Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: A retrospective study

Study designRetrospective cohort.IntroductionConservative intervention of carpometacarpal joint (CMC) thumb pain, caused by osteoarthritis and ligament laxity, is frequently seen in hand therapy. Traditional intervention for pain and disability reduction includes orthoses, exercises, and joint protection education. The literature on conservative management is unclear which design or program of exercises create an effective result. Results of a conservative dynamic stability interventional model for thumb pain are presented as a design which positively effects pain and disability.Purpose of the studyThe purposes were to primarily investigate change in pain and disability in persons with CMC pain in a dynamic stability modeled approach to intervention, and secondarily, to assess the average number of visits and the duration of total visits in this model.MethodsA retrospective chart review was completed on 35 charts of those seen at a multicenter hand therapy clinic. The pain and disability scores from the QuickDASH were used as outcome measures.ResultsThe average group pain and disability scores improved by 17.9% (p < .01) and 19.3% (p < .01) respectively, with average individual disability improvement of 15.7%, which is greater than the accepted MCID. The average patient visits were 2.37 over an average range of 44.5 days. The group demographics match current literature: 31 females to 4 males, with average age of 58 years (range of 30–82 years).ConclusionSignificant reduction in pain and disability is noted with a conservative dynamic stability modeled approach to intervention, with information on average visits and duration in this model of care for individuals with thumb pain at the CMC joint.Level of evidence4.     

Investigating the effects of neuromobilization in lateral epicondylitis

Study DesignRandomized controlled study.IntroductionLateral epicondylitis (LE) causes pain and loss of function in the affected limb. Different exercises have been used for the treatment of LE. In recent years, the technique of neuromobilization has been frequently used to treat tendinopathy. However, there is no study that demonstrates the effects of neuromobilization techniques on patients with LE.Purpose of the StudyThe aim of the present study was to determine the effects of neuromobilization techniques on pain, grip strength, and functional status in LE patients and to compare them with conservative rehabilitation treatment.MethodsA total of 40 patients (26 females and 14 males; age: 42.80 ± 8.91 years) with a history of LE participated in the study. The patients were randomly assigned to two groups: the neuromobilization group and the control group. The neuromobilization group completed a 6-week conservative rehabilitation and radial nerve mobilization program, whereas the control group received conservative rehabilitation therapy only. Both groups underwent a 7-day weekly conservative home rehabilitation program. Pain severity, grip strength, pinch strength, joint motions, and upper extremity functional level were assessed before treatment, at the third week after treatment, and at the sixth week after treatment.ResultsThere was a significant decrease in all pain scores in favor of the neuromobilization group at week 6 after treatment (at rest: P = .001, effect size (ES) = 0.84; at night: P = .001, ES = 0.91 and during activity: P = .004, ES = 1.06). No significant differences were found for grip strength, pinch strength, joint motions, and functional level in the neuromobilization group, although trends toward better improvement were observed.ConclusionsRadial nerve mobilization techniques are more effective on pain than conservative rehabilitation therapy in LE patients, and this effect continues after treatment.     

Pain interference may be an important link between pain severity,impairment, and self-reported disability in participants with wrist/hand pain

Study DesignCross-sectional.IntroductionPain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain.Purpose of the studyThe purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand.MethodsMeasures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire.ResultsThe best-fitting regression model with DASH scores entered as the dependent variable (F_4,50 = 28.8, P < .01) included MPI Pain Interference (β = −0.54), Life Control (β = −0.16), Purdue pegboard scores (β = −0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R² = 0.67, P < .01).ConclusionPain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.     

Ultrasound-guided hyaluronic acid injection for the treatment of insertional Achilles tendinopathy: A prospective case series

BackgroundHeel pain is a common condition and often involves the Achilles tendon and is classified as insertional or non-insertional. Several operative and non-operative treatments have been described, but there is no consensus on the most effective therapy. The aim of this study is to evaluate a case series of patients with insertional Achilles tendinopathy refractory to conservative treatment submitted to a single-dose ultrasound-guided injection of hyaluronic acid (40 mg/2.0 mL).MethodsWe prospectively included 25 patients (29 feet) who underwent a single ultrasound-guided injection of hyaluronic acid after conservative treatment failure. Clinical outcomes such as pain (using the Visual Analog Scale – VAS), function (using the American Orthopedic Foot & Ankle Society – AOFAS score), personal satisfaction, and complications were evaluated. Statistical analysis was performed using the R software.ResultsMost patients were female (80%) and there was a right-side predominance (55%). The median VAS was 8 points [range 4–10] at baseline, decreasing to 3 points [range 0–8] at the six-month follow-up, with statistical significance (p < .001). The median AOFAS score was 71 points [range 38–87] at baseline, increasing to 90 points [range 48–100] at the six-month follow-up (p < .001). The personal satisfaction level was 69%, and 48% of patients considered the result excellent. There were no Achilles tendon ruptures, infections, or allergic reactions post injection.ConclusionSingle-dose injection of hyaluronic acid is a safe treatment option, improving function and reducing pain for six months in patients with insertional Achilles tendinopathy after conservative treatment failure.Level of evidenceIV, case series.     

Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial

Study DesignRandomized control trial.IntroductionThumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis and instruction in joint protection, adaptive equipment, and pain relieving modalities. The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb CMC.Purpose of the StudyTo investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing pain and disability in thumb CMC OA compared to SCT alone.MethodsThe study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home pain management instructions, joint protection strategies with adaptive equipment, and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions for adductor stretching and opponens and first dorsal interosseous strengthening in addition to SCT. Our primary outcome measure was the numerical rating scale (NRS) with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome measurements were assessed at first visit, 6 weeks, and 6 months.ResultsThere was no statistical difference between the 2 groups for NRS and QuickDASH at 6 weeks (P = .28 and P = .36, respectively) or 6 months (P = .52 and P = .97, respectively). However, there was a statistically significant decrease in NRS and QuickDASH scores at 6 weeks and 6 months within both groups.ConclusionsBoth SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH scores at 6-week or 6-month follow-up.     

Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathy

BackgroundThe mainstay of treatment for non-insertional Achilles tendinopathy is non-operative, however a proportion of patients will fail conservative measures. We describe the results of Achilles tendinoscopy with plantaris tendon release in patients who have failed first line conservative treatment for at least 6 months.MethodsA consecutive series of 11 patients with a minimum of 2 years follow up.ResultsThe mean AOFAS scores significantly improved from 68 pre-op to 92 post op (p = 0.0002) as did the AOS scores for both pain (28% pre-op to 8% post op (p = 0.0004)) and disability (38% pre-op to 10% post op (p = 0.0005). The mean SF-36 scores also improved but were not statistically significant (pre-op 76, post op 87 (p = 0.059). There were no complications. 8 of the 11 patients were satisfied, the other 3 somewhat satisfied.ConclusionsThe results of Achilles tendinoscopy and division of the plantaris tendon are encouraging but further studies are required to compare it to other treatments. It is minimally invasive and low risk so should not affect the ability to perform a formal open procedure if unsuccessful.     

Evaluation of short-term and residual effects of Kinesio taping in chronic lateral epicondylitis: A randomized,double-blinded,controlled trial

BackgroundLateral epicondylitis is degenerative tendinosis of the extensor carpi radialis brevis muscle and is the most common work/sports-related chronic musculoskeletal problem affecting the elbow.PurposeThis study aimed to evaluate the short term and residual effectiveness of the Kinesio taping method on pain, grip force, quality of life, and functionality.Study DesignRandomized, double-blinded, controlled study.MethodsSubjects were 50 patients diagnosed with chronic unilateral lateral epicondylitis with a symptom duration of at least 12 weeks. During the first four weeks, the study group received a true inhibitor Kinesio taping while the control group received sham taping. In both groups, progressive stretching and strengthening exercises were given as a home program for six weeks. The primary outcome measure was the Numerical Rating Scale (NRS) for self-report of pain intensity; secondary outcome measures were Cyriax resistive muscle test evaluation, maximal grip strength, Patient- Rated Tennis Elbow Evaluation (PRTEE), and Short Form-36 (SF-36). After the treatment, patients were evaluated by the first assessor who was blinded to taping types.ResultsThere was a significant decrease in NRS scores overtime during the first four weeks in both groups (P < .001,) and effect sizes were large. There was no significant difference in Cyriax muscle resistance test maximal grip strength between groups (P > .05). However, there was a significant improvement in muscle strength of elbow extension and pronation in the study group detected in the intragroup analysis. Intragroup comparisons also showed a significant improvement in all subunits of the PRTEE and SF-36 except energy/vitality, social functioning, and pain in both groups (P < .05) with moderate to high effect sizes. PRTEE pain scores were significantly decreased in the study group compared to the placebo group (P < .05, d = 0.48).ConclusionThe effects of Kinesio taping on muscle strength, quality of life, and function in chronic lateral epicondylitis are not superior to placebo. However, NRS scores showed that in the two weeks after Kinesio taping treatment, pain reduction persisted as a residual effect which may improve the exercise adherence and functionality.     

Comparative efficacy of the dorsal application of Kinesio tape and splinting for carpal tunnel syndrome: A randomized controlled trial

BackgroundCarpal tunnel syndrome (CTS) symptoms are problematic especially when signs and symptoms are not substantial enough to require surgical intervention. Conservative treatments have mixed effectiveness, yet are one of the best options for mild to moderate CTS. Kinesio tape is an emerging modality, as it provides biomechanical support while allowing movement.PurposeThe purpose of this study was to determine the efficacy of dorsal application of Kinesio tape on occupational performance as measured by pain and function in individuals with mild to moderate CTS, as compared with the accepted nonsurgical intervention of general cockup orthosis and lumbrical stretching exercises versus sham tape.Study DesignSingle-blind randomized controlled trial.MethodsForty-four participants (68 wrists) with CTS were randomized to one of three interventions: Kinesio tape group, sham group, or standard protocol group. Each completed baseline and four subsequent measurements of numeric pain rating scale, visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip and pinch, with application of intervention every three days. Daily symptom journals were completed, standard protocol group recorded wearing schedule and exercises.ResultsIn the forearm and wrist, a significant reduction in median numeric pain rating scale pain scores in Kinesio tape group was observed (r = 0.76, P = .01; r = 0.77, P = .01; respectively), but not in the standard protocol group (r = 0.51, P = .17; r = 0.53, P = .11) and sham group (r = 0.46, P = .30; r = 0.39, P = .43) with a minimal clinically important difference of 1.0. In the Kinesio tape group, the forearm (24%) and wrist (36%) reached the clinical significance as compared with the standard protocol forearm (18%) and wrist (32%).The minimal clinically important difference for pain reduction on the visual analog scale was 1.64. Kinesio tape and sham group had significant improvement in function, but not the standard protocol group.DiscussionThis study provides promising evidence for the use of Kinesio tape as a possible conservative intervention for management of symptoms in individuals with mild to moderate CTS. The study also illuminates new considerations of younger, active individuals reporting signs and symptoms of CTS as well as mechanism of effects on pain reduction.ConclusionsKinesio tape provided additional improvement in pain and function as compared to the standard approach.     

Head- and neck-related symptoms post-motor vehicle collision (MVC): Separate entities or two-sides of the same coin?

Background and AimAlthough post-motor vehicle collision (MVC) pain and symptoms are largely convergent among those with mild traumatic brain injury (mTBI) and whiplash associated disorder (WAD), and patients oftentimes report initial neck and head complaints, the clinical picture of mTBI and WAD has been primarily studied as separate conditions which may result in an incomplete clinical picture. As such, this study was conducted to explore the role of pain and post-traumatic psychological features in explaining both head and neck-related symptom variability in a cohort of post-collision patients. This is with the goal of disentangling if contributory factors are uniquely related to each diagnosis, or are shared between the two.MethodsPatients recruited in the very early acute phase (<72 h) returned for clinical and psychological assessment at 6 months post-accident. In order to determine which factors were unique and which ones were overlapping the same potential contributors: mean head pain, mean neck pain, female gender, number of post-collision painful body areas, PTSD, and depression were included in the regression models for both neck disability index (NDI) and Rivermead post-concussion symptoms questionnaire (RPQ).ResultsOf 223 recruited participants, 70 returned for a follow-up visit (age range 18–64, mean(SD) 37.6 (11.9), 29F). This cohort primarily met the criteria for mTBI, but also fulfilled the criteria for whiplash, reinforcing the duality of injury presentation. Correlations existed between the NDI and RPQ scores (Spearman's ρ=0.66, p<0.001), however overlap was only partial. Regression analysis showed that after the removal of area-of-injury pain neck related disability (r = 0.80, p <0.001) was explained solely by number of painful body areas (ß=0.52, p <0.001). In contrast, post-concussion syndrome symptoms (r = 0.86, p<0.001) are influenced by clinical pain, painful body areas (ß=0.31, p = 0.0026), female gender (ß=0.19, p = 0.0053), and psychological factors of depression (ß=0.31, p = 0.0028) and PTSD symptoms (ß=0.36, p = 0.0013).ConclusionsIt seems that while mechanisms of neck- and head-related symptoms in post-collision patients do share a common explanatory feature, of residual body pain, they are not entirely overlapping. In that psychological factors influence post-concussion syndrome symptoms, but not post-whiplash neck disability.     

Short-term clinical outcome of orthosis alone vs combination of orthosis,nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome

Study DesignProspective randomized study.IntroductionCarpal tunnel syndrome (CTS) has been described as the most common compression neuropathy. Many modalities exist for conservative treatment. Efficacy of each modality has been described in the literature. However, the effectiveness of combination of these modalities is not well established. The purpose of this study is to assess the short-term clinical outcome of conservative treatment for CTS comparing orthosis alone with combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy.MethodsForty-one patients who presented to Upper Limb Reconstructive and Microsurgery Clinic, University Malaya Medical Centre with CTS and positive electrodiagnostic study were recruited. Fifteen patients had bilateral CTS. Fifty-six wrists were equally randomized to orthosis alone and a combined therapy of orthosis, nerve/tendon gliding exercise, and ultrasound therapy. All patients were required to complete the Boston Carpal Tunnel Questionnaire during the first visit and 2 months after treatment.ResultsBoth the orthosis and combined therapy groups showed a significant improvement in symptoms and function after treatment. The mean difference of symptoms in the orthosis group was 0.53; 95% confidence interval [CI]: 0.23-0.83 (P = .001) and in the combined therapy group was 0.48; 95% CI: 0.24-0.72 (P < .001). Mean difference of function in the orthosis group was 0.59; 95% CI: 0.28-0.91 (P = .001) and combined group was 0.69; 95% CI: 0.49-0.89 (P < .001). However, there was no significant difference in symptom severity and functional status scores between the groups.DiscussionOur findings support other findings where orthosis and exercises improved symptom severity and functional status scores, however, there was no significant difference between orthosis alone and combined treatment.ConclusionPatients who underwent conservative management for CTS showed improvement in symptoms and function. However, the combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy did not offer additional benefit compared to orthosis alone.     

Biering-Sorensen test scores in coal miners

ObjectivesBiering-Sorensen test is an isometric back endurance test. Biering-Sorensen test scores have varied in different cultural and occupational groups. The aims of this study were to collect normative data on Biering-Sorensen holding times, to determine the discriminative ability of the Biering-Sorensen test in Turkish coal miners, and to examine the association between Biering-Sorensen test result and functional disability.MethodsOne hundred and fifty male coal miners participated in this study. Trunk extensor muscle strength was measured using the Biering-Sorensen test. Oswestry disability index was used to measure the functional disability level of low back pain.ResultsThe mean Biering-Sorensen holding time for the total subject group was 107.3 ± 22.5 s. The mean time of Biering-Sorensen test of the subjects with and without low back pain were 99.9 ± 19.8 and 128.6 ± 15.2 s, respectively. The difference between the subjects with and without low back pain was statistically significant (p < 0.001). There was a statistically significant negative correlation between Oswestry functional disability score and Biering-Sorensen holding time (r = ?0.824, p < 0.001).ConclusionsTurkish coal miners have low mean back extensor endurance holding times. Biering-Sorensen test had a good discriminative ability in our study group. Trunk muscle strength has a significant effect on the disability level of low back pain. Thus trunk muscle endurance training exercise therapy may be effective for the reduction of disability in patients with low back pain.     

Comparison of Analgesic Efficacies of the iPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) and Genicular Nerve Blocks Used in Combination With the Continuous Adductor Canal Block After Total Knee Arthroplasty: A Randomized Clinical Trial

BackgroundThe interspace between the popliteal artery and capsule of the posterior knee (iPACK) block and the genicular nerve block (GNB) are motor-sparing nerve blocks used for knee pain relief. We compared the analgesic efficacies of ultrasound-guided iPACK block and GNB when combined with continuous adductor canal block after total knee arthroplasty.MethodsIn this randomized control study, 132 total knee arthroplasty patients were assigned to the iPACK, GNB, and iPACK + GNB groups. All patients received combined spinal anesthesia and continuous adductor canal block. The primary outcome was the 8-hour postoperative pain score during movement. Secondary outcomes were pain scores, posterior knee pain, intravenous morphine consumption, and tibial and common peroneal nerve sensorimotor function. All included patients completed the study.ResultsThe 4-hour and 8-hour postoperative pain scores during movement were significantly lower in the iPACK + GNB group than that in the iPACK group (−2.5 [3.6, 1.3]; P < .001 and −2 [-3, −1]; P < .001, respectively). The differences in rating pain scores and posterior knee pain were not clinically relevant. The iPACK group demonstrated a significantly higher intravenous morphine consumption than did the GNB and iPACK + GNB groups during the first 48 hours postoperatively (P < .001) but were not clinically relevant. There was no incidence of complete sensorimotor blockade in any of the groups.ConclusionThe iPACK–GNB combination relieved pain during movement better than the iPACK block alone during the 8 hours postoperatively after total knee arthroplasty in setting of multimodal analgesia such as adductor canal block.     

When is Surgery Performed? Trends,Demographic Associations,and Phenotypical Characterization of Baseline Patient-Reported Outcomes Before Total Hip Arthroplasty

BackgroundEvaluating trends and drivers of baseline patient-reported outcome measures (PROMs) is critical to understanding when patients and providers elect to undergo surgery. We aimed to assess the following: (1) 5-year trends in baseline PROMs pre-THA (total hip arthroplasty) stratified by patient determinants; (2) patient factor associated with poor preoperative hip pain/function; (3) phenotypes of combined pain/function PROMs at baseline; and (4) intersurgeon variability in PROM thresholds at surgery.MethodsA prospective cohort of 6,902 primary THAs was enrolled (January 2016 to December 2020). Patient/surgeon details and PROMs were collected at point of care preoperatively. Outcomes included trends (5 years; 20 quarters) in Hip disability and Osteoarthritis Outcome Score (HOOS)-Pain and HOOS-PS (Physical Function Short-Form), stratified by patient demographics. Patients were further classified into phenotype categories of above or equal to median pain/function (P+PS+); below median pain/function (P?PS?); above or equal to median pain but below median function (P+PS?); and below median pain but above or equal to median function (P?PS+).ResultsBaseline HOOS-Pain was consistent across the study period (P-trend = .166), while HOOS-PS demonstrated increasing function (P-trend = .015). Such trends were appreciable in males, females, and White (P-trend < .001, each) but not Black patients (P-trend = .67). Higher odds ratio (OR) of low baseline HOOS-Pain and HOOS-PS were detected among females (HOOS-Pain: OR 1.75, 95% confidence interval [CI] 1.55-1.98, P < .001; HOOS-PS: OR 1.56, 95% CI 1.38-1.77, P < .001), Black patients (HOOS-Pain: OR 1.64, 95% CI 1.35-2.82, P < .001; HOOS-PS: OR 1.59, 95% CI 1.34-1.89, P < .001), and smokers (HOOS-Pain: OR 1.56, 95% CI 1.29-1.89, P < .001; HOOS-PS: OR 1.52, 95% CI 1.25-1.85, P < .001). The P?PS? cohort (32.4%) had lowest age (65.2 ± 11.1 years), highest body mass index (31.6 ± 6.9 kg/m²), females (64.8%), Black (15.8%), and current smokers (12.2%). There was significant intersurgeon preoperative PROM variation in HOOS-Pain and HOOS-PS (P < .001, each).ConclusionIn contrast to the general population, Black patients have consistently received THA at lower functional levels throughout the 5-year period. Females, smokers, and Black patients were more likely to have poorer pain and function at THA. PROMs assessment as combined pain-function phenotypes may provide a more comprehensive interpretation of patient status preoperatively.     

Consequences of fall-induced hip fractures on cognitive function,physical activity,and mortality: Korean longitudinal study of aging 2006–2016

BackgroundFew studies have investigated the consequences of fall-induced hip fractures among healthy, community-dwelling middle-aged adults.ObjectivesTo investigate the effects of fall-induced hip fractures on cognitive function, activities of daily living, and mortality from the time the fractures increase.DesignA secondary data analysis based on data from the Korean Longitudinal Study of Aging (2006–2016).MethodsParticipants were 8,571 people over 45 years in South Korea who had never experienced a fall-induced hip fracture by 2006. Participants were divided into a hip-fracture group (those who experienced one or more hip fractures between 2008 and 2016; N = 306), and a non-hip-fracture group (those who did not experience a hip fracture during this period; N = 8,265). A linear mixed model, Kaplan–Meier analysis, and Cox regression were used to analyze the effects of hip fractures on mortality, the Mini Mental State Examination, Activities of Daily Living, and Instrumental Activities of Daily Living scores during 2008–2016.ResultsIn the hip-fracture group, compared to the non-fracture group, the change in Mini Mental State Examination score was significantly greater (p = 001); however, although there was a significant difference at each time point (p < .001), the cumulative difference over time was not significant (p = .560). The hip-fracture group showed a faster time to initial decline in Mini Mental State Examination scores (hazard ratio = 1.16, CI = 1.022–1.318). The hip-fracture group showed significantly larger changes in Activities of Daily Living and Instrumental Activities of Daily Living scores (p < .001), shorter time until decline began (p < .001), and larger decline as time passed (p < .001). Furthermore, the time before assistance was required from others for activities of daily living and instrumental activities of daily living was also shorter (hazard ratio = 2.18, CI= 1.728–2.759; odds ratio = 1.44, CI = 1.198–1.732). Hip fractures also increased mortality (hazard ratio = 1.42, CI = 1.013–2.002).ConclusionsOur study found that hip fractures accelerate the decline of cognitive function, physical activity, and increased mortality. Our findings can be used to develop fall-prevention programs.     

Comparison of the effectiveness of orthotic intervention,kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study

PurposeThe aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS).Study DesignA single-blind randomized controlled study.MethodsPatients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months.ResultsThere were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05).ConclusionAdding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS.     

Towards a multidimensional patient reported outcome measures assessment: Development and validation of a questionnaire for patients with ankylosing spondylitis/spondyloarthritis

ObjectiveTo assess the validity, reliability and responsiveness to change of a patient self-reported questionnaire that can assess construct outcome measures of patients with ankylosing spondylitis (AS)/spondyloarthritis.MethodsThe questionnaire was developed by integrating information obtained from patients suffering from AS/spondyloarthritis based on the Rasch model. The questionnaire includes assessment of functional disability, quality of life, VAS for spinal pain, joint pain, global status, fatigue, duration of morning stiffness, review of the systems, falls and cardiovascular risks, self-helplessness as well as self-reported joint and soft tissue pain. The questionnaire was completed by 267 consecutive patients with AS (124) and spondyloarthritis (143).ResultsThe PROMs questionnaire was reliable as demonstrated by a high-standardized alpha. The questionnaire items correlated significantly (p < 0.01) with clinical parameters of disease activity. Patient reported tender joints and enthesitis scores correlated significantly with the physician's scores (correlation coefficient 0.848 and 0.821 respectively). Changes in functional disability, quality of life as well as self-helplessness scores showed significant (p < 0.01) variation with diseases activity status. The PROMs questionnaire showed also a high degree of comprehensibility (9.3).ConclusionThe developed PROMs questionnaire is a reliable and valid instrument for assessment of patients suffering from AS and spondyloarthritis. Being short, rapid and comprehensive, this adds more to its applicability. The data support the value of completion of the simple two pages patient questionnaire, which provides a quantitative written documented record by the patient, at each visit to the rheumatologist.     

Factors associated with grip strength among adolescents: An observational study

Study DesignCross-sectional.IntroductionThe muscle strength has been studied in different populations in relation with individual and other factors.Purpose of the StudyThe purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance.MethodsA total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer.ResultsBoys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men.ConclusionsSex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.     

Characterizing response to a dynamic stability modeled approach for thumb carpometacarpal joint pain: A retrospective study

Study DesignRetrospective case series.IntroductionLiterature trends indicate that thumb dynamic stabilization may benefit clients with thumb carpometacarpal (CMC) joint pain and arthritis. There is minimal research investigating whether client characteristics predict responsiveness to hand therapy for thumb dynamic stabilization.Purpose of the Study1) To investigate how adults with thumb CMC joint pain responded to a hand therapy dynamic stabilization modeled intervention. 2) To determine if various client factors influenced responsiveness and to what extent.MethodsAn electronic medical record search identified adults treated from August 2009 through December 2015 for thumb CMC joint pain. Radiographs were retrospectively staged. Outcome measures were 1) Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) total disability score and 2) Numerical Pain Rating Scale (NPRS). Paired t-tests were performed to compare pre and post treatment measures. Multivariate analyses were used to investigate predictive factors.ResultsA total of 249 charts were analyzed. Large overall significant effects were noted for disability score (QuickDASH P <.001, X = 12.1, Cohen's d = 0.9). The average improvement of 2.1 (SD = 2.6) points exceeded the minimal clinically important difference (MCID) of 1.7 points on the NPRS pain scale. Significant predictors of QuickDASH Scores were radiographic staging, bilateral hand involvement and initial pain ratings. Significant predictors for change in pain scores (meeting or exceeding the minimal clinically important difference for the NPRS) were bilateral thumb involvement and initial “pain at worst” rating.ConclusionAfter completing hand therapy with a dynamic stabilization approach, clients had less pain and disability. Those who had unilateral thumb pain, or those who started with higher pain levels were most likely to have clinically meaningful improvements in pain. Clients in early CMC osteoarthritis (OA) stages responded better than those in later stages, indicating that early referral to therapy is important.     

Evolution of an Opioid Sparse Pain Management Program for Total Knee Arthroplasty With the Addition of Intravenous Acetaminophen

BackgroundPerioperative pain management for patients undergoing total knee arthroplasty (TKA) improves patient outcomes and facilitates recovery. In this study, we compared the effects of preoperative oral acetaminophen vs intravenous (IV) acetaminophen administered once intraoperatively and once postoperatively.MethodsTwo standardized, multimodal analgesia protocols were compared in patients undergoing primary, unilateral TKA. The oral acetaminophen cohort (OA) received doses of oral acetaminophen preoperatively and an as-needed basis postoperatively (n = 698). The IV acetaminophen cohort (IA) received 2 doses of IV acetaminophen, one intraoperative and one 6 hours postoperatively, with no oral acetaminophen given (n = 318). No other variables were significantly changed during the study period.ResultsThe IV acetaminophen group demonstrated less narcotic usage on postoperative day 0 (OA: 13.3 mme [morphine mg equivalents], IA: 6.2 mme, P < .001) and overall usage (OA: 66.1 mme, IA: 48.5 mme, P < .001). Pain scores were statistically and clinically significantly decreased in the immediate postoperative (the first 8 hours) for the IA group (OA: patient-reported pain scores of 4.0; IA: patient-reported pain scores of 2.0, P < .001). Both groups progressed and completed their physical therapy similarly for each postoperative day. Length of stay and percent discharge home were slightly improved in the IA group as well, however did not reach statistical difference.ConclusionAn iterative approach to multimodal pain management after TKA led to improvements in narcotic usage, pain scores, and several quality measures. IV acetaminophen is an integral and effective part of our opioid-sparing multimodal pain regimen in TKA.