Purpose

Handgrip dynamometry has previously been used to detect pre - operative malnutrition and predict the likelihood of post - operative complications. This study explored whether a relationship exists between pre-operative pinch and power grip strength and length of hospital stay in patients undergoing hip and knee arthroplasty. We investigated whether handgrip dynamometry could be used pre - operatively to identify patients at greater risk of longer inpatient stays.

Thumb Carpometacarpal (CMC) arthritis is a common pathology of the hand. Surgical treatment with thumb reconstruction is well described. Retrospective outcomes have been described for multiple techniques, suggesting patient satisfaction with multiple different techniques. The Thompson technique uses a slip of Abductor Pollicis Longus for suspension and interposition as well as excision of the trapezium. Retrospective outcomes suggest good patient satisfaction. We describe the improvement in Patient rated outcomes scores (PROS) and changes in pinch and grip strength in a prospectively collected cohort of patients treated with a modification of the Thompson technique. To assess changes in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, as well as to determine the percentage of patients that surpassed the Minimal Clinically Important Difference (MCID) figure that has been described in the literature for these tests. In addition, measurements for evaluation of pinch and grip strength prior to surgery, at six, and at twelve months follow-up were done. Between June 2016 and February 2019, a consecutive prospective series of Thirty-seven LRTI procedures with APL suspension arthroplasty (Thompson technique) were performed on 34 patients with osteoarthritis of the thumb CMC joint (24 women / 13 men; age 63±8.553). All surgeries were performed by the senior surgeon. Data was collected as part of a wrist pain database. Patients failing conservative treatment and electing surgical management of thumb arthritis were enrolled into the database. Patients were evaluated pre-operatively with the PRWE and QDASH questionnaires and grip and pinch strength measurements, and postoperatively at 6 and 12 months. The MCID for QDASH and PRWE is 14 and will be evaluated at the same time points for each patient. Paired student T-test was used to determine differences in the means. Data are presented as mean ± SD unless stated otherwise. Differences with p<.05 were considered significant. Compared to the pre-operative assessment, at six months, the means of PRWE pain score and PRWE functional score decreased significantly (32.824 SD±10.721 vs. 19.265 SD±12.268 and 30.262 SD±10.050 vs. 16.431 SD± 9.697 respectively, n=34,, p<0.05). 69% of the patients surpassed the MCID of 14 six months after the surgery. In addition, QDASH mean score also dropped from 56.108 to 32.219 (SD± 21.375 n=32. p<0.05) at six months. At one year, 76% of the patients were above the MCID of 14. The mean scores of these three questionnaires did not show significant change between six and twelve months. Compared to the initial pre-operative assessment, we found no statistically significant difference in the means of grip strength, point pinch, and lateral key pinch at six and twelve months. Thumb reconstruction with APL suspension arthroplasty demonstrates significant improvement in pain and functionality. No significant improvement in grip and pinch strength is observed, even at one year postoperatively

This is largest collection of outcomes of distal biceps reconstruction in the literature. 8 subjects prospectively measured pre and post reconstruction Strength deficit in patients with chronic tendon deficit is described. To describe outcomes for 53 chronic distal biceps reconstructions with tendon graft. Clinical outcomes as well as strength and endurance in supination and flexion are reported. To examine eight patients measured pre- and post-reconstruction. To identify deficit in supination and flexion in chronic reconstruction. 53 reconstructions of chronic distal biceps with tendon graft were carried out between 1999 and 2015. 26 subjects agreed to undergo strength testing after minimum one year follow up. Eight subjects were tested both before and after reconstruction. Primary outcomes were strength in elbow flexion and forearm supination. Strength testing of supination and flexion included maximum isokinetic power and endurance performed on a Biodex. Clinical outcomes measures included pre-operative retraction severity, surgical fixation technique, postoperative contour, range of motion, subjective satisfaction, SF-12, DASH, MAYO elbow score, ASES and pain VAS Non-parametric data was reported as median (interquartile range), while normally-distributed data was reported as mean with 95% Confidence Limits. Hypothesis testing was performed according to two-tailed, paired t-tests. Median time from index rupture to reconstructions 9.5 (range 3–108) months. Strength measurements were completed at a median follow-up time of 29 (range 12–137) months on 26 subjects. The proportion of patients that achieved 90% strength of the contralateral limb post-reconstruction was 65% (17/26) for peak supination torque, and 62% (16/26) for peak flexion torque. Supination and flexion endurance was 90% of the contralateral arm in 81% (21/26) and 65% (17/26) of subjects, respectively. Ten subjects (39%) achieved 90% strength of the contralateral arm on at least four of five strength tests. Eight of the 26 patients were evaluated pre- and post-surgery. As compared to the contralateral limb, chronic distal biceps rupture was found to have a mean [95%CI] deficit in peak supination torque of 31.0 [21.0, 42.9]% (p=0.002). Mean deficit in peak flexion torque of 34.2 [23.1, 45.4]% (p <0.001). Reconstruction resulted in an increase in peak supination torque of 33.5 [8.7, 58.3]% (p=0.0162), increase in peak flexion torque of 35.0 [6.4, 63.6]% (p=0.023), increase in isometric strength of 57.6 [36.1, 79.1]% (p<0.001), increase in supination endurance of 0.6 [-22.2, 23.4]% (p=0.668), and a decrease in flexion endurance of 4.8 [-23.3, 13.7](p=0.478). Ninety-six percent of the patients (25/26) were satisfied, or very satisfied with the overall outcome of the surgery, while median Mayo score post-reconstruction was 100 (range: 55–100). Chronic distal biceps tendon rupture results in less supination loss and greater flexion loss than previously reported. Reconstruction with tendon graft results in a significant, but incomplete recovery of peak supination and flexion torque, but no significant change in endurance. Clinical patient satisfaction with surgical outcomes is high

Introduction. Although Total elbow arthroplasty (TEA) generally provides favorable clinical outcomes, its complications have been reported with high rate compared with other joints. Previously, we used the Bryan & Morrey approach in TEA, which included separating the triceps muscle subperiosteally from the olecranon; however, since 2008, in order to prevent skin trouble and deficiency of the triceps, we performed TEA by MISTEA method, which required no removal of the subcutaneous tissue in the region of the olecranon and no release or stripping of the triceps tendon. Objectives. The purpose of this study was to examine the utility of the MISTEA method by evaluating and comparing muscle strength and complications by using both the Bryan & Morrey approach and MISTEA method. Materials and Methods. The study was conducted on 23 elbows, on which elbow muscle strength could be measured postoperatively at more than 6 months after TEA. Thirteen elbows were operated on the Bryan & Morrey approach (BM group; mean age, 62.3 years; mean follow-up period, 27 months), and 10 elbows on the MISTEA method (MIS group; mean age, 67.6 years; mean follow-up period, 19.1 months). To determine the elbow extensor and flexor strengths, measurements were conducted on the affected side for the BM group, and on both the affected and healthy sides for the MIS group. Further, the “extension/flexion ratio” as well as the “affected/healthy side ratio” and complications were assessed. Results. Excluding the elbow extensor strength of 3 elbows in the BM group, which could not be measured too week. The extension/flexion ratio was as follows: in the BM group, 0.61 and in the MIS group, 0.93 on the affected side and 0.81 on the healthy side. For the MIS group, in which measurements could be performed on both the sides, the “affected/healthy side ratio” was 0.72 in flexion and 0.91 in extension. In terms of complications, skin trouble was found on 2 elbows in the BM group and on 1 elbow in the MIS group; further, rupture of the triceps tendon was suspected in 3 elbows in the BM group but was not found in the MIS group. Discussion. In our study, deficiency in triceps muscle was found in 3 of 13 elbows with the Bryan & Morrey approach. MISTEA method may be the reason for prevention of deficiency or rupture of the triceps tendon. The MIS group had higher extension/flexion ratio in the affected side, suggesting the possibility that either the extensor strength had increased or the flexor strength had weakened. Further, in the MIS group, the extension showed an “affected/healthy side” ratio, which means that an extensor strength almost equivalent to that of the healthy side was maintained, whereas the flexor strength was 72% of that on the healthy side, suggesting that the flexor strength may have decreased. Loss of the flexor strength may be because the MISTEA method involves partial release of the brachialis muscle and the joint's center of rotation to move slightly towards the proximal side