1,721,057 research outputs found
Manual Therapy vs. Surgery: Which Is Best for Carpal Tunnel Syndrome Relief?
No full textBackground: Carpal Tunnel Syndrome (CTS) is a common condition characterized by compression of the median nerve, leading to pain, numbness, and hand dysfunction. Both manual therapy and surgical decompression are widely used interventions, but their comparative effectiveness remains uncertain. Methods: A systematic review and a meta-analysis were conducted to compare the short- and long-term efficacy of manual therapy versus surgery for CTS. Studies were selected based on randomized controlled trials (RCTs) that met the inclusion criteria, focusing on outcomes such as pain intensity, hand function, symptom severity, and quality of life. Data were extracted and analyzed by using standardized tools to assess treatment effects. Results: Five RCTs with a total of 533 participants were included. Manual therapy was more effective for short-term pain relief, with significant improvements at 1 and 3 months compared with surgery. However, at 6 to 12 months, surgical intervention provided greater improvements in hand function and symptom severity. Quality-of-life improvements were similar in both groups. Risk of bias was moderate to low across the studies, with limitations in blinding due to the nature of the interventions. Conclusions: Manual therapy offers effective short-term relief for CTS, making it a viable option for patients with mild to moderate symptoms. Surgery provides more durable, long-term outcomes, particularly for severe cases. The choice of treatment should be individualized, considering patient preferences and symptom severity
Towards a new frontier in wrist rehabilitation: The traction-free posture orthosis
No full textThis study presents the novel Traction-Free Posture Orthosis, designed to address wrist stiffness without the use of traditional traction methods. The orthosis employs a velcro system to stabilize the position of the wrist in flexion or extension, thereby avoiding the compression and rotational disadvantages associated with non-perpendicular traction forces. Triangular-shaped cuts in the brace allow for plastic material flexibility, ensuring movement and comfort. Significant is the absence of a traction strap, which traditionally reduces the support surface and could create pressure points leading to patient discomfort or treatment rejection. The design facilitates a wide contact surface with the hand, optimal load distribution, and the capacity to adjust dual traction straps independently, adapting to the natural wrist movement. This single-piece base orthosis offers a stable, cost-effective, and patient-friendly alternative to conventional splints. However, patients with stiffness in both flexion and extension may require two separate orthoses, potentially increasing costs and patient inconvenience. Overall, the Traction-Free Posture Orthosis represents an innovative step in wrist rehabilitation, providing a quick-to-construct, easy-to-wear solution with the promise of enhanced patient compliance and comfort
Progression and clinical implications of boutonniere deformity
No full textThe Boutonniere Deformity, characterized by PIP flexion and DIP hyperextension, results from central slip damage. Initial central slip lesion progresses to involve other structures, causing volar migration of lateral bands. Elson's test aids diagnosis by isolating central slip function. Conservative treatment involves immobilization followed by mobilization. Understanding the complex mechanics is crucial for accurate diagnosis and effective management
Harnessing the Power of Water: A Scoping Review of Hydrokinesiotherapy as a Game-Changer in Knee Osteoarthritis Management
No full textBackground: Knee osteoarthritis (OA) is a prevalent condition that significantly impairs pain, mobility, and quality of life. Hydrokinesiotherapy, a water-based exercise therapy, is gaining traction as a potential alternative to traditional land-based rehabilitation for managing knee OA symptoms. Methods: This scoping review aimed to evaluate the effectiveness of hydrokinesiotherapy compared to standard land-based physical therapy and self-administered exercise regimens in improving pain, joint mobility, quality of life, and physical function in patients with knee OA. Five randomized controlled trials (RCTs) were included, assessing outcomes using measures such as the WOMAC score, Visual Analog Scale (VAS), and SF-12. The studies were critically appraised using the PEDro scale and the RoB-2 tool to determine the quality and risk of bias. Results: Hydrokinesiotherapy consistently demonstrated superior outcomes in pain reduction, joint mobility, and physical function across all studies. Patients in the hydrokinesiotherapy groups reported significant improvements in pain and mobility, which were strongly associated with enhanced quality of life. The review also highlighted the potential for hydrokinesiotherapy to serve as an effective alternative or complement to land-based exercises, particularly in populations experiencing severe symptoms. Conlusions: Hydrokinesiotherapy is an effective intervention for managing knee OA, offering significant improvements in key clinical outcomes. Given its benefits, hydrokinesiotherapy should be considered a valuable addition to knee OA treatment protocols. However, further research is needed to confirm long-term effects and to explore ways to improve accessibility to this therapeutic option
Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis
No full textBackground
Effective rehabilitation of peripheral facial paralysis (PFP) requires reliable assessment tools. This systematic review aimed to identify and validate instruments used in PFP rehabilitation, categorizing them according to the ICF framework.
Methods
A comprehensive search was conducted across PubMed, Cinahl, Web of Science, and Scopus up to April 2024. Observational analytical studies and one non-randomized controlled trial that validated tools for assessing PFP were included.
Results
Thirty-three studies were included, covering twenty different tools. Seventeen tools were related to the "Structure and Function" domain, while three addressed "Activity and Participation." The Sunnybrook and House-Brackmann scales were the most extensively studied. The Sunnybrook scale exhibited excellent intra- and inter-rater reproducibility and internal validity, making it suitable for clinical use. The House-Brackmann scale was user-friendly but had limitations in reproducibility and sensitivity to subtle differences, which newer versions like the FNGS 2.0 aimed to address. The FAME scale showed promise by reducing subjective scoring. Computerized tools, such as eFACE and A-FPG, and instruments for lip asymmetry and ocular involvement demonstrated potential but require further validation. The Facial Disability Index and the FaCE Scale were validated for assessing disability and participation restrictions.
Conclusion
This review identified several validated tools for PFP assessment, with the Sunnybrook and House-Brackmann scales being the most reliable. While emerging tools and computerized programs show promise, they need further validation for routine clinical use. Integrating validated tools into clinical practice is essential for comprehensive assessment and effective rehabilitation of PFP
Effectiveness of manual thoracic therapy in treating impingement syndrome: a systematic review
Full text linkBackground
Impingement syndrome, a common cause of shoulder pain, often leads to functional limitations. Manual thoracic therapy is frequently employed as a non-surgical intervention, but its efficacy remains debated. This review assesses the impact of manual thoracic therapy on pain reduction and functional improvement in impingement syndrome.
Methods
A systematic review of randomized clinical trials was conducted, focusing on studies that applied manual thoracic therapy to patients with impingement syndrome. The primary outcomes were pain reduction and functional improvement. Studies were evaluated for methodological quality using the PEDro scale, with scores ≥ 6 indicating high quality.
Results
Nine studies met the inclusion criteria. All studies demonstrated high methodological quality (PEDro score ≥ 6). Pain reduction was consistent across studies, with an NPRS score reduction of 0.6 to 1.5 points immediately after treatment and up to 3.2 points at follow-up. Functionality improvements were statistically significant in some studies. However, the results showed limited homogeneity, and the majority of studies did not report substantial differences between intervention and placebo groups.
Conclusion
This review suggests that manual thoracic therapy may lead to pain reduction in impingement syndrome, with some evidence of functional improvement. However, the variability in manual therapy techniques and the limitations in research methodologies indicate a need for further controlled studies. These findings underscore the potential of manual therapy as a supplementary treatment but also highlight the necessity for more robust clinical trials to fully ascertain its effectiveness in clinical practice
Effectiveness of neurodynamic treatment in managing lateral epicondylitis: a systematic review
Full text linkBackground
Lateral epicondylitis, commonly known as “tennis elbow,” is a prevalent musculoskeletal condition affecting up to 3% of the population, primarily in individuals over 40 years old. It leads to pain and dysfunction at the lateral epicondyle, primarily involving the tendons of forearm extensor muscles, innervated by the radial nerve. Recent insights suggest a multifactorial etiology, questioning the traditional tendinopathy model. Neurodynamics, exploring nerve mechanics, emerges as a potential treatment approach.
Methods
A systematic review following PRISMA guidelines searched multiple databases for clinical trials investigating neurodynamic interventions for lateral epicondylitis. Inclusion criteria involved lateral epicondylitis patients receiving neurodynamic treatment, with pain, disability, and functional improvement as primary outcomes.
Results
Six studies met the inclusion criteria. Neurodynamic techniques, including radial nerve mobilization and home exercises, showed positive outcomes. Significant pain reduction, improved grip strength, and increased ulnar deviation angle were observed in several studies. However, heterogeneity in study design, follow-up durations, and small sample sizes limit conclusive evidence.
Conclusion
Neurodynamic treatment, particularly radial nerve mobilization, appears promising in alleviating pain and improving nerve mechanosensitivity in lateral epicondylitis. High-quality research is needed to establish its efficacy, considering the limitations in existing studies. A multidisciplinary approach and standardized patient inclusion criteria should be emphasized to advance the management of this condition
Non-surgical treatment of oblique diaphyseal fractures of the fourth and fifth metacarpals in a professional athlete A case report
Full text linkIntroduction
Metacarpal fractures are common sports-related injuries, often requiring tailored treatment strategies, especially in athletes. The management of oblique diaphyseal fractures poses unique challenges due to their inherent instability. This case report discusses a non-surgical approach in treating such fractures in a professional athlete.
Case presentation
A 26-year-old professional soccer player sustained oblique diaphyseal fractures of the fourth and fifth metacarpals during training. Given the athlete's professional demands and the fracture's nature, a conservative treatment was implemented. This included the application of a modified ulnar gutter brace, allowing for immobilization of the metacarpophalangeal joints (MP) while permitting active mobilization of the interphalangeal joints(IP).
Clinical discussion
The non-surgical treatment focused on achieving skeletal stability and maintaining hand function. Despite the complexity of oblique fractures, the conservative approach was successful, enabling the athlete to resume professional activities with minimal risk of fracture displacement. Regular radiographic follow-ups showed no further displacement, highlighting the effective management of such fractures through personalized conservative treatment plans.
Conclusions
This case underscores the viability of conservative treatment for specific metacarpal fractures in athletes. Tailoring the treatment to accommodate the athlete's professional needs and understanding the biomechanical characteristics of the fracture are crucial for successful outcomes. The case also suggests that non-surgical management can be a viable option for certain complex metacarpal fractures, especially in high-demand patients
Harnessing Mirror Neurons: A New Frontier in Parkinson’s Disease Rehabilitation—A Scoping Review of the Literature
Full text linkBackground: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, and bradykinesia. Rehabilitation utilizing mirror neurons leverages the brain’s capacity for action observation (AO) and motor imagery (MI) to enhance motor function. This approach involves patients imitating movements observed in therapists or videos, aiming to improve gait, coordination, and overall quality of life. Mirror neuron activation facilitates motor learning and may decelerate disease progression, thus enhancing patient mobility and independence. Methods: This scoping review aimed to map current evidence on PD therapies employing mirror neuron-based rehabilitation. Databases searched included PubMed, PEDro, and Cochrane. The review included randomized controlled trials (RCTs) and systematic reviews that examined the effects of AO and MI in PD rehabilitation. Results: Five studies met the inclusion criteria, encompassing various rehabilitation techniques focusing on AO and MI. These studies consistently demonstrated positive outcomes, such as reduced disease severity and improved quality of life, gait, and balance in PD patients. The activation of mirror neurons through AO and MI was shown to facilitate motor learning and contribute to improved functional mobility. Conclusions: Although the included studies support the beneficial impact of AO and MI techniques in PD rehabilitation, numerous questions remain unresolved. Further research is necessary to evaluate the potential integration of these techniques into standard physiotherapy routines for PD patients. This review highlights the promise of AO and MI in enhancing motor rehabilitation for PD, suggesting the need for more comprehensive studies to validate and refine these therapeutic approaches
Focal Vibration Therapy for Motor Deficits and Spasticity Management in Post-Stroke Rehabilitation
No full textBackground: Focal mechanical vibration therapy has gained attention as a potential intervention to improve motor function while decreasing spasticity and pain in post-stroke patients. Despite promising results, there remains variability in study designs and outcomes, warranting a review of its clinical efficacy. Methods: A review was conducted to evaluate randomized controlled trials (RCTs) investigating the effects of focal mechanical vibration therapy on post-stroke rehabilitation. Six studies were included, assessing outcomes such as spasticity reduction (using the Modified Ashworth Scale), motor function recovery (Wolf Motor Function Test, Fugl-Meyer Assessment), and pain management (Visual Analog Scale, Numerical Rating Scale). The quality of studies was evaluated using the PEDro scale and RoB-2 tool. An overview review was conducted to provide a comprehensive analysis of the topic. Results: The included studies demonstrated significant reductions in spasticity and improvements in motor function in most patients receiving focal vibration therapy. Notable improvements were observed when focal vibration was combined with other rehabilitation techniques, such as progressive modular rebalancing or robotic rehabilitation. Pain levels were also reduced in several studies. However, differences in vibration parameters (frequency, amplitude), small sample sizes, and short follow-up periods limit the generalizability of the findings. Conclusions: Focal mechanical vibration therapy appears to be an effective adjunct in post-stroke rehabilitation, particularly for reducing spasticity and improving motor function. Although short-term benefits are promising, further research is required to determine long-term efficacy and optimal treatment parameters. This review evaluates the effectiveness of focal vibration therapy in treating motor deficits and spasticity in post-stroke patients. The results suggest its potential to improve these conditions, though further studies with larger sample sizes are needed to confirm its long-term efficacy
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