The biomechanics of a thumb carpometacarpal immobilization splint: Design and fitting (2022)

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Journal of Hand Therapy

Volume 13, Issue 3,

July–September 2000

, Pages 228-235

Abstract

Splinting for the common osteoarthritis of the carpometacarpal (CMC) joint of the thumb is infrequently described in the literature, but the few splints that are described include one or both adjacent joints. This paper describes the design and biomechanics of a custom-molded thumb CMC immobilization splint that excludes the thumb metacarpophalangeal and wrist joints. The problem of the imbalance of extrinsic extensor/abductor forces against the intrinsic flexor/adductor forces is described. The accompanying weakening of the thumb CMC capsule allows dorsal shifting of the proximal end of the metacarpal, producing pain. The splint described in this paper 1) prevents motion of the first metacarpal in relation to the other metacarpals, 2) prevents tilting (flexion) of the first metacarpal during pinch, and 3) allows unrestricted thumb metacarpal and wrist joint motion. Attention to detail during construction is required for an accurate pattern, precise positioning of the CMC joint during molding, accurate molding around the first metacarpal, and well-distributed pressure. This design may also be used for protection following thumb CMC arthroplasty or thumb CMC sprain or strain and as a base for thumb metacarpophalangeal and/or interphalangeal mobilization splinting.

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Cited by (64)

  • Anatomy and Biomechanics of the Thumb Carpometacarpal Joint

    2022, Hand Clinics

  • Metacarpal Abduction Orthosis for Patients With the Thumb Carpometacarpal Osteoarthritis

    2020, Journal of Hand Surgery Global Online

    A specific orthosis to increase radial abduction of the metacarpal of the thumb rather than immobilize it was designed for patients with carpometacarpal (CMC) joint osteoarthritis. This orthosis was designed especially for musicians, who need a large abduction angle of the thumb CMC joint to maintain their hand span to perform music.

    The thumb abduction orthosis was custom-made of flexible polypropylene, leaving the thumb metacarpophalangeal and wrist joints unrestricted and compressing the ulnar side of the thenar muscle to increase the radial abduction angle of the thumb metacarpal. Hand span and grip strength were measured, and clinical symptoms were assessed with the visual analog scale and Quick–Disabilities of the Arm, Shoulder, and Hand score. The Tubiana and Chamagne score was used to assess musical performance.

    A total of 23 thumbs of 19 professional musicians with CMC joint osteoarthritis were placed in an orthosis. The radial abduction angle of the thumb CMC joint, grip strength, and hand span were significantly increased or enlarged after bracing. Clinical symptoms evaluated by visual analog score, Quick–Disabilities of the Arm, Shoulder, and Hand score, and Tubiana and Chamagne score also improved.

    Placement of a metacarpal abduction orthosis improved the hand span and improved patient-reported outcomes.

    Therapeutic IV.

  • Predicting Outcome After Hand Orthosis and Hand Therapy for Thumb Carpometacarpal Osteoarthritis: A Prospective Study

    2019, Archives of Physical Medicine and Rehabilitation

    (1) To identify predictive factors for outcome after splinting and hand therapy for carpometacarpal (CMC) osteoarthritis (OA) and to identify predictive factors for conversion to surgical treatment; and (2) to determine how many patients who have not improved in outcome within 6 weeks after start of treatment will eventually improve after 3 months.

    Observational prospective multicenter cohort study.

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    Xpert Clinic in the Netherlands. This clinic comprises 15 locations in the Netherlands, with 16 European Board certified (FESSH) hand surgeons and over 50 hand therapists.

    Between 2011 and 2014, patients with CMC OA (N=809) received splinting and weekly hand therapy for 3 months.

    Not applicable.

    Satisfaction and pain were measured with a visual analog scale and function with the Michigan Hand Questionnaire at baseline, 6 weeks, and 3 months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after 3 months and for conversion to surgery.

    Multivariable regression model explained 34%-42% of the variance in outcome (P<.001) with baseline satisfaction, pain, and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically relevant improvement in pain and function after 6 weeks, 73%-83% also had no clinically relevant improvement after 3 months.

    This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after 6 weeks of therapy, when levels of improvement are still mainly unsatisfactory.

  • Orthosis for rhizarthrosis: A systematic review and meta-analysis

    2019, Seminars in Arthritis and Rheumatism

    investigating the effectiveness of orthosis for rhizarthrosis by means of a systematic review and meta-analysis.

    A systematic review was carried out using eight electronic databases. The randomized controlled trials included were those presenting subjects using orthosis for rhizarthrosis compared with individuals without orthosis or other rehabilitation interventions, as well as studies that compared different types of orthosis. The systematic review was performed according to the Cochrane methodology. The statistical software Review Manager 5.3 was employed to analyze the data.

    Fourteen studies were included in the review and three of them participated in the meta-analysis. The orthosis group had a reduction in pain in the long term as compared to the control group with a statistically significant difference, a medium effect size, and low-quality evidence [Effect size -0.52, Confidence Interval 95% -0.94 to -0.11, p = 0.01), I2= 50%]. The orthosis group presented improvements regarding function in the long term as compared to control group, with a statistically significant difference, a medium effect size, and moderate quality of evidence [Effect size -0.44, Confidence Interval 95% -0.72 to -0.15, p = 0.002), I2= 0%].

    the orthosis for rhizarthrosis presents low-quality evidence for reducing pain in the long term and moderate evidence for an increase in function in the long term. Since imprecision and inconsistency of the data were aspects which influenced the quality of the evidence, future studies with larger samples and standardized data are needed.

  • Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study

    2018, Journal of Hand Surgery

    Initial treatment for symptomatic carpometacarpal (CMC) osteoarthritis (OA) of the thumb is usually nonsurgical. However, evidence on the effect of a hand orthosis and hand therapy for mid- and long-term results is limited, and it is unknown how many patients undergo additional surgical treatment. Therefore, the aim of this study is to describe the outcome of a hand orthosis and hand therapy for CMC OA in a large cohort study, and to evaluate the conversion rate to surgical treatment.

    In this multicenter, prospective cohort study, patients treated with a hand orthosis and hand therapy for primary CMC OA between 2011 and 2014 were included. Pain (visual analog scale) and function (Michigan Hand Questionnaire) were measured at baseline, 6 weeks, 3 months, and at 12 months after the start of treatment. All patients converted to surgery were recorded between 2012 and 2016. Outcome was compared with baseline, and post hoc comparisons were made between patients who were not converted to surgery and patients who were converted to surgery after initially receiving a hand orthosis and hand therapy. Lastly, subgroup analysis was performed based on baseline pain levels.

    After a mean follow-up of 2.2 ± 0.9 years, 15% of all patients were surgically treated. In the group that was not converted to surgery, pain (visual analog scale) significantly improved from 49 ± 20 at baseline to 36 ± 24 at 12 months. The Michigan Hand Questionnaire score was essentially unchanged from 65 ± 15 at baseline to 69 ± 10 at 12 months. Post hoc testing showed that improvement in pain was only significant between baseline and 6 weeks, and thereafter stabilized until 1 year after the start of treatment. The group that converted to surgery did not show any improvement in pain and function at follow-up.

    In this cohort of patients with thumb CMC OA who underwent hand therapy including an orthosis, 15% of the patients underwent additional surgical treatment. The patients (85%) who did not undergo surgery improved in pain and function, although only improvements in pain were significant and clinically relevant. Most improvement was seen in the first 6 weeks and stabilized till 1 year after the start of treatment.

    Therapeutic II.

  • The effectiveness of physical therapies for patients with base of thumb osteoarthritis: Systematic review and meta-analysis

    2018, Musculoskeletal Science and Practice

    Patients presenting with Stage I or II thumb OA are therefore most commonly managed with conservative treatment, delivered by hand therapists, who are typically physical therapists and occupational therapists. Elements of conservative management include splinting to increase joint stability (Taylor, 2000), reduce pain (Colditz, 2000) and contracture (Poole and Pellegrini, 2000), exercise to strengthen muscles (Flatt, 1995; Fransen et al., 2009; Fransen and McConnell, 2008; Felson et al., 2000), manual therapies such as joint mobilisations (Villafañe et al., 2013), and activity modification (Wolock et al., 1989). Splinting is a common element of physical therapy for this condition and includes both customised and “off the shelf,” orthoses to maintain the thumb in a stable position and enhance hand function (Swigart et al., 1999; Poole and Pellegrini, 2000; Galindo and Lim, 2002).

    Trapeziometacarpal osteoarthritis (known as base of thumb OA) is a common condition causing pain and disability worldwide.

    (Video) Circumferential Wrist Orthosis

    The purpose of this review was to evaluate the effectiveness of multimodal and unimodal physical therapies for base of thumb osteoarthritis (OA) compared with usual care, placebo or sham interventions.

    Systematic review and meta-analysis.

    We searched MEDLINE (PubMed), CINAHL, Embase, AMED, PEDro, Cochrane Database of Systematic Review, Cochrane Register of Controlled Trials (CENTRAL) from inception to May 2017. Randomized controlled trials involving adults comparing physical therapy treatment for base of thumb OA with an inactive control (placebo or sham treatment) and reported pain, strength or functional outcomes were included. Meta-analyses were performed where possible. Methodological risk of bias was assessed with the Cochrane Risk of Bias tool.

    Five papers with low risk of bias were included. Meta-analyses of mean differences (MD) with 95% confidence intervals (95% CI), were calculated for between-group differences in point estimates at 4 weeks post-intervention. Multimodal and unimodal physical therapies resulted in clinically worthwhile improvements in pain intensity (MD 2.9 [95% CI 2.8 to 3.0]; MD 3.1 [95% CI 2.5 to 3.8] on a 0–10 scale, respectively). Hand function improved following unimodal treatments (MD 6.8 points [95% CI 1.7 to 11.9)] on a 0–100 scale) and after a multimodal treatment (MD 20.5 (95%CI -0.7 to 41.7).

    High quality evidence shows unimodal and multimodal physical therapy treatments can result in clinically worthwhile improvements in pain and function for patients with base of thumb OA.

View all citing articles on Scopus

Recommended articles (6)

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    Journal of Hand Therapy, Volume 27, Issue 4, 2014, pp. 265-271

    The trapeziometacarpal (TMC) joint of the human thumb is the second most common joint in the hand affected by osteoarthritis. TMC arthroplasty is a common procedure used to alleviate symptoms. No randomized controlled trials have been published on the efficacy of different post-operative orthotic regimes.

    Fifty six participants who underwent TMC arthroplasty were allocated to either rigid orthotic or semi-rigid orthotic groups. Both groups started an identical exercise program at two weeks following surgery. Outcome measures were assessed by an assessor blinded to group allocation. The primary outcome was the Patient Rated Wrist and Hand Evaluation (PRWHE) and secondary outcomes included the Michigan Hand Questionnaire (MHQ), thumb palmar abduction, first metacarpophalangeal extension and three point pinch grip. Measures were taken pre-operatively, at six weeks, three months and one year post-operatively. Between-group differences were analyzed with linear regression.

    Both groups performed equally well. There was no significant between-group difference for PRWHE scores (0.47, CI−11.5 to 12.4), including subscales for pain and function, or for any of the secondary outcomes at one year follow-up.

    We found no difference in outcomes between using a rigid or semi-rigid orthosis after TMC arthroplasty. Patient comfort, cost and availability may determine choice between orthoses in clinical practice.

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    In thumb carpometacarpal osteoarthritis, current evidence suggests that degenerative, bony remodeling primarily occurs within the trapezium. Nevertheless, the pathomechanics involved and the most common sites of wear remain controversial. Quantifying structural bone morphology characteristics with high-resolution computed tomography CT (micro-CT) infer regions of load transmission. Using micro-CT, we investigated whether predominant trabecular patterns exist in arthritic versus normal trapeziums.

    We performed micro-CT analysis on 13 normal cadaveric trapeziums and 16 Eaton stage III to IV trapeziums. We computationally divided each specimen into 4 quadrants: volar-ulnar, volar-radial, dorsal-radial, and dorsal-ulnar. Measurements of trabecular bone morphologic parameters included bone volume ratio, connectivity, trabecular number, and trabecular thickness. Using analysis of variance with post hoc Bonferroni/Dunn correction, we compared osteoarthritic and normal specimen quadrant measurements.

    No significant difference existed in bone volume fraction between the osteoarthritic and normal specimens. Osteoarthritic trapeziums, however, demonstrated significantly higher trabecular number and connectivity than nonosteoarthritic trapeziums. Comparing the volar-ulnar quadrant of osteoarthritis and normal specimens collectively, this quadrant in both consistently possessed significantly higher bone volume fraction, trabecular number, and connectivity than the dorsal-radial and volar-radial quadrants.

    The significantly greater trabecular bone volume, thickness, and connectivity in the volar-ulnar quadrant compared with the dorsal-radial and dorsal-ulnar quadrants provides evidence that the greatest compressive loads at the first carpometacarpal joint occur at the volar-ulnar quadrant of the trapezium, representing a consistently affected region of wear in both normal and arthritic states.

    These findings suggest that trapezial trabecular morphology undergoes pathologic alteration. This provides indirect evidence that changes in load transmission occur with thumb carpometacarpal joint arthritis development.

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    The movement patterns one sees when loads placed on a joint are incrementally increased provides valuable insight as to how a joint functions during different everyday activities. This author describes a simple, yet effective method of assessing the thumb carpometacarpal joint as load demands increase. It may be used as an evaluative tool or as an adjunct to treatment – Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

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    Shorter vs Longer Immobilization After Surgery for Thumb Carpometacarpal Osteoarthritis: A Propensity Score-Matched Study

    Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11, 2019, pp. 2022-2031.e1

    To investigate if shorter immobilization is noninferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis

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    A total of 131 participants with shorter immobilization and 131 participants with longer immobilization (N=262).

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    In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal to longer immobilization for outcomes on pain, hand function, and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner, which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following first carpometacarpal joint arthroplasty.

View full text

Copyright © 2000 Hanley & Belfus, Inc. Published by Elsevier Inc. All rights reserved.

1 CMC artrose van de duim Ton A.R. Schreuders Er Klachten vanwege arthrosis deformans (AD), kortweg artrose van het eers...

Flexie en extensie in het vlak van de handpalm en rotaties om lengteas van het os metacarpale(pro- en supinatie) De totaal beweging van de duim naar de pink wordt antepositie of oppositie genoemd.. c. Vergelijkbaar met voorgaande punt b. behalve dat de nadruk ligt op de rotatie (prosupinatie) van het metacarpale bot van de duim mn bij pincetgreep en bij het knijpen is er een verminderd contact vlak – niet congruente positie- waardoor er een verhoogde druk is (joint impingment)(Kovler et al. 2004).. (Cooney and Chao 1977) d. Er is een relatie aangetoond tussen de aanwezigheid van hyperextensie van het MCP gewricht van de duim en het ontstaan van CMC artrose.. Ter hoogte van het gewricht kan er een verdikking ontstaan wat het gevolg is van de synovitis, maar ook door de subluxatie van de basis van het os metacarpale.. (Koff et al. 2006) Bekend is de zgn Eaton-Littler operatie waarbij een deel van de FCR van volair naar dorsaal wordt gelegd om de functie van het beak ligament en het dorsoradiaire ligament te versterken.. (Zancolli et al. 1987; Zancolli 2001) Ten tweede zijn er de gewrichtsoperaties te onderscheiden in: • Artrodese • Kunst gewricht; verlerlei opties oa donut, compleet gewricht of één hemi-artroplastiek • Resectie met opvulling bv pees (ansjovis) of kunststof eventueel met een ophangingsplastiek In de recente Cochrane review (Wajon et al. 2005) werden van zeven studies (384 patiënten) de resultaten vergeleken van vijf procedures: trapeziectomy, trapeziectomy met interpositie arthroplastiek, trapeziectomy met ligament reconstructie, trapeziectomy met ligament reconstructie en pees interpositie en kunstgewricht.. Resultaten van operaties In het algemeen wordt vaak gezegd dat het effect van de operatie mn op de pijn is en niet op de kracht.

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Treatment of De Quervain tenosynovitis.. The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.. Reliability and validity of pinch and thumb strength measurements in de Quervain’s disease.. De Quervain’s disease.. Treatment of De Quervain tenosynovitis.. The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.. Reliability and validity of pinch and thumb strength measurements in de Quervain’s disease.. De Quervain’s disease.

The author discusses the treatment of disabling thumb arthritis.

The long-term goals of the program are to provide pain relief and improve hand function through a multifaceted treatment approach: splinting, modalities as needed to reduce pain and inflammation, education in abnormal pinch biomechanics, muscle rebalancing exercises (stabilization) and ROM exercises, training in joint protection techniques and adaptive equipment, and provision of community resources.. Assess the CMC joint for edema, a shoulder sign (prominence along the dorsoradial aspect of the CMC joint as a result of subluxation, osteophytes, and/or effusion), localized tenderness, pain with ligament stress, the grind test for pain with or without crepitus (rotate thumb metacarpal while providing axial compression), Evaluate A/PROM, grip and pinch strength within pain limits, abnormal pinch patterns (especially metacarpo-phalangeal [MP] hyperextension), and quality of movement.. Loosen the first web muscles by having the client set the hand on a tennis ball and then use the flexed PIP joint of the opposite middle finger to apply pressure to the dorsal first web; Use an empty roll-on deodorant bottle as a massage tool; Follow these soft tissue release techniques with pain-free ROM exercises.. EXERCISE Exercise goals are to reduce pain and improve strength 8-10 through the following means: maintain joint mobility, prevent CMC flexion and adduction contractures, and reeducate poor pinch patterns (typically CMC flexion with MP hyperextension and IP hyperflexion).. Promote referrals by educating your local rheumatologists, hand surgeons, orthopedists, general practitioners, physical therapists, and chiropractors about the benefits of hand therapy for any of their clients who may mention hand arthritis or pain.

본 고안은 의료용 부목 및 이를 포함하는 의료용 부목 어셈블리에 관한 것으로서, 상기 의료용 부목은 전완 지지부; 상기 전완 지지부의 일단부와 결합되는 제 1 단부를 가지며, 손목의 횡방향으로 길게 형성된 복수의 장공들과 상기 장공들 사이에 배치되는 복수의 스트랩 형태의 서브 지지대들을 포함하는 손목 지지부; 및 상기 손목 지지부의 제 1 단부에 대향하는 제 2 단부와 결합되는 제 1 단부를 갖는 엄지손가락 슬리브부를 포함하며, 상기 전완 지지부, 상기 손목 지지부 및 상기 엄지손가락 슬리브부가 일체형으로 구성될 수 있다.

본 고안은 환자의 움직임에 따른 불편함을 줄이며, 유연성과 강도가 확보되고, 통기성을 갖춘 개선된 의료용 부목을 제공하는 것으로서, 상기 의료용 부목은 손목골절(colles' fracture)에 적용되는 설탕집게 부목(sugar tong splint)와 이중 설탕집게 부목(double sugar tong splint), 슬개골 골절(patella fracture)에 적용되는 실린더 부목(cylinder splint), 발목, 발등 발주의 등 정강이 아래부분의 골절 또는 인대 손상에 적용되는 단하지부목(short leg splint), 대퇴 원위부의 골절, 무릅 주변 관절의 손상 및 골절 등 허벅다리 아래쪽의 손상에 적용되는 장하지부목(long leg splint), 손바닥, 팔목 등 팔꿈치 아래부위의 골절, 인대 손상에 적용되는 짧은 팔 부목(short arm splint), 요골(radius), 척골(ulnar), 팔꿈치(elbow)의 골절, 관절 손상 시 적용되는 의 긴 팔 부목(long arm splint), 4, 5번 중수골 손상에 적용되는 척측 구형성 부목(ulnar gutter splint), 2, 3번 중수골 손상에 적용되는 radial gutter splint, 주상골 골절과 건초염시 수근부와 엄지손가락을 동시에 고정시 적용되는 엄지손가락을 지지하는 부목(thumb spica splint) 중 어느 하나일 수 있다.. 도 1a 및 도 1b를 참조하면, 의료용 부목(10)은 전완 지지부(100), 전완 지지부(100)의 일단부와 결합되는 제 1 단부를 가지며, 손목의 횡방향(HD)으로 길게 형성된 복수의 장공(LH)들과 장공(LH)들 사이에 배치되는 복수의 스트랩 형태의 서브 지지대(SS)들을 포함하는 손목 지지부(200) 및 손목 지지부(200)의 제 1 단부에 대향하는 제 2 단부와 결합되는 제 1 단부를 갖는 엄지손가락 슬리브부(300)를 포함할 수 있다.. 손목 지지부(200)가 지지하는 손목 부위는 좌우방향, 상하방향, 또는 회전방향이 가능한 손목 관절을 포함하고 있어서, 손목 지지부(200)가 지지하는 손목 부위가 후술할 탈부착이 가능한 압착 밴드에 의해 압박 고정되는 경우, 착용자 또는 환자는 일상 생활에서 손목 움직임의 제한으로 불편함을 느낄 수 있다.. 엄지손가락을 포함한 부목은 주상골 골절과 건초염시 수근부와 엄지손가락을 동시에 고정시 적용되는 부목이며, 환부가 아닌 손목 부위를 고정시킬 필요가 없지만 전완 지지부(100), 손목 지지부(200) 및 엄지손가락 슬리브부(300)가 일체형으로 구성되는 의료용 부목(10)에서는 엄지손가락 이외에 손목 부위가 고정될 수 있다.. 이를 해소하기 위해서, 본 고안은 손목 지지부(200)에 의해 손목 부위가 압박 고정되더라도, 복수의 장공(LH)들과 장공(LH)들 사이에 배치되는 복수의 스트랩 형태의 서브 지지대(SS)에 의해 손목 부위의 상하 움직임(굽힘), 좌우 움직임 및 회전 움직임 같은 움직임에 유연하게 변형될 수 있다.. 이러한, 복수의 장공(LH)들은 상기 손목 또는 상기 엄지손가락의 굽힘 또는 움직임 같은 작은 응력에도 손목 지지부(200)가 굽혀지거나 펼쳐지도록 유연성 및 탄성력을 제공할 뿐만 아니라, 전완 지지부(100)의 원형 통기구(HH)처럼, 손목 부위에 공기가 유입되도록 할 수 있다.. 일 실시예에서, 손목 지지부(200)는 복수의 스트랩 형태의 서브 지지대(SS)들의 제 1 단부들을 지지하며, 상기 손목의 상부 일부 그리고 상기 엄지손가락 주변의 일부 손등을 감싸는 상부 지지대(US) 및 상기 복수의 스트랩 형태의 서브 지지대(SS)들의 제 1 단부들에 대향하는 제 2 단부를 지지하며, 상기 손목의 하부 일부 그리고 상기 엄지손가락 주변의 일부 손바닥을 감싸는 하부 지지대(LS)를 더 포함할 수 있다.. 손목 지지부(200)는 안정적이고 사용자에 편안함을 제공하기 위해서, 지지되는 손목 일측면 부위의 굴곡에 대응하는 굴곡을 가질 수 있으며, 특히 손목 지지부(200)의 하부 지지대(LS)는 그립감을 제공하도록 손목 및 손바닥 형태의 굴곡을 가질 수 있다.. 일 실시예에서, 서브 지지대(SS)의 제 1 단부가 상부 지지대(US)에 결합되는 길이(L) 또는 서브 지지대(SS)의 제 2 단부가 하부 지지대(LS)에 결합되는 길이(L)는 2mm 내지 10mm 범위를 가질 수 있다.. 결합 길이(L)가 2mm 미만인 경우, 손목 지지부(200)에 가해지는 압축력 또는 인장력에 의해 서브 지지대(SS)와 1 단부와 상부 지지대(US) 사이의 결합 부위 또는 서브 지지대(SS)의 제 2 단부와 하부 지지대(LS) 사이의 결합 부위가 쉽게 깨질 수 있고, 결합 길이(L)가 10mm 이상인 경우, 손목의 움직임이나 굽힘 같은 작은 압축력 또는 인장력에 의해 서브 지지대(SS)들이 움직이지 않아, 사용자나 환자에게 불편함을 줄 수 있다.. 전술한 바와 같이, 장공(LH)들의 종단부에 있는 병목 형태의 홀(AH)과 종단부가 굴곡져 있는 서브 지지대(SS)의 구조에 의해, 가해지는 압축력 또는 인장력이 크지 않더라도 서브 지지대(SS)들이 쉽게 움직여질 수 있고, 복수의 장공(LH)들 중 일부는 상기 손목 또는 상기 엄지손가락의 움직임에 의해 부분 접히거나 펼쳐질 수 있다.. 한편, 병목 형태의 홀(AH)을 갖는 장공(LH)과 병목 형태의 홀(AH)이 없는 장공(LH)과 비교하여, 병목 형태의 홀(AH)을 갖는 장공(LH)은 병목 형태의 홀(AH)이 없는 장공(LH)보다 더 작은 압축력 또는 인장력으로도 서브 지지대(SS)가 기울어질 수 있다.. 일 실시예에서, 압박 밴드(550)의 일단부는 각각 부목(10)의 전완 지지부(100), 손목 지지부(200) 및 엄지손가락 슬리브부(300)에 고정되어, 각각 횡방향(HD)으로 전완 지지부(100), 손목 지지부(200) 및 엄지손가락 슬리브부(300)를 감싸고 타단부는 일단부와 접착 부재를 통해 접착됨으로써, 의료용 부목(10)은 해당 환부를 압박 고정시킬 수 있다.. 전완 지지부(100), 손목 지지부(200) 및 엄지손가락 슬리브부(300)으로 일체형으로 구성되는 의료용 부목(10)은 3D 프린터에 의한 개인 맞춤형으로 제작 가능하며, 사용자 및 의사에 의해 쉽게 탈착 및 부착 가능하여 의사 입장에서 치료 시간이 절약 가능하고 사용자 입장에서는 필요 시 신체 부위에 압박 고정되는 의료용 부목을 탈착 및 부착이 가능하기 때문에 사용자에게 편의성을 제공할 수 있다.. 또한, 전술한 바와 같이, 길게 형성된 복수의 장공(LH)들과 장공(LH)들 사이에 배치되는 복수의 스트랩 형태의 서브 지지대(SS)들을 포함하는 관절 지지대를 이용함으로써, 지지되는 골절 또는 손상 부위 이외에 다른 인접한 신체 관절 부위는 움직임이 가능하도록 하여, 착용자 또는 환자의 불편함을 개선시킬 수 있다.

OverviewOlumiant (baricitinib) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to:treat moderate to severe rheumatoid arthritis in adults in certain situationstreat severe alopecia areatatreat severe COVID-19 in the hospital, along with breathing assis...

Olumiant formOlumiant strengthsTypical dosage oral tablet1 mg, 2 mg, 4 mg• 2 mg per day for RA• 2 mg or 4 mg per day for alopecia areata• 4 mg per day for COVID-19. For information about the dosage of Olumiant, including its strengths and how to take the drug, keep reading.. This article describes typical dosages for Olumiant provided by the drug’s manufacturer.. When taking Olumiant, always follow the dosage prescribed by your doctor.. Here’s some information about Olumiant’s dosage.. Dosage for rheumatoid arthritis The typical dosage of Olumiant for moderate to severe rheumatoid arthritis (RA) is 2 mg per day.. Dosage for alopecia areata Olumiant may be prescribed in a dosage of 2 mg per day or 4 mg per day for severe alopecia areata.. Dosage for COVID-19 The recommended Olumiant dosage for severe COVID-19 treatment is 4 mg per day.. The Olumiant dosage your doctor prescribes will depend on several factors.. If you have moderate renal (kidney) problems, your doctor will likely decrease your dose of Olumiant to 1 milligram (mg).. If your doctor recommends Olumiant for you, they will prescribe the dosage that’s right for you.. As with any drug, never change your dosage of Olumiant without your doctor’s recommendation.. If you have questions about the dosage of Olumiant that’s right for you, talk with your doctor.

De Quervain’s tenosynovitis is often observed on repetitive flexion of the thumb. In the clinical setting, the conservative treatment is usually an applied thumbspica splint to immobilize the thumb. However, the traditional thumbspica splint is bulky and heavy. Thus, this study used the finite element (FE) method to remove redundant material in order to reduce the splint’s weight and increase ventilation. An FE model of a thumbspica splint was constructed using ANSYS9.0 software. A maximum lateral thumb pinch force of 98&nbsp;N was used as the input loading condition for the FE model. This study implemented topology optimization and design optimization to seek the optimal thickness and shape of the splint. This new design was manufactured and compared with the traditional thumbspica splint. Ten thumbspica splints were tested in a materials testing system, and statistically analyzed using an independent t test. The optimal thickness of the thumbspica splint was 3.2&nbsp;mm. The new design is not significantly different from the traditional splint in the immobilization effect. However, the volume of this new design has been reduced by about 35%. This study produced a new thumbspica splint shape with less volume, but had a similar immobilization effect compared to the traditional shape. In a clinical setting, this result can be used by the occupational therapist as a reference for manufacturing lighter thumbspica splints for patients with de Quervain’s tenosynovitis.

In the clinical setting, the conservative treatment is usually an applied thumbspica splint to immobilize the thumb.. J Hand Surg 4:185–189. Surg Clin North Am 40:531–540. Cotton FJ, Movrison G.M, Bradford CH (1938) DeQuervain’s disease: radial styloid tendovaginitis.. J Hand Surg 30A(1):130–135. Witt J, Pess G, Gelberman RH (1991) Treatment of de Quervain tenosynovitis: a prospective study of the results of injection of steroids and immobilization in a splint.. Zhong ZC, Wei SH, Wang JP, Feng CH, Chen CS, Yu CH (2006) Finite element analysis of the lumbar spine with a new cage using a topology optimization method.. Huang, TH., Feng, CK., Gung, YW.. et al. Optimization design of thumbspica splint using finite element method.. De Quervain’s tenosynovitis Thumbspica splint Optimal design Finite element method Rehabilitation

The big toe is a small part of the body but a major player in many physical actions we take for granted. Never mind squatting down to pick up something – every time you take a step your big toes flex to support you and help you keep your balance. Big toe pain can compromise your daily life to a poin...

If your big toe pain is episodic, intermittent, or otherwise comes on slowly, tracking that toe pain and its symptoms may be your best choice.. Are you experiencing big toe pain when walking, a throbbing pain in big toe, big toe joint pain, or a sharp pain in your big toe?. This can result in extreme and severe pain in the joint of the big toe, so much so that even the covers brushing your toe joint is excruciating.. People with this condition may feel big toe pain when walking, specifically when pushing off the big toe.. Stubbing your toe is a painful experience that most everyone can relate to, but what happens if your throbbing big toe becomes swollen and stays painful well after it should have recovered?. This means that the big toe can develop hammer toe, but the second, third, and fourth toes are most often involved.. How to treat big toe pain depends largely on the cause of your pain.. Depending on the cause of your pain, here’s what you should try for big toe pain treatments.. For big toe pain caused by gout or arthritis, the above treatments combined with changes in diet can help relieve pain.

Videos

1. How to make a MCP Joint Blocking Splint | Technique Peek Series
(Professional Seminars)
2. Drawing the Thumb Muscles
(BraceLab USA)
3. How to use Wrist brace with thumb
(Satyajit Routray)
4. Wrist joint physiotherapy management
(Physiotherapy is Rehabulous- Try it!!!)
5. Managing Thumb Arthritis, webinar recorded 7th July 2021
(Orthopaedic Specialists)
6. Aspetar Sports Medicine Collection Online Forum “Wrist and Hand Injuries"
(Aspetar سبيتار)

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