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PubMed2002

Long-term results of trapeziometacarpal silicone arthroplasty.

Long-term results of trapeziometacarpal (TMC) joint silicone arthroplasty were evaluated. From 1975 to 1990, 90 TMC joint silicone implants were placed in 85 patients with TMC joint arthritis caused by osteoarthritis and inflammatory arthritis. Sixty-two implants in 58 patients were available for follow-up evaluation averaging 16.4 years (range, 10-25 years) with a 10-year minimum. Patient satisfaction; range of motion; grip, key pinch, and tip pinch strengths; and radiographs were recorded. Eighty-four percent of the thumbs had satisfactory results with good-to-excellent pain relief and function. Grip, key pinch, and tip pinch strengths increased. The number of thumb tips able to touch the palmar base of the small finger increased. Subluxation was apparent in 19% of implants but was not clinically important; however, implant fracture occurred in 6% and required revision. None of the 62 implants had frank silicone synovitis. Silicone arthroplasty seems to be a reliable option for disabling TMC joint arthritis and is associated with a high degree of patient satisfaction.

Adult↗

PubMed2002

Nonunions of the distal radius.

Ten nonunions were treated with open reduction, internal fixation, and iliac crest bone graft (7 bicortical corticocancellous; 3 cancellous) through either a dorsal (8) (6 bicortical; 2 cancellous graft) or a palmar (2) approach (1 corticocancellous; 1 cancellous graft), depending on angulation and collapse. After the procedure, the patients wore casts for 2 weeks and then splints for 2 weeks, after which they progressed from active assisted range-of-motion exercises to active range-of-motion and strengthening exercises. Follow-up averaged 18.9 months (range, 9-45 months). Of the 10 patients, there were 8 unions which attained adequate range of motion of the wrist, as demonstrated by the following averages: flexion, 50 degrees; extension, 38 degrees; pronation, 73 degrees; supination, 58 degrees. Grip strength and key pinch averaged 71% and 86% of the opposite side, respectively. Five patients returned to preinjury activity levels or employed status. Five patients were unable to return to work because of associated injuries and pain (5) and poor wrist function (1). These results indicate that nonunion of the distal radius can be treated with open reduction, internal fixation, and bone grafting, that union can be attained, and that function can be restored.

Adult↗

PubMed1996

Physiological profile of age-group wrestlers.

This research compares the physiological characteristics of young wrestlers grouped by age. Three hundred and twenty eight wrestlers (mean age 15.99 +/- 1.08 years and mean weight 65.94 +/- 11.01 kg) attending a wrestling training camp between 1990 and 1994 were tested to determine their physiological capacities. The physiological profile included body weight, body composition measured by hydrostatic weighing, sum of skinfolds, aerobic power, grip strength, absolute and relative endurance, situps, pushups, fatigue, and flexibility measures. Wrestlers were divided into three age categories: G1: < or = 15 years of age; G2: 16 years of age; and G3: > or = 17 years of age. Analysis of variance with Tukey post hoc test revealed statistically significant (p < 0.05) differences in body weight (G1 < G2,G3), fat free weight (G1 < G2,G3), grip strength (G1 < G2,G3), absolute (G1 < G2,G3; G2 < G3) and relative endurance (G1 < G3,G2 < G3), pushups (G1 < G3; G2 < G3), sit and reach (G1 < G3), Margaria-Kalamen power (G1 < G2,G3), and Wingate arm and leg mean powers (G1 < G2,G3). When covaried for body weight and fat free weight, there were no significant differences in grip strength and Margaria-Kalamen power. Significant differences in arm mean power when covaried for body weight and fat free weight (G1 < G3) and for leg mean power when covaried for body weight (G1 < G3) were noted. These wrestlers were similar to young wrestlers in published research, with low body fat, excellent aerobic capacity and flexibility. When separated by age, the younger wrestlers possess less body weight, fat free weight, grip length, and power measures, possibly due to lower muscle mass.

Adolescent↗

PubMed1998

On the reliability and usefulness of methods for grip strength measurement.

The purposes of this investigation were to assess the accuracy of a grip strength measuring instrument, the Grippit, to modify previously developed methods for measuring maximal isometric grip strength (12) and to evaluate the reliability of these methods, with the use of the Grippit. Grip strength during short (maximal voluntary isometric strength, MVC) and sustained (SMVC) contractions was measured. The modifications concerned the definitions of MVC and SMVC, the measuring position, the intervals between trials and sessions, and the recording procedure. The intra-observer reliability study comprised 29 healthy subjects, and the inter-observer study 10 other healthy subjects. The Grippit had very high precision. The intra-observer reliabilities of MVC and SMVC measurements were improved compared to those with the previous methods (12). The inter-observer reliability was very high.

Adult↗

PubMed2001

Consistency of performance on the functional capacity assessment: static strength and dynamic endurance.

OBJECTIVE: To explore the degree of consistency in a subject's performance in physical strength and endurance. DESIGN: Thirty healthy men, aged 19 to 26 yr, were recruited to participate in protocols to assess static strength and dynamic endurance tests on their upper limbs with the Baltimore Therapeutic Equipment Primus. Retests were conducted 7 days after the initial test. RESULTS: The intraclass correlation coefficients were 0.71 to 0.97 and 0.32 to 0.90 for static and dynamic endurance strengths, respectively. These results indicated that the consistency of the subjects' performance across occasions was high for testing static strength, although it was more varied for testing endurance strength. CONCLUSIONS: Higher consistency was observed among subjects in the assessment of static strength than dynamic endurance strength. The range of motion traveled by the limb, speed of performance, and ergonomic design of attachments seemed to confound the subjects' performance on the instrument. Stringent assessment protocols, ergonomically designed hardware, and clear instructions and practice trials before the formal testing were essential to maximize the subjects' consistency of performance. The results of this study were applicable and generalized to other performance-based instruments for physical and functional capacity evaluation and work simulators.

Activities of Daily Living↗

PubMed1998

Meta-analysis of short-term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis.

OBJECTIVE: To determine whether short-term, oral low dose prednisolone (< or = 15 mg daily) is superior to placebo and non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis. DESIGN: Meta-analysis of randomised trials of oral corticosteroids compared with placebo or a non-steroidal anti-inflammatory drug. SETTING: Trials conducted anywhere in the world. SUBJECTS: Patients with rheumatoid arthritis. MAIN OUTCOME MEASURES: Joint tenderness, pain, and grip strength. Outcomes measured on different scales were combined by using the standardised effect size (difference in effect divided by SD of the measurements). RESULTS: Ten studies were included in the meta-analysis. Prednisolone had a marked effect over placebo on joint tenderness (standardised effect size 1.31; 95% confidence interval 0.78 to 1.83), pain (1.75; 0.87 to 2.64), and grip strength (0.41; 0.13 to 0.69). Measured in the original units the differences were 12 (6 to 18) tender joints and 22 mm Hg (5 mm Hg to 40 mm Hg) for grip strength. Prednisolone also had a greater effect than non-steroidal anti-inflammatory drugs on joint tenderness (0.63; 0.11 to 1.16) and pain (1.25; 0.26 to 2.24), whereas the difference in grip strength was not significant (0.31; -0.02 to 0.64). Measured in the original units the differences were 9 (5 to 12) tender joints and 12 mm Hg (-6 mm Hg to 31 mm Hg). The risk of adverse effects during moderate and long term use seemed acceptable. CONCLUSION: Prednisolone in low doses (< or = 15 mg daily) may be used intermittently in patients with rheumatoid arthritis, particularly if the disease cannot be controlled by other means.

Administration, Oral↗

PubMed2003

Measurements of vascular function using strain-gauge plethysmography: technical considerations, standardization, and physiological findings.

The main purpose of the present study was to examine the relationships between measures of fitness [estimated peak oxygen consumption (V(O2) peak) and handgrip strength] and forearm vascular function in 55 young (22.6 +/- 3.5 yr) adults. In addition, the present study considered methodological and technical aspects regarding the examination of the venous system using mercury in-Silastic strain-gauge plethysmography (MSGP). Forearm venous capacitance and outflow were examined using five different [7, 14, 21, 28, and 35 mmHg < diastolic blood pressure (DBP)] venous occlusion pressures and after a 5- and 10-min period of venous occlusion. A pressure of 7 mmHg < DBP and a period of 10 min venous occlusion produced the greatest (P < 0.05) venous capacitance and outflow, without altering arterial indexes. Reproducibility of forearm arterial and venous indexes were evaluated at rest and after 5 min of upper arm arterial occlusion at 240 mmHg on three different occasions within 10 days with the interclass correlation coefficient ranging from 0.70 and 0.94. Estimated V(O2) peak correlated with postocclusion arterial inflow (r = 0.54, P = 0.012) and resting venous outflow (r = 0.56, P = 0.016). Finally, handgrip strength was associated with venous capacitance (r = 0.57, P = 0.007) and outflow (r = 0.67, P = 0.001). These results indicate that the examination of forearm vascular function using MSGP is reproducible. Moreover, the data show the importance of careful consideration of the selection of venous occlusion pressure and period when implementing these measures in longitudinal trials. Finally, the associations between fitness and venous measures suggest a link between venous function and exercise performance.

Adult↗

PubMed2002

A descriptive profile of elite U.S. women's collegiate field hockey players.

BACKGROUND: The purposes of this study were to develop a descriptive profile and examine the relationships between grip strength, power and sport specific test performance in 37 elite, female collegiate field hockey players (N=8 backs, N=13 forwards, N=4 goalkeepers, N=8 midfield players, N=4 wings). METHODS: The tests included circumference and limb lengths, %body fat, Margaria-Kalamen stair test, 50-yard dash test, Queen's College step test, grip strength, Illinois agility test, field hockey specific skills tests, and a coordination test. RESULTS: Mean (+/-SD) height, weight, percent body fat, and predicted oxygen consumption were 164.26 (+/-5.17) cm, 63.06 (+/-8.60) kg, 17.29 (+/-3.79)% and 42.87 (+/-9.08) ml x kg(-1) x min(-1), respectively. Although the goalkeepers were significantly (p<0.05) heavier and had a higher %body fat, there were no significant differences (p>0.05) between any of the player positions in height, limb length, 50-yard dash time, predicted VO(2max), grip strength, agility, or in the field hockey specific tests. There were no significant (p>0.05) correlations (r=0.03 to -0.13) between right and left grip strength and sport-specific test scores but significant (p<0.05) relationships were found between power and pushing accuracy, as well as between the 50 yard dash and coordination test, pushing power and pushing accuracy. CONCLUSIONS: In profiling a sample of elite collegiate field hockey players in the Unites States, the results of this study indicate that there are similarities amongst the defensive and offensive players with international level field hockey players, and that measures of power and sport specific tests are significantly correlated.

Adult↗

PubMed2004

Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament.

In 28 patients with a solitary diagnosis of instability of the trapeziometacarpal joint because of a rupture of the anterior oblique ligament, reconstruction was carried out using a slip of the tendon of flexor carpi radialis. We were able to review 26 patients. The results after a follow-up of four years seven months showed that most (87%) had significant relief from pain and symptoms. Seventeen were graded as good to excellent. The mean grip strength recovered to 86% of the contralateral side. Most patients (81%) felt that they had subjective improvement and would have undergone the operation again. A lesser functional result was seen in those who developed a flexion deformity because of overtightening of the reconstruction. Increased awareness of this lesion can lead to an early and clear diagnosis so that the patient may be advised adequately. We describe a specific, diagnostic, clinical test which we have used consistently and successfully.

Adolescent↗

PubMed2005

Strong association between volume status and nutritional status in peritoneal dialysis patients.

BACKGROUND: Malnutrition is a strong predictor of mortality in maintenance peritoneal dialysis (PD) patients. Various factors have been identified to contribute to the development of malnutrition. The present study tried to investigate the possible role of fluid overload in the development of malnutrition. METHODS: Twenty-eight PD patients were included in this study. Fluid status was evaluated by means of repeated bioimpedance analysis, and nutritional status was assessed by means of handgrip strength and subjective global assessment. All patients were followed up closely for 9 months. Based on changes in bioimpedance analysis data, patients were divided into group A (with continuous and steadily improved fluid status; n = 18) and group B (with consistent fluid overload; n = 10). RESULTS: There were no differences in sex, age, and height between the 2 groups. In group A, patients' extracellular water (ECW) volume decreased significantly during follow-up, whereas intracellular water (ICW) volume increased significantly (both P < 0.001). In group B, ECW volume increased significantly, whereas ICW volume increased at an early stage and then decreased. The ratio of ECW to total-body water decreased significantly in group A, but increased significantly in group B. Along with the improvement in fluid status, nutritional status in group A also improved significantly (the prevalence of malnutrition decreased from 66.7% to 11.1%; P < 0.01). However, in group B, nutritional status deteriorated significantly (handgrip strength decreased from 238.33 +/- 88.93 to 216.1 +/- 86.19 N; P < 0.05; and the prevalence of malnutrition increased from 40% to 50%). CONCLUSION: Our data suggest there is a strong association between fluid status and nutritional status. Improved fluid status is associated with improvement in nutritional status, whereas deterioration in fluid status is associated with the development of malnutrition.

Adult↗

PubMed2006

Methods to rapidly and accurately screen a large number of ENU mutagenized mice for abnormal motor phenotypes.

In a dominant genetic screen for late-onset motor impairments in mice, 16-20-week-old N-nitroso-N-ethylurea (ENU)-mutagenized females were subjected to a behavioural test battery consisting of a visual assessment followed by the vertical pole, rotarod and grip strength tests. SOD1-G93A transgenic mice were tested in parallel as a positive control to provide information on the validity and sensitivity of the screen. From among the 1500 G1 ENU mice screened, four affected mice with impaired motor function were classified as outliers. Approximately 32% of the G2 and G3 progeny of one outlier were affected. Vertical pole, rotarod and grip strength test scores were significantly correlated with each other and with body weight in the G1 progeny, but the correlation with body weight was not maintained in the G2 and G3 progeny. We found that two tests, tail suspension and vertical pole, were sufficient to distinguish ENU outliers and SOD1-G93A hemizygotes from control mice, and could detect abnormalities earlier and more frequently than the other tests employed.

Animals↗

PubMed2001

Operative treatment with radial shortening in Kienböck's disease.

Eighty-eight patients underwent radial shortening for Kienböck's disease. Prerequisites for surgery were radiographic studies positive for Kienböck's disease without evidence of radiocarpal arthritis and wrist pain unrelieved by conservative management. Thirty-nine patients were evaluated by subjective questionnaire at a mean postoperative follow-up of 86 months (range: 24-188 months). Following surgery, a significant decrease was noted in pain severity, frequency, and duration. Functional status improved postoperatively, with the most significant gains noted in the following activities: opening jars, opening car doors, carrying bags, and shoveling. Only 3 of 34 patients employed outside the home were unable to return to their original occupations due to their wrist problems. Seventy-six patients were evaluated by physical examination at a mean postoperative follow-up of 31 months (range: 3-87 months). Objective evaluation by physical examination revealed a significant improvement in wrist motion and grip strength. Seventy-seven patients underwent radiographic evaluation at a mean postoperative follow-up of 31 months (range: 3-180 months). A significant progression in Lichtman stage of Kienböck's disease was noted despite the favorable subjective findings and high satisfaction ratings. Thirty-six of 39 patients stated they would undergo the surgery again. The long-term data demonstrate radial shortening in patients with stage II-IIIA Kienböck's disease provides substantial improvement over preoperative status.

Adolescent↗

PubMed2001

Reporting of outcomes in arthritis trials measured on ordinal and interval scales is inadequate in relation to meta-analysis.

OBJECTIVES: To study whether the reporting of clinical outcomes in arthritis trials measured on ordinal and interval scales is adequate in relation to meta-analysis. METHODS: Systematic review of randomised trials of non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis. Optimal reporting was defined as data in the original ordered categories for global evaluation and pain, and as mean and SD for number of tender joints and grip strength, and if a visual analogue scale had been used to measure pain. RESULTS: A total of 144 trials were included. The median sample size was 60 patients. The quality of the reporting increased over time for three of the four variables. Global evaluation was optimally reported in 52 of the 127 trials (41%) in which it was recorded. Pain was optimally reported in 27 of 98 trials (28%), number of tender joints in 41 of 123 trials (33%), and grip strength in 34 of 124 trials (27%). Even if rather broad criteria are adopted, only about half of the data were reported in a potentially useful way for a meta-analysis. CONCLUSIONS: Arthritis trials have been reported inadequately in relation to meta-analysis. As most trials are underpowered, meta-analysis is indispensable and the deficit therefore needs urgent improvement. Investigators should specify a priori what constitutes an important treatment effect and report numbers of patients improved.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2005

A long-term follow-up of silicone-rubber interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint.

There are several surgical options for osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint. This paper presents our long-term clinical and radiographic review of 12 thumbs in ten patients treated by partial trapezial excision and silicone-rubber interposition arthroplasty. The follow-up period averaged 15; three years with a ten-year minimum. Although the procedure provided early pain relief in most thumbs, all but two had mild to severe pain at follow-up. The average range of post-operative palmar abduction was 23 degrees. The average post-operative grip strength was 9.5 kg. Both tip and key pinch between thumb and index finger averaged about 50% that of normal subjects. Dislocation of the implant occurred in two joints and breakages in five. Bony erosions around the implant, which we attributed silicone synovitis, were found in four thumbs. The indications for silicone-rubber interposition arthroplasty for OA of the thumb CMC joint should be severely restricted as these produced unsatisfactory long-term results.

Activities of Daily Living↗

PubMedDate not supplied

Disruption of the finger flexor pulley system in elite rock climbers.

We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bow-stringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6 degrees (range, 0 degree to 10 degrees) in group A and 4 degrees (range, 0 degree to 10 degrees) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.

Adult↗

PubMed2002

Nutritional status and muscle strength in patients with emphysema and severe alpha(1)-antitrypsin deficiency.

BACKGROUND: The association between emphysema and weight loss is well known. Severe alpha(1)-antitrypsin deficiency is an important risk factor for the development of emphysema. STUDY OBJECTIVE: To study nutritional status and muscle strength in patients with severe alpha(1)-antitrypsin deficiency and emphysema. METHODS: Fifteen alpha(1)-antitrypsin-deficient patients with emphysema (7 men) and 18 healthy control subjects (9 men) were included in the study. Total body protein (TBP) was measured by in vivo neutron activation analysis of nitrogen. Lean body mass (LBM) was estimated from measurement of total body potassium. In analogy with body mass index (BMI), TBP index and LBM index were calculated as TBP/height squared and LBM/height squared, respectively. Respiratory muscle strength was studied by maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), and skeletal muscle strength by handgrip test. Plasma albumin, transthyretin, and retinol-binding protein concentrations were analyzed as biochemical markers of nutritional status. RESULTS: In the alpha(1)-antitrypsin-deficient individuals, lung function test results were consistent with severe chronic airway obstruction, whereas the healthy control subjects had normal lung function. No significant differences were found in age, body weight, or BMI between the groups. TBP (p < 0.05), TBP index (p < 0.001), LBM index (p < 0.05), and plasma concentration of transthyretin (p < 0.01) were significantly lower in the patients than in the control subjects. There was a significant correlation between TBP and LBM (p < 0.001), and between TBP and body weight (p < 0.001). In the male subgroup, PImax (p < 0.05) and PEmax (p < 0.05) were significantly lower in the patients than in the control subjects. In the female subgroup, handgrip strength was significantly lower in the patients than in the control subjects (p < 0.05). Body weight was significantly correlated with handgrip test (p < 0.05) in the male patients. In the female patients, body weight was significantly correlated with PImax (p < 0.05), LBM with PEmax (p < 0.05), and LBM with handgrip test (p < 0.01). CONCLUSION: Reduced TBP and plasma transthyretin concentration in alpha(1)-antitrypsin-deficient patients with emphysema may indicate early signs of malnutrition.

Adult↗

PubMed1998

[A longitudinal cohort study on the relation between physical condition and masticatory ability in the elderly].

The present study was conducted to determine the relation between physical condition and masticatory ability. The subjects were residents over 65 years old living in three different areas in Sagae City. The physical conditions assessed were height, weight, rate of body fat, grip strength, and bone mineral density. Masticatory ability was evaluated by the test jelly method. The results were as follows: 1) There was a difference in physical condition among subjects from the three residential areas. 2) For males, the group who maintained their masticatory ability exhibited better physical condition than those who did not. As for females, however, the physical condition was more strongly affected by age than masticatory ability.

Aged↗

PubMed1998

Yoga-based intervention for carpal tunnel syndrome: a randomized trial.

CONTEXT: Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity. OBJECTIVE: To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome. DESIGN: Randomized, single-blind, controlled trial. SETTING: A geriatric center and an industrial site in 1994-1995. PATIENTS: Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years). INTERVENTION: Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment. MAIN OUTCOME MEASURES: Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time. RESULTS: Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time. CONCLUSION: In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.

Adult↗