Testing overwork weakness in Charcot‐Marie‐tooth disease: Is it true or false?

Abstract

The occurrence of the overwork weakness (OW) in Charcot-Marie-tooth (CMT) disease has been debated for a long time. Especially at the hands level, it is still unclear as to whether OW occurs. Contrasting results may relate to the different muscle groups evaluated and the instruments used. We concentrated to the upper limbs (UL). We recruited 120 subjects, 60 CMT patients and 60 normal controls and evaluated the strength of the tripod pinch and of the hand-grip with a dynamometer, the opposition ability with the thumb opposition test (TOT) and applied an innovative instrumental testing of hand function using the sensor engineered glove test (SEGT), which previously demonstrated its sensitiveness to measure severity of hands dysfunction in CMT patients. In CMT patients, TOT scores were significantly higher in the non-dominant hand (NDH) compared to dominant hand (DH), strength in the NDH was slightly but not significantly better than the DH. Finally, SEGT results were similar between the NDH and DH, whereas in normal controls the DH performed better. In conclusion, this study supports the existence of the overwork weakness in CMT. We can speculate that the dexterity and overall ability of the hands appear more impaired in the DH as a result of a weakness and incapacity of opposition. Our results support the importance of avoiding supramaximal exercises and educating patients to prevent incorrect movements.

Hand Rehabilitation Treatment for Charcot-Marie-Tooth Disease: An Open Label Pilot Study

“…At the baseline, all the measured parameters show an impairment of the strength, of the articularity and the functionality of the hand compared to previously published data normal controls [18].…”

“…The rehabilitation protocol was based on submaximal exercises, specially to avoid the overwork weakness effect [18] and at the same time improve the dexterity and the global functionality of the hand.…”

“…The duration and the frequency has been determined inspiring to some papers about the hand rehabilitation in chronic and acute diseases because, as already mentioned, literature about this argument is still lacking [16,17]. Furthermore, we choose a low frequency of session to avoid an overuse [18]. Exercises had been listed (Table 2) and three professional physiotherapists followed them scrupulously alternating each other in the sessions.…”

“…While muscle recruitment and stretching exercises had been maintained the same over the 4 weeks, proprioceptive exercises had progressed. All exercises were performed alternating right and left hand and respecting a time of rest avoiding the overwork weakness [18]. Therapists made attention to the quality and the quantity of movements, searching the best activation of the single muscles.…”

The suspected SARS-Cov-2 infection in a Charcot-Marie-Tooth patient undergoing postsurgical rehabilitation: the value of telerehabilitation for evaluation and continuing treatment

“…The focus was on the recovery of the joint range of motion with passive and active exercises of the thumb and the ring finger and, progressively, the use of rubber band and Theraputty paste. Exercises were dosed to avoid overwork weakness, which can occur in this neuropathy (Vinci et al, 2003;van Pomeren et al, 2009;Prada et al, 2018). Physiotherapy proceeded until 4 March 2020, when it was suspended because of the upcoming Italian lockdown date (March 9).…”