Michigan Hand Outcomes Questionnaire Research Articles

Ultrasonographic Evaluation of the Metacarpal Cartilage Thicknesses in Weightlifters and Volleyball Players.

The aim of the study was to evaluate the possible effects of impact and loading on the metacarpal cartilage and hand functions in young elite athletes. In this cross-sectional study athletes with at least 3 yrs of sport background and who have been under a scheduled training program were enrolled. The second to fifth fingers' metacarpal head cartilage thicknesses were measured bilaterally by using ultrasonography. Handgrip and pinch strengths were measured. Michigan Hand Outcomes Questionnaire was also completed for every participant. A total of 42 male athletes (19 weightlifters, 23 volleyball players) and 46 healthy control subjects were enrolled. Metacarpal cartilage thicknesses of the athletes were thicker than those of the healthy controls (all P < 0.001). There were no differences between the dominant and nondominant hands (all P > 0.05). In the weightlifting group, Michigan Hand Outcomes Questionnaire work performance and pain scores were worse than the other groups (both P < 0.001). The presence of increased cartilage thickness measurements in the athletes suggests that sports activities might affect the metacarpal articular cartilage. Highest pain scores and lowest work performance scores in the weightlifters with highest metacarpal cartilage thickness might suggest that impact and loading during their sports play could lead to cartilage edema.

Evaluation of versatility and outcomes of the first dorsal metacarpal artery flap in thumb defects.

It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options. A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature. The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was 'good' (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients. Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.

Percutaneous Pinning Versus ORIF For Treatment Of Extraarticular Metacarpal Fractures

Objectives: Metacarpal fractures are common, and several surgical treatment methods have been described. This study aims to compare the clinical and economic aspects of two different surgical methods, closed reduction and K-wire fixation (CRPF) and open reduction and plate screw fixation (ORIF). Methods: Between January 2009 and March 2014, 51 patients who received surgical treatment for metacarpal fractures were retrospectively evaluated. Of them, 36 patients (29M, 7F) performed CRPF, and 15 (12M, 3F) performed ORIF. Patients were followed up for an average of 17.6 weeks. All patients were assessed according to the union, operation time, complications, cost-effectiveness, and the Michigan hand outcome questionnaire scores. Results: The mean operation time was 13.7 minutes (5-37 minutes) in the CRPF group and 32.2 minutes (23-62 minutes) in the ORIF group (p&lt;0.05). The mean union time was 5.4 weeks (4-9 weeks) in the CRPF group and four weeks (3-8 weeks) in the ORIF group (p&lt;0,05). Hospital expenses were found to be, on average, 257.5 USD (45.8-311 USD) in the CRPF group and 660 USD (454.9-1074.6 USD) in the ORIF group (p&lt;0,05). The mean Michigan Hand Surgery Outcome Questionnaire results were 86.4% (66-98) in the CRPF group and 68.7% (62-83) in the ORIF group (p&lt;0,05). Conclusion: We recommend CRPF because of its shorter operation time, better functional scores, and cost-effectiveness. Type of study/level of evidence: Level III; Causal comparative retrospective study

Influence of Pulsed Magnetic Field Therapy on Hand Function Post Flexor Tendon Repair: A Randomized Controlled Trial

IntroductionPurpose: The study was conducted to investigate the influence of pulsed magnetic field therapy on hand function, grip and pinch grip strength in post flexor tendon repair patients.Material and methodsMethods: Fifty male patients with flexor tendon repair took part in this research, with ages ranging from 25 to 50 years. They were assigned randomly into two groups: Group A (experimental) received pulsed magnetic therapy together with exercise, whereas Group B (control) received only exercise. Evaluation of hand grip strength with Jamar hydraulic hand dynamometer, pinch strength with Baseline pinch gauge and hand function with Michigan Hand Outcomes Questionnaire, all measurements were made before and after the treatment. They were received 16 sessions for 8 weeks (2 sessions/week).ResultsResults: 2 x2 mixed design MANOVA revealed that no significant difference between both groups pre- treatment and post treatment in MHOQ total, function, aesthetic (p&gt;0.05) and in hand grip strength while there was a significant difference across groups after treatment in the strength of pinch grip, MHOQ ADL, pain and satisfaction p &lt;0.05), there was also a significant difference between pre- and post-treatment within groups in all outcome measures. (p &lt;0.05).ConclusionsConclusion: PMF increases the efficiency of physical therapy treatment and it also increases the strength of both hand grip and pinches grip in patients after flexor tendon repair in zone II.

What Are the Minimally Important Changes of Four Commonly Used Patient-reported Outcome Measures for 36 Hand and Wrist Condition-Treatment Combinations?

What Are the Minimally Important Changes of Four Commonly Used Patient-reported Outcome Measures for 36 Hand and Wrist Condition-Treatment Combinations?

Efficacy of Mobilization with Movement in Patients with Colles’ Fracture: A Randomized Clinical Trial

Background: Fracture of the distal radius or Colles’ Fracture mainly occurs due to fall on an outstretched hand and Physiotherapy plays an indispensable role in preventing postoperative complication namely hand stiffness. Mulligan concept of mobilization is a specific form of manual therapy technique that embraces skilled movements which is used to mobilize or manipulate soft tissues and joints with the target to improve tissue extensibility, increase in range of motion of joints, foster relaxation and reduce tissue swelling/ inflammation.&#x0D; Objective: To compare the effectiveness of Mulligan concept of mobilization with movement technique and conventional physiotherapy treatment following postsurgical Colles’ Fracture in terms of range of motion and functional activities.&#x0D; Methods: A total number of 36 patients were recruited for the study. They were divided into two groups: group I and group II. Group I (n= 18) was given mobilization with movement (MWM) along with wax bath and group II (n=18) was given conventional physiotherapy along with wax bath. The interventions were given for 7 days. The value of goniometer and Michigan hand outcome questionnaire (MHOQ) were taken both at baseline and after 7 days of interventions.&#x0D; Results: After intervention, there were no significant differences between the groups as the collected information was summarized by using frequency percentage, for qualitative data; and mean, the standard deviation, Median and Inter Quartile Range (IQR) for quantitative data. To compare the difference in proportion Chi square test was used. To compare the ROM and Michigan Hand Outcome Questionnaire between two groups Independent sample t-test was used. Within the group comparison was analysed by using paired t-test. The p-value less than 0.05 was considered significant for the study.&#x0D; Discussion: This study showed consistent with the previous studies as there was a significant improvement in the range of motion and hand functions between and within the groups.&#x0D; Conclusion: It can be concluded that both the treatments are equally effective.

Topical corticosteroid for treatment of hand osteoarthritis: study protocol for a randomised controlled trial

BackgroundHand osteoarthritis is a common and disabling chronic joint disease with a lack of effective therapies. Emerging evidence suggests the role of local inflammation in causing pain in hand osteoarthritis. Corticosteroids are potent anti-inflammatory drugs used in many rheumatic diseases. The aim of this randomised, double-blind, placebo-controlled trial is to determine whether topical corticosteroid reduces pain over 6 weeks in patients with hand osteoarthritis.MethodsOne hundred participants with hand osteoarthritis will be recruited from the community in Melbourne, Australia, and randomly allocated in a 1:1 ratio to receive either topical Diprosone OV or placebo ointment administered 3 times daily on the painful hand joints for 6 weeks. The primary outcome is pain reduction (assessed by 100 mm visual analogue scale) at 6 weeks. The secondary outcomes include changes in pain and function assessed using Functional Index for Hand Osteoarthritis, Australian Canadian Osteoarthritis Hand Index, Michigan Hand Outcomes Questionnaire, and tender and swollen joint count at 6 weeks. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups.DiscussionThis study will provide high-quality evidence to determine whether topical corticosteroid reduces pain over 6 weeks in patients with hand osteoarthritis, with major clinical and public health importance by informing clinical practice guidelines for the management of hand osteoarthritis and reducing the burden of the disabling disease.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000599976. Registered 22 May 2020.

Scaphoidectomy and 4-corner arthrodesis with headless compression screws: results, complications and their treatment.

Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.

Effect of psoriatic arthritis on the strength, proprioception, skill, coordination, and functional condition of the hand.

This study was planned to evaluate the strength, proprioception, skill, coordination, and functional condition of the hand in individuals with psoriatic arthritis and to correlate disease activity with these parameters. Fifty-six individuals (psoriatic arthritis group, n=36; control group, n=20) were included in the study. Evaluations were performed of disease activity with Disease Activity Score 28; grip strength with a dynamometer and pinch strength with pinch gauge dynamometers; joint position sensation with a goniometer; finger skills with a mobile application; and coordination and skill of both hands with the Purdue Pegboard test. The Michigan Hand Outcomes Questionnaire (MHQ) was used for hand functional evaluation. There was a significant difference between the grip and pinch strength of the psoriatic arthritis group and the control group (P<0.05). There was no significant difference between the joint position sense measurements and the mobile application scores between the groups (P>0.05). Purdue Pegboard scores showed a significant difference only in both hands and assembly subsections (P<0.05). With Disease Activity Score 28, significant correlations were found between grip and pinch strength, mobile application scores, Purdue Pegboard all subsections, and left-hand joint position sense average error amount, and between MHQ and grip and pinch strength. This study is the first to show that psoriatic arthritis has a negative effect especially on hand strength; grip strength decreases as disease severity increases and, skill, coordination, and functionality of hand deteriorate.

Intraoperative Load Tolerance of the Thumb Carpometacarpal Joint After Resection-Suspension-Interposition Arthroplasty

PurposeThe objective was to measure the intraoperative load tolerance of the thumb carpometacarpal (CMC) joint after trapeziectomy, tendon suspension, and interposition.MethodsIn this single-center prospective study, preoperative pinch grip, thumb mobility, and hypermobility of the thumb CMC joint were determined by 2 hand surgeons. Patients completed the brief Michigan Hand Outcomes Questionnaire. During surgery and upon removal of the trapezium, the surgeon subjectively rated the degree of thumb CMC load tolerance as “stable,” “medium stable,” or “unstable.” A measurement system with an integrated force sensor was used to measure intraoperative thumb CMC load tolerance. The thumb ray was displaced manually by 10 mm toward the scaphoid, and the counteracting force was measured over the entire displacement. The objective load tolerance was determined as the maximal measured force after trapezium resection, tendon suspension, and interposition. Analysis of variance was used to test for the differences in load tolerance between the surgical steps. Spearman’s coefficient was used to find correlations between load tolerance and clinical or patient-reported variables.ResultsTwenty-nine patients with a mean age of 70 years (SD, 8.1 years) were available for analysis. The measured intraoperative load tolerance after trapeziectomy was 15.5 N (SD, 5.4 N) and significantly increased to 18.7 N (SD, 5.5 N) after suspension. Load tolerance only slightly increased after tendon interposition, increasing the force to 20.3 N (SD, 6.7 N). Neither the surgeon’s subjective stability rating nor the clinical or patient-reported variables correlated with the measured load tolerance after trapeziectomy.ConclusionsOur results show that tendon suspension leads to the highest increase in thumb CMC load tolerance during resection-suspension-interposition arthroplasty.Clinical relevanceTendon suspension appears to be the most important step in stabilizing the metacarpal base after trapeziectomy, whereas tendon interposition does not seem to have a relevant additional effect regarding load tolerance, at least immediately after surgery.

Local steroid injection versus surgical release for treatment of persistent De Quervain’s stenosing tenosynovitis (DQST): a prospective comparative study

Background: De Quervain’s stenosing tenosynovitis (DQST) can prevent patients from performing minor tasks as opening jars and texting. It is common in pregnant women and nursing mothers. The etiology is thought to be from repetitive manual work with thumb abduction and wrist ulnar deviation. The aim of this study was to compare steroid injection versus surgical release results for treatment of persistent DQST. Methods: Thirty-one hands of 30 patients with DQST who fulfilled the study selection criteria and treated during 2020 were included in this prospective study after institutional ethics committee approval. Patients were grouped into the mini-injection (group A) or surgical category (group B). Retrograde injection parallel to the tendons was used for injection. Transverse skin incision followed by longitudinal dissection and incision of the extensor retinaculum was used for surgical release. Clinical assessment of patients was done using a functional De Quervain’s score modified after the Disabilities of the Arm, Shoulder and Hand Score and Michigan Hand Outcome Questionnaire. Results: At the final follow-up, 13 out of 16 hands in group A improved. The mean score was 14±12.38, with nine, four, one, and two hands having excellent, good, fair, and absolute disability results, respectively. All 15 hands of group B improved. The mean score was 9.87±5.17, with nine, five, and one hands having excellent, good, and fair results, respectively. Conclusions: Both corticosteroid injection and surgical release were effective in persistent DQST treatment with insignificant differences, therefore the less invasive injection would be preferred. Level of Evidence: Level II.

Thumb Interphalangeal Joint Arthroplasty With a Surface Replacing Implant: Two-Year Results

The aim of this study was to evaluate the 2-year clinical and patient-reported outcomes of thumb interphalangeal (IP) joint arthroplasty. In this prospective pilot study, we included patients who received a surface replacing implant at the thumb IP joint. Patients rated their pain at rest on a numeric rating scale (0-10) and completed the brief Michigan Hand Outcomes Questionnaire. The range of motion of the IP joint was also measured. If the patient acceptable symptom state was inadequate (i.e., pain at rest ≤ 1.5), the reasons for the remaining symptoms were descriptively presented. Of the 13 patients who underwent arthroplasty, 1 withdrew participation and 1 was considered for arthrodesis because of a dislocated implant. Therefore, the study included 11 patients with a median age of 67 years. The median pain at rest decreased from 6 preoperatively to 0 at 2 years, and the preoperative brief Michigan Hand Outcomes Questionnaire score increased from 38 to 58 at follow-up. The total range of motion of the IP joint was 45° at 2 years. Patient acceptable symptom state was not achieved in 4 patients including a heavy manual worker and a patient with severe systemic lupus erythematosus. Based on the inconsistency of the results, we conclude that thumb IP joint arthroplasty with a surface replacing implant is rarely indicated; it could be an alternative in patients who place great importance on precision tasks. For patients who either have high demands for a powerful pinch grip, the high physical demands of a manual job, or rheumatoid disease, IP joint arthrodesis should be preferred. Therapeutic IV.

Contribution of revision amputation vs replantation for certain digits to functional outcomes after traumatic digit amputations: A comparative study based on multicenter prospective cohort

BackgroundTraumatic digit amputations can result in significant impairment. Optimal surgical treatment is unclear for certain digits in various amputation patterns. Our aim was to compare the contribution of revision amputation vs replantation for each particular digit to functional outcomes. Materials and methodsProspective cohort study at three tertiary hospitals was conducted in China. Eligible participants were 3192 patients with traumatic digit amputations enrolled from January 1, 2014, to January 1, 2018. The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) scores 2 years after initial surgery. Secondary outcome was score on the Disabilities of the Arm, Shoulder, and Hand (DASH). ResultsOf 3192 enrolled patients, 2890 completed the study. Main-effect linear regression showed that participants with replantation of thumb, index, long, and ring (proximal to the proximal interphalangeal [PIP] joint) fingers had significantly better MHQ scores compared to participants with the corresponding finger revision amputation. DASH results were comparable. Finger-finger interaction analyses conducted with multifactor dimensionality reduction (MDR) revealed that the small finger and ring finger had the smallest and greatest interactions with other fingers, respectively. After stratification by amputation level of thumb, index finger, or long finger, linear regression showed that replantation of the ring finger distal to the PIP joint resulted in better MHQ and DASH when the thumb or long finger was also traumatically amputated proximal to the IP/PIP joint. ConclusionsReplantation of the thumb, index, long, and ring (proximal to PIP joint) fingers is preferable to revision amputation, regardless of amputation pattern. Replantation of the ring finger amputated distal to PIP was beneficial only when the thumb or long finger was amputated proximal to IP/PIP joint. Replantation or revision amputation of the small finger was indistinguishable in terms of functional outcome. Future investigations and clinical decisions should take into account the role of finger-finger interactions.

The Italian Version of the Michigan Hand Outcomes Questionnaire (MHQ): Translation, Cross-Cultural Adaptation and Validation.

Background: Patient-reported outcome measures are largely used in clinical practice and scientific community. Michigan hand questionnaire (MHQ) is widely recognized as a standardized reliable instrument for the assessment of any kind of hand disorders. Aim of the study: translation, cross-cultural adaptation and validation of the Italian version of MHQ. Methods: The study was composed by two phases. Phase 1 consisted in translation and cross-cultural adaptation of MHQ, from original language version (English) into Italian, according to the standard procedure of translation and back translation. The final Italian version of MHQ was tested on 136 Italian patients with hand disorders (Phase 2), in addition to Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual analogue scale (VAS) for pain assessment and grip strength, to psychometric properties of the new version, 55 patients repeated the questionnaire after 7 days for test-retest to assess the reproducibility of the questionnaire. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment). Results: Phase 1 was performed without major problems, thus the final Italian version was approved for Phase 2. The questionnaire was clear and easily understood (missing data 0-2.9%). Multitrait analysis brought very good results for each outcome measure. High reliability (Cronbach's alpha: 0.91-0.99) and very good reproducibility (Intraclass correlation coefficients: 0.83-0.98) were revealed. High to moderate correlation was found between MHQ and DASH, grip strength and VAS. Conclusions: The Italian version of MHQ has demonstrated to be reliable and valid.

Evaluation of burned hand function after enzymatic debridement

Hand burns are common injuries that can result in long-term impairment of hand function. Enzymatic debridement (ED) prevents damage to the viable dermis due to the procedure's selectivity and has become an option for obtaining an accurate depth assessment and enabling wound re-epithelialization with less skin graft use. We conducted a prospective study from July 2015 to July 2018, which enrolled patients with deep partial-thickness hand burns and treated them with ED using bromelain. After a specified period, we assessed the patients' hand function, using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHOQ) to assess their disabilities and activities of daily life, respectively. We assessed the hand joint range of motion using a goniometer and assessed scar quality with the Vancouver Scar Scale (VSS). We analyzed 72 patients with 90 burned hands at 3 months and, at the final assessment, 69 patients with 86 burned hands. Fire was the most common cause of the burns. Bromelain allowed for early debridement (73.6% during the first 24h). At the 3-month evaluation, the mean DASH and MHOQ scores were 2.35 and 97.9%, respectively, with a high inverse correlation between the 2 types of scores (Spearman's rho, -0.78; p<.001). The mean wrist flexion and extension were 85.7 and 80°, respectively, the mean metacarpophalangeal flexion was 88.3°, the proximal interphalangeal (PIP) flexion was 112.9°, and the thumb opposition was 77°. The mean VSS score was 2.87. At the final evaluation, with a minimum follow-up of 391 days, the mean DASH and MHOQ scores were 0.18 and 99.71%, respectively. ED with bromelain in deep partial-thickness hand burns resulted in normal values at 3 months and at over 1 year of follow-up, with complete restoration of function and quality of life and good scar results.

Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Background: Stroke is a sudden neurological explosion resulting from poor blood flow perfusion to the brain. Stroke prevalence rates in India are expected to range from eighty-four to two hundred sixty-two strokes every 100,000 persons in remote regions and from three hundred thirty-four to four hundred twenty-four strokes every 100,000 persons in metropolitan areas. It causes brain cells to die abruptly due to inadequate oxygen and is a neurological condition characterized by blood flow blockage.&#x0D; Aim &amp; Objective: to examine the impact of TENS (Transcutaneous Electrical Nerve Stimulation), EMS (Electrical Muscle Stimulation), and ROM (Range of Motion) exercises on upper-limb functioning in hemi paretic stroke victims.&#x0D; Methods: The current study subjects (n=39) would be stroke survivors. Patients will be divided into three groups: group A will receive TENS, group B will receive EMS, and group C will get ROM exercises. The protocol will cover 2 weeks of treatment. We will assess upper limb functioning, activities of everyday living (ADLs), and mental condition at frequent intervals. By using the MHQ (Michigan Hand Outcomes Questionnaire), Hand Grip Strength (HGS), Brunnstrom Hand Function Recovery stages.&#x0D; Results: The successful completion of this study will provide evidence on the best treatment strategy for stroke patients to improve their upper extremity motor function using individual TENS, EMS, or ROM exercises.&#x0D; Conclusion: This study will be beneficial to treat Stroke patients with upper limb dysfunction by treating by TENS modality which might be an option for EMS treatment.

Clinical, electrophysiological, and ultrasound evaluation for early detection of musculoskeletal hand disorders and nerve entrapment in mobile phone users

IntroductionSmartphone overuse may lead to musculoskeletal manifestations, such as carpal tunnel syndrome (CTS) and arthritis of hand joints, with an increased median nerve cross-sectional area (CSA). ObjectiveThe aim of this study is the early detection of musculoskeletal hand disorders using ultrasound techniques, and to detect nerve entrapment using clinical evaluation, ultrasound, and electrophysiological studies, in university employees younger than 35 years using mobile phones. Function is assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Materials and methodsCross-sectional controlled study included 74 smartphone users classified into two groups according to a smartphone addiction scale (SAS), into high and low smart phone users, with 35 non-smartphone users with matched age and gender as a control group. A clinical assessment of nerve entrapment symptoms was performed, and the Michigan Hand Outcomes Questionnaire (MHQ), with a total score from 0 to100, was used to assess hand function. Electrodiagnostic studies of median and ulnar nerves were used to detect early nerve entrapment. Bilateral ultrasound was performed in order to assess the median nerve CSA and involvement of thumb and small hand joints. The data collected were analysed using the SPSS program version 20. ResultsCSAs of median nerves were significantly higher in the dominant hand of high smartphone users than in low and non-smartphone users (p<0.001). There was a significant positive correlation between CSA and SAS (r=0.45), visual analogue scale (VAS) (r=0.61), and duration of smartphone use (r=0.80), with negative correlation with MHQ (r=−0.63). Significant differences in were found in the electrophysiological studies of median and ulnar nerves. The mean ultrasound score for both hands was higher in the high smartphone users compared to low smartphone users (15.08±4.17 vs. 6.46±1.38, p<.001). ConclusionsThere is increased median nerve CSAs among high smartphone users associated with prolongation of both sensory and motor latencies and slow conduction velocities. Caution should be exercised when using mobile phones, in order to minimise the risk of developing hand musculoskeletal disorders.

Reconstruction of a soft tissue defect of the thumb using a modified dorsal metacarpal artery flap: A case report study

Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the index finger with a second DMA perforator flap. 3 months postoperatively, patient’s satisfaction, sensation and range of motion (ROM) of the fingers were assessed using The Michigan Hand Outcomes Questionnaire (MHQ) and the 2-point discrimination (2-PD) test. The patient regained active ROM of the thumb and index along with complete preservation of sensation, while the final cosmetic outcome was satisfactory. The application of this technique allows coverage of both trauma defect and donor site with a single skin incision, providing a successful clinical outcome.

Using Rasch Analysis to Validate the Michigan Hand Outcomes Questionnaire from the Wrist and Radius Injury Surgical Trial.

The Michigan Hand Outcomes Questionnaire is a patient-reported outcome measure that has been validated in many upper extremity disorders using classic test theory. Rasch measurement analysis is a rigorous method of questionnaire validation that offers several advantages over classic test theory and was used to assess the psychometric properties of the Michigan Hand Outcomes Questionnaire. This study used Rasch analysis to evaluate the questionnaire for distal radius fractures in older adults. The incidence and costs of distal radius fractures are rising, and reliable assessment tools are needed to measure outcomes in this growing concern. Rasch analysis was performed using 6-month assessment data from the Wrist and Radius Injury Surgical Trial. Each domain in the Michigan Hand Outcomes Questionnaire was independently analyzed for threshold ordering, person-item targeting, item fit, differential-item functioning, response dependency, unidimensionality, and internal consistency. After collapsing disordered thresholds and removing any misfitting items from the model, five domains (Function, Activities of Daily Living, Work, Pain, and Satisfaction) demonstrated excellent fit to the Rasch model. The Aesthetics domain demonstrated high reliability and internal consistency but had poor fit to the Rasch model. Rasch analysis further supports the reliability and validity of using the Michigan Hand Outcomes Questionnaire to assess hand outcomes in older adults following treatment for distal radius fractures. Results from this study suggest that questionnaire scores should be interpreted in a condition-specific manner, with more emphasis placed on interpreting individual domain scores, rather than the summary Michigan Hand Outcomes Questionnaire score.

An Analysis of the Impact of Timing and Technique on Outcomes after Surgery for Distal Radius Fractures: The Wrist and Radius Injury Surgical Trial Collaborative Study.

Surgical treatment of closed distal radius fractures varies based on treatment, surgeon schedule, and patient preferences. The authors examined how timing and technique impact surgeon-perceived procedural difficulty and quality of reduction, outcomes, and complications. This was a retrospective study of participants in the randomized, multicenter Wrist and Radius Injury Surgical Trial with isolated unstable distal radius fractures. Participants were randomized to treatment with a volar locking plate system, closed reduction and percutaneous pinning, or external fixation. The authors analyzed surgeon-perceived procedural difficulty and reduction quality based on time to operation. Of 184 participants, 88 underwent surgery less than 7 days after fracture (mean, 4.6 days) and 96 underwent surgery at more than 7 days after fracture (mean, 12.3 days). Surgery performed at more than 7 days was rated more difficult versus surgery at less than 7 days [4.6 versus 3.8 of 10 (1 = easiest); p = 0.05]. When the volar locking plate technique was performed, there was no difference in surgeon-perceived difficulty or reduction quality between the groups; however, surgeons performing closed reduction and percutaneous pinning more than 7 days after injury reported greater procedure difficulty (4.1 versus 2.9; p = 0.05) and poorer reduction quality compared to less than 7 days (7.2 versus 8.1; p = 0.03). Participants who underwent surgery at less than 7 days scored 8 and 7 points greater on the Michigan Hand Outcomes Questionnaire Satisfaction (p = 0.05) and Activities of Daily Living (p = 0.03) domains, respectively. Surgery performed less than 7 days after fracture leads to better surgeon-perceived reduction quality and less procedural difficulty. If surgery cannot be performed before 7 days, the authors recommend patients undergo treatment with the volar locking plate system, given the comparable level of surgeon-perceived procedural difficulty and reduction quality when surgery was performed less than 7 days after injury. Therapeutic, III.