The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial.

BACKGROUND: Edema is a possibility with all heating modalities due to the increase in local blood flow caused by vasodilation. Despite the frequent application of superficial heat modalities, their relative effect on hand volume has not been determined for the upper extremity. The objective of this study was to compare the immediate effects of hot packs and whirlpool on hand volume for patients with distal radius fracture (DRF) and to determine whether any changes in volume between these modalities were still present 30 minutes after heat application. Finally, to determine whether there were any differences in volume change between groups after 3 repeated therapy visits. METHODS: Sixty patients with clinically healed DRFs were divided into 2 groups. Half received therapeutic whirlpool at each therapy visit, and the other half received a moist hot pack treatment for 3 consecutive visits. Hand volume was measured before heat, after heat, and at the end of each 30-minute therapy session. RESULTS: There was a significant difference between groups immediately after heat application, as patients in the whirlpool group experienced an initial volume increase greater than those who received a hot pack. When remeasured after a hand therapy session approximately 30 minutes later, this group difference in volume change was no longer significant. The overall change in volume from enrollment in the study to completion of the study 3 weeks later was not statistically different between groups. CONCLUSION: Whirlpool is a potential consideration when selecting a heat modality for patients with DRF.

Laser Treatment on Acupuncture Points Improves Pain and Wrist Functionality in Patients Undergoing Rehabilitation Therapy after Wrist Bone Fracture. A Randomized, Controlled, Blinded Study.

The objective of this study was to determine whether application of laser beam on acupuncture points has a positive effect on the rehabilitation of patients with a diagnosis of distal radius fracture (1.5 inches proximal to distal articular surface of the radius) when applied with active conventional physical therapy exercises. Patients with a distal radius fracture treated with closed reduction, percutaneous pinning, and a short cast for six weeks was included and were assigned to one of two study groups. The control group was given simulated laser acupuncture with the laser off, while the experimental group received laser beam on acupuncture points. A low power infrared 980 nm, 50 mW laser (Diller & Diller Laser Performance) electric energy, was used; each acupuncture point was irradiated for 30 seconds at 8,000 Hz at each therapy session. In both groups, treatment was applied to the following points: Ipsilateral- Yanggu (S15), Yangchi (SJ4), Waiguan (SJ15), Yangxi (LI5), Daling (PC7); Bilateral- Hegu (L14); Contralateral- Shenmail (VL62), Kulun (V60), Taixi (KID3). All of the patients underwent a total of 10 sessions, at a frequency of three times per week. They were evaluated using the VAS, the Patient-Rated Wrist Evaluation (PRWE), and wrist mobility ranges at the beginning of treatment, at the end of the fifth session, at the 10th session, and a week after the 10th session. The patients treated with laser beam exposure on acupuncture points showed 44% reduction in pain and 33% of improvement in the functional status of the wrist compared with the control group. Application of laser beam on acupuncture points combined with active rehabilitation exercises show benefits in the rehabilitation of patients with a distal radius fracture managed with percutaneous pinning and a short cast.

[Research of TCM synthetic rehabilitation on the recovery of wrist joint after distal radius fractures].

OBJECTIVE: To evaluate efficacy and advantages of the Traditional Chinese Medicine (TCM) synthetic rehabilitation therapy in the treatment of wrist dysfunction after distal radius fractures. METHODS: From May 2014 to October 2015, 72 patients with distal radius fracture meeting standards were treated using central randomization system for clinical research. All the patients were divided into two groups: 36 patients in test group and 36 in control group. Sixty-nine cases were finished treatment and followed up in the end. The test group fell off 1 case, and the control group fell off 2 cases. The test group was given TCM synthetic rehabilitation (manipulative therapy, joint mobilization, soaking-washing with Chinese medicinal herbs, functional exercise), and the control group was given functional exercise as well as soaking-washing with Chinese medicinal herbs, 3 weeks for both. Five evaluation standards were used in this research, which were grip strength, patient-rated wrist evaluation (PRWE), Gartland and Werley wrist score, self-rating anxiety scale(SAS) and the overall curative effect evaluation. Before treatment(baseline), after 3 weeks of treatment and 3 months after fracture were the three points in time when collected the data. RESULTS: After 3 weeks of treatment and 3 months after fracture, the test group had a significantly better results than those of control group in the PRWE, G-W wrist score and the overall curative effect evaluation(P<0.05). In terms of grip strength recovery, after 3 weeks of treatment, the intergroup difference between the test group and the control group were statistically significant relative to the baseline regarding grip strength of ipsilateral wrist by group t-test(P<0.05). However, the test group and the control group had no statistically significant relative to the baseline at 3 months after fracture in grip strength(P<0.05). For the anxiety of patients, compared with the test group and control group at before and after rehabilitation treatment, the anxiety of both test group and control group cases was eased(P<0.05). However, The degree of anxiety relief in test group and control group cases had no difference(P>0.05). CONCLUSIONS: The TCM synthetic rehabilitation therapy has better curative effects on the treatment of functional disability of wrist joints after distal radius fractures than the general therapy of soaking-washing with Chinese medicinal herbs and functional exercise.

Luxación aislada del escafoides / Isolated Dislocation of the Scaphoid

El funcionamiento armónico de la mano desempeña un papel fundamental para el desarrollo de la vida del hombre. En la sociedad moderna las lesiones a este nivel, a pesar de su baja incidencia, son causa frecuente de discapacidad funcional. Se presenta un paciente blanco, masculino, de 38 años, atendido por el Servicio de Urgencias tras un trauma de alta energía con hiperflexión forzada de la muñeca. Se diagnostica una luxación aislada del escafoides que se reduce bajo anestesia con ayuda del intensificador de imágenes. Se inmoviliza por 6 semanas con férula braquial, tomando primer dedo, y posteriormente comienza el proceso de rehabilitación. El tratamiento oportuno y adecuado de la afección mencionada es indispensable para obtener los mejores resultados en la recuperación funcional(AU)

The orderly functioning of the hand plays a key role for the development of human life. In modern society injuries at this level are a frequent cause of functional disability, despite its low incidence. A case of a white, male patient, 38, attended by the emergency department after a high-energy trauma with forced hyperflexion of the wrist is presented here. An isolated dislocation of the scaphoid is diagnosed and it is reduced under anesthesia using the image intensifier. It is immobilized for 6 weeks with brachial splint, taking first finger, and then the rehabilitation process begins. The timely and proper treatment of this condition is essential to obtain the best results in functional recovery.

The effectiveness of passive physical modalities for the management of soft tissue injuries and neuropathies of the wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

OBJECTIVE: The purpose of this systematic review was to determine the effectiveness of passive physical modalities compared to other interventions, placebo/sham interventions, or no intervention in improving self-rated recovery, functional recovery, clinical outcomes and/or administrative outcomes (eg, time of disability benefits) in adults and/or children with soft tissue injuries and neuropathies of the wrist and hand. METHODS: We systematically searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials, accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text, accessed through EBSCO host, from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best evidence synthesis principles. RESULTS: We screened 6618 articles and critically appraised 11 studies. Of those, 7 had low risk of bias: 5 addressed carpal tunnel syndrome (CTS) and 2 addressed de Quervain disease. We found evidence that various types of night splints lead to similar outcomes for the management of CTS. The evidence suggests that a night wrist splint is less effective than surgery in the short term but not in the long term. Furthermore, a night wrist splint and needle electroacupuncture lead to similar outcomes immediately postintervention. Finally, low-level laser therapy and placebo low-level laser therapy lead to similar outcomes. The evidence suggests that kinesio tape or a thumb spica cast offers short-term benefit for the management of de Quervain disease. Our search did not identify any low risk of bias studies examining the effectiveness of passive physical modalities for the management of other soft tissue injuries or neuropathies of the wrist and hand. CONCLUSIONS: Different night orthoses provided similar outcomes for CTS. Night orthoses offer similar outcomes to electroacupuncture but are less effective than surgery in the short term. This review suggests that kinesio tape or a thumb spica cast may offer short-term benefit for the management of de Quervain disease.

The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

OBJECTIVE: The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology. RESULTS: We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits. CONCLUSION: The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.

A randomized clinical controlled study comparing the effect of modified manual edema mobilization treatment with traditional edema technique in patients with a fracture of the distal radius.

STUDY DESIGN: Randomized controlled clinical trial. INTRODUCTION: Manual edema mobilization (MEM) is a method of edema reduction based on the lymphatic system's ability to drain and resolve subacute edema. PURPOSE OF THE STUDY: To investigate the effect of a modified MEM approach and compare it with a traditional edema technique in patients with subacute hand/arm edema after a distal radius fracture. METHOD: The patients were randomized into one of two treatment groups: a group that received traditional edema treatment and a group that received a modified MEM treatment. All patients were examined for edema, active range of motion (AROM), pain, and activities of daily living (ADL). The number of edema sessions and the number of all sessions were counted. RESULT: No statistically significant changes were observed in edema reduction, AROM, pain, and ADL at six and nine weeks between the treatment groups. A statistically significant improvement was observed in ADL after three weeks after inclusion (p=0.03) in the modified MEM group compared with the control group. Furthermore, fewer edema treatment sessions were needed (p=0.03) in the modified MEM group. At six weeks, we observed a difference between the two groups' needs for further edema treatment (p=0.04). CONCLUSION: Neither the traditional nor the modified MEM treatment program was superior in terms of edema reduction, although the modified MEM resulted in fewer sessions to decrease subacute hand/arm edema compared with using traditional edema reduction techniques in patients after distal radius fracture. LEVEL OF EVIDENCE: 1.

Case study: musicians' playing-related injuries.

Professional and student musicians are at high risk of acquiring a playing-related injury at some point in their careers. Yet, specialized healthcare for musicians is scarce and expensive for most self-employed musicians. Diagnosing these injuries is challenging, and simply taking a break from an activity that has caused physical problems does not address the ergonomic and biomechanic causes of the problem. Under these circumstances, it is not surprising that musicians are reluctant to seek care, and when they do, lack trust in the care that is provided to them. This article is a case presentation of the experiences of a graduate student musician studying performance at a North American university. A narrative style is used to reflect the quality and nature of experiences this musician encountered, followed by a discussion of how to advance a more participatory and holistic approach to enabling return to function.

Mirror therapy in a patient with a fractured wrist and no active wrist extension.

We report a patient in whom mirror therapy, training moving both hands while watching the reflection of the present or good hand in a parasaggital mirror - a method used for phantom limb and stroke patients - was extremely useful after a fractured wrist with good passive, but no active, extension.

Flexores. Avances en fisioterapia / Flexor muscles. Advances in physical therapy

Introducción. A pesar de contradecir técnicasde rehabilitación tradicionales en las que se inicianlos ejercicios pasivos para posteriormente pasara los activos, con este protocolo se pretende inmovilizarselectivamente las articulaciones más proximalespermitiendo una movilización activa de la articulacióndistal.Material y método. Hemos documentado las lesionestendinosas traumáticas tratadas en nuestro centromediante movilización activa inmediata, comparandolos resultados con un grupo control en el que se haefectuado un protocolo de movilización pasivainmediata.Conclusiones. La utilización de esta técnica permitesolucionar tres problemas simultáneamente: a) resolverla debilidad articular y de tejidos blandos; b) cambiar el patrón de movilidad activa haciéndolo más productivo,y c) movilizar el edema crónico. Cuando se intenta disminuir el estrés de una articulación mediante la utilización de ortesis fijas, estamos dando origen a una debilidad que no puede ser tratada mediante movilizaciones pasivas. Sólo se han documentado efectos negativos de la movilización pasiva; además, una mejora del movimiento pasivo no se corresponde con una mejora de la movilidad activa. Los patrones anormales de movimiento originan cambios en la corteza somatosensorial. La recuperación de la movilidad abarca una rehabilitación mecánica y una reeducación de lospatrones normales de movimiento en la corteza.El empleo de esta metodología nos permite crearpatrones de movimiento deseados sin que aparezcanmovimientos compensatorios

Introduction. In spite of contradict techniques oftraditional rehabilitation where passive exercises arebegun in order to go to the active ones later, this protocol is expected to inmobilize selectively the most proximal articulations permiting an active mobilization of the distal articulation.Material and method. we have documented thetendinous injuries treated in our centre by inmediateactive mobilization and we have checked the results witha controlled group followed by immediate passivemobilization.Conclusions. the use of this technique,allows us to solvethree problems simultaneously. a) To solve the articularweakness and soft tissues; b) to change the active mobility pattern becoming more productive, and c) tTo mobilize the chronic oedema. When it is tried to reduce the stress of an articulation through the use of fixed orthosis, we are provoking a weakness of the passive mobilization which cannot be treated with passive mobilizations.Only negative effects have been researched, also a better passive movementwhich does not correspond with a better active mobility.The abnormal patterns of movement provoke changes atthe somesthetic cortex level. The recovery of the mobility cover a mechanic rehabilitation and normal patterns of movement rehabilitation at the cortex level.Using this methodology allows us to create movementpatterns wanted without the appearance of compensatorymovements

[Physical therapy treatment of distal radius fractures]. / Krankengymnastische Behandlung der distalen Radiusfraktur.

Physiotherapy of fractures of the distal radius is a concomitant treatment, not only after-care, of conservative and operative fracture therapy. Its aim is to avoid muscular atrophy and contraction and to improve circulation. For these reasons physiotherapy should begin shortly after fracture treatment and should include active mobilisation of the fingers, the elbow and the shoulder joints, as well as isometric exercises and neurophysiological physiotherapy. Physicotherapy (local ice treatment, electrotherapy, ultrasound treatment) can support physiotherapy.

Rehabilitation of an electrical burn patient through thermal biofeedback.

A 22-year-old male subject, with high-voltage electrical burns to one wrist, utilized differential relaxation and visual biofeedback to increase skin temperature in the damaged hand. Through 14 thermal biofeedback and passive relaxation sessions, the subject was able to produce temperature increases in his damaged hand of up to 21 degrees F, which considerably diminished the pain. Healing, feeling, and movement control seemed to progress with extreme rapidity, suggesting that axoplasmic transport was greatly enhanced.