Upper-extremity Score Research Articles

Abstract TP105: Non-invasive Brain Stimulation Alters Resting-State Brain Activity in Ischemic Stroke

Stroke is the leading cause of serious long-term disability in the United States. Stroke recovery is greatly varied since the long term effect is determined by the site and size of the initial lesion. Specifically, post stroke motor impairments occur due to damage to the corticospinal tract and maladaptive upregulation of the cortico-reticulospinal tract. Transcranial direct current stimulation (tDCS) may be an effective treatment for stroke rehabilitation. However, conventional tDCS is limited by spatial resolution to precisely target a specific brain region. To improve its spatial resolution, this study used targeted high-definition tDCS (HD-tDCS) navigated by paired-pulse transcranial magnetic stimulation. In a double-blind randomized crossover study, stroke participants (n=12) had three visits 1) anodal HD-tDCS stimulation of the arm region of the primary motor cortex (M1) to improve function of the corticospinal tract in the lesioned hemisphere, 2) cathodal stimulation of the arm region of the dorsal premotor (PM) cortex to inhibit maladaptive use of the cortico-reticulospinal tract in the contralesional hemisphere, and 3) sham. The effect was measured by quantitative electroencephalogram (qEEG) metrics delta alpha ratio (DAR) and delta theta alpha beta ratio (DTABR), calculated from a pre and post 3-minute EEG. Acute changes in brain activity of these power bands have been associated with the severity of motor impairment post stroke. The results demonstrate that anodal (p=0.026) and cathodal (p=0.0108) stimulation significantly decreased the DAR compared to the sham. The reducation of DAR value is associated with the improvement of Fugl-Meyer Upper Extremity score. However, there were no significant differences found in the DTABR. These results indicate that both anodal and cathodal HD-tDCS may improve brain function following stimulation. However, future work is required on the use of qEEG metrics and its use as a marker of stroke recovery. This work is important as qEEG could be used as a more objective method, compared to clinical assessments, to track stroke rehabilitation.

Adolescent Coronal Shear Fractures of the Distal Humerus: Surgical Approach and Outcomes.

Isolated coronal shear fractures of the distal humerus in adolescents are rare injuries with unique surgical challenges. Respect for the posterior blood supply, open physes, and need for direct visualization to achieve anatomic reduction are critical considerations in surgical fixation. This study presents a case series and a surgical approach used in treating these patients. A retrospective review of patients aged 10-19 presenting to a single quaternary-care academic center from 2016 to 2023 with isolated capitellar and trochlear shear fractures was performed. Demographic data, injury mechanism, fracture classification, and surgical approach were recorded. Outcomes included elbow range of motion at the final follow-up, visual analogue scale pain scores, pediatric Patient-Reported Outcome Measurement Information System (PROMIS) scales, radiographic and clinical union, return to sport, and postoperative complications. Eight patients were included, four of whom were treated through a single-incision anterolateral approach. Average age was 13 years. Average time of the final clinical follow-up was 21 months, with a radiographic follow-up of 11 months. Five fractures were classified as Dubberly type 2A, two as type 3A, and one as type 3B. At the final follow-up, average elbow range of motion and visual analogue scale pain scores were 3-137 degrees and 0.28 (range: 0-2), respectively. PROMIS scores demonstrated an average mobility score of 55 (SD: 8), pain interference of 35 (SD: 5), and pediatric upper-extremity score of 55 (SD: 4). One patient with sickle cell disease developed avascular necrosis of the capitellum. There were no other postoperative complications. Short-term clinical outcomes reveal low pain scores, near normal elbow motion, radiographic and clinical union, and normal patient-reported outcome measures in operatively treated coronal shear fractures of the distal humerus in adolescent patients. A single-incision anterolateral approach offers visualization of the anterior articular surface while respecting posterior soft tissues and the olecranon apophysis. Therapeutic V, case series.

Effect of Virtual Reality-Based Training on Upper Limb Dysfunction during Post-Stroke Rehabilitation: A Meta-Analysis Combined with Meta-Regression.

Recently, there has been a surge in virtual reality (VR)-based training for upper limb (UL) rehabilitation, which has yielded mixed results. Therefore, we aimed to explore the effects of conventional therapy combined with VR-based training on UL dysfunction during post-stroke rehabilitation. Studies published in English before May 2023 were retrieved from PubMed, Embase, and the Cochrane Library. We also included randomized controlled trials that compared the use of conventional therapy and VR-based training with conventional therapy alone in post-stroke rehabilitation. The meta-analysis was performed using Review Manager Software (version 5.3; The Nordic Cochrane Centre, The Cochrane Collaboration; Copenhagen, Denmark) and Stata/MP 17.0 (StataCorp, LLC, College Station, TX, USA). Univariate and multivariate meta-regression analyses were performed to investigate the effects of stroke duration, VR characteristics, and type of conventional therapy on VR-based training. In total, 27 randomized controlled trials were included, which enrolled 1354 patients. Our results showed that conventional therapy plus VR-based training is better than conventional therapy alone in UL motor impairment recovery measured using Fugl-Meyer Upper Extremity (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI]: 0.07-0.57, Z = 2.52, p = 0.01). Meta-regression showed that stroke duration had independent effects on Fugl-Meyer Upper Extremity scores of VR-based training in rehabilitation (p = 0.041). Furthermore, in subgroup analysis based on stroke duration, stroke duration >6 months was statistically significant (SMD = 0.20, 95% CI: 0.01-0.39, Z = 2.06, p = 0.04). No relevant publication bias (p = 0.1303), and no significant difference in activity limitation assessed using the Box-Block Test (mean difference [MD] = 2.79, 95% CI: -0.63-6.20, Z = 1.60, p = 0.11) was observed. Regarding the functional independence measured using the Functional Independence Measure scale, studies presented no significant difference between the experimental and control groups (MD = 1.15, 95% CI: -1.84-4.14, Z = 0.76, p = 0.45). Conventional therapy plus VR-based training is superior to conventional therapy alone in promoting the recovery of UL motor function after stroke. Therefore, VR-based training may be a potential option for improving UL motor function. The study was registered on PROSPERO (https://www.crd.york.ac.uk/prospero/), registration number: CRD42023472709.

Lower socioeconomic status is correlated with worse outcomes after arthroscopic rotator cuff repair

BackgroundSocioeconomic status has been recognized as a crucial social determinant of health influencing patient outcomes. Area Deprivation Index (ADI) is a validated measure of an area’s socioeconomic status. Limited data exists on the impact of ADI and clinical outcomes and complications following rotator cuff repair (RCR). The purpose of this study was to investigate the impact socioeconomic factors have on outcomes following primary arthroscopic RCR.MethodsThis is a retrospective cohort study with 1-year follow-up. Patients who underwent primary rotator cuff repair at a single institution from March 2014 to September 2022 were identified. Patient demographics, pre-and post-operative visual analog scale (VAS) scores, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, range of motion, complications, and subsequent ipsilateral shoulder surgeries were collected. ADI was collected from an online mapping database using each patient’s home address. Patients were split into ADI terciles, with ADI1 representing the least disadvantaged group and ADI3 representing the most disadvantaged group. Analysis of variance and T-test were used for continuous variables, and chi-square analyses were conducted for categorical variables.ResultsIn total, 467 patients underwent RCR and had complete demographic data and postoperative follow-ups over a year. There was a significant difference in race, with 78.2% of patients identifying as black in ADI3 and 18.1% in ADI1 (P < .001). Pre-operative PROMIS-Pain Interference, VAS, forward flexion, and abduction were significantly worse in ADI3 compared to ADI1 (P = .001, P < .001, P = .012, and P = .023). At one-year postoperative, patients in ADI3 scored significantly worse than patients in ADI1 in PROMIS- Upper Extremity score (P = .016), PROMIS- Pain Interference (P < .001), VAS (P < .001), forward flexion (P < .001) and abduction (P = .034). Higher ADI scores were associated with a positive correlation for pain (r = .258, P = < 0.001) a negative correlation with upper extremity function (r = − .233, P = .026), a positive correlation with pain interference (r = .355, P < .001), and negative correlation with forward flexion (r = − .227, P < .001). There were no significant differences in postoperative complications (P = .54), retears (P = .47), or reoperations rates (P = .22).ConclusionLower socioeconomic status measured by ADI is associated with worse preoperative and 1-year postoperative pain, shoulder function, and range of motion following RCR. However, no differences were appreciated between cohorts regarding reoperation or complications.Level of Evidence IIIRetrospective Cohort Study.

Association that Neuroimaging and Clinical Measures Have with Change in Arm Impairment in a Phase 3 Stroke Recovery Trial.

Vagus nerve stimulation (VNS) paired with rehabilitation therapy improved motor status compared to rehabilitation alone in the phase III VNS-REHAB stroke trial, but treatment response was variable and not associated with any clinical measures acquired at baseline, such as age or side of paresis. We hypothesized that neuroimaging measures would be associated with treatment-related gains, examining performance of regional injury measures versus global brain health measures in parallel with clinical measures. Baseline magnetic resonance imaging (MRI) scans in the VNS-REHAB trial were used to derive regional injury measures (extent of injury to corticospinal tract, the primary regional measure; plus extent of injury to precentral gyrus and postcentral gyrus; lesion volume; and lesion topography) and global brain health measures (degree of white matter hyperintensities, the primary global brain measure; plus volumes of cerebrospinal fluid, cortical gray matter, white matter, each thalamus, and total brain). Eight clinical measures assessed at baseline were also evaluated (treatment group, age, race, gender, paretic side, pre-stroke dominant hand, time since stroke, and baseline Fugl-Meyer upper extremity score). Bivariate analyses compared each measure with the primary trial end point (change in Fugl-Meyer upper extremity score from baseline to end of 6 weeks of treatment) across all subjects, with secondary analyses examining trial groups separately. MRIs were available from 80 patients (age = 59.8 ± 9.5 years, 29 women). Across all patients, less white matter hyperintensities (r = -0.25, p = 0.028) at baseline was associated with larger Fugl-Meyer score change. In the VNS group, less white matter hyperintensities (r = -0.37, p = 0.018) and larger ipsilesional thalamus volume (r = 0.33, p = 0.046) were each associated with larger Fugl-Meyer score change. Analysis of covariance (ANCOVA) analyses tested the interaction that each baseline measure had with treatment group and found that the model examining white matter hyperintensities had a significant interaction term, indicating 2.3 less change in Fugl-Meyer Upper Extremity (FM-UE) points in the VNS group relative to the control group for each point increase in modified Fazekas scale. Neuroimaging measures are associated with extent of gains on the primary endpoint of a phase III stroke recovery trial. Among the neuroimaging measures examined, a measure of global brain health (extent of white matter hyperintensities) was better at explaining the change in arm impairment as compared with measures of regional injury; this was true when examining all study subjects as well as only those in the VNS group and is consistent with the global mechanism of action that VNS has throughout the cerebrum. Future studies can evaluate additional measures that further predict response to VNS therapy. The current findings suggest that individual patient neuroimaging results may be useful for a personalized medicine approach to stroke recovery therapeutics. ANN NEUROL 2024.

Hand Burn Injuries and Occupational Impairment: A Study on the Impact of Burn Injuries on Return-to-Work Outcomes from the Burn Model System research program.

Return to work (RTW) after burn injury is dependent on many variables, including type and location of burn injury, access to care, and pre-injury mental and physical health. Noting that prior studies were limited by small sample sizes, we aimed to use a large database to explore the associations between hand burn severity, functional hand outcomes, and RTW post-injury. Data from a multicenter longitudinal study were analyzed. Adults with burn injuries were classified into 6 groups ranking in severity of hand injury: (0) no hand burns, (1) single hand burn no grafting, (2) bilateral hand burn no grafting, (3) single hand burn requiring grafting, (4) bilateral hand burn requiring unilateral graft, (5) bilateral hand burn requiring bilateral grafts. Grafting was used as a proxy for burn severity. Self-reported employment status, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) scores and reported request for work accommodations were collected at discharge, 6-, 12-, and 24-months post-injury. Descriptive statistics and analysis of variance (ANOVA) with post-hoc Tukey Test were completed to examine differences in outcomes by hand injury severity. A total of 4,621 participants met inclusion criteria. Group 5, those with most severe burns, had significantly longer RTW times than Groups 0-3 (p< 0.005). Group 5's (bilateral burn/unilateral graft) average RTW was greater, however not significantly, compared to group 4. At 6 months, the mean PROMIS UE scores for grafted groups (Group 3, 40.6; Group 5, 35.4) were significantly worse than non-grafted groups (Group 1, 46.8; Group 2, 45.0; (p< 0.0001). At 12 and 24 months, mean PROMIS UE scores were worse for grafted groups, though differences were no longer significant compared to non-grafted groups. At every time point, the majority of respondents did not request accommodations for their injuries from their employers, regardless of severity. Burn severity plays a significant role in both RTW and hand function for participants with hand burns. Additionally, the lack of correlation between burn severity and request for work accommodations hints at the baseline vulnerability of these populations. These findings suggest a need for systematic improvements in the way these patients are cared for and re-integrated into the workforce.

Abstract 032: TOPSS: TOlerability of tDCS in Pediatric Stroke Survivors

Introduction Pediatric cerebrovascular disease is a leading cause of morbidity in children. Childhood‐onset stroke is defined as stroke occurring after the first month of life and accounts for about half of pediatric stroke. Most children with childhood‐onset stroke will survive to adulthood, but ~75% of those with childhood‐onset stroke experience long‐term neurologic impairments, including motor weakness and cognitive difficulties. Hemiparesis is a frequent complication of childhood‐onset stroke and is tremendously debilitating. Transcranial direct current stimulation (tDCS) is a promising and inexpensive non‐invasive neuromodulation technique that can be used to augment neuronal plasticity as an adjunctive rehabilitation therapy. Methods Participants with chronic hemiparesis from childhood‐onset ischemic or hemorrhagic stroke were prospectively enrolled in this study. All study participants received 5 sessions of tDCS lasting for 20 minutes each while engaging in 1‐on‐1 occupational therapy with a certified occupational therapist. tDCS sessions were followed by an additional 1 hour and 40 minutes of rehabilitation therapy focused on the impaired arm. The amplitude of stimulation was increased daily as follows: sham stimulation on day 1, 0.5mA on day 2, 1.0mA on day 3, 4, and 5. Participants aged 13‐19 years had stimulation further increased to 1.5mA on days 4 and 5. The primary objective measures were safety and tolerability which were assessed with percent study completion, participant tolerability questionnaires, and pre‐ and post‐ stimulation vital signs. Secondary outcome measures included arm function measured using the Fugl‐Meyer Assessment of the Upper Extremity (FMA‐UE) and box and blocks test. Satisfaction was measured using the Canadian Occupational Performance Measure (COPM). A data safety and monitoring board comprised of a pediatric neurologist and pediatric physiatrist reviewed all stimulation monitoring sheets. Results Five participants completed the study. Blood pressure and pulse measurements were within normal limits for all participants for all pre‐ and post‐therapy measurements. Participants reported itching sensations during 40% of tDCS sessions, with reports extinguishing within minutes after cessation of tDCS. The Fugl‐Meyer Assessment of the Upper Extremity is a functional scale with a score range of 0 (profound hemiplegia) to 66 (no impairment). An improvement of 5 points may be considered clinically significant. The median score was 35 at the pre‐therapy assessment, and improved to 42 at the 3 month follow up. 4 out of 5 participants had a clinically significant increase in the Fugl‐Meyer Assessment. Canadian Occupational Performance Measure performance score was 4 at baseline and improved to 6.4 at 3 month follow up. Conclusion tDCS was well‐tolerated in this pilot study of tDCS in participants with chronic hemiparesis from childhood‐onset stroke. There were no major adverse events, and the most common reported side effects were mild itching or tingling which did not limit participation. Fugl‐Meyer Assessment of the Upper Extremity scores improved an average of 7 points 3 months post therapy. Further research with larger, double‐blinded, sham controlled studies is needed. We will continue further research into the utility of tDCS for childhood‐onset stroke with a single center, double‐blinded, randomized controlled trial of tDCS vs sham with a goal enrollment of 20 participants.

Rates of Early Recovery Following Thumb Carpometacarpal Arthroplasty: Comparing Ligament Reconstruction and Tendon Interposition, Abductor Pollicis Longus Suspensionplasty, and Suture Button Suspensionplasty

Abstract Background Several techniques have been previously described for the treatment of thumb carpometacarpal (CMC) arthritis, including trapeziectomy with ligament reconstruction and tendon interposition (LRTI), abductor pollicis longus suspensionplasty (APLS), or suture button suspensionplasty (SBS). It remains unclear whether a specific method produces faster recovery and more rapid return to function. The purpose of this study was to evaluate early clinical outcomes in patients undergoing thumb CMC arthroplasty stratified by method of treatment. Methods This study was conducted using a registry of patients undergoing thumb CMC arthroplasty using LRTI, APLS, or SBS. Patients were grouped by technique for comparison. Patient-reported outcomes were measured using Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity, Pain Interference, and Pain Intensity scores and compared across cohorts using analysis of variance. Regression analysis was used to determine factors associated with early clinical outcomes. Results Note that 150 out of 201 patients met inclusion criteria for this study. Univariate regression demonstrated no difference between technique and achievement of minimal clinically important difference (MCID) by 1 year or ∆PROMIS scores at 1 and 3 months postoperatively. Stepwise multivariate regression analysis also found that technique did not contribute significantly to postoperative outcomes. Increased baseline PROMIS Upper Extremity scores were associated with lower odds of achieving MCID (odds ratio 0.80, p &lt; 0.001). Baseline PROMIS scores were also associated with ∆PROMIS scores at 1 and 3 months postoperatively. Conclusion Patients undergoing thumb CMC arthroplasty via LRTI, APLS, or SBS can expect to experience similar improvements from baseline in the early postoperative period regardless of technique choice.

Mapping individual cortico-basal ganglia-thalamo-cortical circuits integrating structural and functional connectome: implications for upper limb motor impairment poststroke.

This study investigated alterations in functional connectivity (FC) within cortico-basal ganglia-thalamo-cortical (CBTC) circuits and identified critical connections influencing poststroke motor recovery, offering insights into optimizing brain modulation strategies to address the limitations of traditional single-target stimulation. We delineated individual-specific parallel loops of CBTC through probabilistic tracking and voxel connectivity profiles-based segmentation and calculated FC values in poststroke patients and healthy controls, comparing with conventional atlas-based FC calculation. Support vector machine (SVM) analysis distinguished poststroke patients from controls. Connectome-based predictive modeling (CPM) used FC values within CBTC circuits to predict upper limb motor function. Poststroke patients exhibited decreased ipsilesional connectivity within the individual-specific CBTC circuits. SVM analysis achieved 82.8% accuracy, 76.6% sensitivity, and 89.1% specificity using individual-specific parallel loops. Additionally, CPM featuring positive connections/all connections significantly predicted Fugl-Meyer assessment of upper extremity scores. There were no significant differences in the group comparisons of conventional atlas-based FC values, and the FC values resulted in SVM accuracy of 75.0%, sensitivity of 67.2%, and specificity of 82.8%, with no significant CPM capability. Individual-specific parallel loops show superior predictive power for assessing upper limb motor function in poststroke patients. Precise mapping of the disease-related circuits is essential for understanding poststroke brain reorganization.

Effectiveness of mixed reality-based rehabilitation on hands and fingers by individual finger-movement tracking in patients with stroke

BackgroundMixed reality (MR) is helpful in hand training for patients with stroke, allowing them to fully submerge in a virtual space while interacting with real objects. The recognition of individual finger movements is required for MR rehabilitation. This study aimed to assess the effectiveness of updated MR-board 2, adding finger training for patients with stroke.MethodsTwenty-one participants with hemiplegic stroke (10 with left hemiplegia and 11 with right hemiplegia; nine female patients; 56.7 ± 14.2 years of age; and onset of stroke 32.7 ± 34.8 months) participated in this study. MR-board 2 comprised a board plate, a depth camera, plastic-shaped objects, a monitor, a palm-worn camera, and seven gamified training programs. All participants performed 20 self-training sessions involving 30-min training using MR-board 2. The outcome measurements for upper extremity function were the Fugl–Meyer assessment (FMA) upper extremity score, repeated number of finger flexion and extension (Repeat-FE), the thumb opposition test (TOT), Box and Block Test score (BBT), Wolf Motor Function Test score (WMFT), and Stroke Impact Scale (SIS). One-way repeated measures analysis of variance and the post hoc test were applied for the measurements. MR-board 2 recorded the fingers’ active range of motion (AROM) and Dunnett’s test was used for pairwise comparisons.ResultsExcept for the FMA-proximal score (p = 0.617) and TOT (p = 0.005), other FMA scores, BBT score, Repeat-FE, WMFT score, and SIS stroke recovery improved significantly (p < 0.001) during MR-board 2 training and were maintained until follow-up. All AROM values of the finger joints changed significantly during training (p < 0.001).ConclusionsMR-board 2 self-training, which includes natural interactions between humans and computers using a tangible user interface and real-time tracking of the fingers, improved upper limb function across impairment, activity, and participation. MR-board 2 could be used as a self-training tool for patients with stroke, improving their quality of life.Trial registration number: This study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

Does the addition of Patient-Reported Outcome Measure Information System (PROMIS) pain instruments improve the sensitivity of PROMIS upper extremity scores after arthroscopic rotator cuff repair?

Although Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (P-UE) has been validated in upper extremity orthopedics, its ability to capture a patient's functional recovery after arthroscopic rotator cuff repair (aRCR), as measured by its responsiveness, is minimal in the early postoperative period. The primary purpose of this study is to determine if the addition of PROMIS Pain Intensity (P-Intensity) or Pain Interference (P-Interference) scores to PROMIS UE improves the responsiveness throughout the 1-year postoperative period after aRCR. This prospective, longitudinal study included 100 patients who underwent aRCR. Patients completed P-UE, P-Interference, P-Intensity, American Shoulder and Elbow Surgeons, and Western Ontario Rotator Cuff Index scores preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months after surgery. Responsiveness at each time point relative to preoperative baseline and 1-way analysis of variance with post hoc analysis was conducted for each PROM. The responsiveness of the outcome score was determined using the effect size, graded as small (0.2), medium (0.5), or large (0.8). The Pearson correlation coefficient (r) was determined between these instruments at each time point. In isolation, P-UE, P-Interference, and P-Intensity showed a medium-large ability to detect change (positive and negative) throughout the 1-year postoperative period. The addition of PROMIS pain scores to P-UE improved the responsiveness of the instrument (from medium to a large effect size) starting at 3 months and continued throughout the 12-month follow-up period. Although the addition of pain scores increases the response burden for PROMIS, this was still lower than the response burden for the legacy outcome scores (P<.05). The addition of PROMIS pain instruments improves the responsiveness of the P-UE function score in patients undergoing aRCR.

Medial Femoral Trochlea Osteochondral Flap Reconstruction of the Previously Unsalvageable Kienbock-Associated Lunate With a Coronal Split

Patients with Kienbock disease can present with coronal fracture and collapse of the proximal lunate (Unified B2/Bain grade 1, 2B). Traditionally, this was considered unsalvageable. However, medial femoral trochlea (MFT) osteochondral reconstruction, used to recreate the proximal lunate surface, can be paired with reduction and repair of the coronal plane fracture, thus restoring midcarpal congruity. The purpose of this study was to report radiographic and clinical outcomes following lunate coronal fracture fixation at the time of MFT osteochondral reconstruction. This was a retrospective study performed at a single institution. We identified patients with Kienbock disease who underwent MFT osteochondral reconstruction from 2014 to 2023. Patients were included if they had a coronal fracture of the lunate distal articular surface fixed at the time of surgery. Radiographic and clinical parameters were evaluated, including carpal height ratio, union rate, presence of heterotopic ossification, need for revision surgery, and patient-reported outcome measures. Thirty-three patients were included, with a mean age of 27.5 years (range: 15-41); 19 (58%) were women. Mean radiographic follow-up time was 5.8 months, and mean clinical follow-up time was 22.6 months. Union was achieved in 30/33 patients (91%). Carpal height ratio improved from 1.32 to 1.4. Two patients (6%) required reoperation, one for removal of heterotopic ossification and another for conversion to proximal row carpectomy. Patients demonstrated meaningful improvement in brief Michigan Hand Questionnaire and Patient-Reported Outcomes Measurement Information Upper Extremity scores. Range of motion before and after surgery was similar. Lunate coronal fracture fixation with MFT osteochondral reconstruction represents an additional management option in select patients with Kienbock disease. This technique restores the midcarpal joint during lunate reconstruction and may allow patients to avoid salvage procedures. Early radiographic and clinical outcomes are promising. Therapeutic IV.

A Prospective Randomized Pilot Study: One-Year Outcomes of Ligament Reconstruction Tendon Interposition Versus Suture Tape Suspensionplasty for Thumb Carpometacarpal Joint Arthritis

We performed a randomized controlled trial assessing patient-reported outcome measures following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) or suture tape suspensionplasty (STS) for treatment of thumb carpometacarpal joint osteoarthritis. Patients undergoing surgery for thumb carpometacarpal joint osteoarthritis were prospectively randomized to LRTI or STS. Outcome measures were collected at 2 weeks, 4 weeks, 3 months, and 1 year and included visual analog scale pain, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, return to work/activity, range of motion, grip/pinch strength, and complications. Thirty-one patients (32 thumbs) were randomized from 51 patients offered participation over two years. One-year follow-up was 97%. Both groups had a decrease in visual analog scale pain scores at all postoperative time points. The trajectory of postoperative Patient-Reported Outcomes Measurement Information System Upper Extremity scores was similar, and both groups achieved the meaningful clinically important difference for improvement in PROMIS Upper Extremity by three months. Grip strength was substantially increased in both groups at one year. Return to work/activity and surgical complications favored the LRTI group. Our study did not suggest any clinically relevant differences in the postoperative patient-reported outcome measures or objective clinical measurements between LRTI and STS, although LRTI patients had a faster return to work/activity and lower complication rates. Therapeutic IIB.

Operative Versus Nonoperative Treatment of Displaced Proximal Humerus Fractures in Adolescents: Results of a Prospective Multicenter Study.

Proximal humerus fractures (PHFx) constitute around 2% of all pediatric fractures. Although younger children with displaced fractures often undergo nonoperative treatments, optimal treatment for adolescents is not well defined. The study aimed to assess the outcomes of operative versus nonoperative treatment of displaced proximal humerus fractures in adolescents via a prospective multicenter study. This prospective study assessed adolescents aged 10 to 16 years with displaced PHFx from 2018 to 2022 at 6 level 1 trauma centers. Displacement criteria for inclusion were >50% shaft diameter or angulation >30 degrees on AP/lateral shoulder X-rays. Operative versus nonoperative treatment was decided by the treating physician. Radiographic and clinical data were collected at 6 weeks, 3, and 6 months. Patient-reported outcomes (PROs) included: Patient Reported Outcome Measures (PROMIS), Shoulder Pain and Disability Index (SPADI), and QuickDASH questionnaires. Patients were further grouped into a severe displacement cohort, defined as angulation >40° or displacement >75%. Clinical and radiographic data were compared between the 2 treatment cohorts. Out of 78 enrolled patients, 36 (46%) underwent operative treatment. Patients treated operatively were significantly older (13.5 vs. 12.2y, P <0.001) and exhibited greater mean angulation on AP shoulder view at presentation (31.1° vs. 23.5°, P <0.05). All PROs improved over time. At 6 weeks, operative patients demonstrated superior PROMIS upper extremity scores based on the minimally clinically important difference (MCID) (46.4 vs. 34.3, P =0.027); however, this distinction disappeared by 3 months. In a subanalysis of 35 patients with severe displacement, 21 (60.1%) underwent surgical intervention. No metrics showed significant differences between treatment modalities, with all PROs achieving population norm values by 3 months. Range of motion showed no difference between operative and nonoperative treatments, irrespective of fracture displacement. We found no differences in PROs and ROM between operative and nonoperative treatments of PHFx. If not contraindicated, nonoperative treatment may reduce healthcare costs and risks associated with surgery and should be considered for displaced adolescent proximal humerus fractures, irrespective of fracture displacement. II.

QOL-22. PARTICIPATION RESTRICTIONS IN DAILY LIVING ACTIVITIES IN CHILDHOOD CANCER SURVIVORS ACCORDING TO BODY COMPOSITON: A DOUBLE-CENTER STUDY

Abstract BACKGROUND Impact of cancer and treatment adverse effects on daily living activities in childhood cancer survivors (CCS) are well known. In our study, we hypothesized that the participation in daily living activities is affected in CCS. METHODS Fifty-eight CCS (10.07±3.83 years) in the 3-97th percentile range were included in the study. Participation of CCS was evaluated by Pediatric Outcomes Data Collection Instrument (PODCI). Body compositions of CCS were grouped according to body mass index (BMI). RESULTS The mean z score was.64±3.22 and BMI was 17.76±3.56. The global functioning score was 80.25±15.23, upper extremity score was 86.52±12.09, transfer and basic mobility score was 92.17±10.95, sports and physical functioning score was 71.31±25.70, pain/comfort score was 72.37±23.31, and happiness score was 81.31±19.19 of PODCI. While there was no relation between PODCI global functioning score and age chemotherapy, surgery (p&amp;gt;0.05); there was a significant relationship between PODCI global functioning score and gender, body mass index, radiotherapy (p&amp;lt;0.05). The significant functional difference detected between these groups was in upper extremity, transfer basic mobility, happiness, and global functioning (p&amp;lt;0.05). There were no differences between the sports and physical functioning and pain/comfort (p&amp;gt;0.05) according to the BMI categories (underweight, normal/healthy, and overweight). CONCLUSIONS Survivors have participation restrictions in activities at earlier period of cessation of treatment. Patient-reported outcomes can be systematically assessed in CCS. We recommend that supportive interventions in terms of physical functioning and participation in daily living activities for CCS.

PCR92 Association of Rheumatoid Arthritis (RA) Patient Characteristics and Perceived Treatment Satisfaction, RA Impact on Life, and Task Difficulty with Promis Measures’ Physical Functioning and Upper Extremity Scores

PCR92 Association of Rheumatoid Arthritis (RA) Patient Characteristics and Perceived Treatment Satisfaction, RA Impact on Life, and Task Difficulty with Promis Measures’ Physical Functioning and Upper Extremity Scores

Contribution of changes in the spinal cord and brain to the onset and progression of hand clumsiness symptoms in cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) stands as the most prevalent form of spinal cord injury, frequently prompting various changes in both the brain and spinal cord. However, the precise nature of these changes within the brains and spinal cords of CSM patients experiencing hand clumsiness (HCL) symptoms has remained elusive. The authors aimed to scrutinize these alterations and explore potential links between these changes and the onset of HCL symptoms. Using the modified Japanese Orthopaedic Association (mJOA) scale, the authors classified CSM patients into two groups: those without HCL and those with HCL. The authors performed voxel-wise z-score transformation amplitude of low-frequency fluctuations (zALFF) and resting-state functional connectivity (FC) evaluations in the brain. Additionally, they used the Spinal Cord Toolbox to calculate the fractional anisotropy (FA) of spinal cord tracts. The analysis also encompassed an examination of the correlation of these measures with improvements in mJOA scores. Significant disparities in zALFF values surfaced in the right calcarine, right cuneus, right precuneus, right middle occipital gyrus (MOG), right superior occipital gyrus (SOG), and right superior parietal gyrus (SPG) between healthy controls (HC), patients without HCL, and patients with HCL, primarily within the visual cortex. In the patient group, patients with HCL displayed reduced FC between the right calcarine, right MOG, right SOG, right SPG, right SFG, bilateral MFG, and left median cingulate and paracingulate gyri when compared with patients without HCL. Moreover, significant differences in FA values of the corticospinal tract (CST) and reticulospinal tract (REST) at the C2 level emerged among HC, patients without HCL, and patients with HCL. Notably, zALFF, FC, and FA values in specific brain regions and spinal cord tracts exhibited correlations with mJOA upper-extremity scores. Additionally, FA values of the CST and REST correlated with zALFF values in the right calcarine, right MOG, right SOG, and right SPG. Alterations within brain regions associated with the visual cortex, the fronto-parietal-occipital attention network, and spinal cord pathways appear to play a substantial role in the emergence and progression of HCL symptoms. Furthermore, the existence of a potential connection between the spinal cord and the brain suggests that this link might be related to the clinical symptoms of CSM.

Clinical outcomes of open Latarjet-Patte procedures performed for recurrent anterior shoulder instability with primary bone loss versus failed arthroscopic Bankart repair.

This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). LP's performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15-58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss. Level of evidence: III.

Pediatric Outcomes Data Collection Instrument Scores Within Gross Motor Function Classification Scale Levels and Functional Mobility Scale Ratings in Individuals With Cerebral Palsy.

The Pediatric Outcomes Data Collection Instrument (PODCI) is a patient/parent-reported outcome measure used in children with cerebral palsy (CP). PODCI score variability has not been widely examined in patients of Gross Motor Function Classification System (GMFCS) level IV or using the Functional Mobility Scale (FMS). The purpose of this study is to examine the distribution of PODCI scores within patients with CP GMFCS levels I-IV and FMS levels 1-6. Retrospectively identified patients with CP whose parent/caregiver had completed the PODCI at their visit were grouped based on GMFCS and FMS level. One-way ANOVA with pairwise Bonferroni-adjusted post hoc tests was performed to compare the effect of GMFCS and FMS levels (1, 2-4, 5, or 6) on PODCI scores. Three hundred sixty-seven patients were included (128 female, 11.7 years, SD 3.6). Global, Sports, Transfer, and Upper Extremity scores differed among all GMFCS levels ( P ≤0.056) and were significantly lower for GMFCS IV compared with all other levels. Happiness, Expectations, and Pain scores did not differ significantly among GMFCS levels including level IV ( P >0.06). Similar trends were seen at all FMS distances (5, 50, and 500âm). At 50âm, Global, Sports, Transfer, and Upper Extremity scores differed significantly among all FMS levels ( P <0.001) except that Upper Extremity Scores were similar between levels 2-4 and level 5 ( P =1.00). Happiness and Pain scores were not different between FMS levels ( P >0.27). Expectations scores differed only between FMS 1 and FMS 6 with FMS 6 being higher at the 50-m distance only ( P =0.03). Parent-reported outcome measures are important for providing patient-centered care. Providers can examine these measures alongside functional classification systems to create a more complete clinical picture of the patient. Providers should be aware of the score trends seen in our results when evaluating the PODCI for individuals with CP to improve shared decision-making and better monitor their need for future care. Level III-retrospective study.

Patients With and Without Double Crush Syndrome Achieve Similar Rates of Clinical Improvement Following Carpal Tunnel Release.

The purpose of this study is to compare outcomes of carpal tunnel release (CTR) in patients with and without double crush syndrome (DCS), defined as concurrent carpal tunnel syndrome (CTS) and cervical radiculopathy at C5-T1 on preoperative nerve conduction studies. Patients with preoperative nerve conduction studies who underwent unilateral, isolated CTR were retrospectively identified. All patients completed preoperative and 3-month postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI), and Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires, and responded to the anchor question: "Since your treatment, how would you rate your overall function?" (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). Preoperative, postoperative, and changes in scores for UE, PI, and QuickDASH were compared, as were the anchor question responses and rates of achieving the minimal clinically important difference (MCID). Sixty-three patients with DCS and 115 patients with CTS only were included. At 3- to 4-month follow-up, absolute and change in UE, PI, and QuickDASH scores were not statistically different between patients with DCS and CTS. Rates of anchor question response and MCID achievement were comparable for patients with CTS only and DCS on each questionnaire. The MCID achievement ranged from 48.4% to 68.8% in the unmatched cohort and 48.4% to 60% in the matched group. At 3 to 4 months, patients with DCS experience similar patient-reported symptomatic and functional improvement, and achieve MCID of outcome measures at comparable rates to patients with CTS only. For patients with nerve compression at the carpal tunnel and cervical spine, CTR is a reasonable first step prior to proceeding with cervical spine decompression.