Search Results

175 results found

  • Should we and our clients walk/cycle to work?

    Protective effect on mortality of active commuting to work: A systematic review and meta-analysis. Dutheil, F., Pélangeon, S., Duclos, M., Vorilhon, P., Mermillod, M., Baker, J. S., . . . Navel, V. (2020). Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 Type of study: Prognostic, Preventative, Therapeutic Topic: Mortality – Active commuting This is a systematic review and meta-analysis of prospective cohort studies assessing the effect of active commuting (e.g. walking, cycling) on mortality at 5-25 years follow up. Seventeen studies were included for a total of 829,098 participants. The results from this systematic review and meta-analysis were assessed through the Newcastle-Ottawa Quality Assessment Scale, which score from 0 (low quality) to 100 (High quality). The quality of evidence was moderate to high (average of 75 out of 100). Active commuting was defined as cycling or walking. The results showed that moderate to high intensity walking reduced mortality by 15% (95%CI: 2% to 28%) and 19% (95%CI: 8% to 30%) respectively. Cycling reduced mortality independently of intensity from 14% to 28%. It is necessary to keep in mind that the studies included were not randomised (as it would be unethical to randomise participants to 5-25 of sedentary behavior) and other systemic factors may contributed to the findings (e.g. less stressful lifestyle). Clinical Take Home Message: Based on what we know today, walking briskly or at a fast pace, or cycling to work, will reduce our clients' mortality risk in the next 5 to 25 years. As hand therapist we are privileged to be able to positively affect our clients' life and a simple advice on active commuting may provide them with longer healthspan and lifespan. We may also encourage our clients to be active outside of work as a greater number of daily steps, ability to do more than 10 push-ups (in middle aged males), and a greater grip strength have all been shown to predict mortality in previous studies. URL: Available through EBSCO Health Databases for PNZ members. Abstract Background: Sedentary behaviour is a major risk of mortality. However, data are contradictory regarding the effects of active commuting on mortality. Objectives: To perform a systematic review and meta-analysis on the effects of active commuting on mortality. Methods: The PubMed, Cochrane Library, Embase, and Science Direct databases were searched for studies reporting mortality data and active commuting (walking or cycling) to or from work. We computed meta-analysis stratified on type of mortality, type of commuting, and level of commuting, each with two models (based on fully adjusted estimates of risks, and on crude or less adjusted estimates). Results: 17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3–15%), and cardiovascular mortality by 15% (3–27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1–25%), and cycling decreased significantly both all-cause mortality by 21% (11–31%) and cardiovascular mortality by 33% (10–55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3–19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2–28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8–30%) and by 31% (9–52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5–42%), high level of active commuting (14%, 4–24%), and high level of active commuting by walking (16%, 0–32%). Conclusion: Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose–response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.

  • Another quick and reliable way to assess upper limb strength in older clients!

    The reliability and validity of novel clinical strength measures of the upper body in older adults. Legg, H. S., Spindor, J., Dziendzielowski, R., Sharkey, S., Lanovaz, J. L., Farthing, J. P., & Arnold, C. M. (2020) Level of Evidence: 2b Follow recommendation: 👍 👍 Type of study: Diagnostic test Topic: Push off test – Validity and reliability as a strength measure This is a longitudinal study (two repeated measures over 48 hrs) assessing the validity and reliability of the push off test in comparison to hand held dynamometer strength testing of the upper limb. Seventeen healthy participants (11 females, 6 males), who were on average 71 years old, took part in the study. The push off test was completed by inverting the handle of a hand held dynamometer and positioning it on a table. Participants were then asked to put as much weight as possible through it with the elbow and shoulder in 10°-40° of flexion and extension respectively (See picture below from the article). The results from this test were repeated two times (to assess reliability after 48 hrs) and compared to strength measurements of shoulder extension, shoulder abduction, and elbow extension (assessed through a hand held dynamometer) to assess validity. The results showed that the push off test was reliable (meaning that the measurements taken at two different times were very similar) with intraclass correlation coefficient between 0.92 and 0.94 (the closer to 1 the better). The push off test was also valid (it was indeed measuring upper limb strength) with strong correlation with the other measures of upper limb strength ranging from 0.8 to 0.9 (the closer to 1 the better). On average, the push off test was 27kg, and the average weight of the participants was 77kg. This suggests that for healthy patients around the age of 70, they should be able to push off during the test 35% of their weight (27kg/77kg=0.35). Clinical Take Home Message: Based on what we know today, the push off test can be utilised to assess upper limb strength in older people. This test has been previously used to assess late stage TFCC recovery. Getting our clients to achieve 35% of their body weight during this test may be an appropriate goal for our treatment. If our clients are younger, a better test may be the maximum number of push up that they can do in a row without stopping (Reaching 11 push-up may be an appropriate goal). Open Access URL: Abstract Introduction: Research investigating psychometric properties of multi-joint upper body strength assessment tools for older adults is limited. This study aimed to assess the test–retest reliability and concurrent validity of novel clinical strength measures assessing functional concentric and eccentric pushing activities compared to other more traditional upper limb strength measures. Methods: Seventeen participants (6 males and 11 females; 71 ± 10 years) were tested two days apart, performing three maximal repetitions of the novel measurements: vertical push-off test and dynamometer-controlled concentric and eccentric single-arm press. Three maximal repetitions of hand-grip dynamometry and isometric hand-held dynamometry for shoulder flexion, shoulder abduction and elbow extension were also collected. Results: For all measures, strong test–retest reliability was shown (all ICC > 0.90, p < 0.001), root-mean-squared coefficient of variation percentage: 5–13.6%; standard error of mean: 0.17–1.15 Kg; and minimal detectable change (90%): 2.1–9.9. There were good to high significant correlations between the novel and traditional strength measures (all r > 0.8, p < 0.001). Discussion: The push-off test and dynamometer-controlled concentric and eccentric single-arm press are reliable and valid strength measures feasible for testing multi-joint functional upper limb strength assessment in older adults. Higher precision error compared to traditional uni-planar measures warrants caution when completing comparative clinical assessments over time.

  • Thumb OA? - To splint or not to splint, that is the question

    The clinical and cost effectiveness of splints for thumb base osteoarthritis: A randomized controlled clinical trial. Adams, J., Barratt, P., Rombach, I., Arden, N., Barbosa Bouças, S., Bradley, S., . . . Dziedzic, K. (2020) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Thumb osteoarthritis - Real vs Sham thumb splint This is a randomised, multicentre, double-blind, placebo controlled trial assessing the effectiveness of thumb splinting on pain and function in participants with thumb osteoarthritis (OA). Participants (N = 292) were included if they presented with clinical signs of 1st cmcj OA (inclusion criteria available through their supplemental data) and if they had moderate hand pain and disability. Importantly, participants were excluded if they had previously tried thumb splinting. Pain and function were assessed through the AUSCAN at baseline, 8 weeks, and 12 weeks. Participants and assessors were blinded to treatment allocation. Participants were randomised to either an 8 weeks self-management program which provided participants with a handout from Arthritis Research UK and a series of exercises to perform three times per week (n = 97), or the self-management program (advice + exercise) plus a true splint limiting 1st cmcj movement (n = 97), or the self-management treatment (advice + exercise) plus a placebo splint, which did not provide any support to the 1st cmcj (n = 102). Participants in all groups attended one hour session at baseline for the introduction to the program. They also had a follow-up at 4 weeks for 30 minutes where key concepts were reiterated. At the eight weeks mark, a final session reminded participants to continue doing their exercises three times per week and wear the splint for at least 6hrs/day (in the splinting groups). The results showed that participants in all groups improved at the 8 and 12 weeks follow up without differences between groups. The placebo and true splint increased the cost of care by at least £100 without providing any significant benefit. Clinical Take Home Message: Based on what we know today, splinting for thumb OA does not provide any additional benefit than education and simple exercises. Providing a splint is more pricey and the expense does not appear to be justified. Instead of providing a splint, it may be more useful to use those resources (money and time) for an additional session of hand therapy where we can encourage joint motion for lotion, promote joint movement for amusement, and suggest meditation for elation. If this is not enough and clients want something passive (no exercises) that has been shown to have some effect (compared to placebo), although small, look at supplements for osteoarthritis. Also remember: keep smiling, your clients' pain will decrease! Open access URL: Abstract Objectives: To investigate the clinical effectiveness, efficacy and cost effectiveness of splints (orthoses) in people with symptomatic basal thumb joint OA (BTOA). Methods: A pragmatic, multicentre parallel group randomized controlled trial at 17 National Health Service (NHS) hospital departments recruited adults with symptomatic BTOA and at least moderate hand pain and dysfunction. We randomized participants (1:1:1) using a computer-based minimization system to one of three treatment groups: a therapist supported self-management programme (SSM), a therapist supported self-management programme plus a verum thumb splint (SSM+S), or a therapist supported self-management programme plus a placebo thumb splint (SSM+PS). Participants were blinded to group allocation, received 90 min therapy over 8 weeks and were followed up for 12 weeks from baseline. Australian/Canadian (AUSCAN) hand pain at 8 weeks was the primary outcome, using intention to treat analysis. We calculated costs of treatment. Results: We randomized 349 participants to SSM (n = 116), SSM+S (n = 116) or SSM+PS (n = 117) and 292 (84%) provided AUSCAN Osteoarthritis Hand Index hand pain scores at the primary end point (8 weeks). All groups improved, with no mean treatment difference between groups: SSM+S vs SSM −0.5 (95% CI: −1.4, 0.4), P = 0.255; SSM+PS vs SSM −0.1 (95% CI: −1.0, 0.8), P = 0.829; and SSM+S vs SSM+PS −0.4 (95% CI: −1.4, 0.5), P = 0.378. The average 12-week costs were: SSM £586; SSM+S £738; and SSM+PS £685. Conclusion: There was no additional benefit of adding a thumb splint to a high-quality evidence-based, supported self-management programme for thumb OA delivered by therapists.

  • Do you want to help your clients quit smoking?

    The role of physiotherapists in smoking cessation. Luxton, N., & Redfern, J. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Preventative, Therapeutic Topic: Smoking - Help them quit This is a guideline for health professionals on how to help clients quit smoking. A simple 3 steps process is suggested: 1) Ask if they are smoking and when they stopped smoking. If they stopped smoking in the last 6 months, they may benefit from extra support to avoid a relapse. 2) Advise to stop smoking if they are smoking. The advice should be personalised and refer to the impact of smoking in relation to their personal circumstances. These could include delays in wound healing and increased risk of infections, delays in fracture healing, as well as reduce effectiveness of painkillers. 3) Help by connecting your client with a specialist telephone service like Quitline (0800 778 778), internet interventions, or the QuitNow app. A relapse within the first few weeks from quitting is very common and health professionals should kindly check in on their client's progress. Clinical Take Home Message: The figure below speaks for itself. I feel I should screen my clients more than what I do at the moment, I often stop at the "Asking". If you have time, have a look at the Ministry of Health page on "Stop smoking", it has some great resources! Open Access URL: No Abstract available

  • Are we getting weaker?

    Temporal trends in the handgrip strength of 2,592,714 adults from 14 countries between 1960 and 2017: A systematic analysis. Dufner, T. J., Fitzgerald, J. S., Lang, J. J., & Tomkinson, G. R. (2020) Level of Evidence: 2a Follow recommendation: 👍 👍 Type of study: Symptoms prevalence Topic: Grip strength – Changes in the last 57 years This is a systematic review assessing the change in grip strength in the last 57 years. Ten prospective studies were included for a total of 2,592,714 participants. The age of participants ranged between 20 and 90. Data were collected from high to moderate income countries. Hand grip strength was assessed through hand held dynamometers. The results showed that no significant change in grip strength was identified before 2000. However, between 2000 and 2017, there was a trend towards a decrease in grip strength. Clinical Take Home Message: Based on what we know today, grip strength has been declining in the last 20 years. This is unfortunate because grip strength is predictor of mortality at 10 years. It may be worth reminding our clients about the importance of general body strengthening and aerobic exercise to increase lifespan and more importantly health span. URL: Available through EBSCO Health Databases for PNZ members. Abstract Background: Handgrip strength (HGS) is an excellent marker of functional capability and health in adults, although little is known about temporal trends in adult HGS. Objectives: The aim of this study was to systematically analyze national (country-level) temporal trends in adult HGS, and to examine the relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Methods: Data were obtained from a systematic search of studies reporting temporal trends in HGS for adults (aged ≥ 20 years) and by examining national fitness datasets. Trends in mean HGS were estimated at the country–sex–age group level by best-fitting sample-weighted linear/polynomial regression models, with national and sub-regional (pooled data across geographically similar countries) trends estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Results: Data from ten studies/datasets were extracted to estimate trends in mean HGS for 2,592,714 adults from 12 high- and 2 upper-middle-income countries (from Asia, Europe and North America) between 1960 and 2017. National trends were few, mixed and generally negligible pre-2000, whereas most countries (75% or 9/12) experienced negligible-to-small declines ranging from an effect size of 0.05 to 0.27, or 0.6 to 6.3%, per decade post-2000. Sex- and age-related temporal differences were negligible. National trends in adult HGS were not significantly related to national trends in health and socioeconomic/demographic indicators. Conclusions: While trends in adult HGS are currently limited to 14 high- and upper-middle-income countries from three continents, adult HGS appears to have declined since 2000 (at least among most of the countries in this analysis), which is suggestive of corresponding declines in functional capability and health.

  • Can your clients do enough push-up?

    Association between push-up exercise capacity and future cardiovascular events among active adult men. Yang, J., Christophi, C. A., Farioli, A., Baur, D. M., Moffatt, S., Zollinger, T. W., & Kales, S. N. (2019) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Prognostic Topic: Push-up - Mortality prediction This is a retrospective longitudinal cohort study assessing the ability to predict cardiovascular events (CV - e.g. heart failure, coronary hearth disease) in the next 10 years based on the number of push up that somebody can do. A total of 1,562 male firefighters participants were included at baseline. Participants were followed up for 10 years. Participants were on average 40 years old at baseline. The number of push-up was assessed at baseline. Participants had to do as many push ups as possible following the rhythm of a metronome set at 80 beats per minute. The test was interrupted if participants were unable to keep up with the beat for 3 or more consecutive repetitions. The results showed that participants completing less than 10 push-up were at much greater risk of having a CV event in the next 10 years. Participant able to do at least 11 push-up had a 64% reduction in risk at 10 years and those able to complete 40 push-up had a 96% risk reduction. Clinical Take Home Message: Based on what we know today, this push-up test is a quick reference that allows us to assess our clients CV risk at 10 years. This test is however currently applicable to males only. The results do not suggest that just training push-up will reduce your risk as this is just an adaptation to specific training. What this test does however suggest is that by getting people overall stronger, their risk of CV will reduce. This synopsis is a nice addition to the one that was previously completed on grip strength and mortality and walking and mortality. Getting our clients fitter may provide them with a longer lifespan (length of life) and healthspan (years of quality life - free from disease). Open Access URL: Abstract Importance: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Robust evidence indicates an association of increased physical fitness with a lower risk of CVD events and improved longevity; however, few have studied simple, low-cost measures of functional status. Objective: To evaluate the association between push-up capacity and subsequent CVD event incidence in a cohort of active adult men. Design, Setting, and Participants: Retrospective longitudinal cohort study conducted between January 1, 2000, and December 31, 2010, in 1 outpatient clinics in Indiana of male firefighters aged 18 years or older. Baseline and periodic physical examinations, including tests of push-up capacity and exercise tolerance, were performed between February 2, 2000, and November 12, 2007. Participants were stratified into 5 groups based on number of push-ups completed and were followed up for 10 years. Final statistical analyses were completed on August 11, 2018. Main Outcomes and Measures: Cardiovascular disease–related outcomes through 2010 included incident diagnoses of coronary artery disease and other major CVD events. Incidence rate ratios (IRRs) were computed, and logistic regression models were used to model the time to each outcome from baseline, adjusting for age and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared). Kaplan-Meier estimates for cumulative risk were computed for the push-up categories. Results: A total of 1562 participants underwent baseline examination, and 1104 with available push-up data were included in the final analyses. Mean (SD) age of the cohort at baseline was 39.6 (9.2) years, and mean (SD) BMI was 28.7 (4.3). During the 10-year follow up, 37 CVD-related outcomes (8601 person-years) were reported in participants with available push-up data. Significant negative associations were found between increasing push-up capacity and CVD events. Participants able to complete more than 40 push-ups were associated with a significantly lower risk of incident CVD event risk compared with those completing fewer than 10 push-ups (IRR, 0.04; 95% CI, 0.01-0.36). Conclusions and Relevance: The findings suggest that higher baseline push-up capacity is associated with a lower incidence of CVD events. Although larger studies in more diverse cohorts are needed, push-up capacity may be a simple, no-cost measure to estimate functional status.

  • Shall we upgrade our sensory testing for carpal tunnel syndrome?

    Concurrent validity of a low-cost and time-efficient clinical sensory test battery to evaluate somatosensory dysfunction. Zhu, G. C., Böttger, K., Slater, H., Cook, C., Farrell, S. F., Hailey, L., . . . Schmid, A. B. (2019) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 Type of study: Diagnostic Topic: Sensory testing - Bed side tests This is a validation study of bedside tests for clients presenting with musculoskeletal conditions including carpal tunnel syndrome (CTS). The results of a series of bedside tests, which included temperature detection (heat, cold), mechanical detection (e.g. monofilament testing), pressure pain thresholds, and others were compared to quantitative sensory testing, which is the current gold standard to assess the function of the sensory system. The most valid tests for loss of sensation were the warm/cold detection and the cotton wool touch detection. The most valid tests for sensory gain (hyperalgesia) were pressure pain thresholds on the thenar eminence with a pencil eraser or the clinicians' thumb. All the tests were compared to the contralateral limb or a non affected are of the hand to determine whether there was a loss of sensation or hyperalgesia. Clinical Take Home Message: Based on what we know today, a few bedside tests can be implemented in addition to our monofilament and manual muscle tests for carpal tunnel syndrome. These tests include cold/warm sensation assessment, which can be done through cold/warm coins, and pain pressure threshold based on compression of the thenar eminence through a clinician's thumb. These tests need to be compared to the healthy contralateral limb (if asymptomatic) to identify whether we have a loss or gain in sensation. In addition, we can perform pinprick testing, which is on indicator of small nerve fibre integrity. By monitoring our patients through these tests, we may be able to identify improvements following our intervention, which may go unnoticed if assessed through monofilament or manual muscle testing only. Open Access URL: Abstract Background This study describes a low‐cost and time‐efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST). Method Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non‐specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated. Results Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind‐up ratio) did not significantly correlate with QST. Conclusion Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low‐cost screening tool in a clinical setting. Significance Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low‐cost and time‐efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.

  • 5ht metacarpal neck fracture - I like to move it move it

    Challenging the dogma: Severely angulated neck fractures of the fifth metacarpal must be treated surgically. Boeckstyns, M. E. H. (2020) Level of Evidence: 3a Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: 5th metacarpal neck fracture - conservative vs surgical This is a systematic review comparing the effectiveness of different conservative treatment or conservative treatments vs surgical treatment for 5th metacarpal neck fractures. Eighteen studies were included in the systematic review. The studies included were quite heterogeneous and only one author completed the review (usually we have two authors assessing research independently). Efficacy of intervention was assessed by functional outcomes (e.g. DASH), maintenance of fracture reduction, return to work, and complications.The results showed that different types of conservative treatment did not affect any of the outcomes to a significant level. Some of the studies elected to mobilise participants immediately and others utilised a clam shell around the 5th metacarpal without including the mcpj. Return to work was quicker in those participants who were allowed to mobilise early. No clear difference was identified in clients treated surgically or conservatively. Complications appeared to be higher in the surgically treated group. Clinical Take Home Message: Based on what we know today, hand therapists may choose to mobilise early clients with a 5th metacarpal neck fracture. If a form of splinting is chosen, there appears to be no difference between a clam shall including or not the mcpj, or buddy splinting. Surgical treatment seem to lead to worse outcomes. For another great study on this topic, see previous synopsis. URL: Available through EBSCO Health Databases for PNZ members. Abstract Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.

  • Should we keep Telerehabilitation as an alternative to in person appointments?

    Telemedicine in hand and upper-extremity surgery Grandizio, L. C., Foster, B. K., & Klena, J. C. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Telemedicine – Implementation and feasibility This narrative review provides advice on the implementation of telemedicine, and its strength/limitations, for upper limb conditions. Written consent should be gathered before any telemedicine session. This can be obtained online before the appointment. When starting a telemedicine consultation, patients should be made aware of any other people present in the room. Radiology referrals and reports are usually available online making it easier for clinicians to make decisions. Range of movement assessments of wrists and fingers appear to be feasible through video calls. One of the limitations is the assessment of sensation (monofilament testing). No evidence has assessed the feasibility of special tests and reliability of special tests through telemedicine. It appears that wound assessment is feasible with telemedicine and that complications are easily assessed. The cost of telemedicine appears to be lower compared to a traditional outpatient visit, and it seems to be as safe as in person assessments. Clinical Take Home Message: Based on what we know today, telemedicine is possible and may be utilised as an alternative to in person appointments. Limited evidence has assessed the validity and reliability of objective assessments performed remotely. For skin sensation, the Ten Test can be performed by the patient independently and may be suitable for telemedicine use. Toothpicks may be used as an alternative to assess pinprick sensation (assessing nerves' small fibre). In addition, most splints can be posted to patients without them leaving the comfort (or safety) of their own house. Companies such as @Therapy can organise the delivery, without too much effort from the clinician's point of view. URL: Available through The Journal of Hand Surgery for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Smartphones, computers, and Internet access continue to become more available to both patients and physicians. As these technologies develop with respect to health care, opportunities for telemedicine visits continue to emerge. The purpose of this review article was to analyze the current use and potential applications of telemedicine in hand and upper-extremity surgery. Although the literature pertaining to the use of telemedicine in hand surgery is limited, videoconferencing visits may provide benefits to patients. Particularly in rural and underserved regions, patients can decrease considerable travel burdens. Potential applications for this technology include remote inpatient and emergency room consultations, outpatient clinic visits, and postoperative care. There are unique considerations with respect to confidentiality and security. As with any new technology, it is important to analyze safety concerns. Future randomized, prospective investigations are necessary to define the economic implications of telemedicine programs more clearly within hand and upper-extremity surgery.

  • What can you do for elbow instability?

    Rehabilitation of elbow instability. Pipicelli, J. G., & King, G. J. W. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Aetiologic, Therapeutic Topic: Elbow instability - Aetiology and treatment This is a narrative review on aetiology and treatment of elbow stiffness. The aetiology of elbow instability is usually due to a trauma associated with elbow extension. The goal of treatment is to allow time for the ligaments, capsule, and potentially tendinous lesions to heal. Conservative treatment depends on the severity and type of injury. The presence of a "drop sign" on x-ray (more than 4mm distance between the humerus and ulna in 90deg of elbow flexion) suggest significant elbow laxity. If the lateral collateral ligaments (LCL) of the elbow are involved, the forearm should be maintained in pronation to increase the support provided by the common extensor tendons. If the medical collateral ligaments (MCL) have been injured, the forearm should be positioned in supination to increase support from the common flexor tendon. If both LCL and MCL are involved, the forearm should be placed in neutral. Acutely after injury, the elbow is placed in a splint which limits elbow extension to 60deg. Extension is subsequently increased by 10deg per week. Active range of movement exercises can be initiated soon after the injury and they involve flexion/extension of the elbow (within the brace limits) and pronation/supination of the forearm (in 90 deg of elbow flexion) in a supine position with 90deg of shoulder flexion. This position has been suggested to improve joint congruence and reduce instability during the exercises. Elbow x-rays should be repeated at 3 weeks post injury and if a "drop sign" is still present, surgery is indicated. Isometric biceps and triceps exercises should be included within the first 3 weeks if the "drop sign" is present and this may help in reducing instability. At six weeks post injury, isotonic (e.g. dynamic exercises holding a dumbbell) strengthening can generally be initiated. Clinical Take Home Message: Based on what we know today, elbow instability should be treated with ROM brace than can limit AROM to 60deg of extension. The additional positioning of a resting pronation/supination may be used to protect the LCL and MCL respectively. X-rays should be obtained at baseline and at 3 weeks. If a "drop sign" is present, this suggest significant instability and isometric biceps and triceps resistance exercises should be utilised in combination with AROM in supine to reduce instability and maintain range of movement. The development of stiffness following an elbow injury is common and you can take a look at a previous synopsis on the topic. URL: Available through Hand Clinics for HTNZ members. Available through EBSCO Health Databases for PNZ members. No Abstract available


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