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Yu JT, Huang YC, Chen CS. Research and Development of a 3D-Printed Dynamic Finger Flexion Orthosis for Finger Extension Stiffness-A Preliminary Study. Bioengineering (Basel) 2024; 11:339. [PMID: 38671761 PMCID: PMC11048443 DOI: 10.3390/bioengineering11040339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Finger extension stiffness is a common post-traumatic complication that results in the hand's functional impairment. In clinical practice, a dynamic splint enables the patient to stretch the affected finger independently. However, current dynamic splints have drawbacks, such as limited stretching efficacy, and interfere with the hand's functional activities. Therefore, this study aimed to develop a dynamic finger flexion orthosis capable of stretching each finger joint using additive manufacturing (AM) technology, thereby enabling hand functional activity, and analyze the clinical improvement in the range of motion (ROM). One subject with a hand fracture was recruited while undergoing a 7-week home-based rehabilitation program for the orthosis. The outcome measurements included the total active motion (TAM), the tip-to-finger distance (TPD), and the score on the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The results show that the TAM of the participant's fingers increased by 72.7 degrees on average, the TPD decreased by 3.5 cm on average, and the DASH score decreased to 9.5 points. The 7-week home-based rehabilitation program for the orthosis resulted in a 53.6% increase in the TAM on average. The developed orthosis improved hand function and enabled a more complete ROM in finger flexion.
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Affiliation(s)
- June-Tzu Yu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yi-Chao Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chen-Sheng Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
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Yates SE, Glinsky JV, Hirth MJ, Fuller JT. Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis. J Hand Ther 2024:S0894-1130(24)00001-2. [PMID: 38278697 DOI: 10.1016/j.jht.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/01/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking. PURPOSE This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions. STUDY DESIGN Systematic review. METHODS A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. RESULTS Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren's release for improving total active extension (mean difference [MD] -2.8°, 95% confidence interval [CI]: -9.6° to 4.0°, p = 0.84), total active flexion (MD -5.8°, 95% CI: -12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: -2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: -0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD -16.7°, 95% CI: -20.1° to -13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion. CONCLUSION The addition of an extension orthosis following procedures to manage Dupuytren's contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion.
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Affiliation(s)
- Sally E Yates
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Healthia Limited, Brisbane, Queensland, Australia.
| | - Joanne V Glinsky
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Melbourne, Australia; Malvern Hand Therapy, Malvern, Australia
| | - Joel T Fuller
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Collis JM, Mayland EC, Wright-St Clair V, Rashid U, Kayes N, Signal N. An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study. J Hand Ther 2023; 36:593-605. [PMID: 35953335 DOI: 10.1016/j.jht.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.
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Affiliation(s)
- Julie M Collis
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand.
| | - Elizabeth C Mayland
- Western Sydney University, School of Health Sciences, Campbelltown, New South Wales, Australia
| | | | - Usman Rashid
- Auckland University of Technology, Health & Rehabilitation Research Institue, Auckland, New Zealand
| | - Nicola Kayes
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
| | - Nada Signal
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
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Glasgow C, Ballard E. A prospective randomised comparative study of dynamic, static progressive and serial static proximal interphalangeal joint extension orthoses. HAND THERAPY 2022; 27:22-31. [PMID: 37904790 PMCID: PMC10584062 DOI: 10.1177/17589983211070658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/15/2021] [Indexed: 11/01/2023]
Abstract
Introduction Many different types of proximal interphalangeal (PIP) joint extension orthoses exist, yet evidence guiding orthosis choice is largely theoretical. The primary aim of this study was to evaluate the clinical effectiveness of three different PIP joint extension orthoses, over 4 weeks of treatment. Secondly, we aimed to explore the relationship between an abbreviated version of the Weeks test (WT) assessment of joint stiffness, and treatment outcome. Lastly, we wished to better understand participants' satisfaction with orthotic treatment. Methods Using a randomised comparative study design, 61 participants were allocated to a serial static, dynamic or static progressive orthosis, 50 had follow-up data. Blinded assessment of function was completed before and after 4 weeks of orthotic intervention and a standardised therapy program. Participants were blinded to alternative groups. Results Baseline active PIP extension ranged from 14° to 65°. The average improvement in active PIP extension was -9.1° (95% CI -11.0°, -7.1°). There were no statistically significant differences in outcome between the three orthoses groups. However, a trend was observed with greater improvement in active extension for those in the dynamic Capener (-11.5°) compared to the static progressive belly gutter (-7.3°) or serial cast (-8.7°) groups, with less total end range time required. The abbreviated WT was significantly associated with improvement in active extension (p = 0.001). Participants reported a high degree of satisfaction with their orthosis regardless of type. Conclusions No single orthosis demonstrated statistically greater effectiveness, although the dynamic Capener orthosis appeared more efficient. The abbreviated WT is associated with treatment outcome.
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Affiliation(s)
- Celeste Glasgow
- EKCO Hand Therapy, Sonic HealthPlus, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Prolonged Application of Continuous Passive Movement Improves the Postoperative Recovery of Tibial Head Fractures: A Prospective Randomized Controlled Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1236781. [PMID: 35224090 PMCID: PMC8865989 DOI: 10.1155/2022/1236781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
Abstract
Methods 60 patients with THFs were randomly and equally divided into the CPM group and non-CPM group. Both groups immediately received CPM and conventional physical therapies during hospitalization. After discharge, the non-CPM group was treated with conventional physical therapy alone, while the CPM group received conventional physical training in combination with CPM treatment. At 6 weeks and 6 months postoperatively, the primary outcome which was knee ROM and the secondary outcome which was knee functionality and quality of life were evaluated. Results The CPM group had a significantly increased ROM at both follow-up time points. The Knee Society Score, UCLA activity score, and the EuroQoL as well as the pain analysis showed significantly better results of the CPM group than the non-CPM group. Conclusions The prolonged application of CPM therapy is an effective method to improve the postoperative rehabilitation of THFs.
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Albanese GA, Taglione E, Gasparini C, Grandi S, Pettinelli F, Sardelli C, Catitti P, Sandini G, Masia L, Zenzeri J. Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:130. [PMID: 34465356 PMCID: PMC8406564 DOI: 10.1186/s12984-021-00925-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation. Methods After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones. Results Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p < 0.001) and was comparable between groups, both pre (U = 45.5, p = 0.355) and post (U = 47, p = 0.597) treatment. Additionally, even though groups’ performance during the robotic assessment was comparable before the treatment (U = 36, p = 0.077), after rehabilitation the experimental group presented better results than the control one (U = 26, p = 0.015). Conclusions This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists’ effort, increase repeatability and accuracy of assessments, and promote subject’s engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644.
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Affiliation(s)
- Giulia Aurora Albanese
- Robotics, Brain and Cognitive Sciences (RBCS) Unit, Istituto Italiano di Tecnologia, Genoa, Italy. .,Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy.
| | - Elisa Taglione
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Cecilia Gasparini
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Sara Grandi
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Foebe Pettinelli
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Claudio Sardelli
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Paolo Catitti
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Giulio Sandini
- Robotics, Brain and Cognitive Sciences (RBCS) Unit, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lorenzo Masia
- Institut für Technische Informatik (ZITI), Heidelberg University, Heidelberg, Germany
| | - Jacopo Zenzeri
- Robotics, Brain and Cognitive Sciences (RBCS) Unit, Istituto Italiano di Tecnologia, Genoa, Italy
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McClure P, Tevald M, Zarzycki R, Kantak S, Malloy P, Day K, Shah K, Miller A, Mangione K. The 4-Element Movement System Model to Guide Physical Therapist Education, Practice, and Movement-Related Research. Phys Ther 2021; 101:6106275. [PMID: 33482006 DOI: 10.1093/ptj/pzab024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/06/2020] [Indexed: 11/13/2022]
Abstract
The movement system has been adopted as the key identity for the physical therapy profession, and recognition of physical therapists' primary expertise in managing movement dysfunction is an important achievement. However, existing movement system models seem inadequate for guiding education, practice, or research. Lack of a clear, broadly applicable model may hamper progress in physical therapists actually adopting this identity. We propose a model composed of 4 primary elements essential to all movement: motion, force, energy, and control. Although these elements overlap and interact, they can each be examined and tested with some degree of specificity. The proposed 4-element model incorporates specific guidance for visual, qualitative assessment of movement during functional tasks that can be used to develop hypotheses about movement dysfunction and serve as a precursor to more quantitative tests and measures. Human movement always occurs within an environmental context and is affected by personal factors, and these concepts are represented within the model. The proposed scheme is consistent with other widely used models within the profession, such as the International Classification of Functioning, Disability and Health and the Patient Management Model. We demonstrate with multiple examples how the model can be applied to a broad spectrum of patients across the lifespan with musculoskeletal, neurologic, and cardiopulmonary disorders.
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Affiliation(s)
- Philip McClure
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Michael Tevald
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Ryan Zarzycki
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Shailesh Kantak
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA.,Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | - Philip Malloy
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Kristin Day
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Kshamata Shah
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Amy Miller
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
| | - Kathleen Mangione
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
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Molés-Poveda P, Comis LE, Joe GO, Mitchell SA, Pichard DC, Rosenstein RK, Solomon B, Pavletic SZ, Cowen EW. Rehabilitation Interventions in the Multidisciplinary Management of Patients With Sclerotic Graft-Versus-Host Disease of the Skin and Fascia. Arch Phys Med Rehabil 2020; 102:776-788. [PMID: 33347890 DOI: 10.1016/j.apmr.2020.10.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/02/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
Graft-versus-host disease (GVHD) is a multisystemic disorder that affects 30%-80% of patients who undergo allogeneic hematopoietic stem cell transplantation 10%-15% of GVHD patients develop sclerotic features affecting the skin or deeper tissues, leading to functional limitations and poor quality of life. There is limited literature regarding the indications and efficacy of specific rehabilitative interventions in sclerotic GVHD (sclGVHD). In this article, we summarize the current evidence supporting rehabilitation intervention in sclGVHD and offer our approach to the multidisciplinary management of this disease. In addition, we review techniques that have been employed in other sclerotic skin diseases (eg, iontophoresis, extracorporeal shock waves, botulinum toxin A, adipose derived stromal vascular fraction), but that require further validation in the sclGVHD setting. Ultimately, optimal care for this complex disease requires a multidisciplinary approach that includes a rehabilitation and adaptive program tailored to each patient's needs.
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Affiliation(s)
- Paula Molés-Poveda
- Instituto de Investigación Sanitaria la Fe, Valencia, Spain; Dermatology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Hospital Universitario de la Plana, Catellón, Spain.
| | - Leora E Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Galen O Joe
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Dominique C Pichard
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Rachel K Rosenstein
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Beth Solomon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Steven Z Pavletic
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
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Gangatharam S. Target-focused exercise regime to improve patient compliance and range of motion in the stiff hand. J Hand Ther 2019; 31:568-571. [PMID: 30318243 DOI: 10.1016/j.jht.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/14/2018] [Indexed: 02/03/2023]
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10
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Thumb carpometacarpal osteoarthritis: A musculoskeletal physiotherapy perspective. J Bodyw Mov Ther 2019; 23:908-912. [PMID: 31733781 DOI: 10.1016/j.jbmt.2019.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/10/2023]
Abstract
PROPOSAL To perform a literature review to provide the practitioner with a description of the information and techniques to enhance the provision of conservative interventions in clinical practice. METHODS Studies were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to December 2017. Authors independently selected studies, conducted quality assessment, and extracted results. RESULTS There is evidence to support a multimodal approach to the therapeutic management of the patient with CMC OA. This distinct approach includes: patient education, manual therapy, therapeutic exercise programs, and orthotic provision. CONCLUSION There is evidence to support some of the commonly performed conservative interventions to improve hand function and decrease hand pain.
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Abstract
The role of hand therapy in the treatment of Dupuytren disease varies depending on the patient and the procedure. There is limited evidence for hand therapy as a preventive treatment of Dupuytren disease. Before corrective treatment, the hand therapist can contribute with assessments to promote evaluation of outcome. After corrective treatment, hand therapy is tailored to each patient's needs and consists of orthoses, exercise, edema control, and pain or scar management. Orthoses are usually part of the hand therapy protocol after corrective procedures despite lack of strong supporting evidence and should be provided based on individual patient needs.
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Affiliation(s)
- Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping University, Linköping 581 85, Sweden; Department of Social and Welfare Studies, Linköping University, Kungsgatan 40, Norrköping 60174, Sweden.
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12
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Rongières M. Management of posttraumatic finger contractures in adults. HAND SURGERY & REHABILITATION 2018; 37:275-280. [PMID: 30033359 DOI: 10.1016/j.hansur.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 05/18/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
This lecture will focus on posttraumatic finger contractures affecting the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in adults. The pathophysiology, main causes and essential rehabilitation methods that can be used before resorting to surgical treatment are described, along with the clinical examination. The goal is to define the surgical indications, even though the literature shows the functional outcomes are disappointing. While there is little to no change in a joint's angular amplitude, the functional range of motion can be improved. There is practically no functional improvement except in cases of MCP extension contracture. For the PIP joint, the aim is to shift the range of motion into the functional range. Surgical approaches, surgical techniques and rehabilitation protocols are described in detail.
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Affiliation(s)
- M Rongières
- Chirurgie orthopédique-chirurgie de la main, institut locomoteur Pierre-Paul Riquet, hôpital Purpan, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France.
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13
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Abstract
The principles of hand therapy for proximal interphalangeal joint disorders include protecting injured structures, minimizing patient discomfort, and optimizing patient recovery. Comprehension of hand anatomy, the nature of the injury being treated, and the phases of healing are critical when designing a safe and effective hand therapy program. Hand therapists use a combination of orthoses, guided exercises, and modalities to improve edema, sensitivity, range of motion, and function.
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Affiliation(s)
- Nathan P Douglass
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA
| | - Amy L Ladd
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA.
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14
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Midgley R. Case Report: The casting motion to mobilize stiffness technique for rehabilitation after a crush and degloving injury of the hand. J Hand Ther 2017; 29:323-33. [PMID: 27496988 DOI: 10.1016/j.jht.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 03/04/2016] [Accepted: 03/25/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION This case report describes the use of the casting motion to mobilize stiffness (CMMS) technique in the management of a crush and degloving injury of the hand. The patient was unable to attend multiple hand therapy sessions due to geographic constraints. The CMMS technique involved the application of a nonremovable plaster of paris cast that selectively immobilizes proximal joints in an ideal position while constraining distal joints to direct desired motion over a long period. This uses active motion only. Traditional hand therapy techniques or modalities are not used. This treatment approach was beneficial to the patient as a minimum of 2 appointments per month were needed to regain functional hand use. PURPOSE OF THE STUDY To document the use of the CMMS technique as an effective treatment approach in the management of a crush and degloving injury of the hand. METHODS The CMMS technique was applied to the patient's left (nondominant) hand 8 weeks after injury. The technique's aim was to improve the 30° flexion deformity of the left wrist and flexion contractures of the index, middle, and ring fingers with a total active motion of 0°. Orthotic devices and traditional therapy were applied once joint stiffness was resolved, and a normal pattern of motion was reinstated. RESULTS At 6 months, substantial improvement was noted in wrist as well as metacarpophalangeal and interphalangeal joints. Total active motion exceeded 170° in all fingers excellent functional outcome resulted as measured with the upper limb functional index short form-10. The upper limb functional index increased from 0% to 55% of preinjury status (or capacity) over the 18 months of therapy. DISCUSSION Brief immobilization through casting causes certain functional losses, but these are temporary and reversible. CONCLUSION Finger stiffness, edema, and tissue fibrosis were successfully managed with the CMMS technique without the need for attendance at multiple hand therapy sessions. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Robyn Midgley
- Hand Therapy Consulting, Bryanston, Johannesburg, South Africa.
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15
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Santacreu ES, Cabezas NV, Graupera AB. Combined treatment with paraffin, manual therapy, pegboard and splinting in a patient with post-traumatic stiff hand. Arch Physiother 2016; 6:14. [PMID: 29340195 PMCID: PMC5759923 DOI: 10.1186/s40945-016-0028-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background The stiff hand is a still common, severe complication of hand injuries. Case presentation We report here the case of a 56 year-old woman, professional goldsmith, who suffered a distal radius fracture of her right hand. The patient was treated with surgery followed by four weeks of immobilization, and developed a stiff hand. Physical examination showed mild inflammatory signs, pain and a major limitation in the extension and supination of the wrist, and in the mobility of the II, III, IV and V metacarpophalangeal (-5° and 32° of average passive extension and flexion, respectively) and interphalangeal (-35° and 73° of average passive extension and flexion, respectively) joints. There was a lack of slip of the flexor tendons. The diagnosis of complex regional pain syndrome was considered although it could not be definitely established. After five months of adverse evolution the patient was referred to our center where a combined intervention with paraffin, manual therapy, prolonged active and passive stretch on a pegboard, and splinting was applied. After initiation of this therapy, a marked change in the evolution of the pain, the mobility and functionality of the hand was observed. At the end of the rehabilitation program the patient was able to fully resume her job. Conclusion The present case illustrates the need of intensive treatment for post-traumatic hand stiffness, and describes, as an original contribution, a combined intervention therapy including paraffin, manual therapy, pegboard and splinting.
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Affiliation(s)
- Eva Santacreu Santacreu
- Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain
| | - Núria Villanueva Cabezas
- Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain
| | - Asunción Bosch Graupera
- Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain
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Lutsky KF, Matzon JL, Dwyer J, Kim N, Beredjiklian PK. Results of Operative Intervention for Finger Stiffness After Fractures of the Hand. Hand (N Y) 2016; 11:341-346. [PMID: 27698638 PMCID: PMC5030857 DOI: 10.1177/1558944715627238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Posttraumatic finger stiffness can occur as a result of hand fractures. The purpose was to assess and quantify the improvement in range of motion (ROM) after surgical management of the stiff finger in patients who developed loss of motion following treatment for a metacarpal or phalangeal fracture. In addition, an aim was to identify possible risk factors for suboptimal improvement in ROM postoperatively. Methods: A retrospective review was performed on 18 patients who underwent surgery to improve finger stiffness following metacarpal or phalangeal fracture. Demographic data including age, initial diagnosis and treatment, health history, and worker's compensation status were collected. We determined the number of specific procedures performed at the time of surgery, the number of days between surgical release and initiation of therapy, and the total active motion (TAM) prior to surgical release and at the patient's last follow-up. Results: Mean TAM improved from 150° preoperatively (range 60°-241°) to 191° postoperatively (range 61°-271°). Most patients required multiple anatomic structures released concomitantly, with an average of 3.1. Patients who started physical therapy within 7 days of the release improved by 59°, whereas those who started physical therapy after 7 days (average 11.5 days) lost 19° of motion. Patients who had filed a worker's compensation claim improved an average of 9°, whereas nonworker's compensation patients improved an average of 58°. Degree of TAM improvement had a weak correlation with patient age or preoperative TAM. Conclusions: Surgical release for stiff fingers following hand fractures can offer modest improvements in ROM in some patients. Although the overall increase in motion as a result of these operations is generally limited, functional improvement can be obtained. Delay in initiating physical therapy is a risk factor for persistent or worsened stiffness. Patients involved in worker's compensation claims demonstrated significantly lower TAM improvement after surgical intervention.
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Affiliation(s)
- Kevin F. Lutsky
- Division of Hand Surgery, Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonas L. Matzon
- Division of Hand Surgery, Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Dwyer
- Division of Hand Surgery, Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nayoung Kim
- Division of Hand Surgery, Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pedro K. Beredjiklian
- Division of Hand Surgery, Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA,Pedro K. Beredjiklian, Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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Comer GC, Clark SJ, Yao J. Hand Therapy Modalities for Proximal Interphalangeal Joint Stiffness. J Hand Surg Am 2015; 40:2293-6; quiz 2296. [PMID: 26272795 DOI: 10.1016/j.jhsa.2015.06.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Garet C Comer
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Extremity Center, Stanford University School of Medicine, Redwood City, CA
| | - Susan J Clark
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Extremity Center, Stanford University School of Medicine, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Extremity Center, Stanford University School of Medicine, Redwood City, CA.
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Efficacy of Static Progressive Splinting in the Management of Metacarpophalangeal Joint Stiffness: A Pilot Clinical Trial. Hong Kong J Occup Ther 2014. [DOI: 10.1016/j.hkjot.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the efficacy of a static progressive metacarpophalangeal (MCP) joint flexion splint in managing MCP joint stiffness in patients suffering from traumatized hands. Methods A total of 31 patients with stiff MCP joints (n = 116) were recruited for this prospective study. A static progressive MCP flexion splint was designed to manage the MCP joint stiffness of traumatized hands, which is a common problem after surgery. The values of the initial and final passive range of motion (PROM) and active range of motion (AROM) were compared. In addition, the Disabilities of the Arm, Shoulder, and Hand (DASH) scores before and after surgery were also compared. Spearman correlation matrix was used to determine the relationship of the DASH score with PROM and AROM separately. Results The PROM increased from 23.47 ± 16.26 degrees to 59.01 ± 14.75 degrees after treatment, and the difference between the initial and final PROM is 35.54 ± 16.92 degrees (t = 22.63, p < .001, df = 115). The AROM also significantly increased from 10.29 ± 10.67 degrees to 25.03 ± 18.25 degrees, with a mean difference of 14.74 ± 15.40 degrees (t = 10.31, p < .001, df = 115). The DASH score improved from 40.71 ± 13.22 to 24.26 ± 11.33 (t = 7.00, p < .001, df = 30), which indicates a significant negative correlation with the AROM of MCP joints following treatment. Conclusion The static progressive MCP flexion splint promotes both physical and functional outcomes. The increased AROM of the MCP joints improves the functional outcomes in patients with traumatized hands.
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Effects of passive upper extremity joint mobilization on pain sensitivity and function in participants with secondary carpometacarpal osteoarthritis: a case series. J Manipulative Physiol Ther 2013. [PMID: 23206969 DOI: 10.1016/j.jmpt.2012.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this case series is to report on the effects of passive joint mobilization (PJM) of the shoulder, elbow, and wrist on pain intensity, pain sensitivity, and function in elderly participants with secondary carpometacarpal osteoarthritis (CMC OA). METHODS Fifteen inpatients from the Department of Physical Therapy, Residenze Sanitarie Assistenziali, Collegno (Italy), with secondary CMC OA (70-90 years old) were included in this study. All patients received PJM of the dominant arm (shoulder, elbow, and wrist) for 4 sessions for 2 weeks. Pain severity was measured by visual analog scale, and pain sensitivity was measured with pressure pain threshold (PPT) at CMC joint, at the tubercle of the scaphoid bone, and at the unciform apophysis of the hamate bone. Tip and tripod pinch strength were measured by a pinch gauge. RESULTS Passive joint mobilization reduced pain severity after the first follow-up by 30%, in addition to increased PPT by 13% in the hamate bone. Strength was enhanced after treatment. Tripod pinch increased by 18% in the dominant hand after treatment. CONCLUSIONS This case series provides preliminary evidence that PJM of upper extremity joints diminished pain and may increase PPT tip and tripod pinch in some participants with secondary CMC OA.
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Sueoka SS, Detemple K. Static-progressive splinting in under 25 minutes and 25 dollars. J Hand Ther 2011; 24:280-6. [PMID: 21306873 DOI: 10.1016/j.jht.2010.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 11/19/2010] [Indexed: 02/03/2023]
Abstract
Wrist stiffness can occur after injury to the wrist and surrounding structures. Frequently hand therapists treat this stiffness with static-progressive splinting techniques in an attempt to lengthen shortened tissues through tissue growth and collagen reorganization. The hand therapist's goal is to fabricate a splint that effectively increases range of motion in a timely and cost-effective manner. Through creative images, these authors illustrate their fabrication of a static-progressive wrist extension and/or flexion splint that is cost effective and can be fabricated in 22 minutes.
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Affiliation(s)
- Stephanie Sato Sueoka
- Hand Therapy Clinic, Orthopaedic Center, University of Utah, Salt Lake City, Utah 84108, USA.
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