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Case: We report a case in the United States of a 12-year-old girl with multidrug-resistant tuberculous (MDR-TB) osteomyelitis of the hand managed with surgical debridement and second-line anti-TB therapy. The disease course was complicated by dissemination and multifocal progression. Conclusion: Despite early intervention, multidrug resistance makes TB treatment challenging and facilitated progression to disseminated disease in this case. We review the difficulties in diagnosis and treatment of pediatric MDR-TB. [ABSTRACT FROM AUTHOR]

Ozonated water is a potential alternative approach for hand antisepsis. While short-term studies report no immediate adverse effects to human skin or health, there are no published studies of long-term exposure. A retrospective cross-sectional mixed methods study was used to investigate the risk of adverse clinical health effects from chronic intermittent ozonated water exposure at 0.6 µg/ml in the United States. Thirty subjects with long-term use of a kitchen sink faucet that produced ozonated water on command provided quantitative measures of exposure and the prevalence of related adverse skin, pulmonary, gastrointestinal, and other health consequences. Participants averaged 91.6 (range 4-420) minutes of exposure per week over an average of 143.4 (range 30.4-460.4) weeks of exposure. Ozonated water was used for a variety of tasks, including hand hygiene, rinsing of produce and utensils, and family food preparation. Subjects indicated on a variety of measures that there were no individual or family health effects, including but not limited to skin irritation and thickening, respiratory, and gastrointestinal symptoms. In this study, chronic recurrent exposure to ozonated water had no reported adverse health consequences after nearly 3 years of daily exposure. [ABSTRACT FROM AUTHOR]

Objective: Fingers, hands, and wrists (FHW) are the most frequently injured body parts in work-related injuries. This study described and compared FHW injuries among enlisted, officer, and civilian US Air Force (USAF) personnel to those in the US workforce. Methods: All work-related, noncombat FHW injuries (=1 lost workday) and demographics among USAF personnel and US workforce (2008-2018) were included. The USAF FHW injury rates were age adjusted to the US employment and compared by sex, source, event, and nature of the injuries. Results: Finger, hand, and wrist injuries were significantly lower among the USAF personnel and among females. In both populations, FHW injuries from falls were higher and increased with age group among females. Males had higher overall FHW injuries from contact with objects and equipment. Conclusions: Prevention efforts should focus on understanding risk factors and sharing successful prevention activities. [ABSTRACT FROM AUTHOR]

Context: Suspension training devices use body weight resistance and unstable support surfaces that may facilitate muscle recruitment during push-up exercises. Objective: The authors examined muscle recruitment with surface electromyography on 4 shoulder and 4 torso muscles during (1) standard push-ups, (2) feet-suspended push-ups, (3) hands-suspended push-ups, and (4) dual-instability push-ups in which feet were suspended and hands were on unstable surfaces. Design: Cross-sectional design with repeated measures. Setting: Biomechanics laboratory. Participants: Thirty-two healthy men and women (mean age, 24.3 y; mean body mass index, 24.6 kg·m-2) participated. Intervention: Participants were tested while performing 2 repetitions each of 4 variations of push-ups. Main Outcome Measures: Muscle recruitment, normalized to maximum voluntary isometric contraction, was measured in 4 prime movers (anterior deltoid, pectoralis major, serratus anterior, and triceps brachii) and 4 torso stabilizers (external oblique, internal oblique, rectus abdominis, and upper erector spinae). Results: Muscle recruitment in the anterior deltoid, pectoralis major, and serratus anterior during suspended exercises was no greater than during standard push-ups. In contrast, torso stabilizer recruitment was significantly greater in the external oblique, internal oblique, and rectus abdominis during all 3 suspended exercises compared with standard push-ups. Suspended exercises under a dual-instability condition did not generate greater levels of muscle activation compared with conditions of single instability. Conclusions: Push-ups performed with suspension training systems may provide benefit if one's goal is to enhance torso muscle training. One unstable surface may be sufficiently challenging for the client or athlete when performing push-up exercises with a suspension training device. [ABSTRACT FROM AUTHOR]

Forceful hand exertions, when performed for more than 33% of a work cycle, or when performed with more than 18° of shoulder abduction, may increase the risk of workplace neck and shoulder disorders. A prevention strategy may include minimizing the time performing forceful hand exertions, especially in non-neutral shoulder postures. Objective: The aim of this study was to estimate associations between biomechanical exposures and workplace neck and shoulder musculoskeletal disorders (NSMSDs) in a prospective cohort. Methods: Manufacturing workers (N = 349) were followed for 28 months. Biomechanical exposures were collected on each individual, and physical examinations were performed every 4 months. Prevalent cases at baseline (n = 30) were excluded from the analysis. Results: There were 18 incident cases of NSMSDs. Greater than 33% time in forceful hand exertion doubled the rate of incident NSMSDs. Greater than 18 degrees of shoulder abduction, during forceful hand exertion, increased the rate by 55%. Confidence intervals were wide. Conclusions: Effect estimates of the relationship between forceful hand exertions and NSMSDs were consistently elevated whether measured in isolation or while in shoulder abduction. Following a larger cohort with more frequent physical examinations would improve estimates of the model. [ABSTRACT FROM AUTHOR]

Objective: Hand dysfunction is common in systemic sclerosis (SSc). We undertook this study to evaluate the capacity of autologous adipose‐derived regenerative cells (ADRCs) to improve hand function in SSc patients. Methods: The Scleroderma Treatment with Celution Processed Adipose Derived Regenerative Cells Trial was a prospective, randomized, double‐blind trial of ADRCs, in which ADRCs were obtained from patients with SSc by small‐volume adipose tissue harvest, and the fingers of each patient were injected with ADRCs. The primary end point was change in hand function at 24 and 48 weeks, assessed using the Cochin Hand Function Scale (CHFS). One of the secondary end points included the change in Health Assessment Questionnaire disability index (HAQ DI) at 48 weeks. Separate prespecified analyses were performed for patients with diffuse cutaneous SSc (dcSSc) and those with limited cutaneous SSc (lcSSc). Results: Eighty‐eight patients were randomized to receive ADRCs (n = 48 [32 patients with dcSSc and 16 with lcSSc]) or placebo (n = 40 [19 patients with dcSSc and 21 with lcSSc]). Change in hand function according to CHFS score was numerically higher for the ADRC group compared to the placebo group but did not achieve statistical significance (mean ± SD improvement in the CHFS score at 48 weeks 11.0 ± 12.5 versus 8.9 ± 10.5; P = 0.299). For patients with dcSSc, the between‐group difference in the CHFS at 48 weeks was 6.3 points (nominal P = 0.069). For the secondary end point, the dcSSc group exhibited a between‐group difference of 0.17 points in the HAQ DI (nominal P = 0.044) at 48 weeks. Of the ADRC‐treated patients with dcSSc, 52% reported improvement greater than the minimum clinically important difference for both CHFS and HAQ DI compared to 16% in the placebo group (nominal P = 0.016). Small‐volume adipose tissue harvest and ADRC treatment were well tolerated. Conclusion: While the primary end point of this trial was not achieved, efficacy trends were observed in patients with dcSSc. Adipose tissue harvest and ADRC injection were demonstrated to be feasible. Further clinical trials of this intervention in the setting of dcSSc are warranted. [ABSTRACT FROM AUTHOR]

Background: Hand and finger lacerations presenting to U.S. emergency departments (EDs) are common, although the burden of these injuries is not well understood.Objective: Our aim is to describe the epidemiology and causes of hand and finger lacerations in U.S. EDs.Methods: This National Electronic Injury Surveillance System database review investigates hand and finger lacerations presenting to EDs in the United States from 2015 to 2019.Results: Annually, hand and finger lacerations account for 243,844 and 587,451 ED visits, respectively. Affected patients are frequently White (70.5%), male (63.4%), and aged 18 through 44 years (46.3%). The top three products linked to hand and finger lacerations are knives (30.5%), metal containers (4.2%), and drinkware (3.8%), and men are less likely to have injuries from these products than women, especially knives (odds ratio 0.76; 95% confidence interval 0.60-0.96; p < 0.02). Although a minority of hand and finger lacerations involve alcohol (1.2%), men have greater rates of alcohol involvement than women (χ21 = 11.7; p < 0.001). Lacerations frequently occur in the home (61.3%). Many patients (44.2%) present to very large hospitals, and nearly one-half of patients younger than 5 years and one-third of patients aged 5 through 17 years present to pediatric hospitals. Most patients (97.4%) are treated and released without admission and 0.2% are transferred to another hospital. Patients with alcohol, drug, or medication involvement are more likely to leave against medical advice, be admitted, or held for observation (p < 0.001).Conclusions: Hand and finger lacerations result in a significant number of ED visits. A better understanding of injury trends and presentations can guide injury prevention in manufacturing, education, and public health. [ABSTRACT FROM AUTHOR]

Background: Syndactyly is one of the commonly encountered congenital hand anomalies. However, there are no strict guidelines regarding the timing of surgical release. The aim of this study was to investigate the age and factors associated with syndactyly release in the United States. Methods: A retrospective analysis of the California and Florida State Ambulatory Surgery and Services Databases for patients aged 18 years or younger who underwent syndactyly release surgery between 2005 and 2011 was performed. Demographic data that included the age at release, gender, race and primary payor (insurance) was collected. A sub-analysis was performed to compare the demographic characteristics between those patients undergoing syndactyly release before 5 years of age ('Early Release') and at (of after) 5 years ('Late Release'). Results: A total of 2,280 children (68% male, 43% Caucasian) were identified. The mean age of syndactyly release was 3.6 years, and 72.9% of patients underwent release before the age of 5 years. A significantly larger proportion of females (p = 0.002), and Hispanics and African Americans (p = 0.024), underwent late release compared to early release. Additionally, a significantly higher percentage of patients undergoing late release utilised private insurance (p = 0.005). However, the actual differences in gender, race and primary payor were small. Conclusion: The majority of syndactyly releases were performed before school age, which is the primary goal in the management of syndactyly. While gender and racial disparities in the surgical treatment of syndactyly may exist, the differences in the present study were relatively small. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

There have been dwindling numbers of replantations in the United States. Despite the advocacy for centralization in hand trauma, the fundamental landscape and attitudes of surgeons toward replantation have remained lackluster. There is growing and substantial evidence to demonstrate the superior outcomes of replantation in comparison to revision amputation in most scenarios. This article aims to delve into the factors contributing to the decreasing numbers of replantations and proposes strategies to overcome this issue., Competing Interests: Disclosure The authors of this article declare that they have no financial interests or conflicts that could influence the views or conclusions presented in this article. No external funding or financial support was received for this study. The authors have no affiliations with organizations or entities that may have a direct or indirect interest in the subject matter discussed in this article. This work has not been previously published or submitted for publication elsewhere., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The hand surgery fellowship match attracts applicants from general, plastic, and orthopedic surgery residency training. The purpose of this study was to understand recent trends in applications and match rates in the hand surgery fellowship match., Methods: The National Resident Matching Program provided program and applicant data from the hand surgery fellowship match (2012-2020). The primary outcomes of interest were match rates and number of unfilled fellowship positions by specialty. Trends over time and comparisons of the percentage of unfilled spots by specialty were observed., Results: The total number of applicants decreased from 199 to 188 (5.5% decrease), while the number of available positions increased from 150 to 177 (18.0% increase) during the study period. The increase in available positions was driven primarily by orthopedic fellowships, which increased from 124 to 149 (20.2% increase). The percentage of applicants that did not match to a hand surgery fellowship decreased from 24.6% in 2012 to 5.9% in 2020. United States graduates had higher match rates than non-United States graduates during each year, but this disparity narrowed over time. Most applicants matched at one of their top 3 choices (first choice, 33.3%; second choice, 12.9%; third choice, 7.9%). Applicants matching at their first choice increased from 28.1% in 2012 to 39.4% in 2020. Plastic surgery hand surgery fellowships had a higher rate of unmatched positions relative to orthopedic surgery fellowships (6.1% vs 2.2%)., Conclusions: Match rates in the hand surgery fellowship match have increased because of an overall increase in training positions and decrease in applicants. More research is needed to understand disparities in match rates by specialty., Clinical Relevance: The diverse training experiences of hand surgeons historically have been viewed as a strength for the specialty. Understanding recent trends in the hand surgery fellowship match by specialty can help future applicants and faculty anticipate likely match outcomes., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Introduction: Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke., Methods: In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated., Results: The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO., Conclusion: The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Prior studies suggest that native (born to at least one deaf or signing parent) and non-native signers have different musculoskeletal health outcomes from signing, but the individual and combined biomechanical factors driving these differences are not fully understood. Such group differences in signing may be explained by the five biomechanical factors of American Sign Language that have been previously identified: ballistic signing, hand and wrist deviations, work envelope, muscle tension, and "micro" rests. Prior work used motion capture and surface electromyography to collect joint kinematics and muscle activations, respectively, from ten native and thirteen non-native signers as they signed for 7.5 min. Each factor was individually compared between groups. A factor analysis was used to determine the relative contributions of each biomechanical factor between signing groups. No significant differences were found between groups for ballistic signing, hand and wrist deviations, work envelope volume, excursions from recommended work envelope, muscle tension, or "micro" rests. Factor analysis revealed that "micro" rests had the strongest contribution for both groups, while hand and wrist deviations had the weakest contribution. Muscle tension and work envelope had stronger contributions for native compared to non-native signers, while ballistic signing had a stronger contribution for non-native compared to native signers. Using a factor analysis enabled discernment of relative contributions of biomechanical variables across native and non-native signers that could not be detected through isolated analysis of individual measures. Differences in the contributions of these factors may help explain the differences in signing across native and non-native signers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Epinephrine use during hand surgery has been stigmatized due to a fear of digital necrosis. Clinical experience in the past 2 decades has shown epinephrine in local anesthetic to be safe. We sought to analyze the use of epinephrine among hand surgeons and identify variables associated with it., Methods: A deidentified 21-question survey was distributed via email to the 914 and 415 members of the American Association for Hand Surgery and the Canadian Society for Surgery of the Hand, respectively. Questions included residency type, years of practice, practice setup/ownership, practice leadership, usage of epinephrine, availability of reversal agents, and reasons for or against usage., Results: Of 188 responders, 170 (90%) used epinephrine in local anesthetic for hand surgery procedures. By nationality, 100% (43) of Canadian surgeons and 89% (108) of US surgeons use epinephrine ( P = .01). Among surgeons with practice ownership, 88% (102) used epinephrine compared with 93% (85) of those surgeons that we employed ( P = .28). Comparing surgeons with teaching responsibilities versus those without training responsibilities showed that surgeons who did not teach used epinephrine at a higher rate (87% vs 98%, P = .04). In addition, plastic surgery-trained surgeons (111) used epinephrine in 97.2% of cases while orthopedic surgery-trained surgeons (57) used epinephrine in 80.2% of cases ( P = .0003). No difference was found when examining the use of epinephrine and surgeon age ( P = .28)., Conclusions: Most respondents believe that epinephrine is safe. Training background, location, and practice setup are significant factors in the use of epinephrine, whereas practice ownership and physician age are not major factors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Lalonde has edited a book on wide-awake hand surgery, but receives no money in royalties. All royalties from the book go to the effort of the American Association for Hand Surgery. Dr Baratz receives royalties from Integra Implants and receives payment as a speaker for Integra Implants. Dr Fowler sits on the advisory board for Integra Implants. The other authors have no disclosures or financial/grant support to disclose.

Purpose: Carpal tunnel syndrome is the most common compressive neuropathy. There is limited evidence to support endoscopic compared to open carpal tunnel release according to the 2016 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on carpal tunnel syndrome. The purpose of the present study was to assess differences between the two procedures by comparing 30- and 90-day complications and mean hospital costs in a large patient population., Methods: Using the national Mariner15 Database by PearlDiver Technologies, we retrospectively studied 27,192 carpal tunnel syndrome patients who received carpal tunnel release using an endoscopic or open surgical approach from 2010 to 2019. Patients who met the inclusion criteria were grouped and case-matched at a 1:1 ratio through the corresponding International Classification of Diseases codes (n = 13,596) and assessed for 30- and 90-day complications such as median nerve injury, superficial palmar arch injury, and revision carpal tunnel release surgery. Univariate analysis was used to compare outcomes and a multivariate regression was performed to identify risk factors associated with each outcome., Results: Endoscopic carpal tunnel release was associated with a higher rate of median nerve injury than open release at 30 days (0.3% vs. 0.1% odds ratio, 2.21; 95% confidence interval, 1.29-3.81; p < 0.05) and 90 days (0.4% vs. 0.3%; odds ratio, 1.77; 95% confidence interval, 1.16-2.70; p < 0.05). Endoscopic release was also associated with a higher rate of superficial palmar arch injury (0.1% vs. 0%; odds ratio, 25.02; 95% confidence interval, 1.48-423.0; p < 0.05)., Conclusions: In the present study, risk of median nerve injury and vascular injury was higher after endoscopic than open carpal tunnel release. At 90 days, all-cause revision rates were similar between techniques. Surgeons should understand these differences, to optimize surgical decision-making., Level of Evidence: Therapeutic, IIIa., (Copyright © 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Background: The use of standardized outcome measures is essential for best clinical practice by hand therapists to determine patient status, progress, and the outcome of interventions. A better understanding of current patient-reported outcome (PRO) use in hand and upper extremity practice is warranted., Purpose: This study sought to understand what outcome measures are being used in clinical practice, how they are being used, and the perceived usefulness of PROs by active members of the American Society of Hand Therapists (ASHT)., Study Design: This study employed a cross-sectional design., Methods: The web-based survey was distributed through Qualtrics (Qualtrics, Salt Lake City, Utah) to active members of ASHT with an email address on file. The survey consisted of multiple choice and open-ended questions., Results: A total of 348 members responded to the survey. Seven hundred thirty-two different outcome measures were reported to be used by the hand therapist respondents. The most used outcome measure was QuickDASH by 38% of the respondents. Two hundred seventy-five (88%) indicated that their workplace advocated the use of PROs. Most respondents indicated that there were not constraints preventing the use of a PRO. Few therapists respondents use a psychosocial PRO in clinical practice., Conclusions: Most of the hand therapist respondents to our survey use a PRO and discuss the results with their clients. The QuickDASH was the PRO used most often by hand therapists. Only a few hand therapists use a psychosocial tool to measure patient status in clinical practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to evaluate the influence of socioeconomic factors on access to congenital hand surgery care, hospital admission charges, and analyze these geographic trends across regions of the country., Methods: Retrospective cohort study was conducted of congenital hand surgery performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Multivariate regression was used to analyze the impact of socioeconomic factors., Results: During the study interval, 5531 pediatric patients underwent corrective surgery for congenital hand differences, including syndactyly repair (n = 2439), polydactyly repair (n = 2826), and pollicization (n = 266). Patients underwent surgery at significantly earlier age when treated at above-median case volume hospitals ( P < .001). Patients with above-median income ( P < .001), non-white race ( P < .001), commercial insurance ( P < .001), living in an urban community ( P < .001), and not living in an underserved area ( P < .001) were more likely to be treated at high-volume hospitals. Nearly half of patients chose to seek care at a distant hospital rather than the one locally available (49.5%, n = 1172). Of those choosing a distant hospital, most patients chose a higher-volume facility (80.9%, n = 948 of 1172). On multivariate regression, white patients were significantly more likely to choose a more distant, higher-volume hospital ( P < .001)., Conclusions: Socioeconomic and geographic factors significantly contribute to disparate access to congenital hand surgery across the country. Patients with higher socioeconomic status are more likely to be treated at high-volume hospitals. Treatment at hospitals with higher case volume is associated with earlier age at surgery and decreased hospital admission charges., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) are the 2 operative approaches used to treat carpal tunnel syndrome (CTS). This study aims to identify whether differences between OCTR and ECTR rates exist, and, if so, are these differences associated with patient demographics or hospital characteristics., Methods: The 2018 Nationwide Ambulatory Surgery Sample (NASS) was filtered for patient encounters including either OCTR or ECTR operations. All patients undergoing either OCTR or ECTR were included, regardless of surgical specialty. Patient demographics and hospital characteristics data, provided and predefined by the NASS database, were collected and compared between the 2 treatment groups., Results: A total of 180 740 patient encounters were collected for both procedure types (OCTR: 62.4% women, mean age, 58 years; ECTR: 62.2% women, mean age, 58 years). Patients from lower income zip codes were more likely to undergo OCTR ( P < .001). Patients either self-paying ( P < .008) or covered by Medicare ( P < .001) or Medicaid insurance ( P < .001) were also more likely to undergo OCTR. In contrast, patients who received care at academic centers and centers with >300 beds were more likely to undergo ECTR ( P < .001). Patients <65 years old were more likely to undergo ECTR ( P < .001), and patients > 75 years old were more likely to undergo OCTR ( P < .001). In addition, ECTR was found to be more expensive, with average total charges $1568 greater than charges for OCTR ( P < .001)., Conclusions: Significant differences exist in treatment strategies for CTS and are related to patient income, location, and primary payor status. Differences in OCTR and ECTR rates are also present, and are related to the size and academic status of hospitals., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Cross-sectional and descriptive study. Supported by the Centers for Disease Control and Prevention, the National Health and Nutrition Examination Survey (NHANES) began collecting grip strength data from nationally representative samples in 2011. To examine the stability of the grip strength values across 2 data release cycles and provide updated US population-based grip strength values for 6 to 80 year olds. Handgrip data from 13,676 participants aged 6-80 years were extracted from the NHANES 2011-2014 database. The muscle strength/grip test component measured the isometric grip strength using a Takei digital handgrip dynamometer (Takei Scientific Instruments, Shinagawa-Ku, Tokyo). Grip strength values (best of 3 trials for each hand) were summarized by gender, dominant side, and age group. Grip data from 2 data release cycles (2011-2012 vs 2013-2014) were compared. Differences between 2 data release cycles were negligible. Hence, we summarize grip strength values across the entire 2011-2014 period. The mean grip strength ranged from 50.3 kg for the dominant hand of 30- to 34-year-old men to 10.0 kg for the nondominant hand of 6-year-old girls. The summary data we present provide relatively current reference values to which tested individuals can be compared. However, clinicians and/or researchers should be aware that the instrumentation and procedures may influence the values. Results supported the stability of the NHANES grip strength values across data release cycles. • Data obtained from an original and an intergroup replicative cohort of the NHANE. • This is the first study validating of norms based on study replication. • To assist in clinical interpretation, we present the updated grip strength values. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses several articles published within issue on topics related to hyperhidrosis.

Background: The use of musculoskeletal ultrasound (US) among hand surgeons appears to be increasing. The purpose of this study was to determine the utilization patterns and attitudes regarding US among American Society for Surgery of the Hand (ASSH) members in 2020 as well as the changes in usage patterns since a previous survey in 2015., Methods: In 2020, an updated and expanded 27-question survey was distributed to 4852 members of the ASSH. Questions assessed respondent demographics, training, and practice patterns, and access, utilization, training, and opinions pertaining to US., Results: A total of 418 surveys (8.6%) were analyzed. Compared to 2015, there was an increase in the percentage of respondents using US for diagnostic purposes (51%-68%), as well as having personal access to US machines (43% to 58%). US use to assist in diagnosing carpal tunnel syndrome increased from 19% to 27%. The most common reason for using US was convenience and practice efficiency, while the most common reasons for not using US was no machine access. In 2020, 33% of respondents performed US-guided injections., Conclusions: Compared to 2015, the majority of responding upper extremity surgeons now have personal access to US machines. Utilization of diagnostic US appears to be increasing, and two-thirds of respondents believed that US use will continue to increase among upper extremity surgeons., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Hospitals and providers may increase hand surgery charges to compensate for decreasing reimbursement. Higher charges, combined with increasing utilization of ambulatory surgical centers (ASCs), may threaten the accessibility of affordable hand surgery care for uninsured and underinsured patients., Methods: We queried the Physician/Supplier Procedure Summary to collect the number of procedures, charges, and reimbursements of hand procedures from 2010 to 2019. We adjusted procedural volume by Medicare enrollment and monetary values to the 2019 US dollar. We calculated weighted means of charges and reimbursement that were then used to calculate reimbursement-to-charge ratios (RCRs). We calculated overall change and r 2 from 2010 to 2019 for all procedures and stratified by procedural type, service setting, and state where service was rendered., Results: Weighted mean charges, reimbursement, and RCRs changed by + 21.0% (from $1,227 to $1,485; r 2 = 0.93), +10.8% (from $321 to $356; r 2 = 0.69), and -8.4% (from 0.26 to 0.24; r 2 = 0.76), respectively. The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% ( r 2 = 0.95). Trends in utilization and billing varied widely across different procedural types, service settings, and states., Conclusions: Charges for hand surgery procedures steadily increased, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured patients at greater risk for financial catastrophe, as they are often responsible for full or partial charges. In addition, procedures shifted from inpatient to ASC setting. This may further limit access to affordable hand care for uninsured and underinsured patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background Mycobacterium abscessus , an emerging pathogen in healthcare settings, has rarely been associated with community outbreaks. During February–May 2013, Idaho public health officials and pediatric infectious disease physicians investigated an outbreak of M abscessus skin infections in children whose only common exposure was an indoor wading pool. Methods Healthcare providers and parents reported possible M abscessus cases. We used a standardized questionnaire to interview parents of affected children. Clinical specimens were submitted for mycobacterial examination. We conducted an environmental investigation of the pool. Microbial isolates from clinical and environmental samples were identified by sequencing polymerase chain reaction amplicons and underwent pulsed-field gel electrophoresis. Results Twelve cases were identified. Specimens from 4 of 7 children grew M abscessus or Mycobacterium abscessus/Mycobacterium chelonae. Ten (83%) of 12 children were female; median age was 3 years (range, 2 to 6 years); and all were immunocompetent. Pool maintenance did not fully comply with Idaho state rules governing pool operation. Mycobacterium abscessus / chelonae was isolated from pool equipment. Pulsed-field gel electrophoresis composite patterns were 87% similar between isolates from the pool ladder and 1 patient, and they were 90% similar between isolates from 2 patients. Environmental remediation included hyperchlorination, scrubbing and disinfection of pool surfaces, draining the pool, and replacement of worn pool materials. Conclusions Immunocompetent children acquired M abscessus cutaneous infection involving hands and feet after exposure to a wading pool. Environmental remediation and proper pool maintenance likely halted transmission. Medical and public health professionals' collaboration effectively detected and controlled an outbreak caused by an emerging recreational waterborne pathogen. [ABSTRACT FROM AUTHOR]

In nursing homes (NHs), residents are at risk for malnutrition and weight loss. The purpose of this secondary data analysis was to examine the impact of resident cognitive status and level of feeding assistance provided by NH staff on resident's daily nutritional intake and body weight. As part of a large, multisite clinical trial (N = 786), residents with and without dementia were examined according to level of feeding assistance required during mealtimes (independent, set-up only, needs help eating) over a 21-day period. Outcomes analyzed were percent of meal intake by meal type (breakfast, lunch, dinner) and overall daily intake (meals + snacks/supplements). Residents with dementia who required meal set-up assistance had significantly lower meal intake for all three meals. Residents without dementia requiring meal set-up assistance experienced significantly lower intake for breakfast and dinner, but not lunch. When snacks and supplements were offered between meals, residents with dementia consumed approximately 163 additional calories/day, and residents without dementia consumed approximately 156 additional calories/day. This study adds new evidence that residents at greatest risk for low intake are those who are only provided set-up assistance for meals and/or have cognitive impairment. [ABSTRACT FROM AUTHOR]

Reliable and valid neurocognitive (NC) test batteries that assess multiple domains of cognitive functioning are vital tools in the early detection of HIV-associated NC impairment. The HIV Neurobehavioral Research Center's International Neurobehavioral Battery (HNRC Battery) is one such diagnostic tool and has shown cultural validity in several international neuroHIV studies. However, no published norms are currently available for the full HNRC Battery in South Africa. To accurately interpret NC test results, appropriate reference norms are required. In light of this challenge, data were collected from 500 healthy, HIV-uninfected participants to develop demographically corrected South African norms. When demographically corrected United States of America (U.S.) norms were applied to the performance scores of our neurologically intact, HIV-negative sample, an impairment rate of 62.2% was observed compared to a 15.0% impairment rate when the newly generated South African norms were applied. These results reiterate the findings of other low- and middle-income countries, highlighting the need for localized, country-specific norms when interpreting NC performance., (© 2023. The Author(s).)

Background: Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation., Methods: The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence., Results: Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature., Conclusions: This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.

BACKGROUND: Hand-grip strength is an indicator of overall strength and a predictor of important outcomes. Up-to-date, population-specific reference values for measurements of grip strength are needed to properly interpret strength outcomes. OBJECTIVES: To provide population-based grip-strength reference values and equations for US residents 18 to 85 years of age. METHODS: Hand-grip data from 1232 participants 18 to 85 years of age were extracted from the database of the 2011 normative phase of the US National Institutes of Health Toolbox project in this cross-sectional study. Descriptive reference values and equations were derived from the data. RESULTS: The authors present grip-strength reference values using summary statistics (mean, standard deviation, and percentile). The mean grip strength ranged from 49.7 kg for the dominant hand of men 25 to 29 years of age to 18.7 kg for the nondominant hand of women 75 to 79 years of age. The researchers also present reference regression equations for the dominant and nondominant sides of men and women. The explanatory variables in the equations are age, height, and weight. CONCLUSION: The normative reference values and equations provided in this study may serve as a guide for interpreting grip-strength measurements obtained from tested individuals. [ABSTRACT FROM AUTHOR]

Background Exposure to bisphenol A (BPA) can be assessed using external and internal exposure measures. We examined the relationship between two measures of external BPA exposure (air and hand-wipe samples) and one of internal exposure (total BPA in urine) for a group of US manufacturing workers. Methods During 2013–2014, we recruited 78 workers from six US companies that made BPA or made products with BPA. We quantified BPA in seven urine samples, two full-shift air samples and in pre- and end-shift hand-wipe samples collected from workers over 2 consecutive days. We examined correlations between creatinine-corrected urinary concentrations of total BPA (total BPACR) and BPA levels in air and hand wipes using Pearson’s correlation coefficient. We also applied mixed-effects regression models to examine the relationship between total BPACR with BPA in air (urine~air model) and with BPA in end-shift hand wipes (urine~hand model), separately and together (urine~air+hand model), after adjusting for covariates. Results End-shift total BPACR strongly correlated with BPA in air (r p = 0.79, P < 0.0001) and nearly as strongly with BPA in end-shift hand wipes (r p = 0.75, P < 0.0001). In mixed-effect models, BPA air concentration and end-shift hand-wipe BPA level were significantly and positively associated with end-shift total BPACR (P < 0.0001 each). We found a significant effect of the Day 1 BPA air concentration on Day 2 total BPACR (P = 0.0104). When BPA air concentration and end-shift hand-wipe BPA level were in the same model, the air concentration (P < 0.0001) was more significant than the hand-wipe level (P = 0.0106). Conclusion BPA levels in air and end-shift hand wipes strongly correlated with total BPACR, suggesting that both inhalation and dermal contract were likely exposure routes; however, inhalation, on average, appeared to be a more dominant exposure route than dermal contact for these manufacturing workers. [ABSTRACT FROM AUTHOR]

Objective. To develop an optical spectral transmission (OST) model to measure joint inflammation, and thus disease activity, as well as to evaluate (patho-)physiological findings that could lead to misclassification of inflammation. Methods. Forty-six RA patients were included in this cross-sectional study, where US scores, duplicate OST measurements and 28-joint DAS (DAS28) were acquired. With US as a reference standard, the diagnostic performance of OST in detecting inflammation at the joint level was evaluated using receiver operating characteristic (ROC) curve analyses. At the patient level, correlations with US were analysed for DAS28 and OST, and at joint level for OST and tender and swollen joint counts (TJC and SJC, respectively). Joint pathology potentially influencing misclassification by OST [erosions, osteophytes, tendon (sheath) inflammation (ab)normal vasculature and chondrocalcinosis] was evaluated for significance in a multivariate nominal logistic regression model. Results. Diagnostic performance of OST was good for MCP [area under the ROC curve (AUC-ROC) 0.88], PIP (AUC-ROC 0.83) and wrist (AUC-ROC 0.74) joints and for all joints together (AUC-ROC 0.85). At the patient level, DAS28 correlated very poorly (p = 0.06) and OST moderately (p = 0.54) with US. At the joint level, US correlation with OST was strong (p = 0.64), with SJC it was weak (p = 0.30) and with TJC it was very weak (p =-0.02). Misclassification of inflammation by OST was relatively rare (17%). Dorsal erosions [odds ratio (OR) 4.0], osteophytes (OR 2.1) and extensor tendinitis (OR 4.6) increased the risk of underestimating inflammation of MCP and PIP joints and osteophytes (OR 3.0) also increased the risk of overestimating inflammation. Conclusion. OST is a sensitive, specific and objective technique to assess joints inflammation of the hands and wrists of RA patients, even though bone and tendon pathology increases the risk of misclassification. [ABSTRACT FROM AUTHOR]

Objectives Understanding the role of muscle strength as a preventive factor for shorter-term declines in function may provide further insights into the disabling process. This study examined if muscle strength was associated with 2-year preservation of instrumental activities of daily living (IADL) function and activities of daily living (ADL) disability status in older Mexican Americans. Design Longitudinal, panel. Setting Urban and rural households in the Southwestern United States. Participants A subsample of 672 Mexican Americans aged at least 65 years was followed for 2 years. Measurements Muscle strength was assessed with a hand-held dynamometer. IADL and ADL were self-reported. Covariate-adjusted ordinal and multinomial logistic models were used to determine the association between handgrip strength and changes in IADL function, and ADL disability status over 2 years. Results Every 10-kg increase in handgrip strength was associated with 5% decreased odds [odds ratio (OR): 0.95; 95% confidence interval (CI): 0.92, 0.98] of experiencing a lost IADL function in 2 years. Likewise, every 10-kg increase in handgrip strength was associated with an 8% decreased odds (OR: 0.92; CI: 0.88, 0.97) for 2-year onset ADL disability, 12% decreased odds (OR: 0.88; CI: 0.83, 0.94) for 2-year ADL disability progression, and 7% decreased odds (OR: 0.93; CI: 0.89, 0.98) for 2-year ADL disability improvement, compared to those with no ADL disability at baseline and follow-up. Conclusions Higher muscle strength was related to a lower risk for 2-year onset of IADL and ADL disability in older Mexican Americans. Future investigations are warranted to examine how potential mediators influence the association between muscle strength and function, to inform interventions aiming to retain function in vulnerable older adult populations. [ABSTRACT FROM AUTHOR]

Introduction: Despite the large number of individuals experiencing partial hand limb loss or deficiency, and the impact of this level of loss on hand function, there is minimal research available regarding the benefit of partial hand externally powered prostheses. The purpose of this research was to explore how using an externally powered partial hand prosthesis contributes to the completion of functional tasks. Materials and Methods: Fifteen individuals being fit with i-digits partial hand prostheses were evaluated using the Southampton Hand Assessment Procedure (SHAP) and Patient-Specific Functional Scale (PSFS). The individuals were each fit during a 1-week condensed fitting and training process and received 10 to 15 hours of therapy between the prefitting and postfitting testing. Results: Twelve male and three female clients with four- (with thumb remaining) or five-digit partial hand limb loss or deficiency participated. Average age was 42 years, and 87% had acquired amputations an average of 2.44 years before the fitting. All subjects demonstrated clinically significant change scores on both the PSFS and the SHAP. The individuals with five-digit absence demonstrated marked improvement in comparison with those with four-digit absence: however, both were far superior to the minimal detectable change score for the SHAP, with 42.33 and 19.16 average improvement scores, respectively. Conclusions: Subjects fit with four- or five-digit externally powered partial hand prostheses demonstrated significant functional improvements in objective hand function and individualized goals. The remnant thumbs of users fit with four-digit systems sometimes exhibited limitations on range of motion or strength. Despite this, their evaluation scores still showed significant improvement; in fact, almost 10 times the minimal detectable change score. For those with five-digit absence, the change was 20 times the minimal threshold. These results suggest the benefit of the i-digits partial hand prosthesis as contributing to the function of individuals with partial hand limb loss or deficiency, particularly with the individuals' priority functional goals. [ABSTRACT FROM AUTHOR]

Background: Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships.Methods: Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests. An arbitrary 1,000% change between the 90th and 10th percentiles of fellows was used as a threshold to highlight case categories with substantial variability.Results: In this study, 413 orthopaedic hand surgery fellows (87%) and 62 plastic surgery hand surgery fellows (13%) were included. Plastic surgery fellows reported more cases in the following categories: wound closure with graft; wound reconstruction with flap; vascular repair, reconstruction, replantation, or microvascular; closed treatment of fracture or dislocation; nerve injury; and congenital (p < 0.05). Orthopaedic surgery fellows reported more cases in the following categories: wound irrigation and debridement fasciotomy or wound preparation; hand reconstruction or releases; wrist reconstruction, releases, or arthrodesis; forearm, elbow, or shoulder reconstruction or releases; hand fractures, dislocation, or ligament injury; wrist fractures or dislocations; forearm and proximal fractures or dislocations; miscellaneous insertion or removal of devices; shoulder arthroscopy, elbow arthroscopy, and wrist arthroscopy; decompression of tendon sheath, synovectomy, or ganglions; nerve decompression; Dupuytren; and tumor or osteomyelitis (p < 0.05). Plastic surgery fellows reported substantial variability for 12 case categories (range, 1,024% to 2,880%). Orthopaedic surgery fellows reported substantial variability for 9 case categories (range, 1,110% to 9,700%).Conclusions: Orthopaedic and plastic hand surgery fellowships afford disparate operative experiences. Understanding these differences may help to align prospective trainees with future career goals and to guide discussions to better standardize hand surgery training. [ABSTRACT FROM AUTHOR]

Introduction: This study examined the effects on drivers' yields of seven conditions (pedestrian behaviors) at a roundabout, measuring yielding behaviors. Methods: At a roundabout, drivers' yielding responses were recorded (none, soft, hard) when a pedestrian presented one of seven conditions: pedestrian without long cane, long cane display, hand up, reversible step (a single step forward into the street), head turn gaze, hand up plus gaze, and a reversible step plus gaze. Trials were completed at the crosswalks at the entrance and exit lanes. Results: At the entry and exit lanes, the hand up and reversible step conditions received significantly higher yield percentages than all other conditions. At the exit lanes, the reversible step condition received a significantly higher yield percentage than the hand up condition. There was no significant difference among the three head turn gaze conditions: hand up, hand up plus gaze, and reversible step plus gaze. The hand up and reversible step strategies averaged 83% yielding overall, compared with 20% yielding for the other strategies. Discussion: This study demonstrates that forced detectable yields may be generated when pedestrians have not entered the travel lanes of the street at a crosswalk or have only entered the very edge of the street. Gazing behaviors do not substantially influence drivers' yielding rates. Implications for practitioners: Using a hand up or reversible step can allow pedestrians who are visually impaired or blind to create circumstances to help determine if and when to initiate a crossing at a roundabout. [ABSTRACT FROM AUTHOR]

Background: Many people are unaware of the science underlying the biophysical properties of Soldier clothing and personal protective equipment, yet there is a well-refined biomedical methodology initiated by Army physiologists in World War II. This involves a methodical progression of systematic material testing technologies, computer modeling, and human testing that enables more efficient development and rapid evaluation of new concepts for Soldier health and performance. Sophisticated manikins that sweat and move are a central part of this testing continuum. This report briefly summarizes the evolution and use of one specialized form of the manikin technologies, the thermal hand model, and its use in research on Soldier hand-wear items that sustain dexterity and protect the hand in extreme environments.Methods: Thermal manikin testing methodologies were developed to provide an efficient and consistent analytical tool for the rapid evaluation of new clothing concepts. These methods have been upgraded since the original World War II and Korean War eras to include articulation and sweating capabilities, as characterized and illustrated in this article. The earlier "retired" versions of thermal hand models have now been transferred to the National Museum of Health and Science.Findings: The biophysical values from manikin testing are critical inputs to the U.S. Army Research Institute of Environmental Medicine mathematical models that provide predictions of soldier comfort, duration of exposure before loss of manual dexterity, and time to significant risk of freezing (skin temperature <-1°C) and nonfreezing cold injuries (skin temperature <5°C). The greater thickness of better insulated handwear reduces dexterity and also increases surface area which makes added insulation increasingly less effective in retaining heat. Measurements of both thermal resistance (insulation) and evaporative resistance (permeability) collectively characterize the biophysical properties and enable mathematical modeling of the human thermophysiological responses. This information can help guide the hand-wear development and selection process which often requires trade-offs between factors such as material, cost, and sizing.Impact: Soldier hands provide fine motor dexterity in tactical functions, ranging from pulling a trigger to pulling a parachute ripcord; thus, protecting hand function is critical to soldier readiness. Also, the importance of protection against nonbattle cold injuries was highlighted during World War II in northern Europe, in the Aleutian Islands, and later in Korea. The U.S. Army has been on the forefront of the biophysical analysis of clothing including gloves since environmental research was established at the Armored Medical Research Laboratory and Climatic Research Laboratory during World War II. U.S. Army Research Institute of Environmental Medicine does not make the equipment but works with their Natick Soldier Research, Development, and Engineering Center partners to make the equipment better. [ABSTRACT FROM AUTHOR]

Background Nursing home ( NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake. Objectives To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand ( DH), Over Hand ( OH), and Under Hand ( UH). Design A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences. Setting and Participants 30 residents living with advanced dementia in 11 U.S. NHs. Measurements Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. Intervention Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days. Results Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8). Conclusion All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding. [ABSTRACT FROM AUTHOR]

Objectives To derive lean mass cutpoints based on a less-conservative Foundation for the National Institutes of Health ( FNIH) Sarcopenia Project Weakness cutpoint for grip strength (WeakI) and to assess their agreement with European Working Group on Sarcopenia in Older People ( EWGSOP) and prediction of incident slow walking and mortality. Design Longitudinal analysis. Setting Baltimore Longitudinal Study of Aging. Participants Individuals aged 65 and older (287 men, 258 women) with 2 to 10 years of follow-up. Measurements Weakness was determined according to handgrip strength using a hand dynamometer, appendicular lean mass ( ALM) using dual-energy X-ray absorptiometry, and walking speed according to 6-m usual pace walk speed. Analyses were performed using classification and regression tree analysis, Cohen's kappa, and Cox models. Results Cutpoints derived from WeakI for ALM ( ALMI) were less than 21.4 kg in men and less than 14.1 kg in women and for ALM adjusted for body mass index ( ALM/ BMII) were less than 0.725 in men and less than 0.591 in women. Kappas with EWGSOP were 0.65 for men and 0.75 for women for ALMI and 0.34 for men and 0.47 for women for ALM/ BMII. Men with WeakI + ALMI were twice as likely to develop slow walking as those not weak with normal ALMI (Hazard ratio (HR) = 2.44, 95% confidence interval (CI) = 1.02-5.82). Under EWGSOP, men with weakness and low RALM were almost 3 times as likely to develop slow walking as those not weak with normal RALM (HR = 2.91, 95% CI = 1.11-7.62). Neither approach predicted incident slow walking in women. Conclusion The ALMI cutpoints agree with EWGSOP and predict slow walking in men. Future studies should explore sex differences in the relationship between body composition and physical function and the effect of change in muscle mass on muscle strength and physical function. [ABSTRACT FROM AUTHOR]

Background: The U.S. Military Health System (MHS) pioneered the use of telehealth in deployed environments in the early 1990s. However, its use in non-deployed environments historically lagged behind that of the Veterans Health Administration (VHA) and comparable large civilian health systems, due to administrative, policy, and other obstacles that slowed or blocked its expansion in the MHS. A report was prepared in December 2016, which summarized past and then-present telehealth initiatives in the MHS; described the obstacles, opportunities, and policy environment; and provided three possible courses of action for expansion of telehealth in deployed and non-deployed settings., Methods: Gray literature, peer-reviewed literature, presentations, and direct input were aggregated under the guidance of subject matter experts., Results: Past and then-current efforts demonstrated significant telehealth capability in use and in development for the MHS, mainly in deployed or operational settings. Policy from 2011 to 2017 demonstrated an environment favorable for MHS expansion, while the review of comparable civilian and veterans' healthcare systems showed significant benefits including increased access and lower cost from use of telehealth in non-deployed settings. The 2017 National Defense Authorization Act charged the Secretary of Defense with promoting telehealth usage for the Department of Defense, including provisions for removing obstacles and reporting progress within 3 years. The MHS has the ability to reduce burdensome interstate licensing and privileging requirements, but still requires an increased level of cybersecurity, compared to civilian systems., Discussion: The benefits of telehealth fit with the MHS Quadruple Aim of improving cost, quality, access, and readiness. Readiness is particularly served by the use of "physician extenders," which allows nurses, physician assistants, medics, and corpsmen to provide hands-on care under remote oversight and to practice at the top of their licenses. Based on this review, three courses of action were recommended: to focus largely on developing telehealth in deployed environments; to maintain focus in deployed environments and increase telehealth development in non-deployed environments to keep pace with the VHA and private sector; or to use lessons learned from military and civilian telehealth initiatives to leapfrog the private sector., Conclusion: This review serves as a snapshot in time of the steps leading to telehealth expansion before 2017, which helped to set the stage for later use of telehealth in behavioral health initiatives and as a response to coronavirus disease 2019. The lessons learned are ongoing and further research is expected to inform additional development of telehealth capability for the MHS., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR., Methods: We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included., Results: Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status ( P < .001) and commercial insurance status ( P < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications., Conclusions: The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.

Background: Hand dermatitis is a common, chronic relapsing skin disease, resulting from a variety of causes including endogenous predisposition and environmental exposures to irritants and allergens. Physical activities have been reported to be beneficial for patients with hand dermatitis. Objectives: We aim to evaluate the association between self-reported physical activities and hand dermatitis using the 2003-2004 National Health and Nutrition Examination Survey (NHANES) database. Methods: Information regarding 2,688 participants aged 20 to 59 years from the 2003-2004 NHANES cycle were retrieved and analyzed. Diagnosis of hand dermatitis was based on standardized photographs of the hands read by two dermatologists. Physical activity during leisure time for the prior 30 days was assessed using standardized questionnaire. Based on the suggested MET scores provided for each response in the questionnaire section of the NHANES methodology, the MET scores for average level of physical activities, walking/bicycling, and performing tasks around home/yard for the past 30 days was calculated. Results: There were 42 (1.56%) diagnosed cases of active hand dermatitis among the 2,688 participants. Those who reported recent vigorous or moderate physical activities were less likely to have a diagnosis of active hand dermatitis (OR: 0.436, 95% CI: 0.200 to 0.947, P = 0.036 and OR: 0.489, 95% CI: 0.261 to 0.916, P = 0.025, respectively). This negative association remained statistically significant even after adjusting for age, gender, ethnic groups and atopic diathesis. Conclusions: Moderate and vigorous levels of physical activities appeared to be beneficial for hand dermatitis. Therefore, it is important to advise patients with active hand dermatitis to remain physically active. However, clinicians should also be cognizant of the fact that the heat and sweat generated from physical activities might also exacerbate the condition.2 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe and compare decreases in grip and knee extension strength accompanying aging. METHOD: Eighty-five community-dwelling women (20 to 79 years of age) participating in the validation phase of the NIH Toolbox for the Assessment of Neurological and Behavioral Function contributed data to this study. Their strength was measured bilaterally-grip with a hand dynamometer and isometric knee extension with an isokinetic dynamometer. Grip and knee extension strength measures of the left and right sides were combined and analyzed. RESULTS: Both combined grip strength and combined knee extension strength decreased with age. The decreases were significant between the 60-79 year age group and the 20-39 year age group. Strength of the 60-79 year age group, described as a percentage of the 20-39 year age group, was significantly less for knee extension than for grip. CONCLUSION: Grip strength declines less than knee extension strength with age. Grip strength, therefore, may not fully capture the effect of age on muscle strength. [ABSTRACT FROM AUTHOR]

Introduction: The development of multiarticulating hands holds the potential to restore lost function for upper-limb amputees. However, access to the full potential of commercialized devices is limited due to conventional control strategies for switching prosthesis modes, such as hand grips. For example, to switch grips in one conventional strategy, the prosthesis user must generate electromyogram (EMG) triggers (such as a cocontraction), which are cumbersome and nonintuitive. For this reason, alternative control strategies have emerged, which seek to facilitate grip switching. One specific application uses radio frequency identification (RFID) tags programmed with grip information. These tags can be placed on objects in the environment or carried on person. Upon approaching an RFID tag, the user's prosthesis reads the grip programmed on the tag and commands the hand into that grip. The purpose of this study was to compare the conventional strategy (using EMG triggers) with the alternative strategy (using RFID tags). Methods: The study evaluated three subjects: two users who actively use multiarticulating hands ("experienced" users) and one user who had never worn a multiarticulating hand ("new" user). Subjects were evaluated on two performance metrics: trigger completion time and the percentage of triggers that were successful on first attempt (first attempt success rate). Subjects also rated the difficulty, effort, and frustration with each strategy. Results: Results suggested faster trigger completion times with the EMG strategy for the experienced users and mixed results for the new user. Overall, the three subjects rated the RFID strategy as less difficult, tiring, and frustrating than the EMG strategy. Discussion and Conclusions: Continued studies with a larger subject pool are necessary to determine factors influencing performance and patient preference. This would allow identification of best strategies to access the full potential of new commercial devices. Still, the authors suggest that the synergistic use of both strategies can yield great benefits for both experienced and new multiarticulating hand users. [ABSTRACT FROM AUTHOR]

Objectives: There were two main objectives of this study: to establish normative values of hand grip strengths for 6-12-year-old children in Saudi Arabia and to compare results with existing Western data. Methods: Five-hundred twenty-five children from the central area of Riyadh, Saudi Arabia, were recruited. Hand grip strength was measured using a standard adjustable electronic hand dynamometer. Results: The grip strength increased with advancing age in both genders, but grip strength for boys was significantly stronger than that of girls. There was no significant difference in hand grip strength according to the type of hand dominance. The hand strength of the Saudi children appeared to be lower than that of Western children. Conclusion: The reported values of hand grip strength will allow therapists to compare scores from typical and atypical children according to the age, gender, and body measures. [ABSTRACT FROM AUTHOR]

Purpose: Patients may receive surprise out-of-network bills even when they present to in-network facilities. Surprise bills are common following emergency care. We sought to characterize and determine risk factors for surprise billing in hand and upper extremity trauma patients in the emergency department (ED)., Methods: We used IBM MarketScan data to evaluate hand and upper extremity trauma patients who received care in the ED from 2010 to 2017. Our primary outcome was the surprise billing incidence, defined as encounters in in-network EDs with out-of-network claims. We used descriptive and bivariate analyses to characterize surprise billing and used multivariable logistic regression to evaluate independent factors associated with surprise billing., Results: Of 710,974 ED encounters, 97,667 (14%) involved surprise billing. The incidence decreased from 26% in 2010 to 11% in 2017. Mean coinsurance payments were higher for surprise billing encounters and had double the growth from 2010 to 2017 compared to those without surprise billing. Receiving care from different provider types-especially therapists, radiologists, and pathologists, as well as hand surgeons-was associated with significantly higher odds of surprise billing. Transfer to another facility was not significantly associated with surprise billing., Conclusions: Although the incidence of surprise billing decreased, more than 10% of patients treated in an ED for hand trauma remain at risk. Coinsurance for surprise billing encounters increased by twice as much as encounters without surprise billing. Patients requiring services from therapists, radiologists, pathologists, and hand surgeons were at greater risk for surprise bills. The federal No Surprises Act, passed in 2020, targets surprise billing and may help address some of these issues., Clinical Relevance: Many hand and upper extremity patients requiring ED care receive surprise bills from various sources that result in higher out-of-pocket costs., (Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe current hand call practices in the United States (US) and identify aspects of call practices that lead to surgeon satisfaction., Methods: An anonymous survey was administered to practicing members of the American Society for Surgery of the Hand, and responses were filtered to US surgeons taking hand call. Hand call was considered: (A) hand-specific call including replantation or microvascular services or (B) hand-specific call without replantation or microvascular responsibilities. Data were collected pertaining to practices, compensation, assistance, frequency, and satisfaction. Descriptive analyses were performed and regionally subdivided. Pearson correlations were used to determine aspects of a call that influenced surgeon satisfaction., Results: A total of 662 US hand surgeons from 49 states responded. Among the respondents, 38% (251) participate in replantation or microvascular call, 34% (225) participate in hand-specific call excluding replantation, and 28% (186) do not participate in hand-specific call. Of those practicing hand call (476), 60% take 6 or fewer days of call per month, 62% have assistance with staffing consultations, 65% have assistance with surgical procedures, and 49% are financially incentivized to take call. More than half (51%) reported that they have a protected time for call aside from their elective practice, and 10% of the surgeons reported that they have a dedicated operating room (OR) time after a call to care for cases. Two percent reported that the day following call is free from clinical duties. Only 46% of the surgeons were satisfied with their call schedule, with the top concerns among unsatisfied respondents relating to pay, OR availability, and burnout. The factors correlating to surgeon satisfaction included less frequent call, assistance with performing consultations and surgery, pay for call, and OR availability., Conclusions: The majority of US hand surgeons are not satisfied with their current call practices, with frequent concerns relating to pay, OR availability, and burnout., Clinical Relevance: These findings may promote awareness regarding aspects of hand call that correlate with surgeon satisfaction and highlight practice patterns that may reduce burnout., (Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons., Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups., Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups., Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

Background: In 2019, the Hand Therapy Certification Commission (HTCC), in consultation with Scantron Corporation, performed a practice analysis study of hand therapy, the sixth in a series of similar studies performed byHTCC over a 35-year period., Purpose: The primary goal of this study was to update and validate the definition and delineation of hand therapy and to ensure that the test content outline for the Hand Therapy Certification Examination (HTCE) reflects the critical tasks, knowledge, and skills required in the practice of hand therapy. Additionally, HTCC explored specific trends in hand therapy practice, compared findings with previous studies, and gathered data about the frequency, criticality, and performance expectations for the use and fabrication of orthoses by hand therapists., Study Design: Quantitative Descriptive., Methods: More than 40 subject matter experts from the United States and Canada, representing a broad range of experiences and perspectives, developed an updated delineation of the domains, tasks, knowledge, and techniques and tools used in hand therapy practice. A large-scale online survey of all certified hand therapists from the United States, Canada, and other countries was completed to test the profile within the practice of hand therapy., Results: This large-scale online survey overwhelmingly validated the profile of hand therapy. The results affirmed the test specifications for the Hand Therapy Certification Examination; affirmed the definition of hand therapy; and refined the scope of hand therapy practice. New data was gathered regarding the use of orthotics in hand therapy., Conclusions: This study establishes content validity for the HTCE. It highlights that the specialty of hand therapy is a mature and stable specialty field of occupational therapy and physical therapy. Certified Hand Therapists frequently issue pre-fabricated and fabricate custom orthoses in the course of rehabilitation for clients with hand and arm injuries, and overall consider this a highly critical task in hand therapy practice., Level of Evidence: N/A., (Copyright © 2021. Published by Elsevier Inc.)

Background: There is a paucity of data on the health risks and benefits of recreational cycling. Research question: Describes the injury patterns, health risks and benefits of recreational cycling. Type of study: Internet-based retrospective self-reported data. Methods: Web based study of cyclist behaviours, injuries and medical conditions. Subjects: The study was open to subjects over 18 years of age, who cycled at least 2 times a week with internet access. Experimental procedure: Conducted using DatStat® software. Main outcome measurements: Self-reported injuries and health conditions. Results: In this study, 4792 subjects were >18 and met the authors' definition of a cyclist. The majority of injuries were taken care of by the cyclist with no effect on their ability to continue with their job or activities of daily living. At least 7.0% reported the use of performance-enhancing drugs. There were reductions in obesity (76.2%), cholesterol (66.1%), hypertension (50%) and asthma (58.7%) after cycling. There were increases in musculoskeletal complaints. Hand pain and numbness increased by 420%. Urologic complaints increased by 310%. There were decreased reports of all mental health diseases reported. Abrasions were the most common injury (53%). The most injured body parts were the pelvis/hip (15.5%), knee (14.8%), and shoulder (13.6%). The least injured body parts were the abdomen (0.4%), foot (0.5%) and upper arm (0.7%). Conclusions: There is encouraging data that cycling results in reductions in obesity, high cholesterol, diabetes, asthma and hypertension. The greater health risks of cycling appear to be related to compressive forces on the perineum and the hand/wrist. Injuries are common to cycling, although the majority of injuries are minor. [ABSTRACT FROM AUTHOR]

Objectives. (1) To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS), an existing instrument used for clinical assessment of motor performance in stroke survivors; (2) To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients (N = 332) receiving stroke rehabilitation following left (52%) or right (48%) cerebrovascular accident; mean age 64.2 years (sd 15); median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results.The new scales assessing hand movements and hand activitiesmet Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS.The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy. [ABSTRACT FROM AUTHOR]