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

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

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

Do Impairments Predict Hand Dexterity After Distal Radius Fractures? A 6-Month Prospective Cohort Study

© 2017, The Author(s) 2017. Background: The relationship of routinely measured grip and motion measures may be related to hand dexterity. This has not yet been thoroughly examined following a distal radius fracture (DRF). The purpose of this study was to investigate if impairments in range of motion (ROM) and grip strength predict hand dexterity 6 months following a DRF. Methods: Patients with DRFs were recruited from a specialized hand clinic. Hand grip was assessed with a J-Tech dynamometer; ROM was measured using standard landmarks and a manual goniometer. Multiple regression analyses were performed to identify whether potential predictors (grip, ROM, age, hand dominance, and sex) were associated with 3-month or 6-month outcomes in large- and small-object subtests of the NK dexterity test in the affected hand. Results: Age, sex, and arc motion for radial-ulnar deviation were significant predictors of large-object hand dexterity explaining the 23% of the variation. For small-object hand dexterity, age and flexion-extension arc motion were significant predictors explaining 11% of the variation at 3 month after the fracture (n = 391). At 6 months post injury (n = 319), grip strength, arc motion for flexion-extension, and age were found to be significant predictors of large-object dexterity explaining 34% of the variance. For the small objects, age, grip strength, sex, and arc motion of radial-ulnar deviation explained 25% of the variation. Conclusions: Although this confirms that the impairments in ROM and grip that occur after a DRF can explain almost one-third of the variation in hand dexterity, it also suggests the need for dexterity testing to provide more accurate assessment

Comparison of the Short-Term and Long-Term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

© The Author(s) 2018. Background: The objective of the study is to examine the short-term and long-term efficacy of surgical treatment of carpal tunnel syndrome (CTS) compared with conservative treatment (ie, splint, steroid injection, or physical therapy). Methods: Two reviewers searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and PEDro up to September 2017. Quality appraisal and data extraction were performed in duplicate. Patient self-reported functional and symptom changes, as well as improvement of electrophysiological studies, were assessed as outcomes. Meta-analyses were performed in RevMan. Results: From 1438 studies identified after searching, 10 remained for analysis after exclusion criteria were applied. Moderate-quality evidence indicated that surgical interventions were superior to splint or steroid injection at 6 months with a weighted mean difference of 0.25 (95% confidence interval [CI], 0.07-0.44) for functional status and 0.64 (95% CI, 0.07-1.21) for symptom severity. The surgical group had better nerve conduction outcomes at 6 months (0.57 [95% CI, 0.05-0.50] ms). No significant differences were observed at 3 or 12 months. Conclusions: Both surgical and conservative interventions provide treatment benefits in CTS. Further studies on long-term outcome are needed

Recovery of grip strength and hand dexterity after distal radius fracture: A two-year prospective cohort study

© 2017, © The Author(s) 2017. Introduction: Clinicians often evaluate deficits after an injury by comparing the injured and uninjured side. It is important to understand what deficits occur in hand function after distal radius fracture, how they change over time and their clinical relevance. The purpose of this study was to evaluate the differences in grip strength and hand dexterity between the injured and uninjured hands of patients two years following distal radius fracture. Methods: Patients with distal radius fracture were recruited in a specialized hand clinic. Grip strength and hand dexterity were examined bilaterally with a Jamar hand-held dynamometer and with the NK dexterity device at 3, 6, 12 and 24 months’ post-injury respectively. Generalized linear modeling was performed, with age and sex as covariates to assess changes over time, and between sides. Results: Patients (n = 154) exhibited mean differences of grip strength between injured and uninjured side at 3 months’ (12.09 kg) and 6 months’ (7.47 kg) follow-up. The associated deficit standardized response means (SRM) were 1.30 and 0.73, respectively. At 2-years follow-up the mean deficit on the injured side was 2.30 kg with SRM = 0.22. One hundred and eleven patients who completed dexterity testing demonstrated small to trivial side to side differences across all time points. Conclusions: There were clinically important differences in grip strength between the injured and uninjured hands in patients with a distal radius fracture at 3 and 6 months’ follow-up. However, at 12 and 24 months, grip strength differences were small and of uncertain clinical importance. Trivial to small differences in hand dexterity can be expected between the injured and uninjured hand by 2 years after distal radius fracture

Development of a computational technique to measure cartilage contact area

Computational measurement of joint contact distributions offers the benefit of non-invasive measurements of joint contact without the use of interpositional sensors or casting materials. This paper describes a technique for indirectly measuring joint contact based on overlapping of articular cartilage computer models derived from CT images and positioned using in vitro motion capture data. The accuracy of this technique when using the physiological nonuniform cartilage thickness distribution, or simplified uniform cartilage thickness distributions, is quantified through comparison with direct measurements of contact area made using a casting technique. The efficacy of using indirect contact measurement techniques for measuring the changes in contact area resulting from hemiarthroplasty at the elbow is also quantified. Using the physiological nonuniform cartilage thickness distribution reliably measured contact area (ICC=0.727), but not better than the assumed bone specific uniform cartilage thicknesses (ICC=0.673). When a contact pattern agreement score (sagree) was used to assess the accuracy of cartilage contact measurements made using physiological nonuniform or simplified uniform cartilage thickness distributions in terms of size, shape and location, their accuracies were not significantly different (p\u3e0.05). The results of this study demonstrate that cartilage contact can be measured indirectly based on the overlapping of cartilage contact models. However, the results also suggest that in some situations, inter-bone distance measurement and an assumed cartilage thickness may suffice for predicting joint contact patterns. © 2014 Elsevier Ltd

Physical impairments predict hand dexterity function after distal radius fractures: A 2-year prospective cohort study

© 2018, © The Author(s) 2018. Introduction: The overall aim of this study was to determine whether physical impairments – loss of range of motion and grip strength – could be used to predict hand dexterity functions in patients at 1 and 2 years after distal radius fracture. Methods: This was a prospective cohort study. Hand dexterity was assessed at three different levels using the NK hand dexterity test. We used a manual goniometer to measure the active range of motion in the affected hand for wrist flexion and extension movements, and a J-Tech grip strength device to measure patients’ hand grip strength levels. Assessments were performed at 1- and 2-year follow-ups. Separate multivariable regression analyses were performed to determine if range of motion predicts hand dexterity functions at 1 and 2 years after distal radius fracture. Results: A total of 160 patients with distal radius fracture were included in this study. Range of motion (flexion and extension) and grip strength were both statistically significant (p \u3c 0.05) independent variables in predicting hand dexterity functions at all three levels among patients after distal radius fracture at 1-year follow-up. Range of motion and strength levels accounted for 31%, 33% and 22% of the variance in patients’ large, medium and small hand dexterity functions, respectively. At 2 years, grip strength remained the only statistically significant (p \u3c 0.001) independent variable in predicting hand dexterity functions at all three levels. Conclusions: Physical impairments (loss of range of motion and grip strength) have higher predictive values for large and medium hand dexterity functions, than small hand dexterity functions, in patients after distal radius fracture, at both 1- and 2-year follow-up periods