Scoring Systems in the Wrist, Forearm, and Elbow Field

Every symptom that patient claims is different in each individual. When the clinical study is performed, it is quite important to average all data to evaluate results. Objective data, such as the active and passive range of motion (degrees) of the joint or grip power (kilograms), are easy to compare in groups with an average method, and subjective data, such as pain, instability feeling, or uncomfortableness, are difficult to compare. We have used a modified Mayo Wrist Score which includes both patient and physician participation to assess pain, the active flexion/extension arc (in comparison with the contralateral side), grip strength (in comparison with the contralateral side), and the ability to return to regular employment or activities (patient’s satisfaction) for clinical studies. This system includes two categories of subjective data (pain and satisfaction), and two categories of objective data (active range ofmotion andgrip power) to calculate scores (0–25) and then total sum of scores is evaluated for 4 results categories, such as excellent (91–100), good (80–90), fair (65–79) and poor (less than 65). This system is widely used worldwide. Recent patient-related evaluating systemsaremostly basedon patients, such as disabilities of the arm, shoulder and hand questionnaire, patient-related wrist evaluation, or visual analog scale. All scoring systems must calculate the data and are quite difficult to compare each other. It is also quite difficult to understand patient’s condition from the data. Herzberg et al established a new evaluating system for wrist which includes subjective and objective data on one figure like a spider web.1 It is easy to see the data. Narrower web means the patient has multiple problems. From the preoperative data, this system emphasizes what problem(s) the patient has, such as loss of range of motion, severe pain, or moderate instability. Wider web after surgical treatment suggests that acceptable clinical result was obtained both for the surgeon and patient. This issue includes the “Special Review” of “New Computerized Elbow and Forearm Clinical Scores” described by the same authors. They expanded their method for the wrist to the forearm and elbow. We have the elbow scoring system and wrist scoring system, yet there is no clinical scoring system which includes the function of forearm and elbow. Considering the Essex-Lopresti injury violates both the distal radioulnar joint (DRUJ) that is included in the wrist and the proximal radioulnar joint included in the elbow, the wrist, forearm, and elbow may be considered as one unit. Upon this view, we need clinically evaluating scoring system for the forearm, elbow, and wrist. This special review is the first step. Interesting wrist papers, such as arthrodesis of the lunotriquetral joint, volar lunate facet fracture of the radius, DRUJ arthroplasty, thumb carpometacarpal treatments, arthroscopic bone grafting for scaphoid proximal pole, survey for thumb arthritis, and interesting case reports are also included. Don’t miss it.