Orthotics and magnetic solutions for wrist and carpal tunnel - Auris

Elbow / Hand / Wrist

The powerful AURIS therapeutic magnets provide relief to many diseases such as osteoarthritis, tendinopathies and musculoskeletal disorders (MSDs). Designed and developed in our R&D department, they combined lightness, efficiency and comfort. They are suitable for both men and women, right handed or left handed.

Carpal tunnel syndrome

In the wrist, the median nerve and flexor tendons of the fingers pass through a relatively narrow “tunnel” called the carpal tunnel. Any condition that reduces this space, such as inflammation that thickens the tendon sheaths, causes a compression of the median nerve.

Carpal tunnel syndrome affects approximately 11% of women and 3.5% of men. It tends to appear either in the early fifties or after the age of 75. Symptoms are mild and transient at first, and then intensify overtime.

Osteoarthritis of the base of the thumb or rhizarthrosis

Although osteoarthritis is, in general, the most common joint disease, it still does not benefit from significant therapeutic progress. In practice, we have anti-inflammatory drugs and intra-articular cortisone to relieve the symptoms but little or nothing to actually prevent the disease, i.e to delay the destruction of the cartilage.

Structural-modulatory treatments have not yet shown formal proof of an effective action.

In fact, international recommendations for the management of osteoarthritis emphasise non-pharmacological treatments including orthosis.

Trapeziometacarpal osteoarthritis is, with osteoarthritis of the distal interphalangeal joints, one of the most common of the hand. It was named rhizarthrosis by Forestier in 1937. It is an essential osteoarthritis corresponding classically to “Chronic wear and tear of the cartilage” that covers the trapezium and the first metacarpal at the base of the thumb. This is precisely the case for rhizarthrosis.. If the pathogenesis of this condition is still obscure, joint morphological changes, ligament hyperlaxity, a hormonal cause due to its predominance in women after menopause, repetitive occupational gestures occurring on a predisposed ground with work using thumb clamp index, are all factors mentioned in the onset of the condition. More recently, a meta-analysis showed an association between obesity and digital osteoarthritis : adipose tissue releasing mediators, adipokines, which may act on the supporting and non-carrying joints.

Disabling disease for clamp movement

Rhizarthrosis is particularly troublesome because the joint concerned is the one that allows the clamp movements. Pain is most often the first symptom, either spontaneous or in certains gestures of daily life such as turning a key, peeling fruit or opening a jar. It is a mechanical pain but in the event of a congestive flare with synovial inflammation, swelling, heat and redness, the pain becomes permanent. It is a fundamental articulation of the thumb column, which allows the pulp of the thumb to be oriented in opposition to the other fingers (pollici digital clamp) for good gripping movements. This joint is closed by an articular capsule whose reinforcements form the ligaments that ensure its stability with the surrounding muscles.

What treatment for osteoarthritis of the hand?

Initially, the treatment is still medical with the following objectives:

  • to reduce pain
  • and to preserve joint amplitude

It combines rest, painkillers containing paracetamol up to a maximum of 4 grams per day, anti-inflammatory drugs in case of a congestive flare but for as little time as possible to limit any side effects. A corticosteroid infiltration may help to pass the hyperalgesic inflammatory period, but its repetition may alter the capsular ligament apparatus, which will complicate a possible surgical procedure. It is empirically recommended in the world of rheumatologists
not to exceed 3 corticosteroid infiltrations per year in the same joint.

Many studies have shown the efficacy of hyaluronic acid injection in this condition. However, the number and timing of injections are not clearly defined and the studies do not indicate whether or not it is preferable to offer treatment at an early stage of rhizarthrosis as it is offered for knee arthrosis prior to major joint damage. Finally, this treatment with hyaluronic acid is not covered by the French Social Security. Slow-acting anti-arthritis drugs (e.g. glucosamine, chondroitin, diacerhein, avocado unsaponifiables) are commonly prescribed but their efficacy has not been demonstrated yet. Nevertheless, they are a useful help in offering treatment to patients suffering and seeking relief...Treatment is usually offered for at least 4 to 6 months, but these treatments are not covered by the Sickness Insurance (social security) either...

According to the recommendations of the EULAR (European League Against Rheumatism) since 2006 [11], topics (NSAID ointments and capsaicin-based ointments) are a useful aid in morning and evening application.

Wearing orthoses as a first line

During the congress of the French Society of Rheumatology in December 2013, an original work was presented. This was a study on patient satisfaction and efficacy and observance of rheumatological hand and wrist orthoses in 957 dispensations in pharmacies. The conclusion is binal: “On one side, hand and wrist orthoses satisfy the patients by providing them with rapid and significant relief. This satisfaction is very important as the prescription is
early and the orthosis is suitable and specific, which favours its observance. On the other hand, orthoses should be considered more as first-line physical treatments than second-line treatments after drug means have failed”. Finally, one of the best approaches to treating rhizarthrosis remains non-pharmacological with the design of an orthosis that keeps the thumb in a resting position. It should be remembered that the trapeziometacarpal joint works continuously in compression thanks to a specific ligament system, the trapezium being a real keystone in the distribution of pressure forces from the tip of the clamp to the wrist: for a force of 1 kg exerted on a pollici digital pressure, the compressive force trapeziometacarpal is 12 kg. A firm hold of this joint will therefore be preferred to an elastic hold, which is ineffective in relation to the forces involved.

It is therefore very interesting to be able to adapt a specific comfortable orthosis that respects the movement and has an innovative analgesic effect specific to be worn day and night if necessary, hence the idea of this work on the Auris magnetic orthosis.

Mode of action of the magnetic fields

Medical magnets stimulate the secretion of our powerful endogenous opioids to relieve us.

Permanent magnets allow to restore the original magnetic field of the damaged area, which can only contribute to a return to normal of the diseased area and thus help to stabilise a lesion and even to heal. This is called the return to the state of magnetic homeostasis.

In terms of tolerance, magnetotherapy is exceptional

What conclusion?

Rhizarthrosis is a common disease, usually well tolerated with 80% good responders to medical pain treatment. The value of orthosis wearing is demonstrated for its effectiveness in reducing pain and improving function according to the HAS report of January 2010. However, there is room for surgical treatment if pain treatment fails.

Auris, with its experience in the field of magnetic therapy, has developed a suitable orthosis, the Wondermag magnetic fingertips. Thanks to its 3D design, the orthosis perfectly moulds the thumb but also wraps the wrist while preserving opposing finger thumb movements, round pollici digital grasp and flat index thumb clamps.

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