Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients

2020 ◽  
Vol 45 (8) ◽  
pp. 807-812
Author(s):  
Ulla Bergfeldt ◽  
Joakim Strömberg ◽  
Therese Ramström ◽  
Katarzyna Kulbacka-Ortiz ◽  
Carina Reinholdt
Keyword(s):  
Hand Surgery ◽  
Central Nervous System Disease ◽  
Occupational Performance ◽  
Level Of Evidence ◽  
Mean Values ◽  
Visual Analogue Pain ◽  
System Disease ◽  
Modified Ashworth Scale ◽  
Cord Injury

The effects of spasticity-reducing surgery in the upper extremity were assessed in a prospective observational study of 30 consecutive patients with stroke ( n = 13), incomplete spinal cord injury ( n = 9), traumatic brain injury ( n = 5), cerebral palsy ( n = 2), and degenerative central nervous system disease ( n = 1). Surgery, which included lengthening of tendons and release of muscles, was followed by early rehabilitation at three intensity levels depending on the patients’ specific needs and conditions. At 12 months follow-up there were significant improvements in all outcome measures with the following mean values: spasticity decreased by 1.4 points (Modified Ashworth Scale, 0–5), visual analogue pain score by 1.3 points, and both Canadian Occupational Performance Measures increased (performance by 3.4 and satisfaction by 3.6), and most measures of joint position or mobility improved. Hand surgery combined with early and comprehensive rehabilitation improves function, activity and patients’ satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year. Level of evidence: II

scholarly journals Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽  
2017 ◽  
Vol 05 (01) ◽  
pp. 021-026 ◽  
Author(s):  
Cosimo Tudisco ◽  
Salvatore Bisicchia ◽  
Sandro Tormenta ◽  
Amedeo Taglieri ◽  
Ezio Fanucci
Keyword(s):  
Case Series ◽  
Persistent Pain ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Mean Values ◽  
Center Edge ◽  
Patient Groups ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up

2020 ◽  
Vol 45 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Francesco Smeraglia ◽  
Sergi Barrera-Ochoa ◽  
Gerardo Mendez-Sanchez ◽  
Morena A. Basso ◽  
Giovanni Balato ◽  
...  
Keyword(s):  
Young Patients ◽  
Hand Surgery ◽  
Dash Score ◽  
Level Of Evidence ◽  
Interpositional Arthroplasty ◽  
Trapeziometacarpal Osteoarthritis ◽  
Select Group ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
Surgical Treatments

We undertook a retrospective study to evaluate minimal 8-year outcomes of 46 trapeziometacarpal joints (46 patients) treated with pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis in two different hand surgery units. The mean follow-up interval was 9.5 years (average 113 months with a range 97–144 months). The study showed that pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction. All patients experienced a reduction in the DASH score, with an average change of 30 points. The visual analogue scale score, the Kapandji score, and key pinch also showed remarkable improvement. The PyroDisk implant exhibited good longevity, with good implant survival. A review of the literature revealed that the functional outcomes after implant surgery are not superior to more common techniques, such as trapeziectomy with or without ligamentoplasty. Therefore, this is a reliable surgery but may not have added benefits over simpler surgical treatments. This implant could have a role, perhaps in a select group of young patients, as a time-procuring procedure. Level of evidence: IV

Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects

2015 ◽  
Vol 41 (2) ◽  
pp. 177-184 ◽  
Author(s):  
H. Wang ◽  
C. Chen ◽  
J. Li ◽  
X. Yang ◽  
H. Zhang ◽  
...  
Keyword(s):  
Island Flap ◽  
Control Group ◽  
Terminal Branch ◽  
Level Of Evidence ◽  
Mean Values ◽  
Dorsal Branch ◽  
Dorsal Metacarpal Artery ◽  
Sensory Reconstruction ◽  
First Dorsal Metacarpal Artery

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher’s first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes–Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes–Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects. Level of evidence: Therapeutic, level III

Minimal important changes and differences in elective hand surgery

2014 ◽  
Vol 40 (9) ◽  
pp. 900-912 ◽  
Author(s):  
J. N. Rodrigues ◽  
N. T. Mabvuure ◽  
D. Nikkhah ◽  
Z. Shariff ◽  
T. R. C. Davis
Keyword(s):  
Outcome Measures ◽  
Hand Surgery ◽  
Future Research ◽  
Level Of Evidence ◽  
Research Directions ◽  
Future Research Directions ◽  
Minimal Important Differences

Minimal important changes and differences describe the smallest changes and differences between individuals that are relevant to patients following treatment. Minimal important differences may vary between conditions, treatments and lengths of follow-up, and can be calculated in different ways. Minimal important differences for elective hand surgery were reviewed. A total of 99 minimal important differences were identified in 29 articles. The conditions, treatments, outcome measures used and follow-up periods are discussed. The Disabilities of the Arm, Shoulder and Hand had the most estimates of minimal important differences, but these varied. The methods used in the included studies were reviewed and appraised. Most minimal important differences were calculated using retrospective anchors. Future research directions in this area are suggested. Level of evidence: II

Ivory arthroplasty for trapeziometacarpal osteoarthritis: 10-year follow-up

2018 ◽  
Vol 44 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Gino Vissers ◽  
Chul Ki Goorens ◽  
Bert Vanmierlo ◽  
Francis Bonte ◽  
Koen Mermuys ◽  
...  
Keyword(s):  
Long Term Results ◽  
Trapeziometacarpal Joint ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Trapeziometacarpal Osteoarthritis ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
Preoperative Status ◽  
The Mean

This prospective study investigates long-term functional outcome after total trapeziometacarpal joint replacement with the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis. Clinical outcome, overall function, pain, and radiologic outcome after a minimum of 10 years were evaluated for 26 Ivory arthroplasty in 24 patients. Two patients had bilateral arthroplasties. The female to male ratio was 22:2, and the mean age was 71 years (range 57–83). The mean follow-up period was 130 months (range 120–142). Overall functioning as defined by the QuickDASH score and visual analogue pain score improved by 50% and 81%, respectively, when compared with the preoperative status. However, these outcomes deteriorated beyond 5 years after surgery. Long-term results suggest the Ivory arthroplasty to be a reliable treatment for trapeziometacarpal osteoarthritis since it improves overall function and reduces pain up to 10 years postoperatively. However, revision within 10 years after surgery was needed in four of 26 cases. Level of evidence: II

Treatment with Buttress Plate Technique for Symptomatic Ulnar Styloid Base Nonunion

2021 ◽  
Author(s):  
Ömer Faruk Kümbüloğlu ◽  
Necmi Cam ◽  
Hacı Mustafa Özdemir
Keyword(s):  
Pain Score ◽  
Mean Value ◽  
Dash Score ◽  
Visual Analogue Pain Score ◽  
Ulnar Styloid ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Plate Technique ◽  
Buttress Plate

Abstract Background Surgical treatment options for symptomatic ulnar styloid base nonunion can be divided into two groups: styloid excision and styloid fixation methods. Styloid fixation is commonly performed using tension band wiring or distal ulna hook plate. However, these methods are more suitable for large styloids than small ones. For this reason, fixation of small styloids still remains a problem. Purpose To present the surgical details and results of patients operated using the buttress plate technique, due to the symptomatic ulnar styloid base nonunion. Patients and Methods In this study, 11 patients who underwent surgery for symptomatic ulnar styloid base nonunion using buttress plate technique were evaluated retrospectively. The patients were evaluated with the help of forearm and wrist range of motion, grip strength, disabilities of the arm, shoulder, and hand (DASH) score and visual analogue pain score. Results The mean follow-up period was 15 months (range: 13–21 months). Union was achieved in 10 patients. At the final follow-up, the forearm supination and pronation active range of motions were significantly higher than those in the preoperative period, the visual analogue pain score mean value was 0.7 (range: 0–5), and the DASH score mean value was 7 (range: 1–32). Conclusion We conclude that good results can be achieved with the buttress plate technique in patients with both large and small fragmented ulnar styloid base nonunions and no distal radioulnar joint instability. Level of Evidence This is a Level IV, therapeutic study.

‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy

2019 ◽  
Vol 44 (9) ◽  
pp. 905-912
Author(s):  
Türker Özkan ◽  
Hasan Utkan Aydin ◽  
Ömer Berköz ◽  
Safiye Özkan ◽  
Erol Kozanoğlu
Keyword(s):  
Brachial Plexus ◽  
Performance Measure ◽  
Occupational Performance ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Canadian Occupational Performance Measure ◽  
Brachial Plexus Birth Palsy ◽  
Activity Performance ◽  
Birth Palsy

We report outcomes of 17 children with brachial plexus birth palsy that underwent extensor carpi ulnaris to brachioradialis and brachioradialis to abductor pollicis longus transfers to correct supination and ulnar deviation deformity. Mean age at the time of surgery was 8.7 years and mean follow-up time was 21 months (8–44). These patients had marked increases in active forearm rotation and Canadian Occupational Performance Measure scores. Activity performance score on the measure increased from 1.1 to 6.7 and satisfaction score increased from 0.8 to 8.7 at final follow-up. We conclude from our patient series that these tendon transfers are effective in correction of the supination and ulnar deviation deformities in brachial plexus birth palsy. Level of evidence: IV

Ulnar head replacement and sigmoid notch resurfacing arthroplasty with minimum 12-month follow-up

2019 ◽  
Vol 44 (9) ◽  
pp. 957-962 ◽  
Author(s):  
Nicholas J. Clark ◽  
Nicholas Munaretto ◽  
Bassem T. Elhassan ◽  
Sanjeev Kakar
Keyword(s):  
Short Term ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Excellent Outcome ◽  
Ulnar Head ◽  
Pain Scores ◽  
Feasible Option ◽  
And Function ◽  
Joint Arthritis

Our study aimed to report the short-term outcomes of patients who underwent partial ulnar head replacement and distal radial ulnar joint interposition arthroplasty. From 2012 to 2016, nine patients underwent this procedure with mean follow-up of 27 months (range 12–55). Seven of the nine patients had previously undergone surgical intervention on the ipsilateral wrist. The procedure resulted in substantial improvements in pain and function. Mayo Wrist Score improved from 37 preoperatively to 73 postoperatively, and six patients achieved a good or excellent outcome. Visual analogue pain scores decreased from 7 preoperatively to 1 postoperatively. Grip improved from 20 kg preoperatively to 30 kg postoperatively. There was no significant change in wrist range of motion. Two patients underwent revision surgery to improve wrist motion. We conclude that over short-term follow-up the procedure provides a feasible option for distal radial ulnar joint arthritis. Level of evidence: IV

Postoperative follow-up time and justification in prospective hand surgery research: a systematic review

2020 ◽  
Vol 45 (9) ◽  
pp. 899-903
Author(s):  
Rachel C. Hooper ◽  
Jacob S. Nasser ◽  
Helen E. Huetteman ◽  
Shale J. Mack ◽  
Kevin C. Chung
Keyword(s):  
Carpal Tunnel Release ◽  
Demographic Data ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Level Of Evidence ◽  
Thumb Carpometacarpal Joint ◽  
Expected Time ◽  
Surgery Research ◽  
Thumb Carpometacarpal

We systematically reviewed prospective studies for five hand procedures to analyse postoperative follow-up time, clinical or radiographic plateau, and whether the authors provide justification for times used. Demographic data, outcomes and mean follow-up were analysed. A total of 188 articles met our inclusion criteria. The mean postoperative follow-up time among these studies were carpal tunnel release, 21 months (range 1.5–111); cubital tunnel release, 27 months (2.5–46); open reduction and internal fixation for the distal radius fracture, 24 months (3–120); thumb carpometacarpal joint arthroplasty, 64 months (8.5–228); and flexor tendon repair, 25 months (3–59). Authors provided justification for follow-up intervals in 10% of these reports. We conclude that most prospective clinical studies in hand surgery do not properly justify follow-up length. Clinically unnecessary follow-up is costly without much benefit. In prospective research, we believe justified postoperative follow-up is essential, based on expected time to detect clinical plateau, capture complications and determine the need for secondary surgery. Level of evidence: III

Cerebrospinal fluid somatostatin in delirium. II Changes at the acute stage and at one year follow-up

1990 ◽  
Vol 20 (3) ◽  
pp. 501-505 ◽  
Author(s):  
Hannu Koponen ◽  
Kari Reinikainen ◽  
Paavo J. Riekkinen
Keyword(s):  
Cerebrospinal Fluid ◽  
Mini Mental State Examination ◽  
Central Nervous System Disease ◽  
Acute Stage ◽  
Common Phenomenon ◽  
System Disease ◽  
The Central Nervous System ◽  
One Year ◽  
State Examination

SynopsisCerebrospinal fluid somatostatin-like immunoreactivity (CSF SLI) was determined for elderly delirious patients during the acute stage and after one-year follow-up. The SLI levels were compared with age-equivalent controls. For the group as a whole, and also when the group was subdivided according to the severity of cognitive decline at the acute stage, type of delirium, or the central nervous system disease, delirious patients showed significant reduction of SLI as compared with the controls. In the follow-up, we observed a further reduction of CSF SLI together with significant correlations in the second and third samples between SLI levels and Mini-Mental State Examination score. Our results suggest a role for somatostatinergic dysfunction in the genesis of some symptoms of delirium. This dysfunction may be a common phenomenon in various forms of delirium and dementia.

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