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  • Is self-efficacy strongly associated with function in people with hand pathologies?

    The association between pain self-efficacy and patient-reported outcome measures for hand disorders: A cross-sectional study. Overduin, I., Allen, C. and Aret, J. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence study Topic: Self efficacy - Hand function This retrospective study assessed the correlation between pain self-efficacy and patient-reported outcome measures for hand and wrist disorders. A total of 229 participants were included in the present study The outcomes measured included the Dutch translations of the Pain Self-Efficacy Questionnaire Short Form (PSEQ-2) and the Patient Rated Wrist Hand Evaluation (PRWHE). The results showed a strong and significant correlation between the PSEQ-2 and the PRWHE, indicating that a higher pain self-efficacy was associated with less pain and disability as measured by the PRWHE. Pain self-efficacy independently predicted 28% of the PRWHE. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, pain self-efficacy is an important psychological factor that may be assessed in patients with hand conditions. There is a growing amount of evidence suggesting that self-efficacy is an important aspect mediating not only pain and function but also the effect of exercise on patients anxiety/depression and their compliance. URL: https://doi.org/10.1177/17589983231174800 Abstract Introduction: Multiple psychological factors influence the functioning of patients with hand disorders. Pain self-efficacy is a positive psychological factor, which concerns an individual’s confidence to function despite experiencing pain. This study aimed to analyse the association between pain self-efficacy and a patient-reported outcome measure (PROM) for hand and wrist disorders. Methods: Cross-sectional data from patient records were collected prior to hand therapy to analyse the correlation between pain self-efficacy and a PROM for hand and wrist disorders. The assessment tools consisted of the Dutch translations of the Pain Self-Efficacy Questionnaire Short Form (PSEQ-2) and the Patient Rated Wrist Hand Evaluation (PRWHE). Results: The findings were reported for the entire sample of 185 respondents (61% women). The PSEQ-2 and the PRWHE were strongly and significantly correlated, which signifies that a higher pain self-efficacy was associated with less pain and disability as measured by the PRWHE. Within a multivariable regression model which accounted for confounding variables, pain self-efficacy independently predicted 28% of the PRWHE scores. Conclusions: A strong association between the Dutch PSEQ-2 and the PRWHE was found in this sample of hand therapy patients. This study was limited by the use of retrospective data and by the lack of validation of the Dutch PSEQ-2. The findings were consistent with existing research which reported similar correlations between upper extremity PROM scores and pain self-efficacy. The positively worded PSEQ presents a chance to routinely assess pain self-efficacy as a key psychological factor while also affirming a positive coping strategy. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Is driving a low load activity following total elbow arthroplasty?

    Elbow joint loads during simulated activities of daily living: Implications for formulating recommendations after total elbow arthroplasty. Duijn, R. G. A., et al. (2023). Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Loading - Elbow arthroplasty This is a lab based biomechanics study assessing elbow joint loading during activities of daily living (ADL) after total elbow arthroplasty (TEA). The study assessed joint moments during ADL and their relationship to the failure limits of a prosthesis. A total of eight cadavers were included in the present study. Eight different tasks, described in the figure below, were assessed. The results showed that peak joint moments significantly differed between tasks and movement directions, with the most demanding tasks being steering a wheel and rising from a chair. In addition, lifting 1 kg was one of the least biomechanically taxing activities. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, driving and pushing off a chair with your arms are amongst the activities that put the highest loading through the elbow. As a result, it may be useful to avoid doing so for the first few weeks post total elbow arthroplasty. In addition, pushing and pulling, such as lifting and opening doors, put significant stress on the elbow joint, particularly in the flexion-extension and varus-valgus directions. Interestingly, the study questions the effectiveness of the current postoperative instruction of not lifting more than 1 kg as this does not appear to put excessive stress on the prosthesis. This article is an interesting addition to a recent one assessing the amount of upper limb ROM required to return to driving. URL: https://doi.org/10.1016/j.jse.2023.07.042 Abstract Background: Overloading of the elbow joint prosthesis following total elbow arthroplasty can lead to implant failure. Joint moments during daily activities are not well-contextualized for a prosthesis’ failure limits and the effect of the current postoperative instruction on elbow joint loading is unclear. This study investigates the difference in elbow joint moments between simulated daily tasks and between flexion-extension, pronation-supination, varus-valgus movement directions. Additionally, the effect of the current postoperative instruction on elbow joint load is examined. Methods: Nine healthy participants (age 45.8 ± 17 years, 3 males) performed eight tasks; driving a car, opening a door, rising from chair, lifting, sliding, combing hair, drinking, emptying cup, without and with the instruction “not lifting more than 1 kg”. Upper limb kinematics and hand contact forces were measured. Elbow joint angles and net moments were analyzed using inverse dynamic analysis, where the net moments are estimated from movement data and external forces. Results: Peak elbow joint moments differed significantly between tasks (p < 0.01) and movement directions (p < 0.01). The most and least demanding tasks were, rising from a chair (13.4 Nm extension, 5.0 Nm supination, 15.2 Nm valgus) and sliding (4.3 Nm flexion, 1.7 Nm supination, 2.6 Nm varus). Net moments were significantly reduced after instruction only in the chair task (p < 0.01). Conclusion: This study analyzed elbow joint moments in different directions during daily tasks. The outcomes question whether postoperative instruction can lead to decreasing elbow loads. Future research might focus on reducing elbow loads in the flexion-extension and varus-valgus directions. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Is the inclusion of mobilisation with movement to treatment for carpal tunnel syndrome useful?

    The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study. Ceylan, İ., et al. (2023). Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Carpal tunnel syndrome - Mobilisation with movement This is a randomised controlled trial on the effectiveness of mobilisation with movement (MWM) technique in patients with carpal tunnel syndrome (CTS). A total of 45 participants with CTS diagnosed based on symptoms presentation, positive response to provocative tests, and mild to moderate median nerve compression as shown by nerve conduction studies, were included. Participants were randomised to either physiotherapy plus MWM (see picture below) or physiotherapy alone. Each group received three sessions per week for four weeks. The primary outcome was pain measured through the visual analogue scale. The results showed that all participants improved to a clinically relevant level. Furthermore, the study showed that the addition of MWMs did not provide statistically significant or clinically relevant improvements in pain compared to physiotherapy alone. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, mobilisation with movement (MWM) does not provide additional pain relief when compared to physiotherapy alone for people with CTS. However, it appears that a combination of multiple manual therapy interventions and exercise may be beneficial for carpal tunnel syndrome. Other interventions that have a much larger body of evidence supporting their use include surgery, corticosteroid injections, and night splinting. Have a look at the whole database to get a full picture of the most recent papers on the topic. URL: https://doi.org/10.1016/j.jht.2023.02.004 Abstract Study design: Single-blinded, randomized controlled study. Introduction Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. Purpose of the study: This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. Methods: A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. Results: We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. Discussion: This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. Conclusions: MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • A new splint design for radial nerve palsy!

    A new orthotic solution for radial nerve injury. Copuaco, M. and Csajko, A. (2023). Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Radial palsy - Splint This article outlines a new orthotic solution for radial nerve injury which is low-profile, simple, and time-efficient. It requires a limited amount of materials/tools, and the most time consuming aspect involves attaching finger loops to a thermoplastic component. The elastics are threaded through the thermoplastic and finger loops, and finished with a knot on the thermoplastic side. This design is adjustable and easy to apply. It is also simpler and faster to fabricate than a typical dynamic orthosis. The cost would also be much lower compare to an off the shelf radial palsy splint. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, this new splint design for radial nerve palsy appears to be of low-profile, simple, and time-efficient. This approach to splinting may be also useful for hand therapists in training, who may find a full radial nerve palsy splinting design daunting. URL: https://doi.org/10.1016/j.jht.2022.09.008 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Are stabilisation exercises more effective than standard care for thumb OA?

    Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial. Pisano, K., Wolfe, T., Lubahn, J. and Cooney, T. (2023) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Thumb osteoarthritis - Real vs Sham thumb splint This randomised controlled study assessed the effect of adding stabilisation exercises to standard care in people with thumb OA. A total of 190 participants with symptomatic thumb OA were recruited. Participants were randomised to either standar care or standard care plus thumb stabilisation exercises. Standard care included the provision of an orthosis, joint protection advice, and heat modalities. The stabilisation exercises aimed at improving flexibility/strength of the thumb and some of the exercises have been shown in the pictures below. The exercises were to be performed 2-3 times per day for about 10 minutes each time. Objective and subjective measurements were recorded at baseline, 3, 6, and 12 months. The results showed that the addition of stabilisation exercises program did not improve objective or subjective outcomes more than standard care. Both groups had decreased pain with activity and improved PSFS scores, with no statistical significance between the two groups. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, a home exercise program for thumb stability may not provide added benefits compared to standard care in people with thumb thumb OA. Pain can significantly decrease with the provision of standard care with or without the addition of stabilisation exercises. It appears that symptoms and disability in thumb OA are affected by several psychosocial variables and that the thumb stability may play a limited role in symptoms presentation. URL: https://doi.org/10.1016/j.jht.2022.03.009 Abstract Study Design: Randomized, interventional trial with 1 year follow-up. Introduction: Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA). Purpose of the Study: To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength). Methods: A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons. Results: Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥ .398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤ .011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥ .080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study. Conclusions: The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Thumb OA: What psychosocial factors affect pain?

    Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management. Hamasaki, T., et al. (2023). Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence Topic: Thumb osteoarthritis - Psychological factors This is a cross-sectional study assessing the correlation between biopsychosocial factors and pain intensity/disability as well as the most common forms of interventions utilised by people with cmcj osteoarthritis. A total of 228 participants with an average age of 63 were included in the present study. Eighty percent of the participants reported having experienced average pain of moderate to severe intensity during the last 7 days, with a mean pain intensity of 6/10 and a moderate level of disability. Disability was associated with pain catastrophizing, depressive symptoms, and age. Non-surgical cmcj management included acetaminophen, oral NSAIDs, intra-articular cortisone injections, splinting, hand exercises, ergonomic techniques, and assistive devices. Several interventions, which may be useful to reduce depression/pain catastrophising (see graph below) had not been trialed by the majority of patients. The results suggest that a multidisciplinary approach is necessary to adequately tackle patients' specific needs. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, cmcj can cause severe pain, disability, disturbed emotional well-being, limited quality of life, and reduced productivity. Working on modifiable factors such as pain frequency, disability, depression, and pain catastrophising may help reduce the severity of cmcj symptoms. A multidisciplinary approach should also be employed in patients with severe distress to identify opportunities to improve mental health and increase levels of physical activity in those who are sedentary. URL: https://doi.org/10.1016/j.jht.2022.10.001 Abstract Background: Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis. Purpose: This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities. Study Design: Cross-sectional. Methods: Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability. Results: Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants’ norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services. Conclusions: Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians’ priorities. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Can you get an accurate impression of the patient's physical activity during your subjective?

    Do surgeons accurately predict level of activity in patients with distal radius fractures? Harper, C. M., Model, Z., Xiong, G., Hegermiller, K. and Rozental, T. D. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence Topic: Physical activity - Are we good at gaging it? This prospective study investigated the ability of surgeons to correctly differentiate between patient involved in low, moderate, high levels of physical activity level in patients presenting with a distal radius fractures. A total of 97 participants were included in the study. Results showed only "fair" agreement between patient and surgeon assessments, with surgeons accurately identifying 73% of "high activity" patients but failing to correctly identify more than 41% of patients rated as "moderate activity" or "low activity". The odds of receiving surgical treatment were higher with higher surgeon-perceived activity level, but not with patient-reported activity level. The study concluded that surgeon assessment of patient activity level does not have strong agreement with patients' independent assessment of their physical level. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, there is a discrepancy between what level of physical activity patients engage with and surgeon's perception of their patients' physical activity. It appears that surgeons tend to overestimate patients' activity level. There are several repercussions associated with this finding. The first is that surgery may be offered to those people who the surgeon deems physically active, but not to others who may be equally active but don't give that impression (e.g. ORIF for distal radius fracture, distal biceps repair). The second is that as hand therapist we may not advise people who are inactive to increase their physical activity level and viceversa. As a result, we may need to question our patients more on this topic or utilise forms such as the International Physical Activity Questionnaire (IPAQ) to make better informed therapeutic decisions. If you want to gage an understanding on the importance of physical activity for our patients, have a look at the whole database. URL: https://doi.org/10.1016/j.jhsa.2023.07.007 Abstract Purpose: One factor influencing the management of distal radius fractures is the functional status of the patient. The purpose of this study was to assess the agreement between patient and surgeon assessments of patient activity level in patients sustaining a distal radius fracture. Methods: Ninety-seven patients were included, with a mean age of 58.5 years (range, 18–92 years). Patients completed the International Physical Activity Questionnaire, a validated survey that provides a score of low, moderate, or high activity levels. Treating surgeons provided an independent assessment using the same scale. Agreement between patient and surgeon assessments was evaluated using a weighted kappa-statistic, with a secondary analysis using logistic regression models to assess odds of surgical treatment. Results: Interrater agreement between surgeons and patients demonstrated only “fair” agreement, with a kappa-statistic of 0.33. Predictive models showed that surgeons accurately identified 73% of “high activity” patients but failed to correctly identify more than 41% of patients rated as “moderate activity” or “low activity.” There was a correlation between surgical intervention and increasing physical activity status as assessed by the surgeon; however, the magnitude of this effect was unclear (odds ratio, 2.14; 95% confidence interval, 1.07–4.30). This relationship was no longer significant after adjusting for age, Charlson comorbidity index, and fracture class. There was no association between surgical intervention and physical activity status when using the status provided by the patient. Conclusions: Surgeon assessment of patient activity level does not have strong agreement with patients’ independent assessment. Surgeons are most accurate at identifying “high activity level” patients but lack the ability to identify “moderate activity level” or “low activity level” patients. Clinical relevance: Recognition of surgeon assessment of patient activity level as flawed can stimulate improved dialog between patients and physicians, ultimately improving the shared decision-making process. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Does the position of the other fingers affect force output during pinch testing?

    Effect of extension of the ulnar fingers on force control and muscle activity of the hand during a precision pinch. Date, S., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic test Topic: Pinch testing – Effect of positional variations This study investigated the effect of extending the ulnar fingers on force control and muscle activity during a precision tip to tip pinch task. A total of 27 healthy volunteers with a mean age of 22 years were recruited to participate in the study. Their maximum pinch strength was measured both whilst keeping the fingers flexed and extended. In addition, their ability to reach a certain level of force and the time to reach that level were measured in a submaximal task. The results showed that there was no difference in maximum pinch strength (4 kg) when keeping the fingers extended or flexed. In addition, extending the ulnar fingers when pinching resulted in quicker attainment of the target force level. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, extending the ulnar fingers when pinching an object does not affect force output, but it can lead to a faster force production. As a result, it's probably not necessary to force patients to keep a certain position when testing their pinch strength. What may be important is to follow the same strategy every time that we assess it for reliability reasons. If you are interested in other variations of strength measures, have a look at the second interosseous pinch test and an update on devices to measure grip strength. URL: https://doi.org/10.1177/17531934231211254 Abstract Some individuals extend the three ulnar fingers when performing a precision pinch. The aim of the present study was to investigate the mechanisms and effect of the extension of the ulnar fingers during a pinch. When performing a pulp pinch task with the ulnar fingers in two positions (extension and flexion), 27 participants maintained 5% of their maximum force. The mean pinch force, force variability and time taken to reach the targeted force (reaching time) were calculated. Muscle activity was simultaneously measured, using surface electromyography, for nine muscles: the flexor pollicis brevis; abductor pollicis brevis; flexor pollicis longus; first lumbrical; first dorsal interosseous; flexor digitorum superficialis of the index finger; extensor indicis; and extensor digitorum of the index and ring fingers. No significant differences in the mean pinch force or force variability were found. However, the reaching time was significantly shorter (approximately 20% reduction) in the extension position and the activities in the flexor pollicis brevis, first lumbrical, extensor indicis and extensor digitorum of the ring finger were significantly higher. These findings suggest that extending the ulnar fingers during pinching enhances the activity of key muscles involved in the movement and allows for more rapid force exertion. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Does personality affect satisfaction with surgery for carpal tunnel syndrome?

    The impact of temperament on functional and symptomatic relief and satisfaction after carpal tunnel release. Karaduman, M., Bilgin, S. S. and Armangil, M. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence study Topic: Carpal tunnel syndrome - satisfaction with surgery This study examined the impact of different personality traits on the outcomes of surgery for carpal tunnel syndrome (CTS). A total of 171 patients with CTS were included and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), the Boston Carpal Tunnel Questionnaire (BCTQ), and satisfaction using the Patient Evaluation Measure (PEM) at baseline. The results showed that symptoms improved across all personality types, however, patients who presented with a depressive or anxious personality had the lowest postoperative satisfaction. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, patient temperament should be taken into consideration when treating carpal tunnel syndrome or setting treatment expectations. In particular, it appears that some patients presenting with depressive or anxiety tracts will still be dissatisfied with treatment despite improvements in symptoms or their overall condition. I have noticed this happening in clinical practice across a series of hand and upper limb conditions. People may be improving from an objective point of view (e.g. pain-free grip strength in LE) or even subjectively on QuickDASH, but they are still not happy with such improvements. This shows how other factors including psychological and social aspects of the patient determine their happiness with our treatment. There is a growing amount of evidence suggesting that these factors have a significant impact on recovery. URL: https://doi.org/10.1177/17531934231173101 Abstract The aim of this study was to compare the symptomatic, functional and satisfaction outcomes of patients with different temperaments undergoing carpal tunnel surgery by a single surgeon. Dominant temperaments of 171 patients with carpal tunnel syndrome were determined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Patients were divided into six temperament groups, and the impact of their respective group measured against preoperative and postoperative symptom severity and functional capacity using the Boston Carpal Tunnel Questionnaire (BCTQ] and satisfaction using the Patient Evaluation Measure (PEM). Patients in the depressive group had the largest improvement in symptoms (BCTQ score change, -2.2) as well as a significant improvement in function (BCTQ score change, -2.1), yet had the lowest postoperative satisfaction (mean PEM score 9). Determination of patient temperament before surgery for carpal tunnel syndrome (CTS) may be useful as an ancillary technique to help predict postoperative satisfaction, which may in turn help guide preoperative communication and expectation setting. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Do upper limb neural mobilisations reduce Cx root intraneural swelling?

    Upper limb neurodynamic mobilization disperses intraneural fluid in cervical nerve roots: A human cadaveric investigation. Burgess, N. E., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Median nerve mobilisation - cervical radiculopathy This study examined the effects of median nerve-biased neurodynamic mobilisation on intraneural fluid dispersion in the C5, C6, and C7 cervical nerve roots of cadavers. A total of eight cadavers were included in the study. Dye was injected into C5-C6 roots. A period of time with no upper limb movement was utilised to act as a control for dye dispersion. The experimental intervention consistend in five minutes of median nerve tensioner exercise with the movement occurring at the elbow only (2 seconds for elbow extension and return to flexion). Results showed that neurodynamic mobilisation resulted in significant intraneural longitudinal dye spread at C5, C6, C7 nerve roots, with the most movement occurring at C6. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, median nerve-biased neurodynamic mobilization (NDM) may reduce nerve root swelling in people with cervical radiculopathy involving C6. Previous research has shown that neurodynamic exercises are helpful for people with radiculopathy, however, they do not appear to be more effective than other form of exercise. It is possible that most form of exercise are effective in reducing intraneural swelling and they may not need to be very specific. If you are interested in reading more about cervical radiculopathies, have a look at the whole database. URL: https://doi.org/10.1016/j.msksp.2023.102876 Abstract Background: Cervical radiculopathy is a common cause of neck pain with resultant intraneural edema and impaired nerve function. One strategy to treat radiculopathy is neurodynamic mobilization (NDM); however, little is known about the effect of this treatment on nerve tissue fluid dynamics. Objective Investigate the impact of upper limb, median nerve-biased NDM on longitudinal intraneural fluid dispersion in the C5,C6,C7 nerve roots in un-embalmed cadavers. Design In situ repeated measures. Methods: Human cadavers (n = 8) were dissected to expose and inject C5,C6,C7 cervical nerve roots with a dying agent. Initial longitudinal dye spread was recorded after dye spread stabilization. Cadavers were taken through 150 repetitions of upper limb, median nerve-biased NDM followed by dye spread re-measurement. Paired-samples t-tests with Bonferroni correction (α = 0.017) were used to compare pre-vs post-NDM dye spread measurements at C5,C6,C7 nerve roots; a one-way repeated measures ANOVA (α = 0.05) was used to examine differences between change scores for C5,C6,C7 nerve roots. Results: Median nerve-biased NDM resulted in significant intraneural longitudinal dye spread at C5 and C6 nerve roots of 0.6 ± 0.6 mm and 3.4 ± 3.9 mm, respectively (p < 0.014). Dye spread was not significant at C7 nerve root (0.4 ± 0.7 mm). There was no between root difference in change of longitudinal dye spread between C5, C6, and C7 nerve roots. Conclusions: The results of this study show median nerve-biased NDM produced internal fluid movement within C5 and C6 cervical nerve roots. Results provide insight regarding possible mechanism of action and feasibility of NDM in treatment of patients with cervical radiculopathy. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • If your patients asked what causes frozen shoulder, what would you say?

    Type 2 diabetes and fasting glycemic are causal factors of frozen shoulder: A two-sample mendelian randomization analysis. Xu, T., Xia, Q., Zhang, L., Yang, X. and Fu, W. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic, Therapeutic Topic: Frozen shoulder - Diabetes This is a retrospective analysis of existing genetic data assessing whether there is a causal relationship between type 2 diabetes, glycemic traits (fasting glucose, fasting insulin, glycated hemoglobin, and 2-hour postprandial glucose) and frozen shoulder. A total of 48,286 people with frozen shoulder and 250,671 controls were included in the study. The results showed a genetic causal relationship between type 2 diabetes, fasting glucose and frozen shoulder, but no evidence for a causal correlation between fasting insulin, glycated hemoglobin, 2-hour postprandial glucose and frozen shoulder. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, diabetes and fasting glucose levels may be causal factors of frozen shoulder. Controlling glucose levels may be a potential avenue for the prevention and mitigation of frozen shoulder. This may be relevant in our clients who have had a FOOSH, have shoulder pain, and also present with type 2 diabetes. Thus, they may be more likely to develop a frozen shoulder. URL: https://doi-org.ezproxy.aut.ac.nz/10.1016/j.jse.2023.08.006 Abstract Background: The causal relationship between type 2 diabetes (T2D) and frozen shoulder (FS) is unclear. This study aims to explore the genetic causal association between type 2 diabetes (T2D) and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c] and 2hGlu [2-hour postprandial glucose]) on FS. Methods: Using two-sample Mendelian randomization (MR), we analyzed non-confounded estimates of the effects of T2D and glycemic traits on FS. Single nucleotide polymorphisms (SNPs) strongly associated (p<5×10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multi-directionality bias in MR. Results: We found a significant genetic causal correlation between T2D (IVW-MRE P = 0.00697, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (1.03-1.16)), FG (IVW-FE p = 0.000351, OR (95% CI) = 1.455 [1.173-1.806]) and FS, but no evidence for causal correlation between FI, HbA1c, 2hGlu and FS. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. Conclusion: This study supports a genetic causal relationship between T2D, FG and FS. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Would patients find cognitive behavioral therapy useful for their hand pain?

    Patient perspectives on cognitive behavioral therapy for thumb, hand, or wrist pain and function: A survey of 98 patients. Imbergamo, C. M., Durant, N. F., Giladi, A. M. and Means, K. R., Jr. (2023). Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Hand pathology - Cognitive behavioral therapy This survey investigated the use of Cognitive Behavioral Therapy (CBT) to help manage thumb, hand, or wrist pain or dysfunction. Of the 327 patients surveyed, 98 responded, with 17% (17/98) reporting they had participated in CBT. Of this group, 15/17 felt that CBT had been helpful for them, while 75% (60/81) of those who had not used CBT were neutral. The findings suggest that increased CBT utilisation in this setting could positively affect patient outcomes, set realistic expectations, and ultimately improve satisfaction with care. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, there is an opportunity to increase awareness and recommendations of Cognitive Behavioral Therapy (CBT) as a non-medication option to help manage thumb, hand, or wrist pain. Patients who have used CBT reported favorable results, and those without direct experience were open to considering it. Increasing utilization of CBT in this setting could positively affect patient outcomes, set realistic expectations, and ultimately improve satisfaction with care. URL: https://doi.org/10.1016/j.jhsa.2023.08.002 Abstract Purpose: Cognitive behavioral therapy (CBT) is an established option to improve pain and function for many orthopedic conditions. Our purpose was to obtain patient perspectives regarding CBT for thumb, hand, or wrist pain and function. Methods: Between March and April 2022, we distributed an electronic survey via email to patients in our institution’s health system with a diagnosis of arthritic or non-specific thumb, hand, or wrist pain. The survey included the opening statement “Cognitive Behavioral Therapy (CBT) is a non-medication option to help manage pain and improve function” and up to 13 questions pertaining to patients’ experiences and perceptions regarding CBT. The survey was anonymous and did not collect protected health information. We used descriptive statistics for the findings. Results: We distributed the survey to 327 patients, yielding a 30% response rate (98/327). Of the respondents, 17 reported already using CBT to specifically help with pain/function. Of these, 15 felt it was helpful and agreed it could help others. Of the subset that used CBT for arthritis, all felt it was helpful. Of the 75 respondents with no CBT experience, 42 indicated “I’ve never heard of it,” 28 responded “I never had it recommended as an option,” and 16 marked “I don’t know enough about it.” Small subsets noted potential personal barriers to CBT implementation, such as cost, time involved, or perceived lack of potential efficacy for themselves. Conclusions: A small proportion of patients from our institution with thumb, hand, or wrist pain are utilizing CBT, and the majority finds it helpful. Clinical relevance: While some patients are already substantially benefiting from CBT to improve their thumb, hand, or wrist pain or function, there is a notable opportunity for providers to increase awareness and recommendations for this option. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

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