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2.
J Hand Surg Asian Pac Vol ; 24(4): 440-446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690193

RESUMO

Background: Scapholunate dissociation (SLD) is a common and sometimes disabling ligamentous injury of the wrist. The aim of the treatment is to restore carpal alignment and to prevent joint degeneration. In the current study, we reported mid-term results of our technique using suture anchor fixation within the SL interface. Methods: Nine male patients with an average age of 35 years underwent scapholunate suture anchor fixation (SLAF) for chronic and symptomatic dynamic or reducible static SLD from 2011 to 2016 with a mean follow-up of 36 months. After dorsal wrist exposure, a 2.8 mm suture anchor was inserted in the dorsoproximal lateral articular surface of the lunate bone. The two ends of the sutures were passed through the two divergent canals in the scaphoid. The sutures were tied over the tuberosity after reducing the SL alignment. Two K-wires supported SL and scaphocapitate (SC) alignment for 8 weeks. Radiographic parameters, wrist range of motion and grip strength were measured. Quick-DASH and Modified Mayo Wrist Score (MMWS) were used to assess the functional outcome. Results: The grip strength and passive motion reached to 75% and 88% of the other side, respectively. The SL gap was 5.4 mm, 2.6 mm and 3.4 mm before surgery, after pin removal, and on the follow-up stress radiographs, respectively. The SL angle was 82, 52 and 65 degrees at any time point, respectively. Average Quick-DASH score was improved from 60 to 25. According to MMWS score, one patient was excellent, one was good, five were fair, and two were poor. Conclusions: SLAF is a simple technique with minimal soft tissue manipulation that enables correction and maintaining of the carpal alignment with favorable mid-term results.


Assuntos
Fios Ortopédicos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Osso Semilunar/cirurgia , Osso Escafoide/cirurgia , Âncoras de Sutura , Articulação do Punho/cirurgia , Adulto , Doença Crônica , Seguimentos , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Osso Semilunar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Osso Escafoide/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
3.
J Hand Surg Asian Pac Vol ; 24(4): 428-434, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690195

RESUMO

Background: Although there have been many studies of the vascularized bone graft (VBG) or unloading procedures alone for the treatment of Kienböck disease, little information has been reported about patients treated with VBG combined with unloading procedures. The purpose of this study is to 1) describe the outcomes in patients treated with VBG combined with unloading procedures, 2) compare the outcomes according to the unloading procedures and 3) find any radiologic parameters affecting revascularization in Kienböck disease. Methods: A retrospective review was performed involving in 20 patients undergoing 4th and 5th extensor compartmental VBG with unloading procedures for Kienböck disease from 2010-2015. After VBG in all patients, unloading procedures were additionally performed depending on the ulnar variance. These additional operations included joint leveling procedures (radial and capitate shortening osteotomy) or temporary scaphocapitate pinning. Radiologic outcome was evaluated according to Lichtman stage and presence of revascularization evidence. Clinical evaluations included wrist range of motion, grip strength, visual analogue scale (VAS), and Mayo wrist score. Results: VBG with joint leveling procedures was performed in 11 patients (5 radial shortening and 6 capitate shortening) and VBG with temporary scaphocapitate pinning was performed in 9 patients. Although clinical outcomes were not significantly different according to the unloading procedures, there were significantly more patients with evidence of healing of osteonecrosis on radiographs in joint leveling procedure group than temporary scaphocapitate pinning group. Overall, evidence of healing of osteonecrosis was found on plain radiographs in 11 patients and was not found in 9 patients. However, there were no significant preoperative radiological parameters affecting revascularization on radiographs. Conclusions: Not all patients had evidence of revascularization on radiography after VBG combined with unloading procedures for Kienböck disease. However, among the unloading procedures, joint-leveling procedures positively influenced the revascularization process.


Assuntos
Pinos Ortopédicos , Transplante Ósseo/métodos , Capitato/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/transplante , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia , Adolescente , Adulto , Capitato/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Radiografia , Rádio (Anatomia)/irrigação sanguínea , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
4.
J Hand Surg Asian Pac Vol ; 24(4): 412-420, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690197

RESUMO

Background: Distal radius fractures are among the most common fractures encountered in orthopedic practices. If treated operatively, most implants are retained after the fracture heals unless there is hardware failure, limitation of wrist motion, pain, infection, tendon rupture, or tenosynovitis. Complications have been reported during hardware removal, including not knowing the exact implant prior to its removal. If a patient presents for plate removal to a surgeon who did not perform the initial fracture fixation, having a preoperative visual aid can help the treating surgeon choose the right instruments for their removal. Methods: To identify many of the available distal radius fixation devices, we searched the Internet and contacted local industry representatives. We also approached industry personnel at the commercial exhibit of a national hand society meeting to provide us with implants they manufacture. The implants were placed on the volar and dorsal aspects of sawbone models of the distal radius and in one case the radial styloid, using the screws, screwdrivers and accessories in the standard implant set and then posteroanterior and lateral x-rays of the implants were obtained. We created an atlas and a list of the screwdriver(s) used for each. Results: We obtained radiographs and photographs for 28 implants that were manufactured by 14 different companies. Two companies sent us radiographs and photographs placed on either a sawbone or cadaveric model. We found that 7 of the implants were outliers and could be identified easily on the x-rays, whereas 21 implants had similar design of shaft and distal components. Conclusions: To aid the orthopedic surgeon in their removal, we compiled a comprehensive list of most distal radius fixation devices on the market including plates and their corresponding screws and screwdrivers. The goal was to help the surgeon when removing the plate to identify the implant on radiographs.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Radiografia/métodos , Fraturas do Rádio/cirurgia , Desenho de Equipamento , Humanos , Fraturas do Rádio/diagnóstico , Articulação do Punho/fisiopatologia
5.
J Hand Surg Asian Pac Vol ; 24(4): 421-427, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690200

RESUMO

Background: Patients with ulnar-sided wrist pain and positive ulnar fovea sign are usually treated nonsurgically before surgical options are considered. However, the outcomes of nonsurgical management are unknown. Many of these patients also have unstable distal radioulnar joint, but there has been no comparison between the outcomes of these patients with stable and unstable distal radioulnar joint. The objectives of this study are to (1) determine the outcomes of nonsurgical and surgical treatment of patients with positive ulnar fovea sign, and (2) compare the outcomes of patients with stable and unstable distal radioulnar joint. Methods: A retrospective analysis of the outcomes of patients with ulnar sided wrist pain and positive fovea sign was performed from March 2009 to December 2014. Outcomes were measured based on patient-reported pain improvement, grip strength and range of motion of the affected wrist before and after treatment. A total of 100 wrists in 98 patients were reviewed. Results: 54% of wrists managed nonsurgically experienced pain improvement. 83% of wrists managed surgically experienced pain improvement. The mean grip strength increased by 2.8 kg and 2.7 kg, while the range of motion decreased by 14° and 5° after nonsurgical and surgical treatment respectively. When comparing patients with stable and unstable distal radioulnar joint, there were statistically more wrists with unstable distal radioulnar joint that experienced pain improvement after treatment. Conclusions: The study showed that there is a role for nonsurgical treatment for wrists with positive ulnar fovea sign with more than half of the patients experiencing pain improvement. We also found that positive ulnar fovea sign patients with unstable distal radioulnar joint had better pain outcomes compared to those with stable distal radioulnar joint.


Assuntos
Artralgia/terapia , Auditoria Clínica , Procedimentos Ortopédicos/métodos , Amplitude de Movimento Articular/fisiologia , Ulna/diagnóstico por imagem , Traumatismos do Punho/terapia , Articulação do Punho/fisiopatologia , Adolescente , Adulto , Idoso , Artralgia/etiologia , Artralgia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos do Punho/complicações , Traumatismos do Punho/fisiopatologia , Adulto Jovem
6.
J Hand Surg Asian Pac Vol ; 24(4): 447-451, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690205

RESUMO

Background: The objective of this retrospective study was to evaluate the outcomes of ulnar stump stabilization after ulna head resection using the FCU tendon by investigating the rate of postoperative extensor tendon rupture and click on forearm rotation. Methods: Wrist synovectomy (distal radioulnar joint (DRUJ), radiocarpal and midcarpal joints) and ulnar head resection combined with ulnar stump stabilizing procedure were performed in 58 wrists of 53 patients with RA in our hospital. Before operation, the dorsal subluxation ratio (DSR) of the ulnar head was measured with a multi-slice computed tomography (CT) images. The stabilization of ulnar stump after head resection was performed by the value of the DSR or the instability before the operation. Results: There was neither extensor tendon rupture nor click on forearm rotation in all the patients. Smooth forearm rotation was achieved by ulnar head resection and stabilizing procedure for the ulnar stump. The active range of forearm supination and pronation increased significantly from 68° ± 23° (mean ± SD) to 80° ± 10°, and from 69° ± 17° to 74° ± 13°. The grip power increased from 117 ± 62 mmHg to 185 ± 55 mmHg. In the assessment using 3DCT, the preoperative DSR of 54% improved to 8% on the whole (n = 58). In the wrists with extensor tendon rupture (n = 36), the preoperative DSR of 58% improved to 12%. In the wrists without tendon rupture (n = 22), the preoperative DSR of 46% improved to 2%. Conclusions: The operative technique of ulnar stump stabilization using the FCU tendon was one of the suitable procedure to prevent complications after ulnar head resection.


Assuntos
Artrite Reumatoide/cirurgia , Osteotomia/métodos , Tendões/cirurgia , Ulna/cirurgia , Articulação do Punho/cirurgia , Adulto , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/prevenção & controle , Tomografia Computadorizada por Raios X , Ulna/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
7.
BMC Musculoskelet Disord ; 20(1): 542, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727033

RESUMO

OBJECTIVE: To evaluate the prevalence and risk factors of wrist pain. METHODS: Systematic review. DATA SOURCES: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers. RESULTS: In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study). CONCLUSIONS: Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population. TRIAL REGISTRATION: The review protocol was registered with PROSPERO under the registration number CRD42018090834. LEVEL OF EVIDENCE: 1 (Prognostic study).


Assuntos
Artralgia/epidemiologia , Traumatismos em Atletas/epidemiologia , Doenças Profissionais/epidemiologia , Traumatismos do Punho/epidemiologia , Articulação do Punho/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/fisiopatologia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Humanos , Descrição de Cargo , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/fisiopatologia , Saúde do Trabalhador , Prevalência , Medição de Risco , Fatores de Risco , Carga de Trabalho , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/fisiopatologia , Adulto Jovem
8.
Sensors (Basel) ; 19(23)2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31775289

RESUMO

The response to levodopa (LR) is important for managing Parkinson's Disease and is measured with clinical scales prior to (OFF) and after (ON) levodopa. The aim of this study was to ascertain whether an ambulatory wearable device could predict the LR from the response to the first morning dose. The ON and OFF scores were sorted into six categories of severity so that separating Parkinson's Kinetigraph (PKG) features corresponding to the ON and OFF scores became a multi-class classification problem according to whether they fell below or above the threshold for each class. Candidate features were extracted from the PKG data and matched to the class labels. Several linear and non-linear candidate statistical models were examined and compared to classify the six categories of severity. The resulting model predicted a clinically significant LR with an area under the receiver operator curve of 0.92. This study shows that ambulatory data could be used to identify a clinically significant response to levodopa. This study has also identified practical steps that would enhance the reliability of this test in future studies.


Assuntos
Antiparkinsonianos/uso terapêutico , Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Articulação do Punho/fisiopatologia , Punho/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Dispositivos Eletrônicos Vestíveis
9.
BMC Musculoskelet Disord ; 20(1): 440, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601273

RESUMO

BACKGROUND: Several methods have been reported to correct deformity and shortening of the distal radius. However, the results are not entirely satisfactory. The results of bifocal osteosynthesis were retrospectively analyzed in this study. METHODS: Eight patients treated with bifocal osteosynthesis were evaluated retrospectively. Pre-operative and post-operative clinical and radiographic examinations were performed. Subjective symptoms and objective joint function were assessed. Radiographic data of the extent of radial lengthening and distal radial articular angle were collected. RESULTS: The mean follow-up period was 46 months (37-68 months). Satisfactory wrist appearance and radial lengthening was achieved in all patients. All patients were satisfied with the wrist appearance and willing to undergo the same treatment again. The range of motion (ROM) of the forearm and wrist was significantly improved. Pin-track infections occurred in two patients, for which they received wound care and oral antibiotics. Complications such as fixation device failure, tendon rupture, fracture of regenerated bone or nerve impairment did not occur. The duration of lengthening depended on the shortening of the radius. Delayed union in the docking site was observed in two patients and union was achieved after bone grafting. CONCLUSIONS: Bifocal osteosynthesis using the Ilizarov method provides a useful method for correction of radial shortening deformity with dislocation of the inferior radioulnar joint. Despite the fact that we did not validate pre-and post-operation functional outcome scores, all patients were satisfied with the wrist appearance and function.


Assuntos
Técnica de Ilizarov , Luxações Articulares/cirurgia , Rádio (Anatomia)/cirurgia , Articulação do Punho/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Satisfação do Paciente , Rádio (Anatomia)/anatomia & histologia , Rádio (Anatomia)/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/fisiopatologia
10.
BMC Musculoskelet Disord ; 20(1): 436, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533791

RESUMO

BACKGROUND: Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP). METHODS: Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain). RESULTS: After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86). CONCLUSION: Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Carga Global da Doença/estatística & dados numéricos , Dor Musculoesquelética/epidemiologia , Doenças Profissionais/epidemiologia , Articulação do Punho/fisiopatologia , Adulto , Comparação Transcultural , Ergonomia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/prevenção & controle , Doenças Profissionais/fisiopatologia , Doenças Profissionais/prevenção & controle , Prevalência , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
11.
Br J Hosp Med (Lond) ; 80(8): 456-460, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31437039

RESUMO

Ulnar-sided wrist pain is often unfairly labelled as the 'back pain' of the wrist. This reputation comes from the complexity of diagnosing problems related to this area of the wrist. This article summarizes the anatomy and biomechanics of the wrist and presents a logical approach to diagnosing the aetiology of the pain. The problems are categorised based on the anatomical structure from which the pain arises: either bony, soft tissue-related or arising from nerves or vascular structures. The article also outlines the relevant examination findings and the most appropriate investigation that would yield a diagnosis with any given presentation. A linked article detailing the imaging of ulnar-sided wrist pain is included in this issue (10.12968/hmed.2019.80.8.461).


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Artralgia/diagnóstico , Dor/diagnóstico , Radiologia/métodos , Ulna/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Fenômenos Biomecânicos , Competência Clínica , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor , Exame Físico/métodos , Amplitude de Movimento Articular/fisiologia , Traumatismos do Punho/diagnóstico
12.
Trials ; 20(1): 531, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455398

RESUMO

BACKGROUND: Carpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak. The treatment is associated with costs and may cause discomfort and limit daily and work activities. No placebo-controlled trials have been performed. METHODS: This is a randomized controlled trial designed to assess the efficacy of a rigid wrist splint compared with soft wrist bandage (placebo) in patients with primary idiopathic CTS. The trial will be conducted at an orthopedic department. Patients, 25 to 65 years old, who seek primary health-care with symptoms of CTS will be screened, and potentially eligible patients will be referred to the study center. Patients who fulfill the trial's eligibility criteria will be invited to participate. A total of 112 patients who provide informed consent will be randomly assigned to treatment with either a rigid wrist splint or a soft bandage to be used initially for 6 weeks at night and, if possible, during the day. The splints and bandages will be fitted with a temperature-monitoring device to measure the total time during which they have actually been worn. The trial participants will complete a questionnaire that includes the 6-item CTS symptoms scale (CTS-6); the 11-item disabilities of the arm, shoulder, and hand (QuickDASH) scale; and the EuroQol 5-dimension (EQ-5D) health status and quality-of-life measure at baseline and at 6, 12, 24, and 52 weeks after treatment start. The participants will undergo physical examination and nerve conduction testing at baseline and at 52 weeks. The trial's primary outcomes are the change in the CTS-6 score from baseline to 12 weeks and the rate of carpal tunnel release surgery at 52 weeks. DISCUSSION: This is the first placebo-controlled randomized trial with electronic monitoring of actual splint use and will provide evidence regarding the efficacy of wrist splinting in patients with CTS. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN81836603 . Registered on May 5, 2018.


Assuntos
Síndrome do Túnel Carpal/terapia , Procedimentos Ortopédicos/instrumentação , Contenções , Articulação do Punho/fisiopatologia , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Suécia , Fatores de Tempo , Resultado do Tratamento
13.
Br J Hosp Med (Lond) ; 80(8): 461-465, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31437044

RESUMO

Ulnar-sided wrist pain is a complex entity to diagnose clinically and frequently requires imaging to help confirm or determine the diagnosis. This article reviews the imaging and the logical imaging pathway of the common causes of ulnar-sided wrist pain, and illustrates various pathologies. It also discusses appropriate imaging modalities for various conditions. The causes of ulnar-sided wrist pain are stratified according to the affected anatomical structures, such as bony, soft tissue or neurovascular aetiologies. This review provides a handy imaging framework for non-radiologist clinicians of the common conditions producing ulnar-sided wrist pain. A linked article (10.12968/hmed.2019.80.8.456) detailing the diagnosis of ulnar-sided wrist pain is included in this issue.


Assuntos
Artralgia/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Ulna/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Artralgia/etiologia , Artralgia/fisiopatologia , Feminino , Humanos , Masculino , Medição da Dor , Sensibilidade e Especificidade , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/diagnóstico por imagem , Ulna/fisiopatologia , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
14.
Med Hypotheses ; 130: 109278, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383324

RESUMO

Lateral epicondylitis is a chronic angiofibroblastic degeneration of the origins of the wrist extensor muscles and is characterized by diffuse elbow pain. Although it is the most common syndrome of the elbow joint, the most affected structure is the tendon of the extensor carpi radialis brevis (ECRB) muscle. Several theories have been proposed to explain the pathophysiology of lateral epicondylitis, however, there is no evidence to show that the sarcomere length and microanatomical features of the ECRB muscle can be affected by the elongated position of the muscle. We hypothesized that the tensile response may be the responsible mechanism in the pathophysiology of lateral epicondylitis due to the microanatomy of the ECRB muscle and its functioning in the elongated position. Elongated position leads to elongation of the sarcomere length by forming a functional traction angle in the ECRB muscle. The elongated sarcomere length negatively affects muscular microcirculation. Poor microcirculation triggers ischemia in the muscle and tendon and leads to an increase in immature Type III collagen synthesis. Disruption of the collagen continuity and the loss of load-bearing capacity initiate the neovascularization process. This situation accelerates the degeneration process in the tendon and prevents healing. Furthermore, based on our hypothesis, we recommend new physiotherapy approaches that may contribute to reducing the increased incidence of tendinopathy and to the healing process.


Assuntos
Antebraço/fisiopatologia , Sarcômeros/ultraestrutura , Cotovelo de Tenista/fisiopatologia , Fenômenos Biomecânicos , Cotovelo/fisiopatologia , Fibroblastos/metabolismo , Humanos , Inflamação , Modelos Teóricos , Músculo Esquelético/fisiopatologia , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Tendões , Cotovelo de Tenista/etiologia , Articulação do Punho/fisiopatologia
15.
BMC Musculoskelet Disord ; 20(1): 357, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31387574

RESUMO

BACKGROUND: Scaphoid fractures are the most common carpal fractures. They often need to be treated by surgery, where the use of a compression screw is the globally accepted gold standard. Surgeons may choose between different implant materials including titanium alloys, which remain in the body or are removed after healing. An alternative are biodegradable magnesium-based implants. Properties of magnesium alloys include high stability, osteoconductivity, potential reduction of infections and few artifacts in magnetic resonance imaging (MRI). The aim of this trial is to demonstrate non-inferiority of magnesium-based compression screws compared with titanium Herbert screws for scaphoid fractures. METHODS: The trial is designed as a multicenter, blinded observer, randomized controlled parallel two-group post market trial. Approximately 190 patients will be randomized (1:1) with stratification by center either to titanium or magnesium-based compression screws. Follow-up is 1 year per patient. Surgical procedures and aftercare will be performed according to the German treatment guideline for scaphoid fractures. The first primary endpoint is the patient-rated wrist evaluation (PRWE) score after 6 months. The second primary endpoint is a composite safety endpoint including bone union until 6 months, no adverse device effect (ADE) during surgery or wound healing and no serious ADE or reoperation within 1 year. The third primary endpoint is the difference in change MRI artifacts over time. Non-inferiority will be investigated for primary endpoints 1 (t-test confidence interval) and 2 (Wilson's score interval) using both the full analysis set (FAS) and the per protocol population at the one-sided 2.5% test-level. Superiority of magnesium over titanium screws will be established using the FAS at the two-sided 5% test-level (Welch test) only if non-inferiority has been established for both primary endpoints. Secondary endpoints include quality of life. DISCUSSION: This study will inform care providers whether biodegradable magnesium-based implants are non-inferior to standard titanium Herbert screws for the treatment of scaphoid fractures in terms of wrist function and safety. Furthermore, superiority of magnesium-based implants may be demonstrated using MRI, which is used as surrogate endpoint for screw degradation. TRIAL REGISTRATION: DRKS, DRKS00013368 . Registered Dec 04, 2017.


Assuntos
Implantes Absorvíveis/efeitos adversos , Parafusos Ósseos/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Ensaios Clínicos Fase IV como Assunto , Estudos de Equivalência como Asunto , Fixação Interna de Fraturas/efeitos adversos , Humanos , Magnésio/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Titânio/efeitos adversos , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
16.
IEEE Int Conf Rehabil Robot ; 2019: 89-94, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374612

RESUMO

The aim of this work is to present a novel robot-based method to assess the sources of a lack of functionality in patients with recent traumatic wrist injuries. Post-traumatic patients experience limited range of motion as well as strength and proprioceptive deficits. These dysfunctions are related to different complications that usually follow the injuries: pain, increased rigidity, lack of movement fluency and loss of stability could arise differently, according to the severity, site and kind of lesion. Their quantitative evaluation could be essential to target rehabilitation treatments to the specific problem and to optimize and speed up the functional recovery. The use of robotic devices for assessment not only ensures objectivity and repeatability, but could also help to estimate the goodness of the evaluation itself, in terms of reliability and patient's engagement. Ten subjects with different types of wrist injuries were enrolled in this study and required to perform passive robot-guided reaching movements. Forces and angular positions were used to evaluate subject's range of motion, rigidity and pain that, considered together, allowed a comprehensive characterization of the level of healing and functionality achieved by each subject.


Assuntos
Dor/reabilitação , Robótica/instrumentação , Traumatismos do Punho/reabilitação , Articulação do Punho/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aparelhos Ortopédicos , Dor/etiologia , Medição da Dor , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Traumatismos do Punho/complicações , Traumatismos do Punho/fisiopatologia
17.
IEEE Int Conf Rehabil Robot ; 2019: 282-287, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374643

RESUMO

This paper introduces a novel passive wrist bilateral rehabilitation device coupled with a new Virtual Reality (VR) platform. This is the first work to have adapted three-link coaxial spherical parallel manipulator (SPM) to wrist rehabilitation. The device comprises a coaxial SPM and cross-connected cable system. The coaxial SPM facilitates 3 degrees of freedom (DOFs) spherical wrist orientation and singularity-free motion within its workspace. The cross-connected cable system enables bilateral symmetrical exercises in passive mode training. A VR platform with activities of daily living (ADL) task was developed and coupled with the device to increase the adherence of the users to the device. Experiments were conducted with fifteen healthy right-handed individuals with no history of wrist or hand injury to evaluate the feasibility of the system for providing passive bilateral training as well as the effectiveness of the VR platform. Subjects were asked to use their right arms to move the left arms passively through the device to perform four wrist movements, flexion, extension, radial deviation, and ulnar deviation. EMG activations on the left arm were observed when the right arm passively moved the left arm. The results showed that the device was capable of inducing the muscle activation of the left arm and the VR platform increased the motivation to continue the exercises. This demonstrates that this study can serve as the fundamental for larger clinical trials.


Assuntos
Atividades Cotidianas , Desenho de Equipamento , Movimento , Realidade Virtual , Articulação do Punho/fisiopatologia , Punho/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Amplitude de Movimento Articular
18.
IEEE Int Conf Rehabil Robot ; 2019: 288-293, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374644

RESUMO

In this paper, we propose a wrist rehabilitation robot employing a novel actuation mechanism composed of electromagnetic clutch, brake, and motor and a safe-related mechanism. The actuation mechanism of the robot can perform both passive and active rehabilitation by the same mechanism. A torque sensor is also coupled to the actuation mechanism so as to measure the wrist joint moment in real-time. User can align his/her wrist joint to the center of rotation with the indication device. Moreover EMG is measured in real-time to evaluate effectiveness of active rehabilitation and to detect an emergency situation such as muscle spasm while doing active rehabilitation. In experiments, the effectiveness of active rehabilitation is evaluated and verified by 3D motion capture data and EMG data measured in real-time. The feasibility of the indication device is evaluated in the wrist joint alignment by verifying X-ray image of wrist and robot. Finally, we performed a usability test with five experts working in medical field, and the test result showed that the proposed robot can be applied to wrist rehabilitation.


Assuntos
Desenho de Equipamento , Terapia Passiva Contínua de Movimento/instrumentação , Robótica , Segurança , Articulação do Punho/fisiopatologia , Punho/fisiopatologia , Feminino , Humanos , Masculino
19.
IEEE Int Conf Rehabil Robot ; 2019: 542-547, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374686

RESUMO

Vibration stimulation seems to be an affordable easy-to-use rehabilitation tool. Focal muscle vibration (FV) has potential to reduce spasticity and enhance muscle strength and performance. Combined with robotic assisted movement therapy, the rehabilitation can benefit from improvement of more than one aspect. For example, FV could firstly decrease abnormally increased muscle tone and joint rigidity by tackling volitional control for easier robotic movement exercise. Exactly this approach is evaluated within a clinical trial presented in this paper. FV were applied to relaxed spastic wrist flexor and extensor muscles for 15min. Subsequently, the wrist was engaged in a robotic-assisted game-playing. Results from two cases who completed the trial showed short-term decrease in wrist stiffness as assessed by clinical spasticity measurement Modified Ashworth Scale (MAS). Active range of motion (AROM) and engineering joint stiffness (JS) measurements were estimated using a robotic apparatus and the results complemented previous observations. The AROM increased and JS decreased for both cases when compared at the beginning and at the end of each interventional session. These results are a part of an ongoing clinical trial but show promise for reducing repercussions of spasticity in incomplete spinal cord injury.


Assuntos
Técnicas de Exercício e de Movimento , Espasticidade Muscular , Músculo Esquelético/fisiopatologia , Traumatismos da Medula Espinal , Vibração , Articulação do Punho/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Espasticidade Muscular/fisiopatologia , Espasticidade Muscular/reabilitação , Força Muscular , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação
20.
Eklem Hastalik Cerrahisi ; 30(2): 124-9, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291860

RESUMO

OBJECTIVES: This study aims to clinically evaluate the efficacy of pedicle bone flap treatment in stage II Kienböck's disease. PATIENTS AND METHODS: This retrospective study included 10 patients (8 males, 2 females; mean age 33.3 years; range, 23 to 46 years) treated with pedicle bone flap between January 2012 and June 2016. In all patients, a fourth extensor compartment artery (ECA) pedicle bone flap from the dorsal surface of the radius was prepared and placed through a window opened on the lunate bone. Clinical results of the patients were evaluated according to the Mayo wrist score. RESULTS: All patients could return to their daily activities after surgery. No superficial or deep infection developed requiring debridement or antibiotic use other than prophylaxis. None of the patients required reoperation due to complications or the progression of the disease. The mean Mayo wrist score was measured as 81 (good). CONCLUSION: In this study, results of the fourth ECA pedicle bone flap application were found to be effective in the treatment of avascular necrosis of the lunate bone. Further comparative and long-term follow-up studies are required including large and homogeneous patient groups.


Assuntos
Transplante Ósseo , Osso Semilunar/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/transplante , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Osso Semilunar/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico por imagem , Osteonecrose/fisiopatologia , Estudos Retrospectivos , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
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