Research Updates

The ASHT Research Division offers research updates to increase awareness of emerging research in the field of hand and upper extremity therapy. Each month, the Research Division releases a brief summary of an original published research paper selected by members of the Research Division.

2024 Research Updates

 

March Research Update

Long-Term Outcomes in Female Patient with Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared with the Unoperated Side of Carpometacarpal Arthroplasty
Summary provided by Lori Algar OTD, OTR/L, CHT

Does a thumb CMC arthroplasty with a thumb MP joint fusion yield improved pinch strength outcomes in comparison to a CMC arthroplasty alone in the treatment of thumb CMC joint osteoarthritis? What should hand therapists’ expectations be regarding long-term pinch strength outcomes for these patients?

Dock, Stone McGraver and McCarthy completed a retrospective review of long-term results for patients who underwent a CMC arthroplasty and compared outcomes to those who underwent a CMC arthroplasty combined with a thumb MP joint fusion. The study included 53 female patients and 70 operated thumbs (29 with CMC arthroplasties and 41 with arthroplasty plus MP joint fusion). There was a statistically significant difference between post-operative long-term pinch strength outcomes with the individuals undergoing the CMC arthroplasty plus MP joint fusion having an average of 11.3 lbs. of pinch strength versus 8.0 lbs. of pinch on average in individuals who underwent CMC arthroplasty alone. There was no difference in QuickDASH scores.

Citation: Dock CC, Stone McGraver R, McCarthy CK. Long-term outcomes in female patients with carpometacarpal arthroplasty and metacarpophalangeal fusion compared with the unoperated side or carpometacarpal arthroplasty. J Hand Surg. 2023; Article in press.

Journal Source: The Journal of Hand Surgery

Access the Journal Article Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Jenny M. Dorich, PhD, MBA, OTR/L, CHT, ASHT Research Division Director at jenny.dorich@cchmc.org.


February Research Update

The Scope and Distribution of Upper Extremity Nerve Injuries Associated with Combat-Related Extremity Limb Salvage
Summary provided by Mirella Deisher, OTD, MS, OTR/L, CHT

Peripheral nerve injuries following blast trauma and can be overlooked or missed, particularly in warfare conditions which often require multiple hand-offs, and where there is wound contamination, as well as other accompanying injuries that need immediate attention. Delay in diagnosis in severe cases of trauma also occur when decisions on limb salvage versus amputation are primarily driven by infection and bone healing concerns. Thus, concomitant nerve injuries are identified and considered secondarily.

This study’s aim was to define the incidence and locations of upper extremity peripheral nerve injuries as well as pain and functional outcomes in a more recent sample of patients that sustained injuries in combat who underwent limb salvage with flap coverage.

They identified 49 extremities treated with limb salvage and flap coverage, 33 (67%) had associated nerve injuries with a total of 47 injured nerves. Of the 33 extremities with nerve injuries, 18 (55%) underwent surgery to address the nerve injury at a median of 26 days. The most injured nerve was the ulnar nerve (51%), followed by the median nerve (30%) and the radial/posterior interosseous nerve (19%). Of the 14 extremities with multiple nerves injured, the median and ulnar nerves were most often injured together (71%), followed by the median and radial nerves (14%) and the ulnar and radial (14%).

Results of this study further demonstrate the increasing trend of nerve injuries secondary to a blast mechanism with more than 95% of patients in their cohort sustaining their injuries from an IED. The three most injured nerves in their cohort were the ulnar, median, and radial nerves with multiple nerve injuries being relatively common. Chronic pain and patient-reported functional limitations were more common among patients with concomitant peripheral nerve injuries. Operatively managed nerve injuries demonstrated decreased pain scores compared to nonsurgical injured nerves. The median numerical rating scale (NRS) pain score in patients with nerve injuries without operative intervention was 2 compared to a median score of 0 in patients who underwent operative management of the injured nerve.

The authors concluded that surgeons performing limb salvage procedures with flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible.

Citation: Harrington, C. J., Dearden, M., McGlone, P., Potter, B.., Tintle, S., Souza, J. (2023). The Scope and Distribution of Upper Extremity Nerve Injuries Associated with Combat-Related Extremity Limb Salvage. The Journal of Hand Surgery, Article in Press. 

Journal Source: The Journal of Hand Surgery

Access the Journal Article Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Jenny M. Dorich, PhD, MBA, OTR/L, CHT, ASHT Research Division Director at jenny.dorich@cchmc.org.


January Research Update

Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve
Summary provided by Katherine Lagasse, MOT, OTR/L

In patients with severe ulnar neuropathy at the elbow (UNE), outward clinical symptoms may not accurately represent the severity of the underlying nerve lesion, necessitating use of objective assessment tools such as electrodiagnostic studies. Timing is often critical, as delayed diagnosis and treatment can lead to irreversible nerve damage and poorer post-operative outcomes. Traditional electrodiagnostic parameters, such as motor nerve conduction velocity (NCV), conduction block and signal latencies, have not been shown to accurately capture the later stages of UNE. Compound muscle action potential (CMAP), an electrodiagnostic parameter that measures the viability of axons at the distal motor target, may offer a more accurate picture. This study aimed to determine whether specific CMAP parameters were able to accurately predict postoperative outcomes after in situ ulnar nerve decompression at the elbow.

Forty-two patients with UNE were selected from five tertiary hand surgery institutions for this prospective, nonrandomized cohort study. The diagnosis of UNE was confirmed via nerve conduction study, with a motor NCV across the elbow segment of <50 m/s required to meet criteria for study participation. Exclusion criteria included post-traumatic UNE, previous ulnar nerve surgery to the affected elbow, additional compressive neuropathies on the ipsilateral side and a history of substance abuse, traumatic brain injury or major psychiatric comorbidity. Study participants underwent in situ ulnar nerve decompression at the elbow, with follow-up reassessments at six weeks, three months, six months and 12 months after surgery.

Outcomes measures were taken both at baseline and at each subsequent post-surgical visit. These included: nerve conduction studies (latency, NCV, and CMAP), motor and sensory function measures (grip and pinch strength, static 2-point discrimination [2-PD] and Semmes Weinstein Monofilaments) and patient-reported outcomes (PROs; Michigan Hand Outcomes Questionnaire [MHQ], Disabilities of the Arm, Shoulder and Hand [DASH] and Carpal Tunnel Questionnaire [CTQ] ).

Controlling for motor NCV and demographic factors, CMAP amplitude was the only electrodiagnostic variable found to predict scores on all three PROs, as well as overall recovery of motor function (both grip and pinch strength). Notably, male sex was also found to correlate with a faster recovery of grip and pinch strength. Motor NCV scores were found to independently predict recovery of 2-PD and pinch strength. Neither CMAP nor NCV scores predicted the MHQ subsections of pain, aesthetics or satisfaction, or the Semmes-Weinstein outcome postoperatively.

The authors concluded that CMAP is a useful electrodiagnostic parameter to identify the severity of UNE and should be utilized to determine timing of treatment for UNE and prognosis. CMAP scores were predictive of post-operative recovery trends of in situ ulnar nerve decompression, particularly for functional PROs and motor function return of grip and pinch strength. Decreased CMAP amplitude pre-operatively was shown to be predictive of poorer treatment outcomes post-operatively.

Citation: Florczynski, M. M., Kong, L., Burns, P. B., Wang, L., & Chung, K. C. (2023). Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve. The Journal of Hand Surgery48(1), 28–36.

Journal Source: The Journal of Hand Surgery

Access the Journal Article Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Jenny M. Dorich, PhD, MBA, OTR/L, CHT, ASHT Research Division Director at jenny.dorich@cchmc.org.


2023 Research Updates

2022 Research Updates

2021 Research Updates

2020 Research Updates

2019 Research Updates

2018 Research Updates

2017 Research Updates