To compare extracorporeal shockwave therapy (ESWT) with hyaluronic acid (HA) intra-articular injections in terms of pain relief, improvement in hand function, and strength in subjects with first carpometacarpal (CMC) joint osteoarthritis.
Fifty-eight patients received either focused ESWT or HA injection once a week for 3 consecutive weeks. In the ESWT group, 2,400 consecutive pulses were performed during each treatment session using a frequency of 4 Hz and an energy flux density of 0.09 mJ/mm2. The HA group underwent one cycle of three injections of 0.5 cm3 HA. The main outcome measures were pain and hand function as measured by the visual analogue scale (VAS) and Duruoz Hand Index (DHI), respectively. The secondary outcomes were grip and pinch strength. Each assessment was performed at baseline, at the end of treatment, and at 3- and 6-month follow-up visits.
According to VAS and DHI scores, a significant change in test performance was observed over time in both groups (p<0.001), with a greater average improvement in painful symptomatology at the 6-month follow-up in the ESWT group. A significant improvement in strength was observed in both groups, but the ESWT group showed better results on the pinch test starting immediately at the end of treatment.
The use of ESWT in patients with first CMC joint osteoarthritis leads to a reduction in pain, an improvement in pinch test performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.
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We report a rare case of a 10-year-old girl with anomalous course of extensor pollicis longus (EPL) muscle, which exists with absence of thenar muscles and muscles in the 1st extensor compartment. Her chief complaint was severe atrophy on the right thenar eminence. On physical examination, there was no obvious functional abnormality on her right thumb. On magnetic resonance imaging, we found that the abductor pollicis brevis, opponens pollicis, abductor pollicis longus, and extensor pollicis brevis muscles were absent. The tendon of the EPL muscle was found, but it had abnormal insertion on the radial side of the proximal phalanx, not on the distal phalanx. This variation was thought to have played a major role in compensating for impaired abduction of the thumb, which is usually accompanied by agenesis of major abductors of the thumb.
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To derive normative values for ulnar nerve conduction study of the active recording electrode on the first dorsal interosseous muscle (FDI) and the reference electrode on the proximal phalanx of the thumb.
Ulnar nerve motor conduction study with FDI and abductor digiti minimi muscle (ADM) recording was performed in 214 hands of 107 healthy subjects. Ulnar NCS was performed with 2 different recording electrode montages (ADM-base of 5th finger; FDI-thumb) and differences in latency and amplitude were compared. Using this technique, the initial positivity of ulnar compound muscle action potential (CMAP) was not observed in any response with FDI recording.
The maximal values for distal motor latency to the ADM and FDI muscle were 3.8 ms and 4.4 ms, respectively. The maximal difference of distal motor latency between the bilateral FDI recordings was 0.6 ms. The maximal ipsilateral latency difference between ADM and FDI was 1.4 ms.
Placement of the reference electrode on the thumb results in a CMAP without an initial positivity and the normative values obtained may be useful in the diagnosis of ulnar neuropathy at the wrist.
Citations
Objective: The purpose of this study was to evaluate the incidence of inability to flex proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint in normal Koreans. The opposition palm ratio and thumb index ratio was also of interest.
Method: Randomly selected eighty nine normal Korean adults of 48 men and 41 women, with ages 20 to 79 years. The finger flexion was measured using the standard flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) screening tests. Thumb index ratio and opposition palm ratio was also assessed additionally.
Results: In the sample population, 2 subjects (2.2%) were unable to bilaterally flex their fifth PIP joints independently. Four subjects (4.4%) were unable to flex one or both of their fourth or fifth DIP joints. These results show far less incidence of FDS dysfunction comparing with 52% of FDS dysfunction rate in Americans. The opposition palm ratio in men were 63.6% and in women 69.9%, indicating lower ratio in men. The thumb index ratio was not different statistically between the men and women.
Conclusion: These data suggest that the different incidences of FDS and FDP dysfunction should be considered in interpretation. The opposition palm ratio and thumb index ratio might be useful in the hand rehabilitation.
In diagnosis of carpal tunnel syndrome, there are many techniques with high sensitivity. Among them, the median-radial latency difference(MRLD) is one of the most useful technique in screening mild carpal tunnel syndrome with high sensitivity, no painful discomfort to patients and no motor artifact.
In this study, we examined the effect of the thumb position(radial abduction and adduction) on the MRLD. Because the stimulation sites of the median sensory and superficial radial nerves are different from each other, the free movement of the thumb in this examination is not avoidable.
The results are 1) there is no significant effect of the thumb position on median sensory latency. 2) There is no significant effect of the thumb position on superficial radial latency. 3) There is significant effect of the thumb position on MRLD(P<0.01). Therefore, if we diagnose the mild carpal tunnel syndrome with MRLD, the thumb position must be maintained in neutral position through the examination.
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