The aim of this study was two-fold; firstly, to investigate the construct validity of the Disability of the Arm, Shoulder and Hand (DASH) score in patients following injuries to the upper and lower limbs, and to confirm that DASH score does not measure disability solely attributed to the upper limb. Secondly, to create a modified DASH questionnaire (M2 DASH) with fewer questions that can discriminate clearly between disabilities due to problems at the upper limb, and is more specific to the upper limb.

Patients were asked to fill in the DASH questionnaire in a fracture clinic following ethical approval. This included upper limb injuries (79), lower limb injuries (61) and control subjects (52). The median DASH scores for the three groups were 57, 16 and one respectively. The DASH scores varied significantly between the three groups (Kruskal-Wallis: p< 0.001); the scores for the upper limb group were higher than the lower limb group, and the scores for the lower limb group was higher than the control group (Mann-Whitney: p< 0.001). The M2 DASH questionnaire was developed using questions specific to the upper limb and included questions 1–4, 6, 13–17, 21–23 and 26–30. The median M2 DASH scores for the three groups were 50, 7 and 0 respectively. The revised questionnaire score was then calculated for the upper limb group and a correlation study showed good correlation between the two questionnaires.

Our study shows that the original DASH questionnaire is not specific for the upper limb. This has important implications in measuring response in injuries and disease that involve both upper and lower limbs. We have devised a revised questionnaire that we suggest is referred to as M2 DASH questionnaire. The M2 DASH questionnaire has the advantage of being more specific for the upper limb than the DASH questionnaire.

Templating of preoperative radiographs is routinely recommended prior to knee arthroplasty. We performed this study to assess the reproducibility and accuracy of the templates for three commonly used knee implants (PFC, Kinemax, Scorpio). Six lower limb surgeons templated 10 patients for each of the three designs. The inter and intra-observer reliability and accuracy was calculated. There was marked variation in the reliability of the templating with the tibial insert scoring better than the femoral and the Kinemax being the most reproducible of the three. In general, the intra-observer scores (κ= 0.57–0.81) were better than the inter-observer ones (κ= 0.21–0.60). The Scorpio was the most accurately templated of the three implants, with the percentage correlating with what was actually implanted ranging from 55–62% for the femur and 72–75% for the tibia, with no templated sizes more than 1 size different from the actual implant. The other implants ranged from 38–42% for the femur and 53–58% for the tibia with both having up to 3% more than 1 size difference from the actual implant. We believe that the use of templating in total knee arthroplasty should be interpreted with caution and we urge the development of more accurate prosthesis sizing techniques.