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1.
Study Design
Case report.Introduction
Development of extensor tendon adhesions is a common complication after intra-articular metacarpal head fracture. Whenever these adhesions cannot be mobilized by rehabilitation, tenolysis should be considered. However, the decision for tenolysis is often delayed. When the rehabilitation program comes to a plateau and clinical examination may not be sufficient to find out the cause, dynamic ultrasound (US) can show where the gliding mechanism is disrupted and help clinicians to give an accurate decision for determining the next steps.Purpose of the Study
To determine the role of dynamic US during hand rehabilitation.Methods
A 22-year-old woman presented with a fifth metacarpal intra-articular head fracture. Ten days after the surgery (open reduction and internal fixation) the hand rehabilitation program was commenced. After the third week, the metacarpophalangeal (MP) joint range of motion (ROM) gradually diminished. Dynamic US near the level of fifth MP joint revealed diminished extensor tendon excursion and capsular thickening.Results
Considering physical and sonographic findings, surgical tenolysis and capsular release was planned. After surgery, the DIP, PIP and MP joints reached full passive ROM.Conclusion(s)
Ultrasound is a quick and practical way to diagnose tendon adhesions. With this report, the authors suggest that clinicians may use dynamic US, especially in times when the patient comes to plateau during hand rehabilitation.Level of Evidence
IV. 相似文献2.
3.
Joseph A. Gil Kerry Ebert Keri Blanchard Avi D. Goodman Joseph J. Crisco Julia A. Katarincic 《Journal of hand therapy》2019,32(1):80-85
Study Design
Basic research (biomechanics).Introduction
The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament.Purpose of the Study
To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament.Methods
Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated.Results
The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load.Discussion
We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load.Conclusions
This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N.Level of Evidence
n/a (cadaveric). 相似文献4.
Nikolaus Johannes Wachter Martin Mentzel Gert D. Krischak Joachim Gülke 《Journal of hand therapy》2019,32(1):64-70
Study Design
A within-subject research design was used in this study. The difference of the range of motion (ROM) with and without ulnar nerve block was analyzed.Introduction
For the clinical evaluation of the functional effects of ulnar nerve palsy at the hand the relevance of clinical tests is in discussion.Purpose of the Study
The aim of the study was to evaluate the predictive value of 2 clinical tests for a simulated ulnar nerve lesion by motion analysis with a sensor glove.Methods
In 28 healthy subjects, dynamic measurements of the finger joints were performed by a sensor glove with and without ulnar nerve block at the wrist. In the 0° metacarpophalangeal (MCP) stabilization test, the subjects were asked to stabilize the MCP joints actively in 0° while moving the interphalangeal joints, whereas at the 90° MCP stabilization test, the subjects stabilized the MCP joints actively in the 90° position.Results
In the 0° MCP stabilization test, no remarkable changes of the ROM were found at the MCP joints; at the proximal interphalangeal joints 2-5, the ROM decreased with ulnar nerve block, significantly at the index, middle, and ring fingers (P < .05). In the 90° MCP stabilization test, the average ROM of the MCP joints 2-5 significantly increased with ulnar nerve block (P < .05), whereas at the PIP joints, the average ROM decreased (P < .05).Discussion
The 90° MCP stabilization test had a high predictive value for the discrimination between healthy subjects and subjects with a simulated peripheral ulnar nerve lesion.Conclusions
The results could be relevant for the determination of the functional effect of ulnar nerve palsy and the quantification of clawing in hand rehabilitation.Level of Evidence
II. 相似文献5.
Nicholas E. Anton Tomoko Mizota Lava R. Timsina Jake A. Whiteside Erinn M. Myers Dimitrios Stefanidis 《American journal of surgery》2019,217(2):266-271
Introduction
Several studies demonstrated that simulator-acquired skill transfer to the operating room is incomplete. Our objective was to identify trainee characteristics that predict the transfer of simulator-acquired skill to the operating room.Methods
Trainees completed baseline assessments including intracorporeal suturing (IS) performance, attentional selectivity, self-reported use of mental skills, and self-reported prior clinical and simulated laparoscopic experience and confidence. Residents then followed proficiency-based laparoscopic skills training, and their skill transfer was assessed on a live-anesthetized porcine model. Predictive characteristics for transfer test performance were assessed using multiple linear regression.Results
Thirty-eight residents completed the study. Automaticity, attentional selectivity, resident perceived ability with laparoscopy and simulators, and post-training IS performance were predictive of IS performance during the transfer test.Conclusions
Promoting automaticity, self-efficacy, and attention selectivity may help improve the transfer of simulator-acquired skill. Mental skills training and training to automaticity may therefore be valuable interventions to achieve this goal. 相似文献6.
Study Design
Clinical measurement (reliability and validity) study.Introduction
Forearm supination is important in many daily activities and is thus measured by therapists and researchers usually with a universal goniometer. DrGoniometer, a SmartPhone application, has been validated for other joint angles in the body.Purpose of the Study
To establish the reliability and validity of DrGoniometer (CDM S.r.L, Cagliari, Italy) for measuring forearm supination in healthy populations and those with forearm fractures.Methods
Participants had sustained a distal radius fracture that was treated non-surgically. Forearm supination of the participant’s fractured (n = 30) and healthy forearm (n = 30) was measured using DrGoniometer and the universal goniometer by two assessors. The assessors were blinded to each other’s measurements and their own previous measurements. Reliability was established by calculating Intra-class Correlation Coefficients, standard error of measurement and minimal detectable change. The validity of DrGoniometer was established against the universal goniometer using Pearson’s correlation co-efficient.Results
Intra-rater reliability of both DrGoniometer and the universal goniometer was high for both fractured and healthy forearms (ICCs ranged from 0.74-0.88). Inter-rater reliability of both DrGoniometer and the universal goniometer was also high in the fractured forearm group (0.76 and 0.72 respectively), but low in the healthy forearm group (0.34 and 0.42 respectively). Correlation between the tools was excellent across the fractured and healthy forearm groups (0.94 and 0.93 respectively).Discussion
Both goniometers demonstrated good-to-excellent intrarater and iner-rater reliability except in the healthy forearm group where both goniometers demonstrated poor inter-rater reliability which could be due to assessor instructions. The speed the photo can be taken and the digital record obtained are valuable aspects of DrGoniometer.Conclusion
DrGoniometer is a valid, alternate tool for measuring forearm supination. 相似文献7.
Saurabh P. Mehta Hannah R. George Christian A. Goering Danielle R. Shafer Alan Koester Steven Novotny 《Journal of hand therapy》2019,32(1):103-109
Study Design
Clinical measurement study.Introduction
The push-off test (POT) was recently conceived and found to be reliable and valid for assessing weight bearing through injured wrist or elbow. However, further research with larger sample can lend credence to the preliminary findings supporting the use of the POT.Purpose of the Study
This study examined the interrater reliability, construct validity, and measurement error for the POT in patients with wrist conditions.Methods
Participants with musculoskeletal (MSK) wrist conditions were recruited. The performance on the POT, grip isometric strength of wrist extensors was assessed. The shortened version of the Disabilities of the Arm, Shoulder and Hand and numeric pain rating scale were completed. The intraclass correlation coefficient assessed interrater reliability of the POT. Pearson correlation coefficients (r) examined the concurrent relationships between the POT and other measures. The standard error of measurement and the minimal detectable change at 90% confidence interval were assessed as measurement error and index of true change for the POT.Results
A total of 50 participants with different elbow or wrist conditions (age: 48.1 ± 16.6 years) were included in this study. The results of this study strongly supported the interrater reliability (intraclass correlation coefficient: 0.96 and 0.93 for the affected and unaffected sides, respectively) of the POT in patients with wrist MSK conditions. The POT showed convergent relationships with the grip strength on the injured side (r = 0.89) and the wrist extensor strength (r = 0.7). The POT showed smaller standard error of measurement (1.9 kg). The minimal detectable change at 90% confidence interval for the POT was 4.4 kg for the sample.Conclusions
This study provides additional evidence to support the reliability and validity of the POT. This is the first study that provides the values for the measurement error and true change on the POT scores in patients with wrist MSK conditions. Further research should examine the responsiveness and discriminant validity of the POT in patients with wrist conditions. 相似文献8.
Byron D. Hughes Eric Sieloff Hemalkumar B. Mehta Anthony J. Senagore 《American journal of surgery》2019,217(3):534-538
Background
In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts.Methods
Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each.Results
Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005.Conclusion
Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. 相似文献9.
Study Design
Case series.Introduction
A salvaged limb is one that has undergone a major traumatic injury, followed by repeated surgical attempts in order to avoid amputation. Psychological recovery for individuals with lower extremity limb salvage has been examined in a number of studies. However, psychosocial reactions for individuals with upper extremity (UE) limb salvage are understudied in the literature.Purpose of the Study
The purpose of this study was to explore the process of psychosocial adaptation for 3 trauma cases after UE limb salvage.Methods
The Reactions to Impairment and Disability Inventory was used to assess psychosocial adaptation. Physical function outcomes (pain, range of motion, edema, sensation, and dexterity) are presented. The Disabilities of the Arm, Shoulder, and Hand measure was used to assess perceived disability. Medical and rehabilitation history are discussed for each case, in order to provide in-depth understanding of the impact of these injuries.Results
Reactions to injury varied across the cases; however, outcomes suggest that psychosocial adaptation may be influenced by the experience of pain, the ability to participate in valued roles and activities, and having a supportive social network.Discussion
For this population, therapists may consider emphasizing pain management, focusing on client-centered goals and interventions, and facilitating peer support. Providers should closely monitor patients for signs of poor adaptation, such as hand-hiding behaviors.Conclusions
This study is among the first to examine psychological outcomes for the UE limb salvage population. Future research would be beneficial to provide deeper understanding of the psychosocial challenges for these individuals. 相似文献10.
Christina Norrbom Marianne Steding-Jessen Carsten Thye Agger Merete Osler Marie Krabbe-Sorensen Annette Settnes Lisbeth Nilas Ellen Christine Leth Loekkegaard 《American journal of surgery》2019,217(4):694-703
Background
Adhesive bowel obstruction is associated with considerable morbidity and mortality, but the magnitude of the risk is debated.Method
In a national cohort of all Danish women with an abdominal operation (N?=?665,423) between 1977 and 2013, the risk of adhesive bowel obstruction was assessed by Cox multiple regression. Covariates were the number of abdominal operations, the surgical methods, the anatomical site involved, and the calendar year.Results
In the cohort, 1.4% experienced an episode of adhesive bowel obstruction. The risk increased 33–43% during the study period, was lower after gynecological and obstetrical procedures compared to gastrointestinal (HR 0.36 [0.34–0.38]), lower after laparoscopic compared to laparotomic surgery (HR 0.51 [0.48–0.54]) and increased proportionally after each additional operation.Conclusions
The risk of adhesive bowel obstruction after abdominal operations depends on the site of earlier operations, the method of access and the number of earlier operations. 相似文献11.
Background
Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems.Methods
A prospective cohort of SBO patients was compared to a historical cohort of SBO patients after implementation of a SBO protocol using evidence-based guidelines and Omnipaque, a low-osmolar water soluble contrast. Patients without a history of abdominal surgery were excluded and data was collected through chart review.Results
Univariate analyses demonstrated a decrease in both LOS by 1.35 days and in the proportion of patients receiving surgery (37% vs 25%; p?<?0.05). There was a decrease in time to surgery, rate of SBR, and rate of complications, yet an increase in readmission, although these findings were not statistically significant.Conclusions
Utilizing an evidence-based SBO protocol can lead to shorter LOS and may result in fewer operations for adhesive SBO patients. 相似文献12.
Tomoko Mizota Nicholas E. Anton Dimitrios Stefanidis 《American journal of surgery》2019,217(2):222-227
Background
This study aimed to identify differences in pattern recognition skill among individuals with varying surgical experience.Methods
Participants reviewed laparoscopic cholecystectomy videos of various difficulty, and paused them when the cystic duct or artery was identified to outline each structure on the monitor. Time taken to identify each structure, accuracy and work load, which was assessed using the NASA-Task Load Index (TLX), were compared among the three groups.Results
Ten students, ten residents and eight attendings participated in the study. Attendings identified the cystic duct and artery significantly faster and more accurately than students, and identified the cystic artery faster than residents. The NASA-TLX score of attendings was significantly lower than that of students and residents.Conclusions
Attendings identified anatomical structures faster, more accurately, and with less effort than students or residents. This platform may be valuable for the assessment and teaching of pattern recognition skill to novice surgeons.Short summary
Accurate anatomical recognition is paramount to proceeding safely in surgery. The assessment platform used in this study differentiated recognition skill among individuals with varing surgical experience. 相似文献13.
Study Design
Case series.Introduction
Upper extremity (UE) trauma and subsequent immobilization affects functional performance.Purpose of the Study
Determine the usefulness and feasibility of unilateral hand training (UHT) on improving functional performance in patients with UE trauma.Methods
Nine participants received UHT within 10 days of immobilization. Functional performance, dexterity, grip, and pinch strength were measured at initial and 4-week visits. Qualitative interviews were coded to develop themes.Results
All Jebsen-Taylor hand function test subtests improved from pretest to post-test. Disabilities of the Arm, Shoulder and Hand scores of all 9 participants improved. Functional performance was more impaired for participants with dominant UE injury. Four themes emerged: participants were forced to alter or avoid most daily activities, had an increased dependency on others, took longer to perform activities, and felt UHT decreased the impact of UE trauma on function.Discussion
Functional performance was impaired for all participants. Participants believed that UHT was useful and contributed to improved function.Conclusion
This case series tracked a comprehensive intervention based on a holistic activities of daily living framework that considered the nuances of individual complexities of immobilization following hand trauma. Knowledge from this study supports an early intervention like UHT to educate clients on effective strategies to improve immediate activities of daily living functioning and potentially prevent longer term impairments. 相似文献14.
Elise A. Dasinger Westyn Branch-Elliman Steven D. Pizer Hassen Abdulkerim Amy K. Rosen Martin P. Charns Mary T. Hawn Kamal M.F. Itani Hillary J. Mull 《American journal of surgery》2019,217(4):605-612
Background
Opioid-related adverse drug events are common following inpatient surgical procedures. Little is known about opioid prescribing after outpatient surgical procedures and if opioid use is associated with short term risks of outpatient surgical adverse events (AEs).Methods
VA Corporate Data Warehouse was used to identify opioid use within 48?h for FY2012-14 chart-reviewed cases from a larger VA study of AEs in outpatient surgeries. We estimated a multilevel logistic regression model to determine the effect of opioid exposure on risk of AEs between 2 and 30 days postoperatively.Results
Of the 1730 outpatient surgical cases, 628 (36%) had postoperative opioid use and 12% had an AE. Opioid use following outpatient surgery was not significantly associated with higher surgical AE rates after controlling for relevant covariates (OR?=?1.1 95% CI 0.79–1.54). Only procedure RVUs were associated with higher odds of postoperative AEs.Conclusions
Postoperative opioid use following outpatient surgery is not a significant driver of postoperative AEs. 相似文献15.
Stephanie A. Valente Yitian Liu Siddhi Upadhyaya Chao Tu Debra A. Pratt 《American journal of surgery》2019,217(3):514-518
Introduction
The aim of this study was to determine whether complications following mastectomy with immediate breast reconstruction (IBR) were associated with breast cancer recurrence.Methods
A retrospective review was performed of women diagnosed with stage I-III breast cancer who underwent mastectomy with IBR between 2005 and 2010. Patient demographics, tumor data, surgical wound complications, treatment details and timing were recorded and analyzed.Results
We identified 458 women with a median follow up time of 7.6 years. A total of 22% of patients experienced IBR complications. There was a delay in initiation of adjuvant therapy in patients who had a complication (52 vs 41 days, p?<?0.001). There was no significant difference in recurrences between groups with and without complications (p?=?0.65).Conclusions
In breast cancer patients who undergo mastectomy with IBR, wound complications delayed initiation of adjuvant systemic therapy, but were not associated with an increased risk of cancer recurrence. 相似文献16.
Michihiro Osumi Masahiko Sumitani Hiroaki Abe Yuko Otake Shin-ichiro Kumagaya Shu Morioka 《Journal of hand therapy》2019,32(1):41-47
Introduction
Chemotherapy-induced peripheral neuropathy (CIPN) usually affects both sensory and motor function of hands and feet, resulting in impaired skilled hand function (e.g., typing a keyboard). However, quantitative and objective evaluations for this condition have not been established.Purpose of the Study
We evaluated skilled hand function using a kinematic analysis and investigated relationships among hand kinematic function and the clinical sensory and motor features of CIPN.Study Designs
Clinical measurement.Methods
Twelve CIPN patients and 12 age-matched control participants were enrolled. We recorded their reach and grasp movements using a three-dimensional measurement system, and calculated the normalized jerk of these movements as quantitative indexes of skilled hand function. Additionally, we used the number of sequential hand grip–release cycles in 10 seconds as an evaluation of clinical motor function.Results
Our kinematic analyses revealed significant difference in normalized jerk of grasp movement (CIPN: 3.7 ± 0.2, control: 3.4 ± 0.1; P = .005), but this was not the case for reach movement (CIPN: 2.5 ± 0.1, control: 2.5 ± 0.2; P = .43), indicating that the distal part of the forearm is particularly affected in CIPN. Such disturbed grasp movement was directly correlated with poor scores on the hand grip–release test and the sensory tests.Discussion
We revealed deficit impaired hand function objectively and quantitatively in CIPN patients using a kinematic analysis. Further, the hand grip test could represent such kinematic abnormality and could be useful for evaluating skilled hand function of CIPN patients.Conclusions
Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings.Level of Evidence
Cross-sectional observational study. 相似文献17.
Rachel N. Saunders Matthew B. Dull Amanda B. Witte James M. Regan Alan T. Davis Tracy J. Koehler Charles J. Gibson Gaby A. Iskander Carlos H. Rodriguez Stephen D. Cohle Alistair J. Chapman 《American journal of surgery》2019,217(3):552-555
Background
Immediately fatal motorcycle crashes have not been well characterized. This study catalogues injuries sustained in fatal motorcycle crashes and assesses the impact of crash conditions on injury patterns.Methods
Autopsy records from the office of the medical examiner of Kent County, MI and publicly available traffic reports were queried for information pertaining to motorcyclists declared dead on-scene between January 1, 2007, and December 31, 2016.Results
A total of 71 autopsies of on-scene motorcycle crash fatalities were identified. The two most prevalent injuries were traumatic brain injury (TBI) (85%) and rib fractures (79%). The majority of fatalities occurred in daylight hours (54.3%) and in a 55 mph speed limit zone (63.8%).Conclusions
This study provides a catalogue of the injuries sustained in immediately fatal motorcycle crashes and the associated conditions. Advocacy efforts that highlight the risks associated with motorcycle riding and that promote safe riding practices are warranted. 相似文献18.
Solomon Azouz Piper Boyll Marco Swanson Nikki Castel Terry Maffi Alanna M. Rebecca 《American journal of surgery》2019,217(4):634-638
Background
Among hospital staff, little is known concerning barriers to recycling and perception of waste in the operating room (OR), despite continued improvement in recycling programs. This study sought to identify barriers to OR recycling and implement a recycling improvement educational program.Methods
A survey was administered within Mayo Clinic at four campuses. Based on survey results, a recycling improvement program was devised and implemented at a surgery center in Paradise Valley, Arizona. A cost-savings analysis was performed thereafter.Results
Of 524 participants, 56.7% reported being unclear which OR items are recyclable, and 47.7% thought the greatest barrier to recycling was lack of knowledge. After implementation of the recycling educational program, cost savings of 10.3% (p?=?0.004) were achieved in sharps waste disposal when compared to the previous year at the surgery center.Conclusions
Addressing barriers to recycling in the OR can significantly reduce waste and save valuable healthcare dollars. 相似文献19.
Study Design
Two-group randomized controlled trial.Introduction
Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence.Purpose of the Study
The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury.Methods
A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group.Results
After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], ?0.954; P = .348; and 95% confidence interval, ?12.380 to 4.513).Discussion
In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a ‘typical’ position, may not lead to an immediate improvement in hand function.Conclusions
Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term. 相似文献20.
Katherine M. Gerull Maren Loe Kristen Seiler Jared McAllister Arghavan Salles 《American journal of surgery》2019,217(2):306-313