Complex surgical conditions of the hand: avoiding the pitfalls.

Many factors can contribute to a successful result in hand surgery, as is the case in all orthopaedic surgery. An accurate diagnosis with emphasis on a complete history coupled with a detailed physical examination supplemented with the appropriate ancillary studies and proper preoperative surgical planning all are necessary in reaching this goal. An improper diagnosis such as in suspected carpal tunnel syndrome can result in continued symptoms. We will emphasize some of the more complex and difficult conditions in hand surgery that necessitate a high level of clinical acumen. It is hoped that by highlighting these details we may help others avoid common pitfalls and help to achieve an excellent result and avoid litigation. Although these are not the only problems involved in hand surgery, they are complex and can be missed easily.

Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36.

The construct validity of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was evaluated by examining its correlation to the Medical Outcomes Study Short Form-36 (SF-36). The study sample was 90 patients seen at the upper-extremity clinic of a university-based orthopedic practice. Patients were asked to complete a packet that included the DASH and SF-36 questionnaires. Pearson correlation coefficients of the DASH questionnaire to the SF-36 subscales ranged from -0.36 to -0.62. The DASH questionnaire had fewer ceiling and floor scores than most of the SF-36 subscales. These results support the DASH questionnaire as a valid measure of health status useful in patients with a wide variety of upper-extremity complaints.