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An Analytical Study on the Finger Flexion Cascade in General Population of Various Occupations Research Article Orthop Rheumatol Open Access J Volume 1 Issue 1 - August 2015 Copyright © All rights are reserved by Jibu George varghese An Analytical Study on the Finger Flexion Cascade in General Population of Various Occupations K. Asha1, Jibu George Varghese1, V. Srinivasan1 and Kannabiran Bhojan2 1Sri Ramachandra University, India 2RVS College Of Physiotherapy, India Submission: September 10, 2015; Published: October 06, 2015 *Corresponding author: Jibu George varghese, Assistant Professor, Faculty of Physiotherapy, Sri Ramachandra University, Coimbatore, India, Email: Abstract Background and Purpose: Finger flexion cascade (FFC) is a natural phenomenon that is observed in the hand at complete rest. It is the posture/alignment of fingers with some flexion at all the joints of digits, beginning with less flexion at the index finger, progressing to more flexion towards the little finger. The FFC may vary in individuals of different occupations as occupational activities performed over a prolonged period may have an influence on the finger flexion ROM thereby influencing the normal FFC. Understanding the variations may serve as a valuable tool to manage rehabilitation following hand injuries, which may include improving the finger flexion joint ROM suited to the need of the individual. The purpose of this study was to observe, measure and document the FFC in individuals belonging to different occupations and to analyzeMethods: whether a significant variation may be seen within the occupations and between the occupations. One hundred twenty five healthy individuals with an age ranging between 20 to 60 years who met the inclusion criteria participated in the study. Occupations included were electricians, maintenance workers and desk workers. The participants completed a performa related to their occupation prior to the study. Goniometry was used to measure the MCP, PIP and DIP flexion ROM of the dominant and non dominant hand. Composite finger flexion a gross method of measuring finger ROM was also measured using a geometric ruler. The valuesResults: obtained were recorded and analyzed. To find variations within an occupation paired t test was used. ANOVA was used to analyze of variations between the 3 groups. The Conclusion:results between the groups were found to be statistically significant at p value < 0.05 The finger flexion cascade was found to vary in individuals belonging to different occupations therefore occupation has an influence on the normal FFC which suggests that following hand injuries rehabilitation program can be aimed at achieving hand function dependingKeywords: upon the demand the occupation places over the hand. Cascade; Range of motion measurement; Goniometer; Hand injuries; Occupation. Introduction of physiological processes that occur in successive stages and each of the process is dependent on the preceding one to produce Human hand is a highly specialized instrument which serves a cumulating effect (Houghton Miffliz 2002). us well in multitude of ways. It is a primary effector organ for our complex motor behaviors. Hand is intimately correlated with The Finger flexion cascade (FFC) at rest is the posture/ the brain. Our hands contribute to mental processes of thought alignment of fingers with some flexion at all the joints of the digits, and feelings. The functions of the hand are unique, which cannot beginning with less flexion at the index finger and progressing be substituted by any other part of the human body. We use our to more flexion towards the little finger (Text Book Of Rosen’s fingers without an observation as to how they function. If you emergency medicineth – Concepts & Clinical Practice – Marx Hock keenly observe you will be able to appreciate that the fingers of Berger Walls -7 Edition). Ideally, the ‘Cascade sign’ indicates 8our hand at rest form an attitude which is often referred to as natural flexion of the fingers in which the tips point to the theth flexion cascade. According to the Moby’s medical dictionary scaphoid bone at the base of palm [1,2]. The tone and flexibility edition 2009, Cascade is defined as any process that develops of the soft tissues in a resting hand is responsible for the cascade in stages, with each stage developing on the preceding one, often sign in normal subjects. When this normal phenomenon is producing a cumulative effect. It may also be defined as the series disrupted due to any injury to the flexor tendons or digits it may Orthop Rheumatol Open Access J 1(1): OROAJ.MS.ID.555554 (2015) 001 Orthopedics and Rheumatology Open Access Journal Materials and Methods lead to an altered finger flexion cascade which may impair the Methodology function of the hand as a whole. Among the flexor tendons injures the most commonly involved tendons are flexor digitorum superficialis (FDS) and flexor digitorumprofundus (FDP) leading This Observational cross sectionalstudy was conducted in to an abnormal FFC [3]. three different departments of Sri Ramachandra University which included the electrical, maintenance, and medical record Earlier studies have highlighted the importance of observing departments. Subjects, both males and females who met the the flexion cascade following hand injuries as it gives us an idea inclusion criteria were explained in detail about the nature and about the involvement of flexor tendons [3,1]. Though, FFC is the purpose of the study. An informed consent in the regional observed and assessed for all hand injury patients there is a lack language (Tamil) was obtained from all those subjects who were of literature on reference normative values to identify abnormal willing to participate in the study. Subjects of both the genders flexion cascade. Various studies have been done to measure and different occupations were included in the study. Any the flexion and extension angles of resting fingers and wrist in subjects with injury to upper limbs or congenital malformation relation to forearm and shoulder posture in normal subjects [4]. and deformities of hand were excluded. But there are no studies that have assessed the FFC. The present study was conducted on 125 subjects, among Occupational hand injuries are commonly seen worldwide which 106 were males and 24 were females with an age ranging from industrial workers to carpenters, plumbers and various between 20-60 years. Prior to the study all the subjects completed other occupations. A study done to find the prevalence of these a Performa that included questions about the hand dominance, injuries stated that hand and finger injuries accounted for 30% of duration of working hours, nature of work, lifting weights, history all occupational injuries which were more common in males with of hand injury, mode of transport and demographic data maximum involvement of hand and finger tendons [5]. The FFC may vary with different occupations in which the hand may be Subject recruitment: Ethical committee clearance was used with various degrees of finger flexion, occupational activities obtained from the ethics committee for student’s proposal, Sri RamachandraInstrumentation University (REF: csp\14\oct\37\198). performed over a prolonged period of time may lead to a change in the resting hand position based on the type of hand grip used, since some occupations require more of precision handling while a. Baseline finger goniometer some involve prehension activities and few others may involve using both. And therefore occupation may have a significant Procedureb. Ruler influence in the formation of normal FFC. The FFC at rest has been assessed across various parameters for patients who suffer flexor tendon injuries/ hand injuries, in terms of patient’s history, The subjects were made to sit comfortably on a chair with the mechanism of injury, position of hand and digits at the time of dominant hand well supported on a table of comfortable height injury, any deformities and skeletal trauma [6]. and the feet flat on the floor. The upper extremity to be tested was positioned with the shoulder by the side, elbow flexed to The Range of Motion (ROM) is used as an assessment tool midrange,o forearm supinated, and wrist in functional position and an outcome measure to evaluate the joint motion and the (15 -20º extension) and hand in a complete resting position impact of medical, surgical and therapeutic interventions on it placed at the edge of the table. The therapist sat adjacent to the by clinicians [7]. There are many different methods employed patient in order to take the readings. The patient was clearly to measure hand and finger ROM which include goniometry, instructed not to move his upper extremity or the fingers during composite finger flexion to distal palmar crease, visual estimation, the course of assessment and to stay completely relaxed. First torque ROM. Goniometry has been found to have a higher intra- a baseline finger goniometer was used to measure the resting rater reliability and can be thereby used to measure finger ROM, flexion ROM of the MCP joint of index finger. The goniometer was while composite finger flexion has been found to have a higher placed on the dorsal aspect of the hand to be tested, such that intra- rater reliability [8,9]. the stable arm lied parallel to the metacarpal of second digit and Following a hand injury involving the flexor tendons, the midpoint of the goniometer corresponded to the joint axis of surgery and rehabilitation protocols may be designed based on the second MCP joint, the movable arm of the goniometer from a position of zero degrees was then moved till it lied parallel to the occupation of the individual, and henceforth the decision the proximal phalanx ofnd the index finger, this reading was then regarding termination of supervised rehabilitation and return noted down as MCP 2 digit. The flexion ROM of the PIP joint to regular activities may be based on the patient achieving the of the same digit was then measured by placing the goniometer required finger flexion cascade specific to their occupation, for such that the stable arm lied parallel to the proximal phalanx of which the need of the hour is to establish baseline normative the second digit with the midpoint of goniometer corresponding values of the cascade sign in various occupations.
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