Search

Objective: The main objective of this study was to describe the epidemiology of surgically repaired digital nerve injuries in a Swedish population. Secondary objectives were to describe the demographics of the patient population, injury characteristics, post-operative care and rehabilitation. Methods: From 2012 to 2018, 1004 patients with a surgically repaired digital nerve injury resident in the Stockholm region were identified in the Swedish national quality registry for hand surgery and all medical records were thoroughly reviewed. Results: The incidence rate was 8.3 per 100.000 person-years and these injuries were more common in men than women. The median age at the time of injury was 37 years and a sharp cut was the most common mechanism of injury. Injuries were equally distributed over weekdays and the year, but surgery was most often performed on Mondays. There were no differences in treatment and rehabilitation regimens between sexes, except women were more likely than men to be operated within three days from injury. Timing and content of rehabilitation varied largely between individuals. One third of patients did not receive any sensory relearning and sensory assessment was performed in only 7%. Conclusion: The epidemiology shows no major changes over the last decade. However, we found a large individual variation in follow up visits, rehabilitation content and assessments indicating large differences in consumption of health care resources. Our findings expose the need to further improve and evaluate rehabilitation regimens after digital nerve injury. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The study aimed to estimate the incidence and causes of insurance claims (IC) after vascular surgery (VS) reported to the Swedish Medical Injury Insurance (SMII); and to validate the registration of complications in the National Vascular Registry (Swedvasc). Methods: The medical records of all IC in VS in Sweden reported to the SMII 2002–2007 were scrutinised and cross-referenced against Swedvasc. Results: There were 193 claims after VS: varicose-veins (66), lower extremity (45), aortic (31) or carotid artery (21), access (19) or other VS (11). Frequent causes of claims were peripheral nerve injury (76), wound infection (22) and cranial nerve injury (15). More than half of the patients suffered permanent injuries, three died. As many as 55 (28%) received economic compensation (an average of 45% of all ICs in SMII). The highest frequency of compensated claims (1:650 yearly procedures) was for carotid artery surgery. Of the procedures, 187 were elective. Compared with the Swedvasc, claudication was a more common indication (28% vs. 12%). Nearly one-fifth (18%) were incorrectly registered in Swedvasc. Conclusions: The most common causes of insurance claims were peripheral nerve injuries and infections. Patients raising insurance claims after vascular surgery undergo acute procedures less frequently, and are correctly registered in the Swedvasc in 82% of cases. [Copyright &y& Elsevier]

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics. Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression. Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08). Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy in patients with bladder cancer. Background: Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well‐known after prolonged surgery, especially in robot‐assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient‐related and operative risk factors. Methods: A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study‐specific questionnaire 7–10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. Results: Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7–10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. Conclusion: A large proportion of the patients report postoperative extremity symptoms after robot‐assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow‐ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. Relevance to clinical practice: This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow‐ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence‐based positioning guidelines in the operating theatre for optimal positioning. [ABSTRACT FROM AUTHOR]

Background: Distal radius fracture (DRF) often causes reduced ability to perform activities of daily living (ADLs). There is a need for recurrent evaluation of the ability to perform ADL in the early stage of rehabilitation as a complement to traditional functional measures. Aim: Develop a short and simple performance test for use in clinical practice through modification of the Sollerman Grip Function Test (GFT). Method: DRF patients and controls performed the GFT. The tasks that discriminated patients from controls were calculated for sensitivity to change and correlated to the QuickDASH questionnaire at three subsequent occasions. Interrater reliability was tested. Results: Twelve GFT tasks discriminated DRF patients from healthy controls. One task was excluded due to heavy load. Remaining 11 tasks were all sensitive to change. Four tasks with correlation to the QuickDASH and representing the grip types most frequently used in ADL came to constitute the Wrist Performance Test (WPT). A test-retest showed satisfactory interrater reliability (rs = 0.87). Conclusion: A short performance test was developed through modification of the GFT. It is easy to use in clinical practice to evaluate the rehabilitation process after DRF. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI).Method: A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI.Results: Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction.Conclusions: LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work. [ABSTRACT FROM AUTHOR]

Objective To explore the treatment patterns of patients with a diagnosis related to chronic pain ( DRCP) initiating pharmacological treatment indicated for neuropathic pain ( NeuP: tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and anticonvulsants). Design Retrospective study on administrative registers. Setting General population in Western Sweden (one sixth of the country). Subjects All patients with a DRCP (N = 840,000) in years 2004-2009. Outcome Measures Treatment sequence, continuation, switching, and comedication. Results In total, 22,997 patients with a first NeuP in 2007 or 2008 were identified, out of which 2% also had epilepsy and 39% had a mood disorder. The remaining 13,749 patients were assumed to be treated for neuropathic pain, out of which 16% had a neuropathy diagnosis, 18% had a mixed pain diagnosis, and the remaining 66% had another DRCP. The most common first prescription was amitriptyline (40%) followed by pregabalin (22%) and gabapentin (19%). More than half had discontinued treatment after 3 months, and 60-70% at 6 months. Seven percent received another NeuP drug within 6 months of the discontinuation of their first NeuP treatment, 11% had another analgesic and 22% had a prescription indicating psychiatric comorbidity (selective serotonin reuptake inhibitors or benzodiazepine). Conclusions Treatment initiation of currently available drugs indicated for neuropathic pain less frequently lead to long-term treatment in clinical practice compared with clinical trial, and few try more than one drug. We suggest our findings to be indications of a need for better routines in diagnosing patients to ascertain optimal treatment and follow-up. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore hand function in patients with sporadic inclusion body myositis (sIBM) using the Sollerman Hand function test, finger range of motion, hand- and pinch strength, and fine motor ability as well as subjective estimate of hand- and grip function. Forty-five outpatients with definite sIBM were investigated using handgrip-, lateral-, and pinch strength, active finger range of motion (AROM), fine motor ability with Purdue Pegboard test, Sollerman Hand function test, and patients' estimated hand- and grip function. The association between these variables were assessed using correlation statistics. A second test occasion was performed in 16 patients in order to investigate the intra-rater reliability. We found that the reduction of hand- and pinch strength was more pronounced (37% right, 31% left hand) than lateral strength (50%) in relation to normal values. AROM was impaired in 25 (56%) in the right and 29 (64%) in the left hand. Fine motor ability was fairly well preserved; mean right/ left 70 and 60% of normal. AROM deficit was found to be present in 50% of patients 7 years after perceived hand weakness. This is important since it was found to impair the usefulness of the different strength measures, while limitations due to AROM deficit were not found regarding the Sollerman and to a lesser extent the Purdue Pegboard tests. Results of the test-retest showed very good reliability. Our results indicate that impairment of hand function is frequent and severe in sIBM patients. Reduction in AROM is frequent, and it is important to identify since it affects the usefulness of handgrip measurements, and further that may be treatable. Several different tests are probably needed in order to describe the patients' limitations and to capture changes over time. Compensatory strategies when gripping test items is a problem especially in patients with AROM deficits. Research on validity and reliability of these tests in sIBM patients are lacking. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Patients with transthyretin amyloidosis (ATTR) polyneuropathy, a hereditary fatal disease, often report defects in both thermal perception and autonomic nervous system function as their first clinical symptoms. While elevated thermal perception thresholds (TPT) for cold and warmth only recently have been shown as an early marker of small nerve fiber dysfunction in these patients, heart rate variability (HRV) has frequently been used to quantify autonomic neuropathy. The main purpose with this report was to elucidate a possible relationship between estimates of HRV and TPT in a selected group of early and late-onset Swedish Val30Met ATTR patients. The results show significantly more pronounced elevation of TPT in early compared to late-onset patients. Significant correlations between HRV and TPT were found among late-onset cases, indicating a possible relationship between loss of thin nerve fibers in somatic and autonomic nerves, while generally no such relationships were found among early-onset cases. This observation emphasizes the importance of testing both HRV and TPT to ensure optimal early detection of neuropathic changes in an as wide as possible range of small nerve fibers in suspected ATTR patients. This is of particular importance as the phenotype of the ATTR disease varies between groups with different age of onset. [ABSTRACT FROM AUTHOR]

Aim The aim of this investigation was to study the incidence of obstetric brachial plexus palsy (OBPP), to prospectively follow the recovery process, to assess the functional outcome at 18 months of age, and to find early prognostic indicators. Method Of the 38 749 children born between 1999 and 2001 in western Sweden, 114 (70 males, 44 females) had an OBPP. Ninety-eight children were examined on six occasions at up to 18 months of age. Muscle strength, range of motion, hand preference, and functional abilities were noted, and the severity of the OBPP was classified. Results The incidence of OBPP was 2.9 per 1000 live births, and the incidence of persisting OBPP was 0.46 per 1000. At 3 months of age, the predictive value of regained elbow flexion for complete recovery was 100%, 99% of shoulder external rotation, and 96% of forearm supination. Most of the 18 children with persisting OBPP could perform functional activities but asymmetries were noted. Five children had a mild, 11 had a moderate, and two had a severe impairment. Three had undergone nerve surgery, one with a mild and two with a severe persisting impairment. Interpretation Most children with an OBPP recover completely. Muscle strength at 3 months of age can be used to predict outcome. [ABSTRACT FROM AUTHOR]

Congenital insensitivity to pain is a rare hereditary neuropathy. We present patients from a large family in Norrbotten, Sweden with a mutation in the nerve growth factor β gene (NGFβ). Using a model of recessive inheritance, we identified an 8.3-Mb region on chromosome 1p11.2-p13.2 shared by the affected individuals in the family. Analysis of candidate genes in the disease-critical region revealed mutation in the coding region of the NGFβ gene specific for the disease haplotype. All three severely affected individuals were homozygous for the mutation. The disease haplotype was also observed in both unaffected and mildly affected family members, but in heterozygote form. We have identified 43 patients, 3 homozygous and 40 heterozygous. The homozygous patients have a severe congenital form with onset of symptoms at an early age, most often affecting the lower extremities with insidious progressive joint swellings or painless fractures. Fracture healing was normal, but the arthropathy progressive, resulting in disabling Charcot joints with gross deformity and instability. These patients lacked deep pain perception in bones and joints and had no protective reflexes, leading to gross bone and joint complications. They also had abnormal temperature perception but normal ability to sweat. There was no mental retardation. Clinically, they fit best into the group HSAN type V. Sural nerve biopsies showed a moderate loss of thin myelinated fibers (Aδ-fibers) and a severe reduction of unmyelinated fibers (C-fibers). 14 of the 40 heterozygous adult patients had mild or moderate problems with joint deformities, usually with only slight discomfort. Treatment was conservative with (if needed) different kinds of orthosis and in three cases joint replacement. Nine patients had neuropathy, and nine patients had no symptoms. In congenital disorders like these, it is important to evaluate the age and also the slowly progressive nature, when considering treatment. There is an increased risk of growth disturbances in the very young. The orthopedic operations should therefore be planned from a long-term point of view, but patient education and orthosis are cornerstones in the treatment—to delay the development of neuropathic arthropathy. Arthrodesis, limb lengthening and spinal decompression with fusions are the only elective procedures that seem reasonable. This Norrbottnian disease is also interesting as a model system for the study of pain. [ABSTRACT FROM AUTHOR]

Nerve regeneration, measured as axonal outgrowth, Schwann cell migration, macrophage invasion, and neovascularisation, was compared after repair of a 15 mm gap in rats' sciatic nerves using autologous muscle grafts made acellular either by freezing and thawing or by chemical extraction. Both extracted and freeze-thawed acellular muscle grafts could be used to bridge the defect. However, axons and Schwann cells, as shown by immunohistochemical staining for neurofilaments and S-100 protein, respectively, grew faster into the extracted muscle grafts than into the freeze-thawed acellular muscle grafts and somewhat more axons were observed in the former graft. There were no significant differences between the two graft types with respect to neovascularisation as showed by staining for endothelial alkaline phosphatase, and limited differences concerning invasion of macrophages (ED1 and ED2) as detected by immunocytochemistry. The results showed that chemically extracted muscle grafts could be used to bridge an extended nerve defect and that such grafts in some aspects were superior to freeze-thawed muscle grafts for extended gaps. [ABSTRACT FROM AUTHOR]

Highlights the Consensus Meeting held in Lund, Sweden. Culmination of a proposal for the Decade of the Bone and Joint from 2000 to 2010; Objective of the consensus meeting; List of involved organizations.