The Journal of Hand Surgery - European Volume - April 2018 - 4

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achieve more long lasting results. Combining all
these modalities in a time specific manner based
on the individual needs of each patient seems to be
the most effective long term guaranteed
management.
Methods: We present the senior author 14years'
experience of more than 1200 interventions in
cases of upper limb spasticity management and the
evolution of the combination therapy over the years
through comparing the long-term outcomes and
results of single/individual versus combination therapy of upper limb spasticity.
Results: Patients were assessed in a multidisciplinary setting. Hand Therapy, patient, family and carersall contribute to outcome assessment. A combined
approach to treatment in parelell provides better
outcomes in a more time efficient way rather than
the traditional series approach.
Conclusions: Successful management of upper limb
spasticity requires more than Botulinum injections.
We recommend treating the patients within MDT setting and the early consideration of combination therapy to improve the long-term outcomes.

How to Diagnose a 'TOS'ser
Ms Roisin Dolan, Professor Henk Giele, Dr Ravi Knight,
Ms Jia See and Dr Vivek Murthy
John Radcliffe Hospital
Time in Programme: Thursday 3rd May 2018 09:54

Aims: The aim of this study was to correlate symptoms, pre-operative clinical provocative tests, radiological and neurophysiological studies with findings
at surgical exploration, to predict accurate diagnosis
of thoracic outlet syndrome (TOS).
Methods: We performed a retrospective review of a
prospectively maintained TOS database. All patients
were clinically assessed at the Oxford University
Hospitals NHS Trust between April 1997 and
November 2017. Each patient was assessed as follows: 1. Clinical history 2. Clinical tests for vascular
compression (Adson's manoeuvre, Reverse Adson's
test, Wright's hyperabduction test, Falconer's test)
and for neural compression (Roos's test, Spurling's
test, Morley's compression test and Tinel's sign). 3.
Radiological investigations (MRI of cervical spine and
brachial plexus) and 4. Neurophysiological studies.
Results: One-hundred and twenty-five patients
(n ¼ 125) underwent thoracic outlet exploration on
one-hundred and sixty limbs. There was a female
preponderance in this cohort (n ¼ 94, 75%) and age
ranged from 22-75 years (mean: 41 years). At latest

Journal of Hand Surgery (Eur) 43(Supplement 1)
follow ¼ up (minimum of 3 years), recurrences were
noted in n ¼ 18 patients (14%) and n ¼ 99 patients
(79%) reported Derkash's full/good outcomes.
Morley's compression test was the most commonly
positive test (82%), MRI demonstrated pathology in
49% of patients and nerve conduction studies were
suggestive/positive in 36%. Patients with > 4 preoperative positive clinical tests demonstrated highest
Derkash's outcome scores.
Conclusions: We identified the quadriad of 1. positive
Morley's test 2. positive NCS 3. positive findings on
MRI and 4. presence of cervical rib, associated with
highest diagnostic accuracy and resolution of
symptoms.

Surgery for Thumb Base Osteoarthritis: The
Landscape and Outcomes from the BSSH UK
National Hand Registry
Miss Jennifer Lane, Mr Matthew Gardiner,
Mr Jeremy Rodrigues, Professor Dominic Furniss and
Mr Robert Poulter
University of Oxford
Time in programme: Thursday 3rd May 2018 10:01

Aims: To evaluate the impact of surgical subtype
upon patient reported outcomes (PROMs) following
surgery for base of thumb osteoarthritis (BTOA).
Methods: The UK National Hand Registry (UKNHR,
formerly called the BSSH Audit Database) prospectively collects data from patients undergoing hand
surgery as part of an approved national quality assurance process.
This study involved secondary analysis of fully
anonymised data from the registry. Exemption from
ethical approval was confirmed by University of
Oxford Clinical Trials and Research Governance
(CTRG) prospectively.
All procedures captured in the UKNHR from inception (May 2011) to January 2018 were included.
Procedures were sub grouped by surgical intervention type, and outcome evaluated using EQ5D index,
visual analogue score (VAS) and Patient Evaluation
Measure (PEM) outcome measures at baseline, 3, 6
and 12 months post-operatively. Regression analyses
were conducted with procedure type and gender as
factors.
Results: 1298 procedures were included. Simple trapeziectomy with LRTI represented 52% and 43% of
cases respectively; which was static over UKNHR's
history.
There was no significant difference in PROMs at
baseline between trapeziectomy and LRTI, nor in

Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018