Hand surgery & rehabilitation最新文献

A clinical, radiological and four-dimensional computed tomography (4DCT) assessment of the outcomes of scapholunate intercarpal ligamentoplasty (SLICL) was done with a minimum follow-up of 2 years. Twenty-nine patients (23 men and 6 women) with a mean age of 40 years (22-57) who had chronic scapholunate dissociation were treated with the SLICL procedure. There were 18 cases of dynamic instability and 11 of static instability. The patients were evaluated with a mean follow-up of 61 months (24-94). SLICL significantly reduced pain and increased grip strength and wrist function. On radiographs, the mean static and dynamic scapholunate gaps as well as the scapholunate and radiolunate angles improved significantly. The dorsal scaphoid displacement was always corrected. 4DCT after surgery provided a more precise analysis of the SLICL's effectiveness at restoring intracarpal alignment. Correction of the DISI deformity and dorsal scaphoid displacement was confirmed. SLICL restored a normal variation in the scapholunate gap (range value) during radioulnar deviation movement without systematically reducing the distance between the bones (mean and maximum values) which remained pathological in wrists with static instability but not in those with dynamic instability. At the final follow-up, no patients had signs of osteoarthritis due to ScaphoLunate Advanced Collapse. LEVEL OF EVIDENCE: III.

Background: Lacertus syndrome involves dynamic median nerve compression by the lacertus fibrosus, leading to sensory symptoms and loss of strength. Prevalence in the general population is unclear.

Objective: This study aimed to determine the prevalence of lacertus syndrome in the Belgian population and to evaluate the effectiveness of the exhaustion test combined with the scratch collapse test.

Methods: In a cross-sectional study from May 2023 to February 2024, 362 healthy individuals, aged 18 to 86 years underwent clinical examinations, including the scratch-collapse test and exhaustion test, to assess signs of lacertus syndrome.

Results: 11.3% of participants (95% CI: 8.2-15.1%) reported discomfort on lacertus fibrosus palpation. The scratch-collapse test at the lacertus fibrosus was positive in 7.2% of cases (95% CI: 4.8-10.4%), increasing to 25.7% (95% CI: 21.3-30.5%, p < 0.001) following the exhaustion test. There were no significant differences in gender, occupation, or hand dominance (all p > 0.05). Hagert's clinical triad and positive scratch-collapse test over the lacertus fibrosus were found in 2.21% (95% CI: 1.0-4.2%) of this general population after the exhaustion test.

Conclusion: The prevalence of lacertus syndrome was 2.21% after the exhaustion test, and 0.83% before. The exhaustion test led to significant conversion of negative to positive scratch-collapse test from 7.2% to 25.7%. The exhaustion test enhanced the scratch-collapse test's diagnostic accuracy, revealing a spectrum of lacertus syndrome symptoms, from unnoticed mild cases to severe manifestations, and confirmed the importance of Hagert's clinical triad in diagnosing lacertus syndrome.

Popular artificial intelligence systems, like ChatGPT, may be used by anyone to generate humanlike answers to questions. This study assessed whether ChatGPT version 3.5 (ChatGPTv3.5) or the first five results from a Google search provide more accurate, complete, and concise answers to the most common questions patients have about carpal tunnel syndrome. Three orthopedic hand surgeons blindly graded the answers using Likert scales to assess accuracy, completeness, and conciseness. ChatGPTv3.5 and the first five Google results provide answers to carpal tunnel syndrome questions that are similar in accuracy and completeness, but ChatGPTv3.5 answers are more concise. ChatGPTv3.5, being freely accessible to the public, is therefore a good resource for patients seeking concise, Google-equivalent answers to specific medical questions regarding carpal tunnel syndrome. ChatGPTv3.5, given its lack of updated sourcing and risk of presenting false information, should not replace frequently updated academic websites as the primary online medical resource for patients.

Purpose: To explore the distribution and prevalence of osteoarthritis in metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints in long fingers in a cadaveric study, and to discuss potential biomechanical influences on these patterns.

Methods: This cadaveric study evaluated 144 metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints from 12 embalmed cadaver hands. A dorsal dissection approach was used to expose the joints, which were then marked with color-coded pegs for consistent orientation during imaging. High-resolution digital images of the distal articular surfaces were captured for analysis. The images were analyzed using custom software to quantify osteoarthritic areas, distinguishing between radial and ulnar aspects. Percentage affected joint surface was calculated using pixel-based measurements. Statistical analysis was used the Student t-test and ANOVA, with the significance threshold set at p < 0.05 and 95% confidence intervals RESULTS: The ulnar side of the proximal interphalangeal joint in digits 2 and 3 showed higher prevalence of osteoarthritis (59.31% ± 15.48%) than the radial side (40.68% ± 15.48%), p = 0.007; in contrast, for digits 4 and 5, prevalence was greater on the radial (54.3% ± 10.99%) than the ulnar side (45.7% ± 10.99%), p = 0.007. No significant differences were noted in osteoarthritis distribution between the radial and ulnar aspects of the metacarpophalangeal and distal interphalangeal joints.

Conclusions: This study identified distinct patterns of osteoarthritis distribution in long-finger joints, with greater prevalence in the proximal interphalangeal joints. Although there were differences between stable (digits 2 and 3) and mobile (digits 4 and 5) fingers, further research is necessary to conclusively determine the role of biomechanical forces in the development of osteoarthritis. These findings lay the groundwork for future studies of the pathophysiology of osteoarthritis in the hand, and could guide the development of preventive and therapeutic interventions.

Introduction: Ultrasound is gaining popularity for diagnosing scaphoid fractures. However, it hasn't been used to assess fracture displacement, such as humpback deformity. We propose a sonographic method to measure the intra-scaphoid angle, potentially serving as an alternative to CT scans for detecting fragment malposition after a scaphoid fracture.

Methods: We recruited 11 healthy adult volunteers without wrist pathology and performed bilateral wrist ultrasounds, totaling 22 examinations. Each wrist was splinted at 50 ° extension and fully supinated. Two hand surgeons independently performed the ultrasounds. All images were then evaluated separately by two evaluators. The following measurements were taken: 1. Inter-poles distance (IPD): Distance between the summits of the two scaphoid poles on the palmar cortex. 2. Palmar cortical intra-scaphoid angle (PCISA): Angle between the two summits and the deepest point of the waist on the palmar cortex. Measurements were compared for inter-investigator and inter-evaluator reliability using the intraclass correlation coefficient (ICC).

Results: The study included four males and seven females, with an average age of 35 years (range 21-56). The mean PCISA was 142 ° (SD 10 °) and the mean IPD was 16.3 mm (SD 2.1 mm). Differences in IPD measurements averaged 0.3 mm (range 0-5.2 mm) among investigators and 1.0 mm (range 0.1-3.8 mm) among evaluators. For PCISA, the differences averaged 4 ° (range 0-17 °) among investigators and 6 ° (range 0-15 °) among evaluators. The ICC for IPD was 0.804 (investigators) and 0.572 (evaluators); for PCISA, it was 0.704 (investigators) and 0.602 (evaluators).

Conclusion: This study presents a cost-effective and accessible sonographic technique to measure the intra-scaphoid angle. Further research is required to assess its effectiveness in scaphoid fractures and compare it to CT-based measurements like the H/L ratio, LISA, and DCA.

Background: Appropriate postoperative rehabilitation of distal radius fractures is essential for early recovery and pain management, but may be limited by medical staff and equipment availability and costs. Home-based training or wearable devices provide an alternative.

Objectives: To assess use of a wearable device and home-based training for rehabilitation after distal radius fracture surgery.

Design: Prospective comparative cohort study.

Method: Between April and November 2021, patients aged > 20 years with distal radius fracture who could understand and use wearable devices and their application were recruited. Patients with polytrauma, neurological disorder or musculoskeletal disorder were excluded. The control group underwent a regimen of passive and active finger and wrist exercises after surgery, while the experimental group performed equivalent rehabilitation using a wearable device (smart glove). Outcomes comprised pain on visual analog scale, wrist range of motion, Quick Disabilities of the Arm, Shoulder, and Hand score, Modified Mayo Wrist Score, and radiographic parameters (radial inclination, radial height, ulnar variance and volar tilt) at 6 and 12 weeks after surgery.

Results: Fracture type, age and gender did not differ between the control (n = 7) and experimental (n = 7) groups. All participants achieved bone union and exhibited equivalent radiographic parameters at follow-up. The experimental group showed significantly improved Mayo scores (65.7 vs. 56.4, p = 0.044), wrist range of motion (259.3 vs. 179.3, p = 0.021), and pain (1.43 vs. 3.29, p = 0.011) at 6 but not 12 weeks' follow-up.

Conclusions: Rehabilitation using a smart glove showed better short-term clinical outcomes after surgery than conventional rehabilitation. Rehabilitation using a wearable device may be beneficial for early recovery after distal radius fracture surgery.

The best way of immobilization as well as effectiveness of rehabilitation for trapeziometacarpal total joint arthroplasty is unknown. We aimed to identify and describe the available evidence, practice variation and knowledge gaps. The literature was searched without restrictions. 123 studies were included, reporting 21 types of prosthesis. Reported immobilization types were cast (23%), splint (18%), compression bandage (10%), or combinations (26%). In 19%, immobilization time and type was not reported. Supervised rehabilitation (22%), self-rehabilitation (11%), functional use (11%), or customized rehabilitation (16%) were the rehabilitation forms reported. In 28% rehabilitation type was not described. Two (2%) studies used complication classifications, but time to complication was not described in 53 (43%). Multiple evidence gaps exist; lacking studies comparing types of immobilization protocols as well as rehabilitation regimens after trapeziometacarpal total joint arthroplasty. Currently there is no scientific evidence for any postoperative regime. This means that decision-making is based on clinical experience rather than evidence, explaining the wide practice variation.