A descriptive study on wrist and hand sensori-motor impairment and function following distal radius fracture intervention.

STUDY DESIGN Descriptive cross-sectional design. INTRODUCTION Wrist and hand sensori-motor impairment have been observed after distal radius fracture (DRF) treatment. This impairment and its relationship to function lack research. PURPOSE OF THE STUDY The primary aim of this exploratory study was to determine the magnitude of wrist and hand sensori-motor impairment following surgical and non-surgical treatment among older patients following DRF. Secondary aims were to determine the relationship between wrist and hand sensori-motor impairment with function and pain as well as the relationships among wrist and hand sensori-motor impairment and function and age following DRF. METHODS Ten Test (TT), active joint position sense (JPS), electromyography (EMG), computerized hand-grip dynamometer (CHD), and the Patient-Rated Wrist Evaluation (PRWE) were used to assess twenty-four female participants 8 weeks following DRF treatment and their 24 matched-control healthy counterparts on wrist and hand sensibility, proprioception, muscle recruitment, grip force, muscle fatigue, and functional status. RESULTS Participants following DRF demonstrated significantly (p < .05) greater sensory (i.e., JPS, TT), and motor (i.e., EMG, CHD) deficits than their control counterparts. A significantly higher functional deficit (i.e., PRWE) also existed among participants following DRF than the control group. Participants following surgical and non-surgical DRF treatment were found to be statistically different only on total grip force. Group differences on JPS and total grip force revealed the strongest effect size with the highest correlations to PRWE. EMG and muscle fatigue ratio group differences revealed a weaker effect size with a fair degree of correlation to PRWE. Pain significantly correlated with sensori-motor function. Age did not correlate with any measured variable. CONCLUSIONS Significant wrist and hand sensori-motor impairment and functional deficits among older females 8 weeks following DRF surgical and non-surgical interventions were revealed. JPS and total grip force were the most clinically meaningful tests for assessing the sensori-motor status as well as explaining functional disability and pain levels for these patients. LEVEL OF EVIDENCE 2c.

[1]  S. Cummings,et al.  Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. , 1992, American journal of epidemiology.

[2]  N. Taylor,et al.  Correlation of impairment and activity limitation after wrist fracture. , 2002, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[3]  P LaStayo,et al.  Dynamic versus static grip strength: how grip strength changes when the wrist is moved, and why dynamic grip strength may be a more functional measurement. , 1999, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[4]  L. Portney,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[5]  S. Cummings,et al.  Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. , 1989, Archives of internal medicine.

[6]  J. Macdermid,et al.  Patient rating of wrist pain and disability: a reliable and valid measurement tool. , 1998, Journal of orthopaedic trauma.

[7]  G. Laseter,et al.  Management of distal radius fractures. , 1996, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[8]  J. Vedel,et al.  Firing pattern of type‐identified wrist extensor motor units during wrist extension and hand clenching in humans , 1997, The Journal of physiology.

[9]  H. Handoll,et al.  Surgical interventions for treating distal radial fractures in adults. , 2001, The Cochrane database of systematic reviews.

[10]  J. Macdermid,et al.  Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture. , 2002, Journal of clinical epidemiology.

[11]  D. Ring,et al.  Operative Treatment of Volar Intra-Articular Fractures of the Distal End of the Radius* , 1996, The Journal of bone and joint surgery. American volume.

[12]  O. Franko,et al.  Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. , 2009, The Journal of bone and joint surgery. American volume.

[13]  J. Macdermid,et al.  Assessment of complications of distal radius fractures and development of a complication checklist. , 2001, The Journal of hand surgery.

[14]  M. Savic Book review: Reading Statistics and Research Schuyler W. Huck (Pearson Education Inc., Boston 2007) , 2008 .

[15]  K. Valdes A retrospective pilot study comparing the number of therapy visits required to regain functional wrist and forearm range of motion following volar plating of a distal radius fracture. , 2009, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[16]  K. J. Cole,et al.  Wrist action affects precision grip force. , 1997, Journal of neurophysiology.

[17]  W. Wallace,et al.  Incidence of Distal Forearm Fracture in British Men and Women , 2001, Osteoporosis International.

[18]  Uwe Proske,et al.  Effects of muscle conditioning on position sense at the human forearm during loading or fatigue of elbow flexors and the role of the sense of effort , 2007, The Journal of physiology.

[19]  G. Athwal,et al.  Complications Following Internal Fixation of Unstable Distal Radius Fracture With a Palmar Locking-Plate , 2008 .

[20]  J. Abzug,et al.  T-Pin for Distal Radius Fracture , 2006, Techniques in hand & upper extremity surgery.

[21]  C. Carroll Treatment of Unstable Distal Radial Fractures with the Volar Locking Plating System , 2008 .

[22]  V. Mathiowetz,et al.  Reliability and validity of grip and pinch strength evaluations. , 1984, The Journal of hand surgery.

[23]  R. Ericson,et al.  Colles' fracture. How should its displacement be measured and how should it be immobilized? , 1981, The Journal of bone and joint surgery. American volume.

[24]  K. Koval,et al.  Distal radius fractures. , 2009, Journal of orthopaedic trauma.

[25]  S. Riek,et al.  Recruitment of motor units in human forearm extensors. , 1992, Journal of neurophysiology.

[26]  H. Handoll,et al.  Internal fixation and comparisons of different fixation methods for treating distal radial fractures in adults , 2008 .

[27]  U. Nordenskiöld,et al.  Assessing hand grip endurance with repetitive maximal isometric contractions. , 2001, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[28]  Scott M Lephart,et al.  The sensorimotor system, part I: the physiologic basis of functional joint stability. , 2002, Journal of athletic training.

[29]  J. Cram,et al.  Introduction to Surface Electromyography , 1998 .

[30]  P. Bawa,et al.  Recruitment of motor units in human flexor carpi ulnaris , 1993, Brain Research.

[31]  M. Walsh,et al.  Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. , 2008, The Journal of bone and joint surgery. British volume.

[32]  N. Bellamy,et al.  Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. , 2000, The Journal of hand surgery.

[33]  Uwe Proske,et al.  Signals of motor command bias joint position sense in the presence of feedback from proprioceptors. , 2009, Journal of applied physiology.

[34]  T. Christiansen,et al.  Length of immobilisation after fractures of the distal radius , 2004, International Orthopaedics.

[35]  G. Mclauchlan,et al.  Epidemiology of fractures in 15 000 adults: The influence of age and gender , 1998 .

[36]  K. Søgaard,et al.  Control of the wrist joint in humans , 2000, European Journal of Applied Physiology.

[37]  S. Gehrmann,et al.  Distal radius fracture management in elderly patients: a literature review. , 2008, The Journal of hand surgery.

[38]  C. Court-Brown,et al.  iv) Increasing age and fractures of the distal radius , 2003 .

[39]  S. Gandevia,et al.  The kinaesthetic senses , 2009, The Journal of physiology.

[40]  I A Karnezis,et al.  Association between objective clinical variables and patient-rated disability of the wrist. , 2002, The Journal of bone and joint surgery. British volume.

[41]  P. Zysset,et al.  Volar fixed-angle plating of extra-articular distal radius fractures--a biomechanical analysis comparing threaded screws and smooth pegs. , 2010, The Journal of trauma.

[42]  E. Hagert,et al.  Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. , 2010, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[43]  S. Chatterjee,et al.  Comparison of grip strength and isomeric endurance between the right and left hands of men and their relationship with age and other physical parameters. , 1991, Journal of human ergology.

[44]  M. Swiontkowski Unstable Distal Radial Fractures Treated with External Fixation, a Radial Column Plate, or a Volar Plate: A Prospective Randomized Trial , 2010 .

[45]  J. Orbay,et al.  Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. , 2002, The Journal of hand surgery.

[46]  M. Bhandari,et al.  Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures , 2003, Archives of Orthopaedic and Trauma Surgery.

[47]  E. B. Toby,et al.  Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study. , 2005, The Journal of hand surgery.

[48]  Randal P. Morris,et al.  Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. , 2003, The Journal of hand surgery.

[49]  Marco Santello,et al.  Neural control of hand muscles during prehension. , 2009, Advances in experimental medicine and biology.

[50]  K. Koval,et al.  A Biomechanical Comparison of a Dorsal 3.5-mm T-Plate and a Volar Fixed-Angle Plate in a Model of Dorsally Unstable Distal Radius Fractures , 2005, Journal of orthopaedic trauma.

[51]  J B Myers,et al.  The role of the sensorimotor system in the athletic shoulder. , 2000, Journal of athletic training.

[52]  Scott M Lephart,et al.  Sensorimotor system measurement techniques. , 2002, Journal of athletic training.

[53]  E. Panagiotopoulos,et al.  Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. , 2005, Injury.

[54]  S. Mikkelsen,et al.  A Comparison of 3 and 5 Weeks Immobilization for Older Type 1 and 2 Colles’ Fractures , 1998, Journal of hand surgery.

[55]  U. Bengnér,et al.  Increasing incidence of forearm fractures. A comparison of epidemiologic patterns 25 years apart. , 1985, Acta orthopaedica Scandinavica.

[56]  D. Ring,et al.  Treatment of osteoporotic distal radius fractures , 2005, Osteoporosis International.

[57]  K. Chung,et al.  Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment. , 2007, The Journal of hand surgery.

[58]  M. Swiontkowski Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation: A Prospective Randomized Trial , 2010 .

[59]  J. Basmajian Muscles Alive—their functions revealed by electromyography , 1963 .

[60]  M. Rosenwasser,et al.  Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. , 2009, The Journal of bone and joint surgery. American volume.

[61]  J. Yao Volar Fixed-Angle Plating of Extra-Articular Distal Radius Fractures—A Biomechanical Analysis Comparing Threaded Screws and Smooth Pegs , 2011 .

[62]  D. Newstein,et al.  The Ten Test , 1977, Plastic and reconstructive surgery.

[63]  S Solgaard,et al.  Epidemiology of distal radius fractures. , 1985, Acta orthopaedica Scandinavica.

[64]  J. Macdermid,et al.  Distal radius fracture: a prospective outcome study of 275 patients. , 2001, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[65]  Carlo J. De Luca,et al.  The Use of Surface Electromyography in Biomechanics , 1997 .

[66]  J. F. Yang,et al.  Electromyographic amplitude normalization methods: improving their sensitivity as diagnostic tools in gait analysis. , 1984, Archives of physical medicine and rehabilitation.

[67]  R. Rizzoli,et al.  Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women , 2009, Osteoporosis International.

[68]  J. Jupiter,et al.  Distal radius fractures--classification of treatment and indications for surgery. , 2010, Hand Clinics.

[69]  J. Macdermid,et al.  Pain and disability reported in the year following a distal radius fracture: A cohort study , 2003, BMC musculoskeletal disorders.

[70]  J. Macdermid,et al.  Development of a scale for patient rating of wrist pain and disability. , 1996, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[71]  R Madhok,et al.  Rehabilitation for distal radial fractures in adults. , 2006, The Cochrane database of systematic reviews.

[72]  S. Gandevia,et al.  Motor commands contribute to human position sense , 2006, The Journal of physiology.

[73]  Michael J Gardner,et al.  Has locked plating completely replaced conventional plating? , 2004, American journal of orthopedics.

[74]  J. Cauley,et al.  Distal Radius Fractures in Older Women: A 10‐Year Follow‐Up Study of Descriptive Characteristics and Risk Factors. The Study of Osteoporotic Fractures , 2002, Journal of the American Geriatrics Society.

[75]  J. Macdermid,et al.  The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study , 2005, Health and quality of life outcomes.

[76]  L. Catalano,et al.  What??s new in distal radius fracture treatment for 2007 , 2007 .

[77]  Paul W Thompson,et al.  The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. , 2004, Injury.

[78]  H. Handoll,et al.  Conservative interventions for treating distal radial fractures in adults. , 2002, The Cochrane database of systematic reviews.

[79]  T. Baumgartner Reading Statistics and Research (5th ed.) , 2008 .

[80]  G. Bannister,et al.  A Comparison between Subjective Outcome Score and Moderate Radial Shortening Following a Fractured Distal Radius in Patients of Mean Age 69 Years , 2007, The Journal of hand surgery, European volume.

[81]  V. Mathiowetz,et al.  Grip and pinch strength: normative data for adults. , 1985, Archives of physical medicine and rehabilitation.

[82]  K. Chung,et al.  Predictors of functional outcomes after surgical treatment of distal radius fractures. , 2007, The Journal of hand surgery.

[83]  P. LaStayo,et al.  Reliability of passive wrist flexion and extension goniometric measurements: a multicenter study. , 1994, Physical therapy.

[84]  G L Soderberg,et al.  A study of various normalization procedures for within day electromyographic data. , 1994, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[85]  H. Devries MUSCLES ALIVE-THEIR FUNCTIONS REVEALED BY ELECTROMYOGRAPHY , 1976 .

[86]  P. Millett,et al.  Early mobilization in the treatment of Colles' fracture: a 3 year prospective study. , 1995, Injury.

[87]  Terri M. Skirven,et al.  Rehabilitation of the hand and upper extremity , 2011 .

[88]  U. Proske,et al.  Effect of muscle fatigue on the sense of limb position and movement , 2006, Experimental Brain Research.

[89]  Freddie H Fu,et al.  The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics. , 2002, Journal of shoulder and elbow surgery.

[90]  H. Handoll,et al.  External fixation versus conservative treatment for distal radial fractures in adults. , 2007, The Cochrane database of systematic reviews.