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Impaired median nerve mobility in patients with carpal tunnel syndrome: A systematic review and meta-analysis. Lin, M. T., Liu, I. C., Chang, H. P. and Wu, C. H. (2022) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Nerve gliding - Median nerve This is a systematic review and meta-analysis assessing whether people with carpal tunnel syndrome present with a reduction in median nerve gliding. A total of 14 studies, which included experimental, quasi-experimental, and cross-sectional designs were included. Across all studies, 671 participants were included (395 with carpal tunnel syndrome and 296 healthy controls). Median nerve excursion was assessed in all studies through ultrasound imaging. The results showed that the carpal tunnel group presented with a sliding reduction of at least 0.5 cm compared to the healthy controls. 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, median nerve gliding is impaired in people with carpal tunnel syndrome. It is possible that people with carpal tunnel syndrome present with this deficit bilaterally, especially considering that there is a strong genetic component to carpal tunnel syndrome. It is unclear at this stage whether nerve gliding exercises are effective at improving nerve movement and symptoms to a clinically relevant level. Evidence-based interventions include night splinting plus exercise for six weeks, cortisone injections, or carpal tunnel surgery. URL: https://doi.org/10.1007/s00330-022-09262-9 Abstract OBJECTIVES: This systematic review and meta-analysis investigated the mobility of the median nerve (MN) in carpal tunnel syndrome (CTS) patients compared to healthy people. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed and the electronic databases including PubMed, Scopus, EMBASE, and Cochrane Library were searched up to April 2022. All published observational studies comparing the excursion of MN between participants with and without CTS were included. The quality of research was assessed by the Newcastle-Ottawa Scale tool. The primary outcome was the excursion of the MN under dynamic examination, representing nerve mobility quantified by the standardized mean difference (SMD) for random effect meta-analysis. RESULTS: Fourteen studies were included in the qualitative review, and twelve entered the meta-analysis involving a total of 375 CTS patients and 296 healthy controls. The forest plot revealed that the mobility of the MN significantly decreased in the CTS group compared to the non-CTS control (SMD = -1.47, 95% CI: -1.91, -1.03, p < 0.001, heterogeneity 82%). In subgroup analysis, both transverse and longitudinal methods for nerve excursion showed less nerve mobility in CTS than in non-CTS. CONCLUSIONS: This meta-analysis showed that the patients with CTS exhibited less mobility of the MN than those without CTS, suggesting MN mobility as a potential CTS marker. KEY POINTS: • The patients with CTS revealed less mobility of the median nerve than those without CTS. • The mobility of the median nerve could be regarded as a potential CTS marker. 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

Primary elbow osteoarthritis: Evaluation and management. Martinez-Catalan, N. and Sanchez-Sotelo, J. (2021) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Elbow osteoarthritis – Treatment This is an expert opinion on the management of symptomatic primary elbow osteoarthritis (OA) (non-traumatic). This condition often presents with pain and range of movement limitations. It is not uncommon for this condition to be associated with ulnar nerve impingement and joint locking due to loose bodies. X-rays are often required for the differential diagnosis, If the clinical presentation is characterised by pain without locking or severe range of movement limitations, conservative treatment is appropriate. This may include activity modification and the use of pain-relieving medications in adjunct with exercises to recover the available range of movement and strength. At times, it is not possible to regain the full range of movement due to osteophytes. If locking or severe range of movement limitations are present, open or arthroscopic surgery may be effective in resolving these symptoms. Postoperatively, active range of movement should be initiated from day one and gradually progressed to regain function. Splinting may be utilised at night for the first 3-4 weeks for comfort. In severe cases of elbow OA, joint replacement may be beneficial, however, this approach limits the return to recreational activities (e.g. weight lifting) that people enjoy. 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, primary elbow OA may be treated conservatively if there is no locking or severe range of movement limitations. In contrast, open or arthroscopic surgery is utilised for more severe cases. Post-surgical rehabilitation involves early active motion in combination with night splinting for 3-4 weeks for comfort. Finally, in people with symptomatic elbow OA, we need to assess motor (e.g. pinch strength) and sensory function (e.g. light touch, pinprick) of the ulnar never as this is often entrapped at the cubital tunnel due to osteophytes. URL: https://doi.org/10.1016/j.jcot.2021.05.002 Abstract Most patients with primary osteoarthritis of the elbow report a history of heavy lifting with the affected upper extremity - Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages - When surgery is required, and despite the presence of cartilage wear, many patients with primary elbow osteoarthritis experience substantial pain improvement with joint preserving procedures - The ulnar nerve needs to be carefully assessed and addressed at the time of surgery - Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has emerged as the surgical procedure of choice - Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures. 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

Effectiveness of corticosteroid injections in diabetic patients with de quervain tenosynovitis. Buddle, V. P., DeBernardis, D., Lutsky, K. F., Beredjiklian, P. K. and Matzon, J. L. (2022) Level of Evidence: 2b- Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: De Quervain and diabetes - Cortisone injections This is a retrospective study on the failure rate of cortisone injections for De Quervain syndrome in people with diabetes mellitus. A total of 169 participants were retrospectively identified through a USA-based hospital database. Participants were included if the insurance code indicated the presence of De Quervain and diabetes. Failure of injection was defined as the need for a second injection or surgical intervention. The results showed that in 49% of participants, the first injection was successful. The second and third injection was successful in 67% of participants (see figure 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, the first cortisone injection for De Quervain syndrome is less effective in people with diabetes (50%) compared to people without this comorbidity (70%). This result may be due to confounding factors such as age. Thus, previous research in a large sample of people treated for De Quervain did not find significant effects for this comorbidity whilst controlling for several other variables. URL: https://doi.org/10.1097%2FMD.0000000000027067 Abstract PURPOSE: We sought to determine the effectiveness of corticosteroid injections (CSIs) for de Quervain tenosynovitis in patients with diabetes mellitus. METHODS: We retrospectively identified all patients with diabetes receiving a CSI for de Quervain tenosynovitis by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, number and timing of CSIs, and first dorsal compartment release. Success was defined as not undergoing an additional CSI or surgical intervention. The mixture of a corticosteroid and local anesthetic provided in each injection was at the discretion of each individual surgeon. RESULTS: Corticosteroid injections were given to 169 wrists in 169 patients with diabetes. Out of 169 patients, 83 (49%) had success following the initial CSI, 44 (66%) following a second CSI, and 6 (67%) following a third CSI. A statistically significant difference was identified in the success rates between the first and second CSIs. Ultimately, 36 of 169 wrists (21%) underwent a first dorsal compartment release. CONCLUSIONS: Patients with diabetes mellitus have a decreased probability of success following a single CSI for de Quervain tenosynovitis in comparison to nondiabetic patients, as described in the literature. However, the effectiveness of each additional CSI does not appear to diminish. 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

Rupture of the triceps tendon – A case series. Jaiswal, A., Kacchap, N. D., Tanwar, Y. S., Kumar, D. and Kumar, B. (2016) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. The patient was a 25 years old, who presented with sudden onset of left elbow swelling and pain whilst performing resisted elbow extension exercises at the gym. Active range of movement of the elbow was possible and there was no obvious deformity. There was tenderness on palpation across the whole elbow. X-rays are shown below. The patient underwent surgery and the partial triceps tendon rupture was repaired. Following surgery the patient was immobilised for three weeks after which a gradual range of movement exercise program was initiated. Resistance training was introduced three months post-surgery. At one year, there were no functional limitations, however, objective testing revealed a 10 degrees elbow flexion limitation. 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, distal triceps tendon partial/full ruptures can occur due to a fall onto an outstretched arm or gym exercises superseding tissue capacity. Objective testing may reveal bruising, a palpable defect (full ruptures), and weakness in resisted elbow extension. If surgical repair is indicated, return to work is faster compared to a distal biceps tendon repair. Remember that elbow extension weakness may be caused by a low cervical spine (C7) radiculopathy and this condition needs to be considered as a differential diagnosis. Open Access URL: https://doi.org/10.1016/j.cjtee.2016.06.006 Abstract Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed. 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

Nico's blog, which was written for PhysioTutors Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of blog: Diagnostic Topic: Elbow assessment The elbow is the middle-earth of the upper limb, placed above the realm of the hand and below the realm of the shoulder. As per Tolkien’s Lord of The Ring, the scientific literature is full of magical tests with 100% sensitivity and specificity. So how can we decide how to assess our clients? Let’s walk through a few steps that you may find useful in clinical practice 💪. Easy steps First of all, the subjective assessment is our greatest friend. Knowledge of whether the client presents with a traumatic or non-traumatic condition halves the number of tests that we can perform. At the same time, observation will guide us in determining whether it is safe to perform any tests. For example, if the person is complaining of a traumatic injury associated with bruising and deformity, is it likely that the best thing we can do is refer them for an x-ray (Bunshah et al., 2015). In contrast, if the presentation is traumatic but we feel comfortable moving into active range of movement assessment, the elbow extension test may be useful in determining whether we require an x-ray (Appelboam et al., 2008). This is a good screening test, if it’s negative, you can be reasonably confident that they do not have a fracture. Physiotutors have created a helpful video about this test that you should watch! You have now determined whether the client needs an x-ray before proceeding with the physical assessment! Well done! Next, you could further exclude special tests by determining the location and type of symptoms they present with. What is the location of pain, pins and needles, numbness, and/or weakness? If you can answer these questions, the number of special tests will reduce to 0 or 2-3. Zero if pain is widespread and it is not following any specific pattern that you can think of. In this case, after your appointment, you can brainstorm with yourself and your colleagues. On the other hand, if you have a differential diagnosis in mind, you can get through your classic active, passive range of movement testing followed by a few special tests. How good are special tests though? Not so good. As covered in a previous synopsis, the diagnostic accuracy of special tests for the elbow is poor (Zwerus et al., 2018). This means that solely based on the results of special tests for the elbow, we cannot make a diagnosis. Is this surprising? I don’t think so. Often the problem is that we do not have a gold standard against which to compare special test results. For instance, common extensor tendon origin tendinopathy (e.g. tennis elbow) does not have a diagnostic gold standard. Ultrasound and MRI imaging can detect changes within the tendon but not all tendinopathies are symptomatic. In other instances, there is just not enough research to be confident about the results of an isolated special test (e.g., hook test for distal biceps rupture). This does not mean that we cannot use these tests, we just need to be aware of the limitations and reduce our expectations. This last point means that our subjective and clinical reasoning need to have greater importance compared to special tests when making a diagnosis. For those of you who like numbers, it simply means that the change in diagnostic probability should be much more affected by subjective and general objective examination compared to isolated results from special tests! For a list of special tests for the elbow, have a look at the table by Zwerus et al. (2018). On a final note, be aware of studies showing 100% specificity or sensitivity. They often obtain those results because there is a disproportionate number of participants with or without the condition studied. These results are more likely to come from a Harry Potter book rather than reality - ✨ The magic of statistics ✨ References Distal triceps tendinopathies. Lappen, S., et al. (2020) https://doi.org/10.1007/s11678-020-00601-0 Triceps tendon rupture: An uncommon orthopaedic condition. Bunshah, J. J., Raghuwanshi, S., Sharma, D. and Pandita, A. (2015). http://dx.doi.org/10.1136/bcr-2014-206446 Distal biceps tendon repair and reconstruction. Srinivasan, R., Pederson, W., & Morrey, B. (2019) http://dx.doi.org/10.1016/j.jhsa.2019.09.014 Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. Appelboam, A., et al. (2008). https://doi.org/10.1136/bmj.a2428 Physical examination of the elbow, what is the evidence? A systematic literature review. Zwerus, E. L., et al. (2018). http://dx.doi.org/10.1136/bjsports-2016-096712 Disclaimer: This blog was written by one clinician only and it reflects their interpretation. Readers should come to their own conclusions by reading the original articles.

Nearly half of patients with chronic tendinopathy may have a neuropathic pain component, with significant differences seen between different tendon sites: a prospective cohort of more than 300 patients. Wheeler, P. C. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence Topic: Neuropathic pain - Tennis elbow This is a cross-sectional study assessing the presence of neuropathic pain in people with tendinopathy. In this synopsis, we focused on tennis elbow. A total of 39 participants with lateral elbow tendinopathy were included in the study. The diagnosis was made by a sports medicine consultant, and other diagnoses such as upper limb entrapment neuropathies were excluded. To assess the presence of neuropathic pain, the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS). Other clinical outcomes such as average and worst pain were assessed. The results showed that 50% of participants with tennis elbow presented with neuropathic pain characteristics (e.g. burning pain, pins and needles, allodynia). In addition, greater levels of neuropathic pain presented with higher levels of pain. 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 large proportion of patients with lateral elbow tendinopathy present with neuropathic pain characteristics. In addition, these people have greater levels of pain intensity. In clinical practice, it is important to differentiate between lateral elbow tendinopathy and peripheral entrapment neuropathies such as radial tunnel syndrome or cervical radiculopathies. Cervical radiculopathies can also present with upper limb peripheral symptoms (e.g. burning, pins and needles) without neck pain. Although this cervical radiculopathy presentation is rare, we need to keep it in mind as a differential diagnosis. A full neurological assessment would be useful to screen for these conditions. Open access URL: http://dx.doi.org/10.1136/bmjsem-2021-001297 Abstract OBJECTIVES: Identifying the prevalence of neuropathic pain components in patients with chronic tendinopathy conditions using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire. METHODS: Patients with chronic tendinopathy and 'tendon-like' conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified. Pain scores, plus global function patient-reported outcome measures (5-Level version of EuroQol-5 Dimension and Musculoskeletal Health Questionnaire (MSK-HQ)), were completed and compared with the S-LANSS questionnaire. RESULTS: 341 suitable patients with chronic tendinopathy and potentially similar conditions were identified. Numbers: lateral elbow tendinopathy (39), greater trochanteric pain syndrome (GTPS; 112), patellar tendinopathy (11), non-insertional Achilles tendinopathy (40), insertional Achilles tendinopathy (39), plantar fasciopathy (100). 68% were female, with a mean age of 54.0±11.3 years and a mean symptom duration of 38.1±33.7 months.There was a mean S-LANSS score of 11.4±6.4. Overall, 47% of patients scored 12 or greater points on S-LANSS, indicating the possible presence of neuropathic pain. The highest proportion was in patients with plantar fasciopathy (61%), the lowest in those with GTPS (33%). Weak correlations were found between the S-LANSS score and MSK-HQ score, the numerical rating scale (0-10) values for 'average pain' and for 'worst pain', but not with the MSK-HQ %health value. CONCLUSION: S-LANSS identified nearly half of patients with chronic tendinopathy as possibly having a neuropathic pain component. This is of unclear clinical significance but worth further study to see if/how this may relate to treatment outcomes. These results are from a single hospital clinic dealing with patients with chronic tendinopathy, without a control group or those with shorter symptom duration. However, this reinforces the probability of neuropathic pain components in at least some patients with chronic tendinopathy. 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

Tolerability and efficacy of duloxetine for the prevention of persistent musculoskeletal pain after trauma and injury: A pilot three-group randomized controlled trial. Beaudoin, F. L., Gaither, R., DeLomba, W. C. and McLean, S. A. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Duloxetine - Acute musculoskeletal pain This is a pilot randomised double-blind placebo-controlled trial assessing the tolerability and efficacy of duloxetine (an antidepressant) in reducing the likelihood of pain. A total of 65 participants completed the study. Participants were recruited in the emergency department and were randomised to receive either a placebo pill, 30 mg, or 60 mg of duloxetine per day for two weeks. Tolerability was assessed by determining the number of participants reporting side effects and comparing them between placebo and active drugs. Pain intensity was assessed on the numerical rating scale. Participants were followed up for six weeks. The results showed that there was no difference in adverse events across groups. For pain intensity, there was a statistically significant but not clinically relevant difference between the 60 mg duloxetine and placebo groups. 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, 60 mg/daily of duloxetine for 2 weeks does not appear to provide clinically relevant benefits over placebo alone for people with acute musculoskeletal injuries. There is a trend favouring duloxetine over placebo, however, future studies powered for effectiveness need to be completed before routinely prescribing this medication in clinical practice. Considering that depression and anxiety are common after elbow/wrist/hand/finger injury, it is possible that duloxetine may be appropriate for a subgroup of patients. URL: https://doi.org/10.1097/j.pain.0000000000002782 Abstract This study investigated the tolerability and preliminary efficacy of duloxetine as an alternative nonopioid therapeutic option for the prevention of persistent musculoskeletal pain (MSP) among adults presenting to the emergency department with acute MSP after trauma or injury. In this randomized, double-blind, placebo-controlled study, eligible participants (n = 78) were randomized to 2 weeks of a daily dose of one of the following: placebo (n = 27), 30 mg duloxetine (n = 24), or 60 mg duloxetine (n = 27). Tolerability, the primary outcome, was measured by dropout rate and adverse effects. Secondary outcomes assessed drug efficacy as measured by (1) the proportion of participants with moderate to severe pain (numerical rating scale ≥ 4) at 6 weeks (pain persistence); and (2) average pain by group over the six-week study period. We also explored treatment effects by type of trauma (motor vehicle collision [MVC] vs non-MVC). In both intervention groups, duloxetine was well tolerated and there were no serious adverse events. There was a statistically significant difference in pain over time for the 60 mg vs placebo group (P = 0.03) but not for the 30 mg vs placebo group (P = 0.51). In both types of analyses, the size of the effect of duloxetine was larger in MVC vs non-MVC injury. Consistent with the role of stress systems in the development of chronic pain after traumatic stress, our data indicate duloxetine may be a treatment option for reducing the transition from acute to persistent MSP. Larger randomized controlled trials are needed to confirm these promising results. 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/Therapeutic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 25 years old, who presented with sudden onset of left elbow swelling and pain whilst performing resisted elbow extension exercises at the gym. Active range of movement of the elbow was possible and there was no obvious deformity. There was tenderness on palpation across the whole elbow. X-rays are shown below. What is it?

Botulinum toxin for the treatment of intractable raynaud phenomenon. Gallegos, J. E., D. C. Inglesby, Z. T. Young and F. A. Herrera (2020). Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Raynaud's phenomenon - Botox This is narrative review on the use of botulinum injection therapy in people with Raynaud's Phenomenon (RP). This condition is characterised by painful vasocontriction of vessels within the hand, which may lead to ulceration and digit loss in severe cases (see picture below). Several vasodilation medications have been trialled with varies degrees of success. These medications appear to counteract the excessive sympathetic activity leading to vasocontriction. Botulinum toxins injections have been trialled in small studies and appear to be effective in clients who do not respond to more traditional pharmacological approaches. It has been suggested that Botulinum toxin injections are effective in RP by preventing the recruitment of vessels' smoot muscles. Following a Botulinum injection, follow ups should be completed at 1, 3, 6 months. Common transient complications include pain at the site of injection and intrinsic muscle weakness. Rare complications may include generalised muscle weakness, dyaphagia, troubles breathing, and fatigue. 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, Raynaud's phenomenon unresponsive to mainstream medical management may benefit from Botulinum toxin injections. It is important to monitor potential complications such as intrinsic muscle weakness through grip strength after these injections (50% of grip strength comes from the intrinsic muscles of the hand) and reassure clients about this transient impairment. Other rare symptoms include difficulty breathing and they require urgent medical attention. URL: https://doi.org/10.1016/j.jhsa.2020.07.009 Abstract Raynaud phenomenon (RP) is a condition causing vasospasm in the fingers and toes of patients that can have a significant negative impact on quality of life. This can lead to pain, ulceration, and possible loss of digits. Several pharmacological options are available for treatment. However, RP can often be refractory to traditional modalities, leaving surgery or injections as the next available options. This article provides a review and update on the use of botulinum toxin as an effective therapy for the treatment of RP refractory to medical management. 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

Stop using eccentric exercises as the gold standard treatment for the management of lateral elbow tendinopathy. Stasinopoulos, D. (2022) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Eccentric training - Tennis elbow This is an expert opinion on tennis elbow treatment. The author suggests that there are other beneficial treatments beyond eccentric training. These include resistance training approaches involving concentric and isometric exercises. In addition, they suggest that full kinetic chain exercises should be utilised (e.g. shoulder resistance training). Considering that proprioceptive impairments have been identified in people with lateral epicondylalgia, they also suggest utilising position sense training. 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, there is a reasonable amount of research suggesting that any form of resistance training is beneficial for tennis elbow. In addition, the use of other interventions such as blood flow restriction training may be useful in the treatment of this condition. Proprioception training may also be useful in the early stages of tennis elbow as it has been found to be impaired compared to healthy controls. Upper limb resistance training including the shoulder has been trialled in people with lateral epicondylalgia but does not appear to provide better outcomes than isolated elbow exercises. If you are interested in more research about tennis elbow, have a look at the full tennis elbow database. URL: https://doi.org/10.3390/jcm11051325 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

Risk factors for reoperation after flexor tendon repair: A registry study. Svingen, J., Wiig, M., Turesson, C., Farnebo, S. and Arner, M. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Prognostic Topic: Flexor tendon repair - Factors associated with re-rupture This is a retrospective study assessing factors associated with re-rupture of flexor tendon following repair of zone I-III. A total of 1,372 participants were included. The variables recorded included age, sex, type of injury, time between injury and surgery, income, educational level, type and number of fingers involved. Details about post-surgical rehabilitation were missing from 60% of the cohort. Of those who had recorded post-surgical rehabilitation, more than 70% of participants underwent early mobilisation, whilst 20% underwent early passive mobilisation. The remaining 10% had a variable post-surgical rehabilitation. Reoperation for tendon rupture occurred in 6% of cases and greater odds of rupture were associated with being male, being older than 25, and having lesions of both FDS and FDP, or FPL. 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, being male, older than 25, and having injured both FDS and FDP, or FDL increases the likelihood of a re-rupture following flexor tendon repair zone I-II. In addition, existing evidence suggests that greater social deprivation is associated with worse outcomes for our clients. Knowledge of these factors provides us with opportunities to provide better care for our patients. URL: https://doi.org/10.1177/17531934221101563 Abstract The aim of this study was to identify risk factors for reoperations after Zones 1 and 2 flexor tendon repairs. A multiple logistic regression model was used to identify risk factors from data collected via the Swedish national health care registry for hand surgery (HAKIR). The studied potential risk factors were age and gender, socio-economics and surgical techniques. Included were 1372 patients with injuries to 1585 fingers and follow-up of at least 12 months (median 37 IQR 27–56). Tendon ruptures occurred in 80 fingers and tenolysis was required in 76 fingers. Variables that affected the risk of rupture were age >25 years (p < 0.001), flexor pollicis longus tendon injuries (p < 0.001) and being male (p = 0.004). Injury to both finger flexors had an effect on both rupture (p = 0.005) and tenolysis (p < 0.001). Understanding the risk factors may provide important guidance both to surgeons and therapists when treating patients with flexor tendon injuries. 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

Psychological sequelae of hand injuries: An integrative review. Maddison, K., Perry, L. and Debono, D. (2022) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence Topic: Psychological results of hand injuries - Depression and anxiety This is a narrative review assessing the prevalence and risk factors for depression and anxiety following hand injuries. A total of nine articles with retrospective and prospective designs were included. Only participants with injuries from the elbow down were included. Of those presenting with depression 15-30% presented with severe symptoms. Depression tended to resolve in 50% of cases in the subacute stage. Anxiety was reported in 15-40% of people after injury. Factors that appeared to be associated with depression and anxiety were pain intensity, persistent pain, reduced social function, and unemployment. One of the limitations of the studies included was the lack of a control group assessing the presence of anxiety and depression in people without hand injuries. 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, depression and anxiety are common post elbow/wrist/hand/finger injury. There is also an association between these psychological factors and pain intensity, persistent pain, and social participation. We also know that given the same type of injury, greater levels of depression significantly increase levels of pain. Acknowledging these issues and providing patients with as much advice as possible (e.g. taking part in regular exercise) may help them cope with their recovery. If you are interested in the effects of mental health on upper limb injury and recovery, have a look at the full database. URL: https://doi.org/10.1177/17531934221117429 Abstract This integrative review investigated reports of psychological impact and sequelae of traumatic hand injuries. A systematic search using Medline, PsychINFO, PubMed, EMBASE, CINAHL and hand-searching methods was conducted from 2008 to 2020. Nine included articles with a total of 503 participants were reported in prospective cross-sectional or longitudinal cohort studies. Depression and anxiety were common, affecting between 7% and 71% and between 23% and 71% of patients, respectively. Post-traumatic stress disorder affected between 3% and 95% of patients. Factors reported predicting psychological sequelae of hand injuries included injury severity, pain, limb dysfunction, negative perceptions of injured limbs, suboptimal coping mechanisms and limited social support. Symptoms persisted for protracted periods of follow-up but broadly attenuated after 3 months. We conclude that the high prevalence and enduring nature of psychological symptoms demonstrate an urgent need for further research to optimize 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