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Biomedical subjects

J H Roth

Publications and source records attributed to J H Roth.

At least 19 recordsLinked to original sources
PubMed2006

Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand.

OBJECTIVE: To establish the validity of three self-report scales used to measure function following arthroplasty for osteoarthritis (OA) of the carpometacarpal joint. METHOD: Persons with OA of the carpometacarpal joint (n=122) were assessed on one occasion 9-117 months following tendon interposition arthroplasty. They completed three self-report measures of hand/upper limb disability: the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist Hand Evaluation (PRWHE), and the Disabilities of Arm, Shoulder and Hand (DASH). They also completed the Short Form 36 (SF-36) and performed tests of strength, range of motion (ROM), and dexterity. Factor analysis and correlations were used to determine the association among the scales and subscales considered to measure similar constructs (e.g., pain and physical disability). Correlations between the scales and measures of impairment were also conducted to examine construct validity of the disability measures. t-Tests evaluated the hypotheses that subjects with isolated hand OA would have lower scores than those with additional joint involvement. RESULTS: All three scales or their subscales loaded on one factor. Convergent validity of the disability measures was demonstrated by high correlations between similar subscales (r>0.75), and divergent validity by a lack of correlation between the measures and self-report hand appearance. As expected, correlations between disability and strength, dexterity, or a global measure of ROM were higher than with ROM of individual joints. The AUSCAN and the DASH were better able to discriminate those with localized hand OA from those with involvement of other joints. CONCLUSIONS: The AUSCAN, PRWHE, and DASH are valid assessments of pain and/or disability of hand OA, and provide information distinct from impairment measures.

Activities of Daily Living↗
PubMed2002

Dimensionality and clinical importance of pain and disability in hand osteoarthritis: Development of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index.

OBJECTIVE: To develop a reliable, valid, and responsive self-administered questionnaire to probe pain, stiffness and physical disability in patients with osteoarthritis (OA) of the hand. DESIGN: In order to assess the dimensionality of the symptomatology of hand OA, a self-administered questionnaire was developed to probe various aspects of pain (10 items), stiffness (two items), and physical function (83 items). The question inventory was generated from eight existing health status measures and an interactive process involving four rheumatologists, two physiotherapists, and an orthopaedic surgeon. RESULTS: Face-to-face interviews were conducted with 50 OA hand patients; 39 females and 11 males with mean age 62.8 years and mean disease duration 9.4 years. Items retained were those which fulfilled specified selection criteria: prevalence > or =60% and mean importance score approximating or exceeding 2.0 Item exclusion criteria included low prevalence, gender-based, ambiguous, duplicates or similarities, alternatives, composite items, and items that were too restrictive. This process resulted in five pain, one stiffness and nine function items which have been proposed for incorporation in the AUSCAN Index. CONCLUSIONS: Using a traditional development strategy, we have constructed a self-administered multi-dimensional outcome measure for assessing hand OA. The next stage includes reliability, validity and responsiveness testing of the 15-item questionnaire.

Activities of Daily Living↗
PubMed2001

Assessment of complications of distal radius fractures and development of a complication checklist.

The purposes of this study were to determine the overall incidence of distal radius fracture (DRF) complications, determine the incidence and types of DRF complications in a consecutive cohort of 250 patients with DRFs, describe DRF complications reported by patients compared with those reported by physicians, and formulate a DRF complication checklist to improve recording of DRF complications. We found that the overall complication rates vary widely (6% to 80%). Physician-reported complication data were collected for 236 patients, and a physician-reported complication rate of 27% was determined. A patient-reported complication rate of 21% was found for 207 patients whose patient-reported data were collected. We also noted that patients and physicians assess DRF complications differently: patients are more focused on symptoms than diagnoses. A DRF complication checklist was developed to improve prospective data collection. The checklist includes a classification for all DRF complications and allows for assessment of severity of each complication.

Adult↗
PubMed2001

Validity of pulp-to-palm distance as a measure of finger flexion.

This study investigated the validity of pulp-to-palm distance measures as clinical indicators of finger flexion capacity. Pulp-to-palm distance and goniometry of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints were measured by a single tester in 50 patients with abnormal digital flexion using a computerized hand assessment system. The correlation between pulp-to-palm distance measurements and total finger flexion measures obtained by goniometry, was moderate (r=-0.46 and -0.51). This indicates that the measures are not interchangeable. The relationship between an upper extremity disability score (DASH) and restricted motion was stronger for the goniometric measurements (r=0.45, P<0.01) than for the pulp-to-palm distance measurements (r<0.30, P>0.01). Both types of range of motion measurements were able to discriminate between minimal and substantial upper extremity disability. Further methodological evaluation is required to support the use of pulp-to-palm distance measures as an outcome indicator.

Adult↗
PubMed2000

Dorsal perilunate dislocations and fracture-dislocations: questionnaire, clinical, and radiographic evaluation.

Twenty-two consecutive patients (23 wrists) underwent open reduction internal fixation of dorsal perilunate dislocations and fracture-dislocations through combined dorsal and volar approaches. One of 5 experienced wrist surgeons performed these procedures within an average of 3 days of injury (range, 0-26 days) and intercarpal fixation was kept within the proximal carpal row. Motion was instituted an average of 10 weeks (range, 5-16 weeks) after injury. All patients were males. The average age at the time of injury was 32 years (range, 16-60 years). The average follow-up period was 37 months (range, 13-65 months). Average flexion-extension motion arc and grip strength in the injured wrist were 57% and 73%, respectively, compared with the contralateral wrist. The scapholunate angle increased and the revised carpal height ratio decreased over time, which was statistically significant for both measurements. Three patients (3 wrists) required wrist arthrodesis and a fourth patient had an immediate scaphoid excision and 4-corner arthrodesis secondary to an irreparable scaphoid fracture. One patient required a proximal row carpectomy to treat septic arthritis. Nine of the remaining 18 wrists had radiographic evidence of arthritis, most often at the capitolunate or scaphocapitate articulations. Short form-36 mental summary scores were significantly greater than age- and gender-matched US population values; physical summary scores were significantly less. The disabilities of arm, shoulder, and hand evaluation, Mayo wrist score, and patient-rated wrist evaluation all reflected loss of function. Seventy-three percent of all patients had returned to full duties in their usual occupations and a total of 82% were employed.

Adolescent↗
PubMed2000

Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture.

We evaluated the responsiveness of patient questionnaires and physical testing in the assessment of recovery after distal radius fracture. Patients (n = 59) were assessed at their baseline clinic visit and again 3 and 6 months after injury. At each visit patients completed a short form-36, Disability of the Arm, Shoulder, and Hand questionnaire, and patient-rated wrist evaluation (PRWE). At 3 and 6 months grip strength, range of motion, and dexterity were analyzed. Standardized response means (SRM) and effects sizes were calculated to indicate responsiveness. The PRWE was the most responsive. Both the PRWE (SRM = 2.27) and the Disability of the Arm, Shoulder, and Hand (SRM = 2.01) questionnaire were more responsive than the short form-36 (SRM = 0.92). The physical component summary score of the short form-36 was similar to that of the physical component subscales. Questionnaires were highly responsive during the 0- to 3-month time period when physical testing could not be performed. Of the physical tests, grip strength was most responsive, followed by range of motion. Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture.

Adolescent↗
PubMed1998

The outcome of tendon transfers for C6-spared quadriplegics.

The purpose of this study was to review retrospectively and evaluate a uniform group of C6-spared quadriplegics who had similar surgical procedures. Eight patients undergoing 12 procedures were reviewed at an average of 3.8 years follow-up. There were three bilateral procedures. All patients had extensor carpi radialis longus to flexor digitorum profundus and brachioradialis to flexor pollicis longus transfers to improve grip strength and key pinch. All patients reported subjective improvements in quality of life, activities of daily living and patient-centred goals. There were six excellent and two good results. Objective improvements included mild improvements in key pinch and grip strength.

Activities of Daily Living↗
PubMed1998

Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques.

The intra- and interobserver variability of 3 techniques for measuring the humpback deformity of 37 scaphoids using longitudinal computed tomography was assessed. The 3 measuring techniques were the lateral intrascaphoid angle, the dorsal cortical angle, and the height-to-length ratio. The intraobserver reliability of the intrascaphoid angle was poor; the dorsal cortical angle was moderate to excellent, and the height-to-length ratio was excellent. The interobserver reliability of the intrascaphoid angle was poor to moderate, the dorsal cortical angle was moderate to excellent, and the height-to-length ratio was moderate to excellent. For all 3 observers, the intra- and interobserver reliability was the best for the height-to-length ratio and worst for the intrascaphoid angle. The height-to-length ratio is the most reproducible method of assessing the humpback deformity. Clinical correlation is required to establish whether the height-to-length ratio will be of value in predicting the outcome of fractures of the scaphoid.

Carpal Bones↗
PubMed1998

Movement diagram and "end-feel" reliability when measuring passive lateral rotation of the shoulder in patients with shoulder pathology.

BACKGROUND AND PURPOSE: Findings related to joint function can be recorded with movement diagrams or by characterizing the "end-feel" according to the procedure described by Cyriax. Because both methods are used to classify pain and resistance in relation to joint range of motion (ROM), the purpose of this study was to simultaneously evaluate the reliability of these categorizations in a patient sample. SUBJECTS: Two physical therapists performed 2 assessments of passive lateral rotation of the shoulder in 34 patients. METHODS: Pain and resistance findings were recorded using movement diagrams and end-feel categories. Intraclass correlation coefficients (ICC[2,1]) were used to analyze the ratio (movement diagram) data, and kappa statistics (kappa) were used to analyze the categorical (end-feel) data. RESULTS: Intrarater ICCs varied from .58 to .89. Interrater ICCs for locating maximum pain and resistance in joint ROM varied from .85 to .91. Other interrater ICCs were lower (ICC = .34-.88). Intrarater kappa values for end-feel were moderate (kappa = .48-.59), and interrater kappa values were substantial (kappa = .62-.76). CONCLUSION AND DISCUSSION: Movement diagram measures conceptually related to the end of joint ROM and end-feel were highly reliable. This finding and the fact that additional end-feel categories were introduced in the study may partially explain the end-feel reliability findings. Consideration of their use in future studies may help to determine their clinical utility.

Adult↗
PubMed1998

Transmetacarpal intramedullary K-wire fixation of proximal phalangeal fractures.

The management of unstable phalangeal fractures has been associated with significant morbidity. Percutaneous transmetacarpal intramedullary Kirschner wire fixation of proximal phalangeal fractures has been described as a useful technique. We present a retrospective review of 35 digits in 24 patients with unstable fractures of the proximal phalanx treated using this technique between 1985 and 1995. Outcome measures, including radiological adequacy of reduction, total active range of motion, development of joint contracture, grip strength, and digital grip strength, were assessed. Good or excellent results were obtained in 76% of fractures (19 of 25) that were treated and followed. Thirty-two percent of digits (8 of 25) treated developed a proximal interphalangeal joint flexion contracture. Flexion contracture averaged 18.1 deg at the involved joints. Seven secondary procedures were required in 6 patients. Major complications noted during the study included loss of reduction with rotational deformity in four digits, and one nonunion. The use of skeletal traction devices was associated with three of the major complications observed. These devices should not be used concurrently on or adjacent to any digit treated by intramedullary pinning. We conclude that transmetacarpal axial Kirschner wire fixation is a technically simple method of treating unstable proximal phalangeal fractures, and good or excellent results can be obtained in the majority of appropriately selected patients.

Adolescent↗
PubMed1997

Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures.

Arthroscopy was used to assess the soft tissue injuries associated with distal radial fractures in 118 acute intra- and extra-articular fractures. The triangular fibrocartilage complex (TFCC) was torn in 46 of 118 patients--in 35% of intra-articular fractures and in 53% of extra-articular fractures. No correlation between ulnar styloid fractures and TFCC injuries could be found. Scapholunate (SL) ligament injuries with instability were present in 21.5% of intra-articular fractures and in 6.7% of extra-articular fractures. Lunotriquetral (LT) ligament injuries with instability were present in 6.7% of intra-articular fractures. and in 13.3% of extra-articular fractures. Combined SL and LT injuries were present in 5.6% of intra-articular fracture. Preoperative radiographs correlated with TFCC injury. Patients with TFCC tears had greater shortening and dorsal angulation on the preoperative radiographs. Preoperative radiographs had no predictive value for interosseous ligament injury. Ligamentous injuries are commonly associated with both intra-articular and extra-articular distal radial fractures.

Adolescent↗
PubMed1997

Clenched-fist injury complicated by methicillin-resistant Staphylococcus aureus.

Hand infections are a common sequela of clenched-fist injuries. The majority of these infections are due to Staphylococcus and Streptococcus species. Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly being isolated in Canadian health care facilities. In addition, MRSA now needs to be considered in community acquired hand infections that fail to respond to common empiric therapy. A 51-year-old man with MRSA due to a hand injury was treated successfully with vancomycin. The prevalence, mechanism of resistance and treatment of MRSA are briefly reviewed.

Cellulitis↗
PubMed1996

Intrafocal (Kapandji) pinning of unstable distal radius fractures: a preliminary report.

Seventeen consecutive patients (17 wrists) who underwent intrafocal pinning of unstable distal radius fractures, as described by Kapandji, were retrospectively reviewed at a mean of 42 weeks after surgery (range, 13-88 weeks). The patients were immobilized for 6 weeks postoperatively. All patients were assessed by a single physician and were asked a set of questions regarding subjective and functional status. All patients underwent physical examination of their upper extremities, and bilateral wrist PA and lateral x-rays were taken. There were 13 females and four males; the average age was 49 years. Ten dominant and seven nondominant extremities were involved. Average volar tilt on follow-up lateral wrist radiography was 7 degrees. This compares with -20 degrees at initial presentation, -12 degrees preoperatively, 6 degrees immediately postoperatively, and 10 degrees in the normal wrists. Radial shortening (average) was -2 mm at initial presentation, -1mm preoperatively, 1 mm postoperatively, 0 mm at follow-up, and 1 mm in the normal wrists. Radial inclination was 17 degrees initially, 20 degrees preoperatively, 23 degrees immediately postoperatively, 23 degrees on follow-up, and 24 degrees in the normal wrists. There was a trend for patients with osteopenic bone to lose their postoperative reduction. However, this was not statistically significant. Patients older than 65 years of age had significantly inferior radiologic results. Loss of pronation and supination averaged 2 degrees (range 0-10 degrees) compared with the uninjured wrist. Loss of dorsiflexion averaged 6.5 degrees, and palmar flexion averaged 7.6 degrees. The patients' subjective complaints were minimal. Average pain on visual analog scale (VAS) was 0.44/10. Function measured 8.64/10 (VAS). Sixteen of the patients were happy with the surgery and the outcome of their wrists. Complications included extensor tendon rupture (one patient), pin migration requiring premature removal (one patient), and initial loss of reduction requiring reoperation (one patient). Intrafocal pinning of unstable distal radius fractures provides an effective means to stabilize these complex injuries. Early follow-up suggests that the patients have a satisfactory functional outcome. The complications in this series were preventable. Intrafocal pinning should be added to the surgical armamentarium in treating distal radius fractures.

Adolescent↗
PubMed1995

Longitudinal computed tomography of the scaphoid: a new technique.

Computed tomography is increasingly utilized for the evaluation of scaphoid fracture, nonunion, and deformity. We have developed a new technique of positioning patients while performing longitudinal computed tomography of the scaphoid. With the wrist positioned in radial deviation and neutral flexion, greater patient comfort is provided and immobilization of the wrist is not required. A reproducible image can be obtained with attention to the alignment of the scanning plane to the longitudinal axis of the scaphoid on the scout image, and verified with the "target sign". High resolution images, which clearly demonstrate the abnormalities of the scaphoid, can be produced even if the patient has a cast on the wrist or if there is hardware in situ.

Carpal Bones↗
PubMed1995

Matched hemiresection interposition arthroplasty of the distal radioulnar joint.

Since 1986 the senior author has performed a matched hemiresection with retinacular/capsular interposition for patients with painful disorders of the distal radioulnar joint. A retrospective review of 55 wrists was performed by an independent hand surgeon and hand therapist. Forty-nine of 54 wrists in the surviving patients were clinically and radiographically reviewed with an average follow-up interval of 36 months. Subjective assessment included a visual analog rating of pain improvement and satisfaction with treatment. Objective assessment included examination of range of motion, strength, stability, and standardized functional testing with the Jebsen and Minnesota Rate of Manipulation tests. Thirty-five patients reported pain improvement and 41 patients were satisfied. The range of supination and pronation increased from 54 degrees and 67 degrees, respectively, to 72 degrees and 72 degrees. Functional ability as measured by the Jebsen test was similar to the contralateral wrist. Patients had most difficulty turning large objects. The clinical, objective, functional, and x-ray films results correlated poorly with pain improvement and patient satisfaction. Complications included one infection, one reflex sympathetic dystrophy, one neuroma of the dorsal sensory branch of the ulnar nerve, and four cases of ulnar-carpal impaction. Pain relief was the primary determinant of patient satisfaction and should be considered the indication for surgery.

Adolescent↗
PubMed1995

Percutaneous A1 pulley release: a cadaveric study.

Percutaneous A1 pulley release was performed on 17 fresh-frozen cadaveric hands with a 14-gauge angiocath needle. Each hand was then explored to assess the adequacy of release and the degree of injury to adjacent structures. Complete release of the A1 pulley was obtained in 45 of the 66 fingers and in 10 of the 17 thumbs. Significant injury to the flexor tendons was observed in two digits. All tendon injuries occurred along the line of the fibers. There were no digital nerve injuries. The release was within 2 mm of a thumb digital nerve in seven hands and the little finger ulnar digital nerve in two. In the thumb, the close proximity of the digital nerves makes percutaneous trigger digit release potentially hazardous. With the little finger held in abduction the risk of digital nerve injury or inadequate release is reduced. Percutaneous trigger finger release can be safely performed in the index, long, and ring fingers.

Cadaver↗