Characteristic of Physical and Functional Variables by CTS Severity

POSTER AND CONCURRENT SESSION ABSTRACTS FROM THE IFSHT AND ASHT 2010 MEETINGS REHABILITATION OF A RECONSTRUCTED ROTATOR CUFF: PART 1: A SYSTEMATIC REVIEW; PART 2: A CLINICAL, RANDOMIZED, & FACTORIAL TRIAL Ravindiran Appunni, London Health Sciences Centre & University of Western Ontario, Joy C. MacDermid, David M. Walton, Trevor Birmingham, Roy Jean-Sebastien, Canada Purpose: Clients with surgically repaired rotator cuff tears are commonly rehabilitated by physical therapists. Postoperative regimes are used to guide rehabilitation following rotator cuff repair; however, individual regime guidelines for activity vary considerably. It is unknown whether available regimes are being supported by current scientific evidence. Methods: Electronic databases and a network of clinicians were used to collect available post-surgical rotator cuff protocols. Eleven post rotator cuff repair protocols were identified. The components of the protocols were compared and contrasted. Next, we reviewed the scientific literature related to the effectiveness of entire protocols and specific activities in the protocols. Databases were searched for relevant articles and including April 2009 were located from the MEDLINE, the CINAHL, the AMED, the EMBASE, the Cochrane Database of Systematic Reviews, and the PEDro using the terms ‘‘rotator cuff’’ and ‘‘tear/s’’ and ‘‘exercise’’ or ‘‘physiotherapy’’ or ‘‘physical therapy’’ or ‘‘aquatic therapy’’ or ‘‘rehabilitation.’’ Results: Four independent evaluators appraised the methodological quality of the studies, using established criteria. Differences were resolved by consensus. Total of 43 studies met the inclusion criteria with mixed types of studies (randomized controlled trials, observational case series, cohort studies, and single case studies). All studies were specific to massive rotator cuff tears. Because of the heterogeneity of outcome

measures used, it was not possible to combine results. In all studies, an improvement in outcome scores was reported. Physical therapy programs were well documented all studies. Conclusions: The majority of protocols appear to follow general tendon healing timelines. Scientific evidence was related to the protocol elements was sparse and somewhat inconsistent, but supportive of early gentle mobilization within ROM restrictions. The findings suggest that there is some evidence exists to support the hand therapy in the management of full thickness rotator cuff tears, following surgery. A clinician should consider surgical approach, comorbidities and the patients’ individuality when progressing the patient through the post-surgical rotator cuff rehabilitation. There is a definite need for more, well-planned randomized controlled trials investigating the efficacy of hand therapy in the management of full thickness and massive rotator cuff tears. Relevance: This systematic review is being used to plan a randomized, factorial study, which has following objectives: to determine the effectiveness of different dosages of therapy; the effectiveness of adjunctive hydrotherapy; and whether there is an interaction between therapy dosage and hydrotherapy in patients receiving rehabilitation following rotator cuff reconstruction.

OBJECTIVES 1. The aim of this study was to conduct a systematic review of the literature to determine the efficacy of physical therapy for the management of full thickness rotator cuff tears. 2. The other objective is to review the evidence for rehabilitation following surgery for tears of rotator cuff. 3. We undertook an exploratory study to evaluate the effectiveness of different rehabilitation regimes for post-surgical rotator cuff surgery.

CHARACTERISTIC OF PHYSICAL AND FUNCTIONAL VARIABLES BY CTS SEVERITY Sharon R. Flinn, The Ohio State University, William S. Pease, Miriam L. Freimer, United States of America Purpose: The purpose of the poster is to describe the psychometric properties and relationships between commonly used physical and functional assessments for persons with different levels of severity for carpal tunnel syndrome (CTS). Methods: A cross sectional design was used to evaluate established measures that are used commonly to assess persons will carpal tunnel syndrome. Subjects were assigned to six severity levels based on classifications by Padua. Physical assessments were collected for BMI, wrist diameter, phalens, and Semmes Weinstein monofilaments. Functional assessments included the Levine Symptom Severity Scale and the Flinn Performance Screening Tool. Descriptive analysis, score reliability, and correlational analysis will be conducted. Results: A total of 46 persons were referred to PM&R and neurology clinics for nerve conduction studies to assess their median nerve function. Of this group, 20% had severe or moderate CTS, 35% had mild or minimal CTS, and 45% negative finding for CTS. Score reliability of the functional patient-reported outcomes was ..90. Significant relationships existed between physical and functional variables. Conclusions: The findings of the study suggest that physical and patient-reported functional outcomes are needed to represent a holistic approach to physical and social recovery. Reliable measures are available to evaluate persons with carpal tunnel syndrome. Relevance: Findings from the patient reported outcome measures identify specific functional tasks that are important but difficult to perform

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for persons with CTS. Information from the tests can be used in future studies to assess the risk factors related to carpal tunnel syndrome and to recommend splinting regimes and strategies for activity modification.

OBJECTIVES 1. The first objective evaluates the psychometric properties of commonly reported functional assessments for persons with carpal tunnel syndrome. 2. The second objective describes the physical and functional characteristics of persons with CTS by severity level. 3. The third objective defines the relationship between physical and functional measures for persons with carpal tunnel syndrome.

DUPUYTREN’S CONTRACTURE— THERAPY AND RESULT FOLLOWING PERCUTANEOUS FASCIOTOMY WITH XIAFLEX (COLLAGENASE) Christina E.U. Floodmark, Uppsala University Hospital, Sweden Purpose: Sweden has a high prevalence of Dupuytren’s contracture. Increased diasthesis and decreased hand function is common. Experience of surgical and post-surgical treatment has been collected over many years. Alternative methods such as percutaneous fasciotomy is of interest. A mult-center Phase 3 study was conducted during 2008 in Europe and in the United States to evaluate the efficacy and safety of treatment with Xiaflex. At the Department of Hand Surgery in Uppsala a total number of 36 patients (40 hands) were included. Methods: The patients had different stages of extension deficits of MCP and/or PIP joints from minor (minimum 20 degrees) to severe (finger full flexed in palm with no functional use) in one or more fingers. 32

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men and 4 women aged 37–83 years (mean 63.2) participated. Two senior hand surgeons, one study nurse and one hand therapist followed all patients. The patients received 1–9 injections (mean 1.9 per hand). The study protocol was strictly followed with visits Day 0 (when injection was given), Day 1, Day 7, and Day 30 after each injection. New injection, if needed, was given on Day 30. Follow-ups were made at 3 months, 6 months, and 9 months from first injection. Extension deficit, grip strength and patient satisfaction were evaluated at follow-ups. Hand therapy started Day 1 when the cord was ruptured, spontaneously or by the physician. A volar night splint with free wrist was manufactured and home exercise program was given. Circulation in treated finger was maintained in splint by slightly flexed MCP-joints. The hand could be used in normal activities directly, except for heavy manual work. At Day 7 the splint was adjusted and hand function was controlled. Results: Early, transient problems with oedema, hematoma and/or skin rupture were noticed in some patients, with need for extra visit to hand therapist. In case of ruptured skin, full flexion of finger was allowed when healing was complete. All patients, except one, had gained better extension in treated fingers with better hand function and were satisfied with the treatment at 9 months. The amount of hand therapy needed was far less than after surgery, and the time to regain full hand function was considerably shorter. Conclusions: Results after 9month follow-up, hand therapy after treatment will be presented in detail and discussed. Relevance: Evaluation of result and discussion of hand therapy following percutaneous fasciotomy with collagenase is important.

OBJECTIVES 1. Functional result after percutaneous fasciotomy with collagenase at 9-months follow-up. 2. Evaluation of hand therapy following percutaneous fasciotomy with collagenase.

HAND THERAPY AFTER METACARPOPHALANGEAL JOINT IMPLANT ARTHROPLASTY IN RHEUMATOID HAND Yasue Harada, Seieei Hamamatsu Hospital, Syuya Okumura, Yuji Takahashi, Japan Purpose: Implant arthroplasty of the metacarpophalangeal joint (MPJ) in rheumatoid (RA) hand often results in improved cosmetic appearance and extension range of the MPJ but decreased flexion range. We created a new protocol for postoperative hand therapy and showed the clinical results and the essentials for postoperative therapy. Methods: Silicon implants, SWANSON or AVANTA, were used for implant arthroplasty of MPJ. Twelve hands of 11 RA patients were retrospectively investigated from 2004 to 2007. There were ten females and one male with a mean age of 60.8 (range 46–74) years. The mean followup period was 8.7(4–14) months. Clinical outcome measures included MPJ motion, grip strength, pinch power, ulnar deviation of the MPJ and DASH. Postoperative Therapy Protocol: Postoperative 4–5days: An outrigger splint was used for MPJ extension. Rubber band was pulled on an angle toward the radial-sided finger. Active flexion and passive extension of MPJ on the outrigger splint was started. Postoperative 2weeks: An outrigger splint was added for MP flexion. Outrigger splints for MP flexion and extension were used alternately every hour and alternately each night. Postoperative 3–4 weeks: Active and gentle passive motion of MPJ. Postoperative 6 weeks: Use of hand in light ADL. Results: The mean extension/ flexion range of MPJ were index–60/ 90.08 , long–52.0/86.58 , ring–60/93.58 , little–67.5/95.58 preoperatively and index–15/65.08 , long–10.0/65.58 , ring– 5/57.58 , little–5/52.08 postoperatively. The grip strength average was 5.1 kg preoperatively and 4.9 kg postoperatively. The pulp/lateral pinch power averages were 0.65 kg/1.1kg preoperatively and 0.9 kg/1.5 kg postoperatively. Mean angles of ulnar deviation were index–40.08 , long–30.08 , ring–