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1.
BMC Surg ; 21(1): 358, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627230

RESUMO

BACKGROUND: The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures. METHODS: We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment. RESULTS: A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery. CONCLUSIONS: The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.


Assuntos
Ossos Metacarpais , Anestesia Geral , Análise Custo-Benefício , Humanos , Ossos Metacarpais/cirurgia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Punho
2.
Acta Chir Orthop Traumatol Cech ; 88(4 Suppl): 21-26, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34593097

RESUMO

This guide to ultrasound examination of the wrist and hand describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In wrist section, an emphasis is placed on the carpal tunnel and extensor tendons evaluation. In the hand region, the scanning of the flexor pulley system and the flexor pollicis longus is described. Key words: hand, wrist joint, ultrasound, tendons, carpal tunnel syndrome, De Quervain disease, trigger finger disorder, hand injuries, musculoskeletal, protocol.


Assuntos
Articulação do Punho , Punho , Mãos/diagnóstico por imagem , Humanos , Tendões/diagnóstico por imagem , Ultrassonografia , Punho/diagnóstico por imagem
3.
BMC Musculoskelet Disord ; 22(1): 866, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635079

RESUMO

BACKGROUND: To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries. METHODS: Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1-2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate. RESULTS: Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence. CONCLUSION: Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. TRIAL REGISTRATION: The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589 ).


Assuntos
Traumatismos da Mão , Punho , Traumatismos da Mão/diagnóstico por imagem , Traumatismos da Mão/epidemiologia , Humanos , Incidência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Centros de Traumatologia
4.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(5): 507-511, 2021 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-34628762

RESUMO

A 3D printing based wrist orthosis device was developed. After collecting the contour information of the carpal and metacarpophalangeal joints of the patients with a 3D scanner, the wrist orthotics were designed to meet the individual needs of the patients according to the relevant requirements of biomechanics. Choose TPU (thermoplastic polyurethanes) materials for preparation of 3D printing. It can functionally assist the smart brace after stroke patients with hemiplegia early rehabilitation training, the use of orthoses carry MPU6050 inertial sensor, magnetometer, time module device such as a sensor and monitor its movements and record the training time, ensure safe efficient rehabilitation training, help patients return to a normal life as soon as possible.


Assuntos
Acidente Vascular Cerebral , Punho , Humanos , Aparelhos Ortopédicos , Impressão Tridimensional , Articulação do Punho
5.
BMC Musculoskelet Disord ; 22(1): 766, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496832

RESUMO

BACKGROUND: It is controversial whether or not the carpometacarpal joint (CMCJ) should be included in total wrist arthrodesis (TWA). Complications commonly occur at this site and studies examining its inclusion and exclusion are conflicting. A randomised clinical trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation and non-CMCJ spanning plate has not been performed. METHOD: A single centre randomised clinical trial including 120 adults with end-stage isolated wrist arthritis will be performed to compare TWA with and without the CMCJ included in the arthrodesis. The primary outcome is complications in the first post-operative year. Secondary outcomes are Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) and grip strength measured at 1, 2 and 5 years. Late complications, return to work and satisfaction will also be recorded. DISCUSSION: It is unknown whether the CMCJ should be included in TWA. This trial will contribute to an improved understanding of optimal management of the CMCJ in total wrist arthrodesis. TRIAL REGISTRATION: This trial was prospectively registered with the Australia New Zealand Clinical Trials Registry with identifying number ACTRN12621000169842 on the 16th February 2021. WHO: U1111-12626523. ANZCTR: ACTRN12621000169842.


Assuntos
Articulações Carpometacarpais , Artrodese/efeitos adversos , Placas Ósseas , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/cirurgia , Força da Mão , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Punho , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
6.
Praxis (Bern 1994) ; 110(12): 661-665, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34521271

RESUMO

The Painful Wrist Abstract. Wrist pain is a problem that can significantly limit patients in their daily activities. The causes are manifold, and treatment is often challenging. A systematic approach is therefore helpful in working up the correct diagnosis. This article aims to demonstrate a straightforward approach to the evaluation of wrist pain in adults.


Assuntos
Articulação do Punho , Punho , Adulto , Artralgia/etiologia , Humanos , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
7.
Praxis (Bern 1994) ; 110(12): 667-672, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34521272

RESUMO

Tendinopathies - Common Diagnoses in Hand Surgery Abstract. Tendinopathies are among the most frequent reasons for consulting a hand surgeon. The diagnosis can usually be made clinically. A supplementary ultrasound examination helps to visualize the pathology. Most of these diseases respond to non-surgical treatment. If surgical treatment is necessary, it can usually be performed as an outpatient procedure under local anesthesia. This article provides an overview of the most common tendinopathies of the hand and wrist, their diagnosis and treatment.


Assuntos
Mãos , Tendinopatia , Anestesia Local , Mãos/diagnóstico por imagem , Mãos/cirurgia , Humanos , Tendinopatia/diagnóstico por imagem , Tendinopatia/cirurgia , Punho , Articulação do Punho
8.
Sensors (Basel) ; 21(18)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34577457

RESUMO

Wrist-worn consumer-grade activity trackers are popular devices, developed mainly for personal use. This study aimed to explore the validity, reliability and sensitivity to change of movement behaviors metrics from three activity trackers (Polar Vantage M, Garmin Vivoactive 4s and Garmin Vivosport) in controlled and free-living conditions when worn by older adults. Participants (n = 28; 74 ± 5 years) underwent a videotaped laboratory protocol while wearing all three trackers. On a separate occasion, participants (n = 17 for each of the trackers) wore one (randomly assigned) tracker and a research-grade activity monitor ActiGraph wGT3X-BT simultaneously for six consecutive days. Both Garmin trackers showed excellent performance for step counts, with a mean absolute percentage error (MAPE) below 20% and intraclass correlation coefficient (ICC2,1) above 0.90 (p < 0.05). The MAPE for sleep time was within 10% for all the trackers tested, while it was far beyond 20% for all other movement behaviors metrics. The results suggested that all three trackers could be used for measuring sleep time with a high level of accuracy, and both Garmin trackers could also be used for step counts. All other output metrics should be used with caution. The results provided in this study could be used to guide choice on activity trackers aiming for different purposes-individual use, longitudinal monitoring or in clinical trial setting.


Assuntos
Monitores de Aptidão Física , Condições Sociais , Idoso , Humanos , Reprodutibilidade dos Testes , Sono , Punho
9.
Bratisl Lek Listy ; 122(10): 739-743, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34570576

RESUMO

PURPOSE OF THE STUDY:  Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification. PATIENTS AND METHODS:  We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score. RESULTS: The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible. CONCLUSION:  The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk Keywords: distal radius fractures, scapholunate ligament, lunotriquetral ligament, fluoroscopic, diagnosis.


Assuntos
Fraturas do Rádio , Traumatismos do Punho , Fixação Interna de Fraturas , Humanos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Punho , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
10.
Sensors (Basel) ; 21(18)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34577418

RESUMO

The number of smart homes is rapidly increasing. Smart homes typically feature functions such as voice-activated functions, automation, monitoring, and tracking events. Besides comfort and convenience, the integration of smart home functionality with data processing methods can provide valuable information about the well-being of the smart home residence. This study is aimed at taking the data analysis within smart homes beyond occupancy monitoring and fall detection. This work uses a multilayer perceptron neural network to recognize multiple human activities from wrist- and ankle-worn devices. The developed models show very high recognition accuracy across all activity classes. The cross-validation results indicate accuracy levels above 98% across all models, and scoring evaluation methods only resulted in an average accuracy reduction of 10%.


Assuntos
Atividades Humanas , Redes Neurais de Computação , Automação , Habitação , Humanos , Punho
11.
Oper Orthop Traumatol ; 33(5): 399-404, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34477889

RESUMO

OBJECTIVE: The aim of direct distal selective nerve transfer close to the end organ with high radial nerve injury is restoration of the paretic function before irreversible atrophy of the target muscle. Simultaneous tendon transfer enables direct functional correction of wrist drop. INDICATIONS: Selective nerve and tendon transfer of the lower arm is indicated if a) the primary nerve lesion is located proximally distant and reinnervation by direct nerve repair would take too long to reach a paretic muscle because of the long distance involved, b) direct repair of the nerve lesion is impossible or c) there has been a substantial delay after the primary injury. A viable donor nerve must be available. CONTRAINDICATIONS: A) After final denervation of a muscle, which occurs approximately 1.5 years after a nerve injury, the atrophy is irreversible and a nerve transfer can no longer restore the paretic muscle. Only younger patients under 30 years old might benefit from delayed nerve transfer. B) When no sufficient donor nerve is available only tendon transfer is possible. SURGICAL TECHNIQUE: Direct nerve transfer from the median nerve to the radial nerve as well as direct functional correction of wrist drop by tendon transfer of the pronator teres muscle. POSTOPERATIVE MANAGEMENT: Immobilization of the arm for 3 days, wrist orthosis for 6 weeks for protection of the tendon transfer, ergotherapy and physiotherapy preferably by a hand therapist. RESULTS: Active wrist and finger extension 2 years after transfer, with individualized extension of the thumb and index finger is possible, wrist drop reversed.


Assuntos
Neuropatia Radial , Adulto , Humanos , Nervo Radial/cirurgia , Neuropatia Radial/cirurgia , Transferência Tendinosa , Resultado do Tratamento , Punho
12.
Sensors (Basel) ; 21(17)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34502601

RESUMO

Smart sensors, coupled with artificial intelligence (AI)-enabled remote automated monitoring (RAMs), can free a nurse from the task of in-person patient monitoring during the transportation process of patients between different wards in hospital settings. Automation of hospital beds using advanced robotics and sensors has been a growing trend exacerbated by the COVID crisis. In this exploratory study, a polynomial regression (PR) machine learning (ML) RAM algorithm based on a Dreyfusian descriptor for immediate wellbeing monitoring was proposed for the autonomous hospital bed transport (AHBT) application. This method was preferred over several other AI algorithm for its simplicity and quick computation. The algorithm quantified historical data using supervised photoplethysmography (PPG) data for 5 min just before the start of the autonomous journey, referred as pre-journey (PJ) dataset. During the transport process, the algorithm continued to quantify immediate measurements using non-overlapping sets of 30 PPG waveforms, referred as in-journey (IJ) dataset. In combination, this algorithm provided a binary decision condition that determined if AHBT should continue its journey to destination by checking the degree of polynomial (DoP) between PJ and IJ. Wrist PPG was used as algorithm's monitoring parameter. PPG data was collected simultaneously from both wrists of 35 subjects, aged 21 and above in postures mimicking that in AHBT and were given full freedom of upper limb and wrist movement. It was observed that the top goodness-of-fit which indicated potentials for high data accountability had 0.2 to 0.6 cross validation score mean (CVSM) occurring at 8th to 10th DoP for PJ datasets and 0.967 to 0.994 CVSM at 9th to 10th DoP for IJ datasets. CVSM was a reliable metric to pick out the best PJ and IJ DoPs. Central tendency analysis showed that coinciding DoP distributions between PJ and IJ datasets, peaking at 8th DoP, was the precursor to high algorithm stability. Mean algorithm efficacy was 0.20 as our proposed algorithm was able to pick out all signals from a conscious subject having full freedom of movement. This efficacy was acceptable as a first ML proof of concept for AHBT. There was no observable difference between subjects' left and right wrists.


Assuntos
Dispositivos Eletrônicos Vestíveis , Algoritmos , Inteligência Artificial , Hospitais , Humanos , Aprendizado de Máquina , Monitorização Fisiológica , Processamento de Sinais Assistido por Computador , Punho
13.
Clin Sports Med ; 40(4): 625-639, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509202

RESUMO

Injuries to the wrist and hands occur frequently in athletes from the high forces applied during sporting events. The examples presented illustrate the important role imaging has in the diagnosis of wrist and hand injuries. In addition, different imaging modalities are complementary and various examinations may be needed to help guide the management of wrist and hand traumatic pathology.


Assuntos
Traumatismos em Atletas , Traumatismos da Mão , Traumatismos do Punho , Atletas , Traumatismos em Atletas/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Traumatismos da Mão/diagnóstico por imagem , Humanos , Punho/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem
14.
J Bodyw Mov Ther ; 27: 472-476, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391273

RESUMO

BACKGROUND: The aim of this study was to examine the effect of two different wrist immobilization methods on the muscle activation of the upper trapezius muscle and functional typing performance during computer typing tasks in office workers. METHODS: The study was conducted on 11 healthy office workers. The study subjects were asked to type on a computer for 5 min (1) without splint or taping, (2) with a splint, (3) with rigid taping which limits the wrist flexion at the dominant side. The upper trapezius muscle activation was recorded by surface EMG during the task. The mean values obtained from EMG were normalized according to Maximum Voluntary Isometric Contraction (MVIC), comparisons were made according to %MVIC. RESULTS: The office workers' mean age was 27.45 ± 3.64 years. There was no significant difference in immobilization methods between %MVIC on dominant (p = .508) and non-dominant (p = .213) sides. The upper trapezius of the non-dominant side showed higher electromyographic activity when the subjects used a splint (p = .013). There was a significant difference between splinting and rigid taping methods in typing performance (z = -2,491, p = .013). CONCLUSION: There is no significant difference in the upper trapezius muscle activation between the splint and rigid taping methods during the computer typing task on the dominant side. The typing performance was affected more during splint use compared to rigid tape application. Considering the importance of work efficiency in employees, rigid taping might be considered as an alternative splinting for wrist immobilization in office workers.


Assuntos
Músculos Superficiais do Dorso , Adulto , Computadores , Eletromiografia , Humanos , Músculo Esquelético , Punho , Articulação do Punho , Adulto Jovem
15.
BMJ Case Rep ; 14(8)2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400418

RESUMO

Carpal tunnel release is a routinely performed operation to relieve pressure caused by compression on the median nerve. In the majority of cases, the causation of the compression will be idiopathic. Among the secondary causes of median nerve compression is the palmaris profundus, a rare anatomical variant separate to the palmaris longus tendon. It has been suggested that it may cause carpal tunnel syndrome as it courses underneath the flexor retinaculum with the contents of the carpal tunnel reducing the space available to the median nerve. Several cases have found it intimately associated with the median nerve within the carpal tunnel. Raising awareness of this anatomical variant is therefore important for those undertaking carpal tunnel decompression in order to avoid unintended damage.


Assuntos
Síndrome do Túnel Carpal , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Antebraço , Humanos , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Tendões/cirurgia , Punho
16.
Sensors (Basel) ; 21(16)2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34450921

RESUMO

The research area of activity recognition is fast growing with diverse applications. However, advances in this field have not yet been used to monitor the rehabilitation of individuals with spinal cord injury. Noteworthily, relying on patient surveys to assess adherence can undermine the outcomes of rehabilitation. Therefore, this paper presents and implements a systematic activity recognition method to recognize physical activities applied by subjects during rehabilitation for spinal cord injury. In the method, raw sensor data are divided into fragments using a dynamic segmentation technique, providing higher recognition performance compared to the sliding window, which is a commonly used approach. To develop the method and build a predictive model, a machine learning approach was adopted. The proposed method was evaluated on a dataset obtained from a single wrist-worn accelerometer. The results demonstrated the effectiveness of the proposed method in recognizing all of the activities that were examined, and it achieved an overall accuracy of 96.86%.


Assuntos
Traumatismos da Medula Espinal , Dispositivos Eletrônicos Vestíveis , Exercício Físico , Humanos , Aprendizado de Máquina , Punho
17.
Sensors (Basel) ; 21(16)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34451068

RESUMO

BACKGROUND: This study investigates the dart-throwing motion (DTM) by comparing an inertial measurement unit-based system previously validated for basic motion tasks with an optoelectronic motion capture system. The DTM is interesting as wrist movement during many activities of daily living occur in this movement plane, but the complex movement is difficult to assess clinically. METHODS: Ten healthy subjects were recorded while performing the DTM with their right wrist using inertial sensors and skin markers. Maximum range of motion obtained by the different systems and the mean absolute difference were calculated. RESULTS: In the flexion-extension plane, both systems calculated a range of motion of 100° with mean absolute differences of 8°, while in the radial-ulnar deviation plane, a mean absolute difference of 17° and range of motion values of 48° for the optoelectronic system and 59° for the inertial measurement units were found. CONCLUSIONS: This study shows the challenge of comparing results of different kinematic motion capture systems for complex movements while also highlighting inertial measurement units as promising for future clinical application in dynamic and coupled wrist movements. Possible sources of error and solutions are discussed.


Assuntos
Atividades Cotidianas , Punho , Fenômenos Biomecânicos , Humanos , Movimento , Amplitude de Movimento Articular , Articulação do Punho
18.
Med Probl Perform Art ; 36(3): 141-149, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464960

RESUMO

One of the greatest challenges in reducing high rates of performance injuries among musicians is in providing them usable tools to address playing-related musculoskeletal problems (PRMP) before they become disorders. Studies in biomechanics have the potential to provide such tools. In order to better understand the mechanisms through which PRMP manifest in pianists, especially in the distal segments of the upper limbs, the current study quantifies wrist internal loading (WIL) and wrist impact loading frequency. It does so while discussing pianists' motor behaviours and observed effort-reduction strategies in the wrists as a function of anthropometry. This concept has great utility for performers. A VICON 3D motion capture system documented two expert pianists performing a B major scale, hands together, at 4, 6, 8, 9, and 10 notes/sec. Biomechanical modeling quantified WIL. Changes in motor behaviour were observed at 8 notes/sec. Individualized anthropometry influenced the range of motor strategies available to each pianist. The pianist with the larger hand span employed a flexion/extension wrist strategy as a compensatory means for effort reduction, while the pianist with the smaller hand span employed a radial/ ulnar deviation strategy. The current study provides a new perspective in addressing PRMP among pianists by rationalizing anthropometric potentials in terms of ergonomic parameters and documenting the availability and utility of effort-reduction strategies in the wrists during piano performance as performers consider PRMP risk and avoidance.


Assuntos
Música , Punho , Fenômenos Biomecânicos , Mãos , Humanos , Articulação do Punho
19.
Medicine (Baltimore) ; 100(32): e26816, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397884

RESUMO

ABSTRACT: All of the injuries were the open injuries with bone or tendon structures in the hand and wrist region as a result of the firearm injury (FI) in the Syria. In the study, we assessed the outcomes of the posterior interosseous flap (PIF) on hand and wrist that we used for the Syrian injured people including civilians and soldiers in this War. PIF was applied to 77 patients who composed of 43 female and 34 male that all patients were evaluated for tissue loss resulting from gunshot wounds and injured in the War between 2014 and 2020 years with tissue loss in hand and wrist as a result of FI. The flap survival rate was 100% for all the patients. The dimensions of flaps ranged from 4.1 cm × 2.2 cm to 9cm × 5.4 cm with 0.51 ±â€Š0.12 cm thickness. The mean pedicle length was 6.33 ±â€Š1.08 cm. The surgery for PIF took 68.8 ±â€Š22.1 minutes, while blood loss was 60 ±â€Š24 mL. We observed no palsy conditions including the posterior interosseous nerve. The donor sites were treated by primary intention in the patients. We found the superiority of PIF with the postoperative follow-up comfort, ease of fracture healing, easy and fast, easy-to-apply method and no second additional session requirement in FI patients. We did not detect flap necrosis in any patient or observe a flap-related complication. As a result of the present study, it strongly supports the thesis that PIF is the best option in these cases.


Assuntos
Armas de Fogo , Traumatismos da Mão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síria , Cicatrização , Punho/cirurgia , Adulto Jovem
20.
Pan Afr Med J ; 38: 408, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381552

RESUMO

Hydroxyapatite crystal deposition disease (HADD) of the hand and wrist is rare but can cause acute inflammatory syndromes that mimic infectious arthritis. These symptoms, which rapidly resolve with systemic anti-inflammatory drugs, are a source of diagnostic errors and inappropriate treatment. It is of crucial importance to make the diagnosis in order to avoid iatrogenic surgical management. The aim of this study was to determine the clinical and radiographic signs and the key features on which diagnosis depends. Treatment effectiveness and the course of the disease were also examined. Between 1992 and 2008, 12 patients consulted for an isolated acute local inflammatory syndrome of the hand or wrist, which was accompanied by a unique radiographic picture of calcific density. All patients were reassessed clinically and radiographically with a minimum follow-up of 2 years. All patients had presented with acute local inflammatory syndromes. Nine patients had edema and 8 had swelling and erythema. No patient had fever. The course was favorable in 11 patients and one patient required surgery. No patient had a recurrence at the mean final follow-up of 90 ± 64 months. The symptoms associated with hydroxyapatite crystal deposits suggest septic arthritis with acute joint inflammation. The radiological appearance is characteristic and corrects the diagnosis. Oral anti-inflammatory treatment gives more rapid spontaneous improvement, with complete and long-lasting resolution.


Assuntos
Calcinose/diagnóstico por imagem , Durapatita/metabolismo , Mãos/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Artrite Infecciosa/diagnóstico , Calcinose/patologia , Calcinose/terapia , Edema/etiologia , Feminino , Seguimentos , Mãos/patologia , Humanos , Inflamação/diagnóstico por imagem , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Punho/patologia
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