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Preparing Studies for Statistical Analysis
Published in Lynne M. Bianchi, Research during Medical Residency, 2022
Luke J. Rosielle, Lynne M. Bianchi
If you want to know if an intervention helps patients, you test the null hypothesis to determine the likelihood that there is no difference among the groups. If the likelihood of the null being correct is very small, you have found statistical significance, and therefore accept the alternative hypothesis. The logic may appear to be a little backwards for newcomers to statistics, but this is what is meant by “statistical significance.” For example, imagine you are interested in whether an occupational therapy treatment protocol (intervention/exposure) will reduce the amount of pain medication (outcome) taken by patients aged 65–95 with osteoarthritis of the thumb. Your null hypothesis is that patients receiving occupational therapy will be indistinguishable from patients who do not receive occupational therapy in terms of the amount of pain medication taken; in other words, occupational therapy does not change how much pain medication is used by a participant.
Introduction
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The thumb–finger pinch is one of the more delicate movements of the thumb which needs a strong opposition, good webspace and intact neuromuscular function. Thumb tries to oppose to grip on the object by movements occurring at various levels. The first metacarpal adducts in the longitudinal plane of the palm and then pronate towards the item. The proximal phalanx flexes, pronates and radially deviates, and the distal phalanx flexes to a variable degree with pronation required to grip the object. An excellent first webspace, intact ligaments and musculotendinous coordination are essential to make this grip efficient. The termino–terminal pinch is used for small items, where the tip of the thumb opposes the touch of the pulp of the index finger (Figure 1.34(a)). This pinch is precisely the contact between the tips of two fingers whereas the other fingers flex to form a regular “O.”
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Always X-ray to distinguish a stable from an unstable injury. Stable injuries include transverse shaft and greenstick fractures.Unstable injuries include oblique shaft and comminuted fractures, and the fracture–dislocation of the base of the thumb (Bennett's fracture).Bennett's fracturethis is an oblique fracture through the base of the thumb metacarpal involving the joint with the trapezium, with subluxation of the rest of the thumb radiallylook for swelling of the thenar eminence, sometimes with local palmar bruisingmake sure the X-ray includes the base of the thumb to avoid missing this injury.
The association between trauma and paediatric trigger thumb deformity; experience from a single tertiary referral hospital
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Nadia L. Salloum, Pauline McGee, Wee L. Lam
A summary of symptoms, examination findings and x-ray findings are presented in Table 2. Symptoms were noted to be unilateral or bilateral with bilateral symptoms identified in 10 individuals, accounting for 20 thumbs. Two children presented with a history of trauma on one side who subsequently developed symptoms in the contralateral thumb in the absence of trauma. Flexion deformity was reported as either fixed, where it could not be extended, or intermittent. Where pain was associated with the trigger thumb, this was either at rest or on attempted passive extension of the thumb. The presence of Notta’s nodule was not always commented on but where it was documented, this was included as reported in findings in Table 1. The overall proportion of individuals who had x-rays performed is shown in Table 1. All x-rays carried out were formally reported as normal by a radiologist. The only additional examination finding of note was a minor subungal haematoma in one case with a traumatic history. All patients underwent release of the A1 pulley through a transverse incision with complete resolution of symptoms.
Customized designs of short thumb orthoses using 3D hand parametric models
Published in Assistive Technology, 2022
Chih-Hsing Chu, I-Jan Wang, Jing-Ru Sun, Chien-Hsiou Liu
The short thumb orthosis is widely used for clients who have carpometacarpal (CMC) osteoarthritis, thumb pain, repetitive strain injury, and various other thumb conditions (de Almeida, MacDermid, Pontes, Dos Santos-Couto-Paz, & Matheus, 2017; Liu, Yip, & Chiang, 2018; O’brien & McGaha, 2014). Most short thumb orthoses need to be custom-made to be clinically effective. In clinical practice, orthoses are normally constructed by occupational therapists and certified hand therapists with special training. During this process, the stiffness of the thermoplastic material is adjusted during heating, and the 3D contours are molded for a period of time before the material cures and hardens. It is challenging to precisely control this process because of the high variability. The manually fabricated orthosis exhibits several drawbacks, such as easy splitting of the stitched seams of the orthosis when users perform heavy activities (Veraldi, 2017) and loss of the connection of the Velcro with repeated use (Baronio, Volonghi, & Signoroni, 2017). The current manufacturing practices cannot effectively incorporate design rules or functional considerations into the orthosis shape construction process.
Synostosis of the interphalangeal joint: an uncommon cause of post-fracture digital stiffness
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Peter Y. W. Chan, Peter S. H. Chan
There was a delay in transfer resulting in the patient presenting at almost 6 h post-injury. The patient was anxious to proceed with treatment. The patient’s injuries were identifiable from the plain films and due to the open nature of the small finger injury, repeat films were not obtained before surgery. The emergent issue was the open injury to the small finger and treatment options were discussed with the patient. Revision amputation was chosen as treatment for the small finger. Closed treatment without reduction was chosen for the index and middle fingers secondary to the stable nature of the fractures. The intra-articular nature of the thumb fracture was discussed with the patient, including the risk of post-traumatic arthritis. However, the patient declined surgical treatment. Therefore, closed treatment without reduction was chosen as definitive management.