Wrist ROM Research Articles

Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis.

Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists. The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE. Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors. Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups. For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.

Ab. No. 122 Functional Restoration Approach in the Management of Complex Regional Pain Syndrome (Crps) Caused By Onychomycosis: A Case Report

Introduction: The objective of this case report is to highlight the importance of incorporating functional restoration approach in the physiotherapy management of CRPS. The significant pain and disability associated with CRPS is not only biomedically faceted but frequently encompasses psychosocial aspects too. Physiotherapy management should address both these aspects. The functional restoration approach emphasizes gradual progression, starting with pre-sensorimotor cortices activation, then advancing to functional tasks. Methods: This is a case review of a 61 year old man with history of Onychomycosis presenting with left shoulder, wrist and hand stiffness and pain 6 months post the infection. Patient also presented with fear of movement and was reported to have had not used the arm functionally for daily activities since the onset of the infection. Patient is a k/c/o intentional tremors since 25 years. The functional restoration approach included patient education, desensitization using kinetic sand, followed by movement with Mulligan’s technique and graded functional activity by perpetual training over subsequent sessions. Pre and post assessments after a 3-week intervention included Kinesiophobia, Function, Pain, ROM, and grip strength. Additionally, the Archimedes spiral test was used to gauge tremor severity as a secondary outcome. Results: Post-intervention, positive changes were observed in outcome measures: a 16% decrease in Tampa Scale of Kinesiophobia, 10% improvement in Michigan Hand Outcome, 7% in grip strength, and 7% and 8% in wrist and shoulder ROM, respectively. The Archimedes spiral test also showed a notable improvement. Conclusion: The approach demonstrated improvement in Function, pain, and Kinesiophobia, with notable changes in range of motion, grip strength, and tremors as well. Implication: Functional restoration approach is a comprehensive method of managing CRPS since it addresses the syndrome’s multifaceted nature. Simultaneous assessment of biopsychosocial components aids in tracking progress and predicting better outcomes.

Volar Lunate Dislocation: A Case Report

Introduction: Perilunate dislocations are rare high-energy injuries which may often have the potential to cause lifelong disability of the wrist if not addressed optimally. Hence, early recognition, diagnosis, and intervention are of paramount importance in the restoring function and prevention of morbidity. Lunate dislocations are the fourth and last stage of perilunate dislocations being extremely rare, with volar dislocations representing <3% of perilunate dislocations. Case Report: A 24-year-old man suffered from an alleged history of fall from a bike on an outstretched hand following which he developed complaints of pain and swelling in the right wrist. On examination, the patient has relative sensory loss over the lateral half of the palm with no vascular deficit. An accurate range of motion could not be documented due to severe pain. Standard digital X-rays revealed lunate displaced and angulated volarly with a typical “spilled teacup” appearance along with radial and ulnar styloid fractures. Management: The patient was initially given an attempt of closed reduction which was not successful and was followed with open reduction and internal fixation with both volar and dorsal approach with Kirschner wires. The patient’s wrist was immobilized for 6 weeks with below elbow cast with the removal of k wires at 8 weeks after which wrist ROM exercises were started. Results: The patient was followed up for 6 months and now has a functional range of motion of the wrist with no sensory deficit and is able to continue with his profession as a car mechanic. Conclusion: Mayfield progression Stage 4 perilunate dislocations are uncommon with a poor prognosis if not addressed timely. Hence, these injuries need to be identified early and optimally managed with surgical intervention for a favorable outcome. Keywords: Perilunate dislocation, carpal bones, avascular necrosis of lunate, wrist trauma, carpal instability

Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing

Background: Proximal row carpectomy (PRC) has been shown to be an effective treatment option for early stages of wrist arthritis. In the presence of midcarpal arthritis however, PRC has generally been contraindicated due to a high conversion rate to total wrist arthrodesis. Variations to PRC, including radio-capitate soft tissue interposition and capitate resurfacing, have been introduced to delay conversion and have demonstrated similar outcomes compared to standard PRC. Comparative outcomes between these technical variations have not been investigated however. Methods: Retrospective chart review was conducted for patients who underwent PRC with interposition or capitate resurfacing from 2009-2019. Patient demographics, pre- and post-operative range of motion, operative time, cost, and post-operative complications were collected. Descriptive statistics were expressed as means and standard deviations. Survivability was plotted on a Kaplan-Meier survival curve. Results: Final cohorts included ten patients who underwent PRC with interposition and six who underwent PRC with resurfacing. Resurfacing had longer average operative duration (51.3±18.3 vs. 79.0±16.5 min, P=0.009) and higher cost ($29,116±10,036 vs. $15,290±3,743, P=0.028). There was no significant difference in wrist ROM. Two of the six patients who underwent resurfacing experience complications requiring conversion to total wrist arthrodesis, however there was no significant difference in overall survivorship. Conclusions: In this observational comparative study, PRC with capitate resurfacing trended towards longer operative time, increased cost, and higher complication and conversion rate. Future larger and more standardized analyses are needed in order to evaluate the long-term outcomes of these procedures. Level of Evidence: Level IV – Case Series.

A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis

Study DesignSystematic review. IntroductionSeveral treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. Purpose of the StudyTo determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. MethodsSearches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. ResultsA total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. ConclusionThe evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended.

Using Trident distal radial locking plate to fix the fracture of distal radius volar rim.

The volar locking plates have been widely used in a variety of distal radius fractures, but they still have several limitations when dealing with small fragments located around the watershed line with widely reported complications. The volar rim fragments play a critical role in radiocarpal joint stability and failing to secure the volar rim fragment usually results in carpal instability, subluxation, or even dislocation. This study investigates clinical outcomes in the use of a novel implant, the Trident distal radial (TDR) locking plate to treat distal radius fracture with the intermedium column edge (lunate fossa volar rim) fragment involvement. A retrospective study of 25 patients was conducted, all patients had intermedium column fractures with lunate fossa volar rim involvement and treat with the TDR between January 2016 and December 2019. The clinical assessment outcomes included VAS Pain, PRWE, and DASH scores. Objective measurements included ROM of the injured wrist and grip strength. Final radiographs were used to evaluate radial inclination, volar tilt, ulnar variance, and distal radioulnar joint instability. Secondary operations related to hardware complications were also recorded. The outcome revealed that the mean VAS Pain Score was 1.3, mean DASH score was 10.5, and mean PRWE score was 9.3. Objective measurements revealed good ROM recovery and an 89% gripping strength recovery compared with contralateral hand. Radiographic measurements revealed good maintenance of volar tilt, radial inclination, and mean ulnar variance. There were no complications related to the implant and all fracture sites were union. We believe that the TDR provided more stable fixation among distal radial fractures that predominantly involved the intermedial column and volar rim fragment, and allowing early rehabilitation. We could obtain excellent results in the wrist ROM, gripping power, and Pain Score (VAS).

Scaphocapitate Fusion with lunatum excision in advanced Kienböck disease: 5.3-year mean follow-up

Objective: This study evaluated the clinical and radiological outcomes of scaphocapitate fusion (SCF) performed after lunate excision in patients with advanced Stage III Kienbock's disease. Materials and method: Eleven patients diagnosed with Stage 3 Kienbock's disease who underwent SCF following lunate excision retrospectively evaluated in this study. The scores of arm, shoulder and hand disability (DASH) and Visual Analogue Scores (VAS) recorded preoperatively were also recorded at the final follow-ups after surgery. Wrist ROM (flexion, extension, radial, ulnar) was measured using a goniometer in the operated and contralateral wrists. Grip, tip pinch, key pinch forces and palmar grip were measured using a Jamar dynamometer and pinch gauge (Model SH 5005, South Korea). Results: The study included a total of eleven patients including six female and five male patients. The mean follow-up period was 63.45 months (range 24-86). According to the functional evaluation, the mean preoperative and postoperative Visual Analog Scores (VAS) were 8.45 (range 7-10) and 1.18 (range 0-3), respectively. The mean disabilities of the arm, shoulder and hand (DASH) score was reduced from 52.27 (range 36.40-70) to 16.51 (4.5-47.7) between the preoperative and postoperative periods. According to the evaluation of joint range of motion, the mean range of flexion was 72.9%, the mean range of extension was 84.9%, the mean radial deviation range was 57.35% and the mean ulnar deviation range was 82.46% in the operated hands compared to the contralateral wrist. While wrist flexion and extension ranges exhibited a statistically significant increase, radial deviation exhibited a statistically significant decrease compared to the preoperative period (p<0.05). Conclusion: SCF after lunate excision is a successful surgical method that provides pain relief and increases joint range of motion by maintaining acceptable range of motion in the medium-long term.

Treatment of failed scaphoid nonunion fixation using free medial femoral condyle vascularized bone grafting.

Nonunion in scaphoid fractures may be considered a devastating problem. Union failure results in scaphoid deformity, resorption, and bone loss. Failed previous fixation decreases remaining bone stock and makes it more difficult to achieve union. Free vascularized graft represents a good option to achieve scaphoid union with revision fixation. Our study aims at the assessment of the management of scaphoid fractures non-union after failed previous fixation with the use of a free vascularized graft from the medial femoral condyle. This is a retrospective study including 16 cases with persistent scaphoid nonunion after previous fixation managed by vascularized medial femoral condyle grafts. The mean follow-up was 24 months. Previous surgical attempts and nonunion duration were noted. We evaluated the union rate, together with ROM, Scapholunate angles and pain scores. the union was achieved in 13 of 16 cases. Pain improved in all patients (10/16 complete relief). Wrist ROM at follow-up was an average of 50° flexion 48° extension. There was no change in the relationship between lunate and scaphoid with an average angle of 37.5° preoperative and 38° postoperative. Free vascularized MFC grafts are considered a reliable method to treat persistent nonunion of scaphoid fractures after failed previous operations. Short-term follow-up data showed considerable union rates with adequate pain relief and satisfactory ROM.

Effect of the Trunk and Upper Limb Passive Stabilization on Hand Movements and Grip Strength Following Various Types of Strokes-An Observational Cohort Study.

Almost half of the patients surveyed report impaired function of the upper limbx and handx after stroke. The effect of the passive trunk and shoulder stabilization on the recovery of coordinated hand movement is unclear. This study examined whether passive stabilization of the trunk and shoulder could improve the functional state of the hands after various types of strokes. It is an observational prospective cohort study conducted at the Rehabilitation Clinic in two parallel groups of patients with four different types of strokes (hemorrhagic and ischemic of the brain, similar to the cerebellum). A total of 120 patients were analyzed. Patients were examined in various positions: sitting without a backrest with the upper limb adjacent to the body, supine with the upper limb perpendicular to the body, and supine with the arm stabilized in relation to the patient’s body. Hand Tutor devices and a hand dynamometer were used for the measurements. The frequency and maximum range of motion as well as the grip strength were measured in three different positions of the trunk and upper limb. Passive stabilization of the trunk and shoulder showed more statistically significant differences in Group II. In group II, both in patients after hemorrhagic stroke (wrist Hz p = 0.019; wrist ROM p = 0.005; Hz F5 p = 0.021; Hz F4 p = 0.016; Hz F3 p = 0.019; Hz F2 p = 0.021) and ischemic stroke (p = 0.001 for wrist Hz, wrist ROM, Hz F from 5 to F2; and ROM F1; ROM F3 p = 0.009; ROM F2 p = 0.010), and hemorrhagic cerebellum, improvement of parameters was observed. Stabilization of the upper limb and passive stabilization of the trunk improved the frequency and range of movements in the radiocarpal joint and in the fingers of patients after stroke, regardless of the type of stroke.

The patient-rated wrist and hand evaluation was successfully translated to the Slovenian language

BackgroundThe Patient-Rated Wrist and Hand Evaluation (PRWHE) is one of the widely used PROMs in the hand rehabilitation. PurposeTo develop the Slovenian version of the PRWHE (PRWHE-Slo) and to evaluate its psychometric properties. Study designA single-centre observational prospective cohort study. MethodsFifty patients with distal radius fracture (DRF) were enrolled in the study. Construct validity was assessed by examining the correlations between the PRWHE-Slo and QuickDASH, EQ-5D-5L, wrist ROM, and grip strength. Reliability was evaluated by determining internal consistency (Cronbach...s alpha) and test-retest reliability (intraclass correlation coefficient (ICC)). The standard error of measurement (SEM) and the minimal detectable change (MDC) were determined. The responsiveness of the PRWHE-Slo was assessed with the effect size (ES) and standardised response mean (SRM). ResultsThe Cronbach’s alpha value of 0.96 and the ICC (95% CI) value of 0.95 showed excellent internal consistency and reliability for the total PRWHE-Slo score. When assessing construct validity of PRWHE-Slo, there was a strong positive correlation between all subscales and total scores of the PRWHE-Slo and the QuickDASH (r-values ranging from 0.72 to 0.83). The unrelated dimensions such as the function subscale of the PRWHE and the mobility and anxiety/depression subscales of the EQ-5D-5L were not statistically significantly correlated. Grip strength was moderately negatively correlated with all PRWHE subscales, whereas ROM showed no statistically significant correlations with any of the PRWHE-Slo subscales. SEM and MDC for the total PRWHE-Slo score were 5.40 and 14.97, respectively. The PRWHE-Slo proved to be highly responsive in DRF patients with SRM and ES values of 1.27 and 0.91, respectively. ConclusionsThe psychometric analysis of this study shows the PRWHE-Slo to be reliable, valid, and responsive PROM for assessing pain and disability in patients after DRF.

Change in the Results of Motor Coordination and Handgrip Strength Depending on Age and Body Position-An Observational Study of Stroke Patients and Healthy Volunteers.

Objective: The stroke is considered a common disease of the elderly. Young people also get sick, but the risk of stroke increases with the age of 60. Stroke, regardless of the age of the patients, causes functional deficits; therefore, the aim of the study was to analyze the significance of the body position and examined upper limb on the parameters of motor coordination and handgrip strength in various age groups of people after stroke and healthy people. Material and method: This is an observational study. A total of 117 people participated in the study (60 stroke patients and 57 healthy people without neurological disorders). Both patients and healthy volunteers were prospectively divided into three age groups: 18–45, 46–60, and 61+. The tests were carried out in two starting positions: sitting without back support and lying on the back with the upper limb stabilized against the body. HandTutorTM and a hand dynamometer were used to assess the motor coordination, including the maximum range of motion and frequency of movement, as well as the grip strength. Results: The passive stabilization of the trunk and shoulder improved the maximum wrist ROM (p < 0.001) and frequency of finger movements (Hz F5 p = 0.018; F3 p = 0.010; F2 p = 0.011), especially in the oldest stroke patients. In the group of healthy volunteers, the most statistically significant results were obtained in the age range of 46–60. They occurred in both stable (wrist maxROM p = 0.041 and Hz F5 p = 0.034; Hz F4 p = 0.010; Hz F3 p = 0.028; Hz F1 p = 0.034, maxROM F1 p = 0.041) and unstable positions (maxROM F5 p = 0.034; maxROM F4 p = 0.050; maxROM F3 p = 0.002; maxROM F2 p = 0.002). In the group of the oldest healthy people, only one significant result was obtained in the stable position (Hz F3 p = 0.043). Conclusion: Passive stabilization of the trunk and examined upper limb improves the results of motor coordination of the distal part of the upper limb in both study groups. Passive stabilization of the trunk and upper limb improves motor coordination, especially in the oldest group of patients, after stroke.

Perte de hauteur radiale dans une fracture radiale distale extra-articulaire suite à la fixation par plaque antérieure verrouillée

BackgroundRadial height is an important prognostic factor in treating distal radius fracture. However, does further collapse of radial height in distal radius fractures after with volar locking plate fixation have a great impact on the prognosis? The present study aimed to elucidate radial height loss and determine the associated risk factors after open reduction and internal fixation with volar locking plate in patients with extra-articular distal radius fractures. HypothesisPatients with radial height collapse after fracture reduction and internal fixation with a volar locking plate may have poor outcomes. MethodsData of 87 patients (21 male) undergoing surgery for acute extra-articular distal radius fractures (AO: 23-A2 or 23-A3) between February 2014 and July 2016 were evaluated retrospectively. Patients were divided into two groups by radial height loss. Potential risk factors were tested by Pearson correlation coefficients. Stepwise multiple regression logistic analysis determined significant independent risk factors for extra-articular distal radius fractures. Clinical evaluation was performed by the same surgeon by determining wrist ROM. Grip strength was measured with a Jamar dynamometer and compared with non-affect wrist in percentage. In addition, all the patients were asked to grade modified Mayo wrist score and Visual Analogue Scale (VAS) score. These findings were recorded post-operative 1 year of follow up. ResultsMean radial height loss was 1.3±0.9mm. Age (ß=0.002, p=0.003), postoperative ulnar-positive deformity (ß=0.107, p<0.001), DEXA (ß=−0.015, p=0.008), and shortest diameter of distal fracture fragment in AP and lateral views (ß=−0.050, p=0.037; ß=−0.080, p=0.043) were significantly associated with radial height loss. As for the outcome of clinical prognosis, though radial height collapse group had poorer wrist range of motion, there was no statistical difference. Besides, there were no significant differences in grips strength and VAS score between these two groups. However, in regards of modified Mayo wrist score, the percentage of patients with poor outcomes is significant higher in radial height collapse group (p=0.039). Moreover, all patients with poor outcomes in radial height collapse groups were older than 65-year-old. DiscussionRadial height loss is noted in patients undergoing open reduction and internal fixation with volar locking plate for extra-articular distal radius fractures. Risk factors for radial height collapse include advanced age, poor bone quality, shortest distance between fracture site and articular surface and post-operative ulnar-positive deformity. Level of evidenceIV; non-comparative prospective study.

Comparison of functional outcome of extra-articular distal radius fractures treated by volar locking plate versus percutaneous pinning in adults-a retrospective study

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Distal radius fractures are one of the most common fractures in an adult population and accounts for 17.5% of all the fractures. The management of distal radius fractures remains debatable despite the availability of different methods of treatment. The aim of this study is to assess the functional outcomes of extra-articular distal radius fractures treated with percutaneous pinning or internal fixation with volar locking plate in adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study of 40 patients diagnosed with distal radius fracture with AO classification were treated either with percutaneous pinning (n=20) or open reduction and internal fixation with volar locking plate (n=20) were included in study. DASH score and radiographs at 6&lt;sup&gt;th&lt;/sup&gt; month was assessed for functional outcome and radiological union.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean age in plate group was 40 and 45 years in K wire group. The mean passive wrist ROM at the final follow-up evaluation in plate group was 63.8&lt;sup&gt;o&lt;/sup&gt; extension and 70.5&lt;sup&gt;o &lt;/sup&gt;flexion, 81.7&lt;sup&gt;o&lt;/sup&gt; supination and 79&lt;sup&gt;o&lt;/sup&gt; pronation, compared with 56.75&lt;sup&gt;o&lt;/sup&gt; extension and 65.25&lt;sup&gt;o&lt;/sup&gt; flexion, 74.7&lt;sup&gt;o&lt;/sup&gt; supination and 85.5&lt;sup&gt;o&lt;/sup&gt; pronation in patients treated with K wire group. Patients with plate group and K wire group had DASH score of 19.85 and 18.49 respectively (p=0.07) at 6 months follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The use of ORIF with plate resulted in stable fixation of the unstable extraarticular fractures, allowing early post-surgical wrist motion and has good radiological outcome whereas K wire also has advantages of being minimal invasive, reduced hospital stay and minimal cost.&lt;/p&gt;

Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation

BackgroundRadial height is an important prognostic factor in treating distal radius fracture. However, does further collapse of radial height in distal radius fractures after with volar locking plate fixation have a great impact on the prognosis? The present study aimed to elucidate radial height loss and determine the associated risk factors after open reduction and internal fixation with volar locking plate in patients with extra-articular distal radius fractures. HypothesisPatients with radial height collapse after fracture reduction and internal fixation with a volar locking plate may have poor outcomes. MethodsData of 87 patients (21 male) undergoing surgery for acute extra-articular distal radius fractures (AO: 23-A2 or 23-A3) between February 2014 and July 2016 were evaluated retrospectively. Patients were divided into two groups by radial height loss. Potential risk factors were tested by Pearson correlation coefficients. Stepwise multiple regression logistic analysis determined significant independent risk factors for extra-articular distal radius fractures. Clinical evaluation was performed by the same surgeon by determining wrist ROM. Grip strength was measured with a Jamar dynamometer and compared with non-affect wrist in percentage. In addition, all the patients were asked to grade modified Mayo wrist score and Visual Analogue Scale (VAS) score. These findings were recorded postoperative 1 year of follow-up. ResultsMean radial height loss was 1.3±0.9mm. Age (ß=0.002, p=0.003), postoperative ulnar-positive deformity (ß=0.107, p<0.001), DEXA (ß=−0.015, p=0.008), and shortest diameter of distal fracture fragment in AP and lateral views (ß=−0.050, p=0.037; ß=−0.080, p=0.043) were significantly associated with radial height loss. As for the outcome of clinical prognosis, though radial height collapse group had poorer wrist range of motion, there was no statistical difference. Besides, there were no significant differences in grips strength and VAS score between these two groups. However, in regards of modified Mayo wrist score, the percentage of patients with poor outcomes is significant higher in radial height collapse group (p=0.039). Moreover, all patients with poor outcomes in radial height collapse groups were older than 65-year-old. DiscussionRadial height loss is noted in patients undergoing open reduction and internal fixation with volar locking plate for extra-articular distal radius fractures. Risk factors for radial height collapse include advanced age, poor bone quality, shortest distance between fracture site and articular surface and postoperative ulnar-positive deformity. Level of evidenceIV; non-comparative prospective study.

Hand function rehabilitation after Brachial artery revascularization surgery at elbow due to dog bite: A case report

Dog bite injuries to the upper extremity can result in traumatic neurovascular and musculotendinous damage. The brachial artery is the most frequently injured artery in the upper extremity. The study was undertaken with an intention to rehabilitate the hand function post brachial artery revascularization surgery at elbow caused by dog bite. A single case experimental study data was collected with hand dynamometer for the grip strength pinch grip and movement analysis was done using range of motion ROM and manual muscle testing MMT for muscle power. 3 months of physical therapy intervention was done using hand exerciser unit and galvanic stimulation. Result showed significant hand function strength improvement. Wrist extension was 47 and radial deviation 45 and ROM of wrist showed overall 60 improvement post treatment session. Grip strength showed minimal improvement of 7.5 whereas pinch grip had 33 improvement. There was marked improvement in ROM and strength post intervention although the hand function grip strength and pinch grip did not show marked improvement.

Do we need to suture the pronator quadratus muscle when we do open reduction and internal fixation for fracture of the distal radius

BackgroundOpen reduction and internal fixation is often used for the treatment of distal radius fracture. Opening the pronator quadratus muscle during the process of open reduction and internal fixation is necessary to achieve sufficient exposure. Therefore, knowledge on how to suture the pronator quadratus muscle will be of essence.AimThe aim of the present study was to determine if suturing the pronator quadratus during the treatment of the distal radius fracture can enhance limb function .MethodsA total of 126 patients were enrolled for the study. The patients underwent open reduction and internal fixation. During the procedure, the pronator quadratus was cut open to allow insertion of the plate. The pronator quadratus muscles of the patients were stitched together before the surgery was completed. After the fracture healed, the patients underwent surgery to remove the internal fixations. Patients received wrist function scores prior to removal of the internal fixations. Healing of the pronator quadratus was during surgery. Patients were grouped according to the healing of the pronator quadratus. Functional scores between the two groups were compared.ResultsMuscle healing was observed in 23 patients during surgery. However, the PQ muscles of these patients were remarkably atrophic, with scar hyperplasia and fibrosis. The muscle fibers were loose, thin, and had decreased in number. The remaining muscle fibers presented different degrees of adhesion with radial carpal flexor muscles, steel plates and interosseous membrane. A total of 23 patients were included in group A and 103 patients in group B based on the intraoperative condition. No statistically significant differences was observed in age and type of fracture between group A and group B. In addition, no statistically significant differences was observed in the isokinetic forearm pronation strength and clinical outcomes including grip strength, wrist ROM, and PRWE scores between the two groups.ConclusionThis study demonstrates that healing of the PQ muscle does not affect the outcomes of volar plating for distal radius fractures with reference to the isokinetic forearm rotation strength, grip strength, wrist ROM, and PRWE scores. The results of this study support our current practice of PQ muscle incision.

Effects of physiotherapy after surgical treatment of carpal tunnel syndrome

The persistence symptoms of carpal tunnel syndrome causes patients to undergo surgical decompression of the median nerve. The resulting dysfunctions require postoperative physiotherapy. The aim of the study was to assess the effects of physiotherapy on pain, ROM of wrist and forearm, the results of the Phalen and Durkan tests, and the strength of the operated hand. Material and method. A group of 30 patients was included in the study, including 28 women and 2 men. The ROM of the wrist joint and forearm was measured with a goniometer, and pain with the VAS scale. Phalen and Durkan tests and functional test were carried out. Results: physiotherapy has a positive effect on reducing the intensity of pain, improve the ROM of the wrist joint and forearm and the functional capacity of the hand in patients after surgical treatment of carpal tunnel syndrome.

A retrospective analysis comparing functional and radiological outcomes after treatment of unstable distal radius fractures using volar locked plate versus percutaneous fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Distal radius fractures are one of the most routinely encountered injuries in an orthopaedic setting. Despite the wide variety of treatment options available there is still debate about the optimal way to treat these fractures. The aim was to evaluate and compare functional and radiological outcomes of unstable distal radius fractures treated by either by using volar locking compression plating (VLP) or by using percutaneous fixation augmented by Kirschner (K) wires (EF).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective analysis was carried out on all cases of acute unstable unilateral fracture distal radius who were admitted between January 2015 and December 2017 and were treated either by VLP or EF. QuickDASH score and PRWE were documented at every follow up in OPD at 6 weeks, 6 months and 1 year post-op along with serial X-rays at immediate post-op and 01 year which were then compared.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 122 cases of fracture distal radius were selected for study which fulfilled the inclusion criteria out of which 49 were treated by VLP and 73 by EF. There was no statistical difference in QuickDASH, PRWE scores or wrist ROM between two groups at1 year follow up. However VLP group was better in maintaining palmar tilt, radial length and inclination at the end of 1 year.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both VLP and EF show comparable and predictable good outcomes in treating unstable distal radius fractures when measured in terms of ROM and clinically validated patient outcome scores at 01 year follow up with similar rate of complications.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Decreased Movement Of Right Arm In A Non-verbal Child

HISTORY: A 4 y/o non-verbal male with Rubinstein-Taybi syndrome presented for poor motion of his right arm. The patient was noted to become fussy when his parents put his shirt on that morning and when they tried to move his right arm. There were no known injuries, trauma, fever, or recent illness. Birth history was unremarkable. He had a tethered cord release in his first year of life. At baseline he uses all extremities and can crawl but not walk. PHYSICAL EXAMINATION: T 97.9F BP 104/80 HR 115 Well appearing, nonverbal and wheelchair-dependent male. No ecchymosis or significant erythema to the right arm. Limited active and full passive ROM of right shoulder, elbow and wrist with fussiness noted on manipulation. No focal tenderness noted. 2/4 MSR in bilateral upper and lower extremities. DIFFERENTIAL DIAGNOSIS: 1. Radial Head Subluxation 2. Non-accidental Trauma - fracture or dislocation 3. Osteomyelitis 4. Septic Arthritis 5. Tumor/Malignancy TESTS AND RESULTS: R Shoulder and Elbow XRs: No fracture or soft tissue abnormality seen CRP 41.7 mg/L, ESR 44 mm/hr, Blood culture No growth MRI of Right Humerus: Effusion with surrounding enhancement in the right shoulder; subtle changes in the metaphysis of the right humerus with periosteal edema and enhancement FINAL WORKING DIAGNOSIS: Pre-B cell Acute Lymphoblastic Leukemia TREATMENT AND OUTCOMES 1. The patient underwent manual reduction of possible radial head subluxation, which was felt to be successful with improved ROM of the elbow. However, symptoms returned within a day. 2. Labs and imaging were concerning for infection and he was admitted for surgical wash-out of right shoulder and sent home on prolonged IV antibiotics. 3. He developed contralateral shoulder symptoms with prolonged fever and left shoulder MRI showed similar findings. 4. After multiple wash outs and rounds of IV antibiotics, Flow Cytometry was noted to be positive for Pre-B cell acute lymphoblastic leukemia, so patient was started on appropriate chemotherapy regimen and is currently in the maintenance phase. 5. This case demonstrates the difficulty in pediatrics of identifying the cause of medical issues in patients who are non-verbal, as well as the vast differential diagnoses possible in children with musculoskeletal complaints. It also highlights the need for close follow up to resolution of symptoms.

Work-related risk factors for Carpal Tunnel Syndrome among Majmaah University female touchscreen users.

Objectives:This study aimed to explore the prevalence of carpal tunnel syndrome symptoms among female touchscreen users at Majmaah University, Saudi Arabia and to make a comparison for the wrist range of motion between probable CTS and non-CTS female touchscreen users.Methods:Two hundred and twenty-two female touchscreen users were enrolled in the present study. Among this cohort, fifty-two were academic members, 40 were employees and 130 were undergraduates. A Digital Inclinometer device was used to assess ROM of the wrist movements. A computer-based questionnaire, Phalen’s test, and Tinel’s sign were used to investigate the presence of CTS symptoms. The study was conducted between November 2018 and February 2019 at Majmaah University.Results:The prevalence of probable CTS was 34.2% among touchscreen users; the percent of probable CTS was significantly higher in undergraduates compared to other touchscreen users. There was a significant reduction in wrist flexion between the tested groups.Conclusion:Female touchscreen users at Majmaah University tended to have a high-risk for CTS. Wrist ROM measurements, particularly wrist flexion, could be a beneficial indicator for anticipating deviations in wrist posture after long-term touchscreen use. It is necessary to consider the job nature, age, BMI, and duration of using touchscreen as risk factors for CTS symptoms.