Directional preference of the wrist: a preliminary investigation

Maccio, Joseph R.; Carlton, Lindsay; Fink, Sarah; Ninan, Chanel; Vranken, Chandree Van; Biese, Garret; McGowan, Colin; Maccio, Joseph G.; Tranquillo, Julia

doi:10.1080/10669817.2017.1283767

Cited by 6 publications

(19 citation statements)

References 15 publications

(25 reference statements)

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“…Classification in the extremities is determined based on the patient's response to repeated end range movement testing into one of 4 main syndromes; Derangement, Dysfunction, Postural, or Other, which includes referral of symptoms from the spine [7] (see Table 1). Prevalence of the Derangement syndrome in peripheral joints has been reported from 40-79% in the literature [8][9][10][11]. A systematic review reported acceptable inter-rater reliability of MDT assessment in the peripheral joints [12].…”

Section: Introductionmentioning

confidence: 99%

“…Examination of a suspected Derangement seeks to identify a direction of preference, a physiological movement that results in rapidly improved pain and movement. The directional preference movement is then used as an intervention for the patient's condition, leading to favorable patient outcomes [7][8][9]11].…”

Section: Introductionmentioning

confidence: 99%

“…The current series is, to the author's knowledge, the only report of multiple patients treated by a PT. The current caseseries details three patients with MN and their successful outcomes one-year post-discharge following treatment with direction-specific exercise, often referred to as directional preference (DP) [7][8][9]11].…”

Section: Introductionmentioning

confidence: 99%

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Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

Post¹,

Maccio

2019

Journal of Manual & Manipulative Therapy

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Objectives: Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for MN are sparse, and utility of physical therapy (PT) is unknown. Mechanical Diagnosis and Therapy (MDT) is a classification system utilizing direction-specific treatment for orthopedic conditions based on mechanical and symptomatic response to repeated end range movements. The purpose of this case series is to describe the management of three patients with a medical diagnosis of MN using the MDT classification system. Methods: Three female patients aged 54-75 years with unilateral plantar forefoot pain for 6 weeks to 8 years were referred by a podiatrist following positive clinically accepted diagnostic criteria for MN including radiological imaging and provocation testing. Patients were evaluated and treated utilizing MDT assessment and treatment principles. The intervention consisted of repeated movements matched to the patient's directional preference at either the lumbar spine (1 patient) or distal extremity (2 patients). Results: Immediate and one-year outcomes were excellent, demonstrating rapid and lasting improvement. Following discharge, the patients have been asymptomatic or able to selfmanage without seeking additional medical intervention for this condition. Total visit frequency per patient averaged 2-3 visits total across 8-16 days. Discussion: Responses to repeated end range movements testing allowed for classification and prescription of exercise to rapidly improve symptoms and function in three patients referred to PT services with medically diagnosed MN. This series provides preliminary evidence that MDT may be effective in classifying and treating patients with MN.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

Post¹,

Maccio

2019

Journal of Manual & Manipulative Therapy

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“…The reported prevalence of MDT syndromes in peripheral joints includes the following: a survey finding 64% of 388 consecutive patients fitting an MDT syndrome [16], a randomized controlled trial finding 40% of 99 patients with knee OA awaiting total knee replacement surgery to be classified as Derangement syndrome [6], a case series finding 79% of 19 consecutive wrist patients classified as Derangement syndrome [17], and an observational study with 88.2% of 93 shoulder patients fitting an MDT classification [18]. A systematic review of six studies found the inter-rater reliability of MDT assessment to be acceptable between well-trained MDT clinicians in the spine and extremity joints [19].…”

Section: Introductionmentioning

confidence: 99%

“…In attempt to increase the ability and confidence of clinicians using MDT peripheral assessment, Maccio et al [17] examined the historical and physical characteristics of consecutive wrist patients, to determine association with directional preference. The most significant finding was an inverse relationship of excessive mechanical stress and directional preference in wrist Derangement syndrome (i.e.…”

Section: Introductionmentioning

confidence: 99%

Directional preference of the extremity: a preliminary investigation

Maccio

Carlton

Levesque

et al. 2018

Journal of Manual & Manipulative Therapy

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Background: Mechanical diagnosis and therapy (MDT) is a specific classification-based musculoskeletal examination and intervention system that uses repeated end range and sustained movement to classify patients into mechanical syndromes. Research has recently demonstrated increased prevalence, reliability, and efficacy of MDT syndromes in varied peripheral musculoskeletal populations. There is currently no research analyzing if predictive variables exist for establishing directional preference in peripheral joints, other than the wrist. The aim of this study was to examine the clinical application of predictive variables for establishing directional preference and spinal referral in patients with isolated peripheral joint pain. Case Description: Thirty-seven consecutive patients with isolated peripheral pain were evaluated and classified using MDT assessment. Secondary analysis of predetermined variables was performed for association with directional preference and identification of spinal referral in Derangement syndrome. Results: All 37 patients were classified using MDT assessment. Thirty-three (89.2%) were classified as Derangement syndrome: 17 as spinal Derangement (45.9%) and 16 as peripheral Derangement (43.2%). One peripheral derangement also had an underlying Articular Dysfunction. Additionally, there were four patients classified as Other (10.8%). Discussion: Historical and physical examination findings were analyzed to determine if there were associated variables of directional preference or spinal referral. Mechanical stress was found to be the most associated factor in predicting directional preference. No peripheral movement loss, paresthesia, and constant pain were more associated with spinal referral. These findings may lead to a greater understanding of peripheral MDT assessment, which may lead to increased identification of directional preference and improved patient outcomes.

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