Iatrogenic hand trauma in institutionalized brain-injured patients: About 2 cases.

The objective of this work was to draw the attention of caretakers for institutionalized brain-injured patients to the risk of iatrogenic trauma associated with improper manipulation of the fingers during hand opening for grooming. Two clinical cases of chronic open dislocation of the thumb and the fifth finger in institutionalized brain-injured patients were reviewed. Interrogation of the patients and their relatives did not reveal either the date or the mechanism of the injury. In the light of these two cases, it appears that better training of caretakers should make it possible to avoid iatrogenic trauma during hygiene care of institutionalized brain-injured patients.

Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study.

OBJECTIVES: To determine if joint hypermobility is associated with musculoskeletal pain in a population of Italian schoolchildren. DESIGN: Cross-sectional, school-based study, using a pretested questionnaire administered to schoolchildren to enquire about musculoskeletal pain and Beighton criteria, with score of > or =5 as a cut-off, to test for hypermobility. SETTING: Eight primary schools in the town of Cesena, Italy. PARTICIPANTS: 1230 Italian schoolchildren aged 7 to 15 years representing an opportunistic sample of 10% of the schoolchildren in Cesena MAIN OUTCOME MEASURES: (1) The strength of association between hypermobiliy and musculoskeletal pain; (2) the impact of hypermobility on daily activities, using a subjective "disability score" and a "physical activity score." ANALYSIS: Sample size calculation for evaluating if hypermobility was associated with musculoskeletal pain was performed prior starting the study. Children experiencing pain at least once a week were used as cases, children experiencing pain seldom or never served as controls. RESULTS: A total of 1046 consenting Italian schoolchildren (mean age 10.8 years) were included. The prevalence of musculoskeletal pain reported by schoolchildren was 18%. 22% of children with musculoskeletal pain versus 23% of controls had hypermobility (OR 1.057, 95% CI 0.7 to 1.4). Functional limitations measured by a "disability score" correlated in a weak negative way with Beighton score (p = 0.03). The "physical activity score" correlated in a weak positive way with Beighton score (p = 0.012). CONCLUSIONS: No association was found between hypermobility and musculoskeletal pain. Hypermobile children did not experience functional limitations in daily activities, and they were slightly more active than non-hypermobile children.