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Chong HH, Pradhan A, Dhingra M, Liong W, Hau MYT, Shah R. Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis. J Hand Surg Am 2024; 49:557-569. [PMID: 38613563 DOI: 10.1016/j.jhsa.2024.03.003] [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: 10/13/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE This study presents a network meta-analysis aimed at evaluating nonsurgical treatment modalities for de Quervain tenosynovitis. The primary objective was to assess the comparative effectiveness of nonsurgical treatment options. METHODS The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches were performed in multiple databases, and studies meeting predefined criteria were included. Data extraction, risk of bias assessment, and statistical analysis were carried out to compare treatment modalities. The analysis was categorized into short-term (within six weeks), medium-term (six weeks up to six months), and long-term (one year) follow-up. RESULTS The analysis included 14 randomized controlled trials encompassing various treatment modalities for de Quervain tenosynovitis. In the short-term, extracorporeal shockwave therapy demonstrated statistically significant improvement in visual analog scale pain scores compared with placebo. Extracorporeal shockwave therapy also ranked highest in the treatment options based on its treatment effects. Corticosteroid injections (CSIs) combined with casting and laser therapy with orthosis showed favorable outcomes. Corticosteroid injection alone, platelet-rich plasma injections alone, acupuncture, and orthosis alone did not significantly differ from placebo in visual analog scale pain score. In the medium-term, extracorporeal shockwave therapy remained the top-ranking option for visual analog scale pain score, followed by CSI with casting. In the long-term (one year), CSI alone and platelet-rich plasma injections demonstrated sustained pain relief. Combining CSI with orthosis also appeared promising when compared with CSI alone. CONCLUSIONS Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. Extracorporeal shockwave therapy can be considered a secondary option. Alternative treatment modalities, such as isolated therapeutic injection, should be approached with caution because they did not show substantial benefits over placebo. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Han Hong Chong
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom.
| | - Akhilesh Pradhan
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Mohit Dhingra
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom
| | - William Liong
- Department of Orthopaedic, Hospital Shah Alam, Shah Alam, Selangor, Malaysia
| | - Melinda Y T Hau
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Rohi Shah
- Department of Trauma & Orthopaedic, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, United Kingdom
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Mitchell T, Hamilton N, Dean B, Rodgers S, Fowler-Davis S, McLean S. A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders. HAND THERAPY 2024; 29:3-20. [PMID: 38425437 PMCID: PMC10901165 DOI: 10.1177/17589983231219595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Introduction Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.
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Affiliation(s)
- Thomas Mitchell
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Nick Hamilton
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Ben Dean
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarah Rodgers
- The Hand Unit, Northern General Hospital, Sheffield, UK
| | | | - Sionnadh McLean
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
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He K, Zhou X, Zheng F, Ju X, Fu SN, Wong AYL. Histological, Physiological and Biomechanical Effects of Low-Level Laser Therapy on Tendon Healing in Animals and Humans: A Systematic Review. Ann Biomed Eng 2023; 51:2659-2707. [PMID: 37899380 DOI: 10.1007/s10439-023-03364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023]
Abstract
Low-level Laser Therapy (LLLT) was widely used in clinical practice for tendon disorders. However, the underlying mechanisms and effectiveness of LLLT in treating tendon injury remain unclear. Therefore, the present study was conducted aiming to summarize the evidence regarding the histological, physiological, and biomechanical effects of LLLT on tendon healing in animal and human models. Four databases were searched for relevant literature. Four independent reviewers screened abstracts and full-text articles, extracted relevant data, evaluated the risk of bias, and quantified the quality of evidence. Database searches yielded 1400 non-duplicated citations. Fifty-five studies were included (50 animal and five human studies). Animal studies revealed that LT had stimulating effects on collagen organization, collagen I and collagen II formation, matrix metalloproteinase (MMP)-8, transforming growth factor β1, vascular endothelial growth factor, hydroxyproline, maximum load, maximum elongation before breaking, and tendon stiffness. However, LLLT had inhibitory effects on the number of inflammatory cells, histological scores, relative amount of collagen III, cyclooxygenase-2, prostaglandin E2 (PGE2), interleukin-6, tumor necrosis factor-α, MMP-1, and MMP-3. Although one human study found that LLLT reduced the concentration of PGE2 in peritendinous tissue of the Achilles tendon, other human studies revealed that the effects of LLLT on the physiology and biomechanics of human tendons remained uncertain. LLLT facilitates tendon healing through various histological, physiological, and biomechanical effects in animal models. Only post-LLLT anti-inflammatory effects were found in human studies.
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Affiliation(s)
- Kexu He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Feisheng Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Xiaojie Ju
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Siu-Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
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Chongkriengkrai T, Koonalinthip N, Jongprasitkul H, Piriyajarukul A, Surarangsit T, Boonhong J. Effectiveness of high-intensity laser application combined with splinting and therapeutic exercise in subacute de Quervain's tenosynovitis: A pilot study. Lasers Med Sci 2023; 38:229. [PMID: 37783935 DOI: 10.1007/s10103-023-03892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
The purpose of this study is to determine the additional effect of high-intensity laser therapy (HILT) when combined with therapeutic exercise and splinting in the treatment of patients diagnosed with de Quervain's tenosynovitis. Nineteen patients diagnosed with de Quervain's tenosynovitis were randomly divided into two groups: the HILT group and the sham HILT group. A total of 9 HILT or sham HILT sessions were administered, with 3 sessions per week for 3 consecutive weeks. Both groups received the thumb spica splint and therapeutic exercise. A comparison was conducted between the two groups, as well as pre- and post-treatment, focusing on the following outcomes: Visual Analog Scale (VAS) for pain, hand grip strength, and Thai version of Patient-Rated Wrist and Hand Evaluation (PRWHE-Thai) as a disability score. No significant differences were found between the HILT group and the sham group across all evaluated outcomes. However, when examining changes within each group over time, both the HILT and sham groups showed significant reductions in pain and improvements in disability score at the follow-up assessments compared to baseline. On the other hand, no statistically significant differences were observed in grip strength outcomes at any of the measured time points. The combination of HILT with a splint and exercise demonstrates effectiveness as a method for pain management and functional improvement in patients with subacute de Quervain's tenosynovitis. It is important to note that HILT does not offer any additional advantages when compared to the combined use of a splint and exercise.
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Affiliation(s)
- Tanach Chongkriengkrai
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nantawan Koonalinthip
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | - Hathaya Jongprasitkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Apatchanee Piriyajarukul
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Tuangtip Surarangsit
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Jariya Boonhong
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Challoumas D, Ramasubbu R, Rooney E, Seymour-Jackson E, Putti A, Millar NL. Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2337001. [PMID: 37889490 PMCID: PMC10611995 DOI: 10.1001/jamanetworkopen.2023.37001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/28/2023] [Indexed: 10/28/2023] Open
Abstract
Importance There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines. Objective To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines. Data Sources Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022. Study Selection All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT. Data Extraction and Synthesis This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome. Main Outcomes and Measures Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses. Results A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function. Conclusions and Relevance This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.
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Affiliation(s)
- Dimitris Challoumas
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Rohan Ramasubbu
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Elliot Rooney
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Emily Seymour-Jackson
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Amit Putti
- Department of Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, Scotland
| | - Neal L. Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
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Dias FJ, Cury DP, Dias PE, Borie E, Alarcón-Apablaza J, Lezcano MF, Martínez-Rodríguez P, Vargas D, Gutiérrez B, Fazan VPS. Effects of Low-Level Laser Therapy and Purified Natural Latex ( Hevea brasiliensis) Protein on Injured Sciatic Nerve in Rodents: Morpho-Functional Analysis. Int J Mol Sci 2023; 24:14031. [PMID: 37762333 PMCID: PMC10530799 DOI: 10.3390/ijms241814031] [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: 08/10/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The present study analyzed the effects of low-level laser therapy (LLLT) and the purified natural latex protein (Hevea brasiliensis, F1 protein) on the morpho-function of sciatic nerve crush injuries in rats. One-hundred and eight male Wistar rats were randomly allocated to six groups (n = 18): 1. Control; 2. Exposed (nerve exposed); 3. Injury (injured nerve without treatment); 4. LLLT (injured nerve irradiated with LLLT (15 J/cm2, 780 nm)); 5. F1 (injured nerve treated with F1 protein (0.1%)); and 6. LLLT + F1 (injured nerve treated with LLLT and F1). On the 1st, 7th, 14th, and 56th days after injury, a functional sensory analysis of mechanical allodynia and mechanical hyperalgesia and a motor analysis of grip strength and gait were performed. After 3, 15, and 57 days, the animals were euthanized for morphometric/ultrastructural analyses. The treatments applied revealed improvements in morphometric/ultrastructural parameters compared to the injured group. Sensory analyses suggested that the improvements observed were associated with time progression and not influenced by the treatments. Motor analyses revealed significant improvements in grip strength from the 7th day in the LLLT group and in gait from the 56th day in all treated groups. We concluded that even though the morphological analyses showed improvements with the treatments, they did not influence sensory recovery, and LLLT improved motor recovery.
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Affiliation(s)
- Fernando José Dias
- Oral Biology Research Centre (CIBO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile;
- Department of Integral Adults Dentistry, Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Diego Pulzatto Cury
- Department of Anatomy and Department of Cellular Biology and the Development—Institute of Biomedical Sciences, Universidade de São Paulo (ICB-USP), São Paulo 05508-000, Brazil;
| | - Paula Elisa Dias
- School of Pharmaceutical Sciences of Ribeirao Preto, Universidade de São Paulo (FCFRP-USP), Ribeirão Preto 14040-903, Brazil;
| | - Eduardo Borie
- Department of Integral Adults Dentistry, Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile;
- Research Centre in Dental Sciences (CICO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Josefa Alarcón-Apablaza
- Research Centre in Dental Sciences (CICO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile;
- Doctoral Program in Morphological Sciences, Medical School, Universidad de La Frontera, Temuco 4780000, Chile;
| | - María Florencia Lezcano
- Departamento de Bioingeniería, Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Oro Verde 3100, Argentina;
| | - Paulina Martínez-Rodríguez
- Oral Biology Research Centre (CIBO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Daniel Vargas
- Doctoral Program in Morphological Sciences, Medical School, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Brandon Gutiérrez
- Master Program in Dental Sciences, Dental School, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Valéria Paula Sassoli Fazan
- Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, Universidade de São Paulo (FMRP-USP), 14049-900 Ribeirão Preto, Brazil
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Abi-Rafeh J, Mojtahed Jaberi M, Kazan R, Alabdulkarim A, Boily M, Thibaudeau S. Utility of Ultrasonography and Significance of Surgical Anatomy in the Management of de Quervain Disease: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2022; 149:420-434. [PMID: 35077418 DOI: 10.1097/prs.0000000000008792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of ultrasound in plastic surgery practice has grown significantly over the past decade, with notable applications for conditions of the upper extremity. Its utility for the management of de Quervain disease, however, remains to be established, and the prevalence of first dorsal compartment anatomical variations needs to be adequately assessed. METHODS A systematic review was performed to evaluate the role of ultrasound in the diagnosis, anatomical characterization, and clinical management of de Quervain disease. A meta-analysis was conducted to establish the prevalence of first dorsal compartment anatomical variations in the de Quervain disease and general population, along with the diagnostic accuracy of ultrasound for their detection. Outcomes were documented and compared to alternative treatment options. RESULTS Extensor retinaculum thickening, tendon sheath swelling, peritendinous edema, and tendon enlargement were the most common sonographic features of de Quervain disease. The prevalence of an intercompartmental septum in the de Quervain disease surgical population was shown to be significantly greater than in the general cadaveric population (67 percent versus 35 percent, respectively). Although the efficacy of energy-based therapeutic ultrasound remains elusive, ultrasound-guided corticosteroid injections were shown to be more accurate than manual injections (90 to 100 percent versus 40 to 100 percent), and to confer significantly better treatment outcomes (73 to 100 percent versus 59 to 83 percent success rates, respectively). CONCLUSIONS Ultrasound use is essential to achieve the best evidence-based outcomes in the management of de Quervain disease. The varied prevalence of first dorsal compartment anatomical variations and high accuracy of ultrasound for their detection carry significant prognostic implications.
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Affiliation(s)
- Jad Abi-Rafeh
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Mehrad Mojtahed Jaberi
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Roy Kazan
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Abdulaziz Alabdulkarim
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Mathieu Boily
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Stephanie Thibaudeau
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
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The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. BMC Sports Sci Med Rehabil 2021; 13:91. [PMID: 34391447 PMCID: PMC8364035 DOI: 10.1186/s13102-021-00306-z] [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: 02/18/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022]
Abstract
Background Tendinopathy is a common clinical condition that can significantly affect a person’s physical function and quality of life. Despite exercise therapy being the mainstay of tendinopathy management, there are many potential adjunct therapies that remain under investigated, one of which is photobiomodulation (PBM). PBM uses varied wavelengths of light to create a biological effect. While PBM is used frequently in the management of tendinopathy, high quality evidence supporting its utility is lacking. Methods A systematic search of the Pubmed, CINAHL, SCOPUS, Cochrane Database, Web of Science and SPORTSDICUS databases was performed for eligible articles in August 2020. Randomized Control Trials that used red or near-infrared PBM to treat tendinopathy disorders that made comparisons with a sham or ‘other’ intervention were included. Pain and function data were extracted from the included studies. The data were synthesized using a random effects model. The meta-analysis was performed using the mean difference (MD) and standardized mean difference (SMD) statistics. Results A total of 17 trials were included (n = 835). When compared solely to other interventions PBM resulted in similar decreases in pain (MD -0.09; 95% CI − 0.79 to 0.61) and a smaller improvement in function (SMD -0.52; 95% CI − 0.81 to − 0.23). When PBM plus exercise was compared to sham treatment plus exercise, PBM demonstrated greater decreases in pain (MD 1.06; 95% CI 0.57 to 1.55) and improved function (MD 5.65; 95% CI 0.25 to 11.04). When PBM plus exercise was compared to other interventions plus exercise, no differences were noted in pain levels (MD 0.31; 95% CI − 0.07 to 0.70). Most studies were judged as low-risk of bias. The outcome measures were classified as very low to moderate evidence quality according to the Grading of Recommendation, Development and Evaluation tool. Conclusion There is very-low-to-moderate quality evidence demonstrating that PBM has utility as a standalone and/or adjunctive therapy for tendinopathy disorders. Trial registration PROPERO registration number: CRD42020202508. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00306-z.
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Karlıbel İA, Aksoy MK, Alkan A. Paraffin bath therapy in De Quervain's tenosynovitis: a single-blind randomized controlled trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1391-1398. [PMID: 33675398 DOI: 10.1007/s00484-021-02111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Data on the efficacy of treatment modalities in De Quervain's tenosynovitis (DQT) is limited. Paraffin therapy is routinely used in treating hand osteoarthritis and neuropathies. However, there are not enough studies investigating paraffin effectiveness. This study evaluates the effectiveness of paraffin bath therapy on pain, functional status, muscle strength, and quality of life in patients with DQT. This prospective, single-blind, randomized, controlled study enrolled 51 DQT patients. Group 1 (n = 26) received paraffin bath + splint + exercise; Group 2 (n = 25) received splint + exercise therapy. Pain, handgrip strength, thumb palmar pinch strength, functional status, and quality of life were evaluated. Both treatment combinations improved pain, grip strength, palmar pinch strength of the thumb, functional status, and quality of life. The paraffin group provided more effective pain control than the paraffin-free group and was more effective in improving functional status, handgrip strength, and quality of life (p < 0.05). Apparently, adding paraffin therapy to the combination of the splint and therapeutic exercise positively affects the patient's treatment outcomes. For this reason, paraffin therapy should be included in the conservative treatment combinations in DQT.
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Affiliation(s)
- İlknur Aykurt Karlıbel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Bursa Yuksek İhtisas Training and Research Hospital, 16800 Yildirim, Bursa, Turkey.
| | - Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Bursa Yuksek İhtisas Training and Research Hospital, 16800 Yildirim, Bursa, Turkey
| | - Ayşe Alkan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Bursa Yuksek İhtisas Training and Research Hospital, 16800 Yildirim, Bursa, Turkey
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Ferrara PE, Codazza S, Cerulli S, Maccauro G, Ferriero G, Ronconi G. Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review. Semin Arthritis Rheum 2020; 50:1280-1290. [DOI: 10.1016/j.semarthrit.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/10/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022]
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11
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Abi-Rafeh J, Kazan R, Safran T, Thibaudeau S. Conservative Management of de Quervain Stenosing Tenosynovitis: Review and Presentation of Treatment Algorithm. Plast Reconstr Surg 2020; 146:105-126. [PMID: 32590652 DOI: 10.1097/prs.0000000000006901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonsurgical management of de Quervain disease relies mainly on the use of oral nonsteroidal antiinflammatory drug administration, splint therapy, and corticosteroid injections. Although the latter is most effective, with documented success rates of 61 to 83 percent, there exists no clear consensus pertaining to conservative treatment protocols conferring the best outcomes. This article reports on all present conservative treatment modalities in use for the management of de Quervain disease and highlights specific treatment- and patient-related factors associated with the best outcomes. METHODS A systematic search was performed using the PubMed database using appropriate search terms; two independent reviewers evaluated retrieved articles using strict inclusion and exclusion criteria. RESULTS A total of 66 articles met the inclusion criteria for review, consisting of 22 articles reporting on outcomes following a single conservative treatment modality, eight articles reporting on combined treatment approaches, 13 articles directly comparing different conservative treatment regimens, and 23 case reports. CONCLUSIONS A multimodal approach using splint therapy and corticosteroid injections appears to be more beneficial than either used in isolation. Although there exists some evidence showing that multipoint injection techniques and multiple injections before surgical referral may provide benefit over a single point injection technique and a single injection before surgery, corticosteroid use is not benign and should thus be performed with caution. Ultrasound was proven valuable in the visualization of an intercompartmental septum, and ultrasound-guided injections were shown to both be more accurate and confer better outcomes. Several prior and concurrent medical conditions may affect conservative treatment outcome. A Level I to II evidence-based treatment protocol is recommended for the optimal nonsurgical management of de Quervain disease.
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Affiliation(s)
- Jad Abi-Rafeh
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | - Roy Kazan
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | - Tyler Safran
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | - Stephanie Thibaudeau
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
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Haffey PR, Bansal N, Kaye E, Ottestad E, Aiyer R, Noori S, Gulati A. The Regenerative Potential of Therapeutic Ultrasound on Neural Tissue: A Pragmatic Review. PAIN MEDICINE 2020; 21:1494-1506. [DOI: 10.1093/pm/pnaa090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Objectives
Low-intensity ultrasound (LIU)/low-intensity pulsed ultrasound (LIPUS) may influence nerve tissue regeneration and axonal changes in the context of carpal tunnel syndrome (CTS) and in the animal model. The purpose of this pragmatic review is to understand the current knowledge for the effects of low-intensity therapeutic ultrasound in the animal and human model and determine the future directions of this novel field.
Design
Pragmatic review.
Methods
We performed a literature search of available material using OVID, EmBase, and PubMed for LIU/LIPUS, all of which were preclinical trials, case reports, and case series using animal models. For CTS, a literature search was performed on PubMed (1954 to 2019), CENTRAL (the Cochrane Library, 1970 to 2018), Web of Science (1954 to 2019), and SCOPUS (1954 to 2019) to retrieve randomized controlled trials.
Results
Eight articles were discussed showing the potential effects of LIU on nerve regeneration in the animal model. Each of these trials demonstrated evidence of nerve regeneration in the animal model using LIPUS or LIU. Seven randomized controlled trials were reviewed for ultrasound effects for the treatment of carpal tunnel syndrome, each showing clinical efficacy comparable to other treatment modalities.
Conclusions
LIU/LIPUS is a promising and noninvasive means of facilitating nerve regeneration in the animal model and in the treatment of carpal tunnel syndrome. Although many of the trials included in this review are preclinical, each demonstrates promising outcomes that could eventually be extrapolated into human studies.
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Affiliation(s)
- Paul Ryan Haffey
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
| | - Nitin Bansal
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
| | - Elena Kaye
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
| | - Einar Ottestad
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
| | - Rohit Aiyer
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
| | - Selaiman Noori
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
| | - Amitabh Gulati
- Memorial-Sloan Kettering Cancer Center, New York-Presbyterian Hospital, Weill-Cornell Medicine, New York, New York, USA
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13
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Fernandes JG. Occupational Therapists' Role in Perinatal Care: A Health Promotion Approach. Am J Occup Ther 2018; 72:7205347010p1-7205347010p4. [PMID: 30157021 DOI: 10.5014/ajot.2018.028126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article establishes and examines occupational therapists' role in perinatal care and proposes a health promotion approach for new and expectant mothers. The author demonstrates the importance of maintaining meaningful occupational engagement during this critical life stage by incorporating evidence from orthopedic, rehabilitation, and hand therapy research. New and expectant mothers are at high risk for upper extremity (UE) conditions such as carpal tunnel syndrome, De Quervain's tenosynovitis, and tendinosis of the UE. Occupational therapists with basic knowledge of hand therapy are well prepared to manage these conditions conservatively. An occupation-based model and framework are presented to ensure a holistic view of the target population. Topics pertinent to this population include postural techniques, repetitive tasks, patient education, and strengthening related to the perinatal period.
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Affiliation(s)
- Julie Grobbelaar Fernandes
- Julie Grobbelaar Fernandes, OTD, OT/L, CHT, is Senior Occupational Therapist, New York University Langone Orthopedic Center, New York, NY;
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Huisstede BM, Gladdines S, Randsdorp MS, Koes BW. Effectiveness of Conservative, Surgical, and Postsurgical Interventions for Trigger Finger, Dupuytren Disease, and De Quervain Disease: A Systematic Review. Arch Phys Med Rehabil 2018; 99:1635-1649.e21. [DOI: 10.1016/j.apmr.2017.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/13/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
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