Search Results

Therapist's practice patterns for subsequent fall/osteoporotic fracture prevention for patients with a distal radius fracture Dewan, N., MacDermid, J., MacIntyre, N., & Grewal, R. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Preventative Topic: Fracture prevention - Prevention of further falls/fractures after distal radius fracture. This survey study assessed clinicians' knowledge on prevention of subsequent falls/osteoporotic fractures in patients over 45 years old who presented to the clinic after a distal radius fracture. The results showed that there is a lack of attention towards assessment, treatment, and prevention in these patients with only 30% of therapists assessing either balance, lower limb strength, levels of physical activity, or fear of falling. These findings are despite compelling evidence that fall prevention treatments reduce the risks of falls by 50% in older adults. Outcomes measures such as the Chair Stand Test, the Timed up and Go test, the Rapid Assessment of Physical Activity scale, and Fracture Risk Assessment Tool (FRAX) can be used as simple screening tools. Several treatments including Tai Chi, progressive strength training, and aerobic exercises can be promoted to improve bone health. Clinical Take Home Message: Hand therapists should assess risk of falls in people over 45 years old who present to the clinic with a distal radius fracture. A quick assessment tool, which only requires demographic data and minimal history taking, is the FRAX. This is a freely available validated online tool which can predict risk of falls within the next 10 years. If interested, hand therapists can use the Chair Stand Test and the Timed up and Go test, which both take 1-4 minutes to complete. Once screened, patients could be provided with educational resources (e.g. NIH, NOF, IOF) or referred to other health practitioners for fall prevention programs and medical treatment for osteoporosis (e.g. Physiotherapists, community exercise classes, GPs). URL: https://www.jhandtherapy.org/article/S0894-1130(17)30270-3/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. (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

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

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

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

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 verify whether any causality between these factors and disease severity exists. Clinical Take Home Message: Based on what we know today, 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 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