Hand and Upper Limb Center

London, Canada

Hand and Upper Limb Center

London, Canada
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Popovic D.,University of Western Ontario | Popovic D.,Hand and Upper Limb Center | King G.J.W.,University of Western Ontario | King G.J.W.,Hand and Upper Limb Center
Journal of Bone and Joint Surgery - Series B | Year: 2012

In light of the growing number of elderly osteopenic patients with distal humeral fractures, we discuss the history of their management and current trends. Under most circumstances operative fixation and early mobilisation is the treatment of choice, as it gives the best results. The relative indications for and results of total elbow replacement versus internal fixation are discussed. ©2012 British Editorial Society of Bone and Joint Surgery.


Raman J.,University of Western Ontario | MacDermid J.C.,Hand and Upper Limb Center | Grewal R.,Hand and Upper Limb Center | Grewal R.,University of Western Ontario
Journal of Hand Therapy | Year: 2012

Study Design: Systematic Review. Introduction: Lateral epicondylosis (LE) is relatively common with an annual incidence in the general population of 1% to 3%. Systematic reviews have identified exercise is effective, but have not established specific exercise parameters. Purpose: The purpose of this systematic review was to synthesize the quality and content of clinical research addressing type and dosage of resistance exercises in lateral epicondylosis. Methods: Computerized bibliographic databases (1990-2010) were searched using relevant keywords; bibliographies of included papers were hand searched. Of 594 screened abstracts, 11 articles (12 studies) met inclusion criteria. Articles were randomly allocated to pairs of reviewers who independently verified data extraction and appraised the full text, using a structured critical appraisal tool with 24 items. Data extraction was limited by a lack of consistent reporting of elements of exercise dosage. Results: The mean quality rating of the studies was 72%, with 2 papers exceeding 75% quality. Of the 12 studies, 9 addressed the effects of isotonic (eccentric/concentric) exercises, 2 studied the effect of isometric and one studied isokinetic exercises. The exercise programs ranged over a period of 4 to 52 weeks. Exercises were prescribed 1 to 6 times per day, with an average duration of 15 minutes per session, and average of 15 repetitions (range: 3 to 50), with 1 to 4 sets per session. Conclusion: All the studies reported that resistance exercise resulted in substantial improvement in pain and grip strength; eccentric exercise was most studied. Strengthening using resistance exercises is effective in reducing pain and improving function for lateral epicondylosis but optimal dosing is not defined. © 2012 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.


Ecker J.,SJOG Health Care | Perera N.,Hand and Upper Limb Center | Ebert J.,University of Western Australia
Journal of Hand Surgery: European Volume | Year: 2015

Current techniques for endoscopic carpal tunnel release use an infraretinacular approach, inserting the endoscope deep to the flexor retinaculum. We present a supraretinacular endoscopic carpal tunnel release technique in which a dissecting endoscope is inserted superficial to the flexor retinaculum, which improves vision and the ability to dissect and manipulate the median nerve and tendons during surgery. The motor branch of the median nerve and connections between the median and ulnar nerve can be identified and dissected. Because the endoscope is inserted superficial to the flexor retinaculum, the median nerve is not compressed before division of the retinaculum and, as a result, we have observed no cases of the transient median nerve deficits that have been reported using infraretinacular endoscopic techniques.Level of evidence: IV. © The Author(s) 2014.


Mehta S.P.,McMaster University | Mhatre B.,King Edward Memorial Hospital | MacDermid J.C.,McMaster University | MacDermid J.C.,Hand and Upper Limb Center | Mehta A.,King Edward Memorial Hospital
Journal of Hand Therapy | Year: 2012

The purpose of this study was to perform cross-cultural adaptation and Hindi translation of the patient-rated wrist evaluation (PRWE) and assess psychometric properties of the PRWE-Hindi. Cross-cultural adaptation and Hindi translation of the PRWE was performed using standardized guidelines. Intraclass correlation coefficient (ICC) was used for assessing test-retest reliability, and Cronbach's alpha (CA) was used for assessing the internal consistency of the PRWE-Hindi. Construct validity was assessed by examining the correlations between the PRWE-Hindi and grip strength, wrist range of movements, and self-reported pain and disability. A total of 50 patients with distal radius fracture were recruited and assessed three times (baseline, two to three days later, and four to five weeks later). PRWE-Hindi demonstrated excellent test-rest reliability (ICC = 0.81) and internal consistency (CA = 0.89). Moderate to low correlations (r < 0.7) were observed between the PRWE-Hindi and other measures of pain and disability. Our results indicated that PRWE-Hindi is a reliable and valid tool and can be used in patients with wrist/hand injuries whose primary language is Hindi. © 2012 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.


MacDermid J.C.,Hand and Upper Limb Center | MacDermid J.C.,McMaster University | Grewal R.,Hand and Upper Limb Center
BMC Musculoskeletal Disorders | Year: 2013

Background: Compression neuropathy at the elbow causes substantial pain and disability. Clinical research on this disorder is hampered by the lack of a specific outcome measure for this problem. A patient-reported outcome measure, The Patient-Rated Ulnar Nerve Evaluation (PRUNE) was developed to assess pain, symptoms and functional disability in patients with ulnar nerve compression at the elbow. Methods. An iterative process was used to develop and test items. Content validity was addressed using patient/expert interviews and review; linking of the scale items to International Classification of Functioning, Disability, and Health (ICF) codes; and cognitive coding of the items. Psychometric analysis of data collected from 89 patients was evaluated. Patients completed a longer version of the PRUNE at baseline. Item reduction was performed using statistical analyses and patient input to obtain the final 20 item version. Score distribution, reliability, exploratory factor analysis, correlational construct validity, discriminative known group construct validity, and responsiveness to change were evaluated. Results: Content analysis indicated items were aligned with subscale concepts of pain and sensory/motor symptoms impairments; specific upper extremity-related tasks; and that the usual function subscale provided a broad view of self-care, household tasks, major life areas and recreation/ leisure. Four subscales were demonstrated by factor analysis (pain, sensory/motor symptoms impairments, specific activity limitations, and usual activity/role restrictions). The PRUNE and its subscales had high reliability coefficients (ICCs > 0.90; 0.98 for total score) and low absolute error. The minimal detectable change was 7.1 points. It was able to discriminate between clinically meaningful subgroups determined by an independent evaluation assessing work status, residual symptoms, motor recovery, sensory recovery and global improvement) p < 0.01. Responsiveness was excellent (SRM = 1.55). Conclusion: The PRUNE is a brief, open-access, patient-reported outcome measure for patients with ulnar nerve compression that demonstrates strong measurement properties. © 2013 MacDermid and Grewal; licensee BioMed Central Ltd.


Sinden K.,McMaster University | MacDermid J.C.,McMaster University | MacDermid J.C.,Hand and Upper Limb Center
Journal of Occupational Rehabilitation | Year: 2014

Purpose Employers are tasked with developing injury management and return-to-work (RTW) programs in response to occupational health and safety policies. Physical demands analyses (PDAs) are the cornerstone of injury management and RTW development. Synthesizing and contextualizing policy knowledge for use in occupational program development, including PDAs, is challenging due to multiple stakeholder involvement. Few studies have used a knowledge translation theoretical framework to facilitate policy-based interventions in occupational contexts. The primary aim of this case study was to identify how constructs of the knowledge-to-action (KTA) framework were reflected in employer stakeholder-researcher collaborations during development of a firefighter PDA. Methods Four stakeholder meetings were conducted with employee participants who had experience using PDAs in their occupational role. Directed content analysis informed analyses of meeting minutes, stakeholder views and personal reflections recorded throughout the case. Results Existing knowledge sources including local data, stakeholder experiences, policies and priorities were synthesized and tailored to develop a PDA in response to the barriers and facilitators identified by the firefighters. The flexibility of the KTA framework and synthesis of multiple knowledge sources were identified strengths. The KTA Action cycle was useful in directing the overall process but insufficient for directing the specific aspects of PDA development. Integration of specific PDA guidelines into the process provided explicit direction on best practices in tailoring the PDA and knowledge synthesis. Although the themes of the KTA framework were confirmed in our analysis, order modification of the KTA components was required. Despite a complex context with divergent perspectives successful implementation of a draft PDA was achieved. Conclusions The KTA framework facilitated knowledge synthesis and PDA development but specific standards and modifications to the KTA framework were needed to enhance process structure. Flexibility for modification and integration of PDA practice guidelines were identified as assets of the KTA framework during its application. © 2013 Springer Science+Business Media New York.


Leclerc A.,Hand and Upper Limb Center | King G.J.W.,St. Joseph's Health Care London
Hand Clinics | Year: 2011

Total elbow arthroplasty (TEA) is still in its infancy if we compare it with other arthroplasties such as knee or hip. TEA designs have been evolving with experience; however, long-term outcome data remain limited. The designs of total elbow prostheses can be subdivided into 3 general categories: unlinked, linked, and convertible devices. This article focuses on unlinked and convertible prostheses. © 2011 Elsevier Inc.


Daneshvar P.,Hand and Upper Limb Center | Chan R.,Hand and Upper Limb Center | Macdermid J.,Hand and Upper Limb Center | Grewal R.,Hand and Upper Limb Center
Journal of Hand Surgery | Year: 2014

Purpose To determine if ulnar styloid fractures (USF) affect clinical outcome following distal radius fracture (DRF) in adults under 65 years of age. Methods This study involved 312 patients (aged 18e64) with surgically and nonsurgically treated DRFs. Patients were followed prospectively at baseline and 3, 6, and 12 months. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE), and secondary outcomes were range of motion and grip strength. The USFs were classified by location (tip, middle, and base) and union status. Results There were 170 patients with isolated DRFs and 142 with associated USF (64 tip, 32 middle, and 46 base fractures). The mean age of the entire cohort was 48 years with 218 (70%) women. All USFs were treated nonoperatively. There was a trend of higher PRWE scores in DRFs associated with USFs compared to isolated DRFs throughout the study. Associated ulnar styloid base fractures had higher but clinically insignificant PRWE scores than isolated DRFs at 6 and 12 months. Patients with an associated USF had a slower recovery of wrist flexion and grip strength compared to isolated DRF, but values were comparable at 12 months. United USFs and nonunited USFs had similar PRWE scores at all time points. Conclusions Adults under 65 years old with DRFs and associated USFs initially have greater pain and disability than those with isolated DRFs; however, this difference dissipated over time and was not significant at one year. No long-term differences in measured impairments were observed, but the presence of an associated USF resulted in a slower recovery of grip strength and wrist flexion. Presence of a USF nonunion did not significantly affect outcomes. © 2014 American Society for Surgery of the Hand.


Yoon A.,Hand and Upper Limb Center | Athwal G.S.,Hand and Upper Limb Center | Faber K.J.,Hand and Upper Limb Center | King G.J.W.,Hand and Upper Limb Center
Journal of Hand Surgery | Year: 2012

Fractures of the radial head are the most common fractures in the elbow, and they frequently have associated ligamentous, cartilaginous, or other bony injuries. Clinical assessment and radiological investigation allow for accurate diagnosis and the formulation of a management plan. Undisplaced or minimally displaced fractures with no rotational block to motion can be treated nonoperatively with excellent results expected. The minimum amount of displacement in a partial articular radial head fracture required for open reduction and internal fixation to provide a superior outcome to nonoperative management is still unknown. Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement. © 2012 American Society for Surgery of the Hand.


Purpose Osteochondritis dissecans (OCD) of the capitellum most commonly affects adolescent pitchers and gymnasts, who present with pain and mechanical symptoms. Patients with larger lesions have poorer outcomes, possibly related to increased contact pressures on the surrounding articular surface with or without instability. The purpose of this in vitro study was to determine whether displaced OCD lesions of the capitellum lead to altered kinematics and stability of the elbow. Methods We mounted 9 fresh-frozen cadaveric arms in an upper extremity joint testing system, with cables attaching the tendons of the major muscles to motors and pneumatic actuators. An electromagnetic receiver on the ulna enabled quantification of the kinematics of the radius and ulna with respect to the humerus. We used 3-dimensional computed tomography scans and computer-assisted techniques to navigate sequential osteochondral defects ranging in size from 12.5% to 100% of the capitellum. The arms were subjected to active and passive flexion in both the vertical and valgus positions with the forearm in both pronation and supination. Results We found no significant differences in valgus angulation or ulnar rotation between any of the OCD lesions and the intact elbow during flexion, regardless of arm position or forearm rotation. Conclusions Osteochondritis dissecans lesions of the capitellum, both small and large, did not alter the ulnohumeral kinematics and stability with intact collateral ligaments. Therefore, excision of unfixable osteochondral fragments of the capitellum in the setting of intact collateral ligaments can be considered without the risk of creating instability.

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