Deborah Kenney

All Publications

• Decoding the evolutionary landscape of soft tissue sarcomas: From multiregion origins to therapy-driven adaptation Soudi, S., Silvia, N., Subramanian, A., Nouth, S., Ryu, F., Kaneko, T., New, C., Kenney, D., Avedian, R., Steffner, R., Mohler, D., Kalbasi, A., Van De Rijn, M., Charville, G., Moding, E. AMER ASSOC CANCER RESEARCH. 2025: B18

  View details for DOI 10.1158/1538-7445.CANEVOL25-B018

  View details for Web of Science ID 001652158200008

• Two rotational traction techniques for treating dynamic median, ulnar, and radial compressive neuropathies at the elbow: Theoretical implications and ultrasonographic correlations. Journal of hand therapy : official journal of the American Society of Hand Therapists Chou, R., Gordon, C., Kenney, D., Curtin, C. 2025

  View details for DOI 10.1016/j.jht.2025.09.004

  View details for PubMedID 41253576

• Clinical Efficacy of Pulsed Electromagnetic Field Therapy on Thumb Carpometacarpal Joint Pain: A Double-Blind, Randomized, Controlled Trial. Hand (New York, N.Y.) Durtschi, M. S., Rajakumar, V., Kenney, D. E., Pham, N. S., Ladd, A. L., Chou, R. C. 2025: 15589447251371088

  Abstract

  Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common source of hand pain with limited nonoperative treatment options. Pulsed electromagnetic field (PEMF) therapy has been recently shown in studies to be effective in providing sustained pain relief in knee osteoarthritis. This study aimed to assess the efficacy of PEMF therapy for treating thumb CMC OA pain.This single-center, double-blind, randomized controlled trial included adults with radiographically and/or clinically diagnosed CMC OA who reported an average Numeric Pain Rating Scale (NPRS) score between 3 and 8. Participants were randomized to either a PEMF device or an identical sham device that was used for 8 hours each night for 4 weeks. The primary outcome measure was the change in average daily NPRS from baseline to 4 weeks. Secondary outcome measures included Patient-Rated Wrist/Hand Evaluation (PRWHE) and Single Assessment Numeric Evaluation at 4 and 6 weeks.Sixty-one participants were recruited, and 51 participants completed the study at 4 weeks. Both the PEMF therapy and sham device groups showed improvements in average NPRS and PRWHE at 4 weeks, but there was not a significant improvement between groups. At 6 weeks, there was a significantly greater change in average NPRS from baseline in the PEMF therapy group compared with the sham device group (P = .02).Pulsed electromagnetic field therapy may improve thumb CMC OA pain with sustained relief beyond the treatment period. Future studies will need to assess if adjusting treatment duration or other factors can enhance its efficacy.

  View details for DOI 10.1177/15589447251371088

  View details for PubMedID 41015912

• Incidence and Risk Factors for Soft Tissue Hand and Wrist Conditions in Pregnancy and Postpartum. Journal of hand surgery global online Smith, G. B., Young, B., Titan, A. L., Kenney, D. E., Ladd, A. L. 2025; 7 (5): 100778

  Abstract

  This study aimed to identify the incidence of and risk factors associated with soft tissue hand conditions in pregnancy and postpartum. We hypothesized that the incidence of de Quervain tenosynovitis (DQT) and possibly carpal tunnel syndrome (CTS) and trigger finger would be higher in pregnancy and postpartum and that gestational diabetes would be a risk factor for these conditions.Using the PearlDiver administrative claims database, we identified pregnant females undergoing vaginal or Cesarean delivery from 2011 to 2022. This cohort was propensity score matched based on age and Elixhauser comorbidity index to females who were not pregnant. We identified pregnant females with a diagnosis of gestational diabetes. Multivariate regression models were used to assess the risk of developing a hand condition within the first year postpartum, adjusting for age, geographical region, insurance plan, comorbidity index, and inflammatory arthritis or diabetes diagnosis. We applied these models to evaluate the risk of developing a hand condition in gestational diabetes patients.We identified a cohort of 357,534 postpartum patients and 357,803 control patients. We observed a 1.5% incidence of hand conditions postpartum compared to 1.3% in the control population (P < .001). Pregnancy was associated with an increased risk of diagnosis with DQT (odds ratio [OR], 5.11; 95% confidence interval [CI], 4.47-5.85; P < .001). Gestational diabetes was also associated with an increased risk of a hand condition diagnosis (OR, 1.34; 95% CI, 1.26-1.42; P < .001), specifically increased odds of CTS (OR, 1.40; 95% CI, 1.29-1.51; P < .001) and DQT (OR, 1.23; 95% CI, 1.12-1.34; P < .001).Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of DQT. Gestational diabetes is a significant risk factor for CTS and DQT. Our findings can inform screening and patient education efforts for high-risk pregnant patients.Prognostic IIIb.

  View details for DOI 10.1016/j.jhsg.2025.100778

  View details for PubMedID 40746749

  View details for PubMedCentralID PMC12312026

• Forgoing Upper-Extremity Reconstructive Surgery After Cervical Spinal Cord Injury: A Qualitative Prospective Cohort Study. The Journal of hand surgery Elmaraghi, S., L'Hotta, A. J., James, A. S., Novak, C. B., Curtin, C. M., Kennedy, C. R., Kenney, D., Tam, K., Stenson, K. C., Ota, D., Fox, I. K. 2025

  Abstract

  Individuals with cervical spinal cord injury (SCI) rate restoration of upper extremity (UE) function as their top priority. Despite positive outcomes, rates of tendon transfer (TT) surgery remain low, particularly in the United States. The purpose of this study was to better understand why eligible individuals with SCI forgo surgery in an era of expanded treatment options using nerve transfers (NT).Data were collected from adults with midcervical SCI who chose not to undergo UE surgery. A semistructured interview guide was developed and used to elicit information about the surgical decision-making used by the patients and their caregivers. Interviews were transcribed, coded by a team of researchers, and analyzed using conventional content analysis. Findings were summarized into themes. The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.This study included data on 16 primary study participants with SCI (94% men, mean age 39 years, median time since injury 9 years) and eight caregivers. Reasons to forgo both TT and NT surgery included the following: (1) fear of degradation of UE function, (2) desire for more gains in function than can be achieved by surgery, (3) adjustment to existing function, (4) competing priorities, (5) expect natural recovery or a cure, and (6) previous negative health care interactions.Despite the advent of newer NT that augment traditional TT options to restore UE movement in SCI, barriers to UE reconstruction persist. Providing detailed information on surgical risks, outcomes, and comparative data about gains from natural recovery alone could improve shared decision-making about these effective, but underutilized surgeries.This analysis examines reasons why people forgo upper-extremity surgery for cervical SCI despite the advent of newer NT that have expanded treatment options and decreased the need for postoperative immobilization required of traditional TTs.

  View details for DOI 10.1016/j.jhsa.2025.06.005

  View details for PubMedID 40778888

• Prevention in non-oncologic intent sarcoma surgery. Surgical oncology Wise, C. E., Le, C., Pham, N. S., New, C., Kenney, D. E., Avedian, R., Mohler, D., Steffner, R. 2025; 62: 102273

  Abstract

  Non-oncologic resection of soft tissue sarcomas (STS) continue to be a common referral to multidisciplinary sarcoma centers. While previous literature has reported tumor characteristics and outcomes related to non-oncologic resections, little is known regarding the surgical specialties most likely to excise such a mass and the non-oncological manner in which they do so. Such information can facilitate preventative strategies.The goals of this study are: 1) Investigate the surgical specialties that most often perform unplanned excisions and their diagnostic imaging approach, 2) Identify the frequency of non-oncological techniques utilized in initial unplanned excisions, and 3) Define indications for the use of radiation (XRT) in patients with initial non-oncologic resections of STS.Patient data were collected from a large tertiary referral sarcoma center between 2005 and 2022. Eligible patients had a diagnosis of soft tissue sarcoma that was excised at an outside institution in a non-oncologic manner and subsequently underwent tumor bed re-excision using wide resection. Data regarding the index procedures at outside hospitals were obtained from referral documents and tumor bed re-excisions, along with follow-up care. A total of 124 patients were identified.Forty-three percent of referrals for non-oncologic resection of soft tissue sarcomas (STS) involved tumors located deep to the fascia. The majority of these referrals originated from General Surgery (N = 54, 44 %), Orthopedic Surgery (N = 35, 28 %), and Plastic Surgery (N = 11, 9 %). Preoperative imaging was conducted in 59 % of cases. General surgeons were less likely to obtain preoperative imaging (p = 0.009) and perform MRI scans (p = 0.013) than orthopaedic surgeons. The proper orientation of the incision based on location was incorrect for general surgeons in 26 % (N = 20) of cases. General surgeons were less likely to make an appropriate incision (p = 0.052) and to use a tourniquet during the initial procedure (p < 0.001). There were no differences among surgical subspecialties in the use of local anesthetic, drain use, or excision type regarding the initial non-oncologic resection. Residual disease following tumor bed re-excision was linked to masses removed in the clinic (p = 0.030) and initial stage IIIB tumors (p = 0.019). Our institutional use of radiation therapy (XRT) correlated with large initial size, high-grade histology, location deep to fascia, and tumors that were re-excised with staged coverage by plastic surgery.Most referrals for initial non-oncologic resection of STS come from general surgery followed by orthopaedic surgery. Indications for pre-operative MRI imaging, incision orientation, and tourniquet use are education targets for general surgeons in training. Interpretation of MRI scans is an education target for orthopaedic surgeons in training. Clinic procedures are associated with residual disease on tumor re-excision. Radiation before tumor bed re-excision can be considered for larger, high-grade tumors that are deep to the fascia and when plastics coverage is planned.Level IV.

  View details for DOI 10.1016/j.suronc.2025.102273

  View details for PubMedID 40768940

• Proof of Concept and Validation of Single-Camera AI-Assisted Live Thumb Motion Capture. Sensors (Basel, Switzerland) Dinh, H. G., Zhou, J. Y., Benmira, A., Kenney, D. E., Ladd, A. L. 2025; 25 (15)

  Abstract

  Motion analysis can be useful for multiplanar analysis of hand kinematics. The carpometacarpal (CMC) joint has been traditionally difficult to capture with surface-based motion analysis but is the most commonly arthritic joint of the hand and is of particular clinical interest. Traditional 3D motion capture of the CMC joint using multiple cameras and reflective markers and manual goniometer measurement has been challenging to integrate into clinical workflow. We therefore propose a markerless single-camera artificial intelligence (AI)-assisted motion capture method to provide real-time estimation of clinically relevant parameters. Our study enrolled five healthy subjects, two male and three female. Fourteen clinical parameters were extracted from thumb interphalangeal (IP), metacarpal phalangeal (MP), and CMC joint motions using manual goniometry and live motion capture with the Google AI MediaPipe Hands landmarker model. Motion capture measurements were assessed for accuracy, precision, and correlation with manual goniometry. Motion capture demonstrated sufficient accuracy in 11 and precision in all 14 parameters, with mean error of -2.13 ± 2.81° (95% confidence interval [CI]: -5.31, 1.05). Strong agreement was observed between both modalities across all subjects, with a combined Pearson correlation coefficient of 0.97 (p < 0.001) and an intraclass correlation coefficient of 0.97 (p < 0.001). The results suggest AI-assisted live motion capture can be an accurate and practical thumb assessment tool, particularly in virtual patient encounters, for enhanced range of motion (ROM) analysis.

  View details for DOI 10.3390/s25154633

  View details for PubMedID 40807797

• Outcomes of thumb metacarpophalangeal arthrodesis using intramedullary locking screws. The Journal of hand surgery, European volume Wise, C. E., Kenney, D. E., Ladd, A. L. 2025: 17531934251340239

  Abstract

  This study investigated the complications and fusion angles of patients treated for thumb metacarpophalangeal dysfunction with intramedullary locking screws using a fixed-angle device. There were 36 procedures. All joints fused appropriately with a mean fusion angle of 25°, with two complications.Level of evidence: IV.

  View details for DOI 10.1177/17531934251340239

  View details for PubMedID 40391548

• Evolutionary Pressures Shape Undifferentiated Pleomorphic Sarcoma Development and Radiotherapy Response. Cancer research Blomain, E., Soudi, S., Wang, Z., Somani, A., Subramanian, A., Nouth, S. C., Oladipo, E., New, C., Kenney, D. E., Nemat-Gorgani, N., Kindler, T., Avedian, R. S., Steffner, R. J., Mohler, D. G., Hiniker, S. M., Chin, A. L., Kalbasi, A., Binkley, M. S., Fried, M., Gaida, M. M., van de Rijn, M., Moding, E. J. 2025

  Abstract

  Radiotherapy is an integral component in the treatment of many types of cancer, with approximately half of cancer patients receiving radiotherapy. Systemic therapy applies pressure that can select for resistant tumor subpopulations, underscoring the importance of understanding how radiation impacts tumor evolution to improve treatment outcomes. We integrated temporal genomic profiling of 120 spatially distinct tumor regions from 20 patients with undifferentiated pleomorphic sarcomas (UPS), longitudinal circulating tumor DNA (ctDNA) analysis, and evolutionary biology computational pipelines to study UPS evolution during tumorigenesis and in response to radiotherapy. Most unirradiated UPS displayed initial linear evolution followed by subsequent branching evolution with distinct mutational processes during early and late development. Metrics of genetic divergence between regions provided evidence of strong selection pressures during UPS development that further increased during radiotherapy. Subclone abundance changed following radiotherapy with subclone contraction tied to alterations in calcium signaling, and inhibiting calcium transporters radiosensitized sarcoma cells. Finally, ctDNA analysis accurately measured subclone abundance and enabled non-invasive monitoring of subclonal changes. These results demonstrate that radiation exerts selective pressures on UPS and suggest that targeting radioresistant subclonal populations could improve outcomes after radiotherapy.

  View details for DOI 10.1158/0008-5472.CAN-24-3281

  View details for PubMedID 39808162

• Personalized Bistable Orthoses for Rehabilitation of Finger Joints Lin, Y., Zhu, D., Naidu, A., Yu, K., Harper, D., Halilaj, E., Weber, D., Kenney, D., Popchak, A. J., Baratz, M., Ion, A., ACM ASSOC COMPUTING MACHINERY. 2025

  View details for DOI 10.1145/3746059.3747643

  View details for Web of Science ID 001612640500196

• Accessing Rehabilitation after Upper Limb Reconstructive Surgery in Cervical Spinal Cord Injury: A Qualitative Study. Topics in spinal cord injury rehabilitation Randolph, S. B., L'Hotta, A. J., Tam, K., Stenson, K. C., Curtin, C. M., James, A. S., Kennedy, C. R., Ota, D., Novak, C. B., Kenney, D., Fox, I. K. 2024; 30 (4): 35-44

  Abstract

  To investigate the barriers and facilitators to rehabilitation experienced by individuals with cervical SCI after upper limb (UL) reconstructive surgery.We conducted a prospective cohort study with a follow-up period of up to 24 months. Data collection occurred at two academic and two Veterans Affairs medical centers in the United States. Participants were purposively sampled and included 21 adults with cervical SCI (c-SCI) who had received nerve or tendon transfer surgeries and 15 caregivers. We administered semi-structured interviews about participants' experiences of accessing rehabilitation services after surgery.Four themes emerged from the data: (1) participants encountered greater obstacles in accessing therapy as follow-up time increased; (2) practical challenges (e.g., insurance coverage, opportunity costs, transportation) limited rehabilitation access; (3) individuals with c-SCI and their caregivers desired more information about an overall rehabilitation plan; and (4) external support systems facilitated therapy access.Individuals with c-SCI experience multilevel barriers in accessing rehabilitation care after UL reconstructive surgeries in the United States. This work identifies areas of focus to mitigate these challenges, such as enhancing transparency about the overall rehabilitation process, training providers to work with this population, and developing, testing, and disseminating rehabilitation protocols following UL reconstruction among people with c-SCI.

  View details for DOI 10.46292/sci23-00092

  View details for PubMedID 39619821

  View details for PubMedCentralID PMC11603106

• Sarcoma microenvironment cell states and ecosystems are associated with prognosis and predict response to immunotherapy. Nature cancer Subramanian, A., Nemat-Gorgani, N., Ellis-Caleo, T. J., van IJzendoorn, D. G., Sears, T. J., Somani, A., Luca, B. A., Zhou, M. Y., Bradic, M., Torres, I. A., Oladipo, E., New, C., Kenney, D. E., Avedian, R. S., Steffner, R. J., Binkley, M. S., Mohler, D. G., Tap, W. D., D'Angelo, S. P., van de Rijn, M., Ganjoo, K. N., Bui, N. Q., Charville, G. W., Newman, A. M., Moding, E. J. 2024

  Abstract

  Characterization of the diverse malignant and stromal cell states that make up soft tissue sarcomas and their correlation with patient outcomes has proven difficult using fixed clinical specimens. Here, we employed EcoTyper, a machine-learning framework, to identify the fundamental cell states and cellular ecosystems that make up sarcomas on a large scale using bulk transcriptomes with clinical annotations. We identified and validated 23 sarcoma-specific, transcriptionally defined cell states, many of which were highly prognostic of patient outcomes across independent datasets. We discovered three conserved cellular communities or ecotypes associated with underlying genomic alterations and distinct clinical outcomes. We show that one ecotype defined by tumor-associated macrophages and epithelial-like malignant cells predicts response to immune-checkpoint inhibition but not chemotherapy and validate our findings in an independent cohort. Our results may enable identification of patients with soft tissue sarcomas who could benefit from immunotherapy and help develop new therapeutic strategies.

  View details for DOI 10.1038/s43018-024-00743-y

  View details for PubMedID 38429415

  View details for PubMedCentralID 4486342

• Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study. BMC musculoskeletal disorders O'Mara, A., Kerkhof, F., Kenney, D., Segovia, N., Asbell, P., Ladd, A. L. 2024; 25 (1): 159

  Abstract

  Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD).We evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves.2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores.These findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.

  View details for DOI 10.1186/s12891-023-07127-w

  View details for PubMedID 38378510

  View details for PubMedCentralID 3767038

• Peripheral nerve stimulation for saphenous neuralgia. Regional anesthesia and pain medicine McCullough, M., Kenney, D., Curtin, C., Ottestad, E. 2023

  Abstract

  Injury to saphenous nerve branches is frequent during knee surgery and can result in chronic pain. This saphenous neuralgia remains challenging to treat. Peripheral nerve stimulation (PNS) is a new potential non-pharmacologic treatment option. We present our outcomes experience using this technology in 12 patients.We retrospectively reviewed PNS placement for saphenous neuralgia between 2000 and 2022 at a single institution. Demographic information was collected as well as response to the device. Four-question short-form Patient-Reported Outcome Measurement Information System (PROMIS) Scores were collected before and 2 weeks, 6 weeks, and 6 months postprocedure. Specific scores included pain interference and behavior, functional mobility, depression, anxiety, and sleep impairment. Change in pain interference measured by the short-form PROMIS tool at 6 months was chosen as the primary outcome.Twelve patients met inclusion criteria, with 10 patients having the full 6-month follow-up. In these 10 patients, the mean change from baseline in the short-form adjusted pain interference score (greater difference means improved pain) at 6 months was 5.8 (SD 6.5). Among all patients, average follow-up was 11.5 months (range 3-35 months). Most patients' symptoms developed after knee surgery (84%). Prior to PNS, patients underwent other treatments including cryoablation (8%), radiofrequency ablation (16%), saphenous neurectomy (16%), or surgical release of adjacent nerves (25%). Ten patients (83%) reported any improvement in symptoms while two reported no benefit. Complications occurred in four patients (33%). Two patients had the device removed and a third discontinued use. PROMIS Scores for pain, functional mobility, mood, and sleep impairment all improved.Limited effective treatments exist for saphenous neuralgia. Our case series demonstrates the potential of PNS as a treatment for saphenous neuralgia. Comparative effectiveness studies are warranted to assess whether our effect size is clinically relevant.

  View details for DOI 10.1136/rapm-2023-104538

  View details for PubMedID 38050145

• Caregiving for People With Spinal Cord Injury Undergoing Upper Extremity Reconstructive Surgery: A Prospective Exploration of Lived Experiences, Perioperative Care, and Change Across Time. Topics in spinal cord injury rehabilitation Desai, R. H., L'Hotta, A., Kennedy, C., James, A. S., Stenson, K., Curtin, C., Ota, D., Kenney, D., Tam, K., Novak, C., Fox, I. 2023; 29 (3): 58-70

  Abstract

  Nerve transfer (NT) and tendon transfer (TT) surgeries can enhance upper extremity (UE) function and independence in individuals with cervical spinal cord injury (SCI). Caregivers are needed to make this surgery possible, yet caregivers experience their own set of challenges.This comparative study explored the perioperative and nonoperative experiences of caregivers of individuals with cervical SCI, focusing on daily life activities, burden, and mental health.Caregivers of individuals with cervical SCI were recruited and grouped by treatment plan for the person with SCI: (1) no surgery (NS), (2) TT surgery, and (3) NT surgery. Semistructured interviews were conducted at baseline/preoperative, early follow-up/postoperative, and late follow-up/postoperative. Caregivers were asked about their daily life, mental health, and challenges related to caregiving. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative, single-item standardized burden score (0-100) data were collected at each timepoint.Participants included 23 caregivers (18 family members, 4 friends, 1 hired professional). The surgeries often brought hope and motivation for caregivers. Caregivers reported increased burden immediately following surgery (less for the NT compared to TT subgroup) yet no long-term changes in the amount and type of care they provided. NS caregivers discussed social isolation, relationship dysfunction, and everyday challenges.Health care providers should consider the changing needs of SCI caregivers during perioperative rehabilitation. As part of the shared surgical decision-making approach, providers should educate caregivers about the postoperative process and the extent and potential variability of short- and long-term care needs.

  View details for DOI 10.46292/sci22-00063

  View details for PubMedID 38076291

  View details for PubMedCentralID PMC10644855

• Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma. Pediatric emergency care Kha, S. T., Sharma, J., Kenney, D., Daldrup-Link, H., Steffner, R. 2023

  Abstract

  The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis.We conducted a retrospective review of pediatric patients (aged 1-18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis.Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4-18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1-84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0-4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0-493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0-493; P = 0.018).We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.

  View details for DOI 10.1097/PEC.0000000000003031

  View details for PubMedID 37567167

• The biomechanics of osteoarthritis in the hand: Implications and prospects for hand therapy. Journal of hand therapy : official journal of the American Society of Hand Therapists Kerkhof, F., Kenney, D., Ogle, M., Shelby, T., Ladd, A. 2022

  Abstract

  The unique anatomy of the human hand makes it possible to carefully manipulate tools, powerfully grasp objects, and even throw items with precision. These apparent contradictory functions of the hand, high mobility for manual dexterity vs high stability during forceful grasping, imply that daily activities impose a high strain on a relatively instable joint. This makes the hand susceptible to joint disorders such as osteoarthritis. Both systemic (eg, genetics, hormones) and mechanical factors (eg, joint loading) are important in the development of osteoarthritis, but the precise pathomechanism remains largely unknown. This paper focuses on the biomechanical factors in the disease process and how hand therapists can use this knowledge to improve treatment and research.Multiple factors are involved in the onset and development of osteoarthritis in the hand. Comprehension of the biomechanics helps clinicians establish best practices for orthotics intervention, exercise, and joint protection programs even in de absence of clear evidence-based guidelines. The effect and reach of hand therapy for OA patients can be expanded substantially when intervention parameters are optimized and barriers to early referrals, access reimbursement, and adherence are addressed. Close and early collaboration between hand therapists and primary care, women's health, rheumatology, and hand surgery providers upon diagnosis, and with hand surgeons pre and postoperatively, combined with advances in the supporting science and strategies to enhance adherence, appear to be a promising way forward.

  View details for DOI 10.1016/j.jht.2022.11.007

  View details for PubMedID 36509610

• Surgery to Restore Upper Extremity Function in Tetraplegia-Preferences for Early and Frequent Access to Information. PM & R : the journal of injury, function, and rehabilitation L'Hotta, A. J., James, A. S., Curtin, C. M., Kennedy, C., Kenney, D., Tam, K., Ota, D., Stenson, K., Novak, C. B., Fox, I. K. 2022

  Abstract

  INTRODUCTION: People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function.OBJECTIVE: To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function.DESIGN: Prospective cohort study. Participants were followed for 24 months and completed up to three interviews.SETTING: Tertiary care at academic and affiliated Veterans Administration Health Care Centers.PARTICIPANTS: Adults with cervical SCI (n=35) ages 18 to 80years with mid-cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least six months post-injury) and their caregivers (n=23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURE: Semi-structured interviews about surgical knowledge and experiences.RESULTS: Data were analyzed and three themes were identified. First, providing information about UE surgical options early post-injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information.CONCLUSIONS: Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and healthcare providers. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/pmrj.12862

  View details for PubMedID 35665476

• Evaluation of the PROMIS Upper Extremity Against Validated Patient-Reported Outcomes in Patients with Early Carpometacarpal Osteoarthritis. The Journal of hand surgery Garcia-Lopez, E., Moore, D. C., Kenney, D. E., Ladd, A. L., Weiss, A. C., Crisco, J. J. 2022

  Abstract

  PURPOSE: Internal consistency, construct, and criterion validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) v1.2 were evaluated in patients with early-stage carpometacarpal (CMC) osteoarthritis (OA). We hypothesized that in patients with early CMC OA, PROMIS UE scores would: (1) be lower than those in asymptomatic controls; (2) correlate with established patient-reported outcomes; (3) correlate with pinch and grip strengths; and (4) not correlate with radiographic disease progression.METHODS: Patients with early CMC OA (modified Eaton stage 0 or 1) and matched asymptomatic control patients completed the PROMIS UE, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation at 2 time points. The PROMIS UE's internal consistency was evaluated by Cronbach's alpha, construct validity by Spearman correlation coefficients among the patient-reported outcome measures, and criterion validity using measures of strength. A floor or ceiling effect was indicated if more than 15% of patients achieved the lowest or highest possible score.RESULTS: The PROMIS UE had high internal consistency. Patients with early CMC OA had a lower score than healthy controls (average, 42 vs 54, respectively). We observed moderate to high correlations between the PROMIS UEv1.2, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation and good criterion validity when compared to key pinch and grip strengths. The PROMIS UE did not correlate to radiographic disease severity.CONCLUSIONS: The PROMIS UE had a high correlation with Australian and Canadian Osteoarthritis Hand Index and a moderate correlation with Patient-Rated Wrist-Hand Evaluation. The PROMIS UE had high internal consistency and good criterion validity.CLINICAL RELEVANCE: The PROMIS UE is a valid assessment for disability in patients with early CMC OA and can serve as a clinical adjunct to an outcome assessment.

  View details for DOI 10.1016/j.jhsa.2022.03.003

  View details for PubMedID 35527094

• Adhesive Taping Shows Better Cosmetic Outcomes Than Tissue Adhesives for Sutured Upper Extremity Incisions: A Single-Blind Prospective Randomized Controlled Trial ORTHOPEDICS Mcquillan, T. J., Vora, M., Hawkins, J., Kenney, D., Diaz, R., Ladd, A. L. 2022; 45 (1): E42-E46

  Abstract

  Adhesive taping is commonly used to reinforce wound closure and approximate minor lacerations. Recently, tissue adhesives such as 2-octylcyanoacrylate have gained popularity because of their high tensile strength, bacteriostatic properties, and spontaneous peeling. We sought to evaluate the cosmetic result of upper extremity incisions closed primarily by subcuticular suture, randomizing the application of tissue adhesive vs adhesive taping to different halves of the same surgical incision. Subjects were recruited from patients undergoing common procedures at the senior surgeon's hand surgery clinic. After primary closure, we applied either quarter-inch adhesive tape or tissue adhesive to the proximal and distal aspects of the wounds, based on a preoperative randomization protocol. We assessed the scars at approximately 3 months (range, 2-5 months). Subjects completed a validated scar assessment questionnaire, and a blinded photograph was obtained to allow 2 independent surgeons to assess the scar. Mean age was 63 years (SD, 11.8 years; range, 21-88 years); 56% of patients were women, and 44% were men. Most of the incisions were open carpal tunnel release and thumb carpometacarpal arthroplasty (14 each). Adhesive taping showed a better overall mean score based on evaluation by the hand surgeons, a finding that was statistically significant. The greatest differences were observed between color and size, but no subcategories were significantly different. Patients reported nonstatistical, but slightly better overall cosmetic outcomes with adhesive taping rather than tissue adhesive. Adhesive strips provide a modest but significant improvement in cosmetic outcomes vs more expensive tissue adhesive. Future evaluation of closure methods that evaluate cost, speed of application, suture technique, and dressing will optimize scar appearance. [Orthopedics. 2022;45(1):e42-e46.].

  View details for DOI 10.3928/01477447-20211101-08

  View details for Web of Science ID 000759519200014

  View details for PubMedID 34734780

• Ultrasound of Thumb Muscles and Grasp Strength in Early Thumb Carpometacarpal Osteoarthritis. The Journal of hand surgery Lai, C., Kenney, D., Kerkhof, F., Finlay, A., Ladd, A., Roh, E. 2021

  Abstract

  PURPOSE: The pathophysiology of thumb carpometacarpal (CMC) osteoarthritis (OA) involves complex interactions between the ligaments and muscles supporting the joint. Factors such as muscle volume and strength may be more relevant in early disease. We used ultrasound as a noninvasive method to explore differences in the intrinsic hand muscles of patients with early CMC OA, as determined using physical exam and radiographs, and healthy controls. We also assessed differences in grip strength.METHODS: A convenience sample of postmenopausal women with early CMC OA diagnosed using a physical examination or radiographs was recruited from an orthopedic clinic specializing in hand surgery. Healthy controls who were matched for age and hand dominance were recruited from the same clinic. We used ultrasound to determine the length of the first metacarpal and the muscle thickness of the abductor pollicis brevis, opponens pollicis (OPP), and first dorsal interosseous. Grip strength measurements were taken using a standard Jamar dynamometer and 2 custom-designed tools for cylindrical grasp and pinch strength.RESULTS: Twenty-three subjects were enrolled, with a total of 32 thumbs measured: 15 thumbs with arthritis and 17 healthy thumbs. Multivariable logistic regression models indicated that thumbs with thicker OPP had 0.85 lower odds (95% CI= 0.71-0.97) of early OA, adjusting for hand dominance and the first metacarpal length. Linear regression models indicated no association between early OA and grip strength.CONCLUSIONS: The size of OPP may have a weak association with the diagnosis of early OA.CLINICAL RELEVANCE: This study supports further exploration of the role of OPP in stabilizing the CMC joint, particularly with regard to minimizing joint subluxation. This may be clinically relevant to providers who treat patients with CMC OA early in the course of the disease, when nonsurgical treatment is the most relevant.

  View details for DOI 10.1016/j.jhsa.2021.07.021

  View details for PubMedID 34509311

• Single Assessment Numeric Evaluation (SANE) in Hand Surgery: Does a One-Question Outcome Instrument Compare Favorably? The Journal of hand surgery Gire, J. D., Koltsov, J. C., Segovia, N. A., Kenney, D. E., Yao, J., Ladd, A. L. 2020

  Abstract

  PURPOSE: Patient-reported outcome measures are increasingly used to measure patient status, impairments, and disability, but often require lengthy surveys and place a considerable burden on patients. We hypothesized that the Single Assessment Numeric Evaluation (SANE), composed of a single question, would be a valid and responsive instrument to provide a global assessment of hand function.METHODS: The SANE, Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE), and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) data are routinely collected electronically in our hand and upper-extremity center. To identify our cohort, we used Current Procedural Terminology codes to query our electronic medical record research data repository for the 7 most common hand surgery procedures performed over 2 years from December 2016 to 2018. These procedures included carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, wrist arthroscopy, distal radius fracture fixation, first dorsal compartment release, and cubital tunnel release. Patients undergoing a single isolated procedure with questionnaires obtained in the preoperative and/or postoperative period were included in the analysis. Convergent validity, coverage, and responsiveness for each instrument were assessed.RESULTS: We identified 214 patients for inclusion. The SANE score had a moderate to strong correlation with the QuickDASH and PROMIS-UE. Floor and ceiling effects for the SANE were less than 10% at baseline and follow-up. Overall, the QuickDASH was the most responsive, followed by SANE and PROMIS-UE; all 3 instruments exceeded the acceptable thresholds for responsiveness and demonstrated significant changes before to after surgery. Responsiveness of the SANE varied by procedure and was acceptable for carpal tunnel release, carpometacarpal arthroplasty, wrist arthroscopy, and trigger finger release.CONCLUSIONS: The single-item SANE is a reasonable measure of global function in patients undergoing common hand procedures and demonstrates psychometric properties comparable to those of the PROMIS-UE and QuickDASH outcome scores.CLINICAL RELEVANCE: The SANE score is a reasonable outcome measure of global hand function that may have utility in demonstrating response to treatment in a practice setting and may provide a useful adjunct to multiple-item measures in clinical research studies.

  View details for DOI 10.1016/j.jhsa.2020.03.024

  View details for PubMedID 32482496

• The Association of AUSCAN and PRWHE Patient-reported Outcome Measures With Radiographic Progression of Early Thumb Carpometacarpal Arthritis at 36-Month Follow-up Is Limited to Subtle Changes in the Pain Subscale. Hand (New York, N.Y.) Gil, J. A., Kleiner, J. n., McQuillan, T. J., Kenney, D. n., Ladd, A. L., Weiss, A. C., Crisco, J. J. 2020: 1558944720928489

  Abstract

  There is a paucity of literature that examines how patient-reported outcomes correspond to early radiographic progression of thumb carpometacarpal (CMC) osteoarthritis (OA). This study examines how Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Hand and Wrist Evaluation (PRWHE) scores change over 36 months in subjects with early CMC OA.Ninety-one subjects with symptomatic early thumb CMC OA were enrolled. Differences in AUSCAN and PRWHE scores were measured between subjects at baseline and at 18-month follow-up, and between the subjects at baseline and at 36-month follow-up. Radiographic progression was defined as an increase in modified Eaton Stage. Differences in AUSCAN and PRWHE scores were compared between these 2 groups in order to determine if radiographic progression was associated with a greater change in AUSCAN and PRWHE at 18- and 36-month follow-up.At 18- and 36-month follow-up visits, there were no significant differences in AUSCAN or PRWHE compared to baseline. Multivariable logistic regression analysis did not reveal any significant differences between subjects with radiographic progression to subjects without radiographic progression at 18-month follow-up. At 36-month follow-up, this analysis did demonstrate that subjects with evidence of radiographic progression had a significant increase in the PRWHE pain subscale.AUSCAN and PRWHE scores were not found to significantly progress at 18-month and 36-month follow-up. However, when comparing the subset of subjects with and without radiographic OA, subjects with early CMC OA who had 1 stage of radiographic progression were found to have a significantly higher intensity of pain on the PRWHE pain subscale at 36-month follow-up.

  View details for DOI 10.1177/1558944720928489

  View details for PubMedID 32935579

• Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Coughlan, M. J., Bourdillon, A., Crisco, J. J., Kenney, D., Weiss, A., Ladd, A. L. 2017; 475 (2): 522-528

  Abstract

  Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA.(1) Is cylindrical grasp and gross grasp strength reduced in subjects with early thumb CMC OA compared with asymptomatic control subjects? (2) What is the association of cylindrical and gross grasp to thumb CMC OA after adjusting for age, sex, and hand dominance?We recruited 90 subjects with early symptomatic and radiographic thumb CMC OA and 38 asymptomatic healthy control subjects for this multisite controlled study. Demographic information, hand examination, comprehensive histories, plain film radiographs, and cylindrical and gross grasp strength data were collected on all 128 subjects. Mean grasp strength was calculated for cylindrical and gross grasp in the population with early CMC OA and the control population. A t-test was performed on cylindrical and gross grasp to evaluate the difference between the mean in the control and early CMC OA populations. We used separate linear regression models for the two types of grasp to further quantify the association of grasp with a diagnosis of early thumb CMC OA controlling for age, sex, and whether the subject used their dominant or nondominant hand in the study.Cylindrical grasp was weaker in the population with thumb CMC OA compared with healthy control subjects (6.3 ± 2.7 kg versus 8.4 ± 2.5 kg; mean difference, 2.1; 95% CI, 1.1-3.1; p < 0.001), but there was no difference in gross grasp force (29.6 ± 11.6 kg versus 31.4 ± 10.1 kg; mean difference, 1.7; 95% CI, -2.5 to 6.0; p = 0.425). When adjusting for age, sex, and handedness, cylindrical grasp reduction was related to CMC OA (β = -2.3; standard error [SE], 0.46; p < 0.001) (Y-intercept = 8.2; SE, 1.8; R(2) = 0.29), whereas gross grasp was not reduced in early thumb CMC OA (β = -2.8; SE, 1.6; p = 0.072) (Y-intercept = 34.3; SE, 6.3; R(2) = 0.48).A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages.Cylindrical grasp may serve as a more-sensitive measure for detecting early changes in early CMC OA. The associated decline in hand function also might provide an opportunity for measuring the effectiveness of treatment and intervention.

  View details for DOI 10.1007/s11999-016-5151-2

  View details for Web of Science ID 000391931600039

  View details for PubMedCentralID PMC5213951

• The AUSCAN and PRWHE Demonstrate Comparable Internal Consistency and Validity in Patients With Early Thumb Carpometacarpal Osteoarthritis. Hand (New York, N.Y.) McQuillan, T. J., Vora, M. M., Kenney, D. E., Crisco, J. J., Weiss, A. C., Ebert, K. A., Snelgrove, K. E., Sarnowski, A. n., Ladd, A. L. 2017: 1558944717729217

  Abstract

  The Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Wrist-Hand Evaluation (PRWHE) are 2 patient-related outcome measures to assess pain and disability in patients with osteoarthritis (OA). The purpose of this study was to evaluate the AUSCAN and PRWHE in a large-scale, longitudinal cohort of patients with early thumb carpometacarpal (CMC) OA.We obtained baseline data on 135 individuals (92 with early CMC OA participants and 43 asymptomatic controls) and at follow-up (year 1.5) on 83 individuals. We assessed the internal consistency using Cronbach alpha, and construct and criterion validity using other pain scales and objective measures of strength, respectively. We also examined the correlation between the AUSCAN and PRWHE and correlation coefficients at baseline and follow-up, as well as the correlation between changes in these instruments over the follow-up period.Internal consistency was high for both AUSCAN and PRWHE totals and subscales (Cronbach α > 0.70). Both instruments demonstrated construct validity compared with the Verbal Rating Scale ( r = 0.52-0.60, P < .01), an assessment of pain, and moderate criterion validity compared with key pinch and grip strength ( r = -.24 to -.33, P < .05). These instruments were highly correlated with each other at baseline and follow-up time points ( r = 0.76-.94, P < .01), and changes in a patient's total scores over time were also correlated ( r = 0.83, P < .01).The AUSCAN and PRWHE are both valid assessments for pain and/or disability in patients with early thumb CMC OA.

  View details for PubMedID 28934868

• Changes in Local Bone Density in Early Thumb Carpometacarpal Joint Osteoarthritis. The Journal of hand surgery Schreiber, J. J., McQuillan, T. J., Halilaj, E. n., Crisco, J. J., Weiss, A. P., Patel, T. n., Kenney, D. n., Ladd, A. L. 2017

  Abstract

  Thumb carpometacarpal (CMC) osteoarthritis (OA) represents a major source of functional morbidity. The effects of early CMC OA on loading and use patterns potentially lead to changes in local bone density and microarchitecture. Hounsfield units (HU), a quantitative attenuation coefficient obtained from computed tomography (CT) scans, have been shown to be a reliable marker of bone density. We hypothesized that early CMC OA is associated with lower local bone density about the CMC joint as assessed by HU.We examined HU units from CT scans in 23 asymptomatic subjects and 91 patients with early CMC OA. The HU measurements were obtained within cancellous portions of the trapezium, capitate, first and third metacarpal bases, and distal radius. Linear regression models, with age and sex included as covariates, were used to assess the relationship between CMC OA and HU values at each anatomical site.Early OA patients had significantly lower HU than asymptomatic subjects within the trapezium (mean, 377 HU vs 436 HU) and first metacarpal bases (265 HU vs 324 HU). No significant group differences were noted at the capitate, third metacarpal, or distal radius. Male sex and younger age were associated with significantly higher HU at all the anatomical sites, except the first metacarpal base, where age had no significant effect.Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base). Early thumb CMC OA and discomfort may lead to diminished loading across the basal joint, producing focal disuse osteopenia. These findings in symptomatic early arthritis suggest a relationship between symptoms, functional use of the CMC joint, and local bone density.Diagnostic II.

  View details for PubMedID 29029863

• Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clinical orthopaedics and related research Coughlan, M. J., Bourdillon, A., Crisco, J. J., Kenney, D., Weiss, A., Ladd, A. L. 2016: -?

  Abstract

  Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA.(1) Is cylindrical grasp and gross grasp strength reduced in subjects with early thumb CMC OA compared with asymptomatic control subjects? (2) What is the association of cylindrical and gross grasp to thumb CMC OA after adjusting for age, sex, and hand dominance?We recruited 90 subjects with early symptomatic and radiographic thumb CMC OA and 38 asymptomatic healthy control subjects for this multisite controlled study. Demographic information, hand examination, comprehensive histories, plain film radiographs, and cylindrical and gross grasp strength data were collected on all 128 subjects. Mean grasp strength was calculated for cylindrical and gross grasp in the population with early CMC OA and the control population. A t-test was performed on cylindrical and gross grasp to evaluate the difference between the mean in the control and early CMC OA populations. We used separate linear regression models for the two types of grasp to further quantify the association of grasp with a diagnosis of early thumb CMC OA controlling for age, sex, and whether the subject used their dominant or nondominant hand in the study.Cylindrical grasp was weaker in the population with thumb CMC OA compared with healthy control subjects (6.3 ± 2.7 kg versus 8.4 ± 2.5 kg; mean difference, 2.1; 95% CI, 1.1-3.1; p < 0.001), but there was no difference in gross grasp force (29.6 ± 11.6 kg versus 31.4 ± 10.1 kg; mean difference, 1.7; 95% CI, -2.5 to 6.0; p = 0.425). When adjusting for age, sex, and handedness, cylindrical grasp reduction was related to CMC OA (β = -2.3; standard error [SE], 0.46; p < 0.001) (Y-intercept = 8.2; SE, 1.8; R(2) = 0.29), whereas gross grasp was not reduced in early thumb CMC OA (β = -2.8; SE, 1.6; p = 0.072) (Y-intercept = 34.3; SE, 6.3; R(2) = 0.48).A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages.Cylindrical grasp may serve as a more-sensitive measure for detecting early changes in early CMC OA. The associated decline in hand function also might provide an opportunity for measuring the effectiveness of treatment and intervention.

  View details for PubMedID 27822895

• Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis CLINICAL ORTHOPAEDICS AND RELATED RESEARCH McQuillan, T. J., Kenney, D., Crisco, J. J., Weiss, A., Ladd, A. L. 2016; 474 (2): 557-561

  Abstract

  The thumb carpometacarpal (CMC) joint orchestrates pinch in its various positions, and thumb CMC osteoarthritis (OA) is a major source of orthopaedic morbidity. Self-reported pain, weakness, and physical examination may not correspond to radiographic findings when diagnosing early thumb CMC OA. Weakness is a prominent feature of the disease, but little evidence exists to quantify self-reported loss of strength with time, or to compare weakness with that of a nonarthritic population during early disease.We asked: (1) Is pinch strength in subjects with early thumb CMC OA less than that in asymptomatic control subjects; and (2) weakness in which pinch position (key, tripod, or tip pinch) has the strongest association with early OA diagnosis?For this case-control study, we recruited 23 subjects who were asymptomatic and 91 with early OA for comprehensive history, physical examination, strength measurements, pain surveys, and radiographic evaluation. We used multivariate logistic regression to quantify the association between declining pinch strength and early OA diagnosis after controlling for age, sex, and BMI. This analysis was performed for three different pinch positions (key, tripod, and tip pinch) to evaluate which measurement was most closely associated with diagnosis.Pinch strength was less in patients with early thumb CMC OA. Key pinch had the most robust association with OA diagnosis, in which a 20% decrease in key pinch strength from the control subjects' baseline was associated with a 10% increase in the OA diagnosis (95% CI, 3%-16%; p = 0.004). This had a stronger association with OA diagnosis than tip pinch, in which a 20% decrease in strength was associated with a 6% increase in early CMC OA (95% CI, 1.0%-11%; p = 0.031). Tripod pinch also was associated to a lesser extent; a 20% reduction in tripod pinch led to a 5% increase in OA (95% CI, 1.3%-9%; p = 0.048).Decreasing pinch strength, especially key pinch, is associated with early CMC arthritis before the development of extensive radiographic disease.Weakness in pinch strength, especially key pinch, is an important feature in the pathogenesis of early CMC OA and may appear before radiographic disease is present or advanced. These findings suggest a role for intervention in early disease for promoting nonoperative joint protection and strengthening, and designing surgical procedures aimed to delay or prevent clinical and radiographic progression.

  View details for DOI 10.1007/s11999-015-4599-9

  View details for Web of Science ID 000368021900047

  View details for PubMedCentralID PMC4709288

• Multiple Collagenase Injections Are Safe for Treatment of Dupuytren's Contractures. Orthopedics Gajendran, V. K., Hentz, V., Kenney, D., Curtin, C. M. 2014; 37 (7): e657-60

  Abstract

  The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren's disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren's contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren's contractures, although a fasciectomy may ultimately be required in the most severe cases.

  View details for DOI 10.3928/01477447-20140626-64

  View details for PubMedID 24992063

• Functional task kinematics of the thumb carpometacarpal joint. Clinical orthopaedics and related research Luker, K. R., Aguinaldo, A., Kenney, D., Cahill-Rowley, K., Ladd, A. L. 2014; 472 (4): 1123-1129

  Abstract

  Abnormal biomechanical loading has been identified as an associated risk factor of osteoarthritis in the wrist and hand. Empirical data to date are insufficient to describe the role of altered biomechanics in thumb carpometacarpal (CMC) arthritis.This is a pilot study to evaluate motion analysis of the upper extremity while performing functional tasks. We wished to describe the in vivo kinematics of the thumb and hand in relation to the larger joints of the upper extremity in subjects without arthritis in functional positions at rest and while loading the CMC joint. If reproducible, we then planned to compare kinematics between these subjects and a subject with advanced thumb CMC arthritis.In vivo kinematics of the hand and upper extremity during the functional tasks of grasp, jar opening, and pinch with and without loading of the CMC joint were evaluated using cameras and a motion-capture system in four asymptomatic female subjects and one female subject with advanced radiographic (Eaton Stage IV) osteoarthritis.Kinematics of the hand and upper extremity can be reliably quantified. Loading of the CMC joint did not alter the hand and forearm kinematics in control subjects. In the subject with osteoarthritis, the adduction-extension deformity at the CMC joint resulted in kinematic alterations as compared with the four control subjects.This study represents preliminary steps in defining thumb CMC position, motion, and loading associated with activities of daily living. These findings enhance our understanding of motion at the CMC joint and how it differs in arthritic patients.Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  View details for DOI 10.1007/s11999-013-2964-0

  View details for PubMedID 23549712

  View details for PubMedCentralID PMC3940744

• Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT Burgar, C. G., Lum, P. S., Scremin, A., Garber, S. L., Van der Loos, H., Kenney, D., Shor, P. 2011; 48 (4): 445–58

  Abstract

  This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains.

  View details for DOI 10.1682/JRRD.2010.04.0062

  View details for Web of Science ID 000291372200011

  View details for PubMedID 21674393

• Identification of key pinch forces required to complete functional tasks JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT Smaby, N., Johanson, M. E., Baker, B., Kenney, D. E., Murray, W. M., Hentz, V. R. 2004; 41 (2): 215-223

  Abstract

  Reconstructive hand surgeries restore key pinch to individuals with pinch force deficits caused by tetraplegia. Data that define the magnitudes of force necessary to complete functional key pinch tasks are limited. This study aims to establish target pinch forces for completing selected tasks that represent a range of useful functional activities. A robot arm instrumented with a force sensor completed the tasks and simultaneously measured the forces applied to the task objects. Lateral pinch force requirements were calculated from these measured object forces. Pinch force requirements ranged from 1.4 N to push a button on a remote to 31.4 N to insert a plug into an outlet. Of the tasks studied, 9 of 12 required less than 10.5 N. These pinch force requirements, when compared to pinch forces produced by 14 individuals with spinal cord injuries (with and without surgical reconstruction of pinch), accurately predicted success or failure in 81% of subject trials. The prediction errors indicate a need to measure other factors such as pinch opening, force location, force direction, and proximal joint control.

  View details for Web of Science ID 000221807600014

  View details for PubMedID 15558375