Functional outcome of neurotization to the musculocutaneous nerve in traumatic brachial plexus injury

Introduction: Neurotization procedures to the elbow flexors are commonly done in traumatic brachial plexus injury (BPI). The objective of this study was to evaluate the recovery of elbow flexors in patients who underwent neurotization procedure to musculocutaneous nerve in the panplexus and upper trunk BPI. Materials and Methods: This was a cross sectional study involving 70 patients who underwent neurotization to elbow flexor. A total of 31 patients (44%) had panplexus injury and 39 (56%) had upper trunk BPI. Elbow flexor motor power and post-operative Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Results: The mean age of the patients was 22.7 years. Patients with panplexus BPI underwent neurotization to the elbow flexor using spinal accessory nerve as a donor and patients with upper trunk BPI used either ulnar or median nerve as a donor. The results of elbow flexors recovery in panplexus BPI were good (MRC grade 4 and 5) in 11 patients (35.5%) and poor in 20 patients (64.5%). Conversely, the recovery of elbow flexors in upper trunk BPI were better with 28 patients (71.8%). Good post-operative DASH score (score <50 points) were noted in 29 patients (74.4%) with upper trunk BPI. Only seven patients (22.6%) with panplexus BPI showed good post-operative DASH score. Majority of patients with panplexus BPI demonstrated poor recovery of elbow flexor and post-operative DASH score as compare to upper trunk BPI (p= 0.002). Conclusion: Overall, this study showed significantly better functional outcome of neurotization procedure to elbow flexor in upper trunk BPI than in panplexus BPI

Screw complication of ACL reconstruction: report of two cases

Background: We analyzed the complication of ACL reconstruction of the knee which was done at Hospital Tengku Ampuan Afzan, Kuantan, Pahang from 2004 to 2008. Hundred and sixty three cases were operated. Complication arte were about 11% (18 patients) including revision surgery rate of 3.7% (6 patients). We are illustrating two cases of uncommon complication of screw that encounter in ACL surgical reconstructed patients. Case 1: 28 years old man undergo ACL reconstruction at 2004 using bone patella tendon bone (BPTB) graft and fixed with titatium screw. However the femoral screw was dislodging posterior and remains three for three years until he was consented for open removal of the screw. Post operatively uneventful. Case 2: 22 years old man presented in August 2009 with tibial screw protruding through the skin since a week prior to the consultation. The ACL reconstruction was done 2 years before (2007). Emergency removal of the screw and debridement revealed well fixed screw without loosening and no evidence of infection. Histopathological review and culture and sensitivity did not found any evidence of infection. The knee remains stable without any laxity. Conclusion: Using a screw for fixation of the graft in ACL reconstruction carefully and appropriately is mandatory to avoid the complication of both at the femoral and tibial components

Screw complication of ACL reconstruction: report of two cases

Background: We analyzed the comlication of ACL reconstruction of the knee which were done at Hospital Tengku Ampuan AFzan, Kuantan, Pahang from 2004 to 2008. Hundrend and sixty-three cases were operated. Complication rate is about 11% (18 patients)including revision surgery rate of 3.7% (6 patients). We are illustrating two case with uncommon complication of srew that encountered in ACL surgical reconstructed patients. Case 1: 28 year old man had undergo ACL reconstruction at 2004 using bone patella tendon bone (BPTB)graft and fixed with titanium screw. However, the femoral screw was dislodging posteriorly and remains there for there years until he was consented for open removal of the screw. Post-operatively uneventful. Case 2: 22 years old man presented in August 2009 with the tibial screw protruding through the skin since a week prior to the consultation. The ACL reconstruction was done 2 years before (2007). Emergency removal of screw and debridement revealed well fixed screw without loosening an d no evidence of infection. Histopathological review and cultures and sensitivity did not found any evidence of infection. The knee remains stable without any laxity. Conclusion: Using of screws for fixation of the graft in ACL reconstruction carefully and appropriately is mandatory to avoid the complication of both at the femoral and tibial components

The Malay version of the Michigan hand outcomes questionnaire: cross-cultural adaptation, validation and reliability testing

Background: The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability and validity compared with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in a Malay-speaking population. Methods: The MHQ was cross-culturally adapted into a Malay version based on the guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ and DASH questionnaires. The MHQ was tested twice with an interval of two weeks in between. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method and Cronbach’s alpha calculation, respectively. The association between MHQ and DASH questionnaire was assessed with Spearman’s correlation calculation. Results: In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed a good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranging from 0.925 to 0.984. Cronbach’s alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. Spearman’s correlation factor of the MHQ in comparison with DASH showed a fair to moderately strong correlation with the values ranging from 0.513 to 0.757. Conclusions: The Malay version of MHQ was successfully translated and culturally-adapted with excellent reliability (reproducibility and internal consistency) and good construct validity

Malay version of the Michigan hand outcomes questionnaire: cross-cultural adaptation and reliability testing in Kuantan, Pahang

The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability in a Malay-speaking population. The MHQ was cross-culturally adapted into a Malay version based on Beaton et al. guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ twice with an interval of two weeks. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method (Intraclass correlation coefficient analysis) and Cronbach’s alpha calculation, respectively. In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranged from 0.925 to 0.984. Cronbach’s alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. The Malay version of MHQ has been successfully translated and culturally-adapted with good reliability and internal consistency

Malay version of Michigan Hand Outcome Questionnaire: cross culture adaptation and reliability testing in Kuantan Pahang

INTRODUCTION: The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability in a Malay-speaking population. MATERIAL AND METHODS: The MHQ was cross-culturally adapted into a Malay version based on Beaton et al guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ twice with an interval of two weeks. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method (Intraclass correlation coefficient analysis) and Cronbach’s alpha calculation respectively. RESULTS In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed a good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranged from 0.925 to 0.984. Cronbach’s alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. CONCLUSION The Malay version of MHQ has been successfully translated and culturally-adapted with good reliability and internal consistency. REFERENCES: 1. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4):575-87

Efficacy of steroid injection versus physiotherapy treatment in work related trigger finger

Stenosing tenosynovitis or trigger finger is a common problem among patients seeking treatment in the orthopaedic clinic. Multiple approaches can be used to treat a patient with a trigger finger. This study to compare the functional outcome of steroid injection versus physiotherapy between service and professional workers with trigger finger. We use observational cohort study. Evaluating the functional outcome of treatment physiotherapy and steroid injection among professional and service workers for trigger finger grade I, II, and III. We also assess the recurrence of the affected finger. Malaysia Standard Classification of Occupation 2013 (MASCO) has been used to classify two working groups: professional and service worker. Michigan Hand Outcomes Questionnaire (MHQ) used for the finger assessment. The patient was observed with three separated visits; pre-treatment visits, six months and 12 months. The patient was divided into two groups of steroid injection and physiotherapy for evaluation of functional outcome and recurrence. The total number of patients recruited is 149 with 75 in the professional group and 74 in the service group. Out of the 149 patients, 80 were treated with physiotherapy and 69 were with steroid injection. There was no association between the occupation and the grading of trigger finger and the affected finger itself. Functional outcome using MHQ score for steroid group shows a good 12 months outcome (P values <0.01) comparing with physiotherapy group. Functional outcome in terms of physiotherapy was lower compared to steroid injection at six months and 12 months. The recurrence rate in physiotherapy was higher than in the steroid injection group. Single steroid injection had a better functional outcome after six months and 12 months post-intervention compared with physiotherapy. Physiotherapy treatment can be suggested to patients with grade 1, 2, and 3 of trigger finger who refused any steroid injection