-
Acta Orthopaedica Belgica Sep 2023The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of... (Meta-Analysis)
Meta-Analysis
Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis.
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.
Topics: Humans; Trapezium Bone; Osteoarthritis; Upper Extremity; Thumb; Arthrodesis; Ligaments; Range of Motion, Articular
PubMed: 37935242
DOI: 10.52628/89.3.11618 -
Journal of Hand Therapy : Official... 2024Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis....
BACKGROUND
Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored.
PURPOSE
The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations.
STUDY DESIGN
Systematic review.
METHODS
A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted.
RESULTS
Eleven studies were included in the review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case-control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good.
CONCLUSIONS
Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research.
Topics: Humans; Aged; Psychometrics; Thumb; Cross-Sectional Studies; Reproducibility of Results; Osteoarthritis; Carpometacarpal Joints; Pain
PubMed: 37591727
DOI: 10.1016/j.jht.2023.07.002 -
Journal of Plastic, Reconstructive &... Oct 2023Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical...
Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical repair, whereas selected partial tendon injuries may be managed without repair but with splinting and physiotherapy alone. There is limited evidence to support the management of partial lacerations, in particular the decision of whether to repair or not. We aimed to systematically review the literature to determine the optimal management of partial extensor tendon lacerations in the hand and forearm. A protocol for the systematic review was developed prospectively and registered with PROSPERO (CRD42021250431). PubMed, EMBASE, clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1990 to 27/05/2022. 4565 studies were screened, of which 88 underwent full text review. Five studies were included, one randomised control trial and four cohort studies. One study examined outcomes of partial lacerations treated without repair; the other four studies examined outcomes following repair. Pinch and grip strength and time to return to work were similar regardless of management. Adverse outcomes were reported for patients undergoing surgical repair; none were observed in those managed without repair. Meta-analysis was precluded by study heterogeneity and high risk of bias. There is limited evidence to support the management of partial extensor tendon lacerations, with some low-quality evidence that non-operative management of selected partial lacerations is safe. There is a pressing need for pragmatic, multicentre randomised trials to assess the cost-effectiveness of current treatments.
Topics: Humans; Forearm; Hand; Lacerations; Tendon Injuries; Tendons
PubMed: 37454548
DOI: 10.1016/j.bjps.2023.06.004 -
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 -
The Journal of Hand Surgery... Jun 2023Primary repair for traumatic injuries to the ulnar nerve alone does not always restore satisfactory hand function, particularly in injuries above the elbow where the...
Primary repair for traumatic injuries to the ulnar nerve alone does not always restore satisfactory hand function, particularly in injuries above the elbow where the long distances for regeneration limit motor reinnervation. Reductions in key pinch and grip strength are some of the main complaints. Tendon transfers have traditionally been used to improve key pinch and grip strength as a late salvage where primary nerve regeneration has run its course. Nerve transfers have been proposed as an alternative procedure and may be offered early to augment recovery, lengthen the window for reinnervation or provide motor reinnervation where the results of nerve repair are expected to be poor. This review sought to identify whether one type of procedure was superior to the other for reconstructing key pinch and grip strength. Medline, Embase and Cochrane Library were searched to identify articles that concerned nerve or tendon transfer following isolated traumatic injury to the ulnar nerve. Articles were excluded if patients had polytrauma or degenerative diseases of the peripheral nerves. A total of 179 articles were screened for inclusion. And 35 full-text articles were read and assessed for eligibility, of which seven articles were eligible. Following citation search, two additional articles were included. Five tendon transfer articles and four nerve transfer articles were included. Key pinch and grip strength outcomes for both procedures were roughly similar, though tendon transfers carried a much higher risk of complications. Based on the key pinch and grip strength outcomes, tendon transfer and nerve transfer restore a similar degree of function following traumatic ulnar injury. Reported nerve transfer outcomes for grip strength were slightly better. Return to useful function was faster following tendon transfers. Preoperative data and more patient-reported outcome measures should be recorded in future studies to provide more context for each procedure type. Level III (Therapeutic).
Topics: Humans; Hand Strength; Nerve Transfer; Neurosurgical Procedures; Tendon Transfer; Ulnar Nerve
PubMed: 37173143
DOI: 10.1142/S2424835523500340 -
Journal of Hand Therapy : Official... 2023Paraffin bath therapy is noninvasive and is widely used in various hand diseases. Paraffin bath therapy is easy to use, has fewer side effects, and can be applied to...
BACKGROUND
Paraffin bath therapy is noninvasive and is widely used in various hand diseases. Paraffin bath therapy is easy to use, has fewer side effects, and can be applied to various diseases with different etiologies. However, there are few large-scale studies of paraffin bath therapy, and there is insufficient evidence of its efficacy.
PURPOSE
The purpose of the study was to investigate the effectiveness of paraffin bath therapy for pain relief and functional improvement in various hand diseases through a meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis of randomized controlled trials.
METHODS
We searched for studies using PubMed and Embase. Eligible studies were selected based on the following criteria: (1) patients with any diseases of the hand; (2) comparison between paraffin bath therapy and no paraffin bath therapy; and (3) sufficient data on changes in the visual analog scale (VAS) score, grip strength, pulp-to-pulp pinch strength, or Austrian Canadian (AUSCAN) Osteoarthritis Hand index before and after paraffin bath therapy. Forest plots were drawn to visualize the overall effect. Jadad scale score, I statistics, and subgroup analyses were used to assess the risk of bias.
RESULTS
A total of five studies included 153 patients who were treated and 142 who were not treated with paraffin bath therapy. The VAS were measured in all 295 patients included in the study, while the AUSCAN index was measured in the 105 patients with osteoarthritis. Paraffin bath therapy significantly reduced the VAS scores (mean difference [MD], -1.27; 95% confidence interval [CI] -1.93 to -0.60). In osteoarthritis, paraffin bath therapy significantly improved grip and pinch strength (MD -2.53; 95% CI 0.71-4.34; MD 0.77; 95% CI 0.71-0.83) and reduced the VAS and AUSCAN scores (MD -2.61; 95% CI -3.07 to -2.14; MD -5.02; 95% CI -8.95 to -1.09).
DISCUSSION
Paraffin bath therapy significantly reduced the VAS and AUSCAN scores, and improved grip and pinch strength in patients with various hand diseases.
CONCLUSIONS
Paraffin bath therapy is effective for alleviating pain and improving function in hand diseases, thereby improving quality of life. However, owing to the small number of patients included in the study and its heterogeneity, a further large-scale, well-structured study is needed.
PubMed: 36914488
DOI: 10.1016/j.jht.2022.10.005 -
International Journal of Environmental... Feb 2023Carpal tunnel syndrome is a neuropathy that affects the median nerve. The aim of this review is to synthesize the evidence and perform a meta-analysis on the effects of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Carpal tunnel syndrome is a neuropathy that affects the median nerve. The aim of this review is to synthesize the evidence and perform a meta-analysis on the effects of iontophoresis in people with carpal tunnel syndrome.
METHODS
The search was carried out using PubMed, Web of Science, Scopus, CINHAL Complete, Physiotherapy Evidence Database, and SciELO. The methodological quality was evaluated using PEDro. A standardized or mean difference meta-analysis (Hedge's g) using a random-effects model was calculated.
RESULTS
Seven randomized clinical trials using iontophoresis for electrophysiological, pain, and functional outcomes were included. The mean of PEDro was 7/10. No statistical differences were obtained for the median sensory nerve conduction velocity (SMD = -0.89; = 0.27) or latency (SMD = -0.04; = 0.81), motor nerve conduction velocity (SMD = -0.04; = 0.88) or latency (SMD = -0.01; = 0.78), pain intensity (MD = 0.34; = 0.59), handgrip strength (MD = -0.97; = 0.09), or pinch strength (SMD = -2.05; = 0.06). Iontophoresis only seemed to be superior in sensory amplitude (SMD = 0.53; = 0.01).
CONCLUSIONS
Iontophoresis did not obtain an enhanced improvement compared to other interventions, but no clear recommendations could be made due to the limited number of included studies and the heterogeneity found in the assessment and intervention protocols. Further research is needed to draw sound conclusions.
Topics: Humans; Carpal Tunnel Syndrome; Iontophoresis; Hand Strength; Adrenal Cortex Hormones; Pain Measurement
PubMed: 36901312
DOI: 10.3390/ijerph20054287 -
International Journal of Dental Hygiene Aug 2023The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals. (Review)
Review
OBJECTIVE
The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals.
METHODS
Three databases were utilized from September 2019 to November 2021 in addition to hand-searching specific journals and reference lists. Research articles that examined pinch force generation in dental professionals during scaling with manual instruments only were included. Bias was assessed in the individual articles.
RESULTS
Six research articles were included with sample populations that varied from 12 to 24 participants. Four articles evaluated instrument designs in relation to pinch force generation during scaling by dental professionals. Two articles evaluated the clinicians' experience levels and the impact on pinch force generation. Results of three articles revealed instruments with large diameters and low weights produced the least amount of pinch force (p < 0.05). Additionally, two articles found instruments with a round, tapered shape produced less pinch force and instrument handles made of silicone produced higher pinch strength post-scaling (p < 0.05). One study indicated instrument designs associated with modified scaling techniques may reduce thumb and index finger pinch force (p < 0.05).
CONCLUSION
The findings from this review indicate weak evidence for instrument choices to reduce pinch force during scaling. Dental professionals should consider lightweight and large diameter instruments for manual scaling. Clinicians may also want to consider round, tapered handles and instrument designs with modified scaling techniques. This systematic review further identified the need for clinical research studies with rigorous research designs that examine the ergonomic impacts of instrument designs.
Topics: Humans; Research Design; Dental Scaling; Hand; Ergonomics; Dentists
PubMed: 36524311
DOI: 10.1111/idh.12649 -
Journal of Wrist Surgery Dec 2022First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated...
First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. This is a Level III study.
PubMed: 36504539
DOI: 10.1055/s-0042-1744493 -
Clinical Drug Investigation Jan 2023The efficacy and safety of edaravone for the treatment of amyotrophic lateral sclerosis (ALS) remain unclear. The aim of this meta-analysis was to provide... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
The efficacy and safety of edaravone for the treatment of amyotrophic lateral sclerosis (ALS) remain unclear. The aim of this meta-analysis was to provide evidence-based medical guidance and advice for the clinical application of edaravone in the treatment of ALS.
METHODS
PubMed, Embase, Chinese Biomedical Literature Database (CBM), Cochrane Library and Web of Science were searched through 09 March 2022 for randomized controlled trials (RCTs) on the safety and efficacy of edaravone versus placebo during follow-up of patients with ALS. A summary of the outcome measures with GRADE was performed. This study was registered on PROSPERO (ID: CRD 42022319997).
RESULTS
Five RCTs with a total of 566 participants were included, and there was a significant difference (mean difference [MD] 1.33, 95% confidence interval [CI] 0.33-2.34; p = 0.009) in the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score between the treatment and placebo groups. The edaravone group had an increased grip strength (MD 0.26, 95% CI 0.03-0.49; p = 0.03) and modified Norris Scale score (MD 2.81, 95% CI 1.18-4.43; p = 0.0007). However, there were no significant differences between groups for the change in forced vital capacity (FVC)% (MD 0.55, 95% CI - 3.15 to 4.24; p = 0.77), pinch strength (MD 0.05, 95% CI - 0.05 to 0.16; p = 0.33) or Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) score (MD - 4.76, 95% CI - 9.56 to 0.03; p = 0.05). The incidence of adverse events (AEs) (risk ratio [RR] 0.09, 95% CI 0.93-1.05; p = 0.65), serious adverse events (SAEs) (RR 0.72, 95% CI 0.52-1.00; p = 0.05) and the number of deaths (risk difference [RD] 0.00, 95% CI - 0.02 to 0.03; p = 0.83) were not statistically different from the placebo group. The quality of evidence was low only for SAEs, and the remaining outcome measures were of moderate quality.
CONCLUSIONS
Compared with placebo, edaravone may provide potential clinical benefits in the treatment of ALS and may not increase the number of AEs and deaths. However, due to the low-quality evidence of the included studies and the small sample size, more high-quality and high-standard research evidence is needed to confirm these results.
PROTOCOL REGISTRATION
This study was registered on PROSPERO (ID: CRD 42022319997).
Topics: Humans; Edaravone; Amyotrophic Lateral Sclerosis; Surveys and Questionnaires
PubMed: 36462105
DOI: 10.1007/s40261-022-01229-4