Stéphanie J. E. Becker

Abbreviated psychologic questionnaires are valid in patients with hand conditions.

BackgroundThe Pain Catastrophizing Scale (PCS) and Short Health Anxiety Inventory (SHAI) can help hand surgeons identify opportunities for psychologic support, but they are time consuming. If easier-to-use tools were available and valid, they might be widely adopted.Questions/purposesWe tested the validity of shorter versions of the PCS and SHAI, the PCS-4 and the SHAI-5, by assessing: (1) the difference in mean scaled scores of the short and long questionnaires; (2) floor and ceiling effects between the short and long questionnaires; (3) correlation between the short questionnaires and the outcome measures (an indication of construct validity); and (4) variability in disability and pain, between the short and long questionnaires.MethodsOne hundred sixty-four new or followup adult patients in one hand surgery clinic completed the SHAI-18, SHAI-5, PCS-13, PCS-4, Patient Health Questionnaire (PHQ)-9, PHQ-2, DASH, and QuickDASH questionnaires, and an ordinal pain scale, as part of a prospective cross-sectional study. Mean scores for the short and long questionnaires were compared with paired t-tests. Floor and ceiling effects were calculated. Pearson’s correlation was used to assess the correlation between the short and long questionnaires and with outcome measures. Regression analyses were performed to find predictors of pain and disability.ResultsThere were small, but significant differences between the mean scores for the DASH and QuickDASH (QuickDASH higher), SHAI-18 and SHAI-5 (SHAI-18 higher), and PCS-13 and PCS-4 (PCS-4 higher), but not the PHQ-9 and PHQ-2. Floor effects ranged between 0% and 65% and ceiling effects between 0% and 3%. There were greater floor effects for the PHQ-2 than for the PHQ-9, but floor and ceiling effects were otherwise comparable for the other short and long questionnaires. All questionnaires showed convergent and divergent validity and criterion validity was shown in multivariable analyses.ConclusionsContent validity, construct convergent validity, and criterion validity were established for the short versions of the PCS and SHAI. Using shorter forms creates small differences in mean values that we believe are unlikely to affect study results and are more efficient and advantageous because of the decreased responder burden.Level of EvidenceLevel III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Validation of Phone Administration of Short-Form Disability and Psychology Questionnaires

PURPOSE To assess whether there was a difference in score between paper and telephone administration of disability and psychological questionnaires relevant to patients with an upper extremity illness. METHODS The short version of the Disabilities of the Arm, Shoulder, and Hand score, the 5-question version of the Short Health Anxiety Inventory, the 4-question version of the Pain Catastrophizing Scale, the Patient Health Questionnaire-2, and an ordinal pain scale were completed by 135 patients both in the office and the next day over the phone. We compared scores with repeated measures analysis of variance and Pearson correlation. We used intraclass correlation coefficients to test the level of agreement. RESULTS There were small but significant differences between paper and phone administration of the short version of the Disabilities of the Arm, Shoulder, and Hand scores and pain scores, but not the Patient Health Questionnaire-2, Short Health Anxiety Inventory-5, and Pain Catastrophizing Scale-4. There was a large Pearson correlation and excellent intraclass correlation coefficient agreement, as well. CONCLUSIONS Shorter questionnaires can be used to assess disability and psychological factors by phone. Phone administration of measures of disability and psychological factors can replace paper administration in studies that do not require in-person examination.

Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome

This prospective study measured and compared the diagnostic performance characteristics of various clinical signs and physical examination manoeuvres for carpal tunnel syndrome (CTS), including the scratch collapse test. Eighty-eight adult patients that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Attending surgeons documented symptoms and results of standard clinical manoeuvres. The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen’s test (67%), Durkan’s test (77%), Tinel’s test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan’s test (18%) and CTS-6 lax (13%). The sensitivity of the scratch collapse test was not superior to other clinical signs and physical examination manoeuvers for CTS, and the specificity of the scratch collapse test was superior to that of Durkan’s test and CTS-6 lax. Further studies should seek to limit the influence of a patient’s clinical presentation on scratch test performance and assess the scratch test’s inter-rater reliability.

Changes in treatment plan for carpal tunnel syndrome based on electrodiagnostic test results

This study evaluated how often the treatment plan for carpal tunnel syndrome (CTS) changed based on electrodiagnostic test results. Secondly, we assessed factors associated with a change in the treatment plan for CTS. One-hundred-and-thirty English-speaking adult patients underwent electrodiagnostic testing in a prospective cohort study. Treatment plan was recorded before and after testing. Treatment plan changed in 25 patients (19%) based on electrodiagnostic test results. The plan for operative treatment before testing decreased significantly after testing (83% versus 72%). The best logistic regression model for no change in treatment plan included a prolonged or non-recordable median distal sensory latency (normal, prolonged, or non-recordable), and explained 24% of the variation. For surgeons that manage CTS on the basis of objective pathophysiology rather than symptoms, electrodiagnostic test results often lead to changes in recommended treatment.

Risk factors for return with a second trigger digit

The purpose of this study was to determine predictors of return to the same practice with a second idiopathic trigger digit. A total of 2234 patients with Quinnell grade 2 or greater (objective triggering) of one or more digits were retrospectively analysed. A total of 490 of 2234 (22%) patients returned to the same practice with a second trigger digit, with an average follow-up time of 2.1 years (range, 7 days to 10 years). Predictors of return with a second trigger digit included carpal tunnel syndrome, Type 1 diabetes mellitus and duration of follow-up in years. Patients diagnosed with idiopathic trigger digit can be advised that about one in five will return to the same practice with another trigger digit, with approximately double the risk in patients that have carpal tunnel syndrome or Type 1 diabetes.

Creation of the Abbreviated Measures of the Pain Catastrophizing Scale and the Short Health Anxiety Inventory: The PCS-4 and SHAI-5

Abstract Objective: In patients with arm and upper extremity illness, pain catastrophizing and health anxiety are important factors in disability, pain and patient satisfaction. The aim of this study was to develop a shorter version of the 13-item Pain Catastrophizing Scale [PCS] and 18-item Short Health Anxiety Inventory [SHAI]. Methods: One hundred and sixty-four patients [54% women, mean age of 51 years] with a variety of upper extremity diagnoses enrolled in this study. Patients completed the PCS, the SHAI, the Disabilities of Arm Shoulder and Hand questionnaire [DASH] for disability, the Patient Health Questionnaire-9 [PHQ-9] for depressive symptoms and a scale to measure pain. Inter-correlation analyses were conducted on each of the subscales of the PCS and the SHAI and questions were selected based on the magnitude of their inter-item correlation. Results: Questions 3, 6, 8 and 11 remained in the PCS-4 and showed good internal consistency [α = 0.86] and correlated highly with the original PCS [r = 0.96]. Questions 2, 3, 12, 15 and 17 were chosen for the SHAI-5. The SHAI-5 had α = 0.67 and had a correlation or r = 0.87 with the SHAI-18. Both the SHAI-5 and PCS-4 had equal correlations with DASH, PHQ and pain as the original questionnaires. Conclusions: We found that the PCS-4 and SHAI-5 were comparable to the original questionnaires, but further studies should be conducted in order to confirm our findings. This study provides preliminary evidence that the PCS-4 and SHAI-5 could be used to screen for health anxiety and pain catastrophizing in busy orthopedic settings. Level of Evidence: Diagnostic Level II

Benign upper extremity tumors: factors associated with operative treatment

BackgroundTumors are common in the upper extremity and are mostly benign and inconsequential. The purpose of this study was to determine factors associated with operative treatment for suspected benign tumors of the upper extremity.MethodsTreated by three different hand surgeons between July 2001 and July 2011, 1,593 tumors were identified using billing records. The measured variables were: sex, age, marital status, pain, neurovascular status, location of the tumor, bilateral involvement, preoperative diagnosis, prior surgeries in general, prior aesthetic surgery, prior tumor surgery in general, prior upper extremity tumors, prior upper extremity tumor surgery, prior surgery for same tumor, current or prior cancer, and number of visits before treatment. Variables associated with operative treatment were assessed in bivariate analysis and backwards elimination logistic regression analysis.ResultsFactors that significantly increased the probability of surgery were a higher number of visits before treatment, giant cell tumors, treated by surgeon A, lipomas, tumors located on the finger, and prior upper extremity tumors. Factors that significantly decreased the probability of surgery were treated by surgeon B and retinacular/tendon sheath ganglion cysts. Prior or current cancer was not significantly associated with operative treatment.ConclusionsTumor location, preoperative diagnosis, prior upper extremity tumor, and surgeon affect the likelihood of surgery for an upper extremity tumor.Level of evidence: Prognostic II

Night Splinting for Idiopathic Trigger Digits

Background: This study assessed nighttime splinting for 6 weeks as treatment for recent onset idiopathic trigger fingers. Methods: Patients over 18 years with a Quinnell grade 1 or 2, idiopathic trigger finger or thumb causing symptoms for less than 3 months were eligible for a custom-made hand-based orthoplast night orthotic. Improvement of symptoms and/or resolution of triggering were recorded. Patients also completed the short version of the Disabilities of the Arm, Shoulder and Hand and a numerical rating scale for pain at the initial visit, after 6 to 8 weeks, and after 3 months. Results: Thirty-four patients wore a night orthotic for at least 6 weeks. At final evaluation, there was a substantial reduction in disability and pain. Symptoms of triggering resolved completely in 18 patients (55%). Sixteen patients did not resolve their triggering after splinting and therefore underwent a steroid injection. Conclusion: Night splinting is a noninvasive treatment option for idiopathic trigger fingers/thumb with symptoms for less than 3 months.

The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire: Development and Preliminary Validation.

Background: Symptoms and disability at the trapeziometacarpal (TMC) joint are typically assessed with general measures that may not be able to accurately discriminate between TMC arthrosis–specific versus other hand and arm condition concerns. The objective was to develop and preliminary validate the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire designed to assess symptoms and disability at the TMC joint. Methods: English-speaking patients (50 years or older) were enrolled in 1 of 2 samples (sample 1, 64 patients specifically presented for treatment of TMC arthrosis; sample 2, 64 patients received an incidental diagnosis of previously undiagnosed TMC arthrosis when presenting for treatment of another, not thumb-related condition). Principal component analysis identified the number of subscales (factors) and factor loadings of all items (ie, structural construct validity). Internal consistency was assessed with Cronbach alpha. Convergent, discriminant, and known-groups construct validity of the subscales were assessed with Spearman correlations. Results: The final TASD has 12 items and 2 subscales, as confirmed by principal component analysis: symptoms (7 items) and disability (5 items). The subscales’ internal consistency was good to excellent in both samples. The TASD showed good convergent validity as evidenced by moderate to strong correlations between both subscales and upper extremity disability, pain intensity, depression, self-efficacy, and key pinch strength (sample 1). The TASD also showed good discriminant, and good known-groups validity. Conclusions: The concise TASD is useful in assessing symptoms and disability related to TMC arthrosis, has a simple scoring system and administration mode (self-administered), and is free.

Letter of reply to comments on our paper "A prospective randomized comparison of neoprene vs thermoplast hand-based thumb spica splinting for trapeziometacarpal arthrosis".

Dear Editor,We appreciate the interest in our work. Concern is expressedabout the high drop out rate, lack of radiological diagnosis, short-term evaluation time, handling of missing data, and imprecisesplint wear instructions. We agree that our data should be inter-preted in light of these aspects of the study design and execution.This was a pragmatic clinical trial. We compared the effective-ness of prescribing one of two treatments to the typical patientwho would receive that treatment in practice