Orthoses for the Management of Upper Extremity Pain: A Narrative Review

Yoo Jin Choo 대한통증연구학회 2022 International Journal of Pain Vol.13 No.1

Musculoskeletal pain in the upper extremities is a frequently encountered issue in clinical practice. Commonly occurring disorders that can cause such upper extremity pain are de Quervain's tenosynovitis, carpal tunnel syndrome, osteoarthritis affecting the wrists and hands, epicondylitis of the elbow, and shoulder dislocation. Orthoses have proven to be helpful in controlling pain caused by these conditions and are now widely used for their clinical management. Here, we review the application of orthoses for the management of upper extremity pain due to these commonly occurring disorders.

Comparison of Glenohumeral Stabilization Exercise and Scapular Stabilization Exercise on Upper Extremity Stability, Alignment, Pain, Muscle Power and Range of Motion in Patients With Nonspecific Shoulder Pain

Na-young Jeon,Seung-chul Chon 한국전문물리치료학회 2016 한국전문물리치료학회지 Vol.23 No.4

Background: Shoulder stabilization commonly involves two components: the glenohumeral stabilization exercise (GSE) and scapular stabilization exercise (SSE). Despite the fact that the shoulder stabilization has advantageous merit, to our knowledge, only a few studies have compared the superior of the GSE and the SSE. Objects: The purpose of this study was to assess the effects of GSE in patients with nonspecific shoulder pain. Methods: Thirty subjects with nonspecific shoulder pain were randomly divided into an experimental group and control group, each with 15 patients. The experimental group used an GSE, whereas the control group did SSE. All subjects were measured in shoulder stability, scapular symmetric alignment, pain, muscle power, and range of motion before and after the intervention. Results: GSE resulted in significantly better shoulder stability (p=.046, from 8.67±7.54 score to 13.93±9.40) in the experimental group compared with SSE in the control group. However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (p=.829) and inferior scapular height difference (p=.735), pain (p=.113), muscle power including shoulder flexion (p=.723) and abduction (p=.897) and range of motion including shoulder flexion (p=.853) and abduction (p=.472). Conclusion: These findings suggest that GSE may be more effective in increasing the shoulder stability than the SSE in patients with nonspecific shoulder pain, probably through a centralization effect on the shoulder mechanism.

상상연습이 뇌졸중 환자의 상지기능, 통증, 일상생활활동에 미치는 효과

김흥수 ( Kim Heung-su ),정진원 ( Jeong Jin-won ),이해나 ( Lee Hae-na ) 대한인지재활학회 2021 대한인지재활학회지 Vol.10 No.2

목적: 본 연구는 급성기 뇌졸중 환자를 대상으로 상상연습 훈련을 적용하였을 때, 환자의 상지기능과 통증, 일상생활의 독립성에 미치는 영향을 알아보고자 하였다. 연구방법: 연구 대상은 서울 A병원에 뇌졸중으로 진단받은 입원 환자 21명이며 실험군 11명과, 대조군 10명으로 무작위 배정하였다. 실험군, 대조군 모두 총 3주간 주 5회 근력 및 관절범위를 증진시키기 위한 상지운동프로그램이 진행되었으며 실험군은 상지운동프로그램 전이나 후로 상상연습 20분이 추가로 진행되었다. 대조군과 실험군 모두 중재 전과 후로 상지기능을 알아보기 위해 푸글-마이어 검사(Fugl-meyer assessment scale; FMA), 운동 활동 지표검사(Motor activity log scale; MAL)를 평가하였고, 환측 상지의 통증 정도는 통증 척도 검사(Numeric pain rating scale; NRS)를, 일상생활활동능력을 알아보기 위해 한국판 수정바델지수(Korean version of modified barthel index; K-MBI)를 평가하였다. 결과: 실험군, 대조군 모두 중재 전후로 상지기능 및 일상생활활동의 향상을 보였다. 두 군간 비교 시 실험군이 대조군보다 FMA의 유의한 변화가 있었다(p<.01). MAL, NRS의 K-MBI에서는 유의한 차이를 보이지는 않았다. 결론: 상지운동프로그램과 함께 상상연습을 적용하였을 때 뇌졸중 편마비 환자의 환측 상지 기능을 향상시키는데 효과적인 것으로 나타났다. 후속연구로 상상연습의 효과가 지속가능한지에 대한 연구가 필요하다. Purpose: The purpose of this study was to investigate the effect of mental practice training on the acute stroke patients upper extremity function, pain, and independence of daily life. Methods: The subjects of the study were 21 patients diagnosed with stroke, and were randomly assigned to 11 in the experimental group and 10 in the control group. In both two groups, traditional occupational therapy was conducted 5 times a week for 3 weeks. Additionally, 20 minutes of mental practice was performed before or after the traditional occupational therapy in the experimental group. Both two groups were evaluated FMA(Fugl-meyer assessment scale) and MAL(Motor activity log scale) to determine upper extremity function before and after the intervention. The MBI(Modified barthel index) was evaluated to determine the activity ability. RESULTS: When comparing the two groups, there was a significant change in FMA in the experimental group than control group(p<.01). There was no significant difference in MBI, MAL. Conclusion: When mental practice was applied along with upper extremity exercise program, it was found to be effective in improving the function of the affected upper extremity in stroke patients. It is considered to be the basic data for using the mental practice in the future.

대학생의 스마트폰 중독사용 정도에 따른 상지통증, 불안, 우울 및 대인관계

황경혜(Kyung-Hye Hwang),유양숙(Yang-Sook Yoo),조옥희(Ok-Hee Cho) 한국콘텐츠학회 2012 한국콘텐츠학회논문지 Vol.12 No.10

본 연구는 대학생의 스마트폰 중독사용 정도에 따른 상지통증과 불안, 우울 및 대인관계의 관계를 파악하기 위한 서술적 조사연구이다. 자료 수집은 2012년 5월부터 6월까지 일 대학의 대학생들 중 스마트폰 사용자를 대상으로 스마트폰 중독사용 정도, 상지통증, 불안, 우울 및 대인관계에 대해 구조화된 질문지를 이용하여 조사하였다. 응답내용이 누락되거나 불완전한 경우를 제외한 525명의 자료를 분석하였다. 스마트폰 중독사용 정도에 따른 상지통증, 불안, 우울 및 대인관계의 차이는 x2와 t-test로 분석하였고, 스마트폰 중독사용, 불안, 우울 및 대인관계의 상관관계는 Pearson correlation coefficient로 분석하였다. 본 연구의 결과, 중독사용군은 62명(11.8%)이었다. 여자 대학생의 스마트폰 중독사용 정도는 남자 대학생에 비해 심각했으며, 하루에 스마트폰을 사용하는 시간이 긴 대상자가 스마트폰 중독사용 정도가 높았다. 스마트폰 중독사용군이 정상사용군에 비해 어깨통증 호소가 많았으나 다른 부위의 상지 통증의 차이는 없었다. 상태불안, 특성불안, 우울 모두 중독사용군이 정상사용군보다 높았다. 그리고 스마트폰 중독성향이 강할수록 상태불안, 특성불안 및 우울 정도는 높았고, 상태불안, 특성불안 및 우울 정도가 높을수록 대인관계는 좋지 않았다. 이상의 결과는 스마트폰 중독사용 고위험군을 조기에 선별하고, 이들을 위한 바른 자세, 다양한 스트레스 대처방법, 긍정적인 정신건강 및 효율적인 대인관계 향상 등의 중독 예방프로그램 개발의 기초자료로 활용될 것을 기대한다. This study aimed to survey the impact of smartphone overuse on upper extremity pain, anxiety, depression, and interpersonal relationships among college students. Subjects completed a structured questionnaire consisting of the Smartphone Addiction Inventory, the Musculoskeletal Symptom Checklist, the State-Trait Anxiety Inventory, the Beck Depression Inventory-II, and the Relationship Change Scale from May to June 2012. We analyzed the survey data from 525 responses, excluding unreturned or incomplete surveys. Data were analyzed using the x2 test and t-test to determine the differences in smartphone overuse and its impact on upper extremity pain, anxiety, depression, and interpersonal relationships between two groups: the overuse and normal use groups. Moreover, Pearsons correlation coefficient was used to examine the correlation between smartphone overuse and upper extremity pain, anxiety, depression, and interpersonal relationships. The results placed 62 people (11.8%) in the smartphone overuse group. The extent of smartphone overuse was more severe among female than male college students ,and longer time spent using smartphones per day was directly related to smartphone overuse. The smartphone overuse group evidenced higher shoulder pain than the normal use group did, but no differences were found in other sites of the upper extremities. State anxiety, trait anxiety, and depression were higher in the smartphone overuse group than in the normal use group. Subjects with a higher extent of smartphone overuse experienced increased state-anxiety, trait-anxiety, and depression. Moreover, subjects with higher state-anxiety, trait-anxiety, and depression scores were more likely to have poor interpersonal relationships. Therefore, early screening for smartphone overuse should be evaluated, because it can be useful in developing addiction prevention programs to improve posture, stress coping, positive mental health, and effective interpersonal relationships.

수술 후 통증 경감을 위한 초음파 유도하 신경차단술

송재황(Jae Hwang Song),고광표(Kwang Pyo Ko),김대영(Dae Yeung Kim) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.3

수술 후 통증은 환자의 입원일 수의 증가 및 관절 운동의 회복을 지연시키는 중요한 요인이다. 최근 초음파 기기와 술기의 발달로 많은 정형외과 의사들이 수술 후 통증 조절을 위하여 신경차단술을 초음파 유도하에 안전하고 비교적 간단하게 시술할 수 있게 되었다. 이러한 신경차단술로 인하여 환자들은 장시간 동안 통증 경감 효과를 기대할 수 있게 되었다. 정형외과 영역에서 수술 후 통증 조절을 위해 적용할 수 있는 초음파 유도하 상지, 하지 신경차단술에 대해 고찰해 보고자 한다. Postoperative pain is one of the most common reasons for delayed discharge and can impede the recovery of joint motion and rehabilitation. Recently, an ultrasound-guided nerve block was shown to be the most effective method to control postoperative pain. Under ultrasound guidance, orthopedic surgeons can safely perform the nerve block procedure. This review discusses the method of ultrasound-guided nerve block of the upper and lower extremities for postoperative pain control after orthopedic surgery.

유방암 생존자의 상지기능, 통증 및 불안과의 관계

임정선(Lim, Jeong-Sun),김종임(Kim, Jong-Im) 대한근관절건강학회 2012 근관절건강학회지 Vol.19 No.1

Purpose: This study was to compare pain, upper extremity function, and anxiety among disease characteristics in the breast cancer survivors and to clarify the relationship among these variables. Methods: One hundred twenty two participants with breast cancer survivors over the age of 30 were recruited from a general hospital. Data were collected from November 1 to December 25, 2006 using a structured questionnaire. Results: The mean age was 51.17 and their mean survival period was 38.08 months. The breast cancer survivors who had received radiation therapy reported lower levels of pain and upper extremity function, and higher levels of anxiety than those who had other treatments. Pain and anxiety were positively related, and upper extremity function was negatively related to pain and anxiety. Conclusion: The breast cancer survivors experienced pain, upper extremity function disorder and anxiety. This study indicates that nursing interventions for the breast cancer survivors may be needed to improve upper extremity function, and to reduce pain and anxiety.

정형외과 수술에서 정맥 주사를 통한 환자 자가 통증 조절법의 효용성과 조기 중단의 원인

이봉주(Bong-Ju Lee),이철형(Chul-Hyung Lee),고종진(Jongjin Go) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.1

목적: 본 연구는 정형외과 수술 후 사용되는 정맥 주사를 통한 환자 자가 통증 조절법(intravenous patient controlled analgesia, IV-PCA)의 조기중단 빈도를 구하고, 수술 부위 및 종류에 따라 차이가 있는지 확인하여 조기 중단에 미치는 요인을 알아보고자 하였다. 대상 및 방법: 2018년 10월부터 2020년 2월까지 정형외과 수술 후 IV-PCA를 사용한 2,915명의 환자의 의무기록을 바탕으로 성별, 연령, 흡연 상태, 수술 부위, 수술명, 마취 방법, PCA 사용 시간, 만족도, 부작용, 조기 중단 및 조기 중단 이유를 확인하였다. 정형외과 수술은 대수술과 소수술로 분류되었고 수술 부위는 상지, 하지, 척추로 분류되었다. 조기 중단 사유는 부작용, 환자의 단순거부, 퇴원으로 분류하였다. 단변수 분석을 통해 조기 중단에 영향을 미치는 요인을 파악하고, 로지스틱 회귀 분석을 통해 조기 중단에 영향을 미치는 각 요인의 정도를 확인 하였다. 결과: IV-PCA의 조기 중단률은 6% (상지 8.3 %, 하지 5.7 %)였다. 단변수 분석에서 연령, 수술 부위, 수술 분류, 마취 방법, PCA사용 시간, 만족도 및 부작용이 조기 중단에 영향을 미치는 요인으로 확인되었다. 로지스틱 회귀 분석 결과 상지 수술의 조기 중단이 하지 수술보다 높았고(p=0.005, odds ratio [OR]=1.78), 소수술이 대수술보다 높았다(p=0.002, OR=2.029). 하지 수술에서 조기 중단의 가장 흔한 이유는 부작용(71.5%)이고, 상지 수술에서는 환자의 단순 거부(41.7 %)로 확인되었다. 결론: 수술 후 통증 조절을 위한 IV-PCA의 조기 중단이 하지 수술보다 상지 수술에서 더 빈번하며, 상지 수술의 경우 환자의 단순거부 또는 퇴원으로 인한 조기중단의 비율이 하지 수술보다 더 높았다. 상지 수술 후 통증 조절을 위해 IV-PCA 외에 더 적절한 신경차단(neuroaxial anesthesia)와 같은 방법을 고려하는 것이 필요할 것으로 생각된다. Purpose: This study examined the frequency of early cessation of intravenous patient-controlled analgesia (IV-PCA) after orthopedic surgery, and the difference in frequency according to the surgical site and type to determine the factors affecting the early cessation of IVPCA. Materials and Methods: Based on the medical records of 2,915 patients using PCA after orthopedic surgery from October 2018 to February 2020, sex, age, smoking status, surgical site, operation name, anesthesia method, PCA usage time, satisfaction, side effects, early discontinuation and the reason of early discontinuation were assessed. Orthopedic surgery was classified into major surgery and minor surgery, and the surgical site was classified into the upper limb, lower limb, and spine. The reasons for discontinuation were side effects, patient rejection, and discharge. The factors affecting early discontinuation were identified by univariate analysis, and the degree of each factor affecting early discontinuation was confirmed by logistic regression analysis. Results: The early discontinuation rate of IV-PCA was 6% (upper limb: 8.3%, lower limb: 5.7%). Univariate analysis identified, age, surgical site, surgical classification, anesthesia method, PCA usage time, satisfaction, and side effects as factors affecting early discontinuation. Logistic regression analysis showed that early discontinuation of the upper limb surgery was higher than the lower extremity surgery (p=0.005, odds ratio [OR]=1.78). Moreover, that the early discontinuation of minority surgery was higher than that of major surgery (p=0.002, OR=2.029). The most common reason for early discontinuation in lower extremity surgery is the side effects (71.5%), whereas patient rejection was the major reason in upper limb surgery (41.7%). Conclusion: Early cessation of IV-PCA for postoperative pain control was more frequent in upper extremity surgery than lower extremity surgery. The rate of early discontinuation due to simple rejection or discharge of patients was higher in the upper extremity surgery than lower extremity surgery. Therefore, methods such as neuroaxial anesthesia should be considered for pain control after upper limb surgery rather than IV-PCA.

적외선체열촬영을 통한 편측 경항상지통환자의 임상적 고찰

박민정,이경윤,조원영,박쾌환,Park, Min-jung,Lee, Kyung-yun,Cho, Won-young,Park, Koae-hwan 대한침구의학회 2004 대한침구의학회지 Vol.21 No.2

Objectives : We studied to discover the patterns of DITI of the patients having a both neck and upper extremity pain on one side without any nerve root compression sign and the history of cervical disc herniation. Method : We selected 26 patients as an experimental group, who had visited for a both neck and upper extremity pain on one side without any nerve root compression sign, at the department of acupunture and moxibustion in Conmaul oriental medical hospital, during 2001. 01. - 2003. 09. And 31 normal adults were selected as a control group, not having any neck or arm pain and any history of cervical disease. We analyzed the segmental temperature statistically with t-test. Results & Conclusion : There was a significant change of temperatures in the scapula, posterior brachium, lateral forearm and dorsal hand area. And the experimental group showed cold spot and disruption of normal thermographic shape that were usually shown on the cervical sprain.

적외선체열촬영을 통한 편측 경항상지통환자의 임상적 고찰

이경윤,조원영,박쾌환,박민정,Lee, Kyung-Yun,Cho, Won-Young,Park, Koae-Hwan,Park, Min-Jung 대한한방체열의학회 2005 대한한방체열의학회지 Vol.4 No.1

Objectives : We studied to discover the patterns of DITI of the patients having a both neck and upper extremity pain on one side without any nerve root compression sign and the history of cervical disc herniation. Method : We selected 26 patients as an experimental group, who had visited for a both neck and upper extremity pain on one side without any nerve root compression sign, at the department of acupunture and moxibustion in Conmaul oriental medical hospital, during 2001. 01. - 2003. 09. And 31 normal adults were selected as a control group, not having any neck or arm pain and any history of cervical disease. We analyzed the segmental temperature statistically with t-test. Results & Conclusion : There was a significant change of temperatures in the scapula, posterior brachium, lateral forearm and dorsal hand area. And the experimental group showed cold spot and disruption of normal thermographic shape that were usually shown on the cervical sprain.

The effects of complex decongestive therapy on pain and functionality in individuals with breast cancer who developed adhesive capsulitis due to lymphedema: an evaluation by an isokinetic computerized system

Konca Kaya Tatar,Begumhan Turhan 대한통증학회 2022 The Korean Journal of Pain Vol.35 No.3

Background: This study aimed to determine the impact of complex decongestive therapy applications on upper extremity function in breast cancer patients who developed adhesive capsulitis after lymphedema. Methods: Thirty patients who developed adhesive capsulitis due to lymphedema were divided into two groups as study (n = 15) and control (n = 15) groups. Both groups received 20 minutes of exercise five days a week for three weeks using a Biodex isokinetic dynamometer, as well as a hot pack and TENS (Transcutaneous Electrical Nerve Stimulation) treatment to the shoulder joint. The study group received 45 minutes of intensive decongestive therapy along with the adhesive capsulitis treatment. The visual analogue scale was used to assess pain, circumference, and volumetric measurements were used to assess edema, and the Arm, Shoulder, and Hand Problems Questionnaire (DASH: Disabilities of the Arm, Shoulder, and Hand) was used to assess upper extremity functionality. The shoulder range of motion was evaluated. Results: Both groups had improvements in pain (P < 0.001), shoulder joint range of motion (P < 0.001), and upper extremity functionality (P < 0.001) after the treatment. There was a significant decrease in circumference and volumetric measurements in the study group (P < 0.001). However, no differences were seen in measurements in the control group. Conclusions: The results showed that complex decongestive therapy was beneficial in reducing lymphedema in breast cancer patients who acquired adhesive capsulitis due to lymphedema. Consequently, the authors believe that supplementing conventional physiotherapy with complex decongestive therapy will benefit patients.