orthoses were similar regarding to the effect on pain and functional abilities of the patients with De Quervain syndrome. However, according to the higher rate of satisfaction of the patients utilizing articulated orthosis, the use of new articulated design of orthosis is recommended instead of the conventional static model.

Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study.

To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery. A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery. The median duration of symptoms was 12 months (interquartile range, 12-20 months). The compound muscle action potential of the abductor pollisis brevis (CMAP-APB) alsoshowed statistically significant improvement of 0.5+ 0.2 mV after surgery. Tip-tip pulp pinch strength increased from 1.2 ± 0.4 to 2.0 ± 0.4 kg at 6-month follow-up, lateral pulp pinch strength increased from 1.9 ± 0.6 to 2.8 ± 0.9 kg at 6-month follow-up, and 3-point pulp pinch also improved from 1.9 ± 0.5 to 2.8 ± 0.9 at final follow-up. On MR neurogram, the proportion of patients with abnormal median nerve morphology decreased from 81.8% to 68.2%, abnormal thenar branch morphology decreased from 63.6% to 36.4% and denervation edema deceased from 59.1% to 13.6%. Patients suffering from severe CTS with thenar atrophy and detectable CMAP-APB showed promising improvement following open carpal tunnel release. Prognostic IV.

Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury

To explore the effectiveness of functional reconstruction of hand grasp and pinch by tendon transfers in patients with cervical spinal cord injury. Between July 2013 and January 2016, tendon transfer surgery were performed in 21 patients (41 hands) with cervical spinal injury that motion level was located at C 6 to reconstruct hand grasp and pinch function. There were 18 males and 3 females with a mean age of 42.3 years (range, 17-65 years). Nineteen patients were with complete spinal cord injury [American Spinal Injury Association (ASIA) grading A], 1 patient was with central cord syndrome whose bilateral hands were completely paralyzed and lower limbs were normal (ASIA grading D), and 1 patient was with cervical spondylotic myelopathy (AISA grading D). The time from injury to hospitalization was 12-22 months (mean, 16.8 months). According to the International classification of surgery of the hand in tetraplegia (ICSHT), there were 6 cases of grade O3, 10 of grade O4, 3 of grade OCu5, and 2 of grade O5. The surgery was divided into two stages with an interval of 6-11 months. At the first stage, grip function was reconstructed in all patients by transfering the extensor carpi radialis longus from radialis side to palmar side through subcutaneous tunnel, and braided and sutured with the flexor pollicis longus and flexor digitorum profundus. At the second stage, the lateral pinch function of the thumb and index finger was reconstructed by braiding and suturing the radial half of the extensor carpi ulnaris (the patients graded as ICSHT O3) or pronator tere (the patients graded above ICSHT O3) with extensor pollicis longus and abductor pollicis longus. The grasp force, the thumb and index finger lateral pinch force, and the maximum fingertips distance between the thumb and index finger were measured at preoperation and at different time points after operation. The modified Lamb and Chan questionnaire, based upon the activities of daily living, was used to evaluate the hand function of all patients at 6 months after sencond stage surgery. There was 1 patient with elbow skin lesion, 1 patient with wrist stiffness; both of them recovered after corresponding treatment. All the 21 patients were followed up 15-32 months (mean, 19.6 months) without wound infection, tendon adhesion, tendon rupture, and other complications. The grasp forces of all patients were significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the first stage surgery when compared with preoperative value ( P<0.05); and no significant difference was found between different time points after operation ( P>0.05). The thumb and index finger lateral pinch force and the maximum fingertips distance between the thumb and index finger of all patients were also significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the second stage surgery when compared with preoperative values ( P<0.05); and no significant difference was found between different time points after operation ( P>0.05). And there was no significant difference of above indexes between the patients graded as ICSHT O3 and above ICSHT O3 ( P>0.05). The functional outcome was good in 19 cases, fair in 1 case, and poor in 1 case according to modified Lamb and Chan questionnaire at 6 months after second stage surgery. Tendon transfer can significantly improve the hand function and the quality of life of the patients with complete cervical spinal cord injury.

Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity.

Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, "bulbous pinch" LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen. The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face. We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups. There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally. Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60-70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Involuntary Neuromuscular Coupling between the Thumb and Finger of Stroke Survivors during Dynamic Movement.

Finger–thumb coordination is crucial to manual dexterity but remains incompletely understood, particularly following neurological injury such as stroke. While being controlled independently, the index finger and thumb especially must work in concert to perform a variety of tasks requiring lateral or palmar pinch. The impact of stroke on this functionally critical sensorimotor control during dynamic tasks has been largely unexplored. In this study, we explored finger–thumb coupling during close–open pinching motions in stroke survivors with chronic hemiparesis. Two types of perturbations were applied randomly to the index with a novel Cable-Actuated Finger Exoskeleton: a sudden joint acceleration stretching muscle groups of the index finger and a sudden increase in impedance in selected index finger joint(s). Electromyographic signals for specific thumb and index finger muscles, thumb tip trajectory, and index finger joint angles were recorded during each trial. Joint angle perturbations invoked reflex responses in the flexor digitorum superficialis (FDS), first dorsal interossei (FDI), and extensor digitorum communis muscles of the index finger and heteronymous reflex responses in flexor pollicis brevis of the thumb (p < 0.017). Phase of movement played a role as a faster peak reflex response was observed in FDI during opening than during closing (p < 0.002) and direction of perturbations resulted in shorter reflex times for FDS and FDI (p < 0.012) for extension perturbations. Surprisingly, when index finger joint impedance was suddenly increased, thumb tip movement was substantially increased, from 2 to 10 cm (p < 0.001). A greater effect was seen during the opening phase (p < 0.044). Thus, involuntary finger–thumb coupling was present during dynamic movement, with perturbation of the index finger impacting thumb activity. The degree of coupling modulated with the phase of motion. These findings reveal a potential mechanism for direct intervention to improve poststroke hand mobility and provide insight on prospective neurologically oriented therapies.

A Prospective, Randomized Trial of Splinting After Minicarpal Tunnel Release.

To determine if any significant differences exist in patient-reported or clinical outcomes among 3 different postoperative orthotic regimens: no orthosis, removable orthosis, and plaster nonremovable orthosis-following miniopen carpal tunnel release (CTR) surgery for symptomatic isolated carpal tunnel syndrome. A total of 249 patients received a miniopen CTR and were subsequently randomized into1 of 3 orthotic regimens: 80, no orthosis; 83, removable orthosis; and 86, nonremovable orthosis-to be removed at the first postoperative visit 10 to 14 days later. Patient-reported outcomes included the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) surveys, Levine-Katz Symptom Severity and Functional Status Scales, and Pain at Rest and in Action using the Numerical Pain Rating Scale. Clinical outcomes included wrist range of motion, grip, and lateral pinch strengths. All outcomes were evaluated bilaterally at 10 to 14 days, 6 weeks, and 3, 6, and 12 months after surgery by evaluators blinded to the assigned regimen. Demographic information was obtained before surgery, and complications were recorded throughout the study. There were no statistically significant differences in any patient-reported or clinical outcomes at any follow-up period except at 6 and 12 months: the lateral pinch strength of the nonremovable orthosis group with CTR in the dominant hand was weaker than both of the other groups. Patient demographic characteristics did not significantly influence the outcomes at any time. Scar tenderness was the most commonly observed complication followed by stiffness. There were 2 cases each of complex regional pain syndrome and superficial wound dehiscence and 1 case of wound infection that resolved with oral antibiotics. The postoperative orthotic regimen does not change any patient-reported outcome up to at least 12 months following miniopen CTR. Lateral pinch strength was weaker in the nonremovable orthosis group at 6 and 12 months. Our data do not support the use of any postoperative orthosis following routine miniopen CTR. Therapeutic I.

Decreased short-interval intracortical inhibition correlates with better pinch strength in patients with stroke and good motor recovery

BackgroundDeeper short-interval intracortical inhibition (SICI), a marker of GABAA activity, correlates with better motor performance in patients with moderate to severe hand impairments in the chronic phase after stroke. ObjectivesWe evaluated the correlation between SICI in the affected hemisphere and pinch force of the paretic hand in well-recovered patients. We also investigated the correlation between SICI and pinch force in controls. MethodsTwenty-two subjects were included in the study. SICI was measured with a paired-pulse paradigm. The correlation between lateral pinch strength and SICI was assessed with Spearman's rho. ResultsThere was a significant correlation (rho = 0.69, p = 0.014) between SICI and pinch strength in patients, but not in controls. SICI was significantly deeper in patients with greater hand weakness. ConclusionsThese preliminary findings suggest that decreased GABAA activity in M1AH correlates with better hand motor performance in well-recovered subjects with stroke in the chronic phase.

The impact of finger position on pinch strength

Introduction Pinch strength is a widely used measurement of hand function, but digit position on the pinch gauge has not been described in the literature. The aim of this study was to assess for differences in tip, lateral, and three-jaw-chuck pinch force when the digits are placed on the groove or bridge of a Bernadette and Linda pinch gauge. Methods Thirty-six healthy volunteers each pinched six times in random order: one for each type of pinch force with the digits placed in each position. Results There were no significant differences in pinch strength measurements based on digit position, except for three-jaw-chuck pinch which was slightly higher on the groove. Equivalence was found within one pound for tip and lateral pinch but not for three-jaw-chuck. Conclusion Variations in finger position may result in similar pinch strength measurements for tip and lateral pinch. Clinicians may reliably assess lateral and tip pinch using either position; however, standardized positioning is still recommended.

EFFECT OF THE P.A.R.Q.V.E ON RHIZARTHRITIS.

ABSTRACTObjective:To evaluate the effect of a clinical management program involving education on hand function in patients with rhizarthritis. Methods:One hundred and eight patients with rhizarthritis and multiple arthritis (191 hands with clinical and radiographic rhizarthritis) followed for two years as part of an educational program on osteoarthritis were administered the SF-36, DASH, and HAQ questionnaires and measured for the strength of their palmar grip, pulp to pulp pinch, key (lateral) pinch, and tripod pinch at the time of inclusion and after 24 months. Age, race, level and frequency of physical activity, sex, body mass index, percentage of body fat, and degree of osteoarthritis were correlated to the test outcomes. Results:Women improved less than men on the HAQ (p=0.037). Each 1% reduction in fat percentage increased the chance of HAQ score improvement by 9.2% (p=0.038). Physical activity did not influence improvement in the parameters evaluated (p>0.05). Palmar grip improvement was affected by age and presence of rhizarthritis (p<0.05); patients with unilateral rhizarthritis improved 5.3 times more than patients without the disease (p=0.015), while improvement in palmar grip strength decreased 6.8% per year (p=0.004). Pulp pinch grip strength improved more in women than in men (p=0.018). Conclusion:Patients with rhizarthritis and multiple arthritis improved quality of life and grip strength through clinical treatment, an educational program, and fat loss. Level of Evidence II; Retrospective study.