Unaffected Hand Research Articles

Left–Right Interaction during Anticipatory Motor Adjustment

The interaction of anticipatory and reflexive changes in the grip force of the right hand was tested for the effect on the grip force developed by the thumb and index finger of the left hand. The test task for the right hand was the same in all test variants, to hold a cup where a weight fell (with the thumb and index finger). Three different tasks were chosen for the left hand. In the first task, the left fingers touched a sensor with a negligible grip force. In the second task, the subject had to hold a force sensor loaded with a 200-g load. In the third task, the subject was instructed to slowly increase the grip force by fingers of both hands. In response to the impact of the falling weight, an involuntary increase was observed in the grip force of the right-hand fingers, depending on the available visual information of the falling weight and being independent of the motor task performed by left hand. When the subject’s eyes were closed, the grip force increased in all tasks as a response to the impact of the weight fall. When the subject’s eyes were open, an automatic increase in the right-hand grip force occurred 200–300 ms before the impact. The left-hand grip force changed in different ways. In the first and second tasks, the grip force of the left hand did not change despite the changes in the grip force of the right hand in response to the impact of the falling weight. In case of a coordinated slow increase in the grip forces of both hands, an increase in the grip force was observed in the unaffected left hand before the impact and during the response to the impact, like in the right hand. Thus, a common motor task for both hands led to similar changes in grip force, which were recorded in both right and left hands not only during the response to an external stimulus, but also during anticipation. Movement planning was assumed to involve the organization of left–right interaction at the supraspinal level, probably, at the level of motor cortex interactions between the left and right hemispheres.

Effect of Decreased Skeletal Muscle Index and Hand Grip Strength on Functional Recovery in Subacute Ambulatory Stroke Patients.

ObjectiveTo investigate the effect of decreased Skeletal Muscle Index (SMI) and hand grip strength on functional recovery in subacute ambulatory stroke patients.MethodsSubacute stroke patients who were referred to the rehabilitation center were recruited. Decreased SMI and hand grip strength were diagnosed according to the Asian Working Group on Sarcopenia. Diagnostic criteria were decreased SMI and decreased unaffected hand grip strength. SMI was measured by bioelectrical impedance analysis. Unaffected hand grip strength was measured with a hand dynamometer. Patients were divided into two groups, decreased group (DG) and not-decreased group (NDG), according to the presence of decreased SMI and hand grip strength. Both groups received conventional stroke rehabilitation for 3 weeks. All patients were evaluated at the baseline and at 3 weeks after treatment. Functional status was evaluated with 4-meter walk test (4MWT), 6-minute walk test (6MWT), Timed Up and Go test (TUG), and Modified Barthel Index (MBI).ResultsBoth groups showed improvement in 4MWT, TUG, and MBI. NDG showed improvement in 6MWT. Comparing improvements between the two groups, NDG showed more improvement in 6MWT and TUG than DG.ConclusionThe presence of decreased SMI and hand grip strength had negative effects on functional recovery in subacute ambulatory stroke patients.

Mirror feedback assisted recovery from hemiparesis following stroke. In Reply to Morkisch et al.: How to perform mirror therapy after stroke? Evidence from a meta-analysis

1 out of 6 people worldwide will have suffered a stroke in their lifetime, 1/3rd of whom will die. Of the 2/3rd who survive, half will be permanently disabled (World Stroke Organization). Given these alarming statistics, it's not surprising that tremendous of amounts of time, resources and funding have been devoted towards research into stroke rehab. In view of this, simple, easy-to-implement procedures are highly sought after. One such procedure is the use of visual feedback conveyed by a mirror, which seems to reactivate some dormant pathways in patients who have suffered a recent stroke (Altschuler etal., 1999; Ramachandran & Altschuler, 2009). This procedure has been validated in several dozen clinical trials, of which a substantial number were conducted rigorously. Morkisch etal. (2019) now present a systematic review and meta-analysis of this dense literature pertaining to this topic. They conclude that "there is a high level evidence for mirror therapy's effectiveness in treating post-stroke hemiparesis". A novel conclusion that emerged from this meta-analysis was that the larger the mirror the more effective the treatment is. Additionally, if an object is manipulated by the normal hand and its reflection viewed in the mirror, the procedure is not as effective, possibly because the discrepancy of signals between the visual feedback (reflection of the object) and the lack of confirmatory somatosensory input from the affected limb leads to inhibition rather than synergy. Lastly, for reasons yet unclear, sending movement commands to the unaffected hand alone (unilateral) is more effective than sending bilateral commands, contrary to the original protocol.Taken collectively, research in this field has two implications - First, the immediate practical utility in the clinic by optimizing mirror therapy's efficacy for hemiparesis after stroke. Second, it leads to a rejection of the model of the brain as made up of isolated, autonomous modules, towards a more dynamic picture, in which the brain is composed of a fluctuating mosaic of neural activity as it adapts to changing sensory inputs. Therefore, dysfunction results not from 'punch out a module - lose a function', but by shifts in equilibria, which can be corrected, perhaps, by hitting a reset button. Even if this turns out to be true for a minority of syndromes, it will be well worth the effort.

Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome.

It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to “restore” somatotopic representations to treat pain.SIGNIFICANCE STATEMENT This study shows that the spatial map of the fingers in somatosensory cortex is largely preserved in chronic complex regional pain syndrome (CRPS). These findings challenge the treatment rationale for restoring somatotopic representations in complex regional pain syndrome patients.

Phantom touch: How to unmask sensory unawareness after stroke

Comprehending the nature of tactile disorders following brain damage is crucial to understand how the brain constructs sensory awareness. Stroke patients may be unaware of being touched on the affected hand if, simultaneously, they are touched on the unaffected hand (i.e., tactile extinction). More rarely, they feel touches on the two hands, when they are solely touched on the unaffected hand (i.e., synchiria). Using a novel assessment tool, we investigated whether in stroke patients with apparent intact tactile awareness on standard evaluation, tactile extinction might be possibly masked by phantom (synchiric) sensations (i.e., elicited by ipsilesional stimulation) arising exclusively during Double Simultaneous Stimulation (DSS). Patients with right (n = 17) and left (n = 8) hemisphere lesions and age-matched healthy controls (n = 13) were tested with the Tactile Quadrant Stimulation test, consisting in delivering unilateral or bilateral touches to one of four quadrants, identified on the participants' hands. In DSS trials, stimuli were applied to asymmetric quadrants. Participants reported the side(s) and then pointed to the site(s) of stimulation. We found that, with the exception of one patient who showed tactile extinction, about 50% of patients with overall intact tactile perception on classical evaluation, although reporting two stimuli in DSS, failed in pointing to the correct contralesional stimulated site. They reported the felt sensation in positions that corresponded to the ipsilesional stimulated sites. Thus apparent detections of contralesional touches in DSS were accounted for by ‘phantom’ sensations of ipsilesional stimulation that masked unawareness of contralesional touches when classic assessment was applied. Preliminary lesion analyses indicate that the symptom was associated with damage to structures often affected in tactile extinction. These findings, while unveiling important underestimation of the patients' neurological condition, provide a framework for investigating bihemispheric contributions to altered tactile perception following stroke.

Brain-Computer Interface Channel-Selection Strategy Based on Analysis of Event-Related Desynchronization Topography in Stroke Patients.

In the last decade, technology-assisted stroke rehabilitation has been the focus of research. Electroencephalogram- (EEG-) based brain-computer interface (BCI) has a great potential for motor rehabilitation in stroke patients since the closed loop between motor intention and the actual movement established by BCI can stimulate the neural pathways of motor control. Due to the deficits in the brain, motor intention expression may shift to other brain regions during and even after neural reorganization. The objective of this paper was to study the event-related desynchronization (ERD) topography during motor attempt tasks of the paretic hand in stroke patients and compare the classification performance using different channel-selection strategies in EEG-based BCI. Fifteen stroke patients were recruited in this study. A cue-based experimental paradigm was applied in the experiment, in which each patient was required to open the palm of the paretic or the unaffected hand. EEG was recorded and analyzed to measure the motor intention and indicate the activated brain regions. Support vector machine (SVM) combined with common spatial pattern (CSP) algorithm was used to calculate the offline classification accuracy between the motor attempt of the paretic hand and the resting state applying different channel-selection strategies. Results showed individualized ERD topography during the motor attempt of the paretic hand due to the deficits caused by stroke. Statistical analysis showed a significant increase in the classification accuracy by analyzing the channels showing ERD than analyzing the channels from the contralateral sensorimotor cortex (SM1). The results indicated that for stroke patients whose affected motor cortex is extensively damaged, the compensated brain regions should be considered for implementing EEG-based BCI for motor rehabilitation as the closed loop between the altered activated brain regions and the paretic hand can be stimulated more accurately using the individualized channel-selection strategy.

Pilot study: Differences in echo intensity ratios between ulnar and median innervated muscles in ulnar neuropathy.

This study evaluated muscle echo intensity (EI) ratio in patients with ulnar neuropathy at the elbow (UNE) and healthy controls. In this prospective study, 28 patients with electrodiagnostically confirmed unilateral UNE and 12 healthy controls were ultrasonographically assessed for EI ratios of the hypothenar and thenar muscles. The affected and unaffected hands between the UNE patients and controls and patient subgroups (subdivided according to electrodiagnostic severity) were compared to determine any significant differences. In patients with UNE, the EI ratio of the hypothenar to thenar muscles was significantly higher for the affected side than for the unaffected side (1.08 ± 0.11 and 0.97 ± 0.18, respectively) or the control group (0.95 ± 0.05). A significant difference in the EI ratio was observed among the subgroups (mild vs. severe subgroup, P < 0.01). Ultrasonographic EI measurement may be a useful parameter in the evaluation and screening of UNE.

P67-T The value of Sympathetic Skin Response in diagnosing Complex Regional Pain Syndrome

CPRS is a highly painful disorder affecting a limb, usually following traumatic injury. The syndrome includes continuous pain, inflammation and tissue hypoxia, sympathetic dysregulation, small fibre damage, serum antibodies, central sensitization and cortical reorganization. The diagnosis is clinical and can be supported by complementary bone scintigraphy and thermography. Our purpose is to evaluate the role of Sympathetic Skin Response (SSR) in diagnosing CPRS. A prospective and descriptive study was carried out with 51 patients in initial stages of CPRS. SSR was measured in affected and unaffected hands or feet after 3 stimuli applied to contralateral median or posterior tibial nerves. Values were considered abnormal when peak to peak amplitude response was >50% compared to contralateral extremity. Thermal sensory and pain thresholds were also evaluated. Clinical symptoms and signs were recorded: continuous pain, allodynia, changes in thermoalgesic sensitivity, hyperalgesia, inflammation, swelling and limb dysfunction. We studied the correlation between clinical signs and SSR changes. Mobility impairment was found in 78% of patients, followed by swelling (68%), sweating (37%) and allodynia (24%). SSR was abnormal in 49% of patients, who presented a significant correlation between abnormal SSR response, swelling, thermal sensory thresholds and temperature changes (p < 0.05). SSR can be a useful tool for CPRS diagnosis. It may be used as a means of documenting sympathetic dysfunction and help in treatment decision management as it assists in the clarification of the many controversies regarding the cause of CPRS, which remains unknown.

Management of boxers fracture with single antegrade bent K-wire

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of the neck of fifth metacarpal are commonly encountered in orthopaedic practice. Management of these fractures is a debatable topic with treatment varying from conservative management to surgical fixation. In our study we used a pre-bent k wire in antegrade fashion to achieve fracture fixation. We found that pre-bent K wire provides an excellent reduction with good correction of neck shaft angle and good restoration of movements at the metcarpo-phalyngeal and inter-phalyngeal joints. Pre-bent K wire provides an efficient and economical modality of fixation in fracture neck of fifth metacarpal fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All patients presenting with fracture neck of fifth metacarpal were managed by pre-bent K wire in antegrade fashion by a single surgeon using a single prebent K wire.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the fractures involved the dominant hand (16 right and 6 left). The mean duration of surgery was 24 mins. Intra operatively the mean no of X ray shoots were 12. At the end of the follow-up there was no significant difference in the TAM in the affected and the unaffected hand. The p=0.17. The mean DASH at the end of the follow up was 2.42. The mean fracture healing time was 45 days.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Boxers fracture is very common fracture type in young active adults. Conservative management is usually associated with shorting and angular deformities. Percutenous fixation of the fracture with bent K wire placed in antegrade fashion provides good stability at the fracture site.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

The Functionality of the Bio-Mechanical Prosthetic Finger When Compared With Results on Standardized and Functional Assessments: A Single-Case Study

ABSTRACT Introduction The purpose of this study was to examine the functionality of the bio-mechanical prosthetic finger (BPF). The researchers administered various assessments to examine how the BPF performed in comparison with the affected hand without the BPF, as well as the unaffected hand. Materials and Methods A single subject participant with amputations at the proximal phalanx of the third and fourth digits was recruited for this study. The subject was assessed without a prosthetic device and while wearing a BPF on each digit. The researchers also assessed the uninvolved hand for comparison. The following standardized assessments were administered: Minnesota Manual Dexterity Test, Jamar Hand Function Test, and Box and Blocks Test. Two qualitative questionnaires and The Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire were also administered to examine the participant's abilities and satisfaction with and without the prosthetic device. Results The results were analyzed to assess the difference in performance with and without the prosthetic device as compared with the unaffected side. The results indicated that the participant performed at a higher level on all assessments while using the BPF. In addition, the participant reported a higher level of comfort and satisfaction while using the prosthesis. Conclusions The results of the study showed that the BPF is a viable option for digit amputations to restore function in daily tasks.

A Tablet-Based Tool for Accurate Measurement of Hand Proprioception After Stroke.

Proprioceptive deficits in the hand are common following stroke, but current clinical measurement techniques are too imprecise to detect subtle impairments or small changes. We developed a tablet-based tool to measure static hand proprioception using an adaptive staircase procedure. In 16 individuals with chronic stroke and age-matched controls, we quantified proprioception at the metacarpophalangeal joint of the index finger using 3 methods: the tablet task, a custom passive movement direction discrimination test (PMDD), and a manual assessment similar to the Fugl-Meyer (F-M) proprioception subsection. The tablet-based measure and the PMDD both identified impaired proprioception in the affected hand relative to the unaffected hand (P = 0.024 and 0.028), and relative to the control group (P = 0.040 and 0.032), while manual assessment did not. The PMDD had a ceiling effect as movement excursions greater than 15 were not biomechanically feasible. The tablet-based measure and the PMDD detected impaired proprioception in 56% to 75%, and the F-M in only 29%, of patients. PMDD and tablet-based measures were both correlated with primary tactile sensation, but not manual dexterity. Both the tablet-based tool and the custom PMDD performed better than manual assessment. The PMDD may be useful when the deficit is mild or assessment of dynamic proprioception is desired. As the tablet-based measure does not have the ceiling effect that is associated with the PMDD, it may be useful with any level of proprioceptive impairment, and may be preferable if testing or clinician training time needs to be minimized, or pain or spasticity is present.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A256).

Manual function of the unaffected upper extremity can affect functional outcome after stroke.

Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P<0.0001) and total FIM score (P<0.0001). Our findings suggests that initial MFT score of the nonparetic side has a significant correlation with functional outcome. Therefore, it is important to conduct MFT on the nonparetic side as well as the paretic side. Furthermore, it is necessary to undergo rehabilitation therapy on the nonparetic side.

Outcomes of Secondary Combined Proximal Interphalangeal Joint Release and Zone II Flexor Tenolysis.

Background: Tendon adhesions and capsular contractures following trauma to the proximal interphalangeal joint (PIPJ) may significantly reduce hand function. Traditional, staged surgical management prioritizes restoration of PIPJ passive range of motion with joint release prior to restoration of active range of motion (AROM) with tenolysis. This is expensive and burdensome for patients. Our objective was to evaluate functional outcomes of combined PIPJ release and zone II flexor tenolysis. Methods: We retrospectively reviewed patients who underwent combined PIPJ release and flexor tenolysis. Replantation and tendon graft cases were excluded. Data were collected on pre- and postoperative AROM, total active motion (TAM), tip to distal palmar crease (DPC) distance, and grip strength. Functional outcomes were graded using the Boyes, American Society for Surgery of the Hand, and modified Strickland scores. Results: Twelve patients (9 men and 3 women, median age = 40 years) with a total of 15 digits underwent combined PIPJ release and flexor tenolysis a median of 10.1 months after injury. At a median follow-up of 4.0 months, there were significant improvements in median PIPJ AROM (15° to 70°), TAM (105° to 223°), tip to DPC distance (6.0 to 2.0 cm), and grip strength (35% to 54% of unaffected hand). Modified Strickland score was good in 46% of digits and excellent in 38%. There were no tendon ruptures, surgical site infections, or devascularized digits. Conclusion: Proximal interphalangeal joint stiffness is a challenging complication of hand trauma. Although a complete return to premorbid range of motion and function is rarely attained with surgery, improved outcomes may be consistently achieved with secondary combined PIPJ release and zone II flexor tenolysis.

Association of Modifiable Risk Factors with Bone Mineral Density among People with Distal Radius Fracture: A Cross-Sectional Study.

Purpose: This study determined the extent to which modifiable risk factors (balance, muscle strength, and physical activity [PA]) explained variability in bone mineral density (BMD) among people with a recent distal radius fracture (DRF). Method: This cross-sectional study included 190 patients, aged 50-80 years, with a DRF. Participants were assessed for balance, muscle strength, PA, fracture-specific pain, and disability. Areal BMD at the femoral neck (BMD-FN) and total hip (BMD-TH) was assessed. Correlation and multiple linear regression was used to determine the contribution of modifiable risk factors to BMD. Results: Balance, handgrip strength, knee extension strength, and plantar-flexion strength had significant bivariate associations with BMD-FN. There was a weak to moderate correlation (r = 0.25-0.40; p < 0.05) of balance and grip strength with BMD. Grip strength independently (p < 0.05) explained 17% and 12% of the variability in BMD-FN (n = 81) and BMD-TH (n = 82), respectively. Stratified by age, balance (R 2 = 0.10; p = 0.04) and grip strength (R 2 = 0.32; p = 0.003) were independent significant predictors of BMD-FN among women aged 50-64 years and 65-80 years, respectively. Conclusions: Grip strength of the unaffected hand is independently associated with BMD-FN and BMD-TH in people with recent DRF. It may act as a surrogate for general bone health, frailty, or overall muscle strength rather than as a direct target for intervention.

Results of wrist hemiarthroplasty for comminuted distal radius fractures in independent elderly people: A retrospective study on eleven patients

The comminuted distal radius fractures among elderly people are usually linked to osteoporosis, and repairing them in this context is a therapeutical challenge. Several teams have reported good results of radius resurfacing. The goal of our study was to evaluate the usability of the wrist in a new series of patients after surgery. We performed a monocentric retrospective study on the data of the medical files. All the included patients were older than 65 years and received a wrist hemiarthroplasty according to the criteria that have been established by the in charge medical team. Eleven patients have been included, their average age was 80.4 years old, and the average follow-up was 18.3 months. The average QuickDASH Score was 59 (27–95). The Visual Analogue Scale for pain was in average 3.8/10 and the average mobility was: flexion 36° (12–50), extension 27° (12–50), radial deviation 15° (12–15), ulnar deviation 26° (12–40), pronation-supination range of motion 164° (150–170). The average measured strength was 44% (16–72%) of the strength of the unaffected hand. Our results are rather modest, probably because of insufficient follow-up and very severe fractures. Furthermore, the implant that has been used does not take into account the distal radioulnar joint. Another bound of this treatment is the complexity of surgical revision in case of bad result. So far, hemiarthroplasty cannot be considered as the standard treatment for complex fractures of the distal radius.

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization.

We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity. This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population-based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0-5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t-tests, Pearson rank correlation coefficients). Ninety-two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4-17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=-0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=-0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001). Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation. Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a 'directionality factor' to mirror movements highlights additional, clinically relevant functional correlations.

Rapid-paired associative stimulation induces changes in the excitability profile of unaffected hand muscles in patients with idiopathic dystonia

Rapid-paired associative stimulation induces changes in the excitability profile of unaffected hand muscles in patients with idiopathic dystonia

Therapeutic management of closed central slip injuries: Outcome of a service evaluation

Introduction Closed central slip injuries can be difficult to manage and there is a lack of published research to support evidence-based clinical decision making in practice. This article presents the results of a service review in a busy trauma hospital hand therapy department. Method Following a literature review and retrospective review of outcomes, new clinical guidelines for central slip injuries were developed. These were implemented with 22 patients referred to hand therapy for conservative management of closed central slip injuries during a one-year period. Results The majority of patients (72%) had either an excellent or good outcome using the Strickland-Glogovac outcome measure and an average total active motion of 90% compared to their unaffected hand. Conclusions The outcomes following implementation of new treatment guidelines following the service review are in line with the small amount of published data currently available. They provide detailed guidelines for the conservative management of closed central slip injuries in a busy out-patient setting.

Prognostic Factors for Nonsurgically Treated Sagittal Band Injuries of the Metacarpophalangeal Joint

The aim of this study was to evaluate the factors that influence the prognosis for patients with sagittal band injuries who were treated nonsurgically. A total of 94 patients who had been diagnosed with traumatic sagittal band injury and initially treated with 7 weeks of metacarpophalangeal (MCP) joint extension orthosis wear (5 weeks of full-time followed by 2 weeks of part-time use) were studied. The response to treatment, including finger range of motion (ROM), extensor tendon instability, grip strength, and functional outcome measured as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score were assessed at 24-week follow-up. The factors that were assessed for their influence on the outcomes were age, sex, occupation, hand dominance, type of injury, injury severity, time to treatment, and the duration of orthosis wear. Potential predictor variables in bivariate analyses were entered into multivariable analyses to determine prognostic indicators of the outcomes. After 24 weeks' follow-up, 67 patients (71%) achieved resolution of symptomatic tendon translocation with 83% of grip strength and 90% of ROM compared with the unaffected hand. The final mean QuickDASH scores was 15. Twenty-seven patients (29%) had persistently symptomatic tendon subluxation, and of those, 18 (19%) underwent surgical repair. There were significantly more manual laborers in the failure group than in the success group. Subjects in the treatment failure group were older, had longer symptom durations, and were more likely to have grade III injuries than were those in the success group. Multivariable analysis revealed that manual labor, longer symptom duration, and grade III injury were associated with a higher likelihood of treatment failure. An MCP extension orthosis for sagittal band injury (5 weeks of full-time followed by 2 weeks of part-time use) led to mostly satisfactory results with 71% of patients achieving resolution of symptomatic tendon translocation, but manual labor, longer symptom duration, and grade III injury were associated with a higher likelihood of treatment failure. Prognostic IV.

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidenceLevel IV, Therapeutic study.