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At least 613 records · Page 34Linked to original sources
PubMed2006

Basal thumb metacarpal osteotomy for trapeziometacarpal osteoarthritis.

PURPOSE: To review the subjective and functional results of basal thumb metacarpal osteotomy for the treatment of trapeziometacarpal osteoarthritis. METHODS: Between July 1993 and November 1998, 35 thumb osteotomies without internal fixation were performed on 33 patients in the Christchurch Hospital, New Zealand. Records of 28 thumbs (13 right and 15 left) of 26 patients (17 women and 9 men) were available for review. Patients were reviewed using strength testing and the Michigan Hand Outcomes Questionnaire. RESULTS: The mean age of the 26 patients was 54 years (range, 30-69 years). Of the 28 thumbs, 22 (21 patients) had good or excellent results, 2 fair, one poor. The remaining 3 thumbs (3 patients) required further revision and were classified as failures. The mean follow-up period of the 25 thumbs (24 patients) not requiring revision was 34 months (range, 12-73 months). Good thumb motion was present in all hands with no trapeziometacarpal instability seen. Compared with the normative data, the strengths of key pinch, pulp pinch, and tripod pinch of our patients were significantly lower (22-32% lower), but not the grip strength. Michigan Hand Outcomes Questionnaire scores increased 28 (range, 1-56) points after surgery, with significant improvement especially in pain (+44 points), activities of daily living (one-handed tasks, +41 points), and satisfaction (+35 points). CONCLUSION: Basal thumb metacarpal osteotomy is a straightforward, conservative procedure that should be considered for grades II and III trapeziometacarpal osteoarthritis.

Activities of Daily Living↗
PubMed2000

Skeletal muscle morphology and exercise response in congenital generalized lipodystrophy.

OBJECTIVE: Congenital generalized lipodystrophy (CGL) is an autosomal recessive genetic disorder characterized by almost complete absence of adipose tissue, muscular appearance, and severe insulin resistance since birth. We investigated whether insulin resistance in CGL patients is associated with abnormal muscle morphology and whether increased muscularity imparts increased muscle strength and exercise capacity RESEARCH DESIGN AND METHODS: We obtained quadriceps muscle biopsies to study muscle fiber types and capillary density in three African-American women (aged 17-20 years) with CGL. We also assessed quadriceps muscle strength, muscle metabolism, and maximal O2 consumption in the patients. RESULTS: Quadriceps muscle biopsies revealed a markedly higher percentage of type II (fast-twitch glycolytic) muscle fibers in patients with CGL versus sedentary young women (75-78 vs. 47-57%, respectively). The capillary-to-fiber ratio (2.7-3.0), however, was normal. Cross-sectional areas of type I (slow-twitch oxidative) (1,262-2,685 microm2) and type II (2,304-3,594 microm2) fibers were far below the normal values (3,811-4,310 and 3,115-4,193 microm2, respectively), suggesting muscle hyperplasia but not hypertrophy The quadriceps muscle strength, as measured by Cybex, was below average; the maximal O2 consumption (23-32 ml x kg(-1) x min(-1)) was also below average. 31P nuclear magnetic resonance spectroscopy of the forearm muscles revealed normal pH and metabolic responses to static and dynamic exercises. CONCLUSIONS: We conclude that insulin resistance in patients with CGL is associated with an increased proportion of type II muscle fibers but not reduced capillary density. Increased muscularity in CGL is due to muscle hyperplasia and is not associated with increased muscle strength.

Adipose Tissue↗
PubMed2000

[Parametric coupling in sequences of bimanual reversal movements with identical and different amplitudes].

In sequences of bimanual movements, the voluntary modulation of the amplitude of the one hand (inducing hand) induces an involuntary modulation of the amplitude of the other hand (dependent hand), the strength of which increases with increasing tempo. By means of a task in which subjects perform sequences of two short and two long reversal movements in alternation with the inducing hand, but constant short or long reversal movements with the dependent hand, we addressed two questions. The first question was concerned with differences in the effects of tempo on the involuntary amplitude modulation of short and long movements; the second question was whether the involuntary amplitude change fades away or is propagated when bimanual movements with certain target amplitudes are repeated. At low tempo the contralateral effect of voluntary amplitude changes on short-amplitude movements was stronger than the effect on long-amplitude movements, but at high tempo this difference was reversed. This result is not consistent with the assumption that contralateral amplitude modulation results from an overflow of efferent commands, which increases with the force of the movement; however, it is consistent with other findings on a transient coupling during amplitude specification (parametric coupling). The involuntary amplitude change was essentially propagated to the next movement in the sequence and did not fade away. This finding suggests that the assimilation of amplitudes that can be observed in bimanual sequences of movements with different, but for each hand constant, amplitudes could result from an effect of transient parametric coupling during the initial specification of amplitudes and need not necessarily be attributed to cross-talk at the level of motor commands or efferent innervation.

Adult↗
PubMed1994

Experimental development of a chitosan-bonded beta-tricalcium phosphate bone filling paste.

Bone filling substances are needed to meet several requirements including nontoxicity, setting time, changes in pH values, and amount of dissolved elements as well as mechanical properties. In this study, the bone-generating composites were prepared by employing the in vivo absorbable beta-tricalcium phosphate as a parent matrix kneaded with CaO, MgO, and ZnO as bone mineral additives with different compositions. The setting time, pH values, compressive strength were investigated as a function of the amount of these bone mineral additives. It was found that the setting time was shortened by increasing CaO, MgO, and ZnO contents. Increasing ZnO contents resulted in the pH value lower, while the pH values increased by increasing CaO and MgO contents. Increasing ZnO contents caused the compressive strength stronger, on the other hand, the compressive strength was weakened by increasing MgO contents. Furthermore, calcium appears to be selectively released from the hardened composite sample.

Analysis of Variance↗
PubMedDate not supplied

Detection of dangerous malnutrition.

The assessment of malnutrition by simple methods was studied in 120 patients undergoing elective major abdominal surgery to determine which index was of the most value in predicting postoperative complications. Weight for height and weight loss were of little significant value; serum albumin less than 35 g/l was more significant (p less than 0.05) but predicted only a quarter of those patients who developed serious complications. Measurements of muscle stores by anthropometry (arm and forearm muscle circumference) predicted nearly half the patients (p less than 0.01). By far the most useful index was hand-grip dynamometry, which predicted 90% of those who developed complications (p less than 0.001). The incidence of serious complications was 6 times greater in those patients with a low grip strength. Hand-grip dynamometry appears to be a useful screening test of patients at risk, and a valuable additional test for nutritional assessment.

Anthropometry↗
PubMed2005

Estimation of hand force in ergonomic job evaluations.

The aims of the present study were: (1) to collect normative data of pinch and power grip strength with a newer digital dynamometer; (2) to study the ability of hand grip force matching using a hand dynamometer where the validity and reliability issues were studied; and (3) to study the relationship between hand grip force matching and muscle activities of three forearm and hand muscles. This study consisted of two experiments. One hundred and twenty subjects volunteered in the first experiment, where hand grip strength and hand force estimation data were collected. The second experiment had 14 volunteers, where muscle activities of the hand and forearm were collected during the tests of hand grip strength and hand force matching estimations. Results showed that the power grip and pinch grip strengths collected with a newer digital dynamometer were comparable to similar studies using older equipment. At the group level, the force matching method was largely accurate and consistent. Instructions to the subjects about force matching estimation were important to the accuracy and consistency of the estimated forces. Estimation in force matching might depend on perceptions of several major muscle activities.

Adult↗
PubMed2002

Outcome measures for pediatric spinal muscular atrophy.

BACKGROUND: Spinal muscular atrophy (SMA) is a genetic disease of the anterior horn cell with a frequency of 8 per 100 000 live births and a high rate of mortality during infancy. The American Spinal Muscular Atrophy Randomized Trials (AmSMART) Group is an organization of 5 centers formed to perform clinical trials in children with SMA. OBJECTIVE: To devise reliable methods to measure strength, motor function, lung function, and quality of life for use as outcome measures in children with SMA. SETTING: Tertiary referral center, pediatric neurology department. PATIENTS AND METHODS: Twelve children with SMA aged 2 to 14 years were enrolled in a reliability study of 4 outcome measures: quantitative muscle testing (in children >5 years), gross motor function measure, pulmonary function tests, and quality of life. The Richmond Quantitative Measurement System was used to test grip, knee flexion and extension, and elbow flexion. Gross motor function measure was performed as described, and pulmonary function tests were measured using the KoKo system. Quality of life was assessed via the PedsQL and the PedsQL Neuromuscular Module for patients and parents. RESULTS: Ten children fulfilled the inclusion criteria and completed at least 3 visits with 3 evaluators in 6 months. Using a weighted kappa, the gross motor function measure showed high interrater reliability. Quantitative muscle testing showed greater variability among the weakest children; the findings for pulmonary function tests and quality of life were inconclusive. The PedsQL Neuromuscular Module for parents had moderately high reliability. CONCLUSION: A tool for motor function may be more useful in clinical trials of childhood SMA than one for quantitative muscle strength.

Adolescent↗
PubMedDate not supplied

Treatment of axillary and palmar hyperhidrosis with botulinum toxin.

The author presents his experience with hyperhidrosis treatment using type-A botulinum toxin. The drug was applied on axillary, palmar, plantar, facial, inguinal, and gluteus areas for a 36-month period. The effect achieved-sweating decrease-was observed in 100% of the patients for a variable period ranging from 5 to 14 months. There was a slight decrease in hand muscle strength in some cases, which was spontaneously recovered after 2 weeks.

Adolescent↗
PubMedDate not supplied

Muscle strength as a predictor of loss of functional status in hospitalized patients.

OBJECTIVE: The incidence of protein-calorie malnutrition in hospitalized adult patients can reach 30% to 50% and adversely affect clinical outcome. We evaluated the efficacy of muscle strength to predict functional derangement and detect early changes in nutrition status in hospitalized patients. METHODS: Patients hospitalized at medical and surgical wards from two different hospitals in Santiago, Chile, were studied during their hospital stay. Subjective Global Assessment of nutrition status and laboratory parameters were measured on admission. Anthropometric measures, handgrip dynamometry, and maximal inspiratory and expiratory pressures were measured on admission and discharge. The Karnofsky index was used to assess functional status. Twice weekly, caloric balance was calculated with indirect calorimetry and assessment of dietary intake. RESULTS: From the initial selection of patients (n = 70), 50 patients (26 men and 24 women) completed the study. Median hospital stay was 10 d. Subjective Global Assessment was associated with anthropometric data, handgrip dynamometry, and serum levels of total proteins. Patients in whom functional status declined during hospital stay, on admission had lower left handgrip strength, a worse Subjective Global Assessment classification, were older, and had lower fat mass. No association between caloric balance during hospital stay and changes in muscle strength was observed. CONCLUSIONS: Subjective Global Assessment, handgrip strength, and fat mass were good predictors for the decline in functional status during hospital stay. No association between caloric balance and changes in muscle strength was observed.

Adult↗
PubMed2001

Nutrition and handgrip strength of older adults in rural Malawi.

OBJECTIVE: To examine the relationship between the nutritional status and handgrip strength of older people in rural Malawi. DESIGN: Cross-sectional study. SETTING: : Lilongwe rural, Malawi, situated approximately 35-50 km from the city. SUBJECTS: Ninety seven males and 199 females participated in this study. METHODS: Selected anthropometric measurements were taken and nutrition indices were computed using standard equations. Handgrip strength was measured using an electronic grip strength dynamometer. RESULTS: The mean handgrip strength (in kg) for men was significantly higher than for women vs. In addition, there was a significant decline in handgrip strength with age in both sexes. Furthermore, handgrip strength was positively correlated to the following nutritional status indicators: BMI in males and in females), mid-upper arm circumference (MUAC) in males and in females) and arm-muscle area (AMA) in males and in females). After controlling for potential confounders, namely sex, height and age, the correlations between handgrip strength and the nutrition indices were still significant. CONCLUSION: The results of this study support the hypothesis that poor nutritional status is associated with poor handgrip strength. Malawian males had both lower handgrip strength and lower arm muscle area than their counterparts from industrialised countries. However, Malawian females had similar handgrip strength despite lower arm muscle area, in comparison with women from industrialised countries, reflecting perhaps their higher level of physical activity. Further studies are required to determine whether by alleviating nutritional problems a concomitant improvement in handgrip strength can be obtained.

Aged↗
PubMed2004

Relative shoulder flexor and handgrip strength is related to upper limb function after stroke.

OBJECTIVE: To compare the relative strength of different muscle groups of the paretic upper limb and assess the relationship with motor performance. DESIGN: Descriptive study. SETTING: Secondary care rehabilitation centre. SUBJECTS: A convenience sample of 13 chronic hemiparetic stroke subjects. MAIN OUTCOME MEASURES: The maximal active torques of five muscle groups were measured in both upper limbs (UL) and converted into relative strength (paretic/nonparetic). The UL function was assessed using the Box and Block Test, the Finger-to-Nose Test, the Fugl-Meyer Test and the TEMPA (Test Evaluant les Membres supérieurs des Personnes Agées). RESULTS: The Friedman two-way analysis of variance shows a significant difference across the relative strength of the different muscle groups (p = 0.017), but subsequent multiple comparisons indicate a significant difference between handgrip and elbow extension only (relative strength of 0.52 +/- 0.27 and 0.73 +/- 0.23 respectively). However, data show the presence of large intrasubject imbalances between muscle groups. The relative forces for shoulder flexion and handgrip are the best predictors of the UL function, the higher Spearman's rho correlation coefficients for each clinical test ranging from 0.70 to 0.81. CONCLUSIONS: These results do not confirm classical clinical teaching regarding the distribution of weakness following stroke (e.g., proximal to distal gradient; extensors more affected than flexors) but support the hypothesis that strength is related to the function of the paretic upper limb.

Adult↗
PubMed2001

Between-species variation in the development of hand preference among macaques.

This research examined between-species variation in the development of hand preference among Macaca. Specifically, we examined hand preference using juveniles and adults of three macaque species that differ in social and reactive tendencies in order to examine whether the correlation between temperament and handedness that has been noted within Macaca mulatta occurs between closely related species. Each of the species studied exhibited a different pattern of hand preference development. Both juvenile and adult M. mulatta exhibited group-level left-hand bias. Juvenile Macaca nemestrina were not biased towards either hand at the group-level, whereas adults exhibited a group-level left-hand bias. Neither juvenile nor adult Macaca fascicularis exhibited manual bias at the group-level. Analysis of variance indicated statistically significant main effects of species and age class on hand preference measures. Post-hoc analysis indicated greater use of the left- versus right-hand, and greater hand preference strength independent of direction, among M. mulatta and M. nemestrina than among M. fascicularis, and among adults than among juveniles. These results indicate significant between-species variation in the development of hand preference within the genus Macaca, and are inconsistent with any one single-factor theory yet offered to explain the etiology of primate laterality. We hypothesize that the relationship between handedness and temperament that has been shown within M. mulatta may generalize across closely related primate species.

Age Factors↗
PubMed1989

[Effect of sandblast treatment on resin-alloys bond strength by silicoating technique].

The purpose of this study was to investigate why sandblast treatment increases the bond strength of resin-alloy by the Silicoating technique. In this study, two types of alloy specimens, namely Ag-Pd alloy and Ni-Cr alloy, were prepared by casting. These specimens were given sandblast treatment by 37 microns or 250 microns Al2O3 particle under the following conditions: 3 kg/cm2 for 30 sec, 5 kg/cm2 for 10 sec, 30 sec and 45 sec, and 7 kg/cm2 for 30 sec. Under each condition of sandblast treatment, changes in roughness and wettability of the alloy surface were measured. After this treatment, the alloy surface was Silicoated, and then a light-cured resin was bonded to it. Specimens were stored in air for one week and thermal cycled from 4 to 60 degrees C for 10(4) cycles. The bond strength was measured by compressive shear stress. It was shown that the sandblast treatment caused the surface area to increase in the range of 1.3-1.9 times. Also, the sandblast treatment made the alloy-water contact angle smaller and wettability greater. Maximum bond strengths for Ag-Pd alloy and Ni-Cr alloy, when sandblast treated and stored in the air for one week, were 213.7 kg/cm2 and 198.7 kg/cm2 respectively. On the other hand, bond strengths for Ag-Pd alloy and Ni-Cr alloy after thermal cycling were 129.5 kg/cm2 and 159.9 kg/cm2 respectively. These values of bond strength were 2-3 times greater than those of for specimens not given the sandblast treatment. However, varying the conditions of sandblast treatment did not produce any significant differences.

Chromium Alloys↗
PubMed2002

[Functional bracing after operative treatment of metacarpal fractures].

Metacarpal fractures are frequently immobilized for several weeks in forearm plaster cast, even after operative stabilisation. The purpose of this study was to assess the results after early functional treatment using metacarpal braces. 87 patients with 105 metacarpal fractures were included in a prospective study from February 1997 until November 2000. The AO-classification of the fractures was assessed for all patients: n=33 A1,n=9 A2,n=3 A3, n=27 B1,n=6 B2,n=7 B3,n=10 C1,n=7 C2, n=3 C3.Exclusion criteria were tendon or nerve injuries,pathological fractures (tumor or metabolic),additional digital fractures of the same ray,and a patients age of less then 18 years. All fractures were treated operatively. 73 patients (84%) were recruited for follow up after an average period of nine months. Average grip strength reached 96% (Jamar II) for the power grip, 97% for the three finger and 98% for the pinch grip compared to the contra-lateral side in the group where the dominant hand was affected. It was 88% for the power grip, 91% for the three finger grip and 94% for the pinch grip after injury of the non-dominant hand. The mean postoperative pain score on the visual analog scale was 0.2 for resting conditions, 0.8 for motion and 2.2 under stress.A decreased total range of motion was observed in 15 of 73 patients (21%). The average DASH score reached 6.5 points. Physical therapy was required for an average of 6.7 weeks. Only 41% of the patients with early functional treatment required further physical therapy after removal of the brace. The metacarpal brace used in this series protects from direct trauma,and provides a high patients comfort.It has no disadvantages considering fracture retention compared to conventional plaster casts or splints. The need for physical therapy is reduced after functional fracture bracing.Thus, the metacarpal brace has proven to be a suitable tool for early functional treatment after operative stabilisation of metacarpal fractures.

Adolescent↗
PubMedDate not supplied

A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.

PURPOSE: To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. METHODS: Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. RESULTS: Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. CONCLUSIONS: Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.

Adult↗
PubMed2006

Outcomes using an internal osteotomy and distraction device for corrective osteotomy of distal radius malunions requiring correction in multiple planes.

PURPOSE: Many different methods have been proposed for correction of distal radius malunions; however, precise correction of a severe malunion that requires simultaneous adjustment of displacement, angulation, and rotation in multiple planes is difficult. This prospective study measured radiographic and functional outcomes using an adjustable osteotomy, distraction, and fixation system for distal radius malunions that required correction in multiple planes. METHODS: Five consecutive patients with symptomatic distal radius malunions requiring correction in multiple planes were recruited into this study. All patients had correction of the malunion with an adjustable osteotomy, distraction, and fixation device. Radiographic parameters and objective and subjective functional outcomes were measured before surgery and at 3 months, 6 months, and 1 year after surgery. RESULTS: All radiographic measurements improved after surgery. Grip strength, pinch strength, and the Jebsen-Taylor test showed only marginal improvement. Ulnar deviation of the wrist and forearm pronation-supination improved, but the wrist extension-flexion arc did not. The Michigan Hand Outcomes Questionnaire showed improvement in all domains, and significant improvement was seen in the overall, work, aesthetic, and satisfaction domains. The Michigan Hand Outcomes Questionnaire, however, also indicated a substantial amount of residual impairment in all domains, including activities of daily living and pain. CONCLUSIONS: Corrective osteotomy with the adjustable osteotomy, distraction, and fixation device resulted in improvement in distal radius anatomy and function. However, not all improvements were statistically significant, and anatomy and function did not returned to baseline levels. Despite residual disability, patients noted substantial improvement in subjective outcomes. This system is useful for improving anatomy and function in distal radius malunions that require correction in multiple planes, but patients should be informed that they cannot expect to regain normal anatomy or function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Activities of Daily Living↗
PubMed2006

Treatment of scaphoid non-unions by a palmar approach with vascularised bone graft harvested from the thumb.

Ten patients with scaphoid non-unions which had been present for longer than 2 years were treated using a vascularised bone graft harvested from the thumb and pedicled on the first dorsal metacarpal artery. Bone harvesting and grafting were performed by a single palmar approach. Concomitant cancellous bone graft was not used. Bone healing was confirmed by CT scans in nine of the ten patients. Persistence of the non-union was observed in one patient who was the oldest in this series, had the longest standing non-union and was a heavy smoker. Twelve months after surgery, nine of the ten patients had significant pain relief with an improved range of motion and grip strength.

Adult↗