A Simple Physical Exam Maneuver to Distinguish Trigger Digit, Dupuytren's Nodule, and Flexor Sheath Ganglion.

Trigger digit, Dupuytren's disease, and ganglion cysts are 3 common disorders treated by hand surgeons. Despite the varying nature of their pathology, these 3 entities can all present as a mass at the flexor crease in the distal palm. The regional similarity of these presentations can make diagnosis more difficult.

Hand and Wrist Injuries Associated With Application of Physical Restraints: A Systematic Review.

While handcuffs and zip ties are common methods of physical restraint used by law enforcement, they have been noted to damage soft tissue and bony structures of the hand and wrist. This paper seeks to characterize the safety of physical restraints by summarizing its effects on hand and wrist function and disability. Relevant studies were gathered through an independent double selection and extraction process using 3 electronic databases (EMBASE, MEDLINE, and CINAHL) from database inception to June 19, 2020.

The Total Costs of Seismic Retrofits: State of the Art.

This article presents the current state-of-practice with respect to quantifying the total cost to retrofit an existing building. In particular, we combine quantitative, qualitative, and heuristic data to provide a taxonomy for understanding the direct and indirect costs associated with seismic risk mitigation. Much of the literature to date has focused on estimating retrofit costs, the costs of retrofitting the structural elements of a building.

A Predictive Modeling Approach to Estimating Seismic Retrofit Costs.

This paper presents a methodology for estimating seismic retrofit costs from historical data. In particular, historical retrofit cost data from FEMA 156 is used to build a generalized linear model (GLM) to predict retrofit costs as a function of building characteristics. While not as accurate as an engineering professional's estimate, this methodology is easy to apply to generate quick estimates and is especially useful for decision makers with large building portfolios.

Social and Economic Components of Resilient Multi-Hazard Building Design.

In 2017, U.S. damages from natural hazard events exceeded $300B, suggesting that current targets for building performance do not sufficiently mitigate loss.

Direct and indirect utilities of patients with mild to moderate versus severe carpal tunnel syndrome.

Health utility is a quantitative global measure of patients' health status. This retrospective cohort study aimed to compare health utilities of patients with mild to moderate versus severe carpal tunnel syndrome and determine inter-instrumental agreement. Health utilities of 29 patients with varying severity of carpal tunnel syndrome were measured indirectly by Short-Form Sixth Dimension and EuroQol 5D questionnaire and directly by Chained Standard Gamble and a visual analogue scale.

Stable rates of operative treatment of distal radius fractures in Ontario, Canada: a population-based retrospective cohort study (2004–2013).

Background: Rates of surgical management of distal radius fractures are increasing internationally despite the higher cost and limited outcome evidence to support this shift. This study examines the epidemiology of distal radius fractures and asks if the same shift has occurred in Ontario, Canada (population 13.9 million).

Factor Structure of the Disabilities of the Arm, Shoulder and Hand Questionnaire in Upper Extremity Nerve Injury.

Background: This study evaluated the validity of the factor structure of the Disabilities of the Arm, Shoulder and Hand questionnaire to assess upper extremity disability in patients with upper extremity nerve injury.

Methods: Data were used from previous cross-sectional studies of patients with upper extremity nerve injuries. Research ethics approval was obtained for secondary data analyses.

Treatment of carpal tunnel syndrome with wrist splinting: study protocol for a randomized placebo-controlled trial.

Background: Carpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak.

Increasing Community Resilience Through Improved Lifeline Infrastructure Performance.

The concept of community resilience is complex and multidimensional, relying on engineering and other disciplines to help communities break the cycle of destruction and recovery and reduce the impacts of earthquakes and other hazards. This article presents proposed prioritized actions to improve lifeline infrastructure resilience based on an assessment of lifeline infrastructure performance commissioned and funded by the National Institute of Standards and Technology (NIST).

Decisional conflict in surgical patients: Should surgeons care?

Decisional conflict represents a state of uncertainty regarding an action one must take. It is a concept inherent to shared decision-making and can help promote high-quality and patient-centred decisions in surgical care, leading to better outcomes. Specific elements may cause more uncertainty or decisional conflict for patients: lack of knowledge about risks and benefits, poorly defined personal values about the importance of those risks and benefits, perception of a lack of support, unpredictable outcomes, or the impression that an inadequate decision has been made.

Universal Measures of Support Are Needed: A Cross-Sectional Study of Health Literacy in Patients with Dupuytren's Disease.

Background: Health literacy represents the degree to which patients can understand and act on health information. The relevance of health literacy to health care delivery, outcomes, and overall surgical care is unambiguous. This study aimed (1) to determine the prevalence of limited health literacy in patients diagnosed with Dupuytren's contracture and (2) to identify independent predictors of limited health literacy.

Effect of Forearm Warming Compared to Hand Warming for Cold Intolerance Following Upper Extremity Trauma.

Purpose: This study evaluated the effect of forearm or hand warming versus bare hand conditions to improve cold-induced symptoms and skin temperatures in hand trauma patients.

Methods: Adults with symptoms of cold intolerance at least 3 months following hand trauma and age-/sex-matched controls were included. Testing sessions (bare hand, hand warming, forearm warming) were completed in a climate laboratory with continuous temperature monitoring.

Secondary Effects of Radiation Therapy to the Hand for Benign Conditions.

Emerging literature introduces radiation therapy for benign hand conditions. However, hand surgeons are wary recommending radiation therapy for nonmalignant conditions. In our practice, we have used radiation therapy for patients who present with infiltrative or recurrent giant cell tumor of the tendon sheath (GCTTS) since 1998.

Health Literacy Among Surgical Patients: A Systematic Review and Meta-analysis.

Health literacy is the extent to which patients are able to understand and act upon health information. This concept is important for surgeons as their patients have to comprehend the nature, risks and benefits of surgical procedures, adhere to perioperative instructions, and make complex care decisions about interventions. Our review aimed to determine the prevalence of limited health literacy of the surgical patient population.

The Epidemiology of Scapholunate Advanced Collapse.

Scapholunate advanced collapse (SLAC) is the most common pattern of wrist arthritis. Sparse data exist regarding the SLAC wrist pattern of arthritis. This study aimed to document the epidemiology of advanced SLAC in terms of patients' sociodemographics and possible association with trauma.

Case-Cohort Studies: Design and Applicability to Hand Surgery.

Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies.

Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

Objective: This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes.

Methods: Thirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females).

Reliability, Feasibility and Value of Ecography in Clinical-functional Results in Patients Affected by Carpal Tunnel Syndrome: is There a Correlation?

Background: The aim of this study was to evaluate how the ultrasound examination in the carpal tunnel diagnosis could contribute to the clinical and neurophysiological evaluation. This was done by evaluating the cross-sectional area (CSA) and its correlation with symptoms and functionality data assessed by the BTQC questionnaire.

Methods: 60 patients were subjected to open CTR for idiopathic carpal tunnel syndrome.

Using Decision Analysis to Understand the Indications for Unilateral Hand Transplantation.

Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist.

Prevalence of cold sensitivity in patients with hand pathology.

Background: The purpose of this study was to evaluate the prevalence of cold sensitivity in patients with hand- and wrist-related diagnoses.

Methods: We included English-speaking adults who were more than 1 month following hand injury or onset of symptoms. Patients were asked if exposure to cold air or water provoked cold-related symptoms and to rank symptom severity (scale 0-10).

A scoping review of disabilities of the arm, shoulder, and hand scores for hand and wrist conditions.

Purpose: To evaluate the variability of reported baseline Disabilities of the Arm, Shoulder, and Hand (DASH) scores for non-acute hand and wrist conditions. We hypothesized that DASH scores for evaluation of hand and wrist pathology would provide a map of scores that would correspond to severity. In addition to providing a catalog of DASH scores for various upper extremity pathologies, we hypothesized that this review would support the validity of the DASH instrument.

Characteristics of sleep disturbance in patients with carpal tunnel syndrome.

Background: Sleep disturbance is common in carpal tunnel syndrome (CTS), and we hypothesize that it has an important impact on the quality of life of CTS patients. The characteristic of sleep problems associated with CTS has not been evaluated.

Methods: We performed a case-control study to measure the association between a variety of sleep disturbances and CTS.