Range of motion at the wrist: a comparison study of four wrist extension orthoses and the free hand.

OBJECTIVE: This study compared the total wrist range of motion permitted by four different styles of wrist extension orthoses and the free hand. METHOD: Using a repeated-measures, counterbalanced design, 40 healthy female volunteers 20 to 39 years of age shot a basketball while free handed and while wearing each of four wrist extension orthoses: AlignRite; Rolyan D-Ring Long; Rolyan D-Ring Short; and a custom-made, thumb hole design orthosis. The motion at the wrist was measured by an electrogoniometer. RESULTS: No significant differences were found in total wrist motion permitted among the four orthotic conditions. Analyses revealed that the custom-made orthosis allowed significantly less palmar flexion and significantly more dorsiflexion than the three commercially available orthoses. All orthoses significantly restricted wrist movement compared with the free hand. CONCLUSION: The commercially available wrist extension orthoses offered little difference in the amount of restriction they provided. The custom orthosis restricted movement to a different portion of the available range than did the commercial orthoses. Future research should examine how different strapping techniques on custom-made orthoses affect total range of motion permitted at the wrist. Knowledge of patterns of restriction among various styles of orthoses will help therapists to select the most appropriate orthosis for a client's individual needs.     

Flexor muscle incursion into the carpal tunnel: a mechanism for increased carpal tunnel pressure?

PURPOSE: To explore the hypothesis that the extrinsic finger flexor muscles have the potential to move into the proximal end of the carpal tunnel with wrist extension. METHODS: The most distal muscle fibres from the deep and superficial finger flexors were measured relative to the pisiform bone in 18 cadaveric specimens. Muscle excursions during wrist extension were calculated using regression equations previously reported in the literature. RESULTS: The mean distances from the pisiform were 9.3 and 4.9 mm for the deep and superficial flexors, respectively. Ten flexor muscle bellies were at the level of or distal to the pisiform bone in the anatomical position, while 17 of 36 were within 5 mm. DISCUSSION: The excursions expected with wrist extension indicate that many muscles have the potential to enter the carpal tunnel, especially those within 5 mm of the pisiform bone. Comparing the expected excursions to recent pressure data, corroborating support for the pressure increase is found. CONCLUSION: Although not directly measured, the results of this study indicate incursion of the flexor muscles into the carpal tunnel space, particularly with wrist extension, is a plausible mechanism for increased carpal tunnel pressure. RELEVANCE: Proposing a mechanism by which carpal tunnel pressure is elevated during wrist and finger extension is a stepping stone to determining the etiology of the disease itself. Finding that the flexor muscle bellies appear to enter the carpal tunnel with wrist extension indicates that use of the flexor muscles should be avoided when the wrist and fingers are extended.     

Wrist extensor orthoses: dexterity and grip strength across four styles

Orthoses that are used to stabilize, protect, and support the wrist during functional activities often interfere with normal movement and, therefore, with hand function. This study compared the manual dexterity and grip strength of 20 female subjects while using a free hand and while wearing each of four wrist extensor orthoses: a Futuro prefabricated wrist brace (No. 33), a volar thumbhole orthosis, a volar orthosis with a radial connector bar, and a dorsal orthosis with distal transverse arch support. Of these orthoses, the Futuro prefabricated wrist brace afforded the best overall dexterity, although it was significantly slower (p less than .05) than the other orthoses in a writing subtest. Of the custom-made orthoses, the volar style with radial connector bar afforded the best overall dexterity. All of the orthoses significantly (p less than .01) reduced grip strength. The Futuro prefabricated wrist brace afforded the strongest grip strength of the four orthoses studied, and the volar thumbhole orthosis permitted the strongest grip among the custom-made orthotic styles.     

Electromyography of the Upper Limbs During Computer Work: A Comparison of 2 Wrist Orthoses in Healthy Adults

Ferrigno IS, Cliquet Jr, A, Magna LA, Zoppi Filho A. Electromyography of the upper limbs during computer work: a comparison of 2 wrist orthoses in healthy adults.

Objective

To examine the effect of wrist orthoses on the electromyography activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work.

Design

A randomized, 3×2 factorial design: orthoses (no orthosis, wearing a custom-made orthosis, wearing a commercial orthosis) and tasks (typing, using the mouse).

Setting

Laboratory for biomechanics and rehabilitation.

Participants

Healthy university students (N=23), ranging from 18 to 26 years of age.

Intervention

Study volunteers performed standardized tasks such as typing and using the mouse while wearing 1 of 2 types of wrist orthoses or no orthosis.

Main Outcome Measures

We used surface electromyography and considered 100% maximum voluntary contraction to represent the amplitude of electromyographic activity.

Results

We observed a significant increase in the electromyographic activity of the trapezius (P<.05) with the use of orthoses. No significant difference was observed in the activities of the flexor digitorum superficialis or extensor carpi ulnaris in participants who typed with or without orthoses (P>.05). However, when the participants used the mouse, the extensor muscle presented an increase in activity with both orthoses, and the same pattern was observed in the flexor muscle when the volunteers used the custom-made orthosis.

Conclusions

Wrist orthoses affected the muscle activities in the upper limbs of healthy adults who were using a computer. Electromyographic activity increased in the trapezius when the subjects used either type of orthosis, and the same pattern was observed in the extensor carpi ulnaris when the subjects used the mouse. The flexor digitorum superficialis presented an increase in activity only when the subjects worked with the mouse and used a custom-made splint.     

Evaluation of hand orthoses in Duchenne muscular dystrophy

Abstract

Purpose: The purpose of this study was to evaluate whether treatment of boys with Duchenne muscular dystrophy using hand orthoses could benefit joint mobility, grip strength, or fine motor function.

Method: Eight boys with Duchenne muscular dystrophy were provided with individually customised rest orthoses. The results were analysed using single-subject design. The study included a baseline and an intervention phase. A follow-up examination was also performed.

Results: Boys with less than 50° passive wrist extension mobility were included. Wrist extension of the dominant hand increased in four and was maintained in four. Wrist extension in the non-dominant hand increased in five, was maintained in two and decreased in one. Thumb abduction in the dominant hand increased in six and two remained stable. In the non-dominant hand five increased and three remained stable. Grip strength and fine motor function showed also positive results.

Conclusions: This study indicates that the use of hand orthoses in Duchenne muscular dystrophy can delay development of contractures and improve passive wrist extension and thumb abduction. Hand orthoses can therefore be recommended for boys who start to develop contractures in the long finger flexors. Due to small sample size further studies are needed to confirm this result.

• Implications for rehabilitation

• Evaluation of hand orthoses in Duchenne muscular dystrophy.

• Preserved hand function is of uttermost importance for performance of activities in the late stages of Duchenne muscular dystrophy.

• Contractures of long finger flexors affect hand function and limit performance of daily activities.

• Hand orthoses can delay development of contractures and preserve hand function and give prerequisites for independence.

• The occupational therapists should measure wrist joint mobility regularly to be able to find the right time for intervention with hand orthoses in this progressive disorder.

     

一种新型腕手矫形器的结构特点及其使用

目的:介绍一种新型腕手矫形器.方法:该腕手矫形器由腕背护板和腕托架构成的主架,主架的前侧固定安装一U形前支架;食指套圈、中指套圈、无名指套圈和小指套圈分别通过弹力带连接在主架的腕背护扳上;拇指套圈通过钢丝安装在腕背护板的食指套圈一侧;一外展弹力套通过钢丝设置在小指套圈外侧的腕背护板上.使用时可根据矫形需要,将手腕以手心朝上或朝下之方式伸入腕背护板和腕托架构成的主架内,手位于其前方,指套置于滚动套管上的前方,手指伸至滚动套管下的前方,指套圈分别套在食指、中指、无名指和小指上,拇指套圈套在拇指上.然后根据矫形需要活动手腕,实现其各种矫形功能.结果:该新型腕手矫形器可用于伸指肌腱损伤术后保持手指呈伸直状态,以限制手指的活动范围,促进断端的愈合;用于屈指肌腱损伤损伤术后保持腕关节和指关节处于屈曲状态;改善腕关节屈、伸,增加腕关节屈曲的活动范围;增加腕关节桡侧偏移的活动范围;增加桡侧腕屈肌和尺侧腕屈肌肌力、桡侧腕伸肌和尺侧腕伸肌肌力、尺侧伸腕肌和尺侧屈腕肌肌力、指总伸肌肌力、指浅屈肌及指深屈肌肌力.结论:该种型腕手矫形器适用于腕及手的神经、肌腱、肌肉、血管损伤术后保护,腕及手骨折所致的腕关节、指关节运动功能障碍恢复,可改善腕关节活动范围,增加肌力.     

Botulinum toxin injection of spastic finger flexors in hemiplegic patients

OBJECTIVE: To assess the outcomes of botulinum toxin injection of spastic finger flexors followed by intensive training of finger extensors. DESIGN: Fourteen subjects with chronic hemiplegia spasticity of the upper limb had electromyographic-guided botulinum toxin injection into the long finger flexors. All patients presented with minimal active finger extension with the wrist flexed, sustained clonus of the finger flexors, functional proximal arm function, and absence of fixed contracture. Cadaver dissections directed selection of two injection sites: the flexor digitorum sublimis and the flexor digitorum profundus. Fifty mouse units of botulinum toxin were injected into each muscle. After injection, the subjects were instructed in a home program of stretching the long finger flexors, upper limb weight bearing with a weight-bearing splint, and exercise to improve finger extension control. RESULTS: Compared with preinjection measures, assessment the first week after the initial injection showed significantly reduced tone, reduced clonus, and greater active finger extension with the wrist in the neutral position. Four months later, the Ashworth scale increased to preinjection levels in the six subjects with repeated injections but was again decreased postinjection. Active finger extension with the wrist in the neutral position and clonus showed a statistically nonsignificant trend toward cumulative improvement after the second injection. CONCLUSION: The greatest change in finger extension and spasticity reduction occurred after the first injection. Continued significant improvement in finger extension was not observed.     

The immediate and short-term effects of a wrist extension orthosis on upper-extremity kinematics and range of shoulder motion.

OBJECTIVE: The purpose of this study was to investigate upper-extremity kinematics and range of shoulder motion while wearing a wrist extension orthosis compared to the free hand at initial testing and after a week's wear. METHOD: A convenience sample of healthy women, ages 20-50 years, performed a stacking task and a pouring task, freehanded and splinted, at two times, 1 week apart in this counterbalanced, repeated measures design. A Motion Analysis 3-D system measured quality of movement and range of motion variables. A 2 by 2 analysis of variance (splinted vs. freehanded by time of testing) was used to analyze each variable. RESULTS: In both tasks, participants tended to move more slowly (p = 0.005) with less direct movements (p < .001) when wearing the orthosis. In stacking, splinted movements were also less smooth than when free-handed (p < .0001). When splinted both tasks required more shoulder abduction (p < .0001) and pouring required more shoulder flexion (p < .0001). Participants demonstrated several improvements in quality of movement and amount of shoulder motion used after a weeks' orthotic wear, indicating some adaptation to the orthosis with use. CONCLUSION: In this study, a wrist extension orthosis interfered with the quality of upper-extremity movement and required more range of shoulder movement compared to the free hand. Future research is needed to determine whether persons with upper-extremity conditions (i.e., arthritis, carpal tunnel syndrome) respond similarly to wrist orthoses. Therapists should consider discussing with patients how their wrist splint could affect their hand performance and help patients learn techniques to reduce stress on their proximal joints.     

The effect of three levels of foot orthotic wedging on the surface electromyographic activity of selected lower limb muscles during gait

Background. Some types of foot orthoses have been researched for their effect on lower limb electromyographic muscle activity during walking. However, foot orthoses with high levels of medial rearfoot wedging (‘inverted’ foot orthoses) have not been investigated.

Methods. In a cross-sectional study, asymptomatic participants with a pronated foot type (n = 15) were each issued with a pair of 0°, 15° and 30° inverted custom-made foot orthoses. After four weeks of habituation to the orthoses, surface electromyography was used to measure the onset and maximum EMG amplitude of tibialis anterior, peroneus longus, medial gastrocnemius and soleus muscles using five conditions [barefoot, shoe-only, 0°, 15° and 30° inverted foot orthoses conditions].

Findings. A statistically significant increase in tibialis anterior maximum EMG amplitude occurred using the shoe only (30% increase), 0° (33% increase), 15° (38% increase) and 30° (30% increase) inverted orthoses conditions compared to walking barefoot (P < 0.01). Peroneus longus maximum EMG amplitude increased significantly using the 15° inverted orthosis condition compared to walking barefoot (21% increase, P = 0.04).

Interpretation. Footwear and orthoses can significantly alter the maximum EMG amplitude of leg muscles during walking. Foot orthoses appear to increase peroneus longus EMG amplitude compared to footwear alone. However, the level of medial rearfoot posting within an orthosis does not appear to significantly alter maximum EMG amplitude. The individual responses to foot orthoses are highly variable. The changes in EMG amplitude with the use of foot orthoses and shoes may have clinical implications.     

Co-contraction in the hemiparetic forearm: quantitative EMG evaluation

Co-contraction of antagonist muscles is a recognized clinical phenomenon in patients surviving a cerebrovascular accident. Yet, discrepancies persist in the literature as to whether or not antagonist electromyographic activity is increased in hemiparesis. We have developed a technique to obtain simultaneous counts of motor unit activity in a wrist flexor and extensor muscle using monopolar needle electromyography. Stable stroke patients and age/sex matched control subjects were tested during maximal voluntary isometric wrist flexion and extension. Fewer agonist events (p less than 0.05) and more antagonist events (p less than 0.10) were counted in paretic than in control muscles. A co-contraction ratio of antagonist activity to total (agonist and antagonist) activity was much greater for patients than controls (p less than 0.01). We conclude that both agonist recruitment and antagonist inhibition are impaired in the hemiparetic arm.     

A randomized controlled trial comparing the long-term use of soft lumbosacral orthoses at two different pressures in patients with chronic nonspecific low back pain

BackgroundThere is concern that wearing soft lumbosacral orthoses for prolonged periods may impair motor function. Moreover, the pressure applied by lumbosacral orthoses on the abdominal wall is usually ignored when these orthoses are prescribed.MethodIn this randomized controlled trial study, 48 patients with chronic nonspecific low back pain were randomly divided into high pressure, normal pressure and control groups. All groups received medication for 4 weeks. The normal pressure and high pressure groups, in addition to medication, used soft lumbosacral orthoses at normal pressure and 50% increased pressure, respectively. Motor function outcome measures were strength, endurance, proprioception and electromyographic activity of the trunk muscles. Clinical outcome measures were pain and disability, which were evaluated in two sessions before and after a 4-week interval.Findings.Isometric strength, endurance and most of the electromyographic parameters were generally unaffected by wearing the lumbosacral orthosis. Pain improved in all groups, and disability and proprioception improved in the high pressure and normal pressure groups. Between-group differences in these three measures indicated better results in the lumbosacral orthoses groups than in the control group. The improvements in pain and proprioception were significantly greater in the high pressure group than the normal pressure group.Interpretation.Long-term use of lumbosacral orthoses had no significant adverse effects on motor function or clinical factors in patients with chronic low back pain. Increasing lumbosacral orthosis tightness may improve motor functioning and the clinical efficacy of the orthosis.Clinical Trial Registration number: Code: IRCT201708192391N38.     

Performance specification for lower limb orthotic devices

OBJECTIVE: To establish the range of forces and moments applied to lower limb orthoses during ambulation by routine users. DESIGN: Well-established gait analysis techniques were used to determine the loading at the major joints. It was assumed that the joint moments were transmitted by the orthosis encompassing any particular joint. Two hundred and five assessments of 164 patients were successfully completed by a consortium of four gait laboratories in Europe. The orthosis specification and patient clinical data were also recorded. BACKGROUND: The design and development of orthoses has occurred largely by evolution rather than by formal engineering methods. In particular, formal design has been hampered by a lack of information on the forces and moments applied during ambulation. METHODS: A standard gait analysis procedure was employed to capture the data. In-house biomechanical models were used to calculate the joint loading. Data were normalised with respect to patient weight and leg length. RESULTS: It was found that the median maximum normalised ankle moment transmitted by an ankle foot orthosis was 0.15 and the maximum knee moment was 0.09. The greatest moment transmitted by the hip joint of a hip knee ankle foot orthosis was also 0.09. There was a wide variation in the data due to differences in the impairments of the test subjects. CONCLUSION: It is possible to estimate the loads transmitted by an orthosis using established gait analysis procedures without the need for load measurement transducers. There is now a need both to collect a larger representative dataset and to perform validation studies with transducers.     

Customized adjustable orthoses: their use in spasticity

Spastic contractures are a common problem which frequently requires the use of splinting or casting. Customized adjustable orthoses can reduce contractures without the problems often associated with these procedures. These devices reduced contractures in a head-injured patient's severely spastic wrist and ankles. As a wrist contracture decreased, the patient increasingly used her arm and hand for feeding, grooming, and leisure activities. The plastic orthoses, molded to the individual limb, incorporate Klenzak or Lehrman fracture brace joints. Custom fit positions spastic limbs and promotes improved range of motion. Small brace joint adjustments are done at intervals to promote slow stretch of spastic limbs; since the device remains on during the adjustment, there is no loss of range of motion. The device may be removed for skin monitoring. The patient maintains joint range, as the orthosis becomes a permanent part of the home program. High cost of the device is potentially offset by the advantages of decreased skin morbidity, reduced therapist time in making adjustment, and maintenance of gains in range of motion. Such orthoses also have been used for elbow contractures.     

Measurement of angular wrist neutral zone and forearm muscle activity

OBJECTIVES: To determine the forearm muscles activity in different wrist deviated positions and wrist neutral zone, and to assess the self-selected resting position without visual feedback. BACKGROUND: Wrist deviation occurs in almost all industrial and office jobs. This has been deemed hazardous for carpal tunnel syndrome. Proper resting wrist position is likely to decrease the hazard for carpal tunnel pressure. METHODS: Twenty blindfolded subjects without history of hand/forearm musculoskeletal disorders participated in the study. The EMG of the forearm muscles (flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis and, extensor carpi ulnaris) in deviated and neutral wrist postures was recorded at a sampling rate of 1 kHz. Also, wrist neutral zone at rest was measured using a custom-made calibrated uniaxial electrogoniometer. One-way ANOVA with repeated measures was used in order to find the impact of wrist deviation on muscles activity. RESULTS: The participants positioned their wrist in rest at 7 degrees -9 degrees extension and 5 degrees -7 degrees ulnar deviation. Significantly higher EMG activity was recorded for each muscle in the wrist deviated postures when compared to neutral position (P < 0.001). CONCLUSIONS: Self selected wrist neutral posture decreased the muscle activity significantly. Placement of wrists in neutral zone is expected to reduce risk of injuries.     

Contribution of the extrinsic and intrinsic hand muscles to the moments in finger joints

OBJECTIVE: The purpose of this current work is to develop a method of estimating force produced by the extrinsic and intrinsic hand muscles, and to estimate the contribution of these muscles to the finger joint moments. DESIGN: Experimental methods and a biomechanical model were developed for the estimation of (a) moments produced at finger joints, and (b) contribution of the intrinsic and extrinsic muscles to the moments, (c) forces of the extrinsic and intrinsic muscles within individual fingers. BACKGROUND: Because of the differential insertions of the extrinsic flexors, it is possible to isolate their mechanical effect at finger joints. METHODS: During the experiment, the location of force application was varied in parallel along individual fingers. The points of force application were on the distal phalanx, at the distal interphalangeal joint, or at the proximal interphalangeal joint. RESULTS: When the point of force application was varied in the proximal direction from the distal phalanx to the proximal interphalangeal joint the moment at a given joint decreased. The intrinsic and extrinsic muscle forces were dependent on the experimental conditions. The extrinsic muscles were the major contributors in counterbalancing finger joint moments when the point of force application was distal beyond the proximal interphalangeal joint. CONCLUSION: This current work provides both an experimental protocol and a biomechanical model that allows estimation of the contribution of the intrinsic and extrinsic muscles to finger joint moments. RELEVANCE: This study suggests ways of identifying the source of functional deficiency in the hand.     

A case study of gait compensations for hip muscle weakness in idiopathic inflammatory myopathy

BACKGROUND: The purpose of this case series was to quantify different strategies used to compensate in gait for hip muscle weakness. METHODS: An instrumented gait analysis was performed of three females diagnosed with idiopathic inflammatory myopathies and compared to a healthy unimpaired subject. Lower extremity joint moments obtained from the gait analysis were used to drive an induced acceleration model which determined each moment's contribution to upright support, forward progression, and hip joint acceleration. FINDINGS: Results showed that after midstance, the ankle plantar flexors normally provide upright support and forward progression while producing hip extension acceleration. In normal gait, the hip flexors eccentrically resist hip extension, but the hip flexor muscles of the impaired subjects (S1-3) were too weak to control extension. Instead S1-3 altered joint positions and muscle function to produce forward progression while minimizing hip extension acceleration. S1 increased knee flexion angle to decrease the hip extension effect of the ankle plantar flexors. S2 and S3 used either a knee flexor moment or gravity to produce forward progression, which had the advantage of accelerating the hip into flexion rather than extension, and decreased the demand on the hip flexors. INTERPRETATION: Results showed how gait compensations for hip muscle weakness can produce independent (i.e. successful) ambulation, although at a reduced speed as compared to normal gait. Knowledge of these successful strategies can assist the rehabilitation of patients with hip muscle weakness who are unable to ambulate and potentially be used to reduce their disability.     

Passive properties of the forearm musculature with reference to hand and finger postures

OBJECTIVE: To quantify individual forearm muscle passive forces and evaluate their impact on hand function. DESIGN: The passive force-length properties of the 24 extrinsic hand and wrist muscles were determined in five fresh frozen cadaver arms. BACKGROUND: Muscle force production is a summation of the active and passive force components. The passive properties of the extrinsic finger musculature and wrist musculature appear to strongly affect both hand posture and hand movement. METHODS: The passive force-length properties of extrinsic hand and wrist muscles were determined by applying a slow, continuous extension to each muscle and recording the resulting tension. Each force-length curve was fit using exponential regression and were related to specific joint rotations and seven hand postures by calculating the muscle excursions for those postures. RESULTS: The exponential passive force-length relationship explained over 97% of the experimental variance. The largest passive forces were elicited in the digital extensors in grips involving large flexion angles such as tip pinch, key pinch, and a briefcase grip. CONCLUSIONS: The passive properties of the extrinsic finger musculature and wrist musculature affect both hand posture and movement especially in postures with flexed wrist and fingers.     

Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia.

OBJECTIVES: To study the correlation between spasticity and motor dysfunction in the wrist-hand unit of adult hemiplegic patients, and to investigate the correlation between clinical spasticity and hyperactive stretch reflexes. STUDY DESIGN: A survey study with a sequential case series of subjects. SETTING: Neuromuscular Research Laboratory, School of Physical Therapy, Texas Woman's University, Houston, TX. SUBJECTS: Sequential sample recruited from local stroke support groups: 10 patients with chronic hemiplegia caused by cerebral vascular accident who had various degrees of spasticity in the wrist joint. OUTCOME MEASURES: Modified Ashworth Scale, amplitudes of stretch reflexes for wrist flexors, grip strength, active range of motion of the wrist joint, and Fugl-Meyer test. RESULTS: Strong reverse correlation was found between spasticity and grip strength, the Fugl-Meyer test scores, and the Box and Blocks test scores (p = .001 to .005). Results also indicated a strong and consistent correlation between spasticity and reflexive electromyographic activities of the stretch reflex recorded from active muscles (p = .005 and .007), but not between spasticity and torque response of the stretch reflex. CONCLUSIONS: The degree of wrist spasticity is associated with impaired hand function in hemiplegic patients, and hyperactive electromyographic response of the stretch reflex, recorded from active muscles, is a valid indicator of spasticity.     

Comparative Effectiveness of Orthoses for Thumb Osteoarthritis: A Systematic Review and Network Meta-analysis

ObjectiveTo evaluate the best option among orthoses for carpometacarpal (CMC) osteoarthritis (OA) of the thumb, using a network meta-analysis.Data SourcesMedline, Embase, Cochrane, and ClinicalTrials.gov registry databases were used. PubMed, Embase, Cochrane Controlled Trials Register, Cochrane, and other databases were used without language restrictions.Study SelectionWe searched randomized controlled trials (RCTs) on adults with OA of the thumb by studying any orthosis from the beginning to March 10, 2020.Data ExtractionData were extracted and checked for accuracy and completeness by pairs of reviewers. Outcomes were pain and function. Comparative treatment effects were analyzed by random-effects model for direct pairwise comparisons and Bayesian network meta-analyses to integrate direct and indirect evidence.Data SynthesisEleven RCTs involving 619 patients were included. We evaluated 5 groups, for 4 different orthoses: short thermoplastic CMC splint (rigid CMC) (n=5), long thermoplastic carpometacarpal-metacarpophalangeal splint (rigid CMC-MCP) (n=7), short neoprene CMC splint (soft CMC) (n=1), long neoprene CMC-MCP splint (soft CMC-MCP) (n=5), and one as a control group (n=5). Our results show that all splints were superior to placebo to reduce pain intensity and the top-ranked intervention was the rigid CMC-MCP (surface under the cumulative ranking curve analysis [SUCRA], score: 65.4). In function evaluation, we report a 71.6 SUCRA for rigid CMC.ConclusionsAlthough the current evidence is unclear on the use of the splint in OA of the thumb, it is not known which orthosis is more effective and whether the orthosis is more effective than other interventions. The network meta-analysis shows that a long thermoplastic splint it is the best choice for pain relief and the short thermoplastic CMC splint is the best treatment to increase function. These results may suggest initial treatment with a long rigid orthosis and then a short rigid orthosis.     

Knee lock device for knee ankle orthoses for spinal cord injured patients: an evaluation

The effect of a specially designed knee lock in a knee ankle orthosis was studied in 2 able-bodied volunteers and in 2 patients with spinal cord lesions. This lock allows the knee to bend during the swing phase but locks the knee securely during the stance phase. The device is intended to improve gait pattern and reduce oxygen consumption more than a standard knee lock which keeps the knee straight throughout the entire gait cycle. Energy savings with the knee locking mechanism were significant only at ambulation rates at or above 73 meters/min, a speed which could only be attained by able-bodied subjects. To achieve such high rates of ambulation a patient's hip flexors must be strong; yet a knee ankle orthosis is required only when the patient's knee extensors are weak. In patients with spinal cord injuries, this pattern of muscle strength is rarely encountered. The innervation of hip flexors or knee extensors overlaps, so voluntary control of these muscles will either be present or absent for both muscle groups. Therefore, most spinal cord injured persons who need a knee orthosis would not greatly benefit from this locking mechanism. There may be other conditions in which this device will prove valuable.