Background The triangular fibrocartilage complex (TFCC) is essential for distal radioulnar joint (DRUJ) stability and wrist load distribution, with injuries often leading to pain and functional impairment. Management strategies can include hand therapy interventions such as stability training, pain management, and functional retraining, often supported by orthotic devices. The WristWidget® has been proposed as a specialized orthosis providing circumferential compression to enhance DRUJ stability, reduce pain, and improve grip strength and weight-bearing tolerance. Purpose To critically evaluate the evidence for the WristWidget® as a conservative treatment option following TFCC injury, considering biomechanical benefits, clinical outcomes, and practical limitations. Study design Literature review. Methods A comprehensive search was undertaken in Medline, CINAHL Complete, Scopus, Cochrane Library, and Web of Science using terms related to “WristWidget,” “wrist orthosis,” and “TFCC injury.” Studies were included if they investigated clinical or functional outcomes associated with WristWidget® use following TFCC injury. Results From 140 identified studies, three met inclusion criteria. Findings indicate short-term improvements in weight-bearing capacity and function, particularly in patients with DRUJ instability. Biomechanical benefits appear linked to increased joint compression and stabilization. However, studies were limited by small sample sizes, non-randomised designs, and lack of long-term follow-up, restricting generalisability. Conclusion Preliminary evidence suggests that the WristWidget® may provide short-term improvements in pain and function after TFCC injury. Nevertheless, current evidence is constrained by methodological limitations, and its long-term efficacy remains unclear. Further controlled studies are required to better establish its clinical efficacy and guide its optimal use in patients' daily tasks.
Objectives There is a shortage of clinical tools integrating the individual journey through healthcare, as care providers frequently use diverse Patient Reported Outcome Measures (PROMs) that cannot be easily aggregated. The use of a single PROM from primary care into tertiary care would enable a more cohesive journey. The MSK-HQ has the potential to be used in this way but requires validation within the hand therapy population. Our hypothesis is that the concurrent validity and responsiveness of the Musculoskeletal Health Questionnaire (MSK-HQ), is non-inferior to the QuickDASH. Methods 382 individual outcome measures were reviewed spanning a period of 1 year from 07/2022 until 08/2023. Individual demographic information including; sex, age, ethnicity, chronicity, referral source, and borough were collected. Receiver operating characteristic (ROC) curves assessed the ability of the average 4-months change in both MSK-HQ and QuickDASH to distinguish between individuals who showed improvement and those who did not, based on global change scores, calculating MCID. Results Spearman’s correlation between the global change anchor and MSK-HQ was 0.53 (95% CI: 0.45-0.60), and between the global change anchor and QuickDASH was 0.55 (95% CI: 0.48-0.62). The MSK-HQ demonstrated a strong ability to discriminate between Hand Therapy individuals reporting global improvement versus no improvement, with an area under the curve (AUC) of 0.82 (95% CI: 0.77-0.86), comparable to the QuickDASH, which had an AUC of 0.83 (95% CI: 0.79-0.88). The interpretability of a significant improvement in the MSK-HQ was 4.5 points of change. Statistical Significance/Conclusion The analysis validated our hypothesis and revealed no statistically significant difference in sensitivity or improvement in reporting change scores, indicating that the MSK-HQ is non-inferior to the established benchmark, QuickDASH, and is therefore suitable for use in Hand Therapy.
Background:Paraffin therapy and hydrotherapy are widely used thermal modalities in hand rehabilitation; however, limited evidence directly compares their immediate effects on finger joint contractures. Purpose:To compare the immediate effects of paraffin therapy and hydrotherapy on finger contractures. Methods:Three patients with postoperative or post-traumatic contractures participated. An AB single-case design evaluated the additional effects of paraffin therapy administered after hydrotherapy. Phase A involved hydrotherapy combined with manual therapy, followed by Phase B, comprising paraffin therapy with the same manual therapy. Active flexion and extension angles were measured using a standard goniometer immediately after each session. Participants completed 8 sessions (4 per phase). Time-series data were analyzed using a Bayesian local linear trend (LLT) model. A PND of ≥70% indicated a clinically significant intervention effect. Results:Improvements in total joint range of motion (ROM) occurred in both phases for all participants. Bayesian analysis revealed that during the paraffin phase (Phase B), additional ROM improvements were noted in two participants compared to Phase A (hydrotherapy). PND values indicated a clinically significant intervention effect (≥70%) for most joints in all participants. Conclusion:Administering paraffin therapy as a subsequent intervention to hydrotherapy yielded significant additional improvements in active ROM, demonstrating its effectiveness for finger contractures. Additionally, although the fixed-order design limits causal attribution, this study highlights the value of N-of-1 designs combined with Bayesian analysis for data-driven, individualized clinical decision-making in hand rehabilitation.
Introduction:This study set out to explore the experiences of adults receiving treatment in outpatient hand therapy and physiotherapy services in the United Kingdom (UK), specifically in relation to remaining in or returning to work. Motivation for the study included the 2022 UK legislative change that enabled occupational therapists and physiotherapists to issue formal sickness certification (Fit Notes). Methods:Semi-structured 1:1 qualitative interviews were completed between 2022-2023 at two public hospitals with local ethics approval. Questions examined the impact of the injury/condition on work participation, advice received, and recommendations for supporting future patients. Interview transcripts were analysed using reflective thematic analysis. Results:Twenty-three interviews were conducted (12 male, age range 24-72 years). Four themes were developed in relation to remaining in or returning to work: (1) individual experience; (2) workplace support; (3) healthcare support; and (4) provision of return-to-work advice and Fit Notes. Themes captured variation in needs depending on condition, employment type, and workplace support. There were strong expectations for therapists to provide work-related guidance. Discussion:Being in employment was highly valued by participants for purpose and well-being. Participants placed high trust in therapists' expertise and considered them well suited to provide return-to-work advice and Fit Notes. Clear, written, condition-specific guidance with realistic timeframes was strongly desired to aid communication with employers. Meeting these needs may improve patient confidence and facilitate sustained work participation.
Introduction:Carpometacarpal osteoarthritis (CMC OA) is a common problem in mid-older aged adults. Existing guidelines are ambiguous with respect to materials, design and duration of use of orthoses to manage hand OA. A limitation of studies to date is the low dose (hours per day) of orthosis wearing. This study aimed to evaluate the feasibility of investigating the effectiveness of a soft prefabricated orthosis worn at high dose in conjunction with best practice usual care for CMC OA. Methods:Study design: Pragmatic, 2-arm parallel-group feasibility RCT. Adults aged ≥40 years with symptomatic CMC OA were randomised to either best practice usual care or usual care in conjunction with a soft neoprene orthosis prescribed to wear 20 h per day, for 4 weeks. A priori feasibility criteria were: (1) enrolment of 30 participants in 4 months; (2) retention >85% at 6 months; (3) intervention adherence on >80% days; (4) interventions acceptable >90% of participants. Outcome measures were collected at baseline, 4 weeks, and 6 months; analysis used descriptive statistics. Results:Thirty participants were enrolled within 4 months; 97% retained at 6 months. Orthosis wearing achieved ≥20 h on 68% of days. Exercise adherence was 80% on ≥89% of days in both groups. Interventions were acceptable. Clinically significant improvements in pain occurred in both groups. Discussion:High dose orthosis wearing may be acceptable and feasible for managing CMC OA. Orthosis amendments and a wear target of 18 h are recommended for future investigation of this intervention.
