Short-term effects of neurodynamic mobilization in 15 patients with secondary thumb carpometacarpal osteoarthritis

Objective

The purpose of this study is to evaluate whether neurodynamic mobilization of the median nerve improves pressure pain threshold (PPT) and pinch and grip strength in patients with secondary thumb carpometacarpal osteoarthritis (TCOA).

Method

Fifteen patients with secondary TCOA (13 women and 2 men) between 70 and 90 years old were received by neurodynamic therapy. All patients received median nerve mobilization of the dominant hand by sliding technique during 4 sessions over 2 weeks. The outcome measures of this case series were monitored by using PPT measured by algometry as PPT at the trapeziometacarpal (TM) joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone. Tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. These variables were measured at pretreatment, 5 minutes posttreatment, 1 week (first follow-up [FU]) and 2 weeks after treatment (second FU).

Results

Pressure pain threshold in the TM joint was 3.54 ± 0.04 kg/cm². After treatment, it increased to 4.38 ± 0.04 kg/cm² (P < .01) and maintained in the first FU (4.27 ± 0.04 kg/cm², P < .02) and second FU (4.08 ± 0.04 kg/cm², P < .02). In contrast, we found no differences in PPT in the other studied structures after treatment. Similarly, tip and tripod pinch strength remained without change after treatment. Grip strength was 10.77 ± 0.18 kg, and after treatment, it increased to 11.55 ± 0.16 kg (P < .05) and maintained in first FU (11.73 ± 0.18 kg, P < .02) and second FU (11.2 ± 0.17 kg, P < .05).

Conclusions

Median nerve mobilization decreased pain in the TM joint and increased grip strength in this group of patients with TCOA.     

Bilateral Sensory Effects of Unilateral Passive Accessory Mobilization in Patients With Thumb Carpometacarpal Osteoarthritis

ObjectiveThe purpose of this study was to investigate changes in pressure sensitivity and pinch grip force in the nonsymptomatic side in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) after the application of a unilateral passive accessory mobilization to the symptomatic hand.MethodsSecondary analysis of data from a randomized trial with concealed allocation, blinded assessor, and intention-to-treat analysis was performed. Twenty-eight patients (72% females), with unilateral CMC OA and mean age ± SD of 82 ± 6 years, met all the inclusion criteria and agreed to participate. The experimental group received passive accessory mobilization to the CMC OA, and the control group received a nontherapeutic dose of intermittent ultrasound on the affected side for 4 sessions over 2 weeks. Outcome measures including pressure pain thresholds (PPTs) at the lateral epicondyle, thumb CMC joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone and tip and tripod pinch and grip strength of the contralateral/unaffected hand were assessed at baseline as well as 1 and 2 weeks after treatment by an assessor blinded to the group allocation. A repeated measures analysis of variance was used to determine changes in PPT and pinch and grip strength.ResultsNo important baseline differences were observed between groups. At the end of the follow-up period, the experimental group exhibited a significant increase in PPT at the CMC joint as compared with the control group 0.6 kg/cm² (95% confidence interval, 0.3-1.0; F_3.0 = 4.89; P = .009). Although PPT changes in the experimental group were higher than the control group at the remaining sites, differences did not reach statistically significance. Similarly, tip, tripod pinch, and grip strength remained unchanged after the intervention.ConclusionThis secondary analysis found that the application of a unilateral passive accessory mobilization targeted to the symptomatic CMC joint induced an increase of PPT levels 2 weeks after treatment; however, differences were small and likely of limited clinical value. No contralateral motor effects were observed. Future studies including larger sample sizes are needed to examine the effects of joint mobilization on motor and sensory effects.     

Hypoalgesic and motor effects of kaltenborn mobilization on elderly patients with secondary thumb carpometacarpal osteoarthritis: a randomized controlled trial

Objective

This study evaluated the effects of Kaltenborn manual therapy on sensory and motor function in elderly patients with secondary carpometacarpal osteoarthritis (CMC OA).

Method

Twenty-nine female patients with secondary CMC OA (70-90 years old) were randomized into Kaltenborn manual therapy and sham groups. This study was designed as a double-blind, randomized controlled trial (RCT). Therapy consisted of Kaltenborn mobilization of posterior-anterior gliding with distraction in grade 3 of the carpometacarpal (CMC) joint of the dominant hand during 6 sessions over 2 weeks. Pain was measured by algometry, as the pressure pain threshold (PPT) at the CMC joint and tubercle of the scaphoid bone. The tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. Measurements were taken before treatment and after 1 week (first follow-up [FU]) and 2 weeks (second FU).

Results

All values in the sham group remained unchanged during the treatment period. In the treated group, the PPT in the CMC joint was 2.98 ± 0.30 kg/cm², which increased after treatment to 4.07 ± 0.53, and was maintained at the same level during the first FU (3.46 ± 0.31) and second FU (3.84 ± 0.36). Similarly, the PPT in the scaphoid bone was 3.61 ± 0.29 kg/cm², which increased after treatment to 4.87 ± 0.37, and was maintained at the same level during the first FU (4.44 ± 0.43) and second FU (4.22 ± 0.32). In contrast, we found no differences in the tip, tripod pinch, and grip strength measurements between the treatment and sham groups.

Conclusions

This study showed that Kaltenborn manual therapy decreased pain in the CMC joint and scaphoid bone areas of elderly female patients; however, it did not confer an increase in motor function in patients with CMC OA.     

Comparison of custom-made and prefabricated neoprene splinting In patients with the first carpometacarpal joint osteoarthritis

Aim: The objective of this study was to compare the effect of prefabricated and custom made thumb splints on pain, function, grip strength and key pinch In patients with basilar joint osteoarthritis. Method: Volunteer patients (n = 35) with first carpometacarpal joint osteoarthritis were assigned randomly to wear either a prefabricated or custom-made thumb splint or assigned to a control group. This was designed as a cross over study with two 4-week treatment periods, 2 weeks of wash out time for intervention groups between the test conditions and 10-weeks follow-up for the control group. All parameters were measured at the first visit and during the 4th, 6th and 10th weeks In the three groups. Results: In the control group, paIn increased and pinch strength decreased but no statistically significant differences were found In function and grip strength. Both splints changed grip strength with no significant differences between them. PaIn was reduced with the splints, and functions and pinch strength increased significantly as compared to the baseline and control groups. In comparing the two splints only significant differences were observed In pain. Conclusion: In comparing two splints, paIn was the only significantly different parameter between tested parameters; with the custom-made splints demonstrating better results In paIn reduction.

Implications for Rehabilitation

• A high level of disability has been reported In those patients with thumb carpometacarpal joint osteoarthritis.

• Custom-made and prefabricated neoprene splinting is an effective method to improve pain, pinch strength and function by patients with the first carpometacarpal joint osteoarthritis.

• The custom made splint demonstrated better results In paIn reduction.

     

In vivo biomechanical behavior of the trapeziometacarpal joint in healthy and osteoarthritic subjects

BackgroundThe contact biomechanics of the trapeziometacarpal joint have been investigated in several studies. However, these led to conflicting results and were mostly performed in vitro. The purpose of this study was to provide further insight on the contact biomechanics of the trapeziometacarpal joint by in vivo assessment of healthy and osteoarthritic subjects.MethodsThe hands of 16 healthy women and 6 women with trapeziometacarpal osteoarthritis were scanned in positions of maximal thumb extension, flexion, abduction and adduction during three isometric tasks (lateral key pinch, power grasp and jar twist) and in thumb rest posture (relaxed neutral). Three-dimensional surface models of the trapezium and first metacarpal were created for each thumb configuration. The articular surface of each bone was measured in the neutral posture. A computed tomography-based proximity mapping algorithm was developed to calculate the distance between opposing joint surfaces, which was used as a surrogate for intra-articular stress.FindingsDistinct proximity patterns were observed across tasks with a recurrent pattern reported on the volar aspect of the first metacarpal. The comparison between healthy and arthritic subjects showed a significantly larger articular area, in parallel with a significant joint space narrowing and an increase in proximity area in arthritic subjects. We also observed severe articular deformations in subjects with late stage osteoarthritis.InterpretationThis study has increased our insight in the contact biomechanics of the trapeziometacarpal joint during tasks and positions of daily life in healthy and arthritic subjects, which might contribute to a better understanding of the occurrence mechanisms of degenerative diseases such as osteoarthritis.     

Combined Thumb Abduction and Index Finger Extension Strength: A Comparison of Older Adults With and Without Thumb Carpometacarpal Osteoarthritis

ObjectiveThe objectives of this study were to compare thumb combined abduction/index finger extension (hand opening) strength between subjects with carpometacarpal (CMC) osteoarthritis (OA) and normal controls and to assess the reproducibility of hand opening strength and abduction range of motion (ROM) measurements in patients with thumb CMC OA to establish the cutoff values scores for minimal detectable change.MethodsSeventy-seven subjects, 96% female (age, 77 ± 7 years), participated in the study. The CMC OA group consisted of 39 patients (mean ± SD, 81 ± 7) and 38 healthy subjects (mean ± SD, 78 ± 6). Mixed models analysis of variance was conducted to determine the differences between groups.ResultsThe post hoc testing revealed statistically significant differences in pain pressure threshold, opening strength, and ROM measurements within the CMC OA group as compared with the healthy group (all, P < .01) in the dominant right hand. The average measure of CMC OA in the right hand did differ from that of the left hand for opening strength and abduction measurements. No statistical differences were revealed between groups nondominant left (all, P > .05), except in case of opening strength (P < .001). There was also large effect size between the means of the Disabilities of the Arm, Shoulder, and Hand scores between the healthy group and the CMC OA group of 1.17 (confidence interval, 1.19-2.14).ConclusionSubjects with CMC OA exhibited decreased combined thumb abduction and index finger extension strength, reduced thumb abduction ROM, and increased pain sensitivity when compared with their healthy counterparts. The minimal detectable change score in this patient population was 0.23 to 0.25 kg/cm² for pain pressure threshold, 0.12 to 0.13 lb for opening force, and 1.24° to 1.46° for abduction ROM measurement.     

Shorter vs Longer Immobilization After Surgery for Thumb Carpometacarpal Osteoarthritis: A Propensity Score-Matched Study

ObjectiveTo investigate if shorter immobilization is noninferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritisDesignProspective cohort study with propensity score matching.SettingData collection took place in 16 outpatient clinics for hand surgery and hand therapy.ParticipantsA total of 131 participants with shorter immobilization and 131 participants with longer immobilization (N=262).InterventionShorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14 days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks postoperatively) after Weilby procedure for first carpometacarpal joint osteoarthritis. Propensity score matching was used to control for confounders.Main Outcome MeasuresOutcomes were pain measured with a visual analog scale and hand function measured with the Michigan Hand Outcomes Questionnaire at 3 and 12 months. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment, and return to work.ResultsNo significant differences were found in visual analog scale pain (effect size, 0.03; 95% confidence interval [CI], −0.21 to 0.27) or the Michigan Hand Outcomes Questionnaire (effect size, 0.01; 95% CI, −0.23 to 0.25) between the groups at 3 months or at 12 months. Furthermore, no differences were found in complication rate or in other secondary outcomes.ConclusionsIn conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal to longer immobilization for outcomes on pain, hand function, and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner, which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following first carpometacarpal joint arthroplasty.     

In vivo analysis of trapeziometacarpal joint arthrokinematics during multi-directional thumb motions

BackgroundThe investigation of the joint arthrokinematics of the trapeziometacarpal joint is critical to comprehend the causative mechanism underlying this common form of osteoarthritis. Therefore, the purpose of this study is to evaluate the arthrokinematics of the trapeziometacarpal joint during thumb postures in vivo.MethodsFifteen healthy participants were enrolled in this study. Static computed tomography images of the 1st metacarpal bone and trapezium were taken at specific thumb postures during thumb flexion–extension, abduction–adduction, and circumduction motions. Images were analyzed to examine the joint gliding, expressed as displacement of the centroid of the articular surface of the 1st metacarpal bone, relative to the trapezium. The gliding ratio, defined as joint gliding in each direction normalized to the dimension of the trapezium joint surface in the given direction, was computed and compared between different thumb motions.FindingsThe results indicate that thumb motions influenced joint gliding. The centroids of the articular surface of the 1st metacarpal bone were primarily located at the central and dorsal–radial regions while executing these motions. The maximum joint gliding of the 1st metacarpal bone occurred in the radial–ulnar direction when performing abduction–adduction, and in the dorsal–volar direction while performing flexion–extension and circumduction, with the gliding ratio values of 42.35%, 51.65%, and 51.85%, respectively.InterpretationActivities that involved abduction–adduction in the trapeziometacarpal joint caused greater joint gliding in the ulnar–radial direction, while flexion–extension resulted in greater joint gliding in the dorsal–volar and distal–proximal directions. Understanding normal joint kinematics in vivo may provide insights into the possible mechanism leading to osteoarthritis of the trapeziometacarpal joint, and help to improve the design of implants.     

Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis

Abstract

Purpose: The purpose of this study was to conduct a current review of randomized controlled trials regarding the effect of conservative interventions on pain and function in people with thumb carpometacarpal (CMC) osteoarthritis (OA), perform a meta-analysis of the findings and summarize current knowledge. Method: Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to May 2014. Reference lists of relevant literature reviews were also searched. All published randomized trials without restrictions to time of publication or language were considered for inclusion. Study subjects were symptomatic adults with thumb CMC OA. Two reviewers independently selected studies, conducted quality assessment and extracted results. Data were pooled in a meta-analysis, when possible, using a random-effects model. Quality of the body evidence was assessed using GRADE approach. Results: Sixteen RCTs involving 1145 participants met the inclusion criteria. Twelve were of high quality (PEDro score?>?6). We found moderate quality evidence that manual therapy and therapeutic exercise combined with manual therapy improve pain in thumb CMC OA at short- and intermediate-term follow-up, and from low to moderate quality evidences that magneto therapy improves pain and function at short-term follow-up. Orthoses (splints) were found to improve function at long-term follow-up and pinch strength at short-term follow-up. Finally, we found from very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long-term follow-up. Conclusions: Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain. Additional research is required to determine the efficacy of other therapeutic interventions that are performed with patients with thumb CMC OA.

• Implications for Rehabilitation

• Manual therapy and exercise are an effective means of improving pain and function at short-term follow-up by patients with thumb CMC OA.

• Magneto therapy, manual therapy, manual therapy and exercise and Orthoses (splints) were found to have clinically significant results.

• Very few of the included studies showed a clinically significant effect size in favor of treatment.

     

No difference between two splint and exercise regimens for people with osteoarthritis of the thumb: a randomised controlled trial

The purpose of this study was to compare the effects of two 6-week splint and exercise regimens for patients with trapeziometacarpal osteoarthritis. Forty participants were enrolled in a randomised, controlled clinical trial. The experimental group received a newly designed thumb strap splint and an abduction exercise regimen, whereas the control group received current clinical practice consisting of a short opponens splint and a pinch exercise regimen. Outcome measures included pain (VAS at rest in cm), strength (tip pinch in kg), and hand function (Sollerman Test of Hand Function scored out of 80), measured by a blinded assessor at Weeks 0, 2, and 6. By Week 6 there was no significant difference in the extent of mean improvement between the groups in: pain, 0.5 cm (95% CI -1.1 to 2.1); strength, 0.1 kg (95% CI -0.8 to 0.9); or hand function, 0.7 points (95% CI -3.6 to 5.0). While both groups improved, neither regimen is superior to the other in patients with trapeziometacarpal osteoarthritis.     

Factors related to thumb pain in physiotherapists

The aim of this study was to determine whether differences exist between physiotherapists with work-related thumb pain and physiotherapists without thumb pain. Twenty-four physiotherapists with work-related thumb pain (Pain Group) and 20 physiotherapists without thumb or wrist pain (Non-pain Group), who were working at least 20 hours per week in an outpatient musculoskeletal setting, were compared on a number of attributes: generalised joint laxity, hand and thumb strength, height, weight, working environment, hand position and force applied during mobilisation, mobility at individual thumb joints, extent of osteoarthritis at the thumb and radial-sided wrist joints, and demographic data including age, gender and years of experience. All physiotherapists in the Pain Group reported their thumb pain was related to and initially caused by the performance of manual techniques, and 88% had altered their manual techniques because of pain in the thumb. There was extreme variability in hand position and force applied during mobilisation, and a slightly high prevalence of osteoarthritis (22.7%) considering the mean age of the total sample (38.6 years). Statistically significant differences between groups included increased right carpometacarpal joint laxity (6.4%, 95% CI 0.19 to 12.6), decreased right tip pinch strength (0.84 kg, 95% CI 0.01 to 1.68), and lower body mass index (2.0, 95% CI 0.11 to 3.9) for the Pain Group. Other factors were not statistically different between groups. These results indicate that work-related thumb pain affects physiotherapists ability to administer manual treatments, and suggest that decreased stability and strength of the thumb may be associated with work-related thumb pain.     

The added value of measuring thumb and finger strength when comparing strength measurements in hypoplastic thumb patients

Background

When interventions to the hand are aimed at improving function of specific fingers or the thumb, the RIHM (Rotterdam Intrinsic Hand Myometer) is a validated tool and offers more detailed information to assess strength of the involved joints besides grip and pinch measurements.

Methods

In this study, strength was measured in 65 thumbs in 40 patients diagnosed with thumb hypoplasia. These 65 thumbs were classified according to Blauth. Longitudinal radial deficiencies were also classified. The strength measurements comprised of grip, tip, tripod and key pinch. Furthermore palmar abduction and opposition of the thumb as well as abduction of the index and little finger were measured with the RIHM.

Findings

For all longitudinal radial deficiency patients, grip and pinch strength as well as palmar abduction and thumb opposition were significantly lower than reference values (P < 0.001). However, strength in the index finger abduction and the little finger abduction was maintained or decreased to a lesser extent according to the degree of longitudinal radial deficiency. All strength values decreased with increasing Blauth-type. Blauth-type II hands (n = 15) with flexor digitorum superficialis 4 opposition transfer including stabilization of the metacarpophalangeal joint showed a trend toward a higher opposition strength without reaching statistical significance (P = 0.094),however compared to non-operated Blauth-type II hands (n = 6) they showed a lower grip strength (P = 0.019).

Interpretation

The RIHM is comparable in accuracy to other strength dynamometers. Using the RIHM, we were able to illustrate strength patterns on finger-specific level, showing added value when evaluating outcome in patients with hand related problems.     

手术治疗拇指腕掌关节骨性关节炎的系统评价

目的系统评价不同手术方法治疗拇指腕掌关节骨性关节炎的疗效和安全性。方法计算机检索MEDLINE(1966-2005)、Cochrane图书馆临床对照试验注册资料库(2005年第3期)和中国生物医学文献数据库(1978-2005), 手检所获资料的参考文献,收集所有相关的随机对照试验,并对其方法学质量进行评价,而后进行Meta分析及定性分析。结果共纳入7个随机对照试验(RCT),且均有不同程度的方法学缺陷。目前的证据显示,大多角骨切除、韧带重建、肌腱间置术(LRTI)与单纯大多角骨切除术的近期效果．包括疼痛缓解、握力、拇指捏力、活动度、手的功能及患者满意度方面,差异均无统计学意义,但LRTI术后并发症发生率高于单纯大多角骨切除术。关于LRTI与单纯大多角骨切除术相比是否可以减少掌骨下沉,以及成形关节间隙是否与拇指力量相关,目前仅有混杂证据。有中等质量的证据表明,在拇指力量、患者满意度和第一掌骨下沉方面．LRTI 的效果与大多角骨切除、韧带重建术(LR)相似;有有限证据表明,LR术后手功能评分好于LRTI,而两者缓解疼痛的效果相似;有混杂证据支持LR术后拇指活动度好于LRTI。仅有有限证据表明LIRI与Swanson硅橡胶假体植入术的效果相似。尚缺乏关于其他手术方法,如掌骨截骨术、关节融合术、人工关节置换术的随机对照试验。结论尚无证据支持某一种手术方法的效果优于其他方法。需要更多高质量 RCT和更长的随访时间做进一步研究。     

A Pilot Study Comparing of Two Therapy Regimens Following Carpometacarpal Joint Arthroplasty

ABSTRACT

Purpose. The purpose of this pilot study was to compare two occupational therapy regimens following arthroplasty: thumb splint plus home program and thumb splint plus occupational therapy. Methods. Nine participants who underwent a ligament reconstruction and tendon interposition surgery of the carpometacarpal (CMC) joint of the thumb were randomly assigned to either receive a splint and occupational therapy intervention or receive a splint and a home exercise program. Participants were assessed preoperatively and 6 months postoperatively using standardized assessments of joint motion, hand function, strength, and self-reports of pain and functional ability. Results. In each group, participants improved on all measures after surgery but there were no significant differences between the groups. Conclusion. The results suggest that either occupational therapy regimen postsurgery is effective but because of the small sample size, the results should be interpreted with caution.     

The effect of new dynamic splint in pinch strength in De Quervain syndrome: a comparative study

Objective For patients with De Quervain syndrome using thumb spica orthosis is restricting, so many patient are dissatisfied with using static model. The aim of this study is to compare the effect of modified dynamic and conventional static orthoses on pinch power and functional abilities of hand in De Quervain syndrome. Method In this quasi-experimental study, palmar and lateral pinch strength of the thumb, pain and functional abilities of hand, patient’s satisfaction of orthoses, were evaluated after using modified dynamic and conventional static orthosis in two groups. Results Both orthoses improved palmar and lateral pinch strength of the thumb, pain level and functional abilities. In comparison of mentioned variables, there was no significant difference between two groups regarding to pain recovery and abilities improvement (p?>?0.05). However, the satisfaction level of the patients who had used dynamic orthosis was higher (p?Conclusion It seems, adding a joint to the static thumb spica leads to patient’s relief and consequently to their satisfaction.

• Implications for Rehabilitation

• The dynamic thumb spica, is easier to use and patients satisfaction is higher than static thumb spica.

• Therefore, it can be used for conservative treatment of De Quervain syndrome.

     

Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study

Orakifar N, Kamali F, Pirouzi S, Jamshidi F. Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study.ObjectiveTo determine whether sacroiliac joint (SIJ) manipulation decreases α-motoneuron activity and increases the pressure pain threshold (PPT) over the posterior superior iliac spine (PSIS) in healthy women.DesignQuasi-experimental study.SettingA university medical center.ParticipantsHealthy young women (N=20) aged 18 to 30 years were recruited from among the students of a university medical center after a request for volunteers.InterventionsJoint manipulation consisted of the supine rotational glide manipulation for the sacroiliac region. PPT measurements from the PSIS and Hoffman-reflex (H-reflex) amplitudes from the tibial nerve on the same side were recorded before and after joint manipulation. PPT was monitored for 15 minutes and H-reflex for 20 minutes after the procedure.Main Outcome MeasuresChanges in tibial nerve H-reflex amplitude and PPT values after SIJ manipulation.ResultsSIJ manipulation attenuated α-motoneuronal activity significantly (P<.05) but transiently, since the decrease was seen only for 20 seconds after the intervention. There was no positive significant difference in the PPT after SIJ manipulation at any time during postintervention follow-up.ConclusionsSIJ manipulation produced a transient attenuation of α-motoneuron excitability in healthy women. These findings demonstrate that our manipulation technique can lead to a short-term reduction in muscle tone as a result of changes in sensory discharge, predominantly in la afferents. SIJ manipulation did not significantly affect the PPT in healthy women.     

Reliability of Pinch Strength Testing in Elderly Subjects with Unilateral Thumb Carpometacarpal Osteoarthritis

[Purpose] The aim of this study was to examine the test-retest reliability of pinch strength testing in elderly subjects with thumb CMC OA. [Subjects and Methods] A total of 27 patients with unilateral right-thumb CMC OA (mean ± SD age: 81.3 ± 4.7 years) were recruited. Each patient performed three pain-free maximal isometric contractions on each hand on two occasions, one week apart. Three different measurements were taken: tip, tripod, and key pinch strength. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) calculations were performed. [Results] Test-retest reliability of measurements of tip, tripod, and key pinch strength was excellent for the affected side (ICC=0.93, 0.96, and 0.99) and the contralateral thumb (ICC=0.91, 0.92, and 0.94). [Conclusions] The present results indicate that maximum pinch strength can be measured reliably using the Pinch Gauge Dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving pinch strength.Key words: Test-retest, Reliability, Pinch strength     

Effect of Neuromuscular Electrical Stimulation During Walking on Pain Sensitivity in Women With Obesity With Knee Pain: A Randomized Controlled Trial

ObjectiveTo assess the extent to which pain sensitivity is altered in women with obesity with frequent knee symptoms who walk with either a hybrid training system (HTS) that provides antagonist muscle electrical stimulation vs sensory transcutaneous electrical nerve stimulation (TENS).DesignRandomized, double-blinded, controlled trial.SettingUniversity-based fitness center.ParticipantsTwenty-eight women (N=28) with obesity, aged 40-70 years, with daily knee symptoms.InterventionsParticipants were randomized to 12 weeks of biweekly 30-minute walking exercise with either HTS (HTSW group) or sensory TENS (control group).Main Outcome MeasuresPressure pain thresholds (PPTs) at the more symptomatic knee (local PPT) and PPT at the ipsilateral pain-free wrist (remote PPT).ResultsAfter adjustment for preintervention values and body mass index (BMI), there was a statistically significant improvement in local PPT in the HTSW group compared with the control group (P=.039). After adjustment for pretraining value, age, and BMI, changes in remote PPT when comparing groups did not reach statistical significance, although the HTS group tended to demonstrate increased remote PPT (P=.052) compared with the control group. Moreover, after adjustment for pretraining value, knee pain, and quality of life, comparing groups did not reach statistical significance, although the HTS group tended to demonstrate decreased knee pain (P=.069) compared with the control group.ConclusionsAugmentation of walking exercise with HTS was more effective than application of sensory TENS in improving local pain sensitivity at the knee but not at the wrist in women with obesity with frequent knee symptoms.     

Clinical and Ultrasonic Evaluation of the Thumb: Comparison of Young Adults With and Without Thumb Pain With Text Messaging

Objective

The aim of this study was to compare clinical and ultrasound findings of thumb joints in young adults with and without thumb pain associated with text messaging.

Study of the mechanisms of action of the hypoalgesic effect of pressure under shock waves application: A randomised controlled trial

ObjectiveTo determine if the perceived pain intensity during the application of shock waves (SWs) is a determinant mechanism in producing hypoalgesic changes in pressure pain thresholds (PPTs) in asymptomatic individuals.DesignA randomised, single-blind controlled trial [NCT03455933].SettingUniversity.ParticipantsSixty-three asymptomatic individuals.InterventionsParticipants were randomised into three groups: 1-SWs causing mild pain (SW-DP); 2-SWs generating moderate pain (SW-MP); and 3-cold pressor test (CPT).Main outcome measurementsBefore and after the intervention, the PPT was evaluated bilaterally at the following points: lateral epicondyle, median nerve in the flexure of the elbow, and tibia.ResultsThe results showed differences between various groups over time for all PPTs assessments, due to the existence of statistically significant differences in the interaction group x times (dominant arm lateral epicondyle [P < 0.001; η²p = 0.255]; dominant arm median nerve [P = 0.001; η²p = 0.212]; nondominant arm lateral epicondyle [P < 0.001; η²p = 0.275]; nondominant arm median nerve [P < 0.001; η²p = 0.268]; tibia [P = 0.012, η²p = 0.138]). The SW-MP group obtained a significant increase in all the PPT evaluations compared with the SW-DP group (d > 0.80). The CPT group only showed significantly higher results, and of high magnitude (d > 0.80), regarding the SW-DP group for the PPT evaluation in the dominant member. The SW-MP group showed differences compared with the CPT only for the PPT obtained in the nondominant arm.ConclusionsThe findings show that SW treatment generates a hypoalgesic effect on the application point, with moderate pain. Further studies are necessary in order to link these hypoalgesic changes to the activation of the descending inhibitory systems.