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Physical & Occupational Therapy in... 2023Limited information is available on impairments, activity limitations and participation restrictions in youth with Hutchinson-Gilford progeria syndrome (HGPS), a rare...
AIMS
Limited information is available on impairments, activity limitations and participation restrictions in youth with Hutchinson-Gilford progeria syndrome (HGPS), a rare genetic premature aging disease. The purposes were to: (1) describe range of motion (ROM), grip, pinch and quadriceps strength, functional balance, walking endurance, and gross motor limitations and participation restrictions; (2) evaluate the association between ROM impairments and age; and (3) evaluate the association between the Gross Motor Function Measure-88 (GMFM) scores and lower extremity (LE) ROM, quadriceps strength, and age.
METHODS
Upper and LE ROM, grip, pinch and quadriceps strength, Timed Up and Go (TUG), Six Minute Walk Test, GMFM-88, and Canadian Occupational Performance Measure data were recorded for 38 participants with HGPS.
RESULTS
All youth exhibited ROM impairments and most displayed decreased grip and pinch strength, walking endurance, and gross motor skills when compared to same-aged peers. However, the majority had good functional balance with TUG scores in the normal range. Participation restrictions included difficulty keeping up with peers when walking and difficulty completing activities of daily living. Some ROM measurements were negatively associated with age indicating that older participants had more extensive ROM limitation than younger participants.
CONCLUSIONS
Physical and occupational therapists can use this information when evaluating youth with HGPS, designing a plan of care, and providing treatment interventions.
Topics: Humans; Adolescent; Progeria; Activities of Daily Living; Canada; Walking; Range of Motion, Articular
PubMed: 36628480
DOI: 10.1080/01942638.2022.2158054 -
Plastic and Reconstructive Surgery.... Apr 2021Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty....
BACKGROUND
Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty. Meniscal allograft has been used for large joint resurfacing, but its application to smaller joints is less well understood. We propose its use for hand joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function.
METHODS
Thirty-one patients with osteoarthritis of the CMC, MCP, or PIP joints underwent arthroplasty with meniscal allograft. Patient demographics and operative information were recorded. Preoperative Disability of the Shoulder, Arm, and Hand, Wong Baker pain, grip and pinch strength, and range of motion were compared to postoperative scores at 6 weeks, 6 months, and 1 year.
RESULTS
Twenty-three women and 8 men, mean age 62.8 years, underwent 39 joint reconstructions, including CMC (n = 26), thumb MP (n = 2), thumb IP (n = 2), digit MP (n = 2), and digit PIP (n = 7). At 1 year, mean Disability of the Shoulder, Arm, and Hand scores decreased from 41.3 to 15.6 ( < 0.001) and pain scores from 6.9 to 1.0 ( < 0.001). Grip strength increased from 38.1 to 42.9 ( = 0.017) and radial and palmar abduction from 43.1 to 49.2 ( = 0.039) and 43.7 to 51.6 ( = 0.098), respectively. There were no complications related to the meniscus.
CONCLUSIONS
Meniscal allograft represents an alternative to arthrodesis which obviates the need for a donor site and avoids many of the complications inherent to synthetic alternatives. Our early results demonstrate its successful use to reduce subjective pain and disability scores, improve objective strength measures, and maintain range of motion.
PubMed: 33889471
DOI: 10.1097/GOX.0000000000003520 -
Journal of Wrist Surgery May 2017This study aims to compare outcomes after pyrolytic carbon implant hemiarthroplasty (PH) versus Thompson suspensionplasty (TS) for trapezial-metacarpal (TM)...
This study aims to compare outcomes after pyrolytic carbon implant hemiarthroplasty (PH) versus Thompson suspensionplasty (TS) for trapezial-metacarpal (TM) arthritis. There were 87 arthritic TM joints in 71 patients treated with PH ( = 47 joints, 37 patients) or TS ( = 40 joints, 34 patients). Patients had significantly longer follow-up in the TS group (86.9 months, 25th-75th percentile = 55.6-103.8) versus the PH group (38.4 months, 25th-75th percentile = 23.2-65.8, < 0.001). PH patients maintained higher final grip strength ( = 0.03) and apposition pinch strength ( = 0.01) compared with TS patients. Nelson scores were significantly higher among patients undergoing PH (mean = 50.4, standard deviation [SD] = 24.5) compared with TS (mean = 36.8, SD = 12.5, < 0.01). There was a significantly higher proportion of complications ( < 0.01), reoperations ( < 0.01), and joint revision surgery ( < 0.01) in patients undergoing PH compared with TS. Controlling for age and sex, there was a 72.8% lower risk of complications ( = 0.02), 87.7% lower risk of reoperations ( = 0.01), and 87.2% lower risk of joint revision surgery ( < 0.01) among patients undergoing TS compared with PH. There was a shorter time to first complication ( < 0.01), reoperation ( < 0.02), and joint revision ( < 0.01) in those undergoing PH compared with TS. Both cohorts exhibited functional range of motion and pinch and grip strengths postoperatively, and those undergoing PH began with and maintained higher grip and pinch strength at final follow-up. Those undergoing PH had significantly increased risk of complications, reoperations, and joint revision surgery. Most complications in patients undergoing PH were related to suspected development of scaphotrapezotrapezoidal (STT) arthritis postoperatively. We thus recommend careful evaluation of possible STT arthritis when considering PH arthroplasty. Level III.
PubMed: 28428915
DOI: 10.1055/s-0036-1593735 -
Hand (New York, N.Y.) Sep 2019Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose...
Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose of this study is to evaluate the midterm clinical effectiveness of PIP joint arthroplasty for nonrheumatic arthritis. A single-center retrospective cohort study evaluating preoperative and postoperative objective and subjective measures was conducted. Range of motion (ROM), Disabilities of the Arm, Shoulder and Hand scores, key pinch strength, grip strength, and satisfaction with respect to pain, deformity, function, and strength were measured. Forty-five fingers in 25 patients were followed up for a mean period of 42 months. Preoperative and postoperative mean ROM was equivalent at 59.1° and 59.2°, respectively. Postoperative grip and key pinch strength showed significant improvement and near normalization compared with contralateral extremity. Complication rate was 37% with 20% requiring revision surgery. Patients with diabetes mellitus had higher odds of requiring revision surgery. Pain scores improved from 7.4 to 1.9 on a visual analog scale. Overall satisfaction was high at 84%, and 91% of patients would have the surgery performed again. Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. Our study presents midterm follow-up data that support significant pain relief, increased grip and key pinch strength, and high satisfaction associated with this implant.
Topics: Adult; Arthroplasty, Replacement, Finger; Disability Evaluation; Female; Finger Joint; Hand Strength; Humans; Joint Prosthesis; Male; Middle Aged; Osteoarthritis; Pain Measurement; Prosthesis Design; Range of Motion, Articular; Reoperation; Retrospective Studies; Silicones; Treatment Outcome
PubMed: 29619888
DOI: 10.1177/1558944718769427 -
Orthopaedics & Traumatology, Surgery &... Sep 2021Thumb carpometacarpal joint (TCMJ) osteoarthritis is the fourth leading cause of referral to elective hand surgery. None of the available techniques has proved superior...
BACKGROUND
Thumb carpometacarpal joint (TCMJ) osteoarthritis is the fourth leading cause of referral to elective hand surgery. None of the available techniques has proved superior over the others. Some techniques carry unacceptable risks for younger patients, such as loss of strength and shortening of the thumb column after total trapeziectomy, or wear and loosening after total arthroplasty. Our objective was to assess outcomes after partial arthroscopic trapeziectomy (PAT) combined with suspensionplasty using the abductor pollicis longus (APL) tendon in patients younger than 60years of age.
HYPOTHESIS
PAT combined with suspensionplasty using the APL tendon in patients younger than 60years would restore strength in the medium-term without further surgery.
MATERIAL AND METHODS
We retrospectively included consecutive patients operated between 2007 and 2017, in a single centre, and aged less than 60years. All patients had isolated TCMJ osteoarthritis stage 1 to 3 according to Eaton and Glickel classification that remained symptomatic despite optimal conservative treatment. We collected pain intensity, range of motion, strength, the Nelson Hospital Score (NHS), and the Patient-Rated Wrist Evaluation (PRWE) score. Radiographs were reviewed.
RESULTS
We included 27 patients, of whom 6 had surgery on both thumbs, yielding 33 thumbs for the analysis. Mean follow-up was 64.7months (range: 10.6-136.5months). Pain intensity, grip strength, and key-pinch strength were significantly improved (p<0.001), with no difference between men and women. No differences were found for the Kapandji score (p=0.2) or TCMJ hyperextension (p=0.06). At last follow-up, the mean NHS was 83.2±19.4 and the mean PRWE was 15.4±17.9. Mean sick leave duration was 5.4weeks (range: 1-24weeks). Only 2 patients, both in manual jobs, were unable to return to work. The radiographs at last follow-up showed the development of moderate TCMJ narrowing in 14 patients and evidence of scapho-trapezio-trapezoid (STT) osteoarthritis in 10 patients. No patient experienced complex regional pain syndrome or injury to the sensory branch of the radial nerve. A single patient required further surgery for persistent pain.
DISCUSSION
Patients younger than 60years who are treated with this minimally invasive technique are likely to experience sustained improvements in both strength and pain intensity. Total trapeziectomy and pyrocarbon implant has also been evaluated in younger patients, who experienced pain relief and strength gains but had lower levels of satisfaction and developed complications inherent in the implants. The short time off work and low morbidity make our technique a procedure of choice in younger patients. To build on this study, a comparison of PAT and arthroplasty would be of interest.
LEVEL OF EVIDENCE
IV.
Topics: Carpometacarpal Joints; Female; Humans; Male; Range of Motion, Articular; Retrospective Studies; Tendons; Trapezium Bone
PubMed: 34116236
DOI: 10.1016/j.otsr.2021.102983 -
Neuromuscular Disorders : NMD Apr 2022Grip myotonia and weakness are attractive treatment response biomarkers in clinical trials of myotonic dystrophy type 1 (DM1). There is a need to develop simple,...
Grip myotonia and weakness are attractive treatment response biomarkers in clinical trials of myotonic dystrophy type 1 (DM1). There is a need to develop simple, patient-friendly and reproducible methods of quantifying grip myotonia in multisite trial settings. We designed a HandClench Relaxometer (HCR) that measures grip myotonia and strength. In contrast with the existing quantitative myometry (QMA) setup, the HCR is portable, economical, can be used with any laptop and generates automated command prompts. We demonstrate the feasibility and reliability of HCR device in twenty DM1 individuals and ten age-matched controls; patients returned for follow up within two months. The device showed excellent day to day reproducibility (ICC >0.80) in patients. The HCR device detected myotonia in milder muscle disease and measured longer myotonia duration than QMA indicating enhanced sensitivity for quantifying myotonia in DM1. The reaction time to the relax but not squeeze command was delayed and showed warm up similar to myotonia in DM1. HCR outcomes were correlated with key pinch strength, hand dexterity test, and fat replacement in the MRI of the long finger flexor muscles. Use of the HCR is warranted for grip myotonia and strength measurements in longitudinal observational and interventional studies of DM1.
Topics: Electromyography; Hand Strength; Humans; Infant; Myotonia; Myotonic Dystrophy; Reproducibility of Results
PubMed: 35305880
DOI: 10.1016/j.nmd.2022.02.005 -
Hand Therapy Jun 2022Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this... (Review)
Review
INTRODUCTION
Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this review was to establish whether either intervention reduced pain and improved pinch strength in people with first CMCJ OA in the short term and assess whether one intervention is superior to the other.
METHOD
This was a systematic review and meta-analysis. Seven databases were searched until May 2021. Only RCTs were included. The Cochrane Risk of Bias Tool and the Grade of Recommendations Assessment, Development and Evaluation system were utilised to rate the evidence. Random-effects meta-analysis with subgroup analyses were used.
RESULTS
Eight studies were included with a total of 417 participants. Mobilisation treatments included manual therapy with or without exercise while immobilisation interventions utilised thumb splinting with several different designs. Very low-quality and low-quality evidence showed that mobilisation led to statistically but not clinically significant improvements in pain (standardised mean difference (SMD) = 0.53; 95% confidence interval (CI) = 0.03 to 1; I = 60%; = 0.06) and pinch strength (SMD = 0.35; 95% CI = 0.03 to 0.7; I = 12%; = 0.3) compared to placebo. Very low-quality and low-quality evidence showed no effect on pain and pinch strength compared to a control or no intervention. Subgroup analyses revealed no difference between interventions.
DISCUSSION
Neither mobilisation nor immobilisation alone led to clinically important improvements in pain or pinch strength in the short term in people with symptomatic first CMCJ OA. Neither therapeutic strategy appeared to be superior.
PubMed: 37904729
DOI: 10.1177/17589983221083994 -
The Archives of Bone and Joint Surgery Nov 2018The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus short thermoplastic custom-made splints, that are the most commonly... (Review)
Review
BACKGROUND
The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus short thermoplastic custom-made splints, that are the most commonly used for the management of first carpometacarpal (CMC) osteoarthritis (OA).
METHODS
We conducted a meta-analysis and systematic review in the literature based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted the outcomes of disability scores, pain scores, grip and pinch strength and gathered the unified data accordingly.
RESULTS
We included five randomized clinical trials with 230 patients with the mean age of 61 years and the mean follow-up of 8.1 weeks. The results of the pooled data demonstrated only a statistically significant difference in disability scores among splints in favor of the prefabricated splints. The rest of the outcome measures consisting of pain, grip strength, and pinch strength were not statistically different.
CONCLUSION
According to our systematic review and meta-analysis, both thumb-based splints improved pain and function in the first CMC OA in a short-term follow-up, nevertheless the efficacy of prefabricated splints in abatement of disability scores was significantly higher than custom-made splints. In contrast, the other outcome measures including pain, grip and pinch strength were improved identically after wearing either of the splints.
LEVEL OF EVIDENCE
II.
PubMed: 30637302
DOI: No ID Found -
Medicine Jun 2018Although cross tape has recently been used by clinicians for various musculoskeletal conditions, scientific studies on the direction of cross tape application are... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although cross tape has recently been used by clinicians for various musculoskeletal conditions, scientific studies on the direction of cross tape application are lacking.
METHODS
The present study aimed to investigate whether the direction of cross tape application affected the outcomes of the modified O-ring test and maximal pinch strength using a pinch gauge and the conformity between these 2 tests when cross tape was applied to the forearm muscles of individuals with no upper extremity pain and no restriction of joint range of motion.This study used a single-blinding crossover design. The subjects comprised 39 adults (16 men and 23 women). Cross tape was applied to the dominant hand so that the 4 rows were at an angle of 45° to the right or left of the direction of the flexor digitorum superficialis muscle fibers, and then the subjects underwent a modified O-ring test and a test of maximal pinch strength using a pinch gauge. Both tests were performed in both directions, and the order of the directions and tests was randomized. SPSS 18.0 was used for statistical analysis. Cohen's kappa coefficient was used to analyze the conformity of the results from the 2 tests. The statistical significance level was P < .05.
RESULTS
A positive response in the modified O-ring test and maximal pinch strength were both affected by cross tape direction. The modified O-ring test and maximal pinch strength using pinch gauge results were in agreement (P < .00), and the kappa coefficient was significant at 1.00.
CONCLUSION
The direction of cross tape application that produced a positive response in the modified O-ring test also produced greater maximal pinch strength. Thus, we propose that when applying cross tape to muscles, the direction of the 4 lines of the cross tape should be 45° relative to the direction of the muscle fibers, toward the side that produces a positive response in the modified O-ring test or produces the greatest maximal pinch strength using a pinch gauge.
Topics: Adult; Athletic Tape; Cross-Over Studies; Female; Fingers; Forearm; Humans; Male; Pinch Strength; Range of Motion, Articular; Reproducibility of Results; Single-Blind Method
PubMed: 29851806
DOI: 10.1097/MD.0000000000010879 -
Journal of Orthopaedic Surgery and... Nov 2019The thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal... (Comparative Study)
Comparative Study
BACKGROUND
The thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition (LRTI) are the most common. These two surgical treatment methods have received mixed reviews in previous studies in the west patients. This retrospective study studied the effects, advantages, and disadvantages of arthrodesis and arthroplasty for treating thumb carpometacarpal osteoarthritis in Chinese patients.
METHODS
Between February 2012 and September 2017, 39 Chinese patients with stage II or III thumb carpometacarpal osteoarthritis underwent surgery (trapeziometacarpal arthrodesis in 22, trapezial excision with ligament reconstruction and tendon interposition in 17). Postoperative objective and subjective evaluations were performed. The objective evaluation involved grip strength, pinch strength, thumb abduction degree (palmar and radial), and Kapandji opposition scores. The subjective evaluation involved visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.
RESULTS
Intergroup differences in pinch strength, thumb abduction degrees (palmar and radial), and Kapandji opposition scores were obvious, whereas those in grip strength, VAS score, and DASH score were not.
CONCLUSION
In Chinese patients, both techniques relieved pain and improve grip strength. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. Patients were satisfied with the effects of both techniques.
Topics: Adult; Aged; Arthrodesis; Arthroplasty; Carpometacarpal Joints; Female; Humans; Male; Middle Aged; Osteoarthritis; Pinch Strength; Range of Motion, Articular; Retrospective Studies; Thumb
PubMed: 31783888
DOI: 10.1186/s13018-019-1469-2