Long-Term Follow-Up Results of Mechanical Wrist Traction as Non-Invasive Treatment for Carpal Tunnel Syndrome

Background: For patients with carpal tunnel syndrome (CTS), the only long-term effective treatment option is carpal tunnel release surgery. Up to one-third report recurrent symptoms, and 12% needs repeated surgery. This study aimed to evaluate the long-term effects of mechanical traction as a non-invasive treatment option for CTS compared to care as usual.Methods: Patients with electrodiagnostically confirmed CTS [N = 181; mean age, 58.1 (13.0) years; 67% women] were recruited from an outpatient neurology clinic in the Netherlands. Patients completed baseline questionnaires and randomized to the intervention group (12 treatments with mechanical traction, twice a week for 6 weeks) or care as usual. The primary clinical outcome measure was surgery during the 12-month follow-up. Secondly, we assessed symptom severity with the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline and at the 12-month follow-up. Changes in CTS symptom severity between baseline and the 12-month follow-up were analyzed between groups using t-tests and a multiple linear regression analyses, adjusting for duration of complaints, age, gender, and symptom severity at baseline.Results: At the 12-month follow-up, 35 of 94 (37%) patients in the intervention group had surgery, compared to 38 of 87 (44%) in the care-as-usual group (χ12 = 0.78, p = 0.377). Symptom severity and functional status scores did not significantly differ between the intervention (n = 81) and care-as-usual group (n = 55) at follow-up. For patients who did not have surgery, BCTQ scores decreased significantly more from baseline to the 12-month follow-up in the intervention group (n = 53) compared to patients in the care-as-usual group (n = 25). For patients who did not have surgery, belonging to the intervention group and a higher BCTQ score at baseline were related to a greater decrease in BCTQ scores from baseline to the 12-month follow-up, as well as symptom severity and functional status.Conclusions: Mechanical traction is effective in reducing symptom severity compared to current conservative treatment options in standard care and can therefore benefit the large number of patients that prefer conservative treatment for CTS.Clinical Trial Registration: Clinical Trials NL44692.008.13. Registered 19 September 2013, https://clinicaltrials.gov/ct2/show/NCT01949493

EFFECTS OF LUMBAR SNAG AND MECHANICAL TRACTION IN PATIENTS WITH DISCOGENIC LUMBOSACRAL RADICULOPATHY

Objective: To compare the effects of lumbar sustained natural apophyseal glide and Mechanical Traction in patients with discogenic lumbosacral radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Kanaan Physiotherapy and Spine Clinic, from Mar to Sep 2020. Methodology: A total of 44 patients were included in study in 2 groups of 22 each. Patients between ages 30-60 years having chronic radiating pain in one or both legs, patients with minimum of 25 score out of 100, on low back pain index and patients having radiculopathy were included. Exclusion criteria were history of low back pain treatment in last 90. Complications such as cancer, spine pathology and joint disease. Dice roll method was used for group allocation. Group classification was as group 1, sustained natural apophyseal glide group, and group 2, mechanical traction group. NPRS and oswestry disability index were used. Data analysis was done with SPSS version 21. Results: There is statistically significant improvement in pain as mean post treatment value for sustained natural apophyseal glide group is 2.55 ± 1.503 and for mechanical traction group is 4.05 ± 1.864, oswestry disability index and shober test results in sustained natural apophyseal glide group were also significant as compared to mechanical traction with p-value <0.05. Although pain was also decreased in mechanical traction group patients but overall sustained natural apophyseal glides were more effective. Conclusion: Sustained natural apophyseal glide are more effective in the treatment of lumber radiculopathy patients as compared to mechanical traction. Further studies.............

Effectiveness of mechanical traction in supine versus prone lying position for lumbosacral radiculopathy

Objectives: To determine the effectiveness of mechanical traction in supine versus prone lying position for lumbosacral radiculopathy. Methods: A quasi experimental trial was conducted from April to September 2020 among sixty patients of chronic lumbosacral radiculopathy at Ibn-e-Siena Hospital, Multan. Participants were divided into two groups. Group-A (Supine) participants received lumbar traction in supine lying along with conventional treatment. Group-B (Prone) underwent the same treatment except the lumbar traction being applied in prone lying position. Participants were evaluated twice: at pre- treatment (week 0) and at the post treatment (week 2). Oswestry Disability Index and Numeric Pain Rating Scale were used as outcome measure. Data was analyzed on SPSS 23. Results: The mean (±S.D) age of the patients was 39±5.7 vs. 40±5.3 years in supine vs. prone group respectively. Mean ODI score was 25.2±6.13 vs. 26.0±6.26 at the start of treatment in supine vs. prone position respectively while it was 19.45±7.12 vs. 11.05±4.40 at end of treatment in supine vs. prone position respectively. Mean NPRS score was 7.73±1.23 vs. 7.67±0.96 at start of treatment in supine vs. prone position respectively while it was 4.63±0.89 vs. 3.13±0.90 at the end of treatment in supine vs. prone position respectively. Conclusion: Lumbar traction in prone lying position is more effective than lumbar traction in supine lying position for the treatment of chronic lumbosacral radiculopathy. doi: https://doi.org/10.12669/pjms.37.5.4200 How to cite this:Khan RR, Riaz S, Rashid S, Sulman M. Effectiveness of mechanical traction in supine versus prone lying position for lumbosacral radiculopathy. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4200 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-analysis

Objective Lumbar radiculopathy is a pain syndrome caused by compression/irritation of the lumbar nerve root(s). Traction is a well-known and commonly used conservative treatment for lumbar radiculopathy, although its effectiveness is disputed. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effects of different types of traction added to or compared with conservative treatments on pain and disability. Methods Data were obtained from CENTRAL, PUBMED, CINAHL, Scopus, ISI Web of Science, and PEDro from their inception to April 2020. All randomized controlled trials on adults with lumbar radiculopathy, using mechanical traction, without any restriction regarding publication time or language, were considered. Two reviewers selected the studies, evaluated the quality assessment, and extracted the results. Meta-analysis used a random-effects model. Eight studies met the inclusion criteria, and 5 were meta-analyzed. Results Meta-analyses of results from low-quality studies indicated that supine mechanical traction added to physical therapist treatments had significant effects on pain (g = −0.58 [95% CI = −0.87 to −0.29]) and disability (g = −0.78 [95% CI = −1.45 to −0.11]). Analyses of results from high-quality studies of prone mechanical traction added to physical therapist intervention for pain and disability were not significant. These results were also evident at short-term follow-up (up to 3 months after intervention). Conclusions The literature suggests that, for pain and disability in lumbar radiculopathy, there is short-term effectiveness of supine mechanical traction when added to physical therapist intervention. Impact This systematic review may be relevant for clinical practice due to its external validity because the treatments and the outcome measures are very similar to those commonly used in a clinical context.

Microstructural deformation observed by Mueller polarimetry during traction assay on myocardium samples

Despite recent advances, the myocardial microstructure remains imperfectly understood. In particular, bundles of cardiomyocytes have been observed but their three-dimensional organisation remains debated and the associated mechanical consequences unknown. One of the major challenges remains to perform multiscale observations of the mechanical response of the heart wall. For this purpose, in this study, a full-field Mueller polarimetric imager (MPI) was combined, for the first time, with an in-situ traction device. The full-field MPI enables to obtain a macroscopic image of the explored tissue, while providing detailed information about its structure on a microscopic scale. Specifically it exploits the polarization of the light to determine various biophysical quantities related to the tissue scattering or anisotropy properties. Combined with a mechanical traction device, the full-field MPI allows to measure the evolution of such biophysical quantities during tissue stretch. We observe separation lines on the tissue, which are associated with a fast variation of the fiber orientation, and have the size of cardiomyocyte bundles. Thus, we hypothesize that these lines are the perimysium, the collagen layer surrounding these bundles. During the mechanical traction, we observe two mechanisms simultaneously. On one hand, the azimuth shows an affine behavior, meaning the orientation changes according to the tissue deformation, and showing coherence in the tissue. On the other hand, the separation lines appear to be resistant in shear and compression but weak against traction, with a forming of gaps in the tissue.

Attachment performance of stick insects (Phasmatodea) on convex substrates

ABSTRACTPhasmatodea (stick and leaf insects) are herbivorous insects well camouflaged on plant substrates as a result of cryptic masquerade. Also, their close association with plants has allowed them to adapt to different substrate geometries and surface topographies of the plants they imitate. Stick insects are gaining increasing attention in attachment- and locomotion-focused research. However, most studies experimentally investigating stick insect attachment have been performed either on single attachment pads or on flat surfaces. In contrast, curved surfaces, especially twigs or stems of plants, are dominant substrates for phytophagous insects, but not much is known about the influence of curvature on their attachment. In this study, by combining analysis of tarsal usage with mechanical traction and pull-off force measurements, we investigated the attachment performance on curved substrates with different diameters in two species of stick insects with different tarsal lengths. We provide the first quantitative data for forces generated by stick insects on convex curved substrates and show that the curvature significantly influences attachment ability in both species. Within the studied range of substrate curvatures, traction force decreases and pull-off force increases with increasing curvature. Shorter tarsi demonstrate reduced forces; however, tarsus length only has an influence for diameters thinner than the tarsal length. The attachment force generally depends on the number of tarsi/tarsomeres in contact, tarsus/leg orientation and body posture on the surface. Pull-off force is also influenced by the tibiotarsal angle, with higher pull-off force for lower angles, while traction force is mainly influenced by load, i.e. adduction force.