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Background: This study was designed to investigate whether psychological status is associated with upper-extremity health status in an elderly general population. Methods: Using Quick Disabilities of the Arm, Shoulder, and Hand of the Japanese Society for Surgery of the Hand (QuickDASH-JSSH), we evaluated 200 Japanese elderly people (76 men, 124 women; mean age, 71.6 years, 60-98 years) to assess their upper-extremity-specific health status. Each had completed a self-administered questionnaire including gender and dominant hand items. As an indicator of hand muscle function, we measured their bilateral hand grip. Study participants were assessed for depressive symptoms using the Geriatric Depression Scale Short-Japanese Version (GDS-S-J). Statistical analyses were applied to clarify associations between self-assessed upper-extremity dysfunction and screening results for depressive symptoms in an elderly general population. Results: Those reporting no complaint of an upper extremity were 72 (36 men and 36 women) (36.0%). The GDS-J score was found to have significant positive correlation with age ( r = 0.20, P = 0.0045) and the QuickDASH score ( r = 0.25, P = 0.0004). The GDS-J score was found to have significant negative correlation with dominant grip ( r = −0.15, P = 0.04) and non-dominant grip strength ( r = −0.21, P = 0.004). For all participants, multiple regression analysis revealed the QuickDASH score as associated with the GDS-J score. Conclusion: Self-administered upper-extremity health condition as assessed using QuickDASH is correlated with depressive symptoms in elderly people. Objective pathophysiology and subjective illness behavior must be identified in daily clinical practice. A biopsychosocial approach must be used when advising and treating patients.

Pisiform and hamate coalition, a rare congenital anomaly, is most often identified as an asymptomatic incidental finding on radiographs. Some patients have symptomatic coalition with ulnar-sided wrist pain or ulnar nerve neuropathy from ulnar nerve compression. Sports activities such as cycling and weight lifting can cause compression of the ulnar nerve in the hand. This report describes a case of a pisiform and hamate coalition in a 36-year-old man who reported decreased right-hand dexterity and right ulnar-sided wrist pain. The patient, an amateur weight lifter, developed right claw hand through repeated bench press training. Intraoperative findings revealed compression of the deep palmar branch of the ulnar nerve between the tendinous arch of the hypothenar muscles and pisiform and hamate coalition. Surgical resection of the tendinous arch and the enlarged hook of hamate relieved the claw hand deformity.

Purpose: Ultrasonography is useful for evaluating anatomical variations of the median nerve and aids in diagnosing carpal tunnel syndrome by assessing the cross-sectional area (CSA) at the carpal tunnel inlet. The purposes of this study were to investigate the prevalence of the bifid median nerve and to establish reference values for the CSA at the carpal tunnel inlet in healthy participants. Methods: A total of 349 Japanese participants were included (121 men and 228 women, mean age 66.3 years). Study participants underwent ultrasonography to assess the CSA of the median nerve at the carpal tunnel inlet of the bilateral wrist. First, we investigated the prevalence of the bifid median nerve in 349 participants. Then, we assessed the relation between the CSA and clinical factors (age, height, weight, body mass index, fat mass, fat-free mass, bilateral grip strength, and key pinch strength) in healthy participants. Results: Among the 349 participants, 59 (16.9%) had a bifid median nerve. Mean CSA in healthy participants (no bifid median nerve) was 9.7 ± 2.9 mm2 in women and 9.0 ± 1.8 mm2 in men (both: 9.4 ± 2.6 mm2). In women, mean CSA in subjects in their sixties was significantly higher than in younger subjects, and we found a significant positive correlation between the CSA and the fat-free mass. Conclusions: In this observational study of healthy Japanese, the prevalence of the bifid median nerve was 16.9%; the mean CSA was 9.7 ± 2.9 mm2 in women and 9.0 ± 1.8 mm2 in men. Older women had a larger CSA than did younger women. Clinical relevance: This study describes the prevalence of the bifid median nerve and normative values for the CSA of the median nerve precisely diagnose carpal tunnel syndrome to more by ultrasonography. Key words: bifid median nerve, cross-sectional area, median nerve, reference values, ultrasonography

Hypothesis and Background: The relationship between baseball pitchers’ satisfaction with their performance and the incidence of shoulder and elbow injuries is unclear. We hypothesized that self-evaluated satisfaction with pitching performance before an injury and incidence of shoulder and elbow injuries are related. Methods: Baseline data on baseball experience, height, weight, elbow and shoulder range of motion, and shoulder muscle strength of high-school baseball pitchers were collected. During the season, all participants completed a self-recorded questionnaire regarding satisfaction scores, presence of shoulder and/or elbow pain, and pitching limitations due to shoulder and/or elbow pain experienced daily to determine when injuries occurred and record the satisfaction scores. The optimal satisfaction score cutoff value was determined through receiver operating characteristic curve analysis; participants were categorized into satisfied and unsatisfied groups. Statistical tests were performed to evaluate the differences between the groups, obtain the time-to-event curves, and calculate the hazard ratios for the incidence of injury. Results: Overall, 108 participants aged 15-17 years were enrolled and divided into satisfied (88) and unsatisfied (20) groups. The injury incidence rate was 10.2% and 50.0% in the satisfied and unsatisfied groups, respectively. High-school baseball pitchers with low satisfaction had a significantly increased risk of shoulder and elbow injuries; these players had a 7.3-times greater risk of injuries and 1.9-times earlier occurrence of injuries than pitchers who were satisfied with their performance. Conclusion: Daily evaluation of players’ self-satisfaction could predict shoulder and elbow injuries in high-school baseball pitchers.

Background: The aim of this study was to evaluate the efficacy of reciprocal inhibition for posterior shoulder tightness (PST), internal rotation at 90° abduction (ABIR) limitation, and subacromial impingement in elementary and junior high school baseball players. Methods: The present study included 290 elementary school and junior high school baseball players who were members of an organized baseball team and attended a medical checkup in 2014. Seventeen participants were excluded because they were left-handed. We applied a sit-up exercise as a tool of reciprocal inhibition to all participants. Before and after the sit-up exercise, we evaluated the shoulder range of motion (ROM) in external rotation at 90° abduction (ABER), ABIR, and horizontal flexion (HF) in both shoulders and the prevalence of subacromial impingement in the dominant shoulder. We defined PST as a ≧15°decrease in the HF angle of the dominant shoulder in comparison to the nondominant shoulder before the sit-up exercise and divided participants into two groups (the PST group and the non-PST groups). An independent t-test was performed to compare the shoulder ROM, and a chi-squared test was performed to compare the prevalence of subacromial impingement between the two groups. A dependent t-test was performed to compare intragroup changes in the shoulder ROM. The McNemar test was performed to compare intragroup changes in the prevalence of subacromial impingement. Results: Fifty-six of 273 participants had PST in the initial examination. The initial examination revealed that the ROM of ABIR and HF in the dominant shoulder were significantly lower in the PST group than those in the non-PST group, whereas the ROM of ABER and total arc were significantly higher in the PST group. The prevalence of subacromial impingement in the PST group was significantly higher than that in the non-PST group. The sit-up exercise improved ABER, ABIR, total arc, HF, and the prevalence of subacromial impingement in both groups. However, the amount of ROM change did not differ between the two groups for any parameter with the exception of HF. Conclusion: The presence of PST affects the prevalence of subacromial impingement but was not related to the loss of ABIR or the prevalence of pathological glenohumeral internal rotation deficit. The sit-up exercise, as reciprocal inhibition, can transiently improve the prevalence of subacromial impingement via the improvement of PST.

Background: We investigated the differences in the prevalence of ulnar nerve instability (UNI) by hand dominance and evaluated the relationship between UNI and morphologic changes in the ulnar nerve and the clinical findings and upper limb function. Methods: This study examined 153 healthy participants (n = 306 elbows; 44 men, 112 women; mean age 65.4 years) who underwent ultrasonography to assess the ulnar nerve cross-sectional area (UNCSA) at three points of the bilateral cubital tunnel at 30° of elbow flexion. Participants were divided into three groups based on the ultrasonography findings of UNI: no instability (type N), subluxation (type S), and dislocation (type D). For the dominant and nondominant sides, we assessed the relationship between the UNCSA and clinical factors, including the age, gender, height, weight, body mass index, fat mass, grip strength, key pinch strength, UNCSA, and Patient-Rated Elbow Evaluation score. Results: We identified 75 cases without instability in both elbows and 78 cases with some instability. The prevalence of UNI was 51%. No significant difference was found between hand dominance and the prevalence of UNI. The UNCSA at 1 cm proximal to the medial epicondyle on the bilateral sides in type S was the most increased among three types. Conclusion: UNI was identified in almost half of the participants, with no marked difference found in the hand dominance. The UNCSA at 1 cm proximal to the medial epicondyle was significantly increased the most in type S. UNI does not appear to be associated with elbow symptoms in the general population.

Background: Shoulder and elbow injuries are the main cause of throwing disability among high school baseball pitchers. However, longitudinal studies on shoulder and elbow injuries among competitive-level high school baseball pitchers have been insufficient. This study aimed to investigate shoulder and elbow injuries in competitive-level high school baseball pitchers over a four-year period and elucidate the effects of implementing medical checkups on the incidence of shoulder and elbow injuries. Methods: Five hundred fifty-two high school baseball pitchers, who received preseason medical checkups from February 2012 to February 2015, were enrolled in this study. Shoulder and elbow injuries occurring during the season after medical checkups were prospectively evaluated by a postseason questionnaire. Pitchers who were not able to pitch for >7 days owing to shoulder or elbow pain were defined as having shoulder and elbow injuries during the season. The incidence rates of shoulder and elbow injuries during the seasons were calculated and compared over the 4-year period. Results: Ninety-six percent of medical checkup participants were included in the study. The mean questionnaire collection rate of the prospective study was 71.6% (range: 67.7-78.9%). The incidence of shoulder and elbow injuries significantly decreased from 20.0% in 2012 to 7.7% in 2015 (P = .013). Conclusion: The four-year trend in the incidence of shoulder and elbow injuries in competitive-level high school baseball pitchers was evaluated. The incidence of shoulder and elbow injuries during the season significantly decreased with a linear downward trend during the survey period after the implementation of medical checkups.