Search Results

A randomized controlled trial of real versus sham acupuncture for basal thumb joint arthritis. Barnard, A., Jansen, V., Swindells, M., Arundell, M., & Burke, F. (2020) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Thumb osteoarthritis - Real vs Sham acupuncture This is a randomised double-blind placebo controlled trial assessing the effectiveness of acupuncture on pain in participants with thumb osteoarthritis (OA). Participants (N = 70) were diagnosed with 1st cmcj OA through clinical and/or radiological criteria. Participants were excluded if they had previously experienced acupuncture or if they presented any contraindications to acupuncture. Pain was assessed on a Visual Analogue Scale (VAS) 0 to 100 mm during thumb movement and gripping tasks. Treatment allocation was randomised. Participants and assessors were blinded to treatment allocation. Participants were provided with either real (n = 35) or telescopic (sham) (n = 35) acupuncture applied to 4-6 acupuncture points. The results showed that both groups improved to a statistically and clinically significant level in pain during thumb movement (Sham - Median change: 17; Interquarile range (IQR): -30 to 1; Real - Median change: -14; IQR: -38 to 11) and gripping (Sham - Median change: 19; IQR: -25 to 1; Real - Median change: -12; IQR: -26 to 1). No differences in pain during thumb movement or gripping were noticed between groups. Clinical Take Home Message: Acupuncture is as beneficial as sham acupuncture for pain relief. It appears that the effect of acupuncture is non specific and may be associated with the contextual effect of treatment and attention dedicated to the patient. URL: https://journals.sagepub.com/doi/full/10.1177/1753193420911326

Borderline nerve conduction velocities for median neuropathy at the carpal tunnel Kortlever, J., Becker, S., Zhao, M., & Ring, D. (2020) Level of Evidence: 3 Follow recommendation: 👍 👍 👍 Type of study: Diagnostic Topic: Uncertainty in carpal tunnel syndrome - Do nerve conduction studies help? This is a retrospective study assessing the number of patients presenting with a borderline nerve conduction study in patients suspected of having carpal tunnel syndrome (CTS). A total of 565 patients were included in the study. These patients had been referred by specialists or general practitiones for nerve conduction tests to confirm or exclude a diagnosis of CTS. Borderline nerve conduction studies were defined as results 10% above or 10% below the cutoff margin for CTS. The cutoff margins for the six different nerve conduction study criteria utilised were ≥3.6 ms (milliseconds) median nerve distal sensory latency (DSL), ≥4.4 ms median nerve distal motor latency (DML), ≤5mV (millivolt) median nerve motor amplitude, ≥0.4 ms difference in median-ulnar mixed nerve palmar latencies (sensory), ≥1 ms difference between sides on median DML, and ≥1.8 ms difference between median and ulnar DML on the same side. The results showed that if the cutoff values were utilised, 76% (n=407) of patients were diagnosed with CTS. When the criteria were extended to10% above or below the cutoff, 67% and 97.3% of the patients were diagnosed as having CTS respectively. All the nerve conduction studies criteria appeared to be highly specific (95-97%). If the test is specific and its result is positive, you can be more certain that the patient has the condition. The sensitivity of nerve conduction studies for CTS was low (21-97%). If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. Clinical Take Home Message: Hand therapists can be confident of a CTS diagnosis if nerve conduction studies identify a median nerve impairment. However, If nerve conduction studies are normal, it is not possible to exclude the presence of CTS. Often, mild compression neuropathies affect small nerve fibres (C and Aδ), which cannot be assessed by nerve conduction studies. If nerve conduction studies are negative, a thorough assessment to exclude proximal median neuropathies, radiculopathies, and polyneuropathies should be conducted. URL: https://www.jhandsurg.org/article/S0363-5023(20)30002-2/pdf

Do multi-ingredient protein supplements augment resistance training-induced gains in skeletal muscle mass and strength? A systematic review and meta-analysis of 35 trials. O’Bryan, K., Doering, T., Morton, R., Coffey, V., Phillips, S., & Cox, G. (2020) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Strength gains - Multi-ingredient protein (MIP) vs protein only supplements This is a systematic review and meta-analysis assessing the effectiveness of multi-ingredient protein (MIP) vs protein only supplements on total body mass (kg), fat-free mass (kg), fat mass (kg), and maximum lifting ability (kg) after a strength straining period. Twelve studies were included for a total of 265 participants. The MIP included protein based supplements with the addition of creatine, creatine and carbohidrates, extra leucine or glutamine, β-Hydroxy β-methylbutyric acid (HMB), or polyunsaturated fatty acids (PUFAs). The protein only supplements included whey protein with or without caseine. Most studies provided participants with a dosage between 0.3 to 1.5g/kg/day of supplements in both groups. Assumption of the supplements was usually post-exercise. Strength training programs lasted on average 16(±14) weeks, with frequency of 3(±1)/week, 3(±1) sets, 9(±2) reps, with progressive overload during the training period. The results showed that there was no difference on total body mass (Mean difference-MD (kg): 0.65; 95%CI: -0.45 to 1.78), fat-free mass (MD (kg): 0.39; 95%CI: -0.28 to 1.05), and maximum lifting ability (MD (kg): 1.33; 95%CI: -3.81 to 6.48) between groups, although fat mass (MD (kg): 0.76; 95%CI: 0.13 to 1.40) was significantly greater in the MIP group. Clinical Take Home Message: There appears to be no benefit in taking multi-ingredient protein supplements when compared to protein only for strength gains. Hand therapists may advise their patients on these supplements if the aim of the rehabilitation is to increase muscle strength. Protein supplements may also be useful in patients over 40 years old in which sarcopenia leads to an average of 1% muscle mass loss per year. Hand therapists may also consider enquiring about protein intake in patients with healing wounds as their intake appears to help with scar formation. URL: https://bjsm.bmj.com/content/54/10/573.long

Effect of weight-bearing wrist movement with carpal-stabilizing taping on pain and range of motion in subjects with dorsal wrist pain: A randomized controlled trial Kim, G., Weon, J., Kim, M., Koh, E., & Jung, D. (2020) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Non-specific dorsal wrist pain - Tight rigid vs elastic loose tape This is a randomised controlled trial on the effectiveness of tight rigid vs elastic tape on pain and wrist range of movement in people with non-specific dorsal wrist pain. A total of 30 participants with wrist extension limitation (<50°) and non-specific dorsal wrist pain were included. Non-specific dorsal wrist pain was defined as pain in absence of objective joint or soft tissue pathology that we can currently diagnose. Participants were randomised to a rigid tape (n = 15) or an elastic tape (n = 15) intervention. The rigid tape was applied tightly to the wrist, distally to the ulnar and radial styloid while the participant relaxed the hand in 45° of wrist flexion. The elastic tape (similar to kinesio tape) was applied in the same way but without any tension. Participants in both groups performed a wrist extension exercise, which was completed by moving the trunk while keeping the affected hand on a table. This exercise was performed pain-free once per day for 10 repetitions, holding for 10 seconds with 5 seconds rest in between repetitions. The intervention lasted for one week and outcomes were measured at baseline and after the intervention. Pain was assessed through the Visual Analogue Scale (VAS) while active wrist extension range of movement was assessed through an ultrasound-based motion-analysis system. One of the limitations of the study was that treatment allocation was not concealed. The results showed that pain reduced to a clinically significant level from baseline with the tight rigid tape (Mean difference: 2.4; 95%CI: 1.6 to 3.2 points out of 10), but not with the elastic tape (Mean difference: 0.7; 95%CI: 0.3 to 1.1 points out of 10). Active wrist extension range of movement improved to a clinically significant level with the tight rigid tape only (Mean difference: 12.6°; 95%CI: 9.9° to 15.4°). No adverse events were reported. Clinical Take Home Message: Hand therapists may consider utilising rigid tape as described above to improve pain and extension range of movement impairments in people with non-specific dorsal wrist pain. This treatment appears to have a short term analgesic effect and no evident adverse effects. URL: https://www.jhandtherapy.org/article/S0894-1130(18)30090-5/fulltext

Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis. Pozzi, F., Plummer, H. A., Shanley, E., Thigpen, C. A., Bauer, C., Wilson, M. L., & Michener, L. A. (2020) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Prognostic Topic: Elbow injury - risk factor This is a systematic review and meta-analysis assessing the usefulness of shoulder range of movement screening to predict upper limb injury in overhead athletes. The systematic review included prospective studies only. Shoulder flexion, shoulder internal and external rotation at 90° of shoulder abduction, and shoulder horizontal adduction were assessed. Injury was defined as any shoulder or elbow related complaint incurred in the season. A total of 7 studies were included in the meta-analysis. Overhead sports included baseball (n = 2471), handball (n = 535), softball (n = 103), swimming (n = 74), volleyball (n = 66), and tennis (n = 65). The results showed that shoulder external rotation on the throwing arm was a useful screening tool for professional baseball pitchers. Those players who did not present with an external rotation of the throwing arm of at least 5° greater than the contralateral, were twice as likely to injure their pitching shoulder or elbow. Limited evidence was available for the other overhead sports. This may be due to the small number of studies investigating athletes involved in other sports. Clinical Take Home Message: Hand therapists may test shoulder external rotation in professional baseball pitchers to assess their risk of developing an elbow or shoulder injury. Interventions aimed at modifying these impairments may be useful in reducing their risk of elbow and shoulder injury. URL: https://bjsm.bmj.com/content/early/2020/01/13/bjsports-2019-100698

Anatomical relationship of palmar carpal bone landmarks used in locating the lunate and capitate during palpation: A cadaveric investigation Davis, A., Wilhelm, M., Pendergrass, T., Sechrist, D., Brismée, J., Sizer, P., & Gilbert, K. (2019) Level of Evidence: N/A Follow recommendation: N/A Type of study: Anatomical Topic: Carpal bone landmarks - Cadaveric study This anatomical study performed on 25 cadavers, on average 75 years old, identified four reliable ways of locating the capitate on the palmar aspect of the wrist and one reliable way of determining the position of the lunate on the dorsal aspect of the wrist (all 100% correct). The capitate was located by identifying the midpoint of the line between the scaphoid tubercle/trapezium tubercle and pisiform/hook of hamate. Alternatively, the crossing point between these lines could be used. Lunate was located correctly when the midpoint between the radial and ulnar styloid line was found on the dorsal aspect of the wrist. Clinical Take Home Message: Hand therapists can use the well-defined landmarks of the trapezium and scaphoid tubercle, pisiform, and hook of hamate to identify the position of the capitate palmarly. This may be useful in identifying capitate fractures, which occur in 1.3% of all carpal fractures, and capitate stress fractures occasionally identified in gymnasts. The correct identification of lunate's position may help differentiating between symptomatic presentation of lunotriquetral, scapholunate instability, or Kienböck's Disease. URL: https://www.jhandtherapy.org/article/S0894-1130(17)30323-X/fulltext

Forearm torque and lifting strength: Normative data Axelsson, P., Fredrikson, P., Nilsson, A., Andersson, J., & Kärrholm, J. (2018) Level of Evidence: 3b Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Lifting ability - Association with grip strength This is a cross sectional study assessing the correlation between grip strength and lifting ability of the upper limb of participants (n = 499) with an average age of 44 (range: 15 to 85). Grip strength was measured through a Jamar hand dynamometer. For lifting ability, the maximum isometric elbow flexion strength was assessed with the forearm in neutral, supination, and pronation. The elbow was positioned in 90° of flexion, while the shoulder and wrist were positioned in neutral. The test was interrupted if compensatory movements in the upper limb (e.g. wrist e/f, shoulder shrug) were happening. Maximum isometric elbow flexion strength was measured through a dynamometer fixed to the ground, which measured torque while participants were pulling a handle attached to the dynamometer. The results showed that there was a moderate (r = 0.63) to strong (r = 0.8) correlation between maximum grip strength and isometric elbow flexion strength. Maximum isometric elbow flexion in forearm neutral and supination was 45% of maximum grip strength. Maximum isometric elbow flexion in forearm pronation was 30% of maximum grip strength. Clinical Take Home Message: Hand therapists may advice their patients about the lifting limits by assessing grip strength and calculating what is their predicted maximum lifting weight in different forearm positions. Multiplying the grip strength value by 0.45 would provide you with the weight that patients may be able to hold for a brief moment with forearm in neutral or supination position. Multiplying the grip strength value by 0.3 would provide you with the weight that patients may be able to hold for a brief moment with forearm pronation. This information is useful both for patients wanting to return to work or gym workouts, as well as older people needing to perform daily life activities (e.g. lifting grocery bags). URL: https://www.jhandsurg.org/article/S0363-5023(17)30770-0/fulltext

Entrapment neuropathies: Challenging common beliefs with novel evidence Schmid, A. B., Hailey, L., & Tampin, B. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Symptoms prevalence, Aetiologic, Diagnostic Topic: Compression neuropaties - Presentation and diagnostics This is a narrative review on clinical presentation, aetiology, and diagnostic tests for peripheral neuropathies (e.g. carpal tunnel syndrome - CTS). The clinical presentation of compression neuropathies rarely follows peripheral nerve patterns. For example, CTS often presents with symptoms in the whole hand and forearm, which extend beyond the innervation territory of the median nerve. This widespread pain presentation appears to be mediated by an immune-inflammatory response, which is initiated by nerve compression. This inflammatory response can lower neurons' depolarisation threshold, contributing to widespread symptoms. Diagnostic tests for compression neuropathies involve both nerve conduction studies and clinical tests. Nerve conduction studies assess large nerve fibre function. Nerve conduction studies confirm CTS diagnosis in 75% of patients. It is suggested that the remaining 25% of patients with CTS present with a mild compression of the median nerve, which does not affect large fibre function. These mild forms of CTS may be identified by assessing small nerve fibres through clinical tests such as the pinprick tests (pain sensation elicited by a sharp object) and patients' ability to percive warmth/cold through warm/cold coins. If patients are unable to perceive pain during a pinprick test or they are unable to differentiate between warm/cold sensation, the diagnosis of CTS is more likely. Neurodynamic tests are not useful for diagnostic purposes, but they can detect an increased sensitivity of the neural structures. Clinical Take Home Message: Carpal tunnel syndrome may present with uncommon symptom distrubutions. Nerve conduction studies are useful in identifying a severe median nerve compression. Clinical tests including pinprick (utilising single use devices such as Neurotips) and warmth/cold detection may be used to confirm a CTS diagnosis. Neurodynamic tests can only identify an heightened sensitivity of neural structures and should not be used to make a diagnosis of CTS. URL: https://www.jospt.org/doi/10.2519/jospt.2018.0603

Rehabilitation with a stabilizing exercise program in triangular fibrocartilage complex lesions with distal radioulnar joint instability: A pilot intervention study Bonhof-Jansen, E., Kroon, G., Brink, S., & van Uchelen, J. Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Conservative treatment for triangular fibrocartilage complex (TFCC) lesions - Three months exercise intervention to reduce pain and improve function This case series (n = 13) presented a novel exercise intervention for patients with traumatic TFCC lesion associated with clinical evidence of distal radioulnar joint (DRUJ) instability. Diagnosis was confirmed by diagnostic arthroscopy or MRI findings. Participants were assessed at baseline and at 3 months, 6 months, and 12 months. Function was assessed through the Patient-Related Wrist Evaluation (PRWE) at all time points. Surgical interventions due to unresolved symptoms were recorded. Participants were asked to exercise once daily for three months, after which the intervention was discontinued. The rehabilitation was divided in 3 phases. Progression onto the next phase took place when patients were able to control wrist position during the exercises. The first phase included positioning of the wrist in neutral with eyes closed (proprioceptive training), moving the upper limb while maintaining a neutral wrist position, and bouncing a balloon while holding a neutral wrist. The second phase involved strengthening exercises with a bias towards extensor carpi ulnaris (ECU) and pronator quadratus (PQ), achieved through weights ranging from 0.5 to 2kg, elastic bands, and hammer exercises (resisted pronation/supination). These were progressed by adding upper limb movements while holding the wrist in neutral. In the third phase, patients were provided with wrist weightbearing exercises of different intensities and in different positions of wrist extension. During this third phase, exercises such as slow isokinetic wall push-up were progressed to fast plyometric wall push-off. The results should be considered in the context of limitations associated with a case series design (e.g. small sample size, no control group, no randomisation). The results showed that pain (70% reduction) and function (90% reduction) improved to clinically significant levels when assessed through the PRWE. The improvements were maintained at longer term follow-ups (3 months, 6 months, and 12 months), although 24% of patients opted for surgery. Clinical Take Home Message: Hand therapists may consider utilising proprioception exercises early in the rehabilitation of TFCC injuries associated with DRUJ instability. Strength training of PQ and ECU as well as a gradual TFCC loading through wrist weightbearing exercises may be beneficial when patients can control wrist motion and position during basic exercises. URL: https://journals.sagepub.com/doi/10.1177/1758998319861661

Effectiveness of proximal interphalangeal joint–blocking orthosis vs metacarpophalangeal joint–blocking orthosis in trigger digit management: A randomized clinical trial Teo, S., Ng, D., & Wong, Y. Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Trigger finger conservative treatment - mcpj vs pipj splint This is a randomised clinical trial comparing the effectiveness of two splinting regimes for A1-pulley trigger finger (TF). A metacarpophalangeal joint (mcpj) block was compared to an oval 8 positioned at the proximal interphalangeal joint. Effectiveness of splinting regime was assessed through Green's classification (grade 1 to 4) for TF severity, pain (NRS), and function (QuickDASH). Participants with isolated TF of the thumb were excluded. The treatment lasted 8 weeks and participants were asked to wear the splint 24/7. A total of 42 participants were randomised to the mcpj block (n = 18) and oval 8 (n = 24) group. The results need to be considered in the context of several limitations. No information was provided on allocation concealment. Outcome assessors were not blinded to the intervention. No intention to treat (ITT) analysis was reported, making the two groups potentially heterogeneous. Multiple t-tests were used for pain and function instead of using two-way ANOVAs, which would have reduced the chance of type I errors (possibility of identifying statistically significant difference only due to the increased number of tests performed). The results showed no difference between groups on TF severity following treatment (Green's classification system). However, there was a statistically significant difference between groups for pain, with the oval 8 group only showing clinically significant improvements from baseline. There was no difference between groups in functional improvements. A final important note is related to the compliance with splint wearing. Compliance was statistically significantly higher in the oval 8 group (13hrs/day) compared to the mcpj block group (10hrs/day). Clinical Take Home Message: Conservative splinting options for TF appear to be useful in reducing pain. The pipj splint appears to provide better results compared to a mcpj block. Hand therapists should not expect clinically significant changes in triggering grade or function (QuickDASH) when using splints for TF. Compliance with treatment appears to be a potentially important factor and patients should be invited to wear the splint 24/7. URL: https://www.jhandtherapy.org/article/S0894-1130(17)30284-3/pdf

Development and validation of a prognostic, risk-adjusted scoring system for operative upper-extremity infections Sharma, K., Mull, A., Friedman, J., Pan, D., Poppler, L., Fox, I., Levin, L., & Moore, A. M. Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Prognostic Topic: Post-surgical infections - prognostic factors This retrospective study assessed the ability of several risk factors to predict persistent post-surgical infections. The total number of participants was 602. Of these, 301 patients were utilised to assess the individual and combined effect of risk factors. The prediction ability of these risk factors was then validated on another group of 301 patients. The results showed that diabetes, smoking, and animal bites could predict a persistent infection. The presence of any of these factors in isolation increased the likelihood of persistent infections by 15%. The risk increased to 20% when a combination of two were present, and to 45% when all three risk factors were reported by patients. Clinical Take Home Message: Hand therapists may be alerted to a heightened risk of infection if patients report history of diabetes, smoking, or animal bites. Patients with these characteristics should be monitored for the onset of new symptoms and promptly referred if an infection is suspected. URL: https://www.jhandsurg.org/article/S0363-5023(19)31422-4/fulltext

Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome Sim, S., Gunasagaran, J., Goh, K., & Ahmad, T. Level of Evidence: 2b Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Carpal Tunnel Syndrome (CTS) conservative treatment - orthosis vs orthosis plus nerve and tendon gliding exercises. This randomised trial assessed the effectiveness of a custom made wrist splint and wrist exercises on pain and function (Boston Carpal Tunnel Questionnaire) in participants with Carpal Tunnel Syndrome (CTS). Participants had to present with symptoms of carpal CTS. The diagnosis was confirmed through physical examination and nerve conduction studies. Participants were randomly allocated to wear a custom wrist splint only (n = 27) or to wear a custom wrist splint and perform nerve and tendon gliding exercises (n = 29). The trial lasted 8 weeks, with patients required to wear the splint 23 hours per day. The tendon and nerve gliding exercises were performed 10 times per day. The results need to be considered in the context of a few limitations. Allocation concealment was not mentioned in the randomisation process, and independent t-tests were utilised for dependent observations, which is a direct assumption violation for this analysis. The results showed that after 8 weeks of treatment both groups (splint only vs splint plus exercises) presented with statistically significant improvements in pain and function (but only the functional outcomes improved to a clinically meaningful level). There were no differences between groups on pain and function, suggesting that the addition of tendon and nerve gliding exercises to a splinting regime provided no added benefit. Clinical Take Home Message: The addition of nerve and tendon gliding exercises does not appear to add any benefit to the splinting regime. Clinicians might consider utilising these exercises in patients at higher risk of developing stiffness. URL: https://www.jhandtherapy.org/article/S0894-1130(17)30221-1/fulltext