Physiospot Musculoskeletal

Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Christine J. Cheng, Brendan Mackinnon-Patterson, John L. Beck and Susan E. Mackinnon

The purpose of this study was to evaluate the clinical usefulness of a new test, the scratch collapse test, for the diagnosis of carpal tunnel syndrome and cubital tunnel syndrome.  The scratch collapse test was prospectively compared with Tinel's sign and flexion/nerve compression in 169 patients and 109 controls. One hundred nineteen patients were diagnosed with carpal tunnel syndrome and 70 patients were diagnosed with cubital tunnel syndrome based on history, examination, and positive electrodiagnostic test. For the new test, the patient resisted bilateral shoulder external rotation with elbows flexed. The area of suspected nerve compression was lightly “scratched,” and then resisted shoulder external rotation was immediately repeated. Momentary loss of shoulder external rotation resistance on the affected side was considered a positive test.

The scratch collapse test had significantly higher sensitivity than Tinel's test and the flexion/nerve compression test for carpal tunnel and cubital tunnel syndromes. Accuracy for this test was 82% for carpal tunnel syndrome and 89% for cubital tunnel syndrome. This novel test provides a useful addition to existing clinical maneuvers in the diagnosis of these common nerve compression syndromes.

The Journal of Hand Surgery, 2008, 33(9), 1518-1524

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Clinical Features Influencing the Patient-Based Outcome After Carpal Tunnel Release

Hyun Sik Gong, Joo Han Oh, Sung Woo Bin, Woo Sung Kim, Moon Sang Chung and Goo Hyun Baek

This study analyzed several clinical features of carpal tunnel syndrome to identify potential prognostic factors influencing a patient-based outcome assessment after carpal tunnel release. 102 hands of 64 patients with carpal tunnel syndrome using the Boston self-assessment questionnaire preoperatively and 3, 6, 9, and 12 months postoperatively were evaluated. The clinical findings evaluated as prognostic indicators were paresthesia, cold intolerance, subjective weakness, nocturnal pain, thenar atrophy, Tinel sign, Phalen test, and electrophysiologic grades.

The overall symptom and functional scales of the self-assessment questionnaire demonstrated a significant improvement at 3 months after surgery, but no significant further improvement was observed thereafter. Patients with nocturnal pain, patients without subjective weakness, and patients without cold intolerance demonstrated more improvement of the scores in the bivariate analysis.This information may be used in preoperative consultation regarding the outcome of surgery from the patient's perspective.

The Journal of Hand Surgery, 2008, 33(9), 1512-1517

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Evaluation of Static Progressive Stretch for the Treatment of Wrist Stiffness

Mike S. McGrath, Slif D. Ulrich, Peter M. Bonutti, Jonathan M. Smith, Thorsten M. Seyler and Michael A. Mont

The purpose of this study was to assess the total arc of motion and the satisfaction scores of patients who had wrist stiffness and who were treated with a bidirectional, patient-directed orthosis that used the principles of static progressive stretch.  Forty-seven patients who experienced posttraumatic or postsurgical wrist stiffness were treated with a patient-directed orthosis. Treatment consisted of a 30- to 60-minute stretching protocol performed 1 to 3 times per day.

All of the patients who used this protocol improved their total arc of motion. A splinting device that uses the principles of static progressive stretch is a useful treatment for patients who have posttraumatic or postsurgical wrist stiffness and whose progress has plateaued after a course of conventional physical therapy.

The Journal of Hand Surgery, 2008, 33(9), 1498-1504

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Differences in Range of Motion Between Dominant and Nondominant Sides of Upper and Lower Extremities

Luciana Gazzi Macedo, David J. Magee

The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities.  Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5°.

The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.

Journal of Manipulative and Physiological Therapeutics, 2008, 31(8), 577-582

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Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain

J.I.Brox, K. Storheim, M. Grotle, T.H. Tveito, A. Indahl and H.R. Eriksen

The purpose of this review was to assess the effectiveness of back schools, brief education, and fear-avoidance training for chronic low back pain (CLBP).  Conflicting evidence was found for back schools compared with waiting list, placebo, usual care, and exercises, and a cognitive behavioral back school. Strong evidence of effectiveness on sick leave and short-term disability compared with usual care was found for breif education. There was conflicting or limited evidence for back book or Internet discussion compared with waiting list, no intervention, massage, yoga, or exercises. Moderate evidence showed that there is no difference between rehabilitation including fear-avoidance training and spinal fusion.

Consistent recommendations are given for brief education in the clinical setting, and fear-avoidance training should be considered as an alternative to spinal fusion, and back schools may be considered in the occupational setting.

The Spine Journal, 2008, 8(6), 948-958

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Objective Evaluation of Fine Motor Manipulation-A New Clinical Tool.

Andersen Hammond ER, Shay BL, Szturm T

A new performance-based tool has been developed to accurately and precisely evaluate finger/hand function during manipulation of any object, independent of geometric and surface properties. The objectives of this study were to show test-retest reliability and evaluate criterion validity. Twenty healthy, right-handed participants were recruited.Two testing periods, one week apart were performed to evaluate test-retest reliability. Criterion validity was assessed by comparing performance with this tool to performance on commonly used clinical dexterity tests. Global performance, temporal accuracy, and amplitude consistency during manipulation of the objects were highly reliable on the two testing occasions.

The task protocol directly measures the ability of the hand to coordinate movement in response to a visual tracking target. Providing effective and objective ways to evaluate manual dexterity and hand function is a critical part of evidence-based practice.

Journal of Hand Therapy, 2008 Aug 29, online article

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Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial.

Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B

The objective of this study ws to compare the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome with flat inserts or physiotherapy, and to investigate the effectiveness of foot orthoses plus physiotherapy. 179 participants with a clinical diagnosis of patellofemoral pain syndrome of greater than six weeks' duration, who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months underwent either six weeks of physiotherapist intervention with off the shelf foot orthoses, flat inserts, multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy.

While foot orthoses are superior to flat inserts according to participants' overall perception, they are similar to physiotherapy and do not improve outcomes when added to physiotherapy in the short term management of patellofemoral pain. Given the long term improvement observed in all treatment groups, practitioners may seek to hasten recovery by prescribing prefabricated orthoses.

BMJ, 2008 24 Oct, online article

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Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review.

Chantal H.P. de Koning, Sylvia P. Van den heuvel, J. Bart Staal, Bouwien C.M. Smits-Engelsman and Erik J.M. Hendriks

This article provides a critical analysis of the research literature on the clinimetric properties of tests to measure neck muscle strength or endurance in patients with non-specific neck pain, which can be used in daily practice. The search identified a total of 16 studies. The instruments or tests included were: muscle endurance tests for short neck flexors, craniocervical flexion test with an inflatable pressure biofeedback unit, manual muscle testing of neck musculature, dynamometry and functional lifting tests (the cervical progressive iso-inertial lifting evaluation (PILE) test and the timed weighted overhead test).

The endurance test of the short neck flexors and the cervical PILE test can be regarded as appropriate instruments for measuring different aspects of neck muscle function in patients with non-specific neck pain.

BMC Musculoskeletal Disorders, 2008, 9, 142

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Assessment of Chronic Neck Pain and a Brief Trial of Cervical Strengthening.

Rodriquez, Arthur A and Burns, Stephen P

The objective of this study was to determine the relationship among pain, disability, range of motion, isometric strength, and muscle tenderness in persons with chronic non-radicular neck pain and to compare them with healthy controls without neck pain.  Cross-sectional study of 30 subjects with and 14 without chronic neck pain. All subjects were administered pain scales, the neck disability index, isometric cervical strength, cervical range of motion, and a quantitated muscle tenderness measure. In addition, an uncontrolled trial of neck strengthening was performed on a subset of 14 subjects with the same outcome variables.

The results showed that muscle tenderness and disability (but not range of motion or muscle strength) is closely related to average pain in the previous week in neck pain subjects. Neck flexor muscle strengthening resulted in positive changes in pain, neck disability index, range of motion, and strength, but not tenderness.

American Journal of Physical Medicine & Rehabilitation, 2008, 87(11), 903-909

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Early activation or a more protective regime after arthroscopic subacromial decompression -- a description of clinical changes with two different physiotherapy treatment protocols -- a prospective, randomized pilot study with a two-year follow-up

Hultenheim Klintberg, I., Gunnarsson, A.-C., Styf, J., Karlsson, J.

The objective of this study was to describe clinical changes with two protocols of physiotherapy following arthroscopic subacromial decompression (ASD) over two years. The traditional group started with active assisted range of motion exercises on the day of surgery, dynamic exercises for the rotator cuff after six weeks and strengthening exercises after eight weeks. The progressive group started active assisted range of motion and dynamic exercises for the rotator cuff on the day of surgery. Both groups showed significant improvements in pain during activity and at rest, in range of motion in extension and abduction, in strength of external rotation and in function. After two years, the majority of patients achieved ≥160^° in flexion, ≥175^° in abduction and 80^° in external rotation, the traditional achieved 67 and the progressive group 87 with Constant score.

Early activation using a comprehensive, well-defined and controlled physiotherapy protocol can be used safely after arthroscopic subacromial decompression.

Clinical Rehabilitation,2008, 22(10-11), 951-965

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