Congenital thumb anomalies and the consequences for daily life: patients' long-term experience after corrective surgery. A qualitative study.

PURPOSE: The aim of the study was to explore patients' long-term experience of a congenital hand problem, and the consequences for daily life. METHOD: Fifteen participants with a median age 24 years (17-55 years), born with thumb hypoplasia/aplasia or thumb duplication were interviewed using a semi-structured interview guide. The interviews were subjected to qualitative content analysis. RESULTS: Although the mobility and strength in the thumb/hand(s) varied within the group, hand function was generally described as good. Compensatory strategies were used to overcome practical obstacles. The emotional reactions to being visibly different from peers in early life varied from total acceptance and a sense of pride in being special, to deep distress and social withdrawal. Support from parents, teachers and others was important in facing emotional challenges and practical consequences. CONCLUSION: The present study highlights the importance of healthcare professionals addressing appearance-related concerns which may have long-term emotional and social consequences for patients born with a thumb anomaly. Implications for Rehabilitation Appearance-related concerns and need for emotional support should be fully considered throughout the rehabilitation process to prevent distress and social withdrawal. Effective problem-solving strategies, such as compensation, change in occupational performance and support from others may reduce activity limitations and participation restriction.

Cut-off value for self-reported abnormal cold sensitivity and predictors for abnormality and severity in hand injuries.

Our aim was to identify a cut-off value for self-reported, abnormal cold sensitivity and to identify cold sensitivity predictors after hand injuries. The Cold Intolerance Symptom Severity (CISS) questionnaire and a VAS question concerning discomfort on exposure to cold were investigated in 94 normal people and 88 patients. A CISS score >50 was defined as abnormal cold sensitivity. Multiple injured digits, an increased number of injured vessels, complete nerve injury and replantation were variables associated with high VAS scores. Factors linked to both abnormality and worse CISS or VAS scores were: the presence of bone injury; a larger number of repaired vessels; the use of vascular grafts and a high Hand Injury Severity Score (HISS). The causes of abnormality and severity suggest a multifactorial aetiology with bony, vascular and neural components. A cut-off for abnormality is useful for descriptive, comparative and assessment purposes.