Is an intervention with a custom-made splint and an educational program useful on pain in patients with trapeziometacarpal joint osteoarthritis in a daily clinical setting?

AIM: Custom-made splints may be useful in the conservative treatment of osteoarthritis (OA) of trapeziometacarpal (TMC) joint OA. Our aim was to evaluate usefulness of a custom-made splint and educational program in patients with symptomatic TMC joint OA in daily clinical practice. METHODS: Fifty patients with symptomatic TMC joint OA, not treated with surgery, were enrolled in a open prospective study in a clinical day setting and treated with a 'butterfly' custom-made thermoplastic short opponens splint to be worn 16 h/day for 30 days and then when needed, for 12 months. Patients were evaluated at enrolment (T0), at the first month (T1) and at the 12th month (T2) since splint application for pain (main outcome measure) by numeric rating scale 0-10. At T0 and T1, a Jamar dynamometer (kg) was used to assess hand strength, a pinch gauge to evaluate pinch strength (kg) and Dreiser test to assess hand disability (secondary outcome measures). RESULTS: The comparison between T0 and T1 showed a significant improvement in all the outcome measures (P < 0.0001 for pain, muscle and pinch strength; P = 0.001 for Dreiser test). Moreover, at the end of 12 months follow-up, patients maintained the reduction of pain (T2 vs. T1, P = NS) and showed a reduced consumption of analgesics (P < 0.05). CONCLUSIONS: A custom-made thermoplastic short opponens splint for 30 consecutively days for at least 16 h/day, followed by occasional use on pain outbreak is an useful conservative treatment in symptomatic TMC joint OA.

Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis.

Rehabilitation may contribute to the management of systemic sclerosis (SSc) dealing with disabilities due to hand involvement. The aim of this study is to evaluate the efficacy of a rehabilitation programme based on the combination of connective tissue massage and Mc Mennell joint manipulation specifically conceived for SSc patients' hands. Forty SSc patients were enrolled: 20 (interventional group) were treated for a 9-week period (twice a week, 1 h per session) with a combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme, and 20 (control group) were assigned only to home exercise programme. Patients of both groups were assessed at baseline (T0), after 9 week (T1) and at a 9 weeks follow-up (T2). They were evaluated for quality of life by SF-36 and Health Assessment Questionnaire (HAQ), hands involvement by Hand Mobility in Scleroderma (HAMIS) test, Cochin hand functional disability scale and the measurements of ROM. In the interventional group, fist closure, HAMIS test and Cochin hand functional disability scale improved at the end of the treatment (p < 0.0001) as well as HAQ, Physical Synthetic Index (PSI) and Mental Synthetic Index (MSI) of SF-36 scores (HAQ and PSI, p < 0.0001; MSI, p < 0.001). In the control group, the programme of home daily exercises improved only fist closure at the end of the treatment (p < 0.0001). The combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme is effective in the rehabilitative treatment of SSc hands. This combined treatment may lead to an improvement of hand function and quality of life.