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BMJ Open Nov 2023To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP)... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS).
DESIGN
An assessor-blind randomised controlled trial.
SETTING
Hospital-based hand therapy clinics.
PARTICIPANTS
Fifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks.
OUTCOME MEASURES
The standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen's manoeuvre test, Tinel's sign and the Boston CTS Questionnaire.
RESULTS
Both groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen's manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength.
CONCLUSION
Splinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6 months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs.
TRIAL REGISTRATION NUMBER
ISRCTN13189602.
Topics: Adult; Humans; Carpal Tunnel Syndrome; Wrist; Occupational Therapy; Hand Strength; Metacarpophalangeal Joint; Treatment Outcome
PubMed: 38016794
DOI: 10.1136/bmjopen-2023-076961 -
European Review For Medical and... Oct 2023The aim of this study was to compare the effectiveness of high vs. low-intensity exercise training on muscle strength, physical function, and quality of life in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of this study was to compare the effectiveness of high vs. low-intensity exercise training on muscle strength, physical function, and quality of life in post-COVID-19 patients with sarcopenia secondary to chronic kidney disease (CKD).
PATIENTS AND METHODS
82 subjects were randomized into 2 groups: high intensity (HIG, n=42), which received high-intensity resistance training, and low intensity (LIG, n=40), which conducted low-intensity aerobic activities. Exercises were performed for 30 min, 3 times per week for 6 weeks. A handheld dynamometer, pinch press, and 1 min sit-to-stand (STS) test were used to assess muscle strength. Modified physical performance test and sarcopenia Quality of Life questionnaire (SAR-QoL) were used to assess function and quality of life, respectively. Measures were collected before and at the end of the treatment program.
RESULTS
Participants were similar at baseline. The within-group comparisons demonstrated statistically significant improvement in both HIG and LIG groups in all outcome measures (p<0.001). Between groups, comparisons revealed statistically significant better achievements with high effect size in Modified Physical Performance Test (MMPT) (p<0.001, d=1.28), handgrip (p<0.001, d=3.6), STS (p<0.001, d=2.38), and SAR-QoL (p<0.001, d=3.24) in favor of the HIG. On the other hand, pinch press strength was equally improved in both groups (p=0.09, d=0.36).
CONCLUSIONS
High-intensity exercise is better than low-intensity exercises in post-COVID-19 patients with sarcopenia secondary to chronic kidney disease regarding muscle strength, physical function, and quality of life.
Topics: Humans; Sarcopenia; Quality of Life; Hand Strength; COVID-19; Muscle Strength; Exercise; Resistance Training; Renal Insufficiency, Chronic
PubMed: 37916320
DOI: 10.26355/eurrev_202310_34126 -
JPMA. the Journal of the Pakistan... Aug 2023To evaluate immediate and long-term effect of texting or handwriting on hand-grip and key-pinch strength among healthy female students. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate immediate and long-term effect of texting or handwriting on hand-grip and key-pinch strength among healthy female students.
METHODS
The single-blind, randomised controlled trial was conducted between February and April 2021 after approval from the ethics review committee of the College of Medical Rehabilitation Sciences, Taibah University, Saudi Arabia, and comprised female Physio Therapy students aged 19-23 years who were right-hand dominant and had normal body mass index. The subjects used smartphones and electronic gadgets for >2hrs daily, writing more than 10min/day. They were randomised using sealed envelopes into five groups. Group A practised 10min texting, group B 15min texting, group C 10min writing, group D 15min writing, and group E used the phones only for talking or watching, with no texting or writing, and was taken as the control group. Hand-grip strength and key- pinch strength were assessed one minute before starting, and within one minute after having finished the assigned hand activity. All measurements were recorded in the sitting position using a single hand-grip dynamometer. Data was analysed using SPSS 23.
RESULTS
Of the 65 individuals assessed, 60(92.3%) were initially enrolled, but the study was finished by 50(83.3%) subjects with a mean age of 20.88±0.98 years and mean body mass index 20.8±2.30kg/m2. There were 12(24%) subjects in group A, 7(14%) in group B, 12(24%) in group C, 10(20%) in group D and 9(18%) in group E. The association of the time-based groups with hand-grip and key-pinch strength was not significant (p>0.05).
CONCLUSIONS
Texting and handwriting did not have any significant immediate effect on hand- grip or key-pinch strength.
CLINICAL TRIAL NUMBER
(NCT04810416).
Topics: Adult; Female; Humans; Young Adult; Body Mass Index; Hand Strength; Handwriting; Single-Blind Method; Text Messaging
PubMed: 37697745
DOI: 10.47391/JPMA.1577 -
Journal of Hand Surgery Global Online Jul 2023The lacertus fibrosus or bicipital aponeurosis is a sheet of ligamentous tissue just distal to the elbow joint and can be a compression point for the median nerve....
PURPOSE
The lacertus fibrosus or bicipital aponeurosis is a sheet of ligamentous tissue just distal to the elbow joint and can be a compression point for the median nerve. Essentially, lacertus syndrome is a subset of pronator syndrome and an uncommon diagnosis by itself. Surgical release of the lacertus consists of a small 2-cm incision that can be performed under local anesthesia. This study aimed to evaluate the outcome of lacertus release in resolving median nerve symptoms.
METHODS
This retrospective study was performed at Prince Court Medical Centre, Kuala Lumpur, Malaysia, from January 2020 until June 2021. Ninety-three patients who presented with numbness of fingers, hand, or upper limb; forearm pain; and muscle weakness. They were diagnosed with lacertus syndrome on the basis of local tenderness at the lacertus fibrosus with either weakness of flexor pollicis longus and flexor digitorum profundus of the index finger or paresthesia over the thenar eminence. The patients underwent 3 months of hand therapy, and those with no symptom improvement were offered lacertus release performed by a single surgeon. The surgical technique consists of a surgical incision starting from a point 2 cm distally and 2 cm radially to the medial epicondyle. The incision projects 2 cm distally in an oblique fashion toward the radial styloid. A wideawake local anesthesia no tourniquet (WALANT) technqiue was utilized and 20 mL of local anesthesic was injected subcutaneously around this region at least 20 minutes before the surgery. Careful dissection was made subcutaneously, and the lacertus fibrosus was identified as a thickened, shiny white structure and released. The Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, and pinch strength were tested before and after surgery. At 6 months after surgery, the DASH score was again assessed with a WALANT satisfactory questionnaire.
RESULTS
A total of 93 patients were included in the study. The mean age of the patients was 38.7 years, and most were women (77.4%). The mean operating time was 70 minutes. The mean preoperative DASH score was 53, which significantly reduced immediately after surgery to 7.8 ( < .001) and remained low at 6 months after surgery (10.6). The mean grip strength showed a significant increase from a preoperative mean of 16 kg to a postoperative mean of 24 kg ( < .001). Pinch strength also significantly increased from a preoperative mean of 9 kg to 13 kg after surgery ( < .001).
CONCLUSIONS
Lacertus syndrome remains an underdiagnosed disease that can be treated efficiently with a directed minimal surgical incision under wide-awake local anesthesia. Lacertus release appears to significantly reduce pain and numbness with markedly improved hand grip and pinch strength. The corresponding DASH scores also improved significantly after surgery. This study is vital to our understanding of proximal median nerve entrapment and to accurately diagnose it.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic III.
PubMed: 37521562
DOI: 10.1016/j.jhsg.2023.03.001 -
PloS One 2024The aim of the study was to assess the external and internal compatibility of the Biometrics E-LINK EP9 evaluation system device in the area of hand grip and pinch... (Observational Study)
Observational Study
The aim of the study was to assess the external and internal compatibility of the Biometrics E-LINK EP9 evaluation system device in the area of hand grip and pinch strength in the Polish population. The testing of hand grip and pinch strength was carried out among 122 healthy students. Two examiners performed hand grip and pinch strength measurements with a Biometrics E-LINK EP9 evaluation system device. Measurements were made for the right and left hands. The same people were tested again two weeks later, under the same conditions. The scores of one rater on the first and second tests were compared for reproducibility, and the scores of the two raters were compared to assess the reliability of the instrument. The measurements were found to be highly consistent both between the investigators and between the tests in the hand grip dynamometer test. The findings show high values of the Pearson's correlation coefficient equal or close to 1, as well as the interclass correlation coefficient (ICC) >0.9. Analysis of pinch strength measurements performed using the pinchmeter also found high values of the Pearson's correlation coefficient close to 1, as well as the interclass correlation coefficient >0.9; this reflects high agreement between the measurements performed by two investigators as well as assessments performed by one investigator at time intervals. These findings were confirmed by analyses performed using Bland-Altman plots. The measurements made with the Biometrics E-link EP9 evaluation system show high internal and external consistency in hand grip and pinch strength assessment. Biometrics E-link EP9 can be recommended for daily clinical practice.
Topics: Humans; Hand Strength; Male; Female; Poland; Prospective Studies; Pinch Strength; Reproducibility of Results; Adult; Young Adult; Biometry; Muscle Strength Dynamometer
PubMed: 38781271
DOI: 10.1371/journal.pone.0303648 -
Clinics in Orthopedic Surgery Aug 2023This study described the surgical technique of a robot-assisted retroauricular anterior scalenectomy and assessed clinical outcomes and complications for patients with...
BACKGROUND
This study described the surgical technique of a robot-assisted retroauricular anterior scalenectomy and assessed clinical outcomes and complications for patients with neurogenic thoracic outlet syndrome (nTOS).
METHODS
Between February 2014 and August 2016, 5 patients underwent robot-assisted retroauricular anterior scalenectomy using the da Vinci Xi system for nTOS. For clinical assessment, visual analog scale (VAS) symptom score, pinch and grip strength, and disabilities of arm, shoulder and hand (DASH) score were assessed to compare preoperative and postoperative outcomes. Postoperative complications were also reviewed.
RESULTS
The VAS symptom, pinch and grip strength, and DASH scores improved 1 year after the operation. All patients were satisfied with the surgical scars. Temporary postoperative complications, which spontaneously resolved within 3 months, were noticed in 2 patients: one with vocal cord palsy and the other with upper brachial plexus palsy.
CONCLUSIONS
The robot-assisted retroauricular anterior scalenectomy for patients with nTOS seems feasible and safe, providing satisfactory cosmetic results.
Topics: Humans; Robotics; Treatment Outcome; Decompression, Surgical; Thoracic Outlet Syndrome; Postoperative Complications; Retrospective Studies
PubMed: 37529194
DOI: 10.4055/cios22296 -
European Review For Medical and... Oct 2023Hand osteoarthritis (OA) is associated with considerable disability, especially in the elderly patient population. Paraffin wax (PW) and prolotherapy (P) are... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Hand osteoarthritis (OA) is associated with considerable disability, especially in the elderly patient population. Paraffin wax (PW) and prolotherapy (P) are non-pharmacological treatment methods used in this setting. This study aimed to compare the therapeutic efficacy of P and PW in hand osteoarthritis.
PATIENTS AND METHODS
This study was designed as a single-center, randomized-controlled trial conducted at our Physical Medicine and Rehabilitation Clinic between February 2019 and July 2020. Patients with bilateral hand OA were divided into PW and P treatment groups. The PW group was treated 5 days per week for 2 weeks. The P group received an injection of dextrose solution into the ligaments of painful joints once weekly for three weeks. Visual analog scale (VAS), Duruoz Hand Index (DHI) scale, hand dynamometer for grip strength, and pinch meter for lateral pinch were used for baseline and post-treatment follow-up assessments.
RESULTS
Overall, 42 patients were included. The VAS scores significantly decreased in both PW and P groups (p=0.024 and p=0.014). Baseline and third-month post-treatment VAS scores did not significantly differ (p=0.581). The DHI scores improved significantly in both groups (p<0.001 and p<0.001), being higher in the P than in the PW group (p=0.042). Right- and left-hand grip strength increased significantly in PW and P groups (p<0.001, p=0.001; p=0.013, p=0.002, respectively).
CONCLUSIONS
Both treatment methods were effective regarding pain and grip strength; however, P improved the hand functions more significantly.
Topics: Humans; Aged; Paraffin; Hand Strength; Prolotherapy; Osteoarthritis; Hand; Treatment Outcome
PubMed: 37916318
DOI: 10.26355/eurrev_202310_34124 -
Annals of Clinical and Translational... Dec 2023Upper extremity function reflects disease progression in multiple sclerosis (MS). This study evaluated the feasibility, validity, and sensitivity to change of remote...
OBJECTIVE
Upper extremity function reflects disease progression in multiple sclerosis (MS). This study evaluated the feasibility, validity, and sensitivity to change of remote dexterity assessments applying human pose estimation to patient-uploaded videos.
METHODS
A discovery cohort of 50 adults with MS recorded "selfie" videos of self-care tasks at home: buttoning, brushing teeth, and eating. Kinematic data were extracted using MediaPipe Hand pose estimation software. Clinical comparison tests were grip and pinch strength, 9 hole peg test (9HPT), and vibration, and patient-reported dexterity assessments (ABILHAND). Feasibility and acceptability were evaluated (Health-ITUES framework). A validation cohort (N = 35) completed 9HPT and videos.
RESULTS
The modality was feasible: 88% of the 50 enrolled participants uploaded ≥3 videos, and 74% completed the study. It was also usable: assessments easy to access (95%), platform easy to use (97%), and tasks representative of daily activities (86%). The buttoning task revealed four metrics with strong correlations with 9HPT (nondominant: r = 0.60-0.69, dominant: r = 0.51-0.57, P < 0.05) and ABILHAND (r = -0.48, P = 0.05). Retest validity at 1 week was stable (r > 0.8). Cross-sectional correlations between video metrics and 9HPT were similar at 6 months, and in the validation cohort (nondominant: r = 0.46, dominant: r = 0.45, P < 0.05). Over 6 months, pinch strength (5.8-5.0 kg/cm , P = 0.05) and self-reported pinch (ABILHAND) decreased marginally. While only 15% of participants worsened by 20% on 9HPT, 70% worsened in key buttoning video metrics.
INTERPRETATION
Patient-uploaded videos represent a novel, patient-centered modality for capturing dexterity that appears valid and sensitive to change, enhancing its potential to be disseminated for neurological disease monitoring and treatment.
Topics: Adult; Humans; Self Care; Cross-Sectional Studies; Hand; Upper Extremity; Multiple Sclerosis
PubMed: 37877622
DOI: 10.1002/acn3.51928 -
BMC Nephrology May 2024Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch...
BACKGROUND AND AIMS
Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD.
METHODS
Data were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan-Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association.
RESULTS
During a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan-Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64-0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77-1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10-1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased.
CONCLUSIONS
PS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD.
Topics: Humans; Renal Dialysis; Male; Female; Aged; Cardiovascular Diseases; Retrospective Studies; Middle Aged; Pinch Strength; Kaplan-Meier Estimate; Cause of Death; Follow-Up Studies; Kidney Failure, Chronic; Hand Strength
PubMed: 38698329
DOI: 10.1186/s12882-024-03587-x -
Journal of Movement Disorders Sep 2023Cervical proprioception plays a crucial role in posture and movement control. This study aimed to determine the relationships of cervical proprioception, cervical muscle...
OBJECTIVE
Cervical proprioception plays a crucial role in posture and movement control. This study aimed to determine the relationships of cervical proprioception, cervical muscle strength and endurance with manual dexterity and hand strength in individuals with idiopathic Parkinson's disease (PD).
METHODS
Twenty individuals with PD (mean age: 63.9 years) and 20 healthy individuals as a control group (mean age: 61.9 years) were recruited. Cervical joint position error (JPE), static endurance of neck muscles, activation of deep cervical flexor muscles (Craniocervical Flexion Test, CCFT), manual dexterity (Purdue Pegboard Test, PPT), cognitive and motor tasks of the PPT, finger tapping test (FTT), pinch strength, and grip strength were assessed.
RESULTS
Cervical JPE was significantly higher in individuals with PD than in controls (p < 0.05). The strength and endurance of the cervical muscles were significantly decreased in individuals with PD (p < 0.05). Cervical JPE measurements were negatively correlated with PPT, cognitive and motor tasks of the PPT in individuals with PD (all p < 0.05). The endurance of cervical flexor muscles was negatively correlated with PPT and cognitive PPT scores in the PD group (p < 0.05). In addition, a significant positive correlation was found between cervical flexor endurance and hand strength in the PD group (p < 0.05).
CONCLUSION
Cervical proprioception and the strength and endurance of cervical muscles decrease in individuals with PD compared to healthy individuals. Impairment of cervical proprioception appears to be associated with poorer upper extremity performance. Detailed evaluation of the cervical region in PD may help determine the factors affecting upper extremity function.
PubMed: 37394236
DOI: 10.14802/jmd.23039