Harm P. Slijper

Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: A randomized controlled trial

BACKGROUND Both trapeziectomy with ligament reconstruction and tendon interposition and trapeziometacarpal arthrodesis are commonly performed procedures for the treatment of trapeziometacarpal osteoarthritis. The purpose of this study was to compare the outcomes of both treatments for symptomatic osteoarthritis of the thumb trapeziometacarpal joint in a randomized trial. METHODS Women who were forty years of age or older were randomized either to trapeziectomy with ligament reconstruction and tendon interposition or to arthrodesis with plate and screws. Patients were evaluated preoperatively and at three and twelve months postoperatively with respect to pain, function (Patient-Rated Wrist/Hand Evaluation [PRWHE] and Disabilities of the Arm, Shoulder and Hand [DASH] questionnaires), joint motion, strength, complication rate, and patient satisfaction. RESULTS Forty-three patients were enrolled. Since we found significantly more moderate and severe complications following arthrodesis compared with trapeziectomy with ligament reconstruction and tendon interposition (71% versus 29%; p = 0.016), the study was prematurely terminated before the sample size necessary to validly compare the two groups was reached. The higher complication rate for arthrodesis led to an increase in revision surgery (two of seventeen patients). Significantly more patients in the ligament reconstruction and tendon interposition group (86%) than in the arthrodesis group (53%) indicated they would consider the same surgery again under the same circumstances (p = 0.025). In both groups, PRWHE and DASH scores significantly improved over time; however, comparison of the groups showed that the results were similar. CONCLUSIONS Women who are forty years or older with trapeziometacarpal osteoarthritis have fewer moderate and severe complications after trapeziectomy with ligament reconstruction and tendon interposition and are more likely to consider the surgery again under the same circumstances than are those who undergo arthrodesis. Twelve months after surgery, the PRWHE and DASH scores were similar in both groups. We do not recommend routine use of arthrodesis with plate and screws in the treatment of women who are forty years or older with stage-II or III trapeziometacarpal osteoarthritis.

Differences in muscle load between computer and non-computer work among office workers

Introduction of more non-computer tasks has been suggested to increase exposure variation and thus reduce musculoskeletal complaints (MSC) in computer-intensive office work. This study investigated whether muscle activity did, indeed, differ between computer and non-computer activities. Whole-day logs of input device use in 30 office workers were used to identify computer and non-computer work, using a range of classification thresholds (non-computer thresholds (NCTs)). Exposure during these activities was assessed by bilateral electromyography recordings from the upper trapezius and lower arm. Contrasts in muscle activity between computer and non-computer work were distinct but small, even at the individualised, optimal NCT. Using an average group-based NCT resulted in less contrast, even in smaller subgroups defined by job function or MSC. Thus, computer activity logs should be used cautiously as proxies of biomechanical exposure. Conventional non-computer tasks may have a limited potential to increase variation in muscle activity during computer-intensive office work.

Adaptation of the cervico- and vestibulo-ocular reflex in whiplash injury patients

The aim of this study was to investigate the underlying mechanisms of the increased gains of the cervico-ocular reflex (COR) and the lack of synergy between the COR and the vestibulo-ocular reflex (VOR) that have been previously observed in patients with whiplash-associated disorders (WAD). Eye movements during COR or VOR stimulation were recorded in four different experiments. The effect of restricted neck motion and the relationship between muscle activity and COR gain was examined in healthy controls. The adaptive ability of the COR and the VOR was tested in WAD patients and healthy controls. Reduced neck mobility yielded an increase in COR gain. No correlation between COR gain and muscle activity was observed. Adaptation of both the COR and VOR was observed in healthy controls, but not in WAD patients. The increased COR gain of WAD patients may stem from a reduced neck mobility. The lack of adaptation of the two stabilization reflexes may result in a lack of synergy between them. These abnormalities may underlie several of the symptoms frequently observed in WAD, such as vertigo and dizziness.

The effects of pause software on the temporal characteristics of computer use.

The study investigated the natural work–pause pattern of computer users and the possible effects of imposing pause regimes on this pattern. Hereto, the precise timing of computer events was recorded across a large number of days. It was found that the distribution of the pause durations was extremely skewed and that pauses with twice the duration are twice less likely to occur. The effects of imposing pause regimes were studied by performing a simulation of commercially available pause software. It was found that depending on the duration of the introduced pause, the software added 25–57% of the pauses taken naturally. Analysis of the timing of the introduced pauses revealed that a large number of spontaneous pauses were taken close to the inserted pause. Considering the disappointing results of studies investigating the effects of introducing (active) pauses during computer work, this study has cast doubt on the usefulness of introducing short duration pauses.

Computer work duration and its dependence on the used pause definition

Several ergonomic studies have estimated computer work duration using registration software. In these studies, an arbitrary pause definition (Pd; the minimal time between two computer events to constitute a pause) is chosen and the resulting duration of computer work is estimated. In order to uncover the relationship between the used pause definition and the computer work duration (PWT), we used registration software to record usage patterns of 571 computer users across almost 60,000 working days. For a large range of Pds (1-120 s), we found a shallow, log-linear relationship between PWT and Pds. For keyboard and mouse use, a second-order function fitted the data best. We found that these relationships were dependent on the amount of computer work and subject characteristics. Comparison of exposure duration from studies using different pause definitions should take this into account, since it could lead to misclassification. Software manufacturers and ergonomists assessing computer work duration could use the found relationships for software design and study comparison.

Statistics Predict Kinematics of Hand Movements During Everyday Activity

Bayesian decision theory suggests that the statistics of an individuals actions (prior experience) play an important role in motor control and execution. To elucidate this relation, we recorded 7 million mouse movements made by a group of 20 computer users across a 50-day work period, allowing us to estimate the prior distribution of spontaneous hand movements. We found that the most frequent movements were in cardinal directions. The shape of this distribution was participant-specific but constant over time and independent of the computer that the participant used. This nonuniform directional distribution allowed us to predict systematic errors in initial movement directions, which matched well with the actual data. This shows how movement statistics can influence hand kinematics.

Assessment of Velocity, Range, and Smoothness of Wrist Circumduction Using Flexible Electrogoniometry

PURPOSE To quantify the range, velocity, and smoothness of wrist circumduction, to explore the oblique functional plane of wrist circumduction, and to establish the reproducibility and reliability of these measures. METHODS Forty healthy subjects with a mean age of 43 years and without a history of wrist pathology or pain participated in this study. We used a flexible electrogoniometer with a twin-axis sensor to measure the relative angles between the 2 end blocks while the subject performed maximum excursion of flexion-extension, radioulnar deviation, and circumduction of the wrist held in a standardized, fully pronated position. A software package was used to further analyze the characteristics of the circumduction curve or oval such as the mean area (designated as degree-degree or oo) shape, size, rate, smoothness, and orientation. RESULTS The mean area of circumduction (4729 [degree-degree]) and circumference (265°) of the circumduction curve indicated the total range of circumduction. The velocity of circumduction (mean 179°/s) and the time (1.6 second) taken to complete 1 cycle of circumduction were similar in both hands. The 4 quadrants for the velocity of circumduction showed that the velocity was faster in the radioulnar deviation quadrants compared with flexion and extension. Quadrant analysis showed the smoothness was greater in the radioulnar deviation quadrants than in the flexion and extension quadrants. The oblique planes of the circumduction curves of all the normal wrists lie in ulnopalmar and radiodorsal direction with a mean angle of 28° to the vertical flexion and extension plane. CONCLUSIONS This technique was accurate and reliable in measuring the velocity, range, and smoothness of wrist circumduction.

Comparison of Arthroplasties With or Without Bone Tunnel Creation for Thumb Basal Joint Arthritis: A Randomized Controlled Trial

PURPOSE To compare the results for treatment of basal thumb osteoarthritis with and without the use of a bone tunnel at the base of the first metacarpal. METHODS Women aged 40 years or older with stage IV osteoarthritis were randomized to 1 of 2 treatments. Patients were evaluated preoperatively and postoperatively at 3 and 12 months by assessing pain, outcome function measures, range of motion, strength, time to return to work or activities, satisfaction with the results, and complication rate. RESULTS A total of 79 patients were enrolled in this study. Three months after surgery, Patient-Rated Wrist and Hand Evaluation pain and total scores were significantly improved in the bone tunnel group compared with the tunnel-free group. At 12 months, however, we found no significant differences for all outcome scores between groups. In addition, we observed no significant differences between groups in strength, duration to return to work or activities, patient satisfaction, and complication rates. CONCLUSIONS After the bone tunnel technique, patients have better function and less pain 3 months after surgery than do those in the non-bone tunnel group, which indicates faster recovery. However, 12 months after surgery, the functional outcome was similar. Because of faster recovery, we prefer the bone tunnel technique in the treatment of stage IV osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.

Comparative Effectiveness of Percutaneous Needle Aponeurotomy and Limited Fasciectomy for Dupuytren's Contracture: A Multicenter Observational Study.

Background: Percutaneous needle aponeurotomy is a less invasive surgical alternative to limited fasciectomy for Dupuytren’s contracture, but appeared less efficacious in a previous randomized clinical trial. This study compared the effectiveness of both techniques in contemporary clinical practice. Methods: The authors evaluated prospectively gathered data from all patients who were treated with percutaneous needle aponeurotomy or limited fasciectomy between 2011 and 2014 at six hand surgery practice sites in The Netherlands. The degree of total active extension deficit, Michigan Hand Outcomes Questionnaire subscores, and complications evaluated at 6 to 12 weeks after treatment were compared after propensity score–based inverse-probability weighting to account for the differences in baseline characteristics between the treatment groups. Results: After inverse-probability weighting, 78 percutaneous needle aponeurotomy patients and 103 limited fasciectomy patients remained with similar characteristics (88 percent Tubiana grade I or II). The degree of total residual extension deficit at follow-up was similar between the weighted groups (percutaneous needle aponeurotomy, 21 degrees; limited fasciectomy, 18 degrees; p = 0.330). Furthermore, percutaneous needle aponeurotomy was associated with a lower mild complication rate (percutaneous needle aponeurotomy, 5.2 percent; limited fasciectomy, 24.3 percent; p < 0.001) and larger increases in the subdomain scores of satisfaction (p < 0.001), work performance (p < 0.001), activities of daily living (p = 0.009), and overall hand function (p = 0.001). Conclusions: This multicenter observational study found that, among patients with mildly to moderately affected digits, percutaneous needle aponeurotomy reduced contractures as effectively as limited fasciectomy does in clinical practice. Furthermore, percutaneous needle aponeurotomy provided a more rapid functional recovery and had a lower rate of mild complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Trapeziometacarpal Arthrodesis or Trapeziectomy with Ligament Reconstruction in Primary Trapeziometacarpal Osteoarthritis: A 5-Year Follow-Up

PURPOSE To compare the long-term outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with trapeziometacarpal arthrodesis for osteoarthritis (OA) of the basal thumb joint. METHODS Patients were evaluated for pain, daily functioning, strength, and complications after a mean follow-up of 5.3 years. Generalized estimating equations statistics were used to compare repeated measurements over time in both groups. RESULTS After 5 years, patients who had trapeziectomy with LRTI had significantly better pain reduction and function than the arthrodesis group. Pain and function in the LRTI group continued to improve compared with the results 1 year after surgery, whereas the arthrodesis group did not change. Grip and pinch strength were higher than 1 year after surgery but were not different between groups. In the arthrodesis group, 1 patient was reoperated for nonunion between 1 year and a mean of 5 years after surgery, resulting in a total of 18% nonunion. Another patient underwent reoperation for hardware-related pain. One patient from each group required reoperation because of pain due to scaphotrapeziotrapezoid OA. CONCLUSIONS Trapeziectomy with LRTI leads to better pain reduction and functional outcome after between 1 and 5 years compared with trapeziometacarpal arthrodesis in women over 40 years old with OA stages II to III. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.