Dorich Jenny M, Cornwall Roger
Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Hand Surg Glob Online. 2021 Oct 22;4(1):8-13. doi: 10.1016/j.jhsg.2021.09.001. eCollection 2022 Jan.
Chronic, nonspecific wrist pain in adolescents can be challenging to assess and treat. We hypothesized that an algorithmic approach beginning with grip strengthening can alleviate pain, improve function, and identify patients in need of further intervention.
We retrospectively reviewed the results of a grip-strengthening protocol for adolescents with chronic, nonspecific wrist pain. Before and after treatment, grip strength was measured using handheld dynamometry, and patient-reported pain and function were measured using the adolescent self-reported Pediatric Outcomes Data Collection Instrument's (PODCI's) Pain/Comfort and Upper Extremity Function domains (PODCI/pain and PODCI/UE, respectively).
Thirty-two patients (28 female, 4 male) were included, with a mean age of 14 years (range, 10-18 years) and the dominant hand affected in 19, nondominant hand in 9, and bilateral impacts in 4. The mean symptom duration prior to presentation was 9 months (range, 1-63 months); 17 patients had undergone prior immobilization and 5 prior occupational/physical therapy. Grip-strengthening treatment, lasting a mean of 40 days (range, 21-82 days) with a median of 4 therapy visits (range, 2-6), was associated with significantly improved grip strength (mean, 32-48 lbs), PODCI/pain scores (mean, 49.0-78.2 points), and PODCI/UE scores (mean, 78.2-91.2 points). Improvements in grip strength correlated with improvements in PODCI/pain and PODCI/UE scores (r = 0.64 and 0.70, respectively). Eight patients (25%) had either no or incomplete pain relief: 5 underwent successful further intervention (2 ganglion cyst excisions, 1 triangular fibrocartilage complex repair, 1 arthroscopic debridement, 1 steroid injection), 2 received ongoing pain management for generalized pain syndromes, and 1 was lost to further follow-up. No pretreatment variables were identified that predicted failure.
Grip strengthening relieves pain and improves function in the majority of adolescents with chronic, nonspecific wrist pain. Systematic use of this protocol helps to identify patients who require further intervention.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
青少年慢性非特异性腕部疼痛的评估和治疗具有挑战性。我们假设一种从握力增强开始的算法方法可以减轻疼痛、改善功能并识别需要进一步干预的患者。
我们回顾性分析了针对患有慢性非特异性腕部疼痛的青少年的握力增强方案的结果。治疗前后，使用手持式测力计测量握力，并使用青少年自我报告的儿科结果数据收集工具（PODCI）的疼痛/舒适度和上肢功能领域（分别为PODCI/疼痛和PODCI/上肢）测量患者报告的疼痛和功能。
纳入32例患者（28例女性，4例男性），平均年龄14岁（范围10 - 18岁），19例优势手受累，9例非优势手受累，4例双侧受累。就诊前平均症状持续时间为9个月（范围1 - 63个月）；17例患者曾接受过固定治疗，5例曾接受过职业/物理治疗。握力增强治疗平均持续40天（范围21 - 82天），中位治疗次数为4次（范围2 - 6次），与握力显著改善（平均从32磅增至48磅）、PODCI/疼痛评分（平均从49.0分增至78.2分）和PODCI/上肢评分（平均从78.2分增至91.2分）相关。握力的改善与PODCI/疼痛和PODCI/上肢评分的改善相关（r分别为0.64和0.70）。8例患者（25%）疼痛未缓解或缓解不完全：5例接受了成功的进一步干预（2例腱鞘囊肿切除术、1例三角纤维软骨复合体修复术、1例关节镜清创术、1例类固醇注射），2例因全身性疼痛综合征接受持续疼痛管理，1例失访。未发现预测治疗失败的预处理变量。
握力增强可缓解大多数患有慢性非特异性腕部疼痛的青少年的疼痛并改善功能。系统使用该方案有助于识别需要进一步干预的患者。
研究类型/证据水平：治疗性IV级。
