Tip Pinch Strength Research Articles

Long-term biomechanical analysis of donor site morbidity after radial forearm free flap.

Although the radial forearm free flap (RFF) is a commonly used microvascular graft for head and neck reconstruction, long-term biomechanical results regarding donor site morbidity are rare. In a prospective panel study, 32 patients were included. Biomechanical assessment was performed preoperatively, three months postoperatively and two years postoperatively. The primary endpoint of the study was grip strength. In addition, the Mayo wrist score, DASH score (disabilities of the arm, shoulder and hand score), fine motor skill strengths (tip pinch, key pinch, palmar pinch) and the range of motion were analysed. Primary defects were closed with local full-thickness skin grafts (FTSG) from the donor site forearm avoiding a secondary defect site. In the long-term analysis, grip strength was reduced in both arms. A significant improvement over time was found only for the donor arm. A persistent deficit of tip pinch strength and dorsal extension was recorded. Persistent sensory limitations occurred in four cases. Patient contentment after two years of follow-up was high and daily life routine was not restricted. Gross and fine motor skill limitations are reversible short-term effects after RFF harvesting and do not restrict daily routine in the long term. These findings substantiate the value of the RFF as a workhorse in reconstructive surgery.

Long-Term Functional Evaluation on Tendon Transfer to Restore Extension of the Thumb using Extensor Carpi Radialis Brevis

Purpose: To investigate the long-term functional and clinical outcomes of a tendon transfer to restore extension of the thumb using extensor carpi radialis brevis Methods and materials: From Jun 2005 to Sep 2012, 8 patients with rupture or division of extensor pollicis longus (6 males, 2 females; aged 16-52 years, mean age 30 years) underwent a tendon transfer using the extensor carpi radialis brevis to restore extension of the thumb. All patients were assessed by Geldmacher score system, mobility, pinch and grip strength of thumb comparing to the non-operated hand over an average of 36 months (range, 24–84 months) after the operation. Result: At an average follow-up of 36 months, all eight patients were able to extend their thumbs fully, and assessed as good or excellent by Geldmacher score system. Average grip strength of the operated hand was equal to that of the contra lateral hand, and tip pinch strengths were 92% of the contra lateral hand. There was no marked loss of extension motion and strength of wrist, and no other postoperative complications. Conclusions: The procedure of extensor carpi radialis brevis tendon transfer to extensor pollicis longus provides excellent long-term clinical results for restoring extension of the thumb. The procedure is safe, with few complications, which can be an alternate procedure of restoring extension of the thumb.

Lacertus syndrome: a commonly missed and misdiagnosed median nerve entrapment syndrome

Carpal tunnel syndrome is a compression of the median nerve which occurs under a sheet of ligamentous tissue (transverse carpal ligament) just past the wrist joint. Lacertus tunnel syndrome is a compression of the median nerve which occurs under a sheet of ligamentous tissue (lacertus fibrosus) just past the elbow joint. Lacertus syndrome has been well described by Hagert (Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand (NY). 2013; 8(1): 41-6.) The most common complaints in patients with lacertus syndrome are a loss of key and tip pinch strength, a loss of fine motor skills and sense of clumsiness (dropping objects), and, rarely, transient paresthesias in the median nerve innervated region of the hand (thumb-radial aspect of ring finger. They also may get burning and numbness in the palmar cutaneous branch of the median nerve distribution. The patients will usually exhibit: (1) Distinct weakness when manually testing the strength of the muscles innervated by the median nerve distal to the lacertus fibrosus, especially the FPL, FDP II, and FCR. (2) External pressure of the median nerve at the level of the lacertus fibrosus will elicit distinct pain and, at times, a positive Tinel’s sign. This proximal median nerve compression can coexist with carpal tunnel syndrome. If someone is still having symptoms after carpal tunnel release, the hand should be examined for lacertus syndrome. A decrease of power of FPL, FDP2, and FCR as well as tenderness at the medial edge of the lacertus fibrosus over the median nerve will make the diagnosis. Nerve conduction studies are not helpful. The surgery is performed with the patient awake and no tourniquet. After injection of 30cc of 1% lidocaine with 1:100,000 epinephrine and 3cc of 8.4% bicarbonate to decrease the acidic sting of the local anesthetic, 30 minutes are allowed to elapse to let the epinephrine work. The patient can be injected in the waiting area before entering the operating room. A 2–3-cm transverse incision is placed in the flexion crease of the cubital fossa, from 1 cm medial of the biceps tendon to 2 cm lateral of the medial epicondyle. Careful dissection is made subcutaneously to the pronator teres fascia, taking great care to identify and protect branches of the medial antebrachial cutaneous nerve. The pronator teres fascia is incised and followed laterally, allowing exposure of the lacertus fibrosus, which is subsequently divided. By retracting the pronator teres muscle medially, the median nerve is readily exposed. Any focal adherences to the underlying brachialis muscle may then be released. At this point, the strength of the FPL and FDP II is again tested intraoperatively before the skin is closed, as return of muscle strength is usually immediate after proper release of the nerve. After cauterization, the wound is closed with buried interrupted sutures, a small soft dressing applied and immediate mobilization encouraged. Patients with no manual labor return to work within 1–2 days postoperatively. Many patients with residual symptoms after carpal tunnel release will get better after lacertus release.

Results after distraction arthroplasty according to Bufalini and Perugia in early stages of trapeziometacarpal osteoarthritis

A distraction arthroplasty of the trapeziometacarpal joint was introduced by Bufalini and Perugia for the treatment of the early stages of carpometacarpal osteoarthritis. Our retrospective study presents the results of this technique. Thereby, a tendon graft anchored to the distal second metacarpal is fixed at the base of the first metacarpal, keeping it in distraction. 10 distraction arthroplasties were performed in 9 patients with carpometacarpal osteoarthritis stage I and II of the thumb after unsuccessful conservative therapy. In 2 cases, which were excluded from our study, trapeziectomy had to be performed because of persisting pain. Patient satisfaction, pain measurement, range of motion, and tip, key and grip strength were evaluated at a follow-up of 46.5 (29-63) months in the remaining 7 patients (8 operations overall). Strengh measurement was taken in an absolute value and compared to the opposite side. Thumb range of motion was measured with the combined flexion-opposition of the thumb with the Kapandij index and also the angle of abduction of the metacarpal I to metacarpal II. Assessment included a DASH score evaluation and an X-ray control. All of the 7 evaluated patients were satisfied with the operation results. Compared to the opposite side, patients achieved 80.1% (5.9 kg±1.1 kg) of key pinch strength, 86.3% (4.8 kg±0.9 kg) of oppositional tip pinch strength, and 86.1% (23.1 kg±4.8 kg) of grip strength. In combined flexion and opposition a Kapandij index of 8.5 (94.4%) compared to 9 on the opposite side was achieved. Thumb radial abduction was 48.2°±2.8°, compared to 51.0°±2.9° on the contralateral hand. At follow-up, the mean DASH score was 17.8 (±10.0). Radiological control showed no progression of carpometacarpal osteoarthritis of the thumb. The collected data after distraction arthroplasty according to Bufalini and Perugia confirm the efficacy of the technique in the early stage of carpometacarpal osteoarthritis of the thumb. Even though a failure rate of 20% occurred, in our opinion the operation is justified in the early stages of carpometacarpal osteoarthritis of the thumb as the patients benefit from a pain-free interval, leaving the option for future trapeziectomy.

Comparison of Grip and Pinch Strength in Adults with Dexterity Limitations to Normative Values

Upper extremity function, which includes manual dexterity, plays an important role in one's ability to perform activities of daily living. Dexterity may be reduced for a variety of reasons such as age, injury or disease. Understanding the capabilities of these users is critical to the effective design of products to meet their needs. While normative dexterity data is available for healthy adults, none has been compiled for people with dexterity limitations. The purpose of this study was to measure grip strength, key pinch strength and tip pinch strength in users with limited dexterity and compare them to adult norms. Average strength values were lower in all tests in men and women. It was observed that the dominant hand was strongest in each test in women but not always in men. No strong correlation between age and hand strength was observed. The sample size in this study was small so specific results are hard to generalize. The emergences of clear trends that differ from healthy norms indicate that a wider study may be fruitful.

A Comparitive Study on the Changes in Hand Function in Geriatrics vs Young Healthy Adults as Measured by Grip and Pinch Strength

A comparative study on the changes in hand function in geriatrics as compared to young healthy adults was carried out to determine changes in grip and pinch strength with age. 40 older individuals in the age group of 60–75 was compared with 40 young adults in the ages of 20–35. Jamar hand dynamometer and Jamar hydraulic Pinch guage was used to measure the grip and pinch strengths. The findings of the study showed that there is a decline in grip strength in geriatrics as compared to young adults in both dominant and non dominant hand and the difference is statistically significant. Statistical significance was found only in Lateral pinch strength of non dominant hand and Tip to Tip pinch strength of both dominant and non dominant hand although there was a reduction in pinch strength.

Ligament reconstruction with tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis

Background Ligament reconstruction tendon interposition (LRTI) is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthritis. The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence. Methods From January 2008 to January 2011, 19 patients (21 thumbs) underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis (FCR) in Kleinert Kutz Hand Care Center of Louisville University, USA. The follow-up period was an average of 13.9 months. Pain, grip strength, tip pinch strength, range of motion, and radiographic measurements were recorded. Based on first metacarpal subsidence, the cases were classified in to mild, moderate, and severe. Clinical outcomes of the groups were evaluated and compared. Results Grip strength improved from 18.6 kg to 20.5 kg, and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery. Radial abduction and palmar abduction improved after surgery. Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure. Visual analogue scores (VAS) were significantly reduced, from 6.6 to 0.5. Compared with the preoperative radiographs the first metacarpal had subsided about 54.6% of the arthroplasty space. The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively. Between the various groups (mild, moderate and severe metacarpal subsidence), there was no difference in grip strength, tip pinch strength, thumb range of motion, and VAS. Conclusions Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion. However, LRTI cannot maintain the arthroplasty space. Compared with the preoperative radiographs, the metacarpal subsided more than 50%. The amount of first metacarpal subsidence has no bearing on the results.

Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb

This study sought to demonstrate that successful outcomes can be achieved with the new technique presented here for chronic ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal (MCP) joint, as well as with K-wire pinning for acute UCL injury. We followed 19 patients who suffered an UCL rupture (mean follow-up: 14.26±4.65 months) and 32 patients who presented with UCL avulsion fracture (mean follow-up: 16.81±7.54 months). We used a free tendon graft for UCL reconstruction in the UCL rupture group. Both ends of the graft were stabilized with bioabsorbable suture anchors, which were used as biotenodesis interference screws. Closed reduction and K-wire fixation was used in UCL avulsion fracture group. There were no statistically significant differences between operated and contralateral healthy thumb MCP joint in both groups in the grip strength, tip pinch strength, flexion, extension, ulnar deviation, and radial deviation movements at final follow-up. Grip strength, tip pinch strength, ulnar deviation and radial deviation were significantly better in the avulsion group than the rupture group. All patients regained full stability at the MCP joint in avulsion group; 16 patients regained full stability and 3 patients presented with mild laxity (less than 10° laxity) in rupture group. Glickel grading scale used as a functional score was excellent for 30 patients and good for 2 patients in avulsion group; it was excellent for 17 patients and good for 2 patients in rupture group. Our study shows that closed reduction and percutaneous K-wire fixation of acute displaced large UCL avulsion fracture is a simple technique and achieves adequate stability of UCL. For UCL rupture, free tendon reconstruction with bioabsorbable suture anchors provides adequate stability and stable fixation within the tunnels.

Ligament reconstruction tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis

Objective To explore the clinical outcomes of Ligament reconstruction tendon interposition （LRTI） arthro-plasty for first carpometacarpal joint osteoarthritis. Methods From January 2008 to January 2011, 19 patients （21 thumbs） had surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radia-lis （FCR）. There were 1 male and 18 were females with an average age of 60 years （range, 52-75 years）;8 thumbs were on the left side and 13 thumbs on the right side. According to Eaton-Glickel classification, 1 thumb belonged to stageⅡ, 14 thumbs to stageⅢ, and 6 thumbs to stageⅣ. Pain level, grip strength, tip pinch strength, range of motion, and radiographic measurement were re-corded. According to the first metacarpal subsidence, the cases were classified in mild, moderate, and severe groups. Clinical out-comes of different group were evaluated and compared. Results All patients were followed up for 9-28 months with an average of 13.9 months. Comparision with the preoperative X-rays showed the first metacarpal had subsided 54.8% of the arthroplasty space after surgery. Grip strength improved from 18.6±10.1 kg to 20.5±11.9 kg, and tip pinch strength increased from 4.4±2.1 kg to 4.5 ± 1.9 kg after the surgery. Radial abduction increased from 55.7° ± 8.2° to 60.6° ± 7.2° and palmar abduction improved from 56.7° ± 8.5° to 63.5° ± 8.2° after the procedure. Patient pain levels （visual analogue scale, VAS） were significantly reduced, from 6.6 ± 1.4 to 0.5 ± 0.7. There was no difference of grip strength, tip pinch strength, thumbs range of motion, and VAS after LRTI in mild, moderate and severe groups. Conclusion LRTI resulted in excellent relief of pain and increase in range of motion. Howev-er, LRTI cannot sustain the arthroplasty space. Compared with the preoperative X-ray, the first metacarpal subsided more than 50%. Subsidence of the first metacarpal doesn＇t affect the pain relief, range of motion and strength improvement. Key words: Carpometacarpal joints Osteoarthritis Ligaments Reconstructive surgical procedures

Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis.

Background:Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis.Materials and Methods:We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months.Results:There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup.Conclusion:The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.

Long-Term Outcomes Following Radial Polydactyly Reconstruction

To report long-term outcomes (> 10 y) after radial polydactyly reconstruction. We evaluated 43 surgically reconstructed thumbs in 41 patients with radial polydactyly whom we had observed for more than 10 years. The study group included 12 Flatt type II, 8 type III, 17 type IV, and 6 type V. The average age of surgery was 1 year and mean follow-up was 17years. Objective outcome values and validated patient-oriented outcome evaluations were obtained. No early postsurgical complications were encountered. Eight patients had 10 revision procedures at an average of 8 years after the initial procedure. Five patients had interphalangeal joint arthrodesis, all for angulation with accompanying pain. The average Tada score was 4.1. Lateral, tripod, and tip pinch strengths were 96%, 86%, and 92%, respectively, of the unaffected side. As a group, the treated thumbs had significantly weaker tip and tripod pinch strengths than the untreated thumbs. The average Disabilities of the Arm, Shoulder, and Hand score was 4.5 and the average Pediatric Quality of Life Inventory score was 87 when administered to both the patient and the parent. Long-term results after surgical reconstruction for radial polydactyly were excellent but the revision rate trended upward over time despite maintenance of favorable scores on the objective outcome measures used. Therapeutic IV.

The results of pollicization for congenital thumb hypoplasia.

We assessed pollicizations performed by one surgeon; compared function of the pollicized digit in patients with and without forearm/wrist anomalies; and determined if hand function changed with age. A total of 42 hands were assessed an average of 5.7 years post-operatively, 21 with a forearm/wrist anomaly (Group 1) and 21 without (Group 2). Fourteen patients with 16 pollicizations were assessed on two occasions 3.5 years apart. Carpometacarpal joint motion was near normal in both groups (decreased retropulsion in Group 1). Metacarpophalangeal and interphalangeal joint flexion, grip, thumb lateral and tip pinch strengths, and Jebsen timed test were superior in Group 2. Subjective assessment by patients/parents found 72% excellent/good results for function and 94% for appearance. Doctor excellent/good assessments were 60% and 70%, respectively. Forearm/wrist anomalies significantly compromised results but are not a contraindication for pollicization. Strength and Jebsen timed test measurements improved at the second assessment of 16 thumbs, but this was consistent with age-related improvement. LEVEL OF EVIDENCE 4.

Ulnar nerve deep branch compression by a ganglion: A review of nine cases

Background and aimUlnar nerve compression is common at the elbow, but less common at the wrist. The purposes of this study were to report a series of nine patients with pure ulnar nerve deep branch compression by a ganglion and to evaluate the outcome following a surgical treatment. MethodsA retrospective study was conducted with nine patients from 2000 to 2011. The patients included four male and five female patients. The mean duration of symptoms before surgery was 16 months (range, 5–32 months). Different degrees of muscular atrophy and weakness of the interossei and adductor pollicis muscles were present without sensory loss in the hand. Ganglion excision and decompression of Guyon's canal were performed in all patients. We evaluated postoperative results of this uncommon nerve lesion based on the modified Bishop's scoring system. ResultsThe ganglion compressing the deep branch originated from the pisohamate joint in eight cases and from the midpalmar space in one case. At the mean follow-up of 23 months (range, 17–31 months), strength improvement of the grip and tip pinch was achieved in all patients. In comparison, grip strength improved from a mean of 63% of the unaffected side preoperatively to 88% of the unaffected side postoperatively. Tip pinch strength improved from a mean of 61% to 87%. According to the modified Bishop's scoring system, six patients (67%) obtained excellent results, two (22%) had good results, and only one (11%) had a fair result. ConclusionsA ganglion causing ulnar nerve deep branch compression is rare. Early surgical treatment can result in satisfactory functional recovery.

First carpometacarpal arthroplasty with ligamentous reconstruction: a long-term follow-up.

The purpose of the present study is to evaluate a single surgeon's short, intermediate, and long-term clinical, functional, and radiographic outcomes with a trapeziectomy with flexor carpi radialis (FCR) suspension arthroplasty without tendon interposition (LRSA). Twenty-one patients underwent 26 FCR suspension arthroplasties without tendon interposition by a single senior surgeon. All patients had Eaton stage III and IV carpometacarpal (CMC) osteoarthritis. The Patient-Rated Wrist and Hand Evaluation (PRWHE) and Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) were used to evaluate functional outcomes. A comprehensive strength and range of motion evaluation was performed to evaluate clinical outcomes. Plain radiographs at rest and with maximal pinch were performed to evaluate for arthroplasty space subsidence. The LRSA exhibited consistent clinical and functional outcomes throughout postoperative follow-up. As the average patient age and time from surgery increased, range of motion (ROM) and PRWHE scores stayed relatively constant, while lateral tip and tip pinch strength deteriorated with time. The LRSA prevented the proximal migration of the first metacarpal in all but one patient. No patients required revision arthroplasty following LRSA. This study demonstrates the consistent short, intermediate, and long-term clinical, functional, and radiographic outcomes following a trapeziectomy with FCR suspension arthroplasty.

The effect of two different hand exercises on grip strength, forearm circumference, and vascular maturation in patients who underwent arteriovenous fistula surgery.

ObjectiveTo compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery.MethodsWe recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb.ResultsAll of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups.ConclusionThe results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball.

Reliability of pinch strength testing in elderly subjects with unilateral thumb carpometacarpal osteoarthritis.

[Purpose] The aim of this study was to examine the test-retest reliability of pinch strength testing in elderly subjects with thumb CMC OA. [Subjects and Methods] A total of 27 patients with unilateral right-thumb CMC OA (mean ± SD age: 81.3 ± 4.7 years) were recruited. Each patient performed three pain-free maximal isometric contractions on each hand on two occasions, one week apart. Three different measurements were taken: tip, tripod, and key pinch strength. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) calculations were performed. [Results] Test-retest reliability of measurements of tip, tripod, and key pinch strength was excellent for the affected side (ICC=0.93, 0.96, and 0.99) and the contralateral thumb (ICC=0.91, 0.92, and 0.94). [Conclusions] The present results indicate that maximum pinch strength can be measured reliably using the Pinch Gauge Dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving pinch strength.

Extensor Pollicis Longus Injury in Addition to De Quervain's with Text Messaging on Mobile Phones.

To do a clinical and ultrasonic evaluation of subjects with thumb pain with text messaging. Thumbs are commonly used for text messaging, which are not as well designed for fine manipulative or dexterous work. Repetitive use as in text messaging can lead to the injury to the tendons of the thumb. Ninety eight students with symptoms of Repetitive Strain Type of injuries of the thumb were selected from a survey and evaluated both clinically and by ultrasound analysis of the musculotendinous unit of the thumb to note changes due to excessive use of the mobile phone. Age and sex matched controls were also subjected to ultrasound evaluation. Clinical examination showed positive Finkelstein test in 40% of the cases, significant reduction in the lateral and tip pinch strengths in the cases. Ultrasound detected changes in the first and the third compartments in 19% of the cases. Isolated cases of pain in the thumb have been reported but this study noted changes both clinically and by ultrasound in the tendons of the thumb. These changes should be taken as warning signs of possible subclinical changes taking place in the soft tissues of the thumb in these subjects due to repetitive use of mobile phones and thus, making them prone for developing painful Musculoskeletal Disorders. Repetitive use of mobile phones for text messaging can lead to the damage of Extensor pollicis longus of the thumb in addition to the tendons of the first compartment of the wrist.

Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors

BackgroundTo assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre.MethodsThis study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers.ResultsPronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient’s and the observers’ subjective evaluations.ConclusionsDonor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.

Perforator-Based Radial Forearm Fascial Flap for Management of Recurrent Carpal Tunnel Syndrome

To study the benefit of using the perforator-based radial forearm fascial flap for patients with recurrent carpal tunnel syndrome. We used a perforator-based radial forearm fascial flap in 8 patients to cover the median nerve. All of the patients had undergone an index carpal tunnel release, and 3 of them had undergone at least 1 revision surgery to further decompress the median nerve. At average of 20 months (range, 6-30 mo) after the forearm fascial flap, all patients reported symptomatic improvement with complete resolution of nighttime symptoms. No patient reported worsening of symptoms; however, some subjective parasthesias persisted in 3 of the 8 patients. Objective assessment revealed complete resolution of a Tinel sign in 5 of 8 patients and noteworthy improvement in the remaining 3 patients. Average 2-point discrimination was 10.0 mm before surgery and 5.4 mm after surgery, average grip strength improved from 13.5 kg to 21.0 kg, and average tip pinch strength improved from 4.1 kg to 7.0 kg. The perforator-based radial forearm fascial flap may prove useful in the setting of recurrent carpal tunnel syndrome after surgical decompression. Therapeutic IV.

Towards a comprehensive Functional Capacity Evaluation for hand function

The aim of this study was to develop a more efficient (i.e. shortened) protocol for hand function capacity evaluation and to test the agreement of the protocol compared to the original protocol. 643 Healthy subjects performed tests for hand function. Agreement between two shortened protocols was compared with an existing protocol. The original protocol was performed once and the proposed shortened protocol differed in the number of trials which were reduced by statistical elimination. Agreement was determined with Intraclass Correlation Coefficients (ICC) and Limits of Agreement (LoA). Excellent ICCs (≥0.91) were observed in all proposed protocols except for the one trial purdue pegboard test protocol. For all tests of hand function, shorter protocols are valid to determine hand function. For Tip Pinch Strength testing, Palmar Pinch Strength testing and the Purdue Pegboard test, a two-trial protocol is recommended, because the LoA were considerable, which could affect decision-making with regards to hand capacity. For the Hand Grip strength test, the Key Pinch Strength test and the Complete Minnesota Dexterity Test, a one-trial protocol is recommended, because the LoA were acceptable. It was concluded that for healthy subjects, this shorter protocol is a reliable measure. Further testing of the short form hand FCE protocols should be completed on patients with disabling conditions prior to widespread use of these protocols among clinical samples.