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Soft Splinting in Osteoarthritis
Relevance: There are no studies on the results of treating trigger finger with low level laser. There are a number of randomized, double blinded clinical trials and/or meta analyses demonstrating benefit with tendinitis.
OBJECTIVES 1. To provide an overview of the research on low level laser for the treatment of tendinitis. 2. To demonstrate a novel method of using low level laser for the treatment of trigger finger.
THE INCIDENCE AND VARIATION OF THE ACCESSORY TENDONS OF THE ABDUCTOR POLLICIS LONGUS TO THE TRAPEZIUM Jessica E. Aylor, Maryville University, Laura Hanneke, Katie Hobson, Mallory Nathan, Carley Smith, United States of America Purpose: The first carpometacarpal (CMC) joint is of considerable interest to occupational therapists due to the incidence of first CMC osteoarthritis. To provide effective treatment for disorders affecting the thumb, it is imperative for occupational therapists to comprehend the anatomy and biomechanics of the thumb. Unfortunately, the literature concerning the anatomy and function of this joint is confusing at best. The aims of this descriptive research study are: (a) to complete a comprehensive literature review on the structure and function of the first CMC joint and the anatomical variations of the abductor pollicis longus (APL), (b) to plan an algorithm for dissection, (c) to perform a cadaveric dissection to determine the incidence and variation of accessory tendons of the APL to the trapezium, and (d) to compare findings to previous cadaveric research. Overall, this study will address the question: What is the incidence and variation of accessory tendons of the APL to the trapezium?
Methods: Using a convenience sample, 60 formalin fixed cadaveric specimens (120 forearm and hand segments) will be dissected using both a sharp and blunt approach. The APL will be located, released at the origin, and tendon insertion sites will be identified. An algorithm will be utilized to guide dissections and record findings. Comparisons will be made with previous results from Brunelli and Brunelli (1991). Results: Currently, 60 forearm and hand segments have been dissected out of the intended 120. Thus far, 38 accessory tendon insertion sites are in accordance with Brunelli and Brunelli’s (1991) findings. Additionally, common insertion sites within our findings include: the first metacarpal base, abductor pollicis brevis, opponens pollicis, and trapezium. The mean insertion sites per APL are 4 with a range from 1 to 7. Conclusions: It is anticipated that the results of our study will alter upon the completion of dissecting 120 forearm and hand segments. Our estimated date of completion is December, 2009. Relevance: Currently there are no known English publications regarding the incidence and variation of accessory tendons of the APL to the trapezium. It is anticipated that further knowledge of trapezial insertions will increase the understanding of CMC instability. Hand therapists often treat individuals with osteoarthritis, therefore, obtaining such knowledge is pertinent to more efficient and effective intervention planning.
OBJECTIVES 1. To complete a comprehensive literature review on the structure and function of the first CMC joint and the anatomical variations of the abductor pollicis longus (APL). 2. To perform a cadaveric dissection to determine the incidence and variation of accessory tendons of the APL to the trapezium. 3. To compare findings to previous cadaveric research.
SOFT SPLINTING IN OSTEOARTHRITIS Sandra B. Frigeri, Instituto de Rehabilitaci on IJS, Argentina Purpose: To evaluate the effects of a soft splint in lieu of strapping equipment in terms of pain and positioning control in different grades of rizarthrosis. Methods: A prospective study in 28 hands in a total of 21 patients with the diagnosis of TMC arthrosis according to Eaton Classification, Grade I (5 hands), II (15 hands), III (8 hands), who during four weeks wore as a single brace a neoprene splint in the first space, with traction parallel to the second metacarpal bone. Patients with trauma related osteoarthritis, scaphotrapezoidal joint alterations or rheumatoid arthritis were not included. Follow-up: 1 month. Gender: Female 20; Male 1. Average age 50.3 years (42–63). Involved hand: 15 right, 13 left; time to symptom progression: 2 months to 3 years. Objective and subjective changes were evaluated. Pain (Numerical Visual Rating ScaleNRS) at the time of the first visit, at the following day, at the first month; subluxation percentage at rest with and without splinting (A.P. Rx, measurement from the radial edge of the first metacarpal (MTC) to the radial edge of the trapezium); metacarpophalangeal (MCP) flexion and extension (gonimetry) at consultation, 1 month. Results: Decrease in pain (during use) in all patients, the day after the splint was worn, 68.5% compared to the baseline value according to NRS average pain. Grade I: 2 hands from moderate to no pain 5 81.8%, and 5 86.8%, y in 11 hands it improved from severe to mild pain 5 72%. Grade III: in 5 hands it changed from severe to mild pain 5 63%, and in 3 hands from severe to moderate pain 5 41.7%. At one month, the percentage of pain decrease was 78% compared to the baseline value. Increase of MCP flexion at rest with splinting in 26 hands, equal to an average of 368 gain. Greater joint correction of the base 18 MTC, moved medially at rest in 26 hands(Rx control). Grade I 5 average 3.4 mm; grade II 5 average 4.7m; grade III, in 6 hands 5 2. 6 mm correction average.
October–December 2010 e17
Conclusions: The use of this model of splinting in this group of patients was able to decrease pain mainly in mild and moderate grades, leading MCP flexion and contributing in 18 MTC extension and joint alignment, reinforcing dynamic stabilizers action, favoring conservative treatment. Relevance: Simple soft splint for control pain and rebalancing forces that trigger deformities.
OBJECTIVES 1. To share a simple kind of splint (that therapists usually use for neurologic pathologies), for use in rizoarthrosis control symptoms. 2. To introduce a different and more specific action model of soft splint from the conventional ones.
EFFECT OF DIFFERENT WRIST JOINT POSITIONS ON THUMB MUSCLE STRENGTH Seiji Nishimura, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Katsuyuki Shibata, Kaoru Tada, Nobuhiko Komine, Yukiyasu Nakayama, Japan Purpose: Using our original sensor equipped with a 3-component force transducer, we developed a muscle strength measurement system for the thumb based on 3-dimensional analysis to identify muscle strength in the four directions of flexion, extension, abduction and adduction forces. The present study was performed to review the influence of differences in dorsal flexion and palmar flexion angle of the wrist joint on thumb flexion, extension, adduction, and abduction forces. Methods: Twelve thumbs of 15 healthy women with an average age of 22.4 were studied. The subjects, who had no medical history of functional disorders in the arms, voluntarily participated in our experiment,
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JOURNAL OF HAND THERAPY
after being informed that there would be no negative after-effects caused by the measurement. In the muscle strength measurement system, a 3component force transducer was fixed to a custom-built sensor. This unit, which is connected to three strain gauge amplifiers, transmits the data to an A/D conversion analyzer for recording on a personal computer. For measurement, the wrist joint angle was fixed to dorsal flexion 408 , 208 , neutral position 08 , palmar flexion 208 , or 408 . The distal phalanx was pressed onto the prescribed position of the sensor. Results: In flexion, the average force at palmar flexion 408 was 19.6 N, which was significantly smaller than at dorsal flexion 408 , 208 , or neutral position 08 . Furthermore, the average force for palmar flexion 208 was 25.0 N, which was significantly smaller than for dorsal flexion 408 . In adduction, the average force at palmar flexion 408 was 21.7 N, which was significantly smaller than at dorsal flexion 408 , 208 , and neutral position 08 . There were no significant differences in wrist joint angle between extension and abduction. It was suggested that the action efficiency of the flexor pollicis longus was smaller at a palmar flexion angle of 408 than for the other angles. Conclusions: For standardization of this system, it is preferable that wrist joint measurements should be made over a range from dorsal flexion 408 to neutral position 08 . Relevance: In the future, this measuring technique is expected to be of great use in evaluating muscle strength in the field of clinically applied hand surgery, by examining measuring positions of the thumb.
OBJECTIVES 1. The present study was performed to review the influence of differences in dorsal flexion and palmar flexion angle of the wrist joint on thumb flexion, extension, adduction, and abduction forces. 2. We developed the new muscle strength measurement system for the thumb based on 3-dimensional analysis.
OSTEOARTHRITIC HAND PROBLEMS AMONG SOUTH AFRICAN QUILTERS Corrianne van Velze, Private practice/University of Pretoria, South Africa Purpose: Every two years the South African Quilters Guild presents a week long national festival. Quilters from all over the country attend the festival to participate in courses and do shopping. A survey was conducted to determine the most common hand problems among quilters. Methods: At the 2008 festival, members of a regional branch of the SA Society of Hand Therapists manned a booth and assessed the hands of the quilters who stopped by. Quilters were given advice on how to care for their hands, they were taught to do certain basic exercises and in some instances splints were manufactured. Information was recorded about the preferred methods of cutting and sewing, as well as the most common problems experienced. Results: A total of 139 quilters (14% of all registered for the festival) were assessed. Ages ranged from 20 to over 70 years. The average number of years they had been sewing was 14 years. The most common problems experienced were: painful thumbs, painful and stiff IP joints and carpal tunnel syndrome. Conclusions: Quilters and other crafters who use their hands a lot may have an increased risk of developing severe osteoarthritic problems. Relevance: This survey highlights the hand problems experienced by many crafters and forms the basis of an ongoing study relating to the prevention of severe joint degeneration. It may be used as a baseline for further investigations to determine whether certain intervention strategies assist in slowing down the joint destruction.
OBJECTIVES 1. To illustrate that a large proportion of crafters may be at risk of developing early osteoarthritic symptoms, due to the work they do.
OBJECTIVES 1. To provide an overview of the research on low level laser for the treatment of tendinitis. 2. To demonstrate a novel method of using low level laser for the treatment of trigger finger.
THE INCIDENCE AND VARIATION OF THE ACCESSORY TENDONS OF THE ABDUCTOR POLLICIS LONGUS TO THE TRAPEZIUM Jessica E. Aylor, Maryville University, Laura Hanneke, Katie Hobson, Mallory Nathan, Carley Smith, United States of America Purpose: The first carpometacarpal (CMC) joint is of considerable interest to occupational therapists due to the incidence of first CMC osteoarthritis. To provide effective treatment for disorders affecting the thumb, it is imperative for occupational therapists to comprehend the anatomy and biomechanics of the thumb. Unfortunately, the literature concerning the anatomy and function of this joint is confusing at best. The aims of this descriptive research study are: (a) to complete a comprehensive literature review on the structure and function of the first CMC joint and the anatomical variations of the abductor pollicis longus (APL), (b) to plan an algorithm for dissection, (c) to perform a cadaveric dissection to determine the incidence and variation of accessory tendons of the APL to the trapezium, and (d) to compare findings to previous cadaveric research. Overall, this study will address the question: What is the incidence and variation of accessory tendons of the APL to the trapezium?
Methods: Using a convenience sample, 60 formalin fixed cadaveric specimens (120 forearm and hand segments) will be dissected using both a sharp and blunt approach. The APL will be located, released at the origin, and tendon insertion sites will be identified. An algorithm will be utilized to guide dissections and record findings. Comparisons will be made with previous results from Brunelli and Brunelli (1991). Results: Currently, 60 forearm and hand segments have been dissected out of the intended 120. Thus far, 38 accessory tendon insertion sites are in accordance with Brunelli and Brunelli’s (1991) findings. Additionally, common insertion sites within our findings include: the first metacarpal base, abductor pollicis brevis, opponens pollicis, and trapezium. The mean insertion sites per APL are 4 with a range from 1 to 7. Conclusions: It is anticipated that the results of our study will alter upon the completion of dissecting 120 forearm and hand segments. Our estimated date of completion is December, 2009. Relevance: Currently there are no known English publications regarding the incidence and variation of accessory tendons of the APL to the trapezium. It is anticipated that further knowledge of trapezial insertions will increase the understanding of CMC instability. Hand therapists often treat individuals with osteoarthritis, therefore, obtaining such knowledge is pertinent to more efficient and effective intervention planning.
OBJECTIVES 1. To complete a comprehensive literature review on the structure and function of the first CMC joint and the anatomical variations of the abductor pollicis longus (APL). 2. To perform a cadaveric dissection to determine the incidence and variation of accessory tendons of the APL to the trapezium. 3. To compare findings to previous cadaveric research.
SOFT SPLINTING IN OSTEOARTHRITIS Sandra B. Frigeri, Instituto de Rehabilitaci on IJS, Argentina Purpose: To evaluate the effects of a soft splint in lieu of strapping equipment in terms of pain and positioning control in different grades of rizarthrosis. Methods: A prospective study in 28 hands in a total of 21 patients with the diagnosis of TMC arthrosis according to Eaton Classification, Grade I (5 hands), II (15 hands), III (8 hands), who during four weeks wore as a single brace a neoprene splint in the first space, with traction parallel to the second metacarpal bone. Patients with trauma related osteoarthritis, scaphotrapezoidal joint alterations or rheumatoid arthritis were not included. Follow-up: 1 month. Gender: Female 20; Male 1. Average age 50.3 years (42–63). Involved hand: 15 right, 13 left; time to symptom progression: 2 months to 3 years. Objective and subjective changes were evaluated. Pain (Numerical Visual Rating ScaleNRS) at the time of the first visit, at the following day, at the first month; subluxation percentage at rest with and without splinting (A.P. Rx, measurement from the radial edge of the first metacarpal (MTC) to the radial edge of the trapezium); metacarpophalangeal (MCP) flexion and extension (gonimetry) at consultation, 1 month. Results: Decrease in pain (during use) in all patients, the day after the splint was worn, 68.5% compared to the baseline value according to NRS average pain. Grade I: 2 hands from moderate to no pain 5 81.8%, and 5 86.8%, y in 11 hands it improved from severe to mild pain 5 72%. Grade III: in 5 hands it changed from severe to mild pain 5 63%, and in 3 hands from severe to moderate pain 5 41.7%. At one month, the percentage of pain decrease was 78% compared to the baseline value. Increase of MCP flexion at rest with splinting in 26 hands, equal to an average of 368 gain. Greater joint correction of the base 18 MTC, moved medially at rest in 26 hands(Rx control). Grade I 5 average 3.4 mm; grade II 5 average 4.7m; grade III, in 6 hands 5 2. 6 mm correction average.
October–December 2010 e17
Conclusions: The use of this model of splinting in this group of patients was able to decrease pain mainly in mild and moderate grades, leading MCP flexion and contributing in 18 MTC extension and joint alignment, reinforcing dynamic stabilizers action, favoring conservative treatment. Relevance: Simple soft splint for control pain and rebalancing forces that trigger deformities.
OBJECTIVES 1. To share a simple kind of splint (that therapists usually use for neurologic pathologies), for use in rizoarthrosis control symptoms. 2. To introduce a different and more specific action model of soft splint from the conventional ones.
EFFECT OF DIFFERENT WRIST JOINT POSITIONS ON THUMB MUSCLE STRENGTH Seiji Nishimura, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Katsuyuki Shibata, Kaoru Tada, Nobuhiko Komine, Yukiyasu Nakayama, Japan Purpose: Using our original sensor equipped with a 3-component force transducer, we developed a muscle strength measurement system for the thumb based on 3-dimensional analysis to identify muscle strength in the four directions of flexion, extension, abduction and adduction forces. The present study was performed to review the influence of differences in dorsal flexion and palmar flexion angle of the wrist joint on thumb flexion, extension, adduction, and abduction forces. Methods: Twelve thumbs of 15 healthy women with an average age of 22.4 were studied. The subjects, who had no medical history of functional disorders in the arms, voluntarily participated in our experiment,
e18
JOURNAL OF HAND THERAPY
after being informed that there would be no negative after-effects caused by the measurement. In the muscle strength measurement system, a 3component force transducer was fixed to a custom-built sensor. This unit, which is connected to three strain gauge amplifiers, transmits the data to an A/D conversion analyzer for recording on a personal computer. For measurement, the wrist joint angle was fixed to dorsal flexion 408 , 208 , neutral position 08 , palmar flexion 208 , or 408 . The distal phalanx was pressed onto the prescribed position of the sensor. Results: In flexion, the average force at palmar flexion 408 was 19.6 N, which was significantly smaller than at dorsal flexion 408 , 208 , or neutral position 08 . Furthermore, the average force for palmar flexion 208 was 25.0 N, which was significantly smaller than for dorsal flexion 408 . In adduction, the average force at palmar flexion 408 was 21.7 N, which was significantly smaller than at dorsal flexion 408 , 208 , and neutral position 08 . There were no significant differences in wrist joint angle between extension and abduction. It was suggested that the action efficiency of the flexor pollicis longus was smaller at a palmar flexion angle of 408 than for the other angles. Conclusions: For standardization of this system, it is preferable that wrist joint measurements should be made over a range from dorsal flexion 408 to neutral position 08 . Relevance: In the future, this measuring technique is expected to be of great use in evaluating muscle strength in the field of clinically applied hand surgery, by examining measuring positions of the thumb.
OBJECTIVES 1. The present study was performed to review the influence of differences in dorsal flexion and palmar flexion angle of the wrist joint on thumb flexion, extension, adduction, and abduction forces. 2. We developed the new muscle strength measurement system for the thumb based on 3-dimensional analysis.
OSTEOARTHRITIC HAND PROBLEMS AMONG SOUTH AFRICAN QUILTERS Corrianne van Velze, Private practice/University of Pretoria, South Africa Purpose: Every two years the South African Quilters Guild presents a week long national festival. Quilters from all over the country attend the festival to participate in courses and do shopping. A survey was conducted to determine the most common hand problems among quilters. Methods: At the 2008 festival, members of a regional branch of the SA Society of Hand Therapists manned a booth and assessed the hands of the quilters who stopped by. Quilters were given advice on how to care for their hands, they were taught to do certain basic exercises and in some instances splints were manufactured. Information was recorded about the preferred methods of cutting and sewing, as well as the most common problems experienced. Results: A total of 139 quilters (14% of all registered for the festival) were assessed. Ages ranged from 20 to over 70 years. The average number of years they had been sewing was 14 years. The most common problems experienced were: painful thumbs, painful and stiff IP joints and carpal tunnel syndrome. Conclusions: Quilters and other crafters who use their hands a lot may have an increased risk of developing severe osteoarthritic problems. Relevance: This survey highlights the hand problems experienced by many crafters and forms the basis of an ongoing study relating to the prevention of severe joint degeneration. It may be used as a baseline for further investigations to determine whether certain intervention strategies assist in slowing down the joint destruction.
OBJECTIVES 1. To illustrate that a large proportion of crafters may be at risk of developing early osteoarthritic symptoms, due to the work they do.