Search Results (50)

Background/Objectives: Atrophic nonunion presents a significant challenge in hand surgery, often resulting in chronic pain and functional disability. Traditional surgical treatments such as bone grafting and internal fixation may be insufficient. This study evaluates the feasibility, safety, and preliminary effectiveness of a regenerative-first surgical protocol that combines autologous bone micro-grafts with a fresh human amniotic membrane to create a biologically active regenerative chamber. Methods: A total of 8 patients (6 males, 2 females; age range: 22–56 years) with an atrophic nonunion of metacarpals and phalanges were treated using a regenerative-first surgical approach. Autologous bone was harvested from the iliac crest and mechanically disaggregated via Rigenera^® technology to obtain micro-grafts enriched with osteoprogenitor cells and extracellular matrix fragments. These were applied to the bone defect and wrapped in a fresh amniotic membrane, creating a biologically active chamber. Fixation was achieved using low-profile plates or screws, and all patients underwent early protected mobilization. Results: Radiographic consolidation was achieved in all patients within 2 months postoperatively. Functional outcomes at final follow-up demonstrated excellent or good results in Total Active Motion (TAM), with grip and pinch strength within normative ranges and minimal residual pain. Conclusions: This preliminary series suggests that combining autologous bone micro-grafts with an amniotic membrane in a regenerative surgical protocol is a promising strategy for managing atrophic nonunion in the hand. The approach was associated with rapid consolidation and excellent functional recovery. Further research with larger, controlled cohorts is warranted to validate efficacy and define standardized indications and techniques. Full article

Background: Trapeziometacarpal (TM) joint arthritis is a common condition causing pain and functional limitations, particularly in activities requiring pinch and grip strength. Surgical options such as interposition trapeziectomy and prosthetic joint replacement have demonstrated varying degrees of success. However, the role of post-operative rehabilitation in optimizing outcomes for these procedures remains underexplored. Effective rehabilitation may be critical for restoring strength, range of motion (ROM), and overall hand function; yet, no consensus exists on the best approach for either surgical modality. This study aims to evaluate the impact of post-operative rehabilitation on functional and clinical outcomes in patients undergoing interposition trapeziectomy versus prosthetic replacement for TM joint arthritis. Methods: A retrospective cohort study was conducted on patients treated for TM joint arthritis between November 2023 and October 2024. Patients were divided into two groups based on the surgical procedure: interposition trapeziectomy and prosthetic replacement. Patients randomly followed post-operative rehabilitation protocols, auto-assisted exercises, or no type of rehabilitation. The outcomes assessed included pain (VAS), return to work or heavy activities, post-operative complications, hand function (DASH score), and patient satisfaction at 1 and 6 months after surgery. Results: The prosthesis group consisted of 30 patients, while 31 patients underwent interposition trapeziectomy. Patients in both groups showed good improvements in pain, ROM, and hand function post rehabilitation. The prosthetic group demonstrated a faster recovery of strength and higher early satisfaction scores, but in the long term, the results were overlapping. No significant differences were observed in long-term functional outcomes or patient satisfaction at 6 months. In the trapeziectomy group, for patients who followed a rehabilitation program, no significant differences were found. Conclusions: Post-operative rehabilitation finds its place in recovery after both interposition trapeziectomy and prosthetic replacement for TM joint arthritis. While prosthetic replacement allows for quicker functional recovery, interposition trapeziectomy offers comparable long-term results with a lower complication profile. Tailored rehabilitation protocols may enhance outcomes and should be considered an integral part of TM joint arthritis management in selected patients. Full article

Trapeziometacarpal joint osteoarthritis (TMJ OA) is a progressive condition, particularly affecting postmenopausal women. Various surgical techniques have been proposed, but the optimal approach remains debated. This clinical study compares the clinical, functional, and radiological outcomes of two surgical treatments: suspension tenoplasty using the flexor carpi radialis tendon (Altissimi technique, AST) and a dual-mobility prosthesis. The main complications associated with these procedures include postoperative pain, De Quervain’s syndrome, radial nerve injuries, and prosthetic component mobilization. In prosthetic arthroplasty, the most common complication is component mobilization (8%), while in tenoplasty, postoperative pain is the most frequent (15%). A total of 36 patients were randomized into two groups: 18 patients underwent AST (Group A), and 18 received trapeziometacarpal joint arthroplasty (Group B). Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analogue Score (VAS), and Michigan Hand Outcomes Questionnaire (MHQ) at 3, 6, 12, and 24 months. Range of motion (ROM), Kapandji score, pulp pinch strength, hand grip strength (Jamar dynamometer), and radiological maintenance of the trapezial space (step-off measurement) were also evaluated. Both procedures resulted in significant pain reduction (VAS, p < 0.05) and functional improvement (DASH, MHQ, p < 0.05). ROM increased significantly in both groups. The Kapandji scores improved from 4.0 ± 1.1 to 9.2 ± 1.2 (Group A) and 4.3 ± 0.8 to 7.8 ± 1.4 (Group B) (p < 0.05). Group B grip strength results showed a greater increase in hand grip strength than Group A (p = 0.23). The radiographic step-off showed slight proximal migration of the first metacarpal in Group A, whereas Group B maintained joint height. No implant loosening or major complications were reported in either group. Both suspension tenoplasty and dual-mobility arthroplasty are effective in TMJ OA. AST ensures joint stability with minimal radiographic changes, whereas TJA provides superior grip strength and ROM recovery. The absence of major complications suggests that TJA is a safe alternative to AST, but its higher cost and potential for implant-related complications must be considered. Full article

Objectives: The aim of this study was to analyze differences in affected upper limb functionality (grip strength, digital pinch, sensitivity, and manual dexterity) in women with breast cancer and to determine whether these factors can predict perceived disability. This study highlights the motor and sensory deficits resulting from breast cancer treatments and underscores the need for a comprehensive approach to addressing them. Methods: A descriptive cross-sectional study was conducted with 42 women diagnosed with breast cancer who underwent surgery and received chemotherapy, radiotherapy, or hormonal therapy. Strength, sensitivity, and manual dexterity were assessed, along with pain and disability questionnaires. Results: Significant differences were found in affected upper limb functionality according to age, employment status, and time since surgery. Grip strength, pinch strength, manual dexterity, and sensitivity were identified as predictors of perceived disability, explaining 92.15% of the variance in SPADI scores. Conclusions: Women with breast cancer experience functional deficits in the upper limb, particularly in strength, sensitivity, and manual dexterity. Age, employment status, and time since surgery influence the perceived disability. These findings emphasize the need for comprehensive upper limb evaluations to identify functional deficits and guide personalized rehabilitation strategies. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and various surgical techniques are used for its treatment. Extended open carpal tunnel release (EOCTR) has been proposed for improved nerve decompression. This study compares the clinical and functional outcomes of open carpal tunnel release (OCTR) and EOCTR in severe CTS, hypothesizing superior functional outcomes and lower pain levels with EOCTR. Methods: This retrospective study included 53 patients (45 females, 8 males) with severe CTS confirmed by electromyography. Patients underwent either OCTR (n = 28) or EOCTR (n = 25) between January 2020 and February 2023. The EOCTR techinque involved additional neurolysis of the recurrent motor branch and palmar cutaneous branch of the median nerve. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the Visual Analog Scale (VAS) for pain, and hand strength measurements. Complications and recovery parameters were also analyzed. Results: EOCTR resulted in significantly lower postoperative VAS scores (3.31 vs. 3.78, p < 0.001), DASH scores (16.54 vs. 20.68, p < 0.001), and BCTQ symptom scores (1.87 vs. 2.01, p < 0.001). No significant differences were found in grip strength (p = 0.52) or pinch strength (tip-to-tip: p = 0.54, lateral: p = 0.061, 3-point: p = 0.17). No major complications occurred, and pillar pain was similar in both groups (p = 0.82), resolving with conservative treatment. Conclusions: EOCTR with additional palmar cutaneous branch of the median nerve neurolysis may provide better short-term functional outcomes and lower pain levels compared to OCTR in severe CTS. Further prospective studies are needed to validate the long-term benefits and safety of this surgical approach. Full article

Background/objective: Children with autism spectrum disorders (ASD) are recognized to experience challenges with muscle function. However, there is a lack of knowledge about muscle and hand grip strength in autism. Therefore, the study aims to assess the handgrip and pinch strength of ASD and typical children. Material and method: This study enrolled 45 participants of both sexes, 27 males and 18 females, aged 6–12 years old; 24 (13 females and 11 males) were typically developing children and 21 (5 females and 16 males) had ASD. The outcome measures were hand grip and pinch strength, with the handheld dynamometer assessing handgrip strength and the hydraulic pinch gauge evaluating pinch grip. The hydraulic pinch gauge measured the pinch strengths of the key, tripod, and pulp grips. Both groups were assessed on both their dominant and non-dominant sides. Result: A comparison of the ASD group with the control group revealed that children with ASD exhibited lower values of the hand grip, key pinch, tripod pinch, and pulp pinch strengths for both hands (p < 0.05). Conclusions: The hand and pinch strengths of ASD children are lower than those of typically developing children. Therefore, the evaluation process for children with ASD should include hand and pinch strengths as a standard component. Furthermore, the rehabilitation program for ASD should prioritize enhancing hand strength. Full article

This pilot study aimed to evaluate the usability of a new, feedback-based dexterity training system in people with Parkinson’s disease (PwPD) and healthy adults. Seven PwPD and seven healthy adults participated in the study. The System Usability Scale (SUS) and the Post-Study System Usability Questionnaire Version 3 (PSSUQ) were used to assess usability. Additionally, the feedback shown as a counter, detected through newly developed algorithms, was evaluated by comparing the device-detected repetitions during six exercises to those counted by a supervisor. High median SUS scores of 92.5 were obtained in both PwPD (IQR = 81.25–98.75) and healthy adults (IQR = 87.5–93.75, maximum score 100, minimum score 0). Similarly, high PSSUQ median scores were achieved after the session (1.14, IQR = 1.00–1.33, PD; 1.08, IQR = 1.00–1.58, healthy adults, maximum score 1, minimum score 7). PwPD completed 648 repetitions, with 551 (85%) correctly recognized by the system. For healthy adults, 883 out of 913 (97%) repetitions were classified as right. The present study showed high usability and high perceived user satisfaction for the new training system in all study participants. The system effectively detects exercise repetition rates but requires further refinement to enhance accuracy for specific pinch grip exercises. Full article

Background: Dupuytren’s disease (DD) is a systemic connective tissue disorder of the palm, predominantly affecting men of Northern European or Caucasian origin over 55. In addition to conventional surgery, Dupuytren’s contracture can be treated in a minimally invasive way by injecting bacterial collagenase into the cord. However, studies on the long-term success rate when compared to the gold standard, surgical limited fasciectomy, are limited. Methods: This monocentric retrospective study examined 35 patients who had been treated with bacterial collagenase for Dupuytren’s contracture, conducting a long-term follow-up after an average of 5.7 years. The results were compared to a control group of 40 patients treated with surgical limited fasciectomy on average 5.5 years ago. Finger extension (Tubiana stage), strength, sensitivity, the effect of possible risk factors, and patient-reported outcome measures (PROMs) were compared between the two groups. Results: The long-term results after therapy for DD showed a significant reduction in the Tubiana stage for both groups (p < 0.001). Additionally, we observed a longer mean preintervention Tubiana stage and a better long-term improvement in the Tubiana stage for patients with limited fasciectomy when compared to the collagenase group. (both p < 0.001). Neither grip strength nor the pinch test showed significant differences when compared within each group or when comparing both groups. Both the treated and untreated fingers of patients with limited fasciectomy had a superior two-point discrimination (p < 0.001). For the URAM questionnaire, we observed a significantly better result in the control group (p < 0.01). Retrospectively, significantly more patients in the collagenase group would not choose the same therapy to treat DD (35 vs. 8%; p < 0.05). Conclusions: The two therapy options should be seen as complementary for the treatment of DD. Collagenase therapy seems a sensible option for DD with an earlier Tubiana stage and contractures that predominantly affect the MCP joint. Contractures with higher Tubiana stages that also affect the PIP joint should predominantly be treated with limited fasciectomy. Full article

Background: Normative data on hand and precision grip strengths are essential for evaluating the level of development, the efficacy of rehabilitation, and treatment results. The need for established norms of grip strength in Polish children is one of the problems that Polish physiotherapists and physicians face when treating upper limbs. The aim was to establish normative values of hand and precision grips strengths in Polish children and adolescents aged 3–19. Methods: In the years 2012–2023, a sample of 358 children and adolescents with no history of upper limb injuries or congenital upper extremity defects were randomly chosen from kindergartens, primary schools, middle schools, and high schools. They were living in urban agglomerations and in smaller towns or villages. Hand and precision grips like the pincer, three-point, side, and opposition grip strength were assessed using a hand dynamometer and pinchmeter in standard positions. Results: The strength in all types of examined hand grips increases with chronological age in both genders. The grip strength was higher in the boys’ group than in the girls’ and it was higher in the right hand than in the left, but the difference was no more greater than 10%. Detailed data with standard deviation were presented in the form of a table, divided by age and sex. Conclusions: Norms for grip strength were provided for Polish children and adolescents aged 3–19, allowing therapists and physicians to compare Polish patients with that of normally developed, healthy children of the same age and sex. Full article

Background: Osteoarthritis of the basal thumb joint is a debilitating disease with a high prevalence. Among pharmacological treatments, intra-articular injections of hyaluronic acid have been clinically applied. This study aimed to investigate the effectiveness and safety of intra-articular injections of hyaluronic acid for the treatment of trapezio-metacarpal joint osteoarthritis (TMOA), over a one-year period. Methods: Patients with TMOA were enrolled and treated with five consecutive intra-articular injections of hyaluronic acid (20 mg/2 mL, 500–750 KDa, HyalganBio) at weekly intervals. Primary outcomes were pain during different activities (changes in numerical rating scale) and function (pinch and grip strength), and secondary outcomes were safety (adverse events) and patient-reported outcomes (quick-DASH and SF-12). The outcomes were evaluated at baseline and 1-, 3-, 6-, and 12- months after the last injection. Results: A total of 29 patients were included. All participants completed the five injective sessions and the first follow-up. A total of 15 patients completed the study. During the follow-up period, intra-articular injections of hyaluronic acid have significantly reduced spontaneous and provoked pain and improved disability. No severe systemic adverse events were reported. Conclusions: At a follow-up of up to 12 months, patients with TMOA treated with intra-articular hyaluronic acid injections reported improvements in pain relief and quality of life. Full article

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education. Full article

(1) Background: Periodontal instrumentation with dental curettes is associated with discomfort, fatigue, and musculoskeletal diseases. The goal of this study was to compare comfort, fatigue, and muscle work using three different curettes. (2) Methods: Eight hygienists each scaled three typodonts using the three different curettes. Curette A was a prototype with a novel adaptive design, Curette B had a conventional stainless-steel design, and Curette C featured a conventional silicon-covered handle. Time-based work in four muscles, comfort, fatigue, tactile feedback, grip and blade position, and pinch and grasp strength were recorded. Statistical analysis was performed using a General Linear Model (GLIM) and Tukey’s post hoc test. The level of significance was set at p < 0.05. (3) Results: Comfort, correct grasp, fingertip placement, and blade-to-tooth adaptation were significantly better with Curette A (p < 0.05). While pinch and grasp strength were significantly reduced post-instrumentation for Curettes B and C (p < 0.05), they remained unchanged for Curette A. Curette A required significantly less total muscle work and work in individual muscles, resulting in significantly less post-instrumentation fatigue than for Curettes B and C, but similar levels of tactile feedback (p < 0.05). (4) Conclusions: The ergonomic performance of a prototype adaptive periodontal curette was significantly better than that of two conventional instruments with rigid handle designs. Full article

Background/Objectives: Upper-limb function of chronic stroke patients declined when outpatient rehabilitation was interrupted and outings restricted, owing to the novel coronavirus infection (COVID-19) pandemic. We investigated whether these patients recovered upper-limb function post-resumption of outpatient rehabilitation. Methods: In this observational study, 43 chronic stroke hemiparesis patients with impaired upper extremity function were scored for limb function via the Fugl-Meyer assessment of the upper extremity (FMA-UE) and the Action Research Arm Test (ARAT) after a structured interview, evaluation, and intervention. Scores at 6 and 3 months pre- and 3 months post-rehabilitation interruption were examined retrospectively; scores immediately and at 3 and 6 months post-resumption of care were examined prospectively. The amount of change for each time period and an analysis of covariance were performed with time as a factor, changes in the FMA-UE and the ARAT scores as dependent variables, and statistical significance at 5%. Results: The time of evaluation significantly impacted the total score, as well as part C and part D of FMA-UE and total, pinch, and gross movement of the ARAT. Post-hoc tests showed that the magnitude of change in limb-function scores from immediately to 3 months post-resumption was significantly higher than the change from 3 months pre- to immediately post-interruption for the total score and part D of the FMA-UE, as well as grip and gross movement of the ARAT (p < 0.05). Conclusions: Upper-limb functional decline in chronic stroke patients, caused by the COVID-19 pandemic-related therapy interruption and outing restrictions, was resolved approximately 3 months post-resumption of rehabilitation therapy. Our data can serve as reference standards for planning and evaluating treatment for chronic stroke patients with inactivity-related impaired upper-limb function. Full article

Hand exoskeletons are potential solutions for enhancing upper extremity function after stroke, yet achieving intuitive control remains challenging. We recently showed that isometric grip force tracking is preserved after stroke, providing a possible control source for a hand exoskeleton. In this study, we developed a hand exoskeleton with a soft compliant mechanism and novel force control strategy that leverages isometric grip force control of digits 3–5 to control an index–thumb pinch grip. We first present characterization of the compliant mechanisms output impedance (34.77 N/m), and output force (2.3 ± 0.57 N). We then present results of a study that assessed the intuitiveness of the strategy during a grip–lift–move task in ten unimpaired individuals. From four unimpaired individuals we also gathered user preferences on force sensitivity and operating mode, where in one mode flexion force from digits 3–5 caused index finger closing, while in the other mode it caused index finger opening. The strategy proved intuitive, improving movement frequency on the grip–lift–move task by 30%. Users preferred greater force sensitivity and using flexion force from digits 3–5 to drive index finger extension. The force control strategy incorporated into the exoskeleton shows promise warranting further investigation in neurologically impaired participants. Full article

Joint replacement arthroplasty for the treatment of thumb osteoarthritis is gaining popularity as recent studies have demonstrated better pinch and grip strength and faster rehabilitation. Our aim was to identify early complications in modern implant designs using a multicenter study. A total of 381 patients who underwent thumb carpometacarpal replacement surgery in six participating hospitals were enrolled. The complications included were fractures, dislocations, infections, tendon and nerve injuries, and complex regional pain syndrome. Major complications were defined as a failure to implant the prosthesis, revision surgery to remove the implant, and any other need for further surgical intervention. The secondary outcomes were any other complications treated non-surgically and the timing of the complications. Eleven procedures failed, and these patients were treated with trapeziectomies. Twelve other patients required repeat surgical interventions. Minor adverse events occurred in 25.4% of the cases, and transient irritation of the superficial radial nerve and De Quervain tendinopathy were the most prevalent complications. Although this cohort depicted the learning curves of multiple surgeons, our study demonstrated low short-term failure rates. An inability to achieve primary stability of the cup in the trapezium was the leading cause of failure. Dislocations and other major complications with modern implants were very few. Full article