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Dupuytren's Contracture—Therapy and Result Following Percutaneous Fasciotomy With Xiaflex (Collagenase)
for persons with CTS. Information from the tests can be used in future studies to assess the risk factors related to carpal tunnel syndrome and to recommend splinting regimes and strategies for activity modification.
OBJECTIVES 1. The first objective evaluates the psychometric properties of commonly reported functional assessments for persons with carpal tunnel syndrome. 2. The second objective describes the physical and functional characteristics of persons with CTS by severity level. 3. The third objective defines the relationship between physical and functional measures for persons with carpal tunnel syndrome.
DUPUYTREN’S CONTRACTURE— THERAPY AND RESULT FOLLOWING PERCUTANEOUS FASCIOTOMY WITH XIAFLEX (COLLAGENASE) Christina E.U. Floodmark, Uppsala University Hospital, Sweden Purpose: Sweden has a high prevalence of Dupuytren’s contracture. Increased diasthesis and decreased hand function is common. Experience of surgical and post-surgical treatment has been collected over many years. Alternative methods such as percutaneous fasciotomy is of interest. A mult-center Phase 3 study was conducted during 2008 in Europe and in the United States to evaluate the efficacy and safety of treatment with Xiaflex. At the Department of Hand Surgery in Uppsala a total number of 36 patients (40 hands) were included. Methods: The patients had different stages of extension deficits of MCP and/or PIP joints from minor (minimum 20 degrees) to severe (finger full flexed in palm with no functional use) in one or more fingers. 32
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JOURNAL OF HAND THERAPY
men and 4 women aged 37–83 years (mean 63.2) participated. Two senior hand surgeons, one study nurse and one hand therapist followed all patients. The patients received 1–9 injections (mean 1.9 per hand). The study protocol was strictly followed with visits Day 0 (when injection was given), Day 1, Day 7, and Day 30 after each injection. New injection, if needed, was given on Day 30. Follow-ups were made at 3 months, 6 months, and 9 months from first injection. Extension deficit, grip strength and patient satisfaction were evaluated at follow-ups. Hand therapy started Day 1 when the cord was ruptured, spontaneously or by the physician. A volar night splint with free wrist was manufactured and home exercise program was given. Circulation in treated finger was maintained in splint by slightly flexed MCP-joints. The hand could be used in normal activities directly, except for heavy manual work. At Day 7 the splint was adjusted and hand function was controlled. Results: Early, transient problems with oedema, hematoma and/or skin rupture were noticed in some patients, with need for extra visit to hand therapist. In case of ruptured skin, full flexion of finger was allowed when healing was complete. All patients, except one, had gained better extension in treated fingers with better hand function and were satisfied with the treatment at 9 months. The amount of hand therapy needed was far less than after surgery, and the time to regain full hand function was considerably shorter. Conclusions: Results after 9month follow-up, hand therapy after treatment will be presented in detail and discussed. Relevance: Evaluation of result and discussion of hand therapy following percutaneous fasciotomy with collagenase is important.
OBJECTIVES 1. Functional result after percutaneous fasciotomy with collagenase at 9-months follow-up. 2. Evaluation of hand therapy following percutaneous fasciotomy with collagenase.
HAND THERAPY AFTER METACARPOPHALANGEAL JOINT IMPLANT ARTHROPLASTY IN RHEUMATOID HAND Yasue Harada, Seieei Hamamatsu Hospital, Syuya Okumura, Yuji Takahashi, Japan Purpose: Implant arthroplasty of the metacarpophalangeal joint (MPJ) in rheumatoid (RA) hand often results in improved cosmetic appearance and extension range of the MPJ but decreased flexion range. We created a new protocol for postoperative hand therapy and showed the clinical results and the essentials for postoperative therapy. Methods: Silicon implants, SWANSON or AVANTA, were used for implant arthroplasty of MPJ. Twelve hands of 11 RA patients were retrospectively investigated from 2004 to 2007. There were ten females and one male with a mean age of 60.8 (range 46–74) years. The mean followup period was 8.7(4–14) months. Clinical outcome measures included MPJ motion, grip strength, pinch power, ulnar deviation of the MPJ and DASH. Postoperative Therapy Protocol: Postoperative 4–5days: An outrigger splint was used for MPJ extension. Rubber band was pulled on an angle toward the radial-sided finger. Active flexion and passive extension of MPJ on the outrigger splint was started. Postoperative 2weeks: An outrigger splint was added for MP flexion. Outrigger splints for MP flexion and extension were used alternately every hour and alternately each night. Postoperative 3–4 weeks: Active and gentle passive motion of MPJ. Postoperative 6 weeks: Use of hand in light ADL. Results: The mean extension/ flexion range of MPJ were index–60/ 90.08 , long–52.0/86.58 , ring–60/93.58 , little–67.5/95.58 preoperatively and index–15/65.08 , long–10.0/65.58 , ring– 5/57.58 , little–5/52.08 postoperatively. The grip strength average was 5.1 kg preoperatively and 4.9 kg postoperatively. The pulp/lateral pinch power averages were 0.65 kg/1.1kg preoperatively and 0.9 kg/1.5 kg postoperatively. Mean angles of ulnar deviation were index–40.08 , long–30.08 , ring–
OBJECTIVES 1. The first objective evaluates the psychometric properties of commonly reported functional assessments for persons with carpal tunnel syndrome. 2. The second objective describes the physical and functional characteristics of persons with CTS by severity level. 3. The third objective defines the relationship between physical and functional measures for persons with carpal tunnel syndrome.
DUPUYTREN’S CONTRACTURE— THERAPY AND RESULT FOLLOWING PERCUTANEOUS FASCIOTOMY WITH XIAFLEX (COLLAGENASE) Christina E.U. Floodmark, Uppsala University Hospital, Sweden Purpose: Sweden has a high prevalence of Dupuytren’s contracture. Increased diasthesis and decreased hand function is common. Experience of surgical and post-surgical treatment has been collected over many years. Alternative methods such as percutaneous fasciotomy is of interest. A mult-center Phase 3 study was conducted during 2008 in Europe and in the United States to evaluate the efficacy and safety of treatment with Xiaflex. At the Department of Hand Surgery in Uppsala a total number of 36 patients (40 hands) were included. Methods: The patients had different stages of extension deficits of MCP and/or PIP joints from minor (minimum 20 degrees) to severe (finger full flexed in palm with no functional use) in one or more fingers. 32
e2
JOURNAL OF HAND THERAPY
men and 4 women aged 37–83 years (mean 63.2) participated. Two senior hand surgeons, one study nurse and one hand therapist followed all patients. The patients received 1–9 injections (mean 1.9 per hand). The study protocol was strictly followed with visits Day 0 (when injection was given), Day 1, Day 7, and Day 30 after each injection. New injection, if needed, was given on Day 30. Follow-ups were made at 3 months, 6 months, and 9 months from first injection. Extension deficit, grip strength and patient satisfaction were evaluated at follow-ups. Hand therapy started Day 1 when the cord was ruptured, spontaneously or by the physician. A volar night splint with free wrist was manufactured and home exercise program was given. Circulation in treated finger was maintained in splint by slightly flexed MCP-joints. The hand could be used in normal activities directly, except for heavy manual work. At Day 7 the splint was adjusted and hand function was controlled. Results: Early, transient problems with oedema, hematoma and/or skin rupture were noticed in some patients, with need for extra visit to hand therapist. In case of ruptured skin, full flexion of finger was allowed when healing was complete. All patients, except one, had gained better extension in treated fingers with better hand function and were satisfied with the treatment at 9 months. The amount of hand therapy needed was far less than after surgery, and the time to regain full hand function was considerably shorter. Conclusions: Results after 9month follow-up, hand therapy after treatment will be presented in detail and discussed. Relevance: Evaluation of result and discussion of hand therapy following percutaneous fasciotomy with collagenase is important.
OBJECTIVES 1. Functional result after percutaneous fasciotomy with collagenase at 9-months follow-up. 2. Evaluation of hand therapy following percutaneous fasciotomy with collagenase.
HAND THERAPY AFTER METACARPOPHALANGEAL JOINT IMPLANT ARTHROPLASTY IN RHEUMATOID HAND Yasue Harada, Seieei Hamamatsu Hospital, Syuya Okumura, Yuji Takahashi, Japan Purpose: Implant arthroplasty of the metacarpophalangeal joint (MPJ) in rheumatoid (RA) hand often results in improved cosmetic appearance and extension range of the MPJ but decreased flexion range. We created a new protocol for postoperative hand therapy and showed the clinical results and the essentials for postoperative therapy. Methods: Silicon implants, SWANSON or AVANTA, were used for implant arthroplasty of MPJ. Twelve hands of 11 RA patients were retrospectively investigated from 2004 to 2007. There were ten females and one male with a mean age of 60.8 (range 46–74) years. The mean followup period was 8.7(4–14) months. Clinical outcome measures included MPJ motion, grip strength, pinch power, ulnar deviation of the MPJ and DASH. Postoperative Therapy Protocol: Postoperative 4–5days: An outrigger splint was used for MPJ extension. Rubber band was pulled on an angle toward the radial-sided finger. Active flexion and passive extension of MPJ on the outrigger splint was started. Postoperative 2weeks: An outrigger splint was added for MP flexion. Outrigger splints for MP flexion and extension were used alternately every hour and alternately each night. Postoperative 3–4 weeks: Active and gentle passive motion of MPJ. Postoperative 6 weeks: Use of hand in light ADL. Results: The mean extension/ flexion range of MPJ were index–60/ 90.08 , long–52.0/86.58 , ring–60/93.58 , little–67.5/95.58 preoperatively and index–15/65.08 , long–10.0/65.58 , ring– 5/57.58 , little–5/52.08 postoperatively. The grip strength average was 5.1 kg preoperatively and 4.9 kg postoperatively. The pulp/lateral pinch power averages were 0.65 kg/1.1kg preoperatively and 0.9 kg/1.5 kg postoperatively. Mean angles of ulnar deviation were index–40.08 , long–30.08 , ring–