Thesis (M.Sc.) - Dept. of Anatomy, University of Adelaide, 1982. / Photocopy.

Thesis (M. Phil.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 124-134).

M.Sc. (Dent.), Faculty of Health Sciences, University of the Witwatersrand, 2011

In this study the role of the thumb in piano playing is thoroughly investigated. The following areas were studied: attitudes about the thumb; anatomy, movements, and injuries of the thumb the history of the use of the thumb in piano playing; the: role of the thumb in. piano fingering; views about how to use-the thumb in playing; ways piano methods promote the use of the thumb; and study materials that develop the use of the thumbs.Numerous sources provided varying amounts of information on the subject. Books on piano technique and pedagogy, books about anatomy, and periodicals were important sources of information.Pianists have many different ideas about how the thumb should be used in piano playing. All of these ideas were compared and contrasted, discussing the positive and negative aspects of each.A four-item questionnaire was sent to numerous piano teachers to gather additional ideas about how they deal with the use of the thumb. The teachers had a wide range of interesting ideas on the subject. However, most of these ideas are similar to those already found in print. Many of these teachers have developed exercises of their own to improve the use of the thumb among their students.An index of study materials that develop the use of the thumb was compiled. The selections were categorized according to the area of thumb technique they develop, such as passagework or arpeggios. The categories were divided according to whether the problem was present in both hands, the right hand, or the left hand. Within each of these categories the selections were further divided into the categories of exercises, studies, and etudes.

published_or_final_version / Diagnostic Radiology / Master / Master of Philosophy

No

Doctor of Philosophy / The aim of the studies reported in this project was to examine factors associated with the prevention and management of trapeziometacarpal osteoarthritis, both in musculoskeletal physiotherapists and the general patient population. Two studies were undertaken to investigate factors associated with the aggravation of thumb pain in musculoskeletal physiotherapists. Study 1 was a survey of the prevalence of thumb pain, and allowed determination of the most aggravating spinal manipulative therapy technique. It identified that 83% of respondents complained of an aggravation of thumb pain due to the performance of spinal manipulative therapy techniques, with 85-87% of the painful respondents complaining of thumb pain aggravated by unilateral and central PA glides. Study 2 was conducted to determine whether the alignment of the joints of the thumb during performance of these glides was associated with thumb pain. This observational study of 129 musculoskeletal physiotherapists performing a PA glide identified that aligning the metacarpophalangeal and interphalangeal joints in extension was associated with a lower prevalence of work-related thumb pain. Therefore, it is suggested that musculoskeletal physiotherapists be taught to perform these techniques with the joints of their thumb in extension in an effort to reduce the development of work-related thumb pain. Furthermore, it is suggested that those who are unable to maintain this alignment voluntarily be provided with a thermoplastic thumb splint to maintain the extended alignment. Two studies were undertaken to investigate the conservative and surgical management of patients with trapeziometacarpal osteoarthritis. Study 3 was a randomised controlled trial conducted to compare the efficacy of a new thumb strap splint and an abduction exercise regimen against the standard approach to conservative management of trapeziometacarpal osteoarthritis, namely a short opponens splint and pinch exercise regimen. While there was no additional benefit of one approach over the other, all participants improved in the outcomes of pain, strength and hand function over the six-week period of intervention. Nevertheless, some people find that symptom relief from conservative intervention is inadequate and short-lived, requesting surgery for the treatment of disabling and persistent pain from trapeziometacarpal osteoarthritis. Study 4 was a systematic review, conducted to determine evidence of efficacy of one surgical procedure over another. This review identified six randomised controlled trials of surgery for trapeziometacarpal osteoarthritis. While there was evidence of no difference in the reduction in weakness between the procedures, there was insufficient evidence to confirm that there was no difference in the outcomes of pain, contracture, hand function, or patient global assessment. Furthermore, there was sufficient evidence to conclude that trapeziectomy had significantly fewer adverse effects, and trapeziectomy with ligament reconstruction and tendon interposition (LRTI) had significantly more, when compared with the other procedures analysed in this review. It is suggested that the decision as to which intervention is most appropriate for a given patient be based upon the individual patient’s requirements, the extent of disease, and the demands placed upon the joint by domestic duties, work, leisure and recreational activities. The studies presented in this project assist in formulating preventative and management strategies for people with trapeziometacarpal osteoarthritis.

This study investigated the prevalence of thumb problems in Australian physiotherapists and the association between these thumb problems and various potential risk factors. Information concerning the nature and type of thumb problems experienced by physiotherapists was also sought. The study sample consisted of a random selection of physiotherapists identified from the registration lists held by the Physiotherapy Registration Boards of each Australian state and the Northern Territory. The measurement tool used in this study was a self-administered questionnaire that was sent to participating physiotherapists by mail. The questionnaire was purpose designed for this study and was based partly on previously used questionnaires that had investigated work related musculoskeletal disorders. In addition, the questionnaire was based on information obtained from informal discussions with colleagues and formal focus groups. As part of its development, the questionnaire underwent a number of pilot studies and a limited study investigating test-retest reliability. / Questionnaires were mailed to 1562 registered Australian physiotherapists, with a return rate of 70.6 per cent and a completion rate of 67.6 per cent. The sample of 961 respondents included in the study appeared representative of the population of Australian physiotherapists from which it was drawn, in terms of demographic data. The current prevalence of thumb problems was found to be 65.3 per cent (394 respondents) and the lifetime prevalence of thumb problems was 55.3 per cent (628 respondents). The factors that were found to be significantly associated with thumb problems included working in the area of orthopaedic outpatients (odds ratios 2.3-3.4), trigger point therapy (odds ratio 2.3) and massage (odds ratio 2.1); the presence of thumb joint hypermobility (odds ratio 2.2-2.6); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (odds ratio 5.0). Other factors such as the hours worked per week, years worked in an area of physiotherapy practice and the presence of general joint pathology did not increase the risk of thumb problems in this sample of Australian physiotherapists. / The symptoms most often reported by the 628 respondents with thumb problems were pain (90.1%) and instability (22.0%). The majority of the thumbs (57.0%) of respondents with thumb problems had been symptomatic for more than one year, but only 9.0 per cent of thumbs had caused symptoms on a daily basis over the last 12 months. The majority of respondents with thumb problems reported an insidious onset to their thumb problems that was related to their work as a physiotherapist (79.6%), with the onset occurring most frequently during the first five years after graduation. The metacarpophalangeal (MCP) joint was most commonly identified by respondents as being the source of their thumb problems (33.5%). While thumb symptoms did not affect activities to a marked degree, aching, pain and instability (of the MCP joint) were the symptoms that most often stopped activity. / Approximately half of the respondents (52.2%) with thumb problems in this sample had sought treatment for these problems, with taping the most commonly utilised treatment modality. For those physiotherapists with thumb problems, the thumb problems were found to have had a major effect on their career, with 19.1 per cent of those with thumb problems changing their field of physiotherapy practice and 4.0 per cent leaving the physiotherapy profession as a result of their thumb problems. / In conclusion, the prevalence of thumb problems in Australian physiotherapists appears to be high, and can be of sufficient intensity to impact on physiotherapists careers. Working in the area of manual therapy, having hypermobile thumb joints and being able unable to stabilise the joints of the thumbs whilst performing physiotherapy techniques appear to be particular risk factors for the development of thumb problems in physiotherapists. / Thesis (MApSc(Physiotherapy))--University of South Australia, 2005.

Doctor of Philosophy / The aim of the studies reported in this project was to examine factors associated with the prevention and management of trapeziometacarpal osteoarthritis, both in musculoskeletal physiotherapists and the general patient population. Two studies were undertaken to investigate factors associated with the aggravation of thumb pain in musculoskeletal physiotherapists. Study 1 was a survey of the prevalence of thumb pain, and allowed determination of the most aggravating spinal manipulative therapy technique. It identified that 83% of respondents complained of an aggravation of thumb pain due to the performance of spinal manipulative therapy techniques, with 85-87% of the painful respondents complaining of thumb pain aggravated by unilateral and central PA glides. Study 2 was conducted to determine whether the alignment of the joints of the thumb during performance of these glides was associated with thumb pain. This observational study of 129 musculoskeletal physiotherapists performing a PA glide identified that aligning the metacarpophalangeal and interphalangeal joints in extension was associated with a lower prevalence of work-related thumb pain. Therefore, it is suggested that musculoskeletal physiotherapists be taught to perform these techniques with the joints of their thumb in extension in an effort to reduce the development of work-related thumb pain. Furthermore, it is suggested that those who are unable to maintain this alignment voluntarily be provided with a thermoplastic thumb splint to maintain the extended alignment. Two studies were undertaken to investigate the conservative and surgical management of patients with trapeziometacarpal osteoarthritis. Study 3 was a randomised controlled trial conducted to compare the efficacy of a new thumb strap splint and an abduction exercise regimen against the standard approach to conservative management of trapeziometacarpal osteoarthritis, namely a short opponens splint and pinch exercise regimen. While there was no additional benefit of one approach over the other, all participants improved in the outcomes of pain, strength and hand function over the six-week period of intervention. Nevertheless, some people find that symptom relief from conservative intervention is inadequate and short-lived, requesting surgery for the treatment of disabling and persistent pain from trapeziometacarpal osteoarthritis. Study 4 was a systematic review, conducted to determine evidence of efficacy of one surgical procedure over another. This review identified six randomised controlled trials of surgery for trapeziometacarpal osteoarthritis. While there was evidence of no difference in the reduction in weakness between the procedures, there was insufficient evidence to confirm that there was no difference in the outcomes of pain, contracture, hand function, or patient global assessment. Furthermore, there was sufficient evidence to conclude that trapeziectomy had significantly fewer adverse effects, and trapeziectomy with ligament reconstruction and tendon interposition (LRTI) had significantly more, when compared with the other procedures analysed in this review. It is suggested that the decision as to which intervention is most appropriate for a given patient be based upon the individual patient’s requirements, the extent of disease, and the demands placed upon the joint by domestic duties, work, leisure and recreational activities. The studies presented in this project assist in formulating preventative and management strategies for people with trapeziometacarpal osteoarthritis.

Thesis (M.S.)--University of Michigan, 1958.