JHS Journal Club

Created in 2018, the JHS Journal Club is a Twitter-based journal club that allows you to interact with other Journal of Hand Surgery readers and discuss interesting articles in JHS. You’ll participate in live meetings via Twitter, sharing thoughts with readers from around the world.

How to Participate

Step 1. Sign up for Twitter if you haven’t already. If you’re unfamiliar with Twitter, check out Twitter Guide: Getting Started.

Step 2. Join the conversation

Using the actual Twitter website or app is not the best option for participating, as you will be required to continually refresh your feed to follow the conversation. Try one of these easy alternatives:

  • Option 1 (highly recommended): Visit tchat.io and enter the hashtag #JHSJC to follow the conversation in real-time. The site will automatically add the #JHSJC hashtag to each of your tweets and make it easier for you to participate. An alternative to tchat.io is tweetchat.com. Be sure to allow access your Twitter account.
  • Option 2: Follow the #JHSJC hashtag as a saved search in a Twitter client such as Tweetbot (download for Mac, iPhone or iPad), which has the ability to continually stream when you are connected.

Step 3. Participate

Speak your mind!

  • If you’re following options 1 or 2 above, the #JHSJC hashtag will automatically be added to your tweets, so there’s nothing else you need to do.
  • If you’re using the Twitter website or app, be sure to include @JHandSurg and #JHSJC to your Tweets.

Questions? Contact us at jhs@assh.org.

April #JHSJC

April’s #JHSJC will take place on:

Date: April 9, 2019
Time: 9:00 p.m. EDT

Article #1

Evaluation of Version 2.0 of the PROMIS Upper Extremity Computer Adaptive Test in Nonshoulder Upper Extremity Patients
Andrew R. Tyser, MD, Man Hung, PhD, Jerry Bounsanga, BS, Maren W. Voss, ScD, Nikolas H. Kazmers, MD, MSE

April 2019: Volume 44, Issue 4, Pages 267–273
Full article: https://www.jhandsurg.org/article/S0363-5023(18)30376-9/fulltext


The authors administered the QuickDASH and the 2.0 version of the PROMIS Upper Extremity scale to 825 patients seen during a 7-month period in 2017. The purpose was to determine if the performance characteristics of the 2.0 instrument had been improved over the earlier version of the scale. The main findings were that, like the previous release, the UE scale remained highly correlated with the QuickDASH. The ceiling effect of the scale was slightly improved but remained substantial at 6.9%. There was a scoring gap between scores 56 and 60. The authors concluded that there were still important performance gaps in the 2.0 version but that there was shown an ability for the scale to be upgraded. The authors were interviewed for the April podcast.

Points for discussion

  • Without going into all the technical points related to the psychometric meaning of a ceiling effect, the main message is that, for this scale, upper extremity function that exceeds one standard deviation from the mean cannot currently be measured using this scale. In other words, nobody can score over 61 points – and in this study only one person scored 61, with nobody scoring between 56 and 60 so, in reality, the highest score achieved could be as little as 56. Is that a problem?
  • One of the advantages of the computerized adaptive tests is that they use item response theory to limit the number of items that must be measured in order to establish a score. Most of the publications that look at PROMIS instruments emphasize that they take less time complete than the legacy scales, although that difference is usually a matter of minutes. Is that worth the tradeoff that these scales might perform less well than the DASH or MHQ?
  • Assuming that future versions can be refined, what characteristics of the current PROMIS scales should be improved?

Article #2

Defining Quality in Hand Surgery From the Patient’s Perspective: A Qualitative Analysis
Sara L. Eppler, MPH, Sanjeev Kakar, MD, MBA, Nicole Sheikholeslami, MS, Beatrice Sun, BS, Hillary Pennell, PhD, Robin N. Kamal, MD

April 2019: Volume 44, Issue 4, Pages 311–320.e4
Full article: https://www.jhandsurg.org/article/S0363-5023(18)30789-5/fulltext


The authors used qualitative methods to identify areas that hand surgery patients considered indicative of quality. After establishing a survey comprising open-ended questions with a pilot group of 10 patients, another 99 individuals participated at the time of their 6-8 week post-operative visit. Strategies standard for qualitative studies were used to complete a thematic analysis. Four general themes were identified: being prepared and informed for the process of surgery; regaining hand function without pain of complication; patients and caregivers negotiating the physical and psychological challenges of recovery; financial and logistic burdens of undergoing hand surgery. The authors concluded that these are areas that are not currently represented in quality measures for hand surgery.

Points for discussion

  • The paper doesn’t describe the clinical problems with which the patients presented other than stating that 31% were “trauma” and 69% elective”. Does that have any ramifications as far as the findings are concerned?
  • Does it matter to the observations that the patients had already been treated, all of them with surgical procedures?
  • The study was carried out at two tertiary centers and the reported income for was “> $100,000” for over 1/3 of participants. Is the setting and sample for the study a concern? In other words, are these findings likely to be generalizable in the way that payers might consider them in the future?
  • It could be argued that only some of these themes are actually areas that could be controlled by a surgeon, i.e. helping patients be prepared and informed about their surgery and helping them regain function without pain or complication. Most clinicians would likely feel that these are what “quality” should encompass but the findings of this study suggest something else. What are the implications of this as we move closer to a “value”-based system of reimbursement, where the provision of “quality” will be an important determinant of that value?


Previous #JHSJC Discussion Articles

March 2019
Article 1: False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30599-9/fulltext)
Article 2: Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized Double-Blinded Trial (https://www.jhandsurg.org/article/S0363-5023(18)30793-7/fulltext)

February 2019
Article 1: Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol (https://www.jhandsurg.org/article/S0363-5023(17)31857-9/fulltext)
Article 2: Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System (https://www.jhandsurg.org/article/S0363-5023(17)32092-0/fulltext)

January 2019
Article 1: Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up (https://www.jhandsurg.org/article/S0363-5023(18)30248-X/fulltext)
Article 2: External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study (https://www.jhandsurg.org/article/S0363-5023(18)30023-6/fulltext)

December 2018
Article 1: Predicting Clinical Outcome After Surgical Treatment in Patients With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30650-6/fulltext)
Article 2: Cost-Effective Management of Stenosing Tenosynovitis (https://www.jhandsurg.org/article/S0363-5023(17)30874-2/fulltext)

November 2018
Article 1: Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study (https://www.jhandsurg.org/article/S0363-5023(17)30684-6/fulltext)
Article 2: Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery (https://www.jhandsurg.org/article/S0363-5023(17)31145-0/fulltext)

October 2018
Article 1: The Effectiveness of Mini–C-Arm Fluoroscopy for the Closed Reduction of Distal Radius Fractures in Adults: A Randomized Controlled Trial (https://www.jhandsurg.org/article/S0363-5023(17)30746-3/fulltext)
Article 2: Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone (https://www.jhandsurg.org/article/S0363-5023(18)30652-X/fulltext)

September 2018
Article 1: A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31445-4/fulltext)
Article 2: Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties (https://www.jhandsurg.org/article/S0363-5023(16)30694-3/fulltext)

August 2018
Article 1: Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30613-0/fulltext)
Article 2: Cost of Surgical Treatment for Distal Radius Fractures and the Implications of Episode-Based Bundled Payments (https://www.jhandsurg.org/article/S0363-5023(18)30629-4/fulltext)

July 2018
Article 1: Immediate Versus Overnight-Delayed Digital Replantation: A Comparative Retrospective Cohort Study of Survival Outcomes (https://www.jhandsurg.org/article/S0363-5023(18)30459-3/fulltext)
Article 2: Arthroscopic Diagnosis of the Triangular Fibrocartilage Complex Foveal Tear: A Cadaver Assessment (https://www.jhandsurg.org/article/S0363-5023(17)30956-5/fulltext)