Patient-Rated Wrist/Hand Evaluation Research Articles

Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries.

Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the 'push-off' test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen's D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.

Objective Outcome Measures Continue to Improve from 6 to 12 Months after Conservatively Treated Distal Radius Fractures in the Elderly-A Prospective Evaluation of 50 Patients.

Distal radius fractures (DRF) in the elderly population above 65 years represent 18% of all fractures and are thereby the second most frequent fracture in the elderly. Fracture dislocation and comminution are often used to determine whether non-operative or operative treatment is indicated. The purpose of this prospective case series of minimally displaced DRF treated with a dorsal cast was to assess the complication rate and patient-reported outcome measures. This single-centre, single-blinded, prospective case series followed 50 conservatively treated DRF patients for one year. Primary outcomes were complications and Quick Disability of Arm Shoulder and Hand (qDASH) score. Secondary outcomes were range of motion (ROM), grip strength and pain, and Patient-Rated Wrist/Hand Evaluation (PRWHE). Results showed only minor complications with a return to prior ROM, qDASH, and pain after 12 months and improvement in outcomes after 6–12 months. In conclusion, the majority of DRF patients who were treated non-operatively with five-week dorsal casting recover fully after minimally displaced DRF. This standard approach is thus considered safe, and the present results provide a reference for other studies.

Validation of a Malay Version of the Patient-Rated Wrist Hand Evaluation (PRWHE-MV)

INTRODUCTION: The Patient-Rated Wrist Hand Evaluation (PRWHE) is a widely used measure of patient[1]reported disability, pain and appearance related to both hand and wrist disorders. It has been adapted cross[1]culturally worldwide but not in Malaysia. We performed a translation and cross-cultural adaptation of the PRWHE into a Malay version (PRWHE-MV) with assessed reliability and validity in patients presented with hand and/or wrist disorders. MATERIAL AND METHODS: PRWHE-MV was developed via translation and resolution of cultural discrepancies. A total of 83 patients (38 men, 45 women) with the mean age of 38 (SD 14) years and hand and/or wrist disorders completed both PRWHE-MV and the Malay version of Quick DASH during their first orthopaedic hand clinic follow up, and a second PRWHE-MV at 48 hours later. Intraclass Correlation Coefficient (ICC) was used to assess test-retest reliability of the PRWHE-MV while Cronbach’s alpha was calculated to assess the internal consistency. We tested the validity of PRWHE-MV against the Malay version of Quick DASH by calculating the nonparametric Spearman’s correlation coefficient between these two measures. RESULTS: There was no major cultural problems during the forward and backward translation of PRWHE, except for a minor change owing to cultural discrepancy in toilet hygiene. The Cronbach alpha PRWHE-MV was 0.978 (SEM = 5.5) at baseline and 0.979 (SEM = 5.35) at the second assessment. For the test-retest reliability, ICC was 0.99. There was a strong direct correlation between the scores for the PRWHE-MV and the Quick DASH (r = 0.916, p< 0.001). A majority of patients considered hand appearance somewhat important and were bothered in the past week. Their main concerns were gaining back normal hand function and subsequently returning to work. CONCLUSION: The PRWHE-MV showed high internal consistency, test-retest reliability and good validity in patients with hand and/or wrist disorders.

Effect of mCIMT with and without interval on hand in patient suffering from stroke

Introduction. Paresis of hand has severe impact on the life of the stroke patients. Modified constrained induced movement therapy (mCIMT) can be used to treat the involved limb of the patient. It involves constraining of functional hand and increasing the activity of paretic hand which overcomes the “learned disuse” that develops following stroke but the constraining also creates difficulties for the patient and reduces his/her compliance to the treatment. Hence this trial aims to study the effect of mCIMT with and without interval to see if providing relaxation in between the treatment would be able to produce similar effect as mCIMT without interval protocol. Matgerial and methods. 44 patients were recruited in the study and were divided in to three groups: mCIMT without interval (n = 18), mCIMT with interval (n = 16) and control group (n = 10). Participants in three groups were examined for pain and functionality of hand through Patient rated wrist hand evaluation score and Box and Block test at pre and post intervention. The intervention was given for 6 days/week for two weeks. Therapy time was 2 hours and constrain was for 6 hours a day. Clinical trial registration number -CTRI/2019/12/022547. Results. No baseline differences were found in between the three groups. There was significant increase in box and block test score and significant decrease in PRWHE score in pre and post treatment readings for with and without interval mCIMT but non-significant changes in PRWHE score and box and block test were seen in control group. Conclusion. Both interval and without interval mCIMT was effective. Interval mCIMT was seen to be more comfortable than without interval mCIMT for the patient.

Cross‑cultural adaptation, construct validity, reliability, and responsiveness of the Thai version of the Patient-Rated Wrist/Hand Evaluation (Thai PRWHE).

To translate the Patient-Rated Wrist/Hand Evaluation (PRWHE) which is widely used as the evaluation in healthcare and research system in wrist/hand disorder patients into Thai (Thai PRWHE) and to examine its psychometric properties. The PRWHE was translated to Thai, including cross-cultural adaptations, following standard guidelines. Psychometric properties were evaluated with 292 wrist/hand musculoskeletal disorder patients. Internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability over a 7-day interval. Construct validity was evaluated using two methods: Spearman's rank correlation of related and unrelated subscales and confirmatory factor analysis (CFA). Responsiveness was analyzed using the standardized response mean (SRM). All subscales had high Cronbach's alpha (0.91-0.96). Evaluation of the Pain subscale found good correlations with the Thai PRWHE and the Thai version of disabilities of the arm, shoulder, and hand (Thai DASH) questionnaire (r = 0.55, P < 0.0001) in related dimensions. Unrelated dimensions, the Total Function subscale of the Thai PRWHE, and the Mobility subscale of the Thai EQ-5D-5L had a weak correlation (r = 0.09, P < 0.12). Comparison of the one-factor solution and the bifactor model found the first-order three-factor solution fitted the data better than other models. The test-retest reliability with 61 patients in each subscale revealed excellent reliability (ICC = 0.94-0.96). In the assessment of responsiveness, the SRM with 54 patients was large (0.94). The Thai PRWHE has excellent internal consistency in all modules and good construct validity and reliability for Thai patients and provides a large standardized response mean after treatment.

Mid-term outcome of volar plate fixation for scaphoid nonunion.

Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion. Patients with a scaphoid nonunion were prospectively enrolled and treated with open reduction using a volar approach, debridement of the nonunion, and fixation using a locking plate and cancellous bone grafting, from the ipsilateral iliac crest. Follow-up included examination, functional assessment using the patient-rated wrist/hand evaluation (PRWHE), and multiplanar reformation CT scans at three-month intervals until union was confirmed. A total of 49 patients with a mean age of 31 years (16 to 74) and a mean duration of nonunion of 3.6 years (0.4 to 16) were included. Postoperatively, the nonunion healed in 47 patients (96%) as shown on CT scans. The mean time to union was 4.2 months (3 to 12). Due to impingement of the plate on the volar rim of the radius and functional limitation, the hardware was removed in 18 patients. At a median follow-up of 38 months in 34 patients, the mean active range of motion (ROM) improved significantly from 89° to 124° (SD 44°; p = 0.003). The mean grip strength improved significantly from 52% to 79% (SD 28%; p < 0.001) of the contralateral side. The mean PRWHE score improved significantly from 66 to 17 points (SD 25; p < 0.001). Locking plate fixation supplemented with autologous cancellous bone grafting is a successful form of treatment for scaphoid nonunion. Functional outcomes improve with the passage of time, and mid-term results are excellent with a significant improvement in ROM, grip strength, and functional outcome as measured by the PRWHE. Cite this article: Bone Joint J 2020;102-B(12):1697-1702.

Evaluation of the content validity index of the Australian/Canadian osteoarthritis hand index, the patient-rated wrist/hand evaluation and the thumb disability exam in people with hand arthritis

BackgroundThe Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist/Hand Evaluation (PRWHE) and the Thumb Disability Exam (TDX) are patient-reported outcome measures (PROM) designed to assess pain and hand function in patients with hand arthritis, hand pain and disability, or thumb pathology respectively. This study evaluated the content validity of AUSCAN, PRWHE and TDX in people with hand arthritis.MethodsThis study enrolled participants with hand arthritis to rate the items of all 3 PROM in terms of relevance and clarity. The Content Validity Index (CVI) was computed for each item in each scale (I-CVI) as well as for the overall scale (S-CVI). Kappa was used to determine the inter-rater agreement among the raters.ResultsOverall, 64 individuals with hand arthritis (27% with OA, 67% with rheumatoid arthritis and 6% with psoriatic arthritis) participated in the study. The I-CVI for all items and all scales were very high (I-CVI > 0.76) and the modified Kappa agreement among the raters demonstrated excellent agreement (k > 0.76). The S-CVI for all PROMs was very high for relevance (AUSCAN = 0.92, 95% CI 0.90 to 0.94; PRWHE = 0.85, 95% CI 0.82 to 0.88 and TDX = 0.87, 95% CI 0.85 to 0.89) and for clarity (AUSCAN = 0.99, 95% CI 0.98 to 1.00; PRWHE = 0.95, 95% CI 0.93 to 0.97 and TDX = 0.91, 95% CI 0.89 to 0.94), respectively.ConclusionsThis study demonstrated very high content validity indices for the AUSCAN, PRWHE and TDX; with strong consensus across raters. This augments prior studies demonstrating appropriate statistical measurement properties, to provide confidence that all three measures assess important patient concepts of pain and disability.

Second Place Award: Long-term patient-reported outcomes after intramedullary Kirschner-wire fixation for displaced subcapital fractures of the fifth metacarpal bone: A retrospective cohort study

Background: The objective of this study was to analyze complications and patient-reported functional outcome after antegrade intramedullary Kirschner-wire fixation of displaced subcapital fractures of the fifth metacarpal bone. Methods: All consecutive patients treated from January 2010 to December 2015 were retrospectively identified using patient logs and radiographic images. Indications for operative fixation were angulation greater than 40 degrees, shortening less than 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-Rated Wrist/Hand Evaluation (PRWHE) and Disabilities of the Arm, Shoulder and Hand Score (DASH) questionnaires, both ranging from 1-100. Results: Fifty-one patients could be included, with two patients lost to follow-up. The mean outpatient follow-up was 9 wk, and the interval for functional assessment was 34 mo with 40 patients (78%) having responded to the questionnaires. Forty-seven patients (92%) proceeded to fracture union, while the recovery of two patients was complicated by migration of the Kirschner wires through the distal cortex into the metacarpophalangeal joint respectively 5 and 6 wk after primary surgery. Eight minor complications were registered, including a superficial skin infection, mild local dysesthesia or a 10- to 20-degree extension lag at the end of outpatient follow-up. Overall, in 41 patients (80%) the Kirschner wires were removed. Long-term functional outcome was excellent with mean PRWHE and DASH scores of, respectively, 3 and 6 points. Conclusions: If surgical treatment is considered, we recommend temporary antegrade intramedullary Kirschner wire fixation as a reliable therapeutic method with a low complication rate and excellent long-term functional outcome. Level of Evidence: Level III.

Diagnosis of Stage II Rheumatoid Arthritis through Functional Evaluation of Wrist and Hand among Adult Females

Background: Rheumatoid arthritis (RA) is a commonly prevailing disease among women. Disease progression deformities such as ulnar and radial shift of the wrist, Boutonnière, swan neck deformity and mallet finger become evident, which results in marked limitation of hand function. Patients usually lose the ability to hold, grasp and pinch thus activities of daily living are compromised. This study aimed to diagnose stage II Rheumatoid Arthritis through assessing the limitations of hand functions in adult females. Methods: A sample of 37 adult females with Stage II RA presenting to the rheumatology department of National hospital, Lahore and Combined Military Hospital, Lahore were recruited in the study. Patients with clinically diagnosed Stage II RA presenting with pain and dysfunction of the hands and wrist joints were included. Patients with any traumatic condition or any other bone disease that limits hand function were excluded from the study. The scale used for the assessment was Patient Rated Wrist/Hand Evaluation (PRWHE) with the reliability of &gt;0.75 and validity of 0.7. Results: In a sample of adult women with a mean age of 42, 39% reported moderate pain and 61% had severe pain whereas the functional limitations was reported to be moderate in 47.3% while 52.7% had severe limitation of hand function. These results prove that there is a negative impact of hand malformations on hand function. Conclusion: The adult females with stage II Rheumatoid Arthritis had severely limited hand function. The functional limitations of hand were increased with disease progression especially in adult females.

Ligament Reconstruction of Traumatic Pure Dislocation of Carpometacarpal Joint of the Thumb: A Series of Acute and Chronic Cases

Background Traumatic instability of carpometacarpal (CMC) joint of the thumb without a fracture (pure dislocation of CMC joint) is an uncommon injury, and a universally accepted protocol has not yet been developed for its management. Here, we aim to evaluate the outcome of this injury managed with ligament reconstruction technique, in a series of acute and chronic injuries.Patients and Methods Total nine patients (six acute and three chronic) with pure dislocation of CMC joint who underwent ligament reconstruction surgery were included in this retrospective study. Outcome measures included disabilities of the arm, shoulder, and hand (quick-DASH) questionnaire; visual analog scale (VAS) scoring system; patient-rated wrist/hand evaluation (PRWHE) system; pinch and grip strength; and Kapandji thumb opposition scores.Results The patients’ mean age was 32.55 ± 11.4 years. Their mean follow-up period was 27 ± 12.8 months. The mean postoperative pinch and grip strength was equivalent to 91.5% and 108% of the contralateral hand, respectively. The mean Quick-DASH score was 14.7 ± 19.4. The mean PRWHE score was 18.7 ± 22.4. The mean VAS was 1.1 ± 1.5. The mean Kapandji score was 8.3 ± 1.4. The pinch and grip strength were considerably superior in acute injuries. Degenerative changes were seen in all joints at the latest follow-up. None of our patients needed a revision surgery.Conclusion Ligament reconstruction method could result in favorable outcome in the management of pure dislocation of CMC joint. However, delayed surgery of this injury might adversely affect the outcome measures.

Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain's Tenosynovitis? A Cross-sectional Study.

Depression, anxiety, and pain catastrophizing have been associated with worse pain and function in studies of patients with de Quervain's tenosynovitis. Illness perceptions are the patient's thoughts and feelings about their illness. More negative perceptions of the illness such as the illness having a long duration or serious consequences are associated with worse physical function in patients with hand osteoarthritis. It is currently unknown whether these psychological factors play a similar role in de Quervain's. We chose to study patients who have tried nonoperative management and have chosen surgical decompression due to persistent symptoms. Psychological factors may be associated with their ongoing pain and impaired function, so it is particularly important to investigate the role of psychosocial factors that may be targeted with non-invasive interventions. Which psychological variables are independently associated with baseline pain and function in patients undergoing surgical treatment for de Quervain's tenosynovitis, after controlling for clinical and demographic variables? This cross-sectional study included data from a longitudinally maintained database on 229 patients who had surgery for de Quervain's tenosynovitis between September 2017 and October 2018. All management options were discussed with patients, but many had already tried nonoperative management and chose surgery once referred to our institution. Our database included 958 patients with de Quervain's, with 69% (659) managed nonoperatively and 34% (326 of 958) who underwent surgical decompression. A total of 70% (229 of 958) completed all questionnaires and could be included in the study. With the numbers available, we found no differences between those included and those not analyzed in terms of age, gender, duration of symptoms, BMI, smoking status, and workload.Patients completed the Patient-Rated Wrist/Hand Evaluation (PRWHE), Patient Health Questionnaire for emotional distress, Pain Catastrophizing Scale (PCS), and the Brief Illness Perception Questionnaire. We investigated the relative contribution of patient demographics and individual psychosocial factors using a hierarchical multivariable linear regression model. In the first step we considered how demographic factors were associated with the baseline PRWHE score. In the second step we investigated the effect of pain catastrophizing and emotional distress on the baseline PRWHE score after accounting for confounding demographic factors. In the final step, the effect of illness perceptions on baseline PRWHE were considered after accounting for the confounding effects of demographic factors as well as pain catastrophizing and emotional distress. After controlling for confounding variables including workload and emotional distress, a more negative patient perception of the consequences of their condition and worse pain catastrophizing were associated with worse pain and function (consequences, β = 0.31; p < 0.01, pain catastrophizing β = 0.17; p = 0.03). A hierarchical multivariable regression analysis found that 11% of variance in baseline pain and function was explained by pain catastrophizing and emotional distress. Illness perceptions brought the total explained variance of the final model to 34%. More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. In light of these findings, future studies might explore interventions to reduce pain catastrophizing and lower the perceived consequences of the condition. This may reduce the number of patients choosing surgical decompression or may also improve surgical outcomes. Further work should consider if these psychological factors are also associated with postoperative patient-reported outcomes. III, therapeutic study.

Patient-Reported Outcomes and Complications After Surgical Fixation of 143 Proximal Phalanx Fractures

Multiple methods exist to surgically fix unstable phalangeal fractures. Whereas these methods have different rates of complications or reoperation, it is not known whether these differences lead to changes in patient reported outcome. We compared patient-reported outcomes measures and complications of Kirschner wire (K-wire), lag-screw and plate fixation of proximal phalanx fractures (excluding the thumb). From 2010 to 2015, 159 patients with 159 proximal phalanx fractures were identified in 2 level 2 trauma centers and fixed with K-wires (44% of patients), lag-screws (26%), or plates (30%). Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) and complications were assessed. In addition, subjective outcomes were assessed. Follow-up was achieved for 143 fractures (90%) and average time to follow-up was 3.4 years. Mean DASH and PRWHE scores were 5.0 and 8.2, respectively. No differences in functional outcomes were found between fixation methods, although unplanned reoperation was more common in the plate fixation group (9 patients; 21%) than in the K-wire and lag-screw fixation groups (3 patients and 1 patient; 4.8 and 2.7%, respectively). We also found that K-wire fixation was associated with better aesthetic outcome than open reduction internal fixation. Overall patient-reported outcomes measure scores were similar across fixation methods, and unplanned reoperation was more prevalent after plate fixation. In addition, we found that regardless of fracture pattern, percutaneous fixation with K-wires was often sufficient and associated with better aesthetic outcome than open reduction and internal fixation. Prognostic IV.

Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings

Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, andM-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.

Omitting Routine Radiography of Traumatic Distal Radial Fractures After Initial 2-Week Follow-up Does Not Affect Outcomes.

Routine radiography in the follow-up of distal radial fractures is common practice, although its usefulness is disputed. The aim of this study was to determine whether the number of radiographs in the follow-up period can be reduced without resulting in worse patient outcomes. In this multicenter, prospective, randomized controlled trial with a non-inferiority design, patients ≥18 years old with a distal radial fracture could participate. They were randomized between a regimen with routine radiographs at 6 and 12 weeks of follow-up (usual care) and a regimen without routine radiographs at those time points (reduced imaging). Randomization was performed using an online registration and randomization program. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist/Hand Evaluation (PRWHE) score, health-related quality of life, pain, and complications. Outcomes were assessed at baseline and after 6 weeks, 3 months, 6 months, and 1 year of follow-up. Data were analyzed using mixed models. Neither the patients nor the health-care providers were blinded. Three hundred and eighty-six patients were randomized, and 326 of them were ultimately included in the analysis. The DASH scores were comparable between the usual-care group (n = 166) and the reduced-imaging group (n = 160) at all time points as well as overall. The adjusted regression coefficient for the DASH scores was 1.5 (95% confidence interval [CI] = -1.8 to 4.8). There was also no difference between the groups with respect to the overall PRWHE score (adjusted regression coefficient, 1.4 [95% CI = -2.4 to 5.2]), quality of life as measured with the EuroQol-5 Dimensions (EQ-5D) (-0.02 [95% CI = -0.05 to 0.01]), pain at rest as measured with a visual analog scale (VAS) (0.1 [95% CI = -0.2 to 0.5]), or pain when moving (0.3 [95% CI = -0.1 to 0.8]). The complication rate was similar in the reduced imaging group (11.3%) and the usual-care group (11.4%). Fewer radiographs were made for the participants in the reduced-imaging group (median, 3 versus 4; p < 0.05). This study shows that omitting routine radiography after the initial 2 weeks of follow-up for patients with a distal radial fracture does not affect patient-reported outcomes or the risk of complications compared with usual care. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic Distal Scaphoid Resection for Scapho-Trapezium-Trapezoid Arthritis.

Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient's work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. Results: At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest (P = .001), under maximal load (P = .0001), and in Mayo Wrist Score (MWS) (P = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (-10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the "critical" 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Conclusions: Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.

Evaluation of the PROMIS Upper Extremity Computer Adaptive Test Against Validated Patient-Reported Outcomes in Patients With Basilar Thumb Arthritis

The Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity(UE) computer adaptive test was developed to reduce test burden and improve precision. We hypothesized that, in patients with thumb basilar joint arthritis (BJA), (1) PROMIS UE would correlate with established patient-outcomes (PROs), (2) PROMIS UE would require less time and fewer questions than current metrics, (3) there would be no floor or ceiling effects, and (4) PROMIS UE would not correlate with radiographic disease severity. Patients presenting with a primary diagnosis of thumb BJA completed the Quick Disabilities of the Arm Shoulder and Hand (QuickDASH), Thumb Disability Examination (TDX), Patient-Rated Wrist Hand Evaluation (PRWHE), and PROMIS UE. Radiographic disease severity as described bythe Eaton scoring system was recorded. The relationships among PROs were described with Spearman correlation coefficients. The presence of a floor or ceiling effect was confirmed if greater than 15% of patients achieved the lowest or the highest possible score, respectively. One hundred patients with thumb BJA formed the sample for this study. A good to excellent correlation was identified between PROMIS UE and QuickDASH. There were good correlations between PROMIS UE and TDX as well as PRWHE. The PROMIS UE was significantly less time consuming (average: 58.5 seconds vs QuickDASH, 92.2; TDX, 62.6; and PRWHE, 144.7), and required fewer questions than current metrics (average: 4.9 questions vs QuickDASH, 11; TDX, 20; and, 15). In addition, there were no appreciable floor or ceiling effects. Radiographic disease severity did not correlate with PROMIS UE. The PROMIS UE has a good to excellent correlation with QuickDASH and good correlations with PRWHE and TDX. In addition, PROMIS UE required less time and fewer questions than established PROs. There were no floor or ceiling effects. Used as a single PRO, PROMIS UE may be a practical alternative to legacy scales in patients with thumb BJA. The PROMIS UE PRO instrument may be a valuable addition in the assessment of patients with basilar thumb arthritis.

Danish version of the Patient-Rated Wrist/Hand Evaluation questionnaire: Translation, cross-cultural adaptation, test–retest reliability and construct validity

Introduction In Denmark, there is a growing need for valid, reliable and standardized patient-rated outcome measures for use in clinical practice and research. The Patient-Rated Wrist/Hand Evaluation (PRWHE) is a self-reported assessment of hand-related disorders that measures pain and functional difficulties in activities of daily living. The purpose of this study was to: (1) translate and cross-culturally adapt the PRWHE into Danish and (2) assess the reliability and construct validity of the Danish version in patients with hand-related disorders. Methods The PRWHE was translated and cross-culturally adapted into Danish using the dual-panel approach. A total of 97 patients with diverse hand-related disorders and a mean age of 52.6 years (SD 15.2) participated in the psychometric testing. They were assessed on two occasions. Test–retest reliability was assessed using the Intraclass Correlation Coefficient (ICC2.1) to assess test–retest, Cronbach’s alpha to assess internal consistency and a Bland–Altman plot to estimate measurement error. Construct validity was investigated by evaluating the relationship between the Danish PRWHE (PRWHE-DK) and the Danish validated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Results Psychometric testing demonstrated an excellent test–retest reliability (ICC2.1 = 0.94) and internal consistency (alpha = 0.96). A systematic error of 1.5 and a measurement error of ± 16.1 were found. Furthermore, a strong correlation was found between PRWHE-DK and DASH ( r = 0.71). Conclusions The PRWHE-DK is a reliable, valid instrument for patients with different kinds of hand-related disorders, and can be used in clinical practice and multi-cultural research studies to measure pain and functional disability.

Antegrade Percutaneous Intramedullary Fixation Technique for Metacarpal Fractures: Prospective Study on 150 Cases.

The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible. Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013. A total of 150 patients with 165 metacarpal fractures were evaluated until February 2016. Average follow-up duration was 10 weeks. The clinical outcome was assessed by the total active motion of the digit, presence of rotational deformity, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Patient-Rated Wrist/Hand Evaluation (PRWHE) score. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal, comparing the postoperative radiography and the first radiography showing fracture healing. Comparing the injured and contralateral digit average total active motion after 10 weeks from surgery, no statistical significance emerged. No patient developed extensor tendon irritation, so that there was no need to perform tenolysis, ever. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 12.3 (range, 0 to 37). The average Patient-Rated Wrist/Hand Evaluation score was 19 (range, 0 to 41). Fracture union was steadily achieved. Radiographic assessment showed a nonsignificant postoperative loss of reduction. Antegrade intramedullary K-wire fixation technique is valid, reproducible, cheap, and perfectly suited to the treatment of metacarpal fractures requiring surgery, providing immediate mobilization and excellent outcomes for a very wide variety of fractures.

Survival and Long-Term Outcomes of Thumb Metacarpal Extension Osteotomy for Symptomatic Carpometacarpal Laxity and Early Basal Joint Arthritis

To evaluate the survival and long-term outcomes of thumb metacarpal extension osteotomy for early carpometacarpal (CMC) arthritis. Patients who underwent a thumb extension osteotomy between years 2000 and 2011 were identified. Patient demographics, complications, and reoperations were recorded. The Kaplan-Meier survival analysis was used with subsequent CMC surgery defined as failure. Patients who had undergone surgery 10 years or more before the study date underwent radiographic assessment, grip and pinch strength testing, and completed the Patient Rated Wrist/Hand Evaluation (PRWHE) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires. Thirty-two procedures in 7 males and 21 females were performed (mean age, 44.8 y). There were no cases of nonunion. Nine of 32 thumbs developed pin site erythema and were treated with oral antibiotics. Two thumbs developed osteomyelitis. Seven of 32 thumbs (22%) required reoperation. The Kaplan-Meier analysis indicated a 70% probability that patients who have this procedure will not require additional CMC surgery up to 14 years. Seven patients with a mean follow-up of 12.3 years (minimum 10 y) returned for clinical evaluation. The mean PRWHE and QuickDASH scores were 32.1 and 27.7, respectively. Examination revealed 124% pinch and 98% grip strength relative to the preoperative values. One thumb did not progress from stage II disease; 2 thumbs progressed from stage I to stage II; 1 thumb progressed from stage II to stage III; 1 thumb progressed from stage II to stage IV; 1 thumb did not have disease progression at the CMC joint, but developed scaphotrapeziotrapezoidal arthritis. Although reoperation rates and superficial infections with the described method of fixation were relatively high, thumb metacarpal osteotomy provides some degree of pain relief and improvement of function. This procedure may have utility as a temporizing measure in younger patients as it does not compromise future reconstructive procedures. Therapeutic IV.

The AUSCAN and PRWHE Demonstrate Comparable Internal Consistency and Validity in Patients With Early Thumb Carpometacarpal Osteoarthritis

The Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Wrist-Hand Evaluation (PRWHE) are 2 patient-related outcome measures to assess pain and disability in patients with osteoarthritis (OA). The purpose of this study was to evaluate the AUSCAN and PRWHE in a large-scale, longitudinal cohort of patients with early thumb carpometacarpal (CMC) OA. We obtained baseline data on 135 individuals (92 with early CMC OA participants and 43 asymptomatic controls) and at follow-up (year 1.5) on 83 individuals. We assessed the internal consistency using Cronbach alpha, and construct and criterion validity using other pain scales and objective measures of strength, respectively. We also examined the correlation between the AUSCAN and PRWHE and correlation coefficients at baseline and follow-up, as well as the correlation between changes in these instruments over the follow-up period. Internal consistency was high for both AUSCAN and PRWHE totals and subscales (Cronbach α > 0.70). Both instruments demonstrated construct validity compared with the Verbal Rating Scale ( r = 0.52-0.60, P < .01), an assessment of pain, and moderate criterion validity compared with key pinch and grip strength ( r = -.24 to -.33, P < .05). These instruments were highly correlated with each other at baseline and follow-up time points ( r = 0.76-.94, P < .01), and changes in a patient's total scores over time were also correlated ( r = 0.83, P < .01). The AUSCAN and PRWHE are both valid assessments for pain and/or disability in patients with early thumb CMC OA.