Effect of Ulnar-Based Orthotics and Strengthening Exercises on Subjects With Ulnar Wrist Pain

in Journal of Sport Rehabilitation

Click name to view affiliation

Mohamed Abdelmegeed
Search for other papers by Mohamed Abdelmegeed in
Current site
Google Scholar
PubMed Close
,
Everett Lohman
Search for other papers by Everett Lohman in
Current site
Google Scholar
PubMed Close
,
Noha Daher
Search for other papers by Noha Daher in
Current site
Google Scholar
PubMed Close
,
June Kume
Search for other papers by June Kume in
Current site
Google Scholar
PubMed Close
, and
Hasan M. Syed
Search for other papers by Hasan M. Syed in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.1123/jsr.2018-0095
Keywords:
physical therapy; strengthening exercises; ulnar wrist pain; orthotics
In Print:
Volume 29: Issue 2
Page Range:
206–212
Restricted access

Context: In comparison with the published research on the surgical management of ulnar wrist pain, fewer studies that discuss the nonsurgical management of ulnar wrist pain exist. Objective: The purpose of this pilot study was to investigate the effect of ulnar-based wrist orthotics and strengthening exercises on subjects with ulnar wrist pain. Study Design: Prospective randomized controlled pilot study. Setting: Research laboratory. Participants: Thirty subjects with acute and subacute ulnar wrist pain and age ranging from 18 to 53. Interventions: Participants were randomized to receive either ulnar-based orthotics, ulnar-based orthotics plus strengthening exercises, or placebo intervention. Main Outcome Measures: The authors measured pain and function using the Patient-Rated Wrist Evaluation questionnaire, and grip strength using the JAMAR dynamometer, at baseline and at 2- and 4-week postrandomization. A mixed analysis of variance modeling was used to investigate the effect of the intervention over time. Results: There were statistically significant differences between the 2 intervention groups and the control group regarding improvement in pain, function, and strength, whereas there were no statistically significant differences between the 2 intervention groups over the 3 measurement occasions regarding the outcome measures. Conclusion: Based on the results, orthotics intervention is as effective as orthotics plus strengthening exercises in improving pain, function, and grip strength in subjects with ulnar wrist pain. Level of Evidence: Therapy, level 2b individual Randomized Controlled Trial.

Abdelmegeed and Lohman are with the Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA. Abdelmegeed is also with the Department of Orthopedic Physical Therapy, Cairo University, Giza, Egypt. Daher is with the Epidemiology, Biostatistics, and Population Medicine, School of Public Health, Loma Linda University, Loma Linda, CA, USA; and Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA. Kume is with the Department of Physical Therapy, School of Health Science, Touro College & University System, Bay Shore, NY, USA. Syed is with the Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA, USA.

Abdelmegeed (dr.maf_ortho@yahoo.com) is corresponding author.
  • Collapse
  • Expand

Journal of Sport Rehabilitation

Cover Journal of Sport Rehabilitation
  • 1.

    Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg. 2008;33(9):1669–1679. doi:10.1016/j.jhsa.2008.08.026

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Brukner P, Khan K, Garnham A, Ashe M, Gropper P. Wrist, hand and finger injuries. In: Brukner P, Khan K, eds. Clinical Sports Medicine. 3rd ed. Rev. New York, NY: McGraw-Hill Professional; 2010:324–325.

    • Search Google Scholar
    • Export Citation
  • 3.

    Crosby NE, Greenberg JA. Ulnar-sided wrist pain in the athlete. Clin Sports Med. 2015;34:127–141. PubMed ID: 25455400 doi:10.1016/j.csm.2014.09.008

  • 4.

    Shin AY, Deitch MA, Sachar K, Boyer MI. Ulnar-sided wrist pain: diagnosis and treatment. Instr Course Lect. 2005;54:115–128. PubMed ID: 15948439

  • 5.

    Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg. 2007;32(7):1086–1106. doi:10.1016/j.jhsa.2007.06.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg. 1981;6:153–162. doi:10.1016/S0363-5023(81)80170-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Benjamin M, Evans EJ, Pemberton DJ. Histological studies on the triangular fibrocartilage complex of the wrist. J Anat. 1990;172:59–67. PubMed ID: 2272909.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Squire D. Ulnar wrist pain: structures of stability. Can J Diagn. 2005:65–67.

  • 9.

    Kaplan EB. Functional and Surgical Anatomy of the Hand. 2nd ed. Philadelphia, PA/Montreal, Canada: Lippincott Company; 1965:191–194.

  • 10.

    Taleisnik J. Pain on the ulnar side of the wrist. Hand Clin. 1987;3:51–68. PubMed ID: 3818813.

  • 11.

    Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 2004;32:262–273. PubMed ID: 14754754 doi:10.1177/0363546503261422

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg. 1997;22(6):719–723. doi:10.1016/S0266-7681(97)80432-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Tay SC, Tomita K, Berger RA. The “Ulnar Fovea Sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg. 2007;32A:438–444. doi:10.1016/j.jhsa.2007.01.022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Regan OS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg. 1984;9:502–514. doi:10.1016/S0363-5023(84)80101-X

  • 15.

    Wysocki RW, Biswas D, Bayne CO. Injection therapy in the management of musculoskeletal injuries: hand and wrist. Oper Tech Sports Med. 2012;20:132–141. doi:10.1053/j.otsm.2012.02.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Wang C, Gill TJ, Zarins B, Herndon J. Extensor carpi ulnaris tendon rupture in an ice hockey player: a case report. Am J Sports Med. 2003;31(3):459–461. PubMed ID: 12750144 doi:10.1177/03635465030310032301

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg. 2012;37A:1489–1500. doi:10.1016/j.jhsa.2012.04.036

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726–732. PubMed ID: 20335313 doi:10.7326/0003-4819-152-11-201006010-00232

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Lester B, Halbrecht J, Levy IM, Gaudinez R. “Press test” for office diagnosis of triangular fibrocartilage complex tear of the wrist. Ann Plast Surg. 1995;35(1):41–45. PubMed ID: 7574285. doi:10.1097/00000637-199507000-00009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    LaStayo PC. Ulnar wrist pain and impairment: a therapist’s algorithmic approach to the triangular fibrocartilage complex. In: Mackin E, Hunter JM, Callahan AD, Skirven TM, et al. eds. Rehabilitation of the Hand and Upper Extremity. Chapter 70. Mosby, MO: Mosby; 2002:1156–1170.

    • Search Google Scholar
    • Export Citation
  • 21.

    MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998;12(8):577–586. PubMed ID: 9840793 doi:10.1097/00005131-199811000-00009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Bialocerkowski A. Patient rated wrist evaluation. Aust J Physiother. 2008;54(3):221. PubMed ID: 18833689 doi:10.1016/S0004-9514(08)70035-7

  • 23.

    MacDermid JC. Development of a scale for patient rating of wrist pain and disability. J Hand Ther. 1996;9(2):178–183. PubMed ID: 8784681 doi:10.1016/S0894-1130(96)80076-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Goldhahn J, Angst F, Simmen BR. What counts: outcome assessment after distal radius fractures in aged patients. J Orthop Trauma. 2008;22(suppl 8):S126–S130. doi:10.1097/BOT.0b013e31817614a1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand: which one to choose? Int Orthop. 2008;32(1):1–6. PubMed ID: 17534619 doi:10.1007/s00264-007-0368-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Schmitt JS, Di Fabio RP. Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol. 2004;57:1008–1018. PubMed ID: 15528051 doi:10.1016/j.jclinepi.2004.02.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    John M, Angst F, Awiszus F, Pap G, MacDermid JC, Simmen BR. The patient-rated wrist evaluation (PRWE): cross-cultural adaptation into German and evaluation of its psychometric properties. Clin Exp Rheumatol. 2008;26:1047–1058. PubMed ID: 19210869.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Hemelaers L, Angst F, Drerup S, Simmen BR, Wood-Dauphinee S. Reliability and validity of the German version of “the patient-rated wrist evaluation (PRWE)” as an outcome measure of wrist pain and disability in patients with acute distal radius fractures. J Hand Ther. 2008;21(4):366–376. PubMed ID: 19006763 doi:10.1197/j.jht.2008.03.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Imaeda T, Uchiyama S, Wada T, et al. Reliability, validity, and responsiveness of the Japanese version of the patient-rated wrist evaluation. J Orthop Sci. 2010;15:509–517. PubMed ID: 20721719 doi:10.1007/s00776-010-1477-x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Gilbertson L, Barber-Lomax S. Power and pinch grip strength recorded using the hand-held Jamar dynamometer and the B+L hydraulic pinch gauge: British normative data for adults. Br J Occup Ther. 1994;57:483–488. doi:10.1177/030802269405701209

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Escalante A, Haas RW, del Rincón I. Measurement of global functional performance in patients with rheumatoid arthritis using rheumatology function tests. Arthritis Res Ther. 2004;6(4):R315–R325. PubMed ID: 15225367 doi:10.1186/ar1188

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    American Society of Hand Therapists. Clinical Assessment Recommendations. 2nd ed. Chicago, IL: American Society of Hand Therapists; 1992.

    • Search Google Scholar
    • Export Citation
  • 33.

    Wollstein R, Wollstein A, Rodgers J, Ogden TJ. A hand therapy protocol for the treatment of lunate overload or early Kienbock’s disease. J Hand Ther. (2013);26(3):255–260. PubMed ID: 23465629 doi:10.1016/j.jht.2012.12.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Maciel JS, Taylor NF, McIlveen C. A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures. Arch Orthop Trauma Surg. 2005;125(8):515–520. PubMed ID: 16136342 doi:10.1007/s00402-005-0037-x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Page P. Beyond statistical significance: clinical interpretation of rehabilitation research literature. Int J Sports Phys Ther. 2014;9(5):726–736. PubMed ID: 25328834.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Bhardwaj SS, Camacho F, Derrow A, Fleischer AB, Feldman SR. Statistical significance and clinical relevance: the importance of power in clinical trials in dermatology. Arch Dermatol. 2004;140(12):1520–1523. PubMed ID: 15611433 doi:10.1001/archderm.140.12.1520

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Skirven T. Clinical examination of the wrist. J Hand Ther. 1996;9(2):96–107. PubMed ID: 8784673 doi:10.1016/S0894-1130(96)80068-8

  • 38.

    Ozkaya N, Nordin M. Fundamentals of Biomechanics: Equilibrium, Motion, and Deformation. New York, NY: Van Nostrand Reinhold; 1991:278–280.

    • Search Google Scholar
    • Export Citation
  • 39.

    Page PA, Lambert J, Abadie B, Boling R, Collins R, Linton R. Posterior rotator cuff strengthening using Theraband® in a functional diagonal pattern in collegiate baseball pitchers. J Athl Train. 1993;28(4):346–354. PubMed ID: 16558251.

    • Search Google Scholar
    • Export Citation
  • 40.

    Hughes CJ, Hurd K, Jones A, Sprigle S. Resistance properties of Thera-Band® tubing during shoulder abduction exercise. J Orthop Sports Phys Ther. 1999;29(7):413–420. PubMed ID: 10416181 doi:10.2519/jospt.1999.29.7.413

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 3033 737 79
Full Text Views 63 21 3
PDF Downloads 72 24 3