Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis

A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes. Level of evidence: III

Hand Posture and Force Estimation using Surface Electromyography and an Artificial Neural Network

Prior epidemiological studies have shown that heavy hand exertion force and hand posture (grip versus pinch) are important risk factors for distal upper extremity disorders such as wrist tendinosis and carpal tunnel syndrome (CTS). However, quantifying the magnitude of hand exertions reliably and accurately is challenging and has relied heavily upon subjective worker or analyst observations. Prior studies have used electromyography (EMG) with machine learning models to estimate hand exertion but relatively few studies have assessed whether hand posture and exertion forces can be predicted at varying levels of force exertion, duty cycle and repetition rate. Therefore, the purpose of this study was to develop an approach to estimate hand posture (pinch versus grip) and hand exertion force using forearm surface electromyography (sEMG) and artificial neural networks.

Exposure to heavy physical work from early to later adulthood and primary healthcare visits due to musculoskeletal diseases in midlife: a register linked study

ObjectivesTo examine whether exposure to heavy physical work from early to later adulthood is associated with primary healthcare visits due to cause-specific musculoskeletal diseases in midlife.DesignProspective cohort study.SettingNationally representative Young Finns Study cohort, Finland.Participants1056 participants of the Young Finns Study cohort.Exposure measurePhysical work exposure was surveyed in early (18–24 years old, 1986 or 1989) and later adulthood (2007 and 2011), and it was categorised as: ‘no exposure’, ‘early exposure only’, ‘later exposure only’ and ‘early and later exposure’.Primary and secondary outcome measuresVisits due to any musculoskeletal disease and separately due to spine disorders, and upper extremity disorders were followed up from national primary healthcare register from the date of the third survey in 2011 until 2014.ResultsPrevalence of any musculoskeletal disease during the follow-up was 20%, that for spine disorders 10% and that for upper extremity disorders 5%. Those with physically heavy work in early adulthood only had an increased risk of any musculoskeletal disease (risk ratio (RR) 1.55, 95% CI 1.05 to 2.28) after adjustment for age, sex, smoking, body mass index, physical activity and parental occupational class. Later exposure only was associated with visits due to any musculoskeletal disease (RR 1.46, 95% CI 1.01 to 2.12) and spine disorders (RR 2.40, 95% CI 1.41 to 4.06). Early and later exposure was associated with all three outcomes: RR 1.99 (95% CI 1.44 to 2.77) for any musculoskeletal disease, RR 2.43 (95% CI 1.42 to 4.14) for spine disorders and RR 3.97 (95% CI 1.86 to 8.46) for upper extremity disorders.ConclusionsTo reduce burden of musculoskeletal diseases, preventive actions to reduce exposure to or mitigate the consequences of physically heavy work throughout the work career are needed.

Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders

Objective:The relationships between workplace risk factors and upper extremity injuries from epidemiological and laboratory studies were examined.Background:Epidemiological studies are associated with several limitations, affecting the strength of association between risk factors and the development of injuries.Method:In this narrative review, we identified epidemiological and laboratory studies (published primarily since 1997) investigating exposure to workplace risk factors (force, repetition, posture, vibration) and risk of hand/wrist tendon–related disorders, epicondylitis, and carpal tunnel syndrome (CTS).Results:Forceful exertions are strongly associated with hand/wrist tendon–related disorders, epicondylitis, and CTS. Dose–response relationships were found for epicondylitis (repetition) and CTS (posture). Interactions demonstrate multiplicative effects of risk factors for injury risk. Laboratory studies display clear associations between task demands and biomechanical measures linked to mechanisms for upper extremity injuries with animal models providing further evidence of a dose–response between risk factors and injury.Conclusion:Forceful, repetitive work requiring non-neutral postures are associated with increasing risk of hand/wrist tendon–related disorders, epicondylitis, and CTS as evidenced by epidemiology studies and laboratory-based investigations of humans and animals.Application:Understanding the relationship between exposure levels of workplace risk factors and upper extremity disorders can improve injury prevention and rehabilitation strategies.