Journal of hand therapy : official journal of the American Society of Hand Therapists
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Randomized Controlled Trial
The effect of oscillating-energy manual therapy on lateral epicondylitis: a randomized, placebo-control, double-blinded study.
Symptoms of lateral epicondylitis (LE) are attributed to degenerative changes and inflammatory reactions in the common extensor tendon induced by microscopic tears in the tissue after repetitive or overload functions of the wrist and hand extensor muscles. Conventional treatments, provided on the premise of inflammatory basis of LE, have shown 39-80% failure rate. An alternative approach suggests that symptoms of LE could be due to active tender points developed in the origin of hand and wrist extensor muscles after overuse or repetitive movements. ⋯ Follow-up data, collected after six months, showed no significant difference between posttest and follow-up measurements in functional activity (p=0.35), pain intensity (p=0.72), and activity limitation due to pain (p=0.34). Of all the subjects contacted for follow-up assessment, 91% maintained improved function and 73% remained pain free for at least six months. OEMT seems to be a viable, effective, and efficient alternative treatment for LE.
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Comparative Study
Patient-perceived outcome after displaced distal radius fractures. A comparison between radiological parameters, objective physical variables, and the DASH score.
Outcome after distal radius fractures has traditionally been measured by radiological parameters and objective physical variables. To what extent these measurements reflect outcome as perceived by the patient has been questioned. We evaluated the association between radiological position, objective physical result (grip strength and range of movement), and the patient-perceived outcome, measured with the Disabilities of the Arm, Shoulder, and Hand outcome (DASH) score, in 78 patients with a healed unilateral distal radius fracture treated with either closed reduction and plaster splint or external fixation. ⋯ However, radial shortening > or = 2mm, dorsal angulation >15 degrees, and radial angulation >10 degrees were each significantly associated with a poorer DASH score. Reduced grip strength, extension, and ulnar deviation correlated with a poorer DASH score. In conclusion, we found that better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in this patient group.
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The purpose of the study was to determine the intrarater and interrater reliability of the Skin Compliance Device, a tool to measure scar pliability. Three points on 25 scars and the corresponding areas on the uninvolved upper extremities were tested by two evaluators. Testing locations were standardized using a wound-tracing device. ⋯ On the involved side, good inter-rater reliability was found for the most adherent point (ICC=0.79) and the most distal point (ICC=0.77). Fair interrater reliability was found for the most proximal point on the involved side (ICC=0.29) and fair-to-moderate reliability for all points on the unscarred extremity. The Skin Compliance Device demonstrates excellent intrarater reliability and good interrater reliability for measuring the most adherent aspect of scars.
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The diagnosis of upper extremity pain can be a daunting task for the examining physician. The differential diagnosis for pain at each level in the upper extremity is often extensive and diverse. Quite frequently, the clinical signs and symptoms of multiple pathologic conditions are overlapping and nonspecific. ⋯ This is all possible due to an incredible imaging device that creates magnificent images painlessly and with no known detrimental biological side effects. This article demonstrates only a small number of the possible causes of upper extremity pain that can be diagnosed with MR imaging. It is comforting to know that the vast majority of pathology causing pain in the upper extremity can be visualized with MRI scanning.
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Current upper limb regional self-report outcome measures are criticized for poor clinical utility, including length, ease, and time to complete and score, missing responses, and poor psychometric properties. To address these concerns a new measure, the Upper Limb Functional Index (ULFI), was developed with reliability, validity, and responsiveness being determined in a prospective study. ⋯ The ULFI demonstrated sound psychometric properties, practical characteristics, and clinical utility thereby making it a viable clinical outcome tool for the determination of upper limb status and impairment. The ULFI is suggested as the preferred upper limb regional tool due to its superior practical characteristics and clinical utility, and comparable psychometric properties without a tendency toward item redundancy.