The Optimal Position for Arthrodesis of the Proximal Interphalangeal Joints of the Border Digits.

PURPOSE: This study aimed to determine the functional characteristics of various arthrodesis angles of the proximal interphalangeal (PIP) joints of the border fingers. METHODS: The dominant hands of 48 volunteers were tested using custom orthoses to simulate PIP joint arthrodesis. For the index finger (IF), orthoses were made in 25°, 40°, and 55° of flexion (IF25, IF40, and IF55). For the little finger (LF), orthoses were made in 30°, 55°, and 70° of flexion (LF30, LF55, and LF70). Twenty-three volunteers performed grip and pinch (key, tripod, and pulp) strength testing with and without simulated arthrodeses and 25 volunteers performed the Jebsen Hand Function Test (JHFT) with and without simulated arthrodeses. Simulated conditions of arthrodesis were compared with the unrestricted state and with each other within the same finger. RESULTS: For grip and pinch strength, there were no significant differences between simulated arthrodesis angles. Compared with baseline, grip was significantly weaker for all 6 simulated arthrodesis angles. Pinch was tested with simulated IF arthrodesis only; key pinch was significantly weaker for all tested angles and tripod pinch for IF25 and IF40. For JHFT, the 3 experimental angles for the index or ring finger did not show any statistically significant differences for any subtest. Volunteers were slower at completion times for all simulated arthrodesis angles compared to baseline times. This was significant in 5 of 7 tasks for IF25, 3 of 7 tasks for IF40, and 4 of 7 tasks for IF55. Index finger angle of flexion of 40° was significantly faster than IF55 for writing and IF25 for lifting large, light objects. For the LF, LF30 was significantly slower than baseline for 6 of 7 tasks, LF55 for 3 of 7 tasks, and LF70 for 5 of 7 tasks. Index finger angle of flexion of 55° was significantly faster than LF70 for simulated feeding and IF30 for lifting large, heavy objects. CONCLUSIONS: No border digit PIP joint arthrodesis angle was superior for grip and pinch strength. Based on JHFT, IF40 and LF55 might be preferred arthrodesis angles. CLINICAL RELEVANCE: Intermediate arthrodesis angles may provide the best function for patients undergoing PIP joint arthrodesis of the IF and LF.

Physiological Nocturnal Hand Swelling: A Prospective Evaluation of Healthy Volunteers.

PURPOSE: The goal of this study was to quantify the variation in daily volume that is expected in the normal hand. Our hypothesis is that hand swelling occurs overnight. METHODS: Hand volume measurements of 36 healthy volunteers with no hand pathology were taken daily at 8 am, 2 pm, and 8 pm over a 3-day period. Participants were blinded to the objective of the study. Statistical analysis was performed to determine if any of the time points or patient demographics were associated with an increased change in hand volume. RESULTS: Thirty-six healthy volunteers with mean age of 40.9 years and mean body mass index of 24.2 kg/m2 were enrolled. Twenty-one volunteers were men and 15 were women. Three of the volunteers were left-handed. The key finding from this study was that the change in hand volume overnight (8 pm-8 am) is significantly different than the change in hand volume from 8 am to 2 pm and from 2 pm to 8 pm. Although there was a significant reduction in hand volume from 8 am to 2 pm, the further reduction in hand volume from 2 pm to 8 pm was not significant after correcting for the number of post hoc comparisons. In addition, demographic variables such as age, body mass index, and sex did not influence changes in hand volume. CONCLUSIONS: Physiological hand swelling occurs overnight in individuals without active or prior hand pathology. Hand volume then decreases over the course of the day in these same individuals. CLINICAL RELEVANCE: By investigating the changes in hand volume that occur overnight and throughout the day, we gain a better understanding of the temporal relationship between hand swelling and symptoms of chronic hand disease.

Community Science as Resistance to Neoliberal Scientific Praxis.

Background: Flint is a site of resistance to neoliberalism specifically because of the actions of Flint residents. The impacts of this organizing are due, in part, to sustained efforts to reimagine how communities can contribute to scientific knowledge production. We argue that Flint residents' efforts to advance a community-driven research (CDR) agenda represent an important and successful resistance to neoliberal scientific regulatory practices. Methods: We present Flint as a case study in CDR as a form of resistance. This article uses participatory observation within community-based research and draws from the personal experiences of the research team as long-term and lifelong residents of Flint who were actively involved in different aspects of community mobilizing during the water crisis. Case Study: We highlight Flint's rich and sustained community-based participatory research history, resident-led data collection efforts to assess the environmental and health conditions, a resident-led effort to tell the story of the water crisis from the residents' perspective, and recent efforts to develop and advance a CDR model. Discussion: Community-led research efforts in Flint follow Leitner et al.'s typology of contesting neoliberalism through opting in to neoliberal science to advance community needs, collecting data to support direct opposition through protest and mobilization, creating alternative knowledge frames, and using CDR to disengage from the traditional scientific model. Conclusions: Through CDR, Flint residents work in direct resistance to the tacit integration of neoliberal values into science and alternatively advance community organizing as a key aspect of science toward environmental justice.

Effectiveness of Quickcast Versus Custom-Fabricated Thermoplastic Orthosis Immobilization for the Treatment of Mallet Fingers: A Randomized Clinical Trial.

BACKGROUND: Mallet finger is a common injury involving a detachment of the terminal extensor tendon from the distal phalanx. This injury is usually treated with immobilization in a cast or splint. The purpose of this study is to compare outcomes of mallet fingers treated with either a cast (Quickcast) or a traditional thermoplastic custom-fabricated orthosis. METHODS: Our study was a prospective, assessor-blinded, single-center randomized clinical trial of 58 consecutive patients with the diagnosis of bony or soft tissue mallet finger treated with immobilization. Patients were randomized to either an orfilight thermoplastic custom-fabricated orthosis or a Quickcast orthosis. Patients were evaluated at 3, 6, and 10 weeks for bony and 4, 8, and 12 weeks for soft tissue mallets. Skin complications, pain with orthosis, compliance, need for surgical intervention, and extensor lag were compared between the 2 groups. RESULTS: Both bony and soft tissue mallet finger patients experienced significantly less skin complications (33% vs 64%) and pain (11.2 vs 21.6) when using Quickcast versus an orfilight thermoplastic custom-fabricated orthosis. The soft tissue mallet group revealed a greater difference in pain, favoring Quickcast (6.2 vs 22). No significant difference in final extensor droop or need for secondary surgery was found between the 2 groups. CONCLUSIONS: Quickcast immobilization for the treatment of mallet finger demonstrated fewer skin complications and less pain compared with orfilight custom-fabricated splints.

Conventional vs 3-Dimensional Printed Cast Wear Comfort.

Background: The objective of this study was to determine the functionality of 3-dimensional (3D) printed orthoses for upper extremity immobilization compared with conventional immobilization. Methods: Twelve healthy volunteers were fitted with a 3D custom printed short arm cast and a short arm fiberglass cast in separate sessions. The Jebsen Hand Function Test (JHFT) was used to test function and dexterity in each cast. All volunteers completed a modified version of the Patient-Rated Wrist Evaluation (PRWE). Skin complications were recorded. Results: There were no significant differences during the JHFT between casts, although one-third of the participants in the 3D cast could perform the tasks in a normal time, which they could not in the fiberglass cast. The average PRWE function score was lower in the 3D cast group than in the fiberglass group (45.5 vs. 80.8). Minor skin irritation was noted in 42% of patients in the fiberglass cast group compared with only 1 patient (8%) in the 3D cast group. One patient in the fiberglass group required a cast change due to inappropriate fit. Conclusions: Both casting techniques demonstrate similar objective function based on the JHFT. Patient satisfaction, comfort, and perceived function are superior in the 3D printed casts.

A large-scale study of the ultrawideband microwave dielectric properties of normal breast tissue obtained from reduction surgeries.

The efficacy of emerging microwave breast cancer detection and treatment techniques will depend, in part, on the dielectric properties of normal breast tissue. However, knowledge of these properties at microwave frequencies has been limited due to gaps and discrepancies in previously reported small-scale studies. To address these issues, we experimentally characterized the wideband microwave-frequency dielectric properties of a large number of normal breast tissue samples obtained from breast reduction surgeries at the University of Wisconsin and University of Calgary hospitals. The dielectric spectroscopy measurements were conducted from 0.5 to 20 GHz using a precision open-ended coaxial probe. The tissue composition within the probe's sensing region was quantified in terms of percentages of adipose, fibroconnective and glandular tissues. We fit a one-pole Cole-Cole model to the complex permittivity data set obtained for each sample and determined median Cole-Cole parameters for three groups of normal breast tissues, categorized by adipose tissue content (0-30%, 31-84% and 85-100%). Our analysis of the dielectric properties data for 354 tissue samples reveals that there is a large variation in the dielectric properties of normal breast tissue due to substantial tissue heterogeneity. We observed no statistically significant difference between the within-patient and between-patient variability in the dielectric properties.

A large-scale study of the ultrawideband microwave dielectric properties of normal, benign and malignant breast tissues obtained from cancer surgeries.

The development of microwave breast cancer detection and treatment techniques has been driven by reports of substantial contrast in the dielectric properties of malignant and normal breast tissues. However, definitive knowledge of the dielectric properties of normal and diseased breast tissues at microwave frequencies has been limited by gaps and discrepancies across previously published studies. To address these issues, we conducted a large-scale study to experimentally determine the ultrawideband microwave dielectric properties of a variety of normal, malignant and benign breast tissues, measured from 0.5 to 20 GHz using a precision open-ended coaxial probe. Previously, we reported the dielectric properties of normal breast tissue samples obtained from reduction surgeries. Here, we report the dielectric properties of normal (adipose, glandular and fibroconnective), malignant (invasive and non-invasive ductal and lobular carcinomas) and benign (fibroadenomas and cysts) breast tissue samples obtained from cancer surgeries. We fit a one-pole Cole-Cole model to the complex permittivity data set of each characterized sample. Our analyses show that the contrast in the microwave-frequency dielectric properties between malignant and normal adipose-dominated tissues in the breast is considerable, as large as 10:1, while the contrast in the microwave-frequency dielectric properties between malignant and normal glandular/fibroconnective tissues in the breast is no more than about 10%.

Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study.

Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient's functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach.