Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis.

INTRODUCTION: People with ulnar, radial or median nerve injuries can present significant impairment of their sensory and motor functions. The prescribed treatment for these conditions often includes electrophysical therapies, whose effectiveness in improving symptoms and function is a source of debate. Therefore, this systematic review aims to provide an integrative overview of the efficacy of these modalities in sensorimotor rehabilitation compared to placebo, manual therapy, or between them. METHODS: We conducted a systematic review according to PRISMA guidelines. We perform a literature review in the following databases: Biomed Central, Ebscohost, Lilacs, Ovid, PEDro, Sage, Scopus, Science Direct, Semantic Scholar, Taylor & Francis, and Web of Science, for the period 1980-2020. We include studies that discussed the sensorimotor rehabilitation of people with non-degenerative ulnar, radial, or median nerve injury. We assessed the quality of the included studies using the Risk of Bias Tool described in the Cochrane Handbook of Systematic Reviews of Interventions and the risk of bias across studies with the GRADE approach described in the GRADE Handbook. RESULTS: Thirty-eight studies were included in the systematic review and 34 in the meta-analysis. The overall quality of evidence was rated as low or very low according to GRADE criteria. Low-level laser therapy and ultrasound showed favourable results in improving symptom severity and functional status compared to manual therapy. In addition, the low level laser showed improvements in pinch strength compared to placebo and pain (VAS) compared to manual therapy. Splints showed superior results to electrophysical modalities. The clinical significance of the results was assessed by effect size estimation and comparison with the minimum clinically important difference (MCID). CONCLUSIONS: We found favourable results in pain relief, improvement of symptoms, functional status, and neurophysiological parameters for some electrophysical modalities, mainly when applied with a splint. Our results coincide with those obtained in some meta-analyses. However, none of these can be considered clinically significant. TRIAL REGISTRATION: PROSPERO registration number CRD42020168792; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168792.

Prognosis of Traumatic Ulnar Nerve Injuries: A Systematic Review.

Ulnar nerve injury (UNI) is not uncommon and often results in incomplete motor recovery after the initial nerve repair and requires secondary functional reconstruction. To clarify the prognosis and predicting factor of UNI, and if it is reasonable to wait after the initial repair, a systematic literature review from PubMed computerized literature database and Google scholar was performed. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist and guidelines were followed to develop the search protocol for this literature review. Two reviewers independently assessed titles, abstracts, and full-text articles, and a third reviewer resolved any disagreements. Seventeen articles with 260 cases were found with sufficient data and enough follow-up. After multiple logistic regression, age, injury level, gap of lesion, and delayed time to surgery were significant prognostic factors in UNI. If considering only high-level injuries (injury at or above proximal forearm), age became the only predicting factor. In cases with likely poor prognosis, their motor recovery tends to be unsatisfactory, and observation for months after the initial repair might not be reasonable. Other surgical interventions such as early nerve transfer may be an option to improve the outcome.

Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction: A Meta-Regression and Systematic Review.

BACKGROUND: Evidence is limited regarding the complications and outcomes after medial ulnar collateral ligament (UCL) reconstruction. The published data regarding this procedure are composed predominantly of small Level-III and IV retrospective studies for which meta-analysis is not generally useful. Meta-regression is an alternative technique to identify variables across multiple publications that have an effect on published outcomes and complication rates. METHODS: We performed a systematic search of published literature for outcomes after UCL reconstruction. A random effects meta-regression model was constructed to identify the association of study characteristics with outcome proportions. Sensitivity analyses were performed to assess the impact of influential studies on the results. RESULTS: Fourteen studies (median sample size, 26 patients; range, 10 to 743 patients) were included in the systematic review and meta-regression. These studies included a total of 1,177 patients with a reported Conway outcome rating (a measure of a patient's return to play). The majority of patients (mean, 83.2%) achieved an excellent Conway rating. Studies involving the docking technique were more likely to have a higher percentage of patients with an excellent outcome (14% risk difference compared with the figure-of-8 technique, p = 0.002) and lower reported rates of ulnar neurapraxia (Spearman correlation = -0.83). A lower reported rate of ulnar neurapraxia was strongly associated with the likelihood of an excellent (p = 0.01) or good or excellent (p = 0.001) Conway outcome rating. CONCLUSIONS: Despite substantial heterogeneity among study outcomes, studies that involved a docking technique and that had lower reported rates of ulnar neurapraxia were associated with greater percentages of excellent or good-to-excellent reported Conway outcome ratings. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial.

OBJECTIVE: To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries. DESIGN: A prospective, single-blinded, randomized controlled clinical trial. SETTING: Participants' private home. SUBJECTS: A convenience sample of 36 outpatient participants allocated randomly to three equal groups. INTERVENTIONS: Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand. MAIN MEASURES: A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up). RESULTS: Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination. CONCLUSIONS: Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.

A Comprehensive Guide on Restoring Grasp Using Tendon Transfer Procedures for Ulnar Nerve Palsy.

Ulnar nerve paralysis results in classic stigmata, including weakness of grasp and pinch, poorly coordinated flexion, and clawing of digits. Restoration of grasp is a key portion of the reconstructive efforts after loss of ulnar nerve function. Improving flexion at the metacarpophalangeal joint can be done by static and dynamic means, although only the latter can improve interphalangeal extension. Deformity and digital posture are more predictably corrected with surgical intervention. Loss of strength from intrinsic muscle paralysis cannot be fully restored with tendon transfer procedures. Preoperative patient education is paramount to success if realistic expectations are to be met.

Distal Ulna Fracture With Delayed Ulnar Nerve Palsy in a Baseball Player.

We present a case report of a college baseball player who sustained a blunt-trauma, distal-third ulna fracture from a thrown ball with delayed presentation of ulnar nerve palsy. Even after his ulna fracture had healed, the nerve injury made it difficult for the athlete to control a baseball while throwing, resulting in a delayed return to full baseball activity for 3 to 4 months. He had almost complete nerve recovery by 6 months after his injury and complete nerve recovery by 1 year after his injury.

[The damage of the ulnar nerve on the level Guyon's canal--four cases report]. / Uszkodzenie nerwu lokciowego na poziomle kanalu Guyona- -opis czterech przypadków.

The damage of the ulnar nerve on a level Guyon's canal is a rare occur in clinical practice. The presence of pathology mass, injury or long-lasting pressure the most often be caused. The authors represent four patients from this syndrome, in three cases the damage the long-lasting pressure of nerve was caused in neighborhood Guyon's canal, and in one injury of neighborhood of wrist. In therapeutic-rehabilitation management was recommended the avoidance the loading of adjacent of wrist. In two cases in catamnestic examination after retreat provocative factor, the symptoms of damage of ulnar nerve revealed. The principles of diagnosis and treatment in adjacent of wrist the damages of ulnar nerve in article were presented.

The effect of the audio-visual-tactile system on sensory recovery following ulnar nerve repair: a case report.

INTRODUCTION: The aim of this study is to test if deprivation of tactile sense can be compensated by the hearing sense, early after nerve repair in the hand. METHOD: This tool was used early after repair of the ulnar nerve with the intention of improving recovery of hand sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. "Audiovisual tactile" was used early after repair of the ulnar nerve repair in a 25-years-old man. Sensory evaluation was done at regular intervals in 2, 5 and 7 months after introduction of the intervention. RESULTS: Results showed that sensory results are better in the patient who used the artificial sensibility regimen compared with the one who did not. DISCUSSION: This result suggests that deprivation of one sense can be compensated by another sense.

Extensor indicis proprius transfer for the abducted small finger

PURPOSE: Persistent abduction of the small finger has usually been treated by transfer of the extensor digiti minimi muscle. However, anatomic variations of the extensor system may limit the potential for a successful extensor digiti minimi transfer. Therefore, we evaluated the outcomes of an alternative reconstruction method for the abducted small finger using an extensor indicis proprius (EIP) transfer. METHODS: We performed 8 EIP transfers in 8 patients with persistent, flexible abduction posturing of the small finger. The primary etiology of the deformity was incomplete motor reinnervation after surgeries for ulnar neuropathy in 6 patients, rupture of the third palmar interosseous musculotendinous unit in 1 patient, and intrinsic muscle fibrosis in 1 patient. The EIP was elongated by splitting the tendinous portion and was transferred to the distal and radial part of the extensor hood. Surgical outcomes were assessed by comparing preoperative and postoperative active adduction and abduction motion of the 2 ulnar digits. RESULTS: At the mean follow-up of 23 months, the average adduction angle improved from 19 degrees to 1 degrees postoperatively. In terms of active finger motion, 6 patients showed excellent results, 1 good, and 1 fair, without loss of flexion and extension. No patient had an extension lag or complained of functional deficits of the donor index finger. There was not adverse change to digital function or range of motion for the middle and ring fingers that are crossed by the EIP. CONCLUSIONS: Extensor indicis proprius transfer can be a reliable option for correction of abduction deformity of the small finger, maintaining active abduction and full flexion and extension. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Distal ulnar neuropathy in a golf player.

A 51-year-old right-handed amateur golfer has developed fasciculations in the left first dorsal interosseous muscle for 3 weeks. He did not have any pain or motor or sensory deficit. The nerve conduction study and electromyography showed that he had mononeuropathy of the deep palmar branch of the ulnar nerve in his left palm. The forceful grasp of golf club handle in the left palm contributes to this rare focal neuropathy. He was advised to change his grip on the golf club, and the symptom resolved almost immediately.

[Is a dynamic or stable technique needed for metacarpophalangeal joints of the hand in ulnar nerve palsy?]. / Faut-il réanimer ou juste stabiliser les métacarpophalangiennes des doigts et du pouce des mains cubitales?

INTRODUCTION: It seems interesting to choose between the dynamic and the static techniques for the rehabilitation of the hand suffering from an ulnar nerve palsy on the basis of the grasp (F1) and pinch (F2) strengths which are important in this rehabilitation. METHODS: From june 1997 to december 2001, 30 ulnar palsies all post traumatic with non complicated claw deformities have been collected and distributed in three groups of ten patients. In the group A only the static techniques have been used on the MP joints of the fourth and fifth digits and the thumb; in the group B only the dynamic techniques have been used on the fourth and fifth digits, on the flexor pollicis brevis and on the first dorsal interosseous muscle; in the group C, the MP joint of the thumb has been stabilized and dynamic techniques have been used on these two muscles, the MP joints of the fourth and fifth digits have been only stabilized. The techniques used in this study were among the most popular. The grasp and pinch strengths were measured by a mechanical dynamometer at the preoperative period and at third and sixth postoperative month. RESULTS: At sixth month, in the group A, F1 didn't change and F2 has increased by 9%; in the group B, F1 has decreased by 24% without recovery of the preoperative value and F2 has increased by 13%; in the group C, F2 has increased by 19%. DISCUSSION: For a reconstruction of an useful hand in an ulnar nerve palsy, the best solutions seem: for the fourth and fifth digits: simple stabilization of the MP joints for the thumb: an association of this stabilization and a rehabilitation of some muscles involved in the pinch prehension.

Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity.

BACKGROUND: Forearm and wrist injuries are a common cause of morbidity and are often associated with suboptimal recovery of hand function. This study describes and compares outcome after median, ulnar, or combined median-ulnar nerve injuries. METHODS: Three hundred thirteen wrist and forearm nerve injuries operated on between 1980 and 1997 in a large university hospital were reviewed in relation to complications, return to work, and sensor and motor recovery. Of these 313 patients, 220 (age range, 5-73 years) met the inclusion criteria. RESULTS: Motor recovery, progress of sensory reinnervation, and number of severed structures were related to the type of injury (p < 0.05). Multiple linear regression analysis revealed a relation between the appearance of sensory reinnervation and motor recovery (beta = 0.02; 95% confidence interval, 0.01-0.04; p = 0.01). A probability of 24% of work loss, after a mean follow-up of 17.7 months, was found. Poor sensory and motor recovery were associated with work disability (odds ratio [OR], 2.9; p = 0.002; and OR, 2.9; p = 0.007, respectively). No relationship was found between type of injury and return to work (p = 0.47). Level of injury (OR, 2.6; p = 0.01), type of work (OR, 3.1; p = 0.002), number of complications (p < 0.001), and hand-therapy (OR, 0.24; p = 0.001) were found to influence return to work. CONCLUSION: It may be concluded that peripheral nerve injuries at the forearm level can result in substantial functional loss and have major social consequences. This study identified factors influencing return to work that can be used to optimize postoperative treatment strategy.

Ulnar nerve lesions: functional outcome after five years.

OBJECTIVE: To analyse perceived impairments, disability, job restrictions and job changes in subjects with a neurapraxia and neurotmesis of the ulnar nerve five years after trauma. DESIGN: Retrospective, descriptive follow-up study. SETTING: Department of Rehabilitation of a University Hospital. SUBJECTS: Sixteen subjects with a neurotmesis (NT-group) and 20 subjects with a neurapraxia (NP-group) were compared by means of a structured interview assessing perceived impairments and change in job and a questionnaire assessing disabilities (Groningen Activity Restriction Scale: GARS). RESULTS: The NP-group perceived significantly more pain, loss of strength and sensation, loss of dexterity and perceived more job-related restrictions than the NT-group. The NP-group had significantly higher scores on the GARS. There was a moderate correlation between the visual analogue score of the pain and the GARS in the NP- and NT-groups. No significant difference was found between the groups with respect to job changes. CONCLUSIONS: This study shows that subjects with a neurapraxia of the ulnar nerve perceive more impairments and disabilities compared with those subjects with a neurotmesis.