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

Effects of passive upper extremity joint mobilization on pain sensitivity and function in participants with secondary carpometacarpal osteoarthritis: A case series

The purpose of this case series is to report on the effects of passive joint mobilization (PJM) of the shoulder, elbow, and wrist on pain intensity, pain sensitivity, and function in elderly participants with secondary carpometacarpal osteoarthritis (CMC OA). METHODS: Fifteen inpatients from the Department of Physical Therapy, Residenze Sanitarie Assistenziali, Collegno (Italy), with secondary CMC OA (70-90 years old) were included in this study. All patients received PJM of the dominant arm (shoulder, elbow, and wrist) for 4 sessions for 2 weeks. Pain severity was measured by visual analog scale, and pain sensitivity was measured with pressure pain threshold (PPT) at CMC joint, at the tubercle of the scaphoid bone, and at the unciform apophysis of the hamate bone. Tip and tripod pinch strength were measured by a pinch gauge. RESULTS: Passive joint mobilization reduced pain severity after the first follow-up by 30%, in addition to increased PPT by 13% in the hamate bone. Strength was enhanced after treatment. Tripod pinch increased by 18% in the dominant hand after treatment. CONCLUSIONS: This case series provides preliminary evidence that PJM of upper extremity joints diminished pain and may increase PPT tip and tripod pinch in some participants with secondary CMC OA.Fil: Villafañe, Jorge Hugo. Universidad Rey Juan Carlos; EspañaFil: Silva, Guillermo Benjamin. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Chiarotto, Alessandro. Universidad Rey Juan Carlos; Españ

Procedimientos quirúrgicos de los miembros de la Sociedad Española de Cirugía de la Mano (SECMA) para la artrosis trapecio-metacarpiana: Un examen de las tendencias de la práctica clínica actual

Objetivo El objetivo principal de este estudio fue determinar los diferentes enfoques terapéuticos empleados en la práctica clínica habitual entre los cirujanos de mano en España en el abordaje de la artrosis trapecio-metacarpiana (TMC). Material y Método Se desarrolló una encuesta de 15 ítems para determinar los patrones terapéuticos en la práctica clínica de los cirujanos de mano en España que tratan la artrosis TMC. Esa prueba piloto se distribuyó a través de un servicio de encuestas en línea profesional (SurveyMonkey). Resultados El 94% de los cirujanos de mano en España se basan en la intensidad de dolor referida por el paciente para tomar una decisión quirúrgica. El 75% los inmoviliza durante un periodo de 3 semanas tras la cirugía y solo el 36% de los encuestados evalúa la intensidad de dolor después de la cirugía. Conclusiones Esa encuesta proporciona datos valiosos en relación con los patrones terapéuticos de la práctica clínica actual en el tratamiento quirúrgico de la artrosis TMC en los cirujanos de mano españoles. Nivel de Evidencia Nivel V

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

Botulinum toxin type A combined with neurodynamic mobilization for upper limb spasticity after stroke: a case report

Objective: The purpose of this study is to report a case in which combinatory therapy of botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM) was used as treatment for a patient with severe upper limb spasticity and pain after stroke. Clinical Features: A 76-year-old male patient had spastic muscles in the upper limb 10 months after an ischemic stroke. Intervention and Outcome: The patient underwent combined treatment with BoNT-A and NM of the upper limb in 6 monthly applications. Evaluation was performed pretreatment, 3 months after the first injection, 3 months after the second injection, and at a follow-up session 9 months after starting the treatment. The following outcomes were measured: pain by using a numeric rating scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. The patient improved in all outcomes after treatment, and results were maintained during the follow-up sessions. Conclusion: The combined NM and BoNT-A treatment appeared to decrease pain and improve joint ranges of motion during treatment for this patient. The patient showed decreased anxiety and depression during and after the treatment.Fil: Villafañe, Jorge Hugo. Universidad Rey Juan Carlos; EspañaFil: Silva, Guillermo Benjamin. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Chiarotto, Alessandro. Universidad Rey Juan Carlos; EspañaFil: Ragusa, Orazio L. F.. No especifíca

Addressing post-COVID-19 musculoskeletal symptoms through telemedicine: A study protocol

Objective: The purpose of the study will be to evaluate the effect of a rehabilitation program on the improvement of patients with post-COVID-19 musculoskeletal symptoms, as well as to quantify the impact of telemedicine that evaluates the evolution of pain, functionality, and quality of life. Methods: We will carry out a case-control study in post-COVID-19 musculoskeletal symptoms patients who will undergo a multicomponent rehabilitation program, together with an intervention and a follow-up using programmed telemedicine sessions. Data will be collected on the improvement of functional capacity and quality of life, in addition to assessing the evolution of musculoskeletal symptomatology, as well as pain and psychological variables. The telemedicine sessions will improve user adherence and follow-up, and the results are expected to be disseminated to the scientific community during and after the end of the study

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

Association between clinical and neurophysiological outcomes in patients with mechanical neck pain and whiplash-associated disorders

Objectives: To investigate the association between pain, disability, trigger points (TrPs), and pressure pain thresholds (PPTs) in patients with mechanical neck pain (MNP) or whiplash-associated disorders (WAD). Materials and Methods: In total, 46 MNP and 51 WAD patients underwent a physical examination consisting of cervical range of motion, PPTs in the upper trapezius and tibialis anterior muscles, TrPs examination in the upper trapezius, and collection of clinical data including disability, pain intensity, and spontaneous symptomatic pain area. Results: A significantly moderate positive association between pain and disability was found in both groups (P<0.01). Significantly negative associations between pain intensity and PPT in the upper trapezius (P=0.008 and 0.041), pain and PPT in tibialis anterior (P=0.015 and 0.038), disability and PPT in upper trapezius (both, P=0.006) were also found in both MNP and WAD groups. Individuals with MNP showed significantly positive association between pain area and disability (P=0.034) and negative association between disability and PPT in the tibialis anterior (P=0.003). Patients with active TrPs in the upper trapezius exhibited higher intensity of neck pain, higher neck disability, and lower PPTs than those with latent TrPs in upper trapezius in both groups. Discussion: The association between pain, disability, and PPTs is common in patients with neck pain regardless of the origin of neck pain. The presence of active TrPs was related to higher pain intensity and related-disability and lower PPTs