MANAGEMENT OF STIFF HAND: AN OCCUPATIONAL THERAPY PERSPECTIVE

Joint stiffness, resulting from a variety of complications after hand injuries, remains a common problem. Prolonged swelling, scar formation and shortening of soft tissue after prolonged period of immobilisation are the major causes leading to the loss of joint range of motion. Treatment used to improve the joint stiffness should be integrative and problem-focused. Pressure therapy, active and passive mobilisation through remedial activities and corrective splinting should be started as soon as problems arise. Applying low-load stress through prolonged periods of time onto the shortened tissue at its maximum tolerable range is the main principle in restoration of passive joint range of motion. The greater the joint limitation becomes, the longer the time the splint should be applied. Therapists should understand the process of tissue healing and different functions of splints before a correct and effective splint can be prescribed properly.

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Goniometry: is it a reliable tool to monitor passive joint range of motion in horses?

Equine Veterinary Journal ◽

10.1111/j.2042-3306.2010.00254.x ◽

2010 ◽

Vol 42 ◽

pp. 676-682 ◽

Cited By ~ 28

Author(s):

Y. LILJEBRINK ◽

A. BERGH

Keyword(s):

Range Of Motion ◽

Passive Joint ◽

Reliable Tool ◽

Joint Range Of Motion ◽

Joint Range

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Pre-obesity and obesity impacts on passive joint range of motion

Ergonomics ◽

10.1080/00140139.2018.1478455 ◽

2018 ◽

Vol 61 (9) ◽

pp. 1223-1231 ◽

Cited By ~ 7

Author(s):

Yihun Jeong ◽

Suyeon Heo ◽

Giwhyun Lee ◽

Woojin Park

Keyword(s):

Range Of Motion ◽

Passive Joint ◽

Joint Range Of Motion ◽

Joint Range

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Small amounts of involuntary muscle activity reduce passive joint range of motion

Journal of Applied Physiology ◽

10.1152/japplphysiol.00168.2019 ◽

2019 ◽

Vol 127 (1) ◽

pp. 229-234 ◽

Cited By ~ 6

Author(s):

Joanna Diong ◽

Simon C. Gandevia ◽

David Nguyen ◽

Yanni Foo ◽

Cecilia Kastre ◽

...

Keyword(s):

Range Of Motion ◽

Soleus Muscle ◽

Muscle Activity ◽

Random Order ◽

Passive Movement ◽

Ankle Dorsiflexion ◽

Passive Joint ◽

Joint Range Of Motion ◽

Involuntary Muscle ◽

Joint Range

When assessing passive joint range of motion in neurological conditions, concomitant involuntary muscle activity is generally regarded small enough to ignore. This assumption is untested. If false, many clinical and laboratory studies that rely on these assessments may be in error. We determined to what extent small amounts of involuntary muscle activity limit passive range of motion in 30 able-bodied adults. Subjects were seated with the knee flexed 90° and the ankle in neutral, and predicted maximal plantarflexion torque was determined using twitch interpolation. Next, with the knee flexed 90° or fully extended, the soleus muscle was continuously electrically stimulated to generate 1, 2.5, 5, 7.5, and 10% of predicted maximal torque, in random order, while the ankle was passively dorsiflexed to a torque of 9 N·m by a blinded investigator. A trial without stimulation was also performed. Ankle dorsiflexion torque-angle curves were obtained at each percent of predicted maximal torque. On average (mean, 95% confidence interval), each 1% increase in plantarflexion torque decreases ankle range of motion by 2.4° (2.0 to 2.7°; knee flexed 90°) and 2.3° (2.0 to 2.5°; knee fully extended). Thus 5% of involuntary plantarflexion torque, the amount usually considered small enough to ignore, decreases dorsiflexion range of motion by ~12°. Our results indicate that even small amounts of involuntary muscle activity will bias measures of passive range and hinder the differential diagnosis and treatment of neural and nonneural mechanisms of contracture. NEW & NOTEWORTHY The soleus muscle in able-bodied adults was tetanically stimulated while the ankle was passively dorsiflexed. Each 1% increase in involuntary plantarflexion torque at the ankle decreases the range of passive movement into dorsiflexion by >2°. Thus the range of ankle dorsiflexion decreases by ~12° when involuntary plantarflexion torque is 5% of maximum, a torque that is usually ignored. Thus very small amounts of involuntary muscle activity substantially limit passive joint range of motion.

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