Complex motions embedded in a hand exercise regimen - effects on thumb function in participants with carpometacarpal osteoarthritis: A pilot study.

Objective: The goal of this pilot study was to identify changes associated with completion of a unique six-week hand exercise program in persons with carpometacarpal osteoarthritis. Methods: Twenty-four individuals, aged 55-80, with doctor-diagnosed carpometacarpal osteoarthritis participated in the study. Movement data from standard clinical motions and complex multi-planar motions were obtained using a motion capture system at three-time points: an initial visit, after two weeks of hand exercises, and after completion of the six-week exercise program. Results: This exercise program produced trends of improvement in complex multi-planar motions. Specifically, joint angle changes were seen during opposition and the formation of an "okay sign" that was included as part of the exercise program. Conclusion: Through the use of motion capture, changes were identified in thumb joint function after exercise. Specifically, motions associated with the more complex multi-planar tasks showed changes in individual joint contributions following the six-week exercise intervention. The results suggest that further exploration of this exercise program, particularly the inclusion of complex multi-planar tasks during osteoarthritis treatment and associated evaluations, should be considered in future clinical studies.

Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies.

STUDY DESIGN: Invited review. BACKGROUND: Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PURPOSE: The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. METHODS: A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. RESULTS: This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. CONCLUSIONS: The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.

Determining Isolated Thumb Forces in Osteoarthritic and Healthy Persons.

Carpometacarpal (CMC) osteoarthritis (OA) can dramatically impair thumb function resulting in the inability to complete basic tasks. Development of a method to detect thumb forces changes is essential to understand of the progression of carpometacarpal osteoarthritis and the effects of treatment. The goals of this study were to (1) develop a method to measure thumb forces in multiple directions, (2) perform an initial demonstration of this method on three populations, young healthy (YH), older healthy (OH), and older participants with carpometacarpal osteoarthritis, and (3) determine the effects of short-term exercises on thumb force production in these pilot groups. A multi-axis load cell with a custom-built apparatus and a hand grip dynamometer were used to measure thumb and grip forces. Forces were collected in four directions: radial abduction and adduction, and palmar abduction and adduction. All participants completed thumb and grip testing prior to (week 0), during (week 2), and following (week 6), a hand exercise regimen. Group differences and the effects of exercise on force production were determined. Hand exercises improved thumb forces in young healthy female participants during radial (p = 0.017) and palmar abduction (p = 0.031) and female participants with osteoarthritis during palmar abduction (p = 0.010). Exercise improved grip strength in young healthy males (p = 0.028), young healthy females (p = 0.041), and females with osteoarthritis (p = 0.027). This research demonstrates the successful use of a new device to determine isolated thumb forces, and its clinical utility to identify changes after a short exercise regimen.

Complex thumb motions and their potential clinical value in identifying early changes in function.

BACKGROUND: Early diagnosis and treatment of osteoarthritis of the thumb allows for early interventions that may mitigate osteoarthritis progression and decrease severity later in life. Early identification of motion changes is limited by the clinical reliance on single planar measurements using goniometry. Multi-planar measurements using motion capture can provide insights into joint function and pathophysiology that cannot be obtained from single-plane goniometry measurements. Thus, the goals of this research were 1) to determine differences in thumb motions across three groups of participants (young healthy (n = 23), older healthy (n = 11), and those with carpometacarpal osteoarthritis (n = 24)) and 2) to determine if multi-planar motions provided additional movement information in comparison to standard planar measures. METHODS: In this study, a motion capture system was used to collect standard clinical ranges of motion and complex multi-planar tasks. Differences in motion patterns due to aging and osteoarthritis were identified. Motions tested included palmar adduction-abduction, radial adduction-abduction, metacarpophalangeal flexion-extension, interphalangeal flexion-extension, functional adduction-abduction, opposition, and circumduction. FINDINGS: Results indicated that motion capture was capable of detecting changes in carpometacarpal mobility that were not detected using standard approaches. Our results suggested that use of multi-planar measurements have the potential to identify changes that are indicators of early stages of osteoarthritis. INTERPRETATION: Early indicators are clinically useful as they will enhance patient treatment by permitting the application of treatment approaches sooner, potentially leading to reduced overall functional deficits.

A method for quantifying key components of the opening process for opening pouch-style packages containing medical devices.

Healthcare-associated infections are a serious worldwide health concern. Although contaminated medical devices are an avenue for infection, little research has evaluated the techniques used to open sterile packages. The goal of this study was to develop a method to quantify aspects of the package opening process in accordance with opening guidelines and then to demonstrate this methodology through a small sample of clinicians opening two sizes of pouch-style packages. Using motion capture techniques, a method was designed to quantify 11 parameters associated with the opening process. The method was then tested with nine healthcare professionals. Results indicated that all participants crossed the sterile field when opening packages. When opening large packages, participants spent significantly more time over the simulated sterile field and there was a trend towards more manipulations as compared to opening smaller packages. This methodology can be used to quantify the opening process, compare opening practices, and for assessment during the learning process.