1
|
Hagert E, Rein S. Wrist proprioception-An update on scientific insights and clinical implications in rehabilitation of the wrist. J Hand Ther 2024; 37:257-268. [PMID: 37866985 DOI: 10.1016/j.jht.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
The field of wrist proprioception, as it relates to rehabilitation and surgery, has gone through a period of intense growth in the past decade. From being primarily focused on the function of the joint and ligaments in patients with wrist trauma or after wrist surgery, the understanding is now that of a greater complexity in treating not just the wrist but the hand and arm as a whole. Proprioception is derived from the Latin words "proprius" - belonging to (oneself) and "-ception" to sense. In other words, how to sense ourselves. To have a complete sense of self, multiple sensory afferents originating from joints, ligaments, muscles, tendons, nerves, skin, vision, and hearing work together to orchestrate a balanced integration of sensorimotor functions, with the true goal to perceive and adapt to the physical world around us. In this update on wrist proprioception, we review current developments in the understanding of proprioception, with an implication for our everyday work as hand therapists and hand surgeons. Each contributing sense-joint, ligaments, muscles, skin, and brain-will be reviewed, and the clinical relevance will be discussed. An updated wrist rehabilitation protocol is proposed where the therapist is guided to rehabilitate a patient after wrist trauma and/or surgery in 4 stages: (1) basic hand and wrist rehabilitation with a focus on reducing edema, pain, and scar formation; (2) proprioception awareness to improve the sense of joint motion and position; (3) conscious neuromuscular rehabilitation where isometric exercises of muscles that are beneficial for a particular injury are promoted, whereas others that are potentially harmful are avoided; and (4) unconscious neuromuscular rehabilitation with training of the reflex and joint protective senses.
Collapse
Affiliation(s)
- Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar; Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden.
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
2
|
Albert-Lucena D, Navarro-Santana MJ, López-de-Uralde-Villanueva I, Díaz-Arribas MJ, Valera-Calero JA, Fernández-de-Las-Peñas C, Plaza-Manzano G. Immediate effects of percutaneous electrical nerve stimulation in patients with lateral elbow pain. Physiother Theory Pract 2023:1-12. [PMID: 38146921 DOI: 10.1080/09593985.2023.2296063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Ultrasound guided-percutaneous electrical nerve stimulation appears to be effective in the treatment of chronic musculoskeletal pain. OBJECTIVE To investigate the immediate effects of one session of percutaneous electrical nerve stimulation on the radial nerve in patients with lateral elbow pain. METHODS A randomized clinical trial was conducted. Sixty patients with chronic lateral elbow pain were allocated into real-percutaneous electrical nerve stimulation (n = 30) or sham-percutaneous electrical nerve stimulation (n = 30) where the patients received one-single session of the real or sham percutaneous stimulation on the radial nerve, respectively. Pressure pain thresholds, pain intensity, pain-free grip strength, and the self-perceived improvement were evaluated after the intervention. RESULTS Significant differences between groups for pain intensity (-11.55, 95% CI -21.79 to -1.30, p < .028), but not for pressure pain threshold or pain-free grip strength, were found. Patients receiving real-percutaneous stimulation had significant improvement in pain-free grip strength on the treated side. The proportion of individuals reporting moderate to large self-perceived improvement (≥4) was significantly higher (p = .026) after real-percutaneous stimulation than after sham-percutaneous stimulation. CONCLUSION A single session of real-percutaneous electrical nerve stimulation targeting the radial nerve in subjects with lateral elbow pain decreased pain intensity between groups and increased pain-free grip strength on the treated side but not between groups.
Collapse
Affiliation(s)
- Daniel Albert-Lucena
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, Madrid, Spain
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, Madrid, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, Madrid, Spain
| |
Collapse
|
3
|
Computer Intelligent Algorithm in the Recovery of the Elbow Joint Sports Injury Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5044952. [PMID: 35028120 PMCID: PMC8752230 DOI: 10.1155/2022/5044952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022]
Abstract
In this study, the inverse kinematics mathematics computer intelligent algorithm model is used to study the sports injuries of the elbow joint of adolescents. At the same time, we simulated the movement parameter changes during the rehabilitation training of the patient's wrist and proposed a joint angular velocity function based on cubic fitting. Research has found that when the training scene changes greatly or the target task is changed, the smoothness of the elbow joint movement will change. The research conclusions of this article provide a theoretical basis for the selection of man-machine action points and the formulation of rehabilitation training methods. This article establishes the degree-of-freedom simulation model of the operating arm, which is the number of independent position variables in the operating arm, and these position variables determine the positions of all parts in the mechanism.
Collapse
|
4
|
Tran T, Harris C, Ciccarelli M. The impact of a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study. J Hand Ther 2021; 36:45-59. [PMID: 34756796 DOI: 10.1016/j.jht.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients' work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. PURPOSES First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. STUDY DESIGN A randomized controlled trial. METHODS Forty-nine participants were randomized to the control group (n = 25) or intervention group (n == 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, "Working Hands-ED," delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. RESULTS There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). CONCLUSION The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace.
Collapse
Affiliation(s)
- Thuy Tran
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.
| | - Courtenay Harris
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marina Ciccarelli
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|