Orthotic Intervention with Custom-made Thermoplastic Material in Acute and Chronic Mallet Finger Injury: A Comparison of Outcomes.

Objectives: To compare the effect of using custom-made orthosis on improving extension lag and reducing disability in acute and chronic mallet fingers. Methods: We recruited 51 patients with acute or chronic Doyle type-1 mallet fingers, who were provided with a custom-made thermoplastic anti-mallet finger orthosis to wear full-time for 6 weeks and an additional 2 weeks at nighttime. The primary outcome, extension lag, was assessed at enrollment as well as six- and twelve-week follow-ups. Secondary outcomes included disability and satisfaction, which were evaluated using the Disability of the Arm, Shoulder, and Hand questionnaire at enrollment and 12 weeks, and a satisfaction scale at 12 weeks follow-up. Data analysis was conducted using univariate analysis of variance (ANOVA), one-way repeated measure mixed model analysis of covariance (ANCOVA), and independent sample t-test. Results: A total of 43 participants, 25 acute and 18 chronic mallet fingers, completed the 12-week evaluation. The study found no significant difference between the two groups in terms of improvement in extension lag at either follow-up time point (P=0.21). Disability improved in both the acute and chronic groups at follow-up (P<0.05). Additionally, both groups expressed satisfaction with the treatment outcome, and no statistically significant difference was observed (t=0.173, P=0.51). We could not identify any clinically significant difference between the two groups in regard to extension lag, disability, or satisfaction at follow-up. Notably, 96% of the patients in the acute group and 88% of the patients in the chronic group demonstrated good to excellent outcomes. Conclusion: Orthotic intervention with custom-made thermoplastic material in acute and chronic mallet fingers improved extension lag and disability, and both groups were satisfied with the treatment outcomes. The findings of our study indicated that patients with chronic mallet fingers benefited from orthotic interventions in the same way that patients with acute mallet fingers did.

Clinimetric testing of the Persian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires in patients with lateral elbow tendinopathy.

PURPOSE: To evaluate the longitudinal validity and responsiveness of the Persian version of Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) in patients with lateral elbow tendinopathy (LET). METHODS: Sixty-four patients with LET completed the PRTEE, DASH, and Global Rating of Change Scale (GRC) at baseline and six weeks. The external and internal responsiveness, floor and ceiling effects, minimal detectable change (MDC) and minimal clinically important difference (MCID) were calculated. RESULTS: No ceiling and floor effects were detected for either the PRTEE or DASH. External responsiveness as an indicator to detect the relationship between change in the measured and external indicator of change was acceptable for both, but higher for the PRTEE (AUC = 0.90; CI: 0.83-0.97) vs. DASH (AUC = 0.80; CI: 69-90). Internal responsiveness to detect intervention related changes indicated slightly superiority in responsiveness for PRTEE. The relative efficiency (1.21), standard effect size (1.14 PRTEE vs. 1.03 DASH), and standard response mean (1.34 PRTEE vs. 1.10 DASH). The MDC were 11 and 12, and MCID were 20 and 18 for the PRTEE and DASH, respectively. CONCLUSIONS: Both the DASH and PRTEE were responsive in detecting improvement in patients with LET. The PRTEE was shorter, more efficient, and slightly more responsive which supports its use as a core outcome measure in evaluating patients with LET.Implications for RehabilitationThe Patient-Rated Tennis Elbow Evaluation (PRTEE) compared with the Disability of the Arm, Shoulder, and Hand (DASH) is a shorter questionnaire with higher psychometric and clinimetric properties for evaluating the patients with lateral elbow tendinopathy.This supports the use of the PRTEE in evaluating patients with elbow tendinopathy.

Therapeutic results of sciatic nerve repair in Iran-Iraq war casualties.

BACKGROUND: The sciatic nerve is composed of two independent divisions: tibial and peroneal. The results of the repair of these two nerves are not identical. This retrospective study was carried out with the aim of evaluating the results of different therapeutic procedures for sciatic nerve injuries and conducting a comparative evaluation of peroneal and tibial nerve recovery. METHODS: A total of 648 Iranian casualties of the 1980 to 1988 Iran-Iraq war with sciatic nerve injury were treated with nerve grafting, direct end-to-end coaptation, and neurolysis. Patients were subdivided according to nerve injury site into three groups of upper, middle, and lower thirds of the thigh, and followed from 5 to 12 years. RESULTS: In 77.8 percent of patients, the tibial nerve was injured, and in 88.9 percent, the common peroneal nerve was injured. Protective sensation recovery of the sole was evaluated as good in 69.1 percent of those with upper third injuries, 74.4 percent of those with middle third injuries, and 89.3 percent of those with lower third repairs (p < 0.0001), with an overall success rate of 73.4 percent. The overall motor recovery success rate for the three techniques was 86.3 percent for the tibial nerve and 38.9 percent for the common peroneal nerve. CONCLUSIONS: Results of sciatic nerve injury treatment in this group of war casualties were generally satisfactory. Tibial nerve injury repair in the upper thigh has a higher priority than the peroneal nerve. Motor deficits of the common peroneal nerve can be overcome by tendon transfer or orthopedic devices.