Wrist Flexion Research Articles

Blood pressure cuff–induced radial nerve palsy following minimally invasive lateral microdiscectomy: illustrative case

BACKGROUND The authors describe a rare case of transient postoperative wrist and finger drop following a prone position minimally invasive surgery (MIS) lateral microdiscectomy. OBSERVATIONS Hand and wrist drop is an unusual complication following spine surgery, especially in prone positioning. The authors’ multidisciplinary team assessed a patient with this complication following MIS lateral microdiscectomy. The broad differential diagnosis included radial nerve palsy, C7 radiculopathy, stroke, and spinal cord injury. Given the patient’s supinator weakness, intact pronation and wrist flexion, and transient recovery within 4 weeks, the most likely diagnosis was radial nerve neuropraxia secondary to ischemic compression. After careful consideration of the operative environment and anatomical constraints, the patient’s blood pressure cuff was found to be the most probable source of compression. LESSONS Blood pressure cuff–induced peripheral nerve injury may be a source of postoperative radial nerve neuropraxia in patients undergoing spine surgery. Careful considerations must be given to the blood pressure cuff location, which should not be placed at the distal end of the humerus due to higher susceptibility of peripheral nerve compression. Spine surgeons should be aware of and appropriately localize postoperative deficits along the neuroaxis, including central versus proximal or distal peripheral injuries, in order to guide appropriate postoperative management.

Use it or lose it: The relationship between two image-based biomarkers in better understanding osteoarthritis progression in the wrist

Bone tissue is influenced by its mechanical environment and adapts in response to its mechanical load. This is supported by studies analyzing bone adaptation in the knee and hip. Changes to the bone have also been found to precede cartilage degeneration in diseases such as osteoarthritis (OA). Our objective was to demonstrate the relationship between joint contact and bone density in the wrists of healthy adults. Static CT scans with a calibration phantom were taken to obtain measures of bone mineral density (vBMD) in 3 normalized depths; 0 – 2.5, 2.5 – 5, and 5 – 7.5 mm. Participants underwent a four-dimensional CT scan (4DCT) while performing maximum wrist extension to maximum wrist flexion. 3D bone models of the distal radius, scaphoid, and lunate were made, and analyzed vBMD and joint contact area (JCA) in the radiolunate (RL) and radioscaphoid (RS) joints separately. Correlation coefficients were calculated where vBMD was the dependent variable, and kinematic JCA throughout every 10 degrees of motion were the independent variables. Statistically significant independent variables associated with vBMD were assessed using a regression model and were entered in steps; (1) significant correlations, (2) sex, and (3) age.An increase in vBMD was significantly, positively associated with an increase in JCa. Notably, in the deeper regions (5 – 7.5 mm) of the radius that is primarily composed of trabecular bone. Sex contributed to the variance in vBMD, while age did not. Subchondral bone changes are influenced by wrist position, demonstrating that the wrist serves to bear load similar to the knee and hip.

Ergonomic learning curves on gynecological laparoendoscopic single-site (LESS) surgery

BackgroundFew previous studies have introduced general techniques to overcome the “chopstick effect” in laparoendoscopic single-site surgery (LESS). We aim to investigate and highlight the key ergonomic methodologies for gynaecologic LESS based on the surgeon’s hands-on performance.MethodsThe first author surgeon A reviewed and analyzed the LESS procedures performed by herself and how she taught surgeon B from January 2021 to April 2022. The procedures were classified based on technical difficulty and learning periods, and the hands-on technical skills of LESS module were evaluated.ResultsSurgeon A conducted 580 LESS procedures, which were divided into the novice (n = 48) and intermediate (n = 33) periods, and the remaining cases were included in the routine period. We formed a special ergonomic LESS operating methodology: Maintain good LESS laparoscopic spatial sensation, keep hand-eye coordination, well cooperation between the main surgeon and the assistant; Experienced multiport laparoscopy surgery (MPS) skills, improve basic LESS technique: grasp, lift, transfer, place, blunt separating, coagulation and cutting. Coordination location, orientation, movements, and flexion or extension of shoulders, arms, elbow, wrist and finger joints; Maintain strength, tension and ambidexterity postures with joint and muscular efforts to control instruments. Surgeon B learned the above experiences by performing 39 LESS procedures under the guidance of surgeon A.ConclusionThis educational research sheds light on the common challenges faced in LESS and presents the importance of ergonomic hands-on performance skills in improving surgical outcomes, which could serve as a guide for future training and education in LESS.

Clinical Outcomes of Minimally Invasive Fixation with Pre-Bent Elastic Stable Intramedullary Nails for the Treatment of Distal Radius Metaphyseal Diaphysis Junction Fractures in Children.

Although mini-plate fixation is an attractive treatment option for distal radius metaphyseal diaphysis junction (DRMDJ) fractures in children, the benefits of minimally invasive fixation (MIF) with pre-bent elastic stable intramedullary nails (MIF) remain underexplored. Therefore, this study aimed to evaluate the clinical efficacy of MIF administration in children with DRMDJ fractures. This retrospective study enrolled 40 patients with DRMDJ fractures who underwent MIF or mini-plate fixation from January 2016 to January 2021. Radiographic parameters, such as palmar inclination and ulnar deflection angle, were examined postoperatively to assess the anatomical reduction of the wrist joint. Clinical outcomes, including the range of wrist flexion and back extension, were examined to analyze the recovery of the wrist range of motion. Additionally, the Gartland-Werley scoring system was used to assess the recovery status of wrist function and healing condition. The student t-test and χ2 test were used to compare differences among groups. All included patients successfully underwent the operation and were followed up for 12-24 months. Patients in the MIF group had a smaller surgical incision length (0.49 ± 0.06 cm) compared to those in the mini-plate fixation group (4.41 ± 0.73 cm) (t = 22.438, p = 0.000). Palmar inclination and ulnar deflection were within the normal range in patients of both groups, and the fractures were successfully anatomically reduced. Moreover, wrist flexion and back extension in the MIF group and mini-plate group were (72.50° ± 0.64° vs. 70.18° ± 0.56°) and (59.55° ± 1.75° vs. 60.04° ± 1.37°), and differences were statistically significant (t = 2.708, p = 0.010 and t = 0.885, p = 0.382, respectively). Furthermore, MIF treatment resulted in a higher proportion of excellent Gartland-Werley scores (94.44%) than mini-plate fixation (86.36%) (p = 0.390). In addition, one case in the mini-plate fixation group experienced re-fracture following the removal of the internal fixation, and the fracture healed after reduction and cast fixation. All patients achieved satisfactory bone healing without other complications. Compared with mini-plate fixation, MIF has the advantages of small incision length, superior range of motion of thr wrist joint, and better maintenance of the physiological radian, providing a promising approach for clinical and surgical treatment of DRMDJ fractures.

Flexible Piezoresistive Sensors from Polydimethylsiloxane Films with Ridge-like Surface Structures.

Developing flexible sensors and actuators is of paramount importance for wearable devices and systems. In this research, we developed a simple and facile technique to construct flexible piezoresistive sensors from polydimethylsiloxane films with ridge-like surface structures and laser-induced porous graphene. Using a replication strategy, we prepared the ridge-like surface structures from sandpapers. The piezoresistive sensors exhibit excellent sensitivity with a response time of less than 50 ms and long-term cyclic stability under mechanical loading. The smallest weight they can sense is ~96 mg. We demonstrated applications of the piezoresistive sensors in the sensing of bio-related activities, including muscle contraction, finger flexion, wrist flexion, elbow bending, knee bending, swallowing, respiration, sounds, and pulses.

Wrist position affects muscle fatigue during isometric contractions of wrist flexors: An exploratory study

ObjectiveTo investigate the influence of wrist position and torque level on lower arm flexor muscle fatigue. BackgroundWork-related musculoskeletal health risks at the wrist joint may depend on joint position and torque level, as proposed by ergonomic workplace assessment tools. As empirical data are scarce, muscle fatigue, as proxy of work-related musculoskeletal health risks, can be used to explore this assumption. Method18 healthy participants performed fatiguing isometric wrist flexion contractions in three wrist positions (40° flexion, 0° neutral position, and 40° extension) and torque levels (10, 20, 40% of the maximum voluntary contraction). Electromyographic signs of fatigue were analyzed in the flexor carpi radialis (FCR) and flexor digitorum superficialis (FDS) muscles. ResultsMuscle fatigue was dependent on torque level and wrist position and differed between muscles. Signs of fatigue were more evident at higher torque levels for both muscles. While fatigue signs in FCR were not clearly associated with wrist position, the FDS fatigued more during wrist flexion. An interaction effect between torque level and wrist position was not observed. ConclusionHigher torque levels induce greater signs of local muscle fatigue in wrist flexor muscles, and a 40° wrist flexion triggers fatigue, while 40° wrist extension does not. Our data do not support the assumption of increased risk in greater wrist angles in any direction by prevailing ergonomic risk assessments. Relevance to industryPeople with work-related wrist flexor effort may be at increased risk of musculoskeletal disorders when higher torques are applied and flexed wrist positions are required.

Characteristics of multi-channel intermuscular directional coupling based on time-varying partial directional coherence analysis

The human body transmits directional information between muscles during upper limb movements, and this will be particularly evident when the dominant muscle changes during movement transitions. By capturing the electromyography (EMG) signals of wrist flexion and extension continuous transition movements, we investigated the characteristics of multichannel intermuscular directional coupling and directional information transmission, and consequently explored the control mechanism of Central nervous system (CNS) and the coordination mechanism of motor muscles. Multi-channel EMG was collected from 12 healthy subjects under continuous translational movements of wrist flexion and extension, and the time-varying biased directional coherence analysis (TVPDC) model was constructed using partial directional coherence analysis (PDC) frequency domain directionality to study the directional information transfer characteristics in the time–frequency domain, screen closely related muscle pairs and perform directional coupling significance analysis. Palmaris longus (PL) played a dominant role under wrist flexion movements(WF), Extensor Carpi Radialis (ECR) played a dominant role under wrist extension movements(WE), and the remaining muscles responded to them with information and Biceps Brachii (BB) played a responsive role throughout the movement; flexor pairs had the highest positive coupling values in the beta band during Conversion action1 (MC1) and WF phases, and extensor pairs had the highest positive coupling values in the gamma band during Conversion action2(MC2) phase and the highest coupling values in the beta band during WE phase. TVPDC can effectively analyze the multichannel intermuscular directional coupling and information transmission relationship of surface electromyography under wrist flexion and extension transition movements, providing a reference for exploring the control mechanism of CNS and abnormal control mechanism in patients with motor dysfunction in a new perspective.

Full-Body Kinematics and Vertical Ground Reaction Forces in Elite Ten-Pin Bowling: A Field Study.

The purpose was to investigate full-body kinematics and vertical ground reaction forces in the lower extremities of the delivery and to determine delivery changes over time after many deliveries in ten-pin bowling. Six male elite ten-pin bowlers completed six bouts of twelve bowling deliveries, all strike attempts, while measuring full-body kinematics and vertical ground reaction forces. Full-body joint angles, peak vertical ground reaction forces in the feet, vertical breaking impulse, centre of mass velocity, bowling score, and ball release velocity (BRvel) were measured. Results revealed that the BRvel was significantly decreased over bouts (p < 0.001). Additionally, increased flexion of the dominant wrist (p < 0.001) and elbow (p = 0.004) prior to ball release (BR) and increased pronation of the dominant wrist during BR (p = 0.034) were observed at later bouts. It was concluded that these kinematic changes in the dominant wrist and elbow prior to and during BR were performed to compensate for the change in traction between ball and lane during a bowling match. This, in turn, caused a decrease in BRvel. A conservation of energy perspective was discussed to highlight training applications and possibilities to enhance elite athletes' bowling performance.

Wrist Guards/Supports in Gymnastics: Are They Helping or Hurting You?

Background: The prevalence of wrist pain among gymnasts ranges from 46% to 79%. To alleviate wrist pain, gymnasts wear wrist guards/supports (WG/S). Purpose: To investigate the effect of WG/S on the wrist joint through joint moment, angles, total joint range of motion (ROM) arc, and ground-reaction force (GRF). Study Design: Controlled laboratory study. Methods: A cross-sectional study design was used to investigate 23 female gymnasts (mean ± SD: age, 12.3 ± 1.5 years; height, 143.4 ± 7.6 cm; mass, 37.7 ± 6.6 kg; body mass index, 18.6 ± 2.9) who performed back handsprings (analyzed by first half [phase 1] and second half [phase 2]) with the following 3 conditions: no WG/S, Skids/Ultimate Wrist Supports (S/UWS), and Tiger Paws (TP). Wrist joint moments, angles, total ROM arc, and GRF were examined by the 3 conditions using analysis of variance with Bonferroni correction and effect size (Cohen d). Results: For mean wrist flexion moment, both S/UWS and TP showed significantly higher values than the no-WG/S condition in landing phase 1 (S/UWS: P = .001, d = 1.30; TP: P = .019, d = 0.87). In angle comparisons in landing phase 1, no WG/S showed greater mean wrist extension angles compared with S/UWS (P = .046; d = 0.80), but no significant differences with TP (P = .096; d = 0.65). Also, in landing phase 1, total ROM arc of the right wrist was greater in the no-WG/S condition compared with S/UWS (P = .018; d = 0.88), but there were no differences with TP (P = .400; d = 0.52). Conclusion: These data show an increased wrist flexion moment using S/UWS and TP compared with the no-WG/S condition in landing phase 1 of back handsprings. Also, increased wrist extension angles and total arc ROM of the right wrist were found in the no-WG/S condition compared with S/UWS, but not with TP in landing phase 1. S/UWS may be helpful to reduce wrist joint angles, specifically wrist extension in landing phase 1, but both S/UWS and TP caused higher wrist flexion joint moment in landing phase 1. There were no differences found in GFG among the three variables. Clinical Relevance: In the first half of the back handspring, wrist guards can limit wrist extension joint angles and total arc ROM; however, an increased wrist flexion moment was found when wrist guards were worn, which may potentially lead to an increased risk of injury. Injury history, especially overuse signs/symptoms, and previous surgery on the wrist joint need to be well considered before the application or use of wrist guards. Also, the amount of time/exposure wearing wrist guards should be carefully controlled in young female gymnasts.

An analysis of musculoskeletal disorder risk factors associated with common pedagogical principles of the Lhevinne and Taubman piano schools: A literature review

Playing-related musculoskeletal disorders (PRMDs) are highly prevalent among concert pianists due to the unique sociological and historical predispositions of the instrument. Although current literature explores PRMD risk factors in isolation, few studies have explored the complex interdependencies that exist between the procedural and postural practices of pianists. This study aims to reframe this discussion by holistically exploring how common educational principles in phalangeal curvature, wrist flexion range of motion, and technical exercises interact to precipitate in PRMDs. The practices of the Lhevinne and Taubman schools were comparatively evaluated through kinematic studies to discern potential biomechanical stresses, and the findings were compared with current empirical evidence to ascertain links to PRMDs. The findings from this review indicate pedagogical susceptibility patterns may be more nuanced than the claims of stakeholders. However, studies suggest that practitioners of the Lhevinne school should incorporate phalangeal postures with active flexion to reduce susceptibility to tendinitis, osteoarthritis, and carpal tunnel syndrome. Practitioners of the Taubman school should further apply low-intensity technical exercises for warm-ups to increase muscle flexibility and facilitate temperature-related benefits to performance. However, high-intensity exercises at the Lhevinne school such as consecutive intervals and flexibility studies are contrary to current biomechanical observations.

Acute Effects of Strength and Skill Training on the Cortical and Spinal Circuits of Contralateral Limb

Unilateral strength and skill training increase strength and performance in the contralateral untrained limb, a phenomenon known as cross-education. Recent evidence suggests that similar neural mechanisms might be responsible for the increase in strength and skill observed in the untrained hand after unimanual training. The aims of this study were to: investigate whether a single session of unimanual strength and skill (force-tracking) training increased strength and skill in the opposite hand; measure ipsilateral (untrained) brain (via transcranial magnetic stimulation, TMS) and spinal (via the monosynaptic reflex) changes in excitability occurring after training; measure ipsilateral (untrained) pathway-specific changes in neural excitability (via TMS-conditioning of the monosynaptic reflex) occurring after training. Participants (N = 13) completed a session of unimanual strength (ballistic isometric wrist flexions) and skill (force-tracking wrist flexions) training on two separate days. Strength increased after training in the untrained hand (p = 0.025) but not in the trained hand (p = 0.611). Force-tracking performance increased in both the trained (p = 0.007) and untrained (p = 0.010) hand. Corticospinal excitability increased after force-tracking and strength training (p = 0.027), while spinal excitability was not affected (p = 0.214). TMS-conditioned monosynaptic reflex increased after force-tracking (p = 0.001) but not strength training (p = 0.689), suggesting a possible role of polysynaptic pathways in the increase of cortical excitability observed after training. The results suggest that cross-education of strength and skill at the acute stage is supported by increased excitability of the untrained motor cortex. New & Noteworthy: A single session of isometric wrist flexion strength and skill straining increased strength and skill in the untrained limb. The excitability of the untrained motor cortex increased after strength and skill training. TMS-conditioned H-reflexes increased after skill but not strength training in the untrained hand, indicating that polysynaptic pathways in the increase of cortical excitability observed after skill training.

Morphological and radiological features of congenital muscular hypertrophy of the upper limb: experience from a tertiary institution.

Congenital muscular hypertrophy is a rare overgrowth disorder in the phosphatidylinositol-3-kinase related spectrum. In the past 3 years, ten patients with 11 limbs involved were treated in our centre. The aim of the study was to describe the clinical and radiological deformities of these patients. We documented the characteristic clinical morphological changes, such as hypertrophy, loss of wrist flexion, thumb hyperabduction, finger deviation and skin crease changes in the palm. Radiologically, the mean first metacarpal radial deviation angle of the affected side measured 55° (range 34 to 67) compared to the normal contralateral side 42° (range 32 to 53). The mean intermetacarpal space ratio was 1.2 (range 1.1 to 1.4) and the mean palm width ratio was 1.2 (range 1.1 to 1.3). In this study, we were able to further characterize the radiological and morphological changes of congenital muscular hypertrophy of upper limbs, which would be helpful for establishing the diagnosis and monitor treatment of this rare condition.Level of evidence: IV.

Analysis of the causes of soft tissue complications after volar locking plate for the treatment of dorsal displaced distal radius fractures

To investigate the causes of soft tissue complications in patients with dorsal displacement distal radius fractures (DRF) after volar locking plate surgery. From July 2016 to May 2021, 112 patients with dorsal displacement DRF were treated with volar locking plate surgery, including 45 males and 67 females. The average age was (46.24±10.08) years old, ranging from 18 to 85 years old. According to whether there were soft tissue complications after operation, they were divided into complication group (40 cases) and non complication group (72 cases). Compared with preoperation, the radial metacarpal inclination and ulnar deflection angle, wrist flexion activity and dorsal extension activity, and grip strength of patients after operation were significantly improved (P<0.05). Compared with the non complication group, the proportion of patients in the complication group whose age was>60 years, body mass index (BMI) more than 30 kg·m-2, smoking, diabetes, fracture type C, open fracture and operation time more than 90 min was higher (P<0.05). The age, BMI, smoking, diabetes, fracture AO classification, fracture type and operation time were analyzed by multifactor Logistic regression to determine the independent risk factors affecting the occurrence of postoperative soft tissue complications of patients, establish a nomogram prediction model, and evaluate the model. At the latest follow-up, the excellent and good rate of wrist joint function recovery was 83.93% (94/112), and the excellent and good rate of fracture reduction was 84.82% (95/112). Multivariate Logistic regression analysis showed that age more than 60 years old, diabetes, fracture type C, open fracture and operation time more than 90 min were independent risk factors for postoperative soft tissue complications (P<0.05). The receiver operating characteristic (ROC), calibration curve and clinical decision curve of the nomogram prediction model showed discrimination, accuracy and validity were good. Age more than 60 years, diabetes mellitus, fracture type C, open fracture, and operation time more than 90 min are all independent risk factors for soft tissue complications after DRF volar plate fixation. In clinical treatment, perioperative soft tissue management should be done in such patients to prevent complications.

C3 (Clinical Case) Late Presentation of Radial Nerve Palsy Secondary to Extravasation of Peripherally Inserted Catheter in a Neonate: What Paediatricians Need to Know

Abstract Introduction/Background Peripherally inserted central catheters (PICC) are an essential and common procedure in neonatal intensive care units (NICUs). Peripheral nerve injuries secondary to PICC extravasation are a rare occurrence in neonates, who commonly recover with no sequalae. Rarely, extravasation results in compression and ischemia involving adjacent nerves, muscles or joints. Peripheral nerve injury may be induced by compression from tissue infiltration or irritation by the infiltrate. Timely diagnosis and treatment are essential to avoid complex or irreversible nerve damage, such as compartment syndrome, requiring extensive interventions. Isolated radial nerve injury in infants and neonates is limited to a few cases reported in the literature, which have been commonly related to in-utero compression or birth injury due to peripheral positioning. We report a late presentation of an isolated radial nerve injury secondary to PICC extravasation in a preterm infant, leading to neuropraxia and long-term impairment of hand function. Case Description An extreme preterm female infant (245/7 weeks’ gestation, 640 grams) was admitted to the NICU with a complex neonatal course. At 6 days after birth, a right antecubital PICC was inserted for vascular access and to provide parenteral nutrition. It was removed after 18 days following extravasation. Two months later, she developed a right wrist drop, flexed fingers, and edema of the right hand. Her right wrist flexion, elbow flexion, shoulder joint range of motion, and sensation remained intact. A Doppler study showed a small non-occlusive clot in the right brachial vein, attributed to the previous PICC. She was unable to voluntarily open her right hand or extend her metacarpophalangeal (MCP) or interphalangeal (IP) joints (see Figure A, below). Clinical diagnosis of radial nerve palsy was made, and she was referred to physiotherapy (PT) and occupational therapy (OT). Splinting, passive exercise and left-hand constraint resulted in some improvement of the right hand’s strength. At 12 months of age, she had left hand preference with limited active extension of right MCPs and IPs (Figure B). She received a Botox injection to the right-hand flexors to allow strengthening of the extensor muscles. Follow-up at 18 months showed full extension of the index and middle finger MCPs and IPs, but residual lag in ring and small finger IPs. Discussion To our knowledge, this is the first case report of isolated radial nerve injury in an infant following PICC extravasation and soft tissue infiltration. Interestingly, the clinical signs of radial nerve injury in this case presented almost two months after PICC extravasation. Additionally, the left-hand preference and limitation of the active extension of the fingers of the right hand remained at one year of corrected age. Given that this has exceeded the expected recovery time of radial nerve palsy, Botox injection was performed with good response and near age-appropriate development of fine motor skills at 18 months of corrected age. Paediatricians should be aware that the manifestation of potential nerve injury in neonates may have a delayed presentation. Neurology consultation to confirm the diagnosis and rule out other causes of muscle weakness, and referral to PT/OT, are crucial for managing infants and neonates with peripheral nerve injury because treatment is largely focused on splinting and passive motion exercise. Generally, radial nerve palsy carries a relatively good prognosis, with complete functional recovery within 1-6 months. The fact that this case developed long-term complications with impaired right-hand function, despite nerve recovery, raises concerns about the prognosis. Conclusion Peripherally inserted central venous catheters are an everyday procedure in the NICU. Radial nerve palsy secondary to venous catheter extravasation is rare in infants and neonates. Clinicians should be aware of the clinical signs of radial nerve palsy and initiate consultation and referral to physiotherapy and occupational therapy early. Families can be reassured of the good prognosis and functional recovery.

Effect of upper extremity kinesio tape application on hand function, wrist joint position and grip strength in children with hemiparetic cerebral palsy

Abstract Although kinesio taping (KT) is frequently used in musculoskeletal disorders, there is not enough data on the effectiveness of holistic KT application on the upper extremity in spastic hemiparetic children. Our study aims to evaluate the effect of KT application on spasticity, range of motion, dexterity and hand grip strength in these patients. Twenty patients diagnosed with spastic hemiparetic cerebral palsy, aged 5-17 years, who were trained and treated in a private educational institution, were included in the study. Between November 2021 and January 2022, in addition to neurodevelopmental therapy for 12 weeks, KT was applied from the lateral epicondyle region to the end of the metacarpals, with 15-25% tension, to the dorsal face of the hand, with the taping direction facilitation technique (starting direction is the origin of the muscle). Spasticity, range of motion, dexterity and hand grip strength were evaluated as pre-test and post-test. It was determined that the mean score difference between the pre-test and post-test range of motion (ROM) shoulder abduction, ROM supination, ROM wrist flexion, ROM wrist extension and hand grip strength of the individuals was statistically significant (). It was determined that the individuals’ pre-test-post-test Jebsen hand function test (JHFT) Writing, JHFT card flipping, JHFT small objects, JHFT nutrition simulation, JHFT backgammon checkers stamps, JHFT large light objects, JHFT total score average difference was statistically significant (). These results indicate that KT application positively affects upper extremity functions in the rehabilitation of hemiparetic cerebral palsy. Longitudinal studies are recommended in patients with hemiparetic cerebral palsy.

Outcomes of radiocarpal pinning to facilitate nerve repair in wrist level ulnar nerve injuries with defect.

The ideal scenario for ulnar nerve repair is primary end-to-end neurorrhaphy in a tension-free environment. However, this could be complicated by soft tissue loss, scarring and neuroma formation in a delayed injury, creating a nerve defect. With a wrist level nerve defect, a flexion position can help shorten the nerve gap. However, maintaining the position can be challenging intraoperatively and postoperatively. We proposed our method previously of using a 1.6mm K wire for radio-lunate-capitate pinning of the wrist in flexion to minimize the nerve gap, thereby facilitating neuroma excision and end-to-end neurorrhaphy in delayed ulnar nerve injury. In this study, we elaborate our method and present our case series. From October 2018 to July 2020, 5 patients (mean age: 48.2 years; mean delay from injury to surgery: 84.6 days; mean follow-up: 17.5 months) were retrospectively reviewed. The mean flexion fixation angle was 52 degrees and the K wire was removed at an average of 5.1 weeks postoperatively. All patients were followed-up for a minimum of 12 months. All patients achieved M4 and S3 or S3+ neurologically (according to the criteria of the Nerve Injuries Committee of the British Medical Research Council). The mean Disabilities Arm Hand and Shoulder score was 14.1. The mean grasp and pinch strengths were, respectively, 76.8% and 63.6% of the contralateral hand. All wrist range-of-motion returned to normal within 12 weeks. No complications were noted intraoperatively or postoperatively. Our study showed that radiocarpal pinning of the wrist in flexion was safe and convenient to minimize the nerve gap and to facilitate end-to-end neurorrhaphy in limited-sized wrist-level ulnar nerve defects.

Multi-joint Assessment of Proprioception Impairments Poststroke

ObjectivesTo investigate shoulder, elbow and wrist proprioception impairment poststroke. DesignProprioceptive acuity in terms of the threshold detection to passive motion at the shoulder, elbow and wrist joints was evaluated using an exoskeleton robot to the individual joints slowly in either inward or outward direction. SettingA university research laboratory. ParticipantsSeventeen stroke survivors and 17 healthy controls (N=34). Inclusion criteria of stroke survivors were (1) a single stroke; (2) stroke duration <1 year; and (3) cognitive ability to follow simple instructions. InterventionsNot applicable. Main Outcome MeasuresThreshold detection to passive motion and detection error at the shoulder, elbow and wrist. ResultsThere was significant impairment of proprioceptive acuity in stroke survivors as compared to healthy group at all 3 joints and in both the inward (shoulder horizontal adduction, elbow and wrist flexion, P<.01) and outward (P<.01) motion. Furthermore, the distal wrist joint showed more severe impairment in proprioception than the proximal shoulder and elbow joints poststroke (P<.01) in inward motion. Stroke survivors showed significantly larger detection error in identifying the individual joint in motion (P<.01) and the movement direction (P<.01) as compared to the healthy group. There were significant correlations among the proprioception acuity across the shoulder, elbow and wrist joints and 2 movement directions poststroke. ConclusionsThere were significant proprioceptive sensory impairments across the shoulder, elbow and wrist joints poststroke, especially at the distal wrist joint. Accurate evaluations of multi-joint proprioception deficit may help guide more focused rehabilitation.

Comparison of Single Dose with Continuous Infusion of 0.2% Ropivacaine in Interscalene Brachial Plexus Nerve Block for Pain Relief in Rotator Cuff Repair Surgery

Background: Severe postoperative pain is the most common complication after arthroscopic rotator cuff surgery. Peripheral nerve blocks, whether single-shot interscalene block (SSISB) or continuous interscalene nerve block, have consistently demonstrated superior analgesia after upper extremity surgery compared to general anesthesia alone. Aims: The aim of this study was to evaluate the difference in pain relief provided by single shot versus catheterized interscalene block. Materials and Methods: A prospective observational study was conducted in the Department of Orthopedics of Justice K.S.Hegde Charitable Hospital, Mangalore, from January 2020 to June 2021. Thirty patients who were diagnosed of complete rotator cuff tear were included in the study. All of them underwent arthroscopy-assisted single-row rotator cuff repair by the same surgeon under general anesthesia. They were randomly allocated into Groups I and B of 15 each. Patients in Group A received a SSISB and Group II received continuous infusion after the insertion of catheter. The catheter was removed after 24 h of surgery. Both groups followed the same postoperative management protocol. The pain perception assessment was measured using the Visual Analog Scale (VAS) at 6, 24, 48 h after surgery, and at 2nd week postoperative during suture removal. Power was assessed for the wrist (wrist flexion and extension) and for the fingers (finger flexion and abduction) at 6 h, 24 h, 48 h, and after 2 weeks on day 14 when suture removal was done. The results were calculated and tabulated using an independent “t-test” and “Chi-square test.” Results: The patients in Group A had a higher VAS score with a mean of 0.26 ± 0.06 as compared to Group B which showed a mean VAS score of 0 (P = 0.01). Six patients needed analgesia of postoperative day 2. Eight patients of Group B required rescue analgesia on postoperative day 2. Conclusion: Continuous infusion scalene block was noted to be superior to SSISB in the management of postoperative pain postarthroscopy assisted single-row rotator cuff repair.

Neuromotor variability partially explains different endurance capacities of expert pianists

During fatiguing piano tasks, muscle fatigue develops differently between expert pianists. Differences in neuromotor strategies employed could explain a slower rate of fatigue development. The objective was to compare muscle activation and kinematic variabilities between ShortDuration (i.e., pianists with less endurance) and LongDuration groups. Results from 49 pianists showed that EMG activation variability of most shoulder and upper limbs muscles was greater for the ShortDuration group with time during two piano fatiguing tasks, namely Digital and Chord tasks. Segment acceleration variability, assessed using inertial measurement units, was also greater with time for the ShortDuration group at the right arm during the Digital task, and at the thorax and head during the Chord task. Finally, thorax lateroflexion variability increased with time for the LongDuration group (but not the ShortDuration group) during the Digital task. During the Chord task, wrist flexion variability was higher for the LongDuration group compared to the ShortDuration group. These results showed a direct effect of time on the pianists’ acceleration variability and EMG activation variability. In contrast, a protective effect of fatigue development could be attributed to kinematic variability. Results also suggest a higher risk of injury among pianists in the ShortDuration group.

An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients.

Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.