The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients' needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients' requirements and have relevance to their daily activities.

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

The surgical treatment of painful osteoarthrosis of the trapeziometacarpal joint with the Epping technique consists of excision of the trapezium and reconstruction of the first intermetacarpal ligament by using the distally based half of the flexor carpi radialis tendon. This ligament reconstruction procedure aims to prevent proximal migration of the first metacarpal, restore function and stability of the neoarthros. This retrospective study presents operative outcome results after using the Epping arthroplasty technique. The Epping technique has been performed in seventy cases and could be evaluated after a mean follow-up of 34.6 months in 92.4 % of all operated patients. Subjective results were evaluated using patient-based questionnaires such as the Buck-Gramcko-Score and the German Version of the DASH V2.0 questionnaire. Objective and functional outcome analysis including range of motion, strength measurements with the computer-based JAMAR dynamometer and various X-ray views, have been used as further methods of evaluation. Excellent pain relief and very good subjective results with 86 % patient satisfaction have been reported by our patients. The objective outcome analysis demonstrated good functional results with respect to radial abduction (51 degrees) and palmar flexion (45 degrees), and improvement in grip strength, key pinch and pulp pinch. Some patients reported remaining problems with pain during performance of activities of daily life and professional activities. A significant proximal metacarpal migration without correlation to the objective or subjective outcome was found in follow-up X-ray controls. The Epping ligament reconstruction procedure has proven to be a valuable standard procedure after a mid-term follow-up period. Good functional outcome and high patient satisfaction could be achieved, but some patients still remain with problems in different activities. Long-term results still need to be evaluated.

We were able to validate plain radiographs as a reliable tool in the work-up of patients with suspected SL ligament injuries. However, wrist arthroscopy remains the gold standard in diagnosing and treating these lesions.