Samples of skin and underlying cord obtained at dermofasciectomy for Dupuytren's contracture have been examined for the presence of smooth muscle alpha-actin (SM alpha-actin), a marker for myofibroblasts. 15 of the 20 samples stained positively for SM alpha-actin corresponding with areas of hypercellular Dupuytren's tissue. In 12 of these 15 samples SM alpha-actin-positive hypercellular Dupuytren's tissue extended into the dermis, in three cases reaching the epidermis. In eight samples, diffusely distributed cells positive for SM alpha-actin and resembling fibroblasts were seen in the dermis. These cells appeared to be separate from the Dupuytren's foci. The presence of hypercellular foci and isolated fibroblasts positive for SM alpha-actin within the dermis may explain the high recurrence rate of Dupuytren's disease after fasciectomy.

Introduction: The cold intolerance symptom severity (CISS) questionnaire is frequently used for the assessment of cold intolerance (CI) in patients following hand trauma. Its practical and conceptual limitations prompted the development of a new cold intolerance questionnaire (CIQ). The CIQ assesses and gives equal weighting to five components of CI, severity, frequency, extent, duration and prevention. An optional impact score can be included as the CIQþ. Method: Data were collected over a five-month period from adult hand trauma patients. Each patient completed the CISS, CIQ and the Quick DASH questionnaires during their assessment. A total of 51 patients (34 men and 17 women) were examined at a median interval of 14 months (3-48) after injury. Their mean age was 42 years (SE ¼ 2, range 18-81). Results: The median (range) scores were CIQ ¼ 16 (0-27), CIQ þ ¼ 18 (0-33), CISS ¼ 56 (0-89) and Quick DASH ¼ 44 (2-86). The scores were significantly correlated. The majority of patients had symptoms localised to the digit or point of injury. All but one of the five selected components of the CIQ and the separate impact score were significantly correlated. Conclusion: The authors found the CIQ to be a simple scoring system that is suited to clinical use. The CIQ has value as a research tool as it provides a method of categorising patients and of identifying patients suited to certain treatment methods. Furthermore, it may be a more informative tool in monitoring treatment as it is able to assess changes in pattern as well as overall score.

Four hundred adult claimants underwent medico-legal assessment following upper limb injuries. Dynamometry was performed on each using the Jamar five handle-position test. Injury causes loss of power and there is a significant relationship between the percentage loss of power and the measured whole limb impairment. This paper presents a new approach for the analysis of the tests. The normal physiological length-tension pattern of muscle is maintained in the majority of claimants albeit with modifications due to the specific effects of injury on hand function. This paper provides normative data for the analysis of dynamometry in this population and makes recommendations for parameters that suggest that a test is a true reflection of capacity and thus useable in court.

A consecutive group of 250 patients underwent medico-legal assessment at a mean of 24 (±13) months following upper limb injuries. Each had completed questionnaires to assess function (Quick-DASH) and cold intolerance (CIQ36) before clinical assessment following which their whole limb impairment percentage was calculated. The mean(±SD) whole limb impairment, QDASH and CIQ36 scores were 9(±14)%, 43(±24) and 17(±10), respectively. There was a significant correlation between whole limb impairment and QDASH, although some patients reported surprisingly high disability levels despite minimal or no objective functional impairment. Whilst useful qualitative information can be obtained from questionnaires, the correlation between subjective and objective scores is weak albeit statistically significant. Individual patients can show marked discrepancies between objective and subjective functional scores. The results of questionnaires in individual medico-legal patients should be treated with caution.