Introduction We present this case of a British patient living and working in Africa who used audiovisual (SKYPE) equipment as a treatment option for remote consultation. This was investigated in response to a request by the patient for further postoperative support at a distance after a complex hand surgery procedure. Methods Audiovisual (SKYPE) equipment was used by the team in combination with manual therapy as a means of seeking advice, progressing treatment and liaison with a specialist hand therapist and surgeon. The audiovisual equipment was used to complete follow-up of treatment episodes once the patient had returned to Africa. Results After five months of audiovisual consultations with the surgeon and clinical specialist hand therapist, the patient reported significant reductions in anxiety regarding the management of his extensive hand injury. The patient's active and passive range of movement and Disabilities of the Arm Shoulder and Hand scores had all improved. The wider multidisciplinary team in his local area was supported by a specialist service and evidence was gathered to support the organizational benefits of using audiovisual equipment. Conclusion This case report highlights the potential, clinical and cost benefits of utilizing audiovisual equipment in conjunction with other treatments in the management of remote hand injury patients.

Objective The objective of this study was to assess the intra- and inter-rater reliability of manual muscle testing (MMT) and hand-held dynamometer (HHD) in the measurement of isometric wrist strength in asymptomatic and symptomatic (distal radius fractures [DRF] and non-specific wrist pain [NSWP]) populations. Method Thirty-nine adults participated in an intra session, repeat measure, crossover study design. MMT and HHD isometric wrist strength was tested in six standardized test positions by two raters. Results Poor-to-excellent intra- and inter-rater reliability with MMT was found in all patient populations (ICC = 0.04–1.00). Excellent intra-rater reliability with HHD in the DRF (ICC = 0.86–0.95) and NSWP (ICC = 0.92–0.97) populations and excellent inter-rater reliability in the asymptomatic (ICC = 0.77–0.93) and DRF (ICC = 0.82–0.95) populations. Fair to excellent intra-rater reliability with HHD was seen in the asymptomatic population (ICC = 0.71–0.94) and fair to excellent inter-rater reliability in the NSWP population (ICC = 0.59–0.90). Conclusion MMT is shown to have variable reliability when assessing isometric wrist strength and is insensitive to small strength changes. HHD has been shown to be an objective and reliable measure of isometric wrist strength in specific positions in asymptomatic, DRF and NSWP populations. Further studies are required to ensure adequate dynamometry stabilization and obtain an optimal testing procedure for these populations.

Introduction Lateral epicondylitis (LE) is a common, often chronic injury that affects a person's ability to grip and perform manual tasks including activities of daily living and leisure. Treatment of LE is controversial; however, there have been no standardized tools with which to measure outcomes in trials investigating new or existing therapies for LE. The Patient-Rated Tennis Elbow Evaluation (PRTEE) was designed to fill this gap, but has not yet been validated to the same standard as other, similarly developed tools. Methods Sixty subjects with LE who participated in a double-blind randomized controlled trial were measured with respect to the PRTEE, ‘overall pain’, ‘resting pain’, ‘pain during sleep’, ‘pain at its worst’ and ‘pain at its least’, and quality of life. All tools were administered at baseline, four and eight weeks. Results The PRTEE showed poor item-specific validity with measures of similar constructs. The intraclass correlation coefficient for test–retest reliability over four weeks was 0.76. The mean PRTEE differences between the group that experienced clinical significant change and the group that experienced virtually no change were significantly different from one another ( t = −2.96, df = 30, P = 0.006). Discussion The PRTEE shows questionable discriminant ability due to its moderate test–retest reliability and possibly due to low convergent validity with other measures of similar constructs. The PRTEE appears to be sensitive to change, but the margin of difference between a clinically relevant change and ‘no change’ is very small.

Background A changing and competitive health market demands the need to review existing services and develop new ways of working in order to improve and maintain service delivery. Developing the role of the extended scope practitioner (ESP) and altering patient pathways through specialist hand units is one way that service delivery can be improved to adhere to the 18-week waiting time from a General Practitioner (GP) referral to the start of treatment. Methods One-hundred GP referrals for carpal tunnel syndrome (CTS) and first carpometacarpal osteoarthritis (CMC OA) were selected to attend an ESP clinic audit led by two specialist occupational therapists for diagnosis and implementation of a conservative treatment programme, which was confirmed by a consultant. The ESP clinic was audited against key performance indicators to evaluate ESP effectiveness and improvements in the patient pathway. Results The ESP can effectively diagnose and manage CTS and CMC OA patients without increasing the demand for surgical opinion or procedures. The ESP is also effective in diagnosing other conditions such as early-onset Dupuytren's disease, de Quervain's disease, ganglions and trigger finger. Conclusions ESP clinics have the potential to improve the patient pathway by providing earlier access to a specialist opinion for a diagnosis and management of hand conditions thereby improving service delivery.

Background. Surgery on musicians must be entered into cautiously and should be the only treatment option indicated after trialling all other appropriate ones. There are four main principles that must be carefully considered when operating on musicians: the exact location of incisions, anatomic repair and reconstruction, adjustment of any anticipated anatomic compromise to the musician's specific musical needs and the need for an early return to limited playing. The purpose of this case review was to identify which instrument and what medical condition require the most time for the musician to fully return to playing. This in turn can assist in realistic goal setting with individual patients according to these two categories. Methods. A retrospective review of a single surgeon's case series of 130 professional musicians was undertaken. Data regarding their medical condition, instrument played, length of time off the instrument following surgery and the time taken to return to full normal professional playing were recorded and analysed. Results. A total of 97.7 percent of the patients returned to full time playing and there was a 2.3% ‘failure’ rate. The results indicate that piano players appear to initially take the most time to return to their instrument and string players take the most time to fully rehabilitate. Trauma appears to be the most difficult condition from which to initially recover however, nerve decompressions (with the exception of carpal tunnel releases) take the most time to fully rehabilitate. The most common medical condition requiring surgical intervention was nerve compressions and the piano was the most common instrument played in the series. Conclusions. This case series highlights the importance of early return to playing and utilizing the musical instrument as a therapeutic tool in the rehabilitation programme of musicians.

Background The primary symptom reported by patients with lateral epicondylitis is pain. The InterX is a newly developed electrical device aimed at reducing pain by transmitting a varying electrical impulse into the surface of the skin via a portable, hand held applicator. This study investigates whether the InterX could provide additional acute pain relief and function for patients with acute lateral epicondylitis, to that of soft tissue massage, stretching ultrasound and exercise. Methods Twenty-six patients were randomized to two groups. The experimental group received InterX in conjunction with soft tissue massage, stretching, ultrasound and exercise, whereas the control group received soft tissue massage, stretching, ultrasound and exercise. Results In the short term, both regimes resulted in significantly reduced pain and improved functional ability ( P < 0.01). The control therapy also resulted in significantly improved grip strength. Discussion There was no significant difference in the improvements between groups in pain, difficulty with functional activities, although both groups' pain decreased significantly in the short (3 weeks) and medium (9 months) term. The experimental group received 30 minutes' greater treatment duration per week. Conclusions The provision of the InterX in addition to soft tissue massage, stretching, ultrasound and exercise did not affect patients' outcome.