Wrist Splint Research Articles

Kinematic synthesis of Stephenson III six-bar function generators

This paper presents a direct solution of the kinematic synthesis equations for Stephenson III six-bar function generators to achieve as many as 11 accuracy points. The approach is similar to that used to design Stephenson II function generators, except additional algebraic manipulations reduce the system to a multihomogeneous degree of 55,050,240. A numerically general multihomogeneous homotopy was used to obtain 834,441 nonsingular solutions, which were then used to construct an efficient parameter homotopy for specific tasks consisting of 11 accuracy points. The thousands of linkage solutions found by this parameter homotopy are sorted and analyzed to verify nonbranching movement through the specified task positions. An example is presented of a function generator that creates a specified torque-angle profile for a dynamic wrist splint that cancels the effects of spasticity in the wrists of stroke survivors.

The Effectiveness of Passive Physical Modalities for the Management of Soft Tissue Injuries and Neuropathies of the Wrist and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

ObjectiveThe purpose of this systematic review was to determine the effectiveness of passive physical modalities compared to other interventions, placebo/sham interventions, or no intervention in improving self-rated recovery, functional recovery, clinical outcomes and/or administrative outcomes (eg, time of disability benefits) in adults and/or children with soft tissue injuries and neuropathies of the wrist and hand. MethodsWe systematically searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials, accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text, accessed through EBSCO host, from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best evidence synthesis principles. ResultsWe screened 6618 articles and critically appraised 11 studies. Of those, 7 had low risk of bias: 5 addressed carpal tunnel syndrome (CTS) and 2 addressed de Quervain disease. We found evidence that various types of night splints lead to similar outcomes for the management of CTS. The evidence suggests that a night wrist splint is less effective than surgery in the short term but not in the long term. Furthermore, a night wrist splint and needle electroacupuncture lead to similar outcomes immediately postintervention. Finally, low-level laser therapy and placebo low-level laser therapy lead to similar outcomes. The evidence suggests that kinesio tape or a thumb spica cast offers short-term benefit for the management of de Quervain disease. Our search did not identify any low risk of bias studies examining the effectiveness of passive physical modalities for the management of other soft tissue injuries or neuropathies of the wrist and hand. ConclusionsDifferent night orthoses provided similar outcomes for CTS. Night orthoses offer similar outcomes to electroacupuncture but are less effective than surgery in the short term. This review suggests that kinesio tape or a thumb spica cast may offer short-term benefit for the management of de Quervain disease.

Splinting after Carpal Tunnel Release: Does it really Matter?

Splinting of the wrist after carpal tunnel release (CTR) has been practised by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR have had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting.Methods: All 30 of our patients underwent a standardized limited open CTR by a designated surgeon. Post operatively, they were randomized into a splinted (n=16) and a nonsplinted (n=14) group. The splint was kept for a week. Patients were reviewed at regular intervals of one week, two months and six months. At each follow up, these patients were clinically assessed for the following outcome measures: VAS (visual analogue score), 2PD (two-point discrimination), pinch grip, grip, Abductor Pollicis Brevis (APB)) power and completion of the Boston questionnaire. Results: All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up.Conclusion: We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release.

Evaluation and treatment of compression neuropathies of the upper limb

Compression neuropathies of the upper extremity can manifest with an obvious set of symptoms that are easily identified, such as with carpal tunnel syndrome (CTS). They can also appear with diffuse symptoms so similar or in coexistence with other conditions that they can be a challenge to identify, as is often the case in radial tunnel syndrome which closely resembles lateral epicondylitis in presentation [1]. Compression neuropathies are a dynamic mechanical phenomenon occurring when a nerve is compressed under a specific anatomical structure such as an opening in a fibrous or muscular tissue or a fibro-osseous tunnel [2]. The symptoms a patient experiences can be diffuse and variable, and may include muscle weakness, sensory paresthesia, pain, aching and fatigue in the extremity. Initially, a change in position may relieve the compression or alter the area of the nerve that is compressed, in which case the symptoms subside or change. As the compression persists the symptoms become more lasting and can no longer be relieved by an alteration in position. In response to the compressionthe nerve begins to change, progressing from a breakdown of the blood nerve barrier, connective tissue thickening, demyelination and ultimately to axonal degeneration [3]. Untreated, compression neuropathies, can result in permanent sensory loss and /or muscle atrophy, both ofwhich significantly impact function. Conservative treatment of compression neuropathies is multifaceted and may include activity analysis, patient education, ergonomic evaluation, postural exercises, stretching of muscles, nerve gliding exercises, splinting, taping, use of modalities such as ultrasound or iontophoresis [4], strengthening and improvement of aerobic capacity. Conservative treatment requires a careful, balanced, step by step approach on the part of the therapist and the patient. ”Aggressive stretching, particularly of neural tissue will needlessly exacerbate symptoms.”([3] page 633). Patient education is essential for this process to be effective. Success rates for conservative interventions vary. Shah et al. [5] reported an 88% success rate when treating patients with cubital tunnel using splinting and activity modification. Povlsen et al. [6] reported upon long-term results of CTS patients treated with wrist splinting, patient satisfaction was high and a 43% resolution rate was reported. In a group of 197 patients, Rosmaryn [7] compared splinting for CTS to splinting and an exercise program with tendon and nerve gliding exercises and found that the splinting and exercise program was more effective than splinting alone in the conservative treatment of CTS. This workshop will present an overview of upper extremity entrapment neuropathies: the anatomical structures that are involved, the clinical picture of compression neuropathies of the radial, median and ulnar nerves, assessment and therapeutic treatment methods.

Wrist Injury - Tennis

HISTORY: A 14 year old male tennis and hockey player presented to Sports Medicine with right wrist pain of 6 weeks duration located over the radial aspect of the wrist. He had fallen on an outstretched arm 7-8 weeks prior while playing doubles, but was able to complete the match and play several more matches that day and the following day with only minimal pain. About a week after the fall, his wrist pain began; he is not sure if it was the same pain he had experienced briefly after the fall. The pain was aggravated the more he played tennis and relieved by several days of rest. The pain mainly occurred as he was coming through in pronation on the follow through of his forehand. The pain gradually became more severe until the patient could hardly play any tennis due to pain. He was also unable to stick handle or shoot in hockey without pain. He had not played tennis or hockey for 2 weeks prior to presentation. PHYSICAL EXAMINATION: Examination revealed mild tenderness over the distal radius and the radial gutter. Range of motion was full without pain. He had pain with resisted pronation. Strength of the wrist was otherwise normal. There was no evidence of swelling and sensory examination was normal. DIFFERENTIAL DIAGNOSIS: Impaction fracture of the radius Scaphoid fracture Scapholunate dislocation/ligamentous sprain Tendinitis first or second dorsal compartment Interosseous membrane sprain TEST AND RESULTS: X-ray wrist - increased sclerosis of the distal radius and ulnar metaphysis adjacent to the growth plate. MRI wrist - signal abnormality and focal irregularity in the distal radial metaphysis and physis most suggestive of stress reaction. Small ganglion cyst along the radiocarpal joint in the volar aspect of the wrist. No evidence of a Salter fracture. Contents of the carpal tunnel are normal. FINAL WORKING DIAGNOSIS: Distal radial physeal stress reaction (gymnast’s wrist) TREATMENT AND OUTCOMES: Patient was placed in a short arm cast for 4 weeks. As it was hockey season when the cast came off, he was placed in a formfit wrist splint for hockey and started a gradual return to sports. So far the patient has had minimal pain with hockey, but further outcomes will be discussed at the conference. Since this is an injury which typically occurs in adolescent gymnasts, we will discuss the possible mechanism of this injury with tennis.

Comparing additive manufacturing technologies for customised wrist splints

Purpose – The purpose of this paper is to compare four different additive manufacturing (AM) processes to assess their suitability in the context of upper extremity splinting. Design/methodology/approach – This paper describes the design characteristics and subsequent fabrication of six different wrist splints using four different AM processes: laser sintering (LS), fused deposition modelling (FDM), stereolithography (SLA) and polyjet material jetting via Objet Connex. The suitability of each process was then compared against competing designs and processes from traditional splinting. The splints were created using a digital design workflow that combined recognised clinical best practice with design for AM principles. Findings – Research concluded that, based on currently available technology, FDM was considered the least suitable AM process for upper extremity splinting. LS, SLA and material jetting show promise for future applications, but further research and development into AM processes, materials and splint design optimisation is required if the full potential is to be realised. Originality/value – Unlike previous work that has applied AM processes to replicate traditional splint designs, the splints described are based on a digital design for AM workflow, incorporating novel features and physical properties not previously possible in clinical splinting. The benefits of AM for customised splint fabrication have been summarised. A range of AM processes have also been evaluated for splinting, exposing the limitations of existing technology, demonstrating novel and advantageous design features and opportunities for future research.

Transverse Ultrasound Assessment of the Displacement of the Median Nerve in the Carpal Tunnel during Wrist and Finger Motion in Healthy Volunteers.

The purpose of this study was to investigate the displacement of the median nerve in the carpal tunnel during finger motion at varied wrist positions using transverse ultrasound in healthy volunteers, in order to clarify the appropriate position of a wrist splint in treating carpal tunnel syndrome. Fifty wrists of 25 asymptomatic volunteers were evaluated by transverse ultrasound. The location of the median nerve in the carpal tunnel was examined at 5 wrist positions (neutral, 60° dorsiflexion, 60° palmar flexion, 40° ulnar flexion, 10° radial flexion) with all 5 fingers in full extension, all 5 fingers in full flexion, and isolated thumb in full flexion, respectively. The median nerve was located significantly (p<0.05) more dorsally at the wrist dorsal flexion position, more ulnopalmarly at the wrist palmar flexion position, more radially at the wrist radial flexion position, and more radially at the wrist ulnar flexion position than at the wrist neutral position in all 5 fingers at full extension. The median nerve moved the most significantly dorsally among all wrist positions during finger motion at the wrist dorsal flexion position (p<0.05). Conversely, the median nerve moved the most significantly ulnopalmarly at the wrist palmar flexion position with all 5 fingers in full flexion among all wrist positions during finger motion (p<0.05). This latter wrist and finger position induced significant displacement of the median nerve toward the transverse carpal ligament, and compressed it between the flexor tendons and the transverse carpal ligament. This study showed that there is a significant relationship between the median nerve displacement in the carpal tunnel and the motion of the wrist and fingers. This finding suggests that the compression or the shearing stress of the median nerve caused by the movement of the flexor tendons is reduced in the wrist dorsal flexion position compared with other wrist positions. This wrist dorsal flexion position could be the appropriate position for a wrist splint in the treatment for carpal tunnel syndrome. This ultrasound information provides further knowledge and understanding of the biomechanics and pathophysiology of the carpal tunnel. It could also help in the accurate analysis and assessment of diagnostic images and treatment for carpal tunnel syndrome.

The compensatory motion of wrist immobilization on thumb and index finger performance – kinematic analysis and clinical implications

Based on the high prevalence of people with problems in the wrist and hand simultaneously, it is of its importance to clarify whether hand joints exert extra motion to compensate for wrist motion while immobilized. This study aimed to measure the compensatory movement of the thumb and index finger when people perform daily activities with an immobilized wrist. Thirty healthy volunteers were recruited in this study. A wrist splint, the Jebsen-Taylor Hand Function Test, and the OptoTrak Certus motion tracking system were used. Seven inter-digit mean joint angles of the index finger and thumb were calculated. Paired sample t-test was used. (1) The compensatory motions were noted in the Metacarpophalangeal and Carpometacarpal joints of the thumb, and the proximal interphalangeal joints of the index finger; (2) The manifestation of compensatory motion was related to type of activity performed except when picking up light and heavy cans. The compensatory motions appeared while the wrist was immobilized and were found to be disadvantageous to the progression of disease. In the future, studies need to be done to understand how to select products with correct ergonomic design to enable people to reap greater benefits from wearing wrist splints.

Nonunion distal radius fracture – Case series of 6 cases with Review of Literature

Background: Distal radius nonunions are rare but complex problems. They can present with severe disability and functional limitation, however clear guidelines do exist due to sparse literature. We present our experience of 6 cases with review of literature Material and Methods: Retrospective review of 6 cases (4 males and 2 females) was done. Two cases were primarily treated with closed reduction and cast while others underwent surgical procedures ranging from single to 4 procedures. All were treated with open reduction, strut bone grafting using iliac crest bone graft and internal plate fixation. Darrach’s procedure was done in 4 cases and Sauvé-Kapandji in 2 patients after distal radius reconstruction. Supplementary wrist splint or below elbow plaster cast, was given in all cases for 3 wks with gradual mobilization. Results: All patients showed, radiological union at mean 4 months (range 3 to 6 months). Range of flexion extension at wrist and supination and pronation improved over 4 months period in all cases. Grip strength was 30 % weak compared with opposite side in 5 patients. There were no subsequent complications in our series and all patients reported satisfaction with the functional results Conclusions: Nonunion distal radius are rare but respond well to principles of open reduction, strut bone grafting and stable fixation. Distal radio ulna joint requires management in form of either a Sauvé Kapandji procedure (in young patient) or Darrach’s procedure (in older patients) Keywords: nonunion distal radius fracture, open reduction internal fixation, bone grafting, Sauvé Kapandji, Darrach’s procedure.

Neoprene Orthopaedic Supports: An Underrecognised Cause of Allergic Contact Dermatitis.

Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD) in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports' material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication.

Conservative treatment of lateral epicondylitis: The impact of psychosocial factors on perceived treatment efficacy

BACKGROUND: The relationship of pain, function, and treatment in lateral epicondylitis is not fully understood. Improved understanding of this interrelationship may be required to optimize treatment strategies, particularly with regard to bracing and activity modification. METHODS: A cohort of 36 patients diagnosed by a fellowship-trained hand surgeon over a 25-month period that received treatment in the form of a cock-up wrist splint (CUWS) and recommendations of activity modification was identified. The patients’ function was defined by the QuickDash Outcome measure and pain by the Numeric Pain Rating. Retrospective analysis of prospectively collected pre-treatment data were compared to those obtained following treatment using Wilcoxon signed-rank test. Changes in QuickDash Outcome measures and Numeric Pain Rating following treatment were compared between those individuals that stated the treatment helped and those that stated it did not. RESULTS: Following treatment with a CUWS and activity modification, the median QuickDash score was 8 compared to 40 prior to treatment (95% CI: -32 ~ -20, p-value < 0.0001) indicating statistically significant functional improvement. All 36 of 36 (100%) patients stated that they were able to return to a normal activity level at the time of follow-up. Numeric Pain Rating values improved from 6 to 1 following treatment (95% CI: -6 ~ -4, p-value < 0.0001) The Kendall’s Tau-b correlation coefficient between Numeric Pain Ratings and QuickDash Outcome measure was 0.296 (p-value = 0.018) and 0.473 (p-value = 0.001) before and after treatment, respectively, suggesting a weak to moderate correlation. Patients who stated that the treatment was effective experienced a median change in their QuickDash outcome score of -23 compared to -37 for those whom did not think it was an effective treatment; the estimated difference between the two groups was 14 (CI: 2, 30, p-value 0.019) indicating that patients who thought treatment was not effective actually experienced greater functional improvement. CONCLUSIONS: These results indicate that use of a CUWS and recommendations of activity modification is an effective strategy to help improve patient function and pain levels. However, low to moderate correlation between pain and disability both before and after treatment indicate that other factors such as coping skills and psychosocial influences may effect the disease and treatment course. Furthermore, patients may still make gains in function while questioning the effectiveness of their treatment, which may make assessment of therapeutic response difficult. Future research should be directed at identifying which factors other than pain may influence disability and devising strategies to address them.

USE AND ABANDONMENT RATES OF ASSISTIVE DEVICES/ORTHOSES IN PATIENTS WITH STROKE

SUMMARY The aim of this study was to examine the use of assistive devices/orthoses in patients with stroke. The rates of orthotic prescription and abandonment, and the reasons of abandonment were investigated. One hundred and seven stroke patients, who had been rehabilitated in our hospital, were visited by two social service specialists and a questionnaire was applied to all patients. Mean elapsed time after stroke to evaluation time was 48.90±23.49 months. Among subjects, 57.0% were prescribed a tripod or a tetrapod, and 26.2% were given a wheelchair. Overall, 39.3% of patients declared that they were not using their tripod/tetrapod and 28.6% were not using their wheelchair. Concerning upper limb orthoses, 22.4% of patients were given an inhibitor hand splint and 16.8% were given a neutral wrist splint. The abandonment rates were 70.8% and 77.8%, respectively. More than half of those subjects stopped using their orthoses. Regarding lower limb orthoses, 43.0% of patients were prescribed an ankle foot orthosis and 54.3% of them stopped using it. Significant amount of stroke patients seem to stop using their assistive device/orthoses despite their need. Further studies are warranted for better understanding the relevant causes.

Use of diffusion tensor imaging for nonsurgical treatments of carpal tunnel syndrome

This study evaluated the applicability of diffusion tensor imaging (DTI) of therapeutic ultrasound (US) and wrist splints in addition to clinical and electrophysiological assessments of patients with carpal tunnel syndrome (CTS). This prospective study analyzed 41 patients (30 women, 11 men; 56 wrists) with CTS. Therapeutic US and wrist splints were performed for 3 and 4 weeks, respectively. Fractional anisotropy and the apparent diffusion coefficient (ADC) were evaluated in addition to a visual analog scale (VAS), symptom severity scale (SSS), functional status scale (FSS), and electrodiagnostic studies (EDX) before and after treatment. There were significant decreases in the mean ADC, VAS, SSS, FSS, and EDX after treatment. This study suggests that DTI parameters provide helpful information that complements clinical and electrophysiological assessments for evaluating the efficacy of nonsurgical treatment of patients with CTS.

Computer-aided design to support fabrication of wrist splints using 3D printing: A feasibility study

Introduction Issues contributing to poor patient compliance for splint wear include poor aesthetics, fit and performance. This paper describes a novel digitised splinting process using 3D printing in an attempt to overcome these issues. The output of the investigation was the creation of a specialised computer-aided design software workflow to support 3D printing, developed specifically for splinting practitioners in the UK, to enable them to design splints themselves for each individual patient. Method A small-scale feasibility study was done, based on the current splinting process. A thorough literature review and physical engagement in current splinting practice was performed, highlighting key requirements for successful splint fabrication. Key requirements were then replicated in a virtual software environment. Opportunities for integrating new, novel features were explored. The key requirements were then refined into a specialised software workflow to replicate the splinting process. The specialised software was then evaluated by 10 practitioners. User trials of the software were performed, followed by semi-structured interviews. Audio recordings were transcribed and then coded to establish similar trends of opinions, and areas for future research. No patients or vulnerable participants were involved in the study. Results All participants were able to use and navigate around the software prototype with relative ease. Strengths included potential simplicity in modelling more complex splints, but several areas for future research are identified, including cost analysis and materials development. Discussion The digitised splinting process shows promise for the benefit of both practitioners and their patients, provided that future research and investment can overcome current limitations.

Closed reduction and K-wiring with the Kapandji technique for completely displaced pediatric distal radial fractures.

In completely displaced pediatric distal radial fractures, achieving satisfactory reduction with closed manipulation and maintenance of reduction with casting is difficult. Although the Kapandji technique of K-wiring is widely practiced for distal radial fracture fixation in adults, it is rarely used in pediatric acute fractures. Forty-six completely displaced distal radial fractures in children 7 to 14 years old were treated with closed reduction and K-wire fixation. One or 2 intrafocal K-wires were used to lever out and reduce the distal fragment's posterior and radial translation. One or 2 extrafocal K-wires were used to augment intrafocal fixation. Postoperative immobilization was enforced for 3 to 6 weeks (with a short arm plaster of Paris cast for the first half of the time and a removable wrist splint for the second half), after which time the K-wires were removed. Patients were followed for a minimum of 4 months. Mean patient age was 9.5 years. Near-anatomical reduction was achieved easily with the intrafocal leverage technique in all fractures. Mean procedure time for K-wiring was 7 minutes. On follow-up, there was no loss of reduction; remanipulation was not performed in any case. There were no pin-related complications. All fractures healed, and full function of the wrist and forearm was achieved in every case. The Kapandji K-wire technique consistently achieves easy and near-anatomical closed reduction by a leverage reduction method in completely displaced pediatric distal radial fractures. Reduction is maintained throughout the fracture-healing period. The casting duration can be reduced without loss of reduction, and good functional results can be obtained.

The Effectiveness of Carpal Bone Mobilization accompanied by Night Splinting in Idiopathic Carpal Tunnel Syndrome

Objective: The aim of this study was to investigate the effectiveness of carpal bone mobilization (CBM) and night splinting and to compare it with night splinting as a control group in the treatment of Carpal Tunnel Syndrome (CTS). Methods: In the single-blind (assessor) prospective randomised controlled trial, a total of 40 patients with mild to moderate CTS were diagnosed by electroneuromyography (ENMG). In Group 1 (n=20), patients received CBM three times a week, total of 10 times, and used neutral volar wrist splint at night for 3 weeks. Patients in Group 2 (n=20) used only neutral volar wrist splint at night for 3 weeks. All of the patients were assessed at baseline and at the 3 rd month with respect to pain intensity using a numerical rating scale (0-10), handgrip and pinchgrip strength, functional status and symptom severity using the Boston Carpal Tunnel Questionnarie (BCTQ), and ENMG measurements. Results: There were improvements in all of the clinical variables, distal sensory latancy, and sensory nerve action potentials of the median nerve in Group 1. In Group 2, there was improvement in only BCTQ symptom severity and night/day pain intensity at the 3 rd month. Improvement in pinchgrip strength and BCTQ functional status were superior in Group 1 when compared to Group 2 at the 3 rd month.

Conservative treatment using a newly designed custom-made wrist splint for ulnocarpal abutment syndrome.

Immobilization of the wrist joint with a splint is an established approach for ulnar-sided pain due to ulnocarpal abutment syndrome. However, patients have a tendency to stop wearing the splints because of its inconvenience and there have been no reports based on splint therapy. We investigated the usefulness of a newly designed custom-made aluminum splint for ulnar-sided wrist pain. This was a cohort study of the aluminum splint therapy for the patients who had been primarily treated with a conventional splint but ceased to use it because of the inconvenience in activities of daily living. The subjects included 10 female patients (mean age = 44.2 years). The outcome was assessed using the visual analogue scale score for pain, the disabilities of the arm, shoulder and hand score, range of motion of the wrist, and the grip strength. The mean follow-up period after wearing the aluminum splint was 8.8 months. All parameters, including the visual analogue scale pain and disabilities of the arm, shoulder and hand scores, improved significantly (p < 0.05) following use of the aluminum splint relative to the pretreatment scores. Seven patients continued to use the aluminum splint, and three of the seven had complete remission from related pain. Constant use of the aluminum splint during the study period was associated with improvement in the ulnar-sided wrist pain scores, which reconfirmed that increased adherence to splint use in daily activities is an important intentional behavioral strategy. Although the custom splint is effective for alleviation of wrist pain in ulnocarpal abutment syndrome, continuity of splint use is a key element of conservative treatment. This study showed that a splint that patients were willing to wear in their daily life was a useful device for alleviation of pain.

An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal, India.

Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery. The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS). The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS. Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group. Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS.

Effect of Linum usitatissimum L. (linseed) oil on mild and moderate carpal tunnel syndrome: a randomized, double-blind, placebo-controlled clinical trial.

BackgroundCarpal tunnel syndrome is known as the most common entrapment neuropathy. Conservative treatments cannot reduce the symptomatic severity satisfactorily; therefore, effectiveness of Linum usitatissimum L. (linseed) oil on carpal tunnel syndrome, as a complementary treatment, was evaluated in the current study. Linseed oil is a well-known preparation in Iranian traditional medicine and its analgesic, anti-inflammatory and anti-oxidative effects have been shown in previous studies.MethodsA randomized, double-blind, placebo-controlled clinical trial was conducted. One hundred patients (155 hands) with idiopathic mild to moderate carpal tunnel syndrome aged between 18 and 65 years old were randomized in two parallel groups. These two groups were treated during 4 weeks with topical placebo and linseed oil. In addition, a night wrist splint was prescribed for both groups. Symptomatic severity and functional status were measured using Boston Carpal Tunnel Questionnaire. In addition, median sensory nerve conduction velocity, motor distal latency, sensory distal latency and compound latency as electrodiagnostic parameters were measured at baseline and after the intervention period.ResultsAfter the intervention, significant improvement was observed regarding Boston Carpal Tunnel Questionnaire symptomatic severity and functional status mean differences (p <0.001) in the linseed oil group compared with those in the placebo group. Also, regarding the mean differences of both groups, significant improvement of nerve conduction velocity of the median nerve was seen in the linseed oil group by a value of 2.38 m/sec (p < 0.05). However, motor distal latency and sensory distal latency of the median nerve showed no between-group significant changes (p = 0.14 for both items). Finally, compound latency was improved slightly in the case group, comparing mean differences between the groups (p <0.05). No significant adverse events were reported from using linseed oil.ConclusionsIt seems that linseed oil could be effective in the management of mild and moderate carpal tunnel syndrome, especially in improving the severity of symptoms and functional status. In addition, its effect on electerodiagnostic parameters, especially on the nerve conduction velocity, can be considered as a valuable point.

Ergonomic design of a computer mouse for clients with wrist splints.

We explored effects of cutaneous feedback and hump position on efficiency and comfort in mouse use with a splint. We also analyzed the relationship between anthropometric measurements (width of hand and length of hand, palm, and index) and the task performance. Thirty participants performed a computer task with two forms of mice (front hump and rear hump) and two kinds of wrist splints (dorsal and volar). Movement time and satisfaction scores were recorded. No interaction effect (Hump Position × Splint Type) was found on movement time. Movement time was shorter for rear-hump mouse users than for front-hump mouse users. Movement time was also shorter for wearers of dorsal wrist splints than for wearers of volar wrist splints. Limited differences existed in the satisfaction scores. Participants with a longer index finger had shorter movement time. Both dorsal wrist splints and rear-hump mice are recommended. Length of index finger positively correlated with task performance.