Quick Disabilities Of Arm, Shoulder And Hand Research Articles

Comparison of Conservative and Arthroplasty Treatment for 3 or 4 Part Proximal Humerus Fractures in the Elderly

Aim: Proximal humerus fractures are common injuries in the elderly population. This study hypothesizes that arthroplasty is not superior to conservative treatment in the management of multi-part proximal humerus fractures in elderly patients. Material and Method: Patients aged 65 and above with 3–4-part proximal humerus fractures, treated either conservatively or with arthroplasty, were included in the study. The minimum follow-up period was set at 12 months. Functional evaluations of the patients were performed using the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) scoring system. Statistical analysis comparing the two groups was conducted using the SPSS software. The mean values of numerical data were analyzed using the Mann-Whitney U test, while categorical data were compared using the Chi-square test. A significant level of 0.05 was considered. Results: A total of 67 patients who received adequate clinical follow-up were included in the study (50 conservative 17 arthroplasty). The average age of the patients was 76.12 years, with 9 male and 58 female patients. The average follow-up period was 22.61 months (range: 12-82). There were no statistically significant differences in age, gender, side, follow-up period, and fracture type distribution between the two groups. However, a significant difference in Q-DASH scores was observed (p

Minimial clinically important difference values in distal metaphyseal ulnar shortening for ulnar impaction syndrome and assessment of the relationship between level of the osteotomy and bone union time.

We aimed to define minimal clinically important difference (MCID) values of patient-reported outcome measures (PROMs) for distal metaphyseal ulnar shortening and to assess the relationship between level of the osteotomy and time to bone union. 20 patients who had distal metaphyseal ulnar shortening osteotomies due to ulnar impaction syndrome and had at least 6 months of follow-ups were included in this study. The mean follow-up period was 12.3 ± 7.01 months. The PROMs which consisted of patient-rated wrist evaluation (PRWE) and quick disabilities of arm, shoulder, and hand (QDASH) were recorded on the day before the surgery and at follow-up assessments. Grip strength and range of motion were recorded for operated and contralateral wrists at postoperative assessments. Postoperative radiological evaluations of distance of the osteotomy from the distal ulnar articular surface (osteotomy level), the union of osteotomy site; preoperative and postoperative evaluations of styloid-triquetral distance, and ulnar variance were performed using AP wrist x-rays. The MCID values for PRWE and QDASH were calculated using ROC curve analysis. Mean PRWE and QDASH scores decreased statistically significantly. The mean grip strength of contralateral wrists was higher. Mean ulnar variance decreased, whereas styloid-triquetral distance increased postoperatively. Patients with osteotomy levels of greater than 13.7 mm had a longer time from surgery to bone union. Furthermore, patients with time from surgery to bone union shorter than 7 weeks had an osteotomy closer to the ulnar articular surface. The MCID values for PRWE and QDASH were analyzed and calculated through the ROC curve as 22.25 and 20.45, respectively. This study has shown us that the osteotomy level affects the time to bone union and an osteotomy closer than 13.7 mm to the ulnar articular surface seems to result in shorter union time. Furthermore, MCID values were defined for PRWE and QDASH as 22.25 and 20.45, respectively. Level IV, Therapeutic Study.

Evaluation of treatment of nonunited middle third scaphoid fractures using threaded Kirschner wires fixation with iliac bone grafting

Abstract Objectives To evaluate the results of iliac bone grafting with threaded Kirschner wires (K-wires) fixation in treating of nonunited middle third scaphoid fractures. Background Scaphoid nonunion is a common complication after scaphoid fractures as it is an intra-articular fracture with high fracture mobility and instability. In addition, the scaphoid is devoid of periosteum along with impaired vascularity. Scaphoid nonunion results in carpal collapse with secondary osteoarthritis. To avoid that, the aim of treatment should be to enhance the biology of fracture through bone grafting and provide adequate stability of the fracture in an anatomic alignment. Patients and methods This study is a prospective case series of 30 patients with nonunited middle third scaphoid fractures admitted to an academically supervised trauma center from June 2018 to June 2020. They were managed by open reduction, refreshment of the scaphoid nonunion site with iliac crest bone grafting, and threaded K-wires fixation in an anatomical alignment. The mean age was 28.58 ± 4.47 years. Postoperative clinical outcomes were evaluated using the Quick disabilities of arm, shoulder and hand (DASH) score, and modified Mayo wrist score. Postoperative radiological union and scaphoid alignment were assessed. The minimum period of follow-up was one year. Results One year postoperatively, the mean modified Mayo wrist score was 81.67 ± 9.39 and the mean Quick DASH score was 25.67 ± 14.97. Radiologically, the union was achieved in 86.7%. The mean union time was 11.92 ± 1.54 weeks. Conclusions Threaded K-wires fixation with iliac bone grafting is an effective method for treating nonunited middle third scaphoid fractures.

Revised service metrics partially explain variation in outcomes across facilities in a state-wide advanced practice public musculoskeletal service.

Revised service metrics partially explain variation in outcomes across facilities in a state-wide advanced practice public musculoskeletal service.

When Healing Hands Hurt: Epidemiology of Thoracic Outlet Syndrome Among Physicians

Thoracic outlet syndrome (TOS) is an infrequent condition which results in disability in use of upper extremity. While TOS is often associated with manual labor, industrial workers, and accidents, it has not been reported in a physician (MD) population. Given the investment of time and effort in training to become a MD, the impact of TOS may be devastating. Our objective is to report the presentation and outcome of TOS in MDs. A prospectively surgical database was reviewed for MDs who sought care of disabling TOS between 1997 and 2022. Demographic, clinical, outcome and pathological data were reviewed. Outcomes were assessed based on Somatic Pain Scale (SPS), Quick Disabilities of Arm, Shoulder and Hand (DASH) scores, and Derkash scores. Results were also assessed based on return to employment. A total of 19 MDs were identified, from 1,687 TOS cases. The group included 13 (63%) men, 6 (31%) women, average age 45years (range 27-57). Presentations included 1 (5.3%) arterial TOS (ATOS), 9 (47.4%) venous TOS (VTOS), and 9 (47.4) neurogenic TOS (NTOS). All patients were right-handed, and symptomatic side was dominant hand in 7 (37%) patients. Etiologies included repetitive motion injury, athletic injury, and congenital bony abnormalities. Repetitive motion was associated with 3/9 (33%) NTOS. Significant athletic activities were noted in 12 of 19 (63%) MDs, including 8/9 (89%) VTOS and 4/9 (44%) NTOS. Athletic activities associated with VTOS included triathletes (2), rock climbing (1), long distance swimming (2), and weightlifting (3). Of the 9 NTOS cases, 3 were associated with weightlifting and 1 with skiing. Congenital causes included 1 (5%) abnormal first rib and 1 (5%) cervical rib. Time from symptom onset to consultation varied significantly according to diagnosis: ATOS 6days, VTOS 97days, and NTOS 2,335days (P<0.05). All underwent first rib resection (FRR), and 4 (4) patients required contralateral FRR. Time from surgery to last follow-up averaged 1,005days (range: 37-4,535days). On presentation, 6 patients were work disabled and 13 patients were work restricted. Following surgery, 4 MDs remained work restricted with mild to moderate symptoms. After surgery, standardized outcomes (SPS, Quick DASH, and Derkash score) improved in all metrics. All who were initially disabled returned to work without restriction. Significant non-TOS related comorbidities were present in all who had residual restriction. Return to work was documented in all. Although it has not been reported, MDs are subject to developing TOS. Causes include repetitive motions, athletic injuries, and congenital bony abnormalities. Surgical decompression is beneficial with significant reduction in pain and disability. MDs are highly motivated and insightful; accordingly, they have a very high probability of successful work resumption, with all returning to their medical positions.

TO STUDY UPPER LIMB MUSCULOSKELETAL PROBLEMS IN MALABAR PAROTTA MAKERS

Background - Malabar Parotta is a Subcontinental layered atbread made from Maida or Atta. Making it is indeed a task. Musculoskeletal disorders are common health problems throughout the world. Work-related Musculoskeletal disorders arise from arm and hand movements. What makes them risky in the working environment is their continual repetition. Although this comes under restaurant chefs, this specic technique is unique and skillful. Therefore, there is no research done on this difcult and skillful technique and is important to address it for the benet of the makers. To study musculoskeletal Aim of the study – problems of Upper limb in Malabar Parotta makers. A cross-sectional study with 100 individuals was included in the study Methodology And Study Tool - . A self-made demographic questionnaire, Body map, Quick DASH (Disability of Arm, Shoulder, and Hand) scale, and Cornell hand discomfort questionnaire (CHDQ) were administered using the Direct Interview Method. A total of 100 participants w Results – ere analyzed in this study. 51.35% of Males have SHOULDER affection whereas 42.30% of Females show affection for SHOULDER. The affection for ARM is more recorded in Females with 30.68% and affection for FOREARM is more recorded in Males with 63.43%. The affection of HAND is Equal in both Males and Females with 62.6% respectively. The affection for Upper Limb was noticed to be severe in both Conclusion – males and females. As the number of parottas made increased disability and discomfort also increased. The people who worked in Home Based setups had maximum disability and discomfort. As the number of working years increased disability decreased but the discomfort was seen to be increased.

Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference?

PurposeTwo different locking plate designs are now being used for volar plating of the distal radius fractures based on the freedom of screw direction; the fixed-angle, and the variable-angle (polyaxial) plates. We investigated the clinical and radiographic outcomes of both designs.MethodsWe reviewed 96 patients with 113 unstable distal radius fractures that were operated on with volar locking plates. The patients’ mean age was 41 years. Fixed-angle volar locking plates were utilized in 65 fractures and variable-angle volar locking plates in 48 fractures through modified Henry approach or extended carpal tunnel approach. Full clinical and radiographic evaluation was done for all patients with a mean follow-up of 14 months.ResultsAll patients had acceptable clinical and radiographic parameters. The overall functional results (Mayo score, Quick Disability of Arm, Shoulder, and Hand (Q-DASH) score, Range of motion (ROM), and grip strength) were in favor of the variable-angle plate. The radiographic parameters were better with the variable-angle group. The variable-angle group recorded less operative time but more mean image intensifier exposure time. There were two cases of flexor tendon rupture with the fixed-angle group. Fixation with the fixed-angle system needed K-wire augmentation more than the variable-angle group. There was a positive correlation between hand dominance and the final score.ConclusionDistal radius volar locking plates yield satisfactory results comparable among different designs. In our series, the variable-angle system showed slightly better function and radiographic outcomes. Supplementary K-wires were needed more frequently with the fixed-angle system.

Impact of Corticosteroid Injection on The de Quervain’s Tenosynovitis

Background: de Quervain’s tenosynovitis may be caused by thickened extensor retinaculum which holds the tendon in position in wrist. There are both operative and non-operative treatments for the condition. Corticosteroid injection is a very good conservative treatment option. Objective: To see the outcome of corticosteroid Injection in the de Quervain’s Tenosynovitis. Materials and Methods: This was prospective interventional study conducted at the outpatient department of Kurmitola General Hospital during the period from January 2018 to December 2019. Total 71 patients with de Quervain’s tenosynovitis were analyzed. Secondary outcomes were measured by Visual Analogue Scale (VAS) and Quick Disabilities of Arm, Shoulder and Hand (DASH) score. Results: Among the 71 affected hands, 11 (16.22%) patients had recurred. Sixty (83.78%) patients had no positive sign or symptom after 6 months of follow-up. Average VAS before injection was 8.27±1.23. Post injection VAS was 0.82±1.49 at 1 month follow-up and 1.46±2.34 at 6 month follow-up which was improved significantly. Pre-injection average Quick DASH score was 77.33±13.59 which was reduced to 18.34±12.37 after 1 month and 22.97±17.28 after 6 months of follow-up. Conclusion: Single injection of triamcinolone with local anesthetic for the treatment of de Quervain’s disease was proved significant conservative treatment option though there were few complications and failed cases. We should pay more attention to long-term follow-up and proper injection technique. KYAMC Journal.2021;12(02): 88-91

Functional outcome of open latarjet procedure for recurrent anterior shoulder instability: A prospective study

Introduction: Shoulder joint owing to its anatomy and biomechanics is the most unstable and frequently dislocated joint in our body. Anterior shoulder instability is often caused by glenoid and/or humeral bony defects in addition to soft tissue injuries. Most commonly seen in young and athletic population with high demand activities. Arthroscopic Bankart repair and open Latarjet procedure are the mainstay of treatment for recurrent anterior shoulder instability. Here we analyse the functional outcome of the shoulder joint repair following Open Latarjet procedure for recurrent anterior shoulder instability. Methods: Prospective study conducted for 2 years among 34 patients who met our criteria for open Latarjet procedure. In which coracoid process along with the conjoint tendon is transferred and fixed with non-absorbable to the margin of glenoid. This procedure provides stability by bony effect, Bankart effect and dynamic sling effect. Phased Rehabilitation was customised based on tissue quality, stability of repair. Outcome was assessed with ISIS score (Injury Severity Index Score), Rowe score, quick DASH (The Disabilities of Arm, Shoulder and Hand) score, ASES score (The American Shoulder and Elbow Surgeons Shoulder Score) and Visual analogue scale. Results: Follow up done at 2 weeks,1 month,3 month and 6 month showed progressive improvement in Range of motions, Apprehension relief, pain relief, return to normal activities and no any recurrence of instability and improved assessment scores.Conclusion: For recurrent anterior shoulder instability Open Latarjet procedure showed satisfactory result in terms of stability and range of motion mainly with significant bony defect of glenoid.

Early Results of Kinesio Taping and Steroid Injections in Elbow Lateral Epicondylitis: A Randomized, Controlled Study.

Background and objectives: This study prospectively compares early results of Kinesio tape (KT) as an alternative method for the treatment of lateral epicondylitis with those of corticosteroid injection and the rest-and-medication group (RMG). Materials and methods: Among the fifty patients (53 elbows), KT was applied to 20 patients (21 elbows), and corticosteroid injection (CSI) was applied to 15 patients (17 elbows). Fifteen patients were included in the RMG. Patients in the RMG were informed about their condition, and necessary warnings were given. No oral or topical treatments were recommended. If needed, paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed. Patients were classified according to the Nirschl scores and evaluated with visual analog scale (VAS); Quick Disability of Arm, Shoulder and Hand (QDASH); and the Turkish version of the Patient Related Elbow Evaluation (PREE-T). Results: Improvements in all scores were statistically significant in all groups at the end of the second week. At the end of the fourth week, there was also a statistically significant improvement in all three groups, but these improvements were not as high as they were in the first 2 weeks. There was a slight deterioration in the functional scores in the RMG and CSI groups, while the improvement in the KT group continued. In the KT group, the average QDASH score was 18.1 (4.5–35), the VAS score was 2 (1–3), the VAS score in resisted wrist extension was 4 (2–5) and the Nirschl score was 2 (1–3) at the fourth week. The KT group had significant superiority in these parameters over the RMG (p = 0.035, p = 0.035, p = 0.029, p = 0.035, respectively). However, there was no significant difference between the KT, the RMG and the CSI groups at the fourth week. Conclusions: CSI, KT and rest-and-medication treatments were all effective in terms of pain reduction and functional scores at the end of week 2, and the only treatment that continued to be effective in the final week was KT.

The free medial femoral condyle periosteal flaps for the treatment of recalcitrant upper limb long bones nonunion.

Recalcitrant fracture non-union is a condition that is difficult to treat and may require multiple surgeries, sometimes requiring treatment with periosteal flaps. The use of periosteal flaps can be preferred for the treatment of non-unions that do not yet have extensive bone defects. This study aims to share our experience with medial femoral condyle periosteal flap for the treatment of recalcitrant non-union in long bones of the upper limb. Seven patients who underwent treatment for upper limb non-union with a free medial femoral condyle periosteal flap between 2015 and 2019 were retrospectively evaluated. Patients who had previously underwent implant revision and non-vascular grafting procedures and with failed atrophic non-union were included in the study. Non-union was in the humerus in two patients, ulna in three, radius in one, and clavicula in one patient. Demographic data, non-union features, complications, and radiographic findings of the patients were evaluated. Functional results were evaluated according to Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) scores. Mean patient age was 41 (23-60) years and the mean follow-up time was 33 months (16-56). Non-union time ranged from 9 to 24 months. Additional surgical procedures were not required. One patient developed a hematoma in the donor site and required surgical drainage. Medial collateral ligament injury of the knee occurred in one patient. Union was observed in all patients in an average of 3 (2-7) months. Mean pre-operative Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) score was 56 (33-95), while mean post-operative control Q-DASH score was 5 (0-33); the improvement was statistically significant (p=0.017). The functional outcomes of all patients improved, as confirmed by Q-DASH score. The medial femoral condyle periosteal flap offers a viable treatment option for recalcitrant non-unions. This flap has low comorbidity compared to other flaps and is a feasible option for revascularization and bone formation in atrophic non-unions.

The effects of hand splinting in patients with early-stage thumb carpometacarpal joint osteoarthritis: a randomized, controlled study

Background/aimEvidence for the effectiveness of splinting in thumb carpometacarpal osteoarthritis is limited. We aimed to evaluate the effects of a prefabricated carpometacarpal metacarpophalangeal immobilization splint on pain, hand function, and hand strength in patients with early-stage thumb carpometacarpal osteoarthritis.Materials and methodsSixty-three hands with stage 1 or 2 thumb carpometacarpal osteoarthritis were enrolled in the study. The nonsplint group received oral information about how to accommodate daily activities. The splint group was given a prefabricated carpometacarpal metacarpophalangeal immobilization splint for 6 weeks. Pain was evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN). Hand functions were evaluated using the AUSCAN and the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) questionnaire. Grip and pinch strengths were measured using a hydraulic dynamometer and a hydraulic pinch gauge.ResultsThe AUSCAN pain, stiffness, function, total scores, and Q-DASH scores were significantly decreased in the splint group compared to the nonsplint group. Significant increments in grip and pinch strengths were detected in the splint group compared to the nonsplint group.ConclusionThe prefabricated carpometacarpal metacarpophalangeal immobilization splint is effective in improving pain, hand function, and hand strength in patients with thumb carpometacarpal osteoarthritis.

Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure.

Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17-66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. There was no post-operative complication. Mean Quick DASH score 10.9 (range 0-29.5) at mean 35.4-month follow-up (range 29-43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.

Clinical outcome and operative cost comparison: Locked compression plate versus reconstruction plate in midshaft clavicle fractures.

The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture. From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration. The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p<0.001). The 3.5-mm reconstruction plate achieved not only satisfactory clinical outcomes but was also more cost-effective than the LCP in the treatment of displaced midshaft clavicle fractures. Level III, Therapeutic study.

Satisfactory function 12 years after triscaphoid arthrodesis for chronic scapholunate ligament injury

Scapholunate ligament (SLL) injury represents a hazard to the wrist and the treatment of these injuries has been the focus of much debate. We performed a long-term follow (>10 years) of triscaphoid arthrodesis for symptomatic chronic SLL injuries in 10 (8 men) patients 37 (22–49) years of age. All arthrodesis healed. One patient was converted to total wrist arthrodesis during the follow-up period, and three had minor additional surgeries. At final follow-up, the patients had reduced active range of motion (AROM, 55%) and grip strength (85%) compared to the opposite side, but reported low Quick Disability of Arm, Shoulder and Hand (QDASH) (11), Patient-Rated Wrist and Hand Evaluation (PRWHE) (25) and visual analog scale (VAS) pain scores (0 and 10 at rest and activity). Radiographs found minimal degenerative changes in four patients, while CT scans demonstrated changes in seven patients, in three of these scaphoid was subluxed on the rim of the radius. The patients working prior to surgery were working at follow-up. A triscaphoid arthrodesis for SLL renders a functional wrist function in most patients for many years and has postponed more extensive surgery like total wrist arthrodesis or wrist arthroplasty. The patients are still young, and the degenerative changes seen especially on CT scans warrants attention.

Plate osteosynthesis of the coronoid process of the ulna

The aim of surgical treatment is reconstruction of the coronoid process' bony anatomy. Large shear fractures of the coronoid process (Regan-Morrey typeII-III, O'Driscoll "tip" subtype2 and "basal" subtype1-2) and fractures of the anteromedial facet (O'Driscoll "anteromedial" subtype1-3) can occur isolated or as part of the "terrible triad" injuries to the elbow. Due to the resulting instability of these injuries, surgical reconstruction is generally indicated. In case of major accompanying soft tissue injuries to the elbow or an elbow infection, primary operative treatment using anatomical plate osteosynthesis is contraindicated. Plate osteosynthesis of the coronoid process is performed through amedial approach (Hotchkiss or M.flexor carpi ulnaris split). After repositioning of the fracture fragments, apreformed anatomical plate can be fixed to the coronoid process. The arm is immobilized in an over-the-elbow cast until the wounds are dried. Afterwards, the elbow should preferably be treated functionally without varus or valgus stress. Between January 2015 and July 2018, atotal of 11patients underwent osteosynthesis of the coronoid using anatomically preformed plate osteosynthesis. After amean follow-up of 10.7 months, the mean Mayo Elbow Performance Score showed an excellent result with 78.89 points. The Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) score showed amedian of 18.64points with amean functional arc of 118°.

FUNCTIONAL STATUS AND ACTIVITY PARTICIPATION IN PATIENTS WITH DISTAL RADIUS FRACTURE: APPROACH WITH ICF FRAMEWORK

Objectives: Distal radius fracture (DRF) affects overall health status. The International Function Classification (ICF) based approach offered a different perspective on DRF management. The aim was to investigate the effectiveness of the rehabilitation program administered in patients with DRF from an ICF perspective. Methods: In this prospective study, 53 patients were divided into conservative and surgical groups and were admitted to 12-weeks supervised rehabilitation program. Body structure and functions were evaluated with pain assessment, range of motion and muscle strength measurement. Also, radiographic evaluations were done. Activity participation was assessed with Push-Off Test (POT), Michigan Hand Outcomes Questionnaire (MHOQ), Quick Disabilities of Arm-Shoulder and Hand (Q-DASH) and Jebsen-Taylor Hand Function Test (JTHFT). Measurements were made on the 2nd, 6th week and the 3rd, 6th months. Results: A total of 53 patients, 32 female (60.4%) and 21 male (39.6%) were included in the study. The mean age of the patients was 47,43±12,20 (23-60) years. 35 (66%) patients were treated conservatively and 18 (34%) patients were surgically treated. There was no difference between groups in pain level, range of motion, grip strength, POT, MHOQ, Q-DASH, JTHFT and radiologic measurements (p>0,05). Conclusion: Creating an ICF-based assessment and intervention plan for the activity participation of patients with DRF guides hand surgeons and hand therapists in achieving their goals.

Is kinesiophobia associated with lymphedema, upper extremity function, and psychological morbidity in breast cancer survivors?

This study aims to the effects of kinesiophobia on lymphedema, upper extremity function, depression/anxiety, and quality of life in breast cancer survivors. Between January 2015 and January 2016, a total of 81 breast cancer survivors (mean age 54.1±10.8 years; range 44 to 70 years) were included. Lymphedema was evaluated based on the circumference measurements. The Tampa Scale for Kinesiophobia (TSK), the Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 (SF-36) were applied to all patients. We found a significantly higher rate of lymphedema in the patients with kinesiophobia. Kinesiophobic patients had also significantly higher mean scores of TSK, Q-DASH, HADS-A, and HADS-D and lower mean scores of the SF-36 physical scores. Correlation analysis demonstrated that presence of lymphedema, Q-DASH, HADS-A, and HADS-D scores were significantly associated with the TSK scores. Kinesiophobia increases the risk for lymphedema, depression/anxiety, and decreased upper extremity functioning in breast cancer survivors. Identifying kinesiophobia in breast cancer survivors, psychosocial providers may help to prevent undesirable effects of kinesiophobia.

Treatment of Pisotriquetral Arthritis by Pyrocarbon Interposition Arthroplasty.

Purpose Pisiformectomy is the baseline treatment for pisotriquetral arthritis when medical treatment fails to address the problem. This operation may lead to loss of mobility and strength in the wrist. This study reports the short-term outcomes of a new technique for treating pisotriquetral arthritis using a pisotriquetral interposition arthroplasty with a pyrocarbon implant. Patients and Methods We performed a clinical and radiographic study on a series of eight patients who received this treatment at a mean follow-up of 2.8 years. We also studied the mobility of the implant and did assessed articular instability using dynamic radiology and fluoroscopy. Results We observed one proximal dislocation of the implant in one hand which was reoperated to reposition the implant and strengthen the capsule. All patients were satisfied or very satisfied with their operation and had an average functional recovery period of 1.6 months. At the last follow-up, the Mayo Wrist Score (MWS), Quick Disability of Arm Shoulder and Hand (QDASH), and Patient-Rated Wrist Evaluation (PRWE) scores were 89, 18, and 20, respectively. Postoperatively, there was a 22% improvement in the grip strength of the wrists as well as improved mobility, mainly as regards the radioulnar deviation (47% improvement) and the Visual Analogue Scale (VAS) pain scores decreased from 8 preoperatively to 2 at the latest follow-up. The functional radiologic and fluoroscopic study reported good adaptive mobility of the implant in all the patients, without any indication of pisotriquetral joint instability. Conclusion The short-term results of pisotriquetral arthroplasty using the Pyrocardan implant are encouraging. This new surgical solution appears to be a valid alternative to pisiformectomy or pisotriquetral arthrodesis. Long-term studies are required to confirm these preliminary findings.

Symptomatic medial humeral epicondylar fracture non-union- rare presentation of a relatively common injury

BackgroundSymptomatic non-union of medial humeral epicondylar fractures is a limited entity. Some studies recommend surgical excision of the fragment, but the results are controversial. The purpose of this study is to evaluate the outcome of open reduction and internal fixation of a medial epicondyle non-union fragment. Materials and methodsA retrospective study was conducted in all the patients, who were operated in our hospital between the year 2010 and 2015 for symptomatic medial humeral epicondyle non-union. Inclusion criteria were open reduction and internal fixation of symptomatic medial epicondyle non-union and minimum one year of follow-up from time of surgery. Exclusion criteria included other associated musculoskeletal disorders of the affected limb. Open reduction and internal fixation of the fragment was done in all patients and the ulnar nerve was decompressed and anteriorly transposed in cases where symptomatology was present. Outcome was assessed with radiograph, range/arc of motion, Visual analogue pain scoring and two functional outcome tools. ResultsStudy sample consisted of 14 patients, with mean age at presentation of 14.9 years (range 6 to 50 years) with mean time since injury of 7.7 months (range 3 to 24 months). Patients presented with medial elbow pain and prominence, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, at a mean of three years after surgery (range 1.5 to 5 years), patients reported an improvement in visual analogue pain score from a mean of 7.29±1.3 to 0.21±0.4, and the difference was statistically significant (p=0.001). Mean postoperative Quick DASH (Disability of Arm, Shoulder, and Hand) score was 5.21±7.2. Mean Mayo Elbow Performance Score was 96.7±6.1. Improvement in arc of motion was statistically significant (p=0.001). Radiographic union was achieved in all patients except one who had fibrous union. Functional elbow range of motion was achieved in 13 out of 14 cases (92.8%) and ulnar nerve recovered in five patients and one patient required tendon transfer. ConclusionOpen reduction and internal fixation of symptomatic medial humeral epicondyle non-union gives excellent clinical and functional outcome in the majority of cases.