Search Results

The influence of a positive empathetic interaction on conditioned pain modulation and manipulation induced analgesia in people with lateral epicondylalgia. Muhsen, A., Moss, P., Gibson, W., Walker, B., Jacques, A., Schug, S., & Wright, A. (2020) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Lateral epicondylalgia - Emphatic vs neutral interaction This is a randomised double-blind placebo controlled trial assessing the effect of empathy alone vs empathy and cervical mobilisations on endogenous analgesia and pain-free grip strength in participants with lateral epicondilalgia (LE). Participants (N = 68) were diagnosed with LE if they presented with pain on passive stretching of the wrist extensors, resisted contraction of the wrist and finger extensor, and experienced pain at the lateral epicondyle during palpation. If the clinical picture suggested the presence of any other pathology (e.g. cervical radiculopathy, other chronic pain conditions, or history of surgery/fracture in upper limb), participants were excluded. Endogenous analgesia was tested by assessing pain pressure thresholds at the elbow. Participants' pain-free grip strength was assessed on the pathological side only. The effect of empathy (n = 34) vs neutral interaction (n = 34) was measured both in isolation (at Time 1) or in combination with cervical lateral glides (at Time 2). In the empathic group, the interaction between research assistant and participants was supportive, positive, and friendly. For the neutral interaction, the research assistant did not pay much attention to the participants except for explaining the procedure associated with the testing and treatment. The results showed that the effect of an empathic interaction alone, improved endogenous analgesia by 13.5%, which almost doubled with the addition of cervical mobilisation to 25%. The effect of cervical mobilisations alone, without the adjunct of an emphatic interaction, improved endogenous analgesia by 9% from baseline. No differences in pain-free grip strength were noticed between groups. Clinical Take Home Message : A positive therapeutic interaction significantly improves the engodenous pain relieving abilities of patients with lateral epicondylalgia in the short term. When combined with cervical mobilisations, it appears that this effect is boosted. Empathetic bedside manners are a potent ally in patient care. URL : https://journals.lww.com/clinicalpain/Abstract/9000/The_Influence_of_a_Positive_Empathetic_Interaction.98726.aspx

Nonsurgical treatment of De Quervain tenosynovitis: a prospective randomized trial. Ippolito, J. A., Hauser, S., Patel, J., Vosbikian, M., & Ahmed, I. (2018) Level of Evidence : 2b Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : De Quervain tenosynovitis - Conservative management This is a randomised controlled trial assessing the effectiveness of immobilisation following cortisone injection in participants with De Quervain tenosynovitis. Participants (N = 20) were diagnosed with De Quervain if they had pain on the radial side of the wrist, pain greater than 4/10 (VAS), positive Finkelstein test, tenderness on palpation at the first dorsal compartment of the wrist. Participants were excluded if they had a previous cortisone injection within the last 6 months, carpal tunnel syndrome, radiculopathy, or previous infection at the treatment site. Effectiveness of treatment was assessed through the VAS for pain anf the DASH score for function. These outcomes were assessed before treatment, at 3 weeks post treatment, and at 6 months post treatment. Participants and assessors were not blinded to treatment allocation. Participants were randomised to a cortisone injection only (n = 9) or a cortisone injection and splinting for 3 weeks (n = 11). Participants in both groups were advised to rest and limit exercise as much as possible for three weeks. The results showed no difference between the two groups on pain or function at 3 and 6 months. Clinical Take Home Message : Hand therapists should advise their patients to rest their hand as much as possible for 3 weeks following a cortison injection for De Quervain tenosynovitis. Immobilisation does not appear to add any benefit in terms of pain and function at short and long term follow-up. URL : https://journals.sagepub.com/doi/full/10.1177/1558944718791187

A systematic review of musculoskeletal disorders related to mobile phone usage. Zirek, E., Mustafaoglu, R., Yasaci, Z., & Griffiths, M. D. (2020) Level of Evidence : 3a Follow recommendation : 👍 Type of study : Symptoms prevalence study Topic : Mobile phone use - Association with MSK pain This is a systematic review assessing the effect of mobile phones on musculoskeletal (MSK) pain conditions. Eighteen studies were included for a total of 36,243 participants. Of these, 15 were cross-sectional studies, 2 were case-control studies, and 1 was a prospective cohort study. The Scottish Intercollegiate Guidelines Network (SIGN) checklist was utilised to assess study quality. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which is suggested by the Cochrane group for systematic reviews. The results show that there was overall a low and very low quality of evidence supporting the findings of this review. The prevalence of MSK pain was 19% to 53% in the thumb, 15% in the elbow, and 13% to 32% in the wrist and hand. One of the limitations of this review was that the prevalence of MSK pain in people not using mobile technology was not reported. In addition, most of the studies reported correlations between mobile technology use and MSK pain. Correlation does not equate to causation and there may be other factors (e.g. amount of physical activity, mental helath) that contribute to these pain presentations. Clinical Take Home Message : Hand therapists should not advise their patients against the use of mobile technology to avoid MSK pain conditions. Instead, hand therapists may invite patients to be physically active and vary their movements and physical activity during the day. URL : https://www.sciencedirect.com/science/article/abs/pii/S2468781220300114

What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Rolls, C., McCabe, C., Llewellyn, A., & Jones, G. T. (2020) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 Type of study : Prognostic Topic : CRPS I - Incidence after wrist fracture This is a systematic review assessing the incidence of complex regional pain syndrom (CRPS) following a wrist fracture. Nine prospective cohort trials were included for a total of 2465 participants. Studies were only included if CRPS type I (no nerve damage) was assessed. All papers included were scored on the Newcastle-Ottowa Scale for cohort study (0 lowest score, 6 highest score). The diagnosis of CRPS was made through the Budapest Criteria in most studies (n=6). Incidence of CRPS was assessed at 4 months post wrist fracture. Data were extracted from the highest quality studies only (n=3). Wrist fractures included distal radius fractures, ulnar fractures, and carpal fractures (e.g. scaphoid). The pooled results showed that 7% (95%CI: 2% to 13%) of participants with a distal radius fracture developed CRPS type I at 4 months (An incidence meta-analysis was completed for this synopsis as the authors of the study only provided a range). Of interest, one of the studies with the greatest sample size (n=1506), identified pain greater than 5/10 within the first week after trauma as a prognostic factor for the development of CRPS. Clinical Take Home Message : Hand therapists should be aware of the possibility of CRPS type I following wrist fracture. The condition appears to develop in 1 person out of 20 at four months after injury. Moderate to high levels of pain in the first week after trauma may predispose to the development of CRPS type I. URL : https://journals.sagepub.com/doi/abs/10.1177/1758998320910179

The effectiveness of physical therapies for patients with base of thumb osteoarthritis: Systematic review and meta-analysis. Ahern, M., Skyllas, J., Wajon, A., & Hush, J. (2018) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Thumb OA – Unimodal and multimodal treatments This is a systematic review and meta-analysis assessing the effectiveness of unimodal and multimodal treatments for symptomatic thumb osteoarthritis (OA) on pain and function. Five randomised controlled trials were included for a total of 198 participants. All the studies included were assessed through the risk of bias tool suggested by the Cochrane review group (higher scores reflect higher study quality). The active treatments for the studies included varied from mobilisation of the 1st cmcj and surrounding tissues (exercises, neurodynamic exercises, manual therapy) to splinting for the 1st cmcj. Pain was assessed at rest or after pinching through a visual analogue scale (0 to 10). Function was measured through the QuickDASH and the AUSCAN questionnaires. The results showed that four studies scored 5/6 on the study quality score (high quality studies), while one study scored 4/6 (moderate quality study). Pain improved to a clinically and statistically significant level in both multimodal (mean difference 2.9: 95%CI: 2.8 to 3) and unimodal interventions (mean difference 3.1: 95%CI: 2.5 to 3.8) when compared to either a control group or sham treatment. Function improved to a statistically but not to a clinically significant level in the unimodal intervention (mean difference 6.8: 95%CI: 1.7 to 11.9) compared to the control group or sham intervention (no function was reported for multimodal interventions). Clinical Take Home Message : Hand therapists may use manual therapy, exercise, neurodynamic exercise, or splinting to reduce pain for 1st cmcj OA. These interventions do not appear to improve function to a clinically relevant level. URL : https://www.sciencedirect.com/science/article/abs/pii/S2468781218300456

Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis. Brinsley, J., Schuch, F., Lederman, O., Girard, D., Smout, M., Immink, M. A., Stubbs, B., Firth, J., Davison, K., & Rosenbaum, S. (2020) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Depression - Yoga vs treatment as usual This is a systematic review and meta-analysis assessing the effectiveness of yoga on depressive symptoms. Thirteen randomised controlled trials were included for a total of 1080 participants. Studies were included if at least 50% of each yoga session included a movement component - the rest of the yoga session could include breathing control exercises, or mindfulness. The control group underwent either standard care, or were put on a waitlist. The effectiveness of the interventions was assessed by measuring changes in depressive symptoms. Out of the studies included, nine studies included participants with depressive disorders, five included participants with schizophrenia and depression, three included participants with post-traumatic stress disorder and depression, one included participants with substance dependence and depression, and another one included participants with a mix of mental health conditions and depression. The frequency of yoga sessions varied from 1-3 sessions per week with a variable duration between 20-90 minutes. Out of all the studies included, 53% were of high quality and 47% were of fair quality (PEDro scale). The results showed that yoga had a moderate effect (Standardised mean difference=−0.41; 95%CI −0.65 to -0.17) in reducing depressive symptoms compared to all the control groups. The effectiveness of yoga was correlated with the number of sessions attended each weak, with higher number of sessions attended resulting in greater reduction of depressive symptoms. The remission rates (number of participants who were no longer diagnosed as depressed after the intervention) ranged between 39% to 60% in the yoga group compared 10% to 24% in the control group. This difference was statistically significant. No adverse events were reported. Clinical Take Home Message : Hand therapists may suggest the attendance of yoga classes to patients presenting with depressive symptoms. Considering the relationship between depressive symptoms and upper limb recovery as well as mental health and post surgical satisfaction in CTS , it may be worthwile to help patients improving their depressive symptoms. URL : https://bjsm.bmj.com/content/early/2020/04/05/bjsports-2019-101242

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

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

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

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

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

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