Journal of hand therapy : official journal of the American Society of Hand Therapists
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This article examines the concept of tissue adaptation in response to the application of plaster of Paris splints and casts. A review of the history of plaster of Paris and its composition, its working properties, and precautions for its use introduces the reader to this oft-forgotten material. Four designs are described for plaster of Paris application-circumferential padded casts, digital unpadded casts, plaster slabs, and contour molds. ⋯ In addition, a new application called casting motion to mobilize stiffness (CMMS), developed by the author, is discussed. The use of plaster of Paris to improve postoperative flexor tendon glide is also discussed. This review article intends to stimulate the reader to use plaster of Paris splinting or casting more frequently to solve clinical problems.
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Randomized Controlled Trial Clinical Trial
A randomized prospective study to assess the efficacy of two cold-therapy treatments following carpal tunnel release.
A prospective randomized study was performed comparing the efficacy of controlled cold therapy (CCT) with the efficacy of ice therapy in the postoperative treatment of 72 patients with carpal tunnel syndrome. Immediately after surgery, patients applied either a temperature-controlled cooling blanket (CCT) or a standard ice pack over their surgical dressings. Pain was assessed by visual analog scale and swelling by wrist circumference preoperatively, immediately after surgery, and on postoperative day 3. ⋯ Narcotic use (of Vicodin ES) was determined by pill count at day 3 and by daily log book recordings. Patients who used CCT showed significantly greater reduction in pain, edema (wrist circumference), and narcotic use at postoperative day 3 than did those using ice therapy. This study indicates that after carpal tunnel surgery, the use of CCT, compared with traditional ice therapy, provides patients with greater comfort and lessens the need for narcotics.
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The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was developed to evaluate disability and symptoms in single or multiple disorders of the upper limb at one point or at many points in time. ⋯ Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH. This study also demonstrated that the DASH had validity and responsiveness in both proximal and distal disorders, confirming its usefulness across the whole extremity.
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Few painful conditions involving the hand and arm have engendered so much confusion and argument among clinicians and so much suffering in patients as reflex sympathetic dystrophy. Adding to this confusion is the recent proposal by the International Society for the Study of Pain to rename this group of pain conditions "complex regional pain syndrome" (CRPS). ⋯ Sympatholytic interventions are recommended only for the subgroup of patients with sympathetically maintained pain. This article discusses the clinical description of CRPS, reviews the diagnostic tests for this group of conditions, and discusses the lack of reliable data on therapeutic interventions due to poor diagnosis of patients.
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Issues of the theory and methodology of case reports and case studies have been presented. Examples of applications of techniques used in the rehabilitation of the upper extremity conclude this report in pocket format on the theory and methodology of case reports and case studies. Case reports and studies enhance our knowledge about practice in ways that are unique to each case, which are not possible when investigations are performed through group comparison. Case inquiries help us share our practice, sharpen our theoretical reasoning, develop our good habits of applying reliable and valid measurements, and above all help us explore and discuss our treatments.