STABILISATION OF THE DISTAL ULNA USING EXTENSOR CARPI ULNARIS TENODESIS AFTER HEMIRESECTION — INTERPOSITION TECHNIQUE

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 41-45
Author(s):  
Kazuhiro Masada ◽  
Takeshi Fuji ◽  
Satoru Fujita
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Ulna ◽  
Wrist Extension ◽  
Extensor Carpi Ulnaris ◽  
Dorsal Aspect ◽  
Subjective Pain ◽  
Wrist Joints

A new stabilisation technique has been developed by the authors for the prevention of instability of the distal ulna after performance of Bower's hemiresection-interposition technique in rheumatoid patients, is described. This technique consists of the transfer of the extensor carpi ulnaris over the dorsal aspect of the distal ulna and suturing it to the soft tissue over the distal ulna. Operation was performed in 16 rheumatoid patients with 20 wrist joints. The results were evaluated in terms of both subjective (pain during rotation, pain on compression of the ulna) and objective evaluations (wrist/forearm range of motion, grip strength). After the operation, the pain almost disappeared in all but two cases which had insufficient bone excision. Wrist extension/flexion and pronation/supination improved after operation. Average grip strengths also improved. None of the cases showed instability of the distal ulna after the operation. Wrist extension strength did not decrease after operation in spite of tenodesis of the extensor carpi ulnaris. This technique is simple and useful for prevention of instability of the distal ulna after hemiresection-interposition technique has been carried out in rheumatoid patients.

The Ulno-Carpal Abutment Syndrome

1995 ◽  
Vol 20 (2) ◽  
pp. 171-177 ◽  
Author(s):  
A. H. SCHUURMAN ◽  
K. E. BOS
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Dramatic Improvement ◽  
Distal Ulna ◽  
Fair Result ◽  
Extensor Carpi Ulnaris ◽  
Clinical Scoring ◽  
Wrist Function

Seven wrists in six patients with ulno-carpal abutment syndrome were treated by a subchondral distal ulna resection (wafer procedure). The average follow-up was 36 months. Wrist function was evaluated using a clinical scoring chart. The parameters were pain, range of motion, grip strength and activities. One patient had a poor result, one a fair result and the remaining had good to excellent results. In all cases grip strength showed dramatic improvement. Complications were limited to palpable subcutaneous nylon sutures requiring removal in three patients and extensor carpi ulnaris tendinitis in one.

scholarly journals The Effects of Initial Rehabilitation Exercise on Range of Motion, Muscular Strength, and Muscle Pain after Surgery for Osteochondritis Dissecans of the Humeral Capitellum in Middle and High School Baseball Players

2021 ◽  
Author(s):  
Jung-Shik Seo ◽  
Jin-Ho Yoon
Keyword(s):  
High School ◽  
Range Of Motion ◽  
Grip Strength ◽  
Osteochondritis Dissecans ◽  
Rehabilitation Program ◽  
Baseball Players ◽  
Special Clinic ◽  
Flexion And Extension ◽  
Rehabilitation Exercise ◽  
Wrist Joints

Background: This study evaluated the effects of a 4-week initial rehabilitation program in middle and high school baseball players who underwent removal of a loose body from osteochondritis dissecans of the capitellum humerus. Methods: Middle and high school baseball players with osteochondritis dissecans of the capitellum humerus were enrolled in this study. Each had more than 3 yr of experience and had undergone arthroscopic removal of loose bodies from the same expert at Kim's Orthop Special Clinic in Seoul. The initial exercise rehabilitation program was based on a two-stage program. Body composition, range of motion of flexion and extension in the elbow and wrist joints, grip strength, and subjective pain scale were measured before and after rehabilitation. To assess the differences between groups, we used a two-way analysis of variance. Results: The range of motion for flexion and extension of the elbow and wrist joints, grip strength, and score on the visual analog scale each were significantly improved following the 4-week program (P<0.001), had an interactive effect in time × group (P<0.001), and had significance between groups (P<0.05). Conclusion: The 4-week initial rehabilitation exercise program might improve the overall range of motion of the elbow joint and has a positive therapeutic effect on grip strength and visual analog scores. However, future welldesigned studies with more subjects and multicentric research groups are necessary for verification.

scholarly journals Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors

Hand ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 242-248 ◽  
Author(s):  
Ioannis D. Papanastassiou ◽  
Olga D. Savvidou ◽  
George D. Chloros ◽  
Panayiotis D. Megaloikonomos ◽  
Vasileios A. Kontogeorgakos ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Grip Strength ◽  
Giant Cell ◽  
Wide Resection ◽  
Giant Cell Tumors ◽  
Distal Ulna ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Extensor Carpi Ulnaris

Background: The necessity of stabilizing the residual ulnar stump after distal ulna tumor resection remains controversial. The authors retrospectively compared the outcome of patients who underwent wide resection of distal ulna giant cell tumors (GCTs) and reconstruction with tenodesis of the extensor carpi ulnaris (ECU) or without reconstruction. Methods: Between 2007 and 2015, 9 patients (6 females, 3 males; mean age, 36.8 years; range, 24-65 years) who underwent distal ulna resection for GCT of bone were retrospectively reviewed. The mean resection length was 8.1 cm. Five patients had no reconstruction, whereas 4 patients had stabilization of the ulnar stump using ECU tenodesis. With a mean follow-up of 3.6 years (2-9 years), the functional outcome using the quick Disability of Arm, Shoulder and Hand (DASH) score; Musculoskeletal Tumor Society score and grip strength; as well as the oncological outcome were evaluated. Results: Musculoskeletal Tumor Society functional scores were more than 24 in 7 patients and 20 to 24 in 2 patients (mean, 27.6 or 92%). Quick DASH scores ranged from 0 to 27.3 (mean, 11.1). In both groups, similar scores were observed ( P > .5). No patient had instability or pain related to the stump. There was no ulnar translation or subluxation of the radiocarpal joint. Grip strength in the operated hand, controlled for handedness, was 11% less than in the contralateral hand, although there was no difference between groups ( P > .4). All patients were disease-free at the latest follow-up. Conclusions: The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome.

scholarly journals Lunatum excision and scaphocapitate arthrodesis in Kienböck’s disease

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769270 ◽  
Author(s):  
Güzelali Özdemir ◽  
Turgut Akgül ◽  
Özgür Çiçekli ◽  
Barış Yılmaz ◽  
Hasan Atbinici ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Circular Plate ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Kienböck’S Disease ◽  
Vas Score ◽  
Before And After ◽  
Healthy Side ◽  
Kienbock’S Disease

Purpose: The aim of this study was to compare functional results before and after lunatum excision and scaphocapitate arthrodesis (SCA) using an angular stable circular plate in patients with Lichtman’s stage IIIB Kienböck’s disease. Methods: The study included nine patients (six females and three males) with a mean age of 33.2 ± 11 years (range: 18–54 years). Clinical and radiological assessment before and after surgery included wrist extension and flexion, range of motion and grip strength, visual analogue scale (VAS) score to assess pain, modified Mayo wrist scores, and measurements of the scapholunate (SL) angle and modified carpal height ratio. Results: The mean follow-up period was 17.33 ± 4.69 months (range: 12–24 months), mean operation time was 56.67 ± 12.5 min (range: 45–75 min) and mean hospitalization time was 3.44 ± 1.13 days (range: 2–6 days). Preoperative mean wrist extension was 23.89° ± 4.17°, mean wrist flexion was 32.22° ± 5.07°, mean grip strength compared to the healthy side was 34% (range: 28–37%) and mean VAS score was 7.6 (range: 7–8). Modified Mayo wrist scores were poor in all of the nine patients. Post-operative mean wrist extension was 27.78° ± 4.41°, mean wrist flexion was 40.56° ± 4.64°, mean grip strength compared to the healthy side was 71% (range: 63–81%) and mean VAS score was recorded as 1.4 (range: 1–2). Modified Mayo wrist scores were good in five and moderate in four patients. No patients had non-union or additional surgery. Conclusion: Lunatum excision and SCA using angular stable circular plate fixation provide pain relief with acceptable preservation of the range of motion.

Comparative Results of Resection of the Distal Ulna in Rheumatoid Arthritis and Post-Traumatic Conditions

1999 ◽  
Vol 24 (6) ◽  
pp. 667-670 ◽  
Author(s):  
K. E. FRASER ◽  
E. DIAO ◽  
C. A. PEIMER ◽  
F. S. SHERWIN
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Post Traumatic ◽  
Comparative Results ◽  
Trauma Group

The purpose of this study was to determine whether the results of resection of the distal ulna differed depending upon the underlying aetiology of the condition. Patients with rheumatoid arthritis were compared with patients with post-traumatic wrist complaints. Fifty resections in 40 patients (eight male, 32 female) were assessed with respect to pain, range of motion, and grip strength. Of the 23 rheumatoid wrists, 86% were pain-free following surgery; however, only 36% of the patients in the trauma group reported pain relief postoperatively. Pain relief in posttraumatic patients was more predictable when distal radioulnar joint arthrosis was identified as the sole cause of wrist pain.

Do “Anatomic” Distal Ulna Plating Systems Fit the Distal Ulna Without Causing Soft Tissue Impingement?

Hand ◽  
2020 ◽  
pp. 155894472093030
Author(s):  
Daniel A. Shaerf ◽  
Woo Jin Chae ◽  
Reza Sharif-Razavian ◽  
Vasiliki Vardakastani ◽  
Angela E. Kedgley ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Soft Tissue ◽  
Fracture Fixation ◽  
Safe Zone ◽  
Zone Size ◽  
Distal Ulna ◽  
Extensor Carpi Ulnaris ◽  
Soft Tissue Impingement ◽  
Narrow Area ◽  
Flexion And Extension

Background: Distal ulna fracture fixation plates commonly cause irritation, necessitating removal, due to the narrow area between the ulna articular cartilage and the extensor carpi ulnaris. This study defines the safe zone for plate application and determines whether wrist position affects risk of impingement. Methods: Four different distal ulna anatomic plates (Acumed, Medartis, Skeletal Dynamics, and Synthes) were applied to 12 cadaveric specimens. Safe zone size was measured in circumferential distance and angular arc. Impingement was examined in flexion and extension in neutral, pronation, and supination. Results: The distal ulna safe zone has dimensions of a 92° arc and perimeter circumference of 15 mm. Cumulative extensor carpi ulnaris (ECU) impingement occurred in 0% of the 6 simulated wrist/forearm positions for the Acumed plate, 22% for the Synthes plate, 31% for the Skeletal Dynamics plate, and 68% for the Medartis plate. Impingement was most common in supination. Likelihood of ECU impingement significantly decreased in the following order; Medartis > Skeletal Dynamics > Synthes > Acumed. Conclusion: The ECU tendon’s mobility can cause impingement on ulnarly placed distal ulna plates. Intra-operative testing should be performed in supination. Take home points regarding each plate from the 4 different manufacturers: contouring of Medartis plates, when placed ulnarly, is mandatory. The Acumed plate impinged the least but is not designed for far-distal fractures. The Synthes plate is least bulky but not suitable for proximal fractures. The Skeletal Dynamics plate appeared the most versatile with a reduced incidence of impingement compared to other ulnarly based plates.

Physical Activity in Aging Population

2019 ◽  
Vol 5 (3) ◽  
pp. 74
Author(s):  
Rezarta Stena ◽  
Klara Hysenaj ◽  
Mitilda Gugu Karoli ◽  
Armelda Teta ◽  
Gjergji Doka
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Heart Rate ◽  
Pain Intensity ◽  
Range Of Motion ◽  
Training Program ◽  
Grip Strength ◽  
Upper Limb ◽  
Hand Grip ◽  
Trunk Flexibility

It is known that worldwide populations are aging, and also that physical activity can play an important role in minimizing impairments characteristic of old age. Adopting a more active lifestyle and doing regular physical activity, including aerobic and resistance exercises, daily walking etc. have been demonstrated to improve cardiovascular, respiratory, and musculoskeletal parameters in older adults. We assessed a potential participant from Elbasan (Albania), 67 years, for eligibility to participate in a 5 month training program. The subject gave written informed consent before inclusion.The following parameters were measured at the beginning (baseline) and end of the training period: BMI, body fat percentage, hand grip strength, lower/upper limb and trunk flexibility and range of motion, heart rate, balance, pain intensity, as well as VO2 max, directly and/or an estimate using the Rockport fitness test estimate. An initial evaluation was carried out just before starting the training (baseline). A second evaluation was made 5 months after starting the program of physical exercise (post training). Each evaluation included the recording of health related events, such as any changes in previous symptoms, as well as measurements of balance, flexibility, body composition, coordination, muscle strength, and aerobic capacity, to detect any changes that might have been induced specifically by physical activity. The subject’s attendance and participation in the program was also recorded. Range of motion for each part evaluated (trunk, hip, cervical region and shoulder) is improved about 15-20° degree. BMI, hand grip strength, lower/upper limb and trunk flexibility, heart rate, balance, pain intensity, VO2 max are also improved after training program. Following a training program or a regular physical activity in older adults minimise impairments characteristics in this age and cardiovascular, respiratory, and musculoskeletal parameters. According to the low importance shown in my country for the physical activity in older adults, I want to emphasize the importance of state structures involvement and the sensibilization of this group of age to stimulate an actively participation in physical training programs followed by professionals for bests life parameters. A higher investment for this age group, building as many facilities as possible for activation and spending quality free time, hiring more physiotherapists in nursing homes will increase life motivation and improve the quality and the parameters of living.

Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Kaisa Jokinen ◽  
Arja Häkkinen ◽  
Toni Luokkala ◽  
Teemu Karjalainen
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Hand Grip Strength ◽  
Active Motion ◽  
Hand Grip ◽  
Active Range Of Motion

Background Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. Methods We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. Results The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], −8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). Conclusions Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.

scholarly journals AB0747 SPECIFIC ULTRASOUND LESIONS IN PSORIATIC ARTHRITIS: PREVALENCE AND CORRELATION WITH DISEASE ACTIVITY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1670.2-1670
Author(s):  
K. Ben Abdelghani ◽  
H. Boussaa ◽  
S. Miladi ◽  
A. Fazaa ◽  
K. Ouenniche ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Soft Tissue ◽  
Disease Activity ◽  
Disease Duration ◽  
Extensor Tendon ◽  
Biological Data ◽  
Dorsal Aspect ◽  
Tissue Edema ◽  
Linear Probe ◽  
The Mean

Background:Psoriatic arthritis (PsA) is a systemic inflammatory disease with articular and extra-articular features. In recent years, Ultrasonography (US) is playing an important role in the diagnosis and monitoring of this disease. Specific US features of PsA have been reported such as enthesitis, peritenon extensor tendon inflammation (PTI) and soft tissue edema.Objectives:The aims of this study were to evaluate the prevalence of these US signs in PsA patients and to determine their association with disease duration and activity.Methods:Patients with peripheral PsA responding to the Classification Criteria for Psoriatic Arthritis (CASPAR) were enrolled. Clinical and biological data were extracted, and then US examination was performed by an experimented rheumatologist blinded to clinical data using a machine type Esaote MyLAb 60 with a linear probe of 6-18 MHz. The following US features were evaluated: PTI at the dorsal aspect of metacarpo-phalangeal (MCP) joints, soft edema at the volar aspect of MCP joints and enthesitis of the digitorum extensor at the dorsal aspect of distal inter-phalangeal (DIP) joints.A p<0.05 was considered statistically significant.Results:We included twenty PsA patients, 8 men and 12 women, with a mean age of 55 ± 11 [33-77] years old. The mean disease duration was of 10±8 [1-34] years. A family history of PsA or psoriasis was reported in 53% of cases.Oral corticosteroids were used in 21% of patients, at a mean daily posology of 7 mg [5-10] of Prednisone equivalent, Methotrexate in 84% of cases at a mean posology of 15 mg [10-20] per week, Sulfasalazine in 10% of cases and a biological DMARD in 32% of cases (Etanercept=4, Infliximab=1, Adalimumab=1).The mean number of tender and swollen joints were respectively of 8 [0-16] and 2 [0-8]. The mean rate of patient global evaluation and visual analogue scale was of 5 [0-9].The mean DAPSA (Disease Activity in PSoriatic Arthritis) score was of 32±27 [4-112].US examination demonstrated that all patients had at least one of the three specific signs that we were looking for. At MCP level, PTI was noted in 11% of joints with Power Doppler (PD) signal in one case and soft tissue edema was noted in 3% of joints.At DIP level, enthesitis of digitorum extensor tendon was noted in 39% of joints. The elementary lesions reported were: enthesophyte in 25%, erosion in 8%, calcification in 5% and thickened or hypoecoic tendon in 4% of joints. However, no PD signal was detected at the enthesis.A positive association was found between DAPSA score and soft tissue edema (p=0.000), but not with PTI (0.668) and enthesitis (0.137). No relation was found between these three lesions and the disease duration.Conclusion:The presence of soft tissue edema, enthesitis and/or PTI on US can be an argument for the diagnosis of PsA. Soft tissue edema is shown to be associated with disease activity.Disclosure of Interests:None declared

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