Validation of a modern activity hand survey with respect to reliability, construct and criterion validity.

This study validates a novel, modern wrist and hand functional assessment: the Modern Activity Subjective Survey of 2007 (MASS07). In total, 326 patients visiting an academic tertiary-care orthopaedic hand clinic (April 2006-April 2007) were recruited to complete the MASS07 questionnaire, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) to assess construct validity, criterion validity and test-retest reliability of the MASS07. MASS07 correlated strongly with both PRWE (0.81) and DASH (0.85) even when adjusted for age, sex and history of hand problems (P<0.001). MASS07 scores compared for 42 patients with repeated visits indicated no statistically significant difference between MASS07 scores at the patients' first and second clinic visit. We conclude that the newly constructed MASS07 instrument is valid and reliable with respect to the outpatient population with a wide spectrum of hand and wrist pathologies for fast and effective assessment of patient-reported hand function during modern daily activities.

Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis.

Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite the known association, the incidence and morbidity of a phrenic nerve injury and hemidiaphragmatic paralysis associated with traumatic brachial plexus stretch injuries remains ill-defined. The incidence of an associated phrenic nerve injury with brachial plexus trauma ranges from 10% to 20%; however, because unilateral diaphragmatic paralysis often presents without symptoms at rest, a high number of phrenic nerve injuries are likely to be overlooked in the setting of brachial plexus injury. A case report is presented of a unilateral phrenic nerve injury associated with brachial plexus stretch injury presenting with a recalcitrant left lower lobe pneumonia.