The "peg test": a novel technique for dexterity evaluation in hand immobilized with a splint.

Manual dexterity tests are difficult to apply in the clinical practice. They are either destined for specific lesions, or are rather complicated and time-consuming. The aim of this study was to evaluate a new manual dexterity test for hand immobilized with a splint: the "peg test". Our series included 86 persons (without any hand trauma or disease) of mean age 42 years of which 77 were right-handed. Materials included five pegs, splints immobilizing the DIP joint, a desk and a stopwatch. Each subject moved the pegs from a horizontal to a vertical position using the thumb-ring pinch grip. This was repeated three times without a splint, with a palmar splint, with a simple dorsal splint and with a dorsal splint glued to the nail, then once more without a splint. A time score was recorded for each trial. A point was deduced at each fall of a peg for result analysis. Results showed that a learning curve affected performance, but that dominance and age before learning had no effect. After learning performance diminished with these variables in the following order: without splint, then more so with a glued splint, even more with a simple dorsal splint and most with a palmar one. The peg test fulfills metrological requirements of dexterity tests: test-retest (intra-observer) reliability (reproducibility), inter-observer reliability (both measured by correlation coefficient), and validity of instrument of measurement. Simple, rapid and reliable, it is perfectly adapted to manual dexterity evaluation in hand immobilized with a splint.

[Does digital percutaneous fasciotomy in Dupuytren's contracture provokes collateral nerves injuries? 25 cases]. / L'aponévrotomie digitale à l'aiguille dans la maladie de Dupuytren entraîne-t-elle des lésions des nerfs collatéraux ? A propos d'une série de 25 doigts.

It is well known that percutaneous fasciotomy must not be realized at the digital level because of the risks of iatrogenic nervous injury. The purpose of this study is to verify if the percutaneous fasciotomy in the digital level is responsible or not for sensory complication by injury of the collateral nerves, thanks to the precise sensory analysis of a series of twenty five palmodigital or digital fasciotomies. Our series included 20 patients operated on between September 2006 and June 2008, as a total of 25 fingers. Only one patient presented preoperative sensory disorders. It was a multi-operated finger. The patients were operated on in one-day surgery by two senior surgeons using percutaneous fasciotomy in the palm and the digit. The analysis of the results consisted in studying at follow-up pain, DASH score, and discriminative sensibility by the static test of Weber, and the test of mono strands of Semmes Weinstein. The postoperative average follow-up was of 10 months. The pain was on average 1.8/10 and the DASH score of 19.77/100. The statistical analysis of the discriminative sensibility showed that there was no significant difference in the average of the results between the hemi-pulp of the operated finger and that of the not operated finger (test of Weber 0.1 < p < 0.5; test of Semmes Weinstein 0.5 < p < 1). A single patient had a bad result at the same time in the Weber and in the Semmes Weinstein. It was a patient operated on several times. Our study shows that the digital percutaneous fasciotomy provokes no sensory disorder. Consequently, it is possible to spread the indications of percutaneous fasciotomy to Dupuytren's contracture in the digital region.