Research Updates

ASHT Research Updates

The ASHT Research Division offers "Research Updates" to increase awareness of emerging research in the field of hand therapy. Each month, the Research Division releases a brief summary of an original published research paper selected by members of the Research Division.

2018 Research Updates

August Research Update

Low-Intensity Pulsed Ultrasound for Nonoperative Treatment of Scaphoid Nonunions: A Meta-Analysis
                    
Scaphoid fractures have high nonunion rates, which can be from 5% to 10% in nondisplaced fractures and up to 45% in displaced fractures. Standard treatment in these cases is surgery. However, not all patients are optimal surgical candidates or amenable to surgical intervention; a comprehensive review of current literature is needed to assess these nonoperative methods of healing. Low-intensity pulsed ultrasound (LIPUS), a noninvasive treatment using a pulsed 30 mW/cm2 ultrasound signal for 20-minute intervals per day over a period of several weeks, has been shown to improve fracture nonunion healing. This study performed a meta-analysis to determine LIPUS success for treatment of scaphoid nonunion. The authors found 166 nonunions across five studies with a combined healing percentage of 78.6% and average time to union of 4.2 months. These high success rates were seen with multiple fracture types, as well as in cases where LIPUS was attempted following different failed treatments. The results are encouraging in which these challenging fractures can heal without further surgical intervention in the majority of patients. 

Journal Source: Hand
Edward W. Seger et al. "Low-Intensity Pulsed Ultrasound for Nonoperative Treatment of Scaphoid Nonunions: A Meta-Analysis. Hand. Volume 13, Issue 3, Pages 275-280. Issued published: May 1, 2018. 

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


July Research Update

Impact of Axillary Web Syndrome on Function, Shoulder Motion, Pain and Lynohedema in Post-surgical breast cancer
                    
A longitudinal prospective cohort study followed 36 women using a repeated measures design. Physical therapy treatment was only provided if ordered by the subject’s physician and was not necessarily provided by the authors. Axillary web syndrome (AWS) can develop following breast cancer surgery and may present either as a visible or palpable cord in the axilla. Subjects were divided into two groups based on presence or absence of AWS, regardless of when it occurred. Measures assessed included presence of AWS, DASH, shoulder active and passive range of motion, pain and lymphedema. These measures were recorded at 2, 4, and 12 weeks, and again at 18 months post-surgically. At the 12-week assessment, subjects were provided verbal and written education by a physical therapist in lymphedema precautions, signs and symptoms, and description of lymphedema treatment. This may have resulted in a treatment effect in that 12 women received lymphedema treatment during the 18-month period. Thirty-two subjects completed all assessments (4 were lost to follow up for the 18-month assessment). Physical impairments in one or more areas were noted in 66-97% of subjects at one or more visits. The cumulative prevalence of AWS was 50% and it was found to persist at least as long as 18 months, recur after resolution, and to develop beyond the early post-operative period. The authors found that women with AWS had lower BMI and a greater number of lymph nodes removed. AWS was also found to be associated with reduced shoulder range of motion and long term functional impairment. There was no apparent effect by AWS on pain and lymphedema (possible treatment effect from education). The findings of AWS-related impairments and that only 36% of subjects received rehabilitative treatment at least once indicates a need for increased attention to physical impairments in this population. 

Journal Source: Physical Therapy
Linda A. Koehler, David W. Hunter, Anne H. Blaes, Tufia C. Haddad. "Function, Shoulder Motion, Pain, and Lymphedema in Breast Cancer With and Without Axillary Web Syndrome: An 19-Month Follow-Up. Physical Therapy. Volume 98, Issue 6, 1 June 2018, Pages 518-527. 

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


June Research Update

A prospective randomized study investigated if includion of the thumb MCP joint is necessary in orthoses for individuals with thumb CMC joint osteoarthritis.
                    
Sixty six patients were randomly assigned to equal groups. One group had a custom fabricated orthosis that included the MCP joint while the other group’s orthosis immobilized the CMC joint only.  Both groups received identical wearing schedules and were fabricated from the same thermoplastic material. The main outcome measures were the Quick DASH and the VAS.  Both groups achieved statistically significant differences for pain and function. No significant differences were found by including or not including the MCP joint of the thumb for pain or function. Likewise, an orthosis is found to be an effective sole treatment intervention in the conservative treatment of thumb CMC joint OA.

Journal Source: Hand
Cantero-Téllez R, Valdes K, Schwartz DA, Medina-Porqueres I, Arias JC, Villafañe JH. Necessity of Immobilizing the Metacarpophalangeal Joint in Carpometacarpal Osteoarthritis: Short-Term Effect. Hand.  2017 1-6.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.ed


April Research Update

What does the evidence say regrding surgical versus nonsurgical management in the treatment of mallet finger injuries?
                    
This systematic review included forty-four studies examining clinical outcomes of mallet finger management. Twenty-two of the studies evaluated operative treatment, seventeen conservative treatment, and five compared operative versus nonoperative treatment. The included articles studied a variety of surgical techniques and orthotic interventions. Fracture size of >1/3 the joint surface area and subluxation of the distal phalanx were the most frequently described indications for surgery. However, the authors of this study concluded that there is insufficient evidence to determine when surgical intervention is indicated. One conservative management study specifically examined fracture sizes >1/3 of the joint surface area, and achieved an average 9-degree extension lag with thermoplastic orthotic intervention, supporting the use of an orthosis in the management of these cases. Across studies, the average DIP joint extension lag for surgical treatment was 5.7 degrees, with a complication rate of 14.5%. For nonsurgical management, the average DIP extension lag was 7.6 degrees with a complication rate of 12.8%. The study concluded both interventions result in favorable clinical outcomes, and that an individualized treatment approach is appropriate. 

Journal Source: Journal of Hand Surgery
Lin JS, and Samora JB. Surgical and nonsurgical management of mallet finger: A systematic review. Journal of Hand Surgery. February 2018. Volume 43, Issue 2, Pages 146-163.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.ed


March Research Update

Do cadaveric studies demonstrate a dose dependent relationship for loading of the OP and the FDI for thumb CMC joint subluxation?
                    
A recent cadaveric study examined the effect of applying 0%, 25%, 50%, 75% and 100% loads to the first dorsal interosseous (FDI) and opponens pollicis (OP) on subluxation at the thumb CMC joint. Findings suggest that selective activation of the OP alone did reduce subluxation, while activation of the FDI alone did not. Activation of both the OP and FDI improved subluxation to within 10% of pre-subluxed state with 75% or greater load to the FDI and OP. The authors conclude that activation of the FDI and OP reduces subluxation of the thumb CMC joint in a dose-dependent fashion and that the OP is likely the major reducing force and therefore requires emphasis in a hand therapy program for arthritis at the thumb CMC joints. 

Journal Source: Hand
Adams JE, O’Brien V, Magnusson E, Rosenstein B, Nuckley DJ. First dorsal interosseous and opponens pollicis loading upon thumb CMC joint subluxation: a cadaver study. Hand. 2018. 13: 40-44.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


2017 Research Updates

December Research Update

Is the use of a nighttime-only orthosis effective in decreasing symptoms of trigger finger?
                    
A sample of 46 individuals with Quinnell grade I or 2 trigger fingers (actively correctable symptoms for less than three months) were issued a custom orthosis for night wear only to be used for six weeks. The orthosis was an MCP block orthosis with the IP joints free for the digits or a hand-based thumb spica including the IP for the thumb. Fifty-three percent of the 34 participants who did follow-up had complete resolution of symptoms, and pain and function according to the Quick DASH improved following the six weeks of orthosis use for these participants. Satisfaction with the treatment was rated as 5.8/10 with greater satisfaction among the participants with resolution of their symptoms. 

Journal Source: Hand
Drijkoningen T, van Berckel M, Becker SJ, Ring DC, Mudgal CS. “Night splinting for idiopathic trigger digits.” Hand. 2017; Aug 1: 1558944717725374.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


November Research Update

New rehab program for wrist instability shows promising outcomes  
                    
Six patients with stage 1 scapho-lunate ligament injury participated in The Birmingham Wrist Instability Programme, a program that targets proprioceptive training for wrist instability over a 16 month period.  Following participation in the program, improvements were reported in this small pilot cohort for grip strength, pain, and self-reported outcomes (DASH & Euro-Qol).  These early findings suggest promising outcomes of this type of intervention for SL injury rehabilitation. 

Journal Source: Hand Therapy
Holmes MK, Taylor S, Miller C, and Brewster MBS. "Early outcomes of The Birmingham Wrist Instability Programme: A pragmatic intervention for stage one scapholunate instability." Hand Therapy. 2017.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


October Research Update

Are there patient and clinical characteristics that predict health status and recovery of hand function after hand burn injury?  
                    
A sample of 41 community dwelling adults (80.5% males) who were between one and two years after admission to a burn clinic for treatment of burns to one or both of their hands were asked to complete the Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ). These questionnaires in addition to their demographic, injury and treatment data were used to identify predictors of outcomes. The researchers found that psychiatric illness and female gender were key predictors of poorer global status on the BSHS-B. In addition, the need for reconstructive surgery and female gender were important predictors of poorer hand function, leading the researchers to conclude that individuals with these characteristics might benefit from intensive rehabilitation support and long-term follow-up. 

Journal Source: Burns
Knight A et al. "Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge." Burns. 2017.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


September Research Update

Does underwater ultrasound affect pain, inflammation, hand function and quality of life in patients with rheumatoid arthritis?   
                    
Previous research results have already confirmed the effects of ultrasound therapy on pain and function in a range of musculoskeletal disorders. In this randomized controlled trial, 25 patients received seven minutes of underwater ultrasound at 0.7W/cm2 for 10 sessions to both hands and wrists. The 23 patients in the control group received sham treatment under the same conditions. The researchers found promising short-term (two-week post-treatment) effects of underwater US therapy on pain, quality of life and joint function in patients with rheumatoid arthritis, but in the long-term (14 weeks post-treatment) ultrasound was not superior to sham treatment.

Journal Source: Brazilian Journal of Physical Therapy
Kiraly M. et al. “Effects of underwater ultrasound therapy on pain, inflammation, hand function and quality of life in patients with rheumatoid arthritis - a randomized controlled trial.” Brazilian Journal of Physical Therapy. 2017.

Access the Journal Abstract Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


August Research Update

What is the optimal method for rehabilitating LCL (lateral collateral ligament) injury of the elbow?                                   
In this study, LCL injury, LCL with common extensor origin injury and an intact elbow was actively and passively tested in seven cadavers in three arm positions (overhead, dependent and varus) and two forearm positions (pronation and supination). The researchers conclude that rehabilitation with the arm overhead is the most stable, and might decrease stiffness and promote ligament healing. If rehabilitation occurs in the dependent position, active pronation is encouraged. Varus arm position was found to be the least stable and is discouraged. .

Journal Source: Journal of Shoulder and Elbow Surgery
Manocha, Ranita HK, et al. "Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study." Journal of Shoulder and Elbow Surgery. 26.4 (2017): 596-603.

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


July Research Update

Does wearing a thumb spica or wrist immobilization impact driving performance?                                   
A cohort of 20 healthy subjects completed a cone-marked driving course with four forms of below-elbow immobilization (short-arm cast, wrist orthosis, thumb spica cast and spica orthosis) and without any immobilization. The outcomes measures included pass/fail score from a certified driving instructor, subject-perceived difficulty, number of cones hit and driving time. The researchers found the greatest number of failing scores from a certified driving instructor occurred with use of a right or left thumb spica cast. All forms of immobilization with the exception of the left wrist orthosis increased subject-perceived difficulty compared to the control run, but there was no difference in number of cones hit or driving time in the different situations.

Journal Source: Injury
Jones, E.M., Barrow, A.E., Skordas, N.J., Green, D.P. and Cho, M.S. The effects of below-elbow immobilization on driving performance. Injury. 2017

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


June Research Update

The time has come to update our norms for grip and pinch measures!                                   
A new pilot study found statistically significant differences in hand grips strength in a group of 120 healthy subjects compared to the norms established by Mathiowetz et al over 30 years ago. The new study stratified data by gender, age and handedness and found differences across several groups. Negative differences were more frequent than positive differences, particularly in subjects under the age of 45. These preliminary findings suggest that overall as a population this group has decreased hand grip strength compared to previous populations. The authors conclude that further testing in a larger group is necessary in order to update normative standards to reflect current ability for use in clinical practice.

Journal Source: Computers in Biology and Medicine
Larson, C.C. and Ye, Z. Development of an updated normative data table for hand grip and pinch strength: A Pilot Study. Computers in Biology and Medicine. 2017

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


May Research Update

New study finds that a combination of occupation based intervention and therapeutic exercise produces better recovery than therapeutic exercise alone in hand injured people.                                   
Limited evidence is available to support Occupation Based Intervention (OBI), a therapeutic agent that utilizes occupations (e.g. ADLs, IADLs, work, leisure etc.) and purposeful activity (e.g. writing practice, shoelace tying, shirt buttoning etc.) as a treatment medium. The purpose of this study was to investigate the efficacy of OBI and therapeutic exercise (i.e. assisted AROM/PROM, AROM and strengthening) in comparison to therapeutic exercise alone in hand injury rehabilitation practice. They found that a combination of OBI and therapeutic exercise produced better recovery according to DASH scores, total active motion, neuropathic pain, COPM performance and COPM satisfaction than TE alone in patients with hand injury.

Journal Source: The Journal of Hand Therapy

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April Research Update

Does sensory relearning via the performance of sensory re-education activities improve tactile function for individuals with chronic numbness greater than one year status post carpal tunnel release?    
 A recent prospective, randomized controlled trial out of the UK suggests that a home exercise program of short intensive daily sensory re-education tasks did not significantly impact tactile gnosis (measured via the Shape Identification Test), touch threshold, performance on the locognosia test, and outcome of the Moberg Pick-up Test for individuals with at least minor numbness and difficulty using small objects one year or more after carpal tunnel release. The authors (Jerosch-Herold and colleagues) did find a small change in patient reported function through the Michigan Hand Outcome Questionnaire, but cautioned that this did not meet clinical significance and may have been affected by study drop outs who had low self-reported functional statuses at the start of the study. The study concludes that sensory relearning for chronic sensory and functional deficits after carpal tunnel decompression is not effective.

Journal Source: The Journal of Hand Surgery (European Volume)

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


March Research Update

Can Goniometric Measurements Be Influenced By Examiner Bias?
A new study from the Physical Therapy Department of Hadassah Medical Center in Jerusalem suggests that information provided to physical therapists prior to wrist range of motion assessment was associated with differential results of objective goniometric measurement of the wrist. Therapists received different information regarding the clinical condition of a healthy woman with no history of wrist injury. Therapists who were told the injury and outcome were more severe consistently measured the wrist motion as more limited, suggesting cognitive bias.

Journal Source: Journal of Orthopaedic and Sports Physical Therapy

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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.