Handrehabilitation

Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation...

BACKGROUND: Rehabilitation protocols after distal biceps repair are highly variable, with many surgeons favoring at least 2 weeks of immobilization. Is this conservative approach necessary to protect the repair? METHODS: This was a consecutive series of 22 distal biceps tendon repairs in which a cortical button system was used. Patients were encouraged to mobilize their elbow actively from the day of surgery. Physiotherapy commenced at 3 weeks, with strengthening exercises when full range of movement (ROM) was achieved...

UNLABELLED: We studied the correlation between change in the QuickDASH score and the absolute post-operative QuickDASH score with patient satisfaction after open carpal tunnel decompression. Threshold values in the QuickDASH score, the point at which the sensitivity and specificity are maximal in predicting patient satisfaction, were identified. During the study period, outcome data were compiled for 937 carpal tunnel decompressions, which included 219 (23%) male and 718 (77%) female patients with a mean age of 58 years (standard deviation (SD) 14)...

Axons from the median and ulnar nerves can pass to each other through aberrant connections between them. Multiple interconnections between the nerves may provide a detour route for nerve fibres going to the hand. We investigated the incidence of variations and the associations between them in 90 cadaveric upper limbs. In 91% of upper limbs, one to five variations were found, with several statistically significant associations. The contribution of the C8 nerve to the lateral cord was positively associated with an accessory contribution of the lateral cord to the ulnar nerve...

UNLABELLED: This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side...

UNLABELLED: The aim of this study was to provide a clear description of the course, precise branching pattern and distribution of the deep branch of the ulnar nerve. A total of 36 hands from 18 preserved cadavers were dissected. The vertical distance from the pisoscaphoid line to the crossing points between the deep branch of the ulnar nerve and each metacarpal was about 4 cm. The deep branch of the ulnar nerve gave off two types of muscular branches: (1) trunks that innervate more than two intrinsic hand muscles; and (2) multiple separate branches innervating only a single muscle...

PURPOSE: To compare goniometric and visual assessments of angular hand joint and wrist joint positions measured by board-certified hand surgeons and certified hand therapists. We hypothesized that visual estimation would be similar to the goniometric measurement accuracy of digital and wrist joint positions. METHODS: The wrist, index finger metacarpophalangeal (MCP) joint, and index finger proximal interphalangeal (PIP) joint were evaluated in different positions by 40 observers: 20 board-certified hand surgeons and 20 certified hand therapists...

STUDY DESIGN: Randomized controlled trial. INTRODUCTION: Myofascial pain syndrome is characterized by myofascial trigger points (MTrPs) and fascia tenderness. PURPOSE OF THE STUDY: We investigated the effects of manual pressure release (MPR) alone or in combination with taping (MPR/MKT) in subjects with MTrPs. METHODS: Fifteen and 16 subjects received MPR and MPR/MKT respectively. Outcomes including Pressure pain threshold, muscle stiffness, mechanomyography were assessed at baseline, post-intervention and 7-days later...

BACKGROUND: Advanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. HYPOTHESIS: We hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities...

AIM: To report the presentation of complex regional pain syndrome-1 (CRPS-1) as deQuervain's stenosing tenosynovitis (DQST). CASE REPORT: A 24-year-old woman presented with 3-year history of clinical diagnostic criteria (CDC) of CRPS-1. Conservative and surgical treatment for this as DQST had failed to relieve her. We diagnosed the problem as CRPS-1with CDC as inflammatory manifestations of a mechanical tendinoses of all her 5 digital tendons caused by movement of the fingers and hand tethered by agonist (flexor)/ antagonist (extensor) muscles in co-contraction...

BACKGROUND: Motor impairment is an important criterion in the Clinical Diagnostic Criteria (CDC) of Complex Regional Pain Syndrome type-1 (CRPS-1) as defined by International Association for Study of Pain (IASP). OBJECTIVE: To describe the changes in musculoskeletal ultrasonography (MSKUSG) in CRPS-1 before and after treatment with ultrasound-guided dry needling (USGDN) in retrospective data from 44 patients. STUDY DESIGN: Patients irrespective of age, gender, or cause of CRPS were included in this retrospective data analysis; the Budapest criteria for the diagnosis of CRPS were stringently adhered to...

Everyday medical practice shows that most common problems within the hand result from overload, injuries and degeneration. Dorsal side pathologies such as de Quervain's and Wartenberg's disease, intersection syndrome or degenerative lesions of carpometa-carpal joint of the thumb discussed in the paper can be accurately diagnosed and differentiated by means of ultrasound examination. Ultrasound is similarly powerful in detection and grading of traumatic lesions involving extensor tendons and their sagittal bands or the flexor tendons and their pulleys...

UNLABELLED: The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded...

The morphological structure of the seven components of triangular fibrocartilage complexes of 11 cadaver wrists of elderly people was assessed microscopically, after staining with Hematoxylin-Eosin and Elastica van Gieson. The articular disc consisted of tight interlaced fibrocartilage without blood vessels except in its ulnar part. Volar and dorsal radioulnar ligaments showed densely parallel collagen bundles. The subsheath of the extensor carpi ulnaris muscle, the ulnotriquetral and ulnolunate ligament showed mainly mixed tight and loose parallel tissue...

UNLABELLED: A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients...

This study aims to identify the patterns of dominance of extrinsic or intrinsic muscles in finger flexion during initiation of finger curl and mid-finger flexion. We recorded 82 hands of healthy individuals (18-74 years) while flexing their fingers and tracked the finger joint angles of the little finger using video motion tracking. A total of 57 hands (69.5%) were classified as extrinsic dominant, where the finger flexion was initiated and maintained at proximal interphalangeal and distal interphalangeal joints...

OBJECTIVE: To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. DESIGN: Randomized controlled trial. SETTING: Training and research hospital. PARTICIPANTS: Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30)...

Pain is a unique somatosensory perception that can dramatically affect our ability to function. It is also a necessary perception, without which we would do irreparable damage to ourselves. In this article, the authors assess the impact of pain on function of the hand. Pain can be categorized into acute pain, chronic pain, and neuropathic pain. Hand function and objective measurements of hand function are analyzed as well as the impact of different types of pain on each of these areas.

The aim of this study was to investigate the inter- and intra-tester reliability of the static two-point discrimination and Semmes-Weinstein monofilament tests in digital nerve repair. A total of 100 digital nerves from 67 patients were included into the study. An experienced orthopaedic surgeon and a physiotherapist examined the sensory nerve recovery. The reproducibility score of both tests was at a poor level, but the reliability of the Semmes-Weinstein monofilament test was higher than the static two-point discrimination test...

UNLABELLED: Studies suggest that vitamin D has a role in neuroprotection. We investigated whether vitamin D status is associated with carpal tunnel syndrome. Vitamin D levels were compared between carpal tunnel syndrome women (n = 135) and healthy control women (n = 135) or patients with other upper limb conditions (n = 135). There were no differences in vitamin D levels between the patients with carpal tunnel syndrome and the controls. However, women with carpal tunnel syndrome younger than 50 years old had significantly lower vitamin D levels than age-matched healthy control women (P = 0...