Journal of Hand Surgery Global Online最新文献

{"title":"Evaluating Pedicled Groin Flap Reconstruction in Hand Degloving Injuries: A Retrospective Analysis","authors":"Saleh Abualhaj MD ,&nbsp;Yazan S. Al-Zamer MD ,&nbsp;Lina Al-Shadfan MD ,&nbsp;Mosleh Abualhaj PhD ,&nbsp;Ali aloun MD ,&nbsp;Basel Joseph Massad MD","doi":"10.1016/j.jhsg.2025.100828","DOIUrl":"10.1016/j.jhsg.2025.100828","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the clinical outcomes of pedicled groin flap coverage in such injuries and identify factors associated with postoperative complications and flap viability.</div></div><div><h3>Methods</h3><div>A retrospective review of 23 patients who underwent pedicled groin flap reconstruction for finger or hand degloving injuries between 2015 and 2024 was conducted. Patient demographics, surgical details, complication rates, aesthetic outcomes, and functional recovery were analyzed.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 27.9 years, with a male predominance (73.9%) and a high smoking rate (73.9%). Most defects involved the fingers (87%), with a mean defect size of 30.6 cm² and a mean flap size of 72.0 cm². The mean wound healing time was 32.5 days, and the average hospital stay was 3.6 days. Flap success was achieved in 91.3% of the cases. Postoperative complications occurred in 34.8% of the patients, including partial flap necrosis (26.1%), wound dehiscence (13.0%), and infection (4.3%). Intraoperative venous congestion was observed in 39.1% of the cases and was more frequent among patients who developed complications (<em>P</em> = .001). Other variables showing statistically significant differences between patients with and without complications included smoking status (<em>P</em> = .037), additional procedures performed (<em>P</em> = .037), and smaller defect dimensions (<em>P</em> = .011 for width; <em>P</em> = .032 for size). Aesthetic outcomes were rated as good or neutral in over 90% of the cases. Functionally, 91.3% of the patients experienced minimal-to-mild disability, with a mean <em>Quick</em>DASH score of 18.1 (SD = 14.1). Patients with complications had higher disability scores (mean: 27.9 vs 12.9; <em>P</em> = .012).</div></div><div><h3>Conclusions</h3><div>Groin flap reconstruction remains a reliable and accessible option for managing hand degloving injuries, particularly in resource-limited settings, offering acceptable functional and aesthetic outcomes despite a relatively high rate of secondary procedures.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100828"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the Outcomes of Early Active Mobilization Following Flexor Tendon Repair Between Zone 1 and Distal Zone 2 Injuries","authors":"Koji Moriya MD ,&nbsp;Yutaka Maki MD ,&nbsp;Hisao Koda MD ,&nbsp;Masahiro Odagiri OT ,&nbsp;Shota Matsuzawa OT ,&nbsp;Naoto Tsubokawa MD","doi":"10.1016/j.jhsg.2025.100826","DOIUrl":"10.1016/j.jhsg.2025.100826","url":null,"abstract":"<div><h3>Purpose</h3><div>Complete release of the A4 pulley is recommended for flexor tendon repair to allow smooth tendon excursion, provided the proximal sheath is mostly intact. However, it is unclear whether the active range of motion of finger joints differs when the flexor digitorum profundus tendon is repaired at different levels with A4 pulley release. We evaluated differences in the outcomes of flexor tendon repair of zone 1 and zone 2A injuries using a six-strand suture (the Yoshizu #1 technique) and complete release of the A4 pulley, followed by an early active mobilization protocol.</div></div><div><h3>Methods</h3><div>This retrospective case series analyzed 27 fingers from 22 patients: 12 index, 5 middle, 4 ring, and 6 little fingers. There were 13 zone 1 injuries in 12 patients and 14 zone 2A injuries in 10 patients. All tendons were repaired using the same technique, followed by a controlled active mobilization regimen initiated within the first three postoperative weeks. The follow-up period averaged 7 months (range: 3–13 months).</div></div><div><h3>Results</h3><div>No tendon bowstringing was evident in any finger. Rupture of one flexor tendon repair occurred 8 weeks after primary surgery in one patient with a zone 1 injury. Excluding this case, no significant differences were observed in the active range of motion of the two finger joints between patients with zone 1 and 2A injuries. However, active motion of the distal interphalangeal joint of zone 1 was significantly reduced compared with that of zone 2A, given the increase in the total extension deficit.</div></div><div><h3>Conclusions</h3><div>In this series, although complete release of the A4 pulley and postoperative treatment were performed in the same way, zone 1 injuries demonstrated greater total extension deficits and failed to achieve distal interphalangeal joint motion outcomes comparable with those observed in zone 2A injuries.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100826"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Can Answer Postoperative Questions About Distal Radius Fractures—But Can Patients Understand the Answers?","authors":"Rae Tarapore MD ,&nbsp;Suhasini Gupta MD ,&nbsp;Kenneth R. Means Jr MD ,&nbsp;Aviram M. Giladi MD, MS","doi":"10.1016/j.jhsg.2025.100822","DOIUrl":"10.1016/j.jhsg.2025.100822","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to assess the validity, reliability, and readability of responses to common patient questions about postoperative from ChatGPT, Microsoft Copilot, and Google Gemini.</div></div><div><h3>Methods</h3><div>Twenty-seven thoroughly vetted questions regarding distal radius fractures repair surgery were compiled and entered into ChatGPT 4, Gemini, and Copilot. The responses were analyzed for quality, accuracy, and readability using the DISCERN scale, the Journal of the American Medical Association benchmark criteria, Flesch-Kincaid Reading Ease Score, and Flesch-Kincaid Grade Level. Citations provided by Google Gemini and Microsoft Copilot were further categorized by source of reference. Five questions were resubmitted, requesting response simplification. The responses were re-evaluated using the same metrics.</div></div><div><h3>Results</h3><div>All three artificial intelligence platforms produced answers that were considered “good” quality (DISCERN scores &gt;50). Copilot had the highest quality of information (68.3), followed by Gemini (62.9) and ChatGPT (52.9). The information provided by Copilot demonstrated the highest reliability, with a Journal of the American Medical Association benchmark criterion of 3 (of 4) compared with Gemini (1) and ChatGPT (0). All three platforms generated complex texts with Flesch-Kincaid Reading Ease Scores ranging between 35.8 and 41.4 and Flesch-Kincaid Grade Level scores between 10.5 and 12.1, indicating a minimum of high-school graduate reading level required. After simplification, Gemini’s reading level remained unchanged, whereas ChatGPT improved to that of a seventh-grade reading level and Copilot improved to that of an eighth-grade reading level. Copilot had a higher number of references (74) compared with Gemini (36).</div></div><div><h3>Conclusions</h3><div>All three platforms provided safe and reliable answers to postoperative questions about distal radius fractures. High reading levels provided by AI remain the biggest barrier to patient accessibility.</div></div><div><h3>Clinical relevance</h3><div>For the current state of mainstream AI platforms, they are best suited as adjunct tools to support, rather than replace, clinical communication from health care workers.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100822"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified Posterior Approach to the Nerve Transfer of the Spinal Accessory Nerve to the Suprascapular Nerve","authors":"Lenny L. Rivera-Rosario MD ,&nbsp;Ruben Tresgallo Parés MD ,&nbsp;José I. Acosta-Julbe MD ,&nbsp;Alexandra Claudio Marcano MD ,&nbsp;Joseph Salem-Hernández BS ,&nbsp;Gerardo S. Caussade Silvestrini BS ,&nbsp;Norman Ramirez MD ,&nbsp;Christian Foy-Parrilla MD","doi":"10.1016/j.jhsg.2025.100821","DOIUrl":"10.1016/j.jhsg.2025.100821","url":null,"abstract":"<div><h3>Purpose</h3><div>Restoration of shoulder abduction and external rotation is critical in patients with upper brachial plexus injuries (BPIs). The transfer of the spinal accessory nerve to the suprascapular nerve is a well-established surgical technique; however, the optimal approach remains debated. The traditional posterior approach may compromise muscle integrity because of trapezius detachment and splitting of the supraspinatus. This study introduces a muscle-sparing modification to the posterior approach and evaluates functional outcomes in pediatric and adult patients with obstetric or traumatic BPIs.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on patients who underwent spinal accessory nerve to suprascapular nerve transfer using a muscle-sparing posterior approach from September 2018 to November 2022. Inclusion criteria comprised pediatric patients (aged ≤18 months) with obstetric BPIs and adult patients with traumatic BPIs with a minimum postoperative follow-up of 24 months. Pediatric patients were evaluated using the Toronto Muscle Grading System, Modified Mallet Grading System, and Birch Triple System. Adults were assessed using range of motion and Disabilities of the Arm, Shoulder, and Hand questionnaire scores.</div></div><div><h3>Results</h3><div>Fourteen patients met the inclusion criteria (six pediatric and eight adult). Pediatric outcomes demonstrated Modified Mallet Grading System scores of grade IV and Birch Triple System stages IV–V, indicating good shoulder function. Toronto Muscle Grading System scores of 3 reflected active movement against gravity. Among adults, mean forward flexion improved from 35° to 53°, abduction improved from 28° to 47°, and external rotation improved from 12° to 23°. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire score improved from 91 to 48, exceeding the minimal clinically notable difference. No complications were observed.</div></div><div><h3>Conclusions</h3><div>The muscle-sparing posterior approach for spinal accessory nerve to suprascapular nerve transfer is a safe and effective technique that yields favorable functional outcomes in both pediatric and adult BPI populations. Further comparative studies are warranted.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100821"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Application of the WFS-175: A Novel Multidimensional Score for Wrist Function","authors":"Sang Anh Nguyen MD ,&nbsp;Doanh Quoc Tran PhD","doi":"10.1016/j.jhsg.2025.100819","DOIUrl":"10.1016/j.jhsg.2025.100819","url":null,"abstract":"<div><h3>Purpose</h3><div>We present a novel protocol for wrist function assessment that integrates both objective factors (range of motion and grip strength) and subjective domains (pain, motor function, and quality of life) into the composite Wrist Function Score - 175 (WFS-175) score.</div></div><div><h3>Methods</h3><div>The protocol consists of three main steps: (1) data collection, which involves measuring the wrist range of motion in six directions using a goniometer and grip strength, including maximum strength, endurance, and recovery, using a Jamar dynamometer, alongside concurrent subjective assessment with a standardized questionnaire; (2) standardization of all data onto a unified scoring scale, applying a linear formula to calculate the total WFS-175 score (maximum 175 points), with the following components: range of motion (30 points), grip strength (40 points), pain (25 points), motor function (40 points), and quality of life (40 points); and (3) input of results into the AppSheet/Google Sheets system, which provides automated calculation, storage, reporting, and graphical visualization for longitudinal tracking of functional recovery.</div></div><div><h3>Results</h3><div>This protocol yields a standardized assessment form that enables precise calculation of the WFS-175 score. It integrates muscular endurance and recovery measures and fully digitalizes the workflow.</div></div><div><h3>Conclusions</h3><div>Initial applications show that the WFS-175 score effectively evaluates wrist function and tracks recovery over time. For example, a postoperative patient scored 164/175, indicating excellent recovery.</div></div><div><h3>Clinical relevance</h3><div>The WFS-175 protocol offers a novel and digital-ready solution for standardized wrist function assessment. By combining objective and subjective measures in one scoring system, it enhances sensitivity and supports clinical decision making in modern rehabilitation.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100819"},"PeriodicalIF":0.0,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Management of Complications Following Percutaneous K-Wire Fixation in Hand and Wrist Fractures","authors":"Mehmet Yalçın MD ,&nbsp;Yusuf Kıratlıoğlu MD ,&nbsp;Ömer Erim Kepenekçi MD ,&nbsp;Mehmet Armangil MD ,&nbsp;Uğur Bezirgan MD","doi":"10.1016/j.jhsg.2025.100791","DOIUrl":"10.1016/j.jhsg.2025.100791","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the frequency and management of complications in patients who underwent percutaneous K-wire fixation for hand and wrist fractures caused by trauma.</div></div><div><h3>Methods</h3><div>A total of 143 patients (112 men, 31 women) with 333 K-wires were retrospectively analyzed. Demographic data, surgical techniques, postoperative care, and complications were reviewed. Minor complications included pin loosening, migration, and superficial infections, while major complications included nonunion, malunion, and osteomyelitis.</div></div><div><h3>Results</h3><div>Complications were observed in 23 patients (16%), including six major and 17 minor cases. The most common complications were pin loosening (five patients), infection (six patients), and pin migration (seven patients). Infections were primarily caused by <em>Staphylococcus aureus</em>, identified in three cases. Nonunion and malunion required secondary interventions, whereas one osteomyelitis case necessitated surgical debridement and prolonged antibiotics.</div></div><div><h3>Conclusions</h3><div>Complications occurred in 16% of cases, with pin migration, loosening, and infection being the most frequent issues. Although most complications were minor and manageable, major complications such as nonunion and osteomyelitis necessitated additional surgical interventions.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100791"},"PeriodicalIF":0.0,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide-Awake Local Anesthesia No Tourniquet in Adolescent Hand Surgery: A Systematic Review","authors":"Hannah Polley BMSc ,&nbsp;Benjamin Blackman BHSc ,&nbsp;John Tristan Cassidy MBBCh, MCh ,&nbsp;Johan van der Stok MD, PhD","doi":"10.1016/j.jhsg.2025.100820","DOIUrl":"10.1016/j.jhsg.2025.100820","url":null,"abstract":"<div><h3>Purpose</h3><div>Wide-awake local anesthesia no tourniquet (WALANT) allows for intraoperative assessment of function while minimizing systemic anesthesia effects and is frequently used in adult hand surgery. However, the safety and feasibility of WALANT in adolescents remains uncertain because of potential challenges with adherence and cooperation. This review aimed to compile the evidence for using WALANT in adolescents.</div></div><div><h3>Methods</h3><div>PubMed, Medline, Embase, and Scopus were searched from inception to December 2024. Comparative and cohort studies were included. Outcomes, including procedure time, length of hospital stay, and pain scores, were analyzed. Because of the heterogeneity of outcomes investigated, a narrative review was performed.</div></div><div><h3>Results</h3><div>Four studies, three case-control studies (n = 287) and one case series (n = 6), involving 166 WALANT surgeries were included. The mean age across all patients, including WALANT and control, was 14, with a range of 7–20 years old. The most common WALANT procedures were tendon repair (22.3%, n = 37) and ganglion removal (22.3%, n = 37), followed by digital nerve repair (18.1%, n = 30). One conversion (0.6%) to a general anesthetic was reported.</div></div><div><h3>Conclusions</h3><div>Current evidence on the utilization of WALANT in adolescents is limited; WALANT may reduce procedure time, length of hospital stay, and improve pain scores.</div><div>Type of study/level of evidence: Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100820"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualization of Donor Nerve Selection With Intraoperative Nerve Monitoring in Axillary Nerve Neurotization","authors":"Guillermo José Tarnawski-Español MD ,&nbsp;Maria Rosa Morro-Martí MD, PhD ,&nbsp;Manuel Llusá-Pérez MD, PhD ,&nbsp;Isabel Fernández-Conejero MD ,&nbsp;Júlia Benítez-Flores MD ,&nbsp;Aritz Ortega-Centol MD ,&nbsp;Joaquim Casañas-Sintes MD, PhD","doi":"10.1016/j.jhsg.2025.100818","DOIUrl":"10.1016/j.jhsg.2025.100818","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the use of intraoperative nerve conduction studies in radial to axillary nerve transfers using the motor branches to the triceps. We hypothesized that morphological characteristics might not fully express a donor nerve’s suitability for transfer and that choosing the donor branch based on nerve action potential (NAP) amplitudes would lead to better functional outcomes.</div></div><div><h3>Methods</h3><div>This retrospective analysis included 17 patients who underwent radial to axillary nerve transfer. The specific triceps motor branch used as donor and the site of neurorrhaphy were chosen based on intraoperative NAP amplitudes independently of morphological criteria, such as size matching or arc of rotation.</div></div><div><h3>Results</h3><div>We found a moderate correlation between the NAP amplitude of the transferred branch and shoulder abduction strength at the end of the follow-up. The branch to the lateral head of the triceps was the most often selected as a donor. Outcomes were satisfactory in 14 out of 17 patients.</div></div><div><h3>Conclusions</h3><div>The findings suggest that reinnervation is enhanced when the choice of the donor branch is individualized and based on functional metrics like NAP, instead of anatomical characteristics. The study supports the role of intraoperative nerve monitoring as an objective and predictable method to refine donor branch selection in radial to axillary nerve transfer.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100818"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes from Supraclavicular Thoracic Outlet Decompression","authors":"Kazimir R. Bagdady BS ,&nbsp;Jacob A. Thayer MD ,&nbsp;Jaclyn Bredenkamp ,&nbsp;Brian A. Mailey MD","doi":"10.1016/j.jhsg.2025.100817","DOIUrl":"10.1016/j.jhsg.2025.100817","url":null,"abstract":"<div><h3>Purpose</h3><div>The diagnosis of neurogenic thoracic outlet syndrome is based on patient history, provocative maneuvers, and, ultimately, the successful relief of symptoms following surgical decompression. We sought to understand patient-reported outcomes after thoracic outlet decompression.</div></div><div><h3>Methods</h3><div>All patients undergoing thoracic outlet decompression between July 2015 and July 2020 were identified from a single institutional database. Validated questionnaires including, Thoracic Outlet Syndrome Index, Short Form 20, Pain Catastrophizing Scale (PCS), Zung Self-Reporting Depression Scale, and nine of our own questions, were used to report patient outcomes from 10 individuals.</div></div><div><h3>Results</h3><div>The Thoracic Outlet Syndrome Index, Zung Self-Reporting Depression Scale, Short Form 20 pain subscore, and PCS averages were 63 (± 44.3), 58.25 (± 5.04), 40.3 (± 17.5), and 22.6 (± 18.81), respectively. One hundred percent of patients indicated some level of depression with 50% indicating mild levels and 50% indicating moderate levels of depression. Pain was the most commonly reported improved symptom after surgery with 50% indicating a ≥95% improvement. Despite 80% of patients indicating surgery provided the results they were expecting, 60% still had some element of numbness in their arm or hand.</div></div><div><h3>Conclusions</h3><div>Thoracic outlet decompression can produce high levels of symptom improvement, especially in regards to pain. Lack of improvement can be related to a multitude of factors including confounding depression, pain catastrophizing/neurosis, inaccurate diagnosis of thoracic outlet syndrome, or double crush syndrome. More objective tests for identifying thoracic outlet syndrome may help to better understand which patients have a better likelihood of symptom improvement after surgery.</div></div><div><h3>Type of study/level of evidence</h3><div>Symptom Prevalence Study III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100817"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144896629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Likelihood to Repeat Elective Hand Surgery with Early Quick Disabilities of the Arm, Shoulder and Hand Scores: A Feasibility Study","authors":"Daniel A. London MD, MS ,&nbsp;Avery M. Schroeder MD ,&nbsp;Justin P. Chan MD ,&nbsp;Orrin I. Franko MD","doi":"10.1016/j.jhsg.2025.100813","DOIUrl":"10.1016/j.jhsg.2025.100813","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-reported outcome measures (PROMs) are collected after treatment to assess patient improvement. We sought to determine the postoperative timepoint at which changes in PROMs would best predict patients’ likelihood to repeat surgery and offer clinically relevant information.</div></div><div><h3>Methods</h3><div>Quick Disabilities of the Arm, Shoulder and Hand (<em>Quick</em>DASH) scores were collected during the course of care of 883 patients before undergoing elective outpatient hand surgery and at 5 postoperative timepoints. Likelihood to repeat surgery was collected 1 year after surgery, and patients were dichotomized into likely and unlikely to repeat surgery groups. Differences in the change in <em>Quick</em>DASH scores between groups were compared using Mann-Whitney U tests. Receiver operating characteristic curves were used in conjunction with Youden’s index to determine the timepoints and cutoff levels at which likelihood to repeat surgery could be successfully predicted.</div></div><div><h3>Results</h3><div>In our cohort of 883 patients, 88.3% of patients indicated 1 year after surgery that they would be willing to repeat surgery. Receiver operating characteristic analyses demonstrated that changes in <em>Quick</em>DASH scores at 3, 12, 24, and 52 weeks were all significantly associated with patient likelihood to repeat surgery. A change in <em>Quick</em>DASH score of 10.0 three weeks after surgery was the ideal cutoff point to identify an association of patient likelihood to repeat elective hand surgery 1 year after surgery.</div></div><div><h3>Conclusions</h3><div>Changes in <em>Quick</em>DASH scores as early as 3 weeks after surgery were associated with patient likelihood to repeat elective hand surgery 1 year after surgery. Although the heterogeneity of procedures included in the analyzed data pool precludes the complete generalizability of these findings to current clinical practice, it does support a feasible utility for early PROM collection in predicting patient satisfaction with their surgical outcome. This finding supports the continued, focused study of early PROMs, with potential for their employment in various clinical applications including real-time analysis for early postoperative intervention.</div></div><div><h3>Type of Study/Level of Evidence</h3><div>Therapeutic IIIb</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100813"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144896628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}