Clinical Efficacy of Arthroscopic Transplantation of Palmaris Longus Tendon Combined with Early Accelerated Motion Rehabilitation After Scapholunate Ligament Reconstruction for Geissler Type IV Scapholunate Instability.

Objective: The aim of this study is to investigate the clinical efficacy of early accelerated motion rehabilitation in treating wrist joint instability with Geissler IV scapholunate instability (SLI) using arthroscopic palmaris longus tendon transplantation in conjunction with scapholunate ligament reconstruction. Methods: From June 2019 to January 2022, seven patients with Geissler Type IV SLI underwent arthroscopic ligament reconstruction and repair surgery of the wrist joint, followed by early accelerated motion rehabilitation. Postoperative follow-up indicators included visual analogue scale (VAS) for pain assessment, DASH-CHINESE upper limb function score, Mayo wrist joint score, wrist joint range of motion, and grip strength. Surgical efficacy was evaluated based on these indicators. Results: All patients were followed up postoperatively, with a follow-up duration ranging from 6 to 20 months (mean: 15.3 months). No postoperative complications occurred, and significant improvements were observed in all measured parameters. Postoperative MRI results at one year indicated restoration of the anatomical structure of the scapholunate joint with good healing. Both VAS and DASH-CHINESE scores significantly decreased, and the differences between pre- and postoperative scores were statistically significant (P < .001). The preoperative Mayo wrist joint score was (47.857±21.380) points, with 2 cases rated as fair and 5 cases as poor. At the latest follow-up, the score was (84.286±6.726) points, with 2 cases rated as excellent, 2 cases as good, and 3 cases as fair. Wrist joint flexion-extension range, rotation range, and grip strength all significantly improved compared to the preoperative values, with statistically significant differences (P < .001). Conclusion: The combined approach of arthroscopic transplantation of the palmaris longus tendon and early accelerated motion rehabilitation shows satisfactory clinical outcomes in treating Geissler Type IV scapholunate instability of the wrist joint. This combined approach is of great significance in improving the patient's quality of life and wrist function and helps reduce pain symptoms. Furthermore, in future research, it is recommended to increase the sample size and prolong the observation period to further validate the efficacy.

A Double-Blind, Randomized, Placebo-Controlled Trial to Evaluate the Efficacy of a Hydrolyzed Chicken Collagen Type II Supplement in Alleviating Joint Discomfort.

Joint pain and disease affects more than one in four adults in the United States. We conducted a double-blind, randomized, placebo-controlled trial to investigate the efficacy of a hydrolyzed chicken collagen type II (HCII) supplement in reducing joint-related discomfort such as pain and stiffness, and in improving mobility. We enrolled adults aged 40-65 (65.5% were women) who had joint discomfort, but had no co-morbidities, and who were not taking pain medications. The participants were randomized to receive either the HCII supplement (n = 47) or a placebo (n = 43) for eight weeks. At the baseline, and at week 4 and week 8, we administered the Western Ontario and McMaster Universities Arthritis Index (WOMAC) survey with three additional wrist-related questions and the Visual Analog Scale for assessments of joint-related symptoms. In the WOMAC stiffness and physical activity domains and in the overall WOMAC score, the HCII group had a significant reduction in joint-related discomforts compared with the placebo group. For example, at week 4, the HCII group had a 36.9% reduction in the overall WOMAC score, compared with a 14.3% reduction in the placebo group (p = 0.027). This HCII product is effective in reducing joint pain and stiffness and in improving joint function among otherwise healthy adults.

High-density electromyography biofeedback during robotic wrist exercises for reducing co-activation of antagonist muscles: a case report.

High-density (HD) electrodes have been introduced in research and diagnostic electromyography. Recent advances in technology offer an opportunity for using the HDEMG signal as biofeedback in stroke rehabilitation. The purpose of this case study was to test the feasibility of using two 5 × 13 electrode arrays for providing real-time HDEMG biofeedback and the preliminary outcome of combining HDEMG biofeedback with robotic wrist exercises over 4 weeks in a person who suffered a stroke 26 months earlier. The isometric wrist flexion/extension task required to keep the paretic agonist activity within variable preset limits with minimal activation of the antagonists. The participant was able to utilize the provided biofeedback interface and after eight sessions significantly decreased co-activation in the antagonist wrist extensor muscles during isometric wrist flexion. The HDEMG biofeedback seems feasible and may be used alone or in combination with robotic therapy for increasing the selectivity of muscle activation after stroke.

Comparison of Wide-Awake Local Anesthesia No Tourniquet With General Anesthesia With Tourniquet for Volar Plating of Distal Radius Fracture.

Wide-awake local anesthesia no tourniquet (WALANT) is used for various hand surgeries, but there are no reports of its use for distal radius fractures. The authors compared perioperative variables and clinical outcomes for volar plating for distal radius fractures with WALANT vs general anesthesia with tourniquet. This retrospective study included 47 patients who presented with distal radius fractures between January 2015 and February 2017. Twenty-one underwent surgical volar plating with WALANT, and 26 underwent surgical volar plating with general anesthesia with tourniquet. Patients were followed for 12 months. The 2 groups were compared regarding perioperative parameters and clinical outcomes, including perioperative field pain evaluated by visual analog scale score on postoperative day 1, range of motion 12 months postoperatively, and Mayo wrist score. The WALANT group had a lower mean visual analog scale score and a shorter mean hospitalization (both P<.001), but greater mean blood loss (P<.001). No significant differences were found regarding operative time (P=.214) or time to union (P=.180). At 12-month follow-up, no significant differences were found regarding wrist extension (P=.721), wrist flexion (P=.119), or Mayo wrist score (P=.223). Although both techniques permitted volar plating for distal radius fractures, WALANT allowed immediate intervention and led to less postoperative pain and shorter hospitalization. Although control of blood loss was worse with WALANT, blood loss was limited to a mean of 22.62 mL and did not interfere with the surgical field. [Orthopedics. 2019; 42(1):e93-e98.].

A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report.

STUDY DESIGN: Case report. INTRODUCTION: Studies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation. PURPOSE OF THE STUDY: To describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury. METHODS: The patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation. RESULTS: The patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values. DISCUSSION: The results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury. CONCLUSIONS: This is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.

Effect of Manual Therapy on Pain Sensation and Hand Dexterity and Grip Strength in a Patient with RA. Didactic Case Study.

Rheumatoid arthritis (RA) is an inflammatory immune-dependent systemic connective tissue disease leading to joint destruction and organ complications. Recent years have seen a strong interest in manual therapy and its possible use in patients with pain and limited joint mobility. This prompted us to evaluate the effectiveness of joint mobilization in a patient with RA. The present paper assesses the effects of a joint mobilization technique on pain and functionality of the hand and wrist in a patient with rheumatoid arthritis.

The short-term effects of hot packs vs therapeutic whirlpool on active wrist range of motion for patients with distal radius fracture: A randomized controlled trial.

STUDY DESIGN: Blinded randomized controlled trial. INTRODUCTION: It is generally accepted that heat is beneficial for improving range of motion (ROM). However, the mechanism of action is not clearly understood, and the optimal method of heat application has not been established. PURPOSE OF THE STUDY: To investigate the immediate effects of using a moist hot pack (MHP) vs therapeutic whirlpool bath (WB) for improving wrist ROM during a therapy session for patients with distal radius fracture. METHODS: About 60 adult patients, with a mean age of 54 years in the MHP group and 53 years in the WB group, with healed distal radius fracture were randomized into 2 groups of 30. Patients in group 1 were placed in an MHP for 15 minutes during therapy. Patients in group 2 had their arm placed in a WB and were asked to perform active wrist ROM exercises for the same period. This occurred for 3 consecutive therapy visits, with wrist and forearm ROM being measured before and after heat during each visit. RESULTS: The multivariate analysis of variance demonstrated that the canonical variate for ROM was significantly different between groups (F[6,53] = 6.01; P < .05), indicating that patients in the WB group had a significantly larger increase in ROM than patients receiving MHP application. DISCUSSION: Both WB and MHP improved wrist ROM during therapy sessions in this study, making both these acceptable options for clinical use when the goal is to precondition a patient for other treatments. CONCLUSIONS: Individuals who received WB showed a statistically greater increase in wrist ROM than those receiving MHP during a therapy session, although the difference between groups may or may not be clinically important considering the small changes in ROM observed in this study. LEVEL OF EVIDENCE: Level II.

Total Wrist Arthroplasty.

Total wrist arthroplasty (TWA), first performed in the late 19th Century, is still an infrequently used operation. It is most commonly indicated in patients with rheumatoid arthritis who have pan-carpal wrist involvement. It is an alternative to total wrist arthrodesis in patients who wish to preserve joint motion. Patients must lead a low-demand lifestyle and have failed non-operative measures. Complications are not insignificant and have been reported to be as high as 43%. Modern generation implants most often fail due to dislocation or loosening. Because wrist arthrodesis remains the gold standard treatment, particularly in patients with higher physical demands, it remains to be seen whether TWA will gain greater acceptance as prosthetic designs evolve.

Postoperative Physical Therapy Management of Tendon Transfer for Digital/Wrist Extension Due to Multifocal Motor Neuropathy.

Study Design Case report. Background Multifocal motor neuropathy is a progressive motor nerve disorder characterized by muscle weakness in the extremities. Muscle imbalance and weakness can become so severe that the involved extremity can be rendered nonfunctional. The purpose of this case report is to describe the physical therapy postoperative management of a patient who underwent a multiple tendon transfer to correct the loss of digital/wrist extension of the right upper extremity. Case Description A 38-year-old woman with a medical diagnosis of multifocal motor neuropathy, which caused muscle imbalance and weakness in the right hand, underwent a multiple tendon transfer to correct the loss of digit and wrist extension. The pronator teres was transferred and attached to the extensor carpi radialis longus and brevis. The palmaris longus was transferred and attached to the extensor pollicis longus. The flexor carpi radialis was transferred and attached to the extensor digitorum communis. The patient underwent static and dynamic splinting and a modified tendon transfer protocol starting at 3 weeks and ending at 16 weeks postsurgery. The patient attended therapy 1 to 3 times a week, depending on protocol stage and need for skilled therapy intervention. Outcomes Patient-reported outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) survey to monitor the return of function and the numeric pain-rating scale to assess pain. At the initial evaluation (3 weeks postsurgery), the patient's DASH score was 87.5 and her pain score was 7/10. At discharge (16 weeks postsurgery), the patient's DASH score was 37.5 and her pain score was 0/10. Strength impairment was monitored with hydraulic hand dynamometers and manual muscle testing. At discharge, her hand grip strength was 4.5 kg, her key pinch strength was 4.1 kg, and her 3-jaw pinch strength was 2.3 kg. Manual muscle testing grades were 5/5 for elbow extension/flexion, 4/5 for forearm pronation/supination, 2/5 for wrist extension, 1/5 for wrist radial deviation, 4-/5 for wrist ulnar deviation, 3/5 for extension from digits 2 through 4, 3+/5 for thumb extension, 5/5 for wrist flexion, and 5/5 for flexion from digits 1 through 5. At 1 year postsurgery, the DASH survey was sent to the patient for completion, at which time she reported a DASH score of 24.17. Conclusion This case demonstrated good outcomes for a patient who underwent a multiple tendon transfer to correct digital/wrist extension loss caused by multifocal motor neuropathy. This report provides guidance on the postoperative management of a fairly rare neurological disorder with an established orthopaedic surgery. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2016;46(12):1071-1079. Epub 30 Oct 2016. doi:10.2519/jospt.2016.6707.

Development of network-based multichannel neuromuscular electrical stimulation system for stroke rehabilitation.

Neuromuscular electrical stimulation (NMES) is a promising assistive technology for stroke rehabilitation. Here we present the design and development of a multimuscle stimulation system as an emerging therapy for people with paretic stroke. A network-based multichannel NMES system was integrated based on dual bus architecture of communication and an H-bridge current regulator with a power booster. The structure of the system was a body area network embedded with multiple stimulators and a communication protocol of controlled area network to transmit muscle stimulation parameter information to individual stimulators. A graphical user interface was designed to allow clinicians to specify temporal patterns and muscle stimulation parameters. We completed and tested a prototype of the hardware and communication software modules of the multichannel NMES system. The prototype system was first verified in nondisabled subjects for safety, and then tested in subjects with stroke for feasibility with assisting multijoint movements. Results showed that synergistic stimulation of multiple muscles in subjects with stroke improved performance of multijoint movements with more natural velocity profiles at elbow and shoulder and reduced acromion excursion due to compensatory trunk rotation. The network-based NMES system may provide an innovative solution that allows more physiological activation of multiple muscles in multijoint task training for patients with stroke.

Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury.

PURPOSE: To examine the effects of neuromuscular electrical stimulation (NMES) and blood flow restricted (BFR) exercise on wrist extensors cross-sectional area (CSA), torque and hand functions compared NMES only in individuals with incomplete tetraplegia. The acute effect of an acute bout of NMES with BFR on flow mediated dilation (FMD) was compared with BFR only. METHOD: Nine men completed 6 weeks twice weekly of bilateral NMES training of the wrist extensor muscles. The right forearm received NMES + BFR (30 % above the resting systolic blood pressure), while the left forearm received NMES only. The CSA of the extensor carpi radialis longus (ECRL) and extensor digitorum communis (EDC) muscles was measured on ultrasound images. Torque was measured isometrically and hand function with grasp and release test. Another eight men with SCI received NMES+BFR to the right forearm, while the left forearm received BFR only. Immediately, the FMD of the brachial artery was measured. RESULT: Following training, the ECRL CSA was 17 % greater in the NMES+BFR forearm (mean difference = 0.6 cm(2), p = 0.003) compared with the NMES only. The NMES+BFR had a 15 % increase in ECRL CSA (mean increase = 0.58 cm(2), p = 0.048). FMD increased (p = 0.05) in the exercise arm (12 ± 3 %) compared with the control arm (6.5 ± 6 %). CONCLUSION: NMES training with BFR is a strategy that can increase skeletal muscle size. NMES with and without BFR can improve wrist strength and hand function. The acute effects of NMES+BFR may suggest that an increase in FMD may partially contribute to skeletal muscle hypertrophy.

Clinical manual assessment of the wrist.

Although hand therapists often evaluate patients with wrist pain, novice and experienced clinicians alike would benefit from a systematic assessment to efficiently identify the source of dysfunction and initiate an appropriate treatment plan. This article proposes a systematic approach for clinical evaluation of the wrist by describing the basic clinical examination (BCE) process and interpreting the findings in terms of common pathology. The BCE will enable the hand therapist to identify conditions that are contraindicated for conservative care and require further physician intervention, determine a working diagnosis for most musculoskeletal problems, and determine the appropriate extra tests to confirm the working diagnosis and/or rule out differential diagnoses. By combining findings from the patient's history, BCE, and special testing, hand therapists can efficiently determine the underlying pathology and provide appropriate treatment that can optimize clinical outcomes.

Effects of Action Observational Training Plus Brain-Computer Interface-Based Functional Electrical Stimulation on Paretic Arm Motor Recovery in Patient with Stroke: A Randomized Controlled Trial.

The purpose of this study was to investigate whether action observational training (AOT) plus brain-computer interface-based functional electrical stimulation (BCI-FES) has a positive influence on motor recovery of paretic upper extremity in patients with stroke. This was a hospital-based, randomized controlled trial with a blinded assessor. Thirty patients with a first-time stroke were randomly allocated to one of two groups: the BCI-FES group (n = 15) and the control group (n = 15). The BCI-FES group administered to AOT plus BCI-FES on the paretic upper extremity five times per week during 4 weeks while both groups received conventional therapy. The primary outcomes were the Fugl-Meyer Assessment of the Upper Extremity, Motor Activity Log (MAL), Modified Barthel Index and range of motion of paretic arm. A blinded assessor evaluated the outcomes at baseline and 4 weeks. All baseline outcomes did not differ significantly between the two groups. After 4 weeks, the Fugl-Meyer Assessment of the Upper Extremity sub-items (total, shoulder and wrist), MAL (MAL-Activity of Use and Quality of Movement), Modified Barthel Index and wrist flexion range of motion were significantly higher in the BCI-FES group (p < 0.05). AOT plus BCI-based FES is effective in paretic arm rehabilitation by improving the upper extremity performance. The motor improvements suggest that AOT plus BCI-based FES can be used as a therapeutic tool for stroke rehabilitation. The limitations of the study are that subjects had a certain limited level of upper arm function, and the sample size was comparatively small; hence, it is recommended that future large-scale trials should consider stratified and lager populations according to upper arm function.

Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial.

BACKGROUND: Robot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand. METHODS: This was a randomized, double-blind, sham-controlled study. Thirty-nine individuals with chronic stroke were randomly assigned to the RT combined with NMES (RT + ES) or to RT with sham stimulation (RT + Sham) groups. The participants completed the intervention 90 to 100 minutes/day, 5 days/week for 4 weeks. The outcome measures included the upper extremity Fugl-Meyer Assessment (UE-FMA), modified Ashworth scale (MAS), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale 3.0 (SIS). All outcome measures were assessed before and after intervention, and the UE-FMA, MAL, and SIS were reassessed at 3 months of follow-up. RESULTS: Compared with the RT + Sham group, the RT + ES group demonstrated greater improvements in wrist flexor MAS score, WMFT quality of movement, and the hand function domain of the SIS. For other outcome measures, both groups improved significantly after the interventions, but no group differences were found. CONCLUSION: RT + ES induced significant benefits in reducing wrist flexor spasticity and in hand movement quality in patients with chronic stroke. TRIAL REGISTRATION: ClinicalTrials.gov. NCT01655446.

Neuroplasticity of imagined wrist actions after spinal cord injury: a pilot study.

Motor imagery (MI - i.e., the mental representation of an action without physically executing it) stimulates brain motor networks and promotes motor learning after spinal cord injury (SCI). An interesting issue is whether the brain networks controlling MI are being reorganized with reference to spared motor functions. In this pilot study, we tested using magnetoencephalography (MEG) whether changes in cortical recruitment during MI were related to the motor changes elicited by rehabilitation. Over a 1-year period of inclusion, C6 SCI participants (n = 4) met stringent criteria for inclusion in a rehabilitation program focused on the tenodesis prehension (i.e., a compensatory prehension enabling seizing of objects in spite of hand and forearm muscles paralysis). After an extended baseline period of 5 weeks including repeated MEG and chronometric assessments of motor performance, MI training was embedded to the classical course of physiotherapy for five additional weeks. Posttest MEG and motor performance data were collected. A group of matched healthy control participants underwent a similar procedure. The MI intervention resulted in changes in the variability of the wrist extensions, i.e., a key movement of the tenodesis grasp (p < .05). Interestingly, the extent of cortical recruitment, quantified by the number of MEG activation sources recorded within Brodmann areas 1-8 during MI of the wrist extension, significantly predicted actual movement variability changes across sessions (p < .001). However, no such relationship was present for movement times. Repeated measurements afforded a reliable statistical power (range .70-.97). This pilot study does not provide straightforward evidence of MI efficacy, which would require a randomized controlled trial. Nonetheless, the data showed that the relationship between action and imagery of spared actions may be preserved after SCI.

Systematic literature review of abobotulinumtoxinA in clinical trials for adult upper limb spasticity.

OBJECTIVE: The aim of this study was to elucidate clinical trial efficacy, safety, and dosing practices of abobotulinumtoxinA (ABO) treatment in adult patients with upper limb spasticity (ULS). METHODS: A systematic literature review was performed to identify randomized controlled trials and other comparative clinical studies of ABO in the treatment of adult ULS published in English between January 1991 and January 2013. Medical literature databases (PubMed, Cochrane Library, and EMBASE) were searched, and a total of 295 records were identified. Of these, 12 primary publications that evaluated ABO for the management of ULS were included in the final data report. SYNTHESIS: Total ABO doses ranged between 500 and 1500 U for ULS. Most of the studies in ULS showed statistically significant benefits (reduction in muscle tone based on Ashworth score) of ABO vs. placebo. Statistical significance was reached for most evaluations of spasticity using the Modified Ashworth Scale. Statistically significant effects on active movement and pain were demonstrated, albeit less consistently. ABO was generally well tolerated across the individual studies; most adverse events reported were considered unrelated to treatment. Adverse events considered associated with ABO treatment included fatigue, tiredness, arm pain, skin rashes, flu-like symptoms, worsening of spasm, and weakness. CONCLUSIONS: On the basis of data extracted from 12 randomized clinical studies, a strong evidence base (9/12 studies) exists for the use of ABO to reduce ULS caused by stroke.

Influence of the surface electrostimulation controlled by muscle contraction on the bioelectric muscle activity and restoration of the hand function in cerebral stroke patients.

BACKGROUND: Impaired limb mobility is the most troublesome condition in patients after cerebral stroke. The application of the electrode-glove might reduce dysfunctions in patients treated due to stroke. OBJECTIVE: The electrode-glove use in rehabilitation is investigated. The study was conducted on 54 patients aged 28 - 72 (the mean age 54.3 ± 10.3) with hemiparesis who had suffered from cerebral stroke. The patients from Group 1 were applied bipolar stimulation of forearm muscles (flexors and extensors of the wrist joint and hand) with the use of two flat electrodes of the same size. With regards to Group 2, in the study used an electrode-glove. METHODS: The excitation threshold was determined once a week with the use of the EMG. SECONDARY OUTCOMES: The evaluation of the electromyographic bioelectric activity of flexor and extensor muscles in the forearm, of the functional mobility of the hand according to the Brunnström test and of the functional mobility of the hand according to the seven-graded task Frenchay scale. RESULTS: The authors of the study observed a much greater improvement in the function of the hand in Group 2, where the mean value increased by 2.1 points. With regards to Group 1, the mean value increased by 1 point and the differences of the results in the studied groups after the therapy were statistically significant (p = 2.830). CONCLUSIONS: The electrical stimulation method controlled/triggered by muscle contractions is an effective method of normalization of muscle tension in the forearm and hand as well as restoration of the hand function in patients with cerebral stroke.

Acute compartment syndrome after open forearm fracture--scale of the problem and case report.

Acute compartment syndrome is caused due to a sudden increase in the tissue pressure in a given fascial compartment. Missed and undiagnosed or not treated in time can lead to irreversible damage to limb muscles and nerves due to ischemia mechanism. This paper presents a case of a patient with an open forearm fracture treated conservatively in plaster.

[Case-control study on tibetan Baimai ointment (see symbol in text) for the treatment of wrist-dysfunction after distal radius fracture].

OBJECTIVE: To evaluate efficacy and safety of Baimai ointment (see symbol in text) in the treatment of wrist-dysfunction after distal radius fracture. METHODS: From April, 2011 to June, 2012, 43 patients with distal radius fracture were treated with plaster fixation. All the patients were divided into two group: test group and control group. Twenty-one patients in test group and 22 in control group, and the baseline was balance (P > 0.05). The 21 patients in test group were treated with Baimai ointment (see symbol in text), fomentation, functional exercises. The 22 patients in control group were treated with placebo, fomentation, functional exercises. Foment affected side wrist with wet towel in 20 min before medication, with the temperature between 50 degrees C and 60 degrees C. Smear drugs uniformly in range of 3 cm in the vicinity of palm stripes after drying (about 3 g) and take functional exercises for the activities of wrist and hand. Continuous follow the program per 8 hours once and follow-up for 8 weeks. The Wrist's pain was assessed with VAS. The wrist's activities were measured with the protractor of orthopedic. Measure The grip strength was measured with dynamometer. The wrist's function were assessed with the table of Cooney. RESULTS: The test group had a significantly better results than those of control group in the extent of wrist's pain throughout the treatment (P < 0.001), and grip strength on the 28th day and the 56th day (P < 0.05), and Cooney functional assessment on the 56th day (P < 0.05). Wrist's activities had no significane difference throughout the 8 weeks (P > 0.05). There were no drug adverse reactions occurred. CONCLUSION: Tibetan Baimai ointment (see symbol in text) has the treatment of wrist-dysfunction after distal radius fracture for external use, which can reduce the extent of wrist's pain, promote grip strength recovery in the middle and late of process, promote wrist's function recovery latterly, and safety for external use.

The effects of startle and non-startle auditory stimuli on wrist flexion movement in Parkinson's disease.

Startle stimuli lead to shorter reaction times in control subjects and Parkinson's disease (PD) patients. However, non-startle stimuli also enhance movement initiation in PD. We wanted to examine whether a startle-triggered movement would retain similar kinematic and EMG-related characteristics compared to one induced by a non-startle external cue in PD patients. In this study we investigated the electromyography pattern and the reaction time during a wrist flexion movement in response to three different stimuli: a visual imperative stimulus; visual stimulus simultaneous with a non-startle auditory stimulus and with a startle auditory stimulus. Ten PD patients and ten aged matched controls participated in this study. The reaction times were faster for startle and non-startle stimuli in comparison with the visual imperative stimulus, in both patients and control subjects. The startle cue induced a faster reaction than the non-startle cue. The electromyography pattern remained unchanged across the conditions. The results suggest that the startle reaction effect for upper limb movements are unimpaired in PD patients and has different characteristics than the effect of non-startle stimuli.