Michigan Hand Outcomes Questionnaire Research Articles

The Russian Version of the Michigan Hand Outcomes Questionnaire: Cross-Cultural Adaptation and Validation

Background. The Michigan Hand Outcomes Questionnaire (MHQ) is one of the most commonly used specialized scales to assess function, pain, aesthetic component, and overall patient satisfaction with their hands and wrists. However, to date, the scale has not been validated into Russian.
 Aim of the study — validation and cross-cultural adaptation of the Russian-language version of the questionnaire for patients with hand diseases MHQ.
 Methods. Validation and cultural adaptation were carried out in several stages: forward translation, back translation, formation of a preliminary version, pilot testing (pretesting), formation of the final version, with the help of which 50 patients were interviewed, of which 29 men (58%) and 21 women ( 42%), whose average age was 52.72 (25–84) years. Next, the psychometric properties of the questionnaire were assessed: validity, ceiling and floor effects, internal consistency (Cronbach’s α), reproducibility, completion rate. Patients completed the MHQ questionnaire upon initial visit to an orthopedic traumatologist and again the next day. Reproducibility was assessed using the intra-class correlation coefficient (ICC). Validity was assessed by studying the relationship between the results of the questionnaire under study and the results of the DASH questionnaire validated in Russia.
 Results. As part of the study, a rating scale was obtained with good psychometric properties: validity — 0.726, p0.001; Cronbach’s α 0.9, 95% CI (0.65–0.97); reproducibility — 0.92 (0.87–0.96); occupancy rate — 100%; the ceiling effect is observed in 42 questions 1–20, 22–27, 35, 37, 38, 42, 46–57, the floor effect in 13 questions — 17, 20, 28–32, 39–41, 43–45.
 Conclusions. The results of the study of the validity and retest reliability of the Russian version of the MHQ scale indicate that it is a reliable and reliable tool for assessing the function, pain, aesthetic component and overall satisfaction of patients with respect to their hands and wrists, which can be widely used by domestic researchers in practical and scientific activities.

Estimation of Hand Function Impairment in Breast Cancer Survivors with Lymphedema

Breast cancer (BC) is one of the most frequent cancers in women, and breast cancer-related lymphedema (BCRL) is a common side effect of BC treatment. When the lymphatic drainage system is damaged, lymphedema develops, which further exacerbates swelling and leads to pain, an increase in limb circumference, a reduction in joint range of motion, and a decrease in the use of the affected hand for functional tasks. Handgrip strength is essential for performing upper limb functional daily activities. Less is known about the long-term effects of lymphedema on hand function. The objective of the study was estimation of hand function impairment in BC survivors with lymphedema. This study was carried out by randomly selecting 100 out of 1,200 women with lymphedema, aged between 40 and 80 years, and who underwent sentinel lymph node biopsy along with radiotherapy, were included in this study. The handgrip strength was tested using an electronic handheld dynamometer. The functional wrist and hand scales were used to evaluate hand function. The Michigan Hand Outcome Questionnaire (MHQ) was used to evaluate the hand's overall function. A statistical analysis was done using SPSS statistical software (version 23.0). Handgrip strength of the affected hand by BCRL when compared with the unaffected hand was reduced. Functional hand and wrist scale have shown very poor results of the affected hand when compared with the unaffected hand. Majority of participants in the MHQ were unsatisfied with the overall functioning of the hand (p < 0.0001). This study concluded that there was significant hand function impairment in BC survivors with lymphedema. BCRL had a negative impact on daily activities of the individual and also affected the mental, emotional, and social aspects. BCRL also had an impact on overall self-reported physical function and quality of life.

Incision techniques for trigger thumb release: a comparison of outcomes of four types of skin incision.

Although trigger thumb release is commonly performed, there is no consensus on the optimal skin incision. This study aimed to compare outcomes of four incision techniques, including V-shaped, oblique, transverse and longitudinal incisions. Outcomes included the Michigan Hand Outcomes Questionnaire, satisfaction with the treatment and postoperative complications. The results of 875 patients who underwent trigger thumb release were assessed. All groups demonstrated improvement in self-reported hand function (range of 10-14 points), pain (25-27 points) and aesthetics (4-7 points) from baseline to 3 months postoperatively with no differences between incision techniques. Of the patients, 76% reported good or excellent satisfaction with the outcome of treatment. Satisfaction and complication rates of the different incision techniques were similar. These findings imply that there is no clear benefit of one type of incision over another for trigger thumb release, suggesting that surgeons may use the technique of their preference.Level of evidence: III.

Reverse dorsolateral proximal phalangeal island flap: Long-term results

ObjectivesThis study aims to present long-term follow-up results of the reverse dorsolateral proximal phalangeal island flap designed for reconstruction of large fingertip and pulp defects. MethodsWe examined 18 patients who underwent reverse dorsolateral proximal phalangeal island flap surgery to address ≥2.5 cm fingertip and pulp defects. Mean follow-up was 84.4 months. Sensitivity assessments were conducted using the Semmes–Weinstein monofilament and 2-point discrimination tests. Additionally, we evaluated finger joint active range of motion, complications and cold intolerance. ResultsMild venous congestion was observed in 5 flaps. Significant differences were observed in 2-point discrimination and Semmes-Weinstein monofilament tests between the injured and contralateral sides, specifically in the flaps, the dorsal side of the middle phalanx, and the donor site. The flap's mean static 2-point discrimination was 8.3 mm. Restricted distal interphalangeal joint extension was observed in 2 cases. Total active motion with the flap was good or excellent in the injured fingers, but with a significant difference between injured and contralateral fingers. Additionally, 42% of the injured fingers exhibited hook nail deformity, and 2 patients reported cold intolerance. Despite these issues, most patients has high scores for the appearance and satisfaction aspects of the Michigan Hand Outcomes Questionnaire. ConclusionIn moderate or larger fingertip defects, the reverse dorsolateral proximal phalangeal island flap serves as an alternative for reconstructing both fingertip and pulp issues. However, this option involves sacrificing some sensation in the dorsum of the middle phalangeal finger and the donor area. Level of evidenceIV, therapeutic study.

Management of the capsule in trapeziometacarpal joint implant arthroplasty: resection versus repair.

We compared the effects of capsule resection versus capsule suturing in patients treated with a dual-mobility trapeziometacarpal joint prosthesis. We included 131 patients with capsular resection and 57 patients with repair. The mean scores for pain and the brief Michigan Hand Outcomes Questionnaire were similar between the groups preoperatively and at 6 weeks and 1 year postoperatively. Mean key pinch strength was also similar in both groups before surgery and at 1 year, but higher in the capsular resection than in the suture group at 6 weeks. The incidence of complications reported throughout the 1-year postoperative period was not significantly different between the groups. One implant in the capsular resection group was revised for reasons most likely unrelated to capsule management. We conclude that the capsule can be safely resected during trapeziometacarpal joint implant arthroplasty.Level of evidence: III.

Primary Arthrodesis of Non-thumb Metacarpophalangeal Joints of the Hand: Clinical and Patient-Reported Outcomes.

Metacarpophalangeal (MCP) joint arthritis is common secondary to a variety of inflammatory, degenerative, and traumatic causes. Although MCP arthroplasty is more common for the second to fifth digits, primary arthrodesis can be used for high-demand patients with arthritis or unsalvageable fractures of the MCP joint. There has been limited recent studies on the outcomes of these patients. A retrospective review of 38 fingers in 27 patients with primary arthrodesis from 1990 to 2020 was conducted. The major outcomes were complications, reoperations, radiographic union, and time to union. Patient-reported outcomes including the Michigan Hand Outcomes Questionnaire and a questionnaire specific to the operative MCP joint were collected. Rate of radiographic union was 84% including revisions. The average time to union was 3.6 months. Rates of complications, reoperation, and amputation were 26%, 16%, and 7%, respectively. Arthrodesis as part of emergent trauma reconstruction was significantly more likely to result in reoperation (50% vs 7%) and complication (63% vs 17%) than chronic arthritis. Patient-reported outcomes were fair to good with improvement in pain (79%), function (66%), and appearance (40%). Sixty-six percent (66%) of patients were satisfied with their surgery, and 73% would repeat the surgery. Arthrodesis for unsalvageable MCP fractures was associated with higher rates of reoperation and complication than inflammatory or degenerative arthritis. Excluding emergent trauma, MCP fusion was reliable with a reoperation rate of 7% and a modest complication rate of 17%. Patients rated reasonable levels of satisfaction and willingness to repeat the procedure despite complications.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Investigation of the effects of a short opponens splint and structured hand exercise program in computer engineers with wrist pain: a randomized controlled trial

Objectives. This study aimed to examine the effects of a short opponens splint and hand exercise program on pain, hand functionality, daily activities, and work efficacy in computer engineers with wrist pain. Methods. Forty-five engineers were randomized into three groups: group 1 (n = 15) utilized both splints and exercises, group 2 (n = 15) engaged in exercises only and group 3 (n = 15) received no treatment, across 8 weeks, thrice weekly. Only exercises were applied to group 2 (n = 15). No treatment was applied for group 3 (n = 15). The progress of subjects was controlled periodically each week. Outcome measurements including the Jamar hand dynamometer, pinchmeter, nine-hole peg test (9-NHPT), visual analog scale, Boston carpal tunnel syndrome questionnaire and Michigan hand outcome questionnaire (MHQ) were evaluated pre and post treatment during the study period. Results. Comparing the outcome measurements of the three groups showed a statistically significant difference between them except for the 9-NHPT and MHQ pain and esthetics (p < 0.05). According to post-hoc tests, groups 1 and 2 had more significant differences than group 3. Also, there was no statistically significant difference in any parameter between group 1 and group 2 (p > 0.017). Conclusion. Non-restrictive minimal orthosis or exercise programs are advisable for individuals with wrist pain.

ACUTE CARPAL TUNNEL SYNDROME: RESULTS OF A PROTOCOL FOR EARLY NERVE DECOMPRESSION AND SURGICAL STABILIZATION FOR BONY WRIST TRAUMA

We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours.We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing.The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up.We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours.

Stronger pinch strength at long-term follow-up after pyrocarbon disc interposition arthroplasty compared to trapeziectomy with ligament reconstruction and tendon interposition for CMC-1 osteoarthritis.

In this study, we wanted to compare the pyrocarbon disc interposition arthroplasty (PDI) with trapeziectomy plus ligament reconstruction tendon interposition (LRTI). Primarily, we tested whether PDI resulted in a higher pinch strength. Secondarily, we compared the grip strength, range of motion (ROM), patient reported outcomes, satisfaction and complications. Due to scarcity of preoperative hand measurements, we performed a descriptional cross-sectional cohort study of patients operated between 2006 and 2014, with a minimum of 5 years of follow-up. Patients were treated with PDI or LRTI. We determined key pinch strength as primary outcome, followed by tip- and tripod pinch, grip strength, palmar abduction and opposition; the Michigan Hand Outcome Questionnaire (MHQ), Patient Reported hand and Wrist evaluation (PRWHE), satisfaction and complications. Propensity score matching was used to match both study groups on demographic variables. A ratio of 2:1 was used resulting in inclusion of 62 (of 154) PDI and 31 (of 31) LRTI thumbs. The PDI-group patients showed stronger key and tip pinch strength than the LRTI group (p=0.027 and p=0.036 respectively). Tripod pinch, grip strength and ROM were equal for both groups. MHQ and PRWHE were comparable, with higher satisfaction for the PDI group. Eight PDI patients were converted to LRTI due to pain. This study confirmed our hypothesis that key and tip pinch strength is stronger after PDI compared to LRTI for CMC-1 joint osteoarthritis. Both techniques have comparable outcomes considering patient reported outcome (MHQ and PRWHE), ROM and complications.

Single or double Kirschner wire fixation: which provides better outcomes for pediatric proximal phalanx base fractures?

The most common hand fracture in children is seen at the base of the proximal phalanx. This study aims to compare clinical outcomes of single versus double Kirschner wire pinning for pediatric proximal phalanx base fractures. The retrospective study enrolled patients who underwent closed K-wire pinning for proximal phalanx base fractures from January 2016 to February 2022. We divided patients into two groups based on the number of K-wire inserted (single versus double). Demographics, removal of implant, complication rate were analyzed. Patients were asked to answer the Michigan Hand Outcomes Questionnaire (MHQ) by telephone. Data including fracture type, diaphyseal axis-metacarpal head angle (DHA) and Total Active Flexion Scale (TAFS) were analyzed. This study included 37 pediatric patients with proximal phalanx base fractures, treated with either single (n = 10) or double K-wire (n = 27) fixation. The mean operation time was significantly shorter for the single K-wire group. No significant differences were observed in complication rates, TAFS, implant removal times, MHQ, or pre- and post-operative DHA between the two groups. The single K-wire technique demonstrates similar effectiveness to the double K-wire technique in treating pediatric proximal phalanx base fractures, with the added benefit of shorter operation time. Therefore, the choice between using one or two K-wires should be determined based on the surgeon's proficiency and preference.

FUNCTIONS, SLEEP, FATIGUE AND QUALITY OF LIFE IN PATIENTS WITH SCLERODERMA DURING COVID-19: CROSS - SECTIONAL STUDY

Purpose: COVID-19, which has affected people in various ways, has also shown to cause various limitations on the lives of Scleroderma patients. The current study aims at evaluating the upper extremity functions, sleep quality, fatigue, and health-related quality of life in Scleroderma patients and to determine the factors affecting upper extremity functions.&#x0D; Methods: A total of 83 participants were recruited in this study. Of the participants, 39 were Scleroderma patients (mean age 43.28±9.96 years) and 44 were healthy controls (mean age 40.05±8.89 years). The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and Michigan Hand Outcomes Questionnaire (MHQ) were applied to evaluate upper extremity functions of the participants. Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and the Scleroderma Health Assessment Questionnaire (SHAQ) were used to evaluate the sleep quality, fatigue, and health-related quality of life, respectively.&#x0D; Results: Scleroderma patients had significantly lower scores in hand functions, sleep quality, fatigue, and health-related quality than the healthy group (p=0.001). The correlations between DASH and PSQI (r=0.559, p=0.001), FSS (r=0.496, p=0.001), SHAQ scores (r=0.754, p=0.001) were highly positive. Similarly, a high correlation was found between MHQ and SHAQ scores (r=-0.679, p=0.001).&#x0D; Conclusion: Upper extremity functions and health-related quality of life were found to be affected in patients with Scleroderma. It was revealed that upper extremity functions were affected by sleep quality, fatigue, and health-related quality of life. Therefore, knowing all these effects and their relationships with each other allows to draw a systematic treatment plan on Scleroderma patients.

Effect of Adding Kinesiotaping to Median Nerve Gliding Exercise Toward Hand Performance of Patients with Carpal Tunnel Syndrome by Using Michigan Hand Outcomes Questionnaire

Background: CTS occurs due to local compression of the median nerve with manifestations of neuropathy, mostly in the productive population. Many conservative treatments have been observed to reduce the degree of pain and quality of life in CTS patients. Kinesiotaping is a new therapy that has been widely used for various musculoskeletal conditions and is known for reducing median nerve compression. Aim: To determine the effect of adding kinesiotaping to median nerve gliding exercise on hand function in CTS patients by using the Michigan Hand Outcomes Questionnaire. Methods: This research was an experimental randomized pre-and post-test group design. A sample of 24 patients from the Medical Rehabilitation Outpatient in RSUP Dr. Kariadi were divided into two groups randomly. The intervention group (n=12, dropout 1) got kinesiotaping application and median nerve gliding exercise. The control group (n=12, dropout 1) did the median nerve gliding exercise only. Hand performance has been evaluated before and at the end of the 4th week of treatment by using the Michigan Hand Outcomes Questionnaire. Result: There were significant improvements in the intervention group’s right-hand function (p&lt;0,001), activities of daily living (ADLs) or the ability of the right hand to do certain tasks (p&lt;0,001), work performance (p&lt;0,001), pain (p=0,024), and satisfaction (p&lt;0,001), as compared to the control group. Meanwhile, the intervention and the control group did not show significant differences in left-hand function score (p=0.884), left-hand ability score (p=0.884), and aesthetics score (p=1,000). Conclusion: There was a positive effect on improving hand performance in CTS patients by adding kinesiotaping to median nerve gliding exercises.

Explaining Personalized Activity Limitations in Patients With Hand and Wrist Disorders: Insights from Sociodemographic, Clinical, and Mindset Characteristics

ObjectivesTo investigate the association of sociodemographic, clinical, and mindset characteristics on outcomes measured with a patient-specific patient-reported outcome measure (PROM); the Patient Specific Functional Scale (PSFS). Secondly, we examined whether these factors differ when a fixed-item PROM, the Michigan Hand Outcome Questionnaire (MHQ), is used as an outcome. DesignCohort study, using the aforementioned groups of factors in a hierarchical linear regression. SettingTwenty-six clinics for hand and wrist conditions in the Netherlands. ParticipantsTwo samples of patients with various hand and wrist conditions and treatments: n=7111 (PSFS) and n=5872 (MHQ). InterventionsNA. Main Outcome MeasuresThe PSFS and MHQ at 3 months. ResultsThe PSFS exhibited greater between-subject variability in baseline, follow-up, and change scores than the MHQ. Better PSFS outcomes were associated with: no involvement in litigation (β[95% confidence interval=-0.40[-0.54;-0.25]), better treatment expectations (0.09[0.06;0.13]), light workload (0.08[0.03;0.14]), not smoking (-0.07[-0.13;-0.01]), men sex (0.07[0.02;0.12]), better quality of life (0.07[0.05;0.10]), moderate workload (0.06[0.00;0.13]), better hand satisfaction (0.05[0.02; 0.07]), less concern (-0.05[-0.08;-0.02]), less pain at rest (-0.04[-0.08;-0.00]), younger age (-0.04[-0.07;-0.01]), better comprehensibility (0.03[0.01;0.06]), better timeline perception (-0.03[-0.06;-0.01]), and better control (-0.02[-0.04;-0.00]). The MHQ model was highly similar but showed a higher R2 than the PSFS model (0.41 vs 0.15), largely due to the R2 of the baseline scores (0.23 for MHQ vs 0.01 for PSFS). ConclusionsHealth care professionals can improve personalized activity limitations by addressing treatment expectations and illness perceptions, which affect PSFS outcomes. Similar factors affect the MHQ, but the baseline MHQ score has a stronger association with the outcome score than the PSFS. While the PSFS is better for individual patient evaluation, we found that it is difficult to explain PSFS outcomes based on baseline characteristics compared with the MHQ. Using both patient-specific and fixed-item instruments helps health care professionals develop personalized treatment plans that meet individual needs and goals.

The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study

Study designSingle-blinded, randomized controlled study. IntroductionCarpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. Purpose of the studyThis study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. MethodsA total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. ResultsWe found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. DiscussionThis study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. ConclusionsMWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program.

Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis.

We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.

Minimum 5-Year Follow-Up Assessment of Volar Plate Interposition Arthroplasty for Post-Traumatic Osteoarthritis in Proximal Interphalangeal Joints.

This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included the numeric pain scale (on a scale of 0-10), the proximal interphalangeal joint active range of motion, the Michigan Hand Outcomes Questionnaire, the perioperative radiograph of the involved digit, proximal interphalangeal joint stability, and pinch strength. Eight patients with a median age of 44 years old (interquartile range (IQR): 29.3-56.8) were included in this study. The median follow-up period was 6.5 years (range of 5-11 years). The median numeric pain scale improved from 5 (IQR: 4.3-6.0) preoperatively to 0 (IQR 0-0.8) at the follow-up evaluation (p = 0.011). All digits demonstrated stability during manual stress testing compared to their noninjured counterparts. The median active proximal interphalangeal joint arc of motion improved from 25° to 55° (p = 0.011). The pinch strength of the fingers on the injured hand was weaker than those on the contralateral hand (2.2 Kg vs. 3.7 Kg, p = 0.012). We suggested that volar plate interposition arthroplasty may be an alternative surgical option for post-traumatic osteoarthritis in the proximal interphalangeal joints.

Treatment selection for de Quervain's tenosynovitis based on the Michigan’s Hand Questionnaire

Objective: De Quervain's disease is a stenosing tenosynovitis of the first dorsal compartment. Treatment options include conservative measures, injections, and surgery. The main purpose of this study is to eliminate uncertainty in the choice of treatment and to recommend the appropriate treatment to the patient based on Michigan hand questionnaire. &#x0D; Material and Methods: The age, sex, and treatment modality of the patients were recorded retrospectively. Patients' Michigan outcomes were assessed, and patients were divided into three groups: Patients who benefited from conservative treatments (Group 1), from injections (Group 2), and from surgery (Group 3). Statistical analysis of the data was performed.&#x0D; Results: The mean age of the 56 patients (54 women, 2 men) was 35.1±11.4 years. There was a difference between all groups in total hand function and pain scores (p &lt; 0.05). Patients in group 1 were significantly different from the other groups (p &lt; 0.05), and there was no significant difference between group 2 and group 3 (p &gt; 0.05).&#x0D; Conclusion: Various methods have been described for De Quervain's tenosynovitis’s treatment. Choosing the right therapeutic steps for the right patients is important. It is possible to select treatment options by assessing overall hand function and activities of daily living with the Michigan Hand Outcome Questionnaire

Neurectomy of the Nerve of Henle Associated with Periarterial Sympathectomy for Management of Intractable Raynaud's Phenomenon.

In periarterial sympathectomy for intractable Raynaud's phenomenon, the extent of adventitiectomy as well as postoperative outcomes and hand perfusion assessment tools remain debatable. We evaluated the outcome of neurectomy of the nerve of Henle combined with ulnar tunnel release and periarterial adventitiectomy in the treatment of refractory Raynaud's phenomenon using objective measurements and patient-reported outcomes. Nineteen patients with 20 affected hands were prospectively enrolled and underwent the proposed procedures from 2015 to 2021. Relevant data, including Michigan Hand Outcomes Questionnaire and 36-Item Short Form health questionnaire scores, were documented for analysis during a 3-year follow-up. The average ingress value of the three measured fingers (index, long, and ring) on indocyanine green angiography increased after surgery (p=0.02). The median number of ulcers decreased (p<0.001) and the median digital skin temperature increased (p<0.001). Questionnaire scores showed improvement in physical aspects, such as overall hand function (p≤0.001), activities of daily living (p=0.001), work performance (p=0.02), pain (p<0.001), physical function (p=0.053), and general health (p=0.048), as well as mental aspects, such as patient satisfaction (p<0.001) and mental health (p=0.001). The average indocyanine green ingress value of the three measured fingers significantly correlated with the patient-reported outcomes, including overall hand function (r=0.46, p=0.04), work performance (r=0.68, p=0.001), physical function (r=0.51, p=0.02), and patient satisfaction (r=0.35, p=0.03). The proposed surgical procedures provided satisfactory outcomes, both subjectively and objectively, over a follow-up period of up to 3 years. Indocyanine green angiography may provide rapid and quantitative measurements for perioperative hand perfusion assessment.

Effect of 6-week treatment with topical betamethasone dipropionate in patients with symptomatic hand osteoarthritis: A randomized double-blind, placebo-controlled trial

ObjectiveTo examine the efficacy and safety of topical corticosteroid over 6 weeks in patients with symptomatic hand osteoarthritis. DesignIn a randomized, double-blind, placebo-controlled trial, community-based participants with hand osteoarthritis were randomly assigned (1:1) to topical Diprosone OV (betamethasone dipropionate 0.5 ​mg/g in optimised vehicle, n=54) or placebo (plain paraffin, n=52) ointment to painful joints 3 times daily for 6 weeks. Primary outcome was pain reduction [assessed by 100 ​mm visual analogue scale (VAS)] at 6 weeks. Secondary outcomes included changes in pain and function using the Australian Canadian Osteoarthritis Hand Index (AUSCAN), Functional Index for Hand Osteoarthritis (FIHOA), and Michigan Hand Outcomes Questionnaire (MHQ) at 6 weeks. Adverse events were recorded. ResultsOf 106 participants (mean age 64.2 years, 85.9% female), 103 (97.2%) completed the study. Change in VAS at 6 weeks was similar in the Diprosone OV and placebo groups (−19.9 vs. −20.9, adjusted difference 0.6, 95% CI -8.9 to 10.2). There were no significant between-group differences in change in AUSCAN pain [adjusted difference 25.8 (−16.0 to 67.5)], AUSCAN function [21.2 (−55.0 to 97.4)], FIHOA [-0.1 (−1.7 to 1.5)], or MHQ [-1.2 (−6.0 to 3.6)]. Incidence of adverse events was 16.7% in Diprosone OV and 19.2% in placebo group. ConclusionsTopical Diprosone OV ointment, although well-tolerated, was no better than placebo in improving pain or function over 6 weeks in patient with symptomatic hand osteoarthritis. Future studies should consider examining joints with synovitis and whether delivery approaches enhancing transdermal penetration of corticosteroids into joints are effective in hand osteoarthritis. Trial registrationACTRN 12620000599976. Registered May 22, 2020.