Prevention And Management Of Trapeziometacarpal Joint Pain

The aim of the studies reported in this project was to examine factors associated with the prevention and management of trapeziometacarpal osteoarthritis, both in musculoskeletal physiotherapists and the general patient population. Two studies were undertaken to investigate factors associated with the aggravation of thumb pain in musculoskeletal physiotherapists. Study 1 was a survey of the prevalence of thumb pain, and allowed determination of the most aggravating spinal manipulative therapy technique. It identified that 83% of respondents complained of an aggravation of thumb pain due to the performance of spinal manipulative therapy techniques, with 85-87% of the painful respondents complaining of thumb pain aggravated by unilateral and central PA glides. Study 2 was conducted to determine whether the alignment of the joints of the thumb during performance of these glides was associated with thumb pain. This observational study of 129 musculoskeletal physiotherapists performing a PA glide identified that aligning the metacarpophalangeal and interphalangeal joints in extension was associated with a lower prevalence of work-related thumb pain. Therefore, it is suggested that musculoskeletal physiotherapists be taught to perform these techniques with the joints of their thumb in extension in an effort to reduce the development of work-related thumb pain. Furthermore, it is suggested that those who are unable to maintain this alignment voluntarily be provided with a thermoplastic thumb splint to maintain the extended alignment. Two studies were undertaken to investigate the conservative and surgical management of patients with trapeziometacarpal osteoarthritis. Study 3 was a randomised controlled trial conducted to compare the efficacy of a new thumb strap splint and an abduction exercise regimen against the standard approach to conservative management of trapeziometacarpal osteoarthritis, namely a short opponens splint and pinch exercise regimen. While there was no additional benefit of one approach over the other, all participants improved in the outcomes of pain, strength and hand function over the six-week period of intervention. Nevertheless, some people find that symptom relief from conservative intervention is inadequate and short-lived, requesting surgery for the treatment of disabling and persistent pain from trapeziometacarpal osteoarthritis. Study 4 was a systematic review, conducted to determine evidence of efficacy of one surgical procedure over another. This review identified six randomised controlled trials of surgery for trapeziometacarpal osteoarthritis. While there was evidence of no difference in the reduction in weakness between the procedures, there was insufficient evidence to confirm that there was no difference in the outcomes of pain, contracture, hand function, or patient global assessment. Furthermore, there was sufficient evidence to conclude that trapeziectomy had significantly fewer adverse effects, and trapeziectomy with ligament reconstruction and tendon interposition (LRTI) had significantly more, when compared with the other procedures analysed in this review. It is suggested that the decision as to which intervention is most appropriate for a given patient be based upon the individual patient’s requirements, the extent of disease, and the demands placed upon the joint by domestic duties, work, leisure and recreational activities. The studies presented in this project assist in formulating preventative and management strategies for people with trapeziometacarpal osteoarthritis

Clinical update : conservative management of carpometacarpal joint osteoarthritis [letter to the editor]

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No difference between two types of exercise after proximal phalangeal fracture fixation : a randomised trial

Question: Are 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained in an orthosis (constrained exercises) more effective than traditional finger exercises with the metacarpophalangeal joint unconstrained (unconstrained exercises) after open reduction and internal fixation of a proximal phalangeal fracture in terms of impairment, activity limitation and participation restriction at 6 and 12 weeks? Design: Randomised, parallel-group trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. Participants: Sixty-six participants within 1 week of open reduction and internal fixation of proximal phalangeal fractures. Intervention: The experimental group carried out 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained, whilst the control group carried out finger exercises with the metacarpophalangeal joint unconstrained, as part of a comprehensive rehabilitation program. Outcome measures: The primary outcomes were: active proximal interphalangeal joint extension of the injured finger, total active range of motion, and strength. Secondary outcomes were: pain, difficulty with specific hand activity and difficulty with usual hand activity. A blinded assessor measured outcomes at Weeks 1, 6 and 12. Results By Week 6, there were no significant between-group differences in improvement for: active proximal interphalangeal joint extension (MD 2 deg, 95% CI –3 to 7); total active finger range of motion (MD 0 deg, 95% CI –21 to 22); strength (MD –2 kg, 95% CI –8 to 4); pain (MD 1/50, 95% CI –3 to 5); difficulty with specific hand activity (MD 2/60, 95% CI –3 to 8); or difficulty with usual hand activity (MD 0/40, 95% CI –4 to 3). By Week 12, there were also no significant between-group differences in any outcome. Conclusions Constrained and unconstrained exercises has similar effects after open reduction and internal fixation of proximal phalangeal fracture

Pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures in the finger : a prospective longitudinal study

The purpose of this study was to determine the pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures. A prospective longitudinal study of 66 patients who started rehabilitation within 1 week of fixation was undertaken. Measures of the level of impairment (range of motion, pain, strength), activity limitation (hand use) and return to work were collected at Weeks 1, 6, 12 and 26 after operation. Before starting rehabilitation, although pain was minimal, the range of motion was severely restricted and there was considerable restriction in ability to work. Most of the recovery in range of motion, pain, strength, hand use and work participation occurred by Week 6, with smaller gains by Week 12 and Week 26

Time to commencement of active exercise predicts total active range of motion 6 weeks after proximal phalanx fracture fixation : a retrospective review

Introduction: Whether baseline characteristics influence range of motion outcomes following proximal phalanx fracture remains unclear. The aim of this review was to investigate whether fixation type, time to commencement of active finger exercise, location of fracture or which finger is injured predict total active range of motion 6 weeks after surgical fixation. Methods: A retrospective cohort of 49 patients with finger proximal phalanx fracture was analysed. Putative predictors investigated were fixation type, time to commencement of active exercise, location of fracture and injured finger. The outcome of interest was total active finger range of motion 6 weeks post-operatively. Results: Multiple regression analysis found that time to commencement of active exercise was the only significant independent predictor of total active range of motion 6 weeks post-operatively. The main influence on time to commencement of active exercise was fixation type, with fractures repaired using Kirschner wire fixation associated with a delay of nearly 2 weeks, compared with fractures repaired using open reduction and internal fixation. Discussion: Patients who commence active exercise early following surgical fixation of a proximal phalanx fracture may expect greater total active range of motion 6 weeks post-operatively than if exercise is delayed

Time to commencement of active exercise predicts total active range of motion 6 weeks after proximal phalanx fracture fixation: A retrospective review

Introduction: Whether baseline characteristics influence range of motion outcomes following proximal phalanx fracture remains unclear. The aim of this review was to investigate whether fixation type, time to commencement of active finger exercise, location of fracture or which finger is injured predict total active range of motion 6 weeks after surgical fixation. Methods: A retrospective cohort of 49 patients with finger proximal phalanx fracture was analysed. Putative predictors investigated were fixation type, time to commencement of active exercise, location of fracture and injured finger. The outcome of interest was total active finger range of motion 6 weeks post-operatively. Results: Multiple regression analysis found that time to commencement of active exercise was the only significant independent predictor of total active range of motion 6 weeks post-operatively. The main influence on time to commencement of active exercise was fixation type, with fractures repaired using Kirschner wire fixation associated with a delay of nearly 2 weeks, compared with fractures repaired using open reduction and internal fixation. Discussion: Patients who commence active exercise early following surgical fixation of a proximal phalanx fracture may expect greater total active range of motion 6 weeks post-operatively than if exercise is delayed