Finger Strength Research Articles

To be active through indoor-climbing: an exploratory feasibility study in a group of children with cerebral palsy and typically developing children

BackgroundCerebral Palsy (CP) is the most common cause of motor disabilities in children and young adults and it is also often associated with cognitive and physiological challenges. Climbing requires a multifaceted repertoire of movements, participants at all levels of expertise may be challenged functionally and cognitively, making climbing of great potential interest in (re)habilitation settings. However, until now only few research projects have investigated the feasibility of climbing as a potential activity for heightening physical activity in children with CP and the possible beneficial effects of climbing activities in populations with functional and/or cognitive challenges. The aim of this study was therefore to test the feasibility of an intensive 3 weeks indoor-climbing training program in children with CP and typically developing (TD) peers. In addition we evaluated possible functional and cognitive benefits of 3 weeks of intensive climbing training in 11 children with cerebral palsy (CP) aged 11–13 years and six of their TD peers.MethodThe study was designed as a feasibility and interventional study. We evaluated the amount of time spent being physically active during the 9 indoor-climbing training sessions, and climbing abilities were measured. The participants were tested in a series of physiological, psychological and cognitive tests: two times prior to and one time following the training in order to explore possible effects of the intervention.ResultsThe children accomplished the training goal of a total of nine sessions within the 3-week training period. The time of physical activity during a 2:30 h climbing session, was comparably high in the group of children with CP and the TD children. The children with CP were physically active on average for almost 16 h in total during the 3 weeks. Both groups of participants improved their climbing abilities, the children with CP managed to climb a larger proportion of the tested climbing route at the end of training and the TD group climbed faster. For the children with CP this was accompanied by significant improvements in the Sit-to-stand test (p < 0.01), increased rate of force development in the least affected hand during an explosive pinch test and increased muscular-muscular coherence during a pinch precision test (p < 0.05). We found no improvements in maximal hand or finger strength and no changes in cognitive abilities or psychological well-being in any of the groups.ConclusionsThese findings show that it is possible to use climbing as means to make children with CP physically active. The improved motor abilities obtained through the training is likely reflected by increased synchronization between cortex and muscles, which results in a more efficient motor unit recruitment that may be transferred to daily functional abilities.Trial registrationISRCTN18006574; day of registration: 09/05/2017; the trial is registered retrospectively

Separable systems for recovery of finger strength and control after stroke.

Impaired hand function after stroke is a major cause of long-term disability. We developed a novel paradigm that quantifies two critical aspects of hand function, strength, and independent control of fingers (individuation), and also removes any obligatory dependence between them. Hand recovery was tracked in 54 patients with hemiparesis over the first year after stroke. Most recovery of strength and individuation occurred within the first 3 mo. A novel time-invariant recovery function was identified: recovery of strength and individuation were tightly correlated up to a strength level of ~60% of estimated premorbid strength; beyond this threshold, strength improvement was not accompanied by further improvement in individuation. Any additional improvement in individuation was attributable instead to a second process that superimposed on the recovery function. We conclude that two separate systems are responsible for poststroke hand recovery: one contributes almost all of strength and some individuation; the other contributes additional individuation.NEW & NOTEWORTHY We tracked recovery of the hand over a 1-yr period after stroke in a large cohort of patients, using a novel paradigm that enabled independent measurement of finger strength and control. Most recovery of strength and control occurs in the first 3 mo after stroke. We found that two separable systems are responsible for motor recovery of hand: one contributes strength and some dexterity, whereas a second contributes additional dexterity.

Finger forces in fastball baseball pitching

Forces imparted by the fingers onto a baseball are the final, critical aspects for pitching, however these forces have not been quantified previously as no biomechanical technology was available. In this study, an instrumented baseball was developed for direct measurement of ball reaction force by individual fingers and used to provide fundamental information on the forces during a fastball pitch. A tri-axial force transducer with a cable having an easily-detachable connector were installed in an official baseball. Data were collected from 11 pitchers who placed the fingertip of their index, middle, ring, or thumb on the transducer, and threw four-seam fastballs to a target cage from a flat mound. For the index and middle fingers, resultant ball reaction force exhibited a bimodal pattern with initial and second peaks at 38–39ms and 6–7ms before ball release, and their amplitudes were around 97N each. The ring finger and thumb produced single-peak forces of approximately 50 and 83N, respectively. Shear forces for the index and middle fingers formed distinct peak at 4–5ms before release, and the peaks summed to 102N; a kinetic source for backspin on the ball. An additional experiment with submaximal pitching effort showed a linear relationship of peak forces with ball velocity. The peak ball reaction force for fastballs exceeded 80% of maximum finger strength measured, suggesting that strengthening of the distal muscles is important both for enhancing performance and for avoiding injuries.

Upper limb functional capacity of working patients with osteoarthritis of the hands: A cross-sectional study

Study DesignA cross-sectional design was used. IntroductionLittle is known about the effects of osteoarthritis of the hands (OAH) on work ability in working patients with OAH. Purpose of the StudyThe study aimed to analyze the differences in upper limb functional capacity (ULFC) between working patients with OAH and healthy workers and to evaluate variables associated with ULFC and with self-reported disability (SRD) in working patients with OAH. MethodsForty-one patients performed the ULFC Evaluation (ULFCE) and also completed 2 SRD measures. The patients' results were compared with the ULFCE results of 82 matched healthy workers from a reference database. Three sets of multivariate regression analyses were used to reveal the predictors of ULFC and SRD. ResultsPatients scored 12%-45% lower on all ULFCE tests (P values ranging from P P Discussion Working patients with OAH had a considerably lower ULFC compared with healthy workers. Female gender and the presence of OAH predicted lower ULFC. Pain and lower finger strength predicted worse scores on SRD. Conclusion(s)In the case of professionals advising working patients with OAH, our results suggest that a careful evaluation of the ULFC and SRD is warranted. Subsequently, advice regarding exercises or adjustments at work can be given. Level of Evidence3b.

Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures

Finger fractures are the most common skeletal injuries of the upper limbs. The purpose of this study was to evaluate the functional outcomes and complications after surgical management of isolated, closed fractures of the proximal phalanx (PP) of the hand (thumb excluded). Surgical management was indicated in 87 PP fractures. Fractures were reduced and fixed with pins, screws or a plate. Functional outcomes were assessed through the range of motion (ROM) in flexion–extension, hand and finger strength, and the QuickDASH and PRWHE scores. Fixation was done with pins in 32 cases, screws in 41 cases, and a plate in 14 cases. Rehabilitation was started an average of 1.7 weeks after surgery. There was no significant difference in the functional outcomes based on either fracture type or surgical approach. Nevertheless, the following significant differences were observed: PRWHE score (P=0.017) by injured finger; proximal interphalangeal (PIP) ROM (P=0.037) by fixation type; and grip strength (P=0.019), Quick DASH (P=0.017), and PRWHE (P=0.045) by rehabilitation delay. The most common clinical complications were minor malrotation and cold intolerance. Radiological assessment showed complete union in all cases. Surgical management of PP fractures leads to good functional outcomes, including a satisfactory recovery of finger ROM. The functional recovery of a fractured digit is dependent on the right fixation choice, complete bone union, and early rehabilitation. We suggest using screw fixation to achieve patient satisfaction and optimal functional recovery of closed, isolated PP fractures of the long fingers.

PROGNOSTICATION OF SUCCESSFULNESS IN ARM-WRESTLING ON THE BASE OF MORPHOLOGICAL FUNCTIONAL INDICATORS’ ANALYSIS

Purpose: to work out methodic of arm wrestling successfulness prognostication by morphological functional indicators and substantiate it. Material: 189 sportsmen (of age 21.62 +- 0.85 years) were tested. We fulfilled goniometric testing of arms’ joints (n=27) and hand dynamometry (n=50). Characteristics of physiological tremor were studied (n=29). Strength of forearm’s muscles was determined (n=33) as well as the strength of hand fingers’ extensors separately (n=50). Prognostication was realized with the help of sequential procedure by Wald’s methodic, with calculation of prognostic coefficients and their informative potential. Results: prognostic table, containing functional state indicators of arm-wrestlers. It contained 18 criteria. The criteria illustrate power, goniometric and functional indicators. Informative potential varied within 64.70 - 6.33. The sense of prognosis is assessment of results and determination of appropriate prognostic coefficient. Besides, prognosis implies summing up of these coefficients for achievement of one of prognostic thresholds. The value of these thresholds was determined at level of +- 13, that corresponds to 95% probability. Achievement of threshold + 13 and more means sportsman’s successfulness higher level. In case of lower threshold achievement successfulness probability is low. Conclusions: the conducted researches permitted to work out methodic of arm wrestling successfulness prognostication by morphological functional indicators and substantiate it. The offered methodic is based on sequential analysis by Wald and is a simple, informative and objective tool of arm-wrestlers’ condition control.

Interphalangeal Joint Sonography of Symptomatic Hand Osteoarthritis: Clinical and Functional Correlation.

To assess the correlation between inflammatory sonographic findings (grayscale synovial hypertrophy and power Doppler) and clinical and functional assessments in hand osteoarthritis (symptomatic interphalangeal joints) and to correlate the intraobserver and interobserver reliability of these findings. A prospective double-blind study of 60 interphalangeal joints was conducted. The joints were assessed 6 times per year by clinician and sonographer observers. A total of 720 measurement recesses were included (360 palmar and 360 dorsal). Small correlations and a few associations were found. Proximal interphalangeal joint quantitative measurements of the dorsal recess showed a statistical correlation with joint swelling (P = .043) and pulp-to-pulp pinch strength (P = .043); in the palmar recess, statistical correlations were seen for joint swelling (P = .007), the Australian/Canadian (AUSCAN) Function Index (P = .044), and grip and finger strength (P = .037, .003, .019, and .017). In dorsal semiquantitative assessments, there were associations between sonographic findings and joint swelling (P = .010) and pinch strength (P = .027, .003, and .014); in the palmar recess, we found associations with the AUSCAN Index (P = .048) and grip and finger strength (P = .031, .006, and 0.041). No correlations or associations were found in distal interphalangeal joints. Power Doppler signals were found in only 1.7% of the sample, precluding statistical analysis. Excluding palmar semiquantitative assessments in distal interphalangeal joints (P = .623), sonographic findings were reliable (intraclass correlation coefficients, 0.474-0.857; κ = 0.390-0.673). Joint swelling, grip and pinch strength, and the AUSCAN Index were weakly correlated and associated with sonographic findings in proximal interphalangeal joints. Intraobserver and interobserver sonographic assessments were reliable.

Analysis of Tests Evaluating Sport Climbers' Strength and Isometric Endurance.

The present study was designed to determine which types of specific tests provide an effective evaluation of strength and endurance in highly trained competitive sport climbers. The research process consisted of three basic components: the measurement of selected somatic characteristics of the climbers, the assessment of their physical conditioning, and a search for correlations between the anthropometric and “conditioning” variables on the one hand, and climber’s performance on the other. The sample of subjects consisted of 14 experienced volunteer climbers capable of handling 7a- 8a+/b on-sight rock climbing grades. The strongest correlations (Spearman’s rank) were found between climber’s competence and the relative results of the finger strength test (r = 0.7); much lower, but still statistically significant coefficients were found between the level of competence and the results of the muscle endurance tests (r = 0.53 – 0.57). Climbers aspiring to attain an elite level must have strong finger and forearm muscles, but most of all, they must be capable of releasing their potential during specific motor capability tests engaging these parts of the body. The forearm muscles of elite climbers must also be very resistant to fatigue. Since highly trained athletes vary only slightly in body mass, this variable does not have a major effect on their performance during strength and endurance tests.

An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy.

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Pulley Reconstruction to Correct the Dynamic Direction of the Finger for Treatment of IIB Cleft Hand

Purpose: Manske IIB cleft hand is the most common type, which is characterized by severely narrowed first web and rotation of index finger. Some patients suffered from ulnar displacement of flexor tendon system. However, the ulnar displacement was poorly corrected during index to middle transposition during previous procedures and would usually lead to dysfunction of pinch and grip. Here, we developed a new method to correct finger dynamic direction by pulley transposition. Method: In 15 cases with Type IIB cleft hand, incisions from A1 to A2 pulleys were made with pedicle transposition of the flexor tendon and sheath system to the central. A1 pulleys of index and ring fingers were separated to reconstruct transverse ligament. Snow-Littler procedures were performed to reconstruct the first web. Postoperative assessment included subjective considerations of appearance, parent satisfaction, and ability to perform daily activities. Objective assessment included measurement of first web space, index-ring metacarpal separation, pinch strength, and rotation of the index finger. Results: All the patients and parents claimed to be satisfied with the surgery. Pinch grip reached 72% of the opposite hand when that was normal. The radiological measurement of the angle between the first and second metacarpals was 60.8º and the distance between the adjacent metacarpals across the closed cleft was 8 mm. Index rotation was only 1º and the mean thumb-index pinch was 5.6 kg. Conclusions: Pulley transposition can correct the ulnar displacement of flexor tendon system and improve pinch grip strength in Manske IIB cleft hand, which is a supplemental method for physiological and aesthetic reconstruction of cleft hand.

Keyboard Playing as a Hand Exercise for Patients with Subacute Stroke

Recent reports show that MIDI keyboard playing can improve upper-limb functions in neurorehabilitation, but little attention has been paid to this type of intervention with stroke patients in the subacute stage. The purpose of this study was to investigate the effects of keyboard-playing intervention that targeted hand dexterity of subacute stroke patients. A total of 17 subacute stroke patients participated in twelve 30-minute sessions over six weeks. The intervention included repetitive individuated, sequential, and simultaneous key-pressing to increase independent finger movements and strength. Of the four hand-function tests administered in this study, tip pinch in hand grip and pinch strength test and Box and Block Test (BBT) results showed the most significant improvement, indicating the largest effect sizes (0.785 for hand grip and pinch strength test and 0.840 for BBT). Better hand dexterity for subacute stroke patients may be achieved through repetitive key-pressing motions during keyboard playing by exercising the intrinsic and extrinsic flexor muscles primarily involved in the key-pressing motion. Overall, this study supports keyboard playing as a promising therapeutic intervention in subacute stroke rehabilitation.

Nerve transfers for restoration of finger flexion in patients with tetraplegia.

OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale. RESULTS Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed. CONCLUSIONS In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.

ANTERIOR SUBCUTANEOUS TRANSPOSITION OF ULNAR NERVE AND HAND INTRINSIC MUSCLES FUNCTION RECONSTRUCTION FOR SEVERE CUBITAL TUNNEL SYNDROME

To study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. Between March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. All incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. Anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.

Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley-Protection Splint—A Series of 47 Cases

To evaluate the effectiveness of conservative treatment of finger flexor tendon pulley rupture with a pulley-protection splint (PPS) with regard to reduction in tendon-phalanx distance (TPD) and functional and sport-specific outcomes in a retrospective case series. Tendon-phalanx distance in active forced flexion was measured before and after treatment in ultrasound records. Functional and sport-specific outcomes were evaluated by means of a questionnaire, which also contained instructions for self-measurement of finger range of motion and finger strength. Forty-seven complete pulley ruptures in 45 rock climbers (mean age, 33.4 years; range, 21.8-56.2 years) were included in the study. In the 39 patients who had follow-up ultrasound examination, PPS treatment decreased mean ± SD TPD from 4.4 ± 1.0 mm to 2.3 ± 0.6 mm after A2 pulley rupture and from 2.9 ± 0.7 mm to 2.1 ± 0.5 mm after A4 pulley rupture. Tendon-phalanx distance was reduced in all patients. Finger range of motion (n = 42) and finger strength (n = 22) did not differ significantly between treated and contralateral sides. Of the 43 climbers who completed questionnaires, 38 had regained their previous climbing level a mean 8.8 months after pulley rupture; 1 reported reduced finger dexterity; 39 assessed their treatment results to be good, and 4 to be very good. The PPS is an effective conservative treatment modality for pulley ruptures, which reduces TPD and enables the patient to regain previous finger function.

Study of the effects of the hand grip and finger strengths on the friction and petrissage - the massage manipulations - of the students who take massage courses: Kütahya City example

In this research, the effect of the hand grip and finger strengths on the power development between the friction and petrissage techniques - the massage manipulations - have been studied. To the study that has been structured as a single group pretest/post test, 36 healthy males who are the students of the University of Dumlupinar, Academy of Physical Education and Sports and who take massage courses (age = 19.72 ± 1.56 years (average ± Sd)) have been included. The practical massage course has continued for 12 weeks, two days a week for a total of one hour and the hand grip strength of both hands (right hand grip strength = RHG, left hand grip strength = LHG) and the grip strength of both fingers (right finger strength = RF, left finger strength = LF) have been recorded at the beginning. For the measurements carried out before and later of the study with regard to the hand grip strength, a Takkei branded hand dynamometer and with regard to the finger grip strength a (baseline) branded pinch meter have been used. All measurements have been repeated twice and for the analysis, the average values obtained from two deads have been used. For statistical analysis, with regard to the changes in the pre test-post test finger strength and hand grip strength, paired-samples t test has been used. The significance limit has been defined as p 0.05). It is possible to report that massaging regularly with both hands is efficient for the development of the finger and hand grip strengths; especially, with regard to the friction (circular movements that are generally carried out with fingers) and petrissage (kneading that is generally carried out with the palm) techniques.

An Innovative Hangboard Design to Improve Finger Strength in Rock Climbers

In elite rock climbing, finger strength is critical, and is directly related to performance. A hangboard, composed of sets of artificial climbing grips to hang from, is often used by climbers to improve their finger strength. While some research has studied training protocols for climbing, virtually no published research exists addressing the specific enhancement of training equipment to improve training effectiveness. Here we seek to show that hangboard design, especially novel features included in the Rock Prodigy Forge hangboard increases the effectiveness of hangboard training. Recently, this hangboard was developed through an iterative process leveraging modern CAD/CAM techniques. This enabled design engineers to optimize the hangboard for improved training benefit and reduced injuries. As a result, several innovative features were added to the design including: (a) equation-driven grip edge profiles, (b) drafted pockets, (c) novel grip designs, (d) improved grip geometry, and (e) improved texture, among other features. The Forge was tested by experienced climbers, and 92% assessed it as more effective than other training tools, with 91% of users able to train harder without fear of injury relative to other training methods, and 86% reporting improved climbing performance. This is a significant and unique result for the sport of climbing.

Easy to open? Exploring the ‘openability’ of hospital food and beverage packaging by older adults

Food is increasingly a packaged commodity, both in the community and in institutionalised settings such as hospitals, where many older people are malnourished. Previous research with patients aged over 65 years in NSW public hospitals identified difficulties opening milk, water, juices, cereal and tetra packs. The aim of this paper was to assess the ability of well older people living in the community to open food and beverage items routinely used in NSW hospitals in order to gain further insights into the older person/pack interaction and the role of hand and finger strength in pack opening. A sample of 40 older people in good health aged over 65 years from 3 community settings participated in the study. The attempts at pack opening were observed, the time taken to open the pack was measured and the correlation between grip and pinch strengths with opening times was determined. Tetra packs, water bottles, cereal, fruit cups, desserts, biscuits and cheese portions appeared to be the most difficult food products to open. Ten percent of the sample could not open the water bottles and 39% could not open cheese portions. The results were consistent with the previous research involving hospitalised older adults, adding emphasis to the conclusion that food and beverage packaging can be a potential barrier to adequate nutrition when particular types of packaged products are used in hospitals or the community. The ageing population is rapidly becoming a larger and more important group to consider in the provision of goods and services. Designers, manufacturers and providers of food and beverage products need to consider the needs and abilities of these older consumers to ensure good ‘openability’ and promote adequate nutritional intakes.

Combined five-free-tissue transfer for reconstruction of the degloved hand: The results of long-term follow-up

Objective A long-term follow-up was carried to evaluate the function of recipient site and the mobility of donor site after a combined five-free-tissue procedure for reconstruction of the complete degloved hand. Material and methods From 1995 to 2012, we performed a combined five-free-tissue procedure to reconstruct the complete degloved hand in one stage. Nine patients were included in this article. The five tissues included a great toe wrap-around flap for thumb, bilateral second toes for index and middle finger and bilateral anterolateral thigh (ALT) flaps for dorsal and palmar soft tissue defect. Subjective and objective evaluations were performed after 3 years at least. Subjective evaluation included the DASH score, Michigan hand outcomes questionnaire and Maryland foot rating score. Objective measurements included pinch and grip strength, first web space distance, range of motion of reconstructed digitals, and two points discrimination of reconstructed thumb and fingers. The function of reconstructed thumb and fingers were evaluated according to the standard formulated by Chinese Hand Society of The Hand. Results A reconstructed middle finger was necrosis after operation, while others were all survived. Seven patients were followed up from 3 to 12 years (average 5.8 years). The average DASH score was 21.6 ± 16.58. Michigan hand function scores were as follows: hand function score was 67.5% ± 24.05%, activity of daily living score was 99.69% ± 32.58%, working score was 49.57% ± 25.45%, pain evaluation was 24% ± 21.38%, aesthetic score was 48.2% ± 7.11%, satisfaction rate was 78.4% ± 12.65%. Maryland foot rating average score was 84.56 ± 2.44. The average range of motion (ROM) of metacarpal (MP) joint of reconstructed thumb was 56° ± 20.77°, index finger was 78° ± 10.33°, middle finger was 76° ± 9°. There was no active ROM at IP joint of each finger. The average grip power of involved side was 46.7% of uninvolved side. The pinch strength of the thumb and index finger of involved side was 66.52% of uninvolved side. The pinch strength of thumb and middle finger of the involved side was 61.3% of uninvolved side. Two-point discrimination (2-PD) of the pulp of thumb was 8.47 ± 0.68 mm, the pulp of finger was 10.59 ± 0.82 mm. There were pigmentary and hyperplasia scars in 2 cases. There was no complaint of pain after long-distance walking or long-time standing. Conclusion We conclude that the combined five-free-tissue transfer can promise satisfactory appearance and function for complete degloved hand.

Characteristics of Finger Tapping Are Not Affected by Heavy Strength Training

ABSTRACTThe authors investigated the effects of 2 weeks of heavy index finger strength training on characteristics of freely chosen finger tapping including tapping frequency, tap force, and finger displacement. One group (n = 12) performed index finger extension and flexion strength training. A control group (n = 12) performed no intervention. Results showed that the training group increased strength in both extension (19.5 ± 22.2%, p = .015) and flexion (9.4 ± 9.8%, p = .001) from pretest to posttest. Furthermore, training did not affect the frequency and the pattern of the tapping movement (Fs = 0.004–3.441, ps = .077–.954). The present results are in contrast to previous findings of reduced movement frequency and altered movement pattern during ergometer pedaling after strength training. This difference may be explained by the dissimilarity between the 2 tasks.

Autologous adipose-derived stromal vascular fraction in patients with systemic sclerosis: 12-month follow-up.

Impaired hand function greatly contributes to disability and reduced quality of life in SSc patients. Autologous adipose-derived stromal vascular fraction (ADSVF) is recognized as an easily accessible source of regenerative cells. We reported positive 6-month safety and efficacy results from an open-label clinical trial assessing s.c. injection of autologous ADSVF into the fingers in SSc patients. The objective of this report is to describe the effects at 12 months. Twelve females, mean age 54.5 years (s.d. 10.3), were assessed 1 year after ADSVF injection. Patients were eligible if they had a Cochin Hand Function Scale score >20/90. ADSVF was obtained from lipoaspirate using an automated processing system and subsequently injected into the s.c. tissue of each finger in contact with neurovascular pedicles in a one-time procedure. Endpoints were changes in hand disability and skin fibrosis, vascular manifestations, pain and quality of life at the 12 month follow-up. During the visit, patients estimated the benefit of the procedure with a specific self-completed questionnaire. A significant decrease from baseline of 51.3% (P < 0.001) for Cochin Hand Function Scale score, 63.2% (P < 0.001) for RP severity and 46.8% (P = 0.001) for quality of life (Scleroderma Health Assessment Questionnaire) was observed. A significant improvement of finger oedema, skin sclerosis, motion and strength of the hands and of the vascular suppression score was also noted. The reduction in hand pain approached statistical significance (P = 0.052). The questionnaire revealed a benefit in daily activities, housework and social activities. ADSVF injection is a promising therapy and appears to have benefits that extend for at least 1 year.