The Influence of Hand Dominance in Wrist Fracture Post-Operative Functional Evaluation.

Sensorimotor testing is used to measure outcomes in surgery, to document results of treatment and rehabilitation, and to compare results between surgeons, therapists, and institutions. When performing sensorimotor testing, failure to address dominant side differences may cause a bias in evaluation of outcomes. This study evaluated the effect of hand dominance on outcomes testing performed on patients following surgery for distal radius fractures (DRF). We hypothesized that the injured dominant hand will perform differently than the injured non-dominant hand. This is a retrospective study of patients following DRF treated surgically and evaluated in therapy. The patients were evaluated at fixed intervals: initially, at 6 weeks, and at 3 months post-surgery. Testing included grip strength, monofilaments, static and moving 2-point discrimination, Moberg testing, and stereognosis. Sixty patients included 46 (76.6%) females. Age averaged 62.1 (standard deviation: 16.9) years, and 54 were right-handed (90%). There were differences between dominant and non-dominant hand injury in 2 of 9 tests of sensibility for each time period, including little finger monofilament and Moberg testing initially, and moving 2-point discrimination in the little finger, monofilament testing of the thumb at 3 months. Both groups improved between initial and 3-month evaluation without differences in amount of improvement. Despite some significant differences in the applied tests between dominant and non-dominant injured hands, our results do not support correction for hand-dominance when using the described examinations in evaluating outcomes following DRF surgery.

Les tests sensorimoteurs sont utilisés pour mesurer les résultats des opérations, pour établir les résultats des traitements et de la réadaptation et pour comparer les résultats entre les chirurgiens, les thérapeutes et les établissements. Pendant ces tests, le fait de ne pas évaluer les différences du côté dominant peut provoquer un biais dans l'évaluation des résultats. La présente étude évaluait l'effet de la dominance de la main sur les résultats des tests effectués chez des patients après l'opération d'une fracture du radius distal (FDR). Les chercheurs ont postulé que le fonctionnement de la main dominante blessée différerait de celui de la main non-dominante blessée. La présente étude rétrospective portait sur des patients après l'opération d'une FDR et sur leur évaluation en thérapie. Les patients ont été évalués à des intervalles précis : au départ, six semaines après l'opération et trois mois après l'opération. Les tests incluaient la force de préhension, le test aux monofilaments, la discrimination spatiale statique et mobile, le test de Möberg et la stimulation stéréognostique. Les 60 patients, incluant 46 femmes (76,6 %), avaient un âge moyen de 62,1 ans (écart-type de 16,9), et 54 étaient droitiers (90 %). Il y avait des différences entre la blessure de la main dominante et non-dominante dans deux des neuf tests de sensibilité pour chaque période, y compris le test des monofilaments et le test de Möberg de l'auriculaire pour commencer, et la discrimination spatiale mobile de l'auriculaire et le test des monofilaments du pouce à trois mois. L'état des deux groupes s'est amélioré entre l'évaluation initiale et celle au bout de trois mois, sans différences quant à l'importance de l'amélioration. Malgré certaines différences significatives des tests effectués entre les mains dominante et non-dominante, les résultats ne soutiennent pas la correction compte tenu de la main dominante au moment d'utiliser les examens décrits pour évaluer les résultats cliniques après une opération découlant d'une FDR.

Postoperative Treatment of Distal Radius Fractures Using Sensorimotor Rehabilitation.

Background Sensorimotor and specifically proprioception sense has been used in rehabilitation to treat neurological and joint injuries. These feedback loops are not well understood or implemented in wrist treatment. We observed a temporary sensorimotor loss, following distal radius fractures (DRF) that should be addressed postsurgery. Purpose The purpose of this prospective therapeutic study was to compare the outcomes of patients following surgery for DRF treated using a sensorimotor treatment protocol with those patients treated according to the postoperative standard of care. Patients and Methods Patients following surgery for DRF sent for hand therapy were eligible for the study. Both the evaluation and treatment protocols included a comprehensive sensorimotor panel. Patients were randomized into standard and standard plus sensorimotor postoperative therapy and were evaluated a few days following surgery, at 6 weeks, and 3 months postsurgery. Results Sixty patients following surgery were randomized into the two treatment regimens. The initial evaluation was similar for both groups and both demonstrated significant sensorimotor deficits, following surgery for DRF. There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the sensorimotor-proprioception protocol mostly in the wrist; however, not all of the differences were significant. Conclusion Patients after surgery for DRF demonstrate significant sensorimotor deficits which may improve faster when utilizing a comprehensive sensorimotor treatment protocol. However, we did not demonstrate efficacy of the protocol in treating proprioceptive deficits. Further study should include refinement of functional outcome evaluation, studying of the treatment protocol, and establishment of sensorimotor therapeutic guidelines for other conditions. Level of Evidence This is a level II, therapeutic study.

The Use of Cryotherapy to Treat Infantile Digital Fibromatosis with a Functional Deficit: A Case Report.

Infantile Digital Fibromatosis (IDF) is a rare benign lesion that can affect the fingers, often appearing at birth or early on in life. Treatment is controversial due to a high recurrence rate following surgical excision, and the tendency of the lesions to regress or resolve completely after the age of one year. Functional loss has rarely been described. We describe a case of IDF with joint contracture and significant functional deficit that was treated with cryotherapy and post procedural occupational therapy with an excellent result. Indications for treatment and cryotherapy as a therapeutic modality for IDF are discussed.

A Protocol for Evaluation and Rehabilitation of Distal Radius Fractures Using Sensorimotor Input: A Case Series.

BACKGROUND: Proprioception and sensorimotor input are used to treat neurological and joint injuries. Following distal radius fractures (DRF) there is a temporary loss of proprioception that should be addressed. We created a protocol for evaluation, and a treatment plan following wrist surgery that is based on proprioceptive and sensorimotor input. We describe a series of patients undergoing surgery for DRF that were evaluated and treated with these protocols. METHODS: Both evaluation and treatment protocols included comprehensive sensorimotor procedures performed with eyes open and closed. These included Semmes- Weinstein, static and moving 2-point discrimination, vibration, temperature testing, Moberg pick-up- test, stereognosis and proprioception. RESULTS: A series of twelve patients was evaluated and treated with the protocol following surgical treatment for DRF. Patients demonstrated significant sensorimotor deficits, which improved utilizing the comprehensive sensorimotor treatment protocol. CONCLUSIONS: Further study is necessary to validate the results of this pilot series. Use of proprioception and sensorimotor input may improve outcomes of rehabilitation following DRF.

Postoperative Therapy for Chronic Thumb Carpometacarpal (CMC) Joint Dislocation.

Surgical arthroplasty of thumb carpometacarpal (CMC) joint osteoarthritis is commonly performed. Postoperative therapeutic protocols aim to improve range of motion and function of the revised thumb. We describe a case in which the thumb CMC joint had been chronically dislocated before surgery, with shortening of the soft-tissue dynamic and static stabilizers of the joint. The postoperative protocol addressed the soft tissues using splinting and exercises aimed at lengthening and strengthening these structures, with good results. It may be beneficial to evaluate soft-tissue tension and the pattern of thumb use after surgery for thumb CMC joint osteoarthritis to improve postoperative functional results.