De Quervain's Disease Research Articles

Diagnostic accuracy of imaging modalities in the detection of clinically diagnosed de Quervain's syndrome: a systematic review.

To collate and synthesise the literature to provide estimates of the diagnostic accuracy of imaging modalities, and summarise the reported imaging findings associated with de Quervain's syndrome. A systematic search was performed in seven databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PROSPERO, Web of Science, and ProQuest Dissertations & Theses Global). Two reviewers independently performed screening, data extraction and quality assessment using a modified Quality Assessment of Diagnostic Accuracy Studies-2. Measures of diagnostic accuracy were summarised for different modalities and imaging findings. Twenty-two studies were included, reporting ultrasound, magnetic resonance imaging, X-ray and scintigraphy findings. Reported imaging findings included sheath effusion, retinaculum thickening, subcutaneous oedema, tenosynovitis, hypervascularity, increased tendon size, bony erosion, apposition, calcific lesions and increased uptake on scintigraphy. The most commonly reported imaging findings related to the tendon sheath, with a sensitivity ranging from 0.45 to 1.00 for thickening, and 0.29 to 1.00 for effusions. The risk of bias of studies is largely unclear owing to a lack of reported detail. The accuracy of imaging in the diagnosis of de Quervain's syndrome is unable to be determined because of the quality of the studies included. Ultrasound is the most frequently studied imaging modality and may be the modality of choice in clinical practice. Further research involving both symptomatic and asymptomatic participants and clear definitions of abnormal findings are required to better evaluate the effectiveness of imaging in identifying de Quervain's syndrome.

Effect of dose of the corticosteroid injected locally on inflammatory diseases

Background: Local injection of corticosteroid medication is one of the most common therapeutic treatments in inflammatory diseases, yet there are still many controversies surrounding its use. Methods: One hundred and seventy patients with de Quervain disease, lateral epicondylitis, or plantar fasciitis were entered into the study and divided into two groups (groups 1 and 2) according to doses of the steroids (20 mg and 40 mg methylprednisolone acetate, respectively). Patients were evaluated before injection and at 3 wk and 6 wk after injection using a visual analogue scale, quick Disabilities of the Arm, Shoulder and Hand score, the American Orthopedic Foot and Ankle Society Score, and grip strength. Complications were recorded at each visit. Results: All outcome parameters significantly improved 3 wk after injection in all patients. Improvement between weeks 3 and 6 was not significant. There was no significant difference between patients in group 1 and 2 except patients in group 1 with plantar fasciitis had better outcome than those in group 2 at 6 wk. The only encountered complication was change in color of the skin in three patients. Conclusions: A 20-mg injection of methylprednisolone acetate locally was sufficient for improvement of symptoms in patients with de Quervain disease, lateral epicondylitis, and plantar fasciitis. More doses of the steroid had no more beneficial effect.

Asociación entre dedos en resorte múltiples, enfermedades sistémicas y síndrome del túnel carpiano: análisis multivariante

IntroductionTrigger finger (TF) is a frequent pathology depending on several factors. The objective of this study was to assess the relationship between multiple TF and systemic or musculoskeletal disorders in a sample of young patients. Material and methodA retrospective study was performed of all patients with TF operated in our hospital between 2011 and 2015. Multiple or single TF diagnosis and pathologies such as diabetes mellitus (DM), thyroid dysfunction, carpal tunnel syndrome (CTS), epicondylalgia or DeQuervain's disease were collected. Statistical results included a bivariate analysis and a multiple logistic regression. ResultsTwo hundred and seventy-nine patients with a mean age of 48.45years were included. The dominant hand was affected in 217 cases. There were 59 patients with multiple TF, 21 DM, 55 STC, 16 epicondylalgia and 14 DeQuervains. Prevalence of CTS was 19.7%, significantly higher than the general population (2%-4%). No statistical differences were found in age, sex, hypothyroidism, epicondylalgia or DeQuervain in the multiple TF group. Bivariate analysis detected that DM and CTS patients in the multiple TF group was significantly higher than in the single TF group (P=.007, P<.01). Multiple TF was also more frequent on the dominant side (P<.01). Multivariate logistic regression confirmed these findings, showing a statistically significant association between the multiple TF group and DM (OR: 4.98, P<.01), STC (OR: 2.09, P=.037) and dominant side (OR: 3.76, P=.016). ConclusionsDiabetes, CTS and dominant side are independently associated with multiple TF in young patients.

PENCEGAHAN TERJADINYA RESIKO DE QUERVAIN SYNDROM PADA PENGGUNA GADGET

Background: The use of Information and Communication Technology (ICT) devices is very broad, almost all human activities cannot be separated from technological devices, one example of which is the use of gadgets such as mobile phones, smartphones and tablets. Not many realize that using a gadget can pose a number of risks. Risks that can arise are De Quervain Syndrome. De Quervain Syndrome is a form of inflammation of the tendon membrane which is accompanied by pain at the base of the thumb extending to the lower arm, the presence of tendon swelling and causing and involving the narrow tendon movement (known as tenosynovitis) which is in synovial sheaths, that is covering the abductor pollicis longus and extensor pollicis brevis muscles. The purpose of this community service is to find out the impact of knowledge on the prevention of the risk of de quervain syndrome in gadget users at Muhammadiyah 2 Vocational School Pekanbaru-Riau.&#x0D; Methodology: this community service is in the form of lectures and discussions, examinations and measurements of early detection on the scale of pain with a VAS (Verbal Analog Scale) scale. Descriptive data analysis technique.&#x0D; Results and discussion: of community service activities were attended by students with a total of 54 people ranging in age from 15 to 17 years. In the number of students 54, the average value of pre-test and post-test, there is an increase in knowledge by 40%.&#x0D; Conclusion: There is an impact of increasing knowledge in students about the benefits of preventing the risk of de quervain syndrome in gadget users at Muhammadiyah 2 Vocational School Pekanbaru-Riau.&#x0D; Keywords: De Quervain Syndrom, Verbal Analog Scale, Gadget

Investigating the optimal handle diameters and thumb orthoses for individuals with chronic de Quervain's tenosynovitis – a pilot study

Aims: The aims of this study were to compare the differences in forearm muscle activities between two types of thumb orthoses and the optimal handle diameter when the orthosis is worn during a power grasp for individuals with chronic de Quervain’s Tenosynovitis.Methods: A 2 × 3 (Group × orthosis) and a 2 × 2 × 3 (Group × orthosis × diameter) repeated factorial design were used. Grip strength and muscle load were measured. A 2 × 3 mixed repeated measures ANOVA was conducted, and the Least Significant Difference (LSD) test was used for post hoc analysis. Cohen’s d was used to calculate the effect size between groups and handle diameters.Results: Grip strength was significantly lower (in long/short/no-orthosis conditions) and muscle load was higher in 12 participants with chronic de Quervain’s Tenosynovitis than in 16 healthy participants (p < 0.001). No differences in muscle activities were found when the two different orthoses were worn. The muscle activities were higher during grasping of the 33 mm handle diameter.Conclusion: Individuals with chronic de Quervain’s Tenosynovitis require greater muscle loads than healthy controls to produce the same power grasp, and when one of the two orthoses is worn, the optimal handle diameters for performing a power grasp are relatively larger (45 and 55 mm).Implications for RehabilitationBoth the long and short thumb orthoses can be worn by individuals with de Quervain’s Tenosynovitis during daily activities because wearing both orthoses requires the same exertion of muscle load.When performing a power grasp, individuals with de Quervain’s Tenosynovitis tend to exert greater muscle loads than healthy controls to produce the same power grasp.We suggest that patients with de Quervain’s Tenosynovitis use utensils with larger handle diameters, such as 45 mm and 55 mm.

Comparison between myofascial release and myofascial taping as an adjunct to conventional occupational therapy in the management of dequervain's tenosynovitis: A randomized controlled trial

Background: De Quervain's tenosynovitis, the most common overuse injury involving the wrist. There is no consensus in the treatment of De Quervain's tenosynovitis; both surgical and conservative medical management have adverse effects. Myofascial release (MFR) and myofascial taping (MFT) are newer techniques which have been proven effective for other inflammatory and noninflammatory musculoskeletal conditions. Hence, the study was planned to determine and compare the effectiveness of the both the above-mentioned adjunct method along with conventional occupational therapy in the treatment of De Quervain's tenosynovitis. Objective: The objective of this study is to compare and study the effectiveness of MFT and MFR as an adjunct to conventional occupational therapy treatment in patients with De Quervain's tenosynovitis. Study Design: A prospective, comparative randomized controlled trial was conducted for 18 months. Methods: A total of 31 patients (both males and females aged 20-40 years) diagnosed with De Quervain's tenosynovitis, referred to outpatient department were randomized into two groups after screening by simple random allocation using computerized generated table, patients in MFT group (n = 16, 11 females and 5 males) received MFT along with conventional treatment and patients in MFR group (n = 15, 9 females and 6 males) received MFR along with conventional treatment. They followed up for treatment for 5 weeks, two times a week with each session lasting for 30-40 min. Pain level and functional improvement were evaluated using Visual Analog Scale (VAS) score and Patient-Specific Functional Scale (PSFS) score, respectively, before therapy and at the end of the 3rd and 5th week of the 5-week therapy program. Results: Both the groups showed significant improvement in pain scores on VAS at the 3rd and 5th weeks (P

Clinical Outcome of Nonoperative Treatment of de Quervain's Disease with Local Corticosteroid Injection in Nigerian Setting.

Background:The goal of treatment of de Quervain's disease, pain relief and restoration of hand functions, is achievable with local corticosteroid injection. However, published reports indicate variations in its cure rate and efficacy from and within subregions. This study aimed to determine the outcome of this treatment modality in Nigerian setting.Patients and Methods:Fifty-one cases of de Quervain's disease in 41 consecutive eligible patients were enrolled between January 2011 and December 2016, treated with local methylprednisolone acetate injection and followed up prospectively in orthopedic clinics of Federal Teaching Hospital, Abakaliki, and Mater Miserere Cordiae Hospital, Afikpo, Nigeria.Results:Eight weeks post initial injection, 94% of the cases were signs and symptoms free. The recurrence rate post initial injection (19.6%) correlated directly with pain intensity (P < 0.001) and was significantly (P = 0.018) higher in subacute compared to acute and chronic presentations. At the end of a follow-up period that ranged from 24 to 84 months with a mean of 54 months, 47 (92.2%) cases were cured with either single injection (78.4%) or multiple injections (13.7%) of corticosteroid, 3 (5.9%) had incomplete resolution but were satisfied, and in 1 (2%) there was no beneficial response. There was no serious adverse reaction; 14 (27.5%) cases had localized skin depigmentation.Conclusion:In our setting, local corticosteroid injection as a treatment modality for de Quervain's tenosynovitis has short- and long-term success rates of over 90%, and is rarely associated with serious adverse reaction. It is recommended as the initial treatment of choice in de Quervain's disease.

Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients

De Quervain described tenosynovitis of first dorsal compartment more than 120years ago. Women, particularly of 4th-5th decades, are at more risk of developing disease. Steroid injection has been described as first line of management over many decades, but it is associated with some significant complications like depigmentation of skin, atrophy of subcutaneous tissue, suppurative tenosynovitis and even tendon rupture. Animal studies have also reported increased risk of peritendinous adhesions with steroid injection. We prospectively managed 46 cases of De Quervain's tenosynovitis with longitudinal incision at tertiary care hospital from 2014 to 2016. There were totally 40 patients with 9 males and 31 females between age group of 28 and 62years. All patients were evaluated using DASH and VAS scores preoperatively and post-operatively. The mean preoperative DASH score was 42.26 which reduced to 5.37 post-operatively. The mean preoperative VAS score was 7.30 which reduced to 2.33 post-operatively. Intraoperatively, we found peritendinous adhesions in 8 patients and ganglion arising from first dorsal compartment in one patient. Post-operatively, we found hypertrophic scar in 3 patients and persistent numbness to first dorsal web space due to injury to superficial radial nerve in 2 patients. Six patients had recurrent symptoms and required revision surgery. Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons.

Correlation Between IL-20 and De Quervain's Disease Severity.

De Quervain's disease is a stenosing tenosynovitis of the first dorsal compartment of the wrist. Histopathological studies have reported that the thickening of the first dorsal retinaculum is characterized by degeneration rather than inflammation. However, significant infiltration of mast cells and macrophages was noted in a torn tendon study, which suggested that innate immune pathways are part of the mechanism that mediates early tendinopathy. Recently, Interleukin-20 (IL-20) has been reported to provoke potent inflammation and regulate angiogenesis and chemotaxis, which are important for the pathogenesis of inflammatory diseases. The main purpose of our study was to investigate the correlation between IL-20 and tumor necrosis factor (TNF-α) and clarify the potential predictor of tendinopathy progression. Hematoxylin and eosin (H & E) and immunohistochemistry (IHC) staining were used to score and analyze the clinical outcome. TNF-α, IL-20 and related inflammation cytokines were examined. Moreover, the tenocytes were cultured with a stimulator and were used to examine inflammatory cytokine secretions. A real-time polymerase chain reaction (Real-time PCR) was used to detect the gene expression profile. The IHC data showed that TNF-α is up-regulated in grade III de Quervain's. The analysis data showed that IL-20 is positively correlated with TNF-α and disease severity. The real-time PCR showed that the inflammation stimulator enhanced the expression of IL-20 mRNA expression. Inflammation cytokines such as TNF-alpha, transforming growth factor-β (TGF-β) and IL-1 have been used as predictors of de Quervain's; IL-20 is a new predictor based on this study. In the future, IL-20 expression's involvement in the molecular mechanism of the severity of de Quervain's should be further investigated.

Five year long term results of total joint arthroplasties in the treatment of trapeziometacarpal osteoarthritis.

Introduction: Trapeziometacarpal (TMC) osteoarthritis is a common disease. Patients with advanced disease who have failed conservative treatment have different surgical options, including total joint prosthesis. The aim of this study was to investigate the long-term outcome and complications of trapeziometacarpal (TMC) total arthroplasty. Materials and Methods: One hundred and forty-seven patients with TMC osteoarthritis were surgically treated with TMC arthroplasty, and one hundred and thirty-seven patients were seen for follow-up (102 women and 35 men). At follow -up patients were asked to complete a visual linearanalogue scale (VAS) for satisfaction with the result of the operation and persisting pain from the thumb, the Spanish validated Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate function of the affected hand.(9) The radiological examination consisted of posterior-anterior and oblique radiographs. In preoperative radiographs Eaton-Little was used, and in postoperative radiographs were assessed with regard to implant loosening and alignment. Results: The subjective outcome was satisfactory in 126 cases (92 %), 14 (12 %) patients would undergo the same procedure in the other hand. The DASH questionnaireswere 19.55 (range 5.6-33,5) on average, and EVA was 1 on average. The mean key pinch strength was 5.8 Kg at 5 years follow-up. The most frequent postoperative complication was De Quervain tenosynovitis (21%), other complications were: Cup loosening (3.6%), traumatic dislocation (3,6%). The prosthesis was removed in nine cases (7%). There were four intraoperative complications. The survival rate for ARPE prosthesis was 92,7% at 60,5 months. TMC total arthroplasty offers a reliable treatment alternative in patients with thumb carpometacarpal joint osteoarthrosis which conservatives’ treatment had failed. Conclusions: The TMC joint prosthesis is an option for patients with TCM osteoarthritis, provides satisfactory outcomes and has a low failure rate.(www.actabiomedica.it)

Hand tendinopathy risk factors in Taiwan: A population-based cohort study.

De Quervain's disease, carpal tunnel syndrome (CTS), and trigger finger (digit) are three common pathological conditions of the hand. They are considered overuse syndromes and occur predominantly in females. The prevalence rate and cause-specific risks of these three tendinopathies have not yet been clarified. Data from 41,871 cases listed in the Taiwan National Health Insurance Research Database (NHIRD) from 2010 to 2014 were analyzed. The prevalence rate of these 3 conditions by age, sex, and the risk factors of female-dominant diseases (e.g., osteoporosis, rheumatoid arthritis [RA], and tendinopathy), diabetes mellitus, and hormone antagonist treatment was evaluated. We found that 1.59% of the population developed CTS, 0.49% developed de Quervain's, and 1.07% developed trigger finger. Cases were more likely to develop the three hand tendinopathies if they were female, between 50 and 59 years old, and, according to a multivariate analysis, comorbid with RA, diabetes, using hormone antagonists. Our findings should provide an understanding of the risk factors associated with hand tendinopathy.

Successful Treatment with Tokishakuyakusan for de Quervain Disease and Carpal Tunnel Syndrome after Delivery

Successful Treatment with Tokishakuyakusan for de Quervain Disease and Carpal Tunnel Syndrome after Delivery

Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study.

Background: The reported prevalence of a subcompartment housing the extensor pollicis brevis (EPB) tendon within the first dorsal compartment varies widely in the literature, especially regarding the rates of occurrence between genders and among those with and without De Quervain. Based on direct intraoperative observation, we hypothesized that the prevalence of a septated compartment is far greater than previously reported, particularly in those with De Quervain disease. Methods: A prospective analysis of consecutive patients who underwent first dorsal compartment release was carried out. Patients were divided into 2 groups: those with De Quervain tenosynovitis ("De Quervain" group) and a control cohort without a primary diagnosis of De Quervain ("non-De Quervain" group). The intraoperative findings of a single compartment or a separate subcompartment were recorded. The prevalence of a septated compartment was calculated and compared between genders and both patient groups. Results: A total of 102 consecutive patients were included, with a female predominance (74.5%). Overall, 79.4% of patients had a separate subcompartment for the EPB. In the De Quervain cohort, 89.1% had 2 compartments, while 71.4% of non-De Quervain patients had a subcompartment. Men and women had a similar rate of double compartments (80% and 82.4%, respectively). Conclusions: The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients afflicted with De Quervain tenosynovitis. This higher rate of septation occurs with a similar prevalence in both men and women. Owing to its consistent presence, the dual first dorsal compartment should be regarded as an expectant anatomical component of the normal wrist.

One portal endoscopic release of the first extensor compartment in de Quervain's disease

ObjectivesWe aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method. Materials and methodsThe patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. ResultsThe mean operating time was 13.9 min (range, 10–21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation. ConclusionsOne portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. Level of EvidenceLevel IV Therapeutic Study

Platelet-rich plasma as a treatment for DE Quervain's Disease

platelet-rich-plasma is increasingly used in De Quervain's Disease. This study show the clinical outcomes of a single PRP injections.my study was done between Dec. 2015 and Oct. 2016, thirty patient receive single injection of platelet-rich –plasma All patients underwent prospective clinical evaluation, including visual analog scale (VAS) for pain for six month follow up .most of the patient (VAS) significantly improve from 5.9,to 2.0 (p &gt; 0.05) after injection with platelet-rich –plasma .PRP injections in De Quervain's Disease showed better improvement in outcomes

The thickening of flexor tendons pulleys: a useful ultrasonographical sign in the diagnosis of psoriatic arthritis.

To investigate the frequency of thickening of pulleys for flexor tendons in patients with early arthritis in their hands, and to evaluate it as a predictive sign of PsA. A prospective observational study involving 228 consecutive patients presenting with recent onset of arthritis in their hands was conducted at rheumatology outpatient clinics in the Veneto region of Italy between October 2014 and September 2017. Diabetic patients were excluded because of the high frequency of trigger finger. The final diagnosis of the rheumatologist delivered after 12months of follow-up, was considered as the gold standard for the analysis of diagnostic accuracy. Twenty-two patients were excluded from the study because of diabetes. A total of 86 patients with thickening of A1 pulleys in flexor tendons and 120 without were evaluated. Pulley thickness was significantly associated with a family history of psoriasis (18/86 vs 3/120, p˂0.001) and diabetes (9/86 vs 4/120, p = 0.036), and with a personal history of cutaneous psoriasis (25/86 vs 10/120, p˂0.001), psoriatic onychopathy (7/86 vs 2/120, p = 0.028), lower back pain (22/86 vs 11/120, p = 0.001), Dupuytren's disease (7/86 vs 2/120 p = 0.028) and De Quervain tenosynovitis (4/86 vs 0/120, p = 0.028). In isolation, this sign had a good sensitivity rate (80%). The specificity rate for the disease was barely significative (71%), with an LR+ of 2.71 for PsA. The thickening of the pulleys in the flexor tendons is an easy-to-detect sign with good sensitivity for the diagnosis of PsA. Its specificity and positive predictive value are not very high; however, if it is included in a complete classification process, sonographers should report it during hand evaluations of patients with arthritis.

Estrogen and mechanical loading-related regulation of estrogen receptor-β and apoptosis in tendinopathy.

Female-dominant tendinopathies are musculoskeletal disorders caused by repetitive hand posture and motion; they are considered overuse syndromes. Both external mechanical stress and changes in hormone levels might affect disease progression. We have previously reported that estrogen receptor-β (ER)-β expression was associated with the pathogenesis of de Quervain's disease. To study the underlying mechanisms, a cyclic stretching culture system was applied to tendon tissue from ovariectomized (OVX) rats. Furthermore, a collagenase I-induced rat tendinopathy model was established to examine the association of ER-β with disease progression. Our results showed that ER-β expression and the number of apoptotic cells were higher and associated with disease severity in rats with tendinopathy. Mechanical stress altered the morphology of primary tenocytes and collagen fiber alignment in tendons, and up-regulated the expression of matrix metalloproteinase-9, ER-β, and interleukin-1β, as well as induced apoptosis in tenocytes and tendon tissue from OVX rats. This is the first report on the effects of ER-β and mechanical stress in tendinopathy. We hope these findings contribute to new pharmacological therapies targeting ER-β signaling pathways to treat tendon-related diseases.

Musculoskeletal Pain Symptoms and Injuries Among Endoscopists Who Perform ERCP Presidential Poster Award

Introduction: The leaded protective gear worn, patient and endoscopist positioning, and longer average procedural time places endoscopists who perform endoscopic retrograde cholangiopancreatography (ERCP) at an increased risk for injuries as compared to other endoscopists. While multiple studies have investigated the prevalence of various pain symptoms and injuries among endoscopists, only one has been carried out in endoscopists who perform ERCP, and none have investigated potential predisposing risk factors. Methods: An anonymous electronic survey containing 23 questions was sent to 3,276 gastroenterologists. Only providers that performed ERCPs were asked to respond. Participants were only allowed to select one musculoskeletal pain symptom and one musculoskeletal injury thus enabling us to evaluate the predominant symptom and or injury in each participant. Results: A total of 203 surveys were completed. Variables that were assessed included sex, glove size, average number of ERCPs performed per year, types of lead gowns worn, time period ERCPs were performed prior to symptom onset, patient positioning, and the presence or absence of fluoroscopy tables and monitors with adjustable heights, and anti-fatigue matting. Of the 203 respondents, 91% reported a musculoskeletal pain symptom. 42% attributed this pain to performing ERCPs. The most prevalent pain symptoms were neck pain (24%), and lower back pain (17%). 48% of respondents reported a musculoskeletal injury. 16% attributed these injuries to performing ERCPs. The most prevalent musculoskeletal injuries were De Quervain's Tenosynovitis (16%), and cervical radiculopathy (12%). Among the respondents, only 36% used anti-fatigue matting, 40% wore two-piece lead gowns and 74% weren't aware of the thickness of their lead gown. Only 25% of participants had received any education/training on ergonomics in endoscopy and 71% stated they are interested in learning more about preventative strategies regarding ERCP-related injuries. Conclusion: The majority of endoscopists who perform ERCPs suffer from a musculoskeletal pain symptom and almost half report a musculoskeletal injury. Further investigation regarding risk factors and preventative strategies is warranted. Only a small portion of advanced endoscopists report having received any training on ergonomics and the majority are interested in learning more. More information and education regarding ergonomics should be included during fellowship and postgraduate training.

The Effectiveness of a Noninvasive Shot Blocking Device in Reducing Pain of In-Office Injections in Hand Surgery

Contracted Research: AxoGen (Rinker) The gate control theory of pain asserts that nonpainful stimuli can prevent the transit of pain sensation to the brain. The ShotBlocker device is a soft plastic disk with multiple blunt projections that rests on the skin during the administration of an injection, and there is some evidence that it is effective in reducing pain in pediatric vaccinations (Figures 89-1, 89-2). We hypothesized that this device will reduce pain from common hand injections in the office setting. This was a prospective randomized trial of 110 consecutive patients undergoing injections for common inflammatory hand conditions. Patients were randomized into 3 groups: shot blocking device, modified device, and control. The modified device consisted of the plastic disk with the projections removed, and it was held over, but not in contact with, the skin during injection. Age, gender, diagnosis, and pain medication history were recorded. Patients were asked to record on a Likert scale their perception of pain from their most recent tetanus shot. After the injection they scored the pain perception on the same scale. A normalized pain score was obtained from the difference between the injection pain score and the tetanus shot pain score for each subject. The mean nonnormalized and normalized scores for each treatment group were compared with the control group using Student t test. There were 84 women and 26 men in the study group, median age 52 years. Common diagnoses included trigger finger (n = 48), de Quervain tendonitis (n = 32), and basal joint arthritis (n = 20). The 3 groups did not differ significantly in age or pain medication history. The mean pain score in the device group was 5.01 of 10, compared with 5.72 for the control group, P = .34. The normalized pain score in the device group was 1.26, compared with 3.03 for the control group. This difference was statistically significant (P = .02). Normalized and nonnormalized pain scores for the modified device were not significantly lower than for the control group. •The ShotBlocker device effectively reduced pain of injection versus controls when pain scores were normalized to account for pain tolerance.•When the device was modified by removing the projections, it was not shown to reduce the pain of injection, suggesting that regulating gate control, rather than distraction or placebo, may be the mechanism of action.•The ShotBlocker device may reduce the pain of in-office injections for common inflammatory hand conditions.Figure 89-2The device is placed with the projections against the skin prior to the injection procedure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Occupational Therapists' Role in Perinatal Care: A Health Promotion Approach.

This article establishes and examines occupational therapists' role in perinatal care and proposes a health promotion approach for new and expectant mothers. The author demonstrates the importance of maintaining meaningful occupational engagement during this critical life stage by incorporating evidence from orthopedic, rehabilitation, and hand therapy research. New and expectant mothers are at high risk for upper extremity (UE) conditions such as carpal tunnel syndrome, De Quervain's tenosynovitis, and tendinosis of the UE. Occupational therapists with basic knowledge of hand therapy are well prepared to manage these conditions conservatively. An occupation-based model and framework are presented to ensure a holistic view of the target population. Topics pertinent to this population include postural techniques, repetitive tasks, patient education, and strengthening related to the perinatal period.