Explore the vast range of titles available.

Strain sensors capable of monitoring complex human motions are highly desirable for the development of wearable electronic devices and healthcare monitoring systems. Excellent sensitivity and a wide working range of the sensor material are important requirements for distinguishing dynamic human motion. In this study, a highly stretchable strain sensor was fabricated via inkjet printing of single-walled carbon nanotube (SWCNT) thin films on a stretchable polydimethylsiloxane substrate. The sensor was attached to the metacarpophalangeal (MCP) joint of the hand in 12 healthy male subjects. The subjects placed their hands next to a conventional goniometer and flexed the MCP joint to predetermined angles. A linear relationship was found between the change in the length of the strain sensor and the intended angle of the MCP joint. The fabricated thin films showed high durability during repeated cycling (1,000 cycles) and good sensitivity with a gauge factor of 2.75. This study demonstrates that the newly developed stretchable CNT strain sensor can be used for effectively measuring MCP joint angles. This sensor may also be useful for the analysis of complex and dynamic hand motions that are difficult to measure using a conventional goniometer.

Mechanical and biochemical bone properties are influenced by muscles. However, the muscle-bone interaction has not been fully elucidated regarding the upper extremities. The objective of the present study was to evaluate the mechanical muscle-bone interaction at the forearm by evaluating the relationship between the properties of three-dimensional (3D) forearm cortical bone models derived from conventional computed tomography (CT) images and handgrip strength (HGS). A total of 108 women (mean age, 75.2 ± 9.4 years; range, 62-101 years) with a distal radius fracture who took conventional CT scans for the assessment of the fracture were included in this study. Distal radius 3D models were reconstructed and the average cortical bone density (Cd) and thickness (Ct) of the region of interest (ROI), which might be affected by the forearm flexor muscles, were calculated using a 3D modeling software. Clinical parameters including HGS, lumbar and hip bone mineral densities (BMDs), and other demographic factors were also obtained. A multivariate linear regression analysis was performed to identify relevant factors associated with HGS. HGS was found to be independently associated with height and Cd, but no significant difference was found between HGS and Ct, age, weight, as well as lumber and hip BMDs. Cortical bone density might be associated with HGS, which is generated by the forearm flexor muscles. Hence, the mechanical muscle-bone interaction in the upper extremities could be supported by the present study.

Post-traumatic posterolateral rotatory instability (PLRI) can be shown as radiocapitellar incongruity or posterior translation (PT) of the radial head in magnetic resonance imaging (MRI). We aimed to evaluate whether PT correlated with pathologic changes of lateral elbow stabilizers in patients with lateral epicondylitis. In MRIs of 160 patients with lateral epicondylitis, we measured PT of the radial head in the sagittal images. We qualitatively graded five lesions of the lateral elbow structures that included common extensor tendon (CET) lesion (grade 1-3), lateral collateral ligament complex (LCLC) insufficiency (grade 0-2), and absence or presence of bone marrow signal change, osteochondral lesion, and calcification. We analyzed whether the PT correlated with pathologic changes of the lateral elbow stabilizers and evaluated the diagnostic value of the PT for severe lesions. The average PT was 1.9 mm. The PT correlated with both the CET lesion (p < 0.001) and LCLC insufficiency (p 3.4mm as suggested for post-traumatic PLRI, 21 patients had potential PLRI. The positive predictive values of the PT > 3.4mm were 76% for grade 3 CET lesions and 67% for grade 2 LCLC insufficiency. This study demonstrates that PT of the radial head correlates with pathological changes of the lateral elbow stabilizers. As radiocapitellar incongruity is easy to measure quantitatively, it can be used for screening potential PLRI in patients with lateral epicondylitis.

Patients with carpal tunnel syndrome (CTS) often show bilaterally increased pain sensitivity and widespread symptoms. We evaluated the influence of centrally mediated symptoms on functional outcomes of carpal tunnel release (CTR). A total of 120 patients with surgically treated CTS were enrolled. Centrally mediated symptoms were preoperatively measured by administering a self-reported central sensitization inventory (CSI) questionnaire and peripheral sensitization was measured by assessing patient’s pressure pain thresholds (PPT) in the forearm. Boston Carpal Tunnel Questionnaires (BCTQ) were assessed preoperatively and postoperatively at 3 and 12 months. CSI scores slightly correlated with symptom duration and moderately correlated with preoperative BCTQ scores, while PPT slightly correlated with the BCTQ scores. At 3 months, BCTQ symptom and function scores moderately correlated with lower PPTs and higher CSI scores. At 12 months, only severe electrophysiological grade was associated with BCTQ function scores. Multivariable analysis revealed that preoperative PPT, CSI, and female gender were associated with BCTQ scores at 3 months; these factors failed to be associated for 12-month outcomes. Centrally mediated symptoms measured by CSI and peripheral sensitization measured by PPTs correlated with symptom severity and duration. They were associated with poorer functional outcomes after CTR up to 3 months. However, they did not show persistent effects in the long term.

Patients presenting with tears of the triangular fibrocartilage complex (TFCC) can have ulnar positive variance, for which the clinical relevance to concomitant ulnar impaction syndrome (UIS) may be unclear. We hypothesized that maximum standardized uptake value (SUVmax), a semiquantitative single-photon-emission computed tomography/computed tomography (SPECT/CT) value, would distinguish between the traumatic TFCC tear and degenerative TFCC tear associated with the UIS. This study aimed to compare SUVmax between patients with TFCC tear only and patients with TFCC tear and UIS. A total of 26 patients presenting with TFCC tears on magnetic resonance imaging (MRI) underwent semiquantitative SPECT/CT examinations. The diagnosis of concomitant UIS was made based on positive ulnar impaction tests and MRI findings. We compared the SUVmax between patients with and without concomitant UIS. We also calculated the cutoff value for the diagnosis of UIS using receiver operating characteristic curve analysis. Of 26 patients, 14 had concomitant UIS, and 12 had TFCC tears only. The SUVmax was significantly higher in patients with concomitant UIS than in those without UIS (p = 0.048). With a SUVmax cutoff value of 4.09 for UIS, sensitivity of 67% and specificity of 82% were obtained. In the semiquantitative SPECT/CT examinations of patients with TFCC tears, those with concomitant UIS had a higher SUVmax than those without UIS. Semiquantitative SPECT/CT can be helpful in confirming concomitant UIS in patients with TFCC tears.

Ulnar impaction syndrome (UIS) is a common source of ulnar-sided wrist pain, yet not all cases of radiographic ulnar impaction are symptomatic. We retrospectively analyze clinical or radiologic factors that affect prognoses of conservative treatment for idiopathic UIS. A total of 114 patients who had been diagnosed with UIS were treated with 6 weeks of short arm orthosis followed by formal physiotherapy for 6 weeks, with lifestyle modification to limit aggravating movements. The response to treatment, including pain numeric rating scale on an ulnar provocation test, grip strength, Disability of the Arm, Shoulder, and Hand score (DASH), was assessed at 24-week follow-up. For the 24-week follow-up, 29 patients (25%) underwent ulnar shortening osteotomy due to persistent symptoms after conservative treatment, and 18 (16%) patients had pain scores of greater than 5, but they had not undergone surgery. After controlling for confounding variables, female gender (odds ratio (OR) 1.39), duration of symptom (OR 1.27), high pain NRS score on provocation test (OR 1.45), and enhanced carpal or distal ulna bone on MRI (OR 1.82) were associated with a higher likelihood of treatment failure. Knowledge of the factors offers physicians insight into predicting prognoses and helps patients set realistic expectations.

The Neer type II distal clavicle fracture is notorious for its high nonunion rate, and surgical treatment is usually recommended. We reviewed articles from January 1990 to September 2009, and among them, 425 cases from 21 studies were included. According to the 425 cases in the literature, sixty patients were treated nonsurgically and 365 surgically. From 365 patients who were treated surgically, 105 were identified as receiving the coracoclavicular stabilization, 162 hook plate, 42 intramedullary fixation, 16 interfragmentary fixation, and 40 K-wire plus tension band wiring. The nonsurgical treatment resulted in 20 (33.3%) nonunions and 4 (6.7%) other complications. The surgical treatment resulted in 6 (1.6%) nonunions, 81 (22.2%) complications other than nonunion. The nonunion rate was significantly high with nonsurgical treatment ( p < 0.001), and the complication rate was statistically high with surgery ( p = 0.002). With surgical treatment, the nonunion rate was not significantly different among the modalities ( p = 0.391). The complication rate was significantly higher in cases of the hook plate (40.7%) and the K-wire plus tension band wiring (20.0%) than those of the coracoclavicular stabilization (4.8%), the intramedullary (2.4%) and the interfragmentary fixation (6.3%). For the nonsurgical treatment, the functional outcomes were generally acceptable despite the high nonunion rate. The nonsurgical treatment could be considered as the first line treatment after sufficient counsel with the patient. The nonunion rate is high, however, the functional outcome is acceptable in most of the cases with nonunion. If the surgical treatment is considered, the intramedullary screw fixation, CC stabilization and interfragmentary fixation would be preferred because of their low complication rate.

Osteoarthritis (OA) of the trapeziometacarpal joint (TMCJ) can be caused by biomechanical wear on the articular cartilage due to high joint contact pressure, leading to severe pain in the thumb. Static orthoses have been applied for treatment in the early stages of OA to immobilize the TMCJ in the comfortable posture without considering contact pressure at the TMCJ, resulting in a high failure rate of pain relief during splinting. To ensure successful treatment, it is desirable to immobilize the TMCJ in an optimal posture that minimizes biomechanical joint contact pressure. This paper presents a patient-specific TMCJ orthosis design for the optimal posture, based on joint contact pressure obtained from a computed tomography (CT) image-based finite element (FE) TMCJ model. The estimated pressure at the subject-specific optimal posture averaged 2.8E-3 MPa, which was lower compared to the average pressure of 3.2E-2 MPa at the non-optimal but comfortable posture. To maintain this subject-specific optimal TMCJ posture, the orthosis was designed based on individual hand geometries with three-dimensional (3D) printing technology. The 3D-printed orthosis was preliminarily evaluated by patients with moderate to severe OA, and all patients reported pain relief. The Visual Analog Scale (VAS) and Disabilities of Arm, Shoulder, and Hand (DASH) scores improved by 1.8 1.7 and 13.1 5.4, respectively. For orthotic treatment in clinics, the FE model-based TMCJ orthosis design for the subject-specific optimal posture is beneficial in achieving relief of pain caused by OA.

Background Psychologic distress contributes to symptom severity in patients with several musculoskeletal disorders. While numerous shoulder outcome instruments are used it is unclear whether and to what degree psychologic distress contributes to the scores. Questions/purposes We asked (1) to what degree shoulder outcome instruments reflect patients’ psychologic distress, and (2) whether patients who are strongly affected by psychologic distress can be identified. Methods We prospectively evaluated 119 patients with chronic shoulder pain caused by degenerative or inflammatory disorders using the Constant-Murley scale, Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. To evaluate psychologic distress, we measured depression using the Center for Epidemiologic Studies-Depression (CES-D) scale and pain anxiety using the Pain Anxiety Symptom Scale (PASS). Demographic and clinical parameters, such as pain scores, ROM, and abduction strength, also were measured. We then assessed the relative contributions made by psychologic distress and other clinical parameters to the quantitative ratings of the three shoulder outcome instruments. Results Quantitative ratings of shoulder outcome instruments correlated differently with psychologic distress. Constant-Murley scores did not correlate with psychologic measures, whereas SST scores correlated with PASS (r = 0.32) and DASH scores correlated with PASS and CES-D (r = 0.36 and r = 0.32). Psychologic distress contributed to worsening SST and DASH scores but not to Constant-Murley scores. DASH scores were more strongly influenced by pain anxiety and depression than the other two outcome instruments. Conclusions Shoulder outcome measures reflected different psychologic aspects of illness behavior, and the contributions made by psychologic distress to different shoulder outcome instruments apparently differed. Physicians should select and interpret the findings of shoulder outcome instruments properly by considering their psychologic implications. Level of Evidence Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

Background The aims of this study were to propose a novel implant design for the proximal interphalangeal joint (PIPJ) of the hand using a rolling contact joint (RCJ) mechanism and to derive an optimal implant design based on human PIPJ kinematics. Methods In total, 10 participants with normal PIPJs were enrolled in this study. True lateral finger radiographs were obtained in 10° increments from 0º (full extension) to 120° flexion of PIPJ. Radiographs were used to determine the average center of rotation, which formed the basis of a mathematical expression of the PIPJ kinematics. The variations in extensor tendon excursions in relation to the range of motion of PIPJ were determined using results from previous cadaveric studies. As the next step, a PIPJ implant design using an RCJ mechanism that was most consistent with the mathematically expressed PIPJ kinematics and tendon excursions was determined using a constrained optimization algorithm. Results The final proposed PIPJ implant had a relatively constant center of rotation over the entire PIPJ range of motion among the participants. In addition, the extensor tendon excursions of the proposed implant as applied to the phalangeal bones were similar to those of the human tendon. The proposed PIPJ implant achieved an acceptable position of the RCJ surface on the proximal and middle phalanges, which was derived from the constrained optimization algorithm. Conclusions A novel PIPJ implant design using an RCJ mechanism demonstrated acceptable outcomes in terms of PIPJ human kinematics and tendon excursions.