| 1. |
- Carlsson, Mats, 1965-, et al.
(författare)
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Terminology support for development of sharable knowledge modules
- 1996
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Ingår i: Informatics for Health and Social Care. - : Informa UK Limited. - 1753-8157 .- 1753-8165. ; 21:3, s. 207-214
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Tidskriftsartikel (refereegranskat)abstract
- Lack of an agreed infrastructure for terminology is identified as one of the major barriers to interchange of knowledge modules and integration of knowledge bases with other clinical information systems. The goal of the GALEN project is to bridge this gap between different terminology systems through the construction of a terminology server, which is based on a rich conceptual model with mapping facilities to natural language expressions and coding schemas. The long term goal is to support communication between medical information systems. Arden Syntax is a standard format for the creation of knowledge modules, with sharability as one of the main objectives. Since Arden Syntax is based on a data-driven approach, the data items used need to be adapted to locally available terminology. The GALEN approach appears to be complementary to Arden Syntax and to the development of sharable knowledge modules. The major theme of this paper is utilization of the GALEN terminology server for knowledge module authoring. Two systems are presented, a knowledge base manager and a client to the terminology server, allowing the user to navigate in the semantic network and to import concept definitions and terms into the knowledge modules. The benefit of the terminology services is discussed.
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| 2. |
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| 3. |
- Afendras, G, et al.
(författare)
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Hemi-hamate osteochondral transplantation in proximal interphalangeal dorsal fracture dislocations: a minimum 4 year follow-up in eight patients.
- 2010
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 35:8, s. 627-631
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Tidskriftsartikel (refereegranskat)abstract
- Fracture dislocations of the PIP joint are challenging to treat. In hemi-hamate arthroplasty, the palmar lip joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. In the long term, collapse of non-vascularized osteochondral grafts might lead to degenerative arthritis. We examined the radiographic result after a minimum of 4 years with special reference to the development of osteoarthritis and its relation to clinical symptoms in eight patients, mean age 49 (25-66) years. After a mean of 60 (48-69) months, the arc of motion was 67 degrees (45 degrees -95 degrees ) at the PIP joint and grip strength was 91% of the uninjured side. The visual analogue score for pain (0-100) was 10 (0-70) mm. Severe arthritis (grade IV) was found in two and mild arthritis (grade II) in another two patients, but only one of these four cases had troublesome pain. The hemi-hamate technique is an attractive alternative to other treatment options, but some cases develop osteoarthritis in the medium term.
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| 4. |
- Alkner, Björn, 1968-, et al.
(författare)
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Effect of postoperative pneumatic compression after volar plate fixation of distal radial fractures: a randomized controlled trial
- 2018
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 43:8, s. 825-831
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the difference between postoperative rehabilitation with or without adjunctive intermittent pneumatic compression therapy following distal radial fracture treated with volar plating. A total of 115 patients were randomized to a control or to an experimental group. After 4 weeks of immobilization the experimental group received intermittent pneumatic compression therapy in addition to conventional postoperative rehabilitation. Primary outcome up to 1 year postoperatively was assessed using the Canadian Occupational Performance Measure. No significant differences between groups were found. There were no clinically relevant differences regarding the secondary outcome measures swelling, strength, pain and flexibility. We conclude that postoperative intermittent pneumatic compression treatment had no major benefits. The results of the present study do not support general use of intermittent pneumatic compression initiated 4 weeks following volar plating surgery for distal radial fracture. Level of evidence: I
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| 5. |
- Andersson, G-B, et al.
(författare)
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Children with surgically corrected hand deformities and upper limb deficiencies: self-concept and psychological well-being.
- 2011
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Ingår i: The Journal of Hand Surgery, European Volume. - : SAGE Publications. - 0266-7681. ; 36:9, s. 795-801
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Tidskriftsartikel (refereegranskat)abstract
- We studied self-concept and psychological well-being in children with hand deformities and upper limb deficiencies. Ninety-two children, 53 boys, 39 girls, aged 9-11 years were included. The children were divided into two subgroups - one with milder (less visible) deformities and one with severe (more complex and visible) finger-hand-arm deformities. Of the 92 children, 79 had received reconstructive surgery, and 13 had been treated with prostheses. The Piers-Harris Children's Self-Concept Scale (PHCSCS) was used to measure self-esteem and well-being. Overall PHCSCS scores showed that the whole hand deformity group had 'good' self-concept with mean scores in excess of 60 points, equal to a comparison group of healthy children. Within the hand deformity group, those with mild deformities had lower scores than those with severe deformities. This result was also found in the group of boys but not in the girls. The children with severe deformities had even higher scores than the comparison group regarding the subscale 'Intellectual and School Status'. The children with milder deformities had lower scores than the comparison group regarding the subscale 'Popularity'.
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| 6. |
- Andersson, Jonny K, 1972, et al.
(författare)
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Distal radio-ulnar joint instability in children and adolescents after wrist trauma.
- 2014
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 39:6, s. 653-661
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Tidskriftsartikel (refereegranskat)abstract
- This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) joint instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ instability were Salter-Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusion, late DRUJ instability due to wrist fractures or isolated TFCC tears was found to be common in children and adolescents.Level of evidence: IV.
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| 7. |
- Andersson, Jonny K, 1972, et al.
(författare)
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Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm.
- 2016
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 41:7, s. 732-8
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Tidskriftsartikel (refereegranskat)abstract
- A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque.
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| 8. |
- Atroshi, I, et al.
(författare)
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The SF-6D health utility index in carpal tunnel syndrome.
- 2007
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Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32:2, s. 198-202
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Tidskriftsartikel (refereegranskat)abstract
- Cost effectiveness is an important factor to consider when choosing between various hand surgical interventions. Health utility measures can be used to determine cost effectiveness. The SF-6D is a health utility index derived from 11 items of the SF-36 quality of life questionnaire; values range from 0.296 to 1.0 (“perfect” health). We evaluated the validity of the SF-6D in patients with carpal tunnel syndrome (CTS) who completed the SF-36 and the CTS symptom severity and functional status questionnaire before and 3 months after carpal tunnel release. Complete responses to the SF-6D items were available for 100 patients at baseline and 95 patients at baseline and follow-up. The mean SF-6D health utility index was 0.69 (SD 0.13) before surgery and 0.77 (SD 0.13) after surgery (moderate effect size). The SF-6D could discriminate between patient groups differing in self-rated global health and in whether, or not, they had a minimal clinically important improvement in CTS symptom severity after surgery. The SF-6D appears to be a valid measure of health utilities in patients with CTS and can be used in cost effectiveness studies.
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| 9. |
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| 10. |
- Bain, G. I., et al.
(författare)
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The functional range of motion of the finger joints
- 2015
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 40:4, s. 406-411
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to measure the functional range of motion of the finger joints needed to perform activities of daily living. Using the Sollerman hand grip function test, 20 activities were assessed in ten volunteers. The active and passive range of motion was measured with a computerized electric goniometer. The position of each finger joint was evaluated in the pre-grasp and grasp positions. The functional range of motion was defined as the range required to perform 90% of the activities, utilizing the pre-grasp and grasp measurements. The functional range of motion was 19 degrees-71 degrees, 23 degrees-87 degrees, and 10 degrees-64 degrees at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively. This represents 48%, 59%, and 60% of the active motion of these joints, respectively. There was a significant difference in the functional range of motion between the joints of the fingers, with the ulnar digits having greater active and functional range. The functional range of motion is important for directing indications for surgery and rehabilitation, and assessing outcome of treatment.
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| 11. |
- Bergfeldt, Ulla, et al.
(författare)
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Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients
- 2020
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 45:8, s. 807-812
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Tidskriftsartikel (refereegranskat)abstract
- The effects of spasticity-reducing surgery in the upper extremity were assessed in a prospective observational study of 30 consecutive patients with stroke (n = 13), incomplete spinal cord injury (n = 9), traumatic brain injury (n = 5), cerebral palsy (n = 2), and degenerative central nervous system disease (n = 1). Surgery, which included lengthening of tendons and release of muscles, was followed by early rehabilitation at three intensity levels depending on the patients’ specific needs and conditions. At 12 months follow-up there were significant improvements in all outcome measures with the following mean values: spasticity decreased by 1.4 points (Modified Ashworth Scale, 0–5), visual analogue pain score by 1.3 points, and both Canadian Occupational Performance Measures increased (performance by 3.4 and satisfaction by 3.6), and most measures of joint position or mobility improved. Hand surgery combined with early and comprehensive rehabilitation improves function, activity and patients’ satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year. Level of evidence: II. © The Author(s) 2020.
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| 12. |
- Berglund, Maria, 1975-, et al.
(författare)
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The inflammatory response and hyaluronan synthases in the rabbit flexor tendon and tendon sheath following injury
- 2007
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 32:5, s. 581-587
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Tidskriftsartikel (refereegranskat)abstract
- Using a rabbit model of flexor tendon injury, mRNA levels for a subset of relevant molecules involved in inflammatory and fibrotic processes were assessed by reverse transcriptase-polymerase chain reaction 3, 6, 12 and 24 days after injury. Increased levels of COX-2, IL-1beta, MMP-13 and TIMP-1 mRNA were detected in both tendon and tendon sheath following injury, with each molecule exhibiting tissue and time-dependent changes. MMP-13 and TIMP-1 mRNA levels were markedly upregulated in both tissues, whereas COX-2 and IL-1beta predominantly increased in tendon. Both hyaluronan synthase (HAS) 2 and 3 exhibited increases in mRNA levels in tendon tissue after injury, HAS 2 being more pronounced. These findings support the concept that healing in the flexor tendon and the sheath involve different molecular events and that each tissue may require unique modifications if healing is to be enhanced and adhesions reduced.
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| 13. |
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| 14. |
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| 15. |
- Bourke, Gráinne, et al.
(författare)
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Effects of early nerve repair on experimental brachial plexus injury in neonatal rats
- 2018
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 43:3, s. 275-281
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Tidskriftsartikel (refereegranskat)abstract
- Obstetrical brachial plexus injury refers to injury observed at the time of delivery, which may lead to major functional impairment in the upper limb. In this study, the neuroprotective effect of early nerve repair following complete brachial plexus injury in neonatal rats was examined. Brachial plexus injury induced 90% loss of spinal motoneurons and 70% decrease in biceps muscle weight at 28 days after injury. Retrograde degeneration in spinal cord was associated with decreased density of dendritic branches and presynaptic boutons and increased density of astrocytes and macrophages/microglial cells. Early repair of the injured brachial plexus significantly delayed retrograde degeneration of spinal motoneurons and reduced the degree of macrophage/microglial reaction but had no effect on muscle atrophy. The results demonstrate that early nerve repair of neonatal brachial plexus injury could promote survival of injured motoneurons and attenuate neuroinflammation in spinal cord.
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| 16. |
- Brogren, Elisabeth, et al.
(författare)
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Fractures of the distal radius in women aged 50 to 75 years: natural course of patient-reported outcome, wrist motion and grip strength between 1 year and 2-4 years after fracture.
- 2011
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 36E, s. 568-576
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Tidskriftsartikel (refereegranskat)abstract
- Fractures of the distal radius in postmenopausal women may cause prolonged pain and disability, but little is known about their natural course beyond the first year. In this study, women of 50-75 years of age, initially treated with cast or external fixation, were examined 1 year after distal radial fracture and then re-evaluated after a mean of 3 (range, 2-4) years. The evaluation included pain, disability (DASH) scores, grip strength and range of motion. In the 49 participating women pain scores, grip strength and range of motion improved significantly, although the mean improvement was moderate or small. In a subgroup of 13 patients with moderate or severe malunion, the 1 year DASH score was significantly worse than in the remaining patients but improved significantly together with grip strength and range of motion. After fractures of the distal radius, pain, grip strength and range of motion continued to improve beyond 1 year, up to 2-4 years. Patients with malunion had more disability at 1 year but showed significant improvement at 2-4 years.
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| 17. |
- Brown, Daniel J., et al.
(författare)
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Learning curves in Motec total wrist arthroplasty: an international cohort study
- 2023
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- We examined the learning curve of Motec total wrist arthroplasty (TWA) of six experienced surgeons in their first 30 cases. Three times more complications/revisions were encountered in the first half of the study compared with the second half. Motec TWA surgery should be concentrated in a smaller number of centres performing higher volumes.
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| 18. |
- Burkard, T, et al.
(författare)
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The association of bariatric surgery and Dupuytren's disease: a propensity score-matched cohort study
- 2022
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 47:3, s. 288-295
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to assess the association between bariatric surgery and incident Dupuytren’s disease (DD) using propensity score-matched cohort studies among Swedish nationwide healthcare registries. Patients aged 30–79 years who underwent bariatric surgery 2006–2019 were matched on their propensity scores, up to two obese bariatric surgery-free (unexposed) patients. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the risk of DD overall, in subgroups of age, sex, bariatric surgery type and duration of follow-up. Among 34,959 bariatric surgery patients and 54,769 propensity score-matched obese patients, the risk of DD was increased in bariatric surgery patients compared with obese unexposed patients (HR 1.30, 95% CI 1.02–1.65), among women (HR 1.36; 1.00–1.84); those undergoing gastric bypass (HR 1.33; 1.04–1.71) and those with >5 years follow-up (HR 1.63; 1.14–2.34). Our results suggest that substantial weight loss is associated with an increased risk of DD in an obese population. Level of evidence: III
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| 19. |
- Carlsson, Ingela, et al.
(författare)
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Cut-Off Value for Self-Reported Abnormal Cold Sensitivity and Predictors for Abnormality and Severity in Hand Injuries
- 2010
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 35E:5, s. 409-416
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Tidskriftsartikel (refereegranskat)abstract
- 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 >450 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.
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| 20. |
- Carlstedt, T
(författare)
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An overture to basic science aspects of nerve injuries
- 2011
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 36E36:9, s. 726-729
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Tidskriftsartikel (refereegranskat)abstract
- Does the lack of improvement in surgical treatment of nerve injury despite thousands of years of research disturb you? Do you think that basic science has not really contributed to any advancement in the treatment of nerve injury? Have you contributed? Do you think that new molecular biology knowledge in nerve injury and repair is important? Knowing from basic science that the immature nervous system is more fragile would you agree with the view that to be ‘aggressive’ in surgery of the newborn with a brachial plexus injury could be unscrupulous? As molecular biology of the nervous system has demonstrated that the best conditions for regeneration occur immediately after an injury do you find the approach of postponing surgery until at least 3 months after a closed nerve injury to be ignorant and even negligent? Taking into account the normal occurrence of inhibitory molecules in the uninjured peripheral nerve do you think that functional improvement from end to side nerve repair is a myth? Are the recent attempts to artificially enhance nerve regeneration for instance in synthetical conduits like nature seen ‘through a glass darkly’? Do you agree that new concepts in surgical treatment of nerve injury are timely? Do you have the time?
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| 21. |
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| 22. |
- Edsfeldt, Sara, et al.
(författare)
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In vivo flexor tendon forces generated during different rehabilitation exercises
- 2015
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 40:7, s. 705-710
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Tidskriftsartikel (refereegranskat)abstract
- We measured in vivo forces in the flexor digitorum profundus and the flexor digitorum superficialis tendons during commonly used rehabilitation manoeuvres after flexor tendon repair by placing a buckle force transducer on the tendons of the index finger in the carpal canal during open carpal tunnel release of 12 patients. We compared peak forces for each manoeuvre with the reported strength of a flexor tendon repair. Median flexor digitorum profundus force (24 N) during isolated flexor digitorum profundus flexion and median flexor digitorum superficialis force (13 N) during isolated flexor digitorum superficialis flexion were significantly higher than during the other manoeuvres. Significantly higher median forces were observed in the flexor digitorum superficialis with the wrist at 30° flexion (6 N) compared with the neutral wrist position (5 N). Median flexor digitorum profundus forces were significantly higher during active finger flexion (6 N) compared with place and hold (3 N). Place and hold and active finger flexion with the wrist in the neutral position or tenodesis generated the lowest forces; isolated flexion of these tendons generated higher forces along the flexor tendons.
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| 23. |
- Einarsson, Fredrik, 1968, et al.
(författare)
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Subscapularis muscle mechanics in children with obstetric brachial plexus palsy
- 2008
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Ingår i: The Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 33:4, s. 507-12
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the passive mechanical properties of the subscapularis muscle in children with a contracture as a result of obstetrical brachial plexus palsy. Muscle biopsies were harvested from nine children undergoing open surgery for shoulder contracture. Passive mechanical testing of single cells and muscle bundles was performed. Corresponding comparisons were made using muscle biopsies from seven healthy controls. Single muscle fibres from patients with obstetric brachial plexus palsy displayed a shorter slack sarcomere length, linear deformation of the fibre within a wider zone of sarcomere length and a greater relative increase in stiffness compared with muscle bundles. We conclude that secondary changes in muscle fibre properties will occur as a result of a longstanding lack of sufficient passive stretch, leading to compensatory changes in the extracellular matrix. These results suggest the presence of a dynamic feedback system constituting a muscle-to-extracellular matrix communication interface.
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| 24. |
- Engstrand, Fredrik, et al.
(författare)
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Validation of a smartphone application and wearable sensor for measurements of wrist motions
- 2021
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:10, s. 1057-1063
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Tidskriftsartikel (refereegranskat)abstract
- We developed a smartphone application to measure wrist motion using the mobile devices built-in motion sensors or connecting it via Bluetooth to a wearable sensor. Measurement of wrist motion with this method was assessed in 33 participants on two occasions and compared with those obtained with a standard goniometer. The test-retest reproducibility in healthy individuals ranged from good to excellent (intraclass correlation (ICC) 0.76-0.95) for all motions, both with and without the wearable sensor. These results improved to excellent (ICC 0.90-0.96) on the second test day, suggesting a learning effect. The day-to-day reproducibility was overall better with the wearable sensor (mean ICC 0.87) compared with the application without using sensor or goniometer (mean ICC 0.82 and 0.60, respectively). This study suggests that smartphone-based measurements of wrist range of motion are feasible and highly accurate, making it a powerful tool for outcome studies after wrist surgery.
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| 25. |
- Farnebo, Simon, 1972-, et al.
(författare)
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Hand surgery in Sweden
- 2017
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 42:5, s. 537-539
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
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| 26. |
- Farnebo, Simon, et al.
(författare)
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The research question: the What, Why and How in hand surgery
- 2024
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Identifying a good research question is one of the most important steps when laying the foundation of a research project. A good research question can aim to answer a hotly debated clinical issue, challenge a pre-existing dogma or make a contribution to specific aspects of a broader field of study. The difficulty in defining the question lies with pinpointing an important research topic or an area that is characterized by a lack of knowledge (the What), grasping the significance of how a precisely defined study can potentially impact on clinical practices (the Why) and determining the optimal study design tailored to answer the specific question (the How). These three domains constitute pivotal concepts in the process of shaping the research question.
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| 27. |
- Fridén, Jan, 1953, et al.
(författare)
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Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia
- 2019
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Ingår i: Journal of Hand Surgery-European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 44:4, s. 343-353
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Tidskriftsartikel (refereegranskat)abstract
- Reconstructive upper extremity surgeries in tetraplegia are technically challenging because of the many complicated real-time decisions that need to be made, e.g. extent of release of donor muscle-tendon complex, routing of donor muscles, tissue preparation and optimization, tensioning of muscle-tendon units, balancing joints and suturing tendon-to-tendon attachments. Nerve transfer surgeries can add functionality but also make the reconstruction planning more complex. In this overview, we present some of the fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function as well as early postoperative activity-based training in patients with cervical spinal cord injuries. We foresee an increased need for studies addressing combined nerve and tendon transfer reconstructions in parallel with patient-perceived outcome investigations. These should be combined with implementation of assistive technology such as functional electrical stimulation for diagnostic, prognostic and training purposes.
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| 28. |
- Fridén, Jan, 1953, et al.
(författare)
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The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape.
- 2015
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 40:3, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- Tendon transfers frequently require coaptation of two mismatched tendons. In this cadaver study, ultimate load, stiffness, and Young's modulus were measured in tendon-to-tendon attachments with mismatched donor and recipient tendons, using pronator teres (PT) to extensor carpi radialis brevis (ECRB) and flexor carpi ulnaris (FCU) to extensor digitorum communis (EDC). FCU-to-EDC attachments failed at higher loads than PT-to-ECRB attachments, but they had similar modulus and stiffness values. Ultimate tensile strength of the tendon attachments exceeded the maximum predicted contraction force of any of the transferred muscles, with safety factors of four-fold for the FCU-to-EDC and two-fold for the PT-to-ECRB transfers. This implies that size and shape mismatches should not be contraindications to tendon attachment in transfers. The strength safety factors suggest that postoperative immobilization of these transfers is unnecessary.
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| 29. |
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| 30. |
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| 31. |
- Garcia-Elias, Marc, et al.
(författare)
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Ligaments and muscles stabilizing the radio-ulno-carpal joint
- 2022
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 47:1, s. 65-72
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Tidskriftsartikel (refereegranskat)abstract
- The technical simplicity of the Darrach procedure may explain why it has been so popular. Excising the distal ulna, however, may have potentially undesired consequences to the biomechanics in two areas: the distal radioulnar and the ulno-carpal joints. These conjointly define the radio-ulno-carpal joint (RUCJ). The RUCJ is not a small and irrelevant articulation that can be removed without possibly paying a functional penalty. It is an important link of the antebrachial frame that provides stability to the distal forearm and the carpus. This article revisits the mechanisms by which some ligaments and muscles ensure that all forces about and within the RUCJ are dealt with efficiently.
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| 32. |
- Goransson, Ingrid, et al.
(författare)
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Hand function 5 years after treatment with collagenase Clostridium histolyticum injection for Dupuytrens disease
- 2021
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:9, s. 985-994
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to report hand function, disability and satisfaction and patients perception of functionally troublesome contractures 5 years after injection with collagenase Clostridium histolyticum and hand therapy for Dupuytrens disease. Data from 79 patients were collected before and at 3, 12 and 60 months after treatment. Hand function was significantly improved, and 70% achieved a functional range of motion in the treated hand. QuickDASH scores and range of motion were best at 3 months follow-up. At 60 months, mean total extension deficit was 48 degrees, which was 57% of the deficit before treatment. Thirty-seven patients (47%) had developed recurrent contractures in treated finger(s) meeting the criteria for new treatment. The threshold for functionally troublesome contractures was found to be 30 degrees-60 degrees in the finger joints. Treatment was experienced as painful, but few hand function problems occurred. Most patients would choose this treatment method again.
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| 33. |
- Gupta, Anil, et al.
(författare)
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Patient controlled regional analgesia after carpal tunnel release: a double-blind study using distal perineural catheters
- 2011
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Ingår i: JOURNAL OF HAND SURGERY-EUROPEAN VOLUME. - : Elsevier Science B. V., Amsterdam. - 1753-1934 .- 2043-6289. ; 36E:3, s. 219-225
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Tidskriftsartikel (refereegranskat)abstract
- This study was done to assess the efficacy of a perineural catheter for pain relief following carpal tunnel release (CTR). Sixty-six patients undergoing open CTR under local anaesthesia (LA) were randomly divided into three groups: Groups A and B had a perineural catheter and Group C served as non-blinded control group. Postoperative pain relief was by self-administration of either ropivacaine (Group A) or saline (Group B) via an elastometric pump and by oral paracetamol in Group C. Patients in Group A had a significantly greater difference in summed pain intensity than Group B. Fewer patients in Group A requested supplementary analgesics than in Group C. Patient satisfaction was higher in Group A than in Group B on day 1. However better analgesia was not associated with better functional recovery.
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| 34. |
- Gustafsson, Margareta, 1952-, et al.
(författare)
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Ten years follow-up of health and disability in people with acute traumatic hand injury : pain and cold sensitivity are long-standing problems
- 2011
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Ingår i: Journal of Hand Surgery - British and European Volume. - : SAGE Publications. - 0266-7681 .- 1532-2211. ; 36:7, s. 590-598
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate health and disability in people with acute traumatic hand injury 10 years after the accident. A consecutive sample of patients from the Department of Hand Surgery was followed up by means of a postal questionnaire containing the instruments EQ-5D for assessment of health and DASH for assessment of disability. Questions were added about cold sensitivity, numbness and aesthetic problems. The 97 people with various acute hand injuries had greater problems with impairments of hand function than with limitations of activities and participation in daily life. Pain was more common than among the general Swedish population. Cold sensitivity was reported by 78% and was associated with both worse impairments and greater limitations on activity and participation. Despite problems with pain and cold sensitivity, they reported good health and a low degree of disability.
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| 35. |
- Hagert, E, et al.
(författare)
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The role of proprioception and neuromuscular stability in carpal instabilities
- 2016
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 41:1, s. 94-101
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Tidskriftsartikel (refereegranskat)abstract
- Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.
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| 36. |
- Hardie, Claire, et al.
(författare)
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Demographics and deprivation in obstetric brachial plexus palsy : a retrospective cohort study
- 2024
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 49:5, s. 570-575
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Tidskriftsartikel (refereegranskat)abstract
- The present study analyses the relationships between deprivation and obstetric brachial plexus palsy (OBPP). A retrospective observational study was conducted of infants with OBPP seen between 2008 and 2020 (n = 321). The index of multiple deprivation (IMD) was used to assign an IMD rank to patients based on birth postcode and the relationship with OBPP was analysed, including deprivation, gestational diabetes, age at referral and at first assessment. Quintile-based analysis demonstrated over-representation of patients from more deprived neighbourhoods (n = 109, 39%) living in the top 20% most deprived neighbourhoods. A total of 48 (15%) mothers had diabetes and 98 (31%) infants underwent surgical brachial plexus exploration (a marker of disease severity). Neither diabetes, age at referral nor age at first assessment were associated with IMD score. This suggests that neighbourhood deprivation is associated with OBPP, though the mechanisms are unclear. Further studies in this area may enable targeted health intervention for more deprived maternal and infant groups.
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| 37. |
- Herren, Daniel B., et al.
(författare)
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Diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy: a Delphi study
- 2024
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289.
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this Delphi study was to provide a diagnostic and treatment algorithm for patients with persistent or recurrent symptoms after trapeziometacarpal joint resection arthroplasty. Three Delphi rounds were conducted in which surveys were sent to 182 experienced hand surgeons worldwide. Responses were received from 140 participants. A consensus threshold was set at 67% agreement. Diagnostic tools and treatment approaches for six common revision scenarios achieved consensus. Radiographs are appropriate as primary (97%) and CT scans as secondary (76%) diagnostic tools. For scaphometacarpal impingement, 67% of respondents agreed that revision interposition is appropriate, with 93% recommending autologous tendon for the interposition. Additional suspension was considered appropriate by 68% of the participants. The diagnostic and treatment algorithm can help the surgeon to identify the reason for persistent symptoms after trapeziometacarpal joint resection arthroplasty and to choose an appropriate treatment strategy.Level of evidence: V
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| 38. |
- Hultgren, T., et al.
(författare)
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Structural characteristics of the subscapularis muscle in children with medial rotation contracture of the shoulder after obstetric brachial plexus injury
- 2010
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Ingår i: Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1532-2211 .- 1753-1934 .- 2043-6289. ; 35:1, s. 23-28
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to obtain a better understanding of the cause of the medial rotation contracture of the shoulder after obstetric brachial plexus lesions by studying the morphology of the shortened subscapularis muscle. Muscle biopsy specimens were harvested from 13 children with obstetric brachial plexus palsy who underwent corrective surgery for the rotation contracture. The majority of the subscapularis muscle biopsy samples had an essentially normal morphology and showed a predominance of type I myosin heavy chain isoform, while one biopsy showed signs of marked fibrosis and a predominance of type II myosin heavy chain isoform. The findings support the assumption that shortening of the subscapularis is caused primarily by the nerve injury, which weakens the antagonistic lateral rotators, but that direct injury to the muscle might be a contributory factor.
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| 39. |
- Johan, Scheer, 1967-, et al.
(författare)
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Radioulnar laxity and clinical outcome after a distal radius fracture do not correlate after a distal radius fracture
- 2011
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Ingår i: Journal of Hand Surgery - British and European Volume. - : SAGE Journals online. - 0266-7681 .- 1532-2211. ; 36:6, s. 503-508
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Tidskriftsartikel (refereegranskat)abstract
- Injury to the triangular fibrocartilage complex associated with distal radius fracture may cause symptoms of ulnar instability. Assessed by a radioulnar stress test, increased laxity of the distal radio-ulnar joint has in two previous studies been depicted to be associated with poorer outcome. This prospective study of 40 adults investigates the correlation of this test with functional outcome as measured by DASH. No clinically significant difference was found in relation to this test at two and five years after injury. Therefore using this test alone to decide whether or not to perform an acute repair of the TFCC cannot be recommended.
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| 40. |
- Jonsson, K, et al.
(författare)
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Structures contributing to the shoulder contracture in brachial plexus birth palsy. An intraoperative biomechanical study
- 2022
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 47:3, s. 237-242
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Tidskriftsartikel (refereegranskat)abstract
- Internal rotation contracture of the shoulder is a common sequel of the brachial plexus birth palsy. The purpose of this study is to describe the surgical method used in our centre and to measure the effect of sequentially releasing several anatomical structures that have been ascribed as the cause of the contracture. Twenty-four consecutive patients were operated on with an open release. We documented the increase in passive external rotation after each surgical step. We found small gains in passive external rotation when performing coracoidectomy and division of the upper part of the subscapularis tendon; 4° (95% confidence interval [CI] 2°–6° p < 0.01) and 6° (95% CI 4°–8° p < 0.01), respectively. A substantial gain in external rotation occurred when dividing the entire subscapularis tendon, 43° (95% CI 38°–48°, p < 0.01). Our findings indicate that a clinically relevant surgical release of the contracture requires lengthening of the entire subscapularis musculo-tendinous unit. Level of evidence: IV
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| 41. |
- Jordan, Rupert, et al.
(författare)
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Functional deficits as a result of brachial plexus injury in anterior shoulder dislocation
- 2021
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:7, s. 725-730
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of brachial plexus injuries in anterior shoulder dislocation remains relatively uncommon. A retrospective study was conducted to observe the natural neurological recovery of patients following these injuries over a 2-year period. Muscle power according to the Medical Research Council scale and sensation were measured from presentation to discharge. In 28 patients, the power grade of proximal muscles supplied by nine injured nerves failed to improve over a median follow-up of 5 months. There was no statistically significant improvement in sensation over a median follow-up of 6 months. Poorer recovery in muscle power score was related to advancing age, whereby every decade increased the risk by approximately 30%. Anterior shoulder dislocation with a plexus injury carries a risk of permanent nerve injury. Patients should be referred for specialist nerve assessment leading to rehabilitation and timely early nerve reconstruction, if indicated. Level of evidence: IV
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| 42. |
- Jordan, Rupert, et al.
(författare)
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Re. Jordan R, Wade RG, McCauley G, Oxley S, Bains'R, Bourke G. Functional deficits as a result of brachial plexus injury in anterior shoulder dislocation.'J Hand Surg Eur. 2021, 46: 725-30 Reply
- 2022
-
Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 47:8, s. 877-877
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 43. |
- Kalbermatten, Daniel F, 1969-, et al.
(författare)
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Schwann cell strip for peripheral nerve repair
- 2008
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Ingår i: Journal of Hand Surgery - British and European Volume. - : SAGE Publications. - 0266-7681 .- 1532-2211. ; 33:5, s. 587-594
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Tidskriftsartikel (refereegranskat)abstract
- Many strategies have been investigated to provide an ideal substitute to treat a nerve gap injury. Initially, silicone conduits were used and more recently conduits fabricated from natural materials such as poly-3-hydroxybutyrate (PHB) showed good results but still have their limitations. Surgically, a new concept optimising harvested autologous nerve graft has been introduced as the single fascicle method. It has been shown that a single fascicle repair of nerve grafting is successful. We investigated a new approach using a PHB strip seeded with Schwann cells to mimic a small nerve fascicle. Schwann cells were attached to the PHB strip using diluted fibrin glue and used to bridge a 10-mm sciatic nerve gap in rats. Comparison was made with a group using conventional PHB conduit tubes filled with Schwann cells and fibrin glue. After 2 weeks, the nerve samples were harvested and investigated for axonal and Schwann cell markers. PGP9.5 immunohistochemistry showed a superior nerve regeneration distance in the PHB strip group versus the PHB tube group (> 10 mm, crossed versus 3.17+/- 0.32 mm respectively, P<0.05) as well as superior Schwann cell intrusion (S100 staining) from proximal (> 10 mm, crossed versus 3.40+/- 0.36 mm, P<0.01) and distal (> 10 mm, crossed versus 2.91+/- 0.31 mm, P<0.001) ends. These findings suggest a significant advantage of a strip in rapidly connecting a nerve gap lesion and imply that single fascicle nerve grafting is advantageous for nerve repair in rats.
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| 44. |
- Krayem, Mamoun, et al.
(författare)
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Cone-beam computed tomography for primary investigation of wrist trauma provides a new map of fractures of carpal bones
- 2021
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 46:6, s. 621-625
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Tidskriftsartikel (refereegranskat)abstract
- In 2016, our primary modality for radiological examination of wrist trauma, was changed from radiography to cone-beam computed tomography (CBCT). This is a retrospective survey of carpal bone fractures detected by CBCT during 6 months in 2016/2017, compared with those found on conventional radiographs during 6 months in 2013/2014. The incidence of carpal fractures was three times higher during the CBCT period (92/100,000 per year) compared with the radiography period (29/100,000 per year) and the spectrum of anatomical locations was different between the two periods, with fractures of the lunate (n = 6), trapezium (n = 9), trapezoid (n = 4) and capitate (n = 1) detected by CBCT, in contrast to no fractures of these bones diagnosed during the 6 months radiography period. We suggest a more liberal use of CBCT for examination of wrist trauma considering the benefits of being able to give patients a correct primary diagnosis, treatment and prognosis.
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| 45. |
- Lindqvist, Aron, 1964-, et al.
(författare)
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DASH and Sollerman test scores after hand injury from powered wood splitters
- 2011
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 36E:1, s. 57-61
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to describe the outcome after hand injury from powered wood splitters, and to investigate the relation between injury severity and outcome. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score method. The patients were evaluated with the Disabilities of the Arm Shoulder and Hand outcome questionnaire (DASH), and 26 of the most severely injured patients were evaluated with the Sollerman test. The mean DASH score was moderately elevated at 15, indicating that many of these patients have sequelae. A statistically significant correlation between HISS and DASH scores was found, implying that initial injury severity is of importance for outcome. The mean Sollerman score in the injured hand was 66, which amounts to a significantly impaired hand function.
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| 46. |
- Lundin, Anna-Carin, et al.
(författare)
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Trigger finger and tendinosis
- 2012
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 37:3, s. 233-236
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Tidskriftsartikel (refereegranskat)abstract
- The pathogenesis of trigger finger has generally been ascribed to primary changes in the pulley. Histological examination of the affected tendons has rarely been done. We studied biopsies from tendons of trigger fingers from 29 patients and compared these to biopsies from six intact tendons. We used a modified Movin score, which describes the tendinosis of the Achilles tendon. Trigger finger tendons had a high score (14.2; SD, 2.2) consistent with tendinosis, while the controls were almost normal (2.5; SD, 1.9). This suggests that the tendon is also affected, and that trigger finger is a form of tendinosis.
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| 47. |
- Lysak, Andrii, et al.
(författare)
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Muscle preservation in proximal nerve injuries: a current update
- 2024
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 49:6, s. 773-782
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Forskningsöversikt (refereegranskat)abstract
- Optimal recovery of muscle function after proximal nerve injuries remains a complex and challenging problem. After a nerve injury, alterations in the affected muscles lead to atrophy, and later degeneration and replacement by fat-fibrous tissues. At present, several different strategies for the preservation of skeletal muscle have been reported, including various sets of physical exercises, muscle massage, physical methods (e.g. electrical stimulation, magnetic field and laser stimulation, low-intensity pulsed ultrasound), medicines (e.g. nutrients, natural and chemical agents, anti-inflammatory and antioxidants, hormones, enzymes and enzyme inhibitors), regenerative medicine (e.g. growth factors, stem cells and microbiota) and surgical procedures (e.g. supercharge end-to-side neurotization). The present review will focus on methods that aimed to minimize the damage to muscles after denervation based on our present knowledge.
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| 48. |
- McEachan, Jane E., et al.
(författare)
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Round table discussion: the management of idiopathic cubital tunnel syndrome
- 2024
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289.
-
Tidskriftsartikel (refereegranskat)abstract
- Idiopathic cubital tunnel syndrome is the second most common neuropathy in the upper limb. Best evidence regarding the surgical management of this condition has evolved from anterior or submuscular transposition as the former reference standard, to in situ simple release. Differences of opinion remain regarding the timing of surgery, type of surgery and adjunctive surgery. Four surgeons with Level 5 expertise were asked to answer specific questions regarding this condition.
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| 49. |
- McEachan, Jane E., et al.
(författare)
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Round table discussion : the management of idiopathic cubital tunnel syndrome
- 2024
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289.
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Tidskriftsartikel (refereegranskat)abstract
- Idiopathic cubital tunnel syndrome is the second most common neuropathy in the upper limb. Best evidence regarding the surgical management of this condition has evolved from anterior or submuscular transposition as the former reference standard, to in situ simple release. Differences of opinion remain regarding the timing of surgery, type of surgery and adjunctive surgery. Four surgeons with Level 5 expertise were asked to answer specific questions regarding this condition.
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| 50. |
- Miller, Robert, et al.
(författare)
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Insights and trends review: artificial intelligence in hand surgery
- 2023
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 48:5, s. 396-403
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Forskningsöversikt (refereegranskat)abstract
- Artificial intelligence (AI) in hand surgery is an emerging and evolving field that will likely play a large role in the future care of our patients. However, there remain several challenges to makes this technology meaningful, acceptable and usable at scale. In this review article, we discuss basic concepts in AI, including challenges and key considerations, provide an update on how AI is being used in hand and wrist surgery and propose potential future applications. The aims are to equip clinicians and researchers with the basic knowledge needed to understand and explore the incorporation of AI in hand surgery within their own practice and recommends further reading to develop knowledge in this emerging field.
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