Isam Atroshi - Academia.edu (original) (raw)

Papers by Isam Atroshi

Journal of the American Geriatrics Society, 2011

To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication... more To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication in participants with hip fracture before and after the fracture and to analyze differences between five healthcare districts. Population-based cohort study. Data retrieved from two national databases All 2,043 people with hip fracture aged 60 and older in a Swedish county in 2006. Changes in FRIDs and bone-active medications prescribed within 6 months before and 6 months after hip fracture and differences between health care districts. Before hip fracture, 1,308 participants (67.7%) received any FRIDs or combinations; after fracture, 97.7% were treated. Polypharmacy (≥5 drugs) increased 39.3%, excessive polypharmacy (≥10 drugs) increased 36.4%, and use of three or more psychotropic drugs increased 8.6%. After fracture, the use of all analyzed drugs including psychotropic, cardiovascular, opioid, and anticholinergic drugs increased significantly (P<.001). Treatment with calcium and vitamin D increased from 9% before to 27.7% after and with bisphosphonates from 3.5% to 7.6%. Variations in postfracture prescribing between the five health care districts were observed regarding opioids (range 85-64%), bisphosphonates (range 20-4%), and calcium and vitamin D (72-13%) (P<.001, for all comparisons). Two-thirds of participants with hip fracture were prescribed FRIDs before fracture, and the number increased significantly after fracture. Significant variations between healthcare districts in treating osteoporosis and pain were evident; geriatric support could be a contributing factor to the greater treatment in two districts.

Evidence-Based Orthopaedics, 2009

The Journal of Hand Surgery, Jul 1, 2003

Purpose: To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs... more Purpose: To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical treatment in a general population.Methods: A health-status questionnaire was mailed to a random general population sample of 3,000 subjects (ages, 25–74 y). The responders who reported numbness and/or tingling in the median nerve distribution in the hands were asked to attend a clinical evaluation at which they completed the validated CTS questionnaire and underwent physical examination and nerve conduction tests. The CTS questionnaire measures the severity of symptoms and disability on a scale from 1 (none) to 5 (most severe). The potential need for surgery was defined as CTS symptom severity score of 3.2 or greater or functional status score of 2.5 or greater (corresponding to median preoperative scores for surgical patients in previous reports).Results: The response rate for the survey was 83%. Of the responders who reported numbness and/or tingling in the median nerve distribution in the hands 81% attended the clinical evaluation. Of the 94 subjects diagnosed with clinically certain CTS, 19 (20%; 12 with electrophysiologically proven median neuropathy) had previously undiagnosed CTS that potentially needed surgical treatment, yielding a population prevalence of 7 per 1,000 (95% confidence interval, 4–11 per 1,000).Conclusions: In a general population there was a 0.7% prevalence of undiagnosed CTS with a severity similar to that of patients undergoing surgery. The degree to which variable numbers of this group are drawn into a medical system could account for variations in the rate of surgery performed.

Acta Orthopaedica, Jun 1, 2006

BMC Musculoskeletal Disorders

The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used ... more The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item QuickDASH, has been developed. Little is known about the discriminant ability of score changes for the QuickDASH compared to the DASH. The aim of this study was to assess the performance of the QuickDASH and its cross-sectional and longitudinal validity and reliability. The study was based on extracting QuickDASH item responses from the responses to the full-length DASH questionnaire completed by 105 patients with a variety of upper extremity disorders before surgery and at follow-up 6 to 21 months after surgery. The DASH and QuickDASH scores were compared for the whole population and for different diagnostic groups. For longitudinal construct validity the effect size and standardized response mean were calculated. Analyses with ROC curves were performed to comp...

BMC Musculoskeletal Disorders

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region... more The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery. The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6-21 months) change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DAS...

Hand Clinics

In a prospective population-based study, all open hand, wrist, and forearm injuries that were tre... more In a prospective population-based study, all open hand, wrist, and forearm injuries that were treated during a 10-year period, at hospitals and emergency wards in three Norwegian cities with 225,000 inhabitants, were registered. Injury severity was graded using the abbreviated injury scale (AIS). For moderate injuries (AIS 2) overall incidence (95% CI) was 59 (56-62), incidence among males 92 (86-98), and among females 28 (25-31) per 100,000 person-years. For severe injuries (AIS > or = 3), overall incidence (95% CI) was 7.5 (6.3-8.6), incidence among males 11.1 (9.1-13.1), and among females 4.0 (2.8-5.2) per 100,000 person-years. In a second study, all upper extremity amputation and devascularization injuries were referred during a 9-year period to the only replantation center in a southern Swedish region where 1.6 million inhabitants were analyzed. The incidence rate (95% CI) for upper extremity amputation or devascularization injuries potentially requiring replantation or reva...

PloS one, 2015

Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in re... more Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. In Skåne region in Sweden we identified all subjects, aged 17-57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004-2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 ...

The Journal of hand surgery, 2003

To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical... more To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical treatment in a general population. A health-status questionnaire was mailed to a random general population sample of 3,000 subjects (ages, 25-74 y). The responders who reported numbness and/or tingling in the median nerve distribution in the hands were asked to attend a clinical evaluation at which they completed the validated CTS questionnaire and underwent physical examination and nerve conduction tests. The CTS questionnaire measures the severity of symptoms and disability on a scale from 1 (none) to 5 (most severe). The potential need for surgery was defined as CTS symptom severity score of 3.2 or greater or functional status score of 2.5 or greater (corresponding to median preoperative scores for surgical patients in previous reports). The response rate for the survey was 83%. Of the responders who reported numbness and/or tingling in the median nerve distribution in the hands 81% ...

BMC musculoskeletal disorders, Jan 7, 2003

Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS)... more Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and determine the properties of the most accurate test. In a population-based study a questionnaire was mailed to a random sample of 3,000 persons. Of 2,466 responders, 262 symptomatic (numbness/tingling in the radial fingers) and 125 randomly selected asymptomatic responders underwent clinical and electrophysiologic examinations. A standardized hand diagram was administered to the symptomatic persons. At the clinical examination, the examining surgeon identified 94 symptomatic persons as having clinically certain CTS. Nerv...

BMC medical research methodology, Jan 13, 2003

Little work has been done to investigate the suggestion that the use of selected scales from a mu... more Little work has been done to investigate the suggestion that the use of selected scales from a multi-scale health-status questionnaire would compromise reliability and validity. The aim of this study was to compare the performance of three scales selected from the SF-36 generic health questionnaire when administered in isolation or within the entire SF-36 to patients with musculoskeletal disorders. Two groups of patients referred to an orthopedic department completed a mailed questionnaire within 4 weeks prior to and a second questionnaire during their visit. The first group completed three SF-36 scales related to physical health (physical functioning, bodily pain, and general health perceptions) on one occasion and all eight SF-36 scales on the other occasion. The second group completed the entire SF-36 on two occasions. Results for patients who reported unchanged health status and had complete scores were analyzed; 80 patients in the first and 62 patients in the second group. The ...

The Journal of bone and joint surgery. American volume, 2002

The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been po... more The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce. All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation. Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eig...

Acta Orthopaedica, 2015

Background and purpose - Treatment of Dupuytren's contrac... more Background and purpose - Treatment of Dupuytren's contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of ≥ 20º in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was ≤ 5 mm in 30 hands and > 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59º (SD 26) as opposed to 32º (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of ≥ 75º. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55º (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.

The Journal of Hand Surgery, 1999

BMC Musculoskeletal Disorders, 2014

BMC musculoskeletal disorders, 2006

The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used ... more The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item QuickDASH, has been developed. Little is known about the discriminant ability of score changes for the QuickDASH compared to the DASH. The aim of this study was to assess the performance of the QuickDASH and its cross-sectional and longitudinal validity and reliability. The study was based on extracting QuickDASH item responses from the responses to the full-length DASH questionnaire completed by 105 patients with a variety of upper extremity disorders before surgery and at follow-up 6 to 21 months after surgery. The DASH and QuickDASH scores were compared for the whole population and for different diagnostic groups. For longitudinal construct validity the effect size and standardized response mean were calculated. Analyses with ROC curves were performed to comp...

Scandinavian Journal of Rheumatology, 2002

To investigate long-term sick leave among primary care patients with musculoskeletal disorders an... more To investigate long-term sick leave among primary care patients with musculoskeletal disorders and the predictive value of health-status and sense-of-coherence measures. Patients aged 17 to 64 years who, during seven weeks, attended one of six primary care centers because of non-traumatic musculoskeletal pain and who completed the SF-36 health questionnaire and the sense of coherence (SOC) scale at baseline and after one year. Of 189 patients, 36 (19%) were sicklisted for at least three months before and/or after their visit; the most common diagnoses were non-specific soft-tissue or multiple joint, low back, and shoulder pain. The long-term sicklisted patients had significantly worse baseline SF-36 and SOC scores than the non-sicklisted patients; moderate improvement in the SF-36 bodily pain but no improvement in the physical functioning scores occurred. The duration of sick leave at baseline and the SF-36 bodily pain score were significant predictors of continuos one-year work disability. Long-term sick leave was common among primary care patients with musculoskeletal pain. The physical functioning and return-to-work outcomes after one year were poor. The SF-36 bodily pain scale might be helpful in identifying at risk patients.

Journal of the American Geriatrics Society, 2011

To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication... more To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication in participants with hip fracture before and after the fracture and to analyze differences between five healthcare districts. Population-based cohort study. Data retrieved from two national databases All 2,043 people with hip fracture aged 60 and older in a Swedish county in 2006. Changes in FRIDs and bone-active medications prescribed within 6 months before and 6 months after hip fracture and differences between health care districts. Before hip fracture, 1,308 participants (67.7%) received any FRIDs or combinations; after fracture, 97.7% were treated. Polypharmacy (≥5 drugs) increased 39.3%, excessive polypharmacy (≥10 drugs) increased 36.4%, and use of three or more psychotropic drugs increased 8.6%. After fracture, the use of all analyzed drugs including psychotropic, cardiovascular, opioid, and anticholinergic drugs increased significantly (P<.001). Treatment with calcium and vitamin D increased from 9% before to 27.7% after and with bisphosphonates from 3.5% to 7.6%. Variations in postfracture prescribing between the five health care districts were observed regarding opioids (range 85-64%), bisphosphonates (range 20-4%), and calcium and vitamin D (72-13%) (P<.001, for all comparisons). Two-thirds of participants with hip fracture were prescribed FRIDs before fracture, and the number increased significantly after fracture. Significant variations between healthcare districts in treating osteoporosis and pain were evident; geriatric support could be a contributing factor to the greater treatment in two districts.

Evidence-Based Orthopaedics, 2009

The Journal of Hand Surgery, Jul 1, 2003

Purpose: To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs... more Purpose: To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical treatment in a general population.Methods: A health-status questionnaire was mailed to a random general population sample of 3,000 subjects (ages, 25–74 y). The responders who reported numbness and/or tingling in the median nerve distribution in the hands were asked to attend a clinical evaluation at which they completed the validated CTS questionnaire and underwent physical examination and nerve conduction tests. The CTS questionnaire measures the severity of symptoms and disability on a scale from 1 (none) to 5 (most severe). The potential need for surgery was defined as CTS symptom severity score of 3.2 or greater or functional status score of 2.5 or greater (corresponding to median preoperative scores for surgical patients in previous reports).Results: The response rate for the survey was 83%. Of the responders who reported numbness and/or tingling in the median nerve distribution in the hands 81% attended the clinical evaluation. Of the 94 subjects diagnosed with clinically certain CTS, 19 (20%; 12 with electrophysiologically proven median neuropathy) had previously undiagnosed CTS that potentially needed surgical treatment, yielding a population prevalence of 7 per 1,000 (95% confidence interval, 4–11 per 1,000).Conclusions: In a general population there was a 0.7% prevalence of undiagnosed CTS with a severity similar to that of patients undergoing surgery. The degree to which variable numbers of this group are drawn into a medical system could account for variations in the rate of surgery performed.

Acta Orthopaedica, Jun 1, 2006

BMC Musculoskeletal Disorders

The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used ... more The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item QuickDASH, has been developed. Little is known about the discriminant ability of score changes for the QuickDASH compared to the DASH. The aim of this study was to assess the performance of the QuickDASH and its cross-sectional and longitudinal validity and reliability. The study was based on extracting QuickDASH item responses from the responses to the full-length DASH questionnaire completed by 105 patients with a variety of upper extremity disorders before surgery and at follow-up 6 to 21 months after surgery. The DASH and QuickDASH scores were compared for the whole population and for different diagnostic groups. For longitudinal construct validity the effect size and standardized response mean were calculated. Analyses with ROC curves were performed to comp...

BMC Musculoskeletal Disorders

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region... more The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery. The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6-21 months) change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DAS...

Hand Clinics

In a prospective population-based study, all open hand, wrist, and forearm injuries that were tre... more In a prospective population-based study, all open hand, wrist, and forearm injuries that were treated during a 10-year period, at hospitals and emergency wards in three Norwegian cities with 225,000 inhabitants, were registered. Injury severity was graded using the abbreviated injury scale (AIS). For moderate injuries (AIS 2) overall incidence (95% CI) was 59 (56-62), incidence among males 92 (86-98), and among females 28 (25-31) per 100,000 person-years. For severe injuries (AIS > or = 3), overall incidence (95% CI) was 7.5 (6.3-8.6), incidence among males 11.1 (9.1-13.1), and among females 4.0 (2.8-5.2) per 100,000 person-years. In a second study, all upper extremity amputation and devascularization injuries were referred during a 9-year period to the only replantation center in a southern Swedish region where 1.6 million inhabitants were analyzed. The incidence rate (95% CI) for upper extremity amputation or devascularization injuries potentially requiring replantation or reva...

PloS one, 2015

Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in re... more Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. In Skåne region in Sweden we identified all subjects, aged 17-57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004-2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 ...

The Journal of hand surgery, 2003

To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical... more To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical treatment in a general population. A health-status questionnaire was mailed to a random general population sample of 3,000 subjects (ages, 25-74 y). The responders who reported numbness and/or tingling in the median nerve distribution in the hands were asked to attend a clinical evaluation at which they completed the validated CTS questionnaire and underwent physical examination and nerve conduction tests. The CTS questionnaire measures the severity of symptoms and disability on a scale from 1 (none) to 5 (most severe). The potential need for surgery was defined as CTS symptom severity score of 3.2 or greater or functional status score of 2.5 or greater (corresponding to median preoperative scores for surgical patients in previous reports). The response rate for the survey was 83%. Of the responders who reported numbness and/or tingling in the median nerve distribution in the hands 81% ...

BMC musculoskeletal disorders, Jan 7, 2003

Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS)... more Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and determine the properties of the most accurate test. In a population-based study a questionnaire was mailed to a random sample of 3,000 persons. Of 2,466 responders, 262 symptomatic (numbness/tingling in the radial fingers) and 125 randomly selected asymptomatic responders underwent clinical and electrophysiologic examinations. A standardized hand diagram was administered to the symptomatic persons. At the clinical examination, the examining surgeon identified 94 symptomatic persons as having clinically certain CTS. Nerv...

BMC medical research methodology, Jan 13, 2003

Little work has been done to investigate the suggestion that the use of selected scales from a mu... more Little work has been done to investigate the suggestion that the use of selected scales from a multi-scale health-status questionnaire would compromise reliability and validity. The aim of this study was to compare the performance of three scales selected from the SF-36 generic health questionnaire when administered in isolation or within the entire SF-36 to patients with musculoskeletal disorders. Two groups of patients referred to an orthopedic department completed a mailed questionnaire within 4 weeks prior to and a second questionnaire during their visit. The first group completed three SF-36 scales related to physical health (physical functioning, bodily pain, and general health perceptions) on one occasion and all eight SF-36 scales on the other occasion. The second group completed the entire SF-36 on two occasions. Results for patients who reported unchanged health status and had complete scores were analyzed; 80 patients in the first and 62 patients in the second group. The ...

The Journal of bone and joint surgery. American volume, 2002

The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been po... more The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce. All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation. Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eig...

Acta Orthopaedica, 2015

Background and purpose - Treatment of Dupuytren's contrac... more Background and purpose - Treatment of Dupuytren's contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of ≥ 20º in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was ≤ 5 mm in 30 hands and > 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59º (SD 26) as opposed to 32º (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of ≥ 75º. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55º (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.

The Journal of Hand Surgery, 1999

BMC Musculoskeletal Disorders, 2014

BMC musculoskeletal disorders, 2006

The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used ... more The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item QuickDASH, has been developed. Little is known about the discriminant ability of score changes for the QuickDASH compared to the DASH. The aim of this study was to assess the performance of the QuickDASH and its cross-sectional and longitudinal validity and reliability. The study was based on extracting QuickDASH item responses from the responses to the full-length DASH questionnaire completed by 105 patients with a variety of upper extremity disorders before surgery and at follow-up 6 to 21 months after surgery. The DASH and QuickDASH scores were compared for the whole population and for different diagnostic groups. For longitudinal construct validity the effect size and standardized response mean were calculated. Analyses with ROC curves were performed to comp...

Scandinavian Journal of Rheumatology, 2002

To investigate long-term sick leave among primary care patients with musculoskeletal disorders an... more To investigate long-term sick leave among primary care patients with musculoskeletal disorders and the predictive value of health-status and sense-of-coherence measures. Patients aged 17 to 64 years who, during seven weeks, attended one of six primary care centers because of non-traumatic musculoskeletal pain and who completed the SF-36 health questionnaire and the sense of coherence (SOC) scale at baseline and after one year. Of 189 patients, 36 (19%) were sicklisted for at least three months before and/or after their visit; the most common diagnoses were non-specific soft-tissue or multiple joint, low back, and shoulder pain. The long-term sicklisted patients had significantly worse baseline SF-36 and SOC scores than the non-sicklisted patients; moderate improvement in the SF-36 bodily pain but no improvement in the physical functioning scores occurred. The duration of sick leave at baseline and the SF-36 bodily pain score were significant predictors of continuos one-year work disability. Long-term sick leave was common among primary care patients with musculoskeletal pain. The physical functioning and return-to-work outcomes after one year were poor. The SF-36 bodily pain scale might be helpful in identifying at risk patients.