McVeigh, Kimberly H.

Date Presented 03/26/20 In adults with first carpometacarpal degenerative joint disease, does a dynamic stabilization home exercise program (HEP) decrease pain and increase function more than a traditional HEP? Research is needed to assess if this approach will lead to greater function and less pain than the currently accepted approach. It is important for OTs to have a holistic approach that includes traditional joint protection, orthosis use, and self-management of HEPs. Primary Author and Speaker: Cindy Ivy Additional Authors and Speakers: Kaylee Martino, Sara Murphy, Celine De Jesus, Stephanie Kannas, Kimberly McVeigh, Allison Nickolaou

Importance: Evidence has demonstrated that shoulder pain constitutes a functional impairment for patients with amyotrophic lateral sclerosis (ALS). No studies have yet examined the efficacy of scapular mobilization of the painful shoulder among patients with ALS. Objective: Our retrospective case series evaluated the effects of scapular mobilization on pain and shoulder motion among patients with ALS. Design: Retrospective case series over 2 yr. Setting: A multidisciplinary outpatient clinic at an academic medical institution. Participants: Twenty-eight patients with ALS who had shoulder pain and range of motion (ROM) limitations. Patients were excluded if information on visual analog scale (VAS) score for pain and shoulder ROM was not available. Intervention: Scapular mobilization, ROM, and caregiver education. All patients also received standard occupational therapy treatment for this patient population. Outcomes and Measures: The primary outcome was VAS shoulder pain scores; the secondary outcome was shoulder flexion ROM. Results: The median VAS pain score was 2 before treatment and 0 after treatment, with a significant median reduction of 2. Median shoulder flexion ROM was 100° before mobilization treatment and 130° after treatment, with a significant median increase of 25°. Conclusion and Relevance: The results provide strong evidence that both VAS pain score and shoulder ROM noticeably improve after mobilization treatment. What This Article Adds: Occupational therapists can effectively promote shoulder care techniques such as scapular mobilization to both patients and care providers to reduce pain and improve quality of life for patients with ALS.

Objective: Review the use of upper-extremity orthoses and casts after injuries to the wrist and hand in the pediatric, adolescent, and young adult population. The common injuries reviewed include pediatric distal radius fractures, scaphoid fractures, metacarpal fractures, mallet fingers, volar plate injuries of the proximal interphalangeal (PIP) joint, and ulnar collateral ligament (UCL) tears of the thumb metacarpophalangeal (MCP) joint. Data Sources: We conducted a literature review from 1985 to 2016 of upper-extremity orthotic interventions. Non–English language citations and animal studies were excluded. Citations from retrieved studies were used to identify other relevant publications. This review included cases of common injuries to the upper extremity, which required orthotic intervention. Main Results: Immobilization recommendations for nonsurgical pediatric distal radius fractures, nonsurgical metacarpal fractures, mallet fingers, and UCL tears of the thumb MCP include a removable orthosis. Nondisplaced scaphoid fracture orthosis recommendations include initial immobilization in a nonremovable short-arm thumb spica cast. Volar plate injuries of the PIP joint require buddy straps for healing. Conclusions: The literature demonstrates the effectiveness of removable orthoses in healing, patient satisfaction, and time to return to activity after many common upper-extremity injuries. Removable orthoses should be considered an equal or superior treatment method to cast immobilization, immobilization of additional joints, or longer periods of immobilization.