Hand Stiffness Research Articles

1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals

BackgroundHand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City.MethodsWe performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected.ResultsOf the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies.Table 1: Baseline demographics and co-morbid conditions Table 2: Types and numbers of organisms in relation to etiologies ConclusionWithin our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections.Disclosures All Authors: No reported disclosures

Effect of Virtual Reality Training Using Leap Motion Controller on Impairments and Disability in Patients with Wrist and Hand Stiffness

Background and Purpose: Virtual reality (VR) training targets not only the musculoskeletal, but also theneurological system and has been successfully used in neurological rehabilitation. Our objective was to testwhether there are any benefits of adding VR training with conventional physiotherapy on impairments anddisability of wrist and hand stiffness, in patients with distal forearm fractures and early rheumatoid handaffection.Methodology: In this experimental study, 50 patients suffering from wrist and hand stiffness were alternatelyallocated into either Conventional physiotherapy group and VR with conventional physiotherapy group.Both the groups completed 8-12 training sessions over a period of 4 weeks comprising of similar protocol ofconventional physiotherapy with only the VR group receiving additional VR training. Patient was assessedon outcome measures pre and post treatment.Results: All the outcome measures showed significant improvement in both groups. On between groupcomparisons, the VR group showed significantly greater improvements on the outcome measures of gripstrength, dexterity (left hand and assembly), wrist flexion, ulnar deviation, forearm range of motion andwork component of Michigan Hand Questionnaire when compared to the conventional group. There wereno differences between groups on outcome measure of pain, wrist extension, wrist ulnar deviation and totaldisability score of Michigan Hand Questionnaire.Conclusion: We conclude that, adding virtual reality training to conventional physiotherapy has benefits onoutcome of grip strength, hand dexterity, work component of disability and direction specific improvementin the range of motion of wrist and forearm as compared to conventional physiotherapy alone.

Revisiting the dogma of the Edinburgh position for safe immobilization.

Since the concept was first described 50 years ago in Edinburgh by J. I. P. James, the term 'Edinburgh position' has been synonymous with the position of safe immobilization for the hand. Widely employed for the management of injured hands, the position is associated with splinting the metacarpophalangeal joints at 90° and the proximal interphalangeal joints completely straight, namely, 'the intrinsic-plus position', to help reduce the long-term consequences of a stiff hand. Over the decades, the strict joint angles of the Edinburgh position have been debated due to changes in patterns of injury, treatment and rehabilitation. This article challenges the dogma that surrounds the use of the Edinburgh position in clinical practice. The history of the position was explored, and the results of a survey about current practice of hand immobilization from two study centres in Edinburgh is presented.Level of evidence: IV.

Diabetes-associated dermatological manifestations in primary care and their association with vascular complications.

Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications. Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD). 213 diabetic patients were included over a period of 3months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001). In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

BackgroundTherapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)-related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA.MethodsThe project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up.DiscussionThis study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient’s status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care.Trial registrationClinicalTrials.gov NCT04263974. Registered on 7 March 2020. Date of last update 15 April 2020. Ethics committee code: PI_RH_2018.

Neuromorphic Model of Reflex for Realtime Human-Like Compliant Control of Prosthetic Hand

Current control of prosthetic hands is ineffective when grasping deformable, irregular, or heavy objects. In humans, grasping is achieved under spinal reflexive control of the musculotendon skeletal structure, which produces a hand stiffness commensurate with the task. We hypothesize that mimicking reflex on a prosthetic hand may improve grasping performance and safety when interacting with human. Here, we present a design of compliant controller for prosthetic hand with a neuromorphic model of human reflex. The model includes 6 motoneuron pools containing 768 spiking neurons, 1 muscle spindle with 128 spiking afferents, and 1 modified Hill-type muscle. Models are implemented using neuromorphic hardware with 1 kHz real-time computing. Experimental tests showed that the prosthetic hand could sustain a 40 N load compared to 95 N for an adult. Stiffness range was adjustable from 60 to 640 N/m, about 46.6% of that of human hand. The grasping velocity could be ramped up to 14.4 cm/s, or 24% of the human peak velocity. The complaint control could switch between free movement and contact force when pressing a deformable beam. The amputee can achieve a 47% information throughput of healthy humans. Overall, the reflex-enabled prosthetic hand demonstrated the attributes of human compliant grasping with the neuromorphic model of spinal neuromuscular reflex.

Prevalence of musculoskeletal complications of type-2 diabetes mellitus in population of southern Punjab, Pakistan

Diabetes mellitus is a major public health issue globally, and type-2 diabetes mellitus is the most prevalent form of this disease. Due to multiple factors, most diabetic patients develop functional disabilities including musculoskeletal complications. To determine the frequency of musculoskeletal complications, the relationship between these complications and different potential variables, and the status of pharmacotherapy management to treat these complications among patients with type-2 diabetes mellitus. It was a cross-sectional study and data was collected through self-administered, face-validated pro forma in the English language in outpatient clinics of two tertiary care hospitals of Multan, Pakistan. Total n = 270 type-2 diabetic patients of both genders were assessed for musculoskeletal complications; n = 126 (46.7%) patients had at least one musculoskeletal complication. The most common manifestations were shoulder capsulitis or frozen shoulder (20.7%), flexor tenosynovitis (10.4%), hand stiffness syndrome (10%), and limited joint mobility (9.6%). A statistically significant association was found between frozen shoulder, limited joint mobility, and hand stiffness syndrome with the duration of diabetes (p value = 0.003, 0.0001), and overall glycemic control (p value = 0.004, 0.001) respectively. Out of 254 complaints, only 42.9% of complaints were receiving pharmacotherapy management. Main outcome measure: overall prevalence of musculoskeletal complications among patients of type-2 diabetes and level of pharmacotherapy management for them. Periarticular region of the joints in the hands and shoulders should be examined whenever diabetic patients present with uncontrolled diabetes, and pharmacotherapy management should be planned for these patients who will improve their quality of life.

O03 The OA thumb therapy trial: a three arm multi-centre randomised controlled trial of the clinical effectiveness and efficacy of splints for symptomatic thumb base OA

Abstract Background Symptomatic thumb-base osteoarthritis (OA) affects 20% of people aged &amp;gt;55 years. Patients with thumb-base OA may experience pain, work disability, hand dysfunction and reduced quality of life (QoL). Although hand splints are a recommended intervention, this is supported by only low level evidence. Furthermore, the impact of placebo hand splints in OA remains unclear. This is the first trial powered to determine the efficacy of active versus placebo thumb splints, when added to a programme of self-management, for patients with symptomatic thumb-base OA. Methods A pragmatic, multi-centre, superiority randomised controlled clinical effectiveness and efficacy trial was conducted. Patients with symptomatic thumb-base OA and at least moderate thumb-base pain referred to UK out-patient occupational and physiotherapists were included. Patients with recent fractures, intra-articular joint injections and medical red flags were excluded. Eligible participants were randomised equally to either: (A) 8 weeks of self-management; (B) 8 weeks of self-management plus a verum splint; or (C) 8 weeks of self-management plus a placebo splint. The self-management programme was designed and delivered by therapists, based on recommended evidence-based practice. Participants in groups B and C were blinded to the type of splint received; clinical outcome assessors were also blinded. Participants were followed-up for 12 weeks from randomisation. The primary outcome was AUSCAN hand pain at 8 weeks. Secondary outcomes included work productivity, QoL, hand stiffness, hand function, disability and satisfaction. The trial was registered (ISRCTN. No 54744256). Results 17 UK NHS therapy departments assessed 751 patients for eligibility. 349 patients were randomised: 116, 116 and 117 to groups A, B and C, respectively. Treatment groups were well balanced for baseline characteristics. At baseline, no participants in group A received a splint; 99% and 97% of participants in groups B and C received the correct allocated splint. 80% of all participants attended their 4 week follow-up appointment. 8 week primary endpoint data were available for 84% of randomised participants; missing data were balanced across the groups. There was no evidence of clinically or statistically significant differences between treatment arms (B vs. C: -0.4 (95% CI -1.4, 0.6 p = 0.41), B vs. A: -0.5 (95% CI -1.4, 0.4 p = 0.26), C vs. A: -0.1 (95% CI -1.0, 0.8 p = 0.78). The per-protocol analysis, sensitivity analysis for missing data and analyses of secondary endpoints supported these findings. Ten participants reported adverse reactions: 3, 5 and 2 in groups A, B and C, respectively. Conclusion The addition of splinting to the recommended self-management package delivered by therapists did not confer additional benefit. Patients randomised to receive verum splints did not report better outcomes than those randomised to placebo splints. Disclosures J. Adams None. P. Barratt None. N.K. Arden None. S. Barbosa Bouças None. S. Bradley None. M. Doherty None. S. Dutton None. K. Dziedzic None. R. Gooberman-Hill None. K. Hislop None. C. Hutt-Greenyer None. V. Jansen None. R. Lunego None. I. Rombach None. M. Wiliams None.

The hand osteoarthritis of New York university (honey) registry: the impact of obesity and menopausal status

Purpose: Hand osteoarthritis (OA) data in the literature emanates mainly from cohorts of knee or hip OA. Targeted populations of hand OA could better define the clinical spectrum, address etiologies, and discern pathophysiology. While prevalence increases with age, other factors impacting onset and severity are unclear. Many studies suggest adiposity plays a metabolic role in OA beyond the increased mechanical load - as evidenced by a greater prevalence of hand OA in obese patients. Other reports link hormonal status to OA pain. We aimed to study factors contributing to hand OA in a dedicated cohort. Methods: We enrolled patients with interphalangeal (IP) and/or 1st carpometacarpal (CMC) OA by physical exam, excluding those with rheumatoid arthritis, psoriatic arthritis, and lupus. During a one-time visit, participants completed adapted versions of the Michigan Hand Outcomes and QuickDash questionnaires, provided blood and urine samples for future biomarker testing, and were asked about comorbidities, other sites of musculoskeletal disease, prior hand trauma, and current or prior treatments for hand pain. Hand radiographs were scored for involvement of 20 joints (18 IPs, 2 first CMCs), and specifically for presence of erosions. Results: Of 337 patients screened, 171 were eligible and willing to participate. The average age was 66.3±9.5 years (42 to 90) and BMI was 26.2±5.0 kg/m2 (16.4 to 42.1) with 88.5% Caucasian and 78.8% female. Plain radiographs (available for 149 patients) revealed an average of 10.5±5.1 affected joints, with concurrent CMC and IP OA involvement in most patients (69.1%) The average length of time between onset of hand pain and enrollment was 11.7 years. Most patients were diagnosed with OA after their symptoms began (6.6 years after, n=79) though many were diagnosed concurrently with initial occurrence of symptoms (n=53). Radiographs showed erosive changes in at least one joint in 36.5% of the patients. This subset with central erosions had a significantly higher number of joints affected overall (12.5 vs. 9.1, p=<0.001). Patients with BMI > 30 kg/m2 had significantly more hand pain (p=0.022), stiffness (p=0.047), and disability (p=0.025) compared to those with normal weight BMI < 25, despite similarities in age and number of joints affected. Patients reporting OA in additional sites also reported more hand pain (p=0.018) and disability (p=0.003), though they were older (67.7 vs. 62.3 years, p=0.010). Women reported significantly more pain (p=0.035), disability (p=0.004), and a higher average number of joints affected (p=0.020) than males with similar mean ages and BMI (Table 1). Within the female subset, those aged 48 to 54 years (likely to be perimenopausal, +/- 3 years of age 51) reported more pain and disability than younger or older patients, even though females > 54 years of age had more affected joints (Figure 1). This finding raises the possibility that perimenopausal women with hand OA may experience increased hand pain at onset of menopause with improvement upon its conclusion. Conclusions: We have established the only prospective registry and biorepository in North America focused primarily on hand OA. Our findings support literature that hand OA pain and disability may be due in part to an inflammatory-driven process exacerbated by adiposity, and reflect a higher OA burden. Estrogen-mediated mechanisms altered during menopause may also have a role in OA symptoms. We expect the HONEY registry will be useful for elucidating etiologies and pathophysiology, and facilitating clinical trials for emerging therapeutic options.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

832 Trends for Treatment of Complex Hand Burns in the Acute Setting

Abstract Introduction Complex hand burns require special consideration of therapy practices within the acute setting. Deep hand burns, their associated injuries, and the sequelae of healing can cause significant dysfunction. The purpose of this study was to examine current practices in the inpatient treatment of complex hand burns in order to identify potential trends that may guide clinical practice for edema management, anti-deformity positioning, and range of motion (ROM). Methods A confidential internet survey was sent to burn therapists in this country from the American Burn Association (ABA) Occupational and Physical Therapy (OT/PT) Special Interest Group list. One therapist from each burn center was asked to complete the survey. Results There were 41 respondents representing 33% of burn centers. The majority of respondents were occupational therapists (78%) from burn centers with 500 or less annual admissions (76%) and more than 16 years of experience treating burn patients (68%). Burn therapists most commonly measure composite (57%) and isolated (51%) joint passive/active ROM, followed by measuring distance from fingertip to distal palmar crease (43%). With questionable or confirmed tendon involvement, the majority (68%) of OT/PTs performed isolated joint techniques, with active ROM the most common at 38%. Therapists initiate edema management, other than elevation, within 24 hours (44%) from the patient’s admission. The most prevalent edema management practice is active exercise (94%) compared to other more aggressive practices such as self-adherent wrap (50%). Anti-deformity orthotics are initiated within 24 hours (44%) and are the most common means of post-graft immobilization (41%). For hand stiffness, 53% of therapists utilize casting. For stiff proximal interphalangeal (PIP) joints, joint mobilization (45%) and thermal modality with ROM exercises (32%) were viewed as the most effective interventions, surpassing orthotics and casting. While 88% of centers utilize an interdisciplinary approach to care for the hand, 59% view the hand as a surgical priority. Percutaneous pins are utilized for joint stability, most frequently in PIP joints (62%) and remained 2–3 weeks on average (45%). Conclusions The survey highlights trends directed towards a more conservative management of complex hand burns related to edema management, anti-deformity positioning, and ROM. There is less of a clear consensus among burn therapists on how to approach complicated hand injuries that involve exposed/injured tendons or stiff joints. Interdisciplinary rounds can be utilized to promote communication regarding more aggressive means of therapy intervention in order to improve patient outcomes related to the hand. Applicability of Research to Practice Present current trends in the inpatient treatment of complex hand burns.

Abstract P5-12-13: Factors associated with aromatase inhibitor associated musculoskeletal symptoms in early stage breast cancer patients

Abstract Introduction: Aromatase Inhibitors (AI) are a mainstay of treatment for hormone receptor positive breast cancer (BC) in postmenopausal women. However, patients under AI treatment often suffer from Aromatase Inhibitor-Associated Musculoskeletal Symptoms (AIMSS), defined as myalgias, arthralgias, or joint stiffness in hands, fingers, knees, hips and feet, which may limit treatment and subsequently increase BC mortality. The depletion of estrogen following AI initiation has been postulated to cause AIMSS. However, it has not yet been fully established about the clinical significance of AIMSS and its risk factors and the underlying mechanisms. The aim of this study is to identify epidemiologic risk factors associated with the development of AIMSS in BC patients on adjuvant AI therapy. Methods: We conducted a retrospective review of medical records among 111 stages 0-III hormone receptor positive BC patients who received adjuvant AI therapy, including anastrozole, letrozole or exemestane, between January 2009 and June 2017, at the University of Maryland Greenebaum Comprehensive Cancer Center. To be eligible, women had to be either postmenopausal or premenopausal, on a GnRH analog for at least 3 months, and report of no AIMSS before the AI initiation. We collected patients’ data on demographics, lifestyle factors, reproductive histories, tumor characteristics, types of AI and cancer treatment, co-morbidities, use of medications, length of AI therapy, and onset and severity of AIMSS. We defined severe AIMSS as AIMSS requiring the change of AI therapy or discontinuation of AI. The demographics and clinicopathological characteristics of patients on AI therapy and frequencies of AIMSS onset during AI treatment was characterized with means (SDs) or percentages. To estimate the association of severe AIMSS with epidemiologic risk factors, odds ratios (ORs) and 95% confidence intervals were calculated using multivariable-adjusted logistic regression. Results: This study included 111 BC patients with a mean age of 64 years. Their mean BMI at time of BC diagnosis was 30.8 kg/m2, and 41% of patients were White, 39% were Black, 4% were Asian/Pacific Islander, and 16% were other. Majority of patients (77%) had no prior experience of tamoxifen use and used letrozole as an initial AI therapy (70.3%); 15.3% used anastrozole, and 14.4% used exemestane. We found that 52.6% of patients experienced any degree of AIMSS while on AI therapy. In particular, 19.8% of patients required change or holding AI therapy, and 3.6% permanently discontinued AI because of AIMSS. We observed that older age at AI therapy initiation and higher levels of circulating vitamin D-25OH were significantly associated with lower odds of severe AIMSS. Multivariate ORs (95% Cis) comparing the highest to the lowest tertile of age and vitamin D levels at AI initiation were 0.18 (0.05-0.71) and 0.10 (0.02-0.49), respectively (all P-trend: ≤ 0.04). There were no significant association between race, body mass index, smoking, alcohol use, reproductive factors, type of AI therapy, and tamoxifen use prior to AI therapy. Conclusions: In our study, nearly 52.6% of BC patients on adjuvant AI therapy experienced AIMSS. Of those, 23.4% changed or discontinued AI regimen due to severe AIMSS. Older age and higher circulating levels of vitamin D-25OH at the initiation of adjuvant AI therapy were associated with lower risk of developing severe AIMSS. The study results support the clinical significance of AIMSS in BC patients leading to decreased adherence to AI therapy. The replication of our association with age and vitamin D levels in a larger study is warranted as it may provide a greater insight into etiologies of AIMSS. Citation Format: Yamin Sun, Simran Elder, Seungyoun Jung, Candace Mainor, Shruti Murali, Paula Rosenblatt, Katherine Tkaczuk. Factors associated with aromatase inhibitor associated musculoskeletal symptoms in early stage breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-13.

Generalized Tetanus in an 8-Years-Old Boy: A Case Report

Nowadays tetanus is a rare disease in developed countries due to the success of immunization, but children who were not immunized are still at risk. Awareness of early clinical symptoms of tetanus is crucial since the diagnosis is based on clinical symptoms. Severe tetanus can occur and lead to sequelae if there was no timely diagnosis and proper treatment. This case report aimed to emphasize the importance of recognizing early symptoms of tetanus and immunization. An 8 year old boy complained stiffness all over his body since 4 days before admission to hospital. Stiffness was started with pain on his back and stomach since 7 days before admitted, 3 days later his neck and back became stiff and got worsen until his mouth became stiff too. His left toe was pricked by a plant thorn about 3-4 weeks before admission. Physical examination showed risus sardonicus, trismus, stiff hands and opisthotonus. He didn’t get complete immunizations. He was admitted in Pediatric Iintensive Care Unit (PICU) with Human Immunoglobulin, metronidazole, and diazepam. He was treated for 14 days and given Td vaccine before discharged. He underwent physiotherapy in medical rehabilitation department for 1 month because of persisting stiffness in his legs and arms. The diagnosis of tetanus was made based on clinical findings. There was no laboratory test to confirm it. Without timely diagnosis and proper treatment, severe tetanus can be fatal causing sequelae. Tetanus treatment follows several principles such as initial stabilization, maintainance of airway, prevent absorption of tetanospasmin, eradicating organism and supportive therapy. Management of tetanus takes a long time because the irreversible bound of toxin to tissues. It takes 4-6 weeks for the growth of new nerve terminal which is required in recovery period. So it is very important to recognize the symptoms of tetanus and treat it immediately to prevent more toxin bind to neuron.

A 71-year-old man with pain and stiffness in the hand

A 71-year-old man with pain and stiffness in the hand

Evaluation of Simple Microphone-based Mechanomyography (MMG) Probe Sets for Hand Stiffness Classification

Evaluation of Simple Microphone-based Mechanomyography (MMG) Probe Sets for Hand Stiffness Classification

The role of pedicled abdominal flaps in hand and forearm composite tissue injuries: Results of technical refinements for safe harvest

We evaluated the outcome of new technical refinements in abdominal flap coverage of major defects in upper limb for its reliability and safety. 68 patients were assessed for indications, additional procedures, complications and DASH questionnaire evaluation at the end of a year. The mean size of flap was 56 cm2 (range 6-250 cm2). Median DASH score was 11.5 (range: 0-63). Hand stiffness was observed in 39% of patients. However, this was absent in whom prophylactic pinning of metacarpophalangeal joints were done in James position. Abdominal flaps give satisfactory results in hand injuries. Competent hand therapy program is essential to get best results.

Correlates between magnetic resonance imaging and X-ray abnormalities and hand symptoms in older adults

Purpose: The clinical relevance of abnormal features seen on hand magnetic resonance imaging (MRI) have been investigated in patients with hand osteoarthritis (HOA). However, whether these relationships are similar in the general population and if they are independent of features seen on radiographs is not known. Therefore, we aimed to describe cross-sectional associations between presence of MRI-detected effusion-synovitis, bone marrow lesions, erosions, collateral ligaments (CL), osteophytes; radiograph-detected osteophytes and joint space narrowing (JSN) with joint symptoms and grip strength in community-based older adults. Methods: Distal and proximal interphalangeal index finger joints (n=221, mean age= 72, 44% females) were imaged using MRI, conventional radiographs (XR) and assessed using the Oslo HOA score and OARSI atlas, respectively. Joints were assessed clinically for pain and tenderness. Hand pain, function, and stiffness were assessed using the Australian/Canadian HOA index (AUSCAN) questionnaire; grip strength was assessed using a dynamometer. Data was analysed using log binomial, ordinal logistic, and linear regression and adjusted for age, sex, and other MRI or XR abnormalities. Results: Participants with above average (worse) AUSCAN pain scores had higher proportions of women (55%), met clinical HOA criteria (92%), and have poorer grip strength (9psi), and quality of life (AQoL utility 0.66) than those with mild or no pain. Absent CL’s on MRI (RR=3.33 (95% confidence interval; 1.45, 7.61)) and JSN on X-ray (RR=2.47 (1.06, 5.74)) were associated with higher risk of having a painful joint after adjustment for age, sex, and other structures. Participants with JSN had higher odds of moving to a higher category of AUSCAN pain (OR=1.59 (1.08, 2.35)) while effusion, surprisingly, inferred lower odds (OR=0.51 (0.28, 0.91)) of pain. JSN was also associated with lower grip strength independent of pain and other features (β=-0.95 (-1.74, -0.15)). No abnormalities were independently associated with tender joints, AUSCAN function limitation or stiffness. Conclusions: Absence of CL’s, and JSN were independently associated with painful joints; JSN was also associated with weak grip strength. Unexpectedly, effusions were associated with reduced odds of pain. This data does not support using MRI to identify potential targets for therapeutic interventions for hand pain.Tabled 1Associations of presence of MRI and radiographic abnormalities and HOA symptoms and grip strength.Presence of painful joint RR (95% CI)Presence of tender joint OR (95% CI)AUSCAN pain OR (95% CI)AUSCAN physical function limitation OR (95% CI)AUSCAN stiffness OR (95% CI)Grip strength beta (95% CI)MRI abnormalitiesEffusion0.65 (0.16, 2.57)0.46 (0.15, 1.43)0.51 (0.28, 0.91)1.03 (0.40, 2.61)0.72 (0.33, 1.56)0.35 (-0.85, 1.55)Absence of collateral ligament3.33 (1.45, 7.61)0.69 (0.10, 5.01)1.74 (0.82, 3.65)2.66 (0.79, 9.02)2.26 (0.84, 6.05)-1.46 (-2.96, 0.04)BML1.32 (0.34, 5.16)1.31 (0.42, 4.06)1.20 (0.79, 1.81)0.89 (0.50, 1.57)1.40 (0.81, 2.40)0.09 (-0.73, 0.91)Erosion1.80 (0.60, 5.33)1.01 (0.37, 2.76)0.92 (0.62, 1.38)0.61 (0.34, 1.10)0.97 (0.58, 1.63)0.09 (-0.73, 0.91)Osteophytes2.55 (0.33, 19.56)1.02 (0.28, 3.62)1.14 (0.74, 1.75)1.10 (0.61, 1.98)1.25 (0.68, 2.27)0.62 (-0.23, 1.47)X-ray abnormalitiesOstephytes0.58 (0.24, 1.41)0.82 (0.31, 2.19)0.79 (0.52, 1.20)1.07 (0.59, 1.94)1.11 (0.66, 1.87)0.16 (-0.68, 1.00)Joint space narrowing2.47 (1.06, 5.74)1.97 (0.84, 4.58)1.59 (1.08, 2.35)1.37 (0.79, 2.36)1.04 (0.64, 1.68)-0.95 (-1.74, -0.15) Open table in a new tab

Endoscopic Synovectomy of the Ulnar Bursa of the Palm of the Hand

Synovitis of the ulnar bursa is associated with tenosynovitis of the flexor tendons. Reported causes include suppurative or tuberculous infection, rheumatoid arthritis, and pigmented villonodular synovitis. Open synovectomy requires extensive soft-tissue dissection and may result in extensive scarring. The purpose of this Technical Note is to describe the technical details of endoscopic synovectomy of the ulnar bursa of the palm of the hand. This minimally invasive approach with small incisions allows aggressive postoperative hand therapy and avoids the complications of tendon adhesions, joint contractures, and hand stiffness.

Effects of a finger exercise program on hand function in automobile workers with hand osteoarthritis: A randomized controlled trial

Hand osteoarthritis reduces a person's ability to perform work activities and return to their occupation. We investigated the effects of a finger exercise program on hand grip strength, pain, physical function, and stiffness in automobile manufacturing workers with hand osteoarthritis. This randomized controlled trial was conducted on 29 subjects. Fifteen experimental subjects received a finger exercise program with paraffin baths, while 14 control subjects received only paraffin baths. Hand grip strength, pain, physical function, and stiffness were assessed at baseline and 8 weeks later. In the experimental group, hand grip strength (P < 0.001) and Australian/Canadian osteoarthritis hand index (AUSCAN) scores (pain, P < 0.001; stiffness, P < 0.001; physical function, P < 0.001) were significantly improved by 3.52 ± 2.03, 21.6 ± 8.3 (pain), 16.8 ± 10.21 (stiffness), and 13.86 ± 4.54 (physical function) compared with preintervention values. In the control group, hand grip strength (P = 0.004) and AUSCAN scores (pain, P < 0.001; stiffness, P = 0.019; physical function, P < 0.001) were significantly improved by 0.57 ± 0.62, 7.85 ± 5.46 (pain) 11.42 ± 7.18 (stiffness), and 10.28 ± 14.41 (physical function) compared with preintervention values. Significant differences between groups were found for postintervention hand grip strength (P = 0.015) and AUSCAN index subscale scores (pain, P < 0.001; physical function, P = 0.020). A combined finger exercise and paraffin bath program is effective in reducing pain, improving physical function, and increasing hand grip strength in workers with hand osteoarthritis.

Improving stability in physical human–robot interaction by estimating human hand stiffness and a vibration index

PurposeThe purpose of this paper is to eliminate instability which may occur when a human stiffens his arms in physical human–robot interaction by estimating the human hand stiffness and presenting a modified vibration index.Design/methodology/approachHuman hand stiffness is first estimated in real time as a prior indicator of instability by capturing the arm configuration and modeling the level of muscle co-contraction in the human’s arms. A time-domain vibration index based on the interaction force is then modified to reduce the delay in instability detection. The instability is confirmed when the vibration index exceeds a given threshold. The virtual damping coefficient in admittance controller is adjusted accordingly to ensure stability in physical human–robot interaction.FindingsBy estimating the human hand stiffness and modifying the vibration index, the instability which may occur in stiff environment in physical human–robot interaction is detected and eliminated, and the time delay is reduced. The experimental results demonstrate significant improvement in stabilizing the system when the human operator stiffens his arms.Originality/valueThe originality is in estimating the human hand stiffness online as a prior indicator of instability by capturing the arm configuration and modeling the level of muscle co-contraction in the human’s arms. A modification of the vibration index is also an originality to reduce the time delay of instability detection.

Target-focused exercise regime to improve patient compliance and range of motion in the stiff hand

•Stiff hands are more commonly seen in the clinics. •The management of stiff hand is often complicated. •Target-focused exercise regime is fast and simple technique for managing stiff hands. •Target-focused exercise regime improves compliance and ROM with ease and comfort. Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.#1.Blocks are made ofa.ice cubesb.woodc.scrap thermoplastic materiald.plastic marshmallows inexpensively available in all Ace Hardware stores#2.An advantage of AROM over PROM is that AROMa.can enhance lymph drainageb.is psychologically more stimulatingc.positively effects skin elasticity in addition to promoting ligamentous lengtheningd.enhances bone strength and density#3.The following are known to contribute to stiffness of the small joints of the handa.prolonged immobilization following an inflammatory event such as an injuryb.infectionc.advanced age of the patientd.all of the above#4.Patients are selected to perform the targeted exercises (active hold technique) if the results of the Modified Week Test show a _______ degree increasea.5b.10c.20 or mored.15#5.The authors are impressed with the improved compliance in their patients using the described protocola.falseb.true When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.