Hand Therapy

This feasibility study aimed to (i) develop a clinical protocol using a long-term potentiation-like repetitive stimulation protocol for transcutaneous electrical nerve stimulation in patients with upper limb complex regional pain syndrome and (ii) develop a research protocol for a single-blind randomised controlled trial investigating the efficacy of transcutaneous electrical nerve stimulation for complex regional pain syndrome.

This small-scale single-blind feasibility randomised-controlled trial planned to randomise 30 patients with upper limb complex regional pain syndrome to either a variant of transcutaneous electrical nerve stimulation or placebo transcutaneous electrical nerve stimulation for three weeks. Stimulation comprised 20 pulses over 1 s with a non-stimulation interval of 5 s, a so-called repetitive electrical stimulation protocol following the timing of long-term potentiation. Pain, function and body image were measured at baseline, post-treatment and at three months follow-up. At three months, participants were invited to one-to-one interviews, which were analysed thematically.

A transcutaneous electrical nerve stimulation protocol with electrodes applied proximal to the area of allodynia in the region of the upper arm was developed. Participant concordance with the protocol was high. Recruitment was below target (transcutaneous electrical nerve stimulation (n = 6), placebo (n = 2)). Mean (SD) pain intensity for the transcutaneous electrical nerve stimulation group on a 0 to 10 scale was 7.2 (2.4), 6.6 (2.8) and 7.8 (1.9), at baseline, post-treatment and at three-month follow-up, respectively. Qualitative data suggested that some patients found transcutaneous electrical nerve stimulation beneficial, easy to use and were still using it at three months.

Patients tolerated transcutaneous electrical nerve stimulation well, and important methodological information to facilitate the design of a large-scale trial was obtained (ISRCTN48768534).

The purpose of this study was to evaluate a newly developed trapeziectomy rehabilitation protocol. Variability in trapeziectomy rehabilitation protocols and the arrival of new surgeons in our hospital required a uniform protocol.

Fifty hands in 44 patients (32 women/12 men) were immobilised for 4 weeks in a plaster cast after a trapeziectomy. A carpometacarpal splint immediately followed for 2 weeks, taken off for exercises and self-care. Patients were assessed preoperatively and at 3, 6 and 12 months using: a pain visual analogue scale (VAS), grip, tip pinch and lateral pinch strength, goniometry, the Modified Kapandji Index (MKI), the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Q-DASH, Dutch version) and the Short Form 36 (SF-36, Dutch version). At 3, 6 and 12 months, patient’s satisfaction with the operation was rated on a satisfaction VAS.

The correlation between pain and patient satisfaction was significant (ρ = −0.80). VAS pain improved from a median of 75 mm preoperatively to 20 mm at 12 months (p < 0.01). The Q-DASH improved from a median of 48 preoperatively to 20 at 12 months (p < 0.01). Median grip, tip pinch and lateral pinch strength increased at 12 months by 19%, 8% and 24%, respectively from the baseline measurement.

Patients participating in a standardised protocol after trapeziectomy with 4 weeks immobilisation demonstrated improvements in pain, Q-DASH, grip strength, tip pinch and lateral pinch grip. They were satisfied with the results. Further research into the optimal immobilisation time after trapeziectomy surgery is needed.

Whether baseline characteristics influence range of motion outcomes following proximal phalanx fracture remains unclear. The aim of this review was to investigate whether fixation type, time to commencement of active finger exercise, location of fracture or which finger is injured predict total active range of motion 6 weeks after surgical fixation.

A retrospective cohort of 49 patients with finger proximal phalanx fracture was analysed. Putative predictors investigated were fixation type, time to commencement of active exercise, location of fracture and injured finger. The outcome of interest was total active finger range of motion 6 weeks post-operatively.

Multiple regression analysis found that time to commencement of active exercise was the only significant independent predictor of total active range of motion 6 weeks post-operatively. The main influence on time to commencement of active exercise was fixation type, with fractures repaired using Kirschner wire fixation associated with a delay of nearly 2 weeks, compared with fractures repaired using open reduction and internal fixation.

Patients who commence active exercise early following surgical fixation of a proximal phalanx fracture may expect greater total active range of motion 6 weeks post-operatively than if exercise is delayed.

Dexterity assessment is an integral component of hand function evaluation. The Minnesota Rate of Manipulation Test is a valid and reliable tool to evaluate manual dexterity and has been used to study prognosis of therapy. Information available on its reference values is limited. Reference values are required to interpret, set realistic treatment goals, and assess the ability to return to employment. Therefore, manual dexterity was studied in healthy Indian adults to generate reference values.

A descriptive study was conducted on 900 subjects divided into three groups: Group 1: 18–30 years (n = 300): Group 2: 31–60 years (n = 300), and Group 3: ≥61 years (n = 300). The Minnesota Rate of Manipulation Test was used to evaluate manual dexterity. All subjects performed three trials (one practice + two test trials) of the five subtests. The average of two test trials was used to compute the Minnesota Rate of Manipulation Test score.

The total score of the Minnesota Rate of Manipulation Test in Groups 1, 2, and 3 was 275.7 ± 24.1 s, 299.3 ± 31.9 s, and 357.4 ± 48.6 s, respectively. Manual dexterity was moderately associated with age (r = 0.707, p < 0.001); however, differences between males and females were nonsignificant (p = 0.306).

Manual dexterity declined with advancing age; however, differences between genders were not significant. These reference values of manual hand dexterity for healthy adult Indian people will be relevant for clinical assessment of hand function.