Search Results

Clinical outcomes of osteochondritis dissecans lesions of the capitellum treated with arthroscopy with a mean follow-up of 8.3 years. Rothermich, M. A., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Osteochondritis dissecans - Arthroscopy This is a retrospective study assessing the long-term outcomes of capitellar osteochondritis dissecans lesions which underwent arthroscopic surgery between January 2000 and December 2016. A total of 107 participants were included in the study. The average follow-up time was 8.3 years, with 11 patients (12%) requiring revision surgery. The results showed that out of the 87 athletes who played sports at the time of their arthroscopy, 93% returned to play. 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, arthroscopy for osteochondritis dissecans has an excellent return-to-play rate and good subjective outcome scores. The reoperation rate is 12%. We should remember that positive outcomes are achieved at a minimum of 2 years. This knowledge can be beneficial to young athletes and their families. For less severe cases of osteochondritis dissecans, elbow immobilisation appears to be the most effective treatment. URL: https://doi.org/10.1016/j.jse.2023.02.121 Abstract Background: While numerous studies exist evaluating the short-term clinical outcomes for patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes for a large cohort of patients is limited. Purpose /Hypothesis: We hypothesized that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved postoperative subjective functional and pain scores, and with acceptable return to play for these patients. Methods: A retrospective analysis from a prospectively collected surgical database was performed to identify all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Inclusion criteria for this study included the diagnosis of OCD of the capitellum treated arthroscopically with minimum 2-year follow-up. Exclusion criteria included any prior surgical treatment on the ipsilateral elbow, missing operative reports, and patients with any portions of the surgical procedure performed open. Follow-up was performed by telephone using multiple patient-reported outcome questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-e), Andrews/Carson, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, 107 eligible patients were identified. Of these, 90 were successfully contacted for a follow-up rate of 84%. The mean age was 15.2 years and mean follow-up time was 8.3 years. Eleven patients had a subsequent revision procedure for a 12% failure rate in these patients. ASES-e pain was an average of 4.0 out of a max pain scale of 100, ASES-e function was an average of 34.5 out of a maximum of 36, and surgical satisfaction was an average of 9.1 out of 10. The average Andrews/Carson score was 87.1 out of 100 and the average KJOC score for overhead athletes was 83.5 out of 100. Additionally, out of the 87 patients evaluated who played sports at the time of their arthroscopy, 81 (93%) returned to play. Conclusion: This study demonstrated an excellent return-to-play rate and satisfactory subjective questionnaire scores with a 12% failure rate following arthroscopy for OCD of the capitellum with a minimum 2-year follow-up. 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 prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair. Rebello, E., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Distal biceps rupture - Testosterone This case-control study investigated the risk of distal biceps tendon injury (BTI) and subsequent surgical repair among patients who had filled a prescription for testosterone for a minimum of 3 consecutive months. A total of 583,220 participants were retrospectively analysed in the study. Participants' average age was 54 yrs old. The results showed that patients with prior prescription testosterone exposure had an increased rate of BTI and biceps tendon repair compared to those without prescription testosterone exposure. The risk of BTI was particularly high in males, with 4.68-fold increased odds of BTI within 1 year of using testosterone. Despite high odds of having a BTI in people using anabolic steroids, the chance of having this injury was really low (0.002%). 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 who are prescribed testosterone therapy may be at an increased risk of biceps tendon injury and subsequent surgical repair. Testosterone is prescribed by doctors in some instances to improve muscle mass/improve endocrine function (e.g. atrophy due to cancer, endocrine pathologies). If a patient presents with a distal biceps rupture, surgical repair may be considered if a high level of function is required. Thus, there is a high risk of complications when distal biceps repair surgery is performed. URL: https://doi.org/10.1016/j.jse.2023.02.122 Abstract Background: In the United States, testosterone therapy has increased over recent years. Anabolic steroid use has been associated with tendon rupture, although there is a paucity of evidence evaluating the risk of biceps tendon injury (BTI) with testosterone therapy. The aim of this study was to quantify the risk of BTI after initiating testosterone therapy. Methods: This is a retrospective cohort study utilizing the PearlDiver database. Records were queried between 2011 and 2018 for patients aged 35-75 years old who filled a testosterone prescription for a minimum of 3 months. A control group was created of patients aged 35-75 years old who had never filled a prescription for exogenous testosterone. ICD-9, ICD-10, and CPT codes were utilized to identify patients with distal biceps injuries and those undergoing surgical repair. Three matching processes were completed: one for the overall cohort, one for the male-specific cohort, and one for the female-specific cohort. Each cohort was matched to their control on age, gender, Charlson Comorbidity Index (CCI), diabetes, tobacco use, and osteoporosis. Multivariate logistic regression was used to compare rates of distal biceps tendon injury and subsequent surgical repair among the testosterone groups to their control groups. Results: A total of 776,974 patients had filled a prescription for testosterone for a minimum of 3 consecutive months. In the overall matched analysis between testosterone and control groups (N =291,610 in both), the mean age of patients was 53.9-years old and 23.1% were female. Within 1-year of filling a minimum of 3 consecutive months of exogenous testosterone prescriptions, 650 patients experienced a distal BTI compared to 159 patients in the control group (OR = 4.10, 95% CI, 3.45 – 4.89, p<0.001). At any time after the testosterone therapy, patients with testosterone use were more than twice as likely to experience a distal BTI compared to their matched controls (OR = 2.07, 95% CI, 1.94 – 2.38). Patients who filled prescriptions for testosterone were more likely to undergo surgical repair within a year of the injury compared to the control group. There was a similar trend seen in the male-specific cohort (OR = 1.63, 95% CI, 1.29 – 2.07). Conclusion: Patients with prior prescription testosterone exposure have an increased rate of BTI and biceps tendon repair, as compared to patients without prescription testosterone exposure. This provides insight into the risk profile of testosterone therapy and doctors should consider counseling patients of this risk, particularly those of male sex. 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

Prediction of disability in trigger finger: A cross-sectional and longitudinal study. Namaldi, S., Kuru, C. A. and Kuru, I. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Treatment Topic: Trigger finger - Splint wearing This was a prospective study assessing the effects of a 3-month conservative treatment programme on functional status, pain intensity, triggering events, depression, anxiety and kinesiophobia in patients with trigger finger. A total of 55 participants were included in the study. Patients were excluded if they were younger than18 years old, presented with concomitant hand disorder, chronic pain syndrome, neurological disease, rheumatological disease, pregnancy, or psychiatric disorder. Outcome variables were assessed before and after treatment utilising the DASH Questionnaire, visual analogue scale, Beck Depression Scale, Beck Anxiety Scale, and Tampa Scale of Kinesiophobia. Results showed that disability correlated strongly with anxiety, moderately with pain and depression and weakly with triggering and kinesiophobia. Anxiety was found to be predictive of post-treatment DASH scores, suggesting that biopsychosocial treatment approaches that consider the potential contribution of depression and ineffective coping strategies, may increase improvement in functional outcomes after treatment. 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, psychological variables, such as anxiety, depression, and kinesiophobia, can be predictive of disability in patients with trigger finger. Therefore, incorporating a biopsychosocial approach into the rehabilitation programme to improve the emotional state of trigger finger patients could lead to better functional outcomes. Similar research findings have been highlighted by another group of researchers assessing the effectiveness of splinting for De Quervain tenosynovitis. URL: https://doi.org/10.1177/17531934221131883 Abstract The aim of this prospective study of 55 patients was to analyse the cross-sectional and longitudinal relationship between disability and physical and psychological variables after conservative treatment of trigger finger and to determine the predictive factors for the post-treatment disability score and change in disability score. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand questionnaire. Potential predictive factors included pain, number of triggering events, depression, anxiety and kinesiophobia. Disability correlated strongly with anxiety, moderately with pain and depression and weakly with triggering and kinesiophobia. The change in depression score correlated significantly with the change in disability score. Post-treatment pain and anxiety scores accounted for 47% of the explained variance in disability score. Improvement in depression after treatment accounted for 18% of the explained variance in disability change score. Psychological variables appear to be potential predictors of disability. 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 influence of partial union on the mechanical strength of scaphoid fractures: A finite element study. Rothenfluh, E., Jain, S., Guggenberger, R., Taylor, W. R. and Hosseini Nasab, S. H. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Scaphoid healing – Fracture stability This study utilised a computer simulation to analyse the ability of the scaphoid bone to withstand biomechanical stresses based on the type of fracture and extent of healing. A high-resolution CT scan of a cadaveric forearm was used to create a computer-aided design (CAD) model of the scaphoid bone. The loading and boundary conditions were based on previously published experimental data. The results showed that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side. In this instance, before returning to loading through the affected hand, at least 60% union is required. When healing occurs on the radial side, the fracture can withstand loads with as little as 25% union. 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, scaphoid fractures showing healing on the radial side may be able to mobilise earlier compared to fractures healing from the ulnar side. For physiological loading (100 N), at least 2/3 of fracture union is required on the ulnar side, and 1/4 on the radial side. Remember that tenderness on palpation is not a reliable indicator of healing in these fractures. URL: https://doi.org/10.1177/17531934231157565 Abstract Assessment of scaphoid fracture union on computed tomography scans is not currently standardized. We investigated the extent of scaphoid waist fracture union required to withstand physiological loads in a finite element model, based on a high-resolution CT scan of a cadaveric forearm. For simulations, the scaphoid waist was partially fused at the radial and ulnar sides. A physiological load of 100?N was transmitted to the scaphoid and the minimal amount of union to maintain biomechanical stability was recorded. The orientation of the fracture plane was varied to analyse the effect on biomechanical stability. The results indicate that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side, where at least 60% union is required. Union occurring from the radial side can withstand loads with as little as 25% union. In fractures more parallel to the radial axis, the scaphoid seems less resistant on the radial side, as at least 50% union is required. A quantitative CT scan analysis with the proposed cut-off values and a consistently applied clinical examination will guide the clinician as to whether mid-waist scaphoid fractures can be considered as truly united. 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

Reliability and validity of the K-force grip dynamometer in healthy subjects: do we need to assess it three times? Magni, N., Olds, M. and McLaine, S. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: Digital dynamometers - Grip strength This cross-sectional study examined the reliability and validity of the K-force digital grip meter compared to the Jamar hand dynamometer. A total of 27 healthy participants were included in the present study. Grip strength was measured three times with both the K-force and Jamar hand dynamometer. The testing order was randomised. Results showed that both instruments had excellent intra-rater reliability (measurements were consistent when repeated) with ICCs ranging from 0.96 to 0.97. The association between K-force and Jamar measurements was high (r ≥ 0.89), however, the K-force underestimated the grip strength by 4.5–8.5 kg. There was no change in grip strength with either dynamometer over the course of three trials. 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 K-force digital grip meter is reliable when measuring grip strength in healthy people, however, it underestimates grip strength compared to the Jamar hand dynamometer by 5-9 kg. As a result, K-force measurements should not be compared to normative data. However, it can be used to monitor grip strength change over time. In addition, one measurement is sufficient for assessing grip strength in healthy people. If you are interested in knowing what is the minimal clinically important difference for grip strength, have a look at this other synopsis. URL: https://doi.org/10.1177/17589983231152958 Abstract Introduction: Digital dynamometers to assess grip strength are becoming more common in research and clinical settings. The aim of the study was to assess validity and reliability of the K-force dynamometer compared to the Jamar dynamometer. We also aimed to assess differences over the course of three measurements. Methods: Twenty-seven healthy participants were included. Three trials with the K-force and Jamar dynamometers were completed. Testing order was randomised. Intraclass correlation coefficients (ICCs) with absolute agreement assessed reliability and validity. Standard error of the measurement (SEM) and minimal detectable change (MDC95) were calculated. Concurrent validity was assessed using Pearson?s correlations and ICCs. Differences between the three repetitions were assessed using one-way repeated measures ANOVAs. Results: Both the K-force and the Jamar presented excellent intra-rater reliability with ICCs ranging from 0.96 to 0.97. The SEM ranged from 1.7 to 2 kg and the MDC from 4.7 to 5.7 kg for both dynamometers. The concurrent validity of the K-force was high (r ≥ 0.89). However, the K-force underestimated the grip strength by 4.5?8.5 kg. There was no change in grip strength with either dynamometer over the course of three trials. Conclusions: The K-force is reliable, but it underestimates grip strength by 4.5?8.5 kg compared to the Jamar dynamometer. K-force can be used to monitor progress over time but cannot be used to compare results against normative data. The use of a single measurement when assessing grip strength is sufficient when assessing healthy subjects. 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

Hand allodynia, lack of finger flexion, and the need for carpal tunnel release. Piñal, F. d. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Finger stiffness & allodynia - Carpal tunnel syndrome This is a retrospective study assessing the effects of Carpal Tunnel Release (CTR) on participants with hand allodynia and lack of full-finger flexion. A total of 22 patients (35 hands) were included in the study. Symptoms duration ranged from 1-36 months. Nineteen patients were previously denied surgery by other institutions due to their unclear clinical presentation. All participants completed the Disability of the Arm Shoulder and Hand at baseline. A mini-incision approach to the median nerve was performed and this was released. After surgery, nonsteroidal anti-inflammatory drugs were prescribed and self-performed active and assisted exercises were advised. The results showed that post-surgery, finger range of movement, pain, allodynia, and DASH score improved to a clinically relevant level. 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, limited finger flexion may be associated with carpal tunnel syndrome presentation. Prior to surgery, a trial of cortisone injection/night splinting plus exercise/surgery are currently recommended treatments. If you would like to know more about carpal tunnel syndrome, have a look at the entire collection. URL: https://doi.org/10.1016/j.jhsa.2023.01.001 Abstract Purpose: The clinical features of classic carpal tunnel syndrome are well known. However, some patients who may respond equally well to carpal tunnel release (CTR) display atypical signs and symptoms. The chief differential features are allodynia (painful dysesthesias), lack of finger flexion, and, on examination, pain on passive finger flexion. The goal of the study was to present the clinical features, increase awareness, facilitate accurate diagnosis, and report the outcomes after surgery. Methods: Thirty-five hands, from 22 patients with the main features of allodynia and lack of full finger flexion, were gathered in the period 2014-2021. The other common complaints included sleeping disturbances (20 patients), hand swelling (31 hands), and shoulder pain on the same side as the hand problem with limited range of motion (30 sides). The Tinel or Phalen signs were obscured by the pain. However, pain with passive flexion of the fingers was universally present. All the patients were treated with carpal tunnel release through a mini-incision approach: four patients had a trigger finger, which was treated concomitantly in six hands, and one patient underwent contralateral CTR for carpal tunnel syndrome with a more standard presentation. Results: At a minimum of 6 months of follow-up (mean, 22 months; range, 6-60 months), the pain decreased by 7.5 ± 1.9 points on the Numerical Rating Scale, which ranges from 0 to 10. The pulp-to-palm distance improved from 3.7 to 0.3 cm. The mean Disabilities of the Arm, Shoulder, and Hand score decreased from 67 to 20. The mean Single-Assessment Numeric Evaluation score for the whole group was 9.7 ± 0.6. Conclusions: Hand allodynia and lack of finger flexion may be indications of median neuropathy in the carpal canal, which responds to CTR. Awareness of this condition is important because the uncharacteristic clinical presentation may not be considered an indication for surgery that can be beneficial. 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 elbow ulnar collateral ligament complex demonstrates region specific stretching and recovery characteristics with valgus loading. Kwak, D., et al. (2023) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Anatomical Topic: Elbow ucl - Effect of repetetive valgus on its properties This is a cadaveric study investigating the biomechanical changes that occur in the ulnar collateral ligament (UCL) of the elbow under cyclic valgus loading. It was found that repeated valgus stress resulted in permanent stretching of the UCL complex, especially the posterior bundle. The posterior bundle demonstrated a higher strain, which did not appear to recover with the recovery period (rest). These findings suggest that cyclic valgus loading (e.g. pitching or arm wrestling) training should include longer resting periods in between movements to avoid laxity. A limitation of this study is that it was completed in cadavers and it is likely that in vivo, ligament properties can follow a different course if given enough time between valgus cycles (rest periods). 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 UCL complex is permanently stretched after repeated valgus loading and does not recover to intact levels. Whilst the anterior bundle of the ucl resumed a similar resting state to what was measured at baseline, the posterior bundle did not recover. It is possible that acute bouts of valgus elbow torques (e.g. baseball pitching, arm wrestling) may lead to permanent deformation and laxity of the ucl, especially if not enough rest is provided in between valgus cycles. If you would like to know more about how to test the elbow ligaments, have a look at this other synopsis. In addition to repetitive valgus loading, traumatic events such as elbow dislocations have the potential to cause ucl laxity (look at these synopses for elbow dislocation treatment and classification). URL: https://doi.org/10.1016/j.jse.2023.01.017 Abstract Background The objective of this study was to quantify the valgus laxity and strain of the elbow ulnar collateral ligament (UCL) complex after repeated valgus stretching and subsequent recovery. Understanding these changes may have important implications in improving strategies for injury prevention and treatment. The hypothesis was that the UCL complex will demonstrate a permanent increase in valgus laxity and region-specific increase in strain as well as region-specific recovery characteristics. Methods Ten cadaveric elbows (7M, 3F, 61.7 ± 2.7 years) were used. Valgus angle and strain of the anterior and posterior bands of the anterior bundle and the posterior bundle were measured at 1 Nm, 2.5 Nm, 5 Nm, 7.5 Nm and 10 Nm of valgus torque at 70º of flexion for: (1) intact UCL, (2) stretched UCL, and (3) rested UCL. To stretch the UCL, elbows were cycled with increasing valgus torque at 70º of flexion (10 Nm to 20 Nm in 1 Nm increments). until the valgus angle increased 8 degrees from the intact valgus angle measured at 1Nm. This position was held for 30 minutes. Specimens were then unloaded and rested for 2 hours. Linear mixed effects model with Tukey’s post hoc test was used for statistical analysis. Results Stretching significantly increased valgus angle compared to the intact condition 3.2 ± 0.2° (P < .001). Strains of both the anterior and posterior bands of the anterior bundle were significantly increased from intact by 2.8 ± 0.9% (P = .015) and 3.1 ± 0.9% (P = .018), respectively at 10 Nm. Strain in the distal segment of the anterior band was significantly higher than the proximal segment with loads of 5 Nm and higher (P < .030). After resting, the valgus angle significantly decreased from the stretched condition by 1.0 ± 0.1° (P < .001) but failed to recover to intact levels (P < .004). After resting, the posterior band had a significantly increased strain compared to the intact state of 2.6 ± 1.4% (P = .049) while the anterior band was not significantly different from intact. Conclusion After repeated valgus loading and subsequent resting, the UCL complex demonstrated permanent stretching with some recovery but not to intact levels. The anterior band demonstrated increased strain in the distal segment compared to the proximal segment with valgus loading. The anterior band was able to recover to strain levels similar to intact after resting, while the posterior band did not. 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

Insights and trends review: Artificial intelligence in hand surgery. Miller, R., Farnebo, S. and Horwitz, M. D. (2023) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic/Prognostic Topic: Artificial intelligence – Hand therapy This narrative review analysing the use of Artificial Intelligence (AI) in hand surgery, including challenges and key considerations, current applications, and potential future applications. It discusses the use of Machine Learning (ML) algorithms to improve the detection of scaphoid fractures, flagging hand and wrist fractures in emergency departments, and predicting postoperative function. The authors also mentioned the potential of AI to provide prognostic indicators for common conditions, and the use of natural language processing to provide a more holistic view of the patient. The article highlights the need for externally validated models and continuous model maintenance to ensure continued performance and warns of the risk of an influx of AI models with little clinical impact due to a lack of understanding, generalizability, real-world impact, or practical integration into clinical workflows. 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, Artificial Intelligence (AI) is an emerging and evolving field that has the potential to revolutionise the hand surgery and hand therapy fields. AI can be utilised to analyse large datasets, identify patterns and trends, and make predictions from complex data. However, it is important to consider transparency and the potential for bias when using AI in healthcare. Examples of how AI has already entered the hand therapy realm include the identification of scaphoid fractures on x-ray, determining the need to refer for wrist x-ray based on injury, patient advice to estimate the probability of success post carpal tunnel release, or estimating the probability of benefiting from elbow surgery post-traumatic stiffness. I have integrated some of these models in online calculators so you can utilise them. URL: https://doi.org/10.1177/17531934231152592 Abstract Artificial intelligence (AI) in hand surgery is an emerging and evolving field that will likely play a large role in the future care of our patients. However, there remain several challenges to makes this technology meaningful, acceptable and usable at scale. In this review article, we discuss basic concepts in AI, including challenges and key considerations, provide an update on how AI is being used in hand and wrist surgery and propose potential future applications. The aims are to equip clinicians and researchers with the basic knowledge needed to understand and explore the incorporation of AI in hand surgery within their own practice and recommends further reading to develop knowledge in this emerging field. 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 benefits of strength training on musculoskeletal system health: Practical applications for interdisciplinary care. Maestroni, L., et al. (2020) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Preventative, Therapeutic Topic: Resistance training - MSK benefits This is an expert opinion on the benefits of strength training on the musculoskeletal system. The article outlines the principles of mechano-transduction, which is the body's conversion of mechanical loading into cellular responses and provides evidence-based recommendations for the safe interdisciplinary application of strength training across different populations. It discusses the development of muscular strength, which can be divided into morphological (e.g. increase in muscle size) and neural factors (e.g. ability to recruit the muscles), and its role in the regulation and prevention of systemic disorders (e.g. diabetes). It also outlines the effects of weight-bearing, high-impact and multiplanar-impact exercises on bone health and the risk of fracture, as well as the effects of strength training on tendon health. Strength training should include an individualised and periodised approach with 2-3 sets of 1-6 repetitions with rest periods of 3-5 minutes, and a frequency of 2-3 times per week. The authors suggest that strength training confers unique benefits to the musculoskeletal system in common disorders and in healthy people. Healthcare professionals are encouraged to promote strength training among the general population due to its multi-systemic benefits. 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, strength training is an effective strategy for improving musculoskeletal health and should be promoted among the general population. Strength training should be tailored to the individual and precise prescription should be based on the goal of treatment (e.g. improve tendon strength - see table above). Strength training is not only useful to treat musculoskeletal conditions but it has also been shown to reduce mortality. Open Access URL: https://doi.org/10.1007/s40279-020-01309-5 Abstract Global health organizations have provided recommendations regarding exercise for the general population. Strength training has been included in several position statements due to its multi-systemic benefits. In this narrative review, we examine the available literature, first explaining how specific mechanical loading is converted into positive cellular responses. Secondly, benefits related to specific musculoskeletal tissues are discussed, with practical applications and training programmes clearly outlined for both common musculoskeletal disorders and primary prevention strategies. 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 outcomes of surgical repair for partial distal biceps tendon tears. Schmidt, G. J., Fischer, J. P., Crosby, N. E. and Hoyer, R. W. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumb up) Type of study: Therapeutic Topic: Partial distal biceps rupture - Surgery This is a retrospective study assessing the outcomes of surgery for partial distal biceps tears. A total of 74 participants took part in the study. The results showed that post-operatively, QuickDASH score was 2.3, with a 30.7% rate of complications. The paper also showed that 55.7% of patients initially treated nonsurgically ultimately underwent surgery, and those who performed heavy lifting or repetitive elbow flexion for their jobs described themselves as "much better" following surgery compared with nonsurgical treatment. There was no significant difference between patients with known traumatic or insidious onset of their symptoms, and the preoperative duration of symptoms before surgery did not significantly correlate with the outcomes. The complication profile for the repair of partial tears appears similar to previous reports of surgical repair for complete tears. Overall, with non-operative treatment, the score on the QuickDASH improved, however, recovery was slow. 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, surgical repair of partial tears of the distal biceps tendon is a viable treatment option with excellent outcomes and low complication rates. Preoperative duration of symptoms and known traumas preceding the symptoms do not appear to significantly affect the outcome. If patients are not keen to undergo surgery, their disability is likely to reduce over time, however, improvements are slow. Considering that repair of full distal biceps tears are indicated mainly in highly active individuals, the decision to operate on a partial distal biceps tear may depend on the surgeon's and patient's preference. The risk of complications due to surgery should be discussed with patients. URL: https://doi.org/10.1016/j.jhsa.2022.11.015 Abstract Purpose: The purpose of this study was to describe the outcomes of patients treated with surgical repair of partial tears of the distal biceps tendon. Methods: The study was a retrospective review of repairs of partial tears of the distal biceps tendon performed by multiple surgeons from January 1, 2015 to October 15, 2020. Inclusion criteria consisted of preoperative magnetic resonance imaging indicative of distal biceps pathology without a complete tear and surgical treatment with intraoperative confirmation of a partial tear. The presence of preceding trauma, duration of symptoms, and postoperative complications were documented. Patients were contacted for outcome assessment using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Reported Elbow Evaluation outcome measures. Clinical outcomes were obtained from 56 of 74 (76%) eligible patients with an average follow-up of 46 months (range: 15-85 months). Results: After surgery, the median QuickDASH was 2.3 (interquartile range, 0-9.7), and the median Patient-Reported Elbow Evaluation score was 1 (interquartile range, 0-12). Postoperative QuickDASH scores were significantly lower than the preoperative scores. Known traumas preceding the symptoms and duration of symptoms before surgery were not significantly associated with the outcome. Of all eligible patients, 30 complications were reported in 25 (34%) patients and included 2 reruptures, 2 cases of heterotopic ossification, 1 deep infection, 1 case of implant irritation, 21 neuropraxias, and 3 hematomas. Five (7%) patients underwent 6 reoperations including 1 revision for a rerupture, 1 irrigation and debridement, 2 heterotopic ossification excisions, 1 hematoma evacuation, and 1 implant removal. Conclusions: The results suggest that the repair of partial distal biceps tendon tears is a viable treatment option with significant improvement in QuickDASH. There was no significant relationship between the postoperative outcome and duration of symptoms or known traumas preceding the 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

Elbow stiffness imaging: A practical diagnostic and pretherapeutic approach. Lombard, C., et al. (2021) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Diagnostic/Therapeutic Topic: Elbow stiffness - Causes This is an expert opinion on the potential causes of elbow stiffness. Stifness impairments may be caused by a combination of tethering and/or blocks due to trauma or osteoarthritis (OA). Diagnostic imaging (e.g. radiographs, CT, CT-arthrography and MRI) is important for proper diagnosis/management and should be combined with medical history, and physical examination. This approach can help to identify bony impingement, evaluate articular cartilage, and hypothesis the soft-tissue contributors to elbow stiffness. Treatment of elbow stiffness can be either conservative, arthroscopic or surgical, with a current trend for arthroscopic procedures when conservative treatment fails. A complete list of extension/flexion stiffness differential diagnoses is reported below. 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, elbow stiffness can have a multifactorial aetiology associated with tethering and/or blocks due to trauma or osteoarthritis. Conservative management can be trialled and would be especially important in elbow osteoarthritis. In cases such as loose body causing extension/flexion blocks, surgery may be more appropriate. To help your clients determine whether they are likely to recover a functional ROM with surgery, you can read this synopsis and click on the button below to use the prediction tool that I have integrated on a webpage. URL: https://doi.org/10.3390/jcm10225348 Abstract Loss of elbow motion can lead to disability in everyday gestures, recreational activities, and work. Unfortunately, the elbow joint is particularly prone to stiffness because of its complex anatomy and biomechanics. The etiology of elbow stiffness is varied and must be diagnosed accurately in order to allow optimal treatment, which may be challenging for surgeons and physiotherapists. Its treatment can be either conservative, arthroscopic or surgical, with a trend for arthroscopic procedures when conservative treatment fails. There is no consensus on the optimal imaging workup for elbow joint stiffness, which may have an impact on patient management. This article reviews the current classification systems of elbow stiffness and the various imaging techniques used for diagnosis. Report checklists and clarifications on the role of each imaging method, as well as the imaging findings of normal and stiff elbows, are presented, leading to a proposed diagnostic algorithm. The main concern in imaging is to determine the cause of elbow stiffness, as many concomitant abnormalities might be present depending on the clinical scenario. 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

Dynamic splinting for the stiff hand after trauma: Predictors of contracture resolution. Glasgow, C., Tooth, L. R., Fleming, J. and Peters, S. (2011) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: PIPJ flexion deformity - Predictors of improvement This is a prospective study assessing what patient characteristics were associated with improvements in ROM following splinting and exercise in people with pipj contractures. A total of 46 participants (56 joints) were included in the present study. Hand therapists assessed several variables including time from injury, splinting total end range time (TERT), type of injury, and modified weeks test. The modified weeks test assesses short-term improvements in ROM associated with heat and stretching. All participants were treated with a splint and exercise and they attended therapy once or twice weekly for 8 weeks. The results showed that lower severity of injury, longer TERT, lower time from injury, and short terms improvements in ROM during baseline assessment (modified weeks test) were associated with greater ROM improvement. In particular, after eight weeks, participants were able to improve ROM in their pipj by the same amount identified during the baseline modified weeks test. 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, pipj injury early treatment appears to reduce the likelihood of fixed deformities. In addition, greater ROM improvements during baseline assessment are associated with a greater chance of recovering extension/flexion impairments. In addition, the more severe the injury (e.g. intrarticular vs extrarticular fracture), the less likely patients are to recover their ROM. Total end range time appears to have a role in improving ROM, however, it does not appear necessary to splint joints for more than 11 hrs/day. URL: https://doi.org/10.1016/j.jht.2011.03.001 Abstract STUDY DESIGN: Prospective cohort. INTRODUCTION: Many variables are believed to influence the success of dynamic splinting, yet their relationship with contracture resolution is unclear. PURPOSE OF THE STUDY: To identify the predictors of outcome with dynamic splinting of the stiff hand after trauma. METHODS: Forty-six participants (56 joints) completed eight weeks of dynamic splinting, and the relationship between 13 clinical variables and outcome was explored. RESULTS: Improvement in passive range of motion, active range of motion (AROM), and torque range of motion averaged 21.8°, 20.0°, and 13.0°, respectively (average daily total end range time, 7.96 hours). Significant predictors included joint stiffness (modified Weeks Test), time since injury, diagnosis, and deficit (flexion/extension). For every degree change in ROM on the modified Weeks Test, AROM improved 1.09° (standard error, 0.2). Test-retest reliability of the modified Weeks Test was high (intraclass correlation coefficient [2, 1]=0.78). CONCLUSIONS: Better progress with dynamic splinting may be expected in joints with less pretreatment stiffness, shorter time since injury (<12 weeks), and in flexion rather than extension deficits. Further research is needed to determine the accuracy with which the modified Weeks Test may predict contracture resolution. 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