La utilización de ortesis funcionales en el tratamiento de las lesiones nerviosas periféricas.

Las neuropatías periféricas de los nervios mediano, ulnar y radial son una causa frecuente de consulta de fisioterapia y terapia ocupacional. Ocasionan deficiencia y discapacidad variable que puede reducirse mediante la utilización de ortesis funcionales realizadas a medida sobre la mano del paciente. Existen diferentes ortesis descritas en la literatura que ayudan a mejorar la funcionalidad del paciente en las neurópatas de los nervios del miembro superior. No obstante, la diversidad entre los modelos ya la falta de unas medidas outcomes estandarizas nos impiden demostrar o poder saber con exactitud cual de ellas es la mejor opción durante la realización de las actividades cotidianas. Estudios específicos para cada tipo de parálisis y test concretos funcionales aplicados en la práctica cotidiana nos ayudarían a conocer la mejor opción en cada caso en concreto.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Feelings, sensations and proprioception in hand therapy

Ponencia en calidad de Invitada internacional de una hora de duración.Introduction: Thumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population Purpose of the study: To establish the effectiveness of a proprioceptive training program as a complementary therapy for patients with thumb CMC joint OA. Methods: Standard conservative thumb CMC joint OA treatments were received by both the control (n=26) and experimental groups (n=26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included severity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). Results: Fifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. Discussion: Experimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between-group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. Conclusion: Proprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

¿Se puede tratar una disfunción escafolunar sin operarla?

Las inestabilidades escafolunares constituyen el 90% de las inestabilidades carpianas, seguidas de las lunopiramidales y en menor porcentaje de las mediocarpianas. El objetivo final del tratamiento conservador será conseguir una articulación no dolorosa, estable y finalmente capaz de soportar los requerimientos de su actividad laboral, social y/o deportiva. Todo ello logrando un equilibrio entre la movilidad, la estabilidad, y la correcta transmisión de fuerzas hacia las articulaciones de la muñeca y de la mano. Es básico conocer cuáles son los 4 elementos que sustentan una buena estabilidad de la muñeca: la buena congruencia articular, la integridad de todo el sistema ligamentario extrínseco e intrínseco —que constituyen la estabilidad estática—, el mantenimiento de un buen tono muscular antebraquial, y por último disponer de un buen control neuromuscular y propioceptivo; estos 2 últimos constituyen la estabilidad dinámica y es ahí donde la rehabilitación juega un papel esencial

Tratamiento fisioterapéutico de la patología TMC

La artrosis en la articulación trapecio metacarpiana (TMC) es una patología muy frecuente que causa dolor y debilidad, provocando problemas para el desarrollo normal de las actividades cotidianas (AVD). Hemos realizado una revisión sistemática de los ensayos clínicos y ensayos clínicos aleatorizados de los últimos 10 años donde se compara la intervención mediante ejercicios con tratamiento conservador sin ejercicio terapéutico consideran las variables dolor, funcionalidad, debilidad muscular y calidad de vida como medida “outcome”. No fue posible cegar a los participantes al tratamiento a pesar de que en la mayoría de los estudios el terapeuta sí estaba cegado. Determinadas medidas de resultados como el dolor, la función o la calidad de vida son medidas de auto-evaluacion, lo cual también debe ser considerado como un sesgo en los resultados. Tras la intervención con ejercicios en la artrosis TMC solo en cinco estudios se hace referencia a una disminución del dolor. (SMD-0.27, 95% confidence interval (CI) -0.47 to -0.07). Cuatro estudios determinan una mejora en la función tras la intervención con ejercicios (SMD -0.28, 95% CI -0.58 to 0.02). Sólo un estudio evalúa la mejora en la calidad de vida y sus efectos sobre esta variable son inciertos. Acorde a estos resultados, existe una evidencia baja sobre el beneficio de los ejercicios en pacientes con artrosis TMC sobre el dolor y la función. El tamaño del efecto de los resultados es muy pequeño y pocos estudios emplean la mejora en la calidad de vida como medida de resultado. Basándonos en los estudios descritos y biomecánicos, proponemos una protocolo de tratamiento conservador basado en ejercicios específicos sobre determinados grupos musculares para ayudar a estabilizar la artrosis TMC

Does laser therapy improve pain or pinch strength for thumb carpometacarpal joint osteoarthritis as an isolated treatment? A randomized controlled trial.

Objective: Osteoarthritis (OA) is a chronic and prevalent joint disorder that greatly impacts quality of life and has a high economic burden on health resources. Although a number of conservative therapies have proven to be effective for the management of hand OA, only modest treatment effects were reported for most individual interventions. The aim of the proposed study is to assess the effect of laser therapy on pain and pinch strength in subjects with thumb carpometacarpal osteoarthritis (CMC OA) Materials and Methods: 43 patients, (mean ± SD age: 71 ±12 years; 57% female) with the diagnosis of CMC joint OA grade 1-2 were randomized to the control (n=21) or experimental (n=23) groups. The primary outcome measures were pain intensity [Visual Analogue Scale (VAS)], and the secondary outcome measure was key pinch strength (dynamometer). The experimental group received laser therapy and control group received a placebo treatment. All outcome measures were collected at baseline, immediately following the intervention at 4 weeks, and at 12 weeks following the intervention. Results: The experimental group evidenced a 2-point improvement VAS pain score following the treatment. There was a gain of 0.7 kg of pinch strength in the experimental group following the treatment. The effects of both pinch strength gains and pain reduction diminished by the 12 week follow up. Conclusions: High intensity laser therapy effectively decreases pain intensity when used as a isolated treatment for early CMC OA, but the effect of treatment decreases after 3 months.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Key-points en el abordaje postquirúrgico de la mano catastrófica

La calidad de la reconstrucción quirúrgica y el óptimo seguimiento desde Fisioterapia y Terapia ocupacional, son determinantes en la resolución de las lesiones complejas de la mano traumática. Unos resultados óptimos desde el punto de vista analítico y funcional, requieren un plan estratégico de intervención post quirúrgica que permita preservar no solo la máxima función posible, sino una rápida y óptima integración social, laboral y ocupacional del paciente. Debido a la gran variabilidad de lesiones que pueden darse en una mano catastrófica, no existe un standard de intervención que nos permita seguir un protocolo establecido tras la cirugía. Nuestra intervención dependerá de las estructuras que hayan sido reparadas, de las características individuales y de la clínica que presente el paciente en el momento de la valoración. Este abordaje irá cambiando en función a al respuesta al tratamiento. No obstante existen unos objetivos comunes en el tratamiento post quirúrgico de la mano catastrófica que debemos tener en consideración para evitar complicaciones tales como retracciones articulares, rigidez o dolor persistente. Para ello, se establecerán una pautas iniciales dirigidas a controlar la inflamación y la inmovilización, así como, pautas de control del dolor que permitan trabajar con el paciente de forma progresiva

Analyzing the effects of a dynamic or static orthosis after radical nerve injury using the Nine-Hole Peg Test

Objective: The radial nerve is a commonly injured upper extremity peripheral nerve. The inability to extend the wrist results in the loss of hand function and dexterity that affects patients' ability to perform their activities of daily living. There is not strong evidence to support orthosis efficacy to improve dexterity. The purpose of this study was to evaluate whether a static or dynamic orthosis resulted in improved hand dexterity when assessed with the 9-HPT after radial nerve injury. Materials and Methods: Twenty three participants who suffered radial nerve palsy participated in the study. The test was repeated three times for each participant, first without the orthosis, and then wearing the static orthosis, and finally wearing the dynamic orthosis. The 9-HPT was used as the outcome measure. Results: The distribution of the 9-HPT times (sec) was of 35.7 ±4.9 without a wrist orthoses, and decreased with the use of the static and the dynamic orthoses to 33.7 ±4.8 (P<0.01) and 24.6 ±2.6) (P<0.01) respectively. Conclusions: The use of a dynamic orthosis after radial nerve palsy can provide the patient with greater manual dexterity when compared to the use of a static orthosis.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial

Study Design: Randomized Control Trial. Introduction: Thumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population. Purpose of the study: To establish the effectiveness of a proprioceptive training program as a complemen- tary therapy for patients with thumb CMC joint OA. Methods: Standard conservative thumb CMC joint OA treatments were received by both the control (n = 26) and experimental groups (n = 26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included sever- ity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). Results: Fifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. Discussion: Experimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between- group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. Conclusion: Proprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.Funding for open access Charge: University of Málaga

Efecto del trabajo propioceptivo basado en la sensación del Movimiento en la artrosis de la base del pulgar. Estudio piloto.

El objetivo del estudio fue evaluar la efectividad de un programa de ejercicios propiocepceptivos sobre el dolor y funcionalidad en mujeres diagnosticadas con artrosis TMC grado 1 y 2. Se llevó a cabo un estudio experimental doble ciego. Participaron un total de 20 mujeres con una media de edad de 66.25 años (DS 5.12). Las participantes fueron evaluadas al inicio, y a los 3 y 6 meses. Variables de estudio: Dolor durante las AVDs y prorpiocepción con el JPS. No se evidenciaron diferencias significativas entre los grupos

The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial

A randomized controlled trial of forty-five females over 18 years of age with diagnosis of thumb basal osteoarthritis in their dominant hand and with a minimum pain rating of 4/10 on the Visual Analogue Scale (VAS) during activities of daily living (ADLs) were recruited from March to June 2021. The group receiving proprioception training was compared to routine conservative physiotherapy treatment. The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis. Primary outcome was joint position sense (JPS) for the assessment of CMC proprioception and secondary outcomes were Visual Analogue Scale (VAS) and Canadian Occupational Performance Measure (COPM) for the assessment of patient satisfaction and the Quick-DASH which assessed upper limb function. A block randomization was carried out for the control group (n = 22) and experimental group (n = 23). Participants and evaluator were blinded to the group assignment. Proprioception training produced a statistically significant reduction in pain post intervention, but this reduction was small (d = 0.1) at the 3-month follow-up. JPS accuracy demonstrated statistically significant differences between the groups (p = 0.001) postintervention and at the 3-month follow-up (p < 0.003). Statistically significant differences between means were found in both the Quick-Dash and COPM post intervention (both, p < 0.001), as well as at the 3-month follow-up (both, p < 0.001). There was a significant time factor for the reduction of pain intensity over time but effect sizes between groups was small at the 3-month follow-up period. Proprioceptive training improves thumb JPS accuracy; however, it does not contribute to a reduction in pain intensity in the long term. The inclusion of a proprioceptive program may be beneficial for improving individuals with thumb CMC OA sensorimotor performance.His research was partially funded by University of Málaga Spain. Partial funding for open access charge: Universidad de Málag