Repetitive Wrist Extension Research Articles

Assessment of Risk Factors of The Patients With Lateral Epicondylitis

Background: Lateral epicondylitis, is prevalent in the world of sports; however, this injury still causes confusion among healthcare professionals. Numerous studies have evaluated treatment options, but few have taken into consideration the extent to which tennis players, themselves, understand this ailment. Objectives: To identify the risk factors associated with lateral epicondylitis. Materials and methods: An observational case control study design was carried out among 120 patients attended at outdoor Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka from April 2018 to march 2019. Sixty (60) patients with lateral epicondylitis as case group and another 60 patients without lateral epicondylitis as control group. Data was collected using a structured interviewer- administered questionnaire, enquiring about demographic data and details of risk factors. Result: The mean age was found 39.4:6.3 years in case group and 36.97.4 years in control group. Twenty- seven (45.0%) patients had more than 2 hours of use hand in case group and 12(20.0%) in control group. More than half (53.3%) patients had moderate VAS scale in case group and 9(15.0%) in control group, Nine (15.0%) patients were found past history of recurrent injury in case group and not found in control group. The difference was statistically significant (p<0.05) between two groups. Patients having use hand more than 2 hours 3.273 (95% CI 1.453% to 7.36%) times more likely to developed lateral epicondylitis. Conclusion: Use of hand with repetitive wrist extension more than 2 hours was significantly associated with lateral epicondylitis. J Dhaka Med Coll. 2023; 32(1) : 77-84

Effectiveness of Mulligan Mobilization Technique Versus Cyriax Technique for Lateral Epicondylitis: A Pilot Study

Background: Eccentric loading of extensor carpi radialis brevis tendon near its origin causes tennis elbow, alsoknown as lateral epicondylitis. Tennis elbow is primarily caused by repetitive wrist extension or loaded grippingoveruse injuries and when playing tennis, badminton, or any sport are more likely to experience it. The goal of thestudy was to determine whether tennis elbow pain might be decreased and improve the functional status. Subjectsare divided into two groups, Mulligan mobilization technique and Cyriax technique along with ultrasound.Purpose: To find out the effects of Mulligan mobilization technique and Cyriax technique along with ultrasoundin the management of lateral epicondylitis.Materials and Methods: Twenty individuals were chosen with tennis elbow (11 males and 9 females) and receivedtreatment for four times/week for two weeks in RENU’S Physiotherapy & Rehabilitation Centre according to theinclusion and exclusion criteria, explained about the procedure and obtained signed informed consent. Subjectswere divided into two groups by simple random sampling -Mulligan mobilization technique of Movement withMobilization(MWM) and Cyriax technique of Deep Tendon Friction(DTF) massage with Mill’s manipulationalong with ultrasound.Result: Statistical analysis had slight significant difference between Cyriax and Mulligan group for NPRS andPRTEE. Noticeably Cyriax had more improvement in pain reduction than Mulligan group, while Mulligan hadimprovement in functional impairment than Cyriax, with a p value of <0.0001.Conclusion: Mulligan mobilization and Cyriax method with ultrasound both reduced discomfort and enhancedfunctional status.

Effect of repetitive wrist extension with electromyography-triggered stimulation after stroke: a preliminary randomized controlled study

Objective: The purpose of this study was to explore the effect of repetitive wrist extension task training with electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES) for wrist extensor muscle recovery in patients with stroke. Design: Randomized controlled trial. Methods: Fifteen subjects who had suffered a stroke were randomly assigned to an EMG-triggered NMES group (n=8) or control group (n=7); subjects in both groups received conventional therapy as usual. Subjects in the experimental group received application of EMG-triggered NMES to the wrist extensor muscles for 20 minutes, twice per day, five days per week, for a period of four weeks, and were given a task to make a touch alarm go off by activity involving extension of their wrist. In the control group, subjects performed wrist self-exercises for the same duration and frequency as those in the experimental group. Outcome measures included muscle reaction time and spectrum analysis. Assessments were performed during the pre- and post-treatment periods. Results: In the EMG-triggered NMES group, faster muscle reaction time was observed, and median frequency also showed improvement, from 68.2 to 75.3 Hz, after training (p<0.05). Muscle reaction time was significantly faster, and median frequency was significantly higher in the experimental group than in the experimental group after training. Conclusions: EMG-triggered NMES is beneficial for patients with hemiparetic stroke in recovery of upper extremity function.

Impact of Motor Practice on Neuromodulation for Stroke Rehabilitation

Abstract Date Presented 4/7/2016 This study informs practice by indicating the degree of neuromodulation attainable with repetitive wrist extension in survivors of stroke. This is important because of recent advancements in using technologies such as transcranial magnetic stimulation to influence neuromodulation and neuroplasticity. Primary Author and Speaker: Crystal Massie Contributing Authors: Caylen White, Damian Funke

Immediate Effects of Repetitive Wrist Extension on Grip Strength in Patients With Distal Radial Fracture

ObjectiveTo evaluate the immediate effect of repetitive wrist extension on grip strength in patients with distal radial fracture. DesignInterventional study. SettingPatients who were admitted to a hospital department of occupational therapy. ParticipantsConsecutive patients with a unilateral distal radial fracture (N=28). InterventionEach patient was randomly allocated to either the experimental group (n=14) or the control group (n=14). The experimental group performed 30 repetitive wrist extensions with maximal isometric contraction of the extensors of their affected hands during a 6-minute intervention period, whereas the control group did not perform the exercise. Main Outcome MeasuresGrip strength was measured just before and after the intervention period. Pain during grip strength measurements was also quantified using the visual analog scale. Wrist extension strength was measured 10 minutes after the grip strength measurement. ResultsGrip strength increased immediately after repetitive wrist extension in the experimental group, but it remained the same in the control group. Visual analog scale scores indicated that pain was relieved only in the experimental group. However, pain was unrelated to strength production. ConclusionsThe intervention used in this study might be useful during physical examination to reveal the potential grip strength of patients. The intervention may also be an effective warm-up training procedure in preparation for conventional grip-strengthening exercises.

Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study

BackgroundLateral epicondylitis is a common sports injury of the elbow caused due to altered muscle activation during repetitive wrist extension in many athletic and non-athletic endeavours. The amount of muscle activity and timing of contraction eventually is directly dependent upon joint position during the activity. The purpose of our study was to compare the grip strength in athletes with lateral epicondylalgia in two different wrist extension positions and compare them between involved and uninvolved sides of athletes and non-athletes.MethodsAn assessor-blinded case-control study of eight athletes and twenty-two non-athletes was done. The grip strength was measured using JAMAR® hand dynamometer in kilograms-force at 15 degrees (slightly extended) and 35 degrees (moderately extended) wrist extension positions (maintained by wrist splints) on both involved and uninvolved sides of athletes and non-athletes with unilateral lateral epicondylitis of atleast 3 months duration. Their pain was to be elicited with local tenderness and two of three tests being positive- Cozen's, Mill's manoeuvre, resisted middle finger extension tests. For comparisons of grip strength, Wilcoxon signed rank test was used for within-group comparison (between 15 and 35 degrees wrist extension positions) and Mann-Whitney U test was used for between-group (athletes vs. non-athletes) comparisons at 95% confidence interval and were done using SPSS 11.5 for Windows.ResultsStatistically significant greater grip strength was found in 15 degrees (27.75 ± 4.2 kgms in athletes; 16.45 ± 4.2 kgms in non-athletes) wrist extension than at 35 degrees (25.25 ± 3.53 kgm in athletes and 14.18 ± 3.53 kgm in non-athletes). The athletes had greater grip strength than non-athletes in each of test positions (11.3 kgm at 15 degrees and 11.07 kgm at 35 degrees) measured. There was also a significant difference between involved and uninvolved sides' grip strength at both wrist positions (4.44 ± .95 kgm at 15 degrees and 4.44 ± .86 kgm in 35 degrees) which was significant (p < .05) only in non-athletes.ConclusionThe grip strength was greater in 15 degrees wrist extension position and this position could then be used in athletes with lateral epicondylalgia for grip strength assessment and designing wrist splint in this population.

Quantitative Motor Unit Analysis And Motor Unit Number Estimates In Healthy Subjects And Patients With Lateral Epicondylitis

Lateral epicondylitis (LE) is a condition that is caused by repetitive wrist extension activities and involves inflammation of the extensor tendon attachments at the lateral epicondyle. Symptoms associated with LE have been demonstrated to diminish with manual cervical manipulation, and electromyographic (EMG) signal abnormalities have been identified in individuals with LE suggestive of a cervical radiculopathy component. PURPOSE: This study was designed to determine: (i) if the quantitative EMG parameters related to motor unit potential (MUP) morphology, motor unit (MU) firing patterns or motor unit number estimates (MUNEs) detected from the affected extensor carpi radialis brevis (ECRB) muscle of patients with LE are different from those detected in healthy control subjects and whether these measures are suggestive of nerve pathology in patients. METHODS: Ten patients (47.9 ± 10.2 years) with clinically determined LE and eight healthy subjects (30.9 ± 7.9 years) participated in the study. Maximum M-waves, and needle- and surface- detected EMG data were recorded from the ECRB muscle during 30-second contractions performed at 10% of maximum voluntary contraction force. DQEMG™ was used to extract needle-detected and surface- detected (S) MUP morphology and MU firing rates. Maximum M-wave amplitudes were divided by the amplitude of the mean SMUP in each subject to obtain MUNEs. Kruskall-Wallace tests were used to determine between-group differences. RESULTS: Patients with LE had significantly larger MUP area-to-amplitude ratio (1.70 ± 0.58 vs. 1.23 ± 0.41), MUP duration (10.08 ± 3.10 ms vs. 6.90 ± 2.36 ms), SMUP amplitude (118.87 ± 111.10 μV vs. 60.15 ± 27.00 μV), and SMUP area (536.8 ± 528.1 μVms vs. 297.4 ± 189.5 μVms) compared to healthy control subjects (p<0.05). MU firing rates were significantly higher in the healthy control subjects (14.29 ± 2.47 Hz) than patients with LE (13.72 ± 2.69 Hz; p<0.05). The MUNEs were not significantly different between the groups (p>0.05). CONCLUSIONS: The MUP morphology differences between patients with LE and healthy control subjects are suggestive of neurogenic changes in the MUs of the ECRB muscle in the patients with LE; however the MUNEs did not suggest that there was any axonal loss.

Extensor Retinaculum Impingement in the Athlete

Background Athletes with repetitive weightbearing hyperextension activities are predisposed to wrist pain. Purpose To describe extensor retinaculum impingement of the extensor tendons as a new diagnosis for wrist pain for the athlete performing repetitive wrist hyperextension, to present cadaveric dissections to further understand the anatomical basis for extensor retinaculum impingement, and to report treatment outcomes of extensor retinaculum impingement. Study Design Case series; Level of evidence, 4. Methods A retrospective chart review was performed for athletes treated from 1987 to 2006 for wrist pain due to extensor retinaculum impingement. Eight wrists in 7 athletes were reviewed with a mean presenting age of 19.6 years. The hallmark symptom was dorsal wrist pain, and signs were extensor tendon synovitis and tenderness at the distal border of the extensor retinaculum, provoked by wrist hyperextension. Ten cadaveric wrists were dissected and examined to evaluate anatomical factors that may contribute to extensor retinaculum impingement. Results Two athletes (2 wrists) were treated with corticosteroid injections. Five patients (6 wrists) were treated operatively, with pathologic findings of thickening of the distal border of the extensor retinaculum and concomitant extensor tendon synovial thickening or, in 1 patient, tendon rupture. Partial distal resection of the extensor retinaculum was performed to eliminate impingement. All patients had complete relief of pain and full return to sport. Conclusion Competitive sports that require repetitive wrist extension with an axial load predispose the athlete to extensor retinaculum impingement. Athletes with dorsal wrist pain and tenosynovial thickening worsened with wrist hyperextension should be considered for the diagnosis of extensor retinaculum impingement. When nonoperative management fails, surgical resection of the distal impinging border of the extensor retinaculum can eliminate pain and can still allow athletes to return to sport without diminishing the opportunity for significant athletic accomplishments.

Maximum acceptable forces for repetitive wrist extension with a pinch grip

This study represents a continuation of a series of psychophysical studies on repetitive motions of the wrist conducted at the Liberty Mutual Research Center for Safety and Health. The purpose of the study was to quantify maximum acceptable forces for extension motions of the wrist performed with a pinch grip. Subjects grasped a handle with a pinch grip and moved it through a 1.57 rad (90°) extension wrist motion (similar to a light assembly operation). A psychophysical methodology was used in which the subject adjusted the resistance on the handle, and the experimenter manipulated or controlled all other variables. Twenty subjects performed the task at repetition rates of 15, 20 and 25 motions per minute. Subjects performed for 7 h per day, 5 days per week, for 4 weeks. The subjects were instructed to work as if they were on an incentive basis, getting paid for the amount of work they performed. Symptoms were recorded by the subjects during the last 5 min of each hour. The results are presented and compared with maximum acceptable forces for other types of wrist motion investigated in previous studies. Maximum acceptable force for wrist extension with a pinch grip is smaller than any of the other motions investigated so far. Relevance to industry Cumulative trauma disorders of the upper extremities continue to be a problem for industrial workers who perform repetitive tasks. Although a number of physical risk factors have been identified, there are very few data available for establishing acceptable levels of these risk factors. This study attempted to collect such data.

Local muscle fatigue in repetitive work.

Severe local muscle fatigue may be a precursor of repetition strain injuries (RSI). In any event it produces discomfort and limits production. This fatigue is evaluated by analysing the amplitude and frequency of the electromyographic signals of the extensor and flexor muscles during repetitive wrist extension against a constant torque. The absolute integral of the signal increased with extension angle but did not change with the exercise time period. This suggests that amplitude analysis is better for the evaluation of load, and frequency analysis is better in evaluating fatigue. The rate of decrease of the centre frequency with exercise time was also higher for the higher extension angle, and it was higher for female than for male subjects. Ulnar deviation did not affect the rate of fatigue in these experiments. The methodology used here shows promise for the evaluation of tool, job and layout design to prevent RSI.