Tip Pinch Research Articles

Pinch grip strength and fine manual control in children with diplegic cerebral palsy: a cross-sectional study

BackgroundIn children with spastic diplegia, efficient use of the upper extremity especially the hands play an important role in participation in daily living. Hands can perform heavy activities and also enable to perform extremely gentle, skillful, and precise activities. Inadequate hand strength and fine motor skills may lead to functional limitations. This study was planned to investigate the pinch grip strength and fine manual control in children with spastic diplegic cerebral palsy and to determine if there is a relation between them. Thirty children with diplegic cerebral palsy and 30 normal developed children from both sexes between 5 and 10 years old were included in this study as diplegic and control groups. For all children, pinch grip strength measured by Baseline Mechanical Pinch Gauge and Bruininks-Oseretsky Test of Motor Proficiency, Second Edition used to evaluate fine manual control.ResultsChildren with diplegic cerebral palsy have significant impairment in the pinch grip strength (tip, tripod, and key) and the fine manual control (fine motor precision and integration) compared to their healthy peers of the same age. There was large positive significant correlation (r > 0.5, p < 0.05) between tip and tripod pinch strength, and fine motor precision and medium positive significant correlation (r = 0.47, p < 0.05) between key pinch and fine motor precision in children with spastic diplegia. Also, there was large positive significant correlation between tip pinch and fine motor integration (r = 0.54, p < 0.05). The correlations are small and medium positive between tripod and key pinch strength, and fine motor integration respectively but they are not statistically significant.ConclusionsPinch grip strength and fine manual skills are affected in children with spastic diplegia. Also, there is a significant correlation between the pinch strength and activities require precise control of the hand.

Outcome of carpal tunnel release surgery in patients with and without Linburg–Comstock anomaly

Anatomical variations may entail increased volume within the carpal tunnel and consequently the development of carpal tunnel syndrome (CTS) symptoms. The clinical importance of anomalous connection between the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendons was described by Linburg and Comstock. The objective of the present study was to compare postoperative outcomes of carpal tunnel release surgery in patients with and without Linburg–Comstock anomaly (LCA). Hands of CTS patients with and without LCA were evaluated for finger sensitivity, grip, tip, key and tripod pinch strength, pain intensity and Boston Carpal Tunnel Questionnaire score. Patients were evaluated preoperatively and 1, 3 and 6 months after surgery. Forty-six hands in 36 CTS patients with LCA and 50 hands in 38 patients without LCA were included. On all study parameters, no significant difference was found between CTS patients with versus without LCA. As outcomes are similar in both cases, LCA resection is not useful in patients with LCA and CTS. Preoperative diagnosis is unnecessary and screening for LCA is non-contributive for CTS evaluation.

The influence of ethnic differences based on upper limb anthropometry on grip and pinch strength

BackgroundEthnic differences in upper limb anthropometry have significant variations which can influence surgical outcomes and rehabilitation. We hypothesize that there would be a significant difference in the anthropometry based on ethnicity and gender which will reflect on objective measurements. MethodsWe performed 13 anthropometric measurements of the upper limb, grip and three types of pinch strength in 210 volunteers across seven ethnicities in young adults at our university campus. We compared them statistically based on ethnic and gender differences. ResultsThere was a significant correlation noted between grip, palmar and tip to tip pinch strength in 12 of the 13 anthropometric measurements. Key pinch correlated with eight parameters. Mean grip and pinch strength are noted to be more in males and from developed nations across all ethnicities. ConclusionsThis study shows that there is significant variation between the anthropometric measurements based on gender and ethnicity which correlates with differences in grip and pinch strength.

Dorsoradial Ligament Reconstruction in Trapeziometacarpal Joint Arthritis.

The main purpose of the study is to present the alternative novel surgical technique in treating patients with trapeziometacarpal (TMC) joint arthritis using dorsoradial ligament (DRL) reconstruction technique and report the clinical outcomes. Patients who were diagnosed with TMC joint arthritis and underwent DRL reconstruction were evaluated. Visual analog pain score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; grip, tip pinch, tripod pinch, and key pinch strengths along with range of motion of the thumb; and Kapandji score were recorded in the preoperative period and at follow-up. Stress examination was also performed under a fluoroscope. Eleven patients were included in the study. Median follow-up time was 13 months. At follow-up, postoperative visual analog scale and QuickDASH score improved in all patients. Grip, tip pinch, tripod pinch, and key pinch strengths also improved. The range of motion and Kapandji score were slightly improved compared with the preoperative period except for the thumb metacarpophalangeal flexion. Two patients had numbness at the thumb and spontaneously recovered after 3 months. According to recent evidence which proposed the importance of DRL in TMC joint stability, our DRL reconstruction technique may be an alternative treatment in treating patients presented with TMC joint arthritis. Further study with a longer follow-up period is needed.

P-OT016. The comparison of robotic glove training and conventional training in post-stroke hand impairment patients: A pilot randomized controlled trial protocol

Introduction . Rehabilitation in stroke patients is crucial in minimizing the neurological deficit, improving their quality of life and reducing the caretakers’ burden. Post-stroke hand impairment is common and improving hand function is a core element of rehabilitation. For such patients, robotic glove training might be a promising tool. This trial aims to determine the efficacy, safety, feasibility and cost effectiveness of Robotic Glove Training (RGT) compared with Conventional Training (CT) among post-stroke unilateral hand impairment patients. Methods . This is a pilot, randomized, assessor blinded, controlled trial. Adult patients with first onset of stroke with unilateral poststroke hand impairment (Medical Research Council Grading ≤ 3) will be selected. Subjects will be randomized into RGT or CT group in a 1:1 ratio. Both groups also will undergo the usual daily home hand exercises. The endpoints will be measured after 6 weeks of training. Results . For efficacy assessment, hand grip strength; tip, key and palmar pinch strength; and hand motor function will be measured using Hand Dynamometer; Pinch Gauge; Motor Assessment Scale and Fulg Meyer Assessment. For safety assessment, hand spasticity and pain will be assessed using Modified Ashworth Scale and Ministry of Health Pain Scale. For feasibility assessment, adverse event and level of operator difficulty in handling the robotic glove device will be assessed. For cost effectiveness, the average cost per hour of a physiotherapist spend during training will be analyzed. Independent t-test or Mann-Whitney test will be used to compare the two mean scores and a P value of < 0.05 is considered statistically significant. Conclusion . We hypothesized that RGT group will show better improvement in terms of hand grip strength, pinch strength and hand motor function compared to CT group among post- stroke unilateral hand impairment patients. We also expected that RGT will be safe, feasible and cost effective.

The Relationship of Grip and Pinch Strength to Musculoskeletal Disorders in Female Carpet Weavers in Southeastern Iran, 2019.

Background:The repetitive and prolonged exertion of grip and pinch strength are current among carpet weaver tasks. The three objectives of this study were (1) to investigate the relationship between symptoms of musculoskeletal disorders and grip and pinch strength of carpet weavers in carpet weaving workshops in Kerman province, (2) to compare the grip and pinch strength of carpet weavers with normal values, and (3) to identify the relationship between hand postures of carpet weavers during work and force exertion.Methods:In this cross-sectional study, grip strength and key, tip and palmar pinch strengths of 101 female carpet weavers aged 20 to 71 years were measured in Kerman province, in 2018. Nordic Musculoskeletal Questionnaire (Extended version) was also used to evaluate musculoskeletal disorders.Results:Bivariate and multivariate linear regression analyses showed that participants who suffered from musculoskeletal disorders had lower grip and pinch strength than others and this decrease was statistically significant in upper back, wrists/hands, and knees. Moreover, there was a significant difference between grip and three types of pinch strength of carpet weavers and normal values. Furthermore, for both hands, the grip strength in the position recommended by American Society of Hand Therapists was significantly greater than that in the normal position carpet weavers usually adopt.Conclusion:Based on the results, the high prevalence of musculoskeletal disorders has led to a significant decrease in the grip and pinch strength of carpet weavers. Therefore, it is necessary to undertake ergonomic interventions in designing the carpet weaving workstation.

Functional Recovery Following Trapeziectomy and Ligament Reconstruction and Tendon Interposition: A Prospective Longitudinal Study

Patients undergoing surgery for trapeziometacarpal (TMC) joint arthritis require preoperative counseling on the expectations of surgery. This study aims to document the objective and functional recovery over the initial 12 months following trapeziectomy and ligament reconstruction with tendon interposition (LRTI). We prospectively followed 55 patients with symptomatic TMC joint osteoarthritis after trapeziectomy and LRTI. Patients were assessed on functional outcome measures, pain, and objective outcomes of grip, tip and key pinch strength, and range of motion. Outcomes were recorded preoperatively and at 3, 6, 9, and 12 months after surgery. Outcome measures of Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and pain, improved significantly after surgery at each 3-month interval up to 9 months. Palmar and radial abduction were significantly improved compared to their preoperative ranges, but opposition was unchanged. Power grip significantly exceeded the preoperative strength at 6 months and further increased at 9 months. Tip pinch significantly exceeded the preoperative strength at 12 months. There was no difference in the key pinch strength compared to the preoperative strength. Over a follow-up period of 12 months, trapeziectomy and LRTI is an effective treatment in significantly reducing pain in 80% of patients. Although normal patient-reported outcome measures of DASH and PRWE are not regained, when compared to normative values, these measures are significantly improved; the improvement plateaus at 9 months. Patients can expect to attain 37% and 46% of their eventual measured DASH and PRWE scores, respectively, at 3 months, and 82% and 79% of their eventual measured DASH and PRWE scores, respectively, at 6 months. Grip strength exceeded the preoperative strength by 15% at 6 months and by 30% at 9 months. Tip pinch strength significantly exceeded the preoperative strength by 20% at 9 months. Therapeutic II.

Validity of the modified sphygmomanometer test for the assessment of tip pinch strength in Parkinson's disease

BackgroundThe tip pinch is one of the most delicate and precise movement of the hand, and it is used to manipulate small objects, commonly observed in the activities of daily living of any individuals. Individuals with Parkinson Disease (PD) with impaired manual dexterity, manipulative skills, and hand weakness have an important barrier for activities of daily life. However, the dynamometer usually used for measuring the tip pinch have a high cost, so, validate a sphygmomanometer can make this assessment more accessible. ObjectiveTo investigate the validity of the modified sphygmomanometer test in the evaluation of tip pinch strength when compared to the gold standard. Methods50 individuals with idiopathic PD took part in the study. The muscle strength of tip pinch on the dominant and non-dominant side was measured by the modified sphygmomanometer test and the gold standard, the dynamometer. Concurrent validity was analyzed using Pearson's correlation coefficient. Results50 individuals diagnosed with idiopathic PD, mean age of 67 ± 8.0 years, 68% male, mean time of diagnosis in months of 84 ± 66 and Hoehn and Yahr mean of 2.5 ± 0.6. There was a significant correlation of moderate magnitude between the modified sphygmomanometer test and the dynamometer in dominant side (r = 0.44; p < 0.01) and non-dominant side (r = 0.48; p < 0.01). ConclusionThe modified sphygmomanometer test showed adequate validity for assessing the muscle strength of the tip pinch in individuals with PD.

Revision of failed trapeziometacarpal prothesis by CMI pyrocarbon implant: Retrospective study of 28 patients with a mean follow-up of 7.5 years

IntroductionThere is no consensus on the best salvage option after a failed trapeziometacarpal prothesis. Conserving the trapezium and inserting a pyrocarbon hemiarthroplasty implant will prevent thumb shortening and preserve the thumb's motion. The aim of this study was to evaluate the clinical and radiological outcomes in the medium term of trapeziometacarpal prothesis revisions done using the CMI pyrocarbon implant. Patients and methodsThis was a retrospective study of 28 patients with a mean age of 63.5 years. The mean time to revision was 6.1 years after the initial arthroplasty. The dominant side was operated in 70% of patients. The surgery consisted of removing the existing prosthesis, reconstructing the trapezium with a bone graft, and inserting the CMI pyrocarbon implant. The review consisted of a functional assessment (visual analog scale for pain, QuickDASH score, patient satisfaction), physical assessment (Kapandji, grip strength, key pinch strength, tip pinch strength) and radiological assessment (complications, radiolucent lines, scaphometacarpal height, implant centering, bone remodeling). ResultsAt a mean follow-up of 7.5 years, no further surgical revisions were needed. The mean QuickDASH score was 1.1 and the mean QuickDASH was 13%. Twenty-five patients (89%) were satisfied with the outcome. The Kapandji score improved significantly from 7.5 to 9.5 on average. Grip strength improved significantly from 16.7kg to 21.5kg on average. The mean postoperative key pinch strength was 93% of the contralateral side. The mean postoperative tip pinch strength was 88% of the contralateral side. There were no fractures or dislocations visible on the radiographs. However, there was bone remodeling in the trapezium related to the pyrocarbon implant's indentation that was well tolerated by patients in the medium term. ConclusionFor revision of failed trapeziometacarpal prothesis, inserting the CMI pyrocarbon implant combined with trapezium reconstruction appears to be a good alternative to the more commonly used trapeziectomy procedure. Reconstructing the trapezium and inserting this hemiarthroplasty implant preserves the thumb's projection, length, and stability. The functional improvement experienced by patients makes this a relevant treatment option. Level of evidenceIV; retrospective study without control group.

Flexion-extension strength of the index-thumb system in Italian population. A cross-sectional study to gather normative data

Study designCross-sectional study. IntroductionFlexion (Palmar Pinch, PP-MVC and Tip Pinch, TP-MVC) and extension (E-MVC) maximal voluntary contraction (MVC) of the index-thumb system offers a quick way to estimate the level of hands’ impairment in several musculoskeletal and neurologic conditions. Purpose of the StudyThis study established normative data of PP-MVC, TP-MVC, E-MVC in the Italian population and evaluated their correlation with hand dominance, anthropometric factors, dexterity and workload level. MethodsIn our study, 303 healthy people (150F, 153M) were recruited. Participants performed PP-MVC, TP-MVC and E-MVC tests per hand, conducted by using a pinch-gauge. T-test was used to analyze MVC means between sexes and between hands. One-way ANOVA was conducted to compare MVC means in male and female samples stratified by age (18-29, 30-44, 45-59, 60-74, +75). Spearman's correlation analysis was performed to determine anthropometric variables, dexterity and workload level effects on MVCs. ResultsMedium-to-large effect sizes of age were shown in the majority of tasks. The 30 to 44 years and then +75 years age groups showed the highest and the lowest values, respectively, for both sex and both hands. Men were meanly 50% stronger, and the dominant hand showed higher values (6-10%). MVC-tests correlated moderately with weight and height weakly with dexterity and workload level. ConclusionsAfter 30 to 44 years, hand strength declines in line with the normal process of aging that also entails muscle fibers and the reduction of daily activities in older adults. In relative terms, E-MVC showed the highest strength loss in the over 75 seconds. The difference between sexes was higher in E-MVC than in flexion MVCs. E-MVC seems to depend more on musculoskeletal architecture that differs from women to men, according to the highest correlation between E-MVC and anthropometric variables. Only high workload levels impacted hand strength. In heaviest occupations, no PP-MVCs differences were observed between hands.

Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up.

Many surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis, with significant variation. To date, none has proven to be superior. The purpose of this study was to report long-term follow-up results of suture suspension arthroplasty (SSA). The SSA technique uses a single incision, trapeziectomy, and an intra-articular suture suspension sling anchored into the insertions of the flexor carpi radialis (FCR) and abductor pollicis longus (APL), which serves to stabilize the base of the thumb metacarpal, correct subluxation deformity, and maintain arthroplasty space. Ninety of 153 SSA reconstructions (59% recall) were evaluated at long-term follow-up (mean, 12.6 years). Data were analyzed for functional outcomes, including preoperative and postoperative grip and pinch strength, radiographs, complications, and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. The mean age at date of surgery was 61.7 ± 7.6 years (82% women). Significant improvement was noted in grip strength (preoperative mean, 25.0 kg; postoperative mean, 28.0 kg; P < .0001), key pinch (preoperative, 4.2 kg; postoperative, 5.1 kg; P < .0001), and tip pinch (preoperative, 2.9 kg; postoperative, 3.6 kg; P < .0001). Radiographic subsidence averaged 35% (0-90). Postoperative QuickDASH scores (mean, 6.6; range, 0-50) revealed good to excellent pain relief and function. One revision was performed, and postoperative FCR rupture occurred in 3 reconstructions. The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. Potential advantages of the SSA include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware.

Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is currently the most popular technique for treating primary osteoarthritis of the thumb carpometacarpal joint. However, reduced trapezial height has sometimes been reported after LRTI. Longer immobilization and delayed rehabilitation times are also problematic. In this study, we evaluated the clinical and radiological outcomes of patients who underwent our modified LRTI procedure. Retrospective study included 26 thumbs in 24 cases with advanced stages. Our modified Burton's procedure was as follows: (1) trapeziectomy was limited to distal-half, (2) the entire flexor carpi radialis (FCR) was harvested from the forearm, and (3) half-slip of the FCR tendon was stabilized by interference screw in the first metacarpal bone tunnel. Pain on the visual analogue scale (VAS), the quick Disabilities of the Arm Shoulder and Hand score, tip pinch strength significantly improved postoperatively. The preoperative height of the trapezial space was well-maintained at final follow-up. Magnetic resonance imaging at the one-year follow-up showed the existence of FCR tendon ball in 15 cases. Eighteen housewives resumed their daily activities after a mean period of 10days postoperative, while another 6 patients returned to their original jobs after 3weeks. Our modified LRTI method involves distal-half trapeziectomy and entire FCR interposition. A sewn FCR tendon ball always provide enough volume to fill the trapeziectomy space, which helps to prevent sinking of the metacarpal bone. Our technique produced sufficient ligamentoplasty and allowed early mobilization after surgery.

The effect of remaining trapezial space on outcomes after trapeziectomy with ligament reconstruction tendon interposition for trapeziometacarpal osteoarthritis

Ligament reconstruction and tendon interposition (LRTI) procedures for trapeziometacarpal osteoarthritis aim to prevent proximal metacarpal migration to improve thumb function. We sought to evaluate the effect of the remaining trapezial space on outcomes after trapeziectomy with LRTI. Forty-seven patients were included in this study. Patients were evaluated clinically and radiologically. They were divided into two groups according to the remaining trapezial space at last follow-up. Postoperative to preoperative trapezial space ratio was >50% in group 1 and <50% in group 2. Mean follow-up was 30.8 months. Mean age, sex, dominant side, preoperative stage, and follow-up were similar in both groups. The mean QuickDASH scores were significantly better in group 1 than group 2. Mean tip and key pinch were significantly stronger in group 1, than group 2. Trapeziectomy with LRTI is the most used surgical technique and it produces satisfactory results. Improved clinical outcomes can be achieved when more than 50% of the preoperative trapezial space remains.

Trapeziectomy for trapeziometacarpal osteoarthritis.

AimsThe objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded.ResultsAll the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest improvement (+14%), with a mild improvement found in grip strength (+25%) at the last follow-up. The mean progressive trapezial collapse was 48% (0% to 85%) and was not correlated with pain, grip strength, or satisfaction. The most represented complications were linked to tendons or nerves affected during additional procedures to stabilize the joint (11.6%; n = 56). Mechanical complications included symptomatic scapho-M1 impingement (3.1%; n = 15/580), leading to nine surgical revisions out of 581 trapeziectomies. Meta-analysis was not possible due to study heterogeneity and limited data.ConclusionAfter a minimum five-year follow-up, trapeziectomy achieved high patient satisfaction and pain relief. However, strength seemed to be deteriorating with detrimental consequences, but this did not correlate with trapezial collapse. The issues related to underestimating mechanical complications and varying degrees of success should be highlighted in the information given to patients. Evidence-based analyses should help the surgeon in their decision-making.Cite this article: Bone Jt Open 2021;2(3):141–149.

Effects of Virtual Reality and Task-Oriented Training on Hand Function and Activity Performance in Pediatric Hand Burns: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand function, activity performance, and satisfaction in pediatric hand burns. DesignA randomized controlled trial. SettingOutpatient rehabilitation center. ParticipantsFifty children with deep partial-thickness or full-thickness hand burns. (N=50; mean age, 10.70±1.64y; range, 7-14y) InterventionsChildren were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only received TR, all groups received the interventions 3 days per week for 8 weeks. Main Outcome MeasuresWe assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch). ResultsThere was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with that of the control group postintervention (P<.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance, ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P>.05), whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P<.05) in the motion-sensing, hands-free gaming device group compared with the TOT group postintervention. ConclusionsThe motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand rehabilitation.

Double Oblique Osteotomy and Rotation of the trapeziometacarpal Joint (DOOR procedure)

The double oblique osteotomy with rotation of the trapeziometacarpal (TMC) joint procedure (DOOR procedure) is a surgical technique conceived to treat non-traumatic TMC instability, often responsible for TMC joint osteoarthritis. The main goal of this procedure is to correct the exaggerated slope of the trapezium. It also allows opening of the first web space, transfers pressure to healthy cartilage areas, and reverses the forces exerted on the trapeziometacarpal ligaments. The technique is demanding and should be learned in the anatomy laboratory. Since 2000, we have carried out 96 cases, evidence that this technique is reliable. Our case series consists of 88 patients (71 females, 17 males), with 8 patients operated bilaterally. The average age at the time of the procedure was 48 years. The first 22 operated (24 cases) between 2000 and 2005 were reviewed in 2015 with an average follow-up of 13 years. Pain averaged 0.5 on VAS. The average QuickDASH score was 6. The average mobility according to Kapandji's index was 9 for opposition and 3 for retropulsion. The grip strength compared to that of the contralateral side was 180%, the key pinch strength was 100% of the contralateral side and the tip pinch strength was 98%. This intervention makes up approximately 10% of our surgical indications in thumb basal joint arthritis. It is reserved for young women with early arthritis or unstable thumbs, and for men who perform manual labor. While the results take a long time to achieve (about 3 months), they remain highly satisfactory at the average follow-up of 13 years.

Treatment of Nonreplantable Total Thumb Amputation at the CMC Level Using Index Finger Pollicization.

Pollicization of the index finger is a rarely performed reconstructive option for patients with total thumb amputations with nonsalvageable carpometacarpal (CMC) joint and thenar muscles. Successful pollicization can provide basic grasp and pinch to help patients carry out activities of daily living. We present a retrospective review of 4 patients who underwent index finger pollicization for traumatic total thumb amputations. A retrospective review of 4 cases of pollicization using an injured index finger for traumatic thumb amputation was performed. Patients available for follow-up were contacted for functional assessment. Outcomes including range of motion (ROM), grip strength, key pinch, 2-point discrimination, and Disabilities of the Arm, Shoulder, and Hand score were obtained. Functional thenar muscle and the CMC joint were absent in all cases. Injury mechanism was firework in 2 patients and crush in 2 patients. The time from injury to pollicization ranged from 8 days to 17 months. Follow-up time ranged from 10 weeks to 3 years. Three patients regularly used the pollicized thumb in activities of daily living such as writing. Tip pinch and lateral pinch along with grip strength were weak in all cases; the best recorded pinch strength was 24% and grip strength was 25% compared with the contralateral hand. The ROM of the pollicized thumb was limited. Index finger pollicization following total thumb amputation can be a viable last-resort option for patients. The pollicized digit acts as a sensate post and avoids further morbidity from the traumatized extremity.

Mini TightRope® suture button indications for thumb basal joint arthritis

Our aim was to explore the different indications of the Mini TightRope® suture button whether during first-line treatment or secondary surgery of thumb carpometacarpal osteoarthritis (OA). The indications for this new device are presented and discussed based on our own small case series and published data. Twenty-one patients treated with the Mini TightRope® were included in a prospective study. One of them was operated on both sides. Fourteen devices were used in first intention for Eaton stage IV OA; the patients underwent trapeziectomy and suture button suspensioplasty only. Four cases consisted of revision surgery for painful proximalization of the first metacarpal after trapeziectomy and ligamentoplasty. Four cases consisted of secondary surgery after trapeziectomy and implant interposition (two silicone implants and two pyrocarbon implants). We captured the demographic data, follow-up time, pain level, pinch strength before and after surgery, range of motion, metacarpal subsidence, and postoperative complications. The average age of the patients was 60 years. There were 19 women and 2 men. The average follow-up time was 2.5 years (1–4). The average pain level, according to a visual analog scale (1–10) was 3.5 (2–5) preoperatively and 2 (1–4) postoperatively at rest and 7 (6–8) preoperatively and 4 (3–6) postoperatively with maximum load. The mean Kapandji score was 9 (7–10) and the retropulsion score was 3 (1–4). The average key pinch and tip pinch strengths were 80% and 78% of the contralateral side at the final follow-up. The trapeziectomy-suspensioplasty group had greater average trapezial space height compared to the revision surgery group (7.0 mm vs. 4.5 mm). There are several indications for the Mini TightRope® device in the treatment of severe thumb carpometacarpal OA: first metacarpal suspension during open or arthroscopic total or partial trapeziectomy and secondary surgery after failure of trapeziectomy with or without implant interposition. The advantage of this new device, which suspends the first metacarpal off the second metacarpal, is the very short immobilization period contrary to other suspensioplasty procedures.

Differences between simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis.

The optimal management of trapeziometacarpal osteoarthritis remains controversial. This systematic review and meta-analysis assessed the subjective and objective outcomes and complications of simple trapeziectomy (T) versus trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI). The PubMed, Embase, Web of science, and Cochrane electronic databases were searched from inception to Aug 31, 2020. Key words included "osteoarthrosis", "carpometacarpal joint", and "trapeziectomy". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for trapeziometacarpal osteoarthritis were included. The subjective outcomes (visual analog scale [VAS] and disabilities of the arm, shoulder, and hand questionnaire scores), objective outcomes (grip strength, tip, and key pinch strength) and complications were extracted. The methodological quality of each was assessed independently. Meta-analysis was performed for comparative trials. The protocol for this meta-analysis is available in PROSPERO (CRD42020195752). From the 8 included studies (7 RCTs, 1 CCT), 656 cases were divided into T (n = 325) and T + LRTI (n = 331) groups. Compared with the T group, grip and tip pinch strength was better in the T + LRTI group (SMD = - 2.74, 95% confidence interval (CI) (- 3.46 to - 2.02), P < 0.00001) and (SMD = - 0.21, 95% CI (- 0.34 to - 0.08), P = 0.002), respectively, but there were significantly more complications 3months after operation in the T + LRTI group (RR = 0.50, 95% CI (0.31 to 0.80), P = 0.004). The VAS score (SMD = 0.33, 95% CI (- 0.39 to 1.04), P = 0.37), DASH (SMD = - 1.86, 95% CI (- 7.59 to 3.87), P = 0.52), key pinch strength (SMD = - 0.13, 95% CI (- 0.28 to 0.01), P = 0.07), and incidence of complications 1year after operation (RR = 0.83, 95% CI (0.53-1.29), P = 0.41) were not significantly different between the two groups. While the T + LRTI group demonstrated a better effect in grip and tip pinch strength at the one-year follow-up, there was no statistical difference in key pinch strength, pain relief, and DASH. Furthermore, T + LRTI has more latrogenic injury, more short-term postoperative complications, and higher surgical costs. Considered comprehensively, if there is no special strength requirement, we recommend simple trapeziectomy.

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients.

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion-extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results.Level of evidence: IV.