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Spontaneous rupture of the extensor pollicis longus tendon: A systematic review . Lister, et al. (2023) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : EPL rupture - Aetiologies This systematic review investigated the causes, management, and outcomes of spontaneous extensor pollicis longus (EPL) tendon ruptures. A total of 29 studies, including case reports, were part of this review. The EPL tendon was characterised by the authors as vulnerable due to its poor vascularisation at Lister’s tubercle, making it susceptible to trauma, compression, or tenosynovial invasion. Common inciting factors included steroid use, repetitive exercises, trauma, and inflammation. Surgical management options—such as primary repair, tendon transfer (often using extensor digitorum communis or palmaris longus), and grafting (e.g., semitendinosus) generally yielded favorable outcomes. Recovery time frames varied from 6 weeks to over a year, with the average recovery time being 2 months. 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 extensor pollicis longus (EPL) seems to be more vulnerable to rupture due to its poor vascularisation at the Lister's tubercle. Steroid use, direct injury, and inflammatory conditions appear to make rupture more likely . Remember that a differential diagnosis for EPL tenosynovitis at the wrist is distal intersection syndrome . URL : https://doi.org/10.1177/15589447231175513 Abstract Background: Extensor pollicis longus (EPL) rupture and tenosynovitis of the third dorsal compartment is often described in association with a history of rheumatoid arthritis or in the setting of a distal radius fracture. However, the literature suggests multiple other potential factors that may lead to a seemingly spontaneous rupture. Methods: We performed a systematic review following guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search consisted of headings and keywords related to tendon injuries, tendinopathy, hand surgery, tendon transfer, and injections, as published in reports and studies. Citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers, with a third reviewer resolving discrepancies. To be eligible, articles had to meet the following inclusion criterion: describe cases of spontaneous EPL rupture or tenosynovitis of the third dorsal compartment. The exclusion criterion was any history of distal radius fracture or rheumatoid arthritis. Results: We identified 29 articles that met the inclusion criterion. Conclusions: A myriad of prodromal events or predisposing factors ultimately led to EPL rupture or tenosynovitis of the third compartment. Methods of reconstruction described included primary repair, tendon grafting, and tendon transfer techniques; all with generally good outcomes. These results highlight the inherent fragility of this tendon and support the historical recommendation for early release of the EPL tendon in the setting of tenosynovitis of the third dorsal compartment. 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

Social determinants of health are independently predictive of increased hospital length of stay and complications following total elbow arthroplasty. George, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic and Decision Analysis Study Topic : Elbow arthroplasty - Social determinants of health This retrospective study investigated the impact of social determinants of health (SDOH) on hospital resource use, costs, and discharge patterns of patients undergoing Total Elbow Arthroplasty (TEA). a total of 316 patients were compared to more than 5,000 controls. Logistic regression in identified SDOH as being associated with higher rates of complication. Nevertheless, due to the multiple comparisons in this study, there is a 25% chance that these results are due to chance. 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, social determinants of health (SDOH) influence access to Total Elbow Arthroplasty (TEA), healthcare resource utilisation, costs, and complications . These findings appear in line with previous research showing that social deprivation in term of poor nutrition have negative effects on our patients following upper limb surgery . URL : https://doi.org/10.1016/j.jse.2025.03.028 Abstract Background: Social determinants of health (SDOH) are the social, educational, environmental, and economic factors that affect health. The purpose of this study was to determine the effects of preoperative SDOH on the outcomes of total elbow arthroplasty (TEA). Methods: The Nationwide Readmissions Database was used to identify 316 patients with a SDOH diagnosis and 5426 controls who underwent primary TEA from 2016 to 2020. Primary outcomes included cost of admission and hospital length of stay (LOS), adverse clinical outcomes within 180 days and postoperative medical and surgical complications. Binary logistic regression identified independent predictors of postoperative complications. Multiple linear regression identified independent predictors of increased cost and hospital LOS. Results: Compared to controls, patients with SDOH had higher odds of experiencing any complication (odds ratio [OR] 1.3; confidence interval [CI] 1.0-1.7), acute renal failure (OR 1.6; CI 1.0-2.4), cellulitis (OR 11; CI 5.1-23), surgical site infection (OR 2.7; CI 1.7-4.3), urinary tract infections (UTI) (OR 3.2; CI 2.2-4.6), and wound dehiscence (OR 5.7; CI 1.9-18). SDOH was shown to be independently predictive of postoperative cellulitis (OR 7.2; CI 2.9-18) and UTI (OR 2.0; CI 1.3-3.1). SDOH was correlated with increased hospital LOS (3.5 days vs. 5.8 days.). Preoperative SDOH diagnosis was shown to be independently predictive of a 1.67 day increase in hospital LOS following primary TEA (B = 1.67, SE 0.198)."how do social determinants shape access to total elbow arthroplasty and healthcare resource use?" Conclusion: Preoperative SDOH diagnosis, though associated with many complications, was only shown to be independently predictive of postoperative cellulitis and UTI, indicating the presence of confounding variables associated with SDOH. SDOH were correlated with increased cost and independently predictive of increased LOS. These findings are crucial for both physicians and patients to evaluate before proceeding with TEA, as they highlight the significant healthcare resource demands linked to SDOH, a significant concern for a patient population already economically disadvantaged. 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 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic A 49 years old person underwent emergency surgery as they had a penetrating injury of the volar and dorsal forearm caused by a kitchen knife. Objectively, they had limited ability to flex the thumb as well as extend the thumb and the other fingers. There were no sensory deficits in the hand. Surgical exploration revealed lesions of the ECRL, ECRL, EDC, EDM, APL, EPL, and EPB. All of these were repaired. The patient was discharge one week later without evidence of complications. They were then reviewed at two months after surgery, which identified a 20° to 30° extension lag of the thumb, index, and little finger. Extension of the wrist, middle and ring finger was possible. What is going on?

Secondary posterior interosseous nerve lesions associated with humeral fractures. Erra, et al. (2016) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Posterior interosseous nerve lesion - Humeral fractures This cross sectional study assessed the occurrence of double traumatic nerve lesions involving both the radial nerve (at the humerus) and the posterior interosseous nerve (PIN) following humeral fractures. The study highlights that while most patients with combined injuries showed significant clinical improvement, several patients had radial nerve lesion in the proximal third of the forearm (Arcade of Frohse). Ultrasound imaging played a crucial role in diagnosing these lesions and monitoring recovery, revealing reductions in nerve cross-sectional area over time. 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, fractures of the humerus can cause nerve lesions not only at the radial groove but also at the posterior interosseous nerve (PIN). Despite these multilevel lesions, most patients showed significant improvement, often without surgery. Early neurological assessments post-humeral fracture are essential to identify and monitor nerve injuries and incorporating ultrasound into routine evaluations can aid in monitoring progress. URL : https://doi.org/10.1002/mus.24752 Abstract Introduction: Radial nerve lesions associated with humeral shaft fractures are the most common traumatic nerve lesions observed with long bone fractures. Secondary indirect posterior interosseous nerve (PIN) lesions can be associated with traumatic radial nerve palsy. The aim of this study was to identify cases of traumatic double‐site radial nerve involvement through ultrasound (US). Methods: Patients with traumatic radial nerve lesions referred to our laboratory from January 2010 to January 2014 were evaluated. Results: Of the 35 patients, 18 had US evidence of a radial nerve lesion at the fracture site associated with secondary PIN involvement at the arcade of Frohse. Conclusions: Multiple‐site nerve lesions are difficult to demonstrate through electrodiagnostic tests. In our case series, half of the patients with traumatic radial nerve damage had US evidence of PIN injury. Prospective studies with follow‐up are needed to determine the clinical and prognostic relevance of this finding and the best therapeutic approach. 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

Total elbow arthroplasty versus hemiarthroplasty for acute distal humeral fractures: A retrospective cohort study of revision rates in 366 consecutive patients. Nielsen, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Study Topic : Elbow replacement - Total vs hemiarthroplasty This study compares Total Elbow Arthroplasty (TEA) and Hemiarthroplasty (EHA) for treating unreconstructable distal humeral fractures, focusing on mid- to long-term outcomes. Both procedures showed comparable but high revision rates, with no significant difference between TEA and EHA in terms of functional or patient-reported outcomes. Male patients exhibited a four times higher risk of revision compared to female counterparts, though the proportion of male patients in the study was low. The study highlights that EHA is often preferred for its potential benefits in active or mobility-dependent patients, particularly those with higher functional demands. 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, for unreconstructable distal humeral fractures, Total Elbow Arthroplasty (TEA) or Hemiarthroplasty (EHA) provide similar high revision rates, indicating that these surgeries may not offer long-term solutions for all patients. Male patients face a four times higher risk of revision. This suggests a need for closer monitoring and tailored approaches for male patients. URL : https://doi.org/10.1016/j.jse.2025.02.034 Abstract Background: Elbow arthroplasty is an established treatment of distal humeral fractures not amenable to internal fixation. Total elbow arthroplasty (TEA) is the most common modality, but elbow hemiarthroplasty (EHA) is becoming more popular, and it is still unclear which option provides the best results. We hypothesized that EHA is associated with a lower revision rate than TEA, due to fewer mechanical complications. Methods: This study is a retrospective multicenter cohort study. We identified all patients with an acute distal humeral fracture treated with an elbow arthroplasty in Denmark in the period from January 1, 2008, until December 1, 2021. Data were collected retrospectively using electronic health records. Kaplan-Meier analysis was used to estimate the cumulative revision rates for TEA and EHA. Hazard ratios (HRs) were estimated using the Cox proportional hazards model with mutual adjustment for age, sex, body mass index, American Society of Anesthesiologists classification, and implant type (TEA or EHA). Results: Two hundred twenty-five TEA and 141 EHA procedures were included. There were 21 revisions of TEAs and 11 of EHAs. The 2-, 5- and 10-year revision rates were 5.8% (95% confidence interval [CI] 2.5%-9.2%), 8.6% (95% CI 4.4%-12.8%), and 20.5% (95% CI 9.2%-31.9%) for TEA and 4.0% (95% CI 0.5%-7.5%), 9.3% (95% CI 3.0%-15.6%), and 18.7% (95% CI 4.8%-32.7%) for EHA. After adjustment, the HR of revision for male patients was 3.8 (95% CI 1.6-9.1). The HR of revision for EHA was 0.9 (95% CI 0.4-1.9) with TEA as reference. Conclusion: We found comparable but high revision rates of TEA and EHA after unreconstructable distal humeral fracture. An important finding was a 4 times higher risk of revision for male patients. Larger studies are needed for more reliable estimates. 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

Digital wound assessment by hand specialists is moderately reliable. Ring, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Wounds - Assessment This study evaluated the reliability of digital wound assessment by hand specialists after minor surgery. A group of 125 hand surgeons assessed 20 digital photographs of wounds, focusing on four criteria: wound separation, erythema, hematoma/ecchymosis, and purulence. The interobserver agreement was measured using kappa statistics. Results showed moderate reliability for erythema (κ = 0.40) and wound separation (κ = 0.49), while purulence (κ = 0.36) and hematoma/ecchymosis (κ = 0.34) had fair agreement. Demographic factors did not influence reliability. 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, clinicians have moderate reliability when assessing digital wound after minor surgery. It appears that they tend to be better at assessing erythema and wound separation compared to purulence and ecchymosis. Despite these limitations, I still think that asking surgeon's about their opinion in terms of pictures of wound taken in clinic is useful. URL : https://doi.org/10.1016/j.jht.2024.07.001 Abstract 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

Long-term subjective and objective outcomes after digital nerve repair: A cohort study. Evertsson, et al. (2025) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Digital nerve injuries - Long term outcomes The study investigates functional and sensory outcomes in patients with digital nerve injuries repair, comparing those with injuries in central fingers versus border digits. Key findings reveal that younger patients (age <44) exhibit favorable sensory recovery, while older individuals may have limited benefit from surgical repair. Hand function assessment showed no significant differences between injury locations, suggesting similar treatment approaches regardless of digit. The research highlights the importance of minimising neuropathic pain and cold sensitivity, particularly in older adults as these appear to be the most common symptoms. One of the limitations of this paper is the multiple tests performed, which increases the chance of finding difference due to chance. 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, younger patients (under 44) exhibit better sensory recovery following digital nerve repair. Regardless of whether the injury occurs in central fingers or border digits, hand function outcomes are similar. For older patients, attention should be directed towards managing neuropathic pain and cold sensitivity, which may not improve significantly with surgical intervention. It is important to remember that digital nerve sensory loss can have a negative impact in force development as well . URL : https://doi.org/10.1177/17531934241286116 Abstract Digital nerve injuries are common, but few studies report long-term effects for the individual. The primary aim of this matched-pairs study comparing digital nerve injuries in border digits or central fingers was to investigate hand function 3–10 years after digital nerve repair, assessed using the Mini Sollerman test in 86 patients. Secondary outcomes were sensory function, range of motion, grip strength and patient-reported measures. No significant difference was seen in hand function between the groups, except for lower grip strength in patients with central finger injury. Tactile discrimination was achieved in 87%, with best results among participants aged less than 44 years. Touch perception was measurable in 99%. No statistically significant differences in sensory function were found between the groups. Patient-reported disability was low, with median Quick Disabilities of the Arm, Shoulder and Hand score of 5, but half of the patients reported neuropathic pain. Numbness and cold sensitivity were the symptoms graded worst after digital nerve 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

Lateral triceps tendon rupture in a collegiate athlete. Labate, et al. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Study Topic : Lateral elbow pain and dorsal hand pain - Distal triceps tear This paper describes a case of a 20-year-old collegiate football player who sustained a direct elbow contusion during play, leading to lateral elbow pain radiating into the right hand with an 8/10 Numeric Pain Rating Scale (NPRS). Initial imaging included radiographs, which were normal. Subsequent magnetic resonance imaging (MRI) revealed a full-thickness tear of the lateral triceps tendon with significant retraction. The patient underwent surgical repair of the tendon followed by three months of rehabilitation, ultimately returning to his prior level of function and sport with 0/10 NPRS four months post-surgery. The decision pathway highlights the importance of advanced imaging in diagnosing complex injuries like distal triceps tendon tears, particularly when initial findings are inconclusive. Early surgical intervention was crucial for favorable 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, lateral elbow pain following a direct contusion to the elbow with pain spreading into the hand can be associated with a full thickness tear of the triceps. In addition to x-ray, completion of US imaging would have helped identifying the lesion earlier. If you are interested in distal triceps repair and injury, have a look at the whole database on the topic . URL : https://doi.org/10.2519/josptcases.2024.0045 Abstract No abstract available 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 role of preoperative factors, surgical approach, mobilization protocol for improved surgical outcomes after open elbow arthrolysis in post-traumatic elbow stiffness – an ambispective cohort study. Geevarughese, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Post-traumatic elbow stiffness - Splinting and surgery This retrospective study assessed the effectiveness of open elbow arthrolysis in the treatment of elbow stiffness. Only participants who had a splinting trial with plateauing in ROM underwent surgery. A total of 55 participants underwent arthrolysis. Their average elbow arc of motion (flexion-extension) was 33° pre-surgery. Following surgery, all participants underwent an early mobilisation approach with the combined use of splinting in the form of static night splint or static progressive splinting. The results showed that the elbow arc of motion improved to 88° after surgery and that those participants with the worst pre-surgical arc of motion were the ones improving the most. 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 trial of conservative treatment with exercise and splinting should be provided to patients with post-traumatic elbow stiffness. If this course resulted in plateauing of ROM improvements, elbow arthrolysis is indicated as it can recover a significant arc of motion, especially in those people with severe ROM limitation. This study is a nice addition to the one exploring the potential causes of post-traumatic elbow stiffness . If you are interested in this topic, have a look at the whole database , there are a lot of studies available. URL : https://doi.org/10.1016/j.jse.2025.02.042 Abstract Background: Post-traumatic elbow stiffness decreases the range of movement (ROM) and limits functional activities of the upper limb. Postinjury therapy and splints have been used to improve the ROM. Despite this, surgical release is required in several instances. Surgical approaches to open arthrolysis vary. However, the medial approach has been less discussed. Multiple factors impact prognosis, final ROM, and functional outcomes after arthrolysis. The objectives of this study were to analyze functional outcomes following open elbow arthrolysis, outline postinjury and postoperative mobilization protocol implemented, the role of the medial approach, and identify preoperative factors contributing toward favorable functional outcomes in post-traumatic elbow stiffness treated by open elbow arthrolysis. Methods: In this single-center ambispective cohort study, we retrospectively recruited a cohort of post-traumatic elbow stiffness patients. They were placed in a structured preoperative therapy and splinting program. Those persisting with moderate to severe stiffness 3 to 6 months following the therapy underwent open elbow arthrolysis. A prospective study was done to evaluate the functional outcomes, pain, stability, and ROMs after elbow arthrolysis. The effect of the medial approach was evaluated for surgical outcomes. Clinical significance by minimal clinically important difference and statistical significance of various preoperative factors for improved ROM and functional outcomes were evaluated. Results: Ninety-four patients with post-traumatic stiffness underwent the structured preoperative rehabilitation protocol. The severity of stiffness was downgraded with therapy in 39 patients, and the remaining 55 patients underwent open elbow arthrolysis. At a mean follow-up of 76.6 ± 40.4 months, the mean gain in arc of motion from preop was 54° ± 32°, and the mean ROM at final follow-up was 88° ± 30° (P = .026). An isolated medial approach was performed in 65.5%. The mean improvement in arc of motion with the isolated medial approach was 51° ± 28° and 45° ± 34° with the combined medial-lateral approach. The severity of preoperative stiffness showed statistical significance in improvement in arc of motion and postoperative Mayo Elbow Performance Score (P = .033), while the interval from trauma to surgery was shown to be clinically significant by minimal clinically important difference. Conclusions: Structured preoperative rehabilitation protocol downgrades the severity of elbow stiffness. The open elbow arthrolysis significantly improves arc of motion and Mayo Elbow Performance Score. The medial approach demonstrates an improved arc of motion compared to combined and posterior approaches. The severity of preoperative stiffness and interval from trauma to surgery has a significant correlation to improvement in the arc of motion and Mayo Elbow Performance Score. 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

Bilateral spontaneous flexor digitorum profundus tendon rupture of the fifth digit: Case report and literature review. Li , et al. (2013) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : FDP - Spontaneous rupture This study describes the case of a 42-year-old right-handed male writer who injured their right little finger whilst lifting gardening tools. They reported immediate pain in the forearm and little finger. Objectively, they could not flex their little finger, especially at the dipj. Carpal tunnel view x-rays were normal. MRI revealered a hypoplastic but intact flexor digitorum superficialis (FDS) tendon and a ruptured FDP tendon within the palm (zone 6). The patient underwent FDP repair, which restores finger function. Four years later, a similar rupture occurred in the left small finger, likely due to the anatomic variations (hypoplastic FDS) which may predispose to increased biomechanical strain on the FDP tendon. The second rupture was treated similarly with satisfactory results. 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, bilateral spontaneous flexor digitorum profundus (FDP) tendon ruptures are rare injuries. An hypoplastic flexor digitorum superficialis (FDS) may be in part responsible for the increase probability of injury . Ultrasound would be the most readily available option for hand therapist to confirm the diagnosis. URL : https://doi.org/10.1007/s11552-012-9490-5 Abstract Not available 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

Is the feeling of ‘weakness’ associated with unhelpful thoughts or distress regarding symptoms?. Davids, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptom Prevalence Topic : Weakness feeling - Emotional distress The study explores how patients use the term "weakness" to describe their symptoms, particularly in non-traumatic upper extremity conditions, and its connection to distress about symptoms. It finds that self-reported feelings of weakness are associated with higher levels of distress, pain intensity, and reduced capability. The research highlights that clinicians can interpret expressions of weakness as indicators of unhelpful thinking or emotional distress, which could inform comprehensive care strategies addressing both physical and mental health aspects. Distress regarding symptoms is identified as a modifiable factor that could improve patient outcomes. However, the study's findings may be limited by its focus on a predominantly white, educated urban population in the United States. The authors emphasize the importance of recognizing and acknowledging patients' emotional states to build trust and facilitate conversations about mental health support. Clinicians are encouraged to use expressions of weakness as cues for addressing both physical symptoms and emotional distress. 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, when patients report feelings of "weakness", particularly in non-traumatic upper extremity conditions, this appears to be related to distress. I can think of this being true in at least two of my recent patients who were strong in their upper limb, but reported feeling weak. Of note, one is a refugee who had to leave all their family in the country of origin and the other struggles with mental health and addiction to drugs. Let me know if you have noted something similar in your patients who report feeling weak when indeed they are strong. URL : https://doi.org/10.1177/17531934241274134 Abstract This cross-sectional study looked for factors associated with feelings of weakness, level of capability and pain intensity in people seeking musculoskeletal speciality care for non-traumatic upper extremity conditions. A survey was conducted in 139 English-speaking adults, with 135 participants completing it. We found that greater intensity of feelings of weakness correlated with higher distress regarding symptoms and with older age. Lower level of capability was associated with greater intensity of feelings of weakness, greater distress regarding symptoms and older age. Higher pain intensity was associated with greater distress regarding symptoms and greater intensity of feelings of weakness. These findings suggest that the symptom of weakness may be a cue to explore potential distress about symptoms in addition to examining for actual weakness. This understanding could be a guide to a more compassionate approach to alleviate distress rather than focusing on neuromuscular pathophysiology alone, with the potential to reduce unnecessary tests and treatments. 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 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Study This paper describes a case of a 20-year-old collegiate football player who sustained a direct elbow contusion during play, leading to lateral elbow pain radiating into the right hand with an 8/10 Numeric Pain Rating Scale (NPRS). Initial imaging included radiographs, which were normal. Subsequent magnetic resonance imaging (MRI) is show below. What is it?