Outcomes of "Over the Top" Anterior Cruciate Ligament Reconstruction Associated with a Lateral Extra-Articular Tenodesis in Children.

(1) Purpose: The incidence of anterior cruciate ligament (ACL) ruptures in children and adolescents has considerably increased during the last decades due to higher levels of competitive athletic activity, and early sport specialization and professionalization. Contemporary ACL reconstruction techniques have recently been subject to renewed interest in this population. The objective of this study is to report the short- and mid-term results of our physis-sparing ACL reconstruction technique using an "over the top" technique associated with a modified Lemaire procedure. (2) Methods: A retrospective series of 12 junior soccer players who presented to our clinic with a torn ACL between January 2019 and September 2021 was reviewed. The inclusion criteria were patients under 15 years with open tibial and femoral physes, with a stable contralateral knee, a minimum follow-up of 6 months, and a time frame from injury to surgery of <3 months. Patients with previous knee surgery, structural concomitant injuries, muscular, neurological, or vascular abnormalities, or hypersensitivity to metal alloys were excluded. The functional evaluation was performed using the International Knee Documentation Committee (IKDC) rating, Lysholm score, and Tegner activity level. Moreover, clinical and radiological assessments were also performed, including KT-1000 and knee X-rays. (3) Results: We identified 1 female and 11 male patients with ACL tears, with a mean age of 13.17 ± 0.9 months. Concomitant injuries include isolated vertical and bucket-handle tears of the medial meniscus, lateral meniscus tears, bilateral tear of both menisci. The mean follow-up time was 26 ± 12.6 months. The average IKDC, Lysholm and Tegner scores were 93.29 ± 11.04, 95.08 ± 13.2 and 9 ± 0.0 points, respectively. The average KT-1000 score of the participants was 0.96 ± 1.6 points. None of the included patients reported post-surgical complications or required additional surgeries. (4) Conclusions: Our novel ACL reconstruction with LET technique is a safe procedure that resulted in good clinical outcomes, lower failure rate and return to sports in skeletally immature patients.

Anterior cruciate ligament ruptures in Spanish soccer first division: An epidemiological retrospective study.

BACKGROUND: Anterior cruciate ligament (ACL) injury is a severe and complex sport-related injury that can threaten an individual's sporting career. The purpose of this study is to investigate the epidemiological patterns of ACL ruptures in Spanish male first-division soccer players. METHODS: The Transfermarkt and Besoccer online electronic databases were screened for ACL injuries between 2010-2011 and 2019-2020 seasons. Injury incidence, injury mechanism, side of the injury, recurrence of the injury, days of recovery and severity, player's position, dominance, season, and moment in which the injury occurs were collected. RESULTS: A total of 110 ACL ruptures were registered, with 15.45% of them being re-ruptures either ipsilateral (6.36%) or contralateral ruptures (9.09 %). The ACL incidence rate was 0.0364 per 1000 h of total play with a 68-fold risk in matches compared with training. Predominant injury mechanism was non-contact (56.36%) and the mean lay-off time was 218.8 days, with higher incidence in September-October and March-April. Goalkeeper was found to be the less affected position. CONCLUSIONS: This investigation identified an average of 11 ACL tears per season in the Spanish first-division soccer league, most of them occurring in matches with approximately one ACL injury per team every two seasons. Our results from media-based platforms are in accordance with reports based on data from healthcare databases. Further research is needed to corroborate these findings in equivalent contexts. Descriptive studies are classified as Level III evidence according to Daly et al., 2007.

Proprioceptive Neuromuscular Facilitation Protocol for Thumb Osteoarthritis: A Pilot Study.

BACKGROUND: Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint often presents with joint instability and proprioceptive deficits. Proprioception has been found to play an important role in the rehabilitative process. The purpose of this study was to evaluate the effectiveness of a proprioceptive training program on pain and function in individuals with early-stage thumb Carpometacarpal joint OA. METHODS: A double-blind experimental trial using a 2-group pretest/posttest design was used in this pilot study. Participants had a diagnosis of grade I and II thumb CMC joint OA in their dominant hand and a pain rating of >4/10 on Visual Analogue Scale. Participants received either standard treatment (control group) or standard treatment plus a proprioceptive training program (experimental group). Outcome measures were lateral pinch strength, pain intensity during activities, and proprioceptive response via joint position sense (JPS) testing. RESULTS: Twelve individuals (average age of 66.25 years) participated. Both groups had a statistically significant decrease in pain and increase in lateral pinch strength, all occurring with a large effect size but no statistically significant difference between groups. The experimental group experienced a large effect size for JPS testing, whereas the control group experienced a trivial effect size, and there was a statistically significant difference between groups for JPS testing. CONCLUSIONS: Individuals who completed the proprioceptive training program in this study had an improvement in proprioceptive functioning. This program shows potential for routine inclusion in hand therapy for thumb CMC joint OA; however, additional high-level studies with larger sample sizes are required.

Translation, Linguistic Validation, and Readability of the Spanish Version of the VISA-H Scale in Elite Athletes.

Background: Data regarding the diagnosis of Proximal Hamstring Tendinopathy (PHT) is limited. There is a need for a standardized, valid, and reliable instrument for evaluating PHT among Spanish population. The purpose of this study was to linguistically validate and cross-culturally adapt the Spanish version of the VISA-H for Spanish population and to assess its readability, initial feasibility, appropriateness and acceptability. Methods: Cross-cultural adaptation was done according to established guidelines. Process included 5 steps: independent translations, synthesis of the translations, back-translations, expert committee, and pre-test. The linguistic validation of the questionnaire followed a standard methodology that included comprehension test interviews to assess the relevance, understanding and acceptability of the VISA-H. Comprehension was analyzed with cognitive interviews of 18 Spanish Professional basketball and soccer players (n = 8 male, n = 10 female end-users, healthy individuals at risk), using think-aloud and probing techniques. Results: All subjects (18/18) reported that the items were clear and did not cause upset. Additionally, every respondent had no difficulty in completing the form and found it fairly easy. No difficulties with the instructions were reported. Readability score resulted in adequate levels of understanding (Fernandez-Huerta score of 67.5), showing high level of acceptability. Conclusion: The results of the linguistic and semantic validation conducted with health risky population enable the identification that the Sp-VISA-H was well accepted and easily understood by the participants. Further testing on PHT patients is needed to corroborate these preliminary data.

Platelet-rich plasma in the management of trigger finger: A case report.

Platelet-rich plasma (PRP) has emerged as a viable therapeutic alternative for a number of clinical applications and has potential benefit for use in trigger finger. However, PRP use has not been previously reported for this condition. We report a 63-year-old woman sustaining a refractory trigger finger after a series of three PRP injections over a 2-week period. There was resolution of triggering, with no symptom recurrence at 3-month follow-up. On the basis of this report, we can assume that the treatment of trigger finger with PRP is a promising therapeutic option to be further explored with larger samples and high-quality studies.

Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series.

Meniscal injuries are among the most frequently encountered conditions in the knee joint. Therapeutic approaches are diverse and are largely dependent on the extent and location of the injury. The purpose of this study was to describe the clinical and functional outcomes of an intraarticular and percutaneous platelet-rich plasma (PRP) injection regime in patients with stable meniscal injuries. Demographics, the type of tear, affected knee, surgical procedure, type of intervention, follow-up period, and outcomes were recorded in all cases. Patient-reported outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale. Overall patient satisfaction, quality of life, and pain intensity were also assessed. A total of 38 cases (8 females) had sustained a stable meniscal lesion (32 medial, 6 lateral) and met the inclusion criteria. All of them received three intraarticular and percutaneous PRP injections. Patients receiving the PRP injection regime reported clinically (p = 0.000) and functionally (p = 0.000 and p = 0.001) significant improvement in all outcome measures during this interval. All patients reported they were very satisfied or satisfied with the outcome. The results of this study suggest that the treatment of stable meniscal injuries with percutaneous-intraarticular PRP injections can achieve a significant clinical and functional improvement.

Immediate effects of myofascial release on neuromechanical characteristics in female and male patients with low back pain and healthy controls as assessed by tensiomyography. A controlled matched-pair study.

BACKGROUND: Low back pain (LBP) is a major health issue in most industrialised countries. Lumbodorsal fascia has been advocated as a potential source of pain in the lumbopelvic region. Myofascial release constitutes a manual therapeutic approach focussing on the restoration of altered soft tissue function. No previous study has focused on quantifying neuromechanical effects of myofascial release on LBP patients through tensiomyography. The purpose of this study was to quantify immediate neuromechanical alterations of myofascial release on patients with LBP and healthy controls through tensiomyography parameters. METHODS: The participants' (n = 30) bilateral lumbar erector spinae muscles were assessed via tensiomyography before and after a 6-min myofascial release treatment of the lumbodorsal fascia to evaluate the muscles' mechanical characteristics. Subjects with LBP (n = 15) were eligible to partake if they reported having had LBP for most days in the past 12 weeks. Muscle displacement (Dm [mm]), velocity of contraction (Vc [mm/s]), and lateral symmetry (Ls [%]) were assessed through tensiomyography testing. FINDINGS: Statistical analyses revealed a significant increase for velocity of contraction in the right (p = .021) and left (p = .041) lumbar erector spinae for the subjects with LBP but not for the healthy controls (both p > .14). INTERPRETATION: We suggested that myofascial release alters neuromechanical characteristics in subjects with LBP. Tensiomyography may be implemented in clinical settings to monitor intervention effects of the myofascial system, especially the tensiomyography parameter velocity of contraction.

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis.

STUDY DESIGN: This is a longitudinal, observational, multicenter, cohort study. INTRODUCTION: Thumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process. PURPOSE OF THE STUDY: The purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient's self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability. METHODS: Eligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after. RESULTS: One hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively. CONCLUSIONS: Although more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient's self-perception and satisfaction in thumb CMC OA.

Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: a systematic review and meta-analysis.

The effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. Previous research supports the use of intra-articular PRP injections to promote a favorable environment for joint tissue healing and to delay the progression of OA. The purpose of this review is to investigate the effectiveness of PRP in the management of hip osteoarthritis (HOA). Five electronic databases were searched from inception to May 2019: Medline (via PubMed), SportDiscus via EBSCO, ProQuest Health & Medical Complete, CINAHL, and Cochrane. Risk of bias was assessed with the Cochrane risk of bias tool. The GRADE method was used to assess the level of evidence for the studies included in this review. Clinical trials evaluate PRP injections among adult patients diagnosed with HOA according to the American College of Rheumatology criteria. At least one outcome measure for pain or function must have been reported. A total of 4 trials (334 participants, 340 hips) were included, all marked as "moderate risk of bias". Pain and function were assessed throughout the studies with visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Harris Hip Score (HHS) tools. Intra-articular PRP injections were more effective at stages earlier than 3 months for both treatment groups with the exception of WOMAC score in one study. The superiority of PRP against comparative treatments was only reported in one study; longer-term evaluations from 4 to 12 months showed diverse results, with only one study reporting significantly better results for PRP. PRP may be beneficial and safe for patients with HOA at mid-term follow-up. However, its superiority over other procedures such as hyaluronic acid remains unclear. Further researches with high-quality designs and larger samples become imperative.

Tendencias en el abordaje posquirúrgico del síndrome del túnel del carpo. Práctica clínica actual / Tendencies in the post-surgical approach for carpal tunnel syndrome. Current clinical practice

ANTECEDENTES Y OBJETIVOS: La evidencia y las pautas para el uso de intervenciones específicas después de la liberación del túnel carpiano son limitadas. El objetivo principal de este estudio fue determinar los diferentes enfoques terapéuticos empleados en la práctica clínica habitual entre los profesionales de diferentes países tras la liberación del nervio mediano en la muñeca. MATERIAL Y MÉTODOS: Se diseñó una encuesta de 15 ítems en lengua inglesa, que fue distribuida por correo electrónico y a través de las redes sociales a profesionales de diferentes países. RESULTADOS: En nuestro estudio identificamos una gran variedad en el abordaje posquirúrgico del síndrome del túnel del carpo en 23 países diferentes. DISCUSIÓN Y CONCLUSIONES: No hay criterios comunes en las técnicas de tratamiento empleadas tras la liberación del nervio mediano en la muñeca

BACKGROUND AND OBJECTIVES: Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. MATERIAL AND METHODS: A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. RESULTS: In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. DISCUSSION AND CONCLUSIONS: There are no common criteria in the techniques used after surgical decompression of the median nerve

Adductor longus injury after electromechanical self-treatment: A case report.

OBJECTIVE: This case report illustrates an unusual cause of hip adductor muscle injury due to overenthusiastic self-treatment of the previously overloaded adductor muscles. Also, post-injury therapeutic objectives and intervention to facilitate rapid participation in sports after the described process are provided. CASE DESCRIPTION: A 27-year old male, professional soccer player presented with hip adductors pain and impairment due to electromechanical self-treatment of the affected area. He was evaluated using hip-strength assessments, self-report, ultrasonography (US), and magnetic resonance imaging (MRI) until complete functional recovery had occurred. Along with clinical presentation, diagnostic imaging showed evidence of an isolated injury to the adductor longus muscle. A well-structured rehabilitation and readaptation program was followed in order to ensure early recovery and optimal functional outcome. OUTCOMES: The athlete was able to participate in a full soccer training session without any limitation 18 days after his self-treatment session. The patient returned to his previous level of performance by 3rd week post-injury. CONCLUSION: To the authors' knowledge, this is the first report of muscle strain due to overenthusiasthic therapy. Although this is a rare complication of self-treatment procedures, patients and therapists should be aware of this risk in order to prevent and rapidly identify the lesion.

Sex-Based Differences in Tensiomyography as Assessed in the Lower Erector Spinae of Healthy Participants: An Observational Study.

BACKGROUND: Although there is mounting evidence on sex-linked differences in paraspinal muscle function, it is unknown whether sex-based variations in mechanical and contractile characteristics of the lumbar erector spinae (LES) can be monitored noninvasively in healthy participants at rest using tensiomyography (TMG). HYPOTHESIS: Sex-specific effects in muscle displacement (Dm) and velocity of muscle deformation (Vd) will be observed via TMG assessed in the LES. STUDY DESIGN: Observational study. LEVEL OF EVIDENCE: Level 3. METHODS: LES response was measured in a relaxed state in 40 healthy adults (20 females). Possible differences between the conditions were investigated using mixed-model analyses of variance. Two-stage hierarchical linear regression analyses were performed to predict the outcome of TMG Dm and Vd based on participant sex. RESULTS: There were significant main effects of sex with large effect sizes for both TMG parameters, resulting from lower mean values in women compared with men (Dm, P < 0.01; Vd, P < 0.01). In contrast, neither the main effect of side (left vs right LES) nor the interaction between the side and sex reached significance (all P > 0.3). Introducing the sex variable in stage 2 of the regression analyses significantly improved the prediction of the TMG parameters (all ∆R2 ≥ 0.18; all P < 0.01; all f2 ≥ 0.29). CONCLUSION: Sex-based differences in muscle stiffness and contractile characteristics could be observed by TMG on LES muscles in healthy individuals at rest. The data suggest that these disparities are not exclusively attributable to anthropometric measures but may be linked to intrinsic sex-based differences in skeletal muscle characteristics. CLINICAL RELEVANCE: We recommend implementing TMG in a clinical setting using the obtained results as a basis to factor for the patient's biological sex when assessing effects of therapeutic/exercise regimens aiming at the optimization of myofascial tissue regeneration and performance.

Apps to prescribe therapeutic exercise among rehabilitating adults: a systematic review.

INTRODUCTION: There is a growing interest across scientific literature on smartphone applications (apps) aiming to modify various health behaviors. Interventions that include behavior change techniques (BCTs) have been advocated to increase their efficacy. The extent to which those techniques are present among apps is unclear. The aim of this review is to analyze the existing apps for prescribing therapeutic exercise (TE) in rehabilitating adults. EVIDENCE ACQUISITION: The study sample was identified through systematic searches in iTunes (Apple) and Google Play (Android). Applications (apps) were assessed according to the taxonomy of BCTs for the presence/absence of these techniques. Mean and ranges were calculated for the number of observed BCTs. Number of techniques observed in free apps in both stores was calculated, but formal statistical were not conducted due to the exploratory nature of this study. EVIDENCE SYNTHESIS: Eighteen apps were identified (11 for iPhone, two for Android, and five for both). The average number of BCT included in the eligible apps was 11 (range 4 to 16), with predominance of four techniques: "request the establishment of behavior" (100% of the apps), "providing instructions" (100%), "requesting an implementation" (100%), and "determine graded tasks" (100%). Techniques such as "taking a behavioral contract," "stress management," "prevention of relapse," and "promote the identification of barriers" were not used in the apps reviewed. CONCLUSIONS: Our work demonstrates that apps prescribing TE among rehabilitating adults applied an average of 11 BCTs. Presence of BCTs varied by app type. No difference in the number of BCTs identified between iOS and Android apps was found.

Tendencies in the Post-surgical Approach for Carpal Tunnel Syndrome. Current Clinical Practice. / Tendencias en el abordaje posquirúrgico del síndrome del túnel del carpo. Práctica clínica actual.

BACKGROUND AND OBJECTIVES: Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. MATERIAL AND METHODS: A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. RESULTS: In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. DISCUSSION AND CONCLUSIONS: There are no common criteria in the techniques used after surgical decompression of the median nerve.

Effects of High-Intensity Laser Therapy on Pain Sensitivity and Motor Performance in Patients with Thumb Carpometacarpal Joint Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVE: To examine the effects of high-intensity laser therapy (HILT) on pain sensitivity and motor performance in patients with thumb carpometacarpal (CMC) osteoarthritis (OA). DESIGN: Prospective, triple-blinded, randomized, placebo-controlled trial. SETTING: Private practice, Malaga, Spain. SUBJECTS: Forty-three patients (mean ± SD age = 71 ± 12 years) with a diagnosis of thumb CMC OA grade 1-2 were randomized to the control group (N = 21) or experimental group (N = 22). METHODS: The experimental group (ExpG) received high-intensity laser therapy (HILT), and the control group (ConG) received a placebo treatment. The outcome measures were pain intensity (visual analog scale) and key pinch strength measurements (dynamometer). All outcome measures were collected at baseline, immediately following the intervention, at four weeks, and at 12 weeks following the intervention. RESULTS: Analysis of variance revealed a group × time interaction (F = 40.8, P < 0.001) for pain intensity, with those patients receiving LT experiencing a greater reduction in pain compared with those receiving placebo therapy at the end of the intervention (P < 0.001), as well as at 12 weeks after the intervention. Although mean values in the ExpG were higher than in the ConG for key pinch at assessment, these differences were not statistically significant. CONCLUSIONS: HILT effectively diminishes pain intensity when used as an isolated treatment for patients with thumb CMC OA, but the effect of treatment decreases after 12 weeks.

Platelet-rich plasma for thumb carpometacarpal joint osteoarthritis in a professional pianist: case-based review.

Thumb carpometacarpal osteoarthritis (TCMC-OA) is a progressively disabling, debilitating condition presenting with thumb base pain and hand functional impairment. Platelet-rich plasma has been used widely for the management of musculoskeletal pathologies, OA being among them. To our knowledge, only a few cases have been previously reported on this topic until now. A 59-year-old male professional pianist presented with chronic, mild onset of right thumb base pain involving a progressive lack of pinch strength in his right hand, and severe difficulties with playing. Three PRP injections were administered to the TCMC joint on a 1-week interval regime. Clinical outcomes were assessed by using the visual analog scale (VAS) for pain, grip and pinch strength, and the Quick-DASH Questionnaire. Functional outcome was excellent according to patient's capability with daily living activities and specific playing demands. At 12 months follow-up, no recurrences or complications were identified, with the musician returning to his previous level of performance 2 weeks before the end of this period. Patient self-reported satisfaction was high and he reported to return to his routine piano activity with no limitations. This case-based review study documents the clinical efficacy of PRP treatment from both functional and perceived-pain perspectives in a professional pianist. Presenting this case, our aim is to draw attention of healthcare providers dealing with TCMC-OA to PRP as a safe, beneficial therapy for this condition which needs further assessment in randomized controlled trials.

The Spanish Version of the Functional Rating Index in Patients With Low Back Pain: Preliminary Results of the Validation Study.

OBJECTIVE: To assess the reliability, validity, and the psychometric properties of the Spanish version of the Functional Rating Index (Sp-FRI) in a preliminary cohort of patients with low back pain (LBP). DESIGN: Prospective observational multicenter study. SETTING: Outpatient physical therapy clinics and units from public and private settings. PARTICIPANTS: Patients with LBP (N=22; 52.5±12.5y) entered the study. INTERVENTIONS: The translation and cross-cultural adaptation were performed following international guidelines through a 5-step procedure. MAIN OUTCOME MEASURES: The Sp-FRI was administered along with the Spanish version of Roland-Morris Disability Questionnaire (Sp-RMDQ) and numeric pain rating scale (NPRS) index. Preliminary testing included readability, comprehensibility, ceiling and floor effects, reliability, and validity. Statistical analysis was based on the Fernandez-Huerta index, and the calculation of Cronbach alpha, intraclass correlation coefficient (ICC), and Spearmans correlation coefficient, respectively. All patients completed the Sp-FRI again after 1-2 days to assess its test-retest reliability. RESULTS: None of the participants requested clarification of any of the items at the time of completion. The test-retest reliability of the FRI score was substantial (ICC 0.77). Cronbach alpha was 0.859. Spearman correlation coefficient between Sp-FRI and Sp-RMDQ was 0.66; P<.0001, and between Sp-FRI and NPRS was 0.66; P<.0001. No ceiling or floor effects were detected. CONCLUSIONS: In light of these preliminary data, the Sp-FRI appears to be linguistically accurate and has been adapted to the Spanish-speaking population. It demonstrated reliability and validity and is suitable for clinical and research use among Spanish patients with LBP, with an acceptable degree of internal consistency and concurrent validity.

Class IV laser therapy for trapeziometacarpal joint osteoarthritis: Study protocol for a randomized placebo-controlled trial.

OBJECTIVE: Osteoarthritis (OA) is a chronic and prevalent joint disorder with great impact on quality of life and high economic burden. Although a number of conservative therapies have proven to be effective for the management of hand OA, only modest treatment effects were reported for most individual interventions. The aim of the proposed study is to assess the effect of Class IV laser therapy (LT) on pain and pinch strength in patients with thumb carpometacarpal (TCMC) OA. METHODS: A randomized, controlled, single-centre, double-blind, clinical trial, with 1:1 allocation ratio, will be carried out involving patients presenting TCMC-OA Grades 1-2 (aged >18 years). Both assessor and statistician will remain blinded. Patients with TCMC-OA will be randomly assigned to the experimental group (will receive LT) and control group (will receive a placebo treatment). Outcome measures will be pain scores at the base of the thumb measured with visual analogue scale (0-10: 0, no pain and 10, worst pain) and changes in pinch strength, both collected at baseline, 4, and 12 weeks. Statistical analyses will be based on an intention-to-treat analysis using the last value forward method. A two-tailed independent Student's t test for the continuous variable of age and baseline scores will be used for comparison of baseline characteristics and outcome variables. Paired Student's t tests will be used to determine the level of significance of the differences between the pretreatment and posttreatment measurements of the individual groups. Repeated measures analysis of variance will be used to determine the differences in time as the within-subjects factor and group as the between-subjects factor. DISCUSSION: To our knowledge, the results of this study will provide the first double-blinded evidence for Class IV LT in patients with TCMC-OA.