Hand Therapy

Scapholunate instability is commonly caused by a fall on an outstretched hand resulting in structural pathology and pain. In recent years, dynamic stability mechanisms have been described that may aid in the non-operative management of this patient group. Limited evidence exists regarding the clinical application of stability mechanisms for scapholunate instability, and there is a void of reproducible structured exercise regimes.

A service evaluation was conducted over 16 months to assess patient outcomes following an evidence-based treatment protocol in the conservative management of stage one scapholunate instability. Pain-free grip, maximal grip, grip strength ratio, Euro-Qol five dimensions questionnaire (EQ-5D), Visual Analogue Scale (VAS) and Quick Disability of Arm, Shoulder and Hand questionnaire (Quick-DASH) scores were compared between baseline and final follow-up.

Six consecutive patients (seven wrists) were included with five patients (six wrists) completing treatment. Mean grip strength ratio improved by 45%, mean VAS improved by 5.5 points, mean Quick-DASH improved by 33.96% and EQ-5D improved by 0.187 quality-adjusted life years. Where established, all outcomes exceeded minimal clinically important difference values.

The Birmingham Wrist Instability Programme can yield clinically important results for patients with stage one scapholunate instability in the short term based on a small service evaluation. The findings support the need for further research to evaluate the rehabilitation programme in a larger group of patients over the longer term.

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a self-administered region-specific outcome questionnaire developed to measure upper extremity disability and symptoms. The aim of this study was to translate, culturally adapt and validate the Igbo version of the DASH in order to enhance its use in the Igbo-speaking population.

This cross-sectional survey involved 100 participants (56 males, 44 females) with upper extremity musculoskeletal disorders, in the South-Eastern part of Nigeria. Participants completed both English and Igbo versions of the DASH on two occasions. Internal consistency was evaluated with Cronbach’s alpha. Test–retest reliability was analysed by intraclass coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with the Spearman rank correlation coefficient, and a principal component analysis was performed. Alpha was set at 0.05.

Test–retest reliability was excellent (ICC = 0.99). The Cronbach’s alpha coefficient was high (0.979) for the entire items on the scale. There was a significant strong correlation (r = 0.994; p = 0.001) between the scores obtained on the English and Igbo versions of the DASH indicating excellent construct validity. Thirty linear components were identified within the data set. The communalities were above 0.4.

Principal component analysis of the Igbo DASH revealed a two-factor structure, having fulfilled all necessary conditions. The Igbo version of the DASH questionnaire is a valid and reliable outcome measure for individuals with upper extremity musculoskeletal disabilities.

Goniometry is a common measure of range of motion and may be assessed by different therapists and goniometers. To date, there is limited psychometric data on active and passive range of motion measurements of individual thumb joints. The purpose of this study was to analyze inter-rater and inter-instrument reliability of passive and active flexion goniometric measures of thumb joints in healthy adults.

A within-subjects psychometric design was utilized. Two raters each used two goniometers (Baseline™ Flexion-Hyper Extension and Baseline™ 180 Degree Digit) to measure each participant’s (n = 48) thumb carpometacarpal, metacarpophalangeal, and interphalangeal flexion range of motion. Inter-rater and inter-instrument reliability and stability were evaluated through use of intraclass correlation coefficient, standard error of the measurement, and minimal detectable change test statistics.

Inter-rater reliability was poor for carpometacarpal flexion and good-to-excellent for metacarpophalangeal and IP flexion. Between-rater error ranged between 3.9 and 6.3 degrees for active measurements and between 3.9 and 7.9 degrees for passive. Error was generally less when using the Baseline™ 180 Degree Digit goniometer. Inter-instrument reliability was excellent for all joints.

These findings validate the concerns that thumb goniometry inter-rater reliability may differ in clinical and non-clinical populations, support further study in clinical populations, and support a common assumption that the same rater should test the same client with the same goniometer to minimize measurement error. When compared to the Baseline™ Flexion-Hyper Extension Goniometer, the Baseline™ 180 Degree Digit had higher repeatability across raters. Further research on within-rater reliability is required as is study on clinical populations.

Carpometacarpal joint osteoarthritis is a common and painful condition associated with ligament laxity, subluxation and joint instability. Therapy management includes several interventions targeting the symptoms associated with instability and subluxation. This study aimed to explore the perceptions of experienced therapists, about their understanding of joint instability in carpometacarpal joint osteoarthritis and its relationship with laxity, subluxation and strength, and the perceived effectiveness of exercise interventions.

A qualitative research design, consisting of individual semi-structured interviews was conducted with nine therapists. Interviews were transcribed and analysed using a thematic analysis.

Three themes were identified: (a) relationships between instability and laxity – the terms laxity and instability were often used interchangeably. Instability was associated with laxity, subluxation and disease progression, and was perceived to be a problem that includes the whole thumb column; (b) clinical reasoning by stage of disease – conflicting opinions were expressed regarding instability being present in pre-arthritic lax joints, early disease or all stages of disease; (c) the role of exercise in management – there was disagreement as to whether instability could be modified by developing muscle strength, or whether treatment should be focussed on compensating for instability.

Different perceptions of instability were reflected in wide-ranging opinions regarding the need to manage instability, and regarding the potential for altering instability. The impact of instability on function, and the concept of instability were not easily identified. A clearer definition of instability would facilitate the development and assessment of interventions for instability.