Purpose This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal (MCP) joint in Dupuytren disease. Methods This is a prospective, ...single-blinded, randomized study with follow-up 1 week and 1 year after treatment. One hundred and forty patients with an MCP contracture of 20° or more in a single finger were enrolled, of whom 69 patients were randomized to collagenase treatment and 71 patients to needle fasciotomy. The patients were followed at 1 week and were examined by a physiotherapist after 1 year. Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main (URAM) questionnaire and a visual analog scale (VAS) for the estimation of procedural pain and subjective treatment efficacy. Results Eighty-eight percent of the patients in the collagenase group and 90% of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5° 1 week after treatment, and the median gains in passive MCP movement were 48° and 46°, respectively. The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group. After 1 year, 90% of the patients in both groups had full extension of the treated MCP joint. One patient in each group had a recurrence of the contracture. The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups. Conclusions There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year. Type of study/level of evidence Therapeutic I.
Retrospective data analysis OBJECTIVES: To define the distribution of the motor points and excitability of the key wrist and finger actuators in order to detect upper (UMN) and lower motor neuron ...(LMN) lesions potentially influencing the development of a tenodesis grasp.
A rehabilitation centre for spinal cord injuries, Nottwil, Switzerland.
Forearm muscles of 32 patients with tetraplegia (AIS A-D) were tested bilaterally with electrical stimulation (ES) to differentiate whether UMN or LMN was present. For testing, a standardised mapping was developed. All patients underwent the same positioning schedule.
Sixteen hands developed a tenodesis grasps, 24 hands showed neither shortening nor tightening of the finger flexors. Two patients developed unilateral tenodesis grasp and showed no tightening of the finger flexors on the contralateral hand. Seven patients developed tenodesis grasps symmetrically and bilaterally, whereas one maintained an essentially open hand without tightening of the finger flexors. All hands that developed a tenodesis grasp showed a LMN lesion of the M. extensor digitorum communis (EDC). The frequency of the tenodesis grasp differed significantly between the groups with and without intact reflex arc (p < 0.0001).
Surface ES may serve as a diagnostic tool to detect an UMN or LMN lesion of the key actuator muscles affecting the tenodesis grasp. These findings provide information that is essential for the choice of treatment to optimise function of the tetraplegic hand.
To describe the early active rehabilitation concept developed for spasticity-correcting surgery in tetraplegia and to report the outcomes in grip ability and change of performance and satisfaction in ...patients' prioritized activities 1 year postoperatively.
Retrospective case-control study.
Nonprofit rehabilitation unit.
All patients who underwent surgeries for correction of spasticity in tetraplegic hands between 2009 and 2013 in the studied unit (N=37).
Spasticity-correcting upper limb surgery with early active rehabilitation to restore grip ability in tetraplegia.
Grasp and release test (GRT) and modified Canadian Occupational Performance Measure (COPM).
All patients could accomplish the early active rehabilitation concept. The complication rate related to the treatment was low. Compared with preoperatively, all evaluated individuals experienced improvements in grasp ability and activity performance and satisfaction at 1-year follow-up. The performance in prioritized activities, as measured by the COPM, improved by 2.6 scale steps. Satisfaction with performance improved 3.0 scale steps postoperatively (n=21). The grasp ability, measured by the GRT, improved significantly, from 80 preoperatively to 111 (n=10).
The surgery, combined with the early active rehabilitation protocol, is a reliable and safe procedure. The ability to use the hand improved, and gains were maintained at least 1 year after surgery in all patients with respect to both the objective grasp ability and patients' subjective rating of their performance and satisfaction in their prioritized activities. The procedure should therefore be considered as an adjunct to other treatments of upper limb spasticity in spinal cord injury.
Upper extremity function is essential for the autonomy in patients with cervical spinal cord injuries and consequently a focus of the rehabilitation and treatment efforts. Routinely, an ...individualized treatment plan is proposed to the patient by an interprofessional team. It dichotomizes into a conservative and a surgical treatment pathway. To select an optimal pathway, it is important to define predictors that substantiate the treatment strategy. Apart from standard assessments (Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the manual muscle test (MRC), and lower motoneuron integrity of key actuators for hand function performed by motor point (MP) mapping might serve as a possible predictor. Type of damage (upper motor neuron (UMN) or lower motor neuron (LMN) lesion) influences hand posture and thus treatment strategy as positioning and splinting of fingers, hands, arms, and surgical reconstructive procedures (muscle-tendon or nerve transfers) in choice and timing of intervention. For this purpose, an analysis of a database comprising 220 patients with cervical spinal cord injury is used. It includes ISNCSCI, MRC, and MP mapping of defined muscles at selected time points after injury. The ordinal regression analysis performed indicates that MP and ASIA impairment scale (AIS) act as predictors of muscle strength acquisition. In accordance with the innervation status defined by MP, electrical stimulation (ES) is executed either
via
nerve or direct muscle stimulation as a supplementary therapy to the traditional occupational and physiotherapeutic treatment methods. Depending on the objective, ES is applied for motor learning, strengthening, or maintenance of muscle contractile properties. By employing ES, hand and arm function can be predicted by MP and AIS and used as the basis for providing an individualized treatment plan.
Trigger finger is characterized by sometimes painful snapping or locking when flexing the finger. Although trigger finger is frequently seen in clinical practice, no standard treatment protocol has ...been established as "best practice."
The aim of this study was to achieve consensus on a multidisciplinary treatment guideline for trigger finger.
A European Delphi consensus strategy was initiated. Systematic reviews reporting on the effectiveness of surgical and nonsurgical interventions were conducted and used as an evidence-based starting point for this study.
In total, 35 experts (hand therapists and hand surgeons selected by the national member associations of their European federations and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy.
Each Delphi round consisted of a questionnaire, an analysis, and a feedback report.
After 4 Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of trigger finger. The experts agreed that use of orthoses (splinting), corticosteroid injections, corticosteroid injections plus use of orthoses, and surgery are suitable treatment options. Relevant details for the use of orthoses, corticosteroid injections, and surgery were described. Main factors for selecting one of these treatment options were identified as severity and duration of the disease and previous treatments received. A relationship between the severity and duration of the disorder and the choice of therapy was indicated by the experts and reported on in the guideline.
The results represent a group's opinion at a given point in time. When the evidence for the effectiveness of interventions increases, experts' opinions will change, and the guideline should be re-evaluated and adjusted in view of these new insights.
This multidisciplinary treatment guideline may help involved therapists and physicians in the treatment of trigger finger and indicate areas needing additional research.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The use of functional electrical stimulation (FES) to improve upper limb function is an established method in the rehabilitation of persons with tetraplegia after spinal cord injury. Surgical ...reconstruction is another well-established yet underused technique to improve the performance of the upper extremities. Hand surgery plays an essential role in restoring hand function, mobility, and quality of life in the tetraplegic population. The knowledge about the effects of FES on a structural and functional level is fundamental for understanding how and when FES can be used best to support the effect of hand surgery, both pre- and postoperatively. In this article we discuss principles of FES and how FES improves functional outcome after surgical reconstruction. The reported results are based on preliminary clinical observations.
Active wrist extension allowing tenodesis grip is the key function in high-level tetraplegic patients. It is absent and cannot be restored by traditional tendon transfer in patients who have no ...transferable muscle below the elbow. We present a 36-year-old man with high-level tetraplegia treated 12 months after injury who regained active wrist extension after transfer of the brachialis muscle branch of the musculocutaneous nerve to the extensor carpi radialis longus muscle branch of the radial nerve. No functional deficit of elbow flexion occurred after reconstruction.
ObjectiveFunctional electrical stimulation (FES) can enhance motor learning of hand fine motor skills in neurological diseases with upper motoneuron lesions. Nevertheless, FES is rarely applied in ...patients with chronic Guillan-Barré syndrome (GBS) with preserved deep tendon reflexes allowing for stimulation via nerve. This single case report documents the results of an FES-supported, task-oriented grasp training to regain hand closure and pinch grip.Study designSingle-subject repeated measures study.SettingInternational FES Centre®, Swiss Paraplegic Centre Nottwil.MethodsThree individually defined goals were formulated and scored by using the goal attainment scale. With a focus on these goals, FES was applied bilaterally to improve hand closure and pinch grip. Based on principles of motor learning FES was executed together with task-oriented movements. The hand closure distance (cm) between the tip of the middle finger and the palmar side of the hand was measured and the achievement of personal, predefined goals evaluated.ResultsAfter 16 weeks of daily stimulation, hand closure could be voluntarily performed. Regained opposition of the thumb to the index finger enabled improved individually defined fine motor control. Restored function remained unchanged in the follow-up at 6 months without stimulation.ConclusionImproving fine motor skills in chronic GBS with intact deep tendon reflexes was possible utilizing FES combined with task-oriented grasp training. These improvements were maintained over time indicating the combination was effective in promoting functionally meaningful motor gains.
Spasticity is a common and increasingly prevalent secondary complication of spinal cord injury. The aim of the study was to evaluate patient-experienced gains in prioritized activities after surgery ...to reduce the effects of spasticity in upper limbs in tetraplegia. The study includes evaluation of 30 operations for 27 patients performed on hypertonic tetraplegic hands during 2007–2015 using the Canadian Occupational Performance Measure. Activity performance increased at both 6 months and 12 months by a mean of 3.0 and 2.9 points, respectively. Satisfaction increased by 3.3 and 3.4, respectively. All types of activities improved, with wheelchair manoeuvring as one of the highest rated. The intervention increased prioritized activity performance and persisted at least 12 months after surgery. Patients with mild upper limb impairment showed greater improvement after surgery. After operation, patients were able to perform 71% of their prioritized activities, which they could not perform before. Patients’ satisfaction with the performance was high.
Level of evidence: IV
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