title: A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome. Randomized controlled trial of daily total end range time (TERT) for Capener splinting of the stiff proximal interphalangeal joint. Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial. Comparing three postoperative treatment protocols for extensor tendon repair in zones V and VI of the hand. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial Conservative hand therapy treatments in rheumatoid arthritis--a randomized controlled trial. Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger. Assessment of phonophoresis and iontophoresis in the treatment of carpal tunnel syndrome: a randomized controlled trial Effect of mirror therapy on hand function in patients with hand orthopaedic injuries: a randomized controlled trial Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Effectiveness of two finger splints for swan neck deformity in patients with rheumatoid arthritis: a randomized, crossover trial. Comparison of the long-term effectiveness of physiotherapy programs with low-level laser therapy and pulsed magnetic field in patients with carpal tunnel syndrome. The use of kinesiology taping method in patients with rheumatoid hand--pilot study. Dynamic splinting for the stiff hand after trauma: predictors of contracture resolution. Core stabilisation reduces compensatory movement patterns in patients with injury to the arm: a randomized controlled trial Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation Is progressive early digit mobilization intervention beneficial for patients with external fixation of distal radius fracture? A pilot randomized controlled trial A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study A randomized clinical controlled study comparing the effect of modified manual edema mobilization treatment with traditional edema technique in patients with a fracture of the distal radius. A systematic review of rehabilitation protocols after surgical repair of the extensor tendons in zones V-VIII of the hand. Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament. Dynamic splints do not reduce contracture following distal radial fracture: a randomised controlled trial. The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome. Functional thumb orthosis for type I and II boutonniere deformity on the dominant hand in patients with rheumatoid arthritis: a randomized controlled study Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius.
abstract: STUDY DESIGN R and omized clinical trial . OBJECTIVE The aim of this study was to evaluate the effect of ischemic compression therapy in the treatment of chronic carpal tunnel syndrome . METHOD Fifty-five patients suffering from carpal tunnel syndrome were r and omized to two groups . Thirty-seven patients received 15 experimental treatments which consisted of ischemic compressions at trigger points located in the axilla of the shoulder , the length of the biceps muscle , at the bicipital aponeurosis and at the pronator teres muscle in the hollow of the elbow . Eighteen patients received the control treatment involving ischemic compression on trigger points located in the deltoid muscle , supraspinatus muscle and infraspinatus muscle . Of the 18 patients forming the control group , 13 agreed to receive the experimental treatments after the 15 control treatments . Outcome measures included a vali date d 18- question question naire to assess the severity of symptoms and functional status in carpal tunnel syndrome , and a quantification of the patients ' perceived improvement , using a scale from 0 % to 100 % . Outcome measures evaluations were completed at baseline , after 15 treatments , 30 days following the last treatment , and 6 months later . RESULTS For the disability question naire , a significant reduction of symptoms was noted only in the experimental group . In the experimental group the outcome at baseline was 33.5 ( SD , 10.3 ) ; after 15 treatments it was 18.6 ( SD , 7.0 ) . The control group outcome at baseline was 36.3 ( SD , 15.2 ) ; after 15 treatments it was 26.4 ( SD , 9.9 ) and after the crossover ( 15 control treatments plus 15 experimental treatments ) 20.2 ( SD , 12.2 ) . A significant between group difference ( P < 0.021 ) was noted in the patients ' perceived improvement after 15 treatments : 67 ( SD , 26 ) percent and 50 ( SD , 25 ) percent respectively for the experimental and control groups . CONCLUSION This practice -based clinical trial suggests that myofascial therapy using ischemic compression the length of the biceps , at the bicipital aponeurosis , at the pronator teres and at the subscapularis muscles could be a useful approach to reduce symptoms associated with the carpal tunnel syndrome . Patients ' perceived improvement in functional capacities persisted over a 6-month period OBJECTIVE Capener splinting is a common treatment for extension deficit of the proximal interphalangeal ( PIP ) joint . This study compared the effect of daily splint total end range time ( TERT ) of 6 - 12 hr versus 12 - 16 hr . METHOD Twenty-two participants with extension deficits of the PIP joint were r and omly allocated to a daily TERT of 6 - 12 hr or 12 - 16 hr . Progress after 8 wk of splinting was evaluated . RESULTS No significant difference was found in change in extension range of motion ( ROM ) between groups ( active ROM , F[4 , 17 ] = 2.19 , p = .13 ; passive ROM , F[4 , 17 ] = 0.95 , p = .46 ; torque ROM , F[4 , 17 ] = 1.49 , p = .26 ) . Considerable crossover between groups result ed in a similar average daily TERT ( 9.5 hr for the 6 - 12 hr group vs. 11.5 hr for the 12 - 16 hr group ) . CONCLUSION Further research with a larger sample is needed to determine whether longer daily TERT is beneficial . Our results suggest , however , that most patients find it difficult to wear splints > 12 hr/day STUDY DESIGN R and omized clinical trial . INTRODUCTION Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries , it is unclear whether orthosis self-removal has an impact on the final outcome . PURPOSE To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast ( ® ) ( QC ) compared to a removable , lever-type thermoplastic orthosis ( LTTP ) . METHODS 57 subjects were r and omized in 2 groups . DIPj extensor lag and the Gaberman success scale were used as primary outcomes . RESULTS LTTP subjects result ed in greater extensor lag than QC subjects ( x = 5 ° ; p = 0.05 ) at 12 weeks from baseline , and high edema and older age negatively affected DIPj extensor lag . No other differences were found between groups . CONCLUSION Cast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema . LEVEL OF EVIDENCE 1B OBJECTIVE This pilot study compared the effectiveness of 3 postoperative rehabilitation protocol s for patients with Zones V and VI extensor tendon lacerations . METHOD Twenty-seven patients were recruited from 3 sites and r and omly assigned to 1 of 3 established treatment protocol s : immobilization , early passive motion ( EPM ) , and early active motion ( EAM ) . Outcome measures were collected at 3 , 6 , and 12 wk after treatment and included total active motion ( TAM ) . RESULTS At the end of Week 12 , data on 24 injured digits of 18 patients were available for analysis . When data at Weeks 3 , 6 , and 12 were compared , patients in all groups showed steady improvement in TAM , but digits under the EAM treatment improved to a greater extent over time ( F[2 , 46 ] = 75.6 , p < .001 ) . CONCLUSION Patients with Zones V and VI extensor tendon injuries treated with the EAM protocol recovered range of motion more rapidly OBJECTIVE To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures :  treatment by a physical therapist with 12 sessions and an unassisted home exercise program . DESIGN R and omized controlled cohort study . SETTING Hospital-based care , primary center of orthopedic surgery . PARTICIPANTS Volunteers ( N=48 ) with fractures of the distal radius after internal fixation with locking plates . There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Evaluation of grip strength using a Jamar dynamometer , range of motion ( ROM ) , and Patient Related Wrist Evaluation ( PRWE ) . RESULTS After a 6-week period of postoperative treatment , the patients ( n=23 ) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist . Grip strength reached 54 % ( P=.003 ) , and ROM in extension and flexion 79 % ( P<.001 ) of the uninjured side . Ulnar and radial abduction was also higher in this group . In contrast , patients who were treated by a physical therapist achieved grip strength equal to 32 % , and ROM in extension and flexion of 52 % of the uninjured side . Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50 % lower value ( P<.001 ) in the PRWE score . CONCLUSIONS In the postoperative rehabilitation of wrist fractures , instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment PURPOSE To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture . METHODS We conducted a single-center , r and omized , controlled trial to investigate the effect of night extension orthoses on finger range of motion and h and function for 3 months following surgical release of Dupuytren contracture . We also wanted to determine how well finger extension was maintained in the total sample . We r and omized 56 patients to receive a night extension orthosis plus h and therapy  ( n = 26 ) or h and therapy alone ( n = 30 ) . The primary outcome was total active extension of the operated fingers ( ° ) . Secondary outcomes were total active flexion of the operated fingers ( ° ) , active distal palmar crease ( cm ) , grip strength ( kg ) , and self-reported h and function using the Disabilities of the Arm , Shoulder , and H and question naire ( 0 - 100 scale ) . RESULTS There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes . Between the first postoperative measure and 3 months after surgery , 62 % of little fingers had maintained or improved total active extension . CONCLUSIONS The use of a night extension orthosis in combination with st and ard h and therapy has no greater effect on maintaining finger extension than h and therapy alone in the 3 months following surgical release of Dupuytren contracture . Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery . Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients Background Dupuytren 's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired h and function . St and ard treatment involves surgical release or excision followed by post-operative h and therapy and splinting , however the evidence supporting night splinting is of low quality and equivocal . Methods A multi-centre , pragmatic , open , r and omised controlled trial was conducted to evaluate the effect of night splinting on self-reported function , finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy . 154 patients from 5 regional hospitals were r and omised after surgery to receive h and therapy only ( n = 77 ) or h and therapy with night-splinting ( n = 77 ) . Primary outcome was self-reported function using the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . Secondary outcomes were finger range of motion and patient satisfaction . Primary analysis was by intention to treat . Results 148 ( 96 % ) patients completed follow-up at 12 months . No statistically significant differences were observed on the DASH question naire ( 0 - 100 scale : adjusted mean diff . 0.66 , 95%CI - 2.79 to 4.11 , p = 0.703 ) , total extension deficit of operated digits ( degrees : adjusted mean diff 5.11 , 95%CI -2.33 to 12.55 , p = 0.172 ) or patient satisfaction ( 0 - 10 numerical rating scale : adjusted mean diff -0.35 , 95%CI -1.04 to 0.34 , p = 0.315 ) at 1 year post surgery . Similarly , in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes . Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving h and therapy and only splinted if and when contractures occurred . Given the added expense of therapists ' time , thermoplastic material s and the potential inconvenience to patients having to wear a device , the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur . Trial registration The trial was registered as an International St and ard R and omised Controlled Trial IS RCT OBJECTIVE To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the  rheumatoid h and . METHODS In a r and omized controlled trial , participants with rheumatoid arthritis ( RA ) recruited from a rheumatology department in Mid-Staffordshire , UK ( February 1999 to January 2001 ) were r and omized to three groups . All received joint protection ( JP ) information delivered by a therapist at baseline . Group 1 participants received a set of additional h and -strengthening and mobilizing home exercises , group 2 a different set of additional h and -stretching exercises and group 3 the JP information alone . The primary outcome was the Arthritis Impact Measurement Scales II ( AIMS II ) ( upper limb ; h and and finger function subscales ) . Outcomes were assessed at baseline and 1 , 3 and 6 months . Analysis was by intention to treat . RESULTS Sixty-seven participants ( mean age 59.6 yr ) were recruited : group 1 n = 21 , group 2 n = 24 and group 3 n = 22 . A 78 % follow-up was achieved at 6 months . There was a mean fall ( SD ) in AIMS II upper limb function 0 - 6 month change scores in group 1 of 1.00 ( 1.07 ) . In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 ( 1.54 ) and 0.30 ( 1.22 ) , respectively . The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant ( P = 0.007 ) and remained so after adjustment for multiple testing ( P = 0.012 ) . CONCLUSION Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening h and exercises in RA patients compared with simple stretches or advice alone OBJECTIVE To compare Stack , dorsal , and custom splinting techniques in people with acute type 1a or b mallet finger . DESIGN Multi-center r and omized controlled trial . SETTING Outpatient h and therapy clinics ( 2 public hospitals and 1 private clinic ) . PARTICIPANTS Patients ( N=64 ) with acute type 1a or b mallet finger . INTERVENTIONS Prefabricated Stack splint ( control ) , dorsal padded aluminum splint , or custom-made thermoplastic thimble splint . All were worn for 8 weeks continuously , with a 4 week graduated withdrawal and exercise program . MAIN OUTCOME MEASURES The primary outcome was extensor lag at 12 and 20 weeks . Secondary outcomes were incidence of treatment failure , complications , range of motion of the distal interphalangeal joint , pain ( visual analog scale ) patient compliance , and patient satisfaction . RESULTS There was no difference in the primary outcome between groups at 12 or 20 weeks ; however , the Stack and dorsal splints had significant rates of treatment failure ( 23.8 % in both groups , compared to none in the thermoplastic group ; P=.04 ) . There was a medium negative correlation between patient compliance and degree of extensor lag . No significant differences between groups were observed for patient satisfaction or pain . CONCLUSIONS As splints for mallet finger must be worn continuously for 6 to 8 weeks , and compliance correlates with favorable outcomes , treating practitioners must ensure the splint provided is robust enough for daily living requirements and does not cause complications , which are intolerable to the patient . In this study , no extensor lag difference was found between the 3 splint types , but custom-made thermoplastic splints were significantly less likely to result in treatment failure To define the role of phonophoresis and iontophoresis of corticosteroids in conjunction with wrist splint use in the treatment of carpal tunnel syndrome ( CTS ) compared to wrist splint use alone , 52 CTS subjects were analyzed based on clinical and electrophysiological criteria . A prospect i ve , r and omized controlled trial was carried out to assess symptom severity , motor skills , and h and function according to the Boston Symptom Severity Scale ( BSSS ) , grip strength , and nine-hole peg test ( NHPT ) , respectively , on the initial visit and in the 3rd month after treatment . The patients underwent conservative interventions r and omly as follows : ( 1 ) 3 weeks of phonophoresis with betamethasone in conjunction with wrist splint use ( group I , n : 18 ) or ( 2 ) 3 weeks of iontophoresis with betamethasone in conjunction with wrist splint use ( group II , n : 16 ) or ( 3 ) wrist splint use alone ( control , group III , n : 18 ) . The mean age of the patients was 43.7 ± 8.4 ( range 24–57 ) years . Groups I , II , and III showed a significant and further improvement in BSSS at the 3rd month evaluations compared with baseline ( P < 0.001 , P = 0.001 , P < 0.001 , respectively ) , but no significant change was observed in grip strength or NHPT ( P > 0.05 ) . There was a statistically significant difference between the phonophoresis and control groups after treatment only regarding BSSS , in favor of phonophoresis ( P = 0.012 ) . We recommend the use of wrist splints especially with phonophoresis for relief of symptoms in patients with CTS . Our results demonstrated no superiority among the treatment groups . Further , transdermal steroid treatments are not key determinants of efficacy with respect to motor skills and h and dexterity Abstract Purpose : To investigate the effects of mirror therapy ( MT ) in restoring h and function in patients with active range of motion ( AROM ) impairments following orthopaedic injuries . Method : In a r and omized controlled trial ( RCT ) , 30 patients with active ROM impairment ( 8 men and 22 women ; mean age : 38 years ) were measured . Intervention group received MT , 30 min a day , five days a week for three weeks , as well , half an hour conventional rehabilitation after each MT session . Patients in the control group received the same treatment programme , but instead of mirror , they observed directly the affected h and . In addition , both groups performed a 15 min home programme , including MT for intervention group and AROM with direct observation of the affected h and for control group , twice daily . Outcome measures , including total active motion ( TAM ) and Disabilities of Arm , Shoulder and H and ( DASH ) question naire , were administered pre- and post-treatment and three weeks later . This study was registered as an RCT , no. NCT01503762 in http:// clinical trials.gov/. Results : Final analysis was performed on 23 patients . The mean ( SD ) changes at post-test from baseline TAM was 154 ( 32 ) in the MT ( N = 12 ) and 61 ( 24 ) in the control group ( N = 11 ) ; mean difference ( 95 % CI ) 93 ( 68–118 ) , p = 0.001 . The mean ( SD ) change at post-test from baseline DASH was −34 ( 7 ) in the MT ( N = 12 ) and −15 ( 11 ) in the control group ( N = 11 ) ; mean difference ( 95 % CI ) 19 ( −27 to −11 ) , p = 0.001 . Conclusions : Despite significant improvement at post-test in both groups and maintenance of improvement during the follow-up period , MT combined with conventional rehabilitation produced more improvement in h and function than control group . Implication s for Rehabilitation H and orthopaedic injuries can result in disabilities in activities of daily living . Mirror therapy ( MT ) provides perception of two healthy limbs through reflection of the healthy limb as the injured limb . In a r and omized controlled trial , our study shows positive effects of MT combined with a classical rehabilitation programme to improve h and function in patients with orthopaedic injuries OBJECTIVE To evaluate the effects of cross-education ( contralateral effect of unilateral strength training ) during recovery from unilateral distal radius fractures on muscle strength , range of motion ( ROM ) , and function . DESIGN R and omized controlled trial ( 26-wk follow-up ) . SETTING Hospital , orthopedic fracture clinic . PARTICIPANTS Women older than 50 years with a unilateral distal radius fracture . Fifty-one participants were r and omized and 39 participants were included in the final data analysis . INTERVENTIONS Participants were r and omized to st and ard rehabilitation ( Control ) or st and ard rehabilitation plus strength training ( Train ) . St and ard rehabilitation included forearm casting for 40.4±6.2 days and h and exercises for the fractured extremity . Nonfractured h and strength training for the training group began immediately postfracture and was conducted at home 3 times/week for 26 weeks . MAIN OUTCOME MEASURES The primary outcome measure was peak force ( h and grip dynamometer ) . Secondary outcomes were ROM ( flexion/extension ; supination/pronation ) via goniometer and the Patient Rated Wrist Evaluation question naire score for the fractured arm . RESULTS For the fractured h and , the training group ( 17.3±7.4 kg ) was significantly stronger than the control group ( 11.8±5.8 kg ) at 12 weeks postfracture ( P<.017 ) . There were no significant strength differences between the training and control groups at 9 ( 12.5±8.2 kg ; 11.3±6.9 kg ) or 26 weeks ( 23.0±7.6 kg ; 19.6±5.5 kg ) postfracture , respectively . Fractured h and ROM showed that the training group had significantly improved wrist flexion/extension ( 100.5 ° ±19.2 ° ) than the control group ( 80.2 ° ±18.7 ° ) at 12 weeks postfracture ( P<.017 ) . There were no significant differences between the training and control groups for flexion/extension ROM at 9 ( 78.0 ° ±20.7 ° ; 81.7 ° ±25.7 ° ) or 26 weeks ( 104.4 ° ±15.5 ° ; 106.0 ° ±26.5 ° ) or supination/pronation ROM at 9 ( 153.9 ° ±23.9 ° ; 151.8 ° ±33.0 ° ) , 12 ( 170.9 ° ±9.3 ° ; 156.7 ° ±20.8 ° ) or 26 weeks ( 169.4 ° ±11.9 ° ; 162.8 ° ±18.1 ° ) , respectively . There were no significant differences in Patient Rated Wrist Evaluation question naire scores between the training and control groups at 9 ( 54.2±39.0 ; 65.2±28.9 ) , 12 ( 36.4±37.2 ; 46.2±35.3 ) , or 26 weeks ( 23.6±25.6 ; 19.4±16.5 ) , respectively . CONCLUSIONS Strength training for the nonfractured limb after a distal radius fracture was associated with improved strength and ROM in the fractured limb at 12 weeks postfracture . These results have important implication s for rehabilitation strategies after unilateral injuries OBJECTIVE To compare the effectiveness and acceptability of silver ring splints ( SRS ) and commercial prefabricated thermoplastic splints ( PTS ) in treating swan neck deformities in patients with rheumatoid arthritis ( RA ) . METHODS Consecutive patients with RA and a mobile swan neck deformity were included in a r and omized , crossover trial . In 2 different sequences , patients used both splints for 4 weeks , with a washout period of 2 weeks . Afterward , patients used the preferred splint for another 12 weeks . The primary outcome measure was dexterity measured with the Sequential Occupational Dexterity Assessment ( SODA ) . Secondary outcome measures included other measures of h and function , satisfaction with the splints , and splint preference . RESULTS Fifty patients were included , and 47 ( 94 % ) of those completed the study . Eighteen patients ( 36 % ) had 1 swan neck deformity , whereas the other patients had 2 or more . The improvement of the total SODA score with the SRS ( 11.2 ; 95 % confidence interval [ 95 % CI ] 8.1 , 14.3 ) and PTS ( 10.8 ; 95 % CI 7.5 , 14.1 ) was similar ( difference -0.5 ; 95 % CI -2.2 , 1.2 ) . In addition , there were no significant differences in change scores regarding the other clinical outcome measures , or satisfaction . Twenty-four patients preferred the SRS , 21 preferred the PTS , and 2 patients chose neither . A comparison in the 12-week followup period yielded similar clinical outcomes , with the exception of a significantly higher score in 3 items of satisfaction in the SRS group . CONCLUSION For patients with RA and a mobile swan neck deformity , SRS and PTS are equally effective and acceptable PURPOSE The aim of the study was to compare the long term effects of low - level laser therapy ( LLLT ) and pulsed magnetic field ( PMF ) in the rehabilitation of patients with carpal tunnel syndrome ( CTS ) . METHODS The study included 38 patients with idiopathic CTS , confirmed by electroneurographic ( ENG ) examination . All patients were r and omly assigned to 2 groups : group L ( 18 patients ) treated with LLLT and group M ( 20 patients ) with PMF therapy .  Clinical assessment , including day and night pain , the presence of paresthesia , functional tests ( Phalen , Tinel , armb and tests ) and pain severity according to the Visual Analogue Scale ( VAS ) was conducted before treatment , after the first series of 10 sessions , after a two-week break , after the second series of 10 sessions and six months after the last series . RESULTS After LLLT a significant reduction of day and night pain was observed at each stage of treatment and 6 months after the last series ( p<0.05 ) . However , in group M , a significant reduction of both day and night pain was demonstrated only after the second series ( p<0.05 ) . A reduction of the incidence of Phalen 's symptoms were noticed in both groups , however , only in group L the improvement was significant ( p<0.05 ) . In groups L and M a significant reduction of pain intensity was observed at every stage of treatment ( p<0.05 ) . CONCLUSIONS Although after LLL as well as PMF therapy clinical improvement was observed , the most significant differences were registered after the second series and persisted for up to 6 months in both groups BACKGROUND Rheumatoid arthritis ( RA ) most frequently affects smaller joints in the h and s and feet . Among the most common deformations result ing from the progression of the disease are ulnar deviation , Boutonniere deformity , swan neck deformity , contractures and limited range of movement in the h and and wrist joints , muscular atrophy of long and short muscles . The topic of this article is the influence of using Kinesiology Taping method on the functioning of the h and of the patient suffering from rheumatoid arthritis . MATERIAL AND METHODS The research involved 20 patients suffering from rheumatoid arthritis ( 16 women , 4 men ) , treated in the Hospital in Kup . Average age of patients was 62.2 . Research subjects , apart from pharmacological treatment in the hospital ward , received  st and ard physiotherapy . In case of 10 patients additional K-Active Tape applications were used to correct ulnar positioning of the h and and improve h and functioning . Prior to physiotherapy , all patients were given a h and functioning test and a dynamometer measurement was made . The tests were repeated after the 2-week rehabilitation process has been completed . The results were subjected to statistical analysis with the use of the Wilcoxon test and the U Mann-Whitney test . The assessment of the correlation between analysed parameters was made with the use of linear correlation test . RESULT In the group where Kinesiology Tape applications were used , h and muscle strength increased significantly ( p<0.05 ) in comparison with the group treated with st and ard physiotherapy .  H and muscle strength increase correlated with the tempo of carrying out the h and functioning test ( r>0.8 ) . CONCLUSION Results suggest Kinesiology Taping method useful for physiotherapy of rheumatoid h and STUDY DESIGN Prospect i ve cohort . INTRODUCTION Many variables are believed to influence the success of dynamic splinting , yet their relationship with contracture resolution is unclear . PURPOSE OF THE STUDY To identify the predictors of outcome with dynamic splinting of the stiff h and after trauma . METHODS Forty-six participants ( 56 joints ) completed eight weeks of dynamic splinting  , and the relationship between 13 clinical variables and outcome was explored . RESULTS Improvement in passive range of motion , active range of motion ( AROM ) , and torque range of motion averaged 21.8 ° , 20.0 ° , and 13.0 ° , respectively ( average daily total end range time , 7.96 hours ) . Significant predictors included joint stiffness ( modified Weeks Test ) , time since injury , diagnosis , and deficit ( flexion/extension ) . For every degree change in ROM on the modified Weeks Test , AROM improved 1.09 ° ( st and ard error , 0.2 ) . Test-retest reliability of the modified Weeks Test was high ( intraclass correlation coefficient [ 2 , 1]=0.78 ) . CONCLUSIONS Better progress with dynamic splinting may be expected in joints with less pretreatment stiffness , shorter time since injury ( < 12 weeks ) , and in flexion rather than extension deficits . Further research is needed to determine the accuracy with which the modified Weeks Test may predict contracture resolution . LEVEL OF EVIDENCE 2b Objective : To investigate the effects of adding core stabilisation exercises to traditional rehabilitation in patients with arm injuries . Design : R and omized controlled trial . Setting : Outpatient clinic . Subjects : Twenty-seven patients with elbow and wrist injuries were r and omized to a stabilisation or control group . Interventions : The stabilisation group received core stabilisation training and traditional arm rehabilitation and the control group received traditional arm rehabilitation alone for three days/week for six weeks . Main measures : Pre- and post-treatment assessment s comprising an analysis of compensatory movement patterns and trunk muscle strength as well as functional measurements of the arm , including pain , range of motion , disabilities of arm , shoulder and h and question naire and endurance and fatigue severity were performed . Results : Inter-group comparison revealed significantly greater improvements in the degree of mean change ( SD ) in total compensation ( in degrees ) of the head ( –14.47 ( 21.65 ) ) and trunk ( –5.56 ( 5.71 ) ) as well as total compensation ( –50.02 ( 48.62 ) ) for the stabilisation group than for the control group ( p < 0.05 ) . Increase in trunk muscle strength ( 2.43 ( 3.46 ) ) was statistically significant in the stabilisation group compared with the control group . No significant differences were found for functional measures , including pain , range of motion , disabilities of arm , shoulder and h and or endurance and fatigue severity between the groups , although trends towards greater improvement were observed in the stabilisation group . Conclusions : Adding core stabilisation exercises to traditional arm rehabilitation for patients with traumatic arm injury reduces compensatory movement patterns . Trends towards better functional outcomes in the stabilisation group are worth testing in a large-scale trial The objective of this study is to investigate the efficacy of low-level laser therapy ( LLLT ) in patients with carpal tunnel syndrome ( CTS ) . Sixty patients with CTS were included in this placebo-controlled and double-blind study and r and omly assigned to three treatment groups : active laser with a dosage of 1.2 J/per painful point , active laser with a dosage of 0.6 J/per painful point , and placebo groups . A total of 5 points across the median nerve trace were irradiated with Gal-Al-As diode laser . All groups were treated 5 times per week for 3 weeks . Clinical assessment s included pain intensity , grip strength , symptom severity score ( SSS ) , functional status score ( FSS ) , nerve conduction studies , and cross-sectional area ( CSA ) of the median nerve as measured by ultrasonography . Compared to baseline , post-treatment VAS scores ( group 1 , P < 0.001 ; group 2 , P < 0.001 ; group 3 , P < 0.01 ) , grip strength ( P < 0.05 ) , SSS scores ( group 1 , P < 0.001 ; group 2 , P < 0.001 ; group 3 , P < 0.01 ) , and FSS scores ( P < 0.05 ) improved significantly in all groups . Only sensorial nerve velocity measurements on the palmar region showed a significant improvement in both active laser groups ( P < 0.01 ) . There was no significant difference in any of the outcome measures among the groups . With the chosen laser type and dose regimen , the results suggested that LLLT was no more effective than placebo in CTS Objective : To investigate whether progressive early digit mobilization result ed in better outcomes for h and stiffness and related functional results , as well as the effects on the bone healing process . Design : Prospect i ve , pilot r and omized controlled trial . Setting : A university hospital in southern Taiwan . Participants : Twenty-two patients with distal radius fracture r and omized into two groups : early digit mobilization or control .  Interventions : The intervention group received 45 minutes per treatment session and three sessions per week until the external fixator was removed 6 weeks after fracture . The control group received usual home programmes . After removing fixators , both groups received regular rehabilitation programmes until 12 weeks after surgery . Main measures : H and strength , dexterity and functional outcomes were obtained using a dynamometer , Purdue pegboard and self-report assessment , respectively , and X-rays of the distal radius were taken to reveal bone healing 1 , 3 , 6 and 12 weeks after surgery . A motion tracking system measured various kinematic parameters . Results : The recovery rates between the groups showed statistically significant differences in both thumb workspace ( 81.55 % vs. 69.54 % , P = 0.04 ) and finger workspace ( 89.22 % vs. 59.97 % , P = 0.03 ) 12 weeks after injury . However , no statistical differences were found in finger dexterity , strength and self-reported outcomes . The radiographic assessment showed no significant differences between the groups for radial inclination , radial height and volar tilt throughout the examinations . Conclusions : The findings suggest that early rehabilitative intervention for digits is applicable for distal radius fracture treatment , and does not produce additional bone deformities In carpal tunnel syndrome ( CTS ) , manual therapy interventions ( MTI ) reduce tissue adhesion and increase wrist mobility . We evaluated the efficacy of a MTI in relieving CTS signs and symptoms . Twenty-two CTS patients ( pts ) ( 41 h and s ) were treated with a MTI , consisting in 6 treatments ( 2/week for 3 weeks ) of soft tissues of wrist and h and s and of carpal bones . Pts were assessed for h and sensitivity , paresthesia , h and strength , h and and forearm pain , night awakening ; Phalen test , thenar eminence hypotrophy and Boston Carpal Tunnel Question naire ( BCTQ ) Symptom Severity Scale ( SSS ) and Functional Status Scale ( FSS ) . Median nerve was studied by sensory nerve conduction velocity ( SNCV ) and distal motor latency ( DML ) . CTS was scored as minimal , mild , medium , severe and extreme . We considered as control group the same pts assessed before treatment : at baseline ( T0a ) and after 12 weeks ( T0b ) . Pts were evaluated at the end of treatment ( T1 ) and after 24-week ( T2 ) follow-up . At T0b , versus T0a , forearm pain and Phalen test positivity were increased and h and strength reduced ( p < 0.05 ) . BCTQ – SSS and BCTQ – FSS scores improved at T1 versus T0b ( p < 0.05 ) with the amelioration maintained at T2 . At T1 , the number of pts with paresthesia , night awakening , hypoesthesia , Phalen test , h and strength reduction and h and sensitivity was reduced with the lacking of symptoms maintained at T2 ( p < 0.05 ) . No changes in SNCV , DML and CTS scoring were shown . MTI improved CTS signs and symptoms , with benefits maintained at follow-up . Thus , it may be valid as a conservative therapy STUDY DESIGN R and omized controlled clinical trial . INTRODUCTION Manual edema mobilization ( MEM ) is a method of edema reduction based on the lymphatic system 's ability to drain and resolve subacute edema . PURPOSE OF THE STUDY To investigate the effect of a modified MEM approach and compare it with a traditional edema technique in patients with subacute h and /arm edema after a distal radius fracture . METHOD The patients were r and omized into one of two treatment groups : a group that received traditional edema treatment and a group that received a modified MEM treatment . All patients were examined for edema , active range of motion ( AROM ) , pain , and activities of daily living ( ADL ) . The number of edema sessions and the number of all sessions were counted . RESULT No statistically significant changes were observed in edema reduction , AROM , pain , and ADL at six and nine weeks between the treatment groups . A statistically significant improvement was observed in ADL after three weeks after inclusion ( p=0.03 ) in the modified MEM group compared with the control group . Furthermore , fewer edema treatment sessions were needed ( p=0.03 ) in the modified MEM group . At six weeks , we observed a difference between the two groups ' needs for further edema treatment ( p=0.04 ) . CONCLUSION Neither the traditional nor the modified MEM treatment program was superior in terms of edema reduction , although the modified MEM result ed in fewer sessions to decrease subacute h and /arm edema compared with using traditional edema reduction techniques in patients after distal radius fracture . LEVEL OF EVIDENCE 1 STUDY DESIGN Systematic review . INTRODUCTION Controversy exists as to which rehabilitation protocol provides the best outcomes for patients after surgical repair of the extensor tendons of the h and . PURPOSE OF THE STUDY To determine which rehabilitation protocol yields the best outcomes with respect to range of motion and grip strength in extensor zones V-VIII of the h and . METHODS A comprehensive literature review and assessment was undertaken by two independent review ers . Method ological quality of r and omized controlled trials and cohort studies was assessed using the Scottish Intercollegiate Guidelines Network scale . RESULTS Seventeen articles were included in the final analysis ( κ=0.9 ) . From this total , seven evaluated static splinting , 12 evaluated dynamic splinting  , and four evaluated early active splinting . Static splinting yielded " excellent/good " results ranging from 63 % ( minimum ) to 100 % ( maximum ) on the total active motion ( TAM ) classification scheme and TAM ranging from 185 ° ( minimum ) to 258 ° ( maximum ) across zones V-VIII . Dynamic splinting studies demonstrated a percentage of " excellent/good " results ranging from 81 % ( minimum ) and 100 % ( maximum ) and TAM ranging from 214 ° ( minimum ) and 261 ° ( maximum ) . Early active splinting studies showed " excellent/good " results ranging from 81 % ( minimum ) and 100 % ( maximum ) . Only one study evaluated TAM in zones V-VIII , which ranged from 160 ° ( minimum ) and 165 ° ( maximum ) when using two different early active modalities . CONCLUSIONS The available level 3 evidence suggests better outcomes when using dynamic splinting over static splinting . Additional studies comparing dynamic and early active motion protocol s are required before a conclusive recommendation can be made . LEVEL OF EVIDENCE 2 OBJECTIVE The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome ( CTS ) . BACKGROUND DATA Many articles in the literature have demonstrated that low-level laser therapy ( LLLT ) may help to alleviate various types of nerve pain , especially for CTS treatment . We placed an 830-nm laser directly above the transverse carpal ligament , which is between the pisiform and navicular bones of the tested patients , to determine the therapeutic effect of LLLT . MATERIAL S AND METHODS Thirty-six patients with mild to moderate degree of CTS were r and omly divided into two groups . The laser group received laser treatment ( 10 Hz , 50 % duty cycle , 60 mW , 9.7 J/cm(2 ) , at 830 nm ) , and the placebo group received sham laser treatment . Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day , 5 d a week . The therapeutic effects were assessed on symptoms and functional changes , and with nerve conduction studies ( NCS ) , grip strength assessment , and with a visual analogue scale ( VAS ) , soon after treatment and at 2-wk follow-up . RESULTS Before treatment , there were no significant differences between the two groups for all assessment s ( p > 0.05 ) . The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up ( p < 0.05 ) . After 2 wk of treatment , no significant differences were found in grip strengths or for symptoms and functional assessment s ( p > 0.05 ) . However , there were statistically significant differences in these variables at 2-wk follow-up ( p < 0.05 ) . Regarding the findings of NCS , there was no statistically significant difference between groups after treatment and at 2-wk follow-up . CONCLUSIONS LLLT was effective in alleviating pain and symptoms , and in improving functional ability and finger and h and strength for mild and moderate CTS patients with no side effects QUESTION Do dynamic splints reduce contracture following distal radial fracture ? DESIGN Assessor-blinded , r and omised controlled trial . PARTICIPANTS Forty out patients with contracture following distal radial fracture . INTERVENTION The control group received routine care consisting of exercises and advice for 8 weeks . In addition to routine care , during the day the experimental group received a dynamic splint , which stretched the wrist into extension but allowed intermittent movement . OUTCOME MEASURES The primary outcomes were passive wrist extension and the Patient Rated H and Wrist Evaluation ( PRHWE ) . The secondary outcomes were active wrist extension , flexion , radial deviation , and ulnar deviation , and the performance and satisfaction items of the Canadian Occupational Performance Measure ( COPM ) . All outcomes were measured at commencement , at the end of 8 weeks of treatment , and at 12 weeks ( ie , 1 month follow-up ) . RESULTS The mean between-group difference for passive wrist extension and PRHWE at 8 weeks were 4 deg ( 95 % CI -4 to 12 ) and -2 points ( 95 % CI -8 to 4 ) , respectively . The corresponding values at 12 week follow-up were 6 deg ( 95 % CI 1 to 12 ) and 2 points ( 95 % CI -5 to 9 ) . There were no sufficiently important between-group differences for any of the secondary outcome measures at 8 or 12 weeks . CONCLUSION It is unclear whether dynamic splints following distal radial fracture have therapeutic effects on passive wrist extension or PRHWE , but they clearly do not have any therapeutic effects on active wrist extension , flexion , radial or ulnar deviation , or on the performance or satisfaction items of the COPM . The ongoing use of dynamic splints following distal radial fracture is difficult to justify . TRIAL REGISTRATION ACTRN12608000309381 OBJECTIVE To compare the effectiveness of an intensive lumbrical splint/stretch combination with 3 less intensive lumbrical splint/stretch combinations on  carpal tunnel symptoms and function . DESIGN R and omized Clinical Trial . SETTING Outpatient h and therapy clinics . PARTICIPANTS Volunteers ( N=124 ) with mild to moderate carpal tunnel syndrome . INTERVENTIONS A 4-week home regimen of nocturnal splints ( lumbrical splints or cock-up splints ) combined with stretches ( lumbrical intensive or general ) performed 6 times daily . MAIN OUTCOME MEASURES The effect of the intervention on carpal tunnel symptoms and function was examined with the Carpal Tunnel Symptom Severity and Function Question naire ( CTQ ) and Disabilities of the Arm , Shoulder , and H and ( DASH ) . We also evaluated whether subjects obtained surgery at 24 weeks . RESULTS There were significant main effects over time for all outcome measures at 4 , 12 , and 24 weeks . There was a significant interaction effect for the CTQ-Function and DASH at 12 weeks . Post hoc analyses indicated significant differences between the lumbrical splint/general stretch and general splint/lumbrical stretch groups and the other 2 groups . At 24 weeks , a significantly greater percentage of subjects in the general splint/lumbrical stretch group achieved a clinical ly important improvement on the CTQ-Function . By 24 weeks , only 25.5 % of subjects had elected to undergo surgery . CONCLUSIONS A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline . Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment Objective : To evaluate the effectiveness of a functional thumb orthosis on the dominant h and of patients with rheumatoid arthritis and boutonniere thumb . Methods : Forty patients with rheumatoid arthritis and boutonniere deformity of the thumb were r and omly distributed into two groups . The intervention group used the orthosis daily and the control group used the orthosis only during the evaluation . Participants were evaluated at baseline as well as after 45 and 90 days . Assessment s were preformed using the O'Connor Dexterity Test , Jamar dynamometer , pinch gauge , goniometry and the Health Assessment Question naire . A visual analogue scale was used to assess thumb pain in the metacarpophalangeal joint . Results : Patients in the intervention group experienced a statistically significant reduction in pain . The thumb orthosis did not disrupt grip and pinch strength , function , Health Assessment Question naire score or dexterity in either group . Conclusion : The use of thumb orthosis for type I and type II boutonniere deformities was effective in relieving pain We compared the effectiveness of physiotherapy and corticosteroid injection treatment in the management of mild trigger fingers . Mild trigger fingers are those with mild crepitus , uneven finger movements and actively correctable triggering . This is a single-centred , prospect i ve , block r and omized study with 74 patients ; 39 patients for steroid injection and 35 patients for physiotherapy .  The study duration was from Jun 2009 until August 2010 . Evaluation was done at 6 weeks , 3 months and 6 months post-treatment . At 3 months , the success rate ( absence of pain and triggering ) for those receiving steroid injection was 97.4 % and physiotherapy 68.6 % . The group receiving steroid injection also had lower pain score , higher rate of satisfaction , stronger grip strength and early recovery to near normal function ( findings were all significant , p < 0.05 ) . At 6 months , only those who were successfully treated were further question ed on recurrence ( presence of pain and triggering ) . Those who received corticosteroid injections had a significant recurrence rate of pain but not triggering . The physiotherapy group had no recurrence of pain or triggering due to the type of triggering responsive to physiotherapy or possibly due to awareness of physiotherapy exercises . Perhaps they were able to institute self-treatment on early onset of symptoms of trigger fingers . We conclude that corticosteroid injection has a better outcome compared to physiotherapy in the treatment of mild trigger fingers but physiotherapy may have a role in prevention of recurrence BACKGROUND The effect of formal occupational therapy on recovery after open reduction and volar plate fixation of a fracture of the distal part of the radius is uncertain . We hypothesized that there would be no difference in wrist function and arm-specific disability six months after open reduction and volar plate fixation of a distal radial fracture between patients who receive formal occupational therapy and those with instructions for independent exercises .  METHODS Ninety-four patients with an unstable distal radial fracture treated with open reduction and volar locking plate fixation were enrolled in a prospect i ve r and omized controlled trial comparing exercises done under the supervision of an occupational therapist with surgeon-directed independent exercises . The primary study question addressed combined wrist flexion and extension six months after surgery Secondary study questions addressed wrist motion , grip strength , Gartl and and Werley scores , Mayo wrist scores , and DASH ( Disabilities of the Arm , Shoulder and H and ) scores at three months and six months after surgery . RESULTS There was a significant difference in the mean arc of wrist flexion and extension six months after surgery ( 118 ° versus 129 ° ) , favoring patients prescribed independent exercises . Three months after surgery , there was a significant difference in mean pinch strength ( 80 % versus 90 % ) , mean grip strength ( 66 % versus 81 % ) , and mean Gartl and and Werley scores , favoring patients prescribed independent exercises . At six months , there was a significant difference in mean wrist extension ( 55 ° versus 62 ° ) , ulnar deviation ( 82 % versus 93 % ) , mean supination ( 84 ° versus 90 ° ) , mean grip strength ( 81 % versus 92 % ) , and mean Mayo score , favoring patients prescribed independent exercises . There were no differences in arm-specific disability ( DASH score ) at any time point . CONCLUSIONS Prescription of formal occupational therapy does not improve the average motion or disability score after volar locking plate fixation of a fracture of the distal part of the radius
target: The strongest evidence supports postsurgical early active motion protocol s and splinting for various conditions .
  Very few studies have examined occupation-based interventions .
background: Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity .
  It is imperative that practitioners underst and the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purpose ful occupations .
  This systematic review provides an up date to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question , What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm , wrist , and h and ?