Supporting work participation for adults with hand and upper limb conditions: A survey of the British Association of hand therapists.

Introduction: Musculoskeletal disorders affect over a third of the UK adult population and are a common reason for sick leave from work. The aims of this study were to describe the reported provision of work participation support for adults with hand and upper limb conditions by UK hand therapists, and to identify potential training needs in this area. Methods: A previous survey of the Australian Hand Therapy Association was adapted for the UK. The electronic questionnaire was distributed to members of the British Association of Hand Therapists. Eligible individuals were UK-based occupational therapists or physiotherapists whose role included the assessment and/or treatment of patients ≥18 years with hand or upper limb issues. Results: There were 123 participants (17% response rate). The most frequently reported work participation interventions were discussing graded return to work and sign-posting patients to speak with their doctor. The Allied Health Professionals Health and Work Report and Fit Note were not regularly used, and respondents reported low levels of confidence in issuing these documents. Barriers to providing work recommendations included a perceived lack of time, skills, knowledge and training. Facilitators included the patient discussing work as a rehabilitation goal. Conclusion: Development opportunities for UK hand therapists include increasing patient awareness that they can ask for work-related advice and documentation, promoting existing health and work training, developing hand therapy-specific resources, and ensuring access to electronic Fit Notes. International opportunities include the continuation of this survey with a focus on generating exemplar work participation strategies to inform further research.

Pre-operative hand therapy management of Dupuytren's disease: A systematic review.

Introduction: Dupuytren's Disease is a fibroproliferative disorder of the hand, with a heterogenous pathogenesis, ranging from early-stage nodule development to late-stage digital contractures. Hand therapy intervention is not routinely provided pre-operatively. The objective of this systematic review was to explore the efficacy of hand therapy interventions provided for pre-operative Dupuytren's Disease. Methods: A systematic review was undertaken of the databases CENTRAL, CINAHL, OVID Medline and OVID EMBASE, PubMed, BNI, Web of Science, with grey literature and reference searches conducted from database inception to April 2022, and confirmed in August 2023. Included studies required non-surgical intervention and outcome data on individuals with Dupuytren's Disease who have not had surgical intervention. Two reviewers conducted the searches, independently assessed eligibility and completed methodological quality assessments. Data were summarised narratively. Results: Seventeen studies were selected for final inclusion. Interventions included Extracorporeal Shockwave Therapy (ESWT), Corticosteroid Injection (CSI), Splinting, Massage and Stretching, Ultrasound Therapy (US), Temperature Controlled High Energy Adjustable Laser (THEAL). ESWT positively maintained or improved pain, active range of motion (AROM), Disabilities of the Arm Shoulder, and Hand (DASH) scores, and grip strength. US positively maintained or improved ROM and grip. Splinting positively maintained or improved ROM, CSI positively improved nodule size. Cross Frictional Massage positively impacted AROM and THEAL improved pain and DASH scores. Conclusions: Outcomes from therapeutic interventions for pre-operative management of Dupuytren's Disease were largely positive. However, there is a need for further high-quality research into these interventions to understand their full potential for the management of Dupuytren's Disease.

Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study.

Introduction: There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activities; (iii) what wound care and rehabilitation advice should be provided after CTR. Methods: We developed consensus recommendations from an expert panel of hand surgeons, primary care surgeons and hand therapists using an electronic Delphi process. Participants were recruited from clinical organisations using pre-defined criteria. Delphi questionnaires included open text and tick-box responses. Consensus was defined as ≥75% agreement and summary feedback was provided after each round. Results: There were 33 panellists (21 surgeons and 12 hand therapists), of which 27 (82%) completed all rounds. Expected return to driving was agreed as 5-14 days. Expected timescales were also agreed for return to seven selected occupational activities. Post-operative advice focused on using and moving the hand, rather than specific rehabilitation. While consensus was reached for most items, there were important areas of disagreement, including divergent views on driving with sutures in situ and the need to inform car insurers. Conclusion: Recommendations from this study expand on existing advice by including functional descriptors for occupational activities and guidance timescales generated through a formal consensus process. Areas where consensus was not reached warrant further exploration to assess whether different practices impact clinical and functional outcomes for patients.

A randomised controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain.

STUDY DESIGN: Multicentre, double-blind, placebo-controlled randomised clinical trial. OBJECTIVES: To compare the effectiveness of long chain omega-3 polyunsaturated fatty acids (PUFAs) as part of the management for people diagnosed with rotator cuff related shoulder pain (RCRSP). SUMMARY OF BACKGROUND: Although there is no robust evidence to support their use, omega-3 PUFAs have been recommended for those with tendinopathy due to their potential to moderate inflammation. METHODS: Participants with RCRSP (n=73) were randomised to take either nine MaxEPA capsules providing 1.53 g eicosapentaenoic acid, 1.04 g docosahexaenoic acid or nine matching placebo capsules containing oleic acid per day for 8 weeks. In addition, participants attended an exercise/education programme for 8 weeks. Participants were assessed at prerandomisation, 8 weeks (primary outcome point), 3 months, 6 months and 12 months (secondary outcome point). Primary outcome was the Oxford Shoulder Score (OSS). Secondary outcomes included the Shoulder Pain and Disability Index (SPADI), Patient Specific Functional Score, Euro Qol 5D-3L, Short Form 36, global rating of change and impairment measurements. Analysis was by intention to treat. RESULTS: Difference in the change in the OSS between the two groups at 2 months was -0.1 (95% CI -2.6 to 2.5, p=0.95). The change in SPADI scores was -8.3 (95% CI -15.6 to -0.94, p=0.03, analysed by analysis of covariance adjusted for baseline) at 3 months. CONCLUSION:  Omega-3 PUFA supplementation may have a modest effect on disability and pain outcomes in RCRSP.

A randomized controlled trial of manual therapy and pneumatic compression for recovery from prolonged running - an extended study.

Manual therapy (MT) and intermittent pneumatic compression (IPC) are recovery methods used by endurance athletes with little evidence supporting effectiveness. This randomized controlled trial evaluated effectiveness of four daily post-race treatments of a specific MT protocol and IPC compared with supine rest on recovery following an ultramarathon among 56 ultramarathoners. Groups were comparable across all characteristics examined, including post-race plasma creatine kinase concentration. Subject completed timed 400 m runs before the race and on days three, five, seven and 14 post- race, and also provided muscle pain and soreness ratings and fatigue scores immediately before and after treatments, and during the 14 days post- race. Daily subjective measures and 400 m run times were not improved by either treatment, but both treatments reduced (p < .05) muscular fatigue scores acutely after treatment following the race and on post-race day 1, and MT improved (p < .05) muscle pain and soreness acutely following the race.

Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Research has shown that associative factors for CTS include occupational and biomechanical elements, sex, and age. To date, no systematic review has been undertaken to determine specifically whether there are any psychosocial risk factors in developing CTS. The objective is to determine whether psychosocial factors are associated with and/or predict the development of CTS. METHODS: A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE, and CINAHL from inception to May 30, 2017. Quantitative studies must have investigated a minimum of 1 or more psychosocial factors-cognitive, affective, behavioral, vocational, or interpersonal processes (eg, social support)-and include a point or risk estimate. One reviewer conducted the search and 2 reviewers independently assessed eligibility and completed methodological quality assessment using a modified Downs and Black checklist. Data were analyzed narratively. RESULTS: Six moderate- to high-quality studies were included in the final review. Five studies reported a positive association between psychosocial factors and CTS, where psychosocial factors were more in those who reported CTS. One study reported no positive or negative association with CTS development. Four studies reported a negative association between psychosocial factors and CTS, where psychosocial factors were less in those who reported CTS. CONCLUSIONS: There is limited evidence for a positive association between psychosocial factors and CTS. However, this was not a consistent finding across all included studies. Further research is indicated in standardizing CTS diagnostic criteria and investigating other working environments.

Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: A qualitative study.

STUDY DESIGN: Qualitative study. INTRODUCTION: Adherence is paramount to the successful outcome of exercise-based treatment. PURPOSE OF STUDY: The barriers and enablers to adherence to a home- and class-based exercise program were explored in this qualitative study. METHODS: Semi-structured interviews were carried out to establish common themes relating to the participants' experiences during a year-long randomized controlled trial. RESULTS/DISCUSSION: Twelve participants were interviewed. The main enablers to exercise were highlighted as equipment, perceived benefit from the exercises, and longer and more intensive monitoring. Barriers included the lack of motivation, lack of equipment, and pain. CONCLUSIONS: Implications for practice are incorporating enablers and addressing barriers including self-discharge from classes; the importance of longer term follow-up and the benefits of adopting exercise into a well-established routine may provide potential benefits. LEVEL OF EVIDENCE: N/A.

Hand-held nerve conduction device in carpal tunnel syndrome: a prospective study.

INTRODUCTION: We assessed the clinical impact of replacing standard neurophysiologic testing with a hand-held device (Mediracer) for diagnosis of carpal tunnel syndrome (CTS). METHODS: One hundred patients (200 hands) with suspected CTS were studied by blinded assessors [Hand-therapist (HT)1 and Consultant Neurophysiologist] using the Mediracer, followed by standard neurophysiologic testing. To simulate testing by personnel without neurological training, Mediracer recordings were analyzed separately by an assessor who had not seen the patients (HT2). RESULTS: Correlation of the CTS grades was 0.94 for the results obtained by HT1, and 0.87 for HT2. The sensitivity and specificity of the Mediracer was 0.85 and 0.9, respectively, by HT1, and 0.84 and 0.89 for HT2. Nine patients had conditions other than CTS, and 35 patients were judged to require further investigation. CONCLUSIONS: The Mediracer should only be used in patients with typical CTS symptoms and signs and no muscle wasting who have had careful neurological assessment.

Rotation in the interphalangeal thumb joint in vivo.

PURPOSE: To investigate rotation at the thumb interphalangeal (IP) joint in vivo to optimize the position of fusion of this joint. METHODS: Standardized photographs were taken of 176 thumbs end-on (88 asymptomatic volunteers) placed on a custom-made splint with the IP joint at 40 degrees . Three blinded investigators measured rotation at the IP joint from these photographs as the angle between a line aligning the eponychial folds and a line aligning the proximal phalanx condyles. Gender, age, hand dominance, and type of occupation of the asymptomatic vounteers were recorded. RESULTS: The variable pronation at the IP joint of the thumb (range, 0 degrees to 12 degrees) was significantly greater on the left than right (p=.001), although the actual difference was only 1 degrees . In subjects who performed fine dexterous work, thumb IP joint pronation was significantly less than in subjects who performed administrative or manual work (p=.009), but we found no statistical difference between manual and administrative groups. There was no correlation between thumb IP joint rotation and hand dominance (p=.2), age (p=.4) or gender (p=.5). CONCLUSIONS: There is functional pronation at the IP joint of the thumb. We propose that this should be taken into account when performing arthrodesis on the joint or designing a joint replacement. The degree of rotation may be associated with occupation.

Rotator cuff tendinopathy: is there a role for polyunsaturated Fatty acids and antioxidants?

Despite the lack of robust evidence, there has been a steady increase in the use of dietary supplements, including Omega 3 fatty acids and antioxidants, in the management of musculoskeletal conditions. One reason for this is that unsatisfactory outcomes with conventional treatments have lead sufferers to seek alternative solutions including the use of nutritional supplements. In the United Kingdom alone, the current supplement market is estimated to be over 300 pounds million per annum. One target market for nutritional supplements is tendinopathies including conditions involving the rotator cuff. This condition is debilitating and associated with considerable morbidity. Incidence increases with advancing age. High levels of cytokines, such as the pro-inflammatory interleukin 1 beta and vascular endothelial growth factor, have been reported within the bursa of patients with rotator cuff disease. There is also evidence that high concentrations of free-radical oxidants may also be involved in tendon pathology. Therefore, the possibility exists that dietary supplements may have a beneficial effect on tendon pathology, including that of the rotator cuff. A review was conducted to synthesize the available research literature on the histopathology of rotator cuff disease and the effectiveness of polyunsaturated fatty acids (PUFAs) and antioxidants on tendinopathies. A search was conducted using the MEDLINE, CINAHL, AMED, EMBASE, Cochrane, and PEDro databases using the terms "rotator cuff" and "tear/s" and "subacromial impingement syndrome," "burase," "bursitis," "tendinopathy," "tendinitis," "tendinosis," "polyunsaturated fatty acids," "PUFA," "Omega 3," "histopathology," "etiology," and "antioxidants." English language was an inclusion criterion. There were no randomized clinical trials found relating specifically to the rotator cuff. Only one trial was found that investigated the efficacy of PUFAs and antioxidants on tendinopathies. The findings suggest that some (low level) evidence exists to support the supplementation in the management of tendinopathies. Any conclusions based on this one article should be reached with caution. Subsequently, there is a distinct and clear need for well-planned randomized controlled trials that aim to investigate the efficacy of supplements in the management of tendinopathies including those of the rotator cuff.

A study to examine patient adherence to wearing 24-hour forearm thermoplastic splints after tendon repairs.

Adherence is believed to be essential in ensuring a successful clinical outcome. There is a paucity of research available investigating adherence and the effect of nonadherence in hand therapy. This study was conducted to investigate adherence relating to acute hand flexor and extensor tendon injuries. This exploratory descriptive study used a self-report questionnaire. Eighty subjects were recruited four weeks after flexor or extensor tendon repair to complete the anonymous questionnaire. Descriptive statistics were used to analyze the patient group profile. Chi-square test was used to determine any associations between patient profile and adherence. Seventy-six questionnaires were completed and this constitutes a return rate of 95%. Sixty-seven percent of patients reportedly removed their splints, commonly to wash and dress. No significant correlation (p < or = 0.0001) was found between patient profile and nonadherence. Two thirds (67%) of patients report to being nonadherent to their splinting regime, removing their splint after flexor and extensor tendon repairs.