Ulnar Deviation Research Articles

Association between diffuse idiopathic skeletal hyperostosis and long-term use of isotretinoin: case report

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a systemic condition that affects mainly the anterolateral spine, with abundant bone growth and formation of bridges between the vertebral bodies, but ossification in peripheral entheses may also occur. Its prevalence increases with age and is higher in males. Diagnosis at ages under 40 years are extremely rare. Hence, this report aims to describe a rare case of DISH in a young woman probably due to the long-term use of isotretinoin and discuss its presentation, bone involvement and differential diagnosis. A 37-year-old female patient was admitted to the Rheumatology service with progressive limitation of neck rotation and back flexion during the past 3 years, associated with great loss of function and impairment in daily activities. She had a previous diagnosis of congenital ichthyosiform erythroderma, managed with low doses of isotretinoin for 12 years. The current weekly isotretinoin dosage was 180mg. Prior image exams showed axial spondylopathy with diffuse peripheric enthesopathy since she was 33 years old and sacroiliitis with asymmetric syndesmophytes in the lumbar spine that resembled a psoriatic arthritis. Other diseases were denied. Family history included a case of rheumatoid arthritis but no history of psoriasis. Physical exam included erythema and diffuse skin peeling in the upper and lower limbs. Her hands were deformed with ulnar deviation but had no signs of arthritis. Cervical rotation was stiff and ranged 30o to the left and 35o to the right. Schober test distanced 1cm and Patrick’s Faber test was negative. Laboratory tests showed no alteration except for a serum 25-OH vitamin D of 7.25ng/mL (reference value: >30ng/mL). Biochemical and bone turnover markers were normal, including serum total calcium, magnesium, phosphorus, parathyroid hormone and alkaline phosphatase. Inflammatory markers C-reactive protein and erythrocyte sedimentation rate were within normal ranges. Human leukocyte antigen B27 was negative. Conventional radiographies were performed and showed increased bone texture with calcification of anterior and lateral ligaments of the cervical, thoracic and lumbar spine. Bone mineral density, evaluated by dual-energy X-ray absorptiometry (DXA), showed a Z-score of +3.2 SD at lumbar spine. Trabecular bone score by DXA was normal and vertebral fracture assessment showed no fracture and confirmed the formation of bridges between vertebral bodies. Clinical presentation was not compatible with ankylosing spondylitis nor psoriatic arthritis as there was no typical inflammatory pain, no elevated inflammatory markers, no typical skin lesions and no family history of psoriasis. However, the hyperostosis affecting the spine and the diffuse enthesopathy were very exuberant for DISH, but the female sex, young age and bilateral spine involvement were uncommon finds. As this patient was on long-term isotretinoin therapy, DISH development is more likely an adverse effect of retinoids on bone metabolism. Thus, clinicians and dermatologists should be always alert to the adverse effects of prolonged use of isotretinoin and, in cases of movement restriction, possible bone involvement must be further evaluated, as DISH may be a differential diagnosis. Since there is no specific treatment, early diagnosis can be crucial to avoid extensive bone damage and irreversible morbidity.

The Effects of Age and Initial Shoulder Posture on the Upper Limb Range of Harvesting Movements among Oil Palm Harvesters

The occurrence of musculoskeletal diseases (MSDs) among oil palm harvesters has been studied extensively, but there is a lack of published studies on the evaluation of the range of harvesting movements. This information is important to design the ergonomic tools needed in the manual harvesting of oil palm. We examined the upper limb motion of oil palm harvesters to determine the effects of age and initial shoulder postures on their range of harvesting movements. Twenty male harvesters performed a manual push-pull-cutting technique (≥3 m fresh fruit branches (FFBs) height). The study was conducted by capturing the 1-D push-pull cutting technique harvesting movement via the Quintic system at the sagittal plane. The active range of harvesting movements during the harvesting phases and the range of the harvesting movement of the initial and maximum postures of their upper arms were calculated based on the kinematic data generated with the Quintic Biomechanics system (Version 29). Participants were divided into three groups based on their age, and two groups based on their initial support shoulder position, and dominant shoulder position. Data were analysed using the ANOVA and t-test. The joint movement angle pattern of the harvesters was classified into three phases: preparation, execution, and ending. The age-related variances for the initial and maximum support shoulder postures were determined. The range of harvesting movements and the active range of harvesting movements during the preparation phase at the support shoulder and wrist region were also observed. The initial support shoulder posture displayed a statistical variance in the maximum support and dominant range of harvesting movements of the shoulder. It was also linked to a reduced active range of harvesting movements for the support shoulder flexion and dominant wrist ulnar deviation at the preparation phase. Furthermore, the initial dominant shoulder exhibited a statistically significant difference for the dominant arm and a reduced active range of harvesting movements in the dominant wrist ulnar deviation at the preparation phase. This study produced important evidence about factors to be considered for the ergonomic design of harvesting tools and workplaces, especially within the oil palm industry.

Extensor Carpi Ulnaris Subluxation.

Extensor carpi ulnaris tendon subluxation can be a challenging diagnosis as a cause of wrist pain. The tendon is stabilized by a tough subsheath. This subsheath is vulnerable to tears in acute wrist movements, especially those combining supination, flexion, and ulnar deviation. The patient presenting acutely may experience swelling, tenderness, and pain. In a chronic setting, the complaint is often an unstable wrist. The diagnosis can be made with a thorough examination, and ultrasonography can be used to evaluate the dynamics of the tendon. Surgical repair with a flap of extensor retinaculum to re-create the tendon's stabilizing subsheath is recommended.

Rebalancing the Spastic Wrist by Transposition of Antagonistic Muscle-Tendon Complex.

Upper limb spasticity and spasticity-induced deformities after upper motor neuron lesions because of traumatic brain injury, encephalitis or cerebral palsy inhibit activities of daily living, result in impaired self-care and often dependence on assistance of carers. A key element of the dysfunction is wrist hyper-flexion and ulnar deviation deformity. Traditionally, this deformity has been corrected by transfer of the spastic flexor carpi ulnaris to the extensor carpi radialis brevis. Instead, this study emphasizes the causative role of the palmar subluxation of extensor carpi ulnaris and describes a surgical correction strategy detailing transfer of extensor carpi ulnaris-to-extensor carpi radialis brevis. This surgery re-establishes and maintains a more favorable muscle-tendon-joint mechanics and hand position. Patient satisfaction is high, time and effort in daily care for patients and caregivers are less, and incidence of complications is low.

Preliminary Evaluation of an Adaptive Robotic Training Program of the Wrist for Persons with Multiple Sclerosis

Robotics can be used to describe wrist kinematics and assess sensorimotor impairments, while the implementation of training algorithms can be aimed at improving neuromuscular control. The purpose of this study was to use a robotic device to develop an adaptive and individualized training program of the distal upper extremity for individuals with multiple sclerosis (MS). This approach included an online assessment of performance aimed at changing the level of assistance/resistance provided during the task. Participants (N = 7) completed a robotic training program that occurred 3 times weekly for 4 weeks. The training protocol consisted of tracking a target moving along a figure by grasping the end-effector of the robotic device and moving it along the trajectory. Outcome measures were assessed pre- and post-intervention. Improvements in performance were quantified by average tracking (p = 0.028) and figural error (p = 0.028), which was significantly reduced by 26% and 43%, respectively. Isometric wrist strength significantly improved post-intervention (flexion: p = 0.043, radial and ulnar deviation: p = 0.028). The results of this work demonstrate that 4-weeks of adaptive robotic training is a feasible rehabilitative program that has the potential to improve distal upper extremity motor accuracy and muscular strength in a MS population.

Madelung Deformity - Esthetic and Functional Outcomes from the Surgical Treatment with Distal Radial Dome Osteotomy and Vickers Ligament Section.

Objective The present study aimed to evaluate esthetic and functional outcomes from the surgical treatment of Madelung deformity in children. Method This is a retrospective study of pediatric patients with Madelung deformity who were surgically treated with dome osteotomy of the distal radius and Vickers ligament section from 2015 to 2018. Patients with a minimum postoperative follow-up period of 12 months were included. Demographic data, surgical technique, clinical and radiographic outcomes were analyzed. Pre and postoperative radiographic evaluation consisted of ulnar tilt, lunate subsidence lunate fossa angle, and palmar carpal displacement measurements. The postoperative clinical evaluation consisted of ranges of motion of the wrist, visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results Four patients were included, two with idiopathic Madelung deformity and two with bone dysplasia. All patients were females and presented bilateral disease. Six wrists were operated on. The median age at surgery was 15.5 years old, and the median postoperative follow-up time was of 37.5 months. The postoperative radiographic analysis revealed an average correction of 8.8 ± 7.5° for ulnar tilt, 3.0 ± 3.9 mm for lunate subsidence 8.2 ± 6.6° for lunate fossa angle, and 4.7 ± 2.6 mm for palmar carpal displacement. Average postoperative ranges of motion of the wrist joint were 75.8 ± 3.4° for flexion, 62.5 ± 14.1° for extension, 25.7 ± 2.9° for radial deviation, 40.0 ± 2.9° for ulnar deviation, 88.3 ± 2.4° for pronation, and 82.5 ± 2.5° for supination. The median VAS was 1 for residual pain, 0 for functional deficit, 0 for esthetic impairment, and 10 for recommending the surgical procedure. The median DASH score was 0. Conclusion Madelung deformity treatment using dome osteotomy of the distal radius and Vickers ligament section results in excellent esthetic and functional outcomes.

Volar dislocation of the proximal interphalangeal joint

The author reports a volar dislocation of the right-hand ring finger's proximal interphalangeal joint in 65-year-old women presented two days after the injury. Apparent shortening, rotation and ulnar deviation of the finger are the classical clinical findings. Radiographs are essential in differentiating between the variants of volar dislocation. Type 1 dislocation presents as irreducible dislocation because of the entangled proximal phalanx in the buttonhole and always associated with the same side collateral ligament injuries. Type 2 dislocation is reducible because of the central slip rupture and a resultant boutonniere deformity. The author reported a case with a complex spectrum of injury, causing the volar dislocation of the proximal interphalangeal joint with the proximal migration of the middle phalanx and radial displacement. This was because of the same side collateral ligament rupture and central slip avulsion. Central slip reconstruction and radial collateral ligament repair produced a stable, painless joint and a full range of movement at the final follow-up. V • Type 2 Volar dislocation of the proximal interphalangeal joint is rare. • It is reducible and has central slip injury with boutonniere deformity. • Central slip reconstruction and collateral ligament repair produce stable joint.

Wrist Internal Loading and Tempo-Dependent, Effort-Reducing Motor Behaviour Strategies for Two Elite Pianists.

One of the greatest challenges in reducing high rates of performance injuries among musicians is in providing them usable tools to address playing-related musculoskeletal problems (PRMP) before they become disorders. Studies in biomechanics have the potential to provide such tools. In order to better understand the mechanisms through which PRMP manifest in pianists, especially in the distal segments of the upper limbs, the current study quantifies wrist internal loading (WIL) and wrist impact loading frequency. It does so while discussing pianists' motor behaviours and observed effort-reduction strategies in the wrists as a function of anthropometry. This concept has great utility for performers. A VICON 3D motion capture system documented two expert pianists performing a B major scale, hands together, at 4, 6, 8, 9, and 10 notes/sec. Biomechanical modeling quantified WIL. Changes in motor behaviour were observed at 8 notes/sec. Individualized anthropometry influenced the range of motor strategies available to each pianist. The pianist with the larger hand span employed a flexion/extension wrist strategy as a compensatory means for effort reduction, while the pianist with the smaller hand span employed a radial/ ulnar deviation strategy. The current study provides a new perspective in addressing PRMP among pianists by rationalizing anthropometric potentials in terms of ergonomic parameters and documenting the availability and utility of effort-reduction strategies in the wrists during piano performance as performers consider PRMP risk and avoidance.

SPECTRUM OF RHEUMATOID ARTHRITIS PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL IN PAKISTAN

Objective: To describe the demographic, clinical, serological and radiological scores in patients with rheumatoid arthritis (RA) presenting in a tertiary hospital in Pakistan.
 Study Design: Cross sectional study.
 Place and Duration of Study: Department of Rheumatology, Fauji Foundation Hospital (FFH), Rawalpindi, from Sep 2018 to Feb 2019.
 Methodology: The study included 52 female patients with RA between the ages of 18 and 80 years. Data were obtained from FFH Rawalpindi's outpatient department. Demographic details, reference data, and serological status were recorded. The joints involved in the onset of the disease, joint deformities, clinical disease activity index (CDAI) and overall functional status were evaluated. Extra-articular manifestations of rheumatoid arthritis have also been examined during a detailed physical examination. The patient's bone mineral density was calculated by the use of dual energy absorptiometry (DEXA scan). Radiological scores were evaluated using modified sharp score.
 Results: Mean age of the patient was 55.08 ± 8.79 and mean duration of disease 9 .73 ± 7.54. The most common co-morbidity in rheumatoid arthritis patients was hypertension 20 (38.5%). Twenty four (11.7%) patients had osteoporosis. Wrist was the first joint involved in 17 (32.7%) patients. Ulnar deviation was the most common deformity in 12 (23.1%) patients. Sharp score for joint space narrowing was 61.09 ± 36.90 and sharp score joint erosions were 36.90 ± 42.41. Most common extra articular manifestation was anemia.
 Conclusion: Rheumatoid arthritis as a variable spectrum of disease with different manifestations. Patients had radiological damage as demonstrated by high sharp score even before starting.................

Tricho-rhino-phalangeal syndrome: a rare case of disharmonious short stature

Tricho-rhino-phalangeal syndrome (TRPS) is a genetic disease characterized by craniofacial and skeletal malformations including short stature, brachydactyly, with ulnar or radial deviation of the fingers, clinodactyly and early joint dysplasia, especially of the hips. The most remarkable craniofacial features are slow growing, sparse and brittle hair, pear-shaped nose with a bulbous tip, flat philtrum with thin upper lip, micrognatia and large low-set ears. The radiological hallmarks include cone-shaped phalangeal epiphyses, typical of all TRPS patients, but usually not present until 2 years of age, while bone exostoses appear only in TRPS II individuals. Management is primarily supportive. We describe a case of a male child with disharmonious short stature, affected by TRPS I. The diagnosis was established on the basis of clinical features and genetic testing

In Vivo Measurement of Wrist Movements during the Dart-Throwing Motion Using Inertial Measurement Units.

Background: This study investigates the dart-throwing motion (DTM) by comparing an inertial measurement unit-based system previously validated for basic motion tasks with an optoelectronic motion capture system. The DTM is interesting as wrist movement during many activities of daily living occur in this movement plane, but the complex movement is difficult to assess clinically. Methods: Ten healthy subjects were recorded while performing the DTM with their right wrist using inertial sensors and skin markers. Maximum range of motion obtained by the different systems and the mean absolute difference were calculated. Results: In the flexion–extension plane, both systems calculated a range of motion of 100° with mean absolute differences of 8°, while in the radial–ulnar deviation plane, a mean absolute difference of 17° and range of motion values of 48° for the optoelectronic system and 59° for the inertial measurement units were found. Conclusions: This study shows the challenge of comparing results of different kinematic motion capture systems for complex movements while also highlighting inertial measurement units as promising for future clinical application in dynamic and coupled wrist movements. Possible sources of error and solutions are discussed.

Morphofunctional examination of the carpal bones of pygmy hippopotamus from Ayia Napa, Cyprus.

This study provides a complete morphological description and functional analysis of the carpal bones of the endemic pygmy hippopotamus Phanourios minor, derived from the Upper Pleistocene site of Ayia Napa. From this deposit, numerous skeletal remains of this fossil hippo have been collected, making the locality one of the richest in Cyprus. The carpal bones were compared with those of extant hippopotamuses, to determine the changes that occurred in the fossil hippo. Examination of the elements showed that Phanourios presented some important features that were common among the endemic fossil ungulates of the Mediterranean islands. The carpal bones display a proximal-distal compression due to shortening of the distal part of the leg, due to the new ecological island conditions. However, they are robust with rough areas for strong muscular and ligament insertions, providing stability to the carpal joints, and low speed movement to the animal. The great flexor capabilities, and the limitation in ulnar deviation of the carpus, indicate that P. minor had increased agility in the sagittal plane and restricted transverse movements, while the suggestion of a more unguligrade stance for the species is ambiguous. Thus, the endemic Cypriot hippos developed specialized locomotion, suitable for walking on the rugged terrain of Cyprus, which seems to be different from that of its extant counterparts.

Clinical observation of different surgical methods for metaphyseal sequelae of ulna

To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna. From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth. All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (P<0.05). Radiological evaluation parameters (ulnar variance, radial joint angle, wrist slip) were improved, and the differences were statistically significant(P<0.05). The modified Green and O'Brien wrist function scores at the last follow-up were significantly different from those before operation (P<0.05). The clinical effect of wrist joint was significantly different from that before operation (P<0.05). The Mayo elbow function scoreat the latest follow-up was significantly different from that before operation (P<0.05). The clinical effect of elbow joint was significantly different from that before operation (P<0.05). Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.

Pronated Grip View With Wrist Deviation: A Pilot Study on the Effect on Ulnocarpal Relationships.

We hypothesize that different positions of the wrist in the coronal plane makes the carpus susceptible to ulnar impaction. We prospectively enrolled 10 adult volunteers and obtained fluoroscopic images of each wrist in 12 different positions using a standardized protocol. Distances from the ulna to the lunate (UL) and ulna to the triquetrum (UT) were digitally measured as was the portion of the lunate surface area that was uncovered (LUR) with wrist deviation. A wrist position of Pronation, Neutral Deviation, and Grip (P-ND-G) significantly shortened the ulnocarpal distance when compared to a position of Neutral Rotation, Neutral Deviation, and No Grip (NR-ND-NG). Radial deviation during pronation and gripping (Pronated, Radial Deviation, Gripping [P-RD-G]) resulted in the lowest mean UL distance (1.2 mm). UT distance was minimized by a position of ulnar deviation during a pronated grip (Pronated, Ulnar Deviation, Gripping [P-UD-G]) (3.1 mm). The lunate becomes more uncovered with radial deviation. Radial deviation minimizes the UL distance while ulnar deviation minimizes the UT distance during a wrist position of pronation and gripping. Further, there is more proximal lunate surface area uncoverage during all positions of radial deviation compared to ulnar deviation.

Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review

The purpose of this study was to compare the union rates and clinical outcomes of 4-corner arthrodesis with different methods of osteosynthesis. A systematic review of studies published in Ovid, Medline, Embase, and PubMed was conducted. Primary studies that reported clinical and radiographic results following 4-corner arthrodesis for scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), or other types of wrist arthritis in human subjects were eligible. Biomechanical or cadaveric studies, case reports, studies that did not define and report a radiographic union rate, reviews and technical articles, studies that did not report the method of osteosynthesis, and studies that used multiple methods of osteosynthesis, but did not separate results for individual methods of osteosynthesis were excluded. Radiographic union rate, range of motion, and grip strength were analyzed. We identified and reviewed 291 full texts, selecting 57 studies for coding. The radiographic union rate did not significantly differ between studies using K-wire, screw, staple, nonlocking plate, metal locking plate, and radiolucent locking plate osteosynthesis. Fixation method significantly affected flexion, but pairwise comparison did not reveal any significant differences between individual groups. Grip strength as a percentage of the contralateral limb was significantly lower in studies with metal locking plate fixation compared to K-wire fixation (63.2% vs 82.6%). There were no other statistically significant differences between groups with respect to flexion, extension, radial deviation, ulnar deviation, and grip strength. All methods of osteosynthesis result in similar union rates, with no significant differences between methods. While there are some significant differences in range of motion and grip strength, these differences are unlikely to be clinically relevant. Therapeutic IV.

Rheumatoid arthritis in a sickle cell patient: a dangerous association?

Introduction - The diagnosis of rheumatoid arthritis remains a challenge because sickle cell disease can result in various rheumatological manifestations, including joint and bone pain. The concomitant presence of rheumatoid arthritis and sickle cell disease makes the therapeutic management of both conditions problematic.&#x0D; Observation - A 24-year-old man, a nurse by profession, has been followed for 10 years for homozygous sickle cell disease at the Sickle Cell Disease Research Center (CRLD) of Bamako, Mali. He has presented for 8 months symmetrical polyarthritis with morning stiffness of 3 hours, distinct from the usual vaso-occlusive crisis. The Analog Visual Scale was estimated at 80/100. He reported unquantified weight loss and asthenia. The physical examination showed a deformity in bilateral ulnar deviation, flexion of the right elbow, twelve painful joints, and five swollen joints. Normochromic normocytic anemia (hemoglobin 8.3g/dl), inflammatory syndrome with C - Reactive Protein (CRP) 130.91 mg, and Sedimentation Rate (ESR) 72mm at the first hour were noted. Rheumatoid Factor was weakly positive at 21.3 IU and Anti Citrullinated Peptide Antibodies at 385.2 IU. The radiography discovered bilateral erosive carpets without associated tarsitis and osteonecrosis of both femoral heads. The diagnosis of a very active immunopositive erosive rheumatoid arthritis meeting the criteria of ACR / EULAR 2010 was retained. A treatment based on prednisone 10 mg per day was initiated, associated with methotrexate at a dosage of 15 mg weekly in single-dose, folic acid, calcium, and vitamin D.&#x0D; Conclusion - The coexistence of rheumatoid arthritis in sickle cell patients makes the diagnosis of polyarthritis difficult.

Effects of local anaesthetics (neural therapy) on pain and hand functions in patients with De Quervain tenosynovitis: A prospective randomised controlled study.

De Quervain tenosynovitis is the most common cause of lateral wrist pain. The diagnosis can be made with the Finkelstein test when pain is provoked with wrist ulnar deviation. Conservative treatment including rest, non-steroidal anti-inflammatory medication and physical therapy is applied first, then there may be a need for corticosteroid injections, and in resistant cases, surgery. The aim of this study was to evaluate the effectiveness of neural therapy (NT) on pain and hand functions in patients with De Quervain tenosynovitis. A total of 36 patients admitted between May 2019 and March 2020 were randomly assigned to neural therapy (NT) and control groups. Hand rest and thumb spica splint were applied to all the patients, and NT interventions to the NT group only. A visual analogue scale (VAS) and the Duruöz Hand index (DHI) were used to measure pain and functionality at baseline, then at 1 and 12months after the end of the treatment. The NT and control groups both showed improvements in VAS and DHI scores at 1 and 12months compared with baseline (P<.001) according to within group comparisons. The VAS scores were significantly lower at both 1 and 12months compared with baseline in the NT group (P<.001, P=.002 respectively). The DHI scores were lower in the NT group at 1month (P=.009), and at 12months there was no significant difference between the two groups (P=.252). No adverse effects were seen in any patient. NT seems to be effective in reducing pain and improving hand functions in patients with De Quervain tenosynovitis.

The Effect of Ulnar Deviation Orthosis in Patients with Zigzag Deformity Due to Rheumatoid Hand

ABSTRACT Introduction Rheumatoid arthritis (RA) is known as a chronic and multisystem disease accompanied by synovial inflammation leading to deformities such as finger ulnar deviation and pain, as well as functional difficulties. Thus, a conservative treatment in this domain includes orthoses, that is, features added to the body that aim to correct deformity, reduce pain, and finally improve functionality. Objective The purpose of this quasi-experimental study was to evaluate the effect of ulnar deviation orthosis in patients with zigzag deformity due to RA. Material and Methods In total, 12 participants with RA were measured two times: before the start of orthosis use and after 4 weeks of use. The rate of pain, grip strength, and upper-limb function were also measured using a visual analog scale, the Jamar Hydraulic Hand Dynamometer, and the Disability of the Arm, Shoulder, and Hand Questionnaire, respectively. Results After 4 weeks of orthosis use, it was found that the scores of pain (P = 0.03), upper-limb function (P = 0.008), and grip strength had significantly improved in the hands treated over time. Conclusion The use of an ulnar deviation orthosis by patients with RA could reduce hand pain, improve grip strength, and promote upper-limb function.

Multimodal evaluation of donor site morbidity in transgender individuals after phalloplasty with a free radial forearm flap: a case-control study

In phalloplasty, there is a lack of standardized follow-up examinations of motor function and strength after harvesting oversized radial forearm free flaps (RFFF). We evaluated the donor site of 20 transmen after phalloplasty, using a multimodal, standardized approach, assessing the following parameters: opposition of the thumb, composite range of motion of the finger joints, grip strength, mobility of the wrist, lesion of the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, the sensation of pain, and cold intolerance. The contralateral, nonoperated forearm was used as a control. No impairment of the mobility of the thumb (Kapandji score median 10, range 5-10) or fingers (all fingers at both sides pulp-to-palm 0 cm, nail-to-table 0 cm) were detected. Grip strength (median 36,3kg, p=0.629) and wrist extension (62.5°vs.70°, p=0.357), flexion (70°vs.70°, p=0.535), pronation (90°vs.90°), supination (90°vs.90°), radial (30°vs.30°, p=0.195), and ulnar deviation (40°vs.50°, p=0.125) did not statistically differ between donor and control hand. Injury of the dorsal branch of the ulnar nerve was uncommon (0% hypoesthesia, 10% positive Tinel's sign). We did not observe any persistent pain of the donor forearm (NRS median 0, range 0-9). We did observe irritation of the superficial branch of the radial nerve (hypoesthesia 40%, neuroma 45%). The harvest of an oversized RFFF for phalloplasty does not cause any significant difference in motor function or strength between the donor and nonoperated hand. A potential risk of injuring the radial nerve branch is to be avoided. An aesthetic impairment could be addressed in future studies.

A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females: Wrist Range of Motion and Grip Strength Analysis

ObjectiveWrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.DesignRandomised comparative functional study of the wrist/hand with and without WHOs.ParticipantsTen right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measuresThe primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.ResultsFrom the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).ConclusionWHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users’ needs.