Journal of Hand Surgery-American Volume最新文献

{"title":"Quick Response and Management of Patients During a Mass Casualty Incident: Experiences After 2023 Türkiye Earthquake.","authors":"Ömer Faruk Yıkılmaz, Furkan Temizayak, Rıdvan Çit, Özden Baz, Engin Çetinkaya, Burak Yaşar, Ramazan Erkin Ünlü","doi":"10.1016/j.jhsa.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.014","url":null,"abstract":"<p><p>A devastating series of earthquakes hit Kahramanmaraş, Türkiye on February 6, 2023, affecting 14 million people. A true mass casualty incident, these earthquakes reminded us of the importance of being ready and able to address the consequences. Our clinic is a central referral center so during the first few days we had to treat hundreds of patients transferred to us with compartment syndrome in the upper extremities, finger amputations, tissue defects, and infected open wounds. Every member of our team showed tremendous effort and selfless nature to attend to the extreme number of patients in a limited time. We share our experiences during this trying time so that should a mass casualty incident occur again, a hand surgeon anywhere in the world can anticipate the aftereffect and respond adequately and quickly.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcome of Modified Wassel-Flatt Type IV Radial Polydactyly: Analysis of Subtype and Morphology.","authors":"Won Sun Lee, Young Ho Shin, Jae Kwang Kim","doi":"10.1016/j.jhsa.2025.01.017","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.017","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed the differences in clinical outcomes among the subtypes of type IV radial polydactyly and evaluated the distribution of the duplication range according to subtype.</p><p><strong>Methods: </strong>This retrospective study included 85 patients with 89 affected thumbs, who were treated at a single center from October 2017 to May 2023. The patients were classified according to the modified Wassel-Flatt classification, and only those with type IV radial polydactyly were included. The collected data included demographics, surgical techniques, clinical outcomes, and radiological outcomes. Clinical outcomes were analyzed using the Japanese Society for Surgery of the Hand (JSSH) scoring system.</p><p><strong>Results: </strong>The most common subtype of radial polydactyly was IV-B, accounting for 50 patients. Types IV-C and IV-D accounted for 17 and 22 patients, respectively. The median age at the time of surgery was 10 months, and the median follow-up was 24 months. Type IV-D demonstrated significantly lower total JSSH scores and functional parameter scores than types IV-B and IV-C. Regarding functional parameters, type IV-D exhibited significantly poorer outcomes in terms of interphalangeal joint stability and alignment, as well as range of motion; however, metacarpophalangeal joint stability and alignment were similar among the types. Type IV-D also exhibited significant differences in the distribution of the duplication range compared with type IV-B and IV-C. It had a more distal duplication level.</p><p><strong>Conclusions: </strong>Type IV-D radial polydactyly requires more complex surgical interventions and has less favorable outcomes than types IV-B and IV-C. It exhibits poorer functional outcomes, particularly in the interphalangeal joint and range of motion assessments. Furthermore, type IV-D exhibits differences in the duplication range compared with other subtypes, and has a more distal duplication level.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resident Education in Hand Surgery: Barriers and Opportunities.","authors":"Gopal R Lalchandani, George S M Dyer, Nicole S Schroeder","doi":"10.1016/j.jhsa.2025.01.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.016","url":null,"abstract":"<p><p>Resident education is critical in the development, growth, and recruitment of young surgeons into the field of hand surgery. However, the increased emphasis on efficiency and productivity in clinical care, growth of hand fellowships, and wide-awake hand surgery can pose specific challenges to resident education. In this review, we explore barriers to resident education in hand surgery and discuss opportunities for improvement. We also provide a list of updated resources for resident education in hand surgery and review best practices in resident education to help educators and trainees alike.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Successful Outcomes Following Revision Carpal Tunnel Release.","authors":"Akhil Dondapati, Thomas J Carroll, Warren C Hammert, Bilal Mahmood","doi":"10.1016/j.jhsa.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.007","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to identify predictors of successful revision carpal tunnel release (CTR) and compare long-term patient-reported outcomes to individuals who underwent primary CTR with no revision. We hypothesized that patients undergoing revision CTR would have worse patient-reported outcomes scores compared to primary CTR at 1-year follow-up.</p><p><strong>Methods: </strong>We retrospectively compared 521 primary CTR and 57 revision CTR patients. Patients with minimum 1-year follow-up, including Patient-Reported Outcomes Measurement Information System (PROMIS) and Patient Acceptable Symptom State (PASS) scores, were included. PASS and PROMIS Upper Extremity (UE), Pain Interference (PI), and Physical Function (PF) were compared at before surgery and 1-year after surgery timepoints. Demographic and surgical data were compared using bivariate and multivariable analyses.</p><p><strong>Results: </strong>Compared with the primary CTR group, the revision group had a higher body mass index, was more likely to be male, have their dominant hand affected, have diabetes, undergo endoscopic CTR, and have concurrent cubital tunnel syndrome (CuTS). A chief complaint of pain (OR 0.23), tobacco use (OR 0.11), or diabetes (OR 0.22) were less likely to have a positive PASS response, whereas having an interval steroid injection (OR 6.2) was a predictor of a positive PASS response. PROMIS UE, PF, and PI were all similar in the primary group compared with the revision group at both before surgery and 1-year after surgery visits. None of the PROMIS modalities significantly improved at 1-year follow-up in the primary and revision groups compared to before surgery. Positive PASS response in the revision group was lower preoperatively and 1-year postoperatively compared with the primary cohort.</p><p><strong>Conclusions: </strong>Steroid injections, absence of diabetes and tobacco use, and chief symptoms of paresthesias or weakness, rather than pain, are predictors of satisfactory outcomes after revision CTR. Patients undergoing revision demonstrated lower rates of positive PASS response than primary CTR without revision at 1-year follow-up.</p><p><strong>Type of study/level of evidence: </strong>Prognostic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Handheld Lower-Resolution Ultrasound Evaluation Sufficient to Measure the Cross-Sectional Area of the Median Nerve?","authors":"Daniel A Portney, Brendon S Ross, Jeffrey G Stepan","doi":"10.1016/j.jhsa.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.011","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the accuracy of median nerve cross-sectional area (CSA) measurements using a handheld ultrasound (HHUS) and a cart-based high-resolution ultrasound.</p><p><strong>Methods: </strong>Fifteen healthy subjects were prospectively enrolled. Each subject underwent standardized ultrasound evaluations of their median nerves with HHUS and a high-resolution ultrasound by three different providers with different levels of training in musculoskeletal ultrasound. CSA calculations were performed using a standardized method. The primary outcome was the mean difference in CSA (ΔCSA) between the gold standard high-resolution ultrasound and the lower resolution handheld ultrasound, with a noninferiority margin set at ΔCSA < 2 mm². Inter-rater reliability was calculated using Lin concordance correlation coefficient (LCCC), and the intraclass coefficient (ICC) was used to calculate intra-rater reliability.</p><p><strong>Results: </strong>The average CSA of the median nerve across all patients and reviewers using the high-resolution US was > 0.9 mm² for the HHUS. In paired comparisons within subjects, the ΔCSA of the median nerve using the HHUS was 1.8 mm² (95% CI, 0.8-2.7 mm²), and the LCCC was weak 0.258 (0.018-0.470). Noninferiority was not achieved. The intrarater reliability between devices was poor at 0.201. However, the inter-rater reliability among different examiners was good when using the high-resolution device, but it was poor using the HHUS.</p><p><strong>Conclusions: </strong>The findings suggest caution for the use of handheld ultrasound in measurements of median nerve CSA because the difference between HHUS and gold standard high-resolution ultrasound was not within the noninferiority margin of 2 mm².</p><p><strong>Type of study/level of evidence: </strong>Diagnostic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Screw-to-Canal Diameter Ratio on Radiographic and Clinical Outcomes in Metacarpal Shaft Fractures.","authors":"Andrew D Allen, Alexander D Jeffs, Patricia K Wellborn, Bradley J Lauck, G Aman Luther","doi":"10.1016/j.jhsa.2025.01.001","DOIUrl":"10.1016/j.jhsa.2025.01.001","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate the influence of screw-to-canal diameter ratio on clinical and radiographic outcomes for patients with metacarpal shaft fractures treated with retrograde intramedullary headless compression screws (IMHS).</p><p><strong>Methods: </strong>A retrospective analysis was conducted for all patients with metacarpal shaft fractures treated with retrograde IMHS between 2017 and 2022. All procedures were performed using retrograde IMHS through an ulnar sagittal band split. Patients initiated early range of motion and were not immobilized. The ratio of screw diameter to metacarpal canal diameter at the fracture site was calculated. Radiographic displacement, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) scores, grip strength, and range of motion were recorded during a 6-month follow-up period.</p><p><strong>Results: </strong>A total of 52 patients with 58 metacarpal shaft fractures treated with IMHS were included. All fractures achieved union, with 71% healed by 6 weeks and 100% healed by 12 weeks. Mean grip strength measured 86.0% relative to the contralateral side, and the average total active motion measured 248°. The mean QuickDASH score was 2.2, indicating minimal disability. No cases demonstrated extensor lag or required revision surgery. Mean screw-to-canal diameter ratio was 0.81. Oblique fractures were most likely to displace (50%), and there was a strong fit of the linear regression model for the ratio of canal fill and displacement (R² = 0.72) among oblique fractures. No radiographic displacement occurred when the screw diameter was at least 80% of the canal diameter. Comparing patients with and without radiographic displacement, QuickDASH scores, grip strength, and mean total active motion were similar.</p><p><strong>Conclusions: </strong>Our findings suggest that the screw-to-canal diameter ratio influences radiographic displacement in oblique fracture patterns that have a greater propensity to displace. When the screw-to-canal ratio exceeded 80%, there were no cases of displacement regardless of fracture pattern. Despite the occurrence of radiographic displacement, QuickDASH scores, grip strength, and range of motion were similar between the groups.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends of Underrepresented Minorities and Female Trainees in Orthopedic, Plastic, and Hand Surgery: Did We Do Better in 2023?","authors":"Lilah Fones, Harrison Fellheimer, Margaret Pennington, Bryan A Hozack, Daniel J Fletcher, Pedro K Beredjiklian","doi":"10.1016/j.jhsa.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.008","url":null,"abstract":"<p><strong>Purpose: </strong>Orthopedic and plastic surgery are among the least diverse specialties, but recent initiatives have aimed to increase exposure and support of female and underrepresented minority (URM) trainees. Hand surgery incorporates trainees from both orthopedic and plastic surgery. This study aimed to evaluate trends in the presence of female and URM trainees from 2007 to 2023 in orthopedic, plastic, and hand surgery to provide an update on previous reports of diversity in these fields.</p><p><strong>Methods: </strong>The Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book was queried between 2007 and 2023 for all ACGME, orthopedic, plastic, and hand surgery trainees. For each subset, all available gender and race/ethnicity data were collected. Race/ethnicity was stratified into two cohorts: White/Asian and URM.</p><p><strong>Results: </strong>The percentage of female trainees steadily increased from 2007 to 2023 in all ACGME (40.5%-47.8%), orthopedic surgery (11.6%-20.3%), plastic surgery (21.8%-44.2%), and hand surgery (18.8%-35.2%). Logistic regression demonstrated a positive relationship between year and female trainees among all ACGME, orthopedic, plastic, and hand surgery. Female orthopedic trainees increased by approximately 3% in the first 10 years from 2007 to 2017; however, in the most recent 5 years, the representation rose more (5.6%) in half the time. The same trend is not reproduced for all ACGME, plastics, or hand trainees. Between 2011 and 2023, logistic regression demonstrated a positive relationship between year and URM representation among orthopedic and hand surgery trainees but not among all ACGME and plastics trainees.</p><p><strong>Conclusions: </strong>Female and URM trainees have increased in both orthopedic and hand surgery from 2007 to 2023. Plastics surgery trainees have increased female, but not URM trainees.</p><p><strong>Clinical relevance: </strong>This study provides an update on diversity among orthopedic, plastic, and hand surgery trainees, and highlights the progress made.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perceptions of Artificial Intelligence in Hand Surgery: A Survey of 511 Patients Presenting to a Hand Surgery Clinic.","authors":"Sebastian D Arango, Jason C Flynn, Jacob Zeitlin, Samuel H Payne, Andrew J Miller, Tristan B Weir","doi":"10.1016/j.jhsa.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.004","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate patient awareness and perceptions of artificial intelligence (AI) chatbots in a hand surgery clinic setting.</p><p><strong>Methods: </strong>A 16-question, multiple-choice, paper survey was administered to adult patients at five urban and suburban hand clinic locations from February to March 2024. The anonymous survey assessed patient characteristics and patient familiarity, usage, and trust toward chatbots in hand surgery. Descriptive statistics summarized the survey results, whereas multivariable logistic regression analyses determined the factors associated with positive perceptions of AI.</p><p><strong>Results: </strong>Of the 564 surveys administered, 511 (91%) were completed in their entirety and were included in the study. Most patients (81%) reported having at least basic familiarity with computers and smartphones, whereas 45% had never heard of specific AI chatbots (eg, ChatGPT). Only 3.9% of patients frequently use chatbots in daily life, whereas 70% have never used a chatbot. Only 14.1% of patients stated that they were likely to use chatbots to answer questions about their upper-extremity condition. Similarly, low proportions were likely to trust chatbots to accurately answer questions (14.7%), make a diagnosis (9.0%), make appropriate treatment recommendations (11.9%), and help manage complications (10.8%). A greater proportion thought chatbots would play an important role in their future upper- extremity care (18.6%). Positive perceptions of chatbots were associated with uninsured payment status and those with a college degree, whereas patients who were older or who had greater familiarity with technology were less likely to have positive perceptions of chatbots.</p><p><strong>Conclusions: </strong>As AI is increasingly integrated into medical practice, many hand clinic patients remain unaware of or uncertain about its role in their care.</p><p><strong>Clinical relevance: </strong>Although certain populations had positive attitudes toward chatbots, enhancing patient education about the role and benefits of AI, as well as ensuring transparency, may facilitate its integration into patient care.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Social Media Engagement and Conventional Bibliometrics for Articles Related to Distal Radius Fractures.","authors":"David Cornwell, Yagiz Ozdag, Fenil R Bhatt, Victoria C Garcia, Joel C Klena, Louis C Grandizio","doi":"10.1016/j.jhsa.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.005","url":null,"abstract":"<p><strong>Purpose: </strong>As methods of research publication and promotion evolve, conventional bibliometric analyses may not provide a complete representation of audience engagement with peer-reviewed literature. Our purpose was to assess for correlations between social media engagement (Altmetric attention score [AAS]) and conventional article metrics (citation density [CD] and journal impact factor).</p><p><strong>Methods: </strong>Distal radius fracture (DRF) articles with the highest number of citations were identified using Web of Science and imported into Altmetric. The Altmetric database quantifies an article's online engagement and social media footprint to determine the AAS. We evaluated four metrics pertaining to the top 100 DRF articles: AAS, social media mentions (SMM), journal impact factor, and CD. Spearman's ρ was calculated between four pairings of these metrics. Confidence intervals corresponding to each Spearman's ρ were obtained via bootstrapping over 10,000 replications.</p><p><strong>Results: </strong>Of the 1,000 most frequently cited DRF articles, 333 (33%) generated an AAS. The AAS of the top 100 articles according to AAS ranged from 6 to 317 with a mean of 16. Articles were predominantly original research (71%), followed by reviews (21%). A moderately positive correlation (ρ = 0.55) between AAS and SMM was found. Citation density versus SMM and CD versus AAS were both found to be weakly positively correlated with a ρ of 0.34 and 0.30, respectively.</p><p><strong>Conclusions: </strong>For the 1,000 most frequently cited articles related to DRFs, 33% generated an AAS. Citation density demonstrated weak, positive correlations with both SMM and AAS. In addition, we found a moderately positive correlation between AAS and SMM.</p><p><strong>Clinical relevance: </strong>These data suggest that online and social media engagement is weakly correlated with increased citations for peer-reviewed articles related to DRFs. Although AAS cannot determine article quality or scientific merit, online dissemination of peer-reviewed research may be an effective means of promoting academic publications and increasing citations.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kinematics of Trapeziometacarpal Joint During First Dorsal Interosseous Maneuver in Osteoarthritic Patients: An Imaging Study Using Real-Time Magnetic Resonance Imaging and Ultrasonography.","authors":"Dai Ooishi, Hiroaki Ueba, Koji Aso, Masashi Izumi, Masahiko Ikeuchi","doi":"10.1016/j.jhsa.2024.12.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.12.018","url":null,"abstract":"<p><strong>Purpose: </strong>First dorsal interosseous (FDI) exercise is a dynamic stability exercise recommended for patients with trapeziometacarpal osteoarthritis (TMC-OA), although its biomechanical efficacy has only been examined in healthy subjects. This study used real-time magnetic resonance imaging (MRI) and ultrasonography to elucidate the kinematic effects of the FDI maneuver used for the treatment of TMC-OA.</p><p><strong>Methods: </strong>Using a real-time MRI protocol developed for continuous imaging of TMC movements, TMC joints were examined in 10 end-stage patients with TMC-OA and 10 thumbs of five healthy volunteers while performing FDI maneuvers. Changes in translation and tilt of the first metacarpal (MC1) were evaluated using sagittal and coronal images, and FDI volume was analyzed. Based on TMC joint kinematics determined according to dynamic ultrasound observations, the subjects were classified into three groups. Patients with TMC-OA received hand therapy with orthosis and FDI exercise for a period of 1 month.</p><p><strong>Results: </strong>Magnetic Resonance Imaging analyses of the TMC-OA patients demonstrated that radial translation and ulnar/dorsal tilt of the MC1 were significantly greater, whereas FDI volume was significantly lower than healthy thumbs. Results of ultrasound analyses showed increased dorsal subluxation of the TMC joint in six patients with TMC-OA. These values were decreased in six healthy thumbs and unchanged in the remaining thumbs. All of the patients with TMC-OA demonstrated significantly improved pain intensity and pinch strength following implementation of the therapy program, although no direct correlations with MC1 kinematic alterations of were noted.</p><p><strong>Conclusions: </strong>Thumbs in patients with TMC-OA and healthy thumbs have different kinematics during FDI maneuvers. An atrophic FDI may not be an efficient dynamic stabilizer for TMC-OA. In patients with a subluxated TMC-OA, the FDI maneuver was ineffective or caused exacerbation, contradicting previous findings. For a goal of improving dynamic stability in patients with TMC-OA, FDI exercise should be avoided.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic Ⅳ.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}