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International Journal of Biometeorology Aug 2021Data on the efficacy of treatment modalities in De Quervain's tenosynovitis (DQT) is limited. Paraffin therapy is routinely used in treating hand osteoarthritis and... (Randomized Controlled Trial)
Randomized Controlled Trial
Data on the efficacy of treatment modalities in De Quervain's tenosynovitis (DQT) is limited. Paraffin therapy is routinely used in treating hand osteoarthritis and neuropathies. However, there are not enough studies investigating paraffin effectiveness. This study evaluates the effectiveness of paraffin bath therapy on pain, functional status, muscle strength, and quality of life in patients with DQT. This prospective, single-blind, randomized, controlled study enrolled 51 DQT patients. Group 1 (n = 26) received paraffin bath + splint + exercise; Group 2 (n = 25) received splint + exercise therapy. Pain, handgrip strength, thumb palmar pinch strength, functional status, and quality of life were evaluated. Both treatment combinations improved pain, grip strength, palmar pinch strength of the thumb, functional status, and quality of life. The paraffin group provided more effective pain control than the paraffin-free group and was more effective in improving functional status, handgrip strength, and quality of life (p < 0.05). Apparently, adding paraffin therapy to the combination of the splint and therapeutic exercise positively affects the patient's treatment outcomes. For this reason, paraffin therapy should be included in the conservative treatment combinations in DQT.
Topics: De Quervain Disease; Hand Strength; Humans; Paraffin; Prospective Studies; Quality of Life; Single-Blind Method; Tenosynovitis
PubMed: 33675398
DOI: 10.1007/s00484-021-02111-2 -
Current Opinion in Neurology Dec 2019This review discusses recent advances in the rehabilitation of motor deficits after traumatic brain injury (TBI) and spinal cord injury (SCI) using neuromodulatory... (Review)
Review
PURPOSE OF REVIEW
This review discusses recent advances in the rehabilitation of motor deficits after traumatic brain injury (TBI) and spinal cord injury (SCI) using neuromodulatory techniques.
RECENT FINDINGS
Neurorehabilitation is currently the only treatment option for long-term improvement of motor functions that can be offered to patients with TBI or SCI. Major advances have been made in recent years in both preclinical and clinical rehabilitation. Activity-dependent plasticity of neuronal connections and circuits is considered key for successful recovery of motor functions, and great therapeutic potential is attributed to the combination of high-intensity training with electrical neuromodulation. First clinical case reports have demonstrated that repetitive training enabled or enhanced by electrical spinal cord stimulation can yield substantial improvements in motor function. Described achievements include regaining of overground walking capacity, independent standing and stepping, and improved pinch strength that recovered even years after injury.
SUMMARY
Promising treatment options have emerged from research in recent years using neurostimulation to enable or enhance intense training. However, characterizing long-term benefits and side-effects in clinical trials and identifying patient subsets who can benefit are crucial. Regaining lost motor function remains challenging.
Topics: Animals; Brain Injuries, Traumatic; Deep Brain Stimulation; Humans; Neurological Rehabilitation; Neuronal Plasticity; Recovery of Function; Spinal Cord; Spinal Cord Injuries; Spinal Cord Stimulation; Transcranial Direct Current Stimulation
PubMed: 31567546
DOI: 10.1097/WCO.0000000000000750 -
The Journal of Orthopaedic and Sports... Dec 2021We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions.
DESIGN
Intervention systematic review with meta-analysis.
LITERATURE SEARCH
We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020.
STUDY SELECTION CRITERIA
We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS.
DATA SYNTHESIS
Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison.
RESULTS
There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI: -0.95, -0.13) and function (SMD, -0.35; 95% CI: -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty).
CONCLUSION
Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence. .
Topics: Adult; Carpal Tunnel Syndrome; Hand Strength; Humans; Middle Aged; Pain; Physical Therapy Modalities
PubMed: 34784245
DOI: 10.2519/jospt.2021.10533 -
The Israel Medical Association Journal... Apr 2023Physiotherapy can help treat of trigger fingers (TF). (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Physiotherapy can help treat of trigger fingers (TF).
OBJECTIVES
To compare efficacy of fascial manipulation (FM) and traditional physiotherapy (TP) techniques in treatment of TF.
METHODS
Nineteen patients were randomized in the FM group and 15 in the TP group. All patients underwent eight physiotherapy sessions. The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and visual analogue scale (VAS) scores, staging of stenosing tenosynovitis (SST) classification, triggering frequency, grip and pinch strength were recorded before and after treatment. We surveyed participants at 6 months for recurrence, further treatment, and the VAS and QuickDASH scores. The primary outcome measure was reduction in QuickDASH and VAS scores.
RESULTS
Both FM and TF improved the QuickDASH and VAS scores at 6 months follow-up, without a significant difference. The QuickDASH score in the FM group improved from 28.4 ± 17.1 to 12.7 ± 16.3; TF scores improved from 27 ± 16.7 to 18.8 ± 29.4 (P = 0.001). The VAS score improved from 5.7 ± 2.1 to 1.2 ± 2.1 and from 4.8 ± 1.8 to 2 ± 2.6 for both groups, respectively (P < 0.001). SST and grip strength also improved following treatment, regardless of modality. At 6 months, four patients (22%) with an SST score of 1, three (30%) with a score of 2, and two (40%) with a score of 3A underwent additional treatment.
CONCLUSIONS
Both FM and TP techniques are effective for the treatment of TF and should be considered for patients who present with SST scores of 1 or 2.
Topics: Humans; Trigger Finger Disorder; Treatment Outcome; Pilot Projects; Physical Therapy Modalities; Hand
PubMed: 37129129
DOI: No ID Found -
Human Movement Science Oct 2022Impairments of upper limb (UL) sensory-motor functions are common in Parkinson's disease (PD). Virtual reality exercises may improve sensory-motor functions in a safe... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Impairments of upper limb (UL) sensory-motor functions are common in Parkinson's disease (PD). Virtual reality exercises may improve sensory-motor functions in a safe environment and can be used in tele-rehabilitation. This study aimed to investigate the effects of supervised and non-supervised UL virtual reality exercises (ULVRE) on UL sensory-motor functions in patients with idiopathic PD.
METHODS
In this clinical trial study, 45 patients with idiopathic PD (29 male) by mean ± SD age of 58.64 ± 8.69 years were randomly allocated to either the control group (conventional rehabilitation exercises), supervised ULVRE or non-supervised ULVRE. Interventions were 24 sessions, 3 sessions/week. Before/after of interventions and follow-up period all assessment was done. Hand Active Sensation Test and Wrist Position Sense Test were used for assessing UL sensory function. Gross and fine manual dexterity were assessed by Box-Block Test and Nine-Hole Peg Test, respectively. Grip and pinch strength were evaluated by a dynamometer and pinch gauge, respectively.
RESULTS
The results showed significant improvement in discriminative sensory function (HAST-weight and HAST-total), wrist proprioception, gross manual dexterity and grip strength of both less and more affected hands as well as fine manual dexterity of the more affected hand in the three groups in patients with idiopathic PD (P < 0.05).
CONCLUSION
The results of this study indicated that both supervised and non-supervised ULVRE using the Kinect device might potentially improve some aspects of UL sensory-motor functions in patients with PD. Therefore, ULVRE using the Kinect device can be used in tele-rehabilitation, especially in the current limitations induced by the COVID-19 pandemic, for improving UL functions in patients with PD.
Topics: Aged; Humans; Male; Middle Aged; Exercise Therapy; Exergaming; Parkinson Disease; Recovery of Function; Sensation; Treatment Outcome; Upper Extremity; Female
PubMed: 35932518
DOI: 10.1016/j.humov.2022.102977 -
Handchirurgie, Mikrochirurgie,... Jun 2021Pyogenic flexor tenosynovitis within the flexor tendon sheath requires urgent treatment to avoid tendon necrosis and loss of the finger. Objective of this article is the...
BACKGROUND/PURPOSE
Pyogenic flexor tenosynovitis within the flexor tendon sheath requires urgent treatment to avoid tendon necrosis and loss of the finger. Objective of this article is the treatment by revision and postoperative continuous irrigation via a closed irrigation system.
PATIENTS AND METHODS
From 1.1.2007 to 31.12.2016 54 patients with a pyogenic flexor tenosynovitis were treated by revision and closed continuous irrigation. Besides the evaluation of the patient´s records with respect to the involved fingers and hand, duration of hospitalisation, and required revision surgery, 33 patients (19 males, 14 females) with an average age of 51 (8-85) years were re-examined on average after 21 (4-38) months. Re-examination included measurements of the mobility of the involved fingers and thumbs, grip and pinch strength, pain using the numeric rating scale (BRS), and DASH score. The overall result was graded according to the grading system by Buck-Gramcko for flexor tendon reconstruction.
RESULTS
Hospital stay was 9 (3-26) days on average. In 11 patients revision surgery was required including 3 re-installations of the continuous irrigation system, 2 ray amputations, and 1 finger amputation at the level of the proximal interphalangeal joint. The re-examined patients averaged a grip strength of 84 (23-163) % of the unaffected side. On average pain at rest was 0,2 (0-4), pain at daily living activity 1,2 (0-8) on the NRS, the DASH score 16,8 (0-58) points. According to the rating system for flexor tendon function there were one poor, one fair, 5 good and 26 excellent results.
CONCLUSIONS
Continuous irrigation by a closed irrigation system for pyogenic flexor tenosynovitis is a successful procedure with a low amputation rate. The functional results are predominantly good and excellent.
Topics: Female; Fingers; Hand; Humans; Male; Middle Aged; Retrospective Studies; Tendons; Tenosynovitis
PubMed: 34134164
DOI: 10.1055/a-1408-4147 -
British Journal of Sports Medicine May 2021To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function. (Meta-Analysis)
Meta-Analysis
Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials.
OBJECTIVE
To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.
DESIGN
Systematic review and meta-analysis.
METHODS
We used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.
ELIGIBILITY CRITERIA
RCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.
RESULTS
30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.
CONCLUSIONS
Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.
PROSPERO REGISTRATION NUMBER
CRD42018082703.
Topics: Adrenal Cortex Hormones; Adult; Bias; Cryotherapy; Exercise; Exercise Therapy; Female; Humans; Male; Middle Aged; Pain Measurement; Pinch Strength; Publication Bias; Randomized Controlled Trials as Topic; Tennis Elbow; Treatment Outcome; Ultrasonic Therapy; Watchful Waiting
PubMed: 33148599
DOI: 10.1136/bjsports-2020-102525 -
Hand Surgery & Rehabilitation Sep 2023Lacertus syndrome is defined as proximal median nerve entrapment at the lacertus fibrosus. We aimed to analyze change in pinch strengths in patients who underwent median...
PURPOSE
Lacertus syndrome is defined as proximal median nerve entrapment at the lacertus fibrosus. We aimed to analyze change in pinch strengths in patients who underwent median nerve release at the lacertus fibrosus under WALANT (wide-awake local anesthesia, no tourniquet).
METHODS
Pinch strength was measured with a pinch gauge. Subjective DASH score and pain, numbness in the operated extremity and satisfaction on visual analog scales were analyzed before and 6 weeks after surgery.
RESULTS
There were 32 patients. Median nerve release under the lacertus fibrosus elicited statistically significant increases in tip-to-tip, lateral and tripod pinch strength at postoperative week 6. Improvements in DASH score, pain and paresthesia were also statistically significant.
CONCLUSIONS
For lacertus syndrome treatment, mini-incision release of the lacertus fibrosus under WALANT was satisfactory and increased pinch strength significatively.
LEVEL OF EVIDENCE
Therapeutic, Level IV - Case series.
Topics: Humans; Pinch Strength; Median Nerve; Carpal Tunnel Syndrome; Median Neuropathy
PubMed: 37142123
DOI: 10.1016/j.hansur.2023.04.007 -
Hand (New York, N.Y.) Jun 2023Opposition is an essential function of the human thumb to enable fine pinch and grip strength. Loss of opposition can be caused by both congenital and acquired pathology... (Review)
Review
Opposition is an essential function of the human thumb to enable fine pinch and grip strength. Loss of opposition can be caused by both congenital and acquired pathology resulting in significant disability. This systematic review aims to compare the different techniques available to restore opposition. A systematic review of opponensplasty techniques was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines using PubMed, Embase, Medline, and Web of Science. Studies published in English before April 2021 and that reported on original outcomes of opponensplasty techniques used in the context of neurologic dysfunction were eligible for inclusion. A total of 641 articles were included, of which 42 texts were eligible for inclusion with a total cohort of 873 patients. The most commonly used transfers were palmaris longus (PL), extensor indicis proprius (EIP), and flexor digitorum superficialis (FDS). These transfers all demonstrated an improvement in range of motion, pinch strength, and Kapandji scores. Complication rates of 19% and 12% were reported with FDS and EIP transfers, respectively, predominantly related to donor site morbidity. A complication rate of 6% was observed with PL transfers, which was most commonly related to bowstringing. Heterogeneity of outcomes precluded a direct statistical comparison. There is significant heterogeneity in the literature reporting on opponensplasty techniques. There is limited capacity of direct comparison; however, FDS and EIP appear to demonstrate better functional outcomes, at the cost of higher complication rates. Each technique has specific complications and advantages and importance in patient counseling and discussion. Further prospective comparative studies are warranted.
PubMed: 37269095
DOI: 10.1177/15589447231174481 -
Indian Journal of Occupational and... 2021The repetitive and prolonged exertion of grip and pinch strength are current among carpet weaver tasks. The three objectives of this study were (1) to investigate the...
BACKGROUND
The repetitive and prolonged exertion of grip and pinch strength are current among carpet weaver tasks. The three objectives of this study were (1) to investigate the relationship between symptoms of musculoskeletal disorders and grip and pinch strength of carpet weavers in carpet weaving workshops in Kerman province, (2) to compare the grip and pinch strength of carpet weavers with normal values, and (3) to identify the relationship between hand postures of carpet weavers during work and force exertion.
METHODS
In this cross-sectional study, grip strength and key, tip and palmar pinch strengths of 101 female carpet weavers aged 20 to 71 years were measured in Kerman province, in 2018. Nordic Musculoskeletal Questionnaire (Extended version) was also used to evaluate musculoskeletal disorders.
RESULTS
Bivariate and multivariate linear regression analyses showed that participants who suffered from musculoskeletal disorders had lower grip and pinch strength than others and this decrease was statistically significant in upper back, wrists/hands, and knees. Moreover, there was a significant difference between grip and three types of pinch strength of carpet weavers and normal values. Furthermore, for both hands, the grip strength in the position recommended by American Society of Hand Therapists was significantly greater than that in the normal position carpet weavers usually adopt.
CONCLUSION
Based on the results, the high prevalence of musculoskeletal disorders has led to a significant decrease in the grip and pinch strength of carpet weavers. Therefore, it is necessary to undertake ergonomic interventions in designing the carpet weaving workstation.
PubMed: 34759600
DOI: 10.4103/ijoem.IJOEM_223_20