An Image-Based Tool to Examine Joint Congruency at the Elbow

Post-traumatic osteoarthritis commonly occurs as a result of a traumatic event to the articulation. Although the majority of this type of arthritis is preventable, the sequence and mechanism of the interaction between joint injury and the development of osteoarthritis (OA) is not well understood. It is hypothesized that alterations to the joint alignment can cause excessive and damaging wear to the cartilage surfaces resulting in OA. The lack of understanding of both the cause and progression of OA has contributed to the slow development of interventions which can modify the course of the disease. Currently, there have been no reported techniques that have been developed to examine the relationship between joint injury and joint alignment. Therefore, the objective of this thesis was to develop a non-invasive image-based technique that can be used to assess joint congruency and alignment of joints undergoing physiologic motion. An inter-bone distance algorithm was developed and validated to measure joint congruency at the ulnohumeral joint of the elbow. Subsequently, a registration algorithm was created and its accuracy was assessed. This registration algorithm registered 3D reconstructed bone models obtained using x-ray CT to motion capture data of cadaveric upper extremities undergoing simulated elbow flexion. In this way, the relative position and orientation of the 3D bone models could be visualized for any frame of motion. The effect of radial head arthroplasty was used to illustrate the utility of this technique. Once this registration was refined, the inter-bone distance algorithm was integrated to be able to visualize the joint congruency of the ulnohumeral joint undergoing simulated elbow flexion. The effect of collateral ligament repair was examined. This technique proved to be sensitive enough to detect large changes in joint congruency in spite of only small changes in the motion pathways of the ulnohumeral joint following simulated ligament repair. Efforts were also made in this thesis to translate this research into a clinical environment by examining CT scanning protocols that could reduce the amount of radiation exposure required to image patient’s joints. For this study, the glenohumeral joint of the shoulder was examined as this joint is particularly sensitive to potential harmful effects of radiation due to its proximity to highly radiosensitive organs. Using the CT scanning techniques examined in this thesis, the effective dose applied to the shoulder was reduced by almost 90% compared to standard clinical CT imaging. In summary, these studies introduced a technique that can be used to non-invasively and three-dimensionally examine joint congruency. The accuracy of this technique was assessed and its ability to predict regions of joint surface interactions was validated against a gold standard casting approach. Using the techniques developed in this thesis the complex relationship between injury, loading and mal-alignment as contributors to the development and progression of osteoarthritis in the upper extremity can be examined

An Anthropometric Assessment of the Proximal Hamate Autograft for Scaphoid Proximal Pole Reconstruction

© 2019 American Society for Surgery of the Hand Purpose: Fragmentation of the scaphoid proximal pole secondary to avascular necrosis presents a difficult reconstructive problem. This anthropometric study assesses the utility of the ipsilateral proximal hamate for complete osteochondral scaphoid proximal pole reconstruction. Methods: Twenty-nine cadaveric specimens underwent computed tomography scanning and 3-dimensional reconstruction of the carpus and distal radius. Scaphoid height was measured and a third of its height was used to simulate resection of the proximal scaphoid pole and extent of hamate autograft required. The proximal scaphoid and hamate were divided into 6 sections, and compared using an iterative point-to-point distance algorithm. Average distance between the scaphoid and the hamate surfaces was determined. An interbone algorithm was used to assess radioscaphoid joint congruency and articular contact surface of the native scaphoid compared with the scaphoid reconstructed with hamate autograft. Results: The mean height of scaphoid proximal pole excision and proximal hamate autograft height was 9.3 mm. Comparing the morphology of the native scaphoid and hamate autografts, the absolute distances were the largest in the volar radioscaphoid, dorsal radioscaphoid, and dorsal scaphocapitate segments. Without osteotomy, the hamate autograft may cause impaction in the dorsal-radial aspect of the distal radius. The hamate autograft also shifted the articular contact point of the radioscaphoid joint toward the dorsal-radial position. Nine hamate autografts were classified as poor-fitting. Poor-fitting specimens had a greater radial styloid to distal radioulnar joint distance. These specimens also had wider hamates and scaphoids in the radial-ulnar dimension and wider scaphoids in the volar-dorsal dimension. Lunate type did not correspond to anthropometric fit. Conclusions: The proximal hamate osteochondral graft was poor fitting in 31% of cases (9 of 29 specimens). Wrists with radial-ulnar hamate width less than 10 mm, radial-ulnar scaphoid width less than 10 mm, and volar-dorsal scaphoid width less than 16 mm demonstrate better anthropometric fit. Clinical relevance: This study provides an anthropometric assessment of the recently described proximal hamate autograft, a new bone graft option for proximal scaphoid pole reconstruction

Graduate Keynote. Golf Grip Force Evaluation in Individuals with and without Hand Arthritis Using a New Wearable Sensor Technology

BACKGROUND Hand osteoarthritis (H-OA) is the most common type of osteoarthritis largely affecting individuals over 45. H-OA involves pain, loss of grip strength and limiting participation in recreational activities such as golf. Currently, a number of ‘arthritic’ grips are designed using joint protection principles to ‘reduce hand forces and tight gripping’. However, no comprehensive examinations in their effectiveness have been conducted. HYPOTHESIS The purpose of this study is to systematically analyse the hand forces produced from various golf grips and arthritis grips at the distal-phalanges of the hand-grip interface in individuals with and without hand arthritis using new wearable sensor technology. METHODS The finger forces in the hand were measured using Pressure Profiles FingerTPS system for participant’s bottom gripping hand thumb, index, middle and ring fingers. The participants performed 3 golf shots using a real ball on artificial turf with 12, mid-iron clubs fitted with various types of standard and arthritis grips. RESULTS Preliminary results of 4 healthy participants demonstrated that serrated style golf grips designed for players with arthritis produced some of the highest forces. Also, players with larger hand length measures produce higher forces in smaller diameter grips and small hand length measures in larger diameter grips. DISCUSSION These preliminary results demonstrate the possibility that ‘arthritic’ golf grips are not appropriately designed for the given user along with the potential relationship between grip geometry and hand size to finger forces. In better understanding the mechanics of arthritis and its relation to sports, the design of more advanced sporting equipment can be developed

Barriers, facilitators, preferences and expectations of joint protection programmes for patients with hand arthritis: A cross-sectional survey

© Author(s) (or their employer(s)) 2021. Objectives The objective of this survey was to investigate the barriers, facilitators, expectations and patient preferences regarding joint protection (JP) programmes in people with hand arthritis. Design Cross-sectional survey. Setting Tertiary clinic. Participants Patients with hand arthritis: Osteoarthritis, rheumatoid arthritis, psoriatic arthritis and other forms of arthritis. Primary and secondary outcome measures This study used a survey among people with hand arthritis. Descriptive statistics and percentages were reported for all the data about the barriers, facilitators and preferences around JP. Results A total of 192 patients consented to participate. Most of the patients (82%) were unaware of JP. Factors that may act as barriers to participation and were regarded as â a very big concern\u27 were: Cost of the programme (44%), time of offering the programme (39%), work commitments (36%) and having a centre/clinic close to the house (28%). Factors that may act as facilitators and rated as â extremely helpful\u27 were: Research that shows that JP works (26%) and having the centre/clinic close to the house (25%). An online format for JP was the most preferred option (54%). Half (46%) preferred a timeframe of 1 hour, three times per week and 44% preferred a 2-hour programme, for three times per week. Conclusions Awareness of the potential benefits of JP, and prior experience with JP programme were very low. Common potentially modifiable patient-reported barriers to participate in future JP interventions, included: Cost, work commitments, distance from home to clinic and times that the intervention were provided. These barriers might be addressed with free and accessible forms of delivery of JP, which may lead to better uptake and participation in JP programmes

Evaluation of the content validity index of the Australian/Canadian osteoarthritis hand index, the patient-rated wrist/hand evaluation and the thumb disability exam in people with hand arthritis

© 2020 The Author(s). Background: The Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist/Hand Evaluation (PRWHE) and the Thumb Disability Exam (TDX) are patient-reported outcome measures (PROM) designed to assess pain and hand function in patients with hand arthritis, hand pain and disability, or thumb pathology respectively. This study evaluated the content validity of AUSCAN, PRWHE and TDX in people with hand arthritis. Methods: This study enrolled participants with hand arthritis to rate the items of all 3 PROM in terms of relevance and clarity. The Content Validity Index (CVI) was computed for each item in each scale (I-CVI) as well as for the overall scale (S-CVI). Kappa was used to determine the inter-rater agreement among the raters. Results: Overall, 64 individuals with hand arthritis (27% with OA, 67% with rheumatoid arthritis and 6% with psoriatic arthritis) participated in the study. The I-CVI for all items and all scales were very high (I-CVI \u3e 0.76) and the modified Kappa agreement among the raters demonstrated excellent agreement (k \u3e 0.76). The S-CVI for all PROMs was very high for relevance (AUSCAN = 0.92, 95% CI 0.90 to 0.94; PRWHE = 0.85, 95% CI 0.82 to 0.88 and TDX = 0.87, 95% CI 0.85 to 0.89) and for clarity (AUSCAN = 0.99, 95% CI 0.98 to 1.00; PRWHE = 0.95, 95% CI 0.93 to 0.97 and TDX = 0.91, 95% CI 0.89 to 0.94), respectively. Conclusions: This study demonstrated very high content validity indices for the AUSCAN, PRWHE and TDX; with strong consensus across raters. This augments prior studies demonstrating appropriate statistical measurement properties, to provide confidence that all three measures assess important patient concepts of pain and disability

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: Systematic review of psychometric properties

© 2018 The Author(s). Background: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. Methods: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. Results: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. Conclusions: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective

Investigating the grip forces exerted by individuals with and without hand arthritis while swinging a golf club with the use of a new wearable sensor technology

© IMechE 2020. Hand arthritis is the leading cause of disability in individuals over the age of 50, causing impairments in grip strength and range of motion. Golf is often recommended to patients with hand arthritis as a low-impact sport to maintain a healthy lifestyle. As such, numerous “arthritic” golf grips have been marketed, but lack quantitative measures to justify their use. The objective of this study was to quantify the differences in total applied grip force in golfers with/without hand arthritis using several types of golf grips. Twenty-seven participants (17 without and 10 with hand arthritis) were evaluated swinging mid-iron clubs with 12 different golf grip designs (9 standard and 3 “arthritic”). The trail hand thumb, index, middle, and ring finger applied grip forces were measured using the wireless FingerTPS system. Finger grip configuration (finger joint angles) of the thumb and index were measured using the Dartfish Movement Analysis Software paired with the newly developed Grip Configuration Model to obtain grip range of motion. Results indicated that golfers with hand arthritis had a significant deficit of 45% golf grip strength (P = 0.02). In addition, individuals with hand arthritis exhibited larger forces in 11 out of 12 golf grips tested when compared with their maximum golf grip strength. Despite how these grips are marketed, there are no “savings” in finger force or grip configuration when using the “arthritic” designed golf grips. Therefore, these grips may not be beneficial for patients with hand arthritis

The Effect of Distal Radius Fractures on 3-Dimensional Joint Congruency

© 2021 American Society for Surgery of the Hand Purpose: Whereas the goal of distal radius fracture treatment is anatomical restoration, controversy exists as to whether it is the severity of the disruption of joint alignment at the time of fracture or residual malalignment after healing that determines outcome. The objective of this study was to compare joint contact mechanics bilaterally a minimum of 3 years following a distal radius fracture. Our hypothesis was that 3-dimensional joint space would be reduced in individuals following wrist fracture and that these changes in joint load lead to the development of degenerative arthritis. To test the hypothesis, an interbone spacing algorithm was used to determine whether 3-dimensional joint space and contact mechanics were altered in the distal radioulnar (DRUJ) and radiocarpal joints following a wrist fracture. Methods: In 16 subjects with previous unilateral wrist fractures, 3-dimensional interbone distance (joint space), a measure of joint congruency and 3-dimensional alignment, was quantified from reconstructed computed tomography bone models of the distal radius, ulna, scaphoid, and lunate. Results: At an average of 8 years following fracture, joint interbone spacing area was reduced in the radiolunate joint of the injured wrist in comparison with the uninjured wrist. The joint interbone spacing area was decreased in the DRUJ and radioscaphoid joint of the injured wrist compared with the uninjured wrist but this difference was not statistically significant. Conclusions: This study demonstrates the use of a noninvasive tool that can be used to examine joint loading and suggests that further investigation into the association between altered joint loading and the development of posttraumatic arthritis is needed, especially in the radiocarpal joints. Clinical relevance: This paper provides a noninvasive image-based framework that can be used to examine joint contact area over time and provides preliminary data examining the effect of a distal radius fracture on the joint congruency of the DRUJ and radiocarpal joints

Recovery, age, and gender effects on hand dexterity after a distal radius fracture. A 1-year prospective cohort study

© 2017 Hanley & Belfus Study Design: A prospective cohort study. Introduction: Physical factors that predict hand dexterity and the recovery of hand dexterity after a distal radius fracture (DRF) have not yet been examined. Purpose of the Study: The first objective was to evaluate the recovery of hand dexterity comparing the injured and uninjured hands during the year after a DRF. The second objective was to determine the effect of age and sex on hand dexterity of the injured hand. Methods: Hand dexterity was examined bilaterally for the manipulation of 3 different sized objects (small, medium, and large) using the NK hand dexterity test. The measurements took place at 3, 6, and 12 months after DRF. Generalized linear modeling was performed, with age and sex as covariates, to assess changes over time, and between sides. Results: Overall, 242 patients with DRF (45 males and 197 females) with a mean age of 60.2 years with SD of 11.26, participated in the study. Statistical differences in hand dexterity were found between the injured and uninjured hands across all time intervals (P \u3c.001). The effect size for the deficit between the injured and uninjured hands decreased across the time intervals and ranged from 0.19 to 0.38 for large objects, from 0.17 to 0.25 for medium objects, and from 0.11 to 0.32 for small objects. For each 1-year increase in age, hand dexterity scores were 0.3-0.4 seconds slower. Sex had much less effect, with annual increases of 0.1 seconds in hand dexterity scores. Conclusions: Scores on the NK dexterity test improved between 3 and 6 months and then worsened between 6 and 12 months; at no point did dexterity equal the uninjured side. Greater attention to measuring and treating dexterity may be needed to provide a complete recovery after DRF. Scores will be affected by age and sex. Level of Evidence: Prognosis, 2a