An overview of rehabilitation approaches for focal hand dystonia in musicians: A scoping review.

OBJECTIVE: To provide a comprehensive overview of rehabilitation treatment strategies for focal hand dystonia (FHD) in musicians, examining their evolution and effectiveness. DATA SOURCES: A systematic search of five databases, PubMed, PEDro, Cochrane Library, Trip, and Google Scholar, to identify relevant articles on FHD rehabilitation. The last search was performed on 20 December 2023. METHODS: Inclusion criteria were applied to 190 initially identified articles, resulting in 17 articles for review. Exclusions were made for duplicates, irrelevant titles, abstracts, and non-rehabilitation interventions. RESULTS: Ten different rehabilitation approaches were identified over 20 years. While no definitive intervention protocol exists, a multimodal approach is commonly recommended. CONCLUSIONS: This scoping review underscores the diversity of rehabilitation strategies for FHD. It suggests the potential of multimodal approaches, emphasizing the need for further large-scale clinical efficacy studies.

Evidence for exercise therapy in patients with hand and wrist tendinopathy is limited: A systematic review.

BACKGROUND: Several studies reported the efficacy of exercise therapy in hand and wrist tendinopathy. However, no systematic review synthesized the effect of exercise therapy on these patients. PURPOSE: This study aimed to perform a systematic review to summarize evidence if exercise therapy may be considered an effective treatment in conservative management for patients with hand and wrist tendinopathy. STUDY DESIGN: This was a systematic review. METHODS: A literature search in MEDLINE, Cochrane Library, PEDro, and Embase was conducted from their inception until April 10, 2022. Two independent reviewers included the studies administering exercise therapy in patients with hand and/or wrist tendinopathy in the review and extrapolated the data. Methodological quality was assessed using the framework developed by Murad et al for case reports and case series and the PEDro score for clinical trials. RESULTS: Seven case reports, 3 case series, and 2 randomized controlled studies were included and methodologically evaluated, obtaining a low score for all the analyzed studies. The total number of included patients in the analyzed studies was 106, of which 54 were female, 13 were male, and 39 were not specified. The type of exercise was widespread and often not really well described: it varies from eccentric forearm training to mobilization with movement, passing through strengthening exercises, grip proprioception training, and self-management exercises according to the McKenzie method. The dosage was often not precise, making it difficult to reproduce the therapeutic proposals. Exercise therapy was always administered together with different treatments; therefore, its efficacy alone is difficult to distinguish, although in some cases, the patients improved pain and functionality. CONCLUSIONS: Evidence on the efficacy of exercise therapy in patients with hand and wrist tendinopathies is limited. Future research is strongly recommended to determine the appropriate dosage of the exercise therapy to determine clinical changes in these patients.

A case report: Pain in the hand and tingling of the upper limb may be a symptom of a schwannoma in the supraclavicular region.

INTRODUCTION: Schwannomas, or neurilemmomas, are rare benign nerve sheath tumors primarily originating from peripheral nerves. Brachial plexus schwannomas, constituting approximately 5 % of cases, present a diagnostic and surgical challenge due to their rarity and the complex anatomy of the brachial plexus. CASE PRESENTATION: We present the case of a 51-year-old man who visited our physiotherapy clinic with a two-year history of intermittent pain and tingling in the fourth and fifth metacarpals of his non-dominant hand (Numeric Pain Rating Scale 2/10). The pain was nocturnal and resistant to various treatments. Physical examination did not reveal "red flag" symptoms. Considering the persistent and atypical nature of the symptoms, further diagnostic investigations, including an ultrasound of the supraclavicular region, were recommended. CLINICAL DISCUSSION: Our case report emphasizes the importance of considering brachial plexus schwannomas in patients with prolonged and unconventional symptoms in the fourth and fifth digits, accompanied by supraclavicular swelling and a positive Tinel's sign. Comprehensive diagnostic evaluation is crucial to confirm or rule out a schwannoma in the supraclavicular area. The rarity of such tumors and the intricate brachial plexus anatomy require meticulous diagnostic and surgical approaches. CONCLUSIONS: This case adds to the growing understanding of brachial plexus schwannomas and their diagnostic complexities. Our report underscores the significance of recognizing these tumors in patients with distinct symptomatology and highlights the need for detailed diagnostic assessments and surgical planning.