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Force loss and distribution of load in the hands of patients with cubital tunnel syndrome. Garkisch, A., Rohmfeld, K., Fischer, D.-C., Prommersberger, K.-J. and Mühldorfer-Fodor, M. (2023). Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence Topic: Cubital tunnel – Grip strength changes This prospective study aimed to assess grip force and load distribution in patients with cubital tunnel syndrome using manugraphy with three different cylinder sizes. A total of 27 participants who were planned to undergo cubital tunnel release surgery were assessed. Significant differences of up to 29% in grip forces between affected and healthy hands were found, with similar forces noted when gripping smaller handles despite ulnar nerve palsy. Contact area with cylinders was reduced by 5%-9% and correlated with grip force, atrophy, and impaired sensibility. Load distribution varied significantly, with weakness in thumb positioning and stabilisation when gripping large objects, and weakness in intrinsic finger muscles when gripping small objects. 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, cubital tunnel leads to reduction in gripping surface and force production compared to healthy hands. The reduction in grip force was about 30%, which is similar to what has been shown when nerve blocks are applied to the Guyon's canal during laboratory testing. It is likely that this reduction in grip strength is due to a combination of motor and sensory fibre impairments. URL: https://doi.org/10.1177/17531934231198660 Abstract Manugraphy with three different cylinder sizes was used to quantify the contribution of fingers, thumb and palm to grip force in patients with unilateral cubital tunnel syndrome. Forces in the affected and contralateral hands differed by up to 29%. Although grip force is usually maximal when gripping small handles, ulnar nerve palsy resulted in similar absolute grip forces using the 100-mm and 200-mm cylinders. The contact area between the affected hand and the cylinders was reduced by 5%-9%. We noted a high correlation between the contact area and grip force, visible atrophy and permanently impaired sensibility. The load distribution differed significantly between both hands for all cylinder sizes. When gripping large objects, the main functional impairment in cubital tunnel syndrome is weakness in positioning and stabilizing the thumb. Weak intrinsic finger muscles are responsible for loss of force when gripping small objects. 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

Postoperative mobilization after terrible triad injury: Systematic review and single-arm meta-analysis. Ahmed Kamel, S., et al. (2023) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Terrible triad early mobilisation – Outcomes This systematic review and meta-analysis assessed the effect of early vs late postoperative mobilisation in patients with terrible triad injuries of the elbow. A total of 11 prospective and retrospective cohort studies were included. No RCTs were available for inclusion in this review. The Mayo Elbow Performance Index was utilised to assess improvements in function, pain, and elbow stability. The results showed that there was a statistically significant trend towards better function with early mobilisation approaches (see figure below), however, this was not clinically relevant. 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, early postoperative mobilisation may lead to better functional outcomes in patients with manageable triad (otherwise known as "terrible triad") injuries of the elbow without an increased risk of instability. Nevertheless, these improvements appear to be marginal and appear to be of little clinical importance. URL: https://doi.org/10.1016/j.jse.2023.10.012 Abstract Background: Terrible triad is a complex injury of the elbow, involving elbow dislocation with associated fracture of the radial head, avulsion or tear of the lateral ulnar collateral ligament and fracture of the coronoid. These injuries are commonly managed surgically with fixation or replacement of the radial head, repair of collateral ligaments, with or without fixation of the coronoid. Postoperative mobilization is a significant factor that may affect patient outcomes; however the optimal postoperative mobilization protocol is unclear. This study aims to systematically review the available literature regarding postoperative rehabilitation of terrible triad injuries to aid clinical decision-making. Methods: We systematically reviewed PubMed, Embase, Cochrane and CINAHL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were studies with populations aged 16 years or over with terrible triad injury, underwent operative treatment, defined a clear postoperative mobilization protocol and reported the Mayo Elbow Performance Score (MEPS). Secondary outcomes were pain, instability, and range of motion (ROM). Postoperative mobilization was classified as ‘early’, defined as active ROM commenced up to 14 days, or ‘late’, defined as active ROM commenced after 14 days. Results: A total of 119 articles were identified from the initial search, of which 11 (301 patients) were included in the final review. The most common protocols (6 studies) favored early mobilization, whilst 5 studies undertook late mobilization. Meta-regression analysis including mobilization as covariate showed an estimated mean difference of pooled mean MEPS between early and late mobilization of 6.1 points (95% CI 0.2 – 12) with higher pooled mean MEPS in early mobilization (MEPS 91.2) compared to late mobilization (MEPS 85), p = 0.041. Rate of instability reported ranged from 4.5 – 19%, (8-11.5% early mobilization, 4.5-19% late mobilization). Conclusion: Our findings suggest that early postoperative mobilization may confer a benefit in terms of functional outcome following surgical management of terrible triad injuries, without appearing to confer an increased instability risk. Further research in the form of randomized controlled trials between early and late mobilization is advised to provide a higher level of evidence. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A paradigm shift in managing acute and chronic Boutonniere deformity: Anatomic rationale and early clinical results for the relative motion concept permitting immediate active motion and hand use. Merritt, W. H. and Jarrell, K. (2020) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Relative motion flexion splint for Boutonnière - Is it useful? This expert opinion and case series discusses the use of relative motion splinting for the management of both acute and chronic boutonniere deformities. The authors present their clinical results and provide anatomical rationale for this treatment approach. For acute injuries, relative motion flexion splinting is utilized, allowing for immediate active motion and hand use while maintaining full range of motion. This technique has shown promising results in acute cases, with good range of motion and no recurrences. For chronic deformities, serial casting is used to obtain as much PIP extension as possible (6 weeks), followed by relative motion flexion splinting for 12 weeks. This method has been successful in all of their chronic cases, with all patients achieving flexion to their palm and good pipj extension. Overall, the authors conclude that relative motion flexion splinting is an effective technique for managing both acute and chronic boutonniere deformities. It allows for early active motion and hand use, with excellent range of motion achieved. This approach has the advantage of lower morbidity compared to conventional surgical management techniques. 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, relative motion flexion splinting is an effective treatment technique for both acute and chronic boutonniere deformities. For acute injuries, the use of relative motion flexion splinting has shown promising results, with good range of motion and no recurrences. For chronic deformities, serial casting to obtain full passive PIP extension followed by relative motion flexion splinting has been successful in all cases reported by the article. The use of relative motion flexion splints may be particularly useful in those patients who are not keen to undergo finger immobilisation because of work reasons. Relative motion splints have been tested across a series of conditions including extensors tendon repair and flexors tendon repair. If you are interested in the topic, have a look at the full database. URL: https://doi.org/10.1097/SAP.0000000000002307 Abstract Background: We have utilized relative motion splinting for early motion following acute repair of boutonniere injuries, and we have developed nonoperative orthosis-based therapy for the treatment of chronic injuries. We offer our early clinical experience using relative motion flexion splinting for boutonniere deformities and explain the anatomic rationale that permits immediate active motion and hand use following acute injury or repair. For chronic boutonniere deformity, we offer a nonsurgical management method with low morbidity as a safe alternative to surgery. Methods: Our understanding of the extrinsic-intrinsic anatomic interrelationship in boutonniere deformity offers rationale for relative motion flexion splinting, which is confirmed by cadaver study. Our early clinical results in 5 closed and 3 open acute and 15 chronic cases have encouraged recommending this management technique. For repaired open and closed acutely injured digits, we utilize relative motion flexion orthoses that place the injured digits in 15° to 20° greater metacarpophalangeal flexion than its neighboring digits and otherwise permit full active range of motion and functional hand use maintaining the 15° to 20° greater metacarpophalangeal flexion for 6 weeks. In fixed chronic boutonniere cases, serial casting is utilized to obtain as much proximal interphalangeal extension as possible (at least −20°), and then relative motion flexion splinting and hand use is instituted for 12 weeks. Results: Our acute cases obtained as good as, or better range of motion than, conventional management techniques, with early full flexion and maintenance of extension without any recurrences. The most significant difference is morbidity, with ability to preserve hand function during healing and the absence of further therapy after 6 weeks of splinting. Patients with chronic boutonniere deformity presented from 8 weeks to 3 years following injury (averaging 31 weeks) and were 15 to 99 years of age (averaging 42 years). All were serially casted to less than −20° (averaging −4°) and maintained that level of extension after 3 months of relative motion flexion splinting. All achieved flexion to their palm, and all met the Steichen-Strickland chronic boutonniere classification of “excellent.” There were no recurrent progressive boutonniere deformities in either acute or chronic cases and no instances of reflex sympathetic dystrophy/chronic regional pain syndrome (RSD/CRPS). Conclusions: Relative motion flexion splinting affords early active motion and hand use with excellent range of motion achieved following acute open boutonniere repair or closed boutonniere rupture with less morbidity than conventional management. Chronic boutonniere deformity will respond to relative motion flexion splinting if serial casting can place the proximal interphalangeal joint in less than −20° extension, and the patient actively uses the hand in a relative motion flexion orthosis for 3 months, recovering flexion. No further therapy was needed in our cases. We believe this management technique should be attempted for chronic boutonniere deformity as a preferable alternative to surgery, which remains an option if needed. 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 association between pain self-efficacy and patient-reported outcome measures for hand disorders: A cross-sectional study. Overduin, I., Allen, C. and Aret, J. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence study Topic: Self efficacy - Hand function This retrospective study assessed the correlation between pain self-efficacy and patient-reported outcome measures for hand and wrist disorders. A total of 229 participants were included in the present study The outcomes measured included the Dutch translations of the Pain Self-Efficacy Questionnaire Short Form (PSEQ-2) and the Patient Rated Wrist Hand Evaluation (PRWHE). The results showed a strong and significant correlation between the PSEQ-2 and the PRWHE, indicating that a higher pain self-efficacy was associated with less pain and disability as measured by the PRWHE. Pain self-efficacy independently predicted 28% of the PRWHE. 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, pain self-efficacy is an important psychological factor that may be assessed in patients with hand conditions. There is a growing amount of evidence suggesting that self-efficacy is an important aspect mediating not only pain and function but also the effect of exercise on patients anxiety/depression and their compliance. URL: https://doi.org/10.1177/17589983231174800 Abstract Introduction: Multiple psychological factors influence the functioning of patients with hand disorders. Pain self-efficacy is a positive psychological factor, which concerns an individual’s confidence to function despite experiencing pain. This study aimed to analyse the association between pain self-efficacy and a patient-reported outcome measure (PROM) for hand and wrist disorders. Methods: Cross-sectional data from patient records were collected prior to hand therapy to analyse the correlation between pain self-efficacy and a PROM for hand and wrist disorders. The assessment tools consisted of the Dutch translations of the Pain Self-Efficacy Questionnaire Short Form (PSEQ-2) and the Patient Rated Wrist Hand Evaluation (PRWHE). Results: The findings were reported for the entire sample of 185 respondents (61% women). The PSEQ-2 and the PRWHE were strongly and significantly correlated, which signifies that a higher pain self-efficacy was associated with less pain and disability as measured by the PRWHE. Within a multivariable regression model which accounted for confounding variables, pain self-efficacy independently predicted 28% of the PRWHE scores. Conclusions: A strong association between the Dutch PSEQ-2 and the PRWHE was found in this sample of hand therapy patients. This study was limited by the use of retrospective data and by the lack of validation of the Dutch PSEQ-2. The findings were consistent with existing research which reported similar correlations between upper extremity PROM scores and pain self-efficacy. The positively worded PSEQ presents a chance to routinely assess pain self-efficacy as a key psychological factor while also affirming a positive coping strategy. 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 joint loads during simulated activities of daily living: Implications for formulating recommendations after total elbow arthroplasty. Duijn, R. G. A., et al. (2023). Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Loading - Elbow arthroplasty This is a lab based biomechanics study assessing elbow joint loading during activities of daily living (ADL) after total elbow arthroplasty (TEA). The study assessed joint moments during ADL and their relationship to the failure limits of a prosthesis. A total of eight cadavers were included in the present study. Eight different tasks, described in the figure below, were assessed. The results showed that peak joint moments significantly differed between tasks and movement directions, with the most demanding tasks being steering a wheel and rising from a chair. In addition, lifting 1 kg was one of the least biomechanically taxing activities. 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, driving and pushing off a chair with your arms are amongst the activities that put the highest loading through the elbow. As a result, it may be useful to avoid doing so for the first few weeks post total elbow arthroplasty. In addition, pushing and pulling, such as lifting and opening doors, put significant stress on the elbow joint, particularly in the flexion-extension and varus-valgus directions. Interestingly, the study questions the effectiveness of the current postoperative instruction of not lifting more than 1 kg as this does not appear to put excessive stress on the prosthesis. This article is an interesting addition to a recent one assessing the amount of upper limb ROM required to return to driving. URL: https://doi.org/10.1016/j.jse.2023.07.042 Abstract Background: Overloading of the elbow joint prosthesis following total elbow arthroplasty can lead to implant failure. Joint moments during daily activities are not well-contextualized for a prosthesis’ failure limits and the effect of the current postoperative instruction on elbow joint loading is unclear. This study investigates the difference in elbow joint moments between simulated daily tasks and between flexion-extension, pronation-supination, varus-valgus movement directions. Additionally, the effect of the current postoperative instruction on elbow joint load is examined. Methods: Nine healthy participants (age 45.8 ± 17 years, 3 males) performed eight tasks; driving a car, opening a door, rising from chair, lifting, sliding, combing hair, drinking, emptying cup, without and with the instruction “not lifting more than 1 kg”. Upper limb kinematics and hand contact forces were measured. Elbow joint angles and net moments were analyzed using inverse dynamic analysis, where the net moments are estimated from movement data and external forces. Results: Peak elbow joint moments differed significantly between tasks (p < 0.01) and movement directions (p < 0.01). The most and least demanding tasks were, rising from a chair (13.4 Nm extension, 5.0 Nm supination, 15.2 Nm valgus) and sliding (4.3 Nm flexion, 1.7 Nm supination, 2.6 Nm varus). Net moments were significantly reduced after instruction only in the chair task (p < 0.01). Conclusion: This study analyzed elbow joint moments in different directions during daily tasks. The outcomes question whether postoperative instruction can lead to decreasing elbow loads. Future research might focus on reducing elbow loads in the flexion-extension and varus-valgus directions. 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 effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study. Ceylan, İ., et al. (2023). Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Carpal tunnel syndrome - Mobilisation with movement This is a randomised controlled trial on the effectiveness of mobilisation with movement (MWM) technique in patients with carpal tunnel syndrome (CTS). A total of 45 participants with CTS diagnosed based on symptoms presentation, positive response to provocative tests, and mild to moderate median nerve compression as shown by nerve conduction studies, were included. Participants were randomised to either physiotherapy plus MWM (see picture below) or physiotherapy alone. Each group received three sessions per week for four weeks. The primary outcome was pain measured through the visual analogue scale. The results showed that all participants improved to a clinically relevant level. Furthermore, the study showed that the addition of MWMs did not provide statistically significant or clinically relevant improvements in pain compared to physiotherapy alone. 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, mobilisation with movement (MWM) does not provide additional pain relief when compared to physiotherapy alone for people with CTS. However, it appears that a combination of multiple manual therapy interventions and exercise may be beneficial for carpal tunnel syndrome. Other interventions that have a much larger body of evidence supporting their use include surgery, corticosteroid injections, and night splinting. Have a look at the whole database to get a full picture of the most recent papers on the topic. URL: https://doi.org/10.1016/j.jht.2023.02.004 Abstract Study design: Single-blinded, randomized controlled study. Introduction Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. Purpose of the study: This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. Methods: A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. Results: We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. Discussion: This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. Conclusions: MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A new orthotic solution for radial nerve injury. Copuaco, M. and Csajko, A. (2023). Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Radial palsy - Splint This article outlines a new orthotic solution for radial nerve injury which is low-profile, simple, and time-efficient. It requires a limited amount of materials/tools, and the most time consuming aspect involves attaching finger loops to a thermoplastic component. The elastics are threaded through the thermoplastic and finger loops, and finished with a knot on the thermoplastic side. This design is adjustable and easy to apply. It is also simpler and faster to fabricate than a typical dynamic orthosis. The cost would also be much lower compare to an off the shelf radial palsy splint. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, this new splint design for radial nerve palsy appears to be of low-profile, simple, and time-efficient. This approach to splinting may be also useful for hand therapists in training, who may find a full radial nerve palsy splinting design daunting. URL: https://doi.org/10.1016/j.jht.2022.09.008 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

Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial. Pisano, K., Wolfe, T., Lubahn, J. and Cooney, T. (2023) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Thumb osteoarthritis - Real vs Sham thumb splint This randomised controlled study assessed the effect of adding stabilisation exercises to standard care in people with thumb OA. A total of 190 participants with symptomatic thumb OA were recruited. Participants were randomised to either standar care or standard care plus thumb stabilisation exercises. Standard care included the provision of an orthosis, joint protection advice, and heat modalities. The stabilisation exercises aimed at improving flexibility/strength of the thumb and some of the exercises have been shown in the pictures below. The exercises were to be performed 2-3 times per day for about 10 minutes each time. Objective and subjective measurements were recorded at baseline, 3, 6, and 12 months. The results showed that the addition of stabilisation exercises program did not improve objective or subjective outcomes more than standard care. Both groups had decreased pain with activity and improved PSFS scores, with no statistical significance between the two 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, a home exercise program for thumb stability may not provide added benefits compared to standard care in people with thumb thumb OA. Pain can significantly decrease with the provision of standard care with or without the addition of stabilisation exercises. It appears that symptoms and disability in thumb OA are affected by several psychosocial variables and that the thumb stability may play a limited role in symptoms presentation. URL: https://doi.org/10.1016/j.jht.2022.03.009 Abstract Study Design: Randomized, interventional trial with 1 year follow-up. Introduction: Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA). Purpose of the Study: To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength). Methods: A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons. Results: Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥ .398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤ .011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥ .080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study. Conclusions: The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown. 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

Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management. Hamasaki, T., et al. (2023). Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence Topic: Thumb osteoarthritis - Psychological factors This is a cross-sectional study assessing the correlation between biopsychosocial factors and pain intensity/disability as well as the most common forms of interventions utilised by people with cmcj osteoarthritis. A total of 228 participants with an average age of 63 were included in the present study. Eighty percent of the participants reported having experienced average pain of moderate to severe intensity during the last 7 days, with a mean pain intensity of 6/10 and a moderate level of disability. Disability was associated with pain catastrophizing, depressive symptoms, and age. Non-surgical cmcj management included acetaminophen, oral NSAIDs, intra-articular cortisone injections, splinting, hand exercises, ergonomic techniques, and assistive devices. Several interventions, which may be useful to reduce depression/pain catastrophising (see graph below) had not been trialed by the majority of patients. The results suggest that a multidisciplinary approach is necessary to adequately tackle patients' specific needs. 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, cmcj can cause severe pain, disability, disturbed emotional well-being, limited quality of life, and reduced productivity. Working on modifiable factors such as pain frequency, disability, depression, and pain catastrophising may help reduce the severity of cmcj symptoms. A multidisciplinary approach should also be employed in patients with severe distress to identify opportunities to improve mental health and increase levels of physical activity in those who are sedentary. URL: https://doi.org/10.1016/j.jht.2022.10.001 Abstract Background: Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis. Purpose: This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities. Study Design: Cross-sectional. Methods: Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability. Results: Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants’ norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services. Conclusions: Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians’ priorities. 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

Do surgeons accurately predict level of activity in patients with distal radius fractures? Harper, C. M., Model, Z., Xiong, G., Hegermiller, K. and Rozental, T. D. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence Topic: Physical activity - Are we good at gaging it? This prospective study investigated the ability of surgeons to correctly differentiate between patient involved in low, moderate, high levels of physical activity level in patients presenting with a distal radius fractures. A total of 97 participants were included in the study. Results showed only "fair" agreement between patient and surgeon assessments, with surgeons accurately identifying 73% of "high activity" patients but failing to correctly identify more than 41% of patients rated as "moderate activity" or "low activity". The odds of receiving surgical treatment were higher with higher surgeon-perceived activity level, but not with patient-reported activity level. The study concluded that surgeon assessment of patient activity level does not have strong agreement with patients' independent assessment of their physical 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, there is a discrepancy between what level of physical activity patients engage with and surgeon's perception of their patients' physical activity. It appears that surgeons tend to overestimate patients' activity level. There are several repercussions associated with this finding. The first is that surgery may be offered to those people who the surgeon deems physically active, but not to others who may be equally active but don't give that impression (e.g. ORIF for distal radius fracture, distal biceps repair). The second is that as hand therapist we may not advise people who are inactive to increase their physical activity level and viceversa. As a result, we may need to question our patients more on this topic or utilise forms such as the International Physical Activity Questionnaire (IPAQ) to make better informed therapeutic decisions. If you want to gage an understanding on the importance of physical activity for our patients, have a look at the whole database. URL: https://doi.org/10.1016/j.jhsa.2023.07.007 Abstract Purpose: One factor influencing the management of distal radius fractures is the functional status of the patient. The purpose of this study was to assess the agreement between patient and surgeon assessments of patient activity level in patients sustaining a distal radius fracture. Methods: Ninety-seven patients were included, with a mean age of 58.5 years (range, 18–92 years). Patients completed the International Physical Activity Questionnaire, a validated survey that provides a score of low, moderate, or high activity levels. Treating surgeons provided an independent assessment using the same scale. Agreement between patient and surgeon assessments was evaluated using a weighted kappa-statistic, with a secondary analysis using logistic regression models to assess odds of surgical treatment. Results: Interrater agreement between surgeons and patients demonstrated only “fair” agreement, with a kappa-statistic of 0.33. Predictive models showed that surgeons accurately identified 73% of “high activity” patients but failed to correctly identify more than 41% of patients rated as “moderate activity” or “low activity.” There was a correlation between surgical intervention and increasing physical activity status as assessed by the surgeon; however, the magnitude of this effect was unclear (odds ratio, 2.14; 95% confidence interval, 1.07–4.30). This relationship was no longer significant after adjusting for age, Charlson comorbidity index, and fracture class. There was no association between surgical intervention and physical activity status when using the status provided by the patient. Conclusions: Surgeon assessment of patient activity level does not have strong agreement with patients’ independent assessment. Surgeons are most accurate at identifying “high activity level” patients but lack the ability to identify “moderate activity level” or “low activity level” patients. Clinical relevance: Recognition of surgeon assessment of patient activity level as flawed can stimulate improved dialog between patients and physicians, ultimately improving the shared decision-making process. 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

Effect of extension of the ulnar fingers on force control and muscle activity of the hand during a precision pinch. Date, S., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic test Topic: Pinch testing – Effect of positional variations This study investigated the effect of extending the ulnar fingers on force control and muscle activity during a precision tip to tip pinch task. A total of 27 healthy volunteers with a mean age of 22 years were recruited to participate in the study. Their maximum pinch strength was measured both whilst keeping the fingers flexed and extended. In addition, their ability to reach a certain level of force and the time to reach that level were measured in a submaximal task. The results showed that there was no difference in maximum pinch strength (4 kg) when keeping the fingers extended or flexed. In addition, extending the ulnar fingers when pinching resulted in quicker attainment of the target force 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, extending the ulnar fingers when pinching an object does not affect force output, but it can lead to a faster force production. As a result, it's probably not necessary to force patients to keep a certain position when testing their pinch strength. What may be important is to follow the same strategy every time that we assess it for reliability reasons. If you are interested in other variations of strength measures, have a look at the second interosseous pinch test and an update on devices to measure grip strength. URL: https://doi.org/10.1177/17531934231211254 Abstract Some individuals extend the three ulnar fingers when performing a precision pinch. The aim of the present study was to investigate the mechanisms and effect of the extension of the ulnar fingers during a pinch. When performing a pulp pinch task with the ulnar fingers in two positions (extension and flexion), 27 participants maintained 5% of their maximum force. The mean pinch force, force variability and time taken to reach the targeted force (reaching time) were calculated. Muscle activity was simultaneously measured, using surface electromyography, for nine muscles: the flexor pollicis brevis; abductor pollicis brevis; flexor pollicis longus; first lumbrical; first dorsal interosseous; flexor digitorum superficialis of the index finger; extensor indicis; and extensor digitorum of the index and ring fingers. No significant differences in the mean pinch force or force variability were found. However, the reaching time was significantly shorter (approximately 20% reduction) in the extension position and the activities in the flexor pollicis brevis, first lumbrical, extensor indicis and extensor digitorum of the ring finger were significantly higher. These findings suggest that extending the ulnar fingers during pinching enhances the activity of key muscles involved in the movement and allows for more rapid force exertion. 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 impact of temperament on functional and symptomatic relief and satisfaction after carpal tunnel release. Karaduman, M., Bilgin, S. S. and Armangil, M. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence study Topic: Carpal tunnel syndrome - satisfaction with surgery This study examined the impact of different personality traits on the outcomes of surgery for carpal tunnel syndrome (CTS). A total of 171 patients with CTS were included and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), the Boston Carpal Tunnel Questionnaire (BCTQ), and satisfaction using the Patient Evaluation Measure (PEM) at baseline. The results showed that symptoms improved across all personality types, however, patients who presented with a depressive or anxious personality had the lowest postoperative satisfaction. 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, patient temperament should be taken into consideration when treating carpal tunnel syndrome or setting treatment expectations. In particular, it appears that some patients presenting with depressive or anxiety tracts will still be dissatisfied with treatment despite improvements in symptoms or their overall condition. I have noticed this happening in clinical practice across a series of hand and upper limb conditions. People may be improving from an objective point of view (e.g. pain-free grip strength in LE) or even subjectively on QuickDASH, but they are still not happy with such improvements. This shows how other factors including psychological and social aspects of the patient determine their happiness with our treatment. There is a growing amount of evidence suggesting that these factors have a significant impact on recovery. URL: https://doi.org/10.1177/17531934231173101 Abstract The aim of this study was to compare the symptomatic, functional and satisfaction outcomes of patients with different temperaments undergoing carpal tunnel surgery by a single surgeon. Dominant temperaments of 171 patients with carpal tunnel syndrome were determined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Patients were divided into six temperament groups, and the impact of their respective group measured against preoperative and postoperative symptom severity and functional capacity using the Boston Carpal Tunnel Questionnaire (BCTQ] and satisfaction using the Patient Evaluation Measure (PEM). Patients in the depressive group had the largest improvement in symptoms (BCTQ score change, -2.2) as well as a significant improvement in function (BCTQ score change, -2.1), yet had the lowest postoperative satisfaction (mean PEM score 9). Determination of patient temperament before surgery for carpal tunnel syndrome (CTS) may be useful as an ancillary technique to help predict postoperative satisfaction, which may in turn help guide preoperative communication and expectation setting. 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