Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture.

BACKGROUND: The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures. PURPOSE: The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs). STUDY DESIGN: Prospective cohort study METHODS: For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire. RESULTS: The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance. CONCLUSIONS: In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group.

Increased expression of macrophages and inflammatory cytokines at tendon origin in patients with chronic lateral epicondylitis.

BACKGROUND: The success of anti-inflammatory medications and corticosteroid injections in controlling chronic lateral epicondylitis symptoms suggests an underlying inflammatory pathology that is also causative of the pain experienced by patients; however, evidence regarding inflammatory mediators and cells remains inconclusive. METHODS: We conducted a case-control study that included a total of 24 participants (10 patients and 14 controls). Extensor carpi radialis brevis tendon samples were obtained from patients, and flexor carpi radialis tendon samples were obtained from control subjects. We then performed immunohistochemical assessment to determine the expression levels of neuropeptides (substance P and calcitonin gene-related peptide), glutamate receptors (N-methyl-d-aspartate receptor type 1 and metabotropic glutamate receptor 5), inflammatory cytokines (interleukin 1α and tumor necrosis factor α), and inflammatory cells (M1 macrophages [CD68], M2 macrophages [CD163 and CD206], T-lymphocytes [CD3], and B-lymphocytes [CD20]). RESULTS: Patients' sampled extensor carpi radialis brevis tendons showed significantly elevated expression levels of neuropeptides, glutamate receptors, and inflammatory cytokines, along with a number of macrophages, compared with controls (P < .001 or P < .0001); however, there were no differences in the number of T- and B-lymphocytes between the 2 groups. CONCLUSION: The findings of this study showed that inflammation is involved in the pathology of chronic lateral epicondylitis.

The Association Between Smartphone Addiction/Overuse With Hand and Wrist Musculoskeletal Complaints, Saudi Arabia.

Introduction Smartphones have integrated seamlessly into our daily lives in various aspects. When a smartphone is used frequently for communication or internet access, it becomes addictive, which increases the risk of musculoskeletal problems in the hand, wrist, and thumb. Aim This research aimed to examine if there is a connection between excessive smartphone use and discomfort in the thumb and wrist. Subject and methods This cross-sectional study was conducted among the general population of Saudi Arabia. A self-administered questionnaire translated into Arabic was distributed among the targeted population using an online survey. The questionnaire includes three sections, including socio-demographic data (e.g., age, gender, nationality, etc.), assessment of smartphone addiction by using the smartphone addiction scale short-version (SAS-SV), and assessment of wrist/hand pain using the patient-rated wrist and hand evaluation (PRWHE). Results Of the 3057 recruited participants, 1938 (63.4%) were females, and 3025 (99%) were aged between 18 and 65 years old. Perceived pain in the wrist or hand due to excessive usage of a smartphone was reported by 1728 (56.5%) of respondents. The overall mean SAS-SV score was 24.4 (SD 7.47) out of 50 points. The prevalence of smartphone addiction among the general population was 874 (28.6%). Increased SAS-SV and PRWHE scores were associated with respondents living outside Eastern region and using phones for 10 hours or more daily. Conclusion The prevalence of smartphone addiction in this study was 874 (28.6%), directly associated with wrist and hand pains. Musculoskeletal complaints due to smartphone addiction were more prevalent among respondents living outside Eastern Region who spent more time using their phones. A longitudinal study is required to establish the link between smartphone addiction and musculoskeletal complaints among the general population.

Prevalence, Patterns, and Risk Factors of Work-Related Musculoskeletal Diseases Among Teachers in the Eastern Province, Saudi Arabia: A Community-Based Retrospective Cross-Sectional Survey.

Background and objective Work-related musculoskeletal diseases (WMSDs) are one of the most common occupational health concerns among teachers. They refer to a variety of degenerative and inflammatory disorders that can be triggered by the work environment of the people affected. Teachers' health is substantially significant as it impacts their productivity at work. The aim of this study was to determine the prevalence, patterns, implications, and risk factors of WMSDs among teachers in the Eastern Province of Saudi Arabia. Methods This study involved a survey based on a cross-sectional questionnaire that was distributed to 404 random school teachers located in the Eastern province of Saudi Arabia. Information such as sociodemographic characteristics, workplace characteristics, characteristics of WMSDs experienced, associated factors, and impact of the symptoms experienced was collected. Questions related to symptoms were obtained from the Nordic Musculoskeletal Questionnaire and Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). The collected data were then analyzed using the SPSS Statistics version 23.0 (IBM Corp., Armonk, NY). Results Among the participants, back pain, shoulder pain, and knee pain were the most reported symptoms of WMSDs in the past 12 months, while elbow pain was the least experienced; 41.1% had pain, discomfort, or numbness that prevented them from performing regular daily activities. The regression analysis revealed a relationship between moderate to severe pain and a pain duration of more than 12 months (p=0.001). Additionally, those who were able to perform lighter work and were not having depression had a low probability of pain persistence and were able to carry out their usual work while experiencing pain (p=0.002). Conclusions In the Eastern province of Saudi Arabia, WMSDs were commonly reported by school teachers. The prevalence of WMSDs among teachers was 41.1%. The pain was described as disabling and causing a negative impact on performance. The most common locations of symptoms were the back, shoulder, and knees. Risk factors for severe pain were female gender, sleeping for six to seven hours, and pain located in the neck shoulder, elbow, hand, thigh/hips, back, knees, and ankles. Furthermore, severe pain was associated with pain duration of more than 12 months, affecting sleep, causing anxiety, and mild depression. The impact of severe pain seriously affected the daily activities of teachers.

Reoperation after primary operation for pre-axial polydactyly of the hand: A 12-year experience at a single institute.

BACKGROUND: This study aimed to evaluate and describe the rate, reasons, and detailed procedures of reoperations for pre-axial polydactyly of the hand at our institute conducted within 12 years. METHODS: We retrospectively reviewed the medical records and radiographs of 268 patients (292 digits) with pre-axial polydactyly of the hand, who were treated surgically at our institute from November 2006 to May 2018 and followed up for >12 months. RESULTS: Fifty-two thumbs of 47 patients underwent reoperations, yielding a 17.8% reoperation rate. According to the initial deformity type, the highest reoperation rate was observed in the cases classified under modified Wassel type VIIA (60.9%, 14/23 thumbs), followed by those under type VIIB (44.4%, 8/18 thumbs). Scheduled reoperations were performed in seven type VIIA and four type VIIB cases with a triphalangeal thumb and eight with triangular epiphysis of the distal phalanx. Unexpected reoperations were conducted in 33 cases, 31 (93.9%) of which had deviated thumbs. Various surgical treatments, including corrective osteotomy, collateral ligament plication, and flexor pollicis longus tendon relocation, were performed to correct deviations. A total of 23 cases (74.2% of 31 thumbs) received a corrective osteotomy at the second or third operation. CONCLUSIONS: The reoperation rate after primary operation for pre-axial polydactyly of the hand was 17.8%. It was higher in the cases initially classified under modified Wassel type VII; however, a considerable number of cases received scheduled reoperations. A deviated thumb was the most common cause of unexpected reoperation, and corrective osteotomy was the most commonly performed procedure. The rate and details of reoperation should be routinely mentioned for preoperative planning and patient education in pre-axial polydactyly. LEVEL OF EVIDENCE: Therapeutic level IV.

Polydactyly of the thumb: a modification of the Wassel-Flatt classification.

Although the Wassel-Flatt classification system has been widely used for radial polydactyly, it has some limitations. We modified the classification system by introducing the hypoplastic types and refining the definition of triphalangeal thumb without changing the main structure of the original classification system. A total of 200 consecutive duplicated thumbs of 183 patients treated surgically from June 2016 to June 2018 were included. We evaluated intra-observer and inter-observer reliability using the kappa coefficient in the modified and original Wassel-Flatt classification systems (three examiners evaluated each case twice, with an interval of 4 weeks). We also evaluated the surgical methods according to the types of deformity in the modified and original Wassel-Flatt classification systems. The modified Wassel-Flatt classification system had good inter-observer reliability and provides useful information for determining the surgical plan according to the types of radial polydactyly.Level of evidence: IV.

Quantitative bone single-photon emission CT/CT parameters reflect pain and functional status of symptomatic basal joint arthritis of the thumb.

AIMS: The aim of this study was to assess arthritis of the basal joint of the thumb quantitatively using bone single-photon emission CT/CT (SPECT/CT) and evaluate its relationship with patients' pain and function. METHODS: We retrospectively reviewed 30 patients (53 hands) with symptomatic basal joint arthritis of the thumb between April 2019 and March 2020. Visual analogue scale (VAS) scores for pain, grip strength, and pinch power of both hands and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores were recorded for all patients. Basal joint arthritis was classified according to the modified Eaton-Glickel stage using routine radiographs and the CT scans of SPECT/CT, respectively. The maximum standardized uptake value (SUVmax) from SPECT/CT was measured in the four peritrapezial joints and the highest uptake was used for analysis. RESULTS: According to Eaton-Glickel classification, 11, 17, 17, and eight hands were stage 0 to I, II, III, and IV, respectively. The interobserver reliability for determining the stage of arthritis was moderate for radiographs (k = 0.41) and substantial for CT scans (k = 0.67). In a binary categorical analysis using SUVmax, pain (p < 0.001) and PRWHE scores (p = 0.004) were significantly higher in hands with higher SUVmax. Using multivariate linear regression to estimate the pain VAS, only SUVmax (B 0.172 (95% confidence interval (CI) 0.065 to 0.279; p = 0.002) showed a significant association. Estimating the variation of PRWHE scores using the same model, only SUVmax (B 1.378 (95% CI, 0.082 to 2.674); p = 0.038) showed a significant association. CONCLUSION: The CT scans of SPECT/CT provided better interobserver reliability than routine radiographs for evaluating the severity of arthritis. A higher SUVmax in SPECT/CT was associated with more pain and functional disabilities of basal joint arthritis of the thumb. This approach could be used to complement radiographs for the evaluation of patients with this condition. Cite this article: Bone Joint J 2021;103-B(8):1380-1385.