Pathologies such as Scapho-Lunate Advanced Collapse (SLAC), Scaphoid Non-union Advanced Collapse (SNAC) and Kienbock's disease can lead to arthritis in the wrist. Depending on the articular surfaces that are involved, motion preserving surgical procedures can be performed. Proximal Row Carpectomy (PRC) and Four Corner Fusion (4CF) are tried and tested surgical options. However, prospective studies comparing the two methods looking at sufficient sample sizes are limited in the literature.

The purpose of this study was to prospectively compare the early results of PRC vs 4CF performed in a single centre.

Patients with wrist arthritis were prospectively enrolled (2015 to 2021) in a single centre in Vancouver, Canada. Thirty-six patients and a total of 39 wrists underwent either a PRC (n=18) or 4CF (n=21) according to pre-operative clinical, radiographical, and intra-operative assessment. Patient-Rated Wrist Evaluation (PRWE) scores were obtained preoperatively, as well as at six months and one year post operatively. Secondary outcomes were range of motion (ROM) of the wrist, grip strength, reoperation and complication rates. Statistical significance was set at p=0.05

Respectively for PRC and 4CF, the average PRWE scores at baseline were 61.64 (SD=19.62) and 63.67 (SD=20.85). There was significant improvement at the six-month mark to 38.81 (SD=22.95) (p=0.031) and 41.33 (SD=26.61) (p=0.007), then further improvement at the 12month mark to 33.11 (SD=23.42) (p=0.007) and 36.29 (SD=27.25) (p=0.002).

There was no statistical difference between the two groups at any time point.

Regarding ROM, statistical difference was seen in pronation for the PRC group at the 6month mark from an average of 72.18 deg to 61.56 deg and in flexion at the 12 month mark from 47.89 deg to 33.50 deg. All other parameters did not show statistically significant difference post operatively.

For ROM of the 4CF group, only flexion at the 12month mark showed statistically significant change from an average of 48.81 deg to 38.03 deg.

There was no statistical difference in pre-operative ROM between the two groups.

One patient in the 4CF group required a revision for delayed union, and three patients ended up with ulnar sided wrist pain.

Patients undergoing PRC and 4CF showed significant improvement in post operative PRWE scores, this reflects existing literature. For 4CF care must be taken to minimise ulnar sided wrist pain by relatively shortening the unar sided carpal column mass.

ROM analysis showed that patients lost some wrist flexion ROM post-operatively at the 12month mark with both PRC and 4CF. However, other ROM parameters were unchanged

SARS-CoV-2 emerged in Wuhan, China in December 2019 causing pneumonia and resulting in a pandemic, commonly known as COVID-19. This pandemic led to significant changes to our daily lives due to restrictions, such as social distancing, quarantining, stay at home orders and closure of restaurants and shops among other things. The psychological effects of this uncertainty as well as of these changes to our lives have been shown to be significant. This study is a prospective study investigating the mental effects of the pandemic on hand and wrist patients seen in our clinic during this pandemic.

A prospective database on wrist pain was used to identify patients seen in our hand clinic from January 1, 2018 to December 10, 2021. All participants had been diagnosed with either radial sided wrist pain or ulnar side wrist pain. The Center for Epidemiological Studies Depression (CES-D) Scale was used to assess the mental health of our participants before and during this pandemic. An independent samples t-test was used to compare the scores of the 2 groups.

A total of 437 CES-D questionnaires were collected during this period. 118 of them belonging to the pandemic group and 319 to the pre-pandemic group. A difference (p < 0 .05) in the CES-D score was observed between the pre-pandemic and during pandemic groups. The mean score for the pre-pandemic group was found to be 9.23 (8.94) and 12.81 (11.45) for the pandemic group. However, despite the increase in score, it didn't exceed the cut off score of 16 or greater used to assess depression.

Our results indicate that there was a slight increase in score for depression in hand and wrist patients, but not above the cut off level of 16 to be of a significant risk for depression. Other global studies have shown an increase in depression in the general public. Our mild results might be attributed to the fact that British Columbia did not implement severe restrictions compared to other countries or regions, i.e no stay at home orders. Additionally, our study population was skewed and included more middle age and older patients compared to younger ones and age might be a factor in keeping the score down.

Ulnocarpal impaction (UCI) is a common cause of ulnar-sided wrist pain. UCI typically occurs in wrists with positive ulnar variance, which causes altered loading mechanics between the ulnar head, lunate and triquetrum. However, many individuals with positive ulnar variance never develop UCI, and some with neutral or negative ulnar variance do experience UCI. This suggests that other variables contribute to the development of UCI. Suspected culprits include lunate morphology, and dynamic changes with loaded (grip) pronation. If these anatomic variations are contributing to UCI, we expect them to influence functional impairment scores. Therefore, the objective of this study was to evaluate the relationship between radiographic parameters and pre-surgical upper extremity patient-rated outcomes scores (PROS) in patients with a diagnosis of UCI.

Retrospective cohort study of patients undergoing ulnar shortening osteotomy or arthroscopic wafer procedure for UCI. Data derived from prospectively collected departmental database that captured demographic, clinical, functional and radiographic information. Radiographic parameters evaluated were: lunate morphology [presence vs. absence of hamate facet; Antuna-Zapico (A-Z) classification], and dynamic changes on grip view [difference in lunate-ulnar head distance (LUD); difference in lunate uncovering index (LUI)]. PROS assessed were QuickDASH and Patient-Rated Wrist Evaluation (PRWE) scores, collected at patient enrolment. ANOVA was used to assess for differences in PROS between A-Z classification groups. Student's t-test was used to assess for differences in PROS based on presence/absence of a hamate facet. Regression analysis evaluated a relationship between change in LUD with grip and PROS, and change in LUI with grip and PROS.

Preliminary analysis included 23 wrists, with a mean patient age of 48.9 years [standard deviation (SD) 14.5 years]. Forty-eight percent were male, and the dominant limb was involved in 52.2% of cases. Average QuickDASH and PRWE scores at enrolment were 50.9 (SD 22.2) and 62.2 (SD 22.0), respectively. Assessment of radiographs revealed 17 patients (73.9%) without a hamate facet. Five patients (21.7%) had A-Z Type I lunate morphology, and nine (39.1%) had Type II and Type III morphology, respectively. ANOVA revealed no differences in enrolment QuickDASH (p = 0.185) or PRWE (p = 0.256) scores between A-Z classification groups. Similarly, Student's t-test found no difference based on presence/absence of a hamate facet (QuickDASH p = 0.594; PRWE p = 0.573). Regression analysis revealed no relationship between change in LUD with grip and PROS (QuickDash R2 = 0.020, p = 0.619; PRWE R2 = 0.009, p = 0.733), and no relationship between change in LUI with grip and PROS (QuickDash R2 = 0.000, p = 0.913; PRWE R2 = 0.010, p = 0.722).

Preliminary results suggest no relationship between A-Z classification lunate morphology, presence/absence of a hamate facet, change in LUD, or change in LUI and pre-surgical PROS. It is unclear if our findings represent the true relationship between these radiographic parameters and PROS, or reflect our preliminary sample size. Data analysis is ongoing to add clarity to this question.

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.

Physical examination is critical to formation of a differential diagnosis in patients with ulnar-sided wrist pain. Although the specificity and sensitivity of some of those tests have been reported in the literature, the prevalence of positive findings of those provocative maneuvers has not been reported. The aim of the study is to find the prevalence of positive findings of the most commonly performed tests for ulnar sided wrist pain in a population presenting to UE surgeon clinics, and to correlate those findings with wrist arthroscopy findings.

Patients with ulnar sided wrist pain were identified from a prospective database of patients presented with wrist pain from September 2014. Prevalence of positive findings for the following tests were gathered: ECU synergy test, ECU instability test (Ice cream and Fly Swatter), Lunotriquetral ballottement, Kleinman shear, triquetrum tenderness, triquetrum compression test, triquetral-hamate tenderness, pisotriquetral shuck test, ulnar fovea test, ulnocarpal impaction (UCI) maneuver, UCI maneuver with fovea pressure (ulnar carpal plus test), piano key sign. A subgroup was then created for those who underwent wrist arthroscopy, and analysis of the sensitivities, the specificities and the predictive values of these provocative tests was carried out with correlation to arthroscopic finding.

Prevalence of ECU instability tests was t 1.13% (ice cream scoop) and 1.5% (fly swatter). Lunotriquetral ballottement test's positive findings range from 4.91% (excessive laxity) to 14.34% (pain reproducing symptoms. The Kleinman shear test yielded pain in 13.58% of patients, and instability in only 2.26%. Triquetrum compression test reproduces pain in 32.83% of patients, and triquetral-hamate tenderness reproduced pain in 13.21%. Pisotriquetral grind test yields 15.85% positive findings for pain, and 10.57% for crepitus with radioulnar translation. The ulnar fovea test revealed pain in 69.05% of cases. The UCI maneuver yielded pain in 70.19%. The UCI maneuver plus ulnar fovea test reproduced pain in 80.38% of cases. Finally, the piano key sign yields positive finding in 2.64% of cases.

For patients who underwent surgery, sensitivities, specificities and predictive values were calculated based on arthroscopic findings. The lunotriquetral ballottement test has 59.6% sensitivity, 39.6% specificity, 20.3% positive predictive value and 85.4% negative predictive value. The sensitivity of Kleinman test was 62.4%, the specificity was 41.3%, the positive predictive value was 23.5%, and the negative predictive value was 83.2%. The sensitivity of fovea test was 94.3%, the specificity was 82.5%, the positive predictive value was 89.5% and the negative predictive value was 92.3%. The UCI maneuver plus ulnar fovea test has 96.5% sensitivity, 80.7% specificity 86.4% positive predictive value, and 95.3% negative predictive value.

Among the provocative tests, the prevalence of positive findings is low in the majority of those maneuvers. The exceptions are the fovea test, the UCI maneuver, and the UCI plus maneuver. With regard to the sensitivity and the specificity of those tests, the current study reproduces the numbers reported in the literature. Of those patients who underwent wrist arthroscopy, the tests are better at predicting at the absence of injury rather than at predicting its presence

Four-Corner Fusions (4CF) and Proximal Row Carpectomies (PRC) are common procedures utilized to treat carpal pathologies and radial sided wrist pain. Usually, the range of motion (ROM) and grip strength (GS) is affected by such conditions. Literature quotes significant reduction in ROM (50–60%) and grip strength (GS) (80% of normal) with PRC and 4CF. This study aims to determine the correlation between pre-operative ROM and GS and post-operative ROM and GS for patients with wrist pain undergoing PRC or 4CF. We hypothesize that ROM between pre-operative and post-operative patients does not change, but GS improves.

Data from a prospective database of patients with wrist pain was searched to identify patients who have undergone PRC or 4CF with one year follow-up completed in the past two years. 17 such participants were identified. The diagnosis, pre-operative ROM in flexion, extension, radial deviation, ulnar deviation, pronation and supination, as well as GS at time of surgery and at six months and one year follow up were identified and assessed. The data was analysed to determine correlation between pre-and postoperative ROM and GS. The analysis was subdivided to compare patients treated with PRC versus patients with 4CF.

No significant difference between pre- and post-operative ROM was detected, except in flexion at 6 months post-operatively. The average flexion was significantly lower at 6 months (p=0.0251) compared to pre-operative levels. Average flexion pre-operatively and at 6 and 12 months was found to be 46.6 (SD=15), 34.3 (SD=13.3), 51.2 (SD=21.5) respectively. Extension was at 41.4 (SD=15.3) pre-operatively and at 33.4 (SD=12.8) and 42.1 (SD=15.5) at 6 and 12 months post-operatively. Similarly, radial and ulnar deviation averages pre-operatively and at 6 and 12 months post-operatively were found to be 11.33 (SD=5.9), 11.9 (SD=4.5), 16 (SD=8.2) [radial deviation] and 24.1 (SD=8.3), 21.4 (SD=7.3), 26 (SD=12.8) [ulnar deviation].

No significant difference was found in GS at 6 months post-operative. However, significant difference at 12 months post-operatively was observed with an average GS of 28.4 kg (SD=12.8) [p=0.0385]. Average GS pre-operatively and at 6 months was 15.8 kg (SD=9.7) and 17.3 kg (SD=8.9) respectively.

This study provides an insight on ROM and GS after PRC and 4CF. It shows that patients do not gain or lose ROM after surgery. As expected, GS improves with treatment as the pain diminishes. It is interesting to note that flexion gets worse at 6 months post-operatively before it bounces back to pre-operative levels.