Arthritis glove provision in rheumatoid arthritis and hand osteoarthritis: A survey of United Kingdom rheumatology occupational therapists

Introduction Hand pain and function limitations are common in rheumatoid arthritis (RA) and hand osteoarthritis (HOA). Provision of arthritis (compression) gloves to relieve hand symptoms is increasing in occupational therapy. Research evaluating arthritis gloves dates to the 1990s, focussing on night-wear of full-length finger gloves in RA. This survey examined glove provision in contemporary clinical practice in the United Kingdom. Methods A survey of arthritis glove provision in RA was conducted with Royal College of Occupational Therapists Rheumatology Specialist Section members. A more detailed survey about glove provision in RA and HOA was conducted with rheumatology occupational therapists in North-West England. Results Response rates were good, with 60 (73%) therapists responding to the national and 24 (69%) to the regional surveys. Most therapists provided open-finger gloves (commonly IsotonerTM) to about a third of their RA and HOA patients, and to those with any arthritic condition causing significant hand pain and/or swelling. Day-wear was as common as night-wear, and patients were advised to wear these ‘as and when’ for hand symptom relief and support for hand function. They were advised not to wear gloves continually in the day, and regularly perform hand exercises and monitor for potential adverse effects, for example, skin discolouration. Therapists commonly provide replacement gloves as these are often used long-term. Conclusion Prescription of arthritis gloves has changed considerably in the last 30 years, with open-finger gloves provided to a wider range of people with arthritis, for a broader range of clinical reasons.

Improvement of Sleep Quality after Surgical Decompression in Carpal Tunnel Syndrome

Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy which can cause severe sleep disturbance. Carpal tunnel release (CTR) is a choice for severe cases, which has shown to improve sleep quality, but the available evidence is limited. This study aimed to investigate the impact of CTR on sleep quality and hand symptoms and functions in patients with CTS. Methods This was a prospective study in 2019–2020 on patients with CTS and poor sleep quality undergoing CTR. Patients were evaluated before and at 1, 3, and 12 months after CTR by the Pittsburgh sleep quality index (PSQI) and Boston carpal tunnel syndrome questionnaires. Results There were 33 patients with 27 females (82%) and a median age of 51 years. The median time of CTS diagnosis and having sleep disorder before CTR were 12 and 6 months, respectively. The outcomes significantly improved after CTR, with the median PSQI and Boston symptom and function scores reduced from 12, 33, and 23 before CTR to 9, 14, and 11 at 1 month; 7, 13, and 9 at 3 months; and 1, 11, and 8 at 12 months postoperatively, respectively. The correlations between the PSQI and Boston symptom and function scores were > 0.6 at all time-points. Conclusions Surgical decompression significantly improves sleep quality and the hand symptoms and functions in patients with CTS. Long-term evaluations are lacking and thus are required in future studies.

Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study

Background Carpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done. Results Regarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%). Conclusions The concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.

Effects of Orem's Self-Care Model of Nursing on Hand Symptoms and Life Activities in Geriatric Individuals Diagnosed with Rheumatoid Arthritis: A Pilot Study

Background and PurposeAccording to Orem's self-care deficit theory, when patients cannot meet their care needs, they need nursing systems for maintaining their health. Nursing care for elderly patients with rheumatoid arthritis (RA) should be based on maintaining self-care. This study aims to determine the effects of Orem's self-care model of nursing care given to geriatric patients with RA on hand symptoms, life activities, and hand pain.MethodsThe study sample comprised a total of 22 patients (intervention group, 11; control group, 11) who met the sample selection criteria at a rheumatology outpatient clinic of a university hospital between June 17, 2019 and September 20, 2019. All interviews with patients in the intervention group were conducted by daily phone calls and a face-to-face interview at the hospital every 4 weeks. Patients continued to receive routine prescription by a physician during the course of application.ResultsNo difference was observed between the groups in terms of descriptive patient characteristics (p > .05). Hand pain, hand symptoms, and life activities of patients in the intervention group were measured at study initiation, week 4, and week 8. Intragroup comparison revealed that hand pain, hand symptoms, and life activity scores were lowest at week 8 in the intervention group (p < .05).Implications for PracticeThis study indicates that nursing care given according to Orem's self-care model is effective in reducing pain, improving hand functions, and performing life activities.

TO DETERMINE RELATION OF SYMPTOM DURATION IN OUTCOME OF CTS

Background & Method: The study was conducted at the neurology Department of Amaltas Institute of Medical Sciences, Dewas, M.P. In our laboratory, the hands are evaluated for CTS using standard techniques with Nicolet Viking IV (ver12). The skin temperature of the body part, under evaluation, is measured using a probe connected to the machine and is maintained at 310c using a commercial hot air blower. Result: The number of symptomatic hands was more in females (73 vs. 27%) and persons with high BMI (61.5 vs. 38.5); 27.7% of the hands belonged to the persons having concomitant medical issues. Female gender showed slightly higher odds (OR 1.2, CI 0.5-2.6, two-tailed p= 0.5) for remission on medical therapy. The median duration of symptoms of our study population was12 months (mean 24.16 ± 28.93 months). We had 40 patients having CTS in bilateral hands (n= 80 hands), while 50 patients had unilateral hand symptoms (n= 50 hands). Forty-one (31.5%) hands were symptomatic for 10 months or less (median 6 months) while remaining 89 hands were symptomatic for longer than 10 months (median 24 months). Shorter duration of the symptoms, at presentation, had significant higher odds of spontaneous remission (OR 9.47 CI 3.8-23.1, two-tailed p= <0.0001). Conclusion: In conclusion, it seems reasonable to treat subjects of CTS, conservatively for first ten months after symptom onset, more so when they have four or more out of the seven favorable factors. Keywords: Symptom, CTS, MMA & SDL.

Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study

Background Carpal tunnel syndrome (CTS) is a common cause of pain, numbness and tingling in the wrist and hand region and is associated with repetitive wrist and hand use in office workers. However, scarce knowledge exists about the epidemiology of clinically confirmed CTS among Chinese office workers. This study aimed to investigate the prevalence of wrist/hand symptoms and CTS in office workers in China and to identify associated risk factors. Methods A cross-sectional survey was carried out in a metropolitan city in China involving 969 respondents (aged 17–49 years) from 30 workplaces. A questionnaire was distributed to each participant to collect their demographic, work-related physical and psychosocial factors, and wrist and hand symptoms. The wrist and hand pain/numbness symptoms were marked on a body chart and the nature and intensity of symptoms, nocturnal symptoms, as well as aggravating activities were also recorded. Clinically confirmed CTS cases were screened based on the history, Phalen’s test, Tinel Sign and skin sensation testing among symptomatic respondents. Logistic regression was employed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of self-reported wrist and hand symptoms and clinically confirmed CTS. Results The clinically confirmed CTS prevalence was 9.6%. The prevalence of wrist and hand symptoms were 22 and 15%, respectively. Frequently working in pain was associated with higher odds of CTS. Multivariate modelling adjusted for age and gender showed that prolonged computer use time and working without breaks were associated with presence of wrist/hand symptoms (adjusted ORs: 1.11 (95% CI 1.02–1.22) and 1.88 (95% CI 1.12–3.14)). Educational level was inversely associated with CTS and smoking was associated with wrist/hand complaints (adjusted OR: 2.20 (95% CI 1.19–4.07)). Conclusions The prevalence of work-related clinically confirmed CTS symptoms among young office workers in China is high. Frequently working in pain is closely associated with clinically confirmed CTS. Intense computer use and no breaks at work are associated with wrist and hand symptoms.

Acute Median Neuropathy after Subdermal Contraceptive Implant Removal

The contraceptive implant is an effective and well-established method of contraception. A 43-year-old woman presented with paresthesia and weakness of left hand. Symptoms began 3 weeks ago, immediately after removal of a contraceptive device in the left arm. A nerve conduction study showed proximal median neuropathy, and ultrasonography revealed focal swelling of the median nerve at the level of removal. Although nerve damage is a rare complication, special care should be taken to avoid nerve injury during removal procedure.