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Biomedical subjects

P LaStayo

Publications and source records attributed to P LaStayo.

10 recordsLinked to original sources
PubMed1995

Quantification of the relationship between dynamic grip strength and forearm rotation: a preliminary study.

Clinically, the measurement of grip strength is a static measure. It is performed in a standardized posture with the arm at the side, elbow flexed to 90 degrees, and the wrist-forearm positioned in neutral. Many functional activities require dynamic grip strength when an individual moves the wrist-forearm while simultaneously gripping an object. This preliminary study investigated dynamic forearm rotation with isometric grip strength over real time. Thirty wrists from 15 normal subjects were measured with a tilt sensor attached to a strain gauge dynamometer. Each subject underwent randomized trials of maximally gripping the dynamometer while rotating the forearm over a 10-second period. A multiple-regression model was fit for the parameters of extremity, forearm rotation order, fatigue, and loss of strength with supination and pronation. For each parameter, the mean and standard error of its estimate were computed and compared with zero. The significant effects (p = 0.05) of interest were for fatigue and the loss of grip strength from 70 degrees of supination to the end range of supination. Comparisons to existing static grip strength literature were made. We concluded that there is a decrease in grip strength over time as a result of fatigue, there is a decrease in grip strength at supination angles greater than 70 degrees. There is no decrease in grip strength resulting from supination angles less than 70 degrees, nor is there a decrease in grip strength with pronation when measured dynamically. It is suggested that there may be a difference in static and dynamic GS measurements related to forearm rotation.

Adult↗
PubMedDate not supplied

Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment.

Predisposing factors contributing to the development of first carpometacarpal (CMC) osteoarthritis include an inherent laxity or incongruency of this joint, a shallow trapezium saddle, and heavy stresses placed on the joint with pinching and grasping. Splinting is a common mode of conservative treatment for CMC osteoarthritis. This study assessed the objective and subjective responses of patients with CMC osteoarthritis who wore short and long opponens splints, as well as radiographic changes associated with wearing of the splints. The study evaluated 26 hands. Each patient was assigned at random to wear the long or the short splint first. Patients wore the splints for one week. They then documented function in their splints (on 22 activities of daily living) and rated splint satisfaction and pain levels on visual analog scales. One week after application of the first splint, the second splint was applied and worn for one week, and all measures were repeated. On the final visit, tip pinches were evaluated and x-rays were taken to assess subluxation. One-way repeated-measure analysis and paired comparison were used to analyze the pinch, pain, radiographic, and splint-rating measures. Descriptive statistics were used to assess activity-of-daily-living function and splint preference. Both splints appear to reduce subluxation at the first CMC joint in patients with grades 1 and 2 osteoarthritis. The majority of the patients picked the short splint when asked at the end of the study which splint they preferred. The splints do not appear to increase pinch strength or affect pain levels associated with the performance of pinch strength measurements. This study supports anecdotal evidence that patients with CMC osteoarthritis get pain relief with splinting.

Activities of Daily Living↗
PubMedDate not supplied

Intrarater reliability of a new method and instrumentation for measuring passive supination and pronation: a preliminary study.

Because of the clinical impression that traditional forearm goniometry has several potential sources of error and is therefore inherently unreliable, a new method using a newly designed goniometer was compared with traditional forearm passive range-of-motion goniometry. The new method utilized an offset face with a plumbline design and a patient-held tubular handle. Thirty orthopedic patients (31 wrists) were measured by three experienced hand therapists in a test-retest protocol to determine the reliability of both the traditional and new methods. Both the intraclass correlation coefficients and standard error of the measure showed improved scores with the new goniometric technique, compared with the traditional one. The differences between methods may not be clinically significant.

Adult↗
PubMedDate not supplied

Postoperative management of functionally restrictive muscular adherence, a corollary to surgical tenolysis: a case report.

After a surgical release of adhered nongliding tendons, early active mobilization is encouraged to prevent the reformation of unfavorable adhesions that would limit functional tendon excursion. These restricting adhesions can also occur in non-synovial regions, such as within the flexor mass in the forearm. A "myolysis," or release of muscle fibers from tethering adhesions, can be performed surgically to restore the muscle's gliding and lengthening properties. Postoperative management consists of treatment techniques that include low-load prolonged stress, differential tendon gliding, and active-resistive exercises, all of which are effective in restoring and maximizing a patient's active and passive range of motion to allow optimal mobility and performance. This case study demonstrates the successful management of a patient following a surgical myolysis, utilizing treatment techniques conceptually derived from postoperative tenolysis rehabilitation.

Adult↗
PubMedDate not supplied

The GRIT: a quantitative measure of ulnar impaction syndrome.

The gripping rotatory impaction test (GRIT) is performed with a standard grip dynamometer and provides a quantitative measure for identifying ulnar impaction. The purpose of this study was to determine whether patients with unilateral ulnar impaction syndrome (UIS) have a GRIT ratio on the involved side greater than 1.0 while the GRIT ratio on the uninvolved side is no different from 1.0. Twenty-four patients with unilateral UIS were tested with the GRIT on both the symptomatic, involved side and the asymptomatic, uninvolved side. The GRIT was performed with a standard grip dynamometer, and testing alternated between each patient's involved and uninvolved sides, with the wrist in the neutral, supinated, and pronated positions, in that order. The GRIT ratio on the involved side, at 1.37, was significantly greater than 1.0, while the GRIT ratio on the uninvolved side, at 1.03, was not significantly different from 1.0. The GRIT ratio is a quantitative measure that identifies UIS and can be used as an adjunct to imaging studies and qualitative clinical tests for UIS. The GRIT may also be helpful in determining which patients with UIS might benefit from surgical ulnar shortening.

Adult↗
PubMedDate not supplied

Effect of total end range time on improving passive range of motion.

The objective of this study was to test the validity of the so-called total end range time (TERT) theory. This theory claims that the amount of increase in passive range of motion (PROM) of a stiff joint is proportional to the amount of time the joint is held at its end range, or total end range time. Proximal interphalangeal joint (PIP) flexion contractures were chosen as a model upon which to test the theory. Digital extension casts were used to hold the PIPs at the end range of extension. Fifteen patients with 20 PIP flexion contractures between 15 degrees and 60 degrees volunteered for this study. All contractures resulted from primary orthopedic conditions; none arose from a central nervous system lesion. Each joint was treated by two periods of continuous casting in extension: a 6-day period and a 3-day period. Patients were randomly assigned to one of two groups. Group A subjects wore the initial casts for 6 days and the subsequent casts for 3 days. Group B subjects wore the initial casts for 3 days and the subsequent casts for 6 days. Passive range of motion changes were measured under a controlled torque PROM technique before and after each casting period. The sum of the gains in PROM for all subjects during their 6 days of casting totaled 106 degrees (chi = 5.3 degrees). The total gain during the 3 days of casting was 60 degrees (chi = 3.0 degrees). This finding was significant at the p < 0.005 level of confidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Clinical provocative tests used in evaluating wrist pain: a descriptive study.

The purposes of this clinical study were to standardize the method of examination and provocative testing of painful wrists and to compare retrospectively the results of these tests with the arthroscopic findings of three independent hand surgeons. This article operationally defines the scaphoid shift test (SST), the ballottement test (BALLOT), and the ulnomeniscotriquetral dorsal glide test (UMTDG); describes the clinical and arthroscopic examination method; and analyzes the sensitivities, specificities, and predictive values of these provocative tests relative to the arthroscopic findings in 50 painful wrists. Each patient had unspecified wrist pain of at least 4 weeks' duration and was examined by one certified hand therapist who carried out all of the clinical provocative tests. The sensitivities for the SST, the BALLOT, and the UMTDG were 69%, 64%, and 66%, respectively. The specificities for the SST, the BALLOT, and the UMTDG were 66%, 44%, and 64%, respectively. The positive predictive values for the SST, the BALLOT, and the UMTDG were 48%, 24%, and 58%, respectively. The negative predictive values for the SST, the BALLOT, and the UMTDG were 78%, 81%, and 69%, respectively. These wrist provocative tests were efficient for identifying patients who needed a more detailed diagnostic workup and possible arthroscopic inspection. Of those patients who needed arthroscopic inspection, the provocative tests proved to be more efficient at predicting the absence of injury than at predicting its presence.

Adult↗
PubMedDate not supplied

Dynamic versus static grip strength: how grip strength changes when the wrist is moved, and why dynamic grip strength may be a more functional measurement.

The synergistic relationship between wrist/forearm range of motion (ROM) and grip strength (GS) is arguably one of the most important aspects of hand function. Clinically, GS is measured with the wrist in a standardized static position, and the results of such tests have been deemed valid and reliable. The question remains, however, whether this static GS (SGS) measurement is an accurate indication of how an individual functionally grips objects--that is, most functional tasks require the fingers to grasp an object forcibly while moving the proximal joints such as the wrist and forearm. Therefore, further analysis of an individual's dynamic GS (DGS) during wrist/forearm movements may improve the clinician's understanding of hand function and provide more pertinent guidelines for assessing functional gripping, e.g., for vocational and avocational tasks and in designing workstations. The purpose of this study is twofold: to describe and assess a DGS testing device that utilizes optically encoded gyroscopes and a strain-gauge dynamometer to simultaneously measure GS and wrist/forearm position over real time; and to assess and compare grip force production differences in SGS and DGS in uninjured wrists, using this novel device. Twenty-nine uninjured wrists of men (n = 15) and women (n = 14)--age range, 21 to 43 years--were tested with the DGS device. Subjects were excluded if they had any previous wrist/forearm fracture, pain, or limitation of motion. The DGS device was designed and fabricated with two optically encoded gyroengines, a vertical gyroscope with two axes for measuring flexion/extension and radial/ulnar deviation, and a directional gyroscope with one axis for measuring supination/pronation, mounted on a strain-gauge dynamometer. The signals from the gyroscopes and dynamometer were processed by means of a data aquisition board and analog-to-digital circuitry and collected on a 486-MHz computer. The methods included repeated testing of each gyroscope axis to known angular measurements, and randomly assigned maximal gripping trials from the 29 subjects. The standard deviation of gyroengines is 1 degree to 2 degrees for each ROM axis. Maximal DGS is significantly less (mean 14%) than SGS, and SGS is 29% less than DGS at the same three-dimensional ROM positions. Gyroengines are feasible three-dimensional tracking devices that can be used to monitor wrist/forearm ROM in conjunction with GS.

Adult↗