Wrist Extension Research Articles

Using a quantitative assessment of propulsion biomechanics in wheelchair racing to guide the design of personalized gloves: a case study

This study with a T-52 class wheelchair racing athlete aimed to combine quantitative biomechanical measurements to the athlete’s perception to design and test different prototypes of a new kind of rigid gloves. Three personalized rigid gloves with various, fixed wrist extension angles were prototyped and tested on a treadmill in a biomechanics laboratory. The prototype with 45° wrist extension was the athlete’s favourite as it reduced his perception of effort. Biomechanical assessment and user-experience data indicated that his favourite prototype increased wrist stability throughout the propulsion cycle while maintaining a very similar propulsion technique to the athlete’s prior soft gloves. Moreover, the inclusion of an innovative attachment system on the new gloves allowed the athlete to put his gloves on by himself, eliminating the need for external assistance and thus significantly increasing his autonomy. This multidisciplinary approach helped to prototype and develop a new rigid personalized gloves concept and is clearly a promising avenue to tailor adaptive sports equipment to an athlete’s needs.

Efficacy of Therapeutic Ultrasound and Therapeutic Laser Along with Myofascial Release in Reducing Pain and Improving Hand Grip for People with Lateral Epicondylitis

Background: Lateral epicondylitis is a common overuse injury that affects the tendons on the outer side of theelbow. It results from repetitive gripping or wrist extension activities, leading to microtrauma and subsequentinflammation. The condition primarily manifests as pain and reduced grip strength, often affecting dailyactivities and occupational performance. However, limited research directly compares the effectiveness of theseinterventions for lateral epicondylitis.Purpose: The aim of this study is to compare the effectiveness of therapeutic ultrasound and therapeutic laser,in conjunction with myofascial trigger release, in reducing pain and improving handgrip strength in individualswith lateral epicondylitis.Methods: Patients willing to participate in the study were screened for inclusion and exclusion criteria taken fromGet well soon physio rehabilitation centre. The total number of subjects (40) are divided into 20 subjects for theexperimental group (Group A), they are given therapeutic ultrasound along with myofascial release . The controlgroup (Group B) consisting of 20 subjects, are low level therapeutic laser along with myofascial release, NPRS andHandheld dynamometer are used as outcomes measure. The entire process was conducted from November 2022to March 2023.Results: The results revealed significant pain reduction and greater improvements in handgrip strength for thetherapeutic laser group compared to the therapeutic ultrasound group. This study showed that the p value isstatistically significant <0.0001.Conclusion: This study concluded that therapeutic laser, when combined with myofascial trigger release,demonstrated superior effectiveness compared to therapeutic ultrasound in the management of lateral epicondylitis.

Effectiveness of Mulligan Mobilization Technique Versus Cyriax Technique for Lateral Epicondylitis: A Pilot Study

Background: Eccentric loading of extensor carpi radialis brevis tendon near its origin causes tennis elbow, alsoknown as lateral epicondylitis. Tennis elbow is primarily caused by repetitive wrist extension or loaded grippingoveruse injuries and when playing tennis, badminton, or any sport are more likely to experience it. The goal of thestudy was to determine whether tennis elbow pain might be decreased and improve the functional status. Subjectsare divided into two groups, Mulligan mobilization technique and Cyriax technique along with ultrasound.Purpose: To find out the effects of Mulligan mobilization technique and Cyriax technique along with ultrasoundin the management of lateral epicondylitis.Materials and Methods: Twenty individuals were chosen with tennis elbow (11 males and 9 females) and receivedtreatment for four times/week for two weeks in RENU’S Physiotherapy & Rehabilitation Centre according to theinclusion and exclusion criteria, explained about the procedure and obtained signed informed consent. Subjectswere divided into two groups by simple random sampling -Mulligan mobilization technique of Movement withMobilization(MWM) and Cyriax technique of Deep Tendon Friction(DTF) massage with Mill’s manipulationalong with ultrasound.Result: Statistical analysis had slight significant difference between Cyriax and Mulligan group for NPRS andPRTEE. Noticeably Cyriax had more improvement in pain reduction than Mulligan group, while Mulligan hadimprovement in functional impairment than Cyriax, with a p value of <0.0001.Conclusion: Mulligan mobilization and Cyriax method with ultrasound both reduced discomfort and enhancedfunctional status.

THE EFFECT OF PHYSICAL THERAPY INTERVENTION AFTER CEREBELLAR RESECTION

A variety of diseases, including gait ataxia, lack of coordination, diminished dexterity, and unsteady posture, can be brought on by cerebellar dysfunction. This case study looks into how a physical therapy program affected a 40-year-old patient's dynamic balance after cerebellar tumour surgery. The patient complained of losing his balance and having uncoordinated motions on the left side of the body. The Timed Up and Go (TUG) test was used to gauge how the Frenkel coordination exercises and balance training affected dynamic balance following cerebellar tumour removal. The patient's muscle strength in the left-side hip extensors, abductors and adductors, knee flexors and extensors, as well as the left-side shoulder, elbow, and wrist flexion and extension, significantly improved.

Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm

To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic. A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll's hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation. The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll's hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively. Congenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Ultrasound-guided injection versus landmark-guided injection using corticosteroids for the treatment of lateral epicondylitis

Abstract Purpose To compare the clinical results of corticosteroid injection using landmark-guided injection (LMGI) and ultrasound-guided injection (USGI) techniques. Patients and methods We injected corticosteroids in 55 patients with extraarticular tennis elbow using LMGI and USGI techniques. All patients suffered from lateral elbow pain for more than 3 months with a tender point on the lateral epicondyle. This pain was exaggerated by wrist extension and specific physical activity. For postprocedural evaluation, in a randomized controlled assessor-blinded clinical trial, visual analog score (VAS), pain-free grip strength (PFGS), and the Nirschl staging system were assessed at 1, 6, 24 weeks, and 12 months. Results Only 48 participants were included in the final analysis (seven were excluded). Preoperatively, the average VAS scores, tenderness over lateral epicondyle, PFGS values, and Nirschl stages were almost the same (P=0.620, 0.505, 0.784, and 0.455). After 1 week of injection, there was no significant difference noticed in the VAS for pain at rest, tenderness during palpation, the PFGS and Nirschl stages between group 1 and group 2 (P=0.947, 0.724, 0.484, and 0.677, respectively). A statistically significant difference between the two groups was observed from 6 to 48 weeks. At the final follow-up, group 2 had a statistically significant better outcome when compared to group 1 (P<0.05). Conclusion USGI had a better long-term outcome than LMGI in the treatment of lateral epicondylitis.

Physiotherapy Assessment and Intervention for Hirayama Disease: A Case Report

Hirayama Disease (HD) is a type of localised amyotrophy that mostly affects motor neurons. It is benign, self-limiting, and does not progress. It is not the same as distal limb juvenile muscular atrophy, which is a symptom of motor neuron disease. Together with other immunological and physical variables, cervical cord compression, particularly during cervical flexion, is one cause of HD. Over three to five years, the illness usually worsens progressively, resulting in wasting and distal weakness in one or both upper extremities. In addition, patients may experience cold paralysis, coarse finger tremors, and non specific sensory loss. Hereby, the authors present a case report of a 22-year-old male who had been steadily developing right upper extremity weakness for three years was evaluated in the Outpatient Department. The physical examination revealed atrophy of the right forearm muscle, reduced range of motion in right wrist flexion and extension, weak wrist extensors, finger extensors, supinator muscles of the forearm, and shoulder flexors. As HD does not have a well-defined physiotherapy protocol, tailor-made treatment was given for four weeks aimed at improving upper extremity muscle strength and overall hand function. The present case report will aid the physiotherapists understand the assessment and treatment of HD.

Outcomes of Dorsal Capsule-Based Vascularized Radius Grafting Without a Radius Styloidectomy For The Treatment of Stage 1 Scaphoid Non-union Advanced Collapse

Objectives: We report the clinical and radiological outcomes of patients with stage 1 scaphoid non-union advanced collapse (SNAC) treated via placement of a dorsal capsule-based, vascularized, distal radius graft in the absence of radial styloidectomy. Methods: This retrospective study included 15 patients (13 men, 2 women). Radial styloidectomy was not performed in any patient. Radiological assessment was conducted using the scapholunate angle, as well as the original and revised carpal height ratios. The short version of the disabilities of the arm, shoulder, and hand (QDASH) score and the modified Mayo wrist score (MMWS) were used for functional assessment; Pain was rated using a visual analogue scale (VAS). At the last follow-up visit, range of motion, grip strength and key pinch strength were measured on both affected and unaffected sides. Results: The mean patient age was 32 (+/-10.4) years; the mean follow-up time was 23.2 (+/-6.8) months. All patients achieved complete bony union. No complications were observed. Although significant decreases in wrist flexion and extension were observed on the affected side, compared with the unaffected side, there were no significant differences in terms of radial or ulnar deviation. Both the MMWS and QDASH scores improved postoperatively, whereas the mean VAS pain score decreased. At the final follow-up, there was no decrease in mean carpal ratios, but the mean scapholunate angle had decreased. Conclusion: Dorsal capsule-based, vascularized, distal radius grafting without a radial styloidectomy is reproducible and reliable. The functional and radiological results are satisfactory for patients with stage 1 SNAC.

Abnormal Wrist Sagittal Kinematics in Gymnasts With Dorsal Wrist Pain: A New Syndrome

Background: The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear. Purpose/Hypothesis: The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint. Study Design: Controlled laboratory study. Methods: Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups. Results: At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P = .020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P = .004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P = .002) than gymnasts without dorsal wrist pain. Conclusion: Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed “gymnast’s lunate dyskinesia.”

Design and Development of Portable Wrist Rehabilitation Device for Post-Stroke Subjects: A Pilot Study

Wrist mobility is vital for post-stroke patients to carry out their daily activities. The use of robotic devices in hand rehabilitation has increased significantly in recent years, allowing patients to get training at home and effectively compensating for the therapist-to-patient ratio. Nevertheless, rehabilitation devices are expensive, cumbersome, immobile, and difficult to wear and operate. This work proposes a new method for designing a wrist rehabilitation device that uses airbag technology to minimize device weight and size. A triangular prism-shaped Neoprene (synthetic rubber) airbag is utilized in the experiment; which is inflated and deflated using a DC motorized air pump. An accelerometer sensor serves as the control input for the wrist rehabilitation exercise device. The proposed device trains the impaired hand of ten hemiplegic post-stroke patients. A goniometer and Fugl-Meyer Assessment (FMA) are used to measure wrist motion before and after the training regimen to evaluate the results. The mean angle (in degree) of wrist flexion increases from 8.6 ± 2.59 to 18.4 ± 5.19 (p = 0.005). Likewise, an increase in the wrist extension angle from 12.3 ± 3.62 to 17.7 ± 6.2 (p = 0.008) is noted. The wrist rehabilitation device is lightweight, portable, and simple to use, producing good results for hemiplegic individuals with hand disability. The suggested invention enables the user to extend their wrist’s range of motion.

Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries

Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy. To address wrist radial deviation, we propose transferring the anconeus muscle, extended by the intermuscular septum between the ECU and the flexor carpi ulnaris (FCU), to the ECU tendon. Through an incision over the ulna, the intermuscular septum between the ECU and FCU is harvested at the level of the periosteum and left attached to the anconeus proximally. The anconeus muscle is then released from the ulna, and the intramuscular septum extension is sutured to the ECU tendon under maximal tension. Anconeus muscle transfer was performed on two patients to correct chronic wrist radial deviation following PT to ECRB tendon transfer for radial nerve injury, as well as on two patients with PIN paralysis. In four patients, transfer was performed in addition to standard tendon transfers for radial nerve paralysis to prevent radial wrist deviation deformity. Wrist radial deviation was corrected or prevented in all but one patient at an average follow-up of 10 months. Patients with PIN lesions and those who had anconeus transfer concomitantly with radial nerve tendon transfers were capable of active ulnar deviation. No patient experienced elbow extension weakness, pain, or instability. Anconeus muscle transfer extended by intermuscular septum presents a viable alternative for addressing radial deviation of the wrist in cases of PIN nerve lesions or following PT to ECRB tendon transfer in radial nerve paralysis. Therapeutic V.

FUNCTIONAL OUTCOME OF INTRAARTICULAR DISTAL RADIUS FRACTURE TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH DORSAL PLATE

Background: Distal radius fractures are among the most common fractures and there is considerable disparity among surgeons regarding the best way to treat these patients. Intraarticular fractures are treated with open reduction and internal fixation with either dorsal or volar plates. Dorsal plating is not much popular due to its reported complications of extensor tendon irritation and rupture. We conducted this study to assess the functional outcome of dorsal plating in intraarticular distal radius fractures. Methods: A clinical prospective observational study was conducted at Kathmandu Medical College,Sinamangal. A total of 26 patients (male: 14; female: 12) of intraarticular distal radius fractures were enrolled and underwent open reduction and internal fixation using the dorsal plate. The functional outcome of dorsal plating was measured at 3 weeks,3 months and 6 months follow up. Results: All patients achieved a functional range of motion, with greater than 50 degrees of wrist flexion, 25 degrees of wrist extension, and 60 degree arc of pronation and supination. The functional outcome measured was found to be good to excellent with a mean Mayo Wrist score of 89.23(75-100) and Quick Dash-9 score of 9.20(2.75 to 22). There were 3 cases of extensor tendon irritation, which completely resolved and no cases of extensor tendon irritation at final follow up. Conclusions: Dorsal plating is a safe and effective way of treating intra articular distal radius fracture with good functional outcome.

Characterization of Upper Extremity Kinematics Using Virtual Reality Movement Tasks and Wearable IMU Technology.

Task-specific training has been shown to be an effective neuromotor rehabilitation intervention, however, this repetitive approach is not always very engaging. Virtual reality (VR) systems are becoming increasingly popular in therapy due to their ability to encourage movement through customizable and immersive environments. Additionally, VR can allow for a standardization of tasks that is often lacking in upper extremity research. Here, 16 healthy participants performed upper extremity movement tasks synced to music, using a commercially available VR game known as Beat Saber. VR tasks were customized to characterize participants' joint angles with respect to each task's specified cardinal direction (inward, outward, upward, or downward) and relative task location (medial, lateral, high, and/or low). Movement levels were designed using three common therapeutic approaches: (1) one arm moving only (unilateral), (2) two arms moving in mirrored directions about the participant's midline (mirrored), or (3) two arms moving in opposing directions about the participant's midline (opposing). Movement was quantified using an XSens System, a wearable inertial measurement unit (IMU) technology. Results reveal a highly engaging and effective approach to quantifying movement strategies. Inward and outward (horizontal) tasks resulted in decreased wrist extension. Upward and downward (vertical) tasks resulted in increased shoulder flexion, wrist radial deviation, wrist ulnar deviation, and elbow flexion. Lastly, compared to opposing, mirrored, and unilateral movement levels often exaggerated joint angles. Virtual reality games, like Beat Saber, offer a repeatable and customizable upper extremity intervention that has the potential to increase motivation in therapeutic applications.

Clinical and Radiographic Outcomes Following Volar-Locked Plating Versus Dorsal Bridge Plating for Distal Radius Factures

PurposeDistal radius fractures indicated for operative intervention are most commonly treated with volar locked plating (VLP), however dorsal bridge plating (DBP) has been utilized as an alternative fixation method. The purpose of this study was to utilize a propensity score to match and compare the radiographic and clinical outcomes of patients undergoing isolated VLP or DBP for distal radius fractures. MethodsWe performed a retrospective, propensity score-matched analysis of patients undergoing isolated VLP or DBP treatment for isolated distal radius fractures from 2015 to 2022 at a single level-1 trauma center. Patients were propensity score matched by a total of 8 demographic and comorbidity factors, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Our primary outcomes included postoperative complications, wrist and forearm range of motion, grip strength, and radiographic measurements, including radial height, radial inclination, volar tilt, and articular step-off. ResultsOverall, 415 DBP and 2075 VLP were successfully propensity score matched and included in this study. Grip strength and range of motion measurements at 6-month follow-up, including wrist flexion, wrist extension, forearm pronation, forearm supination, radial deviation, and ulnar deviation, were increased in the VLP compared to DBP (p<0.05). Complication rates among both groups were relatively low, however, the rate of malunion and nonunion was significantly higher among the DBP group (p<0.05). Radial height, radial inclination, and articular step-off were improved in the VLP group compared to the DBP group (p<0.05), however, volar tilt was similar between groups. PROMIS Upper Extremity (UE) and Physical Function (PF) were significantly higher among the VLP group (p<0.05). There was no significant difference in PROMIS PI between groups. ConclusionsWhen compared to DBP, patients undergoing VLP are more likely to have improved clinical and radiographic outcomes. While improvement in wrist and forearm range of motion and radiographic parameters is statistically significant, it may not be clinically relevant.

Skin blood flow as an objective measure for lateral elbow tendinopathy

PURPOSE: To investigate the test-retest reliability, side-to-side difference, responsiveness, and concurrent validity of skin blood flow (SkBF) measured by laser Doppler flowmetry (LDF) in individuals with acute or subacute lateral elbow tendinopathy (LET). METHODS: Eighteen individuals with acute or subacute LET were recruited for this study. SkBF was measured over the lateral epicondyle and common extensor origin on both ipsilateral and contralateral sides. The intraclass correlation coefficient (ICC3,1) was used to evaluate test-retest reliability. A paired t-test was used for comparing the side-to-side difference. Responsiveness was reported with a change score, paired t-test, effect size (ES), and standardized response mean (SRM). The concurrent validity of SkBF was investigated by correlating with a visual analog scale (VAS) pain intensity during resisted wrist extension isometric contraction using the Spearman correlation coefficient. RESULTS: Test-retest reliability was good at lateral epicondyle (ICC3,1 = 0.899), and at common extensor origin (ICC3,1 = 0.803). A side-to-side difference was found between the two sides (p &lt; 0.001). For responsiveness, the change score for SkBF at the lateral epicondyle was – 8.04, and the common extensor origin was – 3.54. The ES and SRM ranged from – 0.71 to – 0.78. Concurrent validity was reported with a strong correlation with pain intensity (r = – 0.637). DISCUSSION: SkBF is a reliable and responsive variable for investigating the elbows with acute or subacute LET providing clinical information according to its inflammatory responses. However, the concurrent validity can be found only for SkBF at common extensor origin, which correlates with pain during resisted wrist extension isometric contraction.

Treatment of Scaphoid Non-Unions with Custom-Made 3D-Printed Titanium Partial and Total Scaphoid Prostheses and Scaphoid Interosseous Ligament Reconstruction.

Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed.

Evaluation of the efficiency of an ultrasound-supported infiltration technique in patients with tennis elbow applying the ITEC medical device: a multicenter study

BackgroundThe treatment of lateral epicondylitis (LE) remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months. MethodsIn a prospective, non-randomized, multi - center study design, 68 patients with chronic LE and symptoms lasted of at least 6 weeks were included. Each hospital has been assigned either for Traumeel (A), autologous whole blood (B) or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient related outcome parameter and dorsal wrist extension strength were documented. Pre - interventional (obligate) and after 6 months (optional) radiological evaluation (MRI) was performed. ResultsThe Visual Analog Scale (VAS) showed a significant reduction after 6 months in all groups (A. from 4.8 to 2.5, B. 6.2 to 2.3, C. 5.8 to 2.4). Similar results could be observed with SEV, DASH, MEPS and PRTEE. The loss of strength could be completely compensated after about 6 months. MRI did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A=11, B=8, C=4). Switching to surgical intervention was most frequent observed in group C (A=2, B=1, C=5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method. ConclusionThe primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.

The "Standing Peanut" Scaphoid View: A Semi-supinated Radiographic View for Intraoperative Evaluation of Screw Placement in Scaphoid Waist Fractures.

Scaphoid waist fractures are the most common fracture of the scaphoid. Operative management is indicated with unstable fractures and often for nondisplaced waist fractures to decrease time to union and return to work/sport. Screw placement within the central axis of the scaphoid is paramount and correlates with outcomes. Assessment of intrascaphoid screw placement is classically done via intraoperative fluoroscopy. An additional fluoroscopic view is presented to assist in confirming implant positioning. Along with the standard anterioposterior, lateral, pronated oblique, and "scaphoid" view we obtain a "standing peanut" view for assessment of central screw placement. This view also allows for further evaluation of center/center positioning and better assessment of fixation crossing the fracture into the proximal pole. The "standing peanut" view is best obtained in a sequential manner beginning with the forearm in neutral rotation. First, the forearm is then supinated 30 degrees; next, the wrist is placed at 45 degrees of ulnar deviation. Then finally, 10 degrees of wrist extension. We utilize this additional intraoperative view in conjunction with the standard fluoroscopic views for assessing and ensuring center-center implant positioning, particularly within the proximal pole. When ensuring center-center positioning, we prefer this view as an adjunct view to the standard fluoroscopic views intraoperatively. It provides a beneficial view of the proximal pole delineating the number of screw threads that have obtained proximal pole purchase. We have found it particularly useful in the setting of scaphoid waist fracture nonunion with the classic 'humpback' deformity after correction with volar interposition grafting. Standard radiographic views may be misinterpreted regarding implant positioning if there remains any residual flexion. The view requires little in the way of training to obtain once appreciated and exposes the patient to minimal additional radiation.

Controlling a Below-the-Elbow Prosthetic Arm Using the Infinity Foot Controller

Nowadays there are various prosthetic arm designs in the literature, the market, and CAD design websites, with different shapes, sizes, and degrees of freedom. Only limited options are available for controlling such prostheses. Prosthetic arm users reported muscle fatigue and unreliability when using the market-dominated myoelectric sensors. This work presents the “Infinity Foot Controller” as a new approach to control a five-finger below-the-elbow prosthetic arm with wrist rotation and bending capabilities. This foot control system receives user input from a custom insole and a sensor-controller unit placed alongside the user’s shoe to perform various hand grips, gestures, and/or rotations. To demonstrate the new foot controller, a design of a 3D-printed below-the-elbow prosthetic arm, called the “Infinity Arm”, is presented. This arm is suitable for gripping relatively lightweight objects and making hand gestures. It includes a wrist actuation system that permits 120° wrist rotation and 70° wrist extension and flexion. It also includes a haptic feedback system that utilizes fingertip force sensors to relay a vibratory response in an armband placed on the user’s arm, giving the user a sense of touch. A proof-of-concept model was built to demonstrate the system and a testing procedure was proposed.