Lambert Robert J, Yeoman Thomas Fm, Wang Chaoyang, Grant Jaime, Rust Philippa A
The Hooper Hand Surgery Unit, St John's Hospital, Livingston, UK.
Department of Orthopaedics and Trauma, Royal Infirmary, Edinburgh, UK.
J Hand Surg Asian Pac Vol. 2020 Sep;25(3):296-300. doi: 10.1142/S2424835520500319.
Pain of the hand distal interphalangeal joints may result from trauma, osteoarthritis or inflammatory arthritis. When symptoms are not controlled by non-operative means, surgical arthrodesis may be performed, resulting in complete stiffness of the joint and possible weakening of grip strength. This study aims to quantify the effect of a stiff ring finger distal interphalangeal joint on overall grip strength. One hundred participants were screened to exclude upper limb pathology. A Jamar dynamometer was used to assess overall hand grip strength. A splint was used to prevent distal interphalangeal joint flexion, thus replicating a fused distal interphalangeal joint. Participants were tested with and without the splint and the results compared. The mean of three grip strength tests was taken. The participants included 55 females. Mean age was 31 (18-60 years). 76 participants had a reduction in grip strength with splinting, with a significant difference seen ( < 0.05) on Wilcoxon signed rank test. The median reduction in grip strength with splinting was 1.67 kg. However only 10 participants (10%) had a grip strength loss of greater than 6.5 kg, which is the minimal clinically important difference. This study found a significant loss in overall hand grip strength when the ring finger distal interphalangeal joint was stiffened. However, despite this significant change, only 10 (10%) participants experienced a reduction of greater than 6.5 kg. This is the level of weakness felt to be required to reduce function. Thus our results suggest that 90% of patients with a stiff ring finger distal interphalangeal joint are unlikely to have a clinically identifiable functional reduction in grip strength as a result.
手部远侧指间关节疼痛可能由创伤、骨关节炎或炎性关节炎引起。当非手术方法无法控制症状时，可进行手术关节融合术，这会导致关节完全僵硬，并可能削弱握力。本研究旨在量化僵硬的环指远侧指间关节对整体握力的影响。筛选了100名参与者以排除上肢病变。使用Jamar测力计评估手部整体握力。使用夹板防止远侧指间关节屈曲，从而模拟融合的远侧指间关节。对参与者在佩戴和不佩戴夹板的情况下进行测试，并比较结果。取三次握力测试的平均值。参与者包括55名女性。平均年龄为31岁（18 - 60岁）。76名参与者在佩戴夹板时握力下降，在Wilcoxon符号秩检验中观察到显著差异（<0.05）。佩戴夹板时握力下降的中位数为1.67千克。然而，只有10名参与者（10%）的握力损失大于6.5千克，这是临床上最小的重要差异。本研究发现，当环指远侧指间关节僵硬时，手部整体握力显著下降。然而，尽管有这一显著变化，但只有10名（10%）参与者的握力下降超过6.5千克。这是被认为会导致功能下降所需的虚弱程度。因此，我们的结果表明，90%的环指远侧指间关节僵硬的患者不太可能因握力下降而出现临床上可识别的功能减退。
