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Background: The shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Rated Wrist/Hand Evaluation (PRWHE) are commonly used questionnaires to assess patient-reported hand function. Information about the measurement properties of the Dutch versions is scarce., Objective: To gain insight into the measurement properties of the Dutch language versions of the QuickDASH and the PRWHE in patients with (non)specific complaints of the hand, wrist, forearm and elbow., Methods: Internal consistency, construct validity, test-retest reliability, responsiveness, and floor and ceiling effects were assessed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations., Results: Questionnaires were filled out by 132 patients. Internal consistency of QuickDASH (Cronbach's α= 0.92) and PRWHE (Cronbach's α= 0.97) was high. Predefined hypotheses for construct validity were not confirmed for 75% for both QuickDASH and PRWHE (accordance with 62% of predefined hypotheses for both questionnaires). Test-retest reliability of QuickDASH (ICC = 0.90) and PRWHE (ICC = 0.87) was good. Both QuickDASH (AUC = 0.84) and PRWHE (AUC = 0.80) showed good responsiveness. No floor or ceiling effects were present., Conclusions: Measurement properties of the Dutch language versions of the QuickDASH and the PRWHE, applied to patients with (non)specific complaints of the hand, wrist, forearm and elbow, were very similar. Test-retest reliability and responsiveness were good for both QuickDASH and PRWHE. Construct validity could not be demonstrated sufficiently.

Background: Occupational tasks involve awkward upper limb postures, especially movement of forearm with repetitive combined gripping and torqueing exertions, which may lead to development of WMSDs. From the literature survey it was observed that there was a lack of studies focussed on the combined effect of torque and grip exertions on forearm discomfort., Objective: The present study was to investigate the effects of grip force, stroke rotation and frequency of exertions on discomfort and Electromyography (EMG) activities of the forearm muscles in a repetitive torqueing task., Method: Twenty-seven male participants volunteered in this study. The participants performed repetitive exertions for a 5 minutes duration for each combination of the different levels of stroke rotation, grip force and frequency of exertions. Three levels of stroke rotation, three levels of grip force and three levels of frequency of exertion were chosen as independent variables. Therefore a 3 × 3 customized factorial design was used for the experiment for each level of grip force. Hence, the study was divided into three groups on the basis of grip force (50N, 70N and 90N)., Results: The ANOVA showed that stroke rotation and frequency of exertion were significant on discomfort. Further Students Newmann test (SNK) revealed that discomfort was increased with increasing stroke rotation and frequency of exertion. The multivariate analysis of variances (MANOVA) performed on EMG data instead of ANOVA because EMG activities of five muscles simultaneously were recorded. The Results found that extensor muscles were more fatigued in torqueing with gripping task., Conclusions: It was found that stroke rotation for the torqueing tasks must be kept below 45°. It was concluded that it is important to control stroke rotation to improve performance of repetitive torqueing activity.

Background and Objectives: This report aimed to present a case of lateral antebrachial cutaneous neuropathy (LACNP) that occurred after a steroid injection in the lateral epicondyle to treat lateral epicondylitis in a 40-year-old woman., Material and Method: A 40-year-old woman presented with decreased sensation and paresthesia over her right lateral forearm; the paresthesia had occurred after a steroid injection in the right lateral epicondyle 3 months before. Her sensation of light touch and pain was diminished over the lateral side of the right forearm and wrist area., Results: The sensory action potential amplitude of the right lateral antebrachial cutaneous nerve (LACN) (6.2 μV) was lower than that of the left (13.1 μV). The difference of amplitude between both sides was significant because there was more than a 50% reduction. She was diagnosed with right LACNP (mainly axonal involvement) on the basis of the clinical manifestation and the electrodiagnostic findings. Her symptoms improved through physical therapy but persisted to some degree., Conclusion: This report describes the case of a woman with LACNP that developed after a steroid injection for the treatment of lateral epicondylitis. An electrodiagnostic study, including a nerve conduction study of the LACN, was helpful to diagnose right LACNP and to find the passage of the LACN on the lateral epicondyle.

Background: Impaired limb mobility is the most troublesome condition in patients after cerebral stroke. The application of the electrode-glove might reduce dysfunctions in patients treated due to stroke., Objective: The electrode-glove use in rehabilitation is investigated. The study was conducted on 54 patients aged 28 - 72 (the mean age 54.3 ± 10.3) with hemiparesis who had suffered from cerebral stroke. The patients from Group 1 were applied bipolar stimulation of forearm muscles (flexors and extensors of the wrist joint and hand) with the use of two flat electrodes of the same size. With regards to Group 2, in the study used an electrode-glove., Methods: The excitation threshold was determined once a week with the use of the EMG., Secondary Outcomes: The evaluation of the electromyographic bioelectric activity of flexor and extensor muscles in the forearm, of the functional mobility of the hand according to the Brunnström test and of the functional mobility of the hand according to the seven-graded task Frenchay scale., Results: The authors of the study observed a much greater improvement in the function of the hand in Group 2, where the mean value increased by 2.1 points. With regards to Group 1, the mean value increased by 1 point and the differences of the results in the studied groups after the therapy were statistically significant (p = 2.830)., Conclusions: The electrical stimulation method controlled/triggered by muscle contractions is an effective method of normalization of muscle tension in the forearm and hand as well as restoration of the hand function in patients with cerebral stroke.

Objective: The aim of this study was to elucidate the feasibility, efficacy, and sustainability of a home-based, two-week, forced-use therapy (FUT) program for children with hemiplegic cerebral palsy (CP)., Methods: A single-blinded, randomized controlled design was chosen. The Melbourne Assessment of Unilateral Upper Limb Function (MA) was carried out at baseline, pretest, post-test, and follow-up at two weeks, three months, and 12 months. Additionally, a questionnaire was used to evaluate the clinical relevance and integration of FUT in the home setting. 23 children, ages six to 16 years, took part in the study and were randomized into either an intervention group (n=12, mean age 9.8 ± 3.5 years) or a control group ($n=$ 11, mean age 11.7 ± 3.7 years). The intervention consisted of constraint of the unaffected hand for six hours per day and promotion of different activities of daily living according to an age-related manual for the use of the non-constraint hand., Results: Unpaired t-tests for the change in MA scores relative to the pre-test values showed no difference between the groups at any time point: post-test (p=0.304), two weeks (p=0.193), or three months (p=0.957). Improvements in Activities of Daily Living (ADLs) assessed by questionnaires were observed by 64% of parents of the intervention group. Fifty-five percent of parents stated that the FUT program was exhausting and only 45% indicated that they achieved constraint for 6 hours per day., Conclusion: Our results evaluating a home-based FUT program of 14 days show no statistically significant improvement of upper extremity function in children with CP. The lack of compliance and absence of structured exercises proved to be considerable pitfalls of the home-based FUT program. Therefore, future home based FUT concepts should put special emphasis on the close monitoring and support of children and their families, as well as the integration of structured exercise sessions.

The work of the goldsmiths consists in the manufacture of jewelry. The piece, be it an earring, bracelet or necklace, is hand-assembled. This task requires precision, skill, kindness and patience. In this work, we make use of tools such as cuticle clippers and rounded tip, beads or precious stones and also pieces of metal. This type of activity requires a biomechanical stress of hands and wrists. In order to quantify the biomechanical stress, we performed a case study to measure the movements performed by an assembly of pieces of jewelry. As method for research, filming was done during assembly of parts to a paste, using a Nikon digital camera, for 1 (one) hour. The film was edited by Kinovea software, and the task was divided into cycles, each cycle corresponds to a complete object. In one cycle, there are four two movements of supination and pronation movements of the forearm. The cycle lasts approximately sixteen seconds, totaling 1800 cycles in eight hours. Despite the effort required of the wrists, the activity shows no complaints from the employees, but this fact does not mischaracterizes the ability of employees to acquire repetitive strain injuries and work-related musculoskeletal disorders.

The incidence of neonatal brachial plexus palsy (NBPP) has remained relatively stable despite awareness of the problem and improved obstetric techniques. Deformities of the forearm and hand can result either from untreated NBPP or following early microsurgical nerve reconstruction. These deformities include limb length discrepancy, flexion contracture of the elbow, supination or pronation contractures of the forearm, ulnar deviation of the wrist, and varying types of finger paralysis. The treatment options for these deformities consist of soft tissue releases, corrective osteotomies, tendon transfers, joint fusions, and/or free muscle transfers. Rehabilitation and physical therapy treatment are critical after these procedures. This article reviews the pathogenesis of the common deformities seen in a late presentation of NBPP, the assessment of these children, and provides a reconstructive strategy for the management of this difficult problem.

Background: Spasticity manifesting as a dysbalance between extensor and flexor muscles may contribute to an impaired hand function. We studied clinical (n=10 patients) and electrophysiological (n=9 patients) changes produced by vibration of forearm extensor muscles (FEM) in chronic stroke patients with spastic hemiparesis., Methods: In Exp. 1, the Box and Block Test (BBT) was applied to test dexterity before and after 5 minutes of FEM vibration. In Exp. 2, transcranial magnetic stimulation was used to study the cortical silent period (CSP) before and during FEM vibration. Recordings were taken from the antagonistic flexor carpi radialis muscle., Results: After vibration, performance of the BBT was improved by 20%. The effect persisted for at least 10-15 minutes. Vibration induced a prolongation of the CSP. This effect occurred in the affected and non-affected side to a similar degree. The magnitude of performance changes and CSP changes was not correlated., Conclusions: FEM vibration enhances inhibitory neuronal circuits targeting the antagonistic forearm flexor muscles and is associated with an improved dexterity in the spastic arm. It might become a supporting tool in the motor recovery of spastic hemiparesis.

Background and Purpose: This was a descriptive and exploratory study of electromyographic (EMG) activity of wrist extensor musculature specific to the extensor digitorum (ED), extensor carpi radialis brevis (ECRB) and flexor carpi radialis (FCR) in individuals with a medical diagnosis of the common work associated complaint of lateral epicondylitis (LE). The purpose was to evaluate and compare the EMG activity of the selected forearm muscles during three different types of resistive (strengthening) therapeutic exercises (rubber ball, theraputty, and "make-it-disappear" (MID) sponge) in participants with LE., Participants: Five individuals between the ages of 44 and 55 years of age diagnosed with lateral epicondylitis by a physician were recruited on a voluntary basis from a local outpatient clinic., Methods: The participants completed 1 min. of each of the resistive exercises, which were assigned randomly. Muscle activity was collected simultaneously by 3 surface electrodes (4/18/16 DE-2.3 silver surface EMG electrodes, Delsys Inc, Boston, MA) and recorded on an EMG Myomonitor-4 (Delsys Inc, Boston, MA) utilizing EmgCE software (Delsys Inc, Boston, MA). The raw EMG signal was converted to a root mean square (RMS) at each 0.0625 second interval during the full 60 second recording using EMGWorks, (Delsys, Inc, Boston, MA). The data were pooled, and the mean RMS was then determined as an overall measure of activity for each muscle during the 60 recording., Results: A 1-way ANOVA with Tukey's post-test was completed using Prizm Software (Graph Pad Software, Inc, San Diego, CA) for a comparison of the mean RMS values of each muscle during each activity. Statistically significant between group differences were noted for all muscles, among all exercises. Relative activity was noted to be greatest for ED and FCR during MID exercise, and for ECRB during putty exercise., Conclusion: All three exercises represent different patterns of muscle activity, for the muscles observed. The possible differences in the recorded activity may be consequent to the specific positioning and movement requirements involved in the performance of the distinct exercises. Practitioners may find the evidence of this study helpful in designing rehabilitation programs for those affected with lateral epicondylitis.

Fractures are not rare in male osteoporosis and bone mineral density (BMD) measurement is used in the diagnosis and monitoring, preventing and/or treating the disease. Muscle strength and BMD are highly related to each other. The distal radius is one of the most common sites of osteoporotic fractures. The relationship of quantitative muscle strength and BMD of the forearm has not yet been established. The objective of this study was to assess forearm muscle strength and grip strength in relation to BMD in 46 osteoporotic and randomly selected 45 healthy male participants. Forearm muscle strength and BMD were quantitatively measured using an isokinetic dynamometer and dual-energy-X-ray-absorptiometry (DEXA), respectively. Significant correlation was found among the muscle strength and dominant forearm BMD in 60 and 120 deg/s velocities. In the non-dominant arm, the 120 deg/s velocity was only significantly positively correlated to forearm BMD. Pearson's Product coefficient presented a moderate correlation between muscle strength and BMD at the dominant arms of both groups, whereas, the difference in the non-dominant forearm came from the difference of usage frequency. In conclusion, quantitative forearm muscle strength and BMD is moderately correlated and exercise can be advised to prevent distal radius fractures in male osteoporosis.