Hand Assessment for Elderly People in the Community.

BACKGROUND: Hand conditions are common in elderly persons. PURPOSE: To assess the prevalence of common hand conditions in elderly persons in a community setting, specifically osteoarthritis of the hand, trigger finger, and carpal tunnel syndrome. METHODS: The elderly persons were recruited from community groups for elderly persons. Data collection included participants' demographic and clinical data; quick disability, arm, shoulder, and hand (QuickDASH) questionnaire; and presence of hand conditions. RESULTS: Of the 55 elderly persons recruited, almost a third of them presented with a hand condition (n = 17, 30.8%). Hand conditions were more common in females (39% in females, 7% in males; χ = 4.97, p = .04). Quick-DASH scores were higher in those with hand conditions, indicating lower levels of function (greater disability) (t =-4.61, p = .002). CONCLUSIONS: Most elderly persons did not seek medical attention for their hand condition until the late stages. Nurses can play an important role in providing community hand assessment, education on hand symptoms, information about available treatment, and adaptive approaches to maximize functioning.

Síndrome de la mano diabética, a propósito de tres casos con limitación de la movilidad articular y lesiones complicadas del pie / A propos of three cases of diabetic hand syndrome with limited joint mobility and complicated foot injures

Introducción: La diabetes mellitus está asociada a una gran variedad de alteraciones músculo esqueléticas en las manos. El término síndrome de la mano diabética aparece con frecuencia en la literatura médica, aunque no existe una definición precisa, y hasta la fecha no se ha reconocido como una complicación específica de la enfermedad. El examen físico para la identificación temprana de estas alteraciones podría evitar la discapacidad de las formas severas.Objetivos: describir las alteraciones músculo esqueléticas más frecuentes en las manos de las personas con diabetes, a propósito de 3 pacientes con limitación de la movilidad articular, hospitalizados por lesiones complicadas del pie.Desarrollo: entre las alteraciones más frecuentes de la mano en las personas con diabetes está la limitación de la movilidad articular, la contractura de Dupuytren, el dedo en gatillo, la neuropatía ulnar y el túnel carpiano. Cada una tiene sus particularidades y pueden ser fácilmente diagnosticadas con el examen físico. Se asocian con la duración de la enfermedad, el pobre control metabólico y la presencia de complicaciones microvasculares, como en los casos que se presentan, con limitación de la movilidad articular severa. Estas deformidades afectan las actividades de la vida diaria, y por tanto, la calidad de vida de los pacientes, además, orientan al médico en la búsqueda de complicaciones microvasculares no diagnosticadas, de ahí la importancia de detectarlas.Conclusiones: se establece que la identificación temprana de las alteraciones en las manos de los diabéticos tiene importantes implicaciones individuales y sanitarias, por lo que su examen periódico debe ser realizado a todos los pacientes(AU)

Introduction: Diabetes mellitus is associated to a variety of musculoskeletal alterations in hands. The term diabetic hand syndrome frequently occurs in medical literature, although there is no exact definition and to date, it has not been recognized as specific disease complication. The physical exam for early detection of these alterations might prevent severe disability.Objectives: to describe the most common musculoskeletal alterations in diabetic persons’ hands using 3 patients with limited joint mobility who were hospitalized because of complicated foot injures.Development: among the most common hand alterations observed in diabetic persons are limited joint mobility, Dupuytren’s contracture, ulnar neuropathy and Carpal tunnel syndrome. Each of them has its own particularities and may be easily diagnosed through physical exam. They are related to length of disease, poor metabolic control and microvascular complications as it happens in the present cases with severe limited joint mobility. These deformities affect daily life activities and the quality of life of patients. Additionally, they guide the physicians in searching undiagnosed microvascular complications, hence the importance of detecting them.Conclusions: the early detection of hand alterations in diabetics has significant personal and health implications, so a systematic exam is required to be performed in all the patients(AU)

Síndrome de la mano diabética, a propósito de tres casos con limitación de la movilidad articular y lesiones complicadas del pie / A propos of three cases of diabetic hand syndrome with limited joint mobility and complicated foot injures

Introducción: la diabetes mellitus está asociada a una gran variedad de alteraciones músculo esqueléticas en las manos. El término síndrome de la mano diabética aparece con frecuencia en la literatura médica, aunque no existe una definición precisa, y hasta la fecha no se ha reconocido como una complicación específica de la enfermedad. El examen físico para la identificación temprana de estas alteraciones podría evitar la discapacidad de las formas severas.Objetivos: describir las alteraciones músculo esqueléticas más frecuentes en las manos de las personas con diabetes, a propósito de 3 pacientes con limitación de la movilidad articular, hospitalizados por lesiones complicadas del pie.Desarrollo: entre las alteraciones más frecuentes de la mano en las personas con diabetes está la limitación de la movilidad articular, la contractura de Dupuytren, el dedo en gatillo, la neuropatía ulnar y el túnel carpiano. Cada una tiene sus particularidades y pueden ser fácilmente diagnosticadas con el examen físico. Se asocian con la duración de la enfermedad, el pobre control metabólico y la presencia de complicaciones microvasculares, como en los casos que se presentan, con limitación de la movilidad articular severa. Estas deformidades afectan las actividades de la vida diaria, y por tanto, la calidad de vida de los pacientes, además, orientan al médico en la búsqueda de complicaciones microvasculares no diagnosticadas, de ahí la importancia de detectarlas.Conclusiones: se establece que la identificación temprana de las alteraciones en las manos de los diabéticos tiene importantes implicaciones individuales y sanitarias, por lo que su examen periódico debe ser realizado a todos los pacientes(AU)

Introduction: diabetes mellitus is associated to a variety of musculoskeletal alterations in hands. The term diabetic hand syndrome frequently occurs in medical literature, although there is no exact definition and to date, it has not been recognized as specific disease complication. The physical exam for early detection of these alterations might prevent severe disability.Objectives: to describe the most common musculoskeletal alterations in diabetic persons hands using 3 patients with limited joint mobility who were hospitalized because of complicated foot injures.Development: among the most common hand alterations observed in diabetic persons are limited joint mobility, Dupuytrens contracture, ulnar neuropathy and Carpal tunnel syndrome. Each of them has its own particularities and may be easily diagnosed through physical exam. They are related to length of disease, poor metabolic control and microvascular complications as it happens in the present cases with severe limited joint mobility. These deformities affect daily life activities and the quality of life of patients. Additionally, they guide the physicians in searching undiagnosed microvascular complications, hence the importance of detecting them.Conclusions: the early detection of hand alterations in diabetics has significant personal and health implications, so a systematic exam is required to be performed in all the patients(AU)

Concurrent dorsal dimelia in 160 consecutive patients with congenital anomalies of the hands and feet.

This study was designed to investigate the prevalence of dorsal dimelia in a series of 160 consecutive patients with congenital anomalies of the hands and feet, and to investigate the distribution of dorsal dimelia and the concurrent anomalies. Five cases (3.1%) showed evidence of dorsal dimelia and the distribution of dorsal dimelia was similar to the distribution of concurrent anomalies in all five cases. Another 11 cases of concurrent dorsal dimelia with other congenital anomalies have been reported previously with a positive match in the distributions in all cases. This similarity in the distribution in all 16 reported cases (including the five cases in the current study) is statistically significant. It is concluded that dorsal dimelia in humans is not as rare as it is generally thought to be, and that it may be viewed as an error of dorso-ventral patterning, which occurs in the same distribution as other concurrent anomalies.

Nevoid basal cell carcinoma syndrome: a 40-year study in the South African population.

BACKGROUND: Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary autosomal dominant syndrome presenting with a number of signs and symptoms in different population groups. METHODS: The investigators implemented a 40-year retrospective analysis of the clinical and radiological features of South Africans affected by NBCCS presenting at the Departments of Oral Surgery, Pathology and Radiology of two major referral hospitals. Details of age, gender, ethnic origin, clinical, and radiological findings were recorded and compared to previous reports. A list of diagnostic criteria for diagnosis of NBCCS in this population was complied. Descriptive statistics were computed, and the P value was set at 0.05 or less. RESULTS: The sample was composed of 15 patients. The mean age at the time of diagnosis was 22.7years (SD 20.9) with eight (53.3%) patients diagnosed before 20years of age (P=0.0001). The male: female ratio was 2:1. The most frequent major criteria were keratocystic odontogenic tumors (KCOTs) (100%), calcification of falx cerebri (40%), palmo-plantar pits (26.7%), and basal cell carcinomas (BCCs) (20%). The most frequent minor criteria were bifid ribs (20%), skull anomalies (20%), and hypertelorism (20%). CONCLUSIONS: The results of this study indicate that there was a low frequency of falx cerebri calcifications, BCCs, skull, and rib anomalies in this sample compared to other population groups. These differences could be attributed to genetic, racial, and environmental factors. Future studies are needed to compile diagnostic criteria specific to different population groups.

Evaluación de la función de la mano en las enfermedades reumáticas. Validación y utilidad de los cuestionarios AUSCAN, m-SACRAH, DASH y Cochin en Español / Evaluation of hand function in rheumatic disease. Validation and usefulness of the Spanish version AUSCAN, m-SACRAH and Cochin questionnaires

Introducción: Los cuestionarios para valorar la función de las manos difieren en el número de ítems, dominios evaluados y enfermedades en las que se han utilizado. Objetivos: a) Traducir y validar al español m-SACRAH y AUSCAN; b) hacer la adaptación transcultural del DASHe, ya validado en España, y c) comparar los anteriores más el Cochin (previamente validado en México), en pacientes reumáticos y diversos grados de afección de las manos. Material y métodos: El m-SACRAH, AUSCAN y DASH fueron traducidos/retrotraducidos y adaptados. Evaluamos validez de contenido en los 3 y, junto con el Cochin, se aplicaron a 10 sujetos sanos con escolaridad variable (estudio piloto) y a 16 pacientes reumáticos con diversos diagnósticos y grados de afección de las manos; todos respondieron los 4 cuestionarios y fueron evaluados clínicamente en forma ciega. Resultados: El 76% fueron mujeres, edad: 45,7 ± 11,4 años. El alfa de Cronbach fue > 0,90; el tiempo para responderlos estuvo entre 2,3 ± 0,087 (AUSCAN) a 3,5 ± 0,36 minutos (DASH). Hubo buena correlación de los cuestionarios entre sí (de r = 0,683, AUSCAN-m-SACRAH a r = 0,889 AUSCAN-DASH) y adecuada capacidad discriminatoria en pacientes con afección leve VS moderada a grave; los pacientes con afección leve tardaron menos tiempo en responderlos, no hubo diferencias significativas en las calificaciones de los cuestionarios entre sí. Los pacientes prefirieron: AUSCAN (10/16), Cochin (4/16) y m-SACRAH (2/16). Conclusión: Los 4 cuestionarios son útiles para valorar la afección de las manos en las enfermedades reumáticas y tienen buena capacidad discriminatoria. El AUSCAN fue el que agradó a mayor número de pacientes (AU)

Introduction: Questionnaires to evaluate hand function are variable in the number of items, domains and diseases in which they had been previously used. Objectives: a) To translate to Spanish and validate the m-SACRAH and AUSCAN questionnaires; b) to do a transcultural adaptation of DASHe, previously validated in Spain), and c) to compare them and the Cochin questionnaire (previously validated in México), in rheumatic patients with variable impairment of hand function. Material and methods: m-SACRAH, AUSCAN and DASH were translated/retro-translated and adapted. The final version was revised to determine content validity and them, plus Cochin were applied to 10 healthy subjects (pilot study) with a variable educational level and in 16 rheumatic patients with variable diagnoses and degrees of hand function impairment; all patients answered 4 questionnaires and were evaluated clinically by blinded investigators. Results: Seventy six percent were women, mean age 45.7 ± 11.4 years. Cronbach's Alpha > 0.90; time to answer went from 2.3 ± 0.087 (AUSCAN) to 3.5 ± 0.36 minutes (DASH). There was good correlation among them (r = 0.0683 AUSCAN-m-SACRAH to r = 0.889 AUSCAN-DASH) and good capability for discrimination between patients with mild VS moderate to severe impairment was also demonstrated; patients with mild impairment needed less time to answer them and there were no significant differences among questionnaire scores. Patients prefered AUSCAN (10/16), Cochin (4/16) and m-SACRAH (2/16). Conclusion: The 4 questionnaires are useful to evaluate hand function in rheumatic patients and have good discrimination capability. More patients preferred AUSCAN (AU)

Congenital upper limb deficiencies and associated malformations in Finland: a population-based study.

PURPOSE: To calculate the national incidence of upper limb deficiencies and associated infant mortality in children in Finland using the International Federation of Societies for Surgery of the Hand (IFSSH) classification. Radial ray deficiency, ulnar ray deficiency, central ray deficiency, transverse arrest, phocomelia, undergrowth, and constriction band syndrome with skeletal defects were evaluated. METHODS: We reviewed upper limb deficiencies among all 753,342 births in Finland during 1993 to 2005 reported to the Finnish Register of Congenital Malformations. Classification of these upper limb deficiencies was done according to a modified IFSSH system. We calculated incidence, gender and side distributions, frequency of associated anomalies, and infant mortality rates in different subtypes of the deficiencies. Familial occurrence of congenital upper limb defects was recorded. RESULTS: A total of 419 cases (234 male, 185 female) of upper limb deficiencies were identified. The national incidence of upper limb deficiencies was 5.56 per 10,000 births and 5.25 per 10,000 live births. The most common upper limb abnormality was radial ray deficiency (138), followed by subgroups of undergrowth (91), upper limb defects due to constriction band syndrome (51), central ray deficiency (41), and ulnar ray deficiency (33). Perinatal mortality was 14%. Infant mortality among children with upper limb deficiencies was 137 per 1,000 live births, compared with an overall infant mortality of 3.7 per 1,000 live births in Finland. Additional birth defects were found in 60% of these children. Prevalence of upper limb defects in relatives of the census population was 2% (11 of 419). CONCLUSIONS: The national incidence of upper limb deficiencies is 5.25 per 10,000 live births. Congenital upper limb deficiencies are associated with additional birth defects in two thirds of cases. These children, especially children with radial ray deficiency, have a high perinatal mortality rate. When divided into subgroups using IFSSH classification, differences emerge in both associated anomalies and mortality.

Incidence of Fanconi anemia in children with congenital thumb anomalies referred for diepoxybutane testing.

PURPOSE: Fanconi anemia (FA) is a rare genetic disorder of DNA repair that with near uniformity leads to bone marrow failure and resulting morbidity and mortality. Approximately 50% of FA patients are born with anomalies of the thumb or thumb and radius, and it has been recommended that all patients born with thumb anomalies undergo testing. However, the risk of FA in this population is unknown. We determined the incidence of FA in children with congenital thumb anomalies referred for FA testing and characterized those who tested positive. METHODS: We queried our database for patients who presented with congenital thumb anomalies and who underwent diepoxybutane (DEB) testing for FA between 1999 and 2008 at Children's Hospital Boston and the Dana-Farber Cancer Institute. RESULTS: During this time period, 543 congenital thumb anomaly patients (235 with thumb hypoplasia) presented to our institution. A total of 81 patients with thumb abnormalities underwent DEB testing. Six patients (7% of those tested; 1% of the total; 3% of thumb hypoplasia patients) had a positive DEB test consistent with the diagnosis of FA; all had other non-upper-extremity anomalies associated with FA. Of 6 FA patients, 5 had bilateral involvement; all had some degree of thumb hypoplasia (3 also had radial dysplasia). Mean age at testing was 2.6 years (SD 4.3). Most of the patients tested had multiple physical anomalies (n = 66). The anomaly distribution was: thumb hypoplasia and radial dysplasia (n = 29), thumb hypoplasia (n = 26), radial polydactyly (n = 12), radial polydactyly and radial dysplasia (n = 1), and proximally placed thumb and radial dysplasia (n = 1). Twelve patients had other thumb anomalies. CONCLUSIONS: Although the incidence of FA in patients with thumb anomalies may be low, patients with thumb hypoplasia and other physical findings associated with FA, specifically café au lait spots and short stature, appear to have an increased risk of FA. Because hand surgeons see these patients early in life, they have the opportunity to refer these patients for FA testing to initiate early education, family genetic counseling, and treatment if warranted. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Striatal deformities of the hand and foot in Parkinson's disease.

Striatal deformities of the hand and foot are abnormal postures that are common in patients with advanced Parkinson's disease (PD); they can present in the early stages of PD and in other parkinsonian disorders. Over a century ago, Charcot and Purves-Stewart recognised these deformities, which cause substantial functional disability and discomfort. The term striatal is used because pathology in the neostriatum (putamen and caudate) has been suggested to cause the deformities, but the pathogenesis is unknown. Misdiagnosis of the deformities is common-particularly when they occur early and in the absence of cardinal parkinsonian signs, such as tremor, bradykinesia, and rigidity-because the hand deformities are similar to those in rheumatoid arthritis, equinovarus foot deformity typically suggests an orthopaedic problem, and toe extension may be thought to be the Babinski sign of upper-motor-neuron syndromes. Here we review the background and clinical features of these deformities to highlight these commonly unrecognised and poorly understood parkinsonian signs.

Nevoid basal cell carcinoma syndrome: a retrospective analysis of 33 affected Korean individuals.

This article describes a pooled analysis of Korean individuals with nevoid basal cell carcinoma syndrome (NBCCS). The data upon which this review is based has been retrieved from published case reports in Korean dental and medical literature between the years 1981 to 2002. We found 33 subjects who met the diagnostic criteria for NBCCS. Relative frequencies of associated complications are presented and compared with those of the English literature. Odontogenic keratocyst (OKC) and palmar and/or plantar pits, and hypertelorism were the most frequently observed anomalies. OKCs are often the first signs of NBCCS and can be detected in patients younger than 20 years of age. However, the incidence and clinical manifestations of NBCCS in Korean individuals were found to be rather different from those of other countries. The relatively low frequency of basal cell carcinomas and falx calcification among the major criteria were two major differences. The frequencies of the minor criteria concur in general with the ranges given by some others. It is concluded that these differences may be attributed to genetic and geographic differences.

Musculotendinous anomalies in musician and nonmusician hands.

Musculoskeletal abnormalities of musicians' hands and upper extremities are well-recognized and potentially career-threatening problems. Of the many types of potentiality problematic musculoskeletal disorders that could be assessed, this study focused on joint instability and musculotendinous anomalies. For this study, the hands of 92 music students were compared with the hands of 64 nonmusician control subjects. Flexor anomalies were observed much more frequently than extensor musculotendinous anomalies; clinical evidence of the Linburg-Comstock anomaly was noted for 60 to 70 percent of subjects in both groups. Further analysis of the Linburg-Comstock anomaly demonstrated that the sites of pain among test-positive subjects were variable, test positivity was more frequent in the left hand and among string players, and test positivity tended to decrease from the radial side to the ulnar side of the hand. There were only two definite extensor musculotendinous anomalies (1.3 percent), and both involved a subluxating extensor mechanism affecting the little fingers. Forty-three percent of all subjects exhibited a degree of instability affecting the joints of their hands.

Prevalence of mutilans-like hand deformities in patients with seropositive rheumatoid arthritis. A prospective 20-year study.

This study examined radiographically the prevalence of arthritis mutilans hand deformities in an inception cohort of 68 rheumatoid arthritis (RA) patients. Hand deformities of 103 RF-positive RA patients were evaluated after 8 years, 83 patients after 15 years and 68 patients 20 years after entry. The grade of destruction in the hand joints was assessed by the Larsen method and Larsen scores of 0-50 were determined for both PIP (+IP) and MCP joints. At the end point, 3 patients had Larsen scores > or =40 for both PIP and MCP joints. These three patients had severe resorption in most of the finger joints, but did not demonstrate classical opera-glass hand. The prevalence of mutilans-like hand deformities with RA was 3/68 (4.4%) in a prospective 20-year study.

A medieval casebook: hand cures documented in the Icelandic Sagas of bishops.

The Sagas of Icelandic bishops composed in and around the 13th century reveal something of the incidence and treatment of various hand conditions in the medieval period. A selection from the relevant material is translated and discussed.