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149 results found

  • Carpal tunnel syndrome, Proximal phalanx fracture, Distal biceps re-repture, & Wrist palpation

    The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release Maempel, J., Jenkins, P., & McEachan, J. Level of Evidence: 4 Follow recommendation: 👍 👍 👍 Type of study: Prognostic Topic: Carpal tunnel syndrome (CT) and mental health - Outcomes before and after surgical intervention This is a prospective cohort study assessing the relationship between mental health and outcomes following surgery for CT. The results are to be considered in the context of a few limitations. Of the entire cohort, only 52% of the participants returned the Short Form-12 (SF-12), used to assess mental health. In addition, SF-12 scores were only collected at one-year post surgery, which defeats the point of a prospective cohort study. The results show a correlation between mental health status and patient reported satisfaction at one year after surgery. There was also a statistically, but not clinically significant difference in QuickDASH scores of patients presenting with mental health problems compared to healthy patients at one year follow up. This correlation might be due to worse mental health state leading to lower function or vice versa. It is also possible that a third unknown variable, not measured in the present study, mediated this association. Clinical Take Home Message: Hand therapists should keep in mind that functional recovery of patients undergoing surgery for CT may be worse if they present with poorer mental health. A multidisciplinary approach to treatment and rehabilitation may be effective in improving functional outcomes. URL: https://journals.sagepub.com/doi/full/10.1177/1753193419866400 Non-surgical management of isolated proximal phalangeal fractures with immediate mobilization Byrne, B., Jacques, A., & Gurfinkel, R. Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Conservative treatment of proximal phalanx fracture - Splinting and immediate active movement. This single group prospective cohort study assessed the effectiveness of a splinting regime combined with an immediate range of movement exercise program in people with proximal phalanx fractures. Only patients with stable or stable after reduction fractures were included. In addition, angulation on sagittal and coronal plane had to be less than 25° and 10° respectively. Patients were provided with an edema glove and were immobilised in a custom-made hand splint which extended to the pipj and fixated the mcpj in full flexion. During the first week, patients were advised against removing the splint, however, they were encouraged to flex and extend the pipj and dipj hourly. Between week one and four, patients could remove the splint for hand hygiene only and were advised to continue exercising hourly. After four weeks, the splint was removed for light activities and at six weeks the splint was completely removed with progression to full activity as pain allowed. Discharge took place when pain had resolved and when full range of movement was achieved. The results showed that 2.5% of patients lost fracture reduction after one week and required surgical intervention. The median time to discharge was 6 weeks at which point pain had completely resolved and the average pipj flexion range of movement was 94° with 4° of hyperextension. Clinical Take Home Message: Hand therapists may consider treating a proximal phalanx fracture conservatively with an intrinsic plus immobilisation splint and an early controlled active motion exercise program. This approach is applicable if there is less than 25° of sagital angulation of the fracture and in absence of scissoring of digits. The patient should be monitored closely during the first week after injury as there is a possibility (2.5-9%) of losing fracture stability. URL: https://journals.sagepub.com/doi/full/10.1177/1753193419881086 Diagnosis, etiology and outcomes of revision distal biceps tendon reattachment Prokuski, V., Leung, N., & Leslie, B. Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Distal biceps tendon re-rupture - Patient presentation and characteristics. This retrospective study assessed the clinical presentation and characteristics of patients (n = 10) who underwent a revision surgery for a previously repaired distal biceps tendon rupture. The reason for revision surgery was the presence of persistent pain since primary repair (40% of patients) or acute pain following a specific traumatic event (60% of patients up to two years post-surgery). The re-rupture rate of a distal biceps repair has been reported to be 1-6%. Hook test and MRI were unhelpful in screening or diagnosing re-rupture due to tethering around the surgical site. Three of the 10 patients had a previous re-rupture in the contralateral arm. It has been suggested that if re-rupture occurs without biceps tendon retraction, the repair is not urgent and can be performed up to two years post injury. Clinical Take Home Message: Hand therapists should immediately refer patients with a previous primary biceps tendon repair who report sudden onset of antecubital pain due to trauma. Delays in repair of re-rupture may lead to tendon retractions. On the other hand, if pain has been on-going, referral may not be as urgent. URL: https://www.jhandsurg.org/article/S0363-5023(18)31253-X/fulltext 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. 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

  • Proximal phalangeal # - Immediate mobilisation approach

    Non-surgical management of isolated proximal phalangeal fractures with immediate mobilization Byrne, B., Jacques, A., & Gurfinkel, R. Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Conservative treatment of proximal phalanx fracture - Splinting and immediate active movement. This single group prospective cohort study assessed the effectiveness of a splinting regime combined with an immediate range of movement exercise program in people with proximal phalanx fractures. Only patients with stable or stable after reduction fractures were included. In addition, angulation on sagittal and coronal plane had to be less than 25° and 10° respectively. Patients were provided with an edema glove and were immobilised in a custom-made hand splint which extended to the pipj and fixated the mcpj in full flexion. During the first week, patients were advised against removing the splint, however, they were encouraged to flex and extend the pipj and dipj hourly. Between week one and four, patients could remove the splint for hand hygiene only and were advised to continue exercising hourly. After four weeks, the splint was removed for light activities and at six weeks the splint was completely removed with progression to full activity as pain allowed. Discharge took place when pain had resolved and when full range of movement was achieved. The results showed that 2.5% of patients lost fracture reduction after one week and required surgical intervention. The median time to discharge was 6 weeks at which point pain had completely resolved and the average pipj flexion range of movement was 94° with 4° of hyperextension. Clinical Take Home Message: Hand therapists may consider treating a proximal phalanx fracture conservatively with an intrinsic plus immobilisation splint and an early controlled active motion exercise program. This approach is applicable if there is less than 25° of sagital angulation of the fracture and in absence of scissoring of digits. The patient should be monitored closely during the first week after injury as there is a possibility (2.5-9%) of losing fracture stability. URL: https://journals.sagepub.com/doi/full/10.1177/1753193419881086

  • A reliable way to palpate lunate and capitate

    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

  • Revision of distal biceps rupture repair

    Diagnosis, etiology and outcomes of revision distal biceps tendon reattachment Prokuski, V., Leung, N., & Leslie, B. Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Distal biceps tendon re-rupture - Patient presentation and characteristics. This retrospective study assessed the clinical presentation and characteristics of patients (n = 10) who underwent a revision surgery for a previously repaired distal biceps tendon rupture. The reason for revision surgery was the presence of persistent pain since primary repair (40% of patients) or acute pain following a specific traumatic event (60% of patients up to two years post-surgery). The re-rupture rate of a distal biceps repair has been reported to be 1-6%. Hook test and MRI were unhelpful in screening or diagnosing re-rupture due to tethering around the surgical site. Three of the 10 patients had a previous re-rupture in the contralateral arm. It has been suggested that if re-rupture occurs without biceps tendon retraction, the repair is not urgent and can be performed up to two years post injury. Clinical Take Home Message: Hand therapists should immediately refer patients with a previous primary biceps tendon repair who report sudden onset of antecubital pain due to trauma. Delays in repair of re-rupture may lead to tendon retractions. On the other hand, if pain has been on-going, referral may not be as urgent. URL: https://www.jhandsurg.org/article/S0363-5023(18)31253-X/fulltext

  • Mental health and recovery after carpal tunnel release

    The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release Maempel, J., Jenkins, P., & McEachan, J. Level of Evidence: 4 Follow recommendation: 👍 👍 👍 Type of study: Prognostic Topic: Carpal tunnel syndrome (CT) and mental health - Outcomes before and after surgical intervention This is a prospective cohort study assessing the relationship between mental health and outcomes following surgery for CT. The results are to be considered in the context of a few limitations. Of the entire cohort, only 52% of the participants returned the Short Form-12 (SF-12), used to assess mental health. In addition, SF-12 scores were only collected at one-year post surgery, which defeats the point of a prospective cohort study. The results show a correlation between mental health status and patient reported satisfaction at one year after surgery. There was also a statistically, but not clinically significant difference in QuickDASH scores of patients presenting with mental health problems compared to healthy patients at one year follow up. This correlation might be due to worse mental health state leading to lower function or vice versa. It is also possible that a third unknown variable, not measured in the present study, mediated this association. Clinical Take Home Message: Hand therapists should keep in mind that functional recovery of patients undergoing surgery for CT may be worse if they present with poorer mental health. A multidisciplinary approach to treatment and rehabilitation may be effective in improving functional outcomes. URL: https://journals.sagepub.com/doi/full/10.1177/1753193419866400

  • How to identify a ruptured distal biceps

    Distal biceps tendon repair and reconstruction Srinivasan, R., Pederson, W., & Morrey, B. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Biceps tendon rupture - Incidence, surgery and rehabilitation. This narrative review reported on biceps tendon rupture demographics, diagnostic methods, conservative, surgical, and rehabilitative plans. Ninety percent of biceps tendon lesions occur in middle aged males with smoking and large BMI being significant risk factors. The Hook test is 95% sensitive (useful for screening) and 85% specific (useful for confirmation of diagnosis). MRI is the investigation of choice. Conservative management is appropriate for individuals with low functional demands, elbow OA, and significant medical comorbidities. Conservative management often leads to a forearm supination and elbow flexion strength deficits of 40% and 30% respectively. With operative management data suggests that there is limited flexion strength deficit, however, a 10-20% deficit in supination strength is likely to remain. In case of surgical management, the greatest risk for repair failure within the first two weeks. Post-surgical rehabilitation for low tension repairs requires a posterior elbow orthosis at 80° of elbow flexion and forearm neutral position worn 24/7 for 2/52. When the repair is performed under greater tension (repair after 4/52 from injury), the elbow orthosis is transformed into a hinge splint at 2 weeks with a block at 40° of flexion. Every week, the extension restriction is reduced by 10° until reaching 0° of extension at 6/52. After two weeks, the patient is allowed to lift a maximum of 2kg until week 6-10 according to the type of surgery and quality of tissues repair. Following this period, light resistance training can be initiated with a full return to heavy duties by 3-6 months. Complications can include paraesthesia of the radial aspect of the forearm due to a lateral antebrachial cutaneous nerve lesion or wrist/fingers/thumb extension and thumb abduction weakness due to involvement of the posterior interosseus nerve. Clinical Take Home Message: Hand therapists should use the hook test as a screening and diagnostic tool when suspecting biceps tendon rupture. Conservative treatment is an option, however, considering the complications associated with delays in surgical interventions beyond 4/52, it is advisable to refer patients with this condition to a hand surgeon. Post-surgical rehabilitation includes 2/52 full time elbow splinting, followed by range of movement exercises and introduction of light resistance exercises at 6-10/52 according to surgical procedure and quality of tissues repaired. Hand therapists should watch out for motor and sensory deficits following surgery as they are potential adverse events. URL: https://www.jhandsurg.org/article/S0363-5023(19)31469-8/fulltext

  • Virtual reality for cerebral palsy

    Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review Rathinam, C., Mohan, V., Peirson, J., Skinner, J., Nethaji, K., & Kuhn, I. Level of Evidence: 2a Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Hand rehabilitation in Cerebral Palsy (CP) - Effectiveness of non-immersive virtual reality (VR) in children with CP This systematic review compared the effectiveness of non-immersive VR (e.g. games and PC interface) and traditional physiotherapy interventions on hand function in children/teenagers with CP. The selection of articles, in the results section, has not been clearly reported. Six articles were included in the review. Of these, three were randomised controlled trials, one was an abstract, and the remaining were non-experimental studies. The results were inconsistent across studies and only two studies reported added benefits of VR. Of these, one compared VR and physiotherapy to physiotherapy alone and showed greater improvements when VR was included. However, due to the study design, we are unsure of the effectiveness of VR alone. The other study showing improvements with VR had a very low methodological quality. Clinical Take Home Message: Hand therapists involved in the rehabilitation of children/teenagers with CP should not change their practice based on the results of this systematic review. Considering the added cost of non-immersive VR, its use is not justified to improve hand function in this group of patients. URL: https://www.jhandtherapy.org/article/S0894-1130(17)30107-2/fulltext

  • Dynamic orthosis for pipj extension deficit

    Short functional dynamic orthosis for proximal interphalangeal joint extension deficit. Crest design Cantero-Téllez, R. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Proximal interphalangeal joint (pipj) extension lag treatment - Dynamic orthosis. This practice forum presented step by step instructions on how to create a dynamic splint for pipj extensor lag. It is advised to wear the splint 6 hours daily in combination to a static night splint for 6/52. The orthosis is reported to be a useful alternative in settings where off the shelf products are not available. A piece of 1.6 to 2mm thermoplastic, orficast, and elastic bands are required. A small cylinder for the proximal phalanx is created and connected to the distal cylinder which includes the proximal and distal phalanx. The pipj is therefore left free to move. The two cylinders are connected on radial and ulnar side by two orficast stripes to warrant stability of the splint. Two hooks are positioned on the dorsal proximal cylinder and at the dorsal distal cylinder at dipj level. An elastic band is attached to the two hooks to assist with pipj extension and allow pipj flexion. Clinical Take Home Message: Hand therapists should make sure that the extension lag at the pipj is not due to a central slip before deciding to apply this splint. If no central splip is suspected, the clinician may consider this new design as an alternative to existing splints. If available, however, an off the shelf LMB finger extension splint would probably achieve the same result. In a low resource setting, a relative motion flexion splint may be a suitable alternative to this new design. URL: https://www.jhandtherapy.org/article/S0894-1130(18)30148-0/fulltext

  • Does insurance type matter for cubital tunnel treatment?

    Associations between insurance type and the presentation of cubital tunnel syndrome Cheng, C., & Rodner, C. Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Symptoms prevalence study Topic: Cubital tunnel syndrome (CuTS) progression - Disease stage in privately vs publicly insured patients in USA. This retrospective study analysed Cubital tunnel syndrome (CuTS) stages and time to first surgeon’s visit in American patients who were either privately or publicly insured. The results showed the odds of publicly insured patient to have intrinsic hand muscles weakness, atrophy, mild to severe disturbances on moving two-point discrimination, and nerve conduction impairments, were 4.4 times larger than patients who were privately insured. In addition, the wait time in the publicly insured patients was twice (7yrs) as long as the one for privately insured patients (3.5yrs). It can be speculated that greater disease severity in the publicly insured group were due to longer time with the condition, lower socio-economic status and health literacy, and inability to take leave from work. Further studies need to causality between these factors and disease severity. Clinical Take Home Message: Patients with longer standing CuTS may present with worse signs and symptoms. To avoid long term consequences, a prompt referral to a hand surgeon may be useful when conservative treatment for CuTS fails. In the United States, therapists should be aware that publicly insured patients may present with a worse clinical condition compared to privately insured patients. URL: https://www.jhandsurg.org/article/S0363-5023(18)31402-3/fulltext

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