The Journal of hand surgery
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This investigation tested the null hypothesis that psychological factors have no effect on patient satisfaction in a hand and upper limb practice. ⋯ In this study, the provider's sense that the patient was disproportionately uneasy with his or her symptoms was the only significant predictor of patient satisfaction, and this accounted for a small percentage of the variance in responses to these items. Patient satisfaction is complex, and the divide between medical advice and a patient's expectations are not easily reduced to one or more disease-specific or patient-specific factors.
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The diagnosis and management of complex regional pain syndrome is often challenging. Early diagnosis and intervention improve outcomes in most patients; however, some patients will progress regardless of intervention. Multidisciplinary management facilitates care in complex cases. ⋯ Multimodal treatment with hand therapy, sympatholytic drugs, and stress loading may be augmented with anesthesia blocks. If the dystrophic symptoms are controllable by medications and a nociceptive focus or nerve derangement is correctable, surgery is an appropriate alternative. Chronic sequelae of contracture may also be addressed surgically in patients with controllable sympathetically maintained pain.
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The Michigan hand questionnaire (MHQ) is increasingly being used and has been adapted cross-culturally in some Western and Asian countries, but the validation process for an Asian translation of MHQ has not been well described. In this study, we translated and adapted the original MHQ cross-culturally to produce a Korean version, and then assessed the validity and reliability of the Korean version of the MHQ. ⋯ The Korean version of MHQ showed satisfactory internal consistency, test-retest reliability, and validity and demonstrated a significant correlation with the patient-based upper extremity questionnaire and clinical assessment. We found the application and evaluation of the instrument to be feasible and understandable among patients in Korea.
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To improve the degree of functional return and sensibility provided by composite tissue allotransplantation, enhanced nerve regeneration is essential. Chondroitin sulfate proteoglycans are found in the extracellular matrix of nerves and inhibit regenerating axons after injury. Treatment with chondroitinase to remove chondroitin sulfate proteoglycans has been shown to improve nerve regeneration in isolated nerve graft and transection-and-repair models. This study assesses the efficacy of chondroitinase as a neurotherapeutic agent in the setting of composite tissue allotransplantation. ⋯ Intraneural injection of chondroitinase cleaved inhibitory chondroitin sulfate proteoglycans without disrupting proregenerative laminin and resulted in enhanced nerve regeneration after composite tissue allotransplantation. Studies at later time points are needed to assess whether this enhanced nerve regeneration will produce improved functional return.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study.
We compared saline, corticosteroid, and autologous blood injections for lateral epicondylitis in a prospective, blinded, randomized, controlled trial. The null hypothesis was that patient-rated outcomes after autologous blood injection would not be superior to corticosteroid and saline injections. ⋯ In this prospective, randomized, controlled trial, autologous blood, corticosteroid, and saline injection provide no advantage over placebo saline injections in the treatment of lateral epicondylitis. Patients within each injection group demonstrated improved outcome scores over a 6-month period.