Assessment

Author(s):  
David Warwick ◽  
Roderick Dunn ◽  
Erman Melikyan ◽  
Jane Vadher

Assessment 2Range of motion 4How to measure individual joints 6Oedema 12Muscle testing 14Power grip 16Pinch grip 18Sensory testing 20Pain 29Scar 30Function 32Outcomes 36• Identifying the underlying cause of their problems• Prioritizing their problems...

2021 ◽  
Vol 12 (1) ◽  
pp. 20-26
Author(s):  
Md Ashraful Islam ◽  
Ismat Ara Begum ◽  
Monisha Datta ◽  
Suvendu Kumar Banik ◽  
Shahidullah ◽  
...  

Anatomic consideration: Flexor pollicis longus (FPL) tendon arises from volar aspect of middle third of radial shaft and from the lateral aspect of interosseous membrane. The anterior interosseous branch of median nerve innervates the muscle in the proximal/mid forearm. Blood supply is predominantly from radial artery. Abstract Purpose: The purpose of this study was to evaluate the results of repair and one stage reconstruction of FPL injury and to find out complications and rupture rate and effectiveness of repair and reconstruction. Method: This retrospective review was carried out in Bangabandhu Sheikh Mujib Medical University from January 2015 to December 2018. 30 consecutive patients were enrolled in the study. 4 strands core suture with simple circumferential suture were used for repair and reconstruction. Tendon transfer was done in few cases. Power grip, active and passive range of motion, American Society for Surgery of the Hand criteria and Buck-Gramcko criteria were used for outcome assessment. Results: Out of 30 patients, 20 (67%) were male and 10 (33%) were female. Mean age was 30 years. Mean follow up period was 1.5 years. All cases were due to various type of cut injuries. In subjective assessment 40% patients achieved excellent, 50% good, 10% fair results. Our rupture rate was 0%. Mean power grip, pinch grip strength of index and key pinch strength were 87.5%, 68.18% and 86.66% respectively from contralateral normal hand. Active range of motion of IP joint was 64.28% of normal side. Conclusions: Use of 4 strands core sutures and early active motion give good to excellent results in 90% cases of repair, reconstruction and tendon transfer in FPL injuries with 0% rupture rate J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 20-26


Neurology ◽  
2019 ◽  
Vol 92 (5) ◽  
pp. e461-e474 ◽  
Author(s):  
Ursula Moore ◽  
Marni Jacobs ◽  
Meredith K. James ◽  
Anna G. Mayhew ◽  
Roberto Fernandez-Torron ◽  
...  

ObjectiveTo assess the ability of functional measures to detect disease progression in dysferlinopathy over 6 months and 1 year.MethodsOne hundred ninety-three patients with dysferlinopathy were recruited to the Jain Foundation's International Clinical Outcome Study for Dysferlinopathy. Baseline, 6-month, and 1-year assessments included adapted North Star Ambulatory Assessment (a-NSAA), Motor Function Measure (MFM-20), timed function tests, 6-minute walk test (6MWT), Brooke scale, Jebsen test, manual muscle testing, and hand-held dynamometry. Patients also completed the ACTIVLIM questionnaire. Change in each measure over 6 months and 1 year was calculated and compared between disease severity (ambulant [mild, moderate, or severe based on a-NSAA score] or nonambulant [unable to complete a 10-meter walk]) and clinical diagnosis.ResultsThe functional a-NSAA test was the most sensitive to deterioration for ambulant patients overall. The a-NSAA score was the most sensitive test in the mild and moderate groups, while the 6MWT was most sensitive in the severe group. The 10-meter walk test was the only test showing significant change across all ambulant severity groups. In nonambulant patients, the MFM domain 3, wrist flexion strength, and pinch grip were most sensitive. Progression rates did not differ by clinical diagnosis. Power calculations determined that 46 moderately affected patients are required to determine clinical effectiveness for a hypothetical 1-year clinical trial based on the a-NSAA as a clinical endpoint.ConclusionCertain functional outcome measures can detect changes over 6 months and 1 year in dysferlinopathy and potentially be useful in monitoring progression in clinical trials.ClinicalTrials.gov identifier:NCT01676077.


2017 ◽  
Vol 06 (04) ◽  
pp. 294-300 ◽  
Author(s):  
Avanthi Mandaleson ◽  
Michael Wagels ◽  
Stephen Tham

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.


2019 ◽  
Vol 10 (2) ◽  
pp. 114-128
Author(s):  
Muh Syikir

Hasil-hasil studi dibidang neurologimenyatakan bahwa  stroke merupakan penyebab kematian nomor satu diberbagai rumah sakit di tanah air (Batticaca, 2012). Menurut taksiran WHO, sebanyak 20,5juta jiwa di dunia sudah terjangkit stroke tahun 2015. Dari jumlah tersebut 5,5 jutajiwa telah meninggal dunia.Sebesar80%pasienstroke mengalami kelemahan pada salah satu sisi tubuhnya/hemiparese(Ariani,  2012). Kelemahantanganmaupunkakipada pasien stroke akanmempengaruhikontraksiotot, sehingga salah satuprogram rehabilitasi  yang   dapat  diberikan  pada pasien strokeyaitumobilisasipersendian dengan latihan range of motion (Potter and Perry, 2010).Tujuan Penelitian ini adalah untuk menganalisis pengaruh ROM terhadap peningkatan fungsikekuatan  otot pada pasien stroke  di Ruang Perawatan RSUDPolewali Mandar. Metode Penelitian, yang digunakan adalah metode Quasi Experiment dengan menggunakan rancangan eksperimen Equivalent group (randomized pretest-posttest with control group). Penelitian ini mengambil sampel 10 psien stroke dengan hemiparases 5 kelompok intervensi dan 5 kelompok kontrol, yang mana tekhnik pengambilan sampel secara tehnik accidental sampling yaitu peneliti mengumpulkan data dari subyek yang ditemuinya saat itu dan dalam jumlah secukupnya, dimana Alat Ukur yang digunakan ialah Lembar Observasi dengan Manual Muscle Testing (MMT). Yang mana dianalisis menggunakanuji paired sample test berpasangan dengan tingkat signifikansi  α = 0,05. Hasil Penelitian, uji statistik didapatkan bahwa kelompok intervensi (P = 0,000) mempunyai pengaruh pemberian ROM dalam peningkatan kekuatan otot dan kelompok kontrol (P = 0,178) tidak mempunyai pengaruh. Berdasarkan hasil penelitian menunjukkan dengan pemberian latihan ROM, akan mempengaruhi kekuatan otot pada pasien stroke dengan hemiparases. Sehingga sangat di harapkan agar tenaga kesehatan khususnya perawat dapat lebih intensif memebrikan ROM pada pasien stroke dengan hemiparases


2018 ◽  
Vol 49 (2) ◽  
Author(s):  
Snježana Novaković Bursać ◽  
Slavica Jandrić ◽  
Goran Talić ◽  
Gordana Ljubojević

Introduction: Non-enzymatic protein glycosylation in diabetic patients leads to stiffening of collagen-containing tissues affecting joint mobility. Motor dysfunction in diabetic patients can be detected as muscle weakness or atrophy.Objective: To determine the presence of muscles weakness and limited joint mobility at ankle (AJ), subtalar (SJ) and first metatarsophalangeal joint (I MTP) in diabetic patients and to determine impact of diabetes duration on those changes.Patients and Methods: A cross-sectional study was conducted among 100 diabetic patients in “Primary Health Care Centre Banjaluka” in 2014. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. Range of motion (ROM) at the AJ, SJ and I MTP was measured with goniometer.Results: The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ (47.85°) was significantly decreased compared to the reference value that is 65° (t =-15.378, P=000). The average ROM at SJ (35.10°) was significantly decreased compared to the reference value that is 50° (t =-15.378, P=000). The average ROM at the I MTP (72.70°) was significantly decreased compared to the reference value that is 120° (t =-15.378, P = ,000).Conclusion: Patients with diabetes have decreased foot and ankle muscle strength, and the average values of the range of motion at AJ, SJ and I MTP, but the duration of the diabetes does not correlate significantly with those changes.


2021 ◽  
Vol 10 (20) ◽  
pp. 1469-1473
Author(s):  
Ishan Vivekanand Phatak ◽  
Sujit Ramesh Chavan ◽  
Sandeep Babasaheb Shinde

BACKGROUND Falls are very much common in elderly. Fall in geriatric population is one of the common reasons for hospitalization, which may put financial burden on the patient and family. Fall in geriatric population many a times causes fracture and it may lead to serious complications which can threaten life. It may lead to disability and patient may become a handicap. In our study, we identified the correlation between motor strategies of balance control and causes of fall in post-operative elderly individuals. METHODS In this observational study, a total of 100 post-operative elderly individuals who had a fall and who underwent surgery for fracture correction were included. Both males and females in age group of 60 years and above were included. Outcome measures used were balance tests, manual muscle tests and goniometry. RESULTS 28 % individuals had fall due to low level of motor control at ankle joint and 40 % individuals at hip joint. In 16 % of individuals reaching strategy was affected. Suspensory strategy was affected in 10 % of individuals while stepping strategy was affected in 6 % of elderly. Elderly had fall due to weak musculature at hip joint (35 %), knee joint (15 %), ankle joint (30 %) and spine (25 %) irrespective of the individual’s gender. CONCLUSIONS Impairment in motor strategies of balance control such as, hip strategy, stepping strategy, reaching strategy, suspensory strategy, ankle strategy leads to fall in elderly. On the basis of assessment of manual muscle testing (MMT), range of motion and motor strategies of balance control, we concluded that impairment in motor strategies of balance, and reduced joint range of motion lead to falls. KEY WORDS Motor Strategies for Balance Control, Balance Tests, Manual Muscle Testing, Range of Motion


2021 ◽  
pp. 1-13
Author(s):  
Tina Duong ◽  
Jennifer Canbek ◽  
Alicia Fernandez-Fernandez ◽  
Erik Henricson ◽  
Marisa Birkmeier ◽  
...  

Background: Duchenne Muscular Dystrophy (DMD) is a neuromuscular disorder that presents in childhood and is characterized by slowly progressive proximal weakness and lower extremity contractures that limit ambulatory ability [1, 2]. Contractures develop in the ankles, knees, and hips due to muscle imbalances, fibrotic changes, loss of strength, and static positioning [2, 5]. Currently, standards of care guidelines emphasize the importance of maintaining good musculoskeletal alignment through stretching, bracing, and glucocorticoid (GC) therapy to preserve strength and function. Methods: This is a retrospective analysis of prospectively collected data through the CINRG Duchenne Natural history study (DNHS). The objectives of this analysis are to understand the progression of ankle contractures for individuals with DMD and to investigate the relationship between progressive lower limb contractures, knee strength, and Timed Function Tests. A collection of TFTs including supine to stand (STS), 10 meter walk test (10MWT), and timed stair climbing (4SC) have been used to monitor disease progression and are predictive of loss of ambulation in these patients [4]. Multiple factors contribute to loss of ambulation, including progressive loss of strength and contracture development that leads to changing biomechanical demands for ambulation. A better understanding of the changes in strength and range of motion (ROM) that contribute to loss of function is important in a more individualized rehabilitation management plan. In this longitudinal study, we measured strength using quantitative muscle testing (QMT) with the CINRG Quantitative Measurement System (CQMS)), ROM was measuresed with a goniometer and TFTs were measured using a standard stopwatch and methodology. Results: We enrolled 440 participants; mean baseline age was 8.9 (2.1, 28.0) years with 1321 observations used for analysis. GC use was stratified based on duration on drug with 18.7%at <  6 months or naïve; 4.3%<1 year; 58.0%1 <  10 years; and 19.3%between 10-25 years of GC use. Ankle ROM was better for those on GC compared to GC naive but did not significantly influence long-term progression rates. QMT, ROM, age and GCs contribute to speed of TFTs. Knee extension (KE) strength and Dorsiflexion (DF) ROM are significant predictors of speed for all TFTs (p <  0.001). Of the variables used in this analysis, KE strength is the primary predictor of walking speed, estimating that every pound increase in KE results in a 0.042 m/s improvement in 10MWT, and a smaller similar increase of 0.009 m/s with every degree of ankle DF ROM. Conclusion: GC use provides an improvement in strength and ROM but does not affect rate of change. Knee strength has a greater influence on speed of TFTs than DF ROM, although both are statistically significant predictors of speed. Results show that retaining knee strength [1, 2], along with joint flexibility, may be important factors in the ability to perform walking, climbing and supine to stand activities.


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