Search Results

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

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

Randomized controlled trial of daily total end range time (tert) for capener splinting of the stiff proximal interphalangeal joint. Glasgow, C., Fleming, J., Tooth, L. R. and Peters, S. (2012). Treatment of proximal interphalangeal joint flexion contracture: combined static and dynamic orthotic intervention compared with other therapy intervention: a randomized controlled trial. Cantero-Téllez, R., Cuesta-Vargas, A. I. and Cuadros-Romero, M. (2015). Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: PIPJ flexion contracture - TERT These are two randomised controlled studies investigating the effect of total end range time (TERT) dosage on range of motion (ROM) for pipj flexion contractures. One of the two studies also assessed whether splinting provided better outcomes than exercise and stretching alone. A total of 82 participants with pipj flexion deformity following injury were included. The results showed that static-progressive and dynamic splinting were effective in improving active pipj extension. Exercise/stretching alone provided similar results but the combination with splinting was more beneficial. In terms of TERT dosage, there was no significant difference in ROM improvements between those who wore the splint for 10-12 hours or 12-16 hours. 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 static-progressive and dynamic orthoses is an effective treatment for extension deficits of the proximal interphalangeal (PIP) joint. The results of these studies suggest that longer application times may be beneficial, however, further research is needed to confirm this. It is possible that wearing a splint beyond 11 hrs per day provides no additional benefits. Similar findings were identified when other non-experimental studies were assessed in a recent systematic review. Glasgow et al. (2012) URL: https://doi.org/10.5014/ajot.2012.002816 Cools, A. M., et al. (2014) URL: https://doi.org/10.1016/j.jhsa.2015.01.005 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

Burden of hand osteoarthritis in the middle east and north africa (mena): An epidemiological analysis from 1990 to 2019. Hoveidaei, A. H., et al. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence study Topic: Hand OA - Epidemiology This study evaluated the epidemiology and burden of hand osteoarthritis in the Middle East and North Africa region from 1990 to 2019. The Global Burden of Disease tool was utilised to estimate the prevalence, incidence, and years lived with disability of hand osteoarthritis. The results showed an increase in the prevalence, incidence, and years lived with disability due to hand osteoarthritis in the Middle East and North Africa region from 1990 to 2019. The prevalence of hand osteoarthritis was higher in women than in men and increased with age. 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, hand osteoarthritis disability and burden varies worldwide due to a series of environmental and genetic factors. In the Middle East and North Africa region, the incidence and prevalence of hand OA have increased over the past 30 years. A surge in obesity rates in these regions has been highlighted as a risk factor for future disability due to hand OA. As shown previously, this paper reiterates that the development of hand OA is likely multifactorial and that BMI is a risk factor. URL: https://doi.org/10.1016/j.jhsa.2022.11.016 Abstract Purpose: Hand osteoarthritis (OA) is a common cause of disability in older people. Although often underemphasized, it may affect quality of life and imposes a considerable burden on the health system. This study evaluated the epidemiology of hand OA in the Middle East and North Africa (MENA) region. Methods: This epidemiological study was performed based on the Global Burden of Disease study from 1990 to 2019. The incidence, prevalence, and years lived with disability (YLD) in all 21 MENA countries during the study period were reported in rate, age-standardized, and percentage. Results: Hand osteoarthritis in MENA increased 2.7-fold, from 1.6 million cases to 4.3 million from 1990 to 2019 with an age-standardized incidence rate of 50.2 (95% CI, 38.2-66.4) per 100,000 people in 2019. Saudi Arabia had the highest age-standardized prevalence in both 1990 (2.3%) and 2019 (2.3%), whereas Turkey had the lowest (0.3%) in both years. Total YLDs due to hand osteoarthritis increased by more than 2.7-fold, from 50,335 to 135,336 during the study period. The highest rate of increase in YLD rate from 1990 to 2019 was in Iran (3.3) and the largest decrease was in Qatar (-11.5). Conclusions: In contrast to the global trend, MENA hand OA prevalence and YLDs did not decrease between 1990 and 2019 and remained constant over time. Aging and increasing obesity rates, particularly among women, might be the contributing factors. Hand OA epidemiology varies by country, possibly due to genetic, ethnic, and environmental factors. 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

Complications after volar locking plate fixation of distal radius fractures: A retrospective study of 822 patients. Perregaard, S., Jørgensen, R. W. and Landgren, M. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Distal radius fracture – Complications This is a retrospective study investigating the complication rates following open reduction and internal fixation (ORIF) for distal radius fractures (DRF). A total of 822 participants undergoing ORIF were included in the study and they were followed up for an average of 3 years. Of these, 12% experienced a complication, with 5% experiencing a major complication and 7% experiencing a minor complication. The most common complication was carpal tunnel syndrome (2%), followed by CRPS (1%), and loss of reduction (1%). Tendon ruptures and adhesion were rare events. Revision surgery due to complications was 6%. Patient age and time from trauma to surgery were not associated with post-operative complications. 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 overall complication rate following ORIF for distal radius fractures is 12% (5% major complications, 7% minor complications). Age, sex, time from trauma to surgery, and fracture type were not found to be associated with an increased risk of postoperative complications. However, based on previous evidence it appears that diabetes and smoking increase the risk of complications post-ORIF. URL: https://doi.org/10.1016/j.jhsa.2022.11.012 Abstract Purpose: With the current routine use of volar locking plates as the preferred surgical treatment option for distal radius fractures, the purpose of this study was to investigate the incidence of postoperative complications following surgery and, second, investigate the correlation between demographic factors and the risk of complications. Methods: We retrospectively reviewed all patients who had been surgically treated for a distal radius fracture with open reduction and internal fixation using volar plating and screws during a 3-year period. Relevant demographic information and all postoperative complications of the 822 patients eligible for inclusion were recorded, with a mean follow-up time of 2.8 years. Results: We identified an overall complication rate of 12.3% (101 of the 822 patients), with 4.8% defined as experiencing major complications and 7.5% defined as experiencing minor complications. The most frequent were complications that led to hardware removal, observed in 2.7% (n = 22) of the patients; wound-related problems that did not require surgical revision, observed in 2.2% (n = 18) of the patients; and carpal tunnel syndrome, observed in 1.9% (n = 16) of the patients. Binary logistic regression modeling showed no correlation between demographic factors and the risk of complications. Conclusions: In conclusion, a low overall complication rate of 12.3% was found. Further, 4.8% of the patients experienced a major complication and 7.5% of the patients experienced a minor complication following open reduction and internal fixation using volar plating of distal radius fractures. Age, sex, fracture type, and time from trauma to surgery were not found to be associated with an increased risk of postoperative complications. 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

Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: Analysis of a national cohort of 43,076 surgeries. Lane, J. C., et al. (2021) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Thumb OA surgery – Adverse events This is a retrospective study assessing the incidence of additional surgery/procedures and serious adverse events (SAEs) following surgery for base of thumb osteoarthritis. A total of 43,076 patients were included in the study. The results showed that the overall rate of further thumb base procedure was 1.4%, with the highest rates identified after arthroplasty (4%) and arthrodesis (4%). In contrast, simple trapeziectomy showed a much lower risk of complications (1.12%). Any serious complication was shown to be 0.2% within 90 days, and 0.6% (e.g. thrombosis) for systemic events within 90 days. Additional factors associated with further thumb base procedure included being younger (worse outcomes in the 40-49 years old) and being female. Clinical Take Home Message: Based on what we know today, surgery for base of thumb osteoarthritis is generally safe, with a low rate of additional surgery/interventions or serious adverse events. However, we should be aware that patients undergoing arthroplasty and arthrodesis are at an increased risk of further procedures and adverse events. In addition, smoking and diabetes have been shown to increase the likelihood of post-surgical complications and we should monitor these patients more closely. URL: https://doi.org/10.1136/bmjopen-2020-045614 Abstract OBJECTIVES: To determine the incidence of further procedures and serious adverse events (SAEs) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated with these outcomes. DESIGN: Population based cohort study. SETTING: National Health Service using the national Hospital Episode Statistics data set linked to mortality records over a 19-year period (01 April 1998-31 March 2017). PARTICIPANTS: 43 076 primary surgeries were followed longitudinally in secondary care until death or migration on 37 329 patients over 18 years of age. MAIN OUTCOME MEASURES: Incidence of further thumb base procedures (including revision surgery or intra-articular steroid injection) at any time postoperatively, and local wound complications and systemic events (myocardial infarction, stroke, respiratory tract infection, venous thromboembolic events, urinary tract infection or renal failure) within 30 and 90 days. To identify patient factors associated with outcome, Fine and Gray model regression analysis was used to adjust for the competing risk of mortality in addition to age, overall comorbidity and socioeconomic status. RESULTS: Over the 19 years, there was an increasing trend in surgeries undertaken. The rate of further thumb base procedures after any surgery was 1.39%; the lowest rates after simple trapeziectomy (1.12%), the highest rates after arthroplasty (3.84%) and arthrodesis (3.5%). When matched for age, comorbidity and socioeconomic status, those undergoing arthroplasty and arthrodesis were 2.5 times more likely to undergo a further procedure (subHR 2.51 (95% CI 1.81 to 3.48) and 2.55 (1.91 to 3.40)) than those undergoing simple trapeziectomy. Overall complication rates following surgery were 0.22% for serious local complications and 0.58% for systemic events within 90 days of surgery. CONCLUSIONS: The number of patients proceeding to BTOA surgery has increased over the last 19 years, with a low rate of further thumb base procedures and SAEs after surgery overall registered. Arthrodesis and arthroplasty had a significantly higher revision rate. 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

Thumb and fingertip ischaemia after trapeziectomy. Williams, D. C., Sánchez Ruas, J. and del Piñal, F. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic This is the answer to last week's Sherlock Handy. The patient was a 53 years old office worker who had undergone trapeziectomy with ligament reconstruction and tendon interposition. They did not present with comorbidities. Seven hours after they were discharged, they presented to ED with excruciating pain in their hand. Upon objective examination, the fingers had no capillary refill. Following assessment of a vascular surgeon, they were put on antibiotics, steroids, and aspirin. They were discharged after two days. Seven days after surgery, their hand appeared as shown in the picture below. They were assessed by another team of surgeons and there was no evidence of infection or joint range of movement limitations. An angiogram was performed, which showed a radial artery thrombosis and digital ischaemia. The artery was reconstructed with a vein graft and the patient was administered heparin and aspirin. The skin lesions healed over 6 weeks. The radial artery thrombosis was caused by an iatrogenic injury during trapeziectomy. 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, iatrogenic injuries to the vascular supply of the hand can cause devastating results. The assessment of capillary refill time and Allen's test are important aspects of the objective assessment following post-surgically interventions or insidious onset of hand conditions, which may be caused by vascular impairments. URL: https://doi.org/10.1177/17531934231151215 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

Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review. Valdes, K., Boyd, J. D., Povlak, S. B. and Szelwach, M. A. (2019) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Treatment Topic: Pipj flexion deformity - Splint effect This is a systematic review and meta-analysis assessing the efficacy of splinting for pipj flexion deformity post-injury. Four studies (2 randomised controlled trials) were included in the review. Different orthoses, including a dynamic Capener splint, custom-fabricated thermoplastic mcpj block splints, and a dynamic hand based splints were utilised. The results showed that the orthoses improved range of motion by an average of 20°. The recommended wearing schedule for optimal results was found to be at least 6 hours per day for 2-4 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, pipj splint can improve flexion deformities by an average of 20° when worn for at least 6 hours/day for 8-17 weeks. Best practice suggests low force, intermittent removal for ROM exercises, and monitoring for swelling, cyanosis, or tingling. This is a useful review showing the usefulness of splinting for specific hand conditions. In contrast, splinting for De Quervain does not appear to have the same beneficial effects if worn for long periods of time. However, it may be useful for the reactive stage (acute presentation), when rest appears to be useful. URL: https://doi.org/10.1016/j.jht.2018.05.003 Abstract Study Design: Systematic review. Introduction/Purpose of the Study To determine the efficacy of orthotic devices for increased active proximal interphalangeal (PIP) joint range of motion and optimal wearing schedule of the devices to guide clinical practice. The secondary purpose is to capture the outcome measures used by the authors. The final purpose was to determine if recent studies addressed patient satisfaction and adherence in the orthotic management of a PIP joint injury. Methods: A comprehensive literature search was conducted using the search terms splint, orthotic device, hand orthotic, brace, proximal interphalangeal joint, occupational therapy, and physical therapy using PubMed, CINAHL, MEDLINE, and ProQuest. The following data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines: background statement, objectives, data sources, study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings. Results: Best results were achieved when the PIP orthoses were worn for a longer duration especially for the treatment of extension deficits. Discussion: Studies that provided a wearing schedule of a minimum of 6 hours obtained the greatest improvements in extension deficits of the PIP joint. Conclusion Recommended orthotic dosage to treat PIP joint injury is at least 6 hours a day for 8-17 weeks. 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 multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy: A randomised crossover trial. Hill, C. E., Heales, L. J., Stanton, R. and Kean, C. O. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia – Kinesio taping This is a randomised crossover trial assessing the effects of multidirectional elastic tape on pain-free grip strength and pressure pain threshold in individuals with lateral elbow tendinopathy. A total of 27 participants were included in the study. The tensioned (experimental) tape was applied as shown in the image below. The placebo tape was applied without tension. These conditions were also compared to a "no tape" condition. Pain-free grip strength and pressure pain thresholds were measured immediately before and after the application of taping/no taping. The results showed that the "tensioned" kinesio tape provided no additional benefit compared to the placebo application or no tape. In terms of pain-free grip strength or pressure pain threshold. There were, however, individual variations showing that 7 participants (26%) experienced an increase in pain-free grip strength with the experimental condition. 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, tensioned multidirectional elastic tape does not appear to improve pain-free grip strength or pressure pain threshold in individuals with lateral elbow tendinopathy. This is in line with previous evidence showing that "inhibitory" Kinesio taping is no more effective than a placebo for lateral epicondylalgia (LE). If you are interested in lateral epicondylalgia, have a look at the whole collection. Open Access URL: https://doi.org/10.1177/02692155231152817 Abstract OBJECTIVE: To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy. STUDY DESIGN: Randomised crossover trial. SETTING: Biomechanics laboratory. SUBJECTS: 27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration. INTERVENTIONS: Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions. MAIN MEASURES: Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions. RESULTS: There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F(2,52) = 0.02, p = 0.98; extended position: F(2,52) = 2.26, p = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F(1,26) = 0.94, p = 0.34; extended position: F(1,26) = 0.79, p = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F(1.51,39.17) = 0.54, p = 0.54) or across timepoints (affected lateral epicondyle: F(1,26) = 0.94, p = 0.34). CONCLUSION: Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist. 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

Development and validation of a prognostic nomogram for open elbow arthrolysis: The Shanghai Prediction model for Elbow Stiffness Surgical Outcome. Liu, W., et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Post-traumatic elbow stiffness - Is arthrolysis going to be successful? This is a prognostic study aiming to develop a model to predict the outcome of surgery for post-traumatic stiffness of the elbow. The type of surgery investigated was open arthrolysis. A total of 551 patients were retrospectively identified amongst a cohort of Chinese people presenting with post-traumatic elbow stiffness. A successful surgical outcome was defined as presenting with more than 120° (functional elbow range) post-surgery. Several potential predictors were included. The results showed that higher BMI, longer duration of stiffness, poorer baseline ROM, more severe pain, and more severe OA of the elbow lead to poorer functional recovery after open elbow arthrolysis. The model had a good prediction performance although further validation is required. To calculate the probability of your patients having a successful surgery, you can use the nomogram in the figure below or use the online tool that I created for you. 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 Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) is a valid and convenient model, which can be utilised to predict the outcome of open arthrolysis of the elbow. It can be adopted in combination with clinical reasoning to counsel patients about surgical options (i.e. open arthrolysis) to reduce elbow stiffness. Considering that elbow stiffness can lead to mental health issues such as depression, it is an important impairment to resolve. In terms of conservative treatment, stretching or resistance training appear to be useful to regain range of movement. URL: https://doi.org/10.1302/0301-620x.104b4.bjj-2021-1326.r2 Abstract AIMS: The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. METHODS: We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation. RESULTS: BMI, the duration of stiffness, the preoperative ROM, the preoperative intensity of pain, and grade of post-traumatic osteoarthritis of the elbow were identified as predictors of outcome and incorporated to construct the nomogram. SPESSO displayed good discrimination with a C-index of 0.73 (95% confidence interval 0.64 to 0.81). A high C-index value of 0.70 could still be reached in the interval validation. The calibration graph showed good agreement between the nomogram prediction and the outcome. CONCLUSION: The newly developed SPESSO is a valid and convenient model which can be used to predict the outcome of open arthrolysis of the elbow. It could assist clinicians in counselling patients regarding the choice and expectations of treatment. 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: 👍 (1/4 thumbs up) Type of study: Diagnostic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 53 years old office worker who had undergone trapeziectomy with ligament reconstruction and tendon interposition. They did not present with comorbidities. Seven hours after they were discharged, they presented to ED with excruciating pain in their hand. Upon objective examination, the fingers had no capillary refill. Following assessment of a vascular surgeon, they were put on antibiotics, steroids, and aspirin. They were discharged after two days. Seven days after surgery, their hand appeared as shown in the picture below. They were assessed by another team of surgeons and there was no evidence of infection or joint range of movement limitations. What's the problem?