This study evaluates the time required for grip and pinch strength to return to preoperative levels after carpal tunnel release. Grip strength was 28% of preoperative level at 3 weeks; 73% by 6 ...weeks, and returned to the preoperative level by 3 months. At 6 months grip strength was found to increase to 116%. Pinch strength returned sooner being 74% of preoperative level at 3 weeks and 96% by 6 weeks. By 3 months an increase to 108% was seen and at 6 months an increase to 126% of preoperative levels was found. This data should prove useful in predicting when patients may be able to return to their previous level of occupational-related activity.
Intrinsic muscle contractures are a frequently overlooked cause of hand dysfunction. Tightness of these muscles may occur despite appropriate management. This article addresses the evaluation and ...treatment of these contractures.
Wrist: Terminology and definitions GILULA, Louis A; MANN, Frederick A; DOBYNS, James H ...
Journal of bone and joint surgery. American volume,
2002, 20020101, Letnik:
84a
Journal Article
One-hundred consecutive patients were prospectively evaluated on admission to our Brain Injury Unit for signs and symptoms of reflex sympathetic dystrophy (RSD) in the upper extremity. Patients ...averaged 4 months postinjury and had an average age of 29 years. Thirteen patients had clinical signs and symptoms of RSD and were then evaluated with standard radiographs and 3-phase radionuclide scintigraphy. Twelve of 13 patients had 3-phase bone scans (TPBS) consistent with RSD (12% overall incidence). RSD was present exclusively in the spastic upper extremity. There were 9 patients with hemiparesis and 3 with quadraparesis. There was a significantly higher (P < 0.01) incidence of associated upper extremity injury in the group with RSD (75%). All patients had a mean Rancho Cognitive Level of V and initial Glasgow Coma Scores less than 8. Patients who developed RSD had lower Glasgow Coma Scores than the non-RSD patients. Brain-injured patients often display agitation, hyperalgesia, disuse or neglect of the RSD-involved extremity. In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed RSD in these patients can result in a significant delay in rehabilitation and possible loss of the use of an otherwise functional upper extremity.
The brachioradialis tendon was transferred to the extensor carpi radialis longus and brevis tendons to restore active extension of the wrist in nine patients who had traumatic tetraplegia. The ...classification of neurological function was the fifth cervical level for all patients. The average time from the injury to the operation was six years (range, one to twenty years), and the average duration of follow-up was ten years (range, two to fifteen years). The evaluation of the patient included a determination of the preoperative and postoperative ranges of motion of the wrist, manual muscle-testing of the strength of the brachioradialis and the wrist extensors, a functional assessment of the ability to perform activities of daily living (eating, grooming, dressing, personal hygiene, and desktop activities writing, typing, using a telephone, and so on), and an assessment of functional independence. In addition, the result of the operation was evaluated subjectively by the patient. No patient had active extension of the wrist against gravity preoperatively. The strength of the wrist extensors improved postoperatively to a grade of good in six patients and to a grade of fair-plus in three. Function of the hand improved markedly in seven patients, and no patient had a loss of function. The patients had improvement in the ability to pick up objects, to feed and groom themselves, to tend to personal hygiene, to write and type, and to use a telephone.
Radiocarpal and intercarpal arthrodeses were simulated in 12 fresh cadaver wrists by means of external fixation. Range-of-motion measurements were made before and after simulated arthrodesis and used ...to calculate the contribution of the midcarpal and radiocarpal joints to wrist motion, as well as the residual wrist motion after limited intercarpal arthrodeses. Relative contributions to wrist motion were as follows: wrist flexion: radiocarpal (RC) joint 63%, midcarpal (MC) joint 36%; wrist extension: RC joint 53%, MC joint 46%. The wrist motion remaining after simulated arthrodeses was as follows: capitate-hamate: flexion (Flx) 98%, extension (Ext) 92%, ulnar deviation (UD) 96%, radial deviation (RD) 90%; scaphoid-lunate: Flx 97%, Ext 91%, UD 90%, RD 91%; scaphoid-trapezium-trapezoid: Flx 86%, Ext 88%, UD 67%, RD 69%; scaphoid-lunate-triquetrum: Flx 91%, Ext 82%, UD 86%, RD 70%; capitate-lunate: Flx 70%, Ext 59%, UD 89%, RD 79%; capitate-hamate-triquetrum: Flx 88%, Ext 79%, UD 88%, RD 81%; hamate-triquetrum: Flx 90%, Ext 85%, UD 89%, RD 94%; scaphoid-trapezium-trapezoid-capitate: Flx 85%, Ext 77%, UD 64%, RD 57%.
Forty proximal interphalangeal joint silicone elastomer flexible implant arthroplasties in 19 patients with systemic inflammatory arthritis were reviewed. The follow-up period averaged 94 months. ...Before surgery, the average arc of motion was 26 degrees for the 20 digits with boutonniere deformities and 23 degrees for the 16 digits with swan-neck deformities. Eight digits had moderate (grade 2) pain, and four digits had severe (grade 3) pain. After surgery, the deformity was completely corrected in six digits. Digits with a preoperative boutonniere deformity (20 digits) achieved the same (26 degrees) arc of motion after surgery, whereas those with a preoperative swan-neck deformity (16 digits) actually lost 18 degrees. Six digits had moderate pain and one digit had severe pain at the final follow-up evaluation. Thirteen digits (7 patients) with a boutonniere deformity before surgery and a concurrent or previous silastic metacarpophalangeal arthroplasty had significantly better results than those without. Overall, there were 12 good, 18 fair, and 10 poor results. Based on this study, flexible silicone implant arthroplasty has a limited role in the treatment of proximal interphalangeal joints affected by systemic inflammatory arthritis. When performing the arthroplasty, attention should be directed first toward correction of the deformity at the metacarpophalangeal joint.
The dorsal branch of the ulnar nerve was dissected in 24 cadavers. The nerve arose from the medial aspect of the ulnar nerve at an average distance of 6.4 centimeters from the distal aspect of the ...head of the ulna and 8.3 centimeters from the proximal border of the pisiform. Its mean diameter at origin was 2.4 millimeters. The nerve passed dorsal to the flexor carpi ulnaris and pierced the deep fascia. It became subcutaneous on the medial aspect of the forearm at a mean distance of 5.0 centimeters from the proximal edge of the pisiform. The nerve gave an average of five branches with diameters between 0.7 and 2.2 millimeters. A better understanding of the anatomy of this nerve may help prevent nerve injury during surgical procedures, and can help in locating the nerve for repair of lacerations or administration of local anesthetics for regional nerve blocks.
Nodular fasciitis is an uncommon benign neoplasm infrequently seen in the hand. There are often difficulties in diagnosis of this tumor. It is usually surgically excised while it is still small. The ...patient described here had a large and aggressive tumor that ruptured through the skin of the hand and extended to the periosteum of the ring metacarpal.
