Search Results

Efficacy of intra-articular corticosteroid injection for nonsurgical management of trapeziometacarpal osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Krez, A. N., et al. (2024) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: 1st cmcj OA – injectables This systematic review and meta-analysis assessed the efficacy of intra-articular corticosteroid injections for 1st carpometacarpal joint osteoarthritis (1st cmcj OA) compared to hyaluronic or platelet-rich plasma (PRP) injections alternative. A total of six randomised controlled trials were included in the present study. The results showed that corticosteroid injections provided short-term symptom improvement without significant differences in pain and functional outcomes compared to hyaluronic acid or PRP injections. 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, intra-articular corticosteroid injections have been shown to be as effective as hyluronic acid or PRP injections. Despite findings indicating no significant difference in pain and functional outcomes compared to hyaluronic acid or platelet-rich plasma injections, corticosteroids are favored due to their affordability, and ease of administration. These findings appear to be in line with previous research on the topic. Keep in mind that if patients are about to have surgery to their thumb, having a cortisone or hyaluronic injection increases their risk of post-surgical infection. Have a look at the database on injectables for hand conditions if you are interested in the topic. URL: https://doi.org/10.1016/j.jhsa.2024.02.001 Abstract Purpose: As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA. Methods: A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded. Results: The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma. Conclusions: Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. 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 use of non-invasive skin traction orthosis in managing phalangeal fractures. Yang, Z., Ong, C. X. L. and Jiang, J. K. H. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Phalanx fracture - Traction splint This retrospective study assessed the use of non-invasive skin traction splints for the management of phalangeal fractures. A total of fourteen participants with proximal or middle phalanx, intra-articular or extra-articular fractures were included. These participants were provided with hand-based and forearm-based splints, which allowed the application of finger traction distally to the fracture by using strapping tape. This splint in combination with traction was utilised for 3 weeks followed by the use of splinting only for the remaining weeks of immobilisation. The strapping tape was changed every week during the hand therapy review. Have a look at the picture below to see what the splint and traction system looks like. Unfortunately, the study did not provide a control group assessing the benefit of adding traction compared to no traction. 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, non-invasive skin traction splints may be useful in treating phalangeal fractures which are borderline surgical candidates. It is however unclear whether this approach provides better fracture alignment compared to a traditional splinting approach due to the lack of a control group in this study. URL: https://doi.org/10.1016/j.jht.2023.12.012 Abstract Background: Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion. Purpose: To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option. Study design: Retrospective cohort. Methods: We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles. Results: Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8–21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses. Conclusion: We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained. 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

Steroid versus placebo injections and wrist splints in patients with carpal tunnel syndrome: A systematic review and network meta-analysis. Adindu, E., Ramtin, S., Azarpay, A., Ring, D. and Teunis, T. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 thumb up) Type of study: Therapeutic Topic: Carpal tunnel syndrome - cortisone injections vs saline This is a systematic review and network meta-analysis comparing the effectiveness of corticosteroid injections, placebo injections (e.g. saline, dextrose), and wrist splints in patients with carpal tunnel syndrome (CTS). A total of 10 randomised controlled trials were included. Amongst all of the trials, 776 participants were included. Studies presented with a low risk of bias suggesting that the pooled results are likely to be realistic. The results showed that Corticosteroid injections provided modest and transient improvement in symptom relief within 3 months compared to placebos and splints, but did not meet the clinically important difference threshold. 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, corticosteroid injections may offer modest and transient improvement in symptoms for patients with carpal tunnel syndrome within 3 months compared to placebo injections and wrist splints. However, the difference between these interventions does not appear to be clinically relevant. Like for splinting and exercises, we should provide patients with realistic expectations about the effectiveness of these interventions. If you would like to know who is more likely to respond to CSI for carpal tunnel syndrome, have a look at this synopsis. You can also find the entire collection on carpal tunnel syndrome in our database. URL: https://doi.org/10.1177/17531934241240380 Abstract A network meta-analysis of randomized controlled trials compared the effectiveness of corticosteroid injections with placebo injections and wrist splints for carpal tunnel syndrome, focusing on symptom relief and median nerve conduction velocity. Within 3 months of the corticosteroid injection, there was a modest statistically significant difference in symptom relief compared to placebo injections and wrist splints, as measured by the Symptom Severity Subscore of the Boston Carpal Tunnel Questionnaire; however, this did not meet the minimum clinically important difference. Pain reduction with corticosteroids was slightly better than with wrist splints, but it also failed to reach clinical significance. Electrodiagnostic assessments showed transient changes in distal motor and sensory latencies in favour of corticosteroids at 3 months, but these changes were not evident at 6 months. The best current evidence suggests that corticosteroid injections provide minimal transient improvement in nerve conduction and symptomatology compared with placebo or wrist splints. 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 meta-analysis of the risk factors for lateral epicondylitis. Chen, Q., Shen, P., Zhang, B., Chen, Y. and Zheng, C. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Lateral epicondylalgia – Risk factors This is a systematic review and meta-analysis assessing risk factors for the development of lateral epicondylalgia (LE). Twenty-two studies were included in the meta-analysis, for a total of 34,773 participants. Several potential risk factors were included and these were sex, BMI, manual labour, drinking history, smoking history, diabetes, hypertension, and hypercholesterolemia. The results showed that being female, being involved in manual labour, smoking history, and hypercholesterolemia increased the risk of LE. It is suggested that hypercholesterolemia may be associated with an increased risk due to the potential negative effect of statins on tendon health. 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, female sex, smoking history, manual labor, and hypercholesterolemia are associated with greater odds of LE. This is in line with a previous meta-analysis that assessed risk factors for LE. A novel aspect of this review is that they found an increase risk in people with hypercholesterolemia. This finding appears to be supported by another independent research group, who found the use of statins to be associated with an increase risk of tendinopathies, including upper limb tendinopathies. URL: https://doi.org/10.1016/j.jht.2023.05.013 Abstract Background: Very few meta-analyses discussed risk factors for lateral epicondylitis (LE), and previous meta-analyses reached conflicting conclusions with each other on some specific risk factors. Purpose: To investigate the risk factors for LE through meta-analysis. Study Design: Meta-analysis. Methods: PubMed, Embase, and Web of Science databases were searched for relevant studies in January 2022. Raw data were extracted into a predefined worksheet, and quality analysis was conducted by the Quality in Prognosis Studies (QUIPS) tool. Pooled effect sizes and 95% confidence intervals were calculated. R package "meta" was used for statistical analysis. Results: 22 studies were included in the meta-analysis. Female sex (odds ratio [OR]=1.33 and p-value<0.05), smoking history (OR=1.46 and p-value<0.001), manual labor (OR=2.39 and p-value<0.001), and hypercholesterolemia (OR=1.67 and p-value<0.05) were significant risk factors for LE. Conclusions: Female gender, smoking history, manual labor, and hypercholesterolemia could increase the risk of LE. According to an additional literature review, statin treatment for hypercholesterolemia is described as potentially related to the development of LE. 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

Mental and behavioural disorders increase the risk of tendon rupture after flexor tendon repair in zone I and II. Svingen, J. and Arner, M. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Prognostic Topic: Flexor tendon repair - ADHD This is a retrospective study assessing the effect of mental and behavioral disorders (MBD) on tendon rupture after flexor tendon repair in zones I and II. A total of 593 participants were included, of these, 49 presented with rupture of their flexor tendon repair. ADHD was the most commong MBD (92%), followed by depression, and anxiety. The results showed that patients with MBD had a higher risk of tendon rupture compared to those without MBD, with factors like age over 50 and male gender adding to the risk. Causes of rupture included non-adherence, accidents, infections, and unknown reasons. 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, mental and behavioral disorders (MBD) are a potential risk factor for tendon rupture after flexor tendon repair in zones I and II. This association is likely mediated by non-adherence behavior. Additional risk factors include being male, FPL involvement, laceration of both FDS and FDP, and greater social deprivation. URL: https://doi.org/10.1177/17589983231222832 Abstract IntroductionThe effect of mental and behavioural disorders (MBD) on the risk of tendon ruptures after flexor tendon repair is not well understood. This study aimed to analyse the association between MBD and tendon rupture after flexor tendon repair in zones I and II.MethodsData from the Swedish National Registry for Hand Surgery (HAKIR) on patients with a complete flexor tendon repair at our department between 2012 and 2019 were followed for a minimum of 2 years to assess the rate of rupture. Independent variables were collected from HAKIR and clinical records: prevalence MBD based on ICD-10 codes F0-F99, age, sex, injured tendon, number of injured fingers, day to surgery, core suture, digital nerve injury, smoking, injury mechanism, and rehabilitation method. Multiple logistic regression was used to assess the association between variables.ResultsA cohort of 593 patients with 49 ruptures (8.2%) was identified. Potential causes of rupture were non-adherence behaviour in 16 (33%), accidents in seven (14%), infections in six (12%), and no clear cause in 20 (41%) patients. Patients with MBD had an association to rupture (OR 3.6), 17.7% ruptures compared to 7.2% in patients with no diagnosed disorders. Patients >50 years of age had a higher risk compared to patients <25 years (OR 4.3), 15% compared to 3.9%' respectively. Men had a higher risk compared to women (OR 2.9), 10% compared to 4.3%' respectively.ConclusionWe identified an association between the prevalence of mental and behavioural disorders and rupture after flexor tendon repair. 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

Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint. Kim, S., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Diagnostic Topic: TFCC and weight bearing test - Is it valid? This prospective study assessed the diagnostic accuracy of the weight-bearing test in identifying traumatic triangular fibrocartilage complex (TFCC) lesions and instability of the distal radioulnar joint (DRUJ) from other causes of ulnar sided wrist pain. A total of 48 participants were included and tested prior to diagnostic arthroscopy. Patients with traumatic TFCC lesion and DRUJ instability were found to have a higher weight-bearing capacity compared to all other cases suggesting that the test was unable to identify those with traumatic lesions of TFCC/DRUJ and those without it. 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, reduced weight bearing capacity cannot discriminate between patients with traumatic TFCC lesion or DRUJ instability compared to those without this pathology. We should therefore complete a comprehensive clinical evaluation including range of motion, strength assessments, and stability tests in conjunction with weight-bearing testing to get further information about the potential differential diagnosis and treatment. That being said, the weightbearing test may be useful to assess whether the WristWidget could reduce our patients' symptoms. URL: https://doi.org/10.1016/j.jht.2023.08.002 Abstract BACKGROUND: Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PURPOSE: In this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. STUDY DESIGN: This was a prospective cohort study. METHODS: Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. RESULTS: Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) CONCLUSIONS: The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without. 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

Electrodiagnostic severity does not predict short to mid-term outcomes of cubital tunnel release surgery. Pohl, N., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Cubital tunnel release – Outcomes in patients with and without nerve conduction impairments This study investigated the prognostic value of nerve conduction studies (NCS) in determining the efficacy of cubital tunnel release surgery for cubital tunnel syndrome. Data from patients undergoing surgery from 2012-2022 was analyzed, for a total of 257 patients. Outcomes measured included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. The results showed that NCS severity did not predict short to mid-term outcomes of surgery, and preoperative patient-reported disease severity may predict postoperative outcomes better than NCS. Older age was the only factor associated with larger postoperative functional improvement. 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, preoperative patient-reported disease severity may be a better predictor of postoperative functional improvement after cubital tunnel release surgery compared to nerve conduction studies (NCS). This appears to be in line with another study looking at the association between NCS for the median nerve and improvements following carpal tunnel release. We can therefore reassure our patients undergoing cubital tunnel release, that they are likely to experience improvements independently of their NCS results. Something that has been suggested to be useful prior to undergoing cubital tunnel release is to have a conversation with the patients before surgery and set their expectations. URL: https://doi.org/10.1016/j.jse.2024.01.055 Abstract Hypothesis: This study aimed to explore the prognostic value of electrodiagnostic studies (EDS) to clarify their utility in clinical practice prior to cubital tunnel release surgery as well as identify patient factors associated with patient-reported functional improvement after surgery. Our hypothesis is that patients with severe preoperative findings on EDS will tend to experience less functional improvement after surgery given the extent of ulnar nerve compressive injury. Methods: Patients with cubital tunnel syndrome and preoperative electrodiagnostic data treated from 2012-2022 with cubital tunnel release were assessed regarding demographic information, preoperative physical exam findings, EDS findings, postoperative complications, and patient-reported outcomes. Short to mid-term qDASH scores were collected for all patients for further evaluation of preoperative EDS data. Patients were grouped into those who had met the MCID in delta qDASH at short to mid-term follow-up and those that did not. EDS data included sensory nerve onset latency, peak latency, amplitude, conduction velocity as well as motor nerve latency, velocity, and amplitude. Electromyogram (EMG) studies were also reviewed which included data pertaining to fibrillations, presence of abnormal fasciculation, positive sharp waves, variation in insertional activity, motor unit activity, duration of activity, and presence of increasing polymorphisms. Results: Of the 257 patients included, 160 (62.0%) were found to meet the MCID for short to mid-term qDASH scores. There were no significant differences between patients who did or did not meet the MCID regarding baseline demographics, comorbidities, preoperative exam findings, and operative technique. Patients who met MCID tended to have lower complication (3.80% vs 7.20%; p=0.248) and revision (0.60% vs 4.10%; p=0.069) rates but these findings were not statistically significant. The cubital tunnel severity as determined by the EDS was similar between cohorts (14.1% vs. 14.3%, p=0.498). Analysis of EMG testing showed there were no significant differences in preoperative, short to mid-term qDASH, or delta short to mid-term qDASH scores for patients with or without abnormal EMG findings. Multivariate regression suggested that only age (p=0.003) was associated with larger delta qDASH scores (Table 7). Conclusion: Patient-reported preoperative disease severity may predict the expected postoperative change in ulnar nerve functional improvement and EDS may not have prognostic value for patients undergoing cubital tunnel decompression. Therefore, physicians may suggest surgical treatment without positive EDS findings and still expect postoperative improvement in functional outcomes. 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 JAY (Joint Active Yoke) orthosis for a complex pip fracture-dislocation with failed volar plate repair: A case report. Lama, C. J., Jones, M. C., Dileso, S. and Weiss, A.-P. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Pipj stiffness - Yoke splint for mobilisation This case report focuses on the implementation of a relative motion splint called JAY (Joint Active Yoke) for a complex proximal interphalangeal (PIP) fracture-dislocation with failed volar plate repair. The patient, a 57-year-old neurosurgeon sustained the injury while snowboarding. They underwent hemi-hamate arthroplasty and volar plate repair of the pipj. After facing re-rupture and repair of the volar plate, the patient was fitted with the JAY orthosis to facilitate active controlled flexion of the repaired pipj. This splint was fitted at the middle phalanx of the MF, RF, and LF and was worn 24/7 from the 2 weeks mark following the second volar plate repair. The study showcased the benefits of the splint in promoting an active assisted motion of the pipj whilst providing buddy strapping support via the adjacent fingers. 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 modified relative motion splint fitted to the middle phalanx can be utilised to limit range of movement as well as helping with active assisted mobilisation of complex pipj injuries. The splint can be used to promote active controlled flexion of the pipj whilst providing protection. If you are interested in relative motion splints, have a look at the database. URL: https://doi.org/10.1016/j.jht.2022.09.001 Abstract Introduction: This case report details the postsurgical rehabilitation and outcome of a 57-year old neurosurgeon who underwent hemi-hamate arthroplasty and volar plate repair for a complex ring finger proximal interphalangeal (PIP) fracture-dislocation sustained after a fall while snowboarding. Following re-rupture and repair of his volar plate, the patient was fitted for a “yoke” relative motion flexor orthosis, termed a JAY (Joint Active Yoke) orthosis, in a manner reverse to that which is commonly used for extensor-related injuries. Study Design/Methods: A 57 yo right hand-dominant male who suffered a complex PIP fracture-dislocation with failed volar plate repair undwent hemi-hamate arthroplasty and early active motion following using a custom-fabricated joint active yoke orthosis. Purpose of the Study: The purpose of this study is to illustrate the benefits of this orthosis design in allowing for active controlled flexion of the repaired PIP joint with assist from the adjacent fingers, while also reducing joint torque and dorsal displacement forces. Results: A satisfactory active motion outcome was achieved with maintenance of PIP joint congruity allowing the patient to return to work as a neurosurgeon at 2-months post-operatively. Discussion: There is little published literature on the use of relative motion flexion orthoses following PIP injuries. Most current studies are isolated case reports on boutonniere deformity, flexor tendon repair, and closed reduction of PIP fractures. The following therapeutic intervention was considered an important contributor to a favorable functional outcome, as it minimized unwanted joint reaction forces in a complex PIP fracture-dislocation and unstable volar plate. Conclusion: Future research with greater level of evidence is required to establish the various applications of relative motion flexion orthoses, as well as determine the appropriate time at which to place the patient in a relative motion orthosis following operative repair to prevent long-term stiffness and poor motion. 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

Effects of statin treatment on the development of tendinopathy: A nationwide population-based cohort study. Kwak, D., Moon, S.-j., Park, J. W., Lee, D. H. and Lee, J. I. (2023) Level of Evidence: 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Statins use – Tendinopathy This cross sectional study assessed the association between statin use and the development of tendinopathy. A large cohort (252,000 participants) was recruited from South Korea. Of this, 84,000 were statin users whilst the other 168,000 weren't. The results showed that statins users had a higher risk of developing tendinopathy compared to nonusers, with the risk varying based on the type and cumulative dose of statins. While statin therapy was associated with an increased risk of tendinopathy, higher cumulative doses were linked to a reduced risk. Overall, the use of statins appeared to negatively affect both the upper limb and lower limb tendons within the first 6 months of therapy. 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, statin use, regardless of the type of statin, may be linked to a higher risk of tendinopathy development within the first 6 months of therapy. After the firs six months, the risk of tendinopathy development seems to reduce. Interestingly, statins use appears to affect in equal measure lower limb tendons as well as upper limb tendons. Statins have not only shown to increase the risk of tendinopathy but also upper limb compartment syndrome. URL: https://doi.org/10.1177/23259671231167851 Abstract Background: Previous longitudinal cohort studies have reported the conflicting results of the relationship between statin use and the development of tendinopathy disorder. It is unclear if there is a relationship between statin use, particularly the type or cumulative doses, and the development of tendinopathy disorder. Purpose: To investigate an association between statin treatment and the development of tendinopathy. Study Design: Cohort study; Level of evidence, 3.Methods:A total of 594,130 participants were enrolled in this study in 2002 and evaluated until 2015. There were 84,102 statin users and 168,204 nonusers (controls) selected at a ratio of 1:2 using propensity score matching analysis. The types of included tendinopathy were as follows: (1) trigger finger, (2) radial styloid tenosynovitis, (3) elbow epicondylitis, (4) rotator cuff tendinopathy, and (5) Achilles tendinitis. Cox proportional hazards models with time-varying covariates were constructed to identify the association between statin use and tendinopathy development. Results: Statin treatments regardless of statin types were associated with a significantly greater risk of all types of tendinopathy development (hazard ratio, 1.435; 95% CI, 1.411-1.460) compared with no statin treatment. A trend toward risk reduction was observed according to cumulative statin doses, which was indicated by hazard ratios of 2.337 (95% CI, 2.269-2.406), 2.210 (95% CI, 2.132-2.290), and 1.1 (95% CI, 1.098-1.146) in patients with cumulative defined daily doses of 90, 91-180, and >180, respectively. Conclusion: This nationwide population-based cohort study suggests that statin use regardless of the statin type was associated with a greater risk of tendinopathy compared with that of nonusers. The risk of tendinopathy development was diluted with the increasing cumulative defined daily dose. 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

Carpal tunnel syndrome caused by an interosseous ganglion of the lunate. Heading, S. L., Duraku, L. S. and Lawson, R. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. A 29-year-old healthy woman had been experiencing insidious onset of wrist pain for two years, after which they developed paraesthesias in the median nerve distribution at the hand. On objective examination there were no range of movement restrictions or abnormal findings on special tests, however, carpal tunnel tests were positive. Magnetic resonance imaging (MRI) was completed and one of the images is reported below. What the image shows is a cyst of the lunate, which grew to compress the median nerve at the carpal tunnel. The cyst was surgically removed and symptoms resolved within two weeks from surgery. The authors of this case study highlighted the rarity of carpal tunnel syndrome caused by space-occupying lesions, which accounts for 3-5% of cases, with tophaceous gout being the most common cause. They also reported how these lesions are rarely detected through objective testing and the importance of imaging. 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, we should remain vigilant for uncommon causes of carpal tunnel syndrome in patients presenting with atypical symptoms, such as diffuse wrist pain. Space-occupying lesions, like ganglions, though rare, can lead to carpal tunnel syndrome and must be considered as a differential diagnosis. Imaging modalities like x-ray and US can aid in accurate diagnosis and appropriate treatment planning. If you would like to read another interesting case of carpal tunnel syndrome cause by an anatomical variance, have a look at this synopsis. URL: https://doi.org/10.1177/17531934241227809 Abstract We present a case of a 29-year-old woman with diffuse, unilateral wrist pain and carpal tunnel syndrome secondary to an interosseous ganglion of the lunate and aim to highlight uncommon aetiologies when assessing patients with atypical carpal tunnel symptoms. 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

Increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace. Asmus, A., et al. (2022) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Wrist widget - Symptoms change on weight-bearing This retrospective study focused on the impact of wrist braces on weight-bearing capacity in patients with triangular fibrocartilage complex (TFCC) lesions. A total of 23 patients with a TFCC lesion confirmed arthroscopically, were included in the present study. Participants measured weight-bearing capacity on the unaffected and affected side (see picture below). The affected and unaffected side weight-bearing capacity was assess with and without the WristWidget. The results showed that on the affected side, the splint increased weight-bearing capacity by 23%. Unfortunately, they did not compare these results to a control group wearing a placebo splint. 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 use of a WristWidget may help relieving symptoms in people with ulnar sided wrist pain. It is however unclear whether a placebo splint would have a similar effect. If you are interested in the topic, have a look at the entire database on TFCC. URL: https://doi.org/10.1016/j.jht.2021.03.006 Abstract Study design: Retrospective cross-sectional case series. Background: Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ. Purpose: In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint. Methods: Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values. Results: The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p <0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29) with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative). Conclusion: The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints. 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

Concurrent validity and test-retest reliability of Squegg™ - smart dynamometer and handgrip trainer in healthy individuals. Amin, Z., Gutierrez, G. and True, L. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Squegg dynamometer - Grip strength This cross sectional study assessed the reliability and validity of the Squegg Hand Dynamometer compared to the Jamar Hydraulic Hand Dynamometer for grip strength in healthy individuals. A total of 594 healthy individuals were included in the study. Three measurements were taken for each device. The order of device testing was not randomised. Results showed good concurrent validity between Jamar and Squegg values for both hands, with excellent test-retest reliability for the Squegg. One of the problems of this study is that there was no absolute comparison of the Squegg with the Jamar dynamometer. As a matter of fact, there could be high levels of correlation between the two devices despite a significant and consistent under or overestimation of the Squegg measurements compared to the Jamar. 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 Squegg dynamometer is reliable to measure grip strength. It is however unclear whether it is valid when compared to the Jamar hand dynamometer. In other words, it could be used to measure improvement over time in our patients, but the measurements should not be compared to normative values obtained through the Jamar dynamometer. Similar findings were shown when the k-force digital dynamometer was compared to the Jamar hand dynamometer. URL: https://doi.org/10.1177/17589983231223868 Abstract Introduction: Handgrip strength is crucial for overall health and is often evaluated using hand dynamometers. Two hand dynamometers were used in the study: the Jamar® Hydraulic Hand Dynamometer and Squegg™ Smart Dynamometer and Handgrip Trainer, which is a relatively new, Bluetooth-enabled device to measure handgrip strength. The purpose of the study was to compare Jamar and Squegg to determine concurrent validity and, separately, test-retest reliability of Squegg. Methods: The cross-sectional study measured bimanual handgrip strength using the Jamar and Squegg in two sessions, following standard protocols. Participants were 18+ years old, with no hand disease or dysfunction. Spearman’s rank correlations were used to evaluate concurrent validity between Jamar and Squegg. Test-retest reliability was evaluated with intraclass correlation coefficient (ICC) estimates and 95% confidence intervals calculated using a mean-rating (k = 2) absolute agreement, 2-way mixed effects model. Results: Data from 594 participants were used to evaluate concurrent validity. Moderately strong correlations between Jamar and Squegg values for the right hand (RH) (ρ = 0.670; p = .001) and Jamar and Squegg values for the left hand (LH) (ρ = 0.730; p = .001) were found, indicating ‘good’ concurrent validity. Test-retest reliability for Squegg ranged from good to excellent (RH, ICC = 0.911, 95% CI (0.895, 0.924), p = .001; LH, ICC = 0.928, 95% CI (0.915, 0.939), p = .001). Discussion: The Squegg demonstrated good concurrent validity with Jamar and good-to-excellent test-retest reliability. It can be recommended as an alternative to the Jamar as a handgrip strength measurement tool. Squegg, which uses Bluetooth technology, is a reliable and cost-effective option for consistent handgrip strength testing. 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