Journal of Hand Therapy最新文献

Background

This study focuses on the relationship between forearm muscles, carpal ligaments, and their impact on scapholunate joint stability across varying forearm rotations. This is crucial for optimizing pre and postoperative rehabilitation strategies for scapholunate joint dysfunction.

Purpose

Our study aims to understand the kinetic influence of forearm muscles on scapholunate joint instability. We emphasize the significance of forearm rotation to enhance treatment efficacy.

Study Design

We conducted an experimental study to understand how forearm muscles contribute to the stability of the scapholunate joint during different degrees of forearm rotation and we focused on the joint effect of muscle groups rather than individual muscles for treatment protocols.

Results

Our findings shed light on the conservative treatment of dynamic scapholunate instability and the postoperative rehabilitation of scapholunate ligament repair. We found that the effect of forearm muscles significantly contributes to preserve stability in the scapholunate joint across various forearm rotational positions. These insights have practical implications for hand therapists, offering innovative strategies to enhance clinical practice.

Conclusions

This research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability and provides a valuable perspective in line with current rehabilitation principles.

Background

Improving proprioception can reduce the risk of injuries, while its disruption may lead to injuries and recurrent or persistent symptoms.

Purpose

This study aimed to evaluate the immediate effects of elbow orthoses on elbow proprioception in asymptomatic individuals.

Study Design

This was a randomized, controlled, single-blinded study with a sham application.

Methods

Sixty participants were equally distributed into three orthosis groups (counterforce, sleeve, and sham). Proprioception was assessed using active joint position sense error (JPSE) at 70° and 110° of elbow flexion at three time points: baseline (BS), immediately after (IA) wearing the orthosis, and 30 minutes after (30MA) wearing the orthosis.

Results

Between groups: No significant difference in JPSE was observed at 70° (p = 0.095); however, there was a significant difference at 110° (p = 0.005).

Between time points: At 70°, JPSE did not exhibit a significant difference (p = 0.055), whereas a significant difference was observed at 110° (p = 0.020).

Interaction of time points×groups: No significant interaction was observed either at 70° (p = 0.476) or at 110° (p = 0.346).

At 70°, within the sleeve group, significant differences were identified between BS-30MA (p = 0.001) and IA-30MA (p = 0.009).

At 110°, in the sleeve group, significant differences were observed between BS-30MA (p = 0.007) and IA-30MA (p = 0.007).

In the counterforce group, significant differences were identified between BS-30MA time points (p = 0.001).

At 70°, no difference was observed within the overall evaluation in the counterforce group (p > 0.05), whereas at 110°, a significant difference was noted (p = 0.026).

At both 70° and 110°, no differences were identified within the overall evaluation in the sleeve and sham groups (p > 0.05).

Conclusions

In asymptomatic individuals, sleeve orthosis improved elbow proprioception at 70°, whereas both counterforce and sleeve orthoses were effective at 110°.

Background

Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life.

Purpose

Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength.

Study Design

Superiority randomized clinical trial.

Methods

42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks).

Results

Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P<.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P<.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P<.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P = .003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P = .024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P = .003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P = .049; d = 0.62). These improvements were maintained at follow-up.

Conclusions

The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength.

Background

Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood.

Purpose

This study aimed to investigate the relationship between shoulder pain and proprioception.

Study design

This was a cross-sectional comparative study.

Methods

Twenty-two participants with RCRSP (mean age 27.6 $\pm$ 4.8 years) and 22 matched pain-free participants (23.4 $\pm$ 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations.

Results

Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = −0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = −0.31 [−0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 $\pm$ 1.2 cm vs 5.5 $\pm$ 1.5 cm; superior 3.8 $\pm$ 2.1 cm vs 5.7 $\pm$ 2.9 cm; superior-lateral nondominant targets 4.3 $\pm$ 2.2 cm vs 6.1 $\pm$ 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]).

Conclusions

Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain.