Effectiveness and safety of moxibustion for De Quervain disease: A protocol for systematic review and meta-analysis.

BACKGROUND: De Quervain disease (DQD) is a common clinical disease. As a strainingdisease, DQD is more common in women who frequently engage in manual operations. The main clinical symptoms are local pain and dysfunction. Many clinical studies have reported that moxibustion has a good effect on the treatment of DQD, but there is no relevant systematic review. So the purpose of this study is to evaluate the effectiveness and safety of moxibustion in treating DQD. METHODS: The following 8 electronic databases will be searched, including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Web of Science, Chinese Scientific Journal Database (VIP), Wanfang Database, and Chinese Biomedical Literatures Database (CBM) from their inception to 1 October 2020 without any restrictions. Researchers retrieve the literature and extracted the data, evaluation of research methods, quality of literature. The outcomes will include a visual analogue scale, Finkelsteins, resisted thumb extension, total effective rate, incidence of any adverse events. We use the Cochrane Risk of a bias assessment tool to evaluate methodological qualities. Data synthesis will be completed by RevMan 5.3.0. RESULTS: We will show the results of this study in a peer-reviewed journal. CONCLUSIONS: This meta-analysis will provide reliable evidence for moxibustion treatment of DQD. INPLASY REGISTRATION NUMBER: INPLASY2020100111.

Thumb carpometacarpal osteoarthritis: A musculoskeletal physiotherapy perspective.

PROPOSAL: To perform a literature review to provide the practitioner with a description of the information and techniques to enhance the provision of conservative interventions in clinical practice. METHODS: Studies were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to December 2017. Authors independently selected studies, conducted quality assessment, and extracted results. RESULTS: There is evidence to support a multimodal approach to the therapeutic management of the patient with CMC OA. This distinct approach includes: patient education, manual therapy, therapeutic exercise programs, and orthotic provision. CONCLUSION: There is evidence to support some of the commonly performed conservative interventions to improve hand function and decrease hand pain.

Clinical and Ultrasonic Evaluation of the Thumb: Comparison of Young Adults With and Without Thumb Pain With Text Messaging.

OBJECTIVE: The aim of this study was to compare clinical and ultrasound findings of thumb joints in young adults with and without thumb pain associated with text messaging. METHODS: In this case-control study, 117 students with thumb pain associated with text messaging were evaluated clinically and with ultrasound analysis of the thumb. Age- and sex-matched controls received ultrasound evaluation to note any subclinical changes. RESULTS: Clinical examination in the cases identified tenderness most commonly in the metacarpophalangeal joints, followed by the carpometacarpal joints, and then the interphalangeal joints. Tenderness was noted in the web space and the anatomic snuff box. Hypermobility on the Beighton scale was recorded as 2. Grind tests were positive in 21% of participants. Grip strength did not differ, but lateral and tip pinch strength were significantly reduced in the cases compared with controls. Fluid was detected in the metacarpal joints by ultrasound but not in the carpometacarpal or interphalangeal joints. No changes were detected in the controls. CONCLUSION: Clinical examination indicated involvement of all joints of the thumb, but ultrasound evaluation could identify changes only in metacarpal joints, indicating signs of possible subclinical changes taking place in the thumb in these participants as a result of repetitive use.

Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.

PURPOSE: The purpose of this study was to conduct a current review of randomized controlled trials regarding the effect of conservative interventions on pain and function in people with thumb carpometacarpal (CMC) osteoarthritis (OA), perform a meta-analysis of the findings and summarize current knowledge. METHOD: Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to May 2014. Reference lists of relevant literature reviews were also searched. All published randomized trials without restrictions to time of publication or language were considered for inclusion. Study subjects were symptomatic adults with thumb CMC OA. Two reviewers independently selected studies, conducted quality assessment and extracted results. Data were pooled in a meta-analysis, when possible, using a random-effects model. Quality of the body evidence was assessed using GRADE approach. RESULTS: Sixteen RCTs involving 1145 participants met the inclusion criteria. Twelve were of high quality (PEDro score > 6). We found moderate quality evidence that manual therapy and therapeutic exercise combined with manual therapy improve pain in thumb CMC OA at short- and intermediate-term follow-up, and from low to moderate quality evidences that magneto therapy improves pain and function at short-term follow-up. Orthoses (splints) were found to improve function at long-term follow-up and pinch strength at short-term follow-up. Finally, we found from very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long-term follow-up. CONCLUSIONS: Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain. Additional research is required to determine the efficacy of other therapeutic interventions that are performed with patients with thumb CMC OA. IMPLICATIONS FOR REHABILITATION: Manual therapy and exercise are an effective means of improving pain and function at short-term follow-up by patients with thumb CMC OA. Magneto therapy, manual therapy, manual therapy and exercise and Orthoses (splints) were found to have clinically significant results. Very few of the included studies showed a clinically significant effect size in favor of treatment.

Increased range of motion and decreased strength of the thumb in massage practitioners with thumb pain.

The purpose of this study was to compare the range of motion (ROM) and strength of the metacarpophalangeal (MP) and interphalangeal (IP) joints among massage practitioners with and without thumb pain and control subjects. Sixteen massage practitioners with thumb pain, 16 practitioners without thumb pain, and 16 control subjects participated in this study. ROM of flexion, extension, and abduction in the MP joint; ROM of flexion and extension in the IP joint of the thumb; strength of the flexor pollicis brevis (FPB), extensor pollicis brevis (EPB), abductor pollicis brevis, flexor pollicis longus (FPL), and extensor pollicis longus measured in all subjects. ROM of extension and abduction in the MP joint were significantly increased in massage practitioners with and without thumb pain compared with control subjects. ROM of extension in the IP joint was significantly increased in massage practitioners with thumb pain compared with those without thumb pain. The strength of the EPB and FPL muscle was significantly decreased in massage practitioners with thumb pain compared with those without thumb pain and control subjects, respectively. In addition, there was significantly increased EPB/FPB strength in massage practitioners without thumb pain compared to those with thumb pain and control subjects.

The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial.

STUDY DESIGN: Double-blind, randomized controlled trial. OBJECTIVE: To examine the effectiveness of a manual therapy and exercise approach relative to a placebo intervention in individuals with carpometacarpal (CMC) joint osteoarthritis (OA). BACKGROUND: Recent studies have reported the outcomes of exercise, joint mobilization, and neural mobilization interventions used in isolation in patients with CMC joint OA. However, it is not known if using a combination of these interventions as a multimodal approach to treatment would further improve outcomes in this patient population. METHODS: Sixty patients, 90% female (mean ± SD age, 82 ± 6 years), with CMC joint OA were randomly assigned to receive a multimodal manual treatment approach that included joint mobilization, neural mobilization, and exercise, or a sham intervention, for 12 sessions over 4 weeks. The primary outcome measure was pain. Secondary outcome measures included pressure pain threshold over the first CMC joint, scaphoid, and hamate, as well as pinch and strength measurements. All outcome measures were collected at baseline, immediately following the intervention, and at 1 and 2 months following the end of the intervention. Mixed-model analyses of variance were used to examine the effects of the interventions on each outcome, with group as the between-subject variable and time as the within-subject variable. RESULTS: The mixed-model analysis of variance revealed a group-by-time interaction (F = 47.58, P<.001) for pain intensity, with the patients receiving the multimodal intervention experiencing a greater reduction in pain compared to those receiving the placebo intervention at the end of the intervention, as well as at 1 and 2 months after the intervention (P<.001; all group differences greater than 3.0 cm, which is greater than the minimal clinically important difference of 2.0 cm). A significant group-by-time interaction (F = 3.19, P = .025) was found for pressure pain threshold over the hamate bone immediately after the intervention; however, the interaction was no longer significant at 1 and 2 months postintervention. CONCLUSION: This clinical trial provides evidence that a combination of joint mobilization, neural mobilization, and exercise is more beneficial in treating pain than a sham intervention in patients with CMC joint OA. However, the treatment approach has limited value in improving pressure pain thresholds, as well as pinch and grip strength. Future studies should include several therapists, a measure of function, and long-term outcomes. TRIAL REGISTRATION: Current Controlled Trials ISRCTN37143779. LEVEL OF EVIDENCE: Therapy, level 1b.

Grasp and release with surface functional electrical stimulation using a Model Predictive Control approach.

Stroke often has a disabling effect on the ability to use the hand in a functional manner. Accurate finger and thumb positioning is necessary for many activities of daily living. In the current study, the feasibility of novel FES based approaches for positioning the thumb and fingers for grasp and release of differently sized objects is evaluated. Assistance based on these approaches may be used in rehabilitation of grasp and release after stroke. A model predictive controller (MPC) is compared with a proportional (P) feedback controller. Both methods are compared on their performance in tracking reference trajectories and in the capability of grasping, holding and releasing objects. Both methods are able to selectively activate the fingers such that differently sized objects, selected from the Action Research Arm test, can be grasped. The MPC method is easier to use in practice, as this method is based on a single identification of a model of the biological system. The P-controller has more parameters which need to be set correctly, and therefore needs more time to initialise. The current results are very promising. Evaluation in patients will be done to explore the possibilities to apply these methods in rehabilitation of grasp and release after stroke.

Hypoalgesic and motor effects of kaltenborn mobilization on elderly patients with secondary thumb carpometacarpal osteoarthritis: a randomized controlled trial.

OBJECTIVE: This study evaluated the effects of Kaltenborn manual therapy on sensory and motor function in elderly patients with secondary carpometacarpal osteoarthritis (CMC OA). METHOD: Twenty-nine female patients with secondary CMC OA (70-90 years old) were randomized into Kaltenborn manual therapy and sham groups. This study was designed as a double-blind, randomized controlled trial (RCT). Therapy consisted of Kaltenborn mobilization of posterior-anterior gliding with distraction in grade 3 of the carpometacarpal (CMC) joint of the dominant hand during 6 sessions over 2 weeks. Pain was measured by algometry, as the pressure pain threshold (PPT) at the CMC joint and tubercle of the scaphoid bone. The tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. Measurements were taken before treatment and after 1 week (first follow-up [FU]) and 2 weeks (second FU). RESULTS: All values in the sham group remained unchanged during the treatment period. In the treated group, the PPT in the CMC joint was 2.98 ± 0.30 kg/cm(2), which increased after treatment to 4.07 ± 0.53, and was maintained at the same level during the first FU (3.46 ± 0.31) and second FU (3.84 ± 0.36). Similarly, the PPT in the scaphoid bone was 3.61 ± 0.29 kg/cm(2), which increased after treatment to 4.87 ± 0.37, and was maintained at the same level during the first FU (4.44 ± 0.43) and second FU (4.22 ± 0.32). In contrast, we found no differences in the tip, tripod pinch, and grip strength measurements between the treatment and sham groups. CONCLUSIONS: This study showed that Kaltenborn manual therapy decreased pain in the CMC joint and scaphoid bone areas of elderly female patients; however, it did not confer an increase in motor function in patients with CMC OA.

Immediate effect of a wrist and thumb brace on bimanual activities in children with hemiplegic cerebral palsy.

AIM: The aim of this study was to determine the immediate effect of wearing a wrist and thumb brace on the performance of bimanual activities in children with spastic hemiplegic cerebral palsy. METHOD: In a pre- and post-test cohort study of 25 children (age range 4-11y; mean age 8y 4mo [SD 2y 2mo]; 16 males, 9 females) with spastic hemiplegic cerebral palsy with a Zancolli classification hand score of I, IIA, or IIB (mild and moderate hand dysfunction; children with a Zancolli classification of III - severe hand dysfunction - were excluded from this study), performance of bimanual activities was evaluated with the Assisting Hand Assessment (AHA) on three occasions: one assessment with a static wrist and thumb brace placed on the affected hand and two other assessments without a brace. The differences between AHA scores obtained at the three assessments were evaluated using the repeated measures analysis of variance. RESULTS: Performance of bimanual activities while wearing the brace improved significantly compared to performance without the brace (p<0.001). With the brace, the mean AHA score increased by 3.2 (95% confidence interval 2.1-4.3) from 59.1 to 62.3. The scores of the two assessments without the brace did not differ significantly. INTERPRETATION: In children with spastic hemiplegic cerebral palsy, bracing of the wrist and thumb immediately improves spontaneous use of the affected upper limb in bimanual activities, possibly because bracing permits a more functional hand position.

De Quervain's syndrome associated with osteopoikilosis: a case report and review of the literature.

Osteopoikilosis is a rare, usually asymptomatic, autosomal-dominant bone disorder, which is generally diagnosed incidentally on X-ray. De Quervain's syndrome is a disorder characterized by pain on the radial (thumb) side of the wrist, impairment of thumb function and thickening of the ligamentous structure covering the tendons in the first dorsal compartment of the wrist. In this case report, we present a young woman with De Quervain's syndrome associated with osteopoikilosis.

Forces applied to the cervical spine during posteroanterior mobilization.

OBJECTIVE: There is little information on manual forces applied during cervical mobilization, a common treatment technique. Potential variability of applied forces between therapists and treatment occasions, and factors associated with different force applications are unknown. The purpose of this study is to establish the baseline mechanical properties of cervical spine mobilization and to determine if the applied forces are affected by the characteristics of therapists and mobilized subjects. METHODS: Physiotherapists (n = 116) applied 4 grades of posteroanterior mobilization to the premarked C2 and C7 spinous (central technique) and articular processes (unilateral technique, one right and one left) of 1 of 35 asymptomatic subjects. Techniques were performed in randomized order, and the first one was repeated after 20 minutes. Load cells attached to the treatment table recorded forces in 3 directions. Before mobilization, subjects' spinal stiffness at the C2 and C7 spinous processes was measured using a custom device. Analyses of variance with Bonferroni post hoc tests determined technique and grade differences, intraclass correlation coefficients the reliability between therapists, and linear regression the factors associated with forces. RESULTS: Therapists apply distinct manual forces for different techniques and grades (P < .001). Variability between therapists is high, but intratherapist reliability is good (intraclass correlation coefficient [2,1] for different force parameters, 0.84-0.93). Mean peak forces increase from grades I to IV, ranging from 22 to 92 N for resultant forces. Greater vertical and caudad-cephalad forces are applied to C7 than C2 (P < .01), with higher mediolateral forces during unilateral techniques (P < .001). Male sex of the therapist or the mobilized subject is associated with higher forces, and C2 stiffness, thumb pain and postgraduate training with lower (P < .05). CONCLUSIONS: These results quantify cervical mobilization forces, which will inform future research aimed at improving its application and clinical effectiveness.

Effectiveness of leech therapy in women with symptomatic arthrosis of the first carpometacarpal joint: a randomized controlled trial.

Leech therapy has been shown to be effective for symptomatic treatment of osteoarthritis of the knee. We aimed to investigate the effectiveness of leech therapy in another type of osteoarthritis, osteoarthritis of the first carpometacarpal joint (thumb saddle joint). Thirty-two women with symptomatic painful osteoarthritis of the first carpometacarpal joint and who scored>40 mm on a 100mm VAS pain scale were randomized to a single treatment with 2-3 locally applied leeches (leech group) or a 30-day course with topical diclofenac twice a day. Primary outcome measure was change of overall pain (mean of VAS for pain at rest, in motion, during grip) from baseline to day 7. Secondary outcomes were functional disability (DASH-questionnaire), quality of life (QoL, SF-36) and grip strength. Patients were examined baseline and at days 7, 30 and 60 after treatment. Overall pain score at day 7 was reduced from 59.6+/-13.8 to 27.1+/-20.6 in the leech group (n=16) and from 50.6+/-13.3 to 46.9+/-18.5 with diclofenac (n=16) (group difference -26.5, 95%CI -40.3; -12.7; p=0.0003). Group differences for pain relief favoring the leech treatment increased at days 30 and 60. Significant treatment effects were also observed for the DASH score, QoL and grip. Results were not affected by outcome expectation or consumption of analgetics. A single course of leech therapy is effective in relieving pain, improving disability and QoL for at least 2 months. The potential of leech therapy for treatment of arthritic pain and underlying mechanisms should be further investigated.

Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint.

OBJECTIVE: To explore the biometric and psychometric properties of clinical, generic, and condition-specific instruments and to assess quantitatively the outcome after resection interposition arthroplasty (RIAP) of the thumb saddle joint. METHODS: One hundred three patients requiring 112 arthroplasties were assessed in a 4.5-7.7-year cross-sectional catamnesis by means of 4 widely used questionnaires and clinical and radiographic examinations. RESULTS: In all dimensions of the Short Form 36 (SF-36), the outcome was equal or significantly better than expected by the norm. The Disability of the Arm, Shoulder and Hand questionnaire (DASH) revealed some small, mainly functional limitations (mean score 78.4, norm 86.4). The SF-36, the DASH, and the Patient Related Wrist Evaluation form (PRWE) correlated highly and loaded on the same factor. The Hand Function Index was independent of the clinical measurements (range of motion, strength, etc. on the specially designed Custom Form) and of the self rating. CONCLUSION: Long-term followup of 112 RIAP patients showed excellent health and quality of life. A questionnaire set consisting of the SF-36, the DASH (or alternatively the short PRWE), and the Custom Form is proposed for the comprehensive and specific assessment of thumb joint conditions.

Artificial grasping system for the paralyzed hand.

Neuromuscular electrical stimulation has been used in upper limb rehabilitation towards restoring motor hand function. In this work, an 8 channel microcomputer controlled stimulator with monophasic square voltage output was used. Muscle activation sequences were defined to perform palmar and lateral prehension and power grip (index finger extension type). The sequences used allowed subjects to demonstrate their ability to hold and release objects that are encountered in daily living, permitting activities such as drinking, eating, writing, and typing.

Control of FES thumb force using slip information obtained from the cutaneous electroneurogram in quadriplegic man.

A tetraplegic volunteer was implanted with percutaneous intramuscular electrodes in hand and forearm muscles. Furthermore, a sensory nerve cuff electrode was implanted on the volar digital nerve to the radial side of the index finger branching off the median nerve. In laboratory experiments a stimulation system was used to produce a lateral grasp (key grip) while the neural activity was recorded with the cuff electrode. The nerve signal contained information that could be used to detect the occurrence of slips and further to increase stimulation intensity to the thumb flexor/adductor muscles to stop the slip. Thereby the system provided a grasp that could catch an object if it started to slip due to, e.g., decreasing muscle force or changes in load forces tangential to the surface of the object. This method enabled an automatic adjustment of the stimulation intensity to the lowest possible level without loosing the grip and without any prior knowledge about the strength of the muscles and the weight and surface texture of the object.