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Return to play and outcomes of surgically treated upper limb nerve entrapment in athletes: A systematic review. Lawand, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Surgery for nerve entrapment - Return to sport This systematic review assessed return-to-play (RTP) rates following surgical treatment of upper limb nerve entrapment in athletes. Upper limb nerve entrapment often results from repetitive stress, trauma, and sport-specific biomechanics. Surgical intervention is considered when conservative treatments fail, aiming to restore nerve function and enable athletes to return to their previous performance levels. The review followed the PRISMA guidelines and analysed 31 studies involving 1,297 athletes across 23 sports. Ulnar, brachial plexus, and suprascapular nerves were most commonly affected. Surgical techniques varied, including ulnar nerve decompression, first rib resection for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. Return to sport rates averaged 87%, with suprascapular nerve decompression showing the highest success (100%). TOS outcomes showed greater variability (63–97%). The overall complication rate was low, though TOS had higher reoperation rates. The study highlights surgery's effectiveness in facilitating return to sport and functional recovery for athletes with nerve entrapment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, surgically treating upper limb nerve entrapment in athletes consistently leads to high return-to-play rates and functional recovery. Surgical interventions, particularly for the ulnar and suprascapular nerves, have shown reliable success. However, thoracic outlet syndrome surgeries exhibit more variability in outcomes. Thus, careful patient selection and individualised surgical approaches are crucial for optimising results in nerve decompression surgeries. URL : https://doi.org/10.1007/s00264-025-06473-9 Abstract Purpose: Athletes face a higher risk of upper limb nerve entrapment due to repetitive stress, trauma, and biomechanics. Diagnosis is challenging, and delayed treatment can impair performance. When conservative care fails, surgery may be needed to restore function and enable return to play (RTP). Methods: This systematic review adhered to PRISMA guidelines and evaluated surgical outcomes, RTP rates, and complications in athletes with upper limb nerve entrapment. A comprehensive search was conducted using MeSH terms and keywords for surgical interventions, nerve entrapment syndromes, and sports. Eligible studies included case series, cohort studies, and comparative studies that reported postoperative outcomes in athletes. Data extraction included nerve involvement, surgical techniques, clinical outcomes, and RTP rates. Results: Thirty-one studies, comprising 1,297 athletes across 23 sports, were included. The most common nerve entrapments involved the ulnar nerve (50.1%), brachial plexus (39.2%), and suprascapular nerve (9.5%). Surgical interventions included ulnar nerve decompression/transposition, first rib resection with scalenectomy for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. RTP rates ranged from 62 to 100%, with an average of 87%. Suprascapular nerve decompression had the highest RTP success (100%), while TOS demonstrated greater variability (62.5–97%). Functional improvements included pain reduction, increased grip strength, and enhanced patient-reported outcomes. The overall complication rate was low, but TOS procedures had the highest reoperation rates (3.8–27%). Conclusion: Surgical treatment of upper limb nerve entrapment in athletes yields high RTP rates and functional recovery. Ulnar and suprascapular nerve decompressions show consistent success, while TOS surgery outcomes vary. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Clinical effectiveness of an orthosis after collagenase clostridium histolyticum injection for dupuytren contracture. Dent, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Splinting - Collagenase Clostridium Histolyticum for Dupuytren This randomised controlled study evaluates the effectiveness of a nighttime splint following Collagenase Clostridium Histolyticum (CCH) treatment for Dupuytren contracture. A total of 79 patients were split into two groups: one using a splint and the other not. The splint aimed at improving mcpj or pipj contracture, however, there is limited information about the type of splint. After 4 months, the splint group showed significantly lower contracture, specifically at the proximal interphalangeal (PIP) joints, compared to those without. However, there was no difference between groups when the mcpj was assessed. Reportedly, compliance decreased over time, with 52% adhering to orthosis use most nights by the fourth month. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, post-treatment with Collagenase Clostridium Histolyticum (CCH) for Dupuytren's contracture, a night splint for proximal interphalangeal joint contractures worn over four months, may help improving range of movement. However, considering the lack of change in mcpj flexion deformity, the limited time patients were wearing the splint, and previous meta-analysis on the topic , it is unlikely that the splint would have a large effect size. Have a look at the whole database on the topic . URL : https://doi.org/10.1016/j.jhsa.2025.01.023 Abstract Purpose: Dupuytren contracture is a fibroproliferative disorder forming fascial cords in the hand. Collagenase clostridium histolyticum (CCH) is an alternative treatment to surgery. Current recommendations include nighttime extension orthosis after CCH for 4 months. Our purpose was to evaluate the effectiveness of night orthosis following CCH treatment. Methods: The study was a prospective, randomized, controlled trial at a single institution. Patients with Dupuytren contracture of one or more digits treated with CCH from May 2021 to 2023 were screened. Eighty patients were enrolled and randomized between groups (a nighttime orthosis or no nighttime orthosis). The orthosis group was instructed to wear an extension orthosis nightly until 4 months. Baseline, postmanipulation, and 1-month, and 4-month flexion contractures were collected. QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and splint compliance surveys were collected at 1 and 4 months. Skin tears and adverse events were recorded. Results: There were 39 orthosis patients, and 40 nonorthosis patients who received CCH treatment. A total of 119 joints were treated, including 66 metacarpophalangeal (MCP) and 53 proximal interphalangeal (PIP) joints. Seventy-six and 69 patients completed 1- and 4-month follow-up. Baseline characteristics were similar between two groups. Mean baseline flexion contracture for all joints was 48° and 55° for the orthosis and nonorthosis groups, respectively. The orthosis group had significantly lower residual contracture at 4 months (11° vs 20°). No difference was found at any time for MCP joints. PIP joints in the orthosis group had significantly lower contracture at 1 and 4 months (13° vs 28°; 19° vs 36°). Reported compliance with orthosis was 79% at least “Most of the Time” at 1 month and 52% at least “Half of the Time” at 4 months. Conclusions: Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The arm curl score is the best indicator of reduced upper extremity exercise capacity in women with fibromyalgia: A cross-sectional study. Durdu, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Upper limb strength - Fibromyalgia This cross sectional study assessed upper extremity exercise capacity in women with fibromyalgia (FM), comparing it with age-matched healthy controls. A total of 94 women were included in the study. Of these, 48 had FM and 48 were healthy controls. Using the Six Minute Pegboard and Ring Test (6PBRT) along with various muscle strength and flexibility assessments, the results showed that women with FM had significantly reduced upper extremity exercise capacity, muscle strength, and flexibility. The multivariate analysis indicated that upper extremity exercise capacity were best predicted by a model including the arm curl score, hand grip strength, disability scores, and overall disease impact, with arm curl scores being the most significant predictor. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the arm curl score is a robust predictor of upper extremity exercise capacity in women with fibromyalgia. Given the significant relationship between upper extremity muscle strength and daily activity performance, it is possible that incorporating specific strengthening exercises for the upper limb may effectively enhance upper extremity exercise capacity in women with fibromyalgia. The goals of such exercises would not be to reduce pain , but increase patients' function. URL : https://doi.org/10.1016/j.jht.2024.12.012 Abstract Background: Unsupported upper extremity exercise capacity (UUEEC) is crucial for sustaining everyday functions; whether it is compromised in the fibromyalgia (FM) population is unknown. Purpose: The study aimed to assess UUEEC in women with FM and to determine associated factors. Study Design: This is a cross-sectional study. Methods: This study was conducted with 48 women with FM and 48 healthy women between the ages of 18–65. UUEEC, muscle strength, flexibility and disability of upper extremity, disease severity, pain catastrophizing, and quality of life assessed with the Six Minute Pegboard and Ring Test (6PBRT), arm curl test, hand grip strength test, back-scratch test, Disability of Arm, Shoulder, and Hand (DASH), Fibromyalgia Impact Questionnaire (FIQ) and Pain Catastrophizing Scale and Short-form 36 questionnaires, respectively. Results: The 6PBRT score was significantly decreased in the women with FM compared to healthy women (p < 0.001, Cohen d: 1.28). The multivariate linear regression analysis revealed that the model incorporating the arm curl score, hand grip strength, DASH, and FIQ scores was explained 68% of the variance in 6PBRT score (R2 = 0.672, p < 0.001). The results indicated that all variables in the model were independent predictors of 6PBRT score, with the arm curl score was the strongest predictor (β = 6.36, p = 0.015). Conclusions: This study suggests that UUEEC measured by 6PBRT is reduced in women with FM, and the upper extremity muscle strength is closely related to the 6PBRT score. Accordingly, strengthening the biceps brachii muscle in women with FM, whose muscle weakness is common, may be effective in improving UUEEC, which is directly associated to daily activities. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

‘The treatable triad’ long-term functional results of surgically treated acute isolated terrible triad injuries: An 18-year follow-up. Ormiston, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : The treatable triad - Long term outcomes This prospective study assessed the long-term functional outcomes of patients who underwent surgical treatment for the terrible triad elbow injury, comprising radial head fracture, coronoid process fracture, and posterior dislocation. A total of 20 patients were followed up from surgery for up to 20 years. The results showed that 90% of the patients achieved excellent functional outcomes. Notably, the mean Mayo Elbow Performance Score was 88, and the Disabilities of the Arm, Shoulder, and Hand score averaged 12/100. Despite a 40% reoperation rate, these were predominantly minor procedures, with no severe negative impact on patients' functional status. The study suggests early surgical intervention and the use of a standardised protocol comprising radial head fixation or replacement, lateral ulnar collateral ligament repair, and coronoid fixation can lead to sustained long-term recovery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Base on what we know today, surgical treatment of terrible triad injuries yields favorable long-term functional outcomes. With an average Mayo Elbow Performance Score of 88 after nearly two decades, and a DASH score indicative of minimal disability, patients can expect sustained improvements in elbow function. The findings highlight the importance of structured surgical protocols to ensure optimal recovery, thus transforming the previously dismal outlook for such injuries. As surgical interventions for these injuries continue to evolve, it is crucial to manage patient expectations, acknowledging the possibility of minor surgical revisions while emphasising the potential for high levels of function and satisfaction with early intervention. These findings are in line with another recent paper, which brought us to suggest renaming the "terrible triad" to "manageable triad" . Also remember that postoperative mobilisation strategies that emphasise early activity may provide better functional recovery for this condition . URL : https://doi.org/10.1016/j.jse.2024.06.023 Abstract Background: Surgical techniques for terrible triad injuries developed 20 years ago. Good and excellent short- and medium-term functional results have been reported. No long-term (over 10 years) functional outcomes have previously been reported. This case-series is the longest follow-up of patients treated for acute isolated terrible triad injuries using a standard treatment protocol. Methods: Twenty patients with acute, isolated, surgically managed terrible triad injuries were treated between October 2001 and May 2008. Ten of these patients were seen face-to face for a clinical follow-up and if required a radiological assessment. Mayo Elbow Performance Scores (MEPSs) and Disabilities of the Arm, Shoulder and Hand (DASH) scores, requirement for further surgery and elbow instability were recorded. Results: The average length of follow-up was 18.8 years. The mean Mayo Elbow Performance Score was 88 and the mean Disability of the Arm, Shoulder and Hand score was 12.3. The average loss of pronation was 8°. The average loss of supination was 13°. The reoperation rate was 40%, only one of these was a functionally limiting operation. A trend toward osteoarthritis was observed but there were no conversions to total elbow replacement. Discussion: This is the longest-term follow-up study of these injuries and demonstrates the functional performance that the majority of patients achieve. The low follow-up rate can be expected with such a long interval between treatment and assessment. A relatively high reoperation rate is largely made up of minor procedures (removal of metalwork and cubital tunnel release) which did not impact the patients' functional status. This study adds to the evidence that the terrible triad of the elbow is surgically treatable to allow a high functional standard not only in the short-term but also in the long term. As such this is a useful adjunct to have both when informing patients of what can be expected in their long-term recovery from this injury. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Evaluation of hand function using relative motion extension concept (with or without night wrist orthosis) or dynamic extension orthosis for extensor tendon injuries in zones 4–6: A randomized controlled trial. Bojnec, et al. (2025) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : RME only - Extensors zone 5 and 6 This ransomised controlled study assessed the effect of three different rehabilitation protocols on extensors zones 4–6 repair. In particular, a Dynamic Extension Orthosis (DEO), a Relative Motion Extension (RME) alone, and RME with a night wrist splint were compared. Fifty participants were randomised into these three groups. The outcomes measured included hand functionality via the Jebsen–Taylor hand function test (JTHFT), grip strength, range of motion (TAM), QuickDASH, and Patient Evaluation Measure (PEM). The study found that both RME protocols resulted in better early recovery of hand function, mobility, and strength than the DEO group. No significant differences were noted between RME-only and RME-plus groups, suggesting the RME-only approach is safe and effective. No tendon ruptures were reported, indicating all protocols were safe for rehabilitation. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a Relative Motion Extension (RME) protocol for rehabilitation after extensor tendon injuries in extensors zones 4–6 is superior to a Dynamic Extension Orthosis (DEO) protocol. Thus people appear to regain hand function, range of motion, and grip strength more quickly. These results appear to be in contrast with another recent study showing that RME and DEO approaches had similar outcomes . When the current study assessed RME-only vs RME-plus a wrist splint they appeared to be equally effective, suggesting that the simpler RME-only protocol may be a safe and efficient choice for single extensor tendon injuries. URL : https://doi.org/10.3390/life15020249 Abstract This study aimed to compare outcomes of early active motion (EAM) using the relative motion extension (RME) approach to outcomes of early passive motion (EPM) with a dynamic extension orthosis (DEO) and to evaluate whether the RME-only approach is equivalent to the RME-plus approach. Fifty adults were randomized into one of the three intervention groups receiving the DEO, RME only, or RME plus orthosis. The score of the Jebsen–Taylor hand function test (JTHFT) without writing and QuickDASH at T1, all measures of mobility at T1 and T2, and grip strength were better in the RME-only and RME-plus group compared to the DEO group, whereas the values of Patient Evaluation Measure (PEM) at T1 and T2, as well as QuickDASH score at T2, orthosis adherence, and the patient’s comfort while wearing the orthoses did not statistically significantly differ among the three groups. The RME concept after extensor tendon injuries in zones 4–6 is superior to the DEO protocol in terms of earlier regain of hand function. The DEO and RME protocols were equivalent regarding patients’ adherence and satisfaction with the orthosis. We found no differences in the RME-plus and RME-only protocols, indicating the safe use of the RME-only protocol in single extensor tendon injuries in zones 4–6. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Use of a remote assessment pathway for diagnosis of carpal tunnel syndrome. Macdonald, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Topic : Carpal tunnel screening - Remote pathway The retrospective study investigated a remote assessment pathway for diagnosing carpal tunnel syndrome (CTS), implemented during the COVID-19 pandemic, by using the Kamath and Stothard carpal tunnel questionnaire in a nurse-led telephone clinic. Patients with scores of 3 or higher were referred for nerve conduction studies or reviewed by a consultant hand surgeon. The study assessed the cost-effectiveness and diagnostic efficacy of this remote pathway compared to the previous in-person system. Results showed that a score of 3 or above predicted CTS in 83% of cases, resulting in cost savings of approximately £24,436. While effective in reducing in-person consultations, the remote pathway may have shortcomings in management, such as over-reliance on nerve conduction studies without sufficient clinical evaluation, possibly leading to unnecessary surgeries. Recommendations include refining assessment criteria and utilising more effective diagnostic tools to enhance the pathway's accuracy and efficiency. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, utilising a remote assessment pathway for carpal tunnel syndrome has demonstrated promising cost-effectiveness compared to traditional in-person consultations. The remote use of the Kamath and Stothard questionnaire (see above), supported by nerve conduction studies if required, accurately predicts CTS in most cases, effectively streamlining the diagnostic process. This approach not only reduces direct healthcare costs but also offers an adaptable model for future telemedicine implementations. If you woul like to have a look a the whole database on CTS, have a look at the whole database on the topic . URL : https://doi.org/10.1177/17531934241270347 Abstract We undertook a retrospective cohort study of a remote carpal tunnel syndrome assessment pathway created in response to limitations caused by the COVID-19 pandemic. Between July 2020 and September 2021, 702 patients referred from primary care (general practice) were assessed in a nurse-led telephone clinic using the carpal tunnel questionnaire of Kamath and Stothard (2003) . Depending on their questionnaire score, patients were referred either for nerve conduction studies or a consultant hand surgeon review for diagnosis and treatment planning. Questionnaire scores of 3 and above accurately predicted a likely diagnosis of carpal tunnel syndrome in 83% of patients, and a diagnosis was unlikely in 90% of those with a score below 3. The pathway resulted in an estimated cost savings of £24,436 (€28,862, US$30,945) in comparison with the pre-pandemic service. However, some limitations in the pathway may have impacted effective patient management and we suggest possible improvements. Level of evidence: III publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Shear wave elastography ultrasound assessment of the ulnar collateral ligament in the elbow of college baseball players. Lee, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Elbow UCL - stiffness This study explores the use of shear wave velocity (SWV) to assess the ulnar collateral ligament (UCL) elasticity in college baseball players, particularly focusing on its correlation with valgus laxity of the elbow joint. Thirty healthy male athletes, free from elbow pain and previous UCL injuries, were evaluated using SWE under both resting and valgus stress conditions. Results indicated a significant increase in the ulnohumeral gap, especially in throwing arms, under valgus stress conditions. Notably, a reduced shear wave velocity (SWV), indicating decreased tissue elasticity, was observed in arms showing increased joint gaps. These ligaments were not only less stiff but also thicker. Relying solely on ligament thickness may not be sufficient to determine its biomechanical effect. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, repetitive throwing motions in baseball players can lead to increased joint laxity, which is associated with increase flexibility and thickness of the UCL. It seems that such changes are due to repeated loading of the UCL as it seems that a single session of pitching by itself is not sufficient to change the biomechanical properties of the ligament . URL : https://doi.org/10.1016/j.jse.2025.01.027 Abstract Background: The ulnar collateral ligament (UCL) stabilizes the elbow during overhead throwing activities. Repetitive throwing can cause valgus laxity even without injury. Shear-wave ultrasound elastography (SWE) is a novel imaging technique that assesses tissue elasticity. This study aimed to assess UCL elasticity in college baseball players using SWE under resting and valgus stress conditions. Methods: The study included 30 healthy male college baseball players (mean age 20.48 ± 1.34 years). The dominant and non-dominant arms of participants were examined, excluding those with a history of UCL injury. UCL thickness was measured using conventional ultrasound, and elastography was conducted at the same sites. Measurements were repeated under valgus stress, and the ulnohumeral joint gap was recorded. Participants were categorized into throwing and non-throwing arm groups. A subgroup analysis of the throwing arm was conducted based on joint laxity, defined as an increase of >1 mm in the ulnohumeral joint gap under valgus stress, which is associated with UCL injury and joint laxity. Correlations between UCL evaluation parameters and changes in ulnohumeral gap were analyzed. Results: Out of 54 elbows, 26 were classified as throwing and 28 as non-throwing. The throwing group had a significant increase in the ulnohumeral gap compared to the non-throwing group. The ulnohumeral gap under valgus stress increased from 0.59 to 0.72 cm (p=0.01). There was no significant difference in shear-wave velocity (SWV) between the two groups. Within the throwing group, 13 elbows were classified as lax arms and 15 as non-lax arms. The SWV of the lax arms (6.71 ± 4.59 m/s) was significantly lower than that of the non-lax arms (8.54 ± 5.17 m/s) (p=0.045). Multiple regression analysis showed that UCL thickness and SWV were independently correlated with the rate of change in the ulnohumeral gap (ß=0.335, p=0.018 and ß=-0.319, p=0.013, respectively). Conclusion: Valgus laxity of the elbow joint can be evaluated based on the elasticity of the UCL measured above the joint line using SWE at rest. Thickened UCL may exhibit a decrease in function; therefore, physicians should not evaluate the joint status solely on the basis of the structural properties on conventional ultrasound. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Patient-centered care in the conservative management of an unstable proximal phalanx fracture: A case report. Cole, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : Unstable proximal phalanx fracture - Conservative or surgical management? This case report explores the management of a challenging unstable proximal phalanx fracture in a 56-year-old male, with a focus on patient-centered care. After a football injury (see x-ray below), the patient underwent two local anesthetic and manipulation procedures (LAMP). Following reduction, the patient was placed in hand based splint. Despite the advice, the patient went to the gym, utilised their hand and took place into all their activities whilst wearing the splint. Due to objective evidence of ulnar deviation of the little finger upon splint removal, an additional x-ray was completed and showed loss of reduction (see figure below). An additional LAMP instead of surgical intervention was performed as per patient's preference. Following this procedure, the patient resumed wearing the hand based splint. By 12 weeks following the second LAMP, the patient had regained full range of motion reporting no pain. They were able to return to all daily activities, including manual labor, and gym workouts. As you can see from the latest x-ray image, alignment was better than what they had started with. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, conservative management, even in cases of initially unstable proximal phalanx fractures, can result in acceptable patient outcomes. This approach underscores the value of a tailored, patient-focused strategy where surgical intervention can be reserved for cases where nonsurgical methods do not achieve the desired outcomes. If you would like additional evidence on the possibility of conservative treatment for phalangeal fractures have a look at this synopsis . Several other hand fractures, like metacarpal ones, can be managed conservatively despite past believes that they had to be treated surgically . URL : https://doi.org/10.1016/j.jht.2024.12.008 Abstract Background: Proximal phalangeal fractures are common yet challenging due to their inherent instability. Purpose: This study presents a case for patient-centered care and a nonsurgical management pathway. Study Design: Case report. Methods: M, a 56-year-old male, sustained a comminuted oblique proximal phalanx fracture to his left nondominant small finger while playing football. Five days post injury, the fracture was reduced with local anesthetic and manipulation (LAMP). The injury was managed conservatively with a full-time hand-based orthosis with metacarpophalangeal joint flexion, and buddy taping. One week later, the fracture had lost reduction and significantly displaced. Instead of converting to surgery, a further LAMP (LAMP2) was performed, and conservative management continued. Outcomes were collected at baseline, 6, 12, and 15 weeks, and 10 months following LAMP2. Results: By 12 weeks, M had a full range of motion, minimal pain, no difficulty with personal daily activities, and resumed full manual labor work duties and gym workouts. Quality of life was reported as high from 6 weeks. M was extremely satisfied. Conclusions: Conservative management of an initially unstable proximal phalanx reduced by LAMP, with a second LAMP one week later, demonstrated excellent outcomes and could be a possible management pathway for similar patients. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Kinematics of trapeziometacarpal joint during first dorsal interosseous maneuver in osteoarthritic patients: An imaging study using real-time magnetic resonance imaging and ultrasonography. Ooishi, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : First dorsal interosseous - Thumb OA This study explored the effectiveness of the First Dorsal Interosseous (FDI) exercise in patients with trapeziometacarpal osteoarthritis (cmcj OA) using real-time MRI and ultrasound. The study assessed ten patients with cmcj OA and ten healthy individuals. Results indicated that in cmcj OA patients, the FDI maneuver resulted in greater radial translation and ulnar/dorsal tilt of the first metacarpal, as well as reduced FDI muscle volume compared to healthy thumbs. Patients showed increased dorsal subluxation during the maneuver. Following a month of therapy including splint wear and FDI exercises, pain and pinch strength improved, although kinematic changes did not correlate with these improvements. The study concluded that FDI exercises might not be beneficial and could worsen subluxation in cmcj OA patients due to muscle imbalances, suggesting that such exercises should be avoided for these patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, patients with cmcj OA exhibit greater dorsal subluxation during first dorsal interosseous (FDI) exercises. Hence, the theory that FDI activation can reduce such biomechanical behavior does nor appear to be real. Interestingly, patients' pain improved over a period of conservative treatment, however, this was not associated with cmcj biomechanical changes. If you want to know more about thumb OA, have a look at the whole database . URL : https://doi.org/10.1016/j.jhsa.2024.12.018 Abstract Purpose: First dorsal interosseous (FDI) exercise is a dynamic stability exercise recommended for patients with trapeziometacarpal osteoarthritis (TMC-OA), although its biomechanical efficacy has only been examined in healthy subjects. This study used real-time magnetic resonance imaging (MRI) and ultrasonography to elucidate the kinematic effects of the FDI maneuver used for the treatment of TMC-OA. Methods: Using a real-time MRI protocol developed for continuous imaging of TMC movements, TMC joints were examined in 10 end-stage patients with TMC-OA and 10 thumbs of five healthy volunteers while performing FDI maneuvers. Changes in translation and tilt of the first metacarpal (MC1) were evaluated using sagittal and coronal images, and FDI volume was analyzed. Based on TMC joint kinematics determined according to dynamic ultrasound observations, the subjects were classified into three groups. Patients with TMC-OA received hand therapy with orthosis and FDI exercise for a period of 1 month. Results: Magnetic Resonance Imaging analyses of the TMC-OA patients demonstrated that radial translation and ulnar/dorsal tilt of the MC1 were significantly greater, whereas FDI volume was significantly lower than healthy thumbs. Results of ultrasound analyses showed increased dorsal subluxation of the TMC joint in six patients with TMC-OA. These values were decreased in six healthy thumbs and unchanged in the remaining thumbs. All of the patients with TMC-OA demonstrated significantly improved pain intensity and pinch strength following implementation of the therapy program, although no direct correlations with MC1 kinematic alterations of were noted. Conclusions: Thumbs in patients with TMC-OA and healthy thumbs have different kinematics during FDI maneuvers. An atrophic FDI may not be an efficient dynamic stabilizer for TMC-OA. In patients with a subluxated TMC-OA, the FDI maneuver was ineffective or caused exacerbation, contradicting previous findings. For a goal of improving dynamic stability in patients with TMC-OA, FDI exercise should be avoided. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A comparison between two intervals of daily total end range time for treatment of proximal interphalangeal joint flexion contracture using an elastic tension digital neoprene orthosis. Punsola-Izard, et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : TERT - Range of movement This randomised controlled study assessed the effect of daily Total End Range Time (TERT) on treating proximal interphalangeal joint flexion contractures using a neoprene splint. Fifty patients (57 fingers) were divided into two groups: Group A wore the orthosis between 20 to 22 hours daily, while Group B adhered to a 10-14 hours daily schedule. Both groups participated in identical exercise programs to maintain finger flexion. The results showed that Group A experienced a significantly greater improvement in passive range of motion (PROM), with an average improvement of 30° compared to Group B's 20° over three weeks. Unfortunately, they combined both chronic and subacute presentations without reporting on the number in each group, which could be a confounding factor in the range of movement recovery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a higher dose of daily Total End Range Time (TERT) may improve passive range of motion (PROM) in proximal interphalangeal joint flexion contractures. However, there is other evidence suggesting that beyond 11 hrs per day, the benefit of TERT may reduce . If you would like to know more about splinting for pipj, have a look at the whole database on the topic . URL : https://doi.org/10.3390/jcm12051987 Abstract Focusing on fingers with proximal interphalangeal joint flexion contractures, this study seeks to determine whether significant differences exist between the joint passive range of motion PROM improvement when receiving higher doses of daily total end range time (TERT) compared to those that receive lower doses. The study randomized a parallel group of fifty-seven fingers in fifty patients with concealed allocation and assessor blinding. Divided into two groups receiving different doses of daily total end range time with an elastic tension digital neoprene orthosis, they also participated in an identical exercise program. Patients reported orthosis wear time, and the researchers performed goniometric measurements at every session during the three-week period. The primary outcome related the time patients wore the orthosis to the degrees of improvement in PROM extension. Compared to group B (daily TERT of twelve hours), group A (TERT, twenty+ hours) showed a statistically significant greater improvement in PROM after three weeks of treatment. Group A improved by a mean of 29° compared to group B’s mean of 19° improvement. This study provides evidence that a higher dose of daily TERT can generate better results in the treatment of the proximal interphalangeal joint flexion contractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Routine 6-weeks outpatient visit in patients treated surgically for upper extremity fractures: Is it truly necessary? Bosch, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic Topic : Upper limb fractures - Routine 6 weeks follow up This retrospective cohort study questioned the necessity of routine 6-week outpatient visits and radiographs for patients who have undergone surgical treatment for common upper extremity fractures, such as those of the clavicle, proximal humerus, humeral shaft, olecranon, radial shaft, and distal radius. Conducted at a Level 1 trauma center in Switzerland, the retrospective cohort study included 267 patients treated between 2019 and 2022. Findings revealed that abnormalities were detected in only 4% of radiographs, with clinical implications for just 2% of cases. Only 3% of patients required a deviation from the standard postoperative care, often exhibiting symptoms suggesting complications. The study suggests reconsidering these routine check-ups, proposing selective follow-ups based on patient demand or clinical necessity. Emphasis is placed on educating patients about potential complications, suggesting that e-health applications could support postoperative care, thereby reducing the burden on healthcare systems without compromising patient outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, routine 6-week outpatient visits and radiographs for patients who have undergone surgical treatment for common upper extremity fractures may not be necessary. The low incidence of clinically impactful deviations at these visits suggests that healthcare systems could explore more efficient alternatives, such as selective follow-ups for symptomatic patients or those with higher complication risks. This shift could reduce the burden on healthcare resources without compromising patient care. It is likely that patients requiring further care include those with high levels of catastrophising , lower socioeconomic status , and/or those who present with significant comorbidities . URL : https://doi.org/10.1016/j.jse.2024.04.025 Abstract Background: Due to the increasing burden on the heatlhcare system the usefulness of the routinely planned 6-week outpatient visit and radiograph in patients treated surgically for the most common upper extremity fractures, including clavicle, proximal humerus, humeral shaft, olecranon, radial shaft, and distal radius, should be investigated. Method: This was a retrospective cohort study of all patients treated surgically for the most common upper extremity fractures between 2019 and 2022 in a level 1 trauma center. The first outcome of interest was the incidence of abnormalities found on the radiograph taken at the 6-week outpatient visit. Abnormalities were defined as all differences between the intraoperative (or direct postoperative) and 6-week radiograph. In case an abnormality was detected, the hospital records were screened to determine its clinical consequence. The clinical consequences were categorized into requiring either additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed range of motion (ROM). The second outcome of interest was the incidence of deviations from the local standard postoperative treatment and follow-up protocol based on the 6-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed ROM. Results: A total of 267 patients were included. Abnormalities on radiograph at 6 weeks postoperatively were found in only 10 (3.7%) patients, of which only 4 (1.5%) had clinical implications (in 3 patients extra imaging was required and in 1 patient it was necessary to deviate from standard weightbearing/ROM limitation regimen). The clinical/radiologic findings during the 6-week outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symptoms suggestive of complications. Conclusion: The routine 6-week outpatient visit and radiograph, after surgery for common upper extremity fractures, rarely has clinical consequences. It should be questioned whether these routine visits are necessary and whether a more selective approach should be considered. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 5 Type of study: Therapeutic This case report explores the management of a challenging unstable proximal phalanx fracture in a 56-year-old male, with a focus on patient-centered care. After a football injury (see x-ray below), the patient underwent two local anesthetic and manipulation procedures (LAMP). Following reduction, the patient was placed in hand based splint. Despite the advice, the patient went to the gym, utilised their hand and took place into all their activities whilst wearing the splint. Due to objective evidence of ulnar deviation of the little finger at follow up, an additional x-ray was completed and showed loss of reduction (see figure below). What would you do?