ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2021, 6(1): 255–262
https://doi.org/10.26693/jmbs06.01.255
Physical Therapy and Ergotherapy

Effectiveness of the Influence of Physical Therapy on the Indicators of the Neurological and Functional Status of the Hand in People with Compression Neuropathy of the Median Nerve as a Postimmobilization Complication of Fractures of the Distal Forearm Bo

Byrchak V. M.
Abstract

The social inconsistency of patients with hand injuries is due to the limitation of the possibilities of professional and labor activity (reduced qualifications, limited opportunities for training and retraining, inability to work in their specialty), which justifies the search for new methods of their rehabilitation. The purpose of the study was to determine the effectiveness of physical therapy on the indicators of the neurological and functional status of the hand in patients with compression neuropathy of the median nerve as a postimmobilization complication of fractures of the distal forearm bones. Material and methods. The study involved 56 people with postimmobilization contractures of the wrist joint, complicated by compression neuropathy of the median nerve, as a result of fracture of the bones of the distal forearm. They were divided into two groups: the control group (they practiced according to the principles of polyclinic rehabilitation with a predominance of passive means like manual techniques, preformed physical factors) and the main group (they were engaged in a developed physical therapy program based on the principles of International Classification of Functioning, Disability and Health with a predominance of active means like functional training; massage; warm wet compress combined with post-isometric muscle relaxation, posture treatment; kinesiological taping). The effectiveness of the program was assessed by the presence and degree of pain (VAS and DN4), goniometry results, signs of median nerve irritation (Phalen, Hoffmann-Tinel, Durkan), French Arm Test, ABILIHAND, DASH, Boston carpal tunnel questionnaire. Results and discussion. After the rehabilitation intervention, all examined patients showed a decrease in the intensity of pain at rest and during movement (according to VAS). Signs of compression neuropathy of the median nerve decreased (pain intensity according to the DN4 questionnaire, the prevalence of specific symptoms, the results of a quantitative assessment of the Boston carpal tunnel questionnaire). There was an improvement in the functioning of the upper limb according to the ABILIHAND, DASH, French Arm Test scales. For all the studied parameters, the patients of both groups showed a statistically significantly better result compared to the initial data (p <0.05). However, the patients of the main group showed a better result than the patients of the control group (p <0.05). Conclusion. The developed program of physical therapy with the predominant using of active rehabilitation means revealed a statistically significant better effect on the indicators of the neurological and functional status of the hand in persons with compression neuropathy of the median nerve as a postimmobilization complication of fractures of the distal forearm bones

Keywords: rehabilitation, trauma, carpal tunnel syndrome

Full text: PDF (Ukr) 424K

References
  1. Albanese GA, Marini F, Taglione E, Gasparini C, Grandi S, Pettinelli F, et al. Assessment of human wrist rigidity and pain in post-traumatic patients. International Conference on Rehabilitation Robotics. Proceedings. 2019 Jun; 2019: 89-94. https://doi.org/10.1109/ICORR.2019.8779508
  2. Crowe CS, Massenburg BB, Morrison SD, Chang J, Friedrich JB, Abady GG, et al. Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study. Injury prevention: journal of the International Society for Child and Adolescent Injury Prevention. 2020 Oct; 26(Suppl 1): i115-i124. https://doi.org/10.1136/injuryprev-2019-043495. PMid:32169973 PMCid:PMC7571361
  3. Giummarra MJ, Cameron PA, Ponsford J, Ioannou L, Gibson SJ, Jennings PA, et al. Return to Work After Traumatic Injury: Increased Work-Related Disability in Injured Persons Receiving Financial Compensation is Mediated by Perceived Injustice. Journal of Occupational Rehabilitation. 2017; 27(2): 173-85. https://doi.org/10.1007/s10926-016-9642. PMid:27150733
  4. Kılıç S, Adıyaman S, Sezer F, Cantürk G. Upper Extremity Injuries Due to Work Accidents in Work Accident Disability Assessments: Three Case Reports. The Bulletin of Legal Medicine. 2017; 22 (1): 72-5. https://doi.org/10.17986/blm.2017127145
  5. Byrchak VM, Duma ZV, Aravitska MG. Zminy psykho-emotsiynoho stanu ta funktsionalnykh mozhlyvostey peredplichchya ta zapyastka yak marker efektyvnosti fizychnoyi terapiyi patsiyentiv z postimmobilizatsiynymy kontrakturamy vnaslidok perelomiv dystalnykh viddiliv kistok peredplichchya [Changes in the psycho-emotional state and functionality forearm and wrist as a marker of efficiency of physical therapy of patients with post-mobilization contractures be-cause of distal forearm fractures]. Art of Medicine. 2020; 2(14): 23-31. [Ukrainian]. https://doi.org/10.21802/artm.2020.2.14.23
  6. Koval NP, Aravitska MG. Efektyvnist korektsiyi pokaznykiv ryzyku padinnya ta fizychnoho statusu v osib pokhyloho viku z starechoyu asteniyeyu ta metabolichnym syndromom zasobamy fizychnoyi terapiyi [Effect of Physical Therapy on Fall-Risk and Physical Status in Older Adults with Frailty and Metabolic Syndrome]. Ukrayinskyy zhurnal medytsyny, biolohiyi ta sportu. 2020; 5(6): 282-291. [Ukrainian]. https://doi.org/10.26693/jmbs05.06.282
  7. Sabapaty SR. Treatment of mutilating hand injurues: An international perspective. Hand Clinics. 2016; 32(4): 435-602. https://doi.org/10.1016/S0749-0712(16)30091-9
  8. Bismak H, Shestopal N. The dynamics of the functional indicators of the upper limb with firearm wounds of the forearm and the hand brush in the combination with peripheral nerves damage. Journal of Physical Education and Sport. 2020; 20(1): 298-307. https://doi.org/10.31392/NPU-nc.series15.2019.1(121)20.04
  9. Bobowik PŻ. Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Advances in Rehabilitation/Postępy Rehabilitacji. 2019; 2: 47-58. https://doi.org/10.5114/areh.2019.85023
  10. Hertsyk A. Teoretyko-metodychni osnovy fizychnoyi reabilitatsiyi/ fizychnoyi terapiyi pry porushennyakh diyalʹnosti oporno-rukhovoho aparatu [Theoretical and methodological foundations of physical rehabilitation / physical therapy for disorders of the musculoskeletal system]. Lviv: LDUFK, 2018. [Ukrainian]
  11. Byrchak V, Duma Z, Aravitska M. Effectiveness of the active physical therapy in restoring wrist and hand functional ability in patients with immobility-induced contracture of the wrist joint complicated by median nerve entrapment owing to distal forearm fracture. Journal of Physical Education and Sport. 2020; 20 (6): 3599-3606. https://doi.org/10.7752/jpes.2020.06485
  12. Valeyev MM, Biktasheva EM. Rannyaya razrabotka luchezapyastnogo sustava pri zakrytom perelome distalnogo metaepifiza luchevoy kosti [Early development of the wrist joint with a closed fracture of the distal radial metaepiphysis]. Fizioterapiya, bal'neologiya i reabilitatsiya. 2017; 16 (4): 216-8. [Russian]. https://doi.org/10.18821/1681-3456-2017-16-4-216-218
  13. Kellam JF. Educational video - AO/OTA fracture and dislocation classification 2018 revisions [Internet]. Available from: https://classification.aoeducation.org/video.html
  14. Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) ta tretynnoyi (vysokospetsializovanoyi) medychnoyi dopomohy. Perelomy dystalʹnoho metaepifiza promenevoyi kistky [Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. Fractures of the distal metaepiphysis of the radius]. Litopys of traumatology and orthopedics. 2018; 1-2: 178-97. [Ukrainian]
  15. The International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland; 2001.
  16. Patent 134145 Ukraine, MPK A61F 7/02. Sposib kompleksnoyi reabilitatsiyi khvorykh z kontrakturamy promenevo-zapyastkovykh suhlobiv pislya znyattya immobilizatsiyi [Method for complex rehabilitation of patients with wrist joints contractures after immobilization removal] / Byrchak VM, Duma ZV. (UA); zayavnik i vlasnik patentu DVNZ "Prykarpatskyy natsionalnyy universytet imeni Vasylya Stefanyka" (UA). № u201808710; zayavl. 14.08.2018 ; opubl. 10.05.2019, Byul. № 9. [Ukrainian]
  17. Belova AN, Shchepetov ON. Shkaly, testy i oprosniki v meditsinskoy reabilitatsii [Scales, tests and questionnaires in medical rehabilitation]. M: Antidor; 2002. [Russian]
  18. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Brexelle J, Cunin G, et al. Douleur Neuropathique 4 questions - DN4. Pain. 2005; 114: 29-36. https://doi.org/10.1016/j.pain.2004.12.010. PMid:15733628
  19. Wade DT. Measurement in neurological rehabilitation. Curr Opin Neurol Neurosurg. 1992; 5(5): 682-6.
  20. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993; 75(11): 1585-92. https://doi.org/10.2106/00004623-199311000-00002. PMid:8245050