Ulnar Deviation Research Articles

The effect of rigid tape on wrist postures during tree planting

Taping has been suggested to reduce the incidence of tendinopathy in tree planters. However, the ability of taping to reduce wrist postures during planting has not yet been formally evaluated. The primary aim was to test the effect of rigid taping on wrist postures during tree planting tasks. Eleven tree planters planted up to 50 trees in three conditions: no-tape (NT), tape-on-the-dorsum-of-the-hand (T1) and tape-on-the-thumb (T2) in a randomised cross-over, within-participant, repeat-measures design. Electrogoniometers (EG) recorded continuous wrist postures. Digital video recordings were used to segment EG traces of each planting cycle (one planted tree) into 4 kinematically distinct Phases. The tree and shovel wrist were analysed separately. Tree-wrist peak ulnar deviation and frequency of shovel-wrist awkward frontal plane postures were significantly reduced in the T2 condition. Taping may be effective at reducing non-neutral postures and should be researched further to determine its effectiveness in reducing tree planting injuries. Practitioner summary: The effect of rigid taping on wrist postures during tree planting has not yet been formally evaluated. A randomised cross-over, within-participant, repeat measures design was used to evaluate the effect of rigid taping on wrist postures during planting. Thumb rigid taping appeared to reduce wrist range of motion during planting. KEY POINTS Taping of the thumb reduced peak ulnar deviation of the tree wrist and frequency of awkward frontal plane postures of the shovel wrist. While taping of the dorsum of the hand appeared to be more restrictive, it did not significantly reduce wrist movement; this is likely because only its effect on sagittal plane posture was assessed which had a higher variance. Upon application, tape appeared to restrict voluntary movement patterns, decreased voluntary grip force exertion and physically restrain wrist movement. Overall, rigid tape was found to be an acceptable intervention for the tree planting occupation, with financial costs and perceived effort identified as the primary barriers to acceptability.

Four-Corner Arthrodesis with a Dorsal Locking PEEK Plate: A Retrospective Case Series.

Background Four-corner arthrodesis (4CA) can be performed with a variety of methods. To our knowledge, fewer than 125 cases of 4CA with a locking polyether ether ketone (PEEK) plate have been reported, necessitating further study. Purpose The purpose of this study was to evaluate the radiographic union rate and clinical outcomes in a series of patients who received 4CA with a locking PEEK plate. Methods We re-examined 39 wrists in 37 patients at a mean follow-up of 50 months (median: 52 months, range: 6-128). Patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and participated in measurements of grip strength and range of motion. Anteroposterior, lateral, and oblique radiographs of the operative wrist were examined for union, screw breakage and/or loosening, and lunate change. Results The mean QuickDASH score was 24.4 and the mean PRWE score was 26.5. Mean grip strength was 29.2 kg or 84% of the nonoperative hand. Mean flexion, extension, radial deviation, and ulnar deviation were : 37.2, 28.9, 14.1, and 17.4 degrees, respectively. Eighty-seven percent of wrists achieved union; 8% had nonunion; and5% had indeterminate union. There were seven cases of screw breakage and seven cases of screw loosening (as defined by lucency or bony resorption surrounding screws). Twenty-three percent of wrists required reoperation (four total wrist arthrodesis and five reoperations for other reasons). Conclusion 4CA with a locking PEEK plate has clinical and radiographic outcomes similar to other methods. We observed a high rate of hardware complications. It is unclear whether this implant offers a clear advantage over other methods of fixation used in 4CA. Type of Study/Level of Evidence Level IV, therapeutic study.

Effectiveness of Dynamic Metacarpophalangeal Splint in Treatment of Ulnar Deviation of Rheumatoid Arthritis on Pinch Strength and Functional Ability in Women

ABSTRACT Introduction Rheumatoid arthritis (RA) causes structural damage that causes joint deformity including metacarpophalangeal (MCP) joint ulnar drift (UD), thus hindering the pinch strength and the functional ability of the hand. Orthosis or splints are designed to maintain the hand’s function, improve joint alignment, restore biomechanical balance, and reduce tissue stress. Limited studies have been done on the effects of dynamic splint on pinch strength and functional ability. Therefore, the purpose of this study was to evaluate and quantify the effects of dynamic MCP splint in treatment of ulnar deviation of RA on pinch strength and functional ability in women. Methods Twenty women with RA were recruited and completed a 4-week intervention period with dynamic MCP splint. Pinch strength and functional ability score were measured at baseline and after 4 weeks. Results The results showed a significant improvement in pinch strength (mean ± SD, 11.68 ± 2.14 to 13.53 ± 2.14; P = 0.000) and functional ability score (mean ± SD, 22.70 ± 9.12 to 19.70 ± 8.14; P = 0.000). Conclusion The results of this study show that the dynamic MCP splint had a positive impact on rheumatoid hands that align the joints in their functional position. The dynamic MCP splint improved the mechanical stability of the hand, thus reducing pain and stress on joints, which in turn improves the pinch strength and functional ability of rheumatoid hand. Clinical Relevance To increase patient acceptance and use of the splint, the splint designed and used in this study was compact and only covered the affected areas and joints of the hand. Because there was no involvement of the wrist joint and the fingertips were free, the splint was lightweight and allowed the patient to perform activity while wearing it.

Comparative analysis of scaphoid nonunion treatment with screw fixation and angular stable plate.

Scaphoid fractures represent 5-10% of nonunion rate and the treatment options consist of an open reduction with correction of deformity, restoration of the scaphoid length with autologous wedge grafting and fixation. However, there is still no consensus in the literature on the best fixation method. Therefore, the purpose of the study is to compare plate fixation and screw fixation in treating scaphoid nonunion with humpback deformity and carpal instability. Prospective, non-randomised study comparing the treatment of two groups of patients with scaphoid nonunion. A total of 19 patients were included in the study, the first ten patients were included in group 1 (plate fixation), subsequently nine patients were included in group 2 (screw fixation). The nonunion duration was longer than 6months and patients did not present type III Scaphoid Nonunion Advanced Collapse (SNAC). Clinical evaluations included pain intensity, range of motion, grip strength, pinch test and functional scales Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist Score. Radiographic evaluations consisted of radiographs of both wrists in AP, AP with ulnar deviation, lateral and oblique views. Patients further underwent a tomography of the affected wrist for bone deformity, carpal collapse and later consolidation evaluation. According to post-operative measurements, group 1 showed a significant improvement in the scapholunate angle (p = 0.011) and in the intrascaphoid angle (p = 0.002). Group 2 only showed an improvement in the scapholunate angle (p = 0.011). All patients in group 1 achieved consolidation in 8weeks, while group 2 patients had a slower consolidation, with a mean of 14weeks and standard deviation (SD) of 4.2, with statistical significance (p = 0.006). Our prospective study, despite the limitations, contributes to the literature for demonstrating a better fixation using plate, with a better correction of humpback deformity and Dorsal Intercalated Segment Instability (DISI) and a faster consolidation. II, therapeutics studies; prospective comparative study.

Occupational Therapy for a Child with Aplasia Cutis Congenita with Congenital Volkmann's Ischemic Contracture

Aplasia cutis congenita is a rare malformation characterized by focal or extensive absence of epidermis, dermis, and occasionally subcutaneous tissue. Congenital Volkmann's ischemic contracture is a rare neonatal compartment syndrome caused by intrauterine ischemia and external compression. This is a challenging case for an occupational therapist (OT) focusing on the improvement of hand deformities and function in a child. The objective was to assess the effectiveness of occupational therapy intervention in correcting contracture and improving hand movement. A 4-day-old male child from the neonatal intensive care unit, presented with absence of skin over the right forearm with contracture of right hand, ulnar deviation, and skin discoloration over right hand. Patient was assessed for movement, strength, and level of contracture. Treatment was focused on correcting contracture, improving hand movements, and maintaining skin integrity with the help of splinting and therapeutic exercises. A significant improvement was seen in finger ranges, wrist ranges, hand movements, and skin color. To conclude, splinting techniques helped to stretch out contracture and correct the position of the hand and improvement in hand function.

A Rare Case of Amyoplasia Type of Arthrogryposis Multiplex Congenita with Midfacial Hemangioma in a Neonate

Arthrogryposis multiplex congenita is a condition where multiple contractures of the joint develop, leading to deformity and restriction of movement. It is mostly seen in the neonatal period but the deformity may persist till adulthood also. A 1-day-old male baby presented with multiple deformities and contractures of all four limbs, with breathing difficulties. On examination, there was abnormal shoulder adduction with elbow extension and ulnar deviation of the wrist with thumb and finger deformity. In the lower limb, severe knee flexion with severe bilateral talipes equinus deformity was seen. A midfacial hemangioma and ear abnormalities were also present along with a skin dimple over both knees. The child was investigated fully for other congenital and systemic malformations. Finally, a diagnosis of the amyotrophic type of arthrogryposis congenita with facial hemangioma was made, which is a very rare association. The patient was managed by a multidisciplinary team approach and was discharged successfully. When a baby is presented with such a deformity, then the child should be screened fully and a genetic study should be done to prevent a recurrence of malformation in a subsequent pregnancy. The aim is to prevent early contractures and to restore limb function in the child and proper follow-up.

CLOSED WEDGE OSTEOTOMY FOR THE CORRECTION OF FOREARM DEFORMITIES IN HEREDITARY MULTIPLE OSTEOCHONDROMA A CASE REPORT.

Introduction-Hereditary multiple osteochondroma is rare form of skeletal dysplasia with autosomal inheritance .during childhood ,these cartilage capped bone tumors grow outward from long bone metaphysis ,leading to metaphyseal remodeling and asymmetric longitudinal bone growth. Forearm deformities affect 30% to 60%of patients with HMO. Patient typically complaining of functional disability cosmetic impairment ,and sometimes pain. The deformities may involve a relative shortening ulna bowing of radius, ulnar deviation of the hand and wrist and permanent subluxation or dislocation of radial head. A 15 years old male patient presented Presentation Of Case- with bowing of right forearm with occasionally pain and he also complaining of pain in right shoulder ,knee joint. on a scanogram of right forearm shows ulnar variance -10,radial articular angle 40 degree, radial bowing .07 ,and radial length (121)cm abnormal carpal slip 6 .The patient was managed with surgical intervention. radial osteotomy and resection of osteochondroma and xation with distal radius locking plate and immobilization with long arm cast. patient recover with correction of deformity. The study ndings conrm our hypothesis that radial Discussion- closed wedge osteotomy combined with osteochondroma resection improves the clinical and radiological outcome in this case Masada type 1 deformity (1) increase in the radial articular angle and ulnar variance (2) a decrease in radial ulnar length discrepancy (3) radial shortening (4) correction of carpal slip and bowing of the radius .The decrease in the radial ulnar length discrepancy produced by radial osteotomy probably prevented radial head dislocation because no episode of radial head dislocation was observed due to radial ulnar length discrepancy. This surgical technique is safe and reliable and no episode of necrosis or infection was observed while this technique probably stops the deformity from getting worse. While several treatment Conclusionoption are possible, it make sense to use a simple ,rapid procedure that is not associated with complication or pain-namely radial corrective osteotomy with osteochondroma resection- in children at the end of growth in whom the severe, progressive, radial deformities are associated with HMO.

Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür?

Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared.
 Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation.
 Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively.
 Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.

QUERVAIN'S TENOSYNOVITIS, GENERAL DESCRIPTION

INTRODUCTION: Quervains tenosynovitis is a condition involving tendon entrapment affecting the first dorsal compartment of the wrist, causing pain that increases with thumb movement and radial and ulnar deviation of the wrist. OBJECTIVE: To detail the current information related to Quervains tenosynovitis and its management, as well as to analyze the conservative and surgical treatment of this disease. METHODOLOGY: A total of 28 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 18 bibliographies were used because the other 10 articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Elsevier; the terms used to search for information in Spanish and English were: Quervains Tenosynovitis, surgical quervains tenosynovitis. corticosteroids and quervain, non-surgical treatment tenosynovitis. RESULTS: The choice of preferred treatment is subject to the severity of the condition. Oral non-steroidal anti-inflammatory drugs accompanied by immobilization are a good option. Corticosteroid injections are effective for this tenosynovitis, leading to success 73.4% of the time with 2 injections. The use of ultrasound can improve the accuracy of the injections. Surgery is essential in cases that recur and are not relieved by conservative therapies over the course of 3 to 6 months. CONCLUSIONS: De Quervains tenosynovitis is a pathology based on inflammation of the tendon sheath of the abductor pollicis longus and extensor pollicis brevis in the first extensor compartment of the wrist. Its diagnosis is clinical with a positive Finkelsteins test. Non-surgical measures are preferred for its treatment. The use of splints and corticosteroid injections together provides more benefit than when used individually. And finally surgical treatment is effective and safe but is not without complications. KEY WORDS: Tenosynovitis, Quervains, inflammation

The relationship between changes in elbow valgus laxity and forearm flexor strength during repetitive pitching

ABSTRACT This study examined the changes in the medial elbow joint space width and forearm flexor strength due to repetitive pitching and analysed the relationships among these factors. Thirty-one collegiate baseball players pitched seven sets of 15 pitches each. The medial elbow joint space width, grip strength, and forearm flexor strengths were measured before pitching and after each set. These parameters were compared at baseline and after pitching for each set. Additionally, the relationships between changes in the medial elbow joint space and forearm flexor strength were examined for each set. The medial elbow joint space width significantly increased after four sets compared to baseline values. Compared to baseline values, grip strength decreased significantly after one set, wrist flexion and radial deviation after six, and ulnar deviation after five. However, changes in the medial joint space compared to baseline values after each set were not significantly correlated with changes in forearm flexor strength variables. Therefore, repetitive pitching causes an increase in elbow valgus laxity and a decrease in forearm flexor strength. However, the decrease in forearm muscle strength does not explain the increase in elbow valgus laxity.

Wrist motion assessment using Microsoft Azure Kinect DK: A reliability study in healthy individuals.

Motion analysis systems have been widely used in orthopedics and rehabilitation for diagnostics, patient monitoring and outcome evaluation purposes. Since Microsoft Azure Kinect Developer Kit (DK) had been released, only a few studies were published concerning its usage. However, it has not been used for wrist motion assessments, even though the use of standardized examinations with known reliability, validity and responsiveness remains a constant challenge. This study aimed to examine the reliability of hand and forearm range of motion (ROM) measurements recorded using new software utilizing the Microsoft Azure Kinect DK. Twenty-eight healthy males and 28 healthy females participated in measurements of active ROM for wrist extension, wrist flexion, radial deviation, ulnar deviation, and forearm supination and pronation on 3 separate occasions. Sessions 1 and 2 were carried out on the same day with a 90-minute rest period between each session, while the 3rd session was conducted a week later. Data were recorded simultaneously in both limbs using a custom-made software developed by a software development company (Oleksy Medical & Sports Sciences, Łańcut, Poland) for the purposes of the present study using Microsoft Azure Kinect DK. The assessment of intra-day and inter-day reliability was based on intraclass correlation coefficient (ICC) calculations and interpreted based on commonly used guidelines. In the group of males, the lowest ICC was 0.846 for intra-day comparisons and 0.816 for inter-day analyses. In the female group, the lowest ICC for intra-day comparisons was 0.826 and exceeded 0.833 for inter-day comparisons. The developed software using Microsoft Azure Kinect DK demonstrated high reliability in measuring wrist and forearm active ROM. These promising results support the use of Microsoft Azure Kinect DK in a clinical capacity as a potential hand assessment and rehabilitation tool.

Clinical Features and Surgical Strategies of Distal Radius Posttraumatic Deformity.

Objective To investigate the clinical features and surgical strategies of distal radius posttraumatic deformity. Methods A retrospective analysis was performed on the data of 30 patients with distal radius posttraumatic deformity treated by osteotomy and orthopedic surgery in the department of orthopedics, the First Affiliated Hospital of Nanjing Medical University, from February 2016 to November 2018. All the patients underwent preoperative anterior and lateral X-ray plain scanning of bilateral wrist joints, showing different degrees of radius shortening, inferior ulnar and radial mismatch, palmar angle, and ulnar deviation angle, among which 11 patients had an uneven joint surface. After a full evaluation, osteotomy and orthopedic surgery were performed to restore the original anatomical structure, plaster fixation was performed for two weeks after surgery, and regular outpatient follow-up was conducted. The function of the wrist was evaluated by the MMWS (wrist joint improvement) scoring scale before and after surgery, and the changes in the wrist joint-related treatment parameters were evaluated according to X-ray. Results All 30 patients had no neurological symptoms after surgery, and all wounds healed within the first stage. All patients were followed up for 6–12 months, with an average healing time of 3.5 months. There was no reduction loss, internal fixation loosening, or fracture in the regular postoperative review. Postoperative MMWS (wrist joint improvement) score scale data were significantly higher than those before surgery, and there were differences between groups (P < 0.05). Postoperative treatment parameters of wrist joints such as palmar inclination angle, ulnar deviation angle, radius height, and lower ulnar and radial matching were significantly improved, and there were differences between groups (P < 0.05). Conclusions The patients with distal radius posttraumatic deformity have the clinical characteristics of shortening of radius, mismatch of lower ulnar and radius, an abnormal inclination of palm, and ulnar declination. For patients with distal radius posttraumatic deformity, osteotomy and orthopedic surgery can effectively improve wrist function and improve patients' quality of life, which is worthy of clinical reference.

The Effect of Locking Screws on Distal Component Fixation in Total Wrist Arthroplasty Using a Cadaver Model

The advent of total wrist arthroplasty has allowed for motion-sparing surgical treatment for wrist arthritis. The Integra Freedom Total Wrist Arthroplasty recently incorporated locking caps into its distal component fixation to minimize implant micromotion and improve osseous integration. The purpose of this study was to assess the kinematic effect of locking caps in a cadaveric model. The Integra Freedom was implanted in 4 matched-pair cadavers and tested with and without the use of the locking caps, with the testing order randomized. Each specimen was tested on a custom testing system in a position of 15° of radial deviation, neutral position, and 15° of ulnar deviation with 25 N, 50 N, 75 N, and 100 N of compressive force. The rotation of the capitate, trapezoid, and hamate at all positions was measured using a 3-dimensional digitizer. Statistical analysis showed no difference in carpal rotation between the nonlocking cap and locking cap groups at all testing loads and wrist positions. The absolute motion of the distal row was minimal. However, of the total 216 loads/positions tested, only 4 (1.8%) showed a rotation of greater than 2° and only 34 (15.7%) showed a rotation of greater than 1°. This study shows that in a time zero cadaveric model, the initial osseous fixation of the distal component in the Integra Freedom is robust with or without locking caps. The addition of locking caps did not have a kinematic effect on distal carpal row fixation. However, further investigation into its clinical role is necessary. At time zero, there is minimal carpal motion after implantation of the Integra Freedom Total Wrist with functional loading. The addition of locking caps did not lead to any decrease in carpal motion.

Long-term results of trans-scaphoid perilunate fracture dislocations treated by open reduction and internal fixation

PurposeThe paper holds the research purpose of confirming the long-term results of trans-scaphoid perilunate fracture dislocations (TSPFD) under the treatment of open reduction and internal fixation.MethodsAnteroposterial-lateral radiographs of the patient's wrist were taken before and after surgery. We use a dorsal approach for all cases. Postoperative clinical and radiographic assessments were performed routinely. The scapholunate angle (SLA), estradiol angle (RLA), as well as lunotriquetral distance (LTD) assisted in the radiographic assessment. Clinical assessment was performed using the Krimmer score, modified Mayo wrist score (MWS), active flexion extension arc (FEA), radial deviation and ulnar deviation arc (RUDA) and grip strength. A visual analog scale (VAS) assisted in the pain evaluation, the VAS score ranges from 0 to 10.ResultsTwenty-two TSPFD patients due to the wrist trauma received operative treatment and we retrospectively analyzed the surgical results, together with evaluating their clinical and radiological follow-up. These patients held a mean age of 30 years old. Herzberg’s perilunate fracture-dislocation classification was taken into account to find that 19 males and 3 females suffered dorsal dislocation. The fellow-up time lasted 98.3 months on average. All cases obtained sufficient union after open reduction and internal fixation. The last follow-up found the median of grip strength was 20.00 (interquartile range, 20.00–21.25), which was 84.5% of the normal side. The modified Mayo wrist score evaluation scale considered 12 cases as excellent, and 10 good. The median of VAS and Krimmer scores at the final follow-up were 1.50 (interquartile range, 0.75–2.00) and 100.00 (interquartile range, 100.00–100.00), respectively, higher relative to the pre-operation (P < 0.001). No patients showed nerve damage preoperatively or postoperatively, or pin tract infection in any of the patient.ConclusionsIt is necessary to diagnose such complicated biomechanical damage in early stage and adopt the open reduction and stable fixation for treatment; appropriate treatment can contribute to a functionally adequate and anatomically integrated wrist.

Wrist Movement Variability Assessment in Individuals with Parkinson's Disease.

(1) Background: Parkinson’s disease (PD) is a neurodegenerative disorder represented by the progressive loss of dopamine-producing neurons, it decreases the individual’s motor functions and affects the execution of movements. There is a real need to include quantitative techniques and reliable methods to assess the evolution of PD. (2) Methods: This cross-sectional study assessed the variability of wrist RUD (radial and ulnar deviation) and FE (flexion and extension) movements measured by two pairs of capacitive sensors (PS25454 EPIC). The hypothesis was that PD patients have less variability in wrist movement execution than healthy individuals. The data was collected from 29 participants (age: 62.13 ± 9.7) with PD and 29 healthy individuals (60.70 ± 8). Subjects performed the experimental tasks at normal and fast speeds. Six features that captured the amplitude of the hand movements around two axes were estimated from the collected signals. (3) Results: The movement variability was greater for healthy individuals than for PD patients (p < 0.05). (4) Conclusion: The low variability seen in the PD group may indicate they execute wrist RUD and FE in a more restricted way. The variability analysis proposed here could be used as an indicator of patient progress in therapeutic programs and required changes in medication dosage.

Association between perceived and objective hand-wrist function in distal radius fracture

The relationship between patient-reported outcome measures and objective measures is important for understanding patient expectations. The aim of this study was to investigate the relationship of each section of the Michigan Hand Outcomes Questionnaire (MHQ) to objective measurements in patients with distal radius fracture (DRF). Eighty-four patients who were treated operatively or non-operatively for DRF were included. Injury severity was assessed by the Modified Hand Injury Severity Score. Joint motion was assessed at 6 and 12 weeks and grip strength at 12 weeks after non-operative treatment or surgery. The MHQ was used to assess hand functionality. The relationships between measurements were analyzed by Spearman correlation analysis. Statistical significance was set at p < 0.05. Fifty-one patients (60.7%) were women and 33 (39.3%) men. Mean age was 48.17 ± 12.26 (range, 20–64) years. Fifty-two (61.9%) patients were treated surgically and 32 (38.1%) non-operatively. Forearm pronation-supination and wrist flexion and ulnar deviation at week 6 and forearm pronation-supination, wrist extension and radial deviation at week 12 correlated with MHQ scores, unlike wrist extension and radial deviation at week 6 and flexion and ulnar deviation at week 12. Gross and fine grip strength at week 12 correlated with MHQ, except for the overall hand function, work performance and pain subsections. The MHQ subsections correlated with joint motion and grip strength in the early period after DRF. These findings clarified patient expectations in the early period.

A 15-Year-Old Girl with Trichorhinophalangeal Syndrome Type 1 with Non-ossifying Fibroma in Femur: A Case Report

Introduction: Trichorhinophalangeal syndrome (TRPS) is a sporadic autosomal dominant disorder with approximately 200 reported cases worldwide. We aimed to report a 15-year-old girl with TRPS type 1 (TRPS1) and the second reported case with a rare non-ossifying fibroma (NOF) in the distal part of her left femur. Case Presentation: We introduce a 15-year-old girl who presented to the outpatient rheumatology clinic at 17 Shahrivar Children's Hospital, Rasht, Iran, with the chief complaint of osteoarticular pain and bone deformities. She had sparse hair, a recession of the fronto-temporal hairline, and unusually thick eyebrows at the medial and abnormal sparseness of the lateral margins. Physical examination of the limbs revealed short fingers and toes with proximal interphalangeal (PIP) ulnar deviation of the second and third fingers in both hands. Shortness of the fourth fingers, especially in the right hand, and the swelling of the PIP joints of both hands were prominent. Genetic analysis showed deletion mutation in the TRPS1 gene in chromosome 8q24 compatible with TRPS1. Conclusions: Several symptoms and signs, including distinctive craniofacial features and ectodermal and skeletal abnormalities, are used for proper TRPS diagnosis. A correct and on-time diagnosis is essential to perform supportive care for the patient to prevent morbidities. Bone lesions, such as NOF1, can also be presented in TRPS1 patients and may be correlated with TRPS1 mutation. Further investigations are required on the association of the TRPS gene with NOF bone lesions.

Suture Tape Augmentation for the Repair of Index Finger Radial Collateral Ligament Injury: A Biomechanical Study

Despite their clinical importance in maintaining the stability of the pinch mechanism, injuries of the radial collateral ligament (RCL) of the index finger may be underrecognized and underreported. The purpose of this biomechanical study was to compare the repair of index finger RCL tears with either a standard suture anchor or suture tape augmentation. The index fingers from 24 fresh-frozen human cadavers underwent repair of torn RCLs using either a standard suture anchor or suture tape augmentation. Following the repairs, the initial displacement of the repair with a 3-N ulnar deviating load was evaluated. Next, the change in displacement (cyclic deformation) of the repair after 1,000 cycles of 3 N of ulnar deviating force was calculated (displacement of the 1000th cycle- displacement of the first cycle). Finally, the amount of force required to cause clinical failure (30° ulnar deviation) of the repair was determined. Suture tape augmentation repairs displayed significantly less cyclic deformation (0.8± 0.5 mm) after cyclic loading than suture anchor repairs (1.8 ± 0.7 mm). There was no significant difference in the force required to cause the clinical failure of the repairs between the suture tape (35.1 ± 18.1 N) and suture anchor (24.5 ± 9.2 N) repairs. Index finger RCL repair with suture tape augmentation results in decreased deformation with repetitive motion compared with RCL repair alone. Suture tape augmentation may allow for early mobilization following index finger RCL repair by acting as a brace that protects the repaired ligament from deforming forces.

A Young Man With Acute-Onset Bilateral Arm Weakness After Traumatic Sciatic Neuropathy: A Clinical Vignette.

A Young Man With Acute-Onset Bilateral Arm Weakness After Traumatic Sciatic Neuropathy: A Clinical Vignette.

An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study

PurposeFollowing surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises MethodsThirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. ResultsPurposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. ConclusionsROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.