Effective assessments to identify overuse injuries in unaffected limbs of persons with unilateral upper limb amputations

• Published in: Journal of hand therapy 2021-04, Vol.34 (2), p.298-308
• Main Authors: Flinn, Sharon R., Goodman, Glenn
• Format: Article
• Language: English
• Subjects: Amputation; Assessments; Carpal tunnel syndrome; Data collection; Externally-powered prosthesis; Gender; Gliding; Hands; Health care; Health problems; Injuries; Limbs; Nerves; Overuse injuries; Pain; Populations; Prostheses; Risk; Sensitivity; Statistical analysis; Tendons; Therapists; Tightness; Upper limb amputations; Variance analysis; Wrist
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2021.05.006

Cross-sectional study. Overuse injuries (OI) present major health problems and oftentimes, permanent disability. Persons with unilateral upper limb diagnoses, such as amputation, are at-risk for developing OI in their unaffected limbs. Measures to identify high-risk populations are needed. Scores on 6 OI-assessments were compared for persons with unilateral upper limb amputations (UULA) and healthy participants. Cutoff values were proposed. Sixty-two persons with UULA and 62 healthy controls completed this study. Scores for hand volume (HV), visual analogue scale (VAS), multi-site Semmes Weinstein Monofilament for median and ulnar nerves (SWM-M/SWM-U), torque range of motion for wrist/finger extension and flexion (TROM-E/TROM-F), intrinsic tightness (IT), and differential flexor tendon gliding (DFTG) were collected before and after 15 minutes of repetitive and resistive exercise. When analyzing collected data, descriptive statistics, and ANOVA were used to identify differences between groups. Receiver operating characteristic curves (ROC), area under the curve (AUC), sensitivity, and specificity were calculated to determine acceptable cutoff scores. Cutoff values with significant AUC ≥ 0.60 and sensitivity ≥ 0.80 were accepted. Statistically significant differences were found between HV by gender in both pre-exercise and post-exercise conditions. Gain scores for whole sample HV, female HV, and TROM-E were statistically different although differences were small and not meaningful. Significant AUC and acceptable pre-exercise cutoff values included 375 ml. for female HV (sensitivity 89%, specificity 87%), 505 ml. for male HV (sensitivity 81%, specificity 70%), 82 degrees for TROM-E (sensitivity 92%, specificity 71%), and 73 degrees of TROM-F (sensitivity 90%, specificity 89%). Potential at-risk OI-related populations, especially unaffected limbs of UULA persons, are best identified by pre-exercise cutoff values using HV by gender, TROM, and single-site SWM 2.83. •Unaffected limbs of persons with unilateral upper limb amputations are at-risk for overuse injuries but are not routinely assessed.•Gain scores for six OI-assessments, when performing high repetition and resistive exercises, are not satisfactory indicators to identify persons at-risk for OI.•Hand volumes differ by gender and pre-exercise cutoff scores that identify at-risk OI populations are 375 ml (females) and 505 ml (males).•Torque range of motion pre-exercise cutoff scores that identify at-risk O