Sciatic nerve stimulation alleviates neuropathic pain and associated neuroinflammation in the dorsal root ganglia in a rodent model.

BACKGROUND: Satellite glial cells (SGCs) in the dorsal root ganglia (DRG) play a pivotal role in the formation of neuropathic pain (NP). Sciatic nerve stimulation (SNS) neuromodulation was reported to alleviate NP and reduce neuroinflammation. However, the mechanisms underlying SNS in the DRG remain unclear. This study aimed to elucidate the mechanism of electric stimulation in reducing NP, focusing on the DRG. METHODS: L5 nerve root ligation (NRL) NP rat model was studied. Ipsilateral SNS performed 1 day after NRL. Behavioral tests were performed to assess pain phenotypes. NanoString Ncounter technology was used to explore the differentially expressed genes and cellular pathways. Activated SGCs were characterized in vivo and in vitro. The histochemical alterations of SGCs, macrophages, and neurons in DRG were examined in vivo on post-injury day 8. RESULTS: NRL induced NP behaviors including decreased pain threshold and latency on von Frey and Hargreaves tests. We found that following nerve injury, SGCs were hyperactivated, neurotoxic and had increased expression of NP-related ion channels including TRPA1, Cx43, and SGC-neuron gap junctions. Mechanistically, nerve injury induced reciprocal activation of SGCs and M1 macrophages via cytokines including IL-6, CCL3, and TNF-α mediated by the HIF-1α-NF-κB pathways. SNS suppressed SGC hyperactivation, reduced the expression of NP-related ion channels, and induced M2 macrophage polarization, thereby alleviating NP and associated neuroinflammation in the DRG. CONCLUSIONS: NRL induced hyperactivation of SGCs, which had increased expression of NP-related ion channels. Reciprocal activation of SGCs and M1 macrophages surrounding the primary sensory neurons was mediated by the HIF-1α and NF-κB pathways. SNS suppressed SGC hyperactivation and skewed M1 macrophage towards M2. Our findings establish SGC activation as a crucial pathomechanism in the gliopathic alterations in NP, which can be modulated by SNS neuromodulation.

Metacarpophalangeal joint reconstruction using a costal osteochondral graft: A case report.

RATIONALE: The conventional treatment of giant cell tumors is intralesional curettage with local adjuvant therapy. Because hand tumors have a high local recurrence, the primary goal for treating tumors of the hand is to eradicate the lesion. PATIENT CONCERNS: To preserve the metacarpophalangeal (MCP) joint function as well as avoid further recurrence after surgery. DIAGNOSES: The giant cell tumor invades the patient's MCP joint in an index proximal phalanx. INTERVENTIONS: Using computer-aided design and three-dimensional printing techniques, we reformed the original shapes of the MCP joint and its peripheral bone to replica models. The surgeon then performed an en bloc resection and proximal phalanx with MCP joint reconstruction by fabricating the patient's costal osteochondral graft during the operation. OUTCOMES: After 6 months of rehabilitation, the patient's finger functions could pinch and grasp objects naturally. At the 1-year follow-up, the range of motion of the MCP, proximal interphalangeal, and distal interphalangeal joints improved from flexion of 35° to 60°, 75° to 85°, and 60° to 80°, respectively. The hand function achieved the mean performance of non-preferred hands for young females at the postoperative 3-year follow-up. LESSONS: The customized prototyping technique has the potential to replica the original patient's bony graft to reach the goal of minimizing the defects at the donor site and maximizing the function of the reconstructed MCP joint.

Supporting students with disabilities to achieve high potential through occupational therapy services during transition periods / Apoiando estudantes com deficiência durante períodos de transição para atingirem um elevado potencial por meio de serviços de terapia ocupacional

Abstract Introduction Transition periods are integral parts of a person's life span, characterized by phases of life and shifts in activity before adapting to new situations. Objectives This study aims to understand the high potential characteristics of students with disabilities and evaluate the roles of school-based occupational therapists (SBOT) in assisting these students during transition periods. Method This study comprised 196 students and five SBOT. Research instruments included a characteristic checklist for potential learners and an in-depth interview methodology. The checklist, developed from related literature, consisted of three domains: physical and socio-emotional health, self-determination, and communication and academic performance. Students' performance levels were rated by teachers, with high potential characteristics being defined as achieving an average total score ≥2.0, without obtaining a zero in any checklist item. Results Most participants achieved full scores for high potential characteristics in the physical and socio-emotional health domain. Most SBOT provided direct, indirect, and integrated services using various service delivery models that were tailored to different types of disabilities. Conclusion This study provides fundamental information for SBOT and school professionals to foster high-potential characteristics in students with disabilities during transition periods. Suitable services in the domains of physical and socio-emotional health, self-determination, and communication and academic performance can enhance these high-potential characteristics.

Resumo Introdução O período de transição é parte natural da vida de uma pessoa. Pode ser classificado por fases da vida e mudança de atividade antes de entrar em novas situações. Objetivos Explorar características de alto potencial de alunos com deficiência e investigar os serviços de terapeutas ocupacionais escolares (SBOTs) para esses alunos durante os períodos de transição. Método Participaram 196 alunos e 5 SBOTs. Os instrumentos de pesquisa compreenderam o checklist característico dos potenciais aprendizes e uma entrevista em profundidade. A lista de verificação foi desenvolvida pela literatura relacionada e consistia em três domínios, incluindo saúde física e socioemocional, autodeterminação e comunicação e desempenho acadêmico. A pontuação do nível de desempenho dos alunos foi avaliada pelos professores. As características de alto potencial dos estudantes deste estudo significaram a obtenção de pontuação total média igual ou superior a 2,0, não tendo tido nenhum zero em qualquer item avaliado pelo checklist. Resultados A maioria dos participantes atingiu a pontuação completa das características de alto potencial no domínio saúde física e socioemocional. A maioria das SBOTs prestava serviços diretos, indiretos e integrados com base em diversos modelos de prestação de serviços diferenciados para cada tipo de deficiência. Conclusão Este estudo fornece informações fundamentais para SBOTs e profissionais escolares a fim de estimular características de alto potencial em alunos com deficiência em períodos de transição. Serviços adequados nas áreas de saúde física e socioemocional, autodeterminação e comunicação e desempenho acadêmico podem aprimorar características de alto potencial para esses estudantes.

Estimating the Neovascularity of Human Finger Tendon Through High-Frequency Ultrasound Micro-Doppler Imaging.

OBJECTIVE: Neovascularization of injured tendons prolongs the proliferative phase of healing, but prolonged neovascularization may cause improper healing and pain. Currently, ultrasound Doppler imaging is used for measuring the neovascularization of injured tendons (e.g., Achilles tendon). However, the resolution of state-of-the-art clinical ultrasound machines is insufficient for visualizing the neovascularization in finger tendons. In this study, a high-frequency micro-Doppler imaging (HFµDI) based on 40-MHz ultrafast ultrasound imaging was proposed for visualizing the neovascularization in injured finger tendons during multiple rehabilitation phases. METHOD: The vessel visibility was enhanced through a block-wise singular value decomposition filter and several curvilinear structure enhancement strategies, including the bowler-hat transform and Hessian-based vessel enhancement filtering. HFµDI was verified through small animal kidney and spleen imaging because the related vessel structure patterns of mice are well studied. Five patients with finger tendon injuries underwent HFµDI examination at various rehabilitation phases after surgery (weeks 11-56), and finger function evaluations were performed for comparisons. RESULTS: The results of small animal experiments revealed that the proposed HFµDI provides excellent microvasculature imaging performance; the contrast-to-noise ratio of HFµDI was approximately 15 dB higher than that of the conventional singular value decomposition filter, and the minimum detectable vessel size for mouse kidney was 35 µm without the use of contrast agent. In the human study, neovascularization was clearly observed in injured finger tendons during the early phase of healing (weeks 11-21), but it regressed from week 52 to 56. Finger rehabilitation appears to help reduce neovascularization; neovascular density decreased by approximately 1.8%-8.0% in participants after 4 weeks of rehabilitation. CONCLUSION: The experimental results verified the performance of HFµDI for microvasculature imaging and its potential for injured finger tendon evaluations.

Externally applied force helps reduce bowstring effect of flexors in patients with carpal tunnel release surgery.

BACKGROUND: Patients with severe carpal tunnel syndrome (CTS) undergo carpal tunnel release (CTR) surgery to alleviate pressure in the carpal tunnel. However, the subsequent lack of the transverse carpal ligament (TCL) causes the bowstring phenomenon of the flexor tendons and increases the potential incidence of trigger finger. OBJECTIVE: This study aimed to investigate the effects of various compressive forces on the flexor tendon and identify the appropriate force needed to mitigate the bowstring effect of those flexors. DESIGN: Cross-sectional repeated measures comparison. METHOD: Thirteen CTS patients who underwent CTR surgery were asked to flex the middle finger while applying different external compressive forces, just contact, 4N, and 8N force, over the carpal tunnel. Images of the flexor tendon within the carpal tunnel and at the metacarpal phalangeal (MCP) joint were recorded via ultrasound. RESULT: Results show that the compression force limited the volar migration of the flexor tendon under maximal voluntary contraction (MVC) conditions. Entrance angles between the flexor tendon and metacarpal bone also decreased as the external compressive force increased. CONCLUSIONS: Findings of this study may indicate that applying compression force on the carpal tunnel is useful for CTS patients and can inhibit the volar shift of the flexor digitorum superficialis (FDS) tendon after surgery, which may further prevent trigger finger.

Safe Zones for Percutaneous Carpal Tunnel Release.

Carpal tunnel release (CTR) is an effective procedure used in open, endoscopic, or ultrasound-guided methods. The complications are rare but potentially devasting. Most complications come from errors related to intraoperative technique, especially in the minimally invasive approach. An understanding of the "safe zones" is essential to perform percutaneous CTR safely. This article reviews the anatomy of safe zones and the ultrasound-guided CTR (UCTR) techniques in an attempt to prevent intraoperative complications. In strict accordance with the concepts of safe zones, UCTR is an effective and reliable procedure. Substantial experience for ultrasound-guided injection and surgery is required.

Evaluation of Hand Tendon Elastic Properties During Rehabilitation Through High-Frequency Ultrasound Shear Elastography.

Tendon injuries lead to tendon stiffness, which impairs skeletal muscle movement. Most studies have focused on patellar or Achilles tendons by using ultrasound elastography. Only a few studies have measured the stiffness of hand tendons because their thickness is only 1-2 mm, rendering clinical ultrasound elastography unsuitable for mapping hand tendon stiffness. In this study, a high-frequency ultrasound shear elastography (HFUSE) system was proposed to map the shear wave velocity (SWV) of hand flexor tendons. A handheld vibration system that was coaxially mounted with an external vibrator on a high-frequency ultrasound (HFUS) array transducer allowed the operators to scan hand tendons freely. To quantify the performance of HFUSE, six parameters were comprehensively measured from homogeneous, two-sided, and three-sided gelatin phantom experiments: bias, precision, lateral resolution, contrast, contrast-to-noise ratio (CNR), and accuracy. HFUSE demonstrated an excellent resolution of [Formula: see text] to distinguish the local stiffness of thin phantom (thickness: 1.2 mm) without compromising bias, precision, contrast, CNR, and accuracy, which has been noted with previous systems. Human experiments involved four patients with hand tendon injuries who underwent ≥2 months of rehabilitation. Using HFUSE, two-dimensional SWV images of flexor tendons could be clearly mapped for healthy and injured tendons, respectively. The findings demonstrate that HFUSE can be a promising tool for evaluating the elastic properties of the injured hand tendon after surgery and during rehabilitation and thus help monitor progress.

Dynamic Traction Splint as an Alternative Surgical Treatment for Comminuted Intraarticular Fracture of Metacarpophalangeal Joint.

BACKGROUND: Comminuted intraarticular fractures of the metacarpophalangeal joint (MPJ) are difficult to treat. We evaluated the clinical outcomes of using a dynamic traction splint to treat comminuted intraarticular fracture of MPJ. PATIENTS AND METHODS: We conducted a retrospective chart review on patients with comminuted intraarticular fracture of the MPJ treated with a dynamic traction splint at National Cheng Kung University Hospital between March 2014 and February 2018. The surgical procedures consisted of a transverse Kirschner wire insertion and treatment for concomitant injuries. The patients then received staged regular rehabilitation programs under a hand therapists' supervision for 14 weeks. Active range of motion (ROM) of injured digits, Visual Analog Scale score for pain, and return-to-work status were recorded to evaluate functional outcomes. RESULTS: A total of 10 patients were included. All were male patients and aged 8 to 66 years. The most common injury mechanism was motor vehicle accident (70%). The locations of fractures were 1 at the metacarpal head and 9 at the proximal phalangeal bases. Half of the fractures were open. Concomitant injuries were 1 digital nerve severance, 1 extensor tendon rupture, and 3 dorsal skin avulsions. There were no postoperative complications. The active ROM of the MPJ ranged from 40° to 90° with a median ROM of 80°. The Visual Analog Scale score for pain was 0 in 8 patients and 1 in the other 2 patients. All patients returned to their original workplace after rehabilitation. CONCLUSIONS: Dynamic traction splints and postoperative rehabilitation programs could be an alternative treatment for comminuted intraarticular fracture of the MPJ.

Characterization of the extensor digitorum communis tendon using high-frequency ultrasound shear wave elastography.

PURPOSE: Hand tendon injuries caused by various accidents are common in emergency departments. The assessment of tendon properties is crucial for evaluating the effectiveness of therapy or rehabilitation during recovery after hand injuries. Many recent studies have indicated that the shear wave velocity (SWV) of tendons is related to their stiffness. However, measurement of SWV of hand tendon is still a challenge because the small size of tendon and the limitation of existing ultrasound systems for detecting fast SWV. METHODS: We propose a high-frequency ultrasound (HFUS) elastography system using an external vibrator to measure the SWV of the extensor digitorum communis (EDC) tendon. First, animal studies were performed by measuring the SWV and stress of porcine tendons using the proposed HFUS elastography and materials testing systems respectively. In the human experiment, SWVs were measured during hand extension and flexion. The applied stress from a finger during the movements was recorded synchronously by using a load cell. RESULTS: The experimental results reveal that a favorable linear correction (R2 of 0.96) was obtained between tendon SWV and stress in animal studies. In the human (hand) EDC tendon experiments, the SWV increased with the extension and flexion of the hand. The SWV of the EDC tendon was in the range of 20 to 135 m/s as the applied force from the finger of a healthy human increased to 50% maximal voluntary contraction. CONCLUSIONS: All the experimental results show that the proposed HFUS elastography system can be used to characterize the EDC tendon and has potential use for evaluating tendon stiffness during recovery after hand injures.

Inhibition of CD44 induces apoptosis, inflammation, and matrix metalloproteinase expression in tendinopathy.

Apoptosis has emerged as a primary cause of tendinopathy. CD44 signaling pathways exert anti-apoptotic and -inflammatory effects on tumor cells, chondrocytes, and fibroblast-like synoviocytes. The aim of this study was to examine the association among CD44, apoptosis, and inflammation in tendinopathy. Expression of CD44 and apoptotic cell numbers in tendon tissue from patients with long head of biceps (LHB) tendinopathy were determined according to the histological grades of tendinopathy. Primary tenocytes from Achilles tendon of Sprague-Dawley rats 1 week after collagenase injection were cultured with an antagonizing antibody against CD44. Treatment responses were determined by evaluating cell viability and expression of tendon-related proliferation markers, inflammatory mediators, and apoptosis. The expression of CD44 and apoptosis were positively correlated with the severity of tendinopathy in the human LHB tendinopathy. Furthermore, CD44 expression and apoptotic cells were co-stained in tendinopathic tendon. Blocking the CD44 signaling pathways in rat primary tenocytes by OX-50 induced cell apoptosis and the elevated levels of cleaved caspase-3. Furthermore, they had decreased cell viability and expression of collagen type I, type III, tenomodulin, and phosphorylated AKT. In contrast, there were elevated levels of inflammatory mediators, including interleukin (IL)-1ß, IL-6, tumor necrosis factor-α, cyclooxygenase-2, and phosphorylated NF-κB, as well as matrix metalloproteinase (MMP) family members including MMP-1, -3, -9, and -13 in tenocytes upon OX-50 treatment. This study is the first to demonstrate the association of CD44 and apoptosis in tendinopathy. Our data imply that CD44 may play a role in tendinopathy via regulating apoptosis, inflammation, and extracellular matrix homeostasis.

Magnetic Resonance Elastography in the Assessment of Acute Effects of Kinesio Taping on Lumbar Paraspinal Muscles.

BACKGROUND: Kinesio tape (KT) is an elastic therapeutic tape used for treating sports-related injuries and a number of other disorders. To date, the objective evidence to link pathophysiological effects and actual reactions triggered by KT is limited. PURPOSE: To explore the effect of KT on the lumbar paraspinal muscles by magnetic resonance (MR) elastography. STUDY TYPE: Prospective observational study. POPULATION: Sixty-six asymptomatic volunteers with 31 women and 35 men. FIELD STRENGTH/SEQUENCE: 3.0T MRI and elastography with vibration frequency of 120 Hz. ASSESSMENT: The 5-cm-width KT with full tension was placed on a single side of the lumbar paraspinal muscle. The taping side and adhering direction were randomly decided. Two rectangular regions of interest (ROIs) of 5- and 2.5-cm-width were positioned at the bilateral paraspinal regions from the L2 to L4 level on the confidence map of MR elastography before and after KT taping. The mean shear stiffness values of the ROIs at the superficial, middle, and deep depths were recorded; then the differences between the taping and reference sides were calculated. STATISTICAL TESTS: Paired t-test and Pearson correlations were used to evaluate the stiffness changes after KT application and intraoperator errors of the stiffness measures on the reference side, respectively. RESULTS: A significant decrease in the muscle stiffness value between taping and reference sides (-0.71 kPa ± 0.60 with KT and -0.25 kPa ± 0.78 without KT, P < 0.0001 for 5-cm ROI; -0.67 kPa ± 1.12 with KT and -0.16 kPa ± 1.17 without KT, P = 0.0004 for 2.5-cm ROI) was found in the superficial depth, but no significant differences in the middle and deep depths (P = 0.25 and P = 0.79 for 5-cm ROI; P = 0.09 and P = 0.67 for 2.5-cm ROI, respectively). There were no significant differences of muscle stiffness differences between gender (P = 0.11 for superficial, P = 0.37 for middle, P = 0.78 for deep) and taping direction (P = 0.18 for superficial, P = 0.13 for middle, P = 0.15 for deep). DATA CONCLUSION: Our results demonstrate that KT can reduce the MR elastography-derived shear stiffness in the superficial depth of paraspinal muscles. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1039-1045.

Medical claims-based case-control study of temporal relationship between clinical visits for hand syndromes and subsequent diabetes diagnosis: implications for identifying patients with undiagnosed type 2 diabetes mellitus.

OBJECTIVES: To investigate whether a temporal relationship is present between clinical visits for diabetes-related hand syndromes (DHSs) and subsequent type 2 diabetes mellitus (T2DM) diagnosis and, accordingly, whether DHSs can be used for identifying patients with undiagnosed T2DM. DESIGN: This study had a case-control design nested within a cohort of 1 million people from the general population, which was followed from 2005 to 2010. The odds of prior clinical visits for DHSs, namely carpal tunnel syndrome (CTS), flexor tenosynovitis, limited joint mobility and Dupuytren's disease, were estimated for cases and controls. We used a conditional logistic regression model to estimate the OR and 95% CI of T2DM in association with a history of DHSs. The validity and predictive value of using the history of DHSs in predicting T2DM diagnosis were calculated. SETTING: Taiwan National Health Insurance medical claims. PARTICIPANTS: We identified 33 571 patients receiving a new diagnosis of T2DM (cases) between 2005 and 2010. Each T2DM case was matched with 5 controls who had the same sex and birth year and were alive on the date of T2DM diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was T2DM diagnosis. RESULTS: The OR of T2DM in association with prior clinical visits was significantly increased for overall DHS and CTS, being 1.15 (95% CI 1.10 to 1.20) and 1.22 (95% CI 1.16 to 1.29), respectively. Moreover, 11% of patients with T2DM made clinical visits for CTS within 3 months prior to T2DM diagnosis. The history of DHSs had low sensitivity (<0.1% to 5.2%) and a positive predictive value (9.9% to 11.7%) in predicting T2DM. CONCLUSIONS: Despite the unsatisfactory validity and performance of DHSs as a clinical tool for detecting patients with undiagnosed T2DM, this study provided evidence that clinical visits for DHSs, particularly for CTS, can be a sign of undiagnosed T2DM.

A Novel Adhesion Index for Verifying the Extent of Adhesion for the Extensor Digitorum Communis in Patients with Metacarpal Fractures.

This study aims to determine if the relative displacement between the extensor digitorum communis (EDC) tendon and its surrounding tissues can be used as an adhesion index (AI) for assessing adhesion in metacarpal fractures by comparing two clinical measures, namely single-digit-force and extensor lag (i.e., the difference between passive extension and full active extension). The Fisher-Tippett block-matching method and a Kalman-filter algorithm were used to determine the relative displacements in 39 healthy subjects and 8 patients with metacarpal fractures. A goniometer was used to measure the extensor lag, and a force sensor was used to measure the single-digit-force. Measurements were obtained twice for each patient to evaluate the performance of the AI in assessing the progress of rehabilitation. The Pearson correlation coefficient was calculated to quantify the various correlations between the AI, extensor lag, and single-digit-force. The results showed strong correlations between the AI and the extensor lag, the AI and the single-digit-force, and the extensor lag and the single-digit-force (r = 0.718, -0.849, and -0.741; P = 0.002, P < 0.001, and P = 0.001, respectively). The AI in the patients gradually decreased after continuous rehabilitation, but remained higher than that of healthy participants.

Intratendinous Injection of Hyaluronate Induces Acute Inflammation: A Possible Detrimental Effect.

Hyaluronate (HA) is therapeutic for tendinopathy, but an intratendinous HA injection is usually painful; thus, it is not suggested for clinical practice. However, there are no studies on the histopathological changes after an intratendinous HA injection. We hypothesized that an HA injection would induce more-acute inflammation than that induced by an injection of phosphate buffered saline (PBS). Thirty-two rats were randomly divided into 4 post-injection groups (n = 8): day 3, day 7, day 28, and day 42. HA (0.1 c.c.) was, using ultrasound guidance, intratendinously injected into each left Achilles tendon, and PBS (0.1 c.c.) into each right one. For each group, both Achilles tendons of 3 control-group rats (n = 6) were given only needle punctures. The histopathological score, ED1+ and ED2+ macrophage densities, interleukin (IL)-1ß expression, and the extent of neovascularization were evaluated. In both experimental groups, each Achilles tendon showed significant histopathological changes and inflammation compatible with acute tendon injury until day 42. The HA group showed more-significant (p < 0.05) histopathological changes, higher ED1+ and ED2+ macrophage density, and higher IL-1ß expression than did the PBS group. The neovascularization area was also significantly (p < 0.05) greater in the HA group, except on day 3. Both HA and PBS induced acute tendon injury and inflammation, sequential histopathological changes, ED1+ and ED2+ macrophage accumulation, IL-1ß expression, and neovascularization until post-injection day 42.HA induced more-severe injury than did PBS. Therefore, an intratendinous HA injection should be avoided.

Risk of Hand Syndromes in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan.

The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications.The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders.Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48-1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15-3.24 and 2.99, 95% CI = 2.55-3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86-1.95) and DD (HR = 1.83, 95% CI = 1.39-2.39) than with CTS (HR = 1.31, 95% CI = 1.28-1.34) and LJM (HR = 1.24, 95% CI = 1.13-1.35).Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians.

Ultrasonographically Guided Percutaneous Carpal Tunnel Release: Early Clinical Experiences and Outcomes.

PURPOSE: To present the technique and results of ultrasonographically guided percutaneous carpal tunnel release (PCTR) in a consecutive series of patients with carpal tunnel syndrome (CTS). METHODS: We used previously defined landmarks with the "safe zones," localization, estimated size, and extent of the transverse carpal ligament (TCL) for this prospective clinical study of 91 consecutive cases of carpal tunnel release treated with this technique. The follow-up consisted of 4 time points (1 week and 2, 6, and 12 months) and a final evaluation at an average of 22.5 months. RESULTS: The sensory disturbances disappeared in 76.8%, 93.4%, 100%, and 100% of the patients at 1 week and 2, 6, and 12 months postoperatively, respectively. Moderate pain was experienced in 24.2% of patients within 1 week, in 6.6% of patients within 2 months, and in 1.1% of patients within 12 months after the operation. In the final evaluation, 2 hands were graded as unsatisfactory: one hand had moderate wrist pain without sensory disturbance, and one hand had a recurrence 14 months after the operation. There were no intraoperative or postoperative complications. CONCLUSIONS: Ultrasonographically assisted PCTR is a safe and effective procedure, but it is technically demanding and requires substantial training to be proficient in its use. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Inflammation is present in de Quervain Disease--correlation study between biochemical and histopathological evaluation.

BACKGROUND: De Quervain disease is a stenosing condition of the sheath of the abductor pollicis longus and extensor pollicis brevis tendons at the radial styloid process. Previous studies consistently reported that the pathological change of this condition is thought to be primarily an extensor retinaculum thickened by fibrosis and angiogenesis instead of inflammation. Contradictorily, the conservative treatment for de Quervain disease is anti-inflammatory medication. The inflammatory response may be involved in this disease; however, there is no present study directly evidencing whether the inflammatory responses exist in de Quervain disease or not. The histopathology of de Quervain disease is yet to be elucidated clearly. PURPOSE: To grade all specimens in the different stages and characterize specific inflammatory cell and factors to examine whether inflammatory response is involved in de Quervain disease. METHODS: Retinaculum samples were collected from 13 patients with de Quervain disease after surgery. The specimens were evaluated histologically by collagen structure grading and immunohistochemically by quantifying the presence of neutrophil elastase, macrophages, cyclooxygenase, and vascular endothelium. RESULTS: Neutrophil elastase and cyclooxygenase occur in the de Quervain disease retinaculum and increased with the grade of collagen structure. After angiogenesis, macrophage infiltration occurs in the grade II matrix worse than grade III matrix. CONCLUSIONS: Inflammation is present in de Quervain disease. This study provides direct evidence for inflammatory cell and infiltration factors and offer valuable clues for specific pharmacological therapies for de Quervain disease.

Finger movement function after ultrasound-guided percutaneous pulley release for trigger finger: effects of postoperative rehabilitation.

OBJECTIVE: To develop and test a postoperative rehabilitation protocol for use by individuals with trigger finger undergoing ultrasound-guided percutaneous pulley release. DESIGN: Nonrandomized controlled trial. SETTING: Hospital and local community. PARTICIPANTS: Individuals suffering from trigger finger with joint contracture (N=21) were recruited and grouped into an intervention group (n=9) or a control group (n=12). INTERVENTIONS: All the participants underwent the same surgical procedure performed by the same surgeon. A 4-week postoperative rehabilitation program was designed based on the wound healing process. The intervention group received postoperative rehabilitation after the surgery, whereas the control group received no treatment after the surgery. MAIN OUTCOME MEASURES: The finger movement functions were quantitatively evaluated before and 1 month after the surgery using a 3-dimensional motion capture system. The fingertip workspace and joint range of motion (ROM) were evaluated while the participant was performing a sequential 5-posture movement, including finger extension, intrinsic plus, straight fist, full fist, and hook fist. RESULTS: The intervention group demonstrated significantly more improvements than the control group in the fingertip workspace (49% vs 17%), ROM of the distal interphalangeal (DIP) joint (16% vs 4%), ROM of the proximal interphalangeal (PIP) joint (21% vs 5%), and total active ROM (17% vs 5%). CONCLUSIONS: This pilot study evaluated a postoperative rehabilitation protocol for trigger finger and demonstrated its effects on various finger functions. Participants who underwent the rehabilitation program had significantly more improvements in the fingertip workspace, ROM of the DIP and PIP joints, and total active ROM.

Impact of distal median neuropathy on handwriting performance for patients with carpal tunnel syndrome in office and administrative support occupations.

PURPOSE: This study investigates the handwriting performance of patients with carpal tunnel syndrome (CTS) and healthy controls in office and administrative support occupations, adopting both biomechanical and functional perspectives. This work also explores how surgical intervention altered the performance of the CTS patients. METHODS: Fourteen CTS patients and 14 control subjects were recruited to complete a self-reported survey and participate in sensory tests, hand strength, dexterity and handwriting tasks using a custom force acquisition pen along with motion capture technology. Based on the results of these, the sensory measurements, along with functional and biomechanical parameters, were used to determine the differences between the groups and also reveal any improvements that occurred in the CTS group after surgical intervention. RESULTS: The CTS patients showed significantly poorer hand sensibility and dexterity than the controls, as well as excessive force exertion of the digits and pen tip, and less efficient force adjustment ability during handwriting. After surgery and sensory recovery, the hand dexterity and pen tip force of the CTS patients improved significantly. The force adjustment abilities of the digits also increased, but these changes were not statistically significant. CONCLUSIONS: This study provides the objective measurements and novel apparatus that can be used to determine impairments in the handwriting abilities of office or administrative workers with CTS. The results can also help clinicians or patients to better understand the sensory-related deficits in sensorimotor control of the hand related to CTS, and thus develop and implement more suitable training or adaptive protocols.

Is progressive early digit mobilization intervention beneficial for patients with external fixation of distal radius fracture? A pilot randomized controlled trial.

OBJECTIVE: To investigate whether progressive early digit mobilization resulted in better outcomes for hand stiffness and related functional results, as well as the effects on the bone healing process. DESIGN: Prospective, pilot randomized controlled trial. SETTING: A university hospital in southern Taiwan. PARTICIPANTS: Twenty-two patients with distal radius fracture randomized into two groups: early digit mobilization or control. INTERVENTIONS: The intervention group received 45 minutes per treatment session and three sessions per week until the external fixator was removed 6 weeks after fracture. The control group received usual home programmes. After removing fixators, both groups received regular rehabilitation programmes until 12 weeks after surgery. MAIN MEASURES: Hand strength, dexterity and functional outcomes were obtained using a dynamometer, Purdue pegboard and self-report assessment, respectively, and X-rays of the distal radius were taken to reveal bone healing 1, 3, 6 and 12 weeks after surgery. A motion tracking system measured various kinematic parameters. RESULTS: The recovery rates between the groups showed statistically significant differences in both thumb workspace (81.55% vs. 69.54%, P = 0.04) and finger workspace (89.22% vs. 59.97%, P = 0.03) 12 weeks after injury. However, no statistical differences were found in finger dexterity, strength and self-reported outcomes. The radiographic assessment showed no significant differences between the groups for radial inclination, radial height and volar tilt throughout the examinations. CONCLUSIONS: The findings suggest that early rehabilitative intervention for digits is applicable for distal radius fracture treatment, and does not produce additional bone deformities.