Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hand 85 articles


“Knuckle Cracking”: Can Blinded Observers Detect Changes with Physical Examination and Sonography?

Robert D. Boutin MD, Anuj P. Netto MD, MPH, David Nakamura MD, Cyrus Bateni MD, Robert M. Szabo MD, MPH, Michael Cronan RDMS, Brent Foster BS, William R. Barfield PhD, J. Anthony Seibert PhD, Abhijit J. Chaudhari PhD

Voluntary knuckle cracking is a common habit, with a reported prevalence of 25% to 45%. Habitual knuckle cracking also is a frequent source of questions for physicians, and the largest study to date reported an association with functional hand impairments.

Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis

Monica J. Coughlan BS, Alexandra Bourdillon, Joseph J. Crisco PhD, Deborah Kenney MS, OTR, Arnold-Peter Weiss MD, Amy L. Ladd MD

Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA.

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Mariano E. Menendez MD, Bastiaan T. Hoorn BS, Michael Mackert PhD, Erin E. Donovan PhD, Neal C. Chen MD, David Ring MD, PhD

In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits.

Is Social Support Associated With Upper Extremity Disability?

Sjoerd P. F. T. Nota MD, Silke A. Spit MD, Thijs C. H. Oosterhoff BSc, Michiel G. J. S. Hageman MD, David C. Ring MD, PhD, Ana-Maria Vranceanu PhD

Pain intensity and disability correlate with psychosocial factors such as depression and pain interference (the degree to which pain interferes with activities of daily living) as much or more than pathophysiology in upper extremity illness. However, other factors like emotional support (perception of being cared for and valued as a person), instrumental support (perception of availability of tangible assistance when needed), positive psychosocial impact (perception and focus on the positive side of a difficult situation, sometimes characterized as posttraumatic growth, benefit-finding, or meaning making), also might be associated with disability in patients with upper extremity orthopaedic illness. This is the first published study, to our knowledge, addressing the potential association of emotional support, instrumental support, and positive psychosocial illness impact with disability in patients with upper extremity illness.

Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis

Thomas J. McQuillan BA, Deborah Kenney MS, OTR, Joseph J. Crisco PhD, Arnold-Peter Weiss MD, Amy L. Ladd MD

The thumb carpometacarpal (CMC) joint orchestrates pinch in its various positions, and thumb CMC osteoarthritis (OA) is a major source of orthopaedic morbidity. Self-reported pain, weakness, and physical examination may not correspond to radiographic findings when diagnosing early thumb CMC OA. Weakness is a prominent feature of the disease, but little evidence exists to quantify self-reported loss of strength with time, or to compare weakness with that of a nonarthritic population during early disease.

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Lana Kang MD, MSc, Sohaib Z. Hashmi BS, Joseph Nguyen MPH, Steve K. Lee MD, Andrew J. Weiland MD, Carol A. Mancuso MD

Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge.

What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Wouter F. Leeuwen MD, Stein J. Janssen MD, Dirk P. Meulen MD, David Ring MD, PhD

Kienböck disease is characterized by osteonecrosis of the lunate. Not all patients with radiographic evidence of the disease experience symptoms bothersome enough to consult a doctor. Little research has been performed on the prevalence of Kienböck disease, and the prevalence in the asymptomatic population is unclear. Knowledge of the natural course of the disease and how often patients are not bothered by the symptoms is important, because it might influence the decision as to whether disease-modifying treatment would be beneficial.

What Is the Impact of Comorbidities on Self-rated Hand Function in Patients With Symptomatic Trapeziometacarpal Arthritis?

Ryan Calfee MD, MSc, Jennifer Chu MD, Amelia Sorensen MD, Erin Martens MD, John Elfar MD

The thumb trapeziometacarpal joint is one of the most common sites of arthritic degeneration prompting specialty care. Surgical treatment algorithms are based on radiographic arthritic progression. However, the pain and disability attributable to trapeziometacarpal arthritis do not correlate with arthritic stage, and depression has independently predicted poorer self-rated hand function both at baseline and after treatment in patients’ atraumatic hand conditions.