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Tedeschi R, Labanca L, Platano D, Benedetti MG. Assessment of Balance During a Single-Limb Stance Task in Healthy Adults: A Cross-Sectional Study. Percept Mot Skills 2024:315125241277250. [PMID: 39183035 DOI: 10.1177/00315125241277250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Single-limb stance (SLS) is a demanding postural task, widely used for balance assessment in both research and clinical practice. Despite extensive data on elderly and clinical populations, less is known about younger and healthier adults. Our aim in this study was to assess balance during a SLS task among a cohort of healthy adults to determine whether there are age or sex group or testing condition differences in performances. In this cross-sectional study, we involved 120 participants aged 30-65 years and divided them into four age sub-groups with equal numbers of males and females in each. We assessed balance during a 45-s SLS task on a] the Delos Postural Proprioceptive System for both lower limbs in two conditions - open eyes (OE) and closed eyes (CE). We calculated stability (SI) and autonomy (AU) indices and used analysis of variance to determine that there was no significant effect of limb dominance or sex on balance parameters. However, there was a significant interaction effect between age group and testing condition for both SI and AU (p < .001 for both), with balance worsening as age increased only in the CE condition. These results highlight a pattern of balance decline with age when vision is eliminated from balance performance, underscoring the critical relationship between sensory input and postural control as people age.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniela Platano
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Zhou JY, Jodah R, Joseph LP, Yao J. Scapholunate Ligament Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:245-267. [PMID: 38817761 PMCID: PMC11133945 DOI: 10.1016/j.jhsg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 06/01/2024] Open
Abstract
Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.
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Affiliation(s)
- Joanne Y. Zhou
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | | | - Lauren P. Joseph
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
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Nagore A, Samal S, Thakre VM. Effectiveness of Active Release Technique With Conventional Therapy in the Management of Lateral Epicondylitis: A Case Report. Cureus 2023; 15:e50926. [PMID: 38249180 PMCID: PMC10800006 DOI: 10.7759/cureus.50926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
The condition known as tendonitis, tennis elbow, lateral epicondylalgia, or lateral epicondylitis affects the radiohumeral joint and causes persistent, severe discomfort in the elbow. It commonly affects those who work in professions that need repetitive forearm motions, like athletes who play on courts, computer operators, and woodworkers. It tends to originate from additional rapid, tiresome, recurring eccentric contractions and activities that grab gliding joints. It commonly affects the dominant hand. This case report describes the author's seven years of experience living with lateral epicondylitis, including functional disability in day-to-day life, and then physiotherapy management was started. Mill's and Cozen's tests were performed, and lateral epicondylitis was confirmed. From 2023, the physiotherapy session, including active release technique and conventional therapy, was taken regularly for four weeks. The outcome measure score of the Visual Analog Scale (VAS) was 7/10 pre-treatment and 2/10 post-treatment, and for the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, it was 50/100 pre-treatment and 25/100 post-treatment. The results that are reported from this particular case study suggest that physiotherapy has a significant effect in improving muscle strength, increasing range of motion, improving activities of daily living, and enhancing the overall quality of life. The study concludes a physiotherapist is crucial in treating these overuse injuries and returning the patient to their daily activities.
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Affiliation(s)
- Aditi Nagore
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Subrat Samal
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaishnavi M Thakre
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Factor S, Snopik PG, Albagli A, Rath E, Amar E, Atlan F, Morag G. The "Selfie Test": A Novel Test for the Diagnosis of Lateral Epicondylitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1159. [PMID: 37374364 DOI: 10.3390/medicina59061159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill's, Maudsley's, Cozen's, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test's active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV).
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | | | - Assaf Albagli
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ehud Rath
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Eyal Amar
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Franck Atlan
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Guy Morag
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Soares MM, Souza PC, Ribeiro AP. Differences in Clinical Tests for Assessing Lateral Epicondylitis Elbow in Adults Concerning Their Physical Activity Level: Test Reliability, Accuracy of Ultrasound Imaging, and Relationship with Energy Expenditure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1794. [PMID: 36767167 PMCID: PMC9914816 DOI: 10.3390/ijerph20031794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Physical activity (PA) can generate physical stress on the musculoskeletal system. Thus, the aim of the current study was to assess the influence of the level of physical activity on clinical tests used in the diagnosis of lateral epicondylitis in adults, intertest reliability and accuracy based on ultrasound imaging, and relationship with energy expenditure. METHODS 102 adults with lateral epicondylitis were assessed via an International Physical Activity Questionnaire and divided according to PA level: low (n = 19) moderate (n = 42) or high (n = 41). Pain (visual analog scale), Cozen's and Mill's clinical tests and ultrasound exams were performed. RESULTS The Cozen's and Mill's tests differed among PA levels. Excellent reliability was found for Mill's test for PA levels and the ultrasound exam (low ICC = 1.0, moderate ICC = 0.82 and high ICC = 0.99). Good reliability was found for Cozen's test (low ICC = 0.80, moderate ICC = 0.74 and high ICC = 0.73), but with significant differences between the ultrasound exams. The Cozen's and Mill's clinical tests had no relationship to the level of energy expenditure for PA levels. CONCLUSION Mill's test was reliable and accurate for the PA levels. Intertest reliability was poor for the PA levels. Mill's test proved to be accurate based on the ultrasound exam. The pain caused by the tests was not related to the level of energy expenditure.
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Affiliation(s)
- Marcos Martins Soares
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Patrícia Colombo Souza
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Ana Paula Ribeiro
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
- Medicine and Physical Therapy Department, School of Medicine, University of São Paulo, São Paulo 05360-160, Brazil
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Grosjean D, De Bakker E, Mugnier A, Forterre F, Saunders J, Van Ryssen B, Samoy YCA. Effect of dog-related parameters on the flexion test outcome: A large cohort retrospective study on physiological and orthopedic pathological-related factors. Front Vet Sci 2022; 9:1064795. [PMID: 36590796 PMCID: PMC9797715 DOI: 10.3389/fvets.2022.1064795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives This retrospective study evaluates the dog-related factors of variation influencing the outcome of the flexion test (FT), when performed to localize pain to a joint area, on a large group of canine orthopedic patients. Materials and methods The selection criteria for this retrospective study were dogs undergoing a FT in a referral orthopedic clinic between 2009 and 2020 with a complete medical record. The canine FT, described in a previously published protocol, was performed on dogs presented with an orthopedic problem. In summary, a dog's joint, identified as suspected of an orthopedic problem according to the clinical examination, was flexed for 1 min before walking 15 m on a hard and even surface. The FT was considered positive if the lameness increased after the application of the FT and negative when it remained unchanged. Statistical analysis was performed to determine which of the following criteria could influence the outcome of the flexion test: age, gender, neutered status, weight category, tested joint and initial lameness score. Results Over 1,161 patients' files were collected and analyzed for this research. The FT showed 82.8% (95%IC: 80.5-84.9) of true positives and 17.2% of false negatives. None of the patient's intrinsic characteristics influenced the outcome of the test (age, gender, neutered status, and weight category). The orthopedic parameters, such as the initial lameness score and the tested joint, showed to have a statistically significant influence on the outcome of the test. Clinical relevance The FT is an easy-to-perform technique presenting reliable results on most joints. This test presents an interest when performed in addition to a complete orthopedic examination to localize pain to a joint area. Only the orthopedic pathological-related parameters such as the lameness score and the tested joint seem to influence the outcome of the FT. The FT is not influenced by the physiological-related characteristic of the patient (age, weight category, sex, and neutered status).
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Affiliation(s)
- Diane Grosjean
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium,*Correspondence: Diane Grosjean
| | - Evelien De Bakker
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Amélie Mugnier
- Département NeoCare, Ecole Nationale Vétérinaire de Toulouse (ENVT), Toulouse, France
| | | | - Jimmy Saunders
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther 2022; 52:CPG1-CPG111. [PMID: 36453071 DOI: 10.2519/jospt.2022.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Although often described as a self-limiting condition and likely to resolve on its own, high recurrence rates and extended sick leave frame a need for effective non-surgical treatment for people with lateral elbow tendinopathy. The interrelationship of histological and structural changes to the tendon, the associated impairments in motor control, and potential changes in pain processing may all drive symptoms. This clinical practice guideline covers the epidemiology, functional anatomy and pathophysiology, risk factors, clinical course, prognosis, differential diagnosis, tests and measures, and interventions for managing lateral elbow tendinopathy in the physical therapy clinic. J Orthop Sports Phys Ther 2022;52(12):CPG1-CPG111. doi:10.2519/jospt.2022.0302.
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Barlow SJ, Scholtz JS, Medeiros W. Wrist weight-bearing tolerance in healthy adults. J Hand Ther 2022; 35:74-79. [PMID: 33309075 DOI: 10.1016/j.jht.2020.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Cross-sectional. INTRODUCTION No information is available in the literature regarding the amount of weight-bearing tolerance in a normal human wrist. PURPOSE OF THE STUDY To establish the normal limits of human wrist weight-bearing tolerance and to determine if gender, age and height are predictors of this weight-bearing tolerance. METHODS A sample (N = 465) of healthy adults ages 18-64 completed a questionnaire indicating their gender, age range and height. Subjects were instructed in performing a wrist weight-bearing tolerance test using a calibrated analog scale. The amount of pressure that the subject was able to apply to the scale in 3 independent trials was recorded and analyzed. RESULTS A strong positive correlation was found between average weight- bearing values achieved through the right and left hands for the subjects of this study, r(463)= .97, P < .001. A 2-way analysis of covariance revealed main effects for both gender (20.9, 95% CI [15.7, 26.0] pounds, P < .001) and age (F(4, 454) = 6.143, P < .001, partial η2 = .051). The highest weight-bearing tolerance was observed in males and individuals 25-34 years of age. Multiple regression analysis affirmed that gender, height and age categories of 45-54 and 55 to 64 were all statistically significant predictors of wrist weight-bearing tolerance, P < .01. DISCUSSION These results establish normal wrist weight-bearing tolerance values and demonstrate that gender, age and height are predictors of this weight-bearing tolerance. CONCLUSION These results could allow identification of pathologies associated with wrist instability.
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Affiliation(s)
- Susan J Barlow
- Department of Physical Therapy, University of Lynchburg, Lynchburg, VA, USA.
| | | | - Wendy Medeiros
- Department of Physical Therapy, University of Lynchburg, Lynchburg, VA, USA
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Krastman P, Mathijssen NMC, Bierma-Zeinstra SMA, Kraan GA, Runhaar J. Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update. BMJ Open 2020; 10:e037810. [PMID: 33154046 PMCID: PMC7646346 DOI: 10.1136/bmjopen-2020-037810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist. METHODS Medline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted. RESULTS None of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively. CONCLUSIONS There is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Trillos MC, Soto F, Briceno-Ayala L. Upper limb neurodynamic test 1 in patients with clinical diagnosis of carpal tunnel syndrome: A diagnostic accuracy study. J Hand Ther 2019. [PMID: 28623065 DOI: 10.1016/j.jht.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Diagnostic accuracy. INTRODUCTION Upper limb neurodynamic test 1 (ULNT1) is used to evaluate the mechanical sensitivity especially in the peripheral nerves of the upper limbs. The reproduction of typical symptoms in the affected hand improves the estimation of the probability of carpal tunnel syndrome (CTS). However the test has not been evaluated sufficiently to determine its real usefulness. In the present study the diagnostic accuracy of ULNT1 as a clinical test for CTS was determined. METHODS We used the ULNT1 as the index test and nerve conduction as the reference standard. 120 subjects, (240 hands), with a medical diagnosis of CTS were evaluated. The study population was a consecutive series of participants. Sensitivity, specificity, positive and negative predictive values, accuracy, and positive likelihood ratio were calculated. RESULTS ULNT1 was found to have a sensitivity of 93 % and a specificity of 6.67 %. The positive likelihood ratio was 1.04 and the negative likelihood ratio was 1.00. The positive predictive value was 86.9 % and the negative predictive value was 12.5%. DISCUSSION Acute or relatively mild CTS cases may not be accurately identified through nerve conduction tests. The findings of this study coincide with other studies in the finding that ULNT1 has a significant diagnostic and clinical screening value for CTS in people at-risk, or with upper limb symptoms. CONCLUSION(S) This research suggests the use of ULNT1 as a screening test for CTS, followed by tests that are more specific. LEVEL OF EVIDENCE III-2.
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Affiliation(s)
| | - Felipe Soto
- Instituto de Diagnostico Medico, Idime, Bogota, Colombia
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O'Brien L, Robinson L, Lim E, O'Sullivan H, Kavnoudias H. Cumulative incidence of carpal instability 12-24 months after fall onto outstretched hand. J Hand Ther 2019; 31:282-286. [PMID: 28988679 DOI: 10.1016/j.jht.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Descriptive Epidemiological Study. INTRODUCTION Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown. PURPOSE OF THE STUDY Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment. METHODS We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson's) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation. RESULTS Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female; mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation. DISCUSSION AND CONCLUSION This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lisa O'Brien
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia; Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia.
| | - Luke Robinson
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Eugene Lim
- Department of Plastic and Reconstructive Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Hayley O'Sullivan
- Department of Occupational Therapy, Melbourne Health, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
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Wrist Joint Pain. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roh YH, Kim S, Gong HS, Baek GH. Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome. Sci Rep 2018; 8:9891. [PMID: 29959424 PMCID: PMC6026167 DOI: 10.1038/s41598-018-28060-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/14/2018] [Indexed: 11/16/2022] Open
Abstract
Ulnar impaction syndrome (UIS) is a common source of ulnar-sided wrist pain, yet not all cases of radiographic ulnar impaction are symptomatic. We retrospectively analyze clinical or radiologic factors that affect prognoses of conservative treatment for idiopathic UIS. A total of 114 patients who had been diagnosed with UIS were treated with 6 weeks of short arm orthosis followed by formal physiotherapy for 6 weeks, with lifestyle modification to limit aggravating movements. The response to treatment, including pain numeric rating scale on an ulnar provocation test, grip strength, Disability of the Arm, Shoulder, and Hand score (DASH), was assessed at 24-week follow-up. For the 24-week follow-up, 29 patients (25%) underwent ulnar shortening osteotomy due to persistent symptoms after conservative treatment, and 18 (16%) patients had pain scores of greater than 5, but they had not undergone surgery. After controlling for confounding variables, female gender (odds ratio (OR) 1.39), duration of symptom (OR 1.27), high pain NRS score on provocation test (OR 1.45), and enhanced carpal or distal ulna bone on MRI (OR 1.82) were associated with a higher likelihood of treatment failure. Knowledge of the factors offers physicians insight into predicting prognoses and helps patients set realistic expectations.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Sungnam, 13620, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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Sartorio F, Vercelli S, Bravini E, Zanetta A, Bargeri S, Pisano F, Ferriero G. Assessment of dexterity and diagnostic accuracy of the Functional Dexterity Test in patients with carpal tunnel syndrome. LA MEDICINA DEL LAVORO 2018; 109:31-39. [PMID: 29405175 PMCID: PMC7682158 DOI: 10.23749/mdl.v109i1.6036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The diagnosis of carpal tunnel syndrome (STC) is centered on the symptoms. However, patients also show an impairment of sensorimotor functions, but the relationship between STC and manual dexterity has never been investigated. OBJECTIVES To analyze the correlation between manual dexterity and severity of the STC. Another objective was the diagnostic accuracy of the clinical battery including provocative tests (Phalen, Tinel) and Functional Dexterity Test (FDT). METHODS A sample of 80 subjects with suspected STC was subdivided into 4 groups based on EMG (severe/extreme-GrA, moderate-GrB, mild/minimal-GrC, negative-GrD) and evaluated in blind by Phalen, Tinel and FDT. The relationship between the FDT and the allocation of subjects was investigated by Spearman's rho, while the groups were compared with univariate ANOVA and Tukey's post hoc analysis. Diagnostic accuracy of the clinical battery was expressed by sensitivity, specificity, and likelihood ratios (LR). RESULTS A moderate (r=0.48, p minor of 0.001) correlation was found between FDT and the 4 groups. ANOVA has returned a significant difference between GrA vs. all others and between GrB vs. GrD. The battery showed a sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of 70%, 94%, 11.98 and 0.31 respectively. CONCLUSIONS The results of this study supported the hypothesis that STC patients also have a dexterity impairment. The FDT was able to discriminate between three levels of severity (negative, mild to moderate, severe to extreme), maintaining a good level of diagnostic accuracy in addition to provocative tests.
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15
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It's time to change perspective! New diagnostic tools for lateral elbow pain. Musculoskelet Surg 2017; 101:175-179. [PMID: 28770509 DOI: 10.1007/s12306-017-0486-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/08/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE The presence of intra-articular findings that may complement the extra-articular pathology in lateral epicondilytis has been suggested, and a role for minor instability of the elbow as part of the causative process of this disease has been postulated. This study was designed to describe two new clinical tests, aimed at detecting intra-articular pathology in patients affected by recalcitrant lateral epicondylitis and investigate their diagnostic performance. METHODS Ten patients suffering of atraumatic lateral elbow pain unresponsive to conservative treatment were considered in this study. Two clinical tests were developed and administrated prior to arthroscopy: Supination and Antero-Lateral pain Test (SALT); Posterior Elbow Pain by Palpation-Extension of the Radiocapitellar joint (PEPPER). Sensitivity, specificity, predictive values and accuracy of SALT and PEPPER as diagnostic tests for seven intra-articular findings were calculated. RESULTS In 90% of the patients, at least one test was positive. All patients with signs of lateral ligamentous patholaxity or intra-articular abnormal findings had a positive response to at least one of the two tests. SALT proved to have a high sensitivity but a low specificity and is accurate in detecting the presence of intra-articular abnormal findings, especially synovitis. PEPPER test was sensible, specific and accurate in the detection of radial head chondropathy. CONCLUSIONS Two new diagnostic tests (SALT and PEPPER) were specifically designed to evoke pain from intra-articular structures. These tests could be a valid support in the diagnostic algorithm of recalcitrant lateral elbow pain. Positive findings may be indicative of a minor instability of the lateral elbow condition. LEVEL OF EVIDENCE Diagnostic study, development of diagnostic criteria on basis of consecutive patients, level II.
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Janjic JM, Gorantla VS. Peripheral Nerve Nanoimaging: Monitoring Treatment and Regeneration. AAPS JOURNAL 2017; 19:1304-1316. [PMID: 28779380 DOI: 10.1208/s12248-017-0129-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/23/2017] [Indexed: 12/18/2022]
Abstract
Accidental and iatrogenic trauma are major causes of peripheral nerve injury. Healing after nerve injury is complex and often incomplete, which can lead to acute or chronic pain and functional impairment. Current assessment methods for nerve regeneration lack sensitivity and objectivity. There is a need for reliable and reproducible, noninvasive strategies with adequate spatial and temporal resolution for longitudinal evaluation of degeneration or regeneration after injury/treatment. Methods for noninvasive monitoring of the efficacy and effectiveness of neurotherapeutics in nerve regeneration or of neuropathic pain are needed to ensure adequacy and responsiveness to management, especially given the large variability in the patient populations, etiologies, and complexity of nerve injuries. Surrogate biomarkers are needed with positive predictive correlation for the dynamics and kinetics of neuroregeneration. They can provide direct real-time insight into the efficacy and mechanisms of individualized therapeutic intervention. Here, we review the state-of-the-art tools, technologies, and therapies in peripheral nerve injury and regeneration as well as provide perspectives for the future. We present compelling evidence that advancements in nanomedicine and innovation in nanotechnology such as nanotheranostics hold groundbreaking potential as paradigm shifts in noninvasive peripheral nerve imaging and drug delivery. Nanotechnology, which revolutionized molecular imaging in cancer and inflammatory disease, can be used to delineate dynamic molecular imaging signatures of neuroinflammation and neuroregeneration while simultaneously monitoring cellular or tissue response to drug therapy. We believe that current clinical successes of nanotechnology can and should be adopted and adapted to the science of peripheral nerve injury and regeneration.
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Affiliation(s)
- Jelena M Janjic
- Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, 600 Forbes Avenue, 415 Mellon Hall, Pittsburgh, Pennsylvania, 15282, USA. .,Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania, 15282, USA. .,McGowan Institute for Regenerative Medicine, University of Pittsburgh, 1602 E. Carson Street, Pittsburgh, Pennsylvania, 15203, USA.
| | - Vijay S Gorantla
- Departments of Surgery, Ophthalmology and Bioengineering, Wake Forest Baptist Medical Center, Wake Forest Institute for Regenerative Medicine, 391 Technology Way, Winston-Salem, North Carolina, 27101, USA
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Hincapie OL, Elkins JS, Vasquez-Welsh L. Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability. J Hand Ther 2017; 29:183-90. [PMID: 27264903 DOI: 10.1016/j.jht.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Previously published studies demonstrate the importance of the sensory innervation of the carpal ligaments and the implication for the sensorimotor control of the wrist. In addition, this case considers key rehabilitation concepts to include the dart-throwing motion and the stabilizing effect of the forearm muscles. PURPOSE OF THE STUDY To describe the rehabilitation program for a patient with chronic wrist pain, diagnosed with a partial tear of the dorsal intercarpal ligament and a sprain of the scapholunate ligament of the right wrist. METHODS The patient participated in a staged treatment plan over a 3-month period (20 sessions), which began with a focus on proprioceptive awareness and joint position sense retraining. The treatment progressed to strengthening of specific muscles to enhance stability of the wrist joint. The patient completed the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation on initial evaluation, re-evaluation at ninth session, and discharge at 20th session. RESULTS Raw scores in the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation improved from 33 and 61.5 on initial evaluation to 18 and 17.5 on discharge, respectively. CONCLUSIONS Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. The effectiveness of proprioceptive retraining needs to be evaluated in a well-designed randomized controlled trial recruiting this patient population. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Olga L Hincapie
- NYU Langone Medical Center, Center for Musculoskeletal Care, Hand Therapy Service, New York, NY, USA.
| | - Jeananne S Elkins
- Northeastern University, College of Professional Studies, Boston, MA, USA
| | - Laura Vasquez-Welsh
- NYU Langone Medical Center, Center for Musculoskeletal Care, Hand Therapy Service, New York, NY, USA
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Porretto-Loehrke A, Schuh C, Szekeres M. Clinical manual assessment of the wrist. J Hand Ther 2017; 29:123-35. [PMID: 27112270 DOI: 10.1016/j.jht.2016.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/13/2016] [Accepted: 02/18/2016] [Indexed: 02/03/2023]
Abstract
Although hand therapists often evaluate patients with wrist pain, novice and experienced clinicians alike would benefit from a systematic assessment to efficiently identify the source of dysfunction and initiate an appropriate treatment plan. This article proposes a systematic approach for clinical evaluation of the wrist by describing the basic clinical examination (BCE) process and interpreting the findings in terms of common pathology. The BCE will enable the hand therapist to identify conditions that are contraindicated for conservative care and require further physician intervention, determine a working diagnosis for most musculoskeletal problems, and determine the appropriate extra tests to confirm the working diagnosis and/or rule out differential diagnoses. By combining findings from the patient's history, BCE, and special testing, hand therapists can efficiently determine the underlying pathology and provide appropriate treatment that can optimize clinical outcomes.
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Affiliation(s)
| | | | - Mike Szekeres
- Health and Rehabilitation Sciences, Western University, The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada
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Zwerus EL, Somford MP, Maissan F, Heisen J, Eygendaal D, van den Bekerom MP. Physical examination of the elbow, what is the evidence? A systematic literature review. Br J Sports Med 2017; 52:1253-1260. [PMID: 28249855 DOI: 10.1136/bjsports-2016-096712] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests. DESIGN A systematic literature review according to the PRISMA statement. DATA SOURCES A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE. ELIGIBILITY CRITERIA We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. RESULTS Our primary literature search yielded 1144 hits. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. No articles were selected for triceps rupture, posteromedial impingement and medial epicondylitis. Quality assessment showed high or unclear risk of bias in nine studies. We described 24 test procedures of which 14 tests contained data on diagnostic accuracy. CONCLUSIONS Numerous clinical tests for the elbow were described in literature, seldom accompanied with data on diagnostic accuracy. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy.
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Affiliation(s)
- Elisa L Zwerus
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Matthijs P Somford
- Department of Orthopaedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - François Maissan
- Research Group Lifestyle and Health, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jelle Heisen
- Physiotherapy, Movamento, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Upper limb Unit, Department of Orthopaedic Surgery, Amphia, Breda and University of Amsterdam, Amsterdam, The Netherlands
| | - Michel Pj van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Kwok YY, Ho PC, Feldman G, Lo E, Wells E, Wollstein R. Comparison of Wrist Motion and Grip Strength in a Normal Chinese and Caucasian Population. J Hand Surg Asian Pac Vol 2016; 21:364-8. [PMID: 27595955 DOI: 10.1142/s2424835516500351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anatomical and functional differences between Asian and Caucasian populations have been described and are important in treatment of wrist pathology. The purpose of this study was to establish and compare normal values in an Asian and Caucasian population. We hypothesized that a normal Asian population will have greater wrist ROM and reduced grip- strength when compared to a normal Caucasian population. METHODS One hundred and-seventy-one normal Asian and 156 normal Caucasian wrists were evaluated. We excluded wrists with current or a history of wrist pathology including past surgery, injury or congenital malformation. We collected demographic information regarding occupation, body mass index (BMI), and previous wrist pathology. The wrist measurements included: wrist extension, flexion, radial, ulnar deviation, and grip strength. Wrists were also evaluated for a mid-carpal clunk, and scaphoid shift test. Mixed models accounted for evaluation of both hands in the same individual and for the relative contribution of different factors to the outcome measures of ROM and grip- strength. RESULTS The two groups differed in height, BMI and the distribution of occupation. The Asian group had more flexion, less extension and similar radial/ulnar wrist deviation when compared to the Caucasian group. Ethnicity was a significant predictor of wrist joint flexion and extension significantly predicting grip- strength. Age was associated with ROM while occupation, hand side and gender were not significant factors in the mixed model. CONCLUSIONS We found discrete differences between values in the two populations. More study of anatomical morphological patterns may explain the reason for variations in motion and grip- strength. The differences identified in this study between Asian and Caucasian populations should be taken into account when evaluating outcomes of wrist therapeutic procedures and rehabilitation in different communities.
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Affiliation(s)
- Yan Yan Kwok
- * Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Pak-Cheong Ho
- * Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Guy Feldman
- † Department of Orthopedics, Division of Hand and Upper Extremity Surgery, Technion School of Medicine, Haifa, Israel
| | - Eugene Lo
- * Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Erik Wells
- † Department of Orthopedics, Division of Hand and Upper Extremity Surgery, Technion School of Medicine, Haifa, Israel
| | - Ronit Wollstein
- † Department of Orthopedics, Division of Hand and Upper Extremity Surgery, Technion School of Medicine, Haifa, Israel.,‡ Department of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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21
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Chung VCH, Ho RST, Liu S, Chong MKC, Leung AWN, Yip BHK, Griffiths SM, Zee BCY, Wu JCY, Sit RWS, Lau AYL, Wong SYS. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial. CMAJ 2016; 188:867-875. [PMID: 27270119 PMCID: PMC5008933 DOI: 10.1503/cmaj.151003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/15/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. METHODS We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. RESULTS Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06). INTERPRETATION For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting. TRIAL REGISTRATION Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR-TRC-11001655).
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Affiliation(s)
- Vincent C H Chung
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Robin S T Ho
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Siya Liu
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Marc K C Chong
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Albert W N Leung
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Sian M Griffiths
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Benny C Y Zee
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Justin C Y Wu
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Regina W S Sit
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Alexander Y L Lau
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care (Chong, Chung, Griffiths, Ho, Sit, Liu, Wong, Yip, Zee); Hong Kong Institute of Integrative Medicine (Chung, Lau, Sit, Wong, Wu); Department of Medicine and Therapeutics (Lau, Wu); School of Chinese Medicine (Leung), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Institute of Global Health Innovation (Griffiths), Imperial College London, London, UK
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The diagnostic accuracy of five tests for diagnosing partial-thickness tears of the supraspinatus tendon: A cohort study. J Hand Ther 2016; 28:247-51; quiz 252. [PMID: 26003014 DOI: 10.1016/j.jht.2015.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 01/14/2015] [Accepted: 01/30/2015] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A cohort study. INTRODUCTION The causes of the pain can be difficult for clinicians to diagnose due to the complexity of the shoulder anatomy and the wide spectrum of shoulder conditions. PURPOSE OF THE STUDY The aim of this study was to investigate the clinical usefulness of provocative diagnostic tests, in patients with partial-thickness tears of the supraspinatus (SST) tendon. METHODS The partial-thickness tears SST tendon group consisted of 50 patients and 50 subjects with shoulder pain. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of five physical examination tests were calculated using a 2 × 2 table. RESULTS All the tests exhibited clinical useful positive LR greater than 2 (all, >7.0). The Yocum, Jobe, and Hawkinse-Kennedy exhibited clinically useful negative LR of less than 0.5. CONCLUSIONS The provocative tests examined were clinically useful in determining the presence or absence of pathology of the supraspinatus tendon. LEVEL OF EVIDENCE 2b.
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Redvers-Chubb K. De Quervain’s syndrome: It may not be an isolated pathology. HAND THERAPY 2016. [DOI: 10.1177/1758998315599796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This paper details a retrospective review of patients’ records diagnosed with de Quervain’s syndrome following a traumatic event but no history of repetitive strain. Methods Data analysis of 41 patients was performed. The inclusion criteria were pain over first dorsal compartment, pain on resisted extensor pollicis brevis and/or abductor pollicis longus, and a positive Finkelstein’s test. The assessment included a subjective history to establish a repetitive activity or a traumatic incident and diagnostic tests to establish possible instability or osteoarthritis. Results There were 13 men and 28 women with an age range from 20 to 72 years. Statistical analysis was undertaken using Fisher’s Exact tests. 46.3% ( n = 19) of 41 patients had a ligament injury diagnosed after the de Quervain’s. 94.7% ( n = 18) of 19 patients with ligament instability had a history of trauma, and this was statistically significant. Clinically significant was that 82.9% ( n = 34) of 41 patients demonstrated extensor carpi ulnaris (ECU) muscle weakness, but there was no statistical significant correlation between ECU weakness and ligament instability. Patients could have ECU weakness without ligament instability; however, patients with ligament instability appeared more likely to have ECU weakness. Conclusions The results would suggest that de Quervain’s syndrome, in a proportion of patients, could be secondary to underlying wrist pathology due to previous trauma. If the patient does not report a true repetitive strain history, a more thorough assessment may need to be undertaken to establish if there is any underlying pathology.
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Affiliation(s)
- Karen Redvers-Chubb
- Burns & Plastics Outpatient Department, Wythenshawe Hospital, Manchester, UK
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Sulkers GSI, Schep NWL, Maas M, Strackee SD. Intraobserver and interobserver variability in diagnosing scapholunate dissociation by cineradiography. J Hand Surg Am 2014; 39:1050-4.e3. [PMID: 24815911 DOI: 10.1016/j.jhsa.2014.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist cineradiography. METHODS A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. RESULTS The interobserver variability for diagnosing SLD by cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). CONCLUSIONS Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend cineradiography when an SLD is clinically suspected. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- George S I Sulkers
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Niels W L Schep
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Wilson RJ, Watson JT, Lee DH. Nerve entrapment syndromes in musicians. Clin Anat 2014; 27:861-5. [DOI: 10.1002/ca.22377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Robert J. Wilson
- Vanderbilt Orthopaedic Institute; Vanderbilt University Medical Center; Nashville Tennessee
| | | | - Donald H. Lee
- Vanderbilt Orthopaedic Institute; Vanderbilt University Medical Center; Nashville Tennessee
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McCulloch R, Sheena Y, Simpson C, Power D. Brachial plexus palsy following a training run with a heavy backpack. J ROY ARMY MED CORPS 2013; 160:317-9. [DOI: 10.1136/jramc-2013-000139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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